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Sanie-Jahromi F, Khaki M, Heydari M, Nowroozzadeh MH, Akbarizadeh AR, Daneshamouz S, NejatyJahromy Y, Nejabat M, Mahmoudi A, Zareei A, Nejabat M. Effect of low dose honey on the apoptosis and inflammation gene expression in corneal limbal stem cells and keratocytes and its efficacy as an ophthalmic formulation in the treatment of dry eye: in-vitro and clinical study. Front Med (Lausanne) 2024; 11:1359463. [PMID: 38831993 PMCID: PMC11144896 DOI: 10.3389/fmed.2024.1359463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/29/2024] [Indexed: 06/05/2024] Open
Abstract
Background The use of honey as an eye treatment encounters challenges due to its high osmolarity, low pH, and difficulties in sterilization. This study addresses these issues by employing a low concentration of honey, focusing on both in-vitro experiments and clinical trials for treating dry eye disease in corneal cells. Methods In the in-vitro experiment, we investigated the impact of a 1% honey-supplemented medium (HSM) on limbal stem cells (LSCs) and keratocytes using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay and real-time polymerase chain reaction (PCR) for BCL-2, BAX, and IL-1β gene expression. Simultaneously, in the clinical trial, 80 participants were divided into two groups, receiving either a 1% w/v honey ophthalmic formulation or a placebo for 3 months. Study outcomes included subjective improvement in dry eye symptoms, tear break-up time (TBUT), and Schirmer's test results. Results MTT results indicated that 1% HSM did not compromise the survival of corneal cells and significantly reduced the expression of the IL-1β gene. Additionally, participants in the honey group demonstrated a higher rate of improvement in dry eye symptoms and a significant enhancement in TBUT values at the three-month follow-up. However, there was no significant difference between the study groups in terms of Schirmer's test values. No adverse events were observed or reported. Conclusion In conclusion, 1% honey exhibits anti-inflammatory and anti-infective properties, proving effective in ameliorating dry eye symptoms and enhancing tear film stability in patients with dry eye disease.Clinical Trial Registration: https://irct.behdasht.gov.ir/trial/63800.
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Affiliation(s)
- Fatemeh Sanie-Jahromi
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Khaki
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojtaba Heydari
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Nowroozzadeh
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amin Reza Akbarizadeh
- Department of Quality Control, Food and Drug, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeid Daneshamouz
- Department of Pharmaceutics, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Yaser NejatyJahromy
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Nejabat
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Mahmoudi
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Athar Zareei
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahmood Nejabat
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Hassanpour K, Langari F, Akbarzadeh AR, Kanavi MR, Barani M, Kheiri B, Karimian F, Ahmadieh H, Sadoughi MM. Safety and Efficacy of Topical Vitamin D in the Management of Dry Eye Disease Associated With Meibomian Gland Dysfunction: A Placebo-Controlled Double-Blind Randomized Controlled Trial. Cornea 2024; 43:552-563. [PMID: 37815305 DOI: 10.1097/ico.0000000000003400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/25/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE The aim of this study was to investigate the safety and efficacy of topical vitamin D in the management of dry eye disease associated with meibomian gland dysfunction (MGD). METHODS In this randomized controlled trial, patients with symptomatic MGD were divided into 2 groups to receive topical vitamin D drops or placebo in their randomized eyes. The exclusion criteria consisted of patients with vitamin D deficiency, previous ocular surgery, and patients with ocular diseases affecting the tear film. Patients and researchers were masked to the study groups. The outcomes included the score of Dry Eye Questionnaire (DEQ) 5 and Ocular Surface Disease Index (OSDI), corneal and conjunctival staining score, tear breakup time (TBUT), Schirmer, and MG expressibility score evaluated at baseline and weeks 4 and 8. RESULTS Twenty-eight eyes of 28 patients were recruited in each group. In addition to the improvement of subjective parameters in both groups, there was a statistically significantly greater improvement in the vitamin D group compared with control for average scores of OSDI (13.38 ± 7.32 vs. 27.94 ± 7.49) and DEQ5 (9.67 ± 1.86 vs. 14.14 ± 2.45) at week 8 (Ps <0.001). In addition, a significant improvement in TBUT and Schirmer test was observed in both groups in weeks 4 and 8 ( P value <0.05). There was a significant difference between the treatment and control groups after 8 weeks for OSDI, DEQ5, Schirmer, TBUT, corneal fluorescein staining, and MG expressibility score ( P value <0.05). CONCLUSIONS The preliminary results of this randomized controlled trial suggested that use of topical vitamin D drops with a lipid vehicle could be safe and might significantly improve the symptoms and signs of dry eye associated with MGD.
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Affiliation(s)
- Kiana Hassanpour
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Labbafinejad Medical Center, Department of Ophthalmology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farideh Langari
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mozhgan Rezaei Kanavi
- Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Barani
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Kheiri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Karimian
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Labbafinejad Medical Center, Department of Ophthalmology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad-Mehdi Sadoughi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Labbafinejad Medical Center, Department of Ophthalmology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Tian L, Guo Y, Wang S, Li Z, Wang N, Jie Y. Efficacy of far infrared functional glasses in the treatment of meibomian gland dysfunction-related dry eye. MedComm (Beijing) 2024; 5:e507. [PMID: 38525107 PMCID: PMC10959456 DOI: 10.1002/mco2.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 01/17/2024] [Accepted: 02/01/2024] [Indexed: 03/26/2024] Open
Abstract
Meibomian gland dysfunction (MGD)-related dry eye disease (DED) is a significant subtype of DED. In this research, we investigate the effectiveness of far infrared (FIR) functional glasses in the treatment of MGD-related DED. According to the TFO DEWS II diagnostic criteria, 61 eyes with MGD-related DED were included. All participants wore functional FIR glasses throughout the day for a period of 4 weeks and were followed up three times during the treatment. All subjects were followed up thoroughly in accordance with the DED clinical examination procedure. Ultimately, the treatment's impact was assessed. We found the Visual Analogue Scale and Ocular Surface Disease Index scores after FIR treatment were significantly lower than the baseline values (p < 0.05). Compared with the baseline, fluorescein tear breakup time and corneal fluorescein staining score after FIR treatment were significantly improved (p < 0.05). The eyelid margin signs, meibum quality, and meibomian gland expressibility after the 4-week treatment were significantly better than those at baseline (p < 0.05). We can see that wearing the FIR functional glasses significantly relieves the symptoms and signs of patients. We believe FIR therapy could be considered as a new method of MGD-related DED.
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Affiliation(s)
- Lei Tian
- Beijing Institute of OphthalmologyBeijing Tongren Eye CenterBeijing Tongren HospitalCapital Medical University, Beijing Ophthalmology & Visual Sciences Key LaboratoryBeijingChina
- Beijing Advanced Innovation Center for Big Data‐Based Precision MedicineBeihang University and Capital Medical UniversityBeijingChina
| | - Yihan Guo
- Beijing Institute of OphthalmologyBeijing Tongren Eye CenterBeijing Tongren HospitalCapital Medical University, Beijing Ophthalmology & Visual Sciences Key LaboratoryBeijingChina
| | - Silu Wang
- Beijing Institute of OphthalmologyBeijing Tongren Eye CenterBeijing Tongren HospitalCapital Medical University, Beijing Ophthalmology & Visual Sciences Key LaboratoryBeijingChina
| | - Zhongying Li
- Beijing Institute of OphthalmologyBeijing Tongren Eye CenterBeijing Tongren HospitalCapital Medical University, Beijing Ophthalmology & Visual Sciences Key LaboratoryBeijingChina
| | - Ningli Wang
- Beijing Institute of OphthalmologyBeijing Tongren Eye CenterBeijing Tongren HospitalCapital Medical University, Beijing Ophthalmology & Visual Sciences Key LaboratoryBeijingChina
| | - Ying Jie
- Beijing Institute of OphthalmologyBeijing Tongren Eye CenterBeijing Tongren HospitalCapital Medical University, Beijing Ophthalmology & Visual Sciences Key LaboratoryBeijingChina
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Tu M, Liu R, Xue J, Xiao B, Li J, Liang L. Urban Particulate Matter Triggers Meibomian Gland Dysfunction. Invest Ophthalmol Vis Sci 2024; 65:8. [PMID: 38315493 PMCID: PMC10851789 DOI: 10.1167/iovs.65.2.8] [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: 08/28/2023] [Accepted: 01/04/2024] [Indexed: 02/07/2024] Open
Abstract
Purpose The meibomian gland (MG), as the largest modified sebaceous gland, is potentially damaged by urban particulate matter (UPM) based on epidemiological evidence, but the specific experimental mechanisms remain unknown. This study investigated the effects of UPM on MG dysfunction (MGD) in rodent models. Methods Female C57BL/6J mice received eye drops containing UPM suspension or PBS for 14 days. The proliferative capacity and progenitor of MG were evaluated by immunofluorescence. Cell apoptosis was confirmed by TUNEL assay, along with the analysis of caspase family expression. Lipid accumulation was visualized by Oil Red O staining and LipidTox staining. Ductal hyperkeratinization, neutrophil infiltration, and pyroptosis activation were detected through immunostaining. The relative gene expression and signaling pathway activation were determined by Western blot analysis. Results Administration of UPM caused MGD-like clinical signs, manifested as distinct corneal epithelial erosion, increased MG orifice occlusion, and glandular dropout. UPM exposure significantly induced progenitor loss, cellular apoptosis, and lipogenic disorder in MG, by reducing P63/Lrig1 expression and increasing cleaved caspase-8, -9, and -3 and meibum lipogenic protein (HMGCR/SREBP-1) expression. UPM-treated mice exhibited ductal hyperkeratinization and neutrophil recruitment. Simultaneously, pyroptosis was motivated, as indicated by the heightened expression of NLRP3 and the cleavage of caspase-1 and -4 and gasdermin D, as well as the increase in IL-1β and IL-18 downstream. The underlying pathological mechanisms of UPM involve the phosphorylation of mitogen-activated protein kinase and nuclear factor-κB. Conclusions These results provided direct evidence for the toxicity of UPM in MG. UPM-induced activation of pyroptosis and mitogen-activated protein kinase/nuclear factor-κB signaling pathway might account for the inflammatory MGD.
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Affiliation(s)
- Mengqian Tu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Ren Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Jianwen Xue
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Bing Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Jing Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Lingyi Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
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Aly Zaky M, Galal Zaky A, Fayez Elsawy M, Fatehy Shehata K, Samy Abd Elaziz M. Efficacy of Topical Azithromycin versus Systemic Doxycycline in Treatment of Meibomian Gland Dysfunction. J Ophthalmol 2023; 2023:4182787. [PMID: 37588518 PMCID: PMC10427234 DOI: 10.1155/2023/4182787] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 03/10/2023] [Accepted: 07/13/2023] [Indexed: 08/18/2023] Open
Abstract
Background Ocular surface disease (OSD) is a multifactorial and highly frequent problem. Inadequate or unstable tear film is the main cause, which leads to visual impairments. One of the primary causes of OSD is meibomian gland dysfunction (MGD), with a prevalence of 3.5 to 70%. The aim of this work was to compare the efficacy of azithromycin topical eye drops versus oral doxycycline in MGD individuals. Methods This prospective comparative cohort research was carried out on 56 patients of both sexes of any age with symptomatic MGD. Randomly, patients were classified into two equal groups: Group 1 was treated twice daily for 4 weeks with topical azithromycin 1% eye drops, while group 2 received oral doxycycline 100 mg capsules twice daily for 4 weeks. Results In the 1st follow-up, there was a significant difference between the studied groups in pain and discomfort degree (P value = 0.024) as group 1 showed a higher number of patients with a mild pain degree (P value = 0.013) while group 2 showed a higher number of patients with a severe pain degree (P value = 0.022). There was an insignificant difference between the studied groups in moderate pain degree and lid margin telangiectasia. Conjunctivitis, frothy discharge, and meniscus floaters were significantly higher in group 2 than in group 1 (P value = 0.013, 0.028, and 0.031, respectively). In group 1, the break-up time test was significantly higher than in group 2 (P value = 0.023). In the 2nd follow up, in group 2 only meniscus floaters were significantly higher than in group 1 (P value = 0.044), while in group 1 break-up time test was significantly higher than in group 2 (P value = 0.029). Otherwise, there is no significant difference between both the groups. Conclusions Meibomian gland dysfunction (MGD) could be treated effectively with oral doxycycline and topical azithromycin by improving symptoms, clinical signs, and stabilization of tear film. Moreover, the topical azithromycin group seemed to be superior over the oral doxycycline group in improving the quality of tear film in the short term, having fewer side effects, more compliance, and better tolerability.
