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PurposeTo investigate the features of corneal epithelial thickness topography with Fourier-domain optical coherence tomography (OCT) in dry eye patients.MethodsIn this cross-sectional study, 100 symptomatic dry eye patients and 35 normal subjects were enrolled. All participants answered the ocular surface disease index questionnaire and were subjected to OCT, corneal fluorescein staining, tear breakup time, Schirmer 1 test without anesthetic (S1t), and meibomian morphology. Several epithelium statistics for each eye, including central, superior, inferior, minimum, maximum, minimum - maximum, and map standard deviation, were averaged. Correlations of epithelial thickness with the symptoms of dry eye were calculated.ResultsThe mean (±SD) central, superior, and inferior corneal epithelial thickness was 53.57 (±3.31) μm, 52.00 (±3.39) μm, and 53.03 (±3.67) μm in normal eyes and 52.71 (±2.83) μm, 50.58 (±3.44) μm, and 52.53 (±3.36) μm in dry eyes, respectively. The superior corneal epithelium was thinner in dry eye patients compared with normal subjects (p = 0.037), whereas central and inferior epithelium were not statistically different. In the dry eye group, patients with higher severity grades had thinner superior (p = 0.017) and minimum (p < 0.001) epithelial thickness, more wide range (p = 0.032), and greater deviation (p = 0.003). The average central epithelial thickness had no correlation with tear breakup time, S1t, or the severity of meibomian glands, whereas average superior epithelial thickness positively correlated with S1t (r = 0.238, p = 0.017).ConclusionsFourier-domain OCT demonstrated that the thickness map of the dry eye corneal epithelium was thinner than normal eyes in the superior region. In more severe dry eye disease patients, the superior and minimum epithelium was much thinner, with a greater range of map standard deviation.

Purpose: To evaluate meibomian gland (MG) alterations in patients with primary chronic dacryocystitis (PCD) by in vivo confocal microscopy (IVCM), and to correlate the finding with clinical presentation. Methods: Twenty-eight eyes with the diagnosis of PCD and their contralateral unaffected eyes were studied and compared with 27 normal controls. All subjects completed an Ocular Surface Disease Index questionnaire (OSDI) and underwent slit-lamp biomicroscopy examination, tear break-up time (BUT) measurements, fluorescein staining, Schirmer test I, and an IVCM examination of the MG. IVCM parameters, including the MG acinar unit density (MGAUD), periglandular inflammatory cell density (ICD), MG acinar unit longest diameter (MGALD), and MG acinar unit shortest diameter (MGASD) and their correlation with clinical data were analyzed. Results: The mean MG expressibility scores, BUT values, and staining scores were significantly worse in eyes with PCD compared with the contralateral clinically unaffected eyes and controls ( p < 0.05). A significant decrease in MGAUD was observed in PCD eyes compared with the controls and the contralateral clinically unaffected eyes. Conversely, the mean ICD and MGASD values were significantly higher in the PCD eyes. There were no significant differences in mean MGALD value between the PCD eyes and the contralateral clinically unaffected eyes. In addition, there were significant changes in the IVCM parameters in the contralateral unaffected eyes compared with the controls, including MGAUD, ICD, MGALD, and MGASD. All IVCM parameters showed a strong, significant correlation with MG dropout grades, MG expressibility, fluorescein staining scores, and OSDI values (all p < 0.05). Conclusions: Patients with unilateral PCD demonstrated significant changes in MG as compared with the contralateral clinically unaffected eyes and controls. The MG function should be closely observed in these patients. [ABSTRACT FROM AUTHOR]

