The Complications of Cataract Surgery in Patients with Pseudoexfoliation

The senile cataract represents the blurring of the crystalline lens after the age of 65. It occurs due to metabolic changes in the crystalline lens which occur over the years. The only effective way to treat cataract is the surgical one. Pseudoexfoliation is an age related systemic disorder. PEX represents the accumulation fibrillar material in the extracellular matrix of the tissue. The most known ocular manifestation of the PEX are the collection at iris pupillary margin and anterior lens capsule. This accumulation is associated with many intraoperative and postoperative complications in patients scheduled for cataract surgery. The aim of the study was to investigate the prevalence of the surgical complications during phacoemulsfication in patients with PEX. The study included 91 patients scheduled for cataract surgery divided into two groups (PEX group 46, control group 45 patients). Poor intraoperative midryasis, zonular dehiscence, postoperative corneal edema, anterior chamber inflammation, elevated intraocular pressure and tear film instability had particularly higher rate of occurring in PEX group comparing to the control group (p<0.001). The highest mean value of intraocular pressure was observed in PEX group on the first postoperative day 25.6 ± 1.1 mmHg, while the best corrected visual acuity was measured in control group 0.71 ± 1.2 one month after phacoemulsification. Cataract surgery in patients with PEX carries great risk, but with adequate preoperative planning, the awareness of the potential complications, can provide safe and routine phacoemulification in these patients.

Gut-Derived Butyrate Suppresses Ocular Surface Inflammation

Dry eye is a common ocular inflammatory disorder characterized by tear film instability and reduced tear production. There is increasing evidence that homeostasis of the ocular surface is impacted by the intestinal microbiome. We are interested in investigating the potential role of microbially produced small molecules in mediating the interaction between the intestinal microbiota and the ocular surface. One such molecule is butyrate, a short-chain fatty acid (SCFA) produced by certain members of the gut microbiota through fermentation of dietary fiber. Here we show that SCFA transporter Slc5a8 is expressed in vivo in murine conjunctival and corneal epithelium. Pre-treatment of in vitro corneal epithelial cultures or bone marrow-derived dendritic cells (BMDCs) with phenylbutyrate (PBA) reduces lipopolysaccharide-induced pro-inflammatory Tnf expression. Corneal epithelial cultures and BMDCs isolated from Slc5a8 knockout mice are unable to respond to PBA pre-treatment, suggesting that Slc5a8 is required for the protective effect of PBA. Finally, the treatment of mice undergoing desiccating stress with oral tributyrin, a prodrug form of butyrate, reduces inflammation at the ocular surface in vivo, and this effect partially requires Slc5a8. Together these data support our hypothesis that SCFAs produced in the gut participate in the maintenance of ocular surface homeostasis.

Ayurvedic Management of Severe Dry Eye Syndrome & Complications: A Case Study

Dry eye syndrome (DES) is a common condition that causes pain and can lead to vision problems. Modern living has given rise to a massive increase in the incidence of vision threatening dry eye disease, around 10-30% of population living in industrialized countries suffer from dry eye syndrome (DES). According to Second International Dry Eye Workshop (DEWS II) in 2017 offered dry eye as it is a multifactorial ocular surface disorder defined by a loss of tear film homeostasis and ocular symptoms, in which tear film instability and hyperosmolarity, as well as ocular surface inflammation and injury, play a part in the etiology. If it is not controlled with in time it can lead to corneal blindness. Ayurveda proposes a comprehensive systemic & topical strategy in the treatment of dry eye syndrome, in contrast to the available modern medical treatment. In this publication, a case study of a Shushkakshipaka with many complications who was treated with dynamic Ayurvedic treatments & after continuous efforts patient got very significant results is being discussed here.

The effects of microwave radiation generated by mobile phones on the tear film

Electromagnetic radiation (ER) emitted by mobile phones and other modern devices has potentially harmful effects on ocular tissue. Their effects on the eye surface and tear film are little known so far. The aim of this paper was to investigate the effects of ER emitted by the phone mobile on the tear film. For this study, we selected a total of 50 subjects, young, healthy, without chronic treatment, who are not contact lens wearers and who have no history of ophthalmic surgery. Schirmer I test, tear pH and tear ferning test (TFT) were performed on all subjects before (“-pre”) being exposed to ER emitted by the mobile phone and after (“-post”) exposure for 5 minutes, the pH and TFT of the tears were performed. Following the analysis of the obtained results, we found that there are significant changes in tear quality and increased tear pH, which over time can lead to tear film instability, damage to the eye surface and the appearance of dry eye syndrome.

