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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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          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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          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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              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.

                Author and article information

                Ophthalmic Res
                Ophthalmic Research
                S. Karger AG
                November 2006
                08 November 2006
                : 38
                : 6
                : 343-349
                Department of Ophthalmology, Hanyang University Guri Hospital, College of Medicine, Hanyang University, Guri City, Gyunggi-do, Korea
                96229 Ophthalmic Res 2006;38:343–349
                © 2006 S. Karger AG, Basel

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


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