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Sahin Atik S, Altın Ekin M. The role of Meibomian glands on the development of dry eye disease in patients with unilateral pseudoexfoliation. J Fr Ophtalmol 2022; 45:915-920. [DOI: 10.1016/j.jfo.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
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Asiedu K, Dzasimatu S, Kyei S. Impact of meibomian gland dysfunction on quality of life and mental health in a clinical sample in Ghana: a cross-sectional study. BMJ Open 2022; 12:e061758. [PMID: 36180116 PMCID: PMC9528660 DOI: 10.1136/bmjopen-2022-061758] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study aimed to determine the impact of meibomian gland dysfunction (MGD) on quality of life and psychosomatic conditions. DESIGN This was a clinic-based cross-sectional study. SETTING This study was conducted at the eye clinic of the University of Cape Coast, Ghana. PARTICIPANTS 215 clinical subjects visiting the clinic for a comprehensive eye examination. PRIMARY AND SECONDARY OUTCOME MEASURES Symptomatic MGD, asymptomatic MGD, quality of life scores, depression, anxiety and stress. RESULTS 215 clinical subjects consented to participate in the study, but 212 were included in the analysis. The mean age was 21.9 (± 3.8) years, 54 had MGD and 158 did not have MGD served as controls. There was no statistically significant difference in the mean quality of life scores between subjects with MGD and subjects without MGD (t=1.57, p=0.12). The quality of life scores (DEQS) (p=0.022) were significantly higher in the symptomatic MGD group compared with the asymptomatic MGD group. There was no significant difference in quality of life scores (DEQS) (p=0.251) in the asymptomatic MGD group compared with healthy controls. Using Pillai's trace in the MANOVA, there was a significant effect of MGD on depression, anxiety and stress (V=0.05, F(3,208)=3.76, p=0.012). Furthermore, Pillai's trace in the MANOVA showed a significant difference between asymptomatic and symptomatic MGDs for depression, anxiety and stress scores stress (V=0.24, F(3, 51)=5.24, p=0.003). CONCLUSION The study revealed no difference in the quality of life scores between MGD and non-MGD groups. However, the symptomatic MGD group had worse quality of life and psychosomatic symptoms than the asymptomatic MGD group and non-MGD group.
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Affiliation(s)
- Kofi Asiedu
- Eye Clinic, Cosmopolitan Medical Center, Accra, Ghana
| | - Selassie Dzasimatu
- Department of Optometry and Vision Science, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Samuel Kyei
- Department of Optometry and Vision Science, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
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Meduri A, Oliverio GW, Tedesco G, Aragona P. Combined intense pulsed light and low-level light therapy for the treatment of refractory Meibomian gland dysfunction. Eur J Ophthalmol 2022; 33:11206721221127206. [PMID: 36112864 DOI: 10.1177/11206721221127206] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
PURPOSE To evaluate the efficacy of combined Intense Pulsed Light (IPL) and Low-Level Light Therapy (LLLT) in treatment of Meibomian Gland Dysfunction (MGD). METHODS AND ANALYSIS In this prospective study, 70 patients with refractory MGD were enrolled; group 1 received 3 consecutive sessions of IPL + LLLT treatment using Eye-light® on day 1, day 15 and day 45; group 2 received hyaluronate sodium 2 mg/ml drops 3 times a day for 6 months. Patients underwent at baseline, and after 3 and 6 months Ocular Surface Disease Index (OSDI) questionnaire, Symptom Assessment in Dry Eye (SANDE), tear-film breakup time (TBUT), fluorescein ocular surface staining, meibum expressibility and quality evaluations. Keratograph 5M (Oculus, Germany) was used to assess NIBUT, tear meniscus height (TMH), meibography, and bulbar redness score. RESULTS At 6 months a significant improvement of OSDI (p = 0.03), SANDE (p = 0.02), NIBUT (p = p < 0.0001), TMH (p = 0.04), TBUT (p = 0.02), corneal-conjunctival staining score (p = 0.02), lid margin score (p < 0.0001), and bulbar redness score (p = 0.001) were recorded in group 1. Comparing the two groups, statistically significant differences were observed at 6 months in TBUT (p = 0.03), lid margin score (p < 0.001), Meibum expressibility (p = 0.03) and NIBUT (p < 0.001). No adverse events were recorded throughout the follow-up period. CONCLUSION This study confirmed the efficacy and safety of combined IPL and LLLT demonstrating its superiority compared to topical treatment.
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Affiliation(s)
- Alessandro Meduri
- Department of Biomedical Sciences, Ophthalmology Clinic, 18980University of Messina, Messina, Italy
| | | | | | - Pasquale Aragona
- Department of Biomedical Sciences, Ophthalmology Clinic, 18980University of Messina, Messina, Italy
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Decrease in Tear Film Lipid Layer Thickness in Patients with Keratoconus. J Clin Med 2022; 11:jcm11185252. [PMID: 36142899 PMCID: PMC9503260 DOI: 10.3390/jcm11185252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/01/2022] [Accepted: 09/04/2022] [Indexed: 11/17/2022] Open
Abstract
Keratoconus (KC) is a progressive corneal disorder characterized by thinning and protrusion, mostly of the inferotemporal and central corneal regions. Dysfunction of the meibomian gland, the excretions of which form the lipid layer of the tear film, has been reported to be associated with KC. Thus, this manuscript investigates the correlation among lipid layer thickness (LLT), partial blink rate (PBR), and KC of different degrees. This retrospective study included 54 patients and 24 healthy controls. The anterior corneal curvature, LLT, and PBR were taken from the unilateral eye of all 78 participants. The difference in those ocular parameters between the moderate and severe groups and the control group is significant. No significant association was found between anterior corneal curvature and LLT (r = −0.2, p = 0.15) across all the patients. However, there was a significant negative correlation between anterior corneal curvature and LLT in moderate (r = −0.6, p < 0.05) and severe (r = −0.7, p < 0.05) keratoconus cases. The results also show a significant negative correlation between anterior corneal curvature and PBR (r = −0.41, p < 0.05). Therefore, we conclude that the severity of keratoconus is associated with the thinning of LLT and the reduction of PBR. This may relate to a further epithelial abnormality with the reduced protection of tear film from the air, leading to the release of proteolytic enzymes that degrade stromal collagen and weaken the cornea.
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Atar S, Yurttaser SO, Demirhan E, Er G, Kuru Ö. The ocular findings related to oral bisphosphonate use. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:497-503. [PMID: 35787381 DOI: 10.1016/j.oftale.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 01/13/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE We aimed to investigate ocular involvement findings in female osteoporosis patients using oral bisphosphonate (BP). METHODS A total of 51 female osteoporosis patients aged 50-75 years using oral BP for at least one year for the study group and 64 age-matched non-osteoporosis female patients for the control group were included in the study. The BP type and exposure time were noted. The ophthalmic examination findings and measurements of the flare of the patients who received oral BP due to osteoporosis and the controls were evaluated. RESULTS The mean duration of BP use was 3.96 years. In the study group, it was detected four of 51 patients were diagnosed with meibomian gland dysfunction (MGD) (7.8%), seven of 102 eyes had erythematous, irregular, thickened lid margin or telangiectasia around the glandular orifices. There were no pathological findings on fundus examination. The mean value of measurements of the flare (ph/ms) was 7.90±7.96 in the study group, and 5.02±0.81 in the control group. When the mean values were compared, there was a significant difference between the two groups (P=.001). A significant difference was found in the mean value of measurements of the flare between the patients using alendronate, and ibandronate with the control group (P=.001; P=.005, respectively). CONCLUSION Our study showed that the flare in the anterior chamber associated with chronic ocular inflammation can be seen higher rate in patients using oral alendronate, and ibandronate compared to those who do not. Morever it can be said that oral BPs may cause similar ocular side effects like as intravascular BPs.
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Affiliation(s)
- S Atar
- Department of Physical Medicine and Rehabilitation, Prof. Dr. Cemil Tascioglu City Hospital, University of Health Sciences, Istanbul, Turkey.
| | - S O Yurttaser
- Department of Opthalmology, Prof. Dr. Cemil Tascioglu City Hospital, University of Health Sciences, Istanbul, Turkey
| | - E Demirhan
- Department of Physical Medicine and Rehabilitation, Prof. Dr. Cemil Tascioglu City Hospital, University of Health Sciences, Istanbul, Turkey
| | - G Er
- Department of Physical Medicine and Rehabilitation, Prof. Dr. Cemil Tascioglu City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ö Kuru
- Department of Physical Medicine and Rehabilitation, Prof. Dr. Cemil Tascioglu City Hospital, University of Health Sciences, Istanbul, Turkey
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Yoon CH, Ryu JS, Ko JH, Kim YK, Oh JH, Chung JH, Oh JY. The Eyelid Meibomian Gland Deficiency in Fucosyltransferase 1 Knockout Mice. Int J Mol Sci 2022; 23:ijms23169464. [PMID: 36012728 PMCID: PMC9409428 DOI: 10.3390/ijms23169464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
To investigate the effect of fucosyltransferase (FUT) 1-mediated fucosylation on meibomian glands (MG), we first confirmed that FUT1 and its fucosylated products were expressed in the eyelid, conjunctiva and skin in wild-type (WT) mice, whereas their mRNA and protein levels were downregulated in Fut1 knock-out (KO) mice. We then evaluated age-dependent changes in the total and acinar areas of MG, meibocyte differentiation, lipid synthesis, and eyelid inflammation and oxidative stress in Fut1 KO and WT mice. Results show that both the total and acinar areas of MG were smaller in Fut1 KO mice than in WT mice in all evaluated age groups. Meibocyte differentiation, lipid-producing capacities and the enzyme levels responsible for lipid synthesis were reduced in Fut1 KO mice, compared to WT controls. The levels of pro-inflammatory cytokines and oxidative-stress-related markers were elevated in the eyelids and MG of FUT1 KO mice. These findings demonstrate the physiologic function of FUT1-mediated fucosylation in MG development and function, and indicate its potential role in ocular surface homeostasis.
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Affiliation(s)
- Chang Ho Yoon
- Department of Ophthalmology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Jin Suk Ryu
- Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Jung Hwa Ko
- Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Yeon Kyung Kim
- Department of Dermatology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Jang-Hee Oh
- Department of Dermatology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Jin Ho Chung
- Department of Dermatology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Joo Youn Oh
- Department of Ophthalmology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
- Correspondence: or ; Tel.: +82-2-2072-0027
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Trone MC, Garcin T, Ollier E, Thuret G, Gain P. A retrospective study of the efficacy of intense pulsed light delivered by the Lacrystim® for meibomian gland dysfunction therapy. BMC Ophthalmol 2022; 22:335. [PMID: 35933379 PMCID: PMC9356507 DOI: 10.1186/s12886-022-02531-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/11/2022] [Indexed: 11/21/2022] Open
Abstract
Background Meibomian gland dysfunction is the most common etiology of dry eye disease worldwide and intense pulsed light appears to be a promising treatment with encouraging results. Lacrystim® is a new IPL device (CE marking in 2019) and no studies have yet been published on it. We propose the first study on this device with an objective assessment of its efficacy and an extended follow-up over 6 months. Methods Patients presenting with a dry eye disease (DED) with stable mild to moderate MGD and having received Lacrystim® treatment between june 2019 and june 2020 were included. 3 IPL sessions were performed at D0, D15 and D45 with 4 shots per side at a fluence of 8 mJ/cm2. DED clinical evaluation was performed at D0, D15, D45, 3rd month and 6th month: Oxford scale and break up time, Schirmer test and Ocular Surface Disease Index (OSDI) questionnaire. Lacrydiag® imaging device carried out an objective examination of tear film: interferometry, meibography, tear meniscus height and non-invasive break up time (NIBUT). The primary endpoint was the evolution in NIBUT between the first visit D0 and 3rd month. Data collection was done retrospectively. Statistical analysis was done using a linear mixed-effects model and a non-parametric linear mixed-effects model (R software). Results Forthy five consecutive patients were included. NIBUT significantly increased between D0 and 3rd month: mean difference of 1.63 seconds, IC95% [0.51; 2.62], (p = 0.002) with a prolonged effect at 6th month. OSDI and OXFORD scores and interferometry were also significantly improved at 3rd month and 6th month. There was no significant change in BUT, Schirmer test and tear meniscus height. No adverse event was noted. Conclusions IPL delivered by Lacrystim® appears effective and safe to treat MGD although a randomized controlled trial is needed to validate its results. Trial registration This work was approved by a local ethics committee “Terre d’éthique” (institutional review board number: IRBN672019/CHUSTE) and registered on the clinicaltrial.gov website (NCT04147962, 01/11/2019).
