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Bertram J, Nieri C, Reed L, Gillespie MB. Sialendoscopy Findings Associated with Positive Minor Salivary Gland Biopsy. Laryngoscope 2024; 134:1183-1189. [PMID: 37776242 DOI: 10.1002/lary.31085] [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: 01/23/2023] [Revised: 08/27/2023] [Accepted: 09/20/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVES To determine the sialendoscopy findings associated with positive findings on minor salivary gland biopsy. STUDY DESIGN Single-center retrospective study. METHODS Patients ≥18 years old who underwent sialendoscopy from 2016 to 2022 and were evaluated for SS via labial minor salivary gland biopsy. Biopsy positive and negative patients were compared on the primary outcome measure of sialendoscopy findings. Data were abstracted from the sialendoscopy operative notes and included involved gland, location of ductal pathology, and the presence of scarring, stenosis, mucus plugs, webs, and dilations. Additional characteristics included demographics, presenting symptoms, caffeine or tobacco, use of drying medications, and need for additional treatments. RESULTS The final cohorts included 22 biopsy positive and 21 biopsy negative patients with a total of 42 glands in the biopsy positive and 37 glands in the biopsy negative groups. Biopsy positive patients were found to require dilation at the hilum and distal duct at significantly higher rates than biopsy negative patients (p < 0.0001). However, there was no statistical difference in scarring, stenosis severity, mucus, webs, or dilations between each group. CONCLUSION The outcomes of this study suggest that there are no distinct sialendoscopy findings associated with biopsy positive patients. The presence of significant distal stenosis on sialendoscopy may be associated with positive minor salivary biopsy. Other endoscopic parameters are likely more consistent with non-specific chronic sialadenitis. LEVEL OF EVIDENCE 3 Laryngoscope, 134:1183-1189, 2024.
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Affiliation(s)
- Jessica Bertram
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - Chad Nieri
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - Leighton Reed
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - M Boyd Gillespie
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
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Karadeniz H, Cerit M, Güler AA, Salman RB, Satış H, Yıldırım D, Göker B, Küçük H, Öztürk MA, Tufan A. Lacrimal gland ultrasonography and elastography as a diagnostic and activity tool for primary Sjögren's syndrome. Int J Rheum Dis 2023. [PMID: 37137730 DOI: 10.1111/1756-185x.14702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 03/08/2023] [Accepted: 04/08/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To investigate the effectiveness of 2-dimensional shear wave elastography (2D-SWE) in the assessment of lacrimal gland involvement in primary Sjögren's syndrome (pSS) and to determine the association between ultrasonographic findings and clinical activity measures. METHOD Forty-six patients who fulfilled the 2016 American College of Rheumatology/European League Against Rheumatism (EULAR) classification criteria of pSS and 23 age and gender-matched healthy control subjects were enrolled. Clinical, laboratory and labial biopsy histopathologic characteristics of patients were recorded. Disease activity of pSS and severity of ocular dryness were evaluated with EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI) and Ocular Surface Disease Index (OSDI), respectively. Parotid and lacrimal gland architectures were assessed by B-mode ultrasound and 2D-SWE techniques. RESULTS Mean shear wave elastography measurements, reflecting loss of elasticity, were remarkably higher in pSS patients compared to healthy subjects both in the lacrimal and parotid glands (8.99 ± 3.45 vs 3.68 ± 1.76 in lacrimal glands and 14.14 ± 4.39 vs 7.83 ± 1.69 in parotid glands, all P < 0.001). Shear wave elasticity of lacrimal glands was correlated with OSDI and ESSPRI scores (r = 0.69; P = 0.001 and r = 0.58; P = 0.001, respectively). A cut-off value of 4.6 kPa in the lacrimal gland elasticity discriminated pSS patients from healthy subjects with a sensitivity of 94% and specificity of 87%. CONCLUSION Results of our study suggest that lacrimal glands lose elasticity in patients with pSS and the assessment of elasticity with 2D-SWE might help to classify patients as having pSS. Further studies are needed to validate the diagnostic utility of lacrimal 2D-SWE by including diseases other than pSS.
