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Bohman E, Berggren J, Neumann O, Sheikh R, Malmsjö M. Tear secretion is preserved while the area of meibomian glands is reduced in patients with prosthetic eyes, contributing to the symptoms of dry eye. Br J Ophthalmol 2024:bjo-2024-325777. [PMID: 39216904 DOI: 10.1136/bjo-2024-325777] [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: 05/20/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND/AIMS It is unclear whether a reduction in tear secretion contributes to the discomfort experienced by those with prosthetic eyes. Tear secretion has hitherto only been measured with the Schirmer test which may be affected by the pooling of tears behind the prosthesis. In this study, direct imaging of the lacrimal gland has been performed to measure tear secretion in anophthalmic sockets. The relation between the area of meibomian glands and dry eye symptoms was also assessed. METHODS 12 patients were included. The amount of tear secretion was measured by direct imaging of the lacrimal gland while the presence of meibomian glands was determined using meibography. The 5-item Dry Eye Questionnaire was used to assess symptoms of dry eye. RESULTS No difference was found in tear secretion between the anophthalmic socket and the contralateral eye. The area of meibomian glands was significantly reduced in eyelids on the side of the prosthetic eye, compared with the contralateral eye. Seven patients reported symptoms indicative of dry eye in the anophthalmic socket, compared with only two in the contralateral eye. CONCLUSIONS The effects of an eye prosthesis on meibomian glands may contribute to the frequently perceived symptoms of dry eye despite unaffected in tear secretion.
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Affiliation(s)
- Elin Bohman
- Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Johanna Berggren
- Department of Ophthalmology, Lund University Clinical Sciences, Lund, Sweden
| | - Olof Neumann
- Department of Ophthalmology, Lund University Clinical Sciences, Lund, Sweden
| | - Rafi Sheikh
- Department of Ophthalmology, Lund University Clinical Sciences, Lund, Sweden
| | - Malin Malmsjö
- Department of Ophthalmology, Lund University Clinical Sciences, Lund, Sweden
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2
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Francisco ZM, Sara MM, José-María SG, Facundo U, Carlos RDL, María GL, Jessica M, Carmen AL, Santiago OP, Juan Carlos SE. Standardized clinical evaluation of dry anophthalmic socket syndrome in a real-world approach. Cont Lens Anterior Eye 2024; 47:102149. [PMID: 38521700 DOI: 10.1016/j.clae.2024.102149] [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: 06/19/2023] [Revised: 03/08/2024] [Accepted: 03/18/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE To assess which signs and eye prosthesis care habits are related to subjective discomfort in patients with dry anophthalmic socket syndrome (DASS), using standardized tools from daily practice. METHODS 62 anophthalmic sockets were compared with their healthy fellow eye using the Standard Patient Evaluation of Eye Dryness (SPEED) score. The correlations between SPEED questionnaire and the prosthesis care, discharge characteristics score, conjunctival inflammation score, meibomian gland dysfunction (MGD) scores and Schirmer I test were studied. RESULT The anophthalmic sockets group achieved a higher SPEED test score (p < 0.01), discharge score (p < 0.01), conjunctival inflammation score (p < 0.01), MGD scores (p < 0.01) and lower Schirmer I test (p < 0.01) compared with their fellow, healthy eye. Patients with a prosthesis replacement of one year or less, those with a current fit time of one year or less and those with a cleaning frequency above one month reported better SPEED, (p < 0.01), conjunctiva inflammation (p < 0.01) and MGD scores (p < 0.01). CONCLUSION Most anophthalmic patients suffer mild to severe DASS, which seems related to discharge, conjunctival inflammation and MGD. Moreover, certain practices related to the care of the prosthesis such as replacing with a frequency lower than yearly, current fitting time inferior to one year and a removing and cleaning regime above one month, were related to a lower discomfort sensation, conjunctival inflammation and MGD. Clinicians should consider the DASS when facing patients with anophthalmic socket and discomfort symptoms.