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Affiliation(s)
- Marie-Caroline Trone
- Ophthalmology department, University Hospital, 42055 Saint-Etienne Cedex1, Saint-Etienne, France. .,Corneal Graft Biology, Engineering and Imaging Laboratory BiiGC, EA2521, Health innovation campus, faculty of Medicine, Jean Monnet University, Saint-Etienne, France.
| | - Thibaud Garcin
- Ophthalmology department, University Hospital, 42055 Saint-Etienne Cedex1, Saint-Etienne, France.,Corneal Graft Biology, Engineering and Imaging Laboratory BiiGC, EA2521, Health innovation campus, faculty of Medicine, Jean Monnet University, Saint-Etienne, France
| | - Edouard Ollier
- Clinical Research, Innovation and Pharmacology Unit, University Hospital, Saint-Etienne, France.,Health engineering biology (SAINBIOSE) Inserm U1059, vascular hemostasis dysfunction (DVH) team, Health innovation campus, faculty of Medicine, Jean Monnet University, Saint-Etienne, France
| | - Gilles Thuret
- Ophthalmology department, University Hospital, 42055 Saint-Etienne Cedex1, Saint-Etienne, France.,Corneal Graft Biology, Engineering and Imaging Laboratory BiiGC, EA2521, Health innovation campus, faculty of Medicine, Jean Monnet University, Saint-Etienne, France
| | - Philippe Gain
- Ophthalmology department, University Hospital, 42055 Saint-Etienne Cedex1, Saint-Etienne, France.,Corneal Graft Biology, Engineering and Imaging Laboratory BiiGC, EA2521, Health innovation campus, faculty of Medicine, Jean Monnet University, Saint-Etienne, France
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Vigo L, Pellegrini M, Carones F, Scorcia V, Giannaccare G. Outcomes of serial sessions of Activa mask combined with intense pulsed light therapy in patients with Meibomian gland dysfunction. BMC Ophthalmol 2022; 22:313. [PMID: 35854254 PMCID: PMC9295515 DOI: 10.1186/s12886-022-02538-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/11/2022] [Indexed: 12/18/2022] Open
Abstract
Background To evaluate the effects on ocular surface signs and symptoms of serial sessions of heating and vibrating eye mask followed by intense pulsed light (IPL) therapy for the treatment of dry eye disease owing to meibomian gland dysfunction (MGD). Methods Consecutive patients with MGD whose signs and symptoms were not satisfactorily controlled with conventional therapy were included. Patients received 3 treatments performed at day 1, 15, and 45 incorporating a session with a newly-developed eye mask (Activa, SBS Sistemi, Turin, Italy) immediately followed by IPL therapy (E > Eye device, E-Swin, Paris, France). Patients were examined before the first session (T0) and 30 days after the last session (T1) for the measurement of: noninvasive break-up time (NIBUT); lipid layer thickness (LLT); tear meniscus height (TMH); meibomian gland loss (MGL); tear osmolarity. Ocular discomfort symptoms were ascertained by ocular surface disease index (OSDI) questionnaire. Results Thirty patients were ultimately included in the study. At T1, all objective ocular surface parameters improved significantly, except for TMH: NIBUT and LLT increased from 6.4 ± 1.7 to 8.6 ± 1.7 s and from 57.7 ± 15.5 to 81.3 ± 12.0 μm (all P < 0.001), while MGL and tear osmolarity decreased from 21.1 ± 17.3 to 17.0 ± 14.1% and from 302.0 ± 8.5 to 295.7 ± 6.9 mOsm/L (respectively, P = 0.004 and P < 0.001). In parallel, OSDI score decreased significantly from 49.8 ± 13.5 to 29.8 ± 10.6 (P < 0.001). In the historical control group of patients who underwent only IPL, NIBUT, LLT, tear osmolarity and OSDI improved significantly but not MGL and TMH. Conclusions Serial sessions incorporating the application of an eye mask producing heating and vibration immediately followed by IPL therapy are able to improve all ocular surface parameters as well as ocular discomfort symptoms in MGD patients.
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Affiliation(s)
- Luca Vigo
- Carones Ophthalmology Center, Milan, Italy
| | - Marco Pellegrini
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Ospedali Privati Forlì "Villa Igea", Department of Ophthalmology, Forlì, Italy.,Istituto Internazionale per la Ricerca e Formazione in Oftalmologia, Forlì, Italy
| | | | - Vincenzo Scorcia
- Department of Ophthalmology, University "Magna Græcia" of Catanzaro, Viale Europa, 88100, Germaneto (Catanzaro), Italy
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University "Magna Græcia" of Catanzaro, Viale Europa, 88100, Germaneto (Catanzaro), Italy.
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Safir M, Hecht I, Ahimor A, Zmujack-Yehiam S, Stein R, Bakshi E, Einan-Lifshitz A, Hartstein ME. The effect of thermo-mechanical device (Tixel) treatment on evaporative dry eye disease - A pilot prospective clinical trial. Cont Lens Anterior Eye 2022; 45:101741. [PMID: 35864019 DOI: 10.1016/j.clae.2022.101741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE To examine the effects of treatment with a thermomechanical skin device to the eyelid area on the clinical signs and symptoms of patients who suffer from dry eye disease (DED) secondary to meibomian gland dysfunction (MGD). METHODS Forty patients aged 45 years or older with DED due to MGD were recruited. Both eyes (n = 80) of each patient received three treatments with the Tixel device (Novoxel®, Israel), with each treatment separated by a 2-week period. Treatment was applied across the upper and lower eyelids, with the same intensity, tip protrusion distance, and contact duration. Two additional follow-up visits were performed at 2-week intervals after treatment cessation. DED status was evaluated during each visit via SPEED II questionnaire, tear break-up time (TBUT), corneal staining score (CSS), MGD score, and frequency of lubricant use. Visual acuity (VA) was recorded during first and last visits. RESULTS Mean age was 64.3 ± 12.4 years and 72.5 % (n = 29) were female. 45 % (n = 18) had a history of blepharitis, 12.5 % (n = 5) had chalazia, and 17.5 % (n = 7) suffered from allergic conjunctivitis. Mean follow-up time was 2.1 ± 0.6 months. Comparing the first and last visits, all parameters showed significant improvement after Tixel treatment: mean SPEED II scores (16.5 ± 5.9 to 11.8 ± 6.7, p < 0.001), CSS (2.0 ± 1.3 to 0.5 ± 0.9, p < 0.001), TBUT (2.7 ± 0.8 s to 6.5 ± 2.2 s, p < 0.001), MGD score (2.7 ± 0.5 to 1.2 ± 0.4, p < 0.001), and rate of lubricant use (3.4 ± 2.4 per day to 1.9 ± 2.0, p < 0.001). VA also improved (0.10 ± 0.11 logMAR to 0.08 ± 0.10 logMAR, p < 0.05). No major side effects were observed. CONCLUSIONS In this pilot study Tixel treatment induced significant improvement of signs and symptoms among patients with DED due to MGD. Benefits persisted for at least one month. Further randomized controlled double-blinded studies are needed.
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Affiliation(s)
- Margarita Safir
- Ophthalmology Department, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Idan Hecht
- Ophthalmology Department, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Ahimor
- Ophthalmology Department, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sigal Zmujack-Yehiam
- Ophthalmology Department, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Stein
- Ophthalmology Department, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Erez Bakshi
- Ophthalmology Department, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Einan-Lifshitz
- Ophthalmology Department, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Morris E Hartstein
- Ophthalmology Department, Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Tauber J, Kennedy T, Juthani V. The preoperative management of meibomian gland dysfunction prior to corneal refractive surgery. Curr Opin Ophthalmol 2022; 33:251-257. [PMID: 35779049 DOI: 10.1097/icu.0000000000000866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To describe the significance of meibomian gland dysfunction (MGD) in corneal refractive surgery and to describe available approaches to preoperative evaluation and treatment based on current research. RECENT FINDINGS There are several methods available for the evaluation and treatment of MGD. These are relevant for refractive surgeons to understand, as the presence of MGD preoperatively plays a role in the severity of MGD after corneal refractive surgery. Refractive surgery itself can exacerbate MGD. Treatment of MGD prior to surgery may have a meaningful impact on postoperative MGD. SUMMARY Surgeons should include meibomian gland assessment in the preoperative refractive evaluation and should treat MGD proactively prior to performing refractive surgery. Relevant information in this field is growing; additional prospectively designed studies are needed to further enhance our understanding.
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Affiliation(s)
- Jenna Tauber
- Montefiore Medical Center/Albert Einstein College of Medicine, Department of Ophthalmology
| | | | - Viral Juthani
- Montefiore Medical Center/Albert Einstein College of Medicine, Department of Ophthalmology
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Mathebula SD. Latest developments on meibomian gland dysfunction: Diagnosis, treatment and management. AFRICAN VISION AND EYE HEALTH 2022. [DOI: 10.4102/aveh.v81i1.713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Meibomian gland dysfunction (MGD) is one of the leading causes of evaporative dry eye disease and one of the most common ophthalmic conditions found in clinical practice. Meibomian gland dysfunction tends to be overlooked because its signs and symptoms do not cause blindness. Meibomian gland dysfunction is characterised by the obstruction of the meibomian gland terminal ducts resulting in tear film instability.Aim: The purpose of this article was to provide an update on MGD’s diagnosis and treatment.Method: A literature review was conducted using search engines such as Google Scholar, Medline and ScienceDirect databases. Keywords such as MGD diagnosis and management and treatment of MGD were used to search the databases.Results: A total of 44 relevant papers were reviewed. These papers were then curated to include only those concerning diagnosis of meibomian gland dysfunction, treatment of meibomian gland dysfunction and management options of meibomian gland dysfunction. The references of individual papers from the curated results were checked to yield a further 13 papers.Conclusion: Meibomian gland dysfunction is not a single entity but is multifactorial in origin; however, our understanding of the condition is evolving rapidly because of newer imaging technology. There is no gold standard treatment option for MGD, but many options are available that include medications and other procedures.
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Zandonella Callegher S, Giovannini I, Zenz S, Manfrè V, Stradner MH, Hocevar A, Gutierrez M, Quartuccio L, De Vita S, Zabotti A. Sjögren syndrome: looking forward to the future. Ther Adv Musculoskelet Dis 2022; 14:1759720X221100295. [PMID: 35634352 PMCID: PMC9131387 DOI: 10.1177/1759720x221100295] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 04/26/2022] [Indexed: 12/25/2022] Open
Abstract
Primary Sjögren’s syndrome (pSS) is a heterogeneous disease characterised by a wide spectrum of manifestations that vary according to the different stages of the disease and among different subsets of patients. The aim of this qualitative literature review is to summarise the recent advances that have been reported in pSS, ranging from the early phases to the established disease and its complications. We analysed the diagnostic, prognostic, and management aspects of pSS, with a look into future clinical and research developments. The early phases of pSS, usually antedating diagnosis, allow us to investigate the pathophysiology and risk factors of the overt disease, thus allowing better and timely patient stratification. Salivary gland ultrasound (SGUS) is emerging as a valid complementary, or even alternative, tool for histopathology in the diagnosis of pSS, due to a standardised scoring system with good agreement and performance. Other promising innovations include the application of artificial intelligence to SGUS, ultrasound-guided core needle biopsy, and a wide array of novel diagnostic and prognostic biomarkers. Stratifying pSS patients through the integration of clinical, laboratory, imaging, and histopathological data; differentiating between activity-related and damage-related manifestations; and identifying patients at higher risk of lymphoma development are essential steps for an optimal management and individualised treatment approach. As new treatment options are emerging for both glandular and systemic manifestations, there is a need for a more reliable treatment response evaluation. pSS is a complex and heterogeneous disease, and many distinct aspects should be considered in the different stages of the disease and subsets of patients. In recent years, efforts have been made to improve our understanding of the disease, and certainly in the coming years, some of these novelties will become part of our routine clinical practice, thus improving the management of pSS patients.
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Affiliation(s)
| | - Ivan Giovannini
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Sabine Zenz
- Division of Rheumatology and Immunology, Medical University Graz, Graz, Austria
| | - Valeria Manfrè
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Martin H. Stradner
- Division of Rheumatology and Immunology, Medical University Graz, Graz, Austria
| | - Alojzija Hocevar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Marwin Gutierrez
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
- Rheumatology Center of Excellence, Mexico City, Mexico
| | - Luca Quartuccio
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Alen Zabotti
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
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Dierker DS, Hauswirth SG. Thermal Pulsation with or without Dexamethasone Intracanalicular Insert for Meibomian Gland Dysfunction: A Prospective, Masked Trial. Clin Ophthalmol 2022; 16:1477-1485. [PMID: 35585875 PMCID: PMC9109882 DOI: 10.2147/opth.s359719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/28/2022] [Indexed: 11/23/2022] Open
Abstract
Significance Meibomian gland dysfunction (MGD) is among the most common causes of dry eye disease worldwide. Few studies have compared treatment options, and the basis for an evidentiary approach to MGD management is lacking. We have conducted a non-randomized trial evaluating the additive benefit of a recently developed therapy. Purpose To compare the efficacy of thermal pulsation therapy alone or combined with the dexamethasone intracanalicular insert (Dextenza) on the signs and symptoms of MGD. Methods This was a prospective, patient-masked, sham-controlled, non-randomized trial. All subjects underwent thermal pulsation therapy using the LipiFlow system. The dexamethasone intracanalicular insert was placed in the inferior canaliculus of the more symptomatic eye (DEX group), while sham punctal dilation of the fellow eye was performed to preserve patient masking (SHAM group). Key outcomes were improvement in meibum expressibility at 1, 4, and 12 weeks and patient treatment preference at week 12. Results Nineteen subjects underwent thermal pulsation therapy and received the DEX insert. Meibomian gland expressibility scores improved significantly in both groups at 1, 4, and 12 weeks, with significantly greater improvement in DEX eyes than SHAM eyes at 12 weeks (P=0.027). Improvement from baseline in TBUT was significant at all time points in DEX eyes and only at week 4 in SHAM eyes, with significantly greater improvement in DEX eyes over SHAM eyes at week 12 (P=0.028). Mean best-corrected visual acuity and intraocular pressure remained unchanged from baseline throughout follow-up in both groups, and no adverse events were noted. Combined therapy with DEX was preferred by 61% of subjects. Conclusion This study demonstrated a significant benefit of combining thermal pulsation therapy with the dexamethasone intracanalicular insert on signs of MGD including TBUT and meibomian gland expressibility score. Consequently, a majority of patients preferred combination therapy to thermal pulsation therapy alone.
