The surface and bulk structures of hydrogel contact lenses that contain siloxane moieties, Purevisiontrade mark (balafilcon A) and Focus(R)Night&Daytrade mark (lotrafilcon A), were investigated. Standard hydrogel lenses of low (Seequence(R)), medium (Acuvue(R)), and high water content (Precision UV(R)) were used as controls. All the lenses were dehydrated in a series of ethanol solutions of increased concentration, critical-point dried in CO(2), and sputter coated with gold/palladium before they were examined by scanning electron microscopy. Of all lenses examined, only the balafilcon lenses presented, in addition to the polymer network porosity characteristic of all hydrogels, a macroporous structure that was observed on the front and back surfaces, and in their bulk. The average diameter of the macropores appears to be much larger, from one to several orders of magnitude, than the network porosity of standard hydrogel lenses. The macropores might contribute to the gas and water permeability of these lenses, as well as to their mobility on the cornea.

Introduction Chronic active antibody-mediated rejection (cAMR) is a major determinant of late allograft failure. Rituximab/immunoglobulins (IVIg) + plasma exchange (PLEX) showed controversial results in cAMR treatment. Tocilizumab (TCZ), a humanized anti-interleukin 6 receptor antibody, has been recently used as rescue therapy in patients non-responsive to rituximab/IVIg/PLEX with favorable outcomes. Whether TCZ acts "per se" or requires a priming effect from previous treatments is currently unknown.Methods 15 patients with cAMR were treated with TCZ as a first-line therapy and followed for a median time of 20.7 months.Results Despite the majority of patients experiencing advanced transplant glomerulopathy (TG) at diagnosis (60% with cg3), glomerular filtration rate and proteinuria stabilized during the followup, with a significant reduction in donor-specific antibodies. Protocol biopsies after 6 months demonstrated significant amelioration of microvascular inflammation and no TG, C4d deposition or IF/TA progression. Gene-expression and immunofluorescence analysis showed upregulation of three genes (TJP-1, AKR1C3 and CASK) involved in podocyte, mesangial and tubular restoration.Conclusion TCZ adopted as a first-line approach in cAMR was associated with early serological and histological improvements and functional stabilization even in advanced TG, suggesting a role for the use of TCZ alone with the avoidance of unnecessary previous immunosuppressants.

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In the present study, samples of lotrafilcon A, balafilcon A, and galyfilcon A contact lenses were observed by atomic force microscopy (AFM) in tapping mode at areas ranging from 0.25 to 400 microm2. Mean roughness (Ra), root-mean-square roughness (Rms) and maximum roughness (Rmax) in nanometers were obtained for the three lens materials at different magnifications. The three contact lenses showed significantly different surface topography. However, roughness values were dependent of the surface area to be analyzed. For a 1 microm2 area, statistics revealed a significantly more irregular surface of balafilcon A (Ra = 6.44 nm; Rms = 8.30 nm; Rmax = 96.82 nm) compared with lotrafilcon A (Ra = 2.40 nm; Rms = 3.19 nm; Rmax = 40.89 nm) and galyfilcon A (Ra = 1.40 nm; Rms = 1.79 nm; Rmax = 15.33 nm). Ra and Rms were the most consistent parameters, with Rmax presenting more variability for larger surface areas. The higher roughness of balafilcon A is attributed to the plasma oxidation treatment used to improve wettability. Conversely, galyfilcon A displays a smoother surface. Present observations could have implications in clinical aspects of siloxane-hydrogel contact lens wear such as lens spoliation, resistance to bacterial adhesion, or mechanical interaction with the ocular surface.

DR curves under the conditions of the present study can be described as a three-phase process. Phase I consists of a relatively uniform DR with a duration that ranges from 10 to almost 60 min and is strongly correlated with the EWC of the polymer as it is the CD during this phase. Overall, HEMA-based hydrogels dehydrate to a greater extent and faster than silicone-hydrogel materials. There are differences in water retention between lenses of similar water content and thickness that should be further investigated.