Assessment of Corneal Fluorescein Staining in Different Dry Eye Subtypes Using Digital Image Analysis

To describe a new objective technique of digital image analysis for the quantification and the morphological characterization of corneal staining in the setting of dry eye disease (DED), and to apply it to distinguish Sj\uf6gren syndrome (SS) from ocular graft versus-host disease (oGVHD)

Conjunctival bulbar redness (CBR) analysis to quantify inflammation in dry eye patients

Purpose A red eye is common in the ophthalmic practice, and redness is one out of four cardinal signs of inflammation. The correlation between the conjunctival bulbar redness (CBR) and ocular surface parameters, including tear cytokine levels, was investigated, in patients suffering from Dry Eye (DE). Methods Thirty five patients diagnosed as suffering from DE and fifteen age and sex matched healthy volunteers and were analyzed with respect to: 1. subjective symptoms of discomfort with the Ocular Surface Disease Index (OSDI ranging 0-100), and Visual Analogue Score (VAS, ranging 0-100 mm) ; 2.Tear Film Break Up Time (TFBUT, seconds); 3. Corneal vital and conjunctival vital staining scored by the NEI system (score 0-15, and 0-18, respectively); 4. Tear levels of exudated serum albumin (ALBU, mg/ml), and of the following Interleukins (IL): IL1b. IL-6. IL-17A. and Tumor Necrosis Factor (TNF)a (pg/ml), detected by the Luminex Technology Multiplex Assays; 5. the quantification of CBR analyzed on slit lamp digital images by using image processing of relative Red-channel activity with the free Image J software (NIH). Parameters were statistically analyzed in the two groups of subjects by using t-test and Mann-Whitney U test for parametric and nonparametric variables respectively. Relationship between variables was investigated using Spearman r correlation tests (significance p < 0.05). Results CBR was higher in DE as compared to controls (49.6 \ub1 3.5 vs 41.1 \ub1 2.4. p < 0.001). Tear IL-6 level was higher in DE patients vs controls (25.5 \ub1 15.5 vs 5.9 \ub1 3.1, p < 0.0001), whereas IL1b, IL-17A, and TNFa were detected in only the DE patients (median 5.73, 5.74, and 13.88 respectively) A significant correlation was found between CBR and IL-6 (r = 0.524), TNFa (0.571) TFBUT (-0.561), VAS score (0.832), and ALBU (0.628), p always <0.001. Conclusions Data suggests that digitized CBR analysis may be a useful tool to quantify inflammation in the clinical setting

Longitudinal Corneal Endothelial Cell Changes in Patients Undergoing Hematopoietic Stem Cell Transplantation

Purpose: To evaluate longitudinally corneal endothelial cell changes in patients undergoing hematopoietic stem cell transplantation (HSCT) and to further investigate possible correlations with hematological and ocular characteristics. Methods: Prospective observational study conducted at a single center. All patients underwent a comprehensive ophthalmological examination, before and after HSCT, including slitlamp examination, Schirmer test, tear breakup time, ocular surface staining, specular microscopy of corneal endothelium, and Ocular Surface Disease Index questionnaire. Results: Twenty-five patients undergoing HSCT and 25 age- and sex-matched controls were included. At baseline, hematological patients showed significantly lower values of endothelial cell density (ECD) compared with those of controls (2514.5 \ub1 390.2 vs. 2723.7 \ub1 298.0 cells/mm, P = 0.038). After HSCT, ocular surface disease index score significantly increased (P = 0.020) and tear breakup time significantly decreased (P = 0.036). Conversely, no significant changes were found in Schirmer test and corneal fluorescein staining (always P > 0.05). Eight patients (32%) developed ocular graft-versus-host disease (GVHD). ECD values significantly decreased after HSCT (from 2514.5 \ub1 390.2 to 2409.5 \ub1 330.9 cells/mm, P = 0.009). The decrease in ECD values after HSCT was more pronounced in patients with ocular GVHD compared with those without (231.1 \ub1 188.8 vs. 45.6 \ub1 156.5, P = 0.016). No significant correlations between the changes in ECD and hematological and ocular characteristics were found (always P > 0.05). Conclusions: Hematological patients showed a lower endothelial cell count already before HSCT, compared with controls. After HSCT, the endothelial cell count further significantly decreased, particularly in patients who developed ocular GVHD

CHOROIDAL VASCULARITY INDEX QUANTIFICATION IN GEOGRAPHIC ATROPHY USING BINARIZATION OF ENHANCED-DEPTH IMAGING OPTICAL COHERENCE TOMOGRAPHIC SCANS

Purpose: To evaluate choroidal structural changes occurring over time in geographic atrophy (GA) secondary to age-related macular degeneration using choroidal vascularity index (CVI). Methods: Enhanced-depth imaging optical coherence tomography scans of 34 patients with GA and 32 control subjects were retrospectively analyzed. Data were collected at baseline and after a mean follow-up of 18.3 \ub1 8.3 months. Choroidal images were binarized using the ImageJ software, and the luminal area and stromal area were segmented. Cho- roidal vascularity index was defined as the ratio of luminal area to total choroid area. Results: Patients with GA showed significantly lower values of CVI, total choroid area, luminal area, and subfoveal choroidal thickness compared to control subjects (65.83 \ub1 3.95 vs. 69.33 \ub1 3.11, P , 0.001; 0.400 \ub1 0.239 mm2 vs. 0.491 \ub1 0.132, P = 0.006; 0.263 \ub1 0.152 mm2 vs. 0.340 \ub1 0.094, P = 0.002; 185.2 \ub1 79.8 mm vs. 216.8 \ub1 58.8 mm, P = 0.036, respectively). Best-corrected visual acuity was significantly correlated only with choroidal thickness (R = 20.509; P = 0.002). During the follow-up period in patients with GA, sub- foveal choroidal thickness decreased from 185.2 \ub1 79.8 to 152.2 \ub1 73.1 (P = 0.001), stromal area increased from 0.138 \ub1 0.090 mm2 to 0.156 \ub1 0.068 (P = 0.028), and CVI decreased from 65.83 \ub1 3.95 to 62.24 \ub1 3.63 (P , 0.001). Conclusion: This study showed for the first time that CVI is reduced in patients with GA, and that this metric further worsened during the follow-up period