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Affiliation(s)
- Marwa Aly Zaky
- Ophthalmology Department, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Menoufia, Egypt
| | - Adel Galal Zaky
- Ophthalmology Department, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Menoufia, Egypt
| | - Moataz Fayez Elsawy
- Ophthalmology Department, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Menoufia, Egypt
| | | | - Mohamed Samy Abd Elaziz
- Ophthalmology Department, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Menoufia, Egypt
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Sloesen B, Young A, Forde K, Hodson N, Bentley S, Walsh O, Naujoks C, O'Brien P, Sharma G. Development and content validity assessment of the Dry Eye Disease Questionnaire in patients with dry eye disease, meibomian gland dysfunction, and Sjögren's syndrome dry eye disease. J Patient Rep Outcomes 2023; 7:64. [PMID: 37405617 DOI: 10.1186/s41687-023-00608-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/21/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Dry eye disease (DED), Meibomian gland dysfunction (MGD), and Sjögren's syndrome dry eye disease (SS-DED) are eye dryness conditions that show significant overlap in various symptoms of ocular discomfort. The aim of this study was to qualitatively explore the patient experience and evaluate content validity of the newly developed Dry Eye Disease Questionnaire (DED-Q). METHODS Semi-structured interviews were conducted with 61 US adults who reported experiencing ocular symptoms due to their physician-confirmed primary diagnosis of DED (n = 21), MGD (n = 20), or SS-DED (n = 20). The open-ended concept-elicitation phase was followed by cognitive debriefing (CD) of the DED-Q to evaluate participants' understanding and relevance of the instructions, items, response options, and recall periods. Interviews were also conducted with eight specialist healthcare professionals to assess clinical relevance of the concepts included. Verbatim interview transcripts were analyzed using thematic analysis in ATLAS.ti v8 software. RESULTS A total of 29 symptoms and 14 impacts on quality of life were reported across participant interviews. Primary ocular symptoms reported included eye dryness (n = 61/61; 100%), eye irritation (n = 55/61; 90%), eye itch (n = 54/61; 89%), burning sensation (n = 52/61; 85%), and foreign body sensation (n = 51/61; 84%). The most impacted aspects of daily life were using digital screens (n = 46/61; 75%), driving (n = 45/61; 74%), working (n = 39/61; 64%), and reading (n = 37/61; 61%). CD findings showed most participants had good understanding of DED-Q items and confirmed most concepts were relevant to the lived experience of their condition. Aside from few minor changes to the items and examples to facilitate more accurate interpretation, the proposed instruction wording was modified for various symptom and impact modules to encourage participants to focus only on dry eye vision problems. CONCLUSIONS This research identified multiple prevalent symptoms and impacts of DED, MGD, and SS-DED, most of which were similar across the conditions. The DED-Q was confirmed to be a content-valid PRO measure suitable for use in clinical studies to assess the patient experience of DED, MGD, and SS-DED. Future work will focus on evaluating the psychometric properties of the DED-Q for use as an efficacy endpoint in clinical trials.
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Affiliation(s)
| | - Alyson Young
- Adelphi Values, Patient-Centered Outcomes, Cheshire, UK
| | - Katie Forde
- Adelphi Values, Patient-Centered Outcomes, Cheshire, UK
| | - Nicola Hodson
- Adelphi Values, Patient-Centered Outcomes, Cheshire, UK
| | - Sarah Bentley
- Adelphi Values, Patient-Centered Outcomes, Cheshire, UK
| | | | | | | | - Garima Sharma
- Novartis Healthcare Private Limited, Hyderabad, India
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7
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Amano S, Shimazaki J, Yokoi N, Hori Y, Arita R. Meibomian Gland Dysfunction Clinical Practice Guidelines. Jpn J Ophthalmol 2023; 67:448-539. [PMID: 37351738 DOI: 10.1007/s10384-023-00995-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/21/2022] [Indexed: 06/24/2023]
Affiliation(s)
- Shiro Amano
- Ochanomizu Inoue Eye Clinic, 4-3 Kandasurugadai, Chiyoda-ku, Tokyo, 101-0062, Japan.
| | - Jun Shimazaki
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Norihiko Yokoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuichi Hori
- Department of Ophthalmology, Toho University Omori Medical Center, Tokyo, Japan
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Kudasiewicz-Kardaszewska A, Grant-Kels JM, Grzybowski A. Meibomian gland dysfunction and blepharitis: A common and still unsolved ophthalmic problem. Clin Dermatol 2023; 41:491-502. [PMID: 37574151 DOI: 10.1016/j.clindermatol.2023.08.005] [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: 08/15/2023]
Abstract
Blepharitis and meibomian gland dysfunction (MGD) are very common, usually underdiagnosed and underappreciated diseases. More than 50% of patients seeking ophthalmologic consultations have symptoms and signs indicating one or both entities. We summarize the key points of diagnosis and management of both diseases, comparing the work of Dry Eye Workshop II (2017) with the dry eye blepharitis syndrome unification theory. The impact of MGD/blepharitis on ocular surgery also is described. Although MGD and blepharitis seem to be uncurable, most of the time they can be successfully controlled. Different management options are available, but the key to success remains simple-routine eyelid hygiene and moisturizing with the use of preservative-free lubricants.
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Affiliation(s)
| | - Jane M Grant-Kels
- Dermatology Department, University of Connecticut School of Medicine, Farmington, Connecticut, USA; Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland; Institute for Research in Ophthalmology, Poznań, Poland
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Portal C, Lin Y, Rastogi V, Peterson C, Yiu SCH, Foster JW, Wilkerson A, Butovich IA, Iomini C. Primary cilia control cellular patterning of Meibomian glands during morphogenesis but not lipid composition. Commun Biol 2023; 6:282. [PMID: 36932132 PMCID: PMC10023665 DOI: 10.1038/s42003-023-04632-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 02/27/2023] [Indexed: 03/19/2023] Open
Abstract
Meibomian glands (MGs) are modified sebaceous glands producing the tear film's lipids. Despite their critical role in maintaining clear vision, the mechanisms underlying MG morphogenesis in development and disease remain obscure. Cilia-mediate signals are critical for the development of skin adnexa, including sebaceous glands. Thus, we investigated the role of cilia in MG morphogenesis during development. Most cells were ciliated during early MG development, followed by cilia disassembly during differentiation. In mature glands, ciliated cells were primarily restricted to the basal layer of the proximal gland central duct. Cilia ablation in keratine14-expressing tissue disrupted the accumulation of proliferative cells at the distal tip but did not affect the overall rate of proliferation or apoptosis. Moreover, impaired cellular patterning during elongation resulted in hypertrophy of mature MGs with increased meibum volume without altering its lipid composition. Thus, cilia signaling networks provide a new platform to design therapeutic treatments for MG dysfunction.
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Affiliation(s)
- Céline Portal
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012, Paris, France
| | - Yvonne Lin
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Varuni Rastogi
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Cornelia Peterson
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Samuel Chi-Hung Yiu
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - James W Foster
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Amber Wilkerson
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Igor A Butovich
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
- Graduate School of Biomedical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Carlo Iomini
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.
- Department of Cell Biology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.
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10
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Nagai N, Otake H. Novel drug delivery systems for the management of dry eye. Adv Drug Deliv Rev 2022; 191:114582. [PMID: 36283491 DOI: 10.1016/j.addr.2022.114582] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/21/2022] [Accepted: 10/12/2022] [Indexed: 01/24/2023]
Abstract
Dry eye disease (DED) is a frequently observed eye complaint, which has recently attracted considerable research interest. Conventional therapy for DED involves the use of artificial tear products, cyclosporin, corticosteroids, mucin secretagogues, antibiotics and nonsteroidal anti-inflammatory drugs. In addition, ocular drug delivery systems based on nanotechnology are currently the focus of significant research effort and several nanotherapeutics, such as nanoemulsions, nanosuspensions, microemulsions, liposomes and nanomicelles, are in clinical trials and some have FDA approval as novel treatments for DED. Thus, there has been remarkable progress in the design of nanotechnology-based approaches to overcome the limitations of ophthalmic formulations for the management of anterior eye diseases. This review presents research results on diagnostic methods for DED, current treatment options, and promising pharmaceuticals as future therapeutics, as well as new ocular drug delivery systems.
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Affiliation(s)
- Noriaki Nagai
- Faculty of Pharmacy, Kindai University, 3-4-1 Kowakae, Higashi-Osaka, Osaka 577-8502, Japan.
| | - Hiroko Otake
- Faculty of Pharmacy, Kindai University, 3-4-1 Kowakae, Higashi-Osaka, Osaka 577-8502, Japan.
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Alanazi MA, El-Hiti GA, Alotaibi R, Baashen MA, Alanazi M, Fagehi R, Masmali AM. Effect of surgical face mask wearing on tear film in women with a high body mass index. PLoS One 2022; 17:e0277803. [PMID: 36383575 PMCID: PMC9668155 DOI: 10.1371/journal.pone.0277803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/03/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Due to the COVID-19 pandemic, wearing a face mask has become an essential measure to reduce the rate of virus spreading. The aim of the study was to assess the effect of wearing a surgical face mask for a short period on the tear film parameters in subjects with a high body mass index (BMI). METHODS Twenty-five females with a high BMI (31.4 ± 5.5 kg/m2) aged 18-35 years (22.7 ± 4.6 years) participated in the study. In addition, a control group consisting of 25 females (23.0 ± 6.7 years) with a high BMI (29.9 ± 4.1 kg/m2) participated in the study in which no mask was worn. The standardized patient evaluation of eye dryness (SPEED) questionnaire was completed first, followed by the phenol red thread (PRT) and tear ferning (TF) tests, before wearing the face mask. The subjects wore the face mask for 1 hour, and the measurements were performed again immediately after its removal. For the control group, the measurements were performed twice with one hour gap. RESULTS Significant (Wilcoxon test, p < 0.05) differences were found between the SPEED scores (p = 0.035) and the PRT measurement (p = 0.042), before and after wearing the surgical face mask. The PRT scores have improved after wearing the surgical face mask, while the dry eye symptoms detected by the SPEED questionnaire have increased. On the other hand, no significant (Wilcoxon test, p = 0.201) differences were found between the TF grades before and after wearing a surgical face mask. For the control group, no significant (Wilcoxon test, p > 0.05) differences were found between the two scores from the SPEED questionnaire and the PRT, and TF tests. CONCLUSIONS Wearing a surgical face mask for a short duration leads to a change in volume and quality of tears as well as dry eye symptoms in women with a high BMI.
