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Kim B, Lee Y, Son HS, Choi CY. Clinical outcomes of conjunctivochalasis treatment with a new ophthalmic radiofrequency device. BMC Ophthalmol 2024; 24:302. [PMID: 39039541 PMCID: PMC11265150 DOI: 10.1186/s12886-024-03499-2] [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: 12/09/2023] [Accepted: 05/27/2024] [Indexed: 07/24/2024] Open
Abstract
PURPOSE To investigate the safety and efficacy of a new micro-controlled radiofrequency device for treatment of conjunctivochalasis (Cch). METHODS Data of 127 patients (230 eyes) who underwent ophthalmic radiofrequency treatment for Cch from January 2020 to June 2023 were analyzed retrospectively. Cch coagulation was performed with a radiofrequency electrode tip (OcuRF®, Ilooda, Korea) and a high-frequency radio-wave electric unit (0.6 ~ 0.8 watts, 2 MHz, Acutron™, Ilooda, Korea). Pre- and postoperative Cch grading, slit-lamp photography, tear film break-up time (TBUT), and bulbar conjunctival hyperemia using Keratograph 5 M (Oculus, Wetzlar, Germany) were evaluated. Cch grade 0 or 1 after surgery was regarded as 'success'. Complications, recurrence, and additional treatment rates were analyzed. RESULTS In 227 (98.7%) eyes, the radiofrequency treatment led to marked improvement of Cch, with 224 (97.4%) eyes achieving grade 0 or 1 at 2 months postoperatively. Eight eyes (3.5%) received additional treatment. TBUT improved from 3.17 ± 0.82 s to 5.28 ± 1.10 s after surgery (P < 0.001). The total bulbar conjunctival hyperemia value showed an improvement from 1.7 ± 0.6 to 1.4 ± 0.6 postoperatively (P < 0.05). No serious complications were observed. CONCLUSION The novel ophthalmic radiofrequency device led to a marked improvement of Cch with no serious adverse events during the entire follow-up period. Our results suggest that the radiofrequency device presents a safe and efficacious treatment option for Cch.
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Affiliation(s)
- Bokyung Kim
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yongwoo Lee
- Department of Ophthalmology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Hyeck-Soo Son
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Chul Young Choi
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Kaido M, Arita R. Effects of a Long-Acting Diquafosol Ophthalmic Solution on the Ocular Surface, Tolerability, and Usability in Dry Eye Disease. Adv Ther 2024; 41:2477-2485. [PMID: 38709396 DOI: 10.1007/s12325-024-02871-4] [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: 02/06/2024] [Accepted: 04/05/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION This study aimed to investigate the tolerability of high-viscosity diquafosol tetrasodium (DQS) ophthalmic solution (DIQUAS LX; DQSLX) and examine its usability and effect on clinical findings in patients with dry eye disease (DED). METHODS This interventional retrospective study included 66 eyes of 66 patients with DED who switched from conventional DQS to DQSLX ophthalmic solution. Tear function assessments (tear film breakup time [BUT], keratoconjunctival vital staining [VS] score), evaluations of DED symptom relief, and a four-item usability questionnaire ("comfort upon instillation," "irritation upon instillation," "eye mucus discharge," "convenience of instillation frequency") assessed using a visual analog scale from 0 (worst) to 10 (best) were administered 4 weeks after switching to DQSLX. Factors associated with drug tolerability were assessed using multiple regression analysis. RESULTS The symptoms improved by 64.2% after switching to DQSLX. The BUT value, VS score, and the questionnaire items "comfort upon instillation" and "convenience of instillation frequency" were significantly improved after switching to DQSLX. DQSLX tolerability was reported as acceptable in 56 (84.8%) and unacceptable in 10 (15.2%) patients. Overall, DQSLX tolerability was significantly associated with "comfort upon instillation" and "convenience of instillation frequency" and tended to be associated with a VS score ≥ 1. DQSLX tolerability depended on symptom and VS score improvements and absence of excessive "eye mucus discharge" in patients with a VS score ≥ 1 (39 patients), but on "comfort upon instillation" and absence of excessive "eye mucus discharge" in patients with a VS score = 0 (27 patients). CONCLUSION The high-viscosity DQSLX ophthalmic solution was generally considered acceptable in the study population. However, drug tolerability seemingly differed between patients with DED with and without epithelial damage. The former were affected by improvements in symptoms and clinical findings, whereas the latter were affected by comfort upon instillation. TRIAL REGISTRATION University Hospital Medical Information Network identifier, UMIN000051390.
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Affiliation(s)
- Minako Kaido
- Wada Eye Clinic, Houjyo 2578-27, Tateyama-shi, Chiba, 294-0045, Japan.
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Ballesteros-Sánchez A, Sánchez-González JM, Borrone MA, Borroni D, Rocha-de-Lossada C. The Influence of Lid-Parallel Conjunctival Folds and Conjunctivochalasis on Dry Eye Symptoms with and Without Contact Lens Wear: A Review of the Literature. Ophthalmol Ther 2024; 13:651-670. [PMID: 38217793 PMCID: PMC10853109 DOI: 10.1007/s40123-023-00877-9] [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: 10/30/2023] [Accepted: 12/18/2023] [Indexed: 01/15/2024] Open
Abstract
INTRODUCTION Lid-parallel conjunctival folds (LIPCOF) and conjunctivochalasis (CCH) are similar conditions that seem to be related to dry eye severity. In addition, there is a lack of studies on the topic of LIPCOF and CCH on dry eye symptoms in non-contact lens and contact lens (CL) wearers. Therefore, the aim of this study is to review the relationship of LIPCOF and CCH with dry eye symptoms in non-CL and CL wearers, as well as to report the treatment of dry eye disease (DED) in non-CL and CL wearers who present LIPCOF or CCH. METHODS A literature review of full-length original studies in two databases, PubMed and Scopus, was performed. The search period included observational studies in humans published between April 21, 2009 and March 20, 2023. RESULTS A total of 26 studies were included. The studies suggest that LIPCOF and CCH are significantly related to dry eye symptoms in non-CL and CL wearers. However, the impact of CL wear on LIPCOF and CCH may be complex and may vary depending on individual factors such as lens type, lens care regimen, and pre-existing ocular conditions. Regarding LIPCOF management, tear substitutes seem to significantly reduce LIPCOF and dry eye symptoms in non-CL wearers, while vectored thermal pulsation (VTP) and microblepharoexfoliation (MBE) are suggested as promising treatment for LIPCOF and dry eye symptoms in CL wearers. Regarding CCH management, surgical interventions may be effective in reducing CCH when medical treatments have no response. In addition, an ocular examination by slit lamp is necessary to distinguish both conditions. CONCLUSIONS Tear substitutes, VTP, MBE, and fitting CLs with low coefficient of friction (CoF) seem to reduce and prevent LIPCOF. However, surgical treatment options seem to be more effective in the complete elimination of CCH. An adequate evaluation and differentiation between LIPCOF and CCH are important, and they should be considered by practitioners in managing dry eye symptoms in non-CL and CL wearers.
