title: Conjunctival impression cytology evaluation of patients with dry eye disease using scleral contact lenses.
abstract: OBJECTIVE
  To evaluate conjunctival impression cytology and HLADR expression changes after wearing scleral contact lenses (ScCLs) for moderate to severe dry eye disease (DED).
  
  
  METHODS
  Prospective interventional case series.
  
  
  METHODS
  Forty-one eyes from 25 patients with moderate to severe DED were evaluated for Esclera ScCL treatment. Best-corrected visual acuity (BCVA) and slit-lamp findings were assessed. Impression cytology specimens were obtained from DED patients at the baseline and after wearing ScCLs for 12 months. The impression cytology specimens were analyzed using morphological results score, and HLA-DR positive cells were detected and quantified. The values were compared to assess the IC changes after wearing ScCLs.
  
  
  RESULTS
  Forty-one eyes from 25 patients were fitted with ScCLs to manage DED. The underlying diseases were Stevens-Johnson syndrome (22 eyes), Sjogren's syndrome (11 eyes), graft-versus-host disease (2 eyes), dry eye after keratomileusis (2 eyes) and undifferentiated ocular surface disease (4 eyes). The HE-PAS impression cytology score did not differ significantly before and after wearing ScCLs for 12 months in DED patients (p>0.05). The percentage of eyes expressing the HLA-DR antigen in the temporal conjunctiva after wearing ScCL for 12 months significantly increased in patients with Sjogren's syndrome (11.11% to 66.66%; p=0.0498). In groups with Stevens Johnson syndrome and other ocular surface disorders, we did not observe statistically significant differences (p>0.05).
  
  
  CONCLUSIONS
  The ScCLs did not change the parameters used to evaluate inflammatory processes, which were measured using conjunctival impression cytology and HLA-DR expression, except in Sjogren syndrome, in which there was an unexpected increase in HLA expression.
authors.affiliation: Department of Ophthalmology, Ocular Surface Advanced Center, Federal University of Sao Paulo, 821 Botucatu St-Vila Clementino, Sao Paulo, SP, 04023-062, Brazil. Electronic address: sarahlpweber@gmail.com.
authors.forename: Sarah La Porta
authors.initials: SP
authors.lastname: Weber
authors.affiliation: Department of Ophthalmology, Ocular Surface Advanced Center, Federal University of Sao Paulo, 821 Botucatu St-Vila Clementino, Sao Paulo, SP, 04023-062, Brazil.
authors.forename: Rossen Mihaylov
authors.initials: RM
authors.lastname: Hazarbassanov
authors.affiliation: Department of Ophthalmology, Ocular Surface Advanced Center, Federal University of Sao Paulo, 821 Botucatu St-Vila Clementino, Sao Paulo, SP, 04023-062, Brazil.
authors.forename: Alex
authors.initials: A
authors.lastname: Nasaré
authors.affiliation: Department of Ophthalmology, Ocular Surface Advanced Center, Federal University of Sao Paulo, 821 Botucatu St-Vila Clementino, Sao Paulo, SP, 04023-062, Brazil.
authors.forename: José Álvaro Pereira
authors.initials: JÁP
authors.lastname: Gomes
authors.affiliation: Department of Ophthalmology, Ocular Surface Advanced Center, Federal University of Sao Paulo, 821 Botucatu St-Vila Clementino, Sao Paulo, SP, 04023-062, Brazil.
authors.forename: Ana Luisa
authors.initials: AL
authors.lastname: Hofling-Lima
mesh_terms: D000293:Adolescent; D000328:Adult; D002452:Cell Count; D003228:Conjunctiva / Q000473:pathology*; D003261:Contact Lenses; D003584:Cytological Techniques / Q000379:methods*; D015352:Dry Eye Syndromes / Q000473:pathology*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012590:Sclera; D055815:Young Adult
keywords: Dry eye disease; HLA-DR; Impression cytology; Ocular surface inflammation; Scleral contact lens