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Affiliation(s)
- Mana A. Alanazi
- Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
- * E-mail: (MAA); (GAE-H)
| | - Gamal A. El-Hiti
- Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
- * E-mail: (MAA); (GAE-H)
| | - Reem Alotaibi
- Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Mashaaer A. Baashen
- Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Muteb Alanazi
- Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Raied Fagehi
- Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ali M. Masmali
- Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Wu H, Fang X, Luo S, Shang X, Xie Z, Dong N, Xiao X, Lin Z, Liu Z. Meibomian Glands and Tear Film Findings in Type 2 Diabetic Patients: A Cross-Sectional Study. Front Med (Lausanne) 2022; 9:762493. [PMID: 35479935 PMCID: PMC9037095 DOI: 10.3389/fmed.2022.762493] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 03/03/2022] [Indexed: 11/16/2022] Open
Abstract
Background The characteristics of the meibomian gland and tear film in patients with type 2 diabetes (T2D) with different glycemic control levels and diabetic durations remain largely unexplored. This study aimed to identify the association of dry eye and meibomian gland dysfunction (MGD) in T2D. Materials and Methods Ninety-nine patients with type 2 diabetes mellitus (DM group), 33 dry eye patients without diabetes mellitus (DE group), and 40 normal subjects (NC group) were recruited for this study. Participants were evaluated with an Ocular Surface Disease Index (OSDI) questionnaire, tear film breakup time (BUT), the Schirmer I test (SIT), corneal fluorescein staining (FL), lipid layer thickness (LLT), and MGD parameters. Glycosylated hemoglobin (HbA1c) and duration of diabetes were recorded. Results The SIT value in the DM group was higher than that of the DE group (p < 0.05). The BUT and LLT were lower, and MGD parameters were higher in the DM group than those of the DE and NC groups (p < 0.05). In the DM group, 47 patients were diagnosed with dry eye (DM + DE group), whereas 40 patients without dry eye were categorized as the DM − DE group. The SIT, BUT, and LLT values in the DM − DE group were higher (p < 0.01), and MGD parameters were lower (p < 0.01) in the DM − DE group than those of the DM + DE group. The MGD parameters were higher in the DM − DE group than those in the NC group (p < 0.05). The HbA1c levels were correlated with OSDI, BUT, LLT, FL, and MGD parameters (p < 0.001) in the DM group. However, in patients with low HbA1c, normal SIT value, and low OSDI, the MGD parameters were higher than those in the NC group (p < 0.05). The duration of diabetes positively correlated with MGD parameters (p < 0.001). Conclusion Asymptomatic MGD may be an early sign of dry eye and ocular discomfort in T2D. The MGD parameters were associated with the HbA1c level and diabetic duration.
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Affiliation(s)
- Huping Wu
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, China.,Fujian Key Laboratory of Ocular Surface and Corneal Diseases, Affiliated Xiamen Eye Center of Xiamen University, Xiamen, China
| | - Xie Fang
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Fujian Key Laboratory of Ocular Surface and Corneal Diseases, Affiliated Xiamen Eye Center of Xiamen University, Xiamen, China
| | - Shunrong Luo
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Fujian Key Laboratory of Ocular Surface and Corneal Diseases, Affiliated Xiamen Eye Center of Xiamen University, Xiamen, China
| | - Xumin Shang
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Fujian Key Laboratory of Ocular Surface and Corneal Diseases, Affiliated Xiamen Eye Center of Xiamen University, Xiamen, China
| | - Zhiwen Xie
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Fujian Key Laboratory of Ocular Surface and Corneal Diseases, Affiliated Xiamen Eye Center of Xiamen University, Xiamen, China
| | - Nuo Dong
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Fujian Key Laboratory of Ocular Surface and Corneal Diseases, Affiliated Xiamen Eye Center of Xiamen University, Xiamen, China
| | - Xianwen Xiao
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Fujian Key Laboratory of Ocular Surface and Corneal Diseases, Affiliated Xiamen Eye Center of Xiamen University, Xiamen, China
| | - Zhirong Lin
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, China.,Fujian Key Laboratory of Ocular Surface and Corneal Diseases, Affiliated Xiamen Eye Center of Xiamen University, Xiamen, China
| | - Zuguo Liu
- Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, China
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Yang MK, Sa HS, Kim N, Jeon HS, Hyon JY, Choung H, Khwarg SI. Quantitative analysis of morphological and functional alterations of the meibomian glands in eyes with marginal entropion. PLoS One 2022; 17:e0267118. [PMID: 35421204 PMCID: PMC9009701 DOI: 10.1371/journal.pone.0267118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 04/01/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose
To quantitatively analyze morphological and functional alterations of the meibomian glands in eyes with marginal entropion and their changes after surgery.
Methods
Sixty eyes of 52 patients with marginal entropion and underwent meibography and interferometer were included. One-hundred and seventeen age- and sex-matched eyes with minimal to mild meibomian gland dysfunction (MGD) were recruited as control eyes. Meibomian gland loss (MGL) and lipid layer thickness (LLT) were compared between eyes with marginal entropion and control eyes. Subgroup analysis was performed according to the extent of entropion. MGL and average LLT at 1 and 5 months after surgery were compared with those of 20 eyes with marginal entropion followed without surgery.
Results
In eyes with marginal entropion, MGL was higher (27.7% vs. 12.8%, P = 0.014), and average LLT was thinner (64 nm vs. 86 nm, P = 0.005) than those in control eyes. MGL was higher in eyes with more extensive entropion (> 2/3 eyelid width) than in eyes with less extensive entropion (≤ 1/3 eyelid width) (40.5% vs. 13.2%, P = 0.001). Average LLT increased after surgery (97 nm at 1 month, P = 0.003; 75 nm at 5 months, P = 0.319), and thicker than that of eyes followed without surgery (97 nm vs. 66 nm, P = 0.046). MGLs after surgery remained unchanged from the preoperative MGL (all P > 0.7).
Conclusion
Marginal entropion is associated with morphological and functional alterations of the meibomian glands. Functional improvement after entropion repair suggests that marginal entropion could cause or exacerbate MGD. Further studies are required to establish the role of entropion repair in managing MGD.
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Affiliation(s)
- Min Kyu Yang
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho-Seok Sa
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Namju Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- * E-mail:
| | - Hyun Sun Jeon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joon Young Hyon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hokyung Choung
- Department of Ophthalmology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sang In Khwarg
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
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Efficacy of a 0.05% cyclosporine a topical nanoemulsion in dry eyes with obstructive meibomian gland dysfunction. Jpn J Ophthalmol 2022; 66:254-263. [PMID: 35233694 DOI: 10.1007/s10384-022-00906-3] [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: 07/03/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the efficacy of topical cyclosporin A (CsA) in obstructive meibomian gland dysfunction (MGD). STUDY DESIGN Prospective, randomized, single-blinded, controlled clinical study. METHODS Fifty-one patients with obstructive MGD were randomly assigned to one of two groups. The CsA group received 0.05% CsA topical nanoemulsion (Cyporin N®; Taejoon Pharm) twice daily, 0.15% hyaluronic acid eye drops four times daily, and 10 min of warm compress placement on the eyelids twice daily. In the control group, 0.15% hyaluronic acid eye drops were administered six times daily and warm compress was conducted twice daily for 10 min. The ocular surface disease index (OSDI), Schirmer 1 test, tear film break-up time (TBUT), corneal and conjunctival surface staining using fluorescein, eyelid debris and eyelid redness/swelling, upper and lower meibomian gland (MG) secretion scores, and upper and lower MG loss were assessed at the three-month visits. RESULTS There were no significant differences in observed parameters between the two groups at baseline. At the three-month evaluation, the CsA group showed significantly better improvements in the TBUT, eyelid debris, eyelid redness/swelling, and lower MG secretion score (P < 0.001, P < 0.001, P < 0.001, and P < 0.001, respectively). There was no improvement in upper or lower MG loss in either group. CONCLUSION Treatment with 0.05% CsA nanoemulsion in combination with warm compress twice daily alleviated signs of dry eyes with obstructive MGD. However, although MG secretion was improved, glandular loss could not be restored with three months of CsA nanoemulsion treatment.
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Yoon YC, Cho SY, Park SK, Yoo YS, Whang WJ, Na KS, Kim EC, Kim HS, Hwang HS. Comparison of Meibomian Gland Loss between Demodex-infested Group and Dry Eye Patients without Demodex Infestation. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2022. [DOI: 10.3341/jkos.2022.63.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: To compare the degree of meibomian gland drop-out associated with Demodex infestation using non-contact meibography.Methods: We performed noncontact meibography using an infrared digital camera on 24 adult subjects infested by Demodex and 40 without infestation. The right upper and lower lids were scored based on the loss of meibomian glands, and the scores of the upper and lower eyelids were summed to obtain the total meiboscore for each subject. Meiboscores were evaluated according to Demodex infestation and gender in each group.Results: Sixty-four eyes of 64 people were enrolled in this study. The study subjects had an average age of 67.9 years (range, 40-79 years; men, 65.2 years; women, 69.1 years). There was a significant association between Demodex infestation and total meiboscore and upper and lower eyelid meiboscores (p = 0.000, p = 0.002, p = 0.004, respectively). There was no significant difference in the meiboscores between men and women. Age and meiboscore suggested a weak positive correlation; however, the R2 value was low, due to the concentrated age distribution of the study population.Conclusions: Based on noncontact meibography, the authors concluded that the prevalence of changes in the meibomian glands was significantly related to Demodex infestation; however, there was no significant difference between men and women.
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Meibomian gland dysfunction is highly prevalent among first-time visitors at a Norwegian dry eye specialist clinic. Sci Rep 2021; 11:23412. [PMID: 34862425 PMCID: PMC8642422 DOI: 10.1038/s41598-021-02738-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/22/2021] [Indexed: 11/08/2022] Open
Abstract
To investigate the prevalence of meibomian gland dysfunction (MGD) in patients presenting with subjective dry eye-related symptoms at their first-time consultation in a Norwegian specialized ocular surface clinic. Additionally, to explore the accuracy of the ocular surface disease index score (OSDI) as an extensively applied tool to assess the severity of dry eye symptoms and MGD diagnosis. Patients with subjective dry eye-related complaints (n = 900) attending the clinic for the first time, from 2012 to 2016, were included in the study. At the baseline, patients completed the OSDI questionnaire. Subsequently, objective clinical tests, including fluorescein break-up time (FBUT), Schirmer-I test, ocular surface staining (OSS), and meibomian gland function assessment using gland expressibility and meibum quality were performed. The association between MGD and its severity in relation to symptom severity defined by OSDI-score was examined. MGD was found in 93.8% of the study group. MGD prevalence was not significantly different between groups based on age (p = 0.302) or sex (p = 0.079). There was a significant association between severity of MGD and dry eye-related symptoms (p = 0.014). OSS was significantly higher in patients with severe symptoms (p = 0.031). Sensitivity and specificity of positive symptom-score (OSDI ≥ 13) for disclosing MGD were 85.5% and 30.4%, respectively. MGD was highly prevalent, not associated with age and sex. OSDI ≥ 13 had high sensitivity and high positive predictive value (PPV), but low specificity and negative predictive value (NPV) for disclosing MGD. This underscores the importance of meibomian gland assessment in patients with dry eye-related symptoms.