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Affiliation(s)
- Antonio Ballesteros-Sánchez
- Department of Physics of Condensed Matter, Optics Area, University of Seville, Reina Mercedes Street, Seville, Spain.
- Department of Ophthalmology, Clínica Novovisión, Murcia, Spain.
| | - José-María Sánchez-González
- Department of Physics of Condensed Matter, Optics Area, University of Seville, Reina Mercedes Street, Seville, Spain
| | - María Agustina Borrone
- Department of Ophthalmology, Hospital General de Agudos Dr Ignacio Pirovano, Buenos Aires, Argentina
| | - Davide Borroni
- Department of Doctoral Studies, Riga Stradins University, Riga, 1007, Latvia
- Advalia Vision, Cornea Research Unit, 20145, Milan, Italy
| | - Carlos Rocha-de-Lossada
- Qvision, Ophthalmology Department, VITHAS Almeria Hospital, 04120, Almeria, Spain
- Ophthalmology Department, VITHAS Malaga, 29016, Malaga, Spain
- Regional University Hospital of Malaga, Hospital Civil Square, 29009, Malaga, Spain
- Surgery Department, Ophthalmology Area, University of Seville, Doctor Fedriani, 41009, Seville, Spain
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Parikh AO, Conger JR, Li J, Sibug Saber M, Chang JR. A Review of Current Uses of Amniotic Membrane Transplantation in Ophthalmic Plastic and Reconstructive Surgery. Ophthalmic Plast Reconstr Surg 2024; 40:134-149. [PMID: 38427832 DOI: 10.1097/iop.0000000000002494] [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: 03/03/2024]
Abstract
PURPOSE To review and summarize the existing literature on the clinical applications of amniotic membrane transplantation (AMT) in ophthalmic plastic and reconstructive surgery. METHODS A literature review was conducted on the PubMed database using the following search terms: "amniotic membrane" and "eyelid" or "orbit" or "fornix" or "socket" or "lacrimal". RESULTS In total 516 articles resulted from the search, of which 62 were included. Numerous cases and case series have been published on the use of amniotic membrane transplantation for ocular surface reconstruction, eyelid and forniceal reconstruction, and cicatricial eyelid abnormalities. Surgical methods of securing the graft vary. Few comparative studies exist; some show a similar or improved result when compared to oral mucous membrane grafting for certain indications. CONCLUSIONS Amniotic membrane transplantation can be a useful tool for the oculoplastic surgeon when faced with a case requiring reconstruction of the posterior lamellae, particularly in patients without other graft donor sites available, and uses of AMT continue to expand. Additional studies directly comparing AMT to other reconstructive techniques would be helpful in choosing between the available surgical techniques and standardizing best practices.
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Affiliation(s)
- Alomi O Parikh
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Jordan R Conger
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Joy Li
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Maria Sibug Saber
- Department of Pathology, Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, U.S.A
| | - Jessica R Chang
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
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Aslan Bayhan S, Erkan E, Bozbay Erkan F, Bayhan HA. Clinical correlations and ımpact of conjunctivochalasis in soft contact lens wearers. Int Ophthalmol 2024; 44:39. [PMID: 38334808 DOI: 10.1007/s10792-024-02936-x] [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: 02/21/2023] [Accepted: 12/17/2023] [Indexed: 02/10/2024]
Abstract
PURPOSE To evaluate the correlation between clinical tests, patient symptoms, and conjunctivochalasis in contact lens wearers and non-wearers. METHODS This study comprised 40 eyes of 40 current soft contact lens users and 40 eyes of 40 control subjects. Cross-sectional areas of conjunctivochalasis at three locations (nasal, central, temporal) during straight and downward gazes were determined using anterior segment optical coherence tomography in all participants. Tear film break up time test and Schirmer test with anesthesia were performed and for evaluation of symptoms, the participants completed ocular surface disease index questionnaire. RESULTS During straight gaze, the mean cross-sectional areas of conjunctivochalasis were 0.0112 ± 0.009 and 0.006 ± 0.005 mm2 at nasal, 0.0096 ± 0.007 and 0.002 ± 0.004 mm2 at central, 0.0176 ± 0.014 and 0.008 ± 0.009 mm2 at temporal in contact lens and control groups, respectively. Regardless of location and gaze direction, the mean cross-sectional conjunctivachalasis areas of the contact lens group were significantly higher than those of the controls (all, p < 0.05). Significant positive correlations between ocular surface disease index score and measured conjunctivachalasis areas (in all sites) during straight gaze and downward gaze were observed in the contact lens group (all, p < 0.05 and r > 0.450). CONCLUSION Wearing soft contact lenses is associated with increased conjunctivochalasis areas. Anterior segment optical coherence tomography determined conjunctivochalasis area is an objective clinical measurement value that is positively correlated with patients' symptoms in soft contact lens wearers.
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Affiliation(s)
- Seray Aslan Bayhan
- Ophthalmology Department, Faculty of Medicine, Yozgat Bozok University, Adnan Menderes Bulvarı, Yozgat, Turkey.
| | - Eyüp Erkan
- Ophthalmology Department, Faculty of Medicine, Yozgat Bozok University, Adnan Menderes Bulvarı, Yozgat, Turkey
| | - Fatma Bozbay Erkan
- Ophthalmology Department, Faculty of Medicine, Yozgat Bozok University, Adnan Menderes Bulvarı, Yozgat, Turkey
| | - Hasan Ali Bayhan
- Ophthalmology Department, Faculty of Medicine, Yozgat Bozok University, Adnan Menderes Bulvarı, Yozgat, Turkey
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Jeong Y, Kang S, Seo K. Comparative evaluation of corneal and limbal epithelial thickness in brachycephalic dogs with and without corneal diseases using spectral domain optical coherence tomography. Vet Ophthalmol 2024; 27:30-39. [PMID: 37118910 DOI: 10.1111/vop.13102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/21/2023] [Accepted: 04/11/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVE To evaluate alterations in epithelial thickness during corneal degeneration, corneal pigmentation, and additional features observed through spectral-domain optical coherence tomography (SD-OCT) in brachycephalic dogs. ANIMALS AND PROCEDURES The study used 55 eyes from 49 brachycephalic dogs that underwent OCT-containing ophthalmic examinations. The examined eyes were classified into corneal degeneration, corneal pigmentation, and normal groups according to corneal lesions. For each eye, corneal epithelial thickness (CET) in the central cornea and maximum limbal epithelial thickness (maxLET) in 4 quadrants of limbus (superior, inferior, nasal, and temporal) were measured from OCT images. Additional abnormal findings on OCT images, including irregular epithelium, subepithelial hyperreflectivity, and conjunctivochalasis, were also recorded. RESULTS The corneal degeneration group had significantly thinner nasal and temporal maxLETs than that of the normal group (p < .001). In the central corneal OCT image of the corneal degeneration group, an irregular epithelium was observed in 70.6% and subepithelial hyperreflectivity in 82.4%, both of which were significantly higher than the normal group (p < .001). In a comparative analysis, the nasal, temporal, and inferior maxLETs were significantly thinner in the corneal pigmentation group than those in the normal group (p < .001, p < .001, and p = .01, respectively). CONCLUSIONS Morphological changes in the limbal epithelium were observed in dogs with corneal degeneration and corneal pigmentation. LET reduction could be associated with their pathogenesis and would be valuable as an additional parameter for corneal diseases.
