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T. H. Wakamatsu, M. Dogru, Y. Takano, A. Igarashi, O. Ibrahim, Y. Matsumoto, N. Okada, K. Fukagawa, K. Tsubota, F. Hiroshi; Evaluation of Lipid Oxidative Stress Status in Atopic Ocular Surface Disease. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1235.
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Atopic keratoconjunctivitis(AKC) is a bilateral, chronic inflammation of the conjunctiva and lids associated with atopic dermatitis (AD). Skin inflammation in AD is histologically characterized by intense infiltration of lymphocytes, monocytes and eosinophils whose cells release bioactive substances, such as proinflammatory cytokines and reactive oxygen species such as O2-, H2O2 and peroxinitrite (ONOO-), upon immunological and non-immunological stimulation. Although the oxidative stress status in atopic skin disease has been reported to be elevated, there are still no studies related to the status of oxidative stress in atopic ocular surface disease. The purpose of this study was to evaluate the levels of lipid oxidative stress marker, hexanoyl-lysine (HEL), and inflammatory cell infiltrates from conjunctival brush cytology samples of patients with AKC and normal subjects.
Sixteen eyes of 8 patients (4 males, 4 females) with AKC and 16 eyes of 8 age and sex matched (4 males and 4 females) normal healthy controls were examined in this prospective study. All subjects underwent Schirmer test, tear film break up time, fluorescein / Rose Bengal stainings, and brush cytology from the upper palpebral conjunctiva. The brush cytology spin samples were deposited onto a clearly-defined area of a slide glass and stained with Diff-Quick (DQ) for differentiation of inflammatory cells and immunohistochemistry staining with HEL to study lipid oxidation.
The mean tear film break up times in the patients and controls were 5.8±2.5 seconds and 8±2.3 seconds respectively. The mean fluorescein scores in subjects with AKC and controls were 3±2.4 points and 0.6±1 points, respectively. The tear stability and vital staining scores were significantly worse in eyes with AKC (p<0.01) compared to the controls. Inflammatory cells showed a considerable elevation in brush cytology samples of AKC patients, consisting mainly of eosinophils and neutrophils. Brush cytology also revealed considerably higher numbers of positively stained conjunctival epithelial cells for HEL in the imunnohistochemistry staining specimens of patients with AKC compared to control subjects.
The ocular surface disease in AKC was characterized by marked tear instability, ocular surface epithelial damage, increase of inflammatory infiltrates and presence of increased lipid oxidation.
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