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Change in rat meibomian gland structure with external pressure on the eyelid. Cont Lens Anterior Eye 2021; 45:101523. [PMID: 34657792 DOI: 10.1016/j.clae.2021.101523] [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: 06/18/2021] [Revised: 09/23/2021] [Accepted: 09/30/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE This study investigated structural changes in rat meibomian glands following repeated and sustained application of external pressure on the eyelids using a magnet and then subsequent removal of the external pressure. METHODS Twenty-eight Sprague-Dawley rats were used. The upper eyelid was externally compressed using a pair of magnets. One magnet was placed inside the upper eyelid, another was placed outside the eyelid, and varying periods of pressure were investigated. Untreated eyes were used as controls. Meibography was performed, and the transverse eyelid tissue sections were stained with hematoxylin and eosin and anti-cytokeratin 5 antibody at one hour, two and four weeks after removing the magnets. RESULTS Meibography showed increased meibomian gland loss (30.0 ± 5.0%), and tissue sections showed decreased area of secretory acini (0.04 ± 0.08 mm2) at one hour after applying external pressure using magnets versus in the control eyes (5.0 ± 5.0% and 0.08 ± 0.08 mm2, respectively). On the other hand, there was no meibomian gland loss or reduction of the area of secretory acini at two and four weeks after removing the magnets in comparison with the control eyes. CONCLUSIONS Repeated and sustained application of external pressure on the eyelid could induce meibomian gland loss; however, this meibomian gland loss can be restored when the external pressure is removed. Therefore, the repeated application of external pressure on the eyelid is a safe treatment method for obstructive MGD.
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Grasso A, Di Zazzo A, Giannaccare G, Sung J, Inomata T, Shih KC, Micera A, Gaudenzi D, Spelta S, Romeo MA, Orsaria P, Coassin M, Altomare V. Sex Hormones Related Ocular Dryness in Breast Cancer Women. J Clin Med 2021; 10:jcm10122620. [PMID: 34198684 PMCID: PMC8232194 DOI: 10.3390/jcm10122620] [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: 05/11/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Dry eye syndrome (DES) is strictly connected to systemic and topical sex hormones. Breast cancer treatment, the subsequent hormonal therapy, the subsequent hyperandrogenism and the early sudden menopause, may be responsible for ocular surface system failure and its clinical manifestation as dry eye disease. This local dryness is part of the breast cancer iatrogenic dryness, which affects overall mucosal tissue in the fragile population of those with breast cancer. Methods: A literature review regarding the role of sex hormone changes and systemic hormonal replacement treatments (SHRT) in DES available on PubMed and Web of Science was made without any restriction of language. Results: Androgens exert their role on the ocular surface supporting meibomian gland function and exerting a pro-sebaceous effect. Estrogen seems to show a pro/inflammatory role on the ocular surface, while SHRT effects on dry eye are still not well defined, determining apparently contradictory consequences on the ocular surface homeostasis. The role of sex hormones on dry eye pathogenesis is most likely the result of a strict crosstalk between the protective androgens effects and the androgen-modulating effects of estrogens on the meibomian glands. Conclusions: Patients with a pathological or iatrogenic hormonal imbalance, such as in the case of breast cancer, should be assessed for dry eye disease, as well as systemic dryness, in order to restore their social and personal quality of life.
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Affiliation(s)
- Antonella Grasso
- Breast Unit, University Campus Bio-Medico, 00128 Rome, Italy; (A.G.); (P.O.); (V.A.)
| | - Antonio Di Zazzo
- Ophthalmology Operative Complex Unit, University Campus Bio-Medico, 00128 Rome, Italy; (D.G.); (S.S.); (M.C.)
- Correspondence: ; Tel.: +39-06225418893; Fax: +39-9622541456
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy;
| | - Jaemyoung Sung
- Department of Ophthalmology, School of Medicine, Juntendo University, 1130033 Tokyo, Japan; (J.S.); (T.I.)
| | - Takenori Inomata
- Department of Ophthalmology, School of Medicine, Juntendo University, 1130033 Tokyo, Japan; (J.S.); (T.I.)
| | - Kendrick Co Shih
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong;
| | - Alessandra Micera
- Research and Development Laboratory for Biochemical, Molecular and Cellular Applications in Ophthalmological Sciences, IRCCS–Fondazione Bietti, 00198 Rome, Italy;
| | - Daniele Gaudenzi
- Ophthalmology Operative Complex Unit, University Campus Bio-Medico, 00128 Rome, Italy; (D.G.); (S.S.); (M.C.)
| | - Sara Spelta
- Ophthalmology Operative Complex Unit, University Campus Bio-Medico, 00128 Rome, Italy; (D.G.); (S.S.); (M.C.)
| | | | - Paolo Orsaria
- Breast Unit, University Campus Bio-Medico, 00128 Rome, Italy; (A.G.); (P.O.); (V.A.)
| | - Marco Coassin
- Ophthalmology Operative Complex Unit, University Campus Bio-Medico, 00128 Rome, Italy; (D.G.); (S.S.); (M.C.)
| | - Vittorio Altomare
- Breast Unit, University Campus Bio-Medico, 00128 Rome, Italy; (A.G.); (P.O.); (V.A.)
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Tanriverdi C, Nurozler Tabakci B, Donmez S. Longitudinal assessment of meibomian glands and tear film layer in systemic isotretinoin treatment. Eur J Ophthalmol 2021; 32:11206721211018361. [PMID: 34011178 DOI: 10.1177/11206721211018361] [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] [Indexed: 11/16/2022]
Abstract
PURPOSE This study aimed to analyze the changes in meibomian glands (MGs) and tear film layer over time in patients taking systemic isotretinoin treatment. METHODS Patients who received systemic isotretinoin treatment between 4 and 8 months were prospectively followed up. In addition to full ophthalmologic examination, MG dysfunction (MGD), noncontact meibography, noninvasive and invasive tear break-up time (TBUT), ocular surface disease index (OSDI), corneal staining, and eyelid margin abnormality scores were recorded before, during, and after treatment. RESULTS A total of 88 eyes of 88 patients were included in the study. The right eyes of all the patients were included. The mean age of the patients was 21 ± 2.9 years. Of the 88 patients, 70 (79.6%) were females and 18 (20.4%) were males. Before the treatment, MGD, noncontact meibography, first noninvasive TBUT, mean noninvasive TBUT, invasive TBUT, OSDI, corneal staining, and eyelid margin abnormality scores were 0.29 ± 0.45, 4.93 ± 3.50, 13.78 ± 3.89 s, 14.47 ± 3.09 s, 12.96 ± 3.61 s, 0.54 ± 1.00, 0.04 ± 0.20, and 0.09 ± 0.28, respectively. Twelve months after the end of treatment, the scores were 0.97 ± 0.87 (p < 0.001), 9.62 ± 3.89 (p < 0.001), 11.24 ± 3.52 s (p < 0.001), 12.34 ± 3.02 s (p < 0.001), 11.31 ± 2.90 s (p < 0.001), 1.90 ± 2.44 (p < 0.001), 0.20 ± 0.40 (p < 0.001), and 0.56 ± 0.49 (p < 0.001), respectively. CONCLUSION Systemic isotretinoin treatment causes morphological changes in the MGs. However, this treatment may negatively affect the tear film layer of patients. Some of these changes may persist for a long time even if the treatment is discontinued.
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Dry Eye Disease in University-based Clinics in Canada: A Retrospective Chart Review. Optom Vis Sci 2020; 97:944-953. [PMID: 33110027 DOI: 10.1097/opx.0000000000001603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE Dry eye disease (DED) imposes a substantial burden on patients, which can lead to significant economic consequences for society. We provide insights into the DED patient population and DED diagnostic/management practices in Canada, which to date have been inadequately addressed in the literature. PURPOSE The purpose of this study was to describe DED patient demographic/clinical characteristics alongside DED diagnosis/management in university-based optometry clinics in Canada. METHODS This was a retrospective chart review of nonconcurrent non-Sjögren patients with DED at two university-based optometry clinics in Montreal and Waterloo. Waterloo charts with a diagnosis of DED and all charts from the Montreal dry eye clinic were considered for inclusion. RESULTS Overall, 200 charts were reviewed. Most patients were female (Montreal, 76%; Waterloo, 72%), and the mean age was 57.2 ± 14.9 years at Montreal and 52.6 ± 20.1 years at Waterloo. Patients commonly reported multiple health conditions (e.g., allergies [Montreal, 44%; Waterloo, 36%]), and high use of systemic nonocular medications was observed (Montreal, 76%; Waterloo, 62%). Clinical signs and symptoms of DED were recorded more often in Montreal patients than in Waterloo patients (e.g., dryness symptoms, 100 vs. 72%; tear breakup time, 100 vs. 60%). Warm compresses (Montreal, 63%; Waterloo, 83%) and artificial tears (Montreal, 94%; Waterloo, 96%) were the most frequently recommended nonmedical treatment and ocular lubricant, respectively. Topical steroids were the most frequently prescribed medications (Montreal, 22%; Waterloo, 21%), with typically three to four different interventions recommended per patient at each clinic. No relationship was found between symptoms and clinical signs or recommended interventions. CONCLUSIONS This retrospective chart review provided the demographics, clinical characteristics, diagnosis, and management options for DED patients in Canadian university-based optometry clinics. The more comprehensive assessments conducted at Montreal may be beneficial to better monitor the progression of DED and to determine treatment effects over time.
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Hassanzadeh S, Varmaghani M, Zarei-Ghanavati S, Heravian Shandiz J, Azimi Khorasani A. Global Prevalence of Meibomian Gland Dysfunction: A Systematic Review and Meta-Analysis. Ocul Immunol Inflamm 2020; 29:66-75. [PMID: 32589483 DOI: 10.1080/09273948.2020.1755441] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: The purpose of this study is to assess the pooled prevalence of meibomian gland dysfunction (MGD) and evaluate its risk factors by gender, age, and ethnicity.Methods: Articles were searched reporting the prevalence of MGD from PubMed, Scopus, Web of Science, and Embase databases.Results: The estimated pooled prevalence of MGD was 0.358 (95% CI 0.26-0.46; I2: 99.57%). The prevalence of MGD was 0.358 (95% CI 0.24-0.50) in clinical and 0.359 (95% CI 0.22-0.52) in population-based studies. Men were more prone to MGD than women (OR: 1.24, 95% CI 1.01-1.52, p = 0.034). The rate of MGD was between 21.2% and 29.5% in Africans and Caucasians, to 71.0% in Arabs, and 67.5% in Hispanics.Conclusion: MGD is a quite prevalent disorder with an estimated pooled prevalence of 35.8%. Men are more prone to MGD than women. There is a large variation between studies in terms of quality, sample size, age ranges, diagnostic criteria, and ethnicity.