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Affiliation(s)
- Youngseok Jeong
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Korea
| | - Seonmi Kang
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Korea
| | - Kangmoon Seo
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Korea
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Feng J, Liu Y, Ren Y, Shi W, Kang H, Tan Y, Wu R, Zhang G, He Y. Evaluation of Dry Eye Severity and Ocular Surface Inflammation in Patients with Pemphigus and Pemphigoid. Ocul Immunol Inflamm 2024; 32:62-70. [PMID: 36637982 DOI: 10.1080/09273948.2022.2154680] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/29/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE To evaluate ocular surface involvement, tear cytokine levels, and histopathological changes in pemphigus and pemphigoid patients. METHODS A total of 22 patients (15 pemphigus and 7 pemphigoids) and 21 non-diseased controls were enrolled in our study. All participants underwent ocular surface evaluation, which included ocular surface disease index test, slit lamp observation, dry eye-related examination, tear multicytokine analysis, and conjunctival impression cytology. RESULTS Pemphigus and pemphigoid patients presented much more severe conjunctivochalasis, corneal epithelial defects, corneal opacity, symblepharon and dry eye. Severe ocular surface squamous metaplasia and a significant increase of tear macrophage inflammatory protein-1beta, tumor necrosis factor-alpha, interleukin (IL)-1β, IL -6, and IL-8 occurred in pemphigus and pemphigoid patients. CONCLUSIONS Our results revealed that ocular surface inflammation and dry eye persist in most pemphigus and pemphigoid patients, and do not occur in parallel with the systemic course. Regular ophthalmological examinations and local anti-inflammatory should be provided for pemphigus and pemphigoid patients.
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Affiliation(s)
- Jianing Feng
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Ophthalmology, Hunan Clinical Research Center of Ophthalmic Disease, Changsha, Hunan, China
- Xi'an People's Hospital (Xi'an Fourth Hospital), Shaanxi Eye Hospital, Northwest University Affiliated People's Hospital, Xi'an, Shaanxi Province, China
| | - Yingyi Liu
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Ophthalmology, Hunan Clinical Research Center of Ophthalmic Disease, Changsha, Hunan, China
| | - Yuerong Ren
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Ophthalmology, Hunan Clinical Research Center of Ophthalmic Disease, Changsha, Hunan, China
| | - Wen Shi
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Ophthalmology, Hunan Clinical Research Center of Ophthalmic Disease, Changsha, Hunan, China
| | - Huanmin Kang
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Ophthalmology, Hunan Clinical Research Center of Ophthalmic Disease, Changsha, Hunan, China
| | - Yixin Tan
- Department of Dermatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ruifang Wu
- Department of Dermatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guiying Zhang
- Department of Dermatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yan He
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Ophthalmology, Hunan Clinical Research Center of Ophthalmic Disease, Changsha, Hunan, China
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Goguen CJ, Aouane A, Choulakian MY. Evaluating the impact of conjunctival cauterization for the treatment of conjunctivochalasis on patient-reported symptoms and satisfaction. J Fr Ophtalmol 2023; 46:e278-e280. [PMID: 37149459 DOI: 10.1016/j.jfo.2023.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/12/2023] [Accepted: 01/19/2023] [Indexed: 05/08/2023]
Affiliation(s)
- C J Goguen
- Université de Sherbrooke, CHUS Hôtel-Dieu, Sherbrooke, 580, rue Bowen S, Sherbrooke, QC J1G 2E8, Canada.
| | - A Aouane
- Université de Sherbrooke, CHUS Hôtel-Dieu, Sherbrooke, 580, rue Bowen S, Sherbrooke, QC J1G 2E8, Canada
| | - M Y Choulakian
- Université de Sherbrooke, CHUS Hôtel-Dieu, Sherbrooke, 580, rue Bowen S, Sherbrooke, QC J1G 2E8, Canada
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Xiang M, Liu J, Ma K, Sha Y, Zhan Y, Zhang W, Kong X. The mechanism of Qijing Mingmu decoction on cellular senescence of conjunctivochalasis. BMC Complement Med Ther 2023; 23:302. [PMID: 37644481 PMCID: PMC10466834 DOI: 10.1186/s12906-023-04138-x] [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: 06/03/2022] [Accepted: 08/23/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Qijing Mingmu decoction (QJMM), a compound Chinese medicine preparation, which consists of Lycium barbarum, Polygonatum, Ophiopogon japonicus, Poria cocos, Glycyrrhiza, Eclipta prostrata and Ligusticum striatum, has been confirmed to be effective for the treatment of conjunctivochalasis (CCH) in clinic and reduce cellular senescence. However, the underlying mechanism is still unknown. Our previous study revealed that p38-mediated cellular senescence contributed to the pathogenesis of CCH. METHODS To explore whether p38 might be the potential therapeutic target of QJMM for CCH, CCH fibroblasts were treated with QJMM granule and then the effect of QJMM granule on the expression and promoter activity of p38α was determined by western blot and dual luciferase reporter gene assay, respectively. Meanwhile, the influence of QJMM granule on cell proliferation, oxidative stress, cellular senescence and the expression of the cellular senescence-associated genes were measured by corresponding methods. RESULTS QJMM granule significantly decreased the protein expression of p38α and p-p38α in CCH fibroblasts in a dose-dependent manner and inhibited p38α promoter activity. QJMM granule as well as the p38 inhibitor SB203580 reduced the level of reactive oxygen species and increased the activity of superoxide dismutase in CCH fibroblasts. QJMM granule and SB203580 promoted cell proliferation and reduced the percentage of SA-β-Gal-positive cells. The mRNA and protein expression of p53 and p21 was remarkably down-regulated by QJMM granule as well as SB203580 and that of SMP30 was up-regulated in CCH fibroblasts. CONCLUSIONS Our findings demonstrated that QJMM granule was effective for alleviating cellular senescence of CCH fibroblasts by p38 MAPK signaling and the followed p53/p21 signaling.
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Affiliation(s)
- Minhong Xiang
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, No.164 Lanxi Road, Shanghai, 200062, P.R. China.
