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      Conjunctival Changes Induced by LASIK Suction Ring in a Rabbit Model

      ,

      Ophthalmic Research

      S. Karger AG

      Apoptosis, Conjunctiva, Laser in situ keratomileusis, Mucin, Suction ring

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          Abstract

          Purpose: To study histopathological changes in rabbit conjunctiva after suction ring application. Methods: A suction ring was applied to adult albino rabbit eyes (n = 30) with a vacuum pressure of 508 mm Hg for 40 s. Three rabbits were sacrificed at 3 h (3-hour group), 6 h (6-hour group), 1 day (1-day group), 3 days (3-day group), and 7 days (7-day group) after the suction ring application. Histopathological examinations included hematoxylin and eosin, Alcian blue pH 2.5-periodic acid-Schiff (AB2.5-PAS), and Alcian blue pH 1.0-periodic acid-Schiff (AB1.0-PAS) staining. TdT-dUTP-terminal nick-end labeling (TUNEL) assay and immunohistochemical staining for p65 were also performed. Results: The site of suction ring application and adjacent areas did not show transient inflammation. AB2.5-PAS staining revealed that the percentage of neutral mucin was significantly different between 54.5 ± 1.6% in the control group and 22.3 ± 1.3% in the 7-day group (p = 0.04). Apoptosis occurred not only at the site of suction ring application, but also in adjacent regions. At all time points, conjunctival epithelium showed no positive staining for p65. Conclusion: The transient elevation of pressure induced by a suction ring is sufficient to cause conjunctival damage. These histological results support the finding that conjunctival damage caused by suction ring application is one of many etiologies of dry eye syndrome following laser in situ keratomileusis.

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          Most cited references 16

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          An essential role for NF-kappaB in preventing TNF-alpha-induced cell death.

          Studies on mice deficient in nuclear factor kappa B (NF-kappaB) subunits have shown that this transcription factor is important for lymphocyte responses to antigens and cytokine-inducible gene expression. In particular, the RelA (p65) subunit is required for induction of tumor necrosis factor-alpha (TNF-alpha)-dependent genes. Treatment of RelA-deficient (RelA-/-) mouse fibroblasts and macrophages with TNF-alpha resulted in a significant reduction in viability, whereas RelA+/+ cells were unaffected. Cytotoxicity to both cell types was mediated by TNF receptor 1. Reintroduction of RelA into RelA-/- fibroblasts resulted in enhanced survival, demonstrating that the presence of RelA is required for protection from TNF-alpha. These results have implications for the treatment of inflammatory and proliferative diseases.
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            Cloning of the p50 DNA binding subunit of NF-κB: Homology to rel and dorsal

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              Effects of laser in situ keratomileusis on tear production, clearance, and the ocular surface.

              To evaluate components of the integrated ocular surface/lacrimal gland unit in a series of patients before and after undergoing bilateral laser in situ keratomileusis (LASIK). Prospective, noncomparative case series. Forty-eight eyes of 14 men and 34 women (age range, 26-54; mean, 39.2 years) who underwent bilateral LASIK for myopia or myopic astigmatism. LASIK was performed using a VISX Star Excimer Laser (Santa Clara, CA). Patients completed a questionnaire containing 11 questions that evaluated the character and severity of ocular irritation symptoms. Snellen visual acuity, tear fluorescein clearance, corneal fluorescein staining, aqueous tear production by the Schirmer 1 test, and corneal and conjunctival sensitivity were measured in each eye. Corneal surface regularity (SRI) was evaluated with the Tomey TMS-1 (Tomey, Cambridge, MA) topography instrument. Each randomly chosen eye was evaluated 1 to 2 days (T0) before LASIK and 7 days (T1), 1 (T2), 2 (T3), 6 (T4), 12 (T5), and 16 (T6) months postoperatively. A Wilcoxon test, two-tailed paired t test, Friedman test, or analysis of variance were used for statistical comparisons. Components of the integrated ocular surface/lacrimal gland unit. Both corneal and conjunctival sensitivity were noted to be significantly decreased from preoperative levels at 1week, 1 month, 12 months, and 16 months postoperatively (P < 0.0002 at each time point). Symptom severity scores were significantly increased at 1 week, 12 months, and 16 months postoperatively (P < 0.007 at all time points). The mean Schirmer 1 test scores were 24 +/- 14 mm preoperatively, and they decreased to 18 +/- 14 mm by 1 month postoperatively (P < 0.001). Tear fluorescein clearance showed a linear increase postoperatively and was significantly greater than baseline (P < 0.001) at each time point. There was a significant increase in punctate corneal fluorescein staining at 1 week postoperatively (P < 0.0001), but staining returned to baseline by 12 months. There was a statistically significant increase in SRI 1 week postoperatively (P < 0.007) with return to baseline levels by 6 months. Sensory denervation of the ocular surface after bilateral LASIK disrupts ocular surface tear dynamics and causes irritation symptoms. Patients undergoing LASIK should be informed of these risks.
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                Author and article information

                Journal
                ORE
                Ophthalmic Res
                10.1159/issn.0030-3747
                Ophthalmic Research
                S. Karger AG
                0030-3747
                1423-0259
                2006
                November 2006
                08 November 2006
                : 38
                : 6
                : 343-349
                Affiliations
                Department of Ophthalmology, Hanyang University Guri Hospital, College of Medicine, Hanyang University, Guri City, Gyunggi-do, Korea
                Article
                96229 Ophthalmic Res 2006;38:343–349
                10.1159/000096229
                17047406
                © 2006 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 5, Tables: 2, References: 24, Pages: 7
                Categories
                Original Paper

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