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Affiliation(s)
- Samira Hassanzadeh
- Optometry, Student Research Committee, Paramedical College, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Varmaghani
- Pharmacoeconomics, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Siamak Zarei-Ghanavati
- Ophthalmology, Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Heravian Shandiz
- Optometry, Refractive Error Research Center, Paramedical College, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Azimi Khorasani
- Optometry, Refractive Error Research Center, Paramedical College, Mashhad University of Medical Sciences, Mashhad, Iran
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Ge J, Liu N, Wang X, Du Y, Wang C, Li Z, Li J, Wang L. Evaluation of the efficacy of optimal pulsed technology treatment in patients with cataract and Meibomian gland dysfunction in the perioperative period. BMC Ophthalmol 2020; 20:111. [PMID: 32188437 PMCID: PMC7081679 DOI: 10.1186/s12886-020-01357-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 02/26/2020] [Indexed: 01/24/2023] Open
Abstract
Background The aim of this study was to evaluate the efficacy and safety of M22 Optimal Pulsed Technology (OPT) applied in patients with age-related cataract and Meibomian gland dysfunction (MGD) in perioperative period. Methods This prospective observational study was carried out in the Jinan Mingshui Eye Hospital (Zhangqiu, China). We studied 60 patients (30 in the OPT treatment group and 30 in the conventional surgery group) with age-related cataract and MGD who underwent phacoemulsification and evaluated the efficacy of OPT treatment before and 1 month and 3 months after surgery. Ocular Surface Disease Index (OSDI) questionnaire, biomicroscopic examination of lid margins, Meibomian gland yielding secretion score (MGYSS), corneal fluorescein staining scores (CFS), tear film break-up time (TBUT), tear meniscus height (TMH) and the morphology of the MG (meibography) followed by Keratograph 5 M (K5M) were used to assess the patients’ conditions. Results There were significant differences in the scores of OSDI, MGYSS, TBUT, and CFS between the preoperative and postoperative outcomes (p < 0.05). In the OPT treatment group, the postoperative ocular surface condition was obviously better and the patient satisfaction rate was higher than those before surgery. There were significant differences in the scores of OSDI, EMAS, MGYSS and CFS before and 1 month after surgery (p < 0.05). In addition, there were also significant differences in the scores of OSDI, EMAS, MGYSS and MGLS before and 3 months after surgery (p < 0.05). No complications appeared during OPT treatment. Conclusions Cataract surgery can aggravate MGD and is detrimental to ocular surface health. OPT treatment was a safe and effective intervention for patients with MGD and cataract during perioperative period.
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Affiliation(s)
- Jinling Ge
- Department of Ophthalmology, Jinan Mingshui Eye Hospital, Jinan, Shandong Province, China
| | - Na Liu
- Department of Ophthalmology, Jinan Mingshui Eye Hospital, Jinan, Shandong Province, China
| | - Xiaoming Wang
- Department of Ophthalmology, Jinan Mingshui Eye Hospital, Jinan, Shandong Province, China
| | - Ying Du
- Department of Ophthalmology, Jinan Mingshui Eye Hospital, Jinan, Shandong Province, China
| | - Chaoqing Wang
- Department of Ophthalmology, Jinan Mingshui Eye Hospital, Jinan, Shandong Province, China
| | - Zhaorui Li
- Department of Ophthalmology, Jinan Mingshui Eye Hospital, Jinan, Shandong Province, China
| | - Jing Li
- Department of Ophthalmology, Jinan Mingshui Eye Hospital, Jinan, Shandong Province, China
| | - Lihua Wang
- Department of Ophthalmology, Provincial Hospital, Shandong University, NO. 324 Jingwuweiqi Road, Jinan, Shandong Province, China.
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Efficacy of wheat hot pack (dry heat) and pottery hot pack (moist heat) on eyelid temperature and tissue blood flow in healthy eyes: a randomized control trial. Int Ophthalmol 2020; 40:1347-1357. [PMID: 32060679 DOI: 10.1007/s10792-020-01300-z] [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: 01/22/2019] [Accepted: 02/05/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate the eyelid temperature (Temp) and tissue blood flow (TBF) changes in healthy eyes using wheat hot pack (WHP) and pottery hot pack (PHP). METHODS A randomized, double-blind, within-subject crossover study design was conducted in a Thai tertiary care center. All healthy subjects received warm compress treatment with WHP and PHP. The subjects were randomized to receive the WHP or the PHP at the first sequence. Temp and TBF measurements were taken at baseline, and every 2 min during the 10-min application of the heated compresses, and every 2 min for a 10-min duration after the compresses were removed. RESULTS There were 29 females (96.7%) and 1 male. The mean (SD) age of the subjects was 33.17 (5.21) years. Two warm compresses were able to increase the surface lid Temp significantly from the baseline Temp at every time point of measurement and location. For the WHP application, the maximum surface Temp (SD) of the outer upper lid, outer lower lid, and inner lower lid were 40.07 (0.80) °C, 38.44 (0.91) °C, and 35.83 (0.71) °C, respectively (all P value < 0.001) and under the PHP application, the highest surface Temp (SD) were 40.63 (0.97) °C, 38.32 (1.27) °C, and 35.82 (0.71) °C, respectively (all P value < 0.001). Both WHP and PHP were able to increase TBF significantly with no adverse events and these effects can be sustained until 20 min. CONCLUSIONS The results of this study suggest the potential of using these warm compresses for meibomian gland dysfunction. Further clinical research is needed.
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Blumberg MJ, Millen AE, Patel SP. Influence of eyelid pigmentation on the diagnosis of meibomian gland dysfunction. Clin Ophthalmol 2019; 13:1815-1821. [PMID: 31571820 PMCID: PMC6756854 DOI: 10.2147/opth.s222451] [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: 07/09/2019] [Accepted: 09/01/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To determine whether reliance on eyelid margin vascularization as a diagnostic criterion for meibomian gland dysfunction (MGD) results in underdiagnosis of MGD in individuals with dark skin pigmentation. Patients and Methods This cross-sectional study enrolled consecutive cornea clinic patients in Buffalo, New York. Eyelid margin vascularization was graded qualitatively from slit-lamp photos. Skin pigmentation was quantified from digital photos using red/green/blue (RGB) pixel analysis and dichotomized using the RGB median. MGD was defined as abnormal quantity or quality of meibum or increased pressure required to express meibum. Additional testing included infrared meibography, Schirmer’s testing, and a dry eye questionnaire. Sensitivity of MGD diagnosis by visualization of vascularization, compared to diagnosis by expression of meibum, was estimated with and without stratification by skin pigmentation. Results Among 47 participants, 15–79 years old, meibomian gland truncation/dropout, abnormal tear production, and dry eye symptoms affected individuals of all skin pigmentations. Eyelid margin vascularization was less common in subjects with dark (n=21%) compared to light pigmentation (65%; p=0.002), although the prevalence of MGD assessed via clinical evaluation did not vary significantly between those groups. Use of eyelid margin vascularization alone was not sensitive (33%) for MGD diagnosis. The sensitivity was 17% when limited to those with dark pigmentation. Conclusion Our findings highlight the importance of gland expression and suggest limiting reliance on eyelid margin vascularization for MGD diagnosis, especially in those with dark eyelid skin pigmentation.
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Affiliation(s)
- Max J Blumberg
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Amy E Millen
- Department of Epidemiology and Environmental Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Sangita P Patel
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA.,Research and Ophthalmology Services, Veterans Administration of Western New York Healthcare System, Buffalo, NY, USA
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Adil MY, Xiao J, Olafsson J, Chen X, Lagali NS, Ræder S, Utheim ØA, Dartt DA, Utheim TP. Meibomian Gland Morphology Is a Sensitive Early Indicator of Meibomian Gland Dysfunction. Am J Ophthalmol 2019; 200:16-25. [PMID: 30578784 DOI: 10.1016/j.ajo.2018.12.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 12/09/2018] [Accepted: 12/10/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE To investigate the relationship between meibomian gland (MG) morphology and clinical dry eye tests in patients with meibomian gland dysfunction (MGD). DESIGN Cross-sectional study. SUBJECTS Total 538 MGD patients and 21 healthy controls. METHODS MG loss on meibography images of upper (UL) and lower lids (LL) was graded on a scale of 0 (lowest degree of MG loss) to 3. MG length, thickness, and interglandular space in the UL were measured. Clinical tests included meibum expression and quality, tear film break-up time, ocular staining, osmolarity, Schirmer I, blink interval timing, and Ocular Surface Disease Index (OSDI) questionnaire. RESULTS Mean UL and LL meibogrades were significantly higher in MGD patients compared to controls (P < .001 for UL and LL). The sensitivity and specificity of the meibograde as a diagnostic parameter for MGD was 96.7% and 85%, respectively. Schirmer I was significantly increased in MGD patients with meibograde 1 compared to patients with meibograde 0, 2, and 3 in the UL (P < .05). MG thickness increased with higher meibograde (P < .001). MG morphology correlated significantly but weakly with several clinical parameters (P < .05). OSDI did not correlate with any MG morphologic parameter. CONCLUSIONS Grading of MG loss using meibograde effectively diagnoses MGD. Compensatory mechanisms such as increased aqueous tear production and dilation of MGs make early detection of MGD difficult by standard clinical measures of dry eye, whereas morphologic analysis of MGs reveals an early stage of MGD, and therefore represents a complementary clinical parameter with diagnostic potential.
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Barber L, Khodai O, Croley T, Lievens C, Montaquila S, Ziemanski J, McCart M, Lunacsek O, Burk C, Patel V. Dry eye symptoms and impact on vision-related function across International Task Force guidelines severity levels in the United States. BMC Ophthalmol 2018; 18:260. [PMID: 30268117 PMCID: PMC6162873 DOI: 10.1186/s12886-018-0919-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 09/11/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND International Task Force (ITF) guidelines established a grading scheme to support treatment of dry eye disease based on clinical signs and symptoms. The purpose of this study was to assess the impact of dry eye on vision-related function across ITF severity levels using the Ocular Surface Disease Index (OSDI) questionnaire. METHODS Non-interventional, cross-sectional study of prescription treatment-naïve dry eye patients seeking symptom relief at 10 ophthalmology and optometry practices. Clinicians assessed corneal and conjunctival staining, tear break-up time, Schirmer's test (type I with anesthesia), and best-corrected visual acuity. Patients completed the OSDI questionnaire and OSDI overall and domain (Symptoms, Visual Function, and Environmental Triggers) scores were compared across ITF guidelines severity levels (1-4). RESULTS Of 158 patients (mean age, 55 years) enrolled, 52 (33%) were ITF level 1, 54 (34%) ITF level 2, and 52 (33%) ITF levels 3/4 combined. No significant differences were observed in most baseline characteristics. Overall OSDI scores (mean [standard deviation]) were 26.5 [20.0] for ITF level 1, 33.8 [17.5] for ITF level 2, and 44.9 [26.1] for ITF level 3/4 cohorts (P < 0.0001). Component OSDI Symptoms, Visual Function, and Environmental Triggers domain scores all worsened with increasing ITF severity level (P ≤ 0.01). CONCLUSIONS Dry eye disease has significant deleterious impact on vision-related function across all ITF severity levels.
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Affiliation(s)
- Laurie Barber
- Little Rock Eye Clinic, 203 Executive Court, Suite A, Little Rock, AK 72205 USA
| | - Omid Khodai
- Mobile Medical Solutions, Inc., Foothill Ranch, CA USA
| | | | | | | | - Jillian Ziemanski
- School of Optometry, University of Alabama at Birmingham, Birmingham, AL USA
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Boboridis KG, Konstas AGP. Evaluating the novel application of cyclosporine 0.1% in ocular surface disease. Expert Opin Pharmacother 2018; 19:1027-1039. [PMID: 29847195 DOI: 10.1080/14656566.2018.1479742] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Ocular surface disease (OSD) is a highly prevalent symptomatic condition caused by dry eye disease (DED), intrinsic, environmental, or iatrogenic causes. It affects patient's visual function and quality of life. Its pathophysiology is centered on tear hyperosmolarity, inflammation, and epithelial damage. Current management is suboptimal and includes artificial tear supplementation and short-term use of topical steroids in severe cases. The recent approval of cyclosporine 0.1% has transformed management strategies of severe DED and moderate-to-severe OSD. Areas covered: This review summarizes existing information on the efficacy, safety, and tolerability of the new cyclosporine 0.1% formulation. Expert opinion: Topical cyclosporine A 0.1% represents a promising, novel medication for the management of DED, Meibomian gland dysfunction, and inflammatory OSD. It is primarily beneficial for those patients requiring topical immunomodulatory therapy. This topical formulation also has the potential to meaningfully improve the management of moderate-to-severe glaucoma therapy-related OSD. Currently there is limited published clinical data concerning the efficacy of topical cyclosporine. There are, however, theoretical advantages when comparing this cyclosporine formulation with other established commercial preparations. Future research is needed to delineate the precise role and value of this medication.