- Shanghai Putuo Central School of Clinical Medicine, Anhui Medical University, Hefei, 230032, China.
| | - Jiang Liu
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, No.164 Lanxi Road, Shanghai, 200062, P.R. China
| | - Kai Ma
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, No.164 Lanxi Road, Shanghai, 200062, P.R. China
| | - Yongyi Sha
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, No.164 Lanxi Road, Shanghai, 200062, P.R. China
| | - Yueping Zhan
- Department of Central Lab, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, China
| | - Wei Zhang
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, No.164 Lanxi Road, Shanghai, 200062, P.R. China
| | - Xueqing Kong
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, No.164 Lanxi Road, Shanghai, 200062, P.R. China
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Mo LJ, Wang HM, Zhou HM, Huang L, Gui YX, Li QS. Collagen changes in rabbit conjunctiva after conjunctival crosslinking. Open Life Sci 2023; 18:20220604. [PMID: 37250838 PMCID: PMC10224626 DOI: 10.1515/biol-2022-0604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/15/2023] [Accepted: 03/27/2023] [Indexed: 05/31/2023] Open
Abstract
This study aims to determine the ultrastructural changes in collagen fibrils in rabbit conjunctiva after conjunctival crosslinking using riboflavin and ultraviolet A (UVA) light at an irradiation intensity of 45 mW/cm2. Conjunctival crosslinking may increase conjunctival stiffness. The supertemporal quadrants of the right eyes of 24 adult rabbits were treated with a topical riboflavin solution (0.25%) before irradiation with UVA light at 45 mW/cm2 for 4 min. After 3 weeks, the collagen fibrils in fibril bundles were examined by electron microscopy. Immunohistochemical staining was used to detect the expression levels of collagen I and collagen III in the rabbits' conjunctiva. The diameter of the collagen fibrils in the fibril bundles varied slightly, ranging from 30 to 60 nm in the conjunctival stroma of the control group. In the treatment group, the diameter of collagen fibrils ranged from 60 to 90 nm. The thickest collagen fibrils were observed in the treatment group (up to 90 nm in diameter). In contrast, those in the conjunctival stroma of the control group were considerably smaller (up to 60 nm in diameter). However, thicknesses of collagen fibrils displayed a unimodal distribution. Both collagen I and collagen III increased after treatment with riboflavin and UVA light irradiation at 45 mW/cm2. The data indicate that in rabbits, conjunctival crosslinking with riboflavin and UVA light at 45 mW/cm2 for 4 min is safe and does not induce ultrastructural alterations of the conjunctival cells. The conjunctival crosslinking with riboflavin and UVA light at 45 mW/cm2 can increase the diameter of collagen fibrils, but the average densities of collagen I and collagen III have no statistical significance.
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Affiliation(s)
- Li-Juan Mo
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, No. 164 Lanxi Road, Putuo District, Shanghai200062, China
| | - Han-Min Wang
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, No. 164 Lanxi Road, Putuo District, Shanghai200062, China
| | - Huan-Ming Zhou
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, No. 164 Lanxi Road, Putuo District, Shanghai200062, China
| | - Li Huang
- Department of Gerontology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan-Xiang Gui
- Department of Gerontology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qing-Song Li
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, No. 164 Lanxi Road, Putuo District, Shanghai200062, China
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Stapleton F, Abad JC, Barabino S, Burnett A, Iyer G, Lekhanont K, Li T, Liu Y, Navas A, Obinwanne CJ, Qureshi R, Roshandel D, Sahin A, Shih K, Tichenor A, Jones L. TFOS lifestyle: Impact of societal challenges on the ocular surface. Ocul Surf 2023; 28:165-199. [PMID: 37062429 PMCID: PMC10102706 DOI: 10.1016/j.jtos.2023.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/18/2023]
Abstract
Societal factors associated with ocular surface diseases were mapped using a framework to characterize the relationship between the individual, their health and environment. The impact of the COVID-19 pandemic and mitigating factors on ocular surface diseases were considered in a systematic review. Age and sex effects were generally well-characterized for inflammatory, infectious, autoimmune and trauma-related conditions. Sex and gender, through biological, socio-economic, and cultural factors impact the prevalence and severity of disease, access to, and use of, care. Genetic factors, race, smoking and co-morbidities are generally well characterized, with interdependencies with geographical, employment and socioeconomic factors. Living and working conditions include employment, education, water and sanitation, poverty and socioeconomic class. Employment type and hobbies are associated with eye trauma and burns. Regional, global socio-economic, cultural and environmental conditions, include remoteness, geography, seasonality, availability of and access to services. Violence associated with war, acid attacks and domestic violence are associated with traumatic injuries. The impacts of conflict, pandemic and climate are exacerbated by decreased food security, access to health services and workers. Digital technology can impact diseases through physical and mental health effects and access to health information and services. The COVID-19 pandemic and related mitigating strategies are mostly associated with an increased risk of developing new or worsening existing ocular surface diseases. Societal factors impact the type and severity of ocular surface diseases, although there is considerable interdependence between factors. The overlay of the digital environment, natural disasters, conflict and the pandemic have modified access to services in some regions.
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Affiliation(s)
- Fiona Stapleton
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia.
| | - Juan Carlos Abad
- Department of Ophthalmology, Antioquia Ophthalmology Clinic-Clofan, Medellin, Antioquia, Colombia
| | - Stefano Barabino
- ASST Fatebenefratelli-Sacco, Ospedale L. Sacco-University of Milan, Milan, Italy
| | - Anthea Burnett
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia
| | - Geetha Iyer
- C. J. Shah Cornea Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Kaevalin Lekhanont
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tianjing Li
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Yang Liu
- Ophthalmology Department, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Alejandro Navas
- Conde de Valenciana, National Autonomous University of Mexico UNAM, Mexico City, Mexico
| | | | - Riaz Qureshi
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Danial Roshandel
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, WA, Australia
| | - Afsun Sahin
- Department of Ophthalmology, Koc University Medical School, İstanbul, Turkey
| | - Kendrick Shih
- Department of Ophthalmology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Anna Tichenor
- School of Optometry, Indiana University, Bloomington, IN, USA
| | - Lyndon Jones
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
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Comparison of Efficacy and Inflammatory Response to Thermoconjunctivoplasty Performed with Cautery or Pulsed 1460 nm Laser. Int J Mol Sci 2023; 24:ijms24065740. [PMID: 36982810 PMCID: PMC10053331 DOI: 10.3390/ijms24065740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/12/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
Conjunctivochalasis is a degenerative condition of the conjunctiva that disrupts tear distribution and causes irritation. Thermoreduction of the redundant conjunctiva is required if symptoms are not relieved with medical therapy. Near-infrared laser treatment is a more controlled method to shrink the conjunctiva than thermocautery. This study compared tissue shrinkage, histology, and postoperative inflammation in thermoconjunctivoplasty performed on the mouse conjunctiva using either thermocautery or pulsed 1460 nm near-infrared laser irradiation. Three sets of experiments were performed on female C57BL/6J mice (n = 72, 26 per treatment group and 20 control) to assess conjunctival shrinkage, wound histology, and inflammation 3 and 10 days after treatment. Both treatments effectively shrunk the conjunctiva, but thermocautery caused greater epithelial damage. Thermocautery caused greater infiltration of neutrophils on day 3 and neutrophils and CD11b+ myeloid cells on day 10. The thermocautery group had significantly higher conjunctival expression of IL-1β on day 3. Expression of chemokine CCL2 was higher in the conjunctiva on day 3 and tear concentrations were higher on day 7 in the laser group. These results suggest that pulsed laser treatment causes less tissue damage and postoperative inflammation than thermocautery while effectively addressing conjunctivochalasis.