Background: An understanding of the anatomical structure is crucial for completing successful endoscopic dacryocystorhinostomy (DCR) surgery. This study aimed to precisely delineate the spatial relationship between the lacrimal sac and the agger nasi cell (ANC) and evaluate the impact of ANC on surgical strategies in endoscopic DCR., Methods: This retrospective cross-sectional study included 110 Han Chinese patients diagnosed with unilateral primary acquired nasolacrimal duct obstruction (PANDO) from January 2021 to June 2023. This study was conducted in Eye, Ear, Nose, and Throat Hospital of Fudan University and involved inpatient participants who were scheduled for DCR surgery under general anesthesia. Patients were consecutively enrolled. The patients underwent preoperative computed tomography-dacryocystography (CT-DCG), and contrast-enhanced images were used to locate the positions of the lacrimal sac and the common canaliculus. A dynamic approach was adopted to analyze the multiplanar CT imaging, facilitating a detailed assessment of the morphology of the lacrimal drainage system and potential overlap of the lacrimal sac. Patient ages and measured values are presented as the mean ± standard deviation, which were measured three times by the same observer and averaged for statistical analysis., Results: The prevalence of ANC in this study was 90.9% (100/110). Dynamic examination revealed that only 42.7% (47/110) of ANCs appeared as discrete cells, while the majority were connected to nearby sinus openings. Spatial analysis showed that in 57 out of 110 cases, ANCs were situated below the common canaliculus and not posterior to the lacrimal sac, indicating an overlap rate of 51.8%. Notably, our dynamic approach identified five critical cases of overlap below the level of the common canaliculus, which might have been missed by prior studies that used different methodologies., Conclusions: More than half of the ANCs exhibited overlap with the lacrimal sac, suggesting a significant proportion may necessitate opening during endoscopic DCR procedures. ANCs are often interconnected with adjacent nasal sinuses, necessitating careful consideration in the decision to open the ANCs during surgery. The dynamic evaluation employed in CT-DCG effectively assessed the extent of ANC coverage over the lacrimal sac., Competing Interests: Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-24-541/coif). The authors have no conflicts of interest to declare., (2024 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

Purpose: We sought to determine the role of epithelium-produced thymic stromal lymphopoietin (TSLP) and its underlying mechanisms in corneal innate immune defense against Pseudomonas (P.) aeruginosa keratitis., Methods: The expression of TSLP and TSLPR in cultured human corneal epithelial cells (HCECs) and mouse corneas was determined by PCR, Western, and/or ELISA. Cellular localization of TSLP receptor (TSLPR) was determined by whole mount confocal microscopy. TSLP-TSLPR signaling was downregulated by neutralizing antibodies and/or small interfering (si)RNA; their effects on the severity of P. aeruginosa-keratitis and cytokine expression were assessed using clinical scoring, bacterial counting, PMN infiltration, and real-time PCR. The role of dendritic cells (DCs) in corneal innate immunity was determined by local DC depletion using CD11c-DTR mice., Results: P. aeruginosa-infection induced the expression of TSLP and TSLPR in both cultured primary HCECs and in C57BL/6 mouse corneas. While TSLP was mostly expressed by epithelial cells, CD11c-positive cells were positive for TSLPR. Targeting TSLP or TSLPR with neutralizing antibodies or TSLPR with siRNA resulted in more severe keratitis, attributable to an increase in bacterial burden and PMN infiltration. TSLPR neutralization significantly suppressed infection-induced TSLP and interleukin (IL)-17C expression and augmented the expression of IL-23 and IL-17A. Local depletion of DCs markedly increased the severity of keratitis and exhibited no effects on TSLP and IL-23 expression while suppressing IL-17A and C expression in P. aeruginosa-infected corneas., Conclusions: The epithelium-expressed TSLP plays a protective role in P. aeruginosa keratitis through targeting of DCs and in an IL-23/IL-17 signaling pathway-related manner.

Objective: To evaluate the change of corneal epithelial thickness after pterygium excision with conjunctival autograft transplantation by Fourier Domain Optical Coherence Tomography (FD-OCT) ., Methods: Twenty-two patients (24 eyes) with the diagnosis of primary pterygium were enrolled. They underwent pterygium excision combined with conjunctival autograft transplantation. Twenty-five volunteers (25 eyes) served as the normal control group. FD-OCT was performed preoperatively and 1, 2, 3, 5, 7 days postoperatively to measure the thickness of corneal epithelium at 1 mm and 2 mm anterior to the nasal or temporal scleral spur. Corneal fluorescein staining was performed simultaneously. Comparisons on the thickness of corneal epithelium were made between preoperative values and postoperative ones., Results: The thickness of cornea epithelium at 1 mm anterior to the scleral spur was (43.81 ± 2.55) µm in normal subjects. At day 1 after surgery, corneal epithelial thickness at the same location was (21.28 ± 5.72) µm and then gradually increased to (39.94 ± 5.47) µm at day 7 postoperatively. All the difference on postoperative days had statistically significant (t = -17.69, -14.97, -10.63, -9.86, -3.15, P < 0.05) . The thickness of cornea epithelium at 2 mm anterior to the scleral spur was (40.50 ± 3.17) µm in normal subjects. At day 1 after surgery, corneal epithelial thickness at the same location was (24.02 ± 5.92) µm, and then gradually increased to (940.34 ± 5.69) µm at day 7 postoperatively. All the difference on postoperative days except day 7 had statistically significant (t = -12.08, -10.27, -6.18, -2.99, P < 0.05). Cornea epithelium at this location repaired sooner than that at 1 mm anterior to the scleral spur. At day 1 after surgery, corneal epithelium defect area were (39.31 ± 22.77) mm(2), and then decreased to (1.01 ± 1.72) mm(2) at 7 days (t = 6.68, 5.55, P < 0.05). At day 7 postoperative, 66.7% patients had a complete recovery of corneal epithelium with no fluorescein staining., Conclusions: FD-OCT was the effective instrument for observing the change of limbus-peripheral cornea epithelium thickness.Within 7 days postoperatively, cornea epithelium restored almost normal. After pterygium surgery, limbus-peripheral cornea epithelium restoration showed the tendency from the central to peripheral cornea.