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Affiliation(s)
- Konstadinos G Boboridis
- a 1st and 3rd University Departments of Ophthalmology , Aristotle University , Thessaloniki , Greece
| | - Anastasios G P Konstas
- a 1st and 3rd University Departments of Ophthalmology , Aristotle University , Thessaloniki , Greece
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Li W, Sun X, Wang Z, Zhang Y. A survey of contact lens-related complications in a tertiary hospital in China. Cont Lens Anterior Eye 2018; 41:201-204. [DOI: 10.1016/j.clae.2017.10.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 09/30/2017] [Accepted: 10/06/2017] [Indexed: 11/29/2022]
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Association between meibomian gland dysfunction and compliance of topical prostaglandin analogs in patients with normal tension glaucoma. PLoS One 2018; 13:e0191398. [PMID: 29385185 PMCID: PMC5791996 DOI: 10.1371/journal.pone.0191398] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 12/18/2017] [Indexed: 01/18/2023] Open
Abstract
PURPOSE The aim of this study was to investigate the association between tear film and meibomian gland parameters in patients with normal tension glaucoma (NTG), who underwent topical prostaglandin analog (PGA) monotherapy, and medication compliance. METHODS Ocular surface disease index (OSDI), Schirmer's test, tear film break-up time (TBUT), keratoepitheliopathy (KEP) score with fluorescein, and meibomian gland parameters were assessed in 45 eyes of 45 patients with NTG (NTG group), who received topical PGA monotherapy for more than 1 year. The results were compared to those of 40 eyes of 40 normal subjects (control group). Medication compliance was assessed by an 8-item Morisky Medication Adherence Scale (MMAS-8). Multiple logistic regression analysis was used to identify the factors associated with medication compliance. RESULTS There was a significant difference in OSDI (P = 0.043), Schirmer's test (P < 0.001), TBUT (P < 0.001), KEP score (P = 0.015) and all meibomian gland parameters (all P < 0.001) between two groups. When the NTG group was divided into compliant and non-compliant groups based on the scores of MMAS-8, 30 (75%) patients were classified into the compliant group. Multiple logistic regression analysis revealed that the lid margin score (OR, 0.256; 95% CI, 0.072-0.908, P = 0.035), meibum score (OR, 0.144; 95% CI, 0.023-0.915, P = 0.04), and meibo score (OR, 0.344; 95% CI, 0.140-0.845, P = 0.02) were significant factors associated with compliance in patients with NTG. The meibomian gland parameters showed a negative correlation with medication compliance (all P < 0.005). CONCLUSIONS Malfunction of the meibomian glands can be an important clinical finding associated with compliance of PGA monotherapy in patients with NTG.
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Abstract
Ocular IgE-associated allergy ranges from mild disease (seasonal and perennial allergic conjunctivitis) to more chronic/severe and vision-threatening forms (atopic and vernal keratoconjunctivitis). Whereas mild forms of disease have been studied extensively, less is known about the more chronic forms. Our lab has helped to address this knowledge gap by developing and characterizing an allergen-induced, chronic/severe, IgE-associated model of ocular allergy referred to as the severe allergic eye disease (AED) model. It is distinct from previously described models that mimic the more mild forms, referred to in the literature as the allergic conjunctivitis (AC) model. The purpose of this method article is to detail the protocol to induce and characterize the AED model and directly compare these mice to the mild AC model. Troubleshooting and implications are also discussed.
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Affiliation(s)
- Nancy J Reyes
- Department of Ophthalmology, Duke University School of Medicine, Duke Eye Center, Durham, NC, USA
| | - Rose Mathew
- Department of Ophthalmology, Duke University School of Medicine, Duke Eye Center, Durham, NC, USA
| | - Daniel R Saban
- Department of Ophthalmology, Duke University School of Medicine, Duke Eye Center, Durham, NC, USA.
- Department of Immunology, Duke University School of Medicine, Durham, NC, USA.
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Albietz JM, Schmid KL. Randomised controlled trial of topical antibacterial Manuka (Leptospermum species) honey for evaporative dry eye due to meibomian gland dysfunction. Clin Exp Optom 2017; 100:603-615. [PMID: 28585260 DOI: 10.1111/cxo.12524] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 12/03/2016] [Accepted: 12/13/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The aim was to evaluate the efficacy of standardised Manuka (Leptospermum species) antibacterial honey as adjunctive twice daily treatment to conventional therapy (warm compresses, lid massage and preservative-free lubricant), in participants with evaporative dry eye due to moderate to advanced meibomian gland dysfunction. METHODS This prospective, open-label study involved 114 participants. After two weeks of conventional therapy participants were randomised to one of three treatment groups: Optimel Antibacterial Manuka Eye Gel (98 per cent Leptospermum species honey) plus conventional therapy (n = 37), Optimel Manuka plus Lubricant Eye Drops (16 per cent Leptospermum species honey) plus conventional therapy (n = 37) and a control (conventional therapy) (n = 40). Clinical evaluations performed at baseline and Week 8 included: symptom scores (Ocular Surface Disease Index, Ocular Comfort Index), daily lubricant use, tear assessments (break-up time, secretion, osmolarity and InflammaDry), corneal sensation, ocular surface staining, meibomian gland secretion quality and expressibility, bulbar conjunctival, limbal and lid marginal redness and eyelid marginal bacterial cultures and colony counts. RESULTS Significant improvements (p ≤ 0.05) occurred at Week 8 in symptoms, tear break-up time, staining, tear osmolarity, meibum quality and bulbar, limbal and lid margin redness for all treatments. Improvement in staining was significantly greater with Optimel 16 per cent drops (p = 0.035). Significant improvements (p < 0.05) in meibomian gland expressibility and InflammaDry occurred for both Optimel treatments. Optimel 98 per cent gel was significantly more effective in improving meibum quality (p = 0.005) and gland expressibility (p = 0.042). Total eyelid marginal bacterial colony counts reduced significantly with Optimel 16 per cent drops (p = 0.03) but not the other treatments. Staphylococcus epidermidis counts reduced significantly with Optimel 16 per cent drops (p = 0.041) and Optimel 98 per cent gel (p = 0.027). Both Optimel treatments significantly reduced the need for lubricants, with Optimel 16 per cent drops decreasing lubricant use most (p = 0.001). Temporary redness and stinging were the only adverse effects of Optimel use. CONCLUSIONS Optimel antibacterial honey treatments are effective as adjunctive therapies for meibomian gland dysfunction.
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Affiliation(s)
- Julie M Albietz
- School of Optometry and Vision Science, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Katrina L Schmid
- School of Optometry and Vision Science, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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Meibomian Gland Dysfunction Correlates to the Tear Film Instability and Ocular Discomfort in Patients with Pterygium. Sci Rep 2017; 7:45115. [PMID: 28338041 PMCID: PMC5364464 DOI: 10.1038/srep45115] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/16/2017] [Indexed: 01/19/2023] Open
Abstract
Pterygium is a very common disease in an eye clinic characterized by a benign proliferation of local conjunctiva that often crosses the limber of cornea and extends into corneal surface. Variety of studies has showed that pterygium is able to result in ocular discomfort and the change of ocular surface environment, such as dry eye. However, the link between abnormal tear film function and pterygium is controversial. Meibomian gland dysfunction (MGD) is a common cause of dry eye and ocular discomfort but is often neglected, which may be the missing link between dry eye and pterygium. In this study, our data firstly revealed increased abnormality of meibomian gland structure and function in pterygium patients, representing with increased abnormality of MGD parameters such as meibum expression (P < 0.001) and meibomian gland loss (P < 0.001). Besides, the scores of MGD severity in patients with progressive pterygium were higher than those in patients with resting pterygium. The correlation between MGD parameters and ocular discomfort as well as dry eye indexes is also established. These findings suggest that MGD correlates to the tear film instability and ocular discomfort in patients with pterygium.
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Wolkoff P. External eye symptoms in indoor environments. INDOOR AIR 2017; 27:246-260. [PMID: 27444579 DOI: 10.1111/ina.12322] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/19/2016] [Indexed: 05/22/2023]
Abstract
Eye irritation, for example dry or irritated eyes, is generally among top three reported symptoms in office-like environments, in particular among workplaces with cognitive demanding visual display unit (VDU) work. The symptoms are especially among middle and advanced ages and particularly among women more than men. The symptoms are also among the most commonly reported complaints in the eye clinic. To be in a position to interpret the high prevalence of eye symptoms, a multidisciplinary and integrated approach is necessary that involves the external eye physiology (separate from internal eye effects), eye diseases (evaporative dry eye (DE), aqueous-deficient DE, and gland dysfunctions), and risk factors that aggravate the stability of precorneal tear film (PTF) resulting in hyperosmolarity and initiation of inflammatory reactions. Indoor environmental, occupational and personal risk factors may aggravate the PTF stability; factors such as age, contact lenses, cosmetics, diet, draft, gender, low humidity and high temperature, medication, outdoor and combustion pollutants, and VDU work. Psychological stressors may further influence the reporting behavior of eye symptoms. The impact of the risk factors may occur in a combined and exacerbating manner.
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Affiliation(s)
- P Wolkoff
- National Research Centre for the Working Environment, Copenhagen, Denmark
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Geerling G, Baudouin C, Aragona P, Rolando M, Boboridis KG, Benítez-Del-Castillo JM, Akova YA, Merayo-Lloves J, Labetoulle M, Steinhoff M, Messmer EM. Emerging strategies for the diagnosis and treatment of meibomian gland dysfunction: Proceedings of the OCEAN group meeting. Ocul Surf 2017; 15:179-192. [PMID: 28132878 DOI: 10.1016/j.jtos.2017.01.006] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 01/20/2017] [Accepted: 01/23/2017] [Indexed: 01/01/2023]
Abstract
Meibomian gland dysfunction (MGD) is a common and chronic disorder that has a significant adverse impact on patients' quality of life. It is a leading cause of evaporative dry eye disease (DED), as meibomian glands play an important role in providing lipids to the tear film, which helps to retard the evaporation of tears from the ocular surface. MGD is also often present in conjunction with primary aqueous-deficient DED. Obstructive MGD, the most commonly observed type of MGD, is the main focus of this article. MGD is probably caused by a combination of separate conditions: primary obstructive hyperkeratinization of the meibomian gland, abnormal meibomian gland secretion, eyelid inflammation, corneal inflammation and damage, microbiological changes, and DED. Furthermore, skin diseases such as rosacea may play a part in its pathology. Accurate diagnosis is challenging, as it is difficult to differentiate between ocular surface diseases, but is crucial when choosing treatment options. Ocular imaging has advanced in recent years, providing ophthalmologists with a better understanding of ocular diseases. This review presents a literature update on the 2011 MGD workshop and an optimized approach to accurate diagnosis of MGD using currently available methods and tests. It also outlines the emerging technologies of interferometry, non-contact meibography, keratography and in vivo confocal laser microscopy, which offer exciting possibilities for the future. Selected treatment options for MGD are also discussed.