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Affiliation(s)
- Damon S Dierker
- Eye Surgeons of Indiana, Indianapolis, IN, USA
- Correspondence: Damon S Dierker, Eye Surgeons of Indiana, 9202 N Meridian St, #100, Indianapolis, IN, 46260, USA, Email
| | - Scott G Hauswirth
- Department of Ophthalmology, Sue-Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO, USA
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Rodriguez-Garcia A, Babayan-Sosa A, Ramirez-Miranda A, Santa Cruz-Valdes C, Hernandez-Quintela E, Hernandez-Camarena JC, Ramos-Betancourt N, Velasco-Ramos R, Ruiz-Lozano RE. A Practical Approach to Severity Classification and Treatment of Dry Eye Disease: A Proposal from the Mexican Dry Eye Disease Expert Panel. Clin Ophthalmol 2022; 16:1331-1355. [PMID: 35520107 PMCID: PMC9061212 DOI: 10.2147/opth.s351898] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/13/2022] [Indexed: 11/23/2022] Open
Abstract
Dry eye disease (DED) has a higher prevalence than many important systemic disorders like cardiovascular disease and diabetes mellitus, representing a significant quality of life burden for the affected patients. It is a common reason for consultation in general eye clinics worldwide. Nowadays, the diagnostic and therapeutic approach at the high corneal and ocular surface specialty level should be reserved for cases of severe and chronic dry eye disease associated with systemic autoimmune diseases or complicated corneal and ocular surface pathologies. In such cases, the diagnostic and therapeutic approach is often complex, elaborate, time-consuming, and costly due to the use of extensive dry eye questionnaires, noninvasive electronic diagnostic equipment, and clinical laboratory and ancillary tests. However, other eye care specialists attend a fair amount of DED cases; therefore, its diagnosis, classification, and management should be simple, practical, achievable, and effective. Considering that many patients attending non-specialized dry eye clinics would benefit from better ophthalmological attention, we decided to elaborate a practical DED classification system based on disease severity to help clinicians discriminate cases needing referral to subspecialty clinics from those they could attend. Additionally, we propose a systematic management approach and general management considerations to improve patients' therapeutic outcomes according to disease severity.
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Affiliation(s)
- Alejandro Rodriguez-Garcia
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Cornea and External Disease Service, Monterrey, Mexico
| | - Alejandro Babayan-Sosa
- Cornea and Refractive Surgery Service, Fundación Hospital Nuestra Señora de la Luz, I. A. P, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Arturo Ramirez-Miranda
- Cornea and Refractive Surgery Service, Instituto de Oftalmología Conde de Valenciana, I.A.P, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Concepcion Santa Cruz-Valdes
- Cornea and Refractive Surgery Service, Instituto de Oftalmología Conde de Valenciana, I.A.P, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | | | - Julio C Hernandez-Camarena
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Cornea and External Disease Service, Monterrey, Mexico
| | | | - Regina Velasco-Ramos
- Cornea and Refractive Surgery Service, Fundación Hospital Nuestra Señora de la Luz, I. A. P, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Raul E Ruiz-Lozano
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Cornea and External Disease Service, Monterrey, Mexico
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Hu JG, Dang VT, Chang DH, Goldberg DF, McKinnon C, Makedonsky K, Laron M, Ji L. Performance of a Translucent Activator for LipiFlow Vectored Thermal Pulse (VTP) Treatment of Meibomian Gland Dysfunction. Clin Ophthalmol 2022; 16:963-971. [PMID: 35386613 PMCID: PMC8977218 DOI: 10.2147/opth.s354738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose Investigator feedback was used to assess the clinical use of the LipiFlow® System with the new translucent Activator Clear to successfully complete LipiFlow® treatments. Patients and Methods This was a prospective, open-label clinical investigation. A total of 88 eyes (44 subjects) were treated using the LipiFlow® System with the new Activator Clear. Subjects diagnosed with bilateral meibomian gland dysfunction (MGD) were enrolled in the study. Each investigator performed a complete LipiFlow® treatment with the translucent Activator on both eyes of each subject. Investigators completed a questionnaire assessing the clinical use of the Activator Clear on a 5-point scale (1 – very difficult or strongly disagree, 3 – neutral, 5 – very easy or strongly agree). Results The new translucent Activator provided successful LipiFlow® treatments in 100% of cases, with 95% confidence interval of (96%, 100%). Additionally, the investigators agreed or strongly agreed that the translucent components of the Activator Clear made it easy to access and position the activator with confidence on the subject’s eye. Conclusion The overall investigators’ impressions on usage and functionality of LipiFlow® System with the translucent Activator were very positive. The Activator Clear enables doctors with efficient and confident positioning around patient eyelids to ensure successful LipiFlow® treatment when used as indicated.
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Affiliation(s)
- Jerry G Hu
- Texas Eye & Laser Center, P.A., Hurst, TX, USA
| | - Vin T Dang
- Empire Eye and Laser Center, Bakersfield, CA, USA
| | | | | | | | | | - Michal Laron
- Johnson & Johnson Surgical Vision, Inc., Milpitas, CA, USA
| | - Leilei Ji
- Johnson & Johnson Surgical Vision, Inc., Irvine, CA, USA
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Schanzlin D, Owen JP, Klein S, Yeh TN, Merchea MM, Bullimore MA. Efficacy of the Systane iLux Thermal Pulsation System for the Treatment of Meibomian Gland Dysfunction After 1 Week and 1 Month: A Prospective Study. Eye Contact Lens 2022; 48:155-161. [PMID: 34620785 PMCID: PMC8920001 DOI: 10.1097/icl.0000000000000847] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess 1-week and 1-month efficacy of Systane iLux thermal pulsation treatment for meibomian gland dysfunction (MGD). METHODS This prospective, nonrandomized, open-label, multicenter study enrolled 30 adult patients (60 eyes) who had a Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire score greater than 6 and total meibomian gland secretion (MGS) score equal to or less than 12 in each eye. All participants received thermal pulsation treatment bilaterally. Primary efficacy measures included MGS score (sum of grades for 15 glands graded on a scale of 0-3; 0 [no secretion], 1 [inspissated], 2 [cloudy], and 3 [clear liquid]) and tear breakup time (TBUT). Secondary efficacy measures were SPEED and Ocular Surface Disease Index (OSDI) scores. RESULTS The mean age of patients was 52.9±11.9 years. After 1 week, the mean MGS score improved significantly from 4.1±3.1 to 15.8±7.1 (right eye, OD) and 3.7±3.1 to 16.7±7.6 (left eye, OS); mean TBUT improved significantly from 4.9±4.1 to 8.4±3.6 (OD) and 5.2±4.2 to 8.9±3.9 (OS); and mean SPEED and OSDI scores improved significantly from 16.1±5.3 to 7.2±6.1 and 45.2±21.3 to 19.0±16.8, respectively (all P<0.001). After 1 month, the mean MGS score improved to 18.3±8.2 (OD) and 18.6±7.3 (OS); mean TBUT improved to 9.7±3.8 (OD) and 9.6±3.5 (OS); and mean SPEED and OSDI scores improved to 7.0±5.6 and 16.7±14.5, respectively (all P<0.001). No adverse events were reported. CONCLUSIONS Systane iLux thermal pulsation treatment for MGD resulted in a statistically significant increase in meibomian gland secretion, improvement in tear film stability, and reduction in dry eye symptoms as early as both 1 week and 1 month.
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Affiliation(s)
- David Schanzlin
- Gordon Schanzlin New Vision (D.S.), San Diego, CA; Encinitas Ophthalmic Consulting (J.P.O.), Oceanside, CA; Total Vision (S.K.), LLC, San Diego, CA; Alcon Vision LLC (T.N.Y., M.M.M.), Fort Worth, TX; and University of Houston (M.A.B.), College of Optometry, Houston, TX
| | - James P. Owen
- Gordon Schanzlin New Vision (D.S.), San Diego, CA; Encinitas Ophthalmic Consulting (J.P.O.), Oceanside, CA; Total Vision (S.K.), LLC, San Diego, CA; Alcon Vision LLC (T.N.Y., M.M.M.), Fort Worth, TX; and University of Houston (M.A.B.), College of Optometry, Houston, TX
| | - Steve Klein
- Gordon Schanzlin New Vision (D.S.), San Diego, CA; Encinitas Ophthalmic Consulting (J.P.O.), Oceanside, CA; Total Vision (S.K.), LLC, San Diego, CA; Alcon Vision LLC (T.N.Y., M.M.M.), Fort Worth, TX; and University of Houston (M.A.B.), College of Optometry, Houston, TX
| | - Thao N. Yeh
- Gordon Schanzlin New Vision (D.S.), San Diego, CA; Encinitas Ophthalmic Consulting (J.P.O.), Oceanside, CA; Total Vision (S.K.), LLC, San Diego, CA; Alcon Vision LLC (T.N.Y., M.M.M.), Fort Worth, TX; and University of Houston (M.A.B.), College of Optometry, Houston, TX
| | - Mohinder M. Merchea
- Gordon Schanzlin New Vision (D.S.), San Diego, CA; Encinitas Ophthalmic Consulting (J.P.O.), Oceanside, CA; Total Vision (S.K.), LLC, San Diego, CA; Alcon Vision LLC (T.N.Y., M.M.M.), Fort Worth, TX; and University of Houston (M.A.B.), College of Optometry, Houston, TX
| | - Mark A. Bullimore
- Gordon Schanzlin New Vision (D.S.), San Diego, CA; Encinitas Ophthalmic Consulting (J.P.O.), Oceanside, CA; Total Vision (S.K.), LLC, San Diego, CA; Alcon Vision LLC (T.N.Y., M.M.M.), Fort Worth, TX; and University of Houston (M.A.B.), College of Optometry, Houston, TX
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Widjaja-Adhi MAK, Chao K, Golczak M. Mouse models in studies on the etiology of evaporative dry eye disease. Exp Eye Res 2022; 219:109072. [DOI: 10.1016/j.exer.2022.109072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/28/2022] [Accepted: 04/05/2022] [Indexed: 11/26/2022]
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Li Y, Ou S, Lin S, Qian H, Zhao Z, Zhang M, Li S, Liu Y, Shi G. Meibomian gland alteration in patients with systemic lupus erythematosus. Lupus 2022; 31:407-414. [PMID: 35246003 DOI: 10.1177/09612033221079760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate meibomian gland (MG) alteration in patients with systemic lupus erythematosus (SLE). METHODS This study included 23 SLE patients evaluated with Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and 21 healthy controls (HCs). All the subjects were evaluated with Ocular Surface Disease Index (OSDI) questionnaire, and the eyes were performed examinations of tear meniscus height (TMH), non-invasive keratographic tear film break-up time (NIKBUT), Schirmer I Test, MG eyelid score, meibography score, and in vivo confocal microscopy (IVCM) on the meibomian gland. RESULTS There was no significant difference between the SLE patients and the HCs in the TMH, NIKBUT, and Schirmer I Test. However, the SLE patients had higher MG eyelid scores and meibography scores on both upper eyelid and lower eyelid than the HCs. Through meibography observation, 34.8% of the SLE patients presented MG deficiency in Grade 3, whereas that of all the HCs were less than Grade 3. The SLE patients were found to have significant MG atrophy and vascular enrichment around the meibomian glands (MGs). The SLE patients were also found to have excessive inflammatory cell infiltration around the MGs, especially the typical lymph node-like foci of inflammatory cell infiltration. CONCLUSIONS MG alteration can be found in the SLE patients. Examinations of the MGs can help diagnose or infer ocular diseases at an early stage of SLE.
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Affiliation(s)
- Yixuan Li
- Department of Rheumatology and Clinical Immunology, 117892The First Afiliated Hospital of Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Rheumatology and Clinical Immunology, 12466Xiamen University, Xiame, China
| | - Shangkun Ou
- Fujian Provincial Key Laboratory of Cornea & Ocular Surface Diseases, 12466Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, Xiamen, China.,School of Medicine, 12466Xiamen University, Xiamen, Fujian, China.,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen University, Xiamen, China
| | - Sijie Lin
- Fujian Provincial Key Laboratory of Cornea & Ocular Surface Diseases, 12466Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, Xiamen, China.,School of Medicine, 12466Xiamen University, Xiamen, Fujian, China.,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen University, Xiamen, China
| | - Hongyan Qian
- Department of Rheumatology and Clinical Immunology, 117892The First Afiliated Hospital of Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Rheumatology and Clinical Immunology, 12466Xiamen University, Xiame, China
| | - Zhongyang Zhao
- Fujian Provincial Key Laboratory of Cornea & Ocular Surface Diseases, 12466Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, Xiamen, China.,School of Medicine, 12466Xiamen University, Xiamen, Fujian, China.,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen University, Xiamen, China
| | - Mengqin Zhang
- Department of Rheumatology and Clinical Immunology, 117892The First Afiliated Hospital of Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Rheumatology and Clinical Immunology, 12466Xiamen University, Xiame, China
| | - Siyang Li
- School of Medicine, 12466Xiamen University, Xiamen, Fujian, China
| | - Yuan Liu
- Department of Rheumatology and Clinical Immunology, 117892The First Afiliated Hospital of Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Rheumatology and Clinical Immunology, 12466Xiamen University, Xiame, China
| | - Guixiu Shi
- Department of Rheumatology and Clinical Immunology, 117892The First Afiliated Hospital of Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Rheumatology and Clinical Immunology, 12466Xiamen University, Xiame, China
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Comparison of Two Thermal Pulsation Systems in the Treatment of Meibomian Gland Dysfunction. Optom Vis Sci 2022; 99:323-332. [DOI: 10.1097/opx.0000000000001892] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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70
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Yu H, Yuan Y, Wu W, Zeng W, Tong L, Zhang Y, Feng Y. Orthokeratology Lens Wear for 2 Years in Children Did Not Alter Tear Film Lipid Thickness by Non-Invasive Interferometry. Front Med (Lausanne) 2022; 9:821106. [PMID: 35223920 PMCID: PMC8866645 DOI: 10.3389/fmed.2022.821106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/10/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose Previous studies suggest that overnight orthokeratology (OOK) may be detrimental to tear function. We aimed to investigate the effect of OOK on lipid layer thickness (LLT), blink pattern, and meibomian gland and elucidate the relationship of these variables. Methods Thirty-seven participants who wore OOK lenses every night for at least 2 years and twenty-four healthy non-contact lens wearers (controls) were enrolled in this retrospective study. LipiView interferometry, blink pattern analysis, the ocular surface status, and morphology and function of the meibomian gland were determined. Results The OOK group and healthy controls had similar LLT, blink patterns, ocular surface status, and the function of the meibomian gland. OOK participants demonstrated higher meiboscore in the lower eyelids (p < 0.05) but not in the upper eyelids. Within the OOK group, LLT was significantly impacted by the partial blink rate (p < 0.05) and the total score of the upper meibomian gland (p = 0.10). Conclusions Wearing OOK for 2 or more years increased lower eyelid meibomian gland dropout but did not have a reduction of LLT.