Objective: To compare the corneal epithelial thickness profile in keratoconic and normal eyes with advanced Fourier-domain optical coherence tomography (OCT) and to evaluate the diagnostic efficiency of pachymetry parameters., Methods: Cross-sectional observational study. Twenty-five consecutive keratoconus patients (34 eyes) and 41 normal volunteers (41 eyes) in Eye & ENT Hospital of Fudan University between June 1 and July 31, 2013 were enrolled.Observations of corneal epithelial thickness and corneal thickness profiles were taken from all subjects. The epithelial pachymetry parameters were superior, inferior, inferior-superior (I-S), minimum (Min), maximum (Max), Min-Max, and central. The corneal pachymetry parameters were inferotemporal-superonasal (IT-SN), I-S, Min, Min-median, Min-Max, and central.Statistical analysis methods included Chi-square test, independent two-sample t-test, and Wilcoxon rank sum test. The diagnostic efficiency of all parameters were analyzed by receiver operating characteristic (ROC) curves and Youden index., Results: The inferior, I-S, Min, Min-Max, and central epithelial thickness averages were (50.5 ± 4.8) µm, (-2.7 ± 7.5) µm, (35.9 ± 10.7) µm, (-33.6 ± 18.9) µm, and (50.1 ± 6.8) µm in keratoconic eyes.In normal eyes, they were (54.8 ± 2.5) µm, (0.9 ± 1.3) µm, (51.4 ± 2.6) µm, (-5.7 ± 1.8) µm, and (54.7 ± 2.2) µm. Among the epithelial pachymetry parameters, Min-Max and Min showed high diagnostic efficiency for keratoconus (AUC = 0.967, 0.968; Youden index = 0.882, 0.829); inferior, I-S, and central parameters showed moderate efficiency (AUC = 0.794, 0.728, 0.715; Youden index = 0.461, 0.564, 0.565). The IT-SN, I-S, Min, Min-median, Min-Max, and central corneal thickness averages were (-82.8 ± 65.2) µm, (-72.5 ± 55.6) µm, (401.2 ± 83.8) µm, (-83.4 ± 48.2) µm, (-169.7 ± 99.4) µm, and (453.4 ± 58.6) µm in keratoconic eyes.In normal eyes, these parameters were respectively (-23.7 ± 18.5) µm, (-20.5 ± 19.8) µm, (525.4 ± 28.1) µm, (-23.1 ± 4.8) µm, (-59.2 ± 23.3) µm, and (533.4 ± 28.8) µm. Min, Min-median, and Min-Max had preferable diagnostic efficiency (AUC = 0.952, 0.938, 0.924; Youden index = 0.784, 0.829, 0.721); central, IT-SN, and I-S parameters showed moderate efficiency (AUC = 0.891, 0.877, 0.862; Youden index = 0.643, 0.707, 0.580)., Conclusions: In observation with Fourier-domain OCT, keratoconus was characterized by central and inferior epithelial thinning, increased epithelial thickness variation, central cornea thinning, increase in asymmetry, and gaps between corneal IT-SN and I-S thickness.Fourier-domain OCT was confirmed to have high speed, high resolution, and noninvasion. The pachymetry parameters showed specific strengths in diagnosis of keratoconus, especially epithelial pachymetry parameters of Min and Min-Max, and corneal pachymetry parameters of Min, Min-median and Min-Max.