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Conjunctival Impression Cytology in healthy volunteers

Conjunctival Impression Cytology in healthy volunteers. Diane Marinho, Andressa P. Stolz, Sergio Kwitko, Felipe K. Mallmann, Samuel Rymer Ophthalmology Department - Hospital de Clínicas de Porto Alegre Federal University of Rio Grande do Sul - Porto Alegre - Brazil

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Conjunctival Impression Cytology in healthy volunteers

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  1. Conjunctival Impression Cytology in healthy volunteers Diane Marinho, Andressa P. Stolz, Sergio Kwitko, Felipe K. Mallmann, Samuel Rymer Ophthalmology Department - Hospital de Clínicas de Porto AlegreFederal University of Rio Grande do Sul - Porto Alegre - Brazil The authors have no financial interest in the subject matter of this poster

  2. Purpose • To determine conjunctival cytology findings in volunteers with no history of ocular disease and to correlate results with dry eye tests and frequency of symptoms.

  3. Methods • Impression cytology (IC) of superior, inferior, nasal and temporal conjunctivae (Aragona’s scoring system) • Ocular surface evaluation clinical tests: Schirmer test (ST), tear film break-up time (TFBUT), Fluorescein staining (FS), Rose Bengal staining (RBS) and slit lamp examination • History and symptoms questionnaire

  4. Results • 78 eyes of 39 patients (77% female, 85% white) were examined. Mean age was 362 years (16-71) • Impression cytology : - grade A (normal): • 71% superior • 57% nasal • 87% inferior • 75% temporal • Snake-like chromatin in 15% of superior samples. • Clinical Tests: • Mean BUT was 13.6 seconds (70% ≥10 sec) • ST median was 19.2 mm (76% >6 mm), • RBS grade 0-3 in 87% • FS grade 0 in 75% • Slit lamp eyelid exam normal in 65%

  5. Table 01. Scoring system for conjunctival impression cytology *if snake-like chromatin

  6. Figure 01. Illustrative impression cytology specimens A B C D A. Normal Cytology, B. Borderline Cytology, arrow indicating goblet cell, C. Abnormal Cytology (superior conjunctiva, PAS/HE/Papanicolaou OM 200x), D. 1-10% Snake-like chromatin containing sample, sign indicating a track of anomalous nuclear cells and E. > 10% Snake-likechromatin containing sample (superior conjunctiva, PAS/HE/Papanicolaou OM 400x). E

  7. Results • Nasal IC was associated with ST, TFBUT, RBS and symptoms. • Nasal IC score showed positive correlation with number of abnormal clinical tests (figure 3). • Temporal IC was associated with ST and symptoms. • Snake-like chromatin was associated with age, ST and IC nasal and superior findings.

  8. Figure 02. IC data (valid specimens) for 6 combined clinical tests S N* I T S N* I T S N* I T *Linear-by-linear association 0.001. S = superior; N = nasal; I = inferior; T = temporal.

  9. Conclusions • Our study identified a prevalence of 57 – 81% of normal cytological findings in normal subjects • Impression cytology findings of exposed bulbar conjunctiva were more often altered • Despite a few associations among tests, there was no conclusive correlation among these tests, symptoms and IC results.

  10. References • Aragona P, Romeo GF, Puzzolo D, Micali A, Ferreri G. Impression cytology of the conjunctival epithelium in patients with vernal conjunctivitis. Eye 1996;10 ( Pt 1):82-5. • Nelson JD. Impression cytology. Cornea 1988;7:71-81 • Schein OD, Tielsch JM, Munoz B, Bandeen-Roche K, West S. Relation between signs and symptoms of dry eye in the elderly. A population-based perspective. Ophthalmology 1997;104:1395-401. • Methodologies to diagnose and monitor dry eye disease: report of the Diagnostic Methodology Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf 2007;5:108-52. • Bjerrum KB. Snake-like chromatin in conjunctival cells of a population aged 30-60 years from Copenhagen City. Acta Ophthalmol Scand 1998;76:294-8. • Paschides CA, Petroutsos G, Psilas K. Correlation of conjunctival impression cytology results with lacrimal function and age. Acta Ophthalmol (Copenh) 1991;69:422-5.

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