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Affiliation(s)
- Haozhe Yu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Yifei Yuan
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Wenyu Wu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Weizhen Zeng
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Louis Tong
- Singapore Eye Research Institute, Singapore, Singapore
- Department of Cornea and External Diseases, Singapore National Eye Centre, Singapore, Singapore
- Department of Ophthalmology, Duke-NUS Medical School, Singapore, Singapore
| | - Yu Zhang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- *Correspondence: Yu Zhang
| | - Yun Feng
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Yun Feng
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Affiliation(s)
- Mitsukuni Yoshida
- Academic Scholar Advancement Program, Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USA
| | - Rajendra S Apte
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, MO, USA.
- Department of Medicine, Washington University School of Medicine, St Louis, MO, USA.
- Department of Developmental Biology, Washington University School of Medicine, St Louis, MO, USA.
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Xu YL, Wang XY, Chen J, Kang M, Wang YX, Zhang LJ, Shu HY, Liao XL, Zou J, Wei H, Ling Q, Shao Y. Altered Spontaneous Brain Activity Patterns of Meibomian Gland Dysfunction in Severely Obese Population Measured Using the Fractional Amplitude of Low-Frequency Fluctuations. Front Psychiatry 2022; 13:914039. [PMID: 35633781 PMCID: PMC9130486 DOI: 10.3389/fpsyt.2022.914039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/14/2022] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Utilizing the fractional amplitude of low-frequency fluctuations (fALFF) technique, this study sought to correlate spontaneous cerebral abnormalities with the clinical manifestations of meibomian gland dysfunction (MGD) in severely obese (SO) population. SUBJECTS AND METHODS Twelve MGD patients in SO population (PATs) (4 males and 8 females) and twelve healthy controls (HCs) (6 males and 6 females) matched by gender and age were enrolled. Every participant underwent resting-state functional magnetic resonance imaging (rs-MRI) scanning. Spontaneous cerebral activity alterations were examined using the fALFF method. Receiver operating characteristic (ROC) curves were utilized to classify the medial fALFF values of the PATs and HCs. PATs were also asked to complete anxiety and depression score forms, permitting a correlation analysis. RESULTS In contrast with HCs, PATs had prominently increased fALFF values in the left lingual gyrus, the right globus pallidus, the right anterior cingulate and paracingulate gyri and the left middle occipital lobe (P < 0.05), and decreased fALFF values in the right cerebellum, the left fusiform gyrus, the right medial orbitofrontal gyrus, the left triangle inferior frontal gyrus and the left inferior parietal gyrus (P < 0.05). The results of the ROC curve indicated that changes in regional fALFF values might help diagnose MGD in SO population. Moreover, fALFF values in the right cerebellum of PATs were positively correlated with hospital anxiety and depression scores (HADS) (r = 0.723, P = 0.008). The fALFF values in the left triangle inferior frontal gyrus of PAT were negatively correlated with HADS (r = -0.651, P = 0.022). CONCLUSIONS Aberrant spontaneous activity was observed in multiple regions of the cerebrum, offering helpful information about the pathology of MGD in SO population. Aberrant fALFF values in these regions likely relates to the latent pathologic mechanisms of anomalous cerebral activities in PATs.
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Affiliation(s)
- Yu-Ling Xu
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiao-Yu Wang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jun Chen
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Min Kang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yi-Xin Wang
- Department of Ophthalmology and Visual Sciences, Cardiff University, Cardiff, United Kingdom
| | - Li-Juan Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hui-Ye Shu
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xu-Lin Liao
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jie Zou
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hong Wei
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qian Ling
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Dry eye examination - benefits of Ocular Surface Disease Index (OSDI) questionnaire with clinical testing. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh211204045k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction/Objective Dry eye is a multifactorial disease with up to 50% in
population. It is characterized by a loss of homeostasis of the tear film
and accompanied by ocular symptoms. Ocular Surface Disease Index (OSDI)
questionnaire is designed to provide a rapid assessment of the symptoms. The
aim of this study was to evaluate diagnostic capacity of OSDI. Methods A
prospective, randomized and observational study was conducted at the Clinic
for Eye Disease, Clinical Center of Serbia, between December 2018 and
February 2019. The OSDI questionnaire was used to rate the severity of dry
eye disease. Schirmer I test, tear break-up time test (TBUT), Rose Bengal
test and lid-parallel conjunctival folds (LIPCOF) test were performed as a
clinical proof of the symptoms. Results A total of 27 patients, 15 male
(55.4%) and 12 female (44.6%), with mean age of 60 ? 15 years were included
in the study. The average value of OSDI score was 26.37 ? 23.98 (0-80).
Schirmer I test and Rose Bengal test for right and left eye, as well as BUT
test for left eye were positively correlated with OSDI score (Spearman
correlation coefficient). Conclusion OSDI questionnaire is fast, reliable,
and cheap test. In our study we have found correlation between OSDI score
and other clinical tests, except with LIPCOF test. At this moment, the
questionnaire that could be the gold standard for dry eye disease diagnosis
doesn?t exist, therefore further studies concerning this topic are needed.
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Yu H, Zeng W, Zhao G, Hong J, Feng Y. Response of tear cytokines following intense pulsed light combined with meibomian gland expression for treating meibomian gland dysfunction-related dry eye. Front Endocrinol (Lausanne) 2022; 13:973962. [PMID: 36187125 PMCID: PMC9520485 DOI: 10.3389/fendo.2022.973962] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This study compared the changes in tear inflammatory cytokine levels after intense pulsed light (IPL) combined with meibomian gland expression (MGX) (IPL group) and instant warm compresses combined with MGX (physiotherapy group) as treatments for meibomian gland dysfunction (MGD)-related dry eye disease (DED) to explore their similarities and differences in therapeutic mechanisms. METHODS This study was a post-hoc analysis of a randomized controlled trial. Thirteen patients with MGD-related DED were enrolled in each group and received three treatments correspondingly with 3-week intervals. The levels of 20 tear cytokines, namely, TNF-α, IL-6, MMP-9, CXCL8/IL-8, CXCL10/IP-10, IL-10, EGF, IL-6R, IL-1β, IFN-γ, lactoferrin, Fas ligand, IL-17A, LT-α, S100A9, LCN2/NGAL, IL-13, IL-12/IL-23p40, Fas, and CCL11/Eotaxin, were measured at baseline, before the second and third treatments, and 3 weeks after the third treatment. The primary outcome was the difference in cytokine levels between baseline and the last measurement, and the trends were analyzed at each measurement point. RESULTS At the last measurement, a significant decrease was observed in all tear cytokines for both IPL and physiotherapy groups compared with baseline. The IPL group showed greater reductions in IL-6, IL-6R, IL-1β, IL-13, and CCL11/Eotaxin than the physiotherapy group. TNF-α, CXCL8/IL-8, CXCL10/IP-10, IL-10, EGF, IL-1β, IFN-γ, and Lipocalin-2/NGAL levels continued to decrease with treatment time. Important interactions were found in the changes of IL-6 and IL-13 levels, where the levels first decreased and then slightly increased in the physiotherapy group after treatment, while they continued to decrease in the IPL group. CONCLUSIONS The mechanisms of IPL and physiotherapy in treating MGD-related DED were both associated with reducing inflammation, and the superiority of IPL could be attributed to its better inhibitory effect on inflammatory cytokines like IL-6. In addition, several cytokines were on a downward trend during treatment, suggesting that the vicious cycle of DED was suppressed.
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Affiliation(s)
| | | | | | - Jing Hong
- *Correspondence: Jing Hong, ; Yun Feng,
| | - Yun Feng
- *Correspondence: Jing Hong, ; Yun Feng,
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75
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Zi C, Huang Q, Ren Y, Yao H, He T, Gao Y. Meibomian gland dysfunction and primary Sjögren's syndrome dry eye: a protocol for systematic review and meta-analysis. BMJ Open 2021; 11:e048336. [PMID: 35044322 PMCID: PMC8719179 DOI: 10.1136/bmjopen-2020-048336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Primary Sjögren's syndrome (pSS) is a systemic autoimmune disorder that primarily affects the exocrine glands such as the lacrimal and the salivary glands. Dry eye disease (DED) is one of the most prevalent manifestations of pSS and is usually classified into aqueous-deficient dry eye and evaporative dry eye. Sjögren's syndrome dry eye (SSDE) is generally described as aqueous-deficient dry eye. However, as the leading pathophysiological mechanism of evaporative dry eye, meibomian gland dysfunction (MGD) also has influence on SSDE, which has been shown in recent studies. We speculate that SSDE is more than just an aqueous-deficient dry eye. While no related systematic review and meta-analysis has been published, the present study is designed to derive a better understanding of the association between MGD and SSDE. METHODS AND ANALYSIS The Preferred Reporting items for Systematic Reviews and Meta-Analysis for Protocols 2015 statement was used to prepare this protocol. PubMed, Embase, Web of Science, Cochrane Database, China National Knowledge Infrastructure and Wan Fang Database will be searched from their inception to 31 October 2021, with restrictions to publications in English or Chinese. Two reviewers will independently carry out data extraction and quality assessment. The diagnosis of pSS will meet the standard diagnostic criteria, such as American College of Rheumatology/European League against Rheumatism Classification Criteria (ACR/EULAR) or American-European Consensus Group Classification criteria (AECG), and the definition of MGD and DED will differ between studies. The quality of included studies will be judged using the Newcastle-Ottawa Quality Scale. We will carry out this meta-analysis using RevMan V.5.4.1. The incidence of MGD in patients with SSDE will be indicated as OR with 95% CI. ETHICS AND DISSEMINATION Ethical approval is not required as this meta-analysis is performed based on published studies and does not involve human participants. The results will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42021226017.
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Affiliation(s)
- Changyan Zi
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qun Huang
- Ophthalmology, Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, Sichuan, China
| | - Yuan Ren
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Huan Yao
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Tingting He
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yongxiang Gao
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Zhang YY, Zhao H, Lin JY, Wu SN, Liu XW, Zhang HD, Shao Y, Yang WF. Artificial Intelligence to Detect Meibomian Gland Dysfunction From in-vivo Laser Confocal Microscopy. Front Med (Lausanne) 2021; 8:774344. [PMID: 34901091 PMCID: PMC8655877 DOI: 10.3389/fmed.2021.774344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/04/2021] [Indexed: 02/05/2023] Open
Abstract
Background: In recent years, deep learning has been widely used in a variety of ophthalmic diseases. As a common ophthalmic disease, meibomian gland dysfunction (MGD) has a unique phenotype in in-vivo laser confocal microscope imaging (VLCMI). The purpose of our study was to investigate a deep learning algorithm to differentiate and classify obstructive MGD (OMGD), atrophic MGD (AMGD) and normal groups. Methods: In this study, a multi-layer deep convolution neural network (CNN) was trained using VLCMI from OMGD, AMGD and healthy subjects as verified by medical experts. The automatic differential diagnosis of OMGD, AMGD and healthy people was tested by comparing its image-based identification of each group with the medical expert diagnosis. The CNN was trained and validated with 4,985 and 1,663 VLCMI images, respectively. By using established enhancement techniques, 1,663 untrained VLCMI images were tested. Results: In this study, we included 2,766 healthy control VLCMIs, 2,744 from OMGD and 2,801 from AMGD. Of the three models, differential diagnostic accuracy of the DenseNet169 CNN was highest at over 97%. The sensitivity and specificity of the DenseNet169 model for OMGD were 88.8 and 95.4%, respectively; and for AMGD 89.4 and 98.4%, respectively. Conclusion: This study described a deep learning algorithm to automatically check and classify VLCMI images of MGD. By optimizing the algorithm, the classifier model displayed excellent accuracy. With further development, this model may become an effective tool for the differential diagnosis of MGD.
