International Sicca Award

- Edition 2005 -

Research Projects Hungary

Dr. Fodor Mariann, Dr. Modis Laszlo
University Eye Hospital, Debrecen

Application of morphologic tests in the modern diagnosis of dry eye

Abstract
Purpose: To reveal any possible correlation between dry eye-tests widely used in Hungary (Schirmer test without local anesthesia, Schirmer I.; tear film breakup time, BUT; corneal fluorescein staining) and morphological tests (conjunctival impression cytology, CIC; mucus fern test MFT).
Methods: We examined 50 eyes of 25 patients with dry eye without any association of systemic disease (Group 1, keratoconjunctivitis sicca, KCS), and 50 eyes of 25 patients with primary or secondary Sjogren's syndrome (Group 2, SS). We compared the two groups to each other and to 42 eyes of 21 healthy patients and the data were statistically analysed.
Results: In group 1 corneal fluorescein staining showed positive correlation with the cytological samples taken from the upper conjunctiva (r=0.433, p=0.007). An inverse correlation was observed between BUT and corneal fluorescein staining (r=-0.384, p=0.006). There was also a negative correlation between BUT and corneal fluorescein staining in group 2 (r=-0.493, p=0.0001). In group 2 an inverse correlation was observed between MFT and Schirmer I. test (r=-0.303, p=0.032), and also between MFT and BUT test (r=-0.493, p=0.016). Regarding corneal fluorescein staining no difference was found between the pathologic groups (p=0.414). The results of the Schirmer I test disclosed significant difference in the control group (p<0.0001), and also between the pathologic groups (p=0.002). In all the three groups the four different stages of MFT were noticed. In case of MFT no difference was found between the pathologic groups (p=0.900), but both groups differed from the control group (p=0.008, KCS; p=0.025, SS). CIC samples taken from both places of both diseased groups proved to be significantly different from the corresponding places of the control group (p<0.0001). Comparing the dry eye groups, the cytological samples differed significantly taken from the temporal (p=0.024) but not from superior conjunctiva (p=0.665).
Conclusion: The complex pathogenesis of the dry eye syndrome raise the need of introducing new methods using different analysis and approach in addition to the traditional clinical tests. Beside every day practice tests, conjunctival impression cytology and mucus fern test give extra information about the ocular surface and dry eye. In summary, in the modern diagnosis of dry eye these morphologic methods need to be involved.

Dr. Erdely Bela
Semmelweis University, Budapest

Videokeratography in the diagnosing of dry eye

Abstract
Purpose: To observe the effect of Vidisic on the ocular surface regularity in healthy subjects and in dry eye patients.
Subjects and methods: Five ophthalmologically healthy young volunteers and five dry eye patients were recruited for this study. The examinations were performed with the TMS-1 corneal topograph system. Vidisic was instilled in one eye, the fellow eye being the control. Photos were obtained before and 1,5,15,30 and 60 seconds after instillation from both eyes in a parallel fashion. The changes in time of topographic indices including: SRI (surface regularity index), SAI (surface asimmety index) and PVA (potential visual acuity) were noted.
Results: After initial worsening the corneal topographic indices improved significantly due to instillation of Vidisic in dry eye patients, except for SAI which did not change significantly. In healthy eyes after initial worsening the values regained their original values.
Conclusion: Vidisic was found to be effective in the treatment of ocular surface irregularity caused by dry eye syndrome. After instillation of the artificial tear drops the optical quality of the eye transiently decreased, five minutes later this effect disappeared. The artificial tear drop maintained a smooth ocular surface for 60 minutes, or even more. Longer follow-up of the topographic indices was not possible in this trial.

I. Kovacs, E. Pinter, I.Lukacs,
A. Hartmann, B. Kovacs,
A. Ludany, J. Feher, J. Szolcsanyi

Neuropeptides Released from Sensory Nerve Endings Influence Tear Secretion and Goblet Cell Function in the Rat

Abstract
Purpose: Presenting of morphological and functional evidence to evaluate whether protein, mucin and tear secretion are influenced by sensory neuropeptides rela-sed following antidromic electrical stimulation of rat tri-geminal ganglion.
Methods: Following unilateral stimulation tears were collected at both sides and assessed for volume, protein concentration (Bradford) measurements; sodium do-decyl sulfate-polyacrylamide electrophoresis (SDS-PAGE) and luminol chemiluminescence with immunostaining to IgA and lysozyme. Embedded conjunctival tissue was stained and the number of goblet cells/100 basal cells (goblet cell density -GCD) was recorded. Rats were pre-treated with atropine to block parasympathetic; guanethidine to block sympathetic neuronal pathways. Topical capsaicin was used to deplete neurotransmitters from sensory nerve endings or SR140333 to block substance P neurokinin-1 receptor mediated responses.

Results: On the stimulated side tear volume increased in the absence of pretreatment and following atropine and guanethidine pretreatments (480.67 ± 22.93 %, 520.13 ± 18.13 %, and 531.19 ± 39.59 %, p<0.0001, respectively) while GCD decreased.
Following capsaicin and SR140333 pretreatments the stimulated tear secretion was only 113.27 ± 14.7 % and 304.34 ± 37.87 % (p<0.0001). Protein concentration of stimulated tear decreased to 55.8 ± 4.19 %, (p<0.005) without pretreatment, whilst tear volume and total secreted protein increased (923.9 ± 144 % and 503.4 ± 73.3 %, p<0.005). SDS-PAGE showed no difference in protein pattern and specific luminol chemiluminescence for lysozyme and IgA showed minimal change in the amount of these constituents (2711 ± 347 vs. 2802 ± 331 and 2718 ± 369 vs. 2383 ± 281 counts, p>0.05).

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