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Ma K, Liu J, Sha Y, Zhang W, Ni Z, Kong X, Xiang M. Qi Jing Mingmu decoction inhibits the p38 signaling pathway in conjunctivochalasis fibroblasts by down-regulation of Th17 cell differentiation. JOURNAL OF ETHNOPHARMACOLOGY 2023; 301:115812. [PMID: 36223843 DOI: 10.1016/j.jep.2022.115812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/25/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Qi Jing Mingmu (QJMM) decoction is a traditional Chinese medicine that has been widely used for the clinical treatment of conjunctivochalasis (CCH). It is an effective treatment to relieve ocular symptoms including improving tear film and promoting tear secretion. However, its effects and molecular mechanisms need to be elucidated. AIM OF THE STUDY To determine whether QJMM decoction affected T helper 17 (Th17) cell differentiation of CCH patients. MATERIALS AND METHODS Blood samples and conjunctival tissues were collected from CCH patients and normal controls. The fibroblasts were separately induced, and CD4+ T cells were incubated with increasing concentrations of QJMM decoction and co-cultured with CCH fibroblasts. Th17 cell numbers were then analyzed using flow cytometry. Serum levels of interleukin 17 (IL-17) and IL-22 were detected using enzyme-linked immunosorbent assays. The expressions of signal proteins and genes were detected using western blotting and quantitative real-time PCR. RESULTS Compared with normal controls, Th17 cell numbers and serum levels of IL-17 and IL-22 were elevated in patients with CCH. QJMM decoction down-regulated the expressions of IL-17, IL-22, and STAT3 of CD4+T cells from CCH patients, suggesting that QJMM decoction impeded Th17 cell differentiation. QJMM decoction-treated CD4+ T cells inhibited the expression of p38 in CCH fibroblasts. CONCLUSION QJMM decoction inhibited Th17 cell differentiation of CD4+T cells from CCH patients, and QJMM decoction-treated CD4+T cells down-regulated the p38 signal pathway in CCH fibroblasts. Our study showed that Th17 cells may be good candidates for clinical treatment of CCH.
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Affiliation(s)
- Kai Ma
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, China.
| | - Jiang Liu
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, China.
| | - Yongyi Sha
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, China.
| | - Wei Zhang
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, China.
| | - Zhenhua Ni
- Department of Central Lab, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, China.
| | - Xueqing Kong
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, China.
| | - Minhong Xiang
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, China; Shanghai Putuo Central School of Clinical Medicine, Anhui Medical University, Hefei, 230032, China.
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Ma K, Zhang Y, Liu J, Zhang W, Sha Y, Zhan Y, Xiang M. Mechanism of Akt regulation of the expression of collagens and MMPs in conjunctivochalasis. Exp Eye Res 2023; 226:109313. [PMID: 36403850 DOI: 10.1016/j.exer.2022.109313] [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: 05/01/2022] [Revised: 10/13/2022] [Accepted: 11/06/2022] [Indexed: 11/18/2022]
Abstract
Akt is a central node of many signaling pathways, which plays important roles in cell survival, proliferation, migration, metabolism and collagen synthesis. Conjunctivochalasis (CCH) is one of the most common age-related ocular superficial diseases related to abnormalities in conjunctival extracellular matrix. Here, we studied the role of Akt regulating collagens and MMPs in the pathogenesis of CCH. Primary conjunctival fibroblasts were obtained from CCH patients (n = 13) and age-matched normal controls (n = 10). The levels of Akt, collagen type I, collagen type III, MMP1, and MMP3 were determined by Western blot, qRT-PCR, immunohistochemistry, and immunofluorescence staining. Normal control conjunctival fibroblasts were treated with Akt inhibitor A6730, and CCH fibroblasts were transfected with Akt overexpression vector. The expression of Akt in CCH was significantly lower than that in normal control of conjunctival tissues and cultured fibroblasts. Blocking Akt signaling with Akt inhibitor could inhibit the expression of collagen type I and collagen type III and upregulate the expression of MMP1 and MMP3. Meanwhile, compared with CCH fibroblasts transfected with control mimics, the protein and mRNA expression of collagen type I and collagen type III were increased significantly in Akt overexpression group, while the results of MMP1 and MMP3 in transfected fibroblasts were opposite. Taken together, Akt upregulated the expression of collagen type I and collagen type III and downregulated the expression of MMP1 and MMP3. Akt signaling pathway could provide a direct negative contribution to CCH and might be an attractive target for CCH therapy.
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Affiliation(s)
- Kai Ma
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yixi Zhang
- Department of Oncology Traditional Chinese Medicine, Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiang Liu
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wei Zhang
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yongyi Sha
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yueping Zhan
- Clinical Laboratory Medicine Center, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Minhong Xiang
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Shanghai Putuo Central School of Clinical Medicine, Anhui Medical University, Hefei, China.
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Özen B, Öztürk H. Does the conjunctivochalasis accompanied by pseudoexfoliation syndrome affect the ocular surface and anterior segment structures? Int Ophthalmol 2022; 42:3079-3087. [PMID: 35353291 DOI: 10.1007/s10792-022-02294-6] [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: 12/16/2021] [Accepted: 03/12/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The probability of the coexistence of conjunctivochalasis and pseudoexfoliation syndrome (PES) in the same individual may increase with aging. We investigated the effects of conjunctivochalasis accompanied by PES on the ocular surface (OS) and anterior segment (AS) structures. METHODS Cases with only conjunctivochalasis were determined as Group 1 (n = 62), cases with conjunctivochalasis accompanied by PES as Group 2 (n = 45), and healthy individuals as Group 3 (n = 56). The OS and AS parameters of the groups were compared. RESULTS There were a higher grade-3 conjunctivochalasis rate (17.7% vs. 46.7%, p = 0.039), a greater "mean grade of conjunctivochalasis" value (1.72 ± 0.24 vs. 2.29 ± 0.32, p = 0.036), and a higher "total conjunctivochalasis score" (4.27 ± 1.13 vs. 6.12 ± 1.35, p = 0.025) in Group 2 than in Group 1. Additionally, Group 2 had a shorter tear film break-up time (TBUT) (9.17 ± 2.53 vs. 5.41 ± 1.32, p = 0.010) and a greater OS disease index (OSDI) score (16.28 ± 3.15 vs. 27.36 ± 4.12, p = 0.037) than Group 1. Moreover, both Group 1 and Group 2 had shorter TBUTs (Group 1-3: p = 0.004; Group 2-3: p < 0.001) and greater OSDI scores (Group 1-3: p = 0.042; Group 2-3: p = 0.019) compared to Group 3. The groups' ocular surface staining scores, Schirmer 1 tests, central corneal thicknesses, keratometries, axial lengths, anterior chamber depths, lens thicknesses, and intraocular pressures were similar (p > 0.05). CONCLUSIONS To our knowledge, this was the first study comprehensively investigating the effects of conjunctivochalasis accompanied by PES on the OS and AS structures together. We found that conjunctivochalasis might cause the OS disease, while the presence of PES in conjunctivochalasis cases might worsen both the OS disease and conjunctivochalasis findings.
