Cornea - ARVO

ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Corneato the differing specificity of lissamine vital staining versusfluorescein.Commercial Relationships: Keith J. Lane, Ora, Inc. (E); John D.Rodriguez, Ora, Inc. (E); Endri Angjeli, Ora, Inc. (E); George W.Ousler, Ora, Inc. (E)Program Number: 6046 Poster Board Number: A0109Presentation Time: 10:30 AM - 12:15 PMSurgical Model for Evaporative Loss Dry Eye Model in the NewZealand White RabbitAnthony J. Johnson 1, 3 , Patricia Buttke 3 , Irene E. Kochevar 2 , Heuy-Ching H. Wang 1 , Steven R. Cora 1 , Sheri L. DeMartelaere 3 . 1 OcularTrauma Research, USAISR, Fort Sam Houston, TX; 2 WellmanCenter for Photomedicine, Massachusetts General Hospital, Boston,MA; 3 SAUSHEC Ophthalmology, San Antonio Military MedicalCenter, Fort Sam Houston, TX.Purpose: Patients with severe facial burns often suffer indirectdamage to their eyes. Burn wound contracture of the periocular skincauses cicatricial ectropion resulting in ocular exposure. Skin graftsare often required, but may be insufficient if deeper structures, suchas the periocular muscles, are injured and the protective blink reflexis lost. With loss of the blink reflex the patient quickly developsexposure keratitis. No current treatment adequately addresses thesevere keratitis that these patients develop. We established thisevaporative loss dry eye model that simulates exposure keratopathyresulting from cicatricial ectropion to assist in the development ofnovel therapies for this condition.Methods: Nine white rabbits were included in this study. The righteye of each rabbit was subjected to a 1.5 cm upper and lower lidblepharoplasty, in addition to excision of the nictitating membrane.The left eyes were untreated to serve as controls. Clinicalexamination included fluorescein staining and serial photography ondays 3, 5, 7, 14, 21 and 28. Rabbits were sacrificed on day 28 and thecornea and conjunctiva were evaluated by histopathology.Results: Compared with untreated controls, surgically treated rabbitsshowed significant changes in fluorescein scores on days 5, 7, 14, and28. Clinical examination revealed ocular surface defects ranging fromthe development of punctate epithelial erosions to corneal abrasion,beginning on day 7, with corneal ulceration developing in the mostsevere cases by week 3. Histopathological results revealed epitheliuminfiltrated by heterophilic inflammation with the underlying cornealstroma demonstrating heretophilic, lymphoplasmacytic inflammation,fibrosis and neovascularization.Conclusions: The findings of this study demonstrate that upper andlower lid blepharoplasty combined with excision of the nictitatingmembrane is an excellent surgical model of evaporative dry eye.Damage to the cornea and conjunctiva manifesting as punctateepithelial erosions and corneal ulceration is consistent with clinicalobservations of burn patients with dry eye resulting from cicitricialectropion. Future studies utilizing this model are planned to testmultiple strategies to protect the ocular surface from evaporation dueto ocular exposure.Commercial Relationships: Anthony J. Johnson, None; PatriciaButtke, None; Irene E. Kochevar, Aura MedSystems (P); Heuy-Ching H. Wang, None; Steven R. Cora, None; Sheri L.DeMartelaere, NoneSupport: Department of Defense Congressional Directed MedicalResearch ProgramProgram Number: 6047 Poster Board Number: A0110Presentation Time: 10:30 AM - 12:15 PMClinical Correlations Among Dry Eye Tests, Physical AndMetabolic Findings In Diabetes Mellitus PatientsPeter S. Reinach 1, 2 , Jacqueline F. Faustino 2 , Monica Alves 2 , DaniloRibeiro 2 , Jayter S. Paula 2 , Eduardo M. Rocha 2 . 1 Biological Sciences,SUNY College of Optometry, New York, NY; 2 Oftalmologia,Otorrinolaringologia e Cirurgia de Cabeça e Pescoço., Universidadede São Paulo, Ribeirão Preto, Ribeirao Preto, Brazil.Purpose: To determine in diabetes mellitus (DM) patients, withoutproliferative retinopathy, if there are specific sets of ocular surfacesigns and/or body mass indices as well as clinical laboratory resultsthat correlate with dry eye disease (DED) diagnosis.Methods: Ocular surface dye staining and tear film osmolarity(TFOsm) evaluation were performed (TearLab Osmometer). Theseresults were tested for correlation with measurements of either: a)body mass index; (BMI); b) thoracic and abdominal circumference(TC, AC, respectively); c) triceps crease width or; d) blood glycatedhemoglobin (HbA1c) level and hyperglycemia.Results: In 27 DM patients, 55.+- 19 years old, 20 were DM2whereas 7 others were DM1. Out of both groups, 85% werediagnosed with DED (DM1 and 2 in 75% and 90%, respectively).Most common ocular DED signs were: TFBUT (56%) and tearhyperosmolarity (52%). The most relevant systemic correlations inDM2 patients were between: number of systemic medications or ACand elevated TFOsm (r=0.48, p= 0.044; r=-0.724, p=0.0007,respectively), Ocular Surface Disease Index score with: a) TFBUTand AC (r=0.64, p=0.0044; r=0.5, p=0.033, respectively); b)lissamine green and fluorescein staining (r=0.739, p= 0.0005).However, neither HbA1c,BMI nor triceps crease width correlatedwith any of the ocular surface or DED parameters.Conclusions: DM1 and 2 highly correlate with DED. In DM2,abdominal fat accumulation correlates best with tear filmhyperosmolarity and ocular surface integrity damage. Suchcorrelations in DM2 patients suggest that specific metabolic changesmay promote DED development.Commercial Relationships: Peter S. Reinach, None; Jacqueline F.Faustino, None; Monica Alves, None; Danilo Ribeiro, None;Jayter S. Paula, None; Eduardo M. Rocha, NoneSupport: FAPESPProgram Number: 6048 Poster Board Number: A0111Presentation Time: 10:30 AM - 12:15 PMThe Influence of Punctal Occlusion on Osmolarity in Dry EyeSubjectsDavid C. Eldridge, Michael S. Berg, Benjamin D. Sullivan, WilliamD. Townsend. TearLab Corp, Bixby, OK.Purpose: Dry eye disease is a common and major source of disabilityand its onset may be triggered or modified by exposure to systemicdrugs, contact lens wear, ocular surgery and adverse environmentaland work conditions. Tear hyperosmolarity is central to the dry eyedisease pathogenesis, and may serve as a valuable marker in themonitoring of disease severity. This study is designed to determinethe variation in tear osmolarity over time using TearLab Osmometryin DED subjects being treated with punctal occlusion with punctalplugs.Methods: Ten subjects (9F/1M, age=54.3±15.8 years), with tearosmolarity in one eye greater than 311 mOsm/L, were tested for tearosmolarity, symptoms (VAS), an eyelid exam under slit lamp,fluorescein staining of the cornea and conjunctiva, followed by ameibomian dysfunction assessment. Subjects refrained fromadministering any topical drug within two hours of measurement, andwere excluded if they had any clinically significant eyelid deformity,previous ocular disease including infections, active allergy, LASIK orPRK surgery within one year of the study, abnormality ofnasolacrimal drainage, previous punctal plugs or cauterization,diagnosis of a systemic disease or a change in chronic systemic©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. 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