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.

Study of Relationship Between Dry Eye and Expressions of CXCR3 and CCR5 After Ocular Acid Burn

Objective To investigate the manifestation of dry eye and its relationship with CXCR3 and CCR5 expression in patients with ocular acid burns. Methods This is a case-control study. A total of 27 eyes of 22 cases ocular with acid burns of I-V degrees from Jan.2020 to Feb.2021 in this hospital were selected as observation group, and 8 eyes of 8 cases of normal people were selected as control group. The followed up time was 3 months. The visual acuity, intraocular pressure, BUT, Schirmer Ⅰ test, corneal thickness and tear meniscus height (TMH) were observed at 1 day, 1 and 3 months after injury. The protein expression of CXCR3 and CCR5 were examined by ELISA and were compared among groups at each time point. Results BUT and Schirmer I tests value in the observation group were lower than those in the control group 3 months after injury (all p < 0.05). The corneal thickness and the tear meniscus height 1 day after injury were higher than those in the control group (p < 0.05), and also higher than those at 1 month and 3 months after injury (p < 0.05). The expression levels of CXCR3 and CCR5 protein were significantly negatively correlated with BUT (p < 0.05), and CXCR3 and CCR5 were also significantly negatively correlated with Schirmer I test value (p < 0.05). Conclusion Ocular acid burns can cause dry eye, and the expression of CXCR3 and CCR5 protein in tears may be related to the occurrence of dry eye after ocular acid burn.

Treatment of Dry Eye With Intracanalicular Injection of Hydroxybutyl Chitosan: A Prospective Randomized Clinical Trial

Background: Punctal/intracanalicular plugs on the market nowadays are all designed before clinical use in treating dry eye disease (DED). To provide an individualized lacrimal drainage system occlusion method and reduce the complications, we developed a “liquid plug” strategy by intracanalicular injection of hydroxybutyl chitosan (HBC) solution, a thermosensitive, phase-changing biomaterial. This study evaluated the efficacy and safety of the HBC plug in treating dry eye disease by comparing it with the VisiPlug absorbable intracanalicular plug.Methods: A monocenter, randomized, controlled clinical trial was performed. Fifty patients with DED were randomized 1:1 to undergo either the HBC injection treatment or the VisiPlug treatment. Ocular Surface Disease Index (OSDI) questionnaire, tear break-up time (TBUT), corneal fluorescence staining (CFS), tear meniscus height (TMH), and phenol red thread test were evaluated at Day 0 (baseline, before treatment) and Weeks 1, 4, and 12.Results: The two groups had a balanced baseline of age, gender, and DED-related characteristics. Both occlusion methods could relieve the symptoms and signs of DED. Significant improvement was found in OSDI, phenol red thread test, and tear meniscus height (P &lt; 0.05 compared to baseline) but not in corneal fluorescence staining and tear break-up time (P &gt; 0.05). There is no statistically significant difference between HBC injection and VisiPlug at Weeks 1 and 4 (P &gt; 0.05). However, at week 12, the HBC injection was not as effective as the VisiPlug in maintaining phenol red thread test (HBC: 5.35 ± 3.22 mm, VisiPlug: 8.59 ± 4.35 mm, P = 0.009) and tear meniscus height (HBC: 206.9 ± 47.95 μm, VisiPlug: 242.59 ± 60.30 μm, P = 0.041). The numbers of ocular adverse events were relatively low in both groups.Conclusions: The HBC injection showed similar efficacy and safety compared to VisiPlug. The intracanalicular injection of HBC solution proves to be a promising, individualizing method to treat DED.Clinical Trial Registration: This study is registered with the Chinese Clinical Trial Registry (https://www.chictr.org.cn/enindex.aspx), Identifier: ChiCTR1800016603.

Evaluation of implanted perforated lacrimal punctal plugs using anterior segment optical coherence tomography

Purpose Evaluation of the patency and position of perforated lacrimal punctal plugs implanted for treating punctal stenosis together with quantitative assessment of the precorneal tear film using anterior segment optical coherence tomography (AS-OCT). Methods In a prospective study, the lower punctum of 54 eyes of 29 patients implanted with perforated punctal plugs were examined using AS-OCT during the early postoperative period. Preoperative tear meniscus height (TMH) and tear meniscus area (TMA) were evaluated. Postoperatively, the patency of the plug, its position, TMH and TMA were evaluated, and the results were correlated with postoperative epiphora. Munk scale was used for epiphora grading. Results Using AS-OCT, 48 (88.9%) plugs were found in proper position while 6 (11.1%) were rotated. The lumen of the plugs was completely patent in 47 (87%) plugs, partially obstructed in 2 (3.7%) plugs and completely occluded in 5 (9.2%) plugs. There was a statistically significant postoperative decrease of TMH and TMA (P < 0.001) and postoperative epiphora Munk score (P < 0.001). Conclusion AS-OCT is a valuable, reliable, and noninvasive investigative tool that can detect the proper positioning, patency, and contents of the implanted perforated lacrimal punctal plugs in addition to measurement of TMH and TMA. Trial registration ClinicalTrials.gov ID: NCT04624022, https://clinicaltrials.gov/ct2/show/NCT04624022

Assessment of Tear Meniscus Changes Before and After Dacryocystorhinostomy Using Anterior Segment Optical Coherence Tomography

Background Tear meniscus is one of the most important indices for therapeutic evaluation in treatment for obstruction of the lacrimal drainage system, which can be assessed by slit lamp examination and fluorescein dye disappearance test as a semi quantitative measurement. Recently Anterior Segment Optical Coherence Tomography has enabled noninvasive and quantitative assessment of tear meniscus. Objective To evaluate if measurement of tear meniscus by anterior segment OCT(AS-OCT) is a reliable method of assessment of improvement after Dacryocystorhinostomy (DCR) compared to other known methods which include dye disappearance test and lacrimal passages irrigation. Patients and Methods A prospective interventional study that included 16 eyes from 15 patients with primary acquired nasolacrimal duct obstruction who received external Dacryocystorhinostomy (ex-DCR) from March 2019 till November 2019, were evaluated prospectively on their tear meniscus height (TMH), tear meniscus area (TMA), and tear meniscus volume (TMV) changes by AS-OCT. Measurements were performed before surgery and 3 months after surgery. Results The results showed a highly significant decrease in all tear meniscus parameters (TMH, TMA, TMV) after DCR in patients with primary acquired nasolacrimal duct obstruction (PANDO), we concluded that AS-OCT can evaluate TM noninvasively and quantitatively, therefore it can be used as a reliable method of assessment of improvement after DCR compared to other known methods which include dye disappearance test and lacrimal passages irrigation. Conclusion Perioperative TM changes after ex-DCR can be evaluated noninvasively and quantitatively with use of AS-OCT, therefore it can be used as a reliable method of assessment of improvement after DCR, compared to other known methods which include dye disappearance test and lacrimal passages irrigation.