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Affiliation(s)
- Bediz Özen
- Department of Ophthalmology, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey.
| | - Hakan Öztürk
- Department of Ophthalmology, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
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Zhu HY, Liu XQ, Yuan YZ, Wang DH. Measurement of the Lid Margin Thickness in Meibomian Gland Dysfunction with Vernier Micrometer. Ophthalmol Ther 2021; 11:177-186. [PMID: 34762260 PMCID: PMC8770731 DOI: 10.1007/s40123-021-00421-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction To investigate the lid margin thickness (LMT) from the posterior lash line to the mucocutaneous junction at the middle position in adults with and without meibomian gland dysfunction (MGD) by vernier micrometer (VM). Methods This is a cross-sectional, observational study. A hundred eyes from 100 volunteers aged 20 to 79, including 56 normal participants and 44 participants with MGD, were recruited. Measurements of the LMT by VM were performed by the same person. Results The mean age of 56 normal subjects (24 males and 32 females) and 44 MGD subjects (16 males and 28 females) was 40.0 ± 13.2 years and 42.7 ± 17.1 years, respectively. There was a significant difference in the upper LMT between normal and MGD subjects (1.36 ± 0.25 vs. 1.60 ± 0.27 mm, P < 0.001), but not in the lower LMT (1.0 ± 0.23 vs. 1.10 ± 0.28 mm, P = 0.07). In both normal and MGD subjects, the upper or lower LMT was significantly positively correlated with age (P < 0.05), and the upper LMT was greater than the lower LMT (P < 0.001). In addition, the lower LMT in MGD subjects was significantly positively correlated with meibum expressibility (rs = 0.35, P = 0.02). Conclusions The LMT was closely related to age and could be an important indicator for detecting MGD. Furthermore, we found that the upper LMT was greater than the lower LMT, and the lower LMT in MGD subjects seemed to be related to meibum expressibility.
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Affiliation(s)
- Hua-Ying Zhu
- Department of Ophthalmology, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, Xuhui District, Shanghai, 200032, China
| | - Xin-Quan Liu
- Department of Ophthalmology, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, Xuhui District, Shanghai, 200032, China
| | - Yuan-Zhi Yuan
- Department of Ophthalmology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China.,Centre for Evidence-Based Medicine, Fudan University, Shanghai, China
| | - Da-Hu Wang
- Department of Ophthalmology, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, Xuhui District, Shanghai, 200032, China.
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Measurement of the Lower Lid Margin Thickness by Oculus Keratograph. Eye Contact Lens 2021; 47:341-346. [PMID: 33813586 DOI: 10.1097/icl.0000000000000782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To investigate the lower lid margin thickness (LLMT) from the posterior lash line to the anterior edge of tear meniscus with Oculus Keratograph 4 (K4). METHODS This was a prospective, single-center, observational study. A total of 90 volunteers aged 18 to 79 years with no ocular diseases were included in this study. The LLMT of 90 subjects was measured twice by the same person with K4. To determine the reliability of K4, measuring the LLMT of 30 normal subjects was separately performed by two operators. RESULTS The LLMT measurements with K4 between two operators demonstrated a good reproducibility (0.94±0.18 vs. 0.96±0.16 mm; intraclass correlation coefficient=0.88; P=0.18). The mean age of 90 volunteers (42 men and 48 women) was 45.5±14.1 years. The LLMT was 0.95±0.17 mm, which was a significant positive correlation with age (rs=0.57; P<0.001). In addition, there was no significant difference in the LLMT between genders (0.97±0.16 vs. 0.93±0.18 mm; P=0.32). CONCLUSIONS We found that K4 was a reliable tool in the LLMT measurements, and the LLMT seemed to be closely related to age but not to gender.
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18
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Lahoti S, Weiss M, Johnson DA, Kheirkhah A. Superior limbic keratoconjunctivitis: a comprehensive review. Surv Ophthalmol 2021; 67:331-341. [PMID: 34077767 DOI: 10.1016/j.survophthal.2021.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 11/19/2022]
Abstract
Superior limbic keratoconjunctivitis (SLK) is characterized by chronic inflammation of the superior limbus and superior bulbar and tarsal conjunctivae. Patients also often have fine punctate staining of the limbus and adjacent area, superior limbic proliferation seen as thickening of the limbal epithelium and surrounding conjunctiva, and occasionally filaments at the superior limbus and upper cornea. SLK frequently presents with ocular irritation, foreign body sensation, and photophobia. SLK can be associated with other ocular and non-ocular conditions, such as thyroid disease. Although the pathogenesis of SLK is still unknown, it is thought to be related to mechanical injury, tear film instability, or an autoimmune/inflammatory etiology. Many patients with SLK can be asymptomatic or have symptoms that resolve or remit spontaneously. For symptomatic SLK, patients are managed medically with treatments such as lubricants, topical anti-inflammatory or immunomodulatory medications, punctal occlusion, and bandage contact lenses. Patients with symptoms refractory to medical management may need surgical interventions. We detail the current literature on the epidemiology, clinical manifestations, associated conditions, histopathology, pathogenesis, and treatment of SLK.
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Affiliation(s)
- Sejal Lahoti
- Department of Ophthalmology, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Menachem Weiss
- Department of Ophthalmology, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Daniel A Johnson
- Department of Ophthalmology, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Ahmad Kheirkhah
- Department of Ophthalmology, University of Texas Health San Antonio, San Antonio, TX, USA.
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Jadidi K, Nabavi NS, Nejat MA, Aghamollaei H, Adnani SY, Nejat B, Jadidi H, Nejat F. Evaluation of plasma assisted noninvasive surgery (PANIS) as a new approach for the treatment of conjunctivochalasis; a clinical case series. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1912594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Khosrow Jadidi
- Vision Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Nazanin-Sadat Nabavi
- Vision Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Mohammad Amin Nejat
- Vision Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Hossein Aghamollaei
- Vision Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | | | - Bahar Nejat
- Vision Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Hanie Jadidi
- Vision Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Farhad Nejat
- Vision Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
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Muhafiz E, Bozkurt E, Erten R. Impression cytology and meibomian glands in conjunctivochalasis. Eur J Ophthalmol 2021; 32:11206721211008789. [PMID: 33843265 DOI: 10.1177/11206721211008789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the tear parameters, meibomian glands and lid margin and tarsal conjunctival impression cytology in patients with conjunctivochalasis (CCH). METHODS The study included 57 patients diagnosed with CCH and 35 healthy volunteers. Tear break-up time (TBUT) was measured and Schirmer test was performed. Meibomian gland morphologies, dropout rates, and meiboscores were evaluated using meibography. Finally, impression cytology samples were taken by pressing the impression filters on the lower lid margin and lower tarsal conjunctiva. The samples were evaluated according to the Nelson grading system. RESULTS Schirmer test was longer and TBUT was shorter in the study group (p = 0.035 and p < 0.001, respectively). The median of meibomian gland dropout rate was 33.45% (Interquartile range [IQR]; 23.17%-49.75%) and 18.80% (IQR; 12.35%-26.50%) in the study and control groups, respectively (p < 0.001). There was no significant difference in terms of lid-margin cytology between the two groups (p = 0.481). In tarsal conjunctiva cytology, the median value of Nelson grade of the study group was 2 (IQR; 1-2) and that of the control group was 1 (IQR; 1-2) (p = 0.040). When Nelson grade-2 and above was accepted as the pathological limit, it was found that 27.5% of the study group and 15.2% of the control group showed pathological findings (p = 0.204). CONCLUSIONS In patients with CCH, damage occurs in the tarsal conjunctiva with the effects of redundant conjunctival folds. In these patients, atrophy occurs in the meibomian glands and tear stability is impaired. Therefore, CCH should not be overlooked in clinical practice.