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Affiliation(s)
- Ye-Ye Zhang
- Department of Electronic Engineering, School of Science, Hainan University, Haikou, China.,Department of Electronic Engineering, College of Engineering, Shantou University, Shantou, China
| | - Hui Zhao
- Department of Ophthalmology, Shanghai First People's Hospital, Shanghai Jiao Tong University, National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Jin-Yan Lin
- Research Center for Advanced Optics and Photoelectronics, Department of Physics, College of Science, Shantou University, Shantou, China
| | - Shi-Nan Wu
- Jiangxi Centre of National Ophthalmology Clinical Research Center, Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xi-Wang Liu
- Research Center for Advanced Optics and Photoelectronics, Department of Physics, College of Science, Shantou University, Shantou, China.,Department of Mathematics, College of Science, Shantou University, Shantou, China
| | - Hong-Dan Zhang
- Research Center for Advanced Optics and Photoelectronics, Department of Physics, College of Science, Shantou University, Shantou, China.,Department of Mathematics, College of Science, Shantou University, Shantou, China
| | - Yi Shao
- Jiangxi Centre of National Ophthalmology Clinical Research Center, Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei-Feng Yang
- Department of Electronic Engineering, College of Engineering, Shantou University, Shantou, China.,Research Center for Advanced Optics and Photoelectronics, Department of Physics, College of Science, Shantou University, Shantou, China.,Department of Mathematics, College of Science, Shantou University, Shantou, China
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GlicoPro, Novel Standardized and Sterile Snail Mucus Extract for Multi-Modulative Ocular Formulations: New Perspective in Dry Eye Disease Management. Pharmaceutics 2021; 13:pharmaceutics13122139. [PMID: 34959420 PMCID: PMC8708832 DOI: 10.3390/pharmaceutics13122139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 11/24/2022] Open
Abstract
This study aimed to evaluate the mucoadhesive and regenerative properties of a novel lubricating multimolecular ophthalmic solution (GlicoPro®) extracted from snail mucus and its potential anti-inflammatory and analgesic role in the management of dry eye disease (DED). GlicoPro bio-adhesive efficacy was assessed using a lectin-based assay, and its regenerative properties were studied in a human corneal epithelial cell line. In vitro DED was induced in human corneal tissues; the histology and mRNA expression of selected genes of inflammatory and corneal damage biomarkers were analyzed in DED tissues treated with GlicoPro. A higher percentage of bio-adhesivity was observed in corneal cells treated with GlicoPro than with sodium hyaluronate-based compounds. In the scratch test GlicoPro improved in vitro corneal wound healing. Histo-morphological analysis revealed restoration of cellular organization of the corneal epithelium, microvilli, and mucin network in DED corneal tissues treated with GlicoPro. A significant reduction in inflammatory and ocular damage biomarkers was observed. High-performance liquid chromatography-mass spectrometry analysis identified an endogenous opioid, opiorphin, in the peptide fraction of GlicoPro. In conclusion, GlicoPro induced regeneration and bio-adhesivity in corneal cells; moreover, considering its anti-inflammatory and analgesic properties, this novel ophthalmic lubricating solution may be an innovative approach for the management of DED.
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Chen C, Chen D, Chou YY, Long Q. Factors influencing the clinical outcomes of intense pulsed light for meibomian gland dysfunction. Medicine (Baltimore) 2021; 100:e28166. [PMID: 34889288 PMCID: PMC8663838 DOI: 10.1097/md.0000000000028166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 11/17/2021] [Indexed: 01/05/2023] Open
Abstract
To observe the clinical outcomes of intense pulsed light (IPL) for meibomian gland dysfunction (MGD) and identify its influencing factors.Forty-eight eyes of 48 patients with MGD were included. Subjects were followed up 5 times on day 1, day 15, day 30, day 45, and day 120, and underwent 3 sessions of the IPL treatment on day 1, day 15 and day 30. Gender, age, duration of MGD, time of video display terminal usage, and severity of MGD were recorded at baseline. At every visit, Ocular Surface Disease Index (OSDI), eyelid margin abnormality score, tear film breakup time, Schirmer I test (S ɪ t) and corneal fluorescein staining were recorded. The clinical parameters before and after 3 IPL treatments were compared. Univariate and multivariable logistic regression analyses were performed to explore influencing factors.Compared with baseline, the tear film breakup time was increased and the corneal fluorescein staining score and OSDI were significantly decreased on day 45 and day 120 (all P < .001). In univariate analysis, among the patients with a younger age (18-39 years), moderate MGD, higher baseline S ɪ t and higher baseline OSDI, the IPL treatment had a higher effective rate (P = .032, .004, .024, and .014 respectively). The MGD severity was strongly associated with effective IPL, and patients with moderate MGD had an OR of 22.454 compared with the severe MGD patients (OR = 22.454, 95% CI: 2.890-174.436, P = .003).IPL effectively improves clinical symptoms and some signs in MGD patients. Age, MGD severity, baseline S ɪ t and baseline OSDI are potential factors that may influence the clinical outcomes of IPL. MGD severity is an independent influencing factor.
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Affiliation(s)
- Chen Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Di Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yu-yu Chou
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qin Long
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Zhao H, Wu SN, Zhang Q, Zhao C, Shu HY, Ge QM, Shao Y. Video display terminal use and other risk factors for abnormal blinking in children: gender differences. BMC Ophthalmol 2021; 21:428. [PMID: 34893048 PMCID: PMC8665574 DOI: 10.1186/s12886-021-02194-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/26/2021] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To explore the risk factors for abnormal blinking in children and compare these between boys and girls. METHODS Children attending the Children's Optometry Clinic between June 2019 and June 2020 were recruited for the study. The time they had spent viewing video displays (VDTt) over the past 6 months was recorded. Incomplete blinking (IB) and blinking rate were measured and all participants were allocated to groups based on their blink rate (<20 times/min = normal blinking group, NBG; ≥20 times/min = abnormal blinking group, ABG). Tear film (TF) stability was also evaluated. The corresponding statistical methods are used to analyze the data. RESULTS A total of 87 boys and 80 girls were enrolled in the study. No significant difference in age was found between the 2 groups. There was a significant difference in TF stability between the two groups (P<0.05). According to binary logistic analysis, VDTt and ocular protection index (OPI) are important risk factors for abnormal blinking, with cut-off values of 1.75 hours and 1.014 respectively in boys; and 1.25 hours and 1.770 respectively in girls. The average of lipid layer thickness was an important protective factor for children using VDT for long periods, with a cut-off value of 58.5 nm in boys and 53.5nm in girls. CONCLUSION Risk factors for abnormal blinking in both boys and girls include VDTt and OPI.
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Affiliation(s)
- Hui Zhao
- Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China. .,Department of Radiology, Jiangxi Province Medical Imaging Research Institute, The First Affiliated Hospital of Nanchang University, Jiangxi, 330006, Nanchang, People's Republic of China.
| | - Shi-Nan Wu
- Department of Radiology, Jiangxi Province Medical Imaging Research Institute, The First Affiliated Hospital of Nanchang University, Jiangxi, 330006, Nanchang, People's Republic of China.,Department of Ophthalmology, Jiangxi Province Ocular Disease Clinical Research Center, The First Affiliated Hospital of Nanchang University, No 17, YongWaiZheng Street, DongHu District, Jiangxi, 330006, Nanchang, China
| | - Qi Zhang
- Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.,Department of Radiology, Jiangxi Province Medical Imaging Research Institute, The First Affiliated Hospital of Nanchang University, Jiangxi, 330006, Nanchang, People's Republic of China
| | - Chen Zhao
- Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.,Department of Radiology, Jiangxi Province Medical Imaging Research Institute, The First Affiliated Hospital of Nanchang University, Jiangxi, 330006, Nanchang, People's Republic of China
| | - Hui-Ye Shu
- Department of Radiology, Jiangxi Province Medical Imaging Research Institute, The First Affiliated Hospital of Nanchang University, Jiangxi, 330006, Nanchang, People's Republic of China.,Department of Ophthalmology, Jiangxi Province Ocular Disease Clinical Research Center, The First Affiliated Hospital of Nanchang University, No 17, YongWaiZheng Street, DongHu District, Jiangxi, 330006, Nanchang, China
| | - Qian-Min Ge
- Department of Radiology, Jiangxi Province Medical Imaging Research Institute, The First Affiliated Hospital of Nanchang University, Jiangxi, 330006, Nanchang, People's Republic of China.,Department of Ophthalmology, Jiangxi Province Ocular Disease Clinical Research Center, The First Affiliated Hospital of Nanchang University, No 17, YongWaiZheng Street, DongHu District, Jiangxi, 330006, Nanchang, China
| | - Yi Shao
- Department of Radiology, Jiangxi Province Medical Imaging Research Institute, The First Affiliated Hospital of Nanchang University, Jiangxi, 330006, Nanchang, People's Republic of China. .,Department of Ophthalmology, Jiangxi Province Ocular Disease Clinical Research Center, The First Affiliated Hospital of Nanchang University, No 17, YongWaiZheng Street, DongHu District, Jiangxi, 330006, Nanchang, China.
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Polat OA, Çetinkaya Z, Evereklioğlu C, Karaca Ç, Erkiliç K. Effect of Repeated Topical Povidone-Iodine and Antibiotic Applications on Meibomian Glands and Ocular Surface Parameters in Patients With Repeated Intravitreal Injections. Eye Contact Lens 2021; 47:651-654. [PMID: 34570021 DOI: 10.1097/icl.0000000000000828] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess whether meibomian glands and ocular surface parameters are affected by repeated topical povidone-iodine and antibiotic applications in patients with repeated intravitreal injections. METHODS Forty-five patients with at least three previous intravitreal injections and 28 healthy controls were included in the study. In the injection group, 21 patients had age-related macular degeneration and 24 patients had diabetic macular edema. For each participant, infrared meibography for the upper and lower eyelids and noninvasive tear break-up time calculation were performed with a corneal topographer. Fluorescein tear break-up time and ocular surface disease index (OSDI) scores were also obtained. Noninvasive tear break-up time, fluorescein tear break-up time, and OSDI scores were recorded for each participant and compared between the injection and control groups. These parameters were also compared as a subgroup analysis between patients with age-related macular degeneration (AMD) and diabetic macular edema (DME). RESULTS Upper lid meibomian gland loss, lower lid meibomian gland loss ratios, and OSDI scores were significantly higher in the intravitreal injection group compared with the control group (P=0.004, P<0.001, P<0.001, respectively). Fluorescein tear break-up time and noninvasive tear break-up time were significantly lower in the intravitreal injection group compared with the control group (P<0.001, P<0.001). There was no significant difference between the AMD and DME groups for these parameters. CONCLUSION This study showed for the first time that meibomian gland losses were significantly increased by repeated povidone-iodine and antibiotic applications in patients with repeated intravitreal injections. Ocular surface parameters were altered with higher ocular surface symptoms in those patients.
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Affiliation(s)
- Osman A Polat
- Department of Ophthalmology (O.A.P., C.E., Ç.K., K.E.), Erciyes University, Faculty of Medicine, Kayseri, Turkey; and Department of Ophthalmology, Kahramanmaraş Elbistan State Hospital (Z.Ç.), Kahmaranmaraş, Turkey
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81
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Ren X, Chou Y, Wang Y, Chen Y, Liu Z, Li X. Comparison of intense pulsed light and near-infrared light in the treatment of dry eye disease: a prospective randomized study. Acta Ophthalmol 2021; 99:e1307-e1314. [PMID: 33899331 DOI: 10.1111/aos.14833] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 02/12/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the efficacy of intense pulsed light (IPL) and near-infrared light (NIL) treatments in alleviating symptoms and signs of dry eye disease (DED). METHODS Patients diagnosed with DED at the Peking University Third Hospital Eye Center from January 2019 to October 2019 were randomized to undergo either NIL therapy combined with meibomian gland expression (MGX; NIL Group) or IPL combined with MGX (IPL Group). Treatments were performed three times at 1-month intervals. DED signs and symptoms were evaluated before every treatment. We compared the clinical improvement within and between the groups. Additional comparisons were made according to the meibomian gland (MG) dropout grade. RESULTS A total of 260 eyes of 130 patients (mean age, 49.68 ± 18.01 years) were included. The dryness and total symptom scores and the MG expressibility and secretion quality (upper and lower eyelids) significantly improved after the three treatments in both groups (p < 0.05). However, IPL had superior efficacy in improving blurred vision, photophobia, burning, increased secretions and the total symptom score at 2 months in patients with more severe MG dropout. CONCLUSIONS Both IPL and NIL treatments were effective in the treatment of DED, but IPL provided greater symptom improvement, particularly in patients with severe MG dropout. NIL can be a new therapeutic option for the treatment of DED.
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Affiliation(s)
- Xiaotong Ren
- Department of Ophthalmology Peking University Third Hospital Beijing China
| | - Yilin Chou
- Department of Ophthalmology Peking University Third Hospital Beijing China
| | - Yuexin Wang
- Department of Ophthalmology Peking University Third Hospital Beijing China
| | - Yanyan Chen
- Department of Ophthalmology Daqing Oilfield General Hospital Heilongjiang China
| | - Ziyuan Liu
- Department of Ophthalmology Peking University Third Hospital Beijing China
| | - Xuemin Li
- Department of Ophthalmology Peking University Third Hospital Beijing China
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Zarei-Ghanavati S, Hassanzadeh S, Khorasani AA, Ehsaei A. The Effect of Meibomian Gland Dysfunction Treatment on Sleep Quality. J Curr Ophthalmol 2021; 33:272-276. [PMID: 34765814 PMCID: PMC8579795 DOI: 10.4103/joco.joco_171_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 11/04/2022] Open
Abstract
Purpose To assess the therapeutic efficacy of a combinational therapy, including conventional treatment and intense pulsed light (IPL) technique on sleep quality of patients with meibomian gland dysfunction (MGD). Methods Fifty participants with a clinical diagnosis of MGD were enrolled in this study. Participants underwent three sessions of IPL therapy. There was a 2-week interval between IPL sessions 1 and 2 and 1 month between sessions 2 and 3. Treatment was supplemented with conventional home-based therapy (including lid hygiene, warm compress, eyelid massage, and lid margin scrub) for MGD. Dry eye symptomatology, tear film, and ocular surface parameters were evaluated at baseline (day 0) and days 15, 45, and 75. Sleep quality was assessed before and after the study using Pittsburgh Sleep Quality Index (PSQI). Results PSQI components improved significantly at day 75 in comparison with the baseline (all P < 0.05). Ocular Surface Disease Index (OSDI) score, noninvasive Keratograph tear break-up time (NIKBUT), fluorescein tear break-up time (FTBUT), meibomian gland expressibility, meibum quality score, and tear osmolarity improved at follow-up visits (P < 0.05). Younger patients showed more improvement in NIKBUT, sleep quality, and duration (P = 0.024, P = 0.047, and P = 0.008). Sleep latency decreased with increased NIKBUT and FTBUT and decreased OSDI score (P = 0.001, P = 0.005, and P = 0.041). Conclusions The treatment of MGD is effective for improving sleep quality. Younger patients may preferentially benefit from the treatment.