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Affiliation(s)
- Hazan Karadeniz
- Department of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Mahinur Cerit
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | | | | | - Hasan Satış
- Department of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Derya Yıldırım
- Department of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Berna Göker
- Department of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Hamit Küçük
- Department of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Akif Öztürk
- Department of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Abdurrahman Tufan
- Department of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
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Loureiro T, Rodrigues-Barros S, Carreira AR, Gouveia-Moraes F, Carreira P, Vide Escada A, Campos P, Machado I, Campos N, Ambrosio R, Archer TJ, Reinstein DZ. Corneal Epithelial Thickness Changes After Topical Treatment of Dry Eye Disease in Primary Sjögren Syndrome. Clin Ophthalmol 2023; 17:993-1005. [PMID: 37035513 PMCID: PMC10075387 DOI: 10.2147/opth.s375505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/11/2022] [Indexed: 04/03/2023] Open
Abstract
Purpose To evaluate the changes on epithelial thickness before and after topical treatment in primary Sjögren syndrome-associated dry eye disease (SS-DED). Methods This was a prospective study that included referred women with SS-DED and healthy age-matched controls. Corneal epithelial thickness was evaluated using high-definition anterior segment optical coherence tomography (Cirrus 5000 HD-OCT) in the baseline first consultation, and four weeks after treatment with preservative free 1mg/1mL sodium hyaluronate. Schirmer test 1 (ST1), tear break-up time (TBUT), tear meniscus height (TMH), SICCA Ocular Surface Score (SICCA OSS) and Ocular Surface Disease Index (OSDI) were evaluated. Statistical significance was defined as p-value <0.05. Results The study included 40 eyes, 20 with SS-DED and 20 controls. At baseline, SS-DED patients had lower ST1 (11.1 ± 2.2mm vs 14.1 ± 3.1mm, p<0.01), faster TBUT (9.1 ± 1.8s vs 13.2 ± 1.1s, p<0.01) and lower TMH (211.2 ± 68.4 µm vs 217.2 ± 60.1µm; p<0.01) than the control group, whereas SICCA OSS and OSDI were higher (p<0.01). The superior epithelium was thinner in SS-DED group (41.1 ± 3.2 µm vs 43.1± 2.3 µm, p<0.01). After treatment, ST1, TBUT, TMH, SICCA OSS, and OSDI improved (p<0.01), and superior epithelium thickened (p<0.01) in the SS-DED group. Conclusion Treatment with sodium hyaluronate improved ST1, TBUT, TMH, SICCA-OSS, and OSDI score. Superior epithelium tends to be thinner in SS-DED but becomes thicker with treatment. Our results seem to illustrate the morphological changes in the corneal epithelium in DED, which could be further recognized as a clinical biomarker of SS-DED.
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Affiliation(s)
- Tomas Loureiro
- Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
- Correspondence: Tomas Loureiro, Ophthalmology Department, Hospital Garcia de Orta, Avenida Torrado da Silva, Almada, 2805-267, Portugal, Tel +351 913 513 175, Email
| | | | | | | | - Pedro Carreira
- Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Ana Vide Escada
- Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Paul Campos
- Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Ines Machado
- Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Nuno Campos
- Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Renato Ambrosio
- Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
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Stapleton F, Abad JC, Barabino S, Burnett A, Iyer G, Lekhanont K, Li T, Liu Y, Navas A, Obinwanne CJ, Qureshi R, Roshandel D, Sahin A, Shih K, Tichenor A, Jones L. TFOS lifestyle: Impact of societal challenges on the ocular surface. Ocul Surf 2023; 28:165-199. [PMID: 37062429 PMCID: PMC10102706 DOI: 10.1016/j.jtos.2023.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/18/2023]
Abstract
Societal factors associated with ocular surface diseases were mapped using a framework to characterize the relationship between the individual, their health and environment. The impact of the COVID-19 pandemic and mitigating factors on ocular surface diseases were considered in a systematic review. Age and sex effects were generally well-characterized for inflammatory, infectious, autoimmune and trauma-related conditions. Sex and gender, through biological, socio-economic, and cultural factors impact the prevalence and severity of disease, access to, and use of, care. Genetic factors, race, smoking and co-morbidities are generally well characterized, with interdependencies with geographical, employment and socioeconomic factors. Living and working conditions include employment, education, water and sanitation, poverty and socioeconomic class. Employment type and hobbies are associated with eye trauma and burns. Regional, global socio-economic, cultural and environmental conditions, include remoteness, geography, seasonality, availability of and access to services. Violence associated with war, acid attacks and domestic violence are associated with traumatic injuries. The impacts of conflict, pandemic and climate are exacerbated by decreased food security, access to health services and workers. Digital technology can impact diseases through physical and mental health effects and access to health information and services. The COVID-19 pandemic and related mitigating strategies are mostly associated with an increased risk of developing new or worsening existing ocular surface diseases. Societal factors impact the type and severity of ocular surface diseases, although there is considerable interdependence between factors. The overlay of the digital environment, natural disasters, conflict and the pandemic have modified access to services in some regions.