Investigating the Corrosion Behaviour of Corrosion Resistant Alloys in Solutions Containing Dilute Fluoride

The ability of fluoride ions, in trace concentrations, to promote film instability and transpassive dissolution was shown for several corrosion resistant alloys. While the addition of fluoride ion was found to decrease the transpassive dissolution potential by approximately 0.1 V, the decrease was particularly pronounced in mildly acidic media (pH 5). Results suggest that the decreased potential range of stability for the heavily-relied-upon Cr(III)-rich oxide film is a concern in the presence of oxidizing impurities which may push the corrosion potentials toward the transpassive region. The decreased potential range of passive film stability was observed using both dynamic and static polarization experiments and supported by solution and surface analyses.

Post-Operative Evaluation of Tear Film Instability After Cataract Surgery

Purpose of Study: To evaluate tear film instability after cataract surgery by measuring tear break up time. Place of Study: This study was carried out in Teaching Hospital, University of Lahore, Lahore, Pakistan. Materials and Methods: A descriptive cross- sectional study was conducted in Teaching Hospital, UOL. Tear break up time was measured on patients post-operatively who under -went cataract surgery. A total of 60 patients were included in study after non –probability convenient sampling technique. Both male and female patients were included in study age 45-65 years. Data was collected through self-designed questionnaire based proforma. Further results were analyzed using SPSS version 20. Results: Tear break up time was found statistically reduced at 1 week, 2 week and after one month postoperatively(P =.0002, P<.0001). However, the tear film stability had reverted to approximately the preoperative measurement 1 month after surgery. The mean values of postoperative results were altered from preoperative measurement values. BUT outcomes had reduced considerably at 1 week postoperatively (P=.0001) but had resumed to very nearly the preoperative value 1 month after of cataract surgery. While goblet cell density (GCD) had reduced considerably at 1 week, 2 weekand 1 month postoperatively (P<.0001). Conclusion: This study concludes that tear breakup time is significantly reduced after cataract surgery due to destruction of goblet cells as shown in above tables. But tear break up time is significantly improved after one week, two weeks and one month of follow ups respectively

An Association Rule Analysis of Combined Acupoints for the Treatment of Patients with Dry Eye Disease

<b><i>Background:</i></b> Dry eye disease (DED) has a higher incidence in old age and is seen predominantly in females worldwide. Neurosensory abnormalities, ocular surface inflammation and damage, film instability, and hyperosmolarity are major and proven pathologies responsible for a poor quality of life. Tear breakup time and Schirmer’s I test are predominantly used for the evaluation of primary outcomes in patients undergoing conventional treatment. A previous meta-analysis of some relevant studies proved that combination of acupoints could be more effective than single acupoint treatment. <b><i>Objectives:</i></b> The present study aimed to undertake association rule mining and examined the potential kernel acupoint combination in DED treatment constructed from the extracted randomized controlled trials (RCTs) based on a previous meta-analysis. <b><i>Methods:</i></b> We summarized 32 acupoints as binary data from the 12 eligible RCTs and analyzed them based on the Apriori algorithm. <b><i>Results:</i></b> TE23, BL2, ST2, ST1, EX-HN5, BL1, LI4, ST36, SP6, and KI3 were the 10 most frequently selected acupoints. The major associated rules in combination of acupoints were {TE23, LI4} ≥ {ST1} and {TE23, ST1} ≥ {LI4}, as inferred from 23 association rules. <b><i>Conclusions:</i></b> For acupuncture treatment of DED, combined TE23, LI4, and ST1 acupoints could be settled as the kernel of acupoint combination.

Autophagy Activation Protects Ocular Surface from Inflammation in a Dry Eye Model In Vitro

Inflammation is the main pathophysiology of dry eye, characterized by tear film instability and hyperosmolarity. The aim of this study was to investigate the association of inflammation and cellular autophagy using an in vitro dry eye model with primary cultured human corneal epithelial cells (HCECs). Primary HCECs cultured with fresh limbal explants from donors were switched to a hyperosmotic medium (450 mOsM) by adding sodium chloride into the culture medium. We observed the stimulated inflammatory mediators, TNF-α, IL-1β, IL-6 and IL-8, as well as the increased expression of autophagy related genes, Ulk1, Beclin1, Atg5 and LC3B, as evaluated by RT-qPCR and ELISA. The immunofluorescent staining of LC3B and Western blotting revealed the activated autophagosome formation and autophagic flux, as evidenced by the increased LC3B autophagic cells with activated Beclin1, Atg5, Atg7 and LC3B proteins, and the decreased levels of P62 protein in HCECs. Interestingly, the autophagy activation was later at 24 h than inflammation induced at 4 h in HCECs exposed to 450 mOsM. Furthermore, application of rapamycin enhanced autophagy activation also reduced the inflammatory mediators and restored cell viability in HCECs exposed to the hyperosmotic medium. Our findings for the first time demonstrate that the autophagy activation is a late phase response to hyperosmotic stress, and is enhanced by rapamycin, which protects HCECs by suppressing inflammation and promoting cells survival, suggesting a new therapeutic potential to treat dry eye diseases.