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Affiliation(s)
- Gerd Geerling
- Department of Ophthalmology, University Hospital Duesseldorf, Heinrich-Heine University, Duesseldorf, Germany.
| | - Christophe Baudouin
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, University Paris-Saclay, Paris, France.
| | - Pasquale Aragona
- Institute of Ophthalmology, Department of Biomedical Sciences, University of Messina, Messina, Italy
| | | | - Kostas G Boboridis
- Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Yonca A Akova
- Department of Ophthalmology, Bayındır Hospital, Ankara, Turkey
| | - Jesús Merayo-Lloves
- Instituto Universitario Fernández-Vega, University of Oviedo, Asturias, Spain
| | - Marc Labetoulle
- Service d'Ophtalmologie, CHU Bicêtre, APHP, Université Paris-Sud, Le Kremlin-Bicêtre, Paris, France
| | - Martin Steinhoff
- Department of Dermatology and UCD Charles Institute for Translational Dermatology, University College Dublin, Dublin, Ireland
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Lockington D. Oral azithromycin and blepharitis: symptoms and signs improve, so where are the publications? Clin Exp Ophthalmol 2016; 44:866-867. [DOI: 10.1111/ceo.12799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 06/29/2016] [Indexed: 11/29/2022]
Affiliation(s)
- David Lockington
- Tennent Institute of Ophthalmology; Gartnavel General Hospital; Glasgow UK
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Effects of topical acne treatment on the ocular surface in patients with acne vulgaris. Cont Lens Anterior Eye 2016; 39:431-434. [DOI: 10.1016/j.clae.2016.06.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/27/2016] [Accepted: 06/27/2016] [Indexed: 02/08/2023]
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Baudouin C, Messmer EM, Aragona P, Geerling G, Akova YA, Benítez-del-Castillo J, Boboridis KG, Merayo-Lloves J, Rolando M, Labetoulle M. Revisiting the vicious circle of dry eye disease: a focus on the pathophysiology of meibomian gland dysfunction. Br J Ophthalmol 2016; 100:300-6. [PMID: 26781133 PMCID: PMC4789719 DOI: 10.1136/bjophthalmol-2015-307415] [Citation(s) in RCA: 302] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 10/29/2015] [Accepted: 11/28/2015] [Indexed: 12/29/2022]
Abstract
Meibomian gland dysfunction (MGD) is the most frequent cause of dry eye disease (DED). Eyelid inflammation, microbial growth, associated skin disorders as well as potentially severe corneal complications culminate to make MGD a complex multifactorial disorder. It is probable that MGD is a heterogeneous condition arising from any combination of the following five separate pathophysiological mechanisms: eyelid inflammation, conjunctival inflammation, corneal damage, microbiological changes and DED resulting from tear film instability. The pathogenesis of both MGD and DED can be described in terms of a 'vicious circle': the underlying pathophysiological mechanisms of DED and MGD interact, resulting in a double vicious circle. The MGD vicious circle is self-stimulated by microbiological changes, which results in increased melting temperature of meibum and subsequent meibomian gland blockage, reinforcing the vicious circle of MGD. Meibomian gland blockage, dropout and inflammation directly link the two vicious circles. MGD-associated tear film instability provides an entry point into the vicious circle of DED and leads to hyperosmolarity and inflammation, which are both a cause and consequence of DED. Here we propose a new pathophysiological scheme for MGD in order to better identify the pathological mechanisms involved and to allow more efficient targeting of therapeutics. Through better understanding of this scheme, MGD may gain true disease status rather than being viewed as a mere dysfunction.
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Affiliation(s)
- Christophe Baudouin
- Quinze-Vingts National Ophthalmology Hospital, University Versailles St Quentin en Yvelines, Versailles, France
- UPMC Univ Paris 06, UMR_S 968, Institut de la Vision, Paris, France
| | | | - Pasquale Aragona
- Institute of Ophthalmology, University of Messina, Messina, Italy
| | - Gerd Geerling
- Department of Ophthalmology, University Hospital Düsseldorf, Heinrich-Heine University, Düsseldorf, Germany
| | - Yonca A Akova
- Department of Ophthalmology, Bayindir Hospital, Ankara, Turkey
| | | | - Kostas G Boboridis
- Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Jesús Merayo-Lloves
- University of Oviedo and Fernández-Vega Ophthalmological Institute, Oviedo, Spain
| | - Maurizio Rolando
- Department of Neuroscience, Ophthalmology, and Genetics, University of Genoa, Genoa, Italy
| | - Marc Labetoulle
- Ophthalmology Department, Bicêtre University Hospital, Le Kremlin-Bicêtre, France
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Doughty MJ. On the prescribing of oral doxycycline or minocycline by UK optometrists as part of management of chronic Meibomian Gland Dysfunction (MGD). Cont Lens Anterior Eye 2016; 39:2-8. [DOI: 10.1016/j.clae.2015.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 07/30/2015] [Accepted: 08/08/2015] [Indexed: 12/17/2022]
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Abstract
PURPOSE To compare the effects on ocular temperature, lipid layer grade, tear film stability, and tear meniscus height after a single application of two commercially available warm compresses in mild-to-moderate dry eye and to report participant treatment preference. METHODS Forty-one subjects with mild-to-moderate dry eye symptoms were enrolled in a randomized, paired-eye, investigator-masked trial. Heat was applied simultaneously to one eye (randomized) with a portable eye mask (EyeGiene) and to the contralateral eye with a microwave-heated flaxseed eye bag (MGDRx Eye Bag). Outer and inner eyelid temperatures, tear film lipid layer grade (LLG), and noninvasive tear film breakup time (NIBUT) were measured at baseline and immediately after 10 minutes of device application. RESULTS Outer and inner eyelid temperatures, LLG, and NIBUT did not differ before treatment between eyes assigned to eye mask and eye bag therapy. All measurements were significantly increased from baseline, after warming with both devices (all p < 0.05). Outer and inner eyelid temperature changes were significantly greater with the eye bag than with the eye mask (outer eyelid, +3.5 ± 1.0°C vs. +2.4 ± 0.8°C; inner eyelid, +3.5 ± 1.0°C vs. +2.5 ± 0.9°C; all p < 0.001), although there was no significant difference in LLG and NIBUT improvement between treatments (all p > 0.05). A majority of subjects (78%) preferred the application of heat with the eye bag over the eye mask. CONCLUSIONS Both the EyeGiene mask and the MGDRx Eye Bag are convenient eyelid warming devices that result in clinically and statistically significant increases in NIBUT and LLG in patients with mild-to-moderate dry eye symptoms. The MGDRx Eye Bag is more effective in raising ocular temperature and is the preferred treatment method among subjects.
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40
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Dyslipidemia and its association with meibomian gland dysfunction. Int Ophthalmol 2015; 36:469-76. [DOI: 10.1007/s10792-015-0149-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 10/19/2015] [Indexed: 10/22/2022]
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41
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Halkiadakis I, Kontadakis GA, Tsiakou D, Patsea E, Mitropoulos P, Kandarakis AS. Effect of Glaucoma Medication in Tear Film Osmolarity of Patients Without Symptoms of Ocular Discomfort. J Ocul Pharmacol Ther 2015; 31:330-4. [DOI: 10.1089/jop.2014.0124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | - Eleni Patsea
- Ophthalmiatreio Eye Hospital of Athens, Athens, Greece
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Wang MTM, Gokul A, Craig JP. Temperature profiles of patient-applied eyelid warming therapies. Cont Lens Anterior Eye 2015; 38:430-4. [PMID: 26126722 DOI: 10.1016/j.clae.2015.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 05/18/2015] [Accepted: 06/18/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare temperature profile characteristics (on and off eye) of two patient-applied heat therapies for meibomian gland dysfunction (MGD): an eye mask containing disposable warming units (EyeGiene(®)) and a microwave-heated flaxseed eye bag(®) (MGDRx EyeBag(®)). METHODS In vitro evaluation: surface temperature profiles of activated eye masks and heated eye bags(®) (both n=10), were tracked every 10s until return to ambient temperature. Heat-transfer assessment: outer and inner eyelid temperature profiles throughout the eye mask and eye bag(®) treatment application period (10min) were investigated in triplicate. The devices were applied for 12 different time intervals in a randomised order, with a cool-down period in between to ensure ocular temperatures returned to baseline. Temperature measurements were taken before and immediately after each application. RESULTS In vitro evaluation: on profile, the eye bag(®) surface temperature peaked earlier (0±0 s vs. 100±20 s, p<0.001), cooled more slowly and displayed less variability than the eye mask (all p<0.05). Heat-transfer assessment: the eye bag(®) effected higher peak inner eyelid temperatures (38.1±0.4°C vs. 37.4±0.2°C, p=0.04), as well as larger inner eyelid temperature increases over the first 2 min, and between 9 and 10 min (all p<0.05). CONCLUSIONS The eye bag(®) surface temperature profile displayed greater uniformity and slower cooling than the eye mask, and was demonstrated to be significantly more effective in raising ocular temperatures than the eye mask, both statistically and clinically. This has implications for MGD treatment, where the melting points of meibomian secretions are likely to be higher with increasing disease severity.
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Affiliation(s)
- Michael T M Wang
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand
| | - Akilesh Gokul
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand
| | - Jennifer P Craig
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand.
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43
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A Comprehensive Review on Dry Eye Disease: Diagnosis, Medical Management, Recent Developments, and Future Challenges. ACTA ACUST UNITED AC 2015. [DOI: 10.1155/2015/704946] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Dry eye syndrome (DES) or keratoconjunctivitis sicca (KCS) is a common disorder of the tear film caused by decreased tear production or increased evaporation and manifests with a wide variety of signs and symptoms. The present review from interpretation of the literature gives detailed information on the prevalence, definition, causes, diagnostic tests, and medical management of dry eye disease. A number of systems contribute to the physiological integrity of the ocular surface and disruption of system may or may not produce symptoms. Therefore accurate diagnosis of dry eyes with no or minimal disruption of physiological function is necessary. The paper also discusses different colloidal drug delivery systems and current challenges in the development of topical ophthalmic drug delivery systems for treatment of KCS. Due to the wide prevalence and number of factors involved, newer, more sensitive diagnostic techniques and novel therapeutic agents have been developed to provide ocular delivery systems with high therapeutic efficacy. The aim of this review is to provide awareness among the patients, health care professionals, and researchers about diagnosis and treatment of KCS and recent developments and future challenges in management of dry eye disease.
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Chang M, Lee H, Park MS, Baek S. The clinical characteristics and new classification of sticky eyelid syndrome in East Asian patients. Acta Ophthalmol 2014; 92:e667-70. [PMID: 24919521 DOI: 10.1111/aos.12439] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 04/11/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to demonstrate the characteristics of sticky eyelid syndrome (SES) and to suggest a modified definition and new classification of the disease in relation to the severity of the syndrome in East Asian patients. METHODS Forty-four eyes of 31 patients with sticky eyelid syndrome were included in this study. The medical records of patients who were diagnosed with sticky eyelid syndrome were retrospectively reviewed. Sticky eyelid syndrome was defined as an abnormal adhesion between the upper and lower eyelids during blinking. We divided the subjects into four grades according to the severity of the disease. RESULTS Among 31 patients, there were 10 men and 21 women. The mean age of patients was 62.5 years. A total of 13 patients had SES bilaterally. All patients had meibomian gland dysfunction (MGD). Thirty-three eyes had dermatochalasis, and 30 eyes had involutional ptosis. Horizontal lower lid laxity was observed in 23 eyes, and reverse ptosis found in 15 eyes. Patients were classified into four groups as follows: G1: 11 (25%), G2: 24 (54.5%), G3: 6 (13.6%) and G4: 3 eyes (6.8%). Patients in Grade 1 tended to improve only with medical treatment for MGD. However, surgical management was necessary for patients in Grades 3 and 4. CONCLUSIONS Meibomian gland dysfunction is a fundamental risk factor for developing sticky eyelid syndrome. Further, combined upper lid ptosis or lower lid laxity may be aggravating factors. According to the grading, medical or surgical management can be chosen.