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Affiliation(s)
- Siamak Zarei-Ghanavati
- Eye Research Center, Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samira Hassanzadeh
- Department of Optometry, Paramedical College, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Azimi Khorasani
- Refractive Error Research Center, Paramedical College, Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Asieh Ehsaei
- Refractive Error Research Center, Paramedical College, Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran
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Zarei-Ghanavati S, Hassanzadeh S, Azimi Khorasani A, Ehsaei A, Bakhtiari E. Efficacy of five-flash intense pulsed light therapy technique in patients with meibomian gland dysfunction. Clin Exp Optom 2021; 105:687-693. [PMID: 34538227 DOI: 10.1080/08164622.2021.1976595] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
CLINICAL RELEVANCE Meibomian gland dysfunction is the main cause of evaporative dry eye disease and can lead to ocular discomfort and ocular surface damage. Early diagnosis and management of this condition can prevent its impact on patients 'visual health and quality of life. BACKGROUND In the last decade, intense pulsed light therapy (IPL) has been introduced as a therapeutic option for patients with meibomian gland dysfunction (MGD). Various treatment modalities and protocols have been reported to increase the efficacy of this technique. This study aimed to assess the efficacy of a novel five-flash IPL technique in combination with home-based therapy and to compare it with conventional home care alone in patients with MGD. METHODS In a randomised controlled trial, 100 symptomatic MGD patients were enrolled. The treatment group underwent three sessions of a five-flash IPL therapy. For all participants, eyelid warming, lid hygiene and lubricant therapy was prescribed. Ocular surface parameters were compared for control and treatment groups. RESULTS Ocular Surface Disease Index (OSDI), non-invasive keratograph tear break up time (NIKBUT), fluorescein TBUT, MG expressibility, meibum quality and tear osmolarity were improved at follow up visits in both groups (p < 0.05). On day 75, NIKBUT was significantly higher in the IPL group (p = 0.045). The IPL treatment effect was not statistically significant (p > 0.05), except for bulbar and limbal hyperaemia (p = 0.02 and p = 0.02). In both groups, younger patients showed more improvement in NIKBUT (p = 0.02, r = -0.32; p < 0.001, r = -0.52). CONCLUSION IPL therapy combined with conventional home-based therapy, and home care alone are both effective for patients with MGD. IPL may have an additional role in the improvement of ocular hyperaemia.
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Affiliation(s)
- Siamak Zarei-Ghanavati
- Eye Research Center, Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samira Hassanzadeh
- Department of Optometry, Paramedical College, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Azimi Khorasani
- Department of Optometry, Paramedical College, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Asieh Ehsaei
- Department of Optometry, Paramedical College, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elham Bakhtiari
- Eye Research Center, Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
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Huang C, Chen S, Fu S, Li Y, Li Z, Li S, Liang X, Wang Z, Wang Z, Chen Y, Deng Q, Yi G, Fu M. A Survey on How Ocular Surface Demodex Infestation Interactively Associates with Diabetes Mellitus and Dry Eye Disease. Acta Parasitol 2021; 66:1039-1047. [PMID: 33813654 PMCID: PMC8390423 DOI: 10.1007/s11686-021-00382-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 03/23/2021] [Indexed: 01/21/2023]
Abstract
PURPOSE Prevention of ocular surface (OS) Demodex infestation plays an important role in OS hygiene and variety of factors may be associated with it, in which diabetes mellitus (DM) or dry eye disease (DED) has caught the attention of most scholars. However, there has been no research on whether there was a potential interaction between DM and DED in the process of OS Demodex infestation. This cross-sectional study was implemented in Zhujiang Hospital of Southern Medical University. METHODS Ophthalmologic interviews, questionnaires, and examinations were conducted. Factors including general information, DM status, dry eye condition, etc. were collected to study the correlation of DM and DED on OS Demodex infestation. RESULTS After statistical analysis, we found that both DM (P < 0.001) and DED (P = 0.013 < 0.05) are closely associated with OS Demodex infestation. Compared with DED, DM has higher priority association with OS Demodex infestation, and patients with both diseases have a significant higher risk of OS Demodex infestation (R = 0.197, P < 0.001). Meanwhile, age (R = 0.299, P < 0.001) and hypertension (P < 0.05) were also correlated with OS Demodex infestation. CONCLUSION This study provides a new evidence-based basis for clinical prevention and management of OS Demodex infestation.
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Affiliation(s)
- Chang Huang
- The Second Clinical School, Southern Medical University, Guangzhou, Guangdong, China
| | - Shuze Chen
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Sheng Fu
- The University of South China, Hengyang, Hunan, China
| | - Yingli Li
- Department of Ophthalmology, Shenzhen Hospital, Southern Medical University, 1333 Xinhu Road, Baoan District, Shenzhen, China
| | - Zhenhao Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Siqi Li
- Department of Pediatrics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaoqian Liang
- The Second Clinical School, Southern Medical University, Guangzhou, Guangdong, China
| | - Zihong Wang
- The Second Clinical School, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhoucheng Wang
- The Second Clinical School, Southern Medical University, Guangzhou, Guangdong, China
| | - Yifan Chen
- The Second Clinical School, Southern Medical University, Guangzhou, Guangdong, China
| | - Qixin Deng
- The Second Clinical School, Southern Medical University, Guangzhou, Guangdong, China
| | - Guoguo Yi
- Department of Ophthalmology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
| | - Min Fu
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, No. 253 Industrial Avenue Center, Haizhu District, Guangzhou, Guangdong, China.
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Short-Term Effects of a Novel Eye Mask Producing Heat and Vibration for the Treatment of Meibomian Gland Dysfunction: A Pilot Study. J Ophthalmol 2021; 2021:1370002. [PMID: 34457358 PMCID: PMC8387185 DOI: 10.1155/2021/1370002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/11/2021] [Indexed: 01/16/2023] Open
Abstract
Purpose To investigate the short-term effects on tear film parameters and ocular symptoms of a novel eye mask producing heat and vibration developed for the treatment of dry eye disease owing to meibomian gland dysfunction (MGD). Methods This is a pilot study including the first 20 consecutive patients (6 males, 14 females; mean age 52.4 ± 16.8 years) who were treated with a novel eye mask producing heat (42°) and vibration (up to 20 Hz) (Activa, SBS Sistemi, Turin, Italy) for 15 minutes. The treatment incorporates 2 phases in the following chronological order: 5 minutes of heating (phase I); 10 minutes of combination of heating and vibration (phase II). Noninvasive ocular surface examination was carried out before (T0) and 30 minutes after the mask session (T1) by means of Idra (SBS Sistemi, Turin, Italy) for the measurement of noninvasive break-up time (NIBUT) and lipid layer thickness (LLT). Patients' satisfaction after treatment was ascertained by asking the patients whether they perceived improvement from their baseline symptoms according to a 5-grade scale: none = 0; trace = 1; mild = 2; moderate = 3; high = 4. Results All patients completed regularly the mask session and no device-related adverse events were noted. NIBUT improved significantly from T0 to T1 (from 7.2 ± 1.8 s to 8.1 ± 2.1; P = 0.014). In parallel, also LLT improved from from T0 to T1 (72.5 ± 13.9 nm to 83.1 ± 16.1; P = 0.016). Seven patients (35% of the total) had a moderate satisfaction (grade 3) while 13 patients (65%) had a high satisfaction (grade 4) with treatment. Conclusions This eye mask represents a novel well tolerated tool in the armamentarium of MGD treatments. Thirty minutes after the session, NIBUT and LLT increased significantly; furthermore, all patients reported an improvement of discomfort symptoms with a moderate to high satisfaction with treatment.
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Yaykasli KO, Schauer C, Muñoz LE, Mahajan A, Knopf J, Schett G, Herrmann M. Neutrophil Extracellular Trap-Driven Occlusive Diseases. Cells 2021; 10:2208. [PMID: 34571857 PMCID: PMC8466545 DOI: 10.3390/cells10092208] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 12/15/2022] Open
Abstract
The enlightenment of the formation of neutrophil extracellular traps (NETs) as a part of the innate immune system shed new insights into the pathologies of various diseases. The initial idea that NETs are a pivotal defense structure was gradually amended due to several deleterious effects in consecutive investigations. NETs formation is now considered a double-edged sword. The harmful effects are not limited to the induction of inflammation by NETs remnants but also include occlusions caused by aggregated NETs (aggNETs). The latter carries the risk of occluding tubular structures like vessels or ducts and appear to be associated with the pathologies of various diseases. In addition to life-threatening vascular clogging, other occlusions include painful stone formation in the biliary system, the kidneys, the prostate, and the appendix. AggNETs are also prone to occlude the ductal system of exocrine glands, as seen in ocular glands, salivary glands, and others. Last, but not least, they also clog the pancreatic ducts in a murine model of neutrophilia. In this regard, elucidating the mechanism of NETs-dependent occlusions is of crucial importance for the development of new therapeutic approaches. Therefore, the purpose of this review is to address the putative mechanisms of NETs-associated occlusions in the pathogenesis of disease, as well as prospective treatment modalities.
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Affiliation(s)
- Kursat Oguz Yaykasli
- Department of Internal Medicine 3—Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054 Erlangen, Germany; (K.O.Y.); (L.E.M.); (A.M.); (J.K.); (G.S.); (M.H.)
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Christine Schauer
- Department of Internal Medicine 3—Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054 Erlangen, Germany; (K.O.Y.); (L.E.M.); (A.M.); (J.K.); (G.S.); (M.H.)
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Luis E. Muñoz
- Department of Internal Medicine 3—Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054 Erlangen, Germany; (K.O.Y.); (L.E.M.); (A.M.); (J.K.); (G.S.); (M.H.)
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Aparna Mahajan
- Department of Internal Medicine 3—Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054 Erlangen, Germany; (K.O.Y.); (L.E.M.); (A.M.); (J.K.); (G.S.); (M.H.)
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Jasmin Knopf
- Department of Internal Medicine 3—Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054 Erlangen, Germany; (K.O.Y.); (L.E.M.); (A.M.); (J.K.); (G.S.); (M.H.)
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3—Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054 Erlangen, Germany; (K.O.Y.); (L.E.M.); (A.M.); (J.K.); (G.S.); (M.H.)
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Martin Herrmann
- Department of Internal Medicine 3—Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054 Erlangen, Germany; (K.O.Y.); (L.E.M.); (A.M.); (J.K.); (G.S.); (M.H.)
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
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Pan S, Chen Y. A clinical study on the correlation between demodex infestation and ocular surface changes in patients with meibomian gland dysfunction. Indian J Ophthalmol 2021; 69:2389-2394. [PMID: 34427228 PMCID: PMC8544033 DOI: 10.4103/ijo.ijo_3641_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Purpose To observe the effect of demodex infection on the ocular surface changes of patients with meibomian gland dysfunction (MGD) and analyze the correlation between the number of demodex and the changes of the ocular surface. Methods Hundred patients with MGD aged 18-70 years who visited the dry eye center of Shanghai Aier Eye Hospital were recruited. All patients were examined with in vivo confocal microscopy to quantify the demodex and divided them into two groups (demodex negative group and demodex positive group) according to the number of demodex mites. The subjects underwent questionnaires of ocular surface disease index (OSDI) and a series of examinations. Parameters including the OSDI score, fluorescein tear film break-up time (FBUT), meibum quality, meibum gland expressibility, meibomian gland dropout (MG dropout), and ocular redness were recorded and compared between the two groups. The correlation between the number of demodex and the ocular surface changes was further analyzed. Results Among 100 patients, 51 were positive for demodex. The demodex-positive group showed significantly increased scores of OSDI (24.41 ± 3.43 vs 20.98 ± 2.31, P = 0.00), ocular redness score (1.38 ± 0.46 vs 1.00 ± 0.30, P = 0.00), and MG dropout (3.00 ± 1.13 vs 2.18 ± 0.64, P = 0.00) and decreased FBUT (6.40 ± 1.63 vs 6.54 ± 1.83, P = 0.00), compared to the demodex-negative group. A significant correlation was noted between the number of demodex and OSDI, ocular redness, and FBUT. Conclusion : Ocular demodex infestation might play a role in the ocular surface discomfort, inflammation, and meibomian gland dropout in MGD patients. It is necessary to pay attention to the examination and treatment of demodex mite in patients with MGD.
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Affiliation(s)
| | - Yan Chen
- Shanghai Aier Eye Hospital, Shanghai, China
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Abstract
PURPOSE OF REVIEW Dry eye disease (DED) is a multifactorial disease affecting approximately 5-50% of individuals in various populations. Contributors to DED include, but are not limited to, lacrimal gland hypofunction, meibomian gland dysfunction (MGD), ocular surface inflammation, and corneal nerve dysfunction. Current DED treatments target some facets of the disease, such as ocular surface inflammation, but not all individuals experience adequate symptom relief. As such, this review focuses on alternative and adjunct approaches that are being explored to target underlying contributors to DED. RECENT FINDINGS Neuromodulation, stem cell treatments, and oral royal jelly have all been studied in individuals with DED and lacrimal gland hypofunction, with promising results. In individuals with MGD, devices that provide eyelid warming or intense pulsed light therapy may reduce DED symptoms and signs, as may topical Manuka honey. For those with ocular surface inflammation, naturally derived anti-inflammatory agents may be helpful, with the compound trehalose being farthest along in the process of investigation. Nerve growth factor, blood-derived products, corneal neurotization, and to a lesser degree, fatty acids have been studied in individuals with DED and neurotrophic keratitis (i.e. corneal nerve hyposensitivity). Various adjuvant therapies have been investigated in individuals with DED with neuropathic pain (i.e. corneal nerve hypersensitivity) including nerve blocks, neurostimulation, botulinum toxin, and acupuncture, although study numbers and design are generally weaker than for the other DED sub-types. SUMMARY Several alternatives and adjunct DED therapies are being investigated that target various aspects of disease. For many, more robust studies are required to assess their sustainability and applicability.