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Affiliation(s)
- Fiona Stapleton
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia.
| | - Juan Carlos Abad
- Department of Ophthalmology, Antioquia Ophthalmology Clinic-Clofan, Medellin, Antioquia, Colombia
| | - Stefano Barabino
- ASST Fatebenefratelli-Sacco, Ospedale L. Sacco-University of Milan, Milan, Italy
| | - Anthea Burnett
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia
| | - Geetha Iyer
- C. J. Shah Cornea Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Kaevalin Lekhanont
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tianjing Li
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Yang Liu
- Ophthalmology Department, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Alejandro Navas
- Conde de Valenciana, National Autonomous University of Mexico UNAM, Mexico City, Mexico
| | | | - Riaz Qureshi
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Danial Roshandel
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, WA, Australia
| | - Afsun Sahin
- Department of Ophthalmology, Koc University Medical School, İstanbul, Turkey
| | - Kendrick Shih
- Department of Ophthalmology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Anna Tichenor
- School of Optometry, Indiana University, Bloomington, IN, USA
| | - Lyndon Jones
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
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5
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Clinical Registries in Dry Eye Disease: A Systematic Review. Cornea 2022; 41:1572-1583. [DOI: 10.1097/ico.0000000000003139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 05/19/2022] [Indexed: 11/25/2022]
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Caban M, Omulecki W, Latecka-Krajewska B. Dry eye in Sjögren's syndrome - characteristics and therapy. Eur J Ophthalmol 2022; 32:3174-3184. [PMID: 35354331 DOI: 10.1177/11206721221091375] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Sjögren's syndrome is an autoimmune disease, and its important feature is the lymphocyte infiltration of exocrine glands, including lacrimal glands. It contributes to defects of their activity and causes that one of the main manifestation of Sjögren's syndrome is dry eye. Unfortunately, the discrimination between dry eye related and non-related to Sjögren's syndrome is difficult at the initial stages of diseases. In addition, the available agents for the treatment of Sjögren's syndrome-related dry eye have limited efficacy. AIM The purpose of this study was to describe and emphasize differences between Sjögren's Syndrome-related dry eye and non-Sjögren's Syndrome-related dry eye together with the determination of novel therapeutic options for Sjögren's Syndrome-related dry eye. METHOD A review of the relevant papers describing characteristics of Sjögren's Syndrome-related dry eye and its therapy was conducted. This article is based on both pre-clinical and clinical evidences. RESULTS On the basis of our analysis, we indicated differences between Sjögren's Syndrome-related dry eye and non-Sjögren's Syndrome-related dry eye. Moreover, there are some novel markers that could be used in the diagnosis of Sjögren's Syndrome-related dry eye. In addition, expect artificial tear, other agents e.g. hydroxychloroquine can be effective in therapy of disease. CONCLUSIONS Sjögren's Syndrome-related dry eye is a disorder, whose diagnosis may be difficult and mistaken for non-Sjögren's Syndrome-related dry eye. However, Sjögren's Syndrome-related dry eye has some specific features. In addition, the development of newer and safer therapeutic agents for Sjögren's syndrome-related dry eye is needed, and therefore further clinical, randomized studies are necessary.