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Affiliation(s)
- Minwook Chang
- Department of Ophthalmology; Dongguk University Ilsan Hospital; Goyang Korea
| | - Hwa Lee
- Department of Ophthalmology; Korea University College of Medicine; Seoul Korea
| | - Min Soo Park
- Department of Ophthalmology; KEPCO Medical Center; Seoul Korea
| | - Sehyun Baek
- Department of Ophthalmology; Korea University College of Medicine; Seoul Korea
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Baudouin C. [Revisiting meibomian gland dysfunction]. J Fr Ophtalmol 2014; 37:757-62. [PMID: 25455142 DOI: 10.1016/j.jfo.2014.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 09/28/2014] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
Abstract
Meibomian gland dysfunctions (MGD) are frequent affections, sometimes asymptomatic, more often responsible for disabling, potentially severe, manifestations. MGD is indeed the most frequent cause of dry eye, through the induction of tear film instability. However, eyelid inflammation, microbial proliferation that modifies melting temperature of meibum, frequent association with skin diseases, as well as potentially severe corneal complications make them complex multifactorial disorders. Complementary mechanisms combine to actually result in a vicious circle, or more accurately a double vicious cycle. The first one is self-stimulated by the microbiological changes, which create their own conditions for MGD development. The second one is related to tear film instability that results from MGD and is also self-stimulated through hyperosmolarity and inflammatory phenomena, which are both consequence and cause of dry eye. We herein propose a new pathophysiological schema on MGD, in order to better identify mechanisms and more efficiently target therapeutics.
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Affiliation(s)
- C Baudouin
- Centre hospitalier national d'ophtalmologie des Quinze-Vingts, DHU ViewMaintain, Inserm-DHOS CIC 1423, 28, rue de Charenton, 75012 Paris, France; Inserm, U968, 75012 Paris, France; Sorbonne universités, UPMC - université Paris 06, UMR_S 968, institut de la vision, 75012 Paris, France; CNRS, UMR_7210, 75012 Paris, France; Hôpital Ambroise-Paré, AP-HP, université Versailles - Saint-Quentin-en-Yvelines, 92100 Versailles, France.
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Vehof J, Wang B, Kozareva D, Hysi PG, Snieder H, Hammond CJ. The heritability of dry eye disease in a female twin cohort. Invest Ophthalmol Vis Sci 2014; 55:7278-83. [PMID: 25249607 DOI: 10.1167/iovs.14-15200] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE We estimated the relative importance of genes and environment in dry eye disease (DED) using a classic twin study. METHODS A large sample of 3930 female monozygotic and dizygotic twins from the UK Adult Twin Registry (TwinsUK) was questioned about the presence of a DED diagnosis and about DED symptoms in the preceding 3 months. In addition, a subset of 606 twins was examined for several dry eye signs. Genetic and environmental effects were estimated using maximum likelihood structural equation modeling. RESULTS All DED outcome variables showed higher correlation in monozygotic twin pairs than in dizygotic twin pairs, suggesting genes have a contributory role in DED. The DED symptoms showed a heritability of 29% (95% confidence interval [CI], 18%-40%). A clinician's diagnosis of DED with concurrent use of artificial tears showed a heritability of 41% (95% CI, 26%-56%). Estimates of the heritability of DED signs were 25% (95% CI, 7%-42%) for interblink interval, 58% (95% CI, 43%-70%) for Schirmer value, 40% (95% CI, 25%-53%) for tear osmolarity, and 78% (95% CI, 59%-90%) for the presence of blepharitis. The unique environment explained the remainder of the variance. We found no significant heritability for tear breakup time. CONCLUSIONS Genetic factors contribute moderately to the diagnosis, symptoms, and the signs of DED. Compared to other ocular phenotypes, the lower heritability might reflect some of the difficulties in objective phenotyping of DED in a population-based sample. However, future genetic studies are now justified and may help in unraveling the pathophysiology of DED.
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Affiliation(s)
- Jelle Vehof
- Department of Twin Research & Genetic Epidemiology, King's College London, St. Thomas' Hospital, London, United Kingdom
| | - Bin Wang
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Diana Kozareva
- Department of Twin Research & Genetic Epidemiology, King's College London, St. Thomas' Hospital, London, United Kingdom
| | - Pirro G Hysi
- Department of Twin Research & Genetic Epidemiology, King's College London, St. Thomas' Hospital, London, United Kingdom
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Christopher J Hammond
- Department of Twin Research & Genetic Epidemiology, King's College London, St. Thomas' Hospital, London, United Kingdom Department of Ophthalmology, King's College London, St. Thomas' Hospital, London, United Kingdom
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Wu H, Wang Y, Dong N, Yang F, Lin Z, Shang X, Li C. Meibomian gland dysfunction determines the severity of the dry eye conditions in visual display terminal workers. PLoS One 2014; 9:e105575. [PMID: 25144638 PMCID: PMC4140788 DOI: 10.1371/journal.pone.0105575] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 07/21/2014] [Indexed: 11/18/2022] Open
Abstract
Objective To explore meibomian gland dysfunction (MGD) may determine the severity of dry eye conditions in visual display terminal (VDT) workers. Methodology Prospective, case-control study carried out in China.106 eyes of 53 patients (VDT work time >4 hour per day) were recruited as the Long time VDT group; 80 eyes of 40 control subjects (VDT work time ≤4 hour per day) served as the Short time VDT group. A questionnaire of Ocular Surface Disease Index (OSDI) and multiple tests were performed. Three dry eye tests: tear film breakup time (BUT), corneal fluorescein staining, Schirmer I test; and three MGD parameters: lid margin abnormality score, meibum expression assessment (meibum score), and meibomian gland dropout degree (meiboscore) using Keratograph 5 M. Principal Findings OSDI and corneal fluorescein score were significantly higher while BUT was dramatically shorter in the long time VDT group than the short time VDT group. However, the average of Schirmer tear volumes was in normal ranges in both groups. Interestingly, the three MGD parameters were significantly higher in the long time VDT group than the short time one (P<0.0001). When 52 eyes with Schirmer <10 mm and 54 eyes with Schirmer ≥10 mm were separated from the long time VDT workers, no significant differences were found between the two subgroups in OSDI, fluorescein staining and BUT, as well as the three MGD parameters. All three MGD parameters were positively correlated with VDT working time (P<0.0001) and fluorescein scores (P<0.0001), inversely correlated with BUT (P<0.05), but not correlated with Schirmer tear volumes in the VDT workers. Conclusions Our findings suggest that a malfunction of meibomian glands is associated with dry eye patients in long term VDT workers with higher OSDI scores whereas some of those patients presenting a normal tear volume.
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Affiliation(s)
- Huping Wu
- Xiamen Eye Center of Xiamen University, Xiamen, Fujian, China
- * E-mail:
| | - Yuqian Wang
- Xiamen Eye Center of Xiamen University, Xiamen, Fujian, China
| | - Nuo Dong
- Xiamen Eye Center of Xiamen University, Xiamen, Fujian, China
| | - Fan Yang
- Xiamen Eye Center of Xiamen University, Xiamen, Fujian, China
| | - Zhirong Lin
- Xiamen Eye Center of Xiamen University, Xiamen, Fujian, China
| | - Xumin Shang
- Xiamen Eye Center of Xiamen University, Xiamen, Fujian, China
| | - Cheng Li
- Xiamen Eye Center of Xiamen University, Xiamen, Fujian, China
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Aging: a predisposition to dry eyes. J Ophthalmol 2014; 2014:781683. [PMID: 25197560 PMCID: PMC4150485 DOI: 10.1155/2014/781683] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 07/23/2014] [Accepted: 07/31/2014] [Indexed: 01/28/2023] Open
Abstract
Dry eye syndrome is a disease of the ocular surface and tear film that is prevalent in older adults. Even though the degree of visual acuity loss in dry eye patients is commonly mild-to-moderate, in the aging population, this minimal change in visual status can lead to a significant decrease in visual function and quality of life. A healthy ocular surface is maintained by appropriate tear production and tear drainage, and deficiencies in this delicate balance can lead to dryness. In the aging eye, risk factors such as polypharmacy, androgen deficiency, decreased blink rates, and oxidative stress can predispose the patient to developing dry eye that is frequently more severe, has higher economic costs, and leads to worse consequences to the well-being of the patient. Understanding why elderly patients are at higher risk for developing dry eyes can provide insights into the diagnosis and management of the growing number of older adults struggling with dry eye and minimize the burden of disease on our aging population.
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Azcarate PM, Venincasa VD, Feuer W, Stanczyk F, Schally AV, Galor A. Androgen deficiency and dry eye syndrome in the aging male. Invest Ophthalmol Vis Sci 2014; 55:5046-53. [PMID: 24994872 DOI: 10.1167/iovs.14-14689] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To evaluate the relationship between androgen levels and subjective and objective measures of dry eye syndrome (DES). METHODS A total of 263 male patients from the Miami Veterans Affairs Medical Center eye clinic aged ≥50 were recruited for this prospective cross-sectional study. Patients completed Dry Eye Questionnaire 5, underwent tear film evaluation, and had serum androgen levels measured. The correlations between androgen levels, DES composite scores, DES symptoms, and global, lipid, and aqueous tear film parameters were evaluated. RESULTS Two hundred sixty-three patients with a mean age of 69 (50-95) were examined. There was no linear association between composite DES scores (generated using latent class analysis) and androgen levels. However, eyes with high DES scores (0.95-1.0) had higher levels of sex hormone-binding globulin (P = 0.03) and lower levels of dehydroepiandrosterone sulfate (DHEAS) (P = 0.02), androstenedione (A) (P = 0.02), and androstane-3α,17β-diol glucuronide (P = 0.03) compared to eyes with intermediate (0.05-0.95) or low (0-0.05) scores. There were no strong correlations between tear film measures and androgen levels. Regarding global parameters, a weak inverse correlation was found between corneal staining and A (r = -0.17, P = 0.009). For lipid parameters, a weak correlation existed between tear breakup time (TBUT) and A (r = 0.15, P = 0.02). When considering aqueous and lipid deficiency independently, the association between TBUT and A existed only with aqueous tear deficiency (r = 0.66, P = 0.002). Regarding aqueous parameters, a weak correlation existed between Schirmer test and DHEAS (r = 0.13, P = 0.047) and A (r = 0.21, P = 0.001). CONCLUSIONS There was a weak correlation between higher levels of androstenedione and healthier global, lipid, and aqueous tear film parameters.
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Affiliation(s)
- Patrick M Azcarate
- Miami Veterans Administration Medical Center, Miami, Florida, United States Bascom Palmer Eye Institute, University of Miami, Miami, Florida, United States
| | - Vincent D Venincasa
- Miami Veterans Administration Medical Center, Miami, Florida, United States Bascom Palmer Eye Institute, University of Miami, Miami, Florida, United States
| | - William Feuer
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, United States
| | - Frank Stanczyk
- Departments of Obstetrics and Gynecology and Preventive Medicine, University of Southern California, Los Angeles, California, United States
| | - Andrew V Schally
- Department of Pathology Department of Medicine Divisions of Oncology and Endocrinology, University of Miami, Miami, Florida, United States
| | - Anat Galor
- Miami Veterans Administration Medical Center, Miami, Florida, United States Bascom Palmer Eye Institute, University of Miami, Miami, Florida, United States
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50
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Pinna A, Blasetti F, Zinellu A, Carru C, Solinas G. Meibomian Gland Dysfunction and Hypercholesterolemia. Ophthalmology 2013; 120:2385-2389. [DOI: 10.1016/j.ophtha.2013.05.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 04/27/2013] [Accepted: 05/01/2013] [Indexed: 10/26/2022] Open
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