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Affiliation(s)
- Rhiya Mittal
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Sneh Patel
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Anat Galor
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
- Research Services, Miami Veterans Affairs Medical Center, Miami, FL, USA
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Meibomian Gland Dysfunction: Intense Pulsed Light Therapy in Combination with Low-Level Light Therapy as Rescue Treatment. ACTA ACUST UNITED AC 2021; 57:medicina57060619. [PMID: 34198493 PMCID: PMC8231972 DOI: 10.3390/medicina57060619] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/24/2021] [Accepted: 06/02/2021] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Evaporative dry eye disease is frequently associated with meibomian gland dysfunction. Patients are often unhappy because of daily drops, care burden, and suboptimal conventional treatments. In this study, we assessed the efficacy of a novel device, the Eye-light®, a combination of intense pulsed light therapy and low-level light therapy, as a novel treatment for meibomian gland dysfunction and dry eye disease. Materials and Methods: This was a retrospective, single-center study carried out over a 6-week period, in which 22 eyes from 11 patients were included. Each patient received four combined light therapy treatment sessions, once weekly over 4 weeks. Patients underwent a clinical examination and filled out a standardized questionnaire to evaluate symptoms one week prior to treatment, and one week after the fourth session. Results: Combined light therapy improved several ocular surface outcome measures in our patients. This study demonstrates that this adjunctive treatment significantly improves the ocular surface and quality of life of patients with dry eye disease and meibomian gland dysfunction. Conclusions: Combined light therapy may be included in meibomian gland dysfunction treatment protocols as an adjunctive rescue treatment.
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90
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Moon SY, Han SA, Kwon HJ, Park SY, Lee JH, Chung HS, Kim JY, Tchah H, Lee H. Effects of lid debris debridement combined with meibomian gland expression on the ocular surface MMP-9 levels and clinical outcomes in moderate and severe meibomian gland dysfunction. BMC Ophthalmol 2021; 21:175. [PMID: 33845799 PMCID: PMC8040198 DOI: 10.1186/s12886-021-01926-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/29/2021] [Indexed: 11/28/2022] Open
Abstract
Background To evaluate the effects of lid debris debridement and meibomian gland expression (MGX) on extracellular matrix metalloproteinase-9 (MMP-9) levels and clinical outcomes of moderate and severe MGD. Methods In this retrospective case series study, a total 48 eyes of 24 patients with moderate and severe MGD underwent one session of lid debris debridement using the BlephEx combined with MGX. We evaluated the tear film break-up time (TBUT), corneal and conjunctival fluorescein staining scores, Schirmer 1 test, biomicroscopic examination of lid margins and meibomian gland (MG), ocular surface disease index (OSDI) questionnaire score, and extracellular MMP-9 levels using a point-of-care MMP-9 immunoassay device before and 4 weeks after lid debris debridement and MGX. Linear mixed model and generalized estimating equations model were used to evaluate possible differences. Results There were significant improvements in the TBUT (P = 0.002), SICCA and Oxford staining scores (all P < 0.001), lid margin telangiectasia (P < 0.001 for upper and lower eyelids), lid thickness (P < 0.001 for upper and lower eyelids), MG orifice plugging (P < 0.001 for upper and lower eyelids), meibum color (P = 0.026 for upper eyelid, P < 0.001 for lower eyelid), meibum consistency (P < 0.001 for upper and lower eyelids), meibum grade (P < 0.001), MGD stage (P < 0.001), and OSDI score (P = 0.002). MMP-9 immunoassay positivity rate significantly decreased from 83.3 to 50.0% 4 weeks after treatment (P = 0.014). Conclusions In patients with moderate to severe MGD, lid debris debridement using the BlephEx combined with MGX improved clinical findings, subjective symptoms, meibomian gland function, along with ocular surface MMP-9 level. We hereby suggest lid debris debridement using BlephEx combined with MGX as an effective clinical strategy for treatment of moderate to severe MGD.
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Affiliation(s)
- Su Young Moon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Sol Ah Han
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Hye Ji Kwon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - So Young Park
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Jae Hyuck Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Ho Seok Chung
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Jae Yong Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Hungwon Tchah
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Hun Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea.
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Chan AYY, Chuang JC, Wong VWY. Evaluation of Meibomian Gland Dysfunction Among Ophthalmic Healthcare Workers. Clin Ophthalmol 2021; 15:1201-1206. [PMID: 33776416 PMCID: PMC7989054 DOI: 10.2147/opth.s299338] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/22/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the prevalence of meibomian gland dysfunction (MGD) among ophthalmic healthcare workers. Setting A tertiary ophthalmic center. Design Prospective, observational study. Methods Forty-four volunteer ophthalmologists and ophthalmic nurses were recruited. Information including demographics, contact lens wear, history of refractive surgery and symptom score based on Standardized Patient Evaluation of Eye Dryness (SPEED) II Questionnaire for Dry Eye Disease/Ocular Surface Disease were recorded. Lipid layer thickness (LLT), meibomian glands dropout and dilation grades, and proportion of partial blinking were evaluated using an ocular surface interferometer with dynamic meibomian imaging (LipiView, Johnson & Johnson). Based on the chance of MGD, meibomian gland dropout and dilation, selected subjects also underwent treatment with a thermal pulsation system (LipiFlow, Johnson & Johnson) in one or both eyes. Results Eighty-eight eyes of 44 volunteers were evaluated during the study period. The mean LLT was 60.0nm. Twenty-seven (61.4%) subjects had a 90% or high chance of MGD and their mean lower lid meibomian gland dropout and dilation grades were 1.2 and 1.7, respectively. Twenty-eight eyes of 16 volunteers received treatment with the thermal pulsation system. Following treatment, the mean LLT improved from 50.3nm to 61.0nm (Wilcoxon's signed rank test, p=0.001). Conclusion Despite being more knowledgeable to MGD and more accessible to treatment, MGD is a highly prevalent condition among ophthalmic healthcare workers, with a 61.4% prevalence among the recruited subjects. This is similar to reported prevalence in Asian populations of up to 74.5%. Targeted therapy based on dynamic meibomian imaging is effective in improving both objective and subjective measures of MGD.
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Affiliation(s)
- Alison Y Y Chan
- Hong Kong Eye Hospital, Kowloon, Hong Kong.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Jasmine C Chuang
- Hong Kong Eye Hospital, Kowloon, Hong Kong.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Victoria W Y Wong
- Hong Kong Eye Hospital, Kowloon, Hong Kong.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong.,HKU Health System, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
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Mencucci R, Vignapiano R, Rubino P, Favuzza E, Cantera E, Aragona P, Rolando M. Iatrogenic Dry Eye Disease: Dealing with the Conundrum of Post-Cataract Discomfort. A P.I.C.A.S.S.O. Board Narrative Review. Ophthalmol Ther 2021; 10:211-223. [PMID: 33555571 PMCID: PMC8079532 DOI: 10.1007/s40123-021-00332-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/15/2021] [Indexed: 12/11/2022] Open
Abstract
The incidence and prevalence of dry eye disease (DED) after cataract surgery is greatly underestimated. The severity of dry eye symptoms has been reported to peak 7 days after cataract surgery and may persist for months, significantly affecting patients' quality of life (QoL). The importance of considering surgical outcomes not only in terms of visual acuity, but also in terms of the patients' QoL, necessitates the assessment and evaluation of the ocular surface by the cataract surgeon prior to the procedure. This narrative review, drafted by the P.I.C.A.S.S.O. (Italian Partners for the Correction of Ocular Surface Alterations) board, analyses the physiopathology of post-cataract surgery DED and highlights the pre-, intra- and postoperative risk factors that may alter ocular surface homeostasis; it proposes a practical comprehensive algorithm for the prevention, treatment and management of DED associated with cataract surgery. Particular attention needs to be paid to the pre- and intraoperative risk factors to reduce the incidence of postoperative dry eye and to improve cataract surgery outcome.
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Affiliation(s)
- Rita Mencucci
- Eye Clinic, NEUROFARBA Department, University of Florence, Florence, Italy.
| | - Roberto Vignapiano
- Eye Clinic, NEUROFARBA Department, University of Florence, Florence, Italy
| | | | - Eleonora Favuzza
- Eye Clinic, NEUROFARBA Department, University of Florence, Florence, Italy
| | | | - Pasquale Aragona
- Department of Biomedical Sciences, Ophthalmology Clinic, University of Messina, Messina, Italy
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Magno M, Moschowits E, Arita R, Vehof J, Utheim TP. Intraductal meibomian gland probing and its efficacy in the treatment of meibomian gland dysfunction. Surv Ophthalmol 2021; 66:612-622. [PMID: 33352147 DOI: 10.1016/j.survophthal.2020.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/23/2020] [Accepted: 11/30/2020] [Indexed: 11/19/2022]
Abstract
Meibomian gland dysfunction (MGD) is a major cause of dry eye, affecting millions worldwide. Intraductal meibomian gland probing (MGP) aims to open obstructed meibomian glands using a small probe to promote meibum secretion. MGP has received increasing interest since 2010, and we critically evaluated the literature on the efficacy and safety of MGP. Despite positive results of MGP on dry eye symptoms in early single-group studies, MGP was not shown to consistently outperform controls in later controlled trials. Furthermore, MGP alone did not show improvement beyond placebo in the only placebo-controlled RCT conducted. Overall, the procedure appears safe. Self-limited intraoperative bleeding was frequent, but no major complications were reported. In conclusion, MGP has not yet been shown to be an effective treatment for MGD. Larger placebo-controlled trials need to be conducted to establish the potential effect of this novel treatment modality.
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Affiliation(s)
- Morten Magno
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Emily Moschowits
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Reiko Arita
- Department of Ophthalmology, Itoh Clinic, Saitama, Japan
| | - Jelle Vehof
- Department of Twin Research & Genetic Epidemiology, King's College London, St Thomas' Hospital, London, United Kingdom; Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tor Paaske Utheim
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway; Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway; Department of Ophthalmology, Stavanger University Hospital, Stavanger, Norway
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Jie L, Shang-Kun O, Wei L, Zu-Guo L, Qing-Hua P. Physical Therapy Modalities of Western Medicine and Traditional Chinese Medicine for Meibomian Gland Dysfunction. DIGITAL CHINESE MEDICINE 2020. [DOI: 10.1016/j.dcmed.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Lu Y, Yin Y, Gong L. Meibomian gland dysfunction model induced with complete Freund's adjuvant in C57BL/6 mice. Int J Ophthalmol 2020; 13:1705-1712. [PMID: 33214999 DOI: 10.18240/ijo.2020.11.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 08/04/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To establish a new inflammatory animal model of meibomian gland dysfunction (MGD) in C57BL/6 mice. METHODS C57BL/6 mice were randomly divided into complete Freund's adjuvant (CFA) group (14 animals, 14 eyes), naphthazolin hydrochloride (NH) group (14 animals, 14 eyes) and control group (14 animals, 14 eyes). In CFA group, CFA was used in eyelid conjunctiva injection; in NH group, NH eye drops were used twice a day; control group was injected with equal dose of saline at the same time point and same site with animals in CFA group. The meibomian gland orifices score (MGOS) was evaluated on a scale of 0 to 3 in the middle five meibomian gland orifices of the upper and lower eyelid using slit lamp. After the successful induction of each animal model, intense pulsed light (IPL) was introduced on each mouse in CFA and NH group. Oil red O (ORO), hematoxylin and eosin (H&E) staining were performed before and after successful induction of CFA, NH and control group. RESULTS At 12wk after CFA injection, inflammatory cell infiltration and fiber necrosis was observed, with acinar density and duct dilatation significantly lower compared with control group. In NH group, the meibomian gland acini were relatively smaller and deformed compared with control group, the number of meibomian gland acini was also slightly lower. No inflammatory cell or fiber necrosis was observed in NH group. After three times of IPL treatment (5/10 mice in each group, and the other 5 mice served as non-IPL control), MGOS was significantly lower in IPL-treated mice in NH group (P<0.01). After three times of IPL treatment, the MGOS of NH group was significantly lower than that in the CFA group (P<0.01). CONCLUSION We develop a novel animal model that studies the role of inflammation in the development of MGD and IPL treatment. This model indicates that persistent inflammatory state may be the cause of MGD and weaken the therapeutic effect of IPL.