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Affiliation(s)
- Miłosz Caban
- Department of Ophthalmology, Medical University Barlicki Hospital No. 1, 37808Medical University of Lodz, Lodz, Poland
| | - Wojciech Omulecki
- Department of Ophthalmology, Medical University Barlicki Hospital No. 1, 37808Medical University of Lodz, Lodz, Poland
| | - Beata Latecka-Krajewska
- Department of Ophthalmology, Medical University Barlicki Hospital No. 1, 37808Medical University of Lodz, Lodz, Poland
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7
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Salivary Calcium Level in Patients with Sjogren's Syndrome. JOURNAL OF RESEARCH IN DENTAL AND MAXILLOFACIAL SCIENCES 2022. [DOI: 10.52547/jrdms.7.2.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Singh S, Das AV, Basu S. Ocular Involvement in Sjögren Syndrome: Risk Factors for Severe Visual Impairment and Vision-Threatening Corneal Complications. Am J Ophthalmol 2021; 225:11-17. [PMID: 33385368 DOI: 10.1016/j.ajo.2020.12.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To assess the risk factors for severe visual impairment (SVI) and corneal complications in primary and secondary Sjögren syndrome (SS). DESIGN Retrospective case series. METHODS Ocular data of all consecutive SS patients presenting to an eye-care network and receiving a diagnosis according to 2012 American College of Rheumatology criteria over the past 8 years were reviewed. MAIN OUTCOME MEASUREMENT risk factors associated with SVI (best-corrected visual acuity <20/200) and vision-threatening corneal complications (ulceration or perforation) at presentation were evaluated using multivariate analysis and odds ratios (OR). RESULTS Of the 919 patients, 285 (31%) had primary and 634 (69%) had secondary SS. The most common cause of secondary SS was rheumatoid arthritis (98.1%), followed by systemic lupus erythematosus (0.79%), psoriasis (0.79%), and scleroderma (0.6%). Among the 1,838 eyes, SVI was noted in 10%, and 2.5% had corneal complications at presentation. The presence of corneal scarring (P < .00001; OR: 3.00), corneal ulceration (P < .00001; OR: 12.96), low Schirmer values (P = .0084; OR: 0.93), cataract (P = .0036; OR: 2.4), glaucoma (P = .04; OR: 4.09), and age at diagnosis (P = .005; OR: 1.02) were independent risk factors for developing SVI. The risk factors for corneal complications were presence of scleritis (P < .0001; OR: 8.9) and a diagnosis of secondary SS (P = .009; OR: 2.94). CONCLUSIONS In patients with SS, severity of dryness, corneal ulceration and scarring, cataract, and glaucoma are factors associated with poor visual acuity. Eyes with scleritis have a greater risk of developing vision-threatening corneal complications and therefore should be monitored closely.
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Gairy K, Knight C, Anthony P, Hoskin B. Burden of illness among subgroups of patients with primary Sjögren's syndrome and systemic involvement. Rheumatology (Oxford) 2021; 60:1871-1881. [PMID: 33147609 PMCID: PMC8023993 DOI: 10.1093/rheumatology/keaa508] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/19/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To describe how patients with primary SS (pSS) and systemic organ involvement are classified and clustered in routine practice. METHODS This multinational, cross-sectional survey of real-world quantitative data was conducted across Europe and the US. Rheumatologists who treated seven or more adult patients per month with pSS and current/past systemic manifestations undertook a survey before completing a patient record form capturing demographic, clinical and treatment information for their next six eligible patients. Patients with a completed patient record form were invited to complete a patient self-completion questionnaire capturing insights into their disease and treatment. Subgroups were defined by physicians' assessment of disease severity; clusters were derived based on key clinical characteristics using latent class analysis. RESULTS Rheumatologists completed 316 physician surveys and 1879 patient record forms; 888 patients completed the patient self-completion questionnaire. pSS severity reflected organ involvement and symptomatology. Latent class analysis produced five clusters distinguished by the organ systems involved and the presence of pain and fatigue symptoms at the time of the survey. A minority of patients [n = 67 (4%)] were categorized with multiple organ involvement and the highest frequency of pain and fatigue. A total of 324 patients (17%) were categorized as 'low burden'. The remaining three clusters exhibited high frequencies of articular involvement but were distinguished by the extent of other organ system involvement. CONCLUSION Cluster analysis using a real-world cohort of patients with pSS and systemic organ involvement highlights the heterogeneous presentation of patients with pSS and confirms the importance of pain and fatigue as well as organ involvement when determining disease burden.
