In Vivo Confocal Microscopy of the Corneal Sub-Basal Nerve plexus in Medically Controlled Glaucoma

The present study investigated the corneal sub-basal nerve plexus (SNP) modifications in glaucoma. Ninety-five glaucomatous patients were enrolled and divided into Group 1 and 2, preserved and preservative-free mono-therapy (30 and 28 patients), and Group 3, multi-therapy (37). Thirty patients with dry eye disease (DED) and 32 healthy subjects (HC) served as controls. In vivo confocal microscopy evaluated the nerve fibers density (CNFD), length (CNFL), thickness (CNFT), branching density (CNBD), and dendritic cell density (DCD). CNFD, CNFL, and CNBD were reduced in Group 3 and DED compared to HC (p < 0.05). CNFL was reduced in Group 3 compared to Group 2 (p < 0.05), and in Group 1 compared to HC (p < 0.001). CNFD, CNBD, and CNFT did not differ between glaucomatous groups. DCD was higher in Group 3 and DED compared to HC and Group 2 (p < 0.01). Group 3 showed worse ocular surface disease index (OSDI) scores compared to Group 1, 2, and HC (p < 0.05). CNFL and DCD correlated with OSDI score in Group 3 (r = −0.658, p < 0.001; r = 0.699, p = 0.002). Medical therapy for glaucoma harms the corneal nerves, especially in multi-therapy regimens. Given the relations with the OSDI score, SNP changes seem features of glaucoma therapy-related OSD and negatively affects the patient's quality of life.

HUBUNGAN PEMAKAIAN KONTRASEPSI HORMONAL TERHADAP KUANTITAS TEAR FILM

Mata kering adalah penyakit multifaktorial yang ditandai dengan hilangnya homeostasis tear film yang diikuti gejala okular akibat penurunan kuantitas tear film. Pada jaringan mata, hormon seksual berperan dalam mengatur struktur dan fungsi dari kelenjar lakrimal. Penggunaan kontrasepsi hormonal merupakan salah satu terapi sistemik yang dapat dihubungkan dengan penurunan kuantitas tear film. Penelitian ini merupakan penelitian analitik dengan pendekatan observasional pada 40 orang wanita dengan rentang usia 21-44 tahun. Kelompok sampel adalah wanita yang menggunakan kontrasepsi hormonal minimal dalam 1 tahun dan kelompok kontrol adalah kelompok yang tidak menggunakan kontrasepsi hormonal. Hasil penelitian dan analisis data mendapatkan rerata uji Schirmer kelompok sampel dan kontrol adalah (21,3±12,7) dan (23,9±10). Rerata terkecil uji Schirmer adalah pada kontrasepsi jenis injeksi 3 bulan, yaitu (18,2 ± 11,6). Pada tear meniscus terjadi penurunan pada kelompok sampel (40%) dan kontrol (30%). Hasil kuesioner ocular surface disease index (OSDI) kelompok sampel didapatkan dry eye ringan (20%), sedang (20%), dan berat (5%). Sementara itu kelompok kontrol hanya mengalami dry eye ringan (45%). Dalam penelitian ini menunjukkan tidak terdapat perbedaan hasil yang bermakna (p > 0,05) antara kelompok tersebut. Kesimpulan yang didapatkan adalah tidak terdapat hubungan yang bermakna pemakaian kontrasepsi hormonal dengan kuantitas tear film.