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Affiliation(s)
- Ersin Muhafiz
- Department of Ophthalmology, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Erdinç Bozkurt
- Department of Ophthalmology, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Remzi Erten
- Department of Pathology, Faculty of Medicine, Van Yüzüncüyıl University, Van, Turkey
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The correction of conjunctivochalasis using high-frequency radiowave electrosurgery improves dry eye disease. Sci Rep 2021; 11:2551. [PMID: 33510304 PMCID: PMC7844232 DOI: 10.1038/s41598-021-82088-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/31/2020] [Indexed: 11/29/2022] Open
Abstract
We aimed to determine the clinical impact of conjunctivochalasis (CCh) and its correction using high-frequency radiowave electrosurgery (HFR-ES), for signs and symptoms of dry eye disease (DED). Forty patients diagnosed with symptomatic CCh were prospectively enrolled. As a result, patients with CCh had moderate to severe DED and most of them exhibited meibomian gland dysfunction (MGD). Corneo-conjunctival fluorescein staining score (CFS) and all lid-parallel-conjunctival-folds scores (LIPCOFs) were positively correlated. Nasal LIPCOF significantly correlated with symptoms and tear volume. Central, temporal, and total LIPCOF significantly correlated with MG loss, MGD stage, and lipid layer thickness. Independent significant factors associated with total LIPCOF included CFS, tear break-up time, and MGD stage. One month following HFR-ES, CCh was completely resolved in all cases. Patient age and preoperative nasal LIPCOF were determinants of outcomes associated with postoperative improvements in symptoms. Ocular surface parameters significantly improved, but MGD-related signs did not. Collectively, CCh associated with MGD severity deteriorates not only tear film stability and reservoir capacity, leading to DED exacerbation. Therefore, CCh should be corrected in patients with DED and MGD. Younger patients with nasal CCh are likely to experience more symptomatic relief after HFR-ES. Particularly, management for MGD should be maintained after CCh correction.
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Komuro A, Yokoi N, Kato H, Sonomura Y, Sotozono C, Kinoshita S. The Relationship between Subjective Symptoms and Quality of Life in Conjunctivochalasis Patients. Diagnostics (Basel) 2021; 11:diagnostics11020179. [PMID: 33513725 PMCID: PMC7911897 DOI: 10.3390/diagnostics11020179] [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: 01/01/2021] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 01/10/2023] Open
Abstract
The purpose of this study was to evaluate the differences in subjective symptoms between patients with conjunctivochalasis (CCh) and dry eye (DE), and examine the relationship between subjective symptoms and quality of life (QOL). In 75 eyes of 75 CCh patients and 122 eyes of 122 DE patients, 12 subjective symptoms classified into four groups depending on the mechanisms associated with symptoms (ITF: instability of tear film, IF: increased friction, R: reflex, and DTC: delayed tear clearance) were evaluated by use of a visual analogue scale (VAS). Fifteen items related to DE symptoms and their influence on daily life were evaluated by use of the dry eye-related quality-of-life score (DEQS) questionnaire, with overall degree of QOL impairment calculated as a QOL score. The correlation between the Total VAS score and QOL score were evaluated. Between the CCh and DE patients, significant differences in subjective symptoms were found in eye dryness, pain, tearing sensitivity to light, and heavy eyelids, while tearing was higher in CCh. A significant strong correlation was found between QOL score and Total VAS score, ITF, and IF in CCh patients. The QOL of CCh patients is strongly determined by decreased tear-film stability and increased friction during blinking.
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Affiliation(s)
- Aoi Komuro
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (A.K.); (H.K.); (Y.S.); (C.S.)
| | - Norihiko Yokoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (A.K.); (H.K.); (Y.S.); (C.S.)
- Correspondence: ; Tel.: +81-75-251-5578
| | - Hiroaki Kato
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (A.K.); (H.K.); (Y.S.); (C.S.)
| | - Yukiko Sonomura
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (A.K.); (H.K.); (Y.S.); (C.S.)
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (A.K.); (H.K.); (Y.S.); (C.S.)
| | - Shigeru Kinoshita
- Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan;
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Wang DH, Yao J, Liu XQ. Comparison of two measurements for the lower lid margin thickness: vernier micrometer and anterior segment optical coherence tomography. Int Ophthalmol 2020; 40:3223-3232. [PMID: 32656579 DOI: 10.1007/s10792-020-01505-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To investigate the reliability of using anterior segment optical coherence tomography (AS-OCT) to measure the lower lid margin thickness (LLMT) from the posterior lash line to the Marx's line by comparing with a vernier micrometer. METHODS This was a prospective, single-center, diagnostic test study. Sixty volunteers aged between 20 and 79 without ocular diseases were recruited. A vernier micrometer and AS-OCT were, respectively, used to measure the same lid margin thickness at the central lower lid. RESULTS The mean age of volunteers was 39.1 ± 13.7 years. The LLMT in 60 subjects (25 males and 35 females) measured by a vernier micrometer and AS-OCT was 1.03 ± 0.25 mm and 0.82 ± 0.21 mm, respectively. There was a significant difference between two measurements (P < 0.001). In addition, intraclass correlation coefficient (ICC) was engaged to evaluate the reliability and agreement of two measurements (ICC = 0.83). Bland-Altman plots demonstrated that 57 of 60 spots were within 95% limits of agreement. No adverse events were detected in all subjects after the measurements. CONCLUSION Although the LLMT measured by AS-OCT was less than that measured by a vernier micrometer, AS-OCT providing quantitative measurements and imaging data was also seemed to be a reliable method with a good agreement. It could be a substitute for a vernier micrometer in clinical practice in the future.
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Affiliation(s)
- Da-Hu Wang
- Department of Ophthalmology, LongHua Hospital Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, Xuhui District, Shanghai, 200032, China
| | - Jie Yao
- Department of Ophthalmology, Shanghai Qingpu Traditional Chinese Medicine Hospital, Shanghai, China
| | - Xin-Quan Liu
- Department of Ophthalmology, LongHua Hospital Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, Xuhui District, Shanghai, 200032, China.
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Walker MK, Schornack MM, Vincent SJ. Anatomical and physiological considerations in scleral lens wear: Conjunctiva and sclera. Cont Lens Anterior Eye 2020; 43:517-528. [PMID: 32624363 DOI: 10.1016/j.clae.2020.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 12/20/2022]
Abstract
While scleral lenses have been fitted using diagnostic lenses or impression moulding techniques for over a century, recent advances in anterior segment imaging such as optical coherence tomography and corneo-scleral profilometry have significantly improved the current understanding of the anatomy of the anterior eye including the morphometry of the conjunctiva, sclera, and corneo-scleral junction, as well as the ocular surface shape and elevation. These technological advances in ocular imaging along with continual improvements and innovations in scleral lens design and manufacturing have led to a global increase in scleral lens prescribing. This review provides a comprehensive overview of the conjunctiva and sclera in the context of modern scleral lens practice, including anatomical variations in healthy and diseased eyes, the physiological impact of scleral lens wear, potential fitting challenges, and current approaches to lens modifications in order to minimise lens-induced complications and adverse ocular effects. Specific topics requiring further research are also discussed.