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Affiliation(s)
- Zamorano-Martín Francisco
- Department of Ophthalmology, Hospital Regional Universitario de Málaga, Malaga, Spain; Deparment of Radiology and Physical Medicine, Ophthalmology and Otorhinolaryngology, Ophthalmology Area, Facultad de Medicina, Universidad de Málaga, Malaga, Spain
| | | | - Sánchez-González José-María
- Department of Physics of Condensed Matter, Optics Area, Universidad de Sevilla, Seville, Spain; Department of Ophthalmology (Tecnolaser Clinic Vision), Refractive Surgery Centre, Seville, Spain.
| | - Urbinati Facundo
- Department of Ophthalmology, Hospital Regional Universitario de Málaga, Malaga, Spain
| | - Rocha-de-Lossada Carlos
- Department of Ophthalmology, Hospital Regional Universitario de Málaga, Malaga, Spain; Department of Ophthalmology (Qvision), Vithas Virgen del Mar Hospital, Almeria, Spain
| | - García-Lorente María
- Department of Ophthalmology, Hospital Regional Universitario de Málaga, Malaga, Spain; Deparment of Radiology and Physical Medicine, Ophthalmology and Otorhinolaryngology, Ophthalmology Area, Facultad de Medicina, Universidad de Málaga, Malaga, Spain
| | - Mata Jessica
- Department of Ophthalmology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alba-Linero Carmen
- Deparment of Radiology and Physical Medicine, Ophthalmology and Otorhinolaryngology, Ophthalmology Area, Facultad de Medicina, Universidad de Málaga, Malaga, Spain; Department of Ophthalmology, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - Ortiz-Pérez Santiago
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Departamento de Cirugía y sus especialidades, Universidad de Granada, Spain; Granada Vision and Eye Research Team (VER), Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
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3
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Rokohl AC, Trester M, Pine KR, Heindl LM. How to diagnose dry anophthalmic socket syndrome (DASS) in the clinical routine. Graefes Arch Clin Exp Ophthalmol 2023; 261:2713-2715. [PMID: 37103625 PMCID: PMC10432313 DOI: 10.1007/s00417-023-06074-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/12/2023] [Accepted: 04/15/2023] [Indexed: 04/28/2023] Open
Affiliation(s)
- Alexander C Rokohl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
- Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Düsseldorf, Cologne, Germany.
| | - Marc Trester
- Trester-Institute for Ocular Prosthetics and Artificial Eyes, Cologne, Germany
| | - Keith R Pine
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Ludwig M Heindl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Düsseldorf, Cologne, Germany
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4
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Mouriaux F. How to analyze conjunctival inflammation in dry anophthalmic socket syndrome (DASS)? Graefes Arch Clin Exp Ophthalmol 2023; 261:629-630. [PMID: 36355084 DOI: 10.1007/s00417-022-05899-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 10/20/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Frederic Mouriaux
- Ophthalmology Dept, CHU Rennes, Université Rennes 1, Rennes, France.
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5
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Rokohl AC, Wall K, Trester M, Wawer Matos PA, Guo Y, Adler W, Pine KR, Heindl LM. Novel point-of-care biomarkers of the dry anophthalmic socket syndrome: tear film osmolarity and matrix metalloproteinase 9 immunoassay. Graefes Arch Clin Exp Ophthalmol 2023; 261:821-831. [PMID: 36357674 PMCID: PMC9988811 DOI: 10.1007/s00417-022-05895-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 10/06/2022] [Accepted: 10/12/2022] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To compare tear film osmolarity (TFO) values and matrix metalloproteinase 9 (MMP-9) levels between anophthalmic sockets and healthy fellow eyes and to assess the use of the MMP-9 and TFO as objective biomarkers for the dry anophthalmic socket syndrome (DASS). METHODS In this prospective single-center study, the anophthalmic sockets and healthy fellow eyes of 98 unilateral anophthalmic patients were assessed using the ocular surface disease index (OSDI) questionnaire, InflammaDry® MMP-9 point-of-care immunoassay, TFO with TearLab™ Osmolarity System, and clinical conjunctival inflammation. MMP-9 concentration and conjunctival inflammation were graded semi-quantitatively. Differences between anophthalmic sockets and the healthy fellow eyes for OSDI scores, MMP-9, TFO values, clinical conjunctival inflammation, and eyelid abnormalities as well as the correlation between these factors and demographic data were evaluated. RESULTS Patients had significantly higher OSDI, MMP-9, and TFO values, as well as higher conjunctival inflammation on the anophthalmic side, compared to the healthy side (p ≤ 0.002, respectively). For anophthalmic sockets, there was a significant positive correlation between OSDI scores and TFO values (p = 0.007), between the grade of posterior blepharitis and TFO values (p = 0.026), and between the conjunctival inflammation and MMP-9 values (p < 0.001), as well as between MMP-9 levels and time since eye loss (p = 0.004). CONCLUSIONS Measuring MMP-9 and TFO may be helpful tools as efficient, quantifiable biomarkers, disease course parameters, or predictors for treatment response in the clinical management of patients with DASS or future therapy studies. Ophthalmologists should consider the updated diagnosis criteria including TFO and the definition for DASS proposed in this study.