OCULAR SURFACE DISEASE AMONG PATIENTS WITH OPEN ANGLE GLAUCOMA USING TOPICAL ANTI-GLAUCOMA MEDICATIONS

Objective: To determine the frequency of ocular surface disease among patients with open angle glaucoma using topical antiglaucoma medications presenting at a tertiary care eye hospital. Study Design: Cross-sectional analytical study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, from May 2019 to Jan 2020. Methodology: One hundred and eighty patients aged 18 or more, with open angle glaucoma using any of the topical antiglaucoma medications including preparations of dorzolamide, brimonidine, timolol, levobunolol, betaxolol, latanoprost, travoprost, bimatoprost or a combination of these for more than six months took part in the study. Ocular surface disease index was used to assess the presence and severity of ocular surface disease. Results: Out of 180 patients of glaucoma managed with topical anti-glaucoma medications, 83 (46.1%) did not show presence of ocular surface disease when ocular surface disease index was administered. Twenty-nine (16.1%) patients had mild symptoms, 17 (9.4%) had moderate symptoms while 51 (28.3%) patients reported severe symptoms of ocular surface disease. Advancing age and longer duration of treatment with topical anti-glaucoma medications had statistically significant association with the presence of ocular surface disease (p-value <0.05). Conclusion: Presence of ocular surface disease was a common finding among patients using topical agents for the management of glaucoma. Advancing age and prolonged use of anti-glaucoma medication emerged as risk factors statistically related to the presence of ocular surface disease.

Dry eye disease in students with myopia during COVID-19 pandemic

Background. Today, the urgent problem is coronavirus disease 2019 pandemic in the whole world. Safety measures such as the use of masks, distance learning have been implemented. However, ophthalmologists, as well as the general population, should know that a face mask together with prolonged use of digital devices leads to an increase in the number of dry eye cases in many patients. The purpose was to study the frequency of dry eye disease in students with myopia. Materials and methods. The study involved 96 medical students diagnosed with myopia taken by random sampling, who were examined by an ophthalmologist. Apart from the standard ophthalmologic examination, all patients underwent the evaluation of the stability of the precorneal tear film by means of corneal topography, and Norn test (tear break-up time (TBUT)). There was also used a standard questionnaire designed to assess the severity of dry eye disease symptoms (Ocular Surface Disease Index). Results. The corneal topography of the 47 patients did not demonstrate any reduction in TBUT. The average time of the concentric ring remained stable for 20.2 ± 3.0 seconds. But 49 individuals exhibited signs of tear film instability over time compared to 47 patients without TBUT impairment. In 47 people without impairments, corneal topography demonstrated that this indicator in Norn test varied from 25 to 18 seconds, i.e. was within the age norm (21.5 ± 3.5 seconds on average). In 3 patients with a minimum TBUT on keratotopography, its value during the Norn test was 9 seconds. In 36 patients with reduced TBUT according to both methods, there was a weak degree of dry eyes, in 10 — moderate, in 3 — severe. The most common complaints were a sandy, gritty sensation in the eyes, visual discomfort when working at a computer and in windy weather, and with prolonged use of a protective mask. Conclusions. Among students who were on distance learning, 51.04 % of individuals have objectively confirmed dry eye disease. People wearing contact lenses have a more pronounced degree of dry eye, so it is mandatory for ophthalmologists to prescribe lubricating eye drops.

Influence of pars plana vitrectomy on ocular surface using noninvasive Keratograph 5M

AIM: To evaluate the influence of pars plana vitrectomy (PPV) on ocular surface using Keratograph 5M. METHODS: Totally 30 consecutive patients (30 eyes) undergoing primary 23-gauge PPV were recruited in the study. Ocular Surface Disease Index (OSDI) questionnaire was performed. Ocular surface parameters, including tear meniscus height (TMH), noninvasive tear break up time (NITBUT) and bulbar redness score were obtained preoperatively, in 1, 2, 4, 8 and 12wk postoperatively by Keratograph 5M. Correlations between all the clinical parameters were analyzed further. RESULTS: The percentages of both photophobia and gritty within 4wk after PPV were significantly higher than pre-operation, while they decreased to the preoperative levels in both 8wk and 12wk postoperatively. The percentage of sore eyes in the first week postoperatively was significantly higher than pre-operation, but there were no significant differences between the percentages of pre-operation and 2, 4, 8, and 12wk postoperatively. OSDI score increased significantly within 4wk postoperatively, but it returned to the preoperative level in 8 and 12wk. TMH increased with 2wk postoperatively, but there were no significant differences compared with preoperation. Both NITBUT-first and NITBUT-average shortened significantly within 8 weeks postoperatively, but they gradually improved to the preoperative levels in 12wk. Bulbar redness score was significantly higher than the preoperative level within 4wk postoperatively, but it returned to the preoperative level in 8wk. NITBUT-first and NITBUT-average had a significant positive correlation at each visit. TMH had a significant positive correlation with NITBUT-average in the first week postoperatively. CONCLUSION: Keratograph 5M can provide a reliable noninvasive method to assess the influence of PPV on the ocular surface. PPV may cause various changes in both symptoms and signs of ocular surface damages at the early stage, while all these changes will return to preoperative levels gradually in 12wk postoperatively.