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Affiliation(s)
- Maria K Walker
- University of Houston College of Optometry, The Ocular Surface Institute, Houston, USA
| | | | - Stephen J Vincent
- Queensland University of Technology (QUT), Centre for Vision and Eye Research, School of Optometry and Vision Science, Contact Lens and Visual Optics Laboratory, Institute of Health and Biomedical Innovation, Queensland, Australia.
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Lacorzana J. Amniotic membrane, clinical applications and tissue engineering. Review of its ophthalmic use. ACTA ACUST UNITED AC 2019; 95:15-23. [PMID: 31784120 DOI: 10.1016/j.oftal.2019.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/06/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
Abstract
The use of amniotic membrane in ophthalmology has been increasing in recent years due to its multiple biological and tectonic properties, improvement in the process of obtaining, ease of use, and advancement in tissue engineering. The amniotic membrane has become one of the main adjuvant treatments, in ophthalmic surgery as well as in other medical-surgical specialties. The development of tissue engineering has allowed it to be used, not only in its classic form, but also by the use of drops and other presentations. The different steps prior to its use (preparation and conservation), the different surgical techniques, and their main clinical applications are described throughout the article.
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Affiliation(s)
- J Lacorzana
- Departamento de Oftalmología, Hospital Universitario Virgen de las Nieves, Granada, España; Escuela de Doctorado y Posgrado, Universidad de Granada, Granada, España; Master en Ingeniería Tisular, Universidad de Granada. Granada, España.
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Xiang M, Mo L, Zhan Y, Wen H, Zhou H, Miao W. P38-Mediated Cellular Senescence in Conjunctivochalasis Fibroblasts. Invest Ophthalmol Vis Sci 2019; 60:4643-4651. [PMID: 31682715 DOI: 10.1167/iovs.19-27617] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Conjunctivochalasis (CCH) is a common ocular disease and has received extensive attention recently. However, its exact pathogenesis remains largely unknown. Owing to the high morbidity of CCH in older people, this study aimed to investigate whether cellular senescence contributes to CCH progression and the underlying mechanism. Methods Loose conjunctival tissues from CCH patients (n = 13) and normal conjunctival tissues from age-matched persons (n = 12) were obtained and the fibroblasts were separately induced and obtained. Cellular senescence, and the expression of senescence-associated genes (p53 and p21) and p38 in CCH conjunctival tissues and normal controls, were determined by senescence-associated β-galactosidase (SA-β-Gal) staining and quantitative (q)RT-PCR, respectively. To explore the effects of p38 on cellular senescence in CCH fibroblasts, small interfering RNA (siRNA) targeting p38 (siP38) and p38-specific inhibitor SB203580 was performed in CCH fibroblasts. Then, cellular senescence, cell viability, reactive oxygen species (ROS) production, and gene expression were detected according to the corresponding methods. Results CCH conjunctival tissues had significantly more senescent cells, evidenced by more SA-β-Gal-positive cells, and higher expression of senescence-associated genes (p53 and p21) and p38. CCH fibroblasts transfected with siP38 or treated with SB203580 had obviously reduced numbers of senescent cells, decreased ROS production, and increased cell viability, as well as reduced expression of senescence-associated genes. Meanwhile, blocking p38 signaling decreased the expression of p53 and p21. Conclusions Therefore, these findings indicate that cellular senescence might be a causative factor for CCH. P38 signaling might play an important role in the progress of cellular senescence in CCH fibroblasts via manipulation of p53/p21 signaling.
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Affiliation(s)
- Minhong Xiang
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lijuan Mo
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yueping Zhan
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hang Wen
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Huanming Zhou
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wanhong Miao
- Department of Ophthalmology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Department of Ophthalmology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Comparative transcriptome analysis of human conjunctiva between normal and conjunctivochalasis persons by RNA sequencing. Exp Eye Res 2019; 184:38-47. [DOI: 10.1016/j.exer.2019.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 03/18/2019] [Accepted: 04/05/2019] [Indexed: 11/23/2022]
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28
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Medical and surgical management of conjunctivochalasis. Ocul Surf 2019; 17:393-399. [DOI: 10.1016/j.jtos.2019.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/10/2019] [Accepted: 04/17/2019] [Indexed: 11/23/2022]
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Lid-parallel conjunctival fold (LIPCOF) morphology imaged by optical coherence tomography and its relationship to LIPCOF grade. Cont Lens Anterior Eye 2018; 42:299-303. [PMID: 30442513 DOI: 10.1016/j.clae.2018.10.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/28/2018] [Accepted: 10/31/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Lid-parallel conjunctival folds (LIPCOF) are a well-accepted clinical sign in dry eye diagnosis. Commonly, LIPCOF is classified by grading the number of folds observed by slit-lamp microscope. This study investigated the relationship between subjective grading scale and LIPCOF morphology imaged by optical coherence tomography (OCT). METHODS Temporal and nasal LIPCOF of 42 subjects (mean age 27.3 ± 8.4 (SD) years; 13 M, 29 F) were observed and classified by an experienced optometrist using the Pult LIPCOF grading scale (0: no permanent, lid-parallel conjunctival fold; 1: one fold; 2: two folds, 3: three or more folds). Additionally, LIPCOF cross-sectional area (LIPCOF-A) and fold count (LIPCOF-C), as imaged by OCT (Cirrus HD; Carl Zeiss Meditec, Jena, Germany), were analysed with ImageJ 1.50 (http://rsbweb.nih.gov/ij). Correlations between subjective grading and LIPCOF-A and LIPCOF-C were analysed by Spearman correlation, differences between subjective grading and LIPCOF-C were analysed by Wilcoxon test. RESULTS For temporal and nasal sectors, mean subjective LIPCOF grade was 1.43 ± 0.86 grade units and 0.57 ± 0.80 grade units, mean LIPCOF-C was 1.67 ± 0.82 folds and 0.69 ± 0.78 folds, and mean LIPCOF-A was 0.0676 ± 0.0236mm2 and 0.0389 ± 0.0352 mm2, respectively. Subjective temporal and nasal LIPCOF grade was significantly correlated to LIPCOF-C (r = 0.610, p < 0.001 and r = 0.645, p < 0.001, respectively), and to LIPCOF-A (r = 0.612, p < 0.001 and r = 0.583, p < 0.001, respectively). LIPCOF-C was not statistical different to subjective LIPCOF grade (p = 0.07 and p = 0.239; temporal and nasal sectors, respectively). CONCLUSIONS OCT allows for better imaging of finer details of LIPCOF morphology, and especially of LIPCOF area. OCT evaluation of LIPCOF area correlated well with subjective grading and appears to be a promising objective method for LIPCOF classification.
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