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Affiliation(s)
- Kerry Gairy
- Value Evidence & Outcomes, GlaxoSmithKline, Brentford, Middlesex, UK
| | - Claudia Knight
- Adelphi Real World, Adelphi Group, Macclesfield, Cheshire, UK
| | - Papa Anthony
- Adelphi Real World, Adelphi Group, Macclesfield, Cheshire, UK
| | - Ben Hoskin
- Adelphi Real World, Adelphi Group, Macclesfield, Cheshire, UK
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10
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Kim JE, Kim NR, Chin HS, Seo KY, Kim TI, Jung JW. Factors associated with ocular surface epithelial damage in patients with primary Sjögren's syndrome. BMC Ophthalmol 2021; 21:114. [PMID: 33653304 PMCID: PMC7927221 DOI: 10.1186/s12886-021-01871-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 02/17/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the effects of systemic parameters, laboratory findings, oral parameters, and other ocular surface parameters on ocular surface epithelial damage in patients with primary Sjögren's syndrome (pSS). METHODS A total of 82 dry eye disease (DED) patients with pSS were enrolled in this study. Ocular surface epithelial damage was measured by ocular staining score (OSS). Systemic parameters, laboratory findings including serologic markers, oral parameters, and other ocular surface parameters were collected. Other ocular surface parameter assessments such as the Schirmer's test, fluorescein tear breakup time, meibomian gland examinations, noninvasive keratographic tear film break-up time measurements using the Keratograph® 5 M were performed, and the Ocular Surface Disease Index was determined. RESULTS In a multivariate analysis, decreased age and increased duration of pSS were significantly related to increased logarithm-transformed OSS (β = -0.011, P = 0.043 and β = 0.003, P = 0.008). Among the ocular surface parameters, decreased fluorescein tear breakup time and increased MGD grade were significantly associated with increased logarithm-transformed OSS (β = -0.183, P < 0.001 and β = 0.192, P = 0.049). CONCLUSIONS Ocular surface epithelial damage in patients with pSS was associated with young age, long duration of disease, unstable tear film, and decreased meibomian gland function.
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Affiliation(s)
- Ji Eun Kim
- Department of Ophthalmology and Inha Vision Science Laboratory, Inha University School of Medicine, 27, Inhang-Ro, Jung-gu, 22332, Incheon, South Korea
| | - Na Rae Kim
- Department of Ophthalmology and Inha Vision Science Laboratory, Inha University School of Medicine, 27, Inhang-Ro, Jung-gu, 22332, Incheon, South Korea
| | - Hee Seung Chin
- Department of Ophthalmology and Inha Vision Science Laboratory, Inha University School of Medicine, 27, Inhang-Ro, Jung-gu, 22332, Incheon, South Korea
| | - Kyoung Yul Seo
- Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Tae-Im Kim
- Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji Won Jung
- Department of Ophthalmology and Inha Vision Science Laboratory, Inha University School of Medicine, 27, Inhang-Ro, Jung-gu, 22332, Incheon, South Korea.
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Hao R, Chou Y, Wan Y, Jiang X, Li X. Patient satisfaction with the ocular surface individualized medical program. Eur J Ophthalmol 2020; 31:2746-2754. [PMID: 32722934 DOI: 10.1177/1120672120945653] [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: 11/16/2022]
Abstract
PURPOSE To improve the medical management system and the quality of medical treatment, this study aimed to assess patient satisfaction related to an ocular surface individualized medical program for dry eye, and identified patient needs that should be addressed in future. METHODS We enrolled 166 patients from the dry eye clinic at the Peking University Third Hospital from December 2017 to May 2019. An investigator followed up with all patients by telephone 2 months after the first assessment of overall patient satisfaction, expectations, and experiences. We determined patient satisfaction using a questionnaire and analyzed the results. Multivariate linear regression analysis was used to assess the predictors of overall patient satisfaction. RESULTS The overall patient satisfaction with the ocular surface individualized medical program skewed toward a positive assessment. Ten variables were significantly associated with overall patient satisfaction: two involving fulfilment of expectations, seven involving patient-reported experiences, and one involving socio-demographics. The most important predictor of overall patient satisfaction was patient-reported experiences with the treatment outcome (β = 0.281, p < 0.001), followed by experiences with medical staff services (β = 0.240, p = 0.002), examination services (β = 0.198, p = 0.002), and interpretation and professionalism (β = 0.168, p = 0.04), expectations fulfilment (β = 0.147, p = 0.025), as well as age (β = -0.13, p = 0.014). Free response-style negative patient feedback suggested that examination wait time and environment needed improvement. CONCLUSION Overall, the ocular surface individualized medical program is effective and is able to achieve satisfaction for most patients. The examination procedures and environment require improvements, and treatment must be made more patient-centric to improve satisfaction.