Clinical Analysis of Dry Eye Syndrome According to Anterior Displacement of the Marx Line

Purpose: To evaluate the clinical characteristics of patients with dry eye syndrome according to anterior displacement of the Marx line.Methods: This retrospective study involved 127 eyes in 127 patients with dry eye, who were divided into three groups: group 1, aqueous-deficient, including Sjögren syndrome; group 2, meibomian gland dysfunction (MGD) dry eye; and group 3, other tear layer instability. A detailed assessment was conducted, involving the Ocular Surface Disease Index, corneal fluorescein staining (score: 0-15), conjunctival Lissamine green staining (score: 0-12), measurement of tear breakup time, and Schirmer’s test.Results: The proportion of patients with MGD was highest in the group with anterior displacement of the Marx line (p < 0.05). The correlation between anterior dislocation of the Marx line and Schirmer’s test, an objective indicator of dry eye syndrome, was significantly weaker when there was anterior displacement of the Marx line.Conclusions: Anterior dislocation of the Marx line was more common in patients with MGD. The Marx line is a useful marker for diagnosing MGD.

Assessment of Tear Film Anomalies in Childhood Obesity

Purpose To determine if childhood obesity has an effect on the ocular surface and tear film of children who are afflicted. Methods Patients who had childhood obesity, 85 eyes, and patients who were healthy, 75 eyes, were enrolled in this prospective and comparative study. The tear film breakup time (TF-BUT), tear meniscus area and height (TMA and TMH) values, Schirmer test scores, and ocular surface disease index (OSDI) scores were obtained for all participants. Results The TMH, TMA, TF-BUT, and Schirmer test results were statistically significantly lower in the obesity group (p < 0.001 for all). The children with obesity and insulin resistance had lower TMH, TMA, TF-BUT, and Schirmer test results when compared to the children without insulin resistance (p < 0.05 for all). The body mass index was found to be correlated with the TMH, TMA, TF-BUT, and Schirmer test results (p < 0.001 for all). Conclusion Children with obesity had lower TMA, TMH, TF-BUT, and Schirmer test results than healthy subjects. When insulin resistance was added to obesity, these values were even lower.

Changes in Tear Osmolarity and Matrix Metalloproteinase-9 Relative to Ocular Discomfort after Femtosecond Laser-Assisted Cataract Surgery

The aim of this study was to evaluate the changes in tear osmolarity and matrix metalloproteinase-9 (MMP-9) and their relationships with ocular discomfort in patients after femtosecond laser-assisted cataract surgery (FLACS). This retrospective observational case series reviewed medical records of 51 eyes of 51 patients who underwent FLACS. Tear osmolarity and MMP-9 were evaluated preoperatively and at 1 day, 1 week, and 1 month postoperatively. Tear osmolarity ≥ 310 mOsm/L and MMP-9 ≥ trace positive were defined as abnormal results. The ocular surface disease index (OSDI) was evaluated preoperatively and postoperatively at 1 month. Tear osmolarity level and the number of eyes with abnormal tear osmolarity results did not change significantly up to 1 month after surgery. MMP-9 level and the number of eyes with abnormal MMP-9 results increased at 1-day postoperatively and then decreased at 1-month postoperatively (all p < 0.001). Among the OSDI subscales, ocular discomfort was aggravated (p < 0.001) but the visual function score improved at 1 month postoperatively (p < 0.001). Ocular discomfort aggravated after FLACS without an increase in either tear osmolarity or MMP-9. Ocular discomfort which patients commonly experience after FLACS may be due to etiology other than development or aggravation of dry eye disease.