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Affiliation(s)
- Yang Lu
- Department of Ophthalmology and Vision Science, Eye&ENT Hospital of Fudan University, Shanghai 200031, China
| | - Yue Yin
- Department of Ophthalmology and Vision Science, Eye&ENT Hospital of Fudan University, Shanghai 200031, China
| | - Lan Gong
- Department of Ophthalmology and Vision Science, Eye&ENT Hospital of Fudan University, Shanghai 200031, China
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Qiao C, Li L, Wang H, Zhao C, Ke L, Sen D, Qi M, Li S, Wang M, Zeng Q. Adverse Events of Intense Pulsed Light Combined With Meibomian Gland Expression Versus Meibomian Gland Expression in the Treatment of Meibomian Gland Dysfunction. Lasers Surg Med 2020; 53:664-670. [PMID: 33161597 DOI: 10.1002/lsm.23339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/27/2020] [Accepted: 10/08/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVE To analyze the occurrence and causes of adverse events (AEs) in intense pulsed light (IPL) combined with meibomian gland expression (MGX) and MGX treatment alone for meibomian gland dysfunction (MGD). STUDY DESIGN/MATERIALS AND METHODS A retrospective study was conducted on MGD patients treated in Wuhan Aier Hankou Eye Hospital from February 2018 to October 2019 to compare the AEs between IPL-MGX and MGX groups. Relevant AEs that occurred during the treatment and within 1 month after the patients' last treatment were recorded and the causes of the AEs were analyzed. RESULTS A total of 2,282 patients received IPL-MGX and 1,407 received MGX treatment. No serious AEs occurred in both groups. There were 74 AEs in the IPL-MGX group, with an incidence of 3.24%, including 14 significant AEs (2 cases of epidemic keratoconjunctivitis, 1 recurrent herpes simplex keratitis (HSK), 9 new onsets of floaters, 1 recurrent glaucomatocyclitic crises, and 1 recurrent iridocyclitis). There were 27 AEs in the MGX group with a rate of 1.92%, including 4 significant AEs (2 cases of keratoconjunctivitis epidemic, 2 new cases of floaters). Compared with the IPL-MGX group, the incidence of AEs in the MGX group was lower (P = 0.017). CONCLUSIONS Both IPL-MGX and MGX treatment are safe therapies with low risk for AEs. IPL treatment is not recommended for young children (age 10 or less) as well as patients with anterior uveitis or glaucomatocyclitic crises. The previous history of HSK and eyes with high myopia are advised to exercise caution in IPL treatment. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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Affiliation(s)
- Chen Qiao
- Aier Eye Hospital of Wuhan University, Wuhan, Hubei, 430063, China.,Department of Cornea & Ocular Surface Diseases, Wuhan Aier Hankou Eye Hospital, Wuhan, Hubei, 430024, China
| | - Liping Li
- Department of Cornea & Ocular Surface Diseases, Wuhan Aier Hankou Eye Hospital, Wuhan, Hubei, 430024, China
| | - Haoyu Wang
- Department of Cornea & Ocular Surface Diseases, Wuhan Aier Hankou Eye Hospital, Wuhan, Hubei, 430024, China
| | - Cong Zhao
- Department of Cornea & Ocular Surface Diseases, Wuhan Aier Hankou Eye Hospital, Wuhan, Hubei, 430024, China
| | - Lan Ke
- Aier Eye Hospital of Wuhan University, Wuhan, Hubei, 430063, China.,Department of Cornea & Ocular Surface Diseases, Wuhan Aier Hankou Eye Hospital, Wuhan, Hubei, 430024, China
| | - Dan Sen
- Department of Cornea & Ocular Surface Diseases, Wuhan Aier Hankou Eye Hospital, Wuhan, Hubei, 430024, China
| | - Mengying Qi
- Department of Cornea & Ocular Surface Diseases, Wuhan Aier Hankou Eye Hospital, Wuhan, Hubei, 430024, China
| | - Shaowei Li
- Aier Cornea Institute, Beijing, 100021, China
| | - Mingwu Wang
- Aier Cornea Institute, Beijing, 100021, China.,Department of Ophthalmology and Vision Science, University of Arizona College of Medicine, Tucson, 85711, Arizona
| | - Qingyan Zeng
- Aier Eye Hospital of Wuhan University, Wuhan, Hubei, 430063, China.,Department of Cornea & Ocular Surface Diseases, Wuhan Aier Hankou Eye Hospital, Wuhan, Hubei, 430024, China.,Aier Cornea Institute, Beijing, 100021, China
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97
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Ben Hadj Salah W, Baudouin C, Doan S, Angoulvant A, Gottlieb J, Bénichou J, Da Cunha E, Eid L, Labetoulle M, Rousseau A. [Demodex and ocular surface disease]. J Fr Ophtalmol 2020; 43:1069-1077. [PMID: 33127178 DOI: 10.1016/j.jfo.2020.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/08/2020] [Accepted: 08/24/2020] [Indexed: 12/12/2022]
Abstract
Demodex is a saprophytic mite of the ocular adnexa, which can in certain circumstances proliferate on the skin of the face and on the eyelid margins. It is involved in facial rosacea (especially in the papulopustular form) and in the development or aggravation of anterior and/or posterior blepharitis or even keratoconjunctivitis, often in association with cutaneous lesions ; the pathophysiology is often multifactorial. Symptoms are non-specific, but the presence of cylindrical sleeves on the eyelashes is very suggestive of infestation, and certain techniques of biomicroscopic examination or imaging, such as confocal microscopy in vivo, allow direct visualization of the parasite. Parasitological examination of the eyelashes can confirm the diagnosis and can be improved by good sampling technique. Eyelid hygiene and oil-based ointments are the cornerstone of treatment. New specific treatments, in particular topical treatments based on tea tree oil, ivermectin, as well as pulsed light therapy and micro-exfoliation of the eyelid margin, can help to reduce the parasitic load and improve symptoms.
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Affiliation(s)
- W Ben Hadj Salah
- Service d'ophtalmologie, hôpital Bicêtre, CHU de Bicêtre, Assistance Publique-Hôpitaux de Paris, université Paris-Saclay, réseau OPHTARA : maladies rares en ophtalmologie, Paris, France
| | - C Baudouin
- Services d'ophtalmologie, CHNO des XV-XX, et hôpital Ambroise-Paré, Assistance Publique-Hôpitaux de Paris, université Versailles-St-Quentin-en-Yvelines, IHU de Sight Restore Saclay, Paris, France; Institut de la vision, Sorbonne université, Inserm, CNRS, Sorbonne, France
| | - S Doan
- Service d'ophtalmologie, CHU de Bichat, Assistance Publique-Hôpitaux de Paris et Fondation ophtalmologique Rothschild, réseau OPHTARA : maladies rares en ophtalmologie, Paris, France
| | - A Angoulvant
- Service de parasitologie, hôpital Bicêtre, CHU de Bicêtre, Assistance Publique-Hôpitaux de Paris, université Paris-Saclay, Paris, France
| | - J Gottlieb
- Service d'immunologie clinique & consultation de dermatologie, hôpital Bicêtre, CHU de Bicêtre, Assistance Publique-Hôpitaux de Paris, université Paris-Saclay, Paris, France
| | - J Bénichou
- Service d'ophtalmologie, hôpital Bicêtre, CHU de Bicêtre, Assistance Publique-Hôpitaux de Paris, université Paris-Saclay, réseau OPHTARA : maladies rares en ophtalmologie, Paris, France
| | - E Da Cunha
- Service d'ophtalmologie, hôpital Bicêtre, CHU de Bicêtre, Assistance Publique-Hôpitaux de Paris, université Paris-Saclay, réseau OPHTARA : maladies rares en ophtalmologie, Paris, France
| | - L Eid
- Service d'ophtalmologie, hôpital Bicêtre, CHU de Bicêtre, Assistance Publique-Hôpitaux de Paris, université Paris-Saclay, réseau OPHTARA : maladies rares en ophtalmologie, Paris, France
| | - M Labetoulle
- Service d'ophtalmologie, hôpital Bicêtre, CHU de Bicêtre, Assistance Publique-Hôpitaux de Paris, université Paris-Saclay, réseau OPHTARA : maladies rares en ophtalmologie, Paris, France; Département immunologie des maladies virales, auto-immunes, bactériennes et hématologiques (IMVA-HB). UMR 1184, CEA, Fontenay-Aux-Roses, France
| | - A Rousseau
- Service d'ophtalmologie, hôpital Bicêtre, CHU de Bicêtre, Assistance Publique-Hôpitaux de Paris, université Paris-Saclay, réseau OPHTARA : maladies rares en ophtalmologie, Paris, France; Département immunologie des maladies virales, auto-immunes, bactériennes et hématologiques (IMVA-HB). UMR 1184, CEA, Fontenay-Aux-Roses, France.
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Abstract
BACKGROUND Demodex blepharitis is a chronic condition commonly associated with recalcitrant dry eye symptoms though many people with Demodex mites are asymptomatic. The primary cause of this condition in humans is two types of Demodex mites: Demodex folliculorum and Demodex brevis. There are varying reports of the prevalence of Demodex blepharitis among adults, and it affects both men and women equally. While Demodex mites are commonly treated with tea tree oil, the effectiveness of tea tree oil for treating Demodex blepharitis is not well documented. OBJECTIVES To evaluate the effects of tea tree oil on ocular Demodex infestation in people with Demodex blepharitis. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2019, Issue 6); Ovid MEDLINE; Embase.com; PubMed; LILACS; ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We used no date or language restrictions in the electronic search for trials. We last searched the databases on 18 June 2019. SELECTION CRITERIA We included randomized controlled trials (RCTs) that compared treatment with tea tree oil (or its components) versus another treatment or no treatment for people with Demodex blepharitis. DATA COLLECTION AND ANALYSIS Two review authors independently screened the titles and abstracts and then full text of records to determine their eligibility. The review authors independently extracted data and assessed risk of bias using Covidence. A third review author resolved any conflicts at all stages. MAIN RESULTS We included six RCTs (1124 eyes of 562 participants; 17 to 281 participants per study) from the US, Korea, China, Australia, Ireland, and Turkey. The RCTs compared some formulation of tea tree oil to another treatment or no treatment. Included participants were both men and women, ranging from 39 to 55 years of age. All RCTs were assessed at unclear or high risk of bias in one or more domains. We also identified two RCTs that are ongoing or awaiting publications. Data from three RCTs that reported a short-term mean change in the number of Demodex mites per eight eyelashes contributed to a meta-analysis. We are uncertain about the mean reduction for the groups that received the tea tree oil intervention (mean difference [MD] 0.70, 95% confidence interval [CI] 0.24 to 1.16) at four to six weeks as compared to other interventions. Only one RCT reported data for long-term changes, which found that the group that received intense pulse light as the treatment had complete eradication of Demodex mites at three months. We graded the certainty of the evidence for this outcome as very low. Three RCTs reported no evidence of a difference for participant reported symptoms measured on the Ocular Surface Disease Index (OSDI) between the tea tree oil group and the group receiving other forms of intervention. Mean differences in these studies ranged from -10.54 (95% CI - 24.19, 3.11) to 3.40 (95% CI -0.70 7.50). We did not conduct a meta-analysis for this outcome given substantial statistical heterogeneity and graded the certainty of the evidence as low. One RCT provided information concerning visual acuity but did not provide sufficient data for between-group comparisons. The authors noted that mean habitual LogMAR visual acuity for all study participants improved post-treatment (mean LogMAR 1.16, standard deviation 0.26 at 4 weeks). We graded the certainty of evidence for this outcome as low. No RCTs provided data on mean change in number of cylindrical dandruff or the proportion of participants experiencing conjunctival injection or experiencing meibomian gland dysfunction. Three RCTs provided information on adverse events. One reported no adverse events. The other two described a total of six participants randomized to treatment with tea tree oil who experienced ocular irritation or discomfort that resolved with re-educating the patient on application techniques and continuing use of the tea tree oil. We graded the certainty of the evidence for this outcome as very low. AUTHORS' CONCLUSIONS The current review suggests that there is uncertainty related to the effectiveness of 5% to 50% tea tree oil for the short-term treatment of Demodex blepharitis; however, if used, lower concentrations may be preferable in the eye care arena to avoid induced ocular irritation. Future studies should be better controlled, assess outcomes at long term (e.g. 10 to 12 weeks or beyond), account for patient compliance, and study the effects of different tea tree oil concentrations.
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Affiliation(s)
- Keyur Savla
- School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jimmy T Le
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrew D Pucker
- School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Rokohl AC, Trester M, Guo Y, Adler W, Jaeger VK, Loreck N, Mor JM, Pine KR, Heindl LM. Dry anophthalmic socket syndrome - Standardized clinical evaluation of symptoms and signs. Ocul Surf 2020; 18:453-459. [PMID: 32387569 DOI: 10.1016/j.jtos.2020.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/26/2020] [Accepted: 05/02/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To assess symptoms and signs of the dry anophthalmic socket syndrome (DASS) in a standardized manner. METHODS 87 unilateral anophthalmic patients were evaluated using the Ocular Surface Disease Index (OSDI), the 5-Item Dry Eye Questionnaire (DEQ-5), and a modified version of Symptom Assessment iN Dry Eye (SANDE) questionnaire separately for the anophthalmic socket and for the healthy fellow eye. Conjunctival inflammation was semi-quantitatively graded and Schirmer I test with topical anesthesia was performed bilaterally. The correlations between scores of the dry eye questionnaires and the results of the Schirmer tests, conjunctival inflammation, and demographic data were examined. RESULTS Patients had significantly higher OSDI, DEQ-5 and SANDE scores at the anophthalmic side compared to the healthy eye (p ≤ 0.019, respectively). 63% of patients complained of anophthalmic socket dryness in at least one of the three questionnaires. Patients had higher inflammation (p < 0.001) and more tear volume in the Schirmer I test with topical anesthesia (p ≤ 0.024) on the anophthalmic side compared to the fellow eye. CONCLUSIONS Most anophthalmic patients have significantly more subjective dryness complaints on their anophthalmic side compared to the healthy fellow eye, even in absence of tear deficiency and clinical blepharitis. Eye care practitioners should consider the diagnosis criteria and the definition for DASS proposed in this study, when counseling anophthalmic patients. However, research should be undertaken to investigate the role and the interactions of causative etiological causes for DASS. Furthermore, there is a high priority to establish a standardized examination protocol and to develop an evidence-based treatment algorithm for DASS.
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Affiliation(s)
- Alexander C Rokohl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany.
| | - Marc Trester
- Trester-Institute for Ocular Prosthetics and Artificial Eyes, Cologne, Germany
| | - Yongwei Guo
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Werner Adler
- Department of Biometry and Epidemiology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Viktoria K Jaeger
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Niklas Loreck
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Joel M Mor
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Keith R Pine
- School of Optometry and Vision Science, University of Auckland, New Zealand
| | - Ludwig M Heindl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany; Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Dusseldorf, Cologne, Germany
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