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Tear Ferning Test and Pathological Effects on Ocular Surface before and after Topical Cyclosporine in Vernal
Marcella Nebbioso1, Marta Sacchetti1, Guia Bianchi1
1Department of Sense Organs, Sapienza University of Rome, p. le A. Moro 5, 00185 Rome, Italy.
Insights
Vernal keratoconjunctivitis (VKC) involves altered lacrimal mucin, impacting tear ferning. Cyclosporine A (CY) eye drops improved VKC symptoms and mucin component, showing potential therapeutic benefits for this rare eye condition.
Area of Science:
- Ophthalmology
- Immunology
- Biochemistry
Background:
- Vernal keratoconjunctivitis (VKC) is a rare inflammatory eye disease affecting children, typically regressing at puberty.
- Early therapeutic intervention is crucial for managing VKC before puberty onset.
Purpose of the Study:
- To investigate the role of the lacrimal mucous component in VKC patients.
- To compare tear ferning test (TFT) modifications, MUC5AC levels, and conjunctival goblet cell density in VKC patients before and after cyclosporine A (CY) treatment.
Main Methods:
- Enrolled 47 VKC patients and 30 healthy controls (ages 3-16).
- Performed comprehensive eye exams, skin prick tests (SPT), tear collection, and impression cytology.
- Evaluated TFT, MUC5AC levels, and goblet cell density pre- and post-CY eye drop treatment.
Main Results:
- VKC patients exhibited significant alterations in tear ferning, indicating a compromised lacrimal mucous layer.
- Increased conjunctival goblet cell density was observed in VKC patients; MUC5AC levels showed no significant difference between groups.
- CY treatment improved VKC signs/symptoms, including TFT, and showed a trend towards normalizing goblet cell density.
Conclusions:
- Demonstrated a significant alteration in the lacrimal mucin component in VKC patients for the first time.
- Showed improvement in the lacrimal mucin component following cyclosporine A therapy in VKC patients.
Background:
Vernal keratoconjunctivitis (VKC) is a rare ocular surface inflammatory disease that affects mainly boys in the first decade of life. Clinical observations show that it generally regresses spontaneously with the onset of puberty, but therapeutic measures must be taken before then to control the course of the disease.
Purpose:
To evaluate the role of the lacrimal mucous component in VKC patients and compare tear ferning test (TFT) modifications, MUC5AC levels in tears, and density of conjunctival goblet cells to clinical characteristics before and after treatment with cyclosporine A (CY) in eye drops.
Methods:
Forty-seven patients affected by VKC and 30 healthy subjects aged between 3 and 16 years of life were enrolled. All individuals were submitted to complete eye examination and skin prick test (SPT) for the most common allergens. Then, they were subjected to collection of the tears and to impression cytology to evaluate TFT, MUC5AC levels, and conjunctival goblet cell density, before and after treatment with CY in eye drops.
Results:
Comparing the VKC group vs. the control group at baseline, a significant alteration in the degree of the ferns was found, indicating a pathological condition of the lacrimal mucous layer. In addition, an increased number of goblet cells were observed in the patients. The concentration of lacrimal secretory mucins (MUC5AC) did not show significant differences between the 2 groups. Patients treated with CY have reported improvements of some signs and symptoms of disease activity, including TFT, and a tendency of conjunctival goblet cell density to normalise.
Conclusions:
The results obtained demonstrated for the first time a significant alteration of the lacrimal mucin component evaluated in the VKC group, and an improvement of the latter after CY therapy.
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