Changes of Dry Eye Related Markers and Tear Inflammatory Cytokines After Upper Blepharoplasty

Objectives: To investigate the changes of dry eye-related clinical manifestations, ocular surface parameters, and tear inflammatory cytokines after upper blepharoplasty.Methods: Forty eyes of 20 who underwent upper blepharoplasty were divided into either the group with or the group without preexisting dry eye before upper blepharoplasty. Ocular Surface Disease Index (OSDI), Schirmer I test, tear meniscus height, lipid layer thickness, non-invasive tear break-up time (NIKBUT), fluorescein tear film break-up time (FBUT), corneal fluorescein staining, meibum expression, lid margin changes, and tear inflammatory cytokines were assessed preoperatively and at 1, 3, and 6 months postoperatively. Correlations between inflammatory cytokines and dry eye-related parameters were determined.Results: The OSDI scores increased significantly at 1 month (p = 0.040) and subsequently decreased to the preoperative levels at 6 months postoperatively in subjects with dry eye. First (f)-NIKBUT and FBUT were significantly shortened at 1, 3, and 6 months postoperatively in subjects with dry eye (f-NIKBUT: p &lt;0.001, p = 0.010, p = 0.042; FBUT: p = 0.002, p = 0.005, p = 0.037, respectively), but were only shortened at 1 month (p = 0.028, p = 0.005) and returned to baseline levels at 6 months postoperatively in subjects without preexisting dry eye. A significant increasing trend of interleukin (IL)-6 was found in both dry eye and subjects without preexisting dry eye (p = 0.016, p = 0.008), while IL-8 and tumor necrosis factor alpha (TNF-α) were only found to be increased in subjects with dry eye postoperatively (p = 0.031, p = 0.031). The levels of IL-8 and TNF-α were positively correlated with OSDI scores (p = 0.046, p = 0.043, respectively) and negatively correlated with f-NIKBUT and FBUT (p = 0.026, p = 0.006, respectively).Conclusions: Upper blepharoplasty might increase the release of tear inflammatory cytokines and tear film instability that contribute to the development of postoperative dry eye in the early postoperative period and the changes most relieved in 6 months. Preexisting dry eye is a higher risk factor for worse and persistent ocular surface damage after upper blepharoplasty.

Evaluation of Plasma Assisted Noninvasive Surgery (PANIS) As a New Approach for the Treatment of Conjunctival Concretions: A Clinical Case Series

Background and Objective: Plasma is one of the newest therapies recently used. This study aimed to evaluate a quick treatment modality of conjunctival concretions using plasma as a noninvasive procedure. Methods: Six eyes of six patients with conjunctival concretions were evaluated. The procedure was performed using plasma spots generated by the white handpiece of the Plexr device. The eyelid was everted and concretions sublimated by plasma spots from the upper and lower eyelids. Refractive Errors, visual acuity (BCVA and UCVA), Ocular Surface Disease Index (OSDI), and Intraocular pressure (IOP) were measured before and after six months of the procedure. Results: The results of 6 months follow-up show that this effective method had no recurrence or side effects. Treatment was effective in all of the patients. No complication and recurrence was observed. The OSDI score was improved to the normal range. This method had no effects on Refractive Errors, Visual Acuity, and IOP. Conclusion: Based on the results, it seems that the PANIS method can be used as a practical, quick, and straightforward approach for the treatment of conjunctival concretions.