Corneal confocal scanning laser microscopy in patients with dry eye disease treated with topical cyclosporine

Purpose To investigate the effect of cyclosporine on corneal ultrastructure and on major signs and symptoms of patients with dry eye disease.Patients and methods In this prospective cohort study, patients with dry eye disease were treated with a drop of cyclosporine 0.05% twice daily. Clinical evaluation was carried out at baseline and at months 1, 3, and 6. All patients completed the Ocular Surface Disease Index (OSDI) questionnaire, and tear film break-up time (BUT), fluorescein and lissamine green staining, and Schirmer test were carried out. In vivo confocal microscopy was also performed and epithelial cellular density, keratocyte activation, and subbasal plexus morphology were assessed.Results A total of 40 patients completed the study. After 6 months, OSDI, BUT, and fluorescein and lissamine green staining showed a clinically significant improvement. During the 6-month follow-up, density of intermediate epithelial cells increased from 1969.5 +/- 85.4 cell/mm(2) to 4881.2 +/- 75.7 cell/mm(2) (P<0.01); average grade of keratocyte activation decreased from 3.6 +/- 0.1 to 1.8 +/- 0.1 (P<0.001); average grade of number of subbasal nerves decreased from 5.3 +/- 0.2 to 2.6 +/- 0.2 (P<0.001); average grade of nerve reflectivity decreased from 3.8 +/- 0.1 to 2.1 +/- 0.2 (P<0.001); and average grade of nerve tortuosity decreased from 3.8 +/- 0.1 to 2.2 +/- 0.2 (P<0.001).Conclusion Cyclosporine was effective in controlling symptoms and signs of dry eye disease. In vivo confocal microscopy showed an increase in cell density of intermediate epithelium cells, a decrease in hyper-reflective keratocytes, and a decrease in density, tortuosity, and reflectivity of nerve fibers

Confocal scanning laser microscopy in patients with postoperative endophthalmitis

Purpose: To investigate alterations of corneal layers in eyes treated for acute postoperative endophthalmitis. Methods: In this retrospective, nonrandomized comparative study, eyes treated with 25 gauge pars plana vitrectomy (PPV) for acute post-cataract endophthalmitis (group A) were compared to eyes receiving uneventful cataract surgery (group B) and uneventful 25 gauge PPV for epiretinal membrane (group C). After a minimum follow-up of 8 months from last surgical procedure, laser scanning in vivo confocal microscopy (IVCM) was performed. Results: Twelve eyes for each group were recruited. Comparing study eyes with control eyes of group B and C, no statistical difference was found in corneal epithelial cell density (p = n.s.), in density of nerve fibers (p = n.s.), mean grade of nerve reflectivity (p = n.s.), mean grade of nerve tortuosity (p = n.s.), mean grade of anterior keratocyte activation (p = n.s.), and corneal endothelium cell density (p = n.s.), whereas a statistically higher mean grade of posterior keratocyte activation was found in group A (p < 0.01). Epithelial and endothelial corneal morphologies were graded as regular in all groups. Langerhans cells and corneal dendritic-shaped hyper-reflective endothelial deposits were found in group A. Both findings were absent in group B and C, and the difference was statistically significant (p < 0.01). Conclusions: IVCM was a useful tool in the detection of microscopic chronic corneal abnormalities caused by postoperative endophthalmitis. These findings confirmed the presence of a subclinical chronic corneal inflammation localized to the posterior stroma that should be related to the infectious process. Future studies might clarify pathological processes in the acute phase of postoperative endophthalmitis

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Reply to Comment on: ‘Corneal confocal scanning laser microscopy in patients with dry eye disease treated with topical cyclosporine

Primary small gauge pars plana vitrectomy and silicone oil endotamponade for endophthalmitis after cataract surgery: Clinical and OCT findings

Background: Retrospective analysis of morphological and functional outcomes after pars-plana vitrectomy and Silicone-Oil (SO) endotamponade in acute postoperative endophthalmitis (APOE). Methods: Minimum follow-up was 6 months. Every included patient received best-corrected visual acuity (BCVA) assessment, pre-operatively and at last follow-up. Spectralis OCT was used to investigate disorganization of inner (DRIL) and outer (DROL) retinal layers at 1, 3, 6 months and at last follow-up. OCT-A was performed to assess foveal avascular zone (FAZ) and vascular perfusion density (VPD) at 6 months and at last follow-up. Results: Seventeen eyes were recruited. Postoperative findings: BCVA ≥ 20/40 (in 14 eyes); epiretinal membranes (13); hyperreflective epiretinal material soon after surgery in (6) SO-filled eyes; inner retinal layers atrophy (5); macular edema (2); DROL (4) with persistent EZ disruption at final visit (2); no significant difference between study and fellow eyes in central macular thickness, FAZ and VPD; VPD decreased in all cases with prominent disorganization of retinal architecture. Conclusion: OCT changes after APOE can be persistent or completely/partially self-resolving and seems related to the outward progression path of the infection/inflammation from the vitreous cavity to the inner and outer retina, rather than to the surgery

Choroidal Vascular Changes in Multiple Evanescent White Dot Syndrome

Purpose: To evaluate choroidal structural changes in patients with multiple evanescent white dot syndrome (MEWDS) during the acute and recovery stages. Methods: Enhanced-depth imaging optical coherence tomography (EDI-OCT) scans of 16 patients with unilateral MEWDS were acquired during the acute and recovery stages in both eyes. Images were binarized with the ImageJ software to measure subfoveal choroidal thickness (CT), total choroid area, luminal area and choroidal vascularity index (CVI). Results: In the acute stage, subfoveal CT, total choroidal area and CVI were significantly higher in eyes with MEWDS compared to fellow eyes (371.2&nbsp;±&nbsp;101.8 vs 317.1&nbsp;±&nbsp;90.3&nbsp;µm, p =&nbsp;.001; 2.826&nbsp;±&nbsp;0.686 vs 2.524&nbsp;±&nbsp;0.674 mm2, p =&nbsp;.014; 69.49&nbsp;±&nbsp;3.51 vs 68.27&nbsp;±&nbsp;3.41%, p =&nbsp;.044, respectively). In the recovery stage, subfoveal CT, total choroidal area and CVI in eyes with MEWDS significantly decreased to respectively 333.4&nbsp;±&nbsp;90.5&nbsp;µm, p =&nbsp;.007, 2.592&nbsp;±&nbsp;0.570 p =&nbsp;.002, and 67.31&nbsp;±&nbsp;2.74%, p =&nbsp;.014. Conclusions: Choroidal thickness and vascularity are significantly increased during the acute stage of MEWDS