Assessment of the Efficiency of HP-Guar and hyaluronic Acid Tear Supplements to Control Tear Film Evaporation Rate in Dry Eye Subjects

Background: The most common factor that could lead to dryness is the accelerated tear evaporation rate. Controlling the tear evaporation rate is increasingly used as a method to control dry eye complications. The present study explores the effects of different tear supplements formulations on tear film evaporation rate. Objective: This study aimed to evaluate the short-term effects of Systane ULTRA and Artelac Advanced eye drops on the tear film evaporation rate. Methods: Fifteen male dry eye subjects were enrolled in the current study. Tear film parameters were observed at several time points post installation (10, 20, 30, and 60 min). The tear film parameters observed in the current study were tear evaporation rate, noninvasive breakup time (NITBUT) and tear meniscus height (TMH). Two visits were required to conduct this study. One visit was conducted to assess the physiological tear film parameters with the use of Systane® ULTRA eye drop. The other visit was conducted to assess tear film parameters with the use of Artelac Advanced eye drop. Results: The mean tear evaporation rate at baseline was 52.58 ± 23.24 g/m2 h. A box plot of tear evaporation showed a reduction in tear film evaporation rate after instillation of Systane eye drop. A drop in tear film evaporation rate of 14% was observed at 20 and 60 min time point after instillation of Systane ULTRA eye drop. A significant increase in NITBUT was found after instillation of Systane ULTRA (P = 0.01) and Artelac Advanced (P = 0.02). Conclusion: The current study indicates a significant improvement in the tear film parameters using both HP-Guar and hyaluronic acid formulations. However, it was apparent that the use of HP-Guar was superior to hyaluronic acid in controlling the tear evaporation rate in dry eye subjects.

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.

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.

Meibomian Gland Morphology Changes After Cataract Surgery: A Contra-Lateral Eye Study

Purpose: To evaluate the morphology changes of meibomian glands (MGs) after cataract surgery.Setting: Hangzhou Branch of the Eye Hospital of Wenzhou Medical University, Zhejiang, China.Methods: In this contra-lateral eye study, 40 patients received unilateral cataract surgery for age-related cataract. All the patients underwent the evaluation of non-invasive break-up time (NIBUT) and lower tear meniscus height (TMH) before the surgery and 6 months post-operatively. The MGs were evaluated via ImageJ and Meibomian Gland Bio-image Analyzer. MG dropout, length, width, area, gland diameter deformation index (DI), and gland signal index (SI) were recorded.Results: MG length, width, area, DI, and SI were significantly decreased after cataract surgery in the study group (operated eyes, P &lt; 0.001, P = 0.003, P &lt; 0.001, P = 0.001, and P &lt; 0.001, respectively) and showed no significant changes in the control group (non-operated eyes) (all P &gt; 0.05). MG loss increased more in the study group (P = 0.030), and the changes in TMH and NIBUT were not significantly different between the two eyes (both P &gt; 0.05).Conclusion: Cataract surgery aggravated meibomian gland morphology, such as MG loss, MG length, width, area, and SI, and produced no change in NIBUT and TMH at 6 months post-operatively.

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

Repeatability and Reliability of Different Diagnostic Platforms in Normal Tear Film Evaluation

Purpose To assess the repeatability and reliability of different commercially available diagnostic platforms in the objective assessment of normal tear film parameters. Methods Thirty healthy individuals (N = 60 eyes) had their tear film parameters (Lipid layer thickness (LLT), Tear meniscus height (TMH), Non-invasive tear break up time (NIBUT)) assessed by two observers on different occasions. The three instruments that were used are- LipiView® II, IDRA ocular surface analyzer and Oculus keratograph 5M. Bland-Altman analysis and mixed effects model with maximum likelihood estimation were used to calculate intra- and interobserver variability between the instruments. Results There were no significant intraobserver differences noted in LLT values measured with Lipiview, NIBUT using Oculus & IDRA, and Oculus TMH values. Between two observers, there were significant differences in LLT measurements (mean difference of 6.60; p = 0.002) and TMH measurements (mean difference of 0.03; p = 0.0001), obtained using IDRA but not for Oculus or Lipiview. Between instruments, all the measurements (LLT, NIBUT and TMH) were significantly different (p < 0.0001 for LLT; p = 0.002 for TMH; p < 0.0001 for NIBUT). Conclusion No two dry eye diagnostic platforms can be used interchangeably for the evaluation of the normal tear film. The NIBUT and LLT measurements using Oculus and Lipiview are more reliable than IDRA, and Oculus is more reliable than IDRA for TMH assessment.