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Affiliation(s)
- Ran Hao
- Department of Ophthalmology, Peking University Third Hospital, Beijing, P.R. China
| | - Yilin Chou
- Department of Ophthalmology, Peking University Third Hospital, Beijing, P.R. China
| | - Yu Wan
- Department of Ophthalmology, Peking University Third Hospital, Beijing, P.R. China
| | - Xiaodan Jiang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, P.R. China
| | - Xuemin Li
- Department of Ophthalmology, Peking University Third Hospital, Beijing, P.R. China
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Immune Response Targeting Sjögren's Syndrome Antigen Ro52 Suppresses Tear Production in Female Mice. Int J Mol Sci 2018; 19:ijms19102935. [PMID: 30261673 PMCID: PMC6213551 DOI: 10.3390/ijms19102935] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 09/23/2018] [Accepted: 09/24/2018] [Indexed: 01/04/2023] Open
Abstract
Autoantibodies reactive against Ro52 are present in 70% of Sjögren’s syndrome patients and are associated with higher disease severity. However, their role in causing aqueous deficient dry eye, a major cause for morbidity in Sjögren’s syndrome, is unclear. To investigate whether immune responses targeting Ro52 contribute towards the dry eye, male and female NZM2758 mice were immunized with recombinant Ro52. Tear production was measured by the phenol red thread test. Sera were analyzed for anti-Ro52 levels by immunoprecipitation. Lacrimal glands were evaluated for inflammatory foci and IgG deposits. Our results showed that, although all mice generated anti-Ro52 antibodies, only females developed a significant drop in tear production. None of the mice developed severe lacrimal gland inflammation, and female mice with anti-Ro52 showed higher levels of IgG deposits within their glands. Passive transfer of anti-Ro52 sera caused reduced tear production in female mice, but not in males. This study demonstrates for the first time that immune responses initiated by Ro52 induce aqueous dry eye, and this may be driven by anti-Ro52 antibodies. Furthermore, the sexual dimorphism in glandular dysfunction suggests that the lacrimal glands in females are more susceptible to autoantibody-mediated injury.
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13
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Li Z, Fu T, Li L, Cui Y, Dong C, Li J, Gu Z. Prevalence, severity, and predictors of dry eye and dry mouth in Chinese patients with primary Sjögren syndrome. Clin Rheumatol 2018; 37:2971-2979. [PMID: 30094749 DOI: 10.1007/s10067-018-4233-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/23/2018] [Accepted: 07/23/2018] [Indexed: 02/08/2023]
Abstract
Dry eye and dry mouth are typical clinical symptoms of primary Sjögren's syndrome (pSS), yet not considered in the assessment of severity and predictors in China. This study aimed to investigate the prevalence, severity, and potential predictors of dry eye/dry mouth among Chinese pSS patients. A cross-sectional study was conducted from the Affiliated Hospital of Nantong University. A series of questionnaires were applied: Ocular Surface Disease Index (OSDI), EULAR Sjogren's Syndrome Patient Reported Index (ESSPRI)-dry mouth items, fatigue severity scale (FSS), the 10 cm visual analog scale (VAS). Laboratory examinations were taken to obtain some biochemical indicators (i.e., C-reactive protein, erythrocyte sedimentation rate, anti-SSA/SSB antibody). Stepwise logistic/linear regression model was used to investigate the potential predictors of dry eye/dry mouth, respectively. Statistical analysis was performed using SPSS version 20.0. Two hundred twenty-four pSS patients were included in this study. Among them, 215 (95.98%) patients reported ESSPRI-dry mouth items score > 0, and the mean score was 4.92 ± 2.43. In addition, according to the score of OSDI, 84 (37.5%) subjects reported non-dry eye, whereas 140 (62.5%) subjects reported dry eye (44 mild, 31 moderate, 65 severe), and the mean of the total OSDI score was 25.01 ± 23.58. Then, using logistic regression and linear regression respectively, we found that age and fatigue were the potential predictors of dry eye, whereas dry mouth was predicted by age, fatigue, total pain, and ESR. The results of this study suggested that rheumatologists should pay attention to pSS patients' dry eye and dry mouth, especially those with older age, higher level of ESR, more severe fatigue, and pain.
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Affiliation(s)
- Zhenyu Li
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong, 226001, China.,School of Nursing, Nantong University, 19th Qixiu Road, Nantong, 226001, China
| | - Ting Fu
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong, 226001, China
| | - Lin Li
- School of Nursing, Nantong University, 19th Qixiu Road, Nantong, 226001, China
| | - Yafei Cui
- School of Nursing, Nantong University, 19th Qixiu Road, Nantong, 226001, China
| | - Chen Dong
- School of Nursing, Nantong University, 19th Qixiu Road, Nantong, 226001, China
| | - Jing Li
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong, 226001, China.
| | - Zhifeng Gu
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong, 226001, China. .,Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, Nantong, 226001, China.
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