Alternation of Lipidomic in the Meibomian Gland After Exposure to Intense Pulsed Light in Patients With Meibomian Gland Dysfunction and Suggestions for Applications of 3PM Medicine

Importance: Aside from the clinical index, there is no established criterion for assessing the effectiveness of intense pulsed light (IPL) in treating meibomian gland disease.Objective：To determine if there is an association between changes in the meibum lipidomic profiles and alleviation of clinical signs in patients with meibomian gland dysfunction (MGD) who are treated with IPL. To provide predictive, preventive and and personalized medical programs for MGD patients. Design: This is an observational Study. Patients were followed for up for 6 months from January 1, 2019.Setting: This is a single center, human-oriented clinical and basic research study.Participants: Adult patients, who were diagnosed with MGD and had not received any alternative treatments for at least 3 months, were enrolled in the study. Exposures: Each patient received a series of three treatments at 3-week intervals. The meibum was collected before the first treatment (T0) and the third treatment (T2). All enrolled patients completed the whole examination and treatment. The meibum of randomly assigned 26 patients and 10 healthy volunteers was chosen for performing the lipid analysis using LC-MS/MS. Main Measures: The following information from each patient was recorded: tear break-up time (BUT), average tear BUT, tear meniscus height, assessment of the lid margin, bulbar redness, meibomian gland opening position, corneal fluorescein staining, meibomian gland drop, meibomian gland expressibility, and meibum quality.Results: A total of 191 patients’ right eyes were enrolled in the study, including 95 females (49.7%) and 96 males (50.3%), with a median age of 53 years (range: 28–85 years). IPL increased the BUT (P<0.0001, t=7.9, df=380), average tear BUT (P<0.01, t=2.774, df=374.5), and tear meniscus height (P<0.01, t=2.642, df=367.1). At the same time, IPL improved bulbar redness (P<0.0001, t=12.95, df=380) and corneal fluorescein staining (P<0.0001, t=4.147, df=380). Furthermore, following IPL treatment, the meibomian gland expressibility (MGE) and meibum quality were significantly improved (from 1.342±0.05815 to 0.9354±0.03922, P<0.0001, t=5.798, df=380 and from 1.266±0.04969 to 0.8639±0.03318, P<0.0001, t=6.733, df=380, respectively). Lipidomic analysis of the meibum characterized the changes in lipid profiles induced by IPL. Conclusion: IPL treatment offers a novel approach to markedly improve the treatment of patients with MGD due to correction of altered lipid profiles. The changes in lipid expression profiles are potential indexes to evaluate the therapeutic effectiveness of IPL treatment or other treatments on MGD. The lipid changes that are pertinent include: LPC(18:2)+HCOO, OAHFA(18:1/34:1)-H, TG(16:0/18:2/20:5)+H, and etc.. Therefore, accurate evaluation of the changes of lipid expression profile in patients with MGD can be used as a predictive, preventive, and personalized medical method.

Changes in Ocular Surface Disease Evaluated after Nonpenetrating Deep Sclerectomy

Objective: To analyse the ocular surface changes in eyes after the withdraw of anti-glaucomatous drugs when non-penetrating deep sclerectomy (NPDS) is performed.Methods: 31 patients (33 eyes) diagnosed of glaucoma that underwent NPDS, were included in this prospective study. Control group included 33 eyes of 33 age and sex-matched volunteers. Five variables were studied with Keratograph 5M (K5M): ocular hyperaemia (OH), non-invasive tear film break-up time (NI-BUT), lower tear meniscus height (LTMH) and meibography. LTMH was also measured using the anterior segment module of Spectralis Fourier-Domain Optical Coherence Tomography (FD-OCT). Also, an evaluation of corneal and conjunctival staining was performed.In addition, patients were asked to answer two questionnaires: Ocular Surface Disease Index (OSDI) and National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) before and 6-months after surgery.Results: Before NPDS, treated eyes, showed worse objective data than healthy controls (p ≤0.049). In this group, a significant improvement was observed in the questionnaires (p< 0.001), LTMH FD-OCT (p=0.037) and LTMH K5M (p=0.025), K5M OH (p=0.003), NI-BUT (=0.022) and conjunctival and corneal staining (p<0.001). No significant differences were observed between groups in FD-OCT and K5M LTMH, NI-BUT, corneal-conjunctival staining and in the most OH sector values at 6 months(p ≥0.62).Conclusion: A significant improvement in the ocular surface was observed 6 months after NPDS, suggesting that the withdrawn of the topical anti-glaucomatous treatment has a beneficial effect.

SCREENING FOR DRY EYE IN TYPE II DIABETIC PATIENTS IN A TERITIARY EYE CARE HOSPITAL

AIM: To screen for dry eye among type 2 diabetic patients ,determine the prevalence and correlate with blood sugar levels. METHODS: 100 patients who were diagnosed cases of type 2 diabetes were included in the study .Detailed history regarding ocular symptoms, diabetes and its duration was taken. A thorough ocular examination using Slit lamp bio microscopy was done and visual acuity tested with Snellen's chart.Tear lm status evaluated by Schirmer's I test, Tear lm break up time(TBUT),Tear meniscus height. Two or all of the above performed tests was positive in a given patient, the patient was deemed to be suffering from dry eye. RESULTS:Out of 100 patients, males were 48 and females were 52. 39 patients were found to show positive screening tests for dry eye.38% (out of 39 patients) had major symptom of foreign body sensation. 23 out of 39 patients were females. 14 out of 39 patients were in age group 51 to 60 years.Most of the diabetics with dry eye had duration of disease 5 to 10 years .39 patients had Tear Break Up time <10 sec, 25 patients had Tear Meniscus Height <0.25mm and 36 patients had Schirmers I test<10mm.Diabetics with dry eyes had average RBS of 179.63+57.28 and PPBS of 247.75+88.39 mg/dl. These values were more when compared to diabetics with no dry eye. CONCLUSION: Early ocular examination in Diabetic patients and good glycemic control should be done considering increased incidence of dry eyes.This should be an integral part of the assessment of diabetic eye disease so as to improve the patient's comfort and to prevent or minimize further structural damage to the ocular surface.