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Affiliation(s)
- Alexander C Rokohl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
- Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Düsseldorf, Cologne, Germany.
| | - Katharina Wall
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Marc Trester
- Trester-Institute for Ocular Prosthetics and Artificial Eyes, Cologne, Germany
| | - Philomena A Wawer Matos
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Düsseldorf, Cologne, Germany
| | - Yongwei Guo
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Werner Adler
- Department of Biometry and Epidemiology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Keith R Pine
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Ludwig M Heindl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Düsseldorf, Cologne, Germany
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6
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Kowanz DH, Wawer Matos PA, Gordon E, Doulis A, Simon M, Rokohl AC, Heindl LM. [Evisceration, enucleation and exenteration-Indications, techniques, and postoperative care]. DIE OPHTHALMOLOGIE 2023; 120:126-138. [PMID: 36635593 DOI: 10.1007/s00347-022-01791-4] [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] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
Various surgical techniques are available for the extirpation of an eye, depending on the underlying disease. Typical indications encompass tumors, inflammatory and infectious processes, glaucoma, trauma as well as congenital malformations. Surgical procedures include evisceration (resection of the intraocular space with preservation of the sclera), enucleation (extirpation of the entire eyeball including sclera and cornea) and exenteration (resection of the complete orbital soft tissue). The early detection of postoperatively manifesting complications, such as implant extrusion, conjunctivitis, postenucleation socket syndrome as well as the development of enophthalmus or ptosis, is of particular relevance in the context of postoperative care regarding functional, esthetic and social outcome. Special attention must be paid to ensuring a complication-free rehabilitation process, including the supply of a suitable, precisely fitting prosthesis or epithesis. This ensures the patient's psychosocial reintegration, in which an integrated interdisciplinary cooperation with ocularists and psychologists is essential. The latter play a particularly important role, as the psychological stress resulting from the procedure is often associated with a considerable reduction in the quality of life.
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Affiliation(s)
- Dominik H Kowanz
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
- Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Philomena A Wawer Matos
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
- Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
- Centrum für Integrierte Onkologie (CIO) Aachen-Bonn-Köln-Düsseldorf, Köln, Deutschland
| | - Erik Gordon
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
- Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Alexandros Doulis
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
- Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Michael Simon
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
- Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Alexander C Rokohl
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
- Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland.
- Centrum für Integrierte Onkologie (CIO) Aachen-Bonn-Köln-Düsseldorf, Köln, Deutschland.
| | - Ludwig M Heindl
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
- Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
- Centrum für Integrierte Onkologie (CIO) Aachen-Bonn-Köln-Düsseldorf, Köln, Deutschland
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7
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Lauber R, Kopecky A, Wawer Matos PA, Simon M, Rokohl AC, Heindl LM. [Complications of anophthalmic orbits-Treatment and aftercare]. DIE OPHTHALMOLOGIE 2023; 120:150-159. [PMID: 36705680 DOI: 10.1007/s00347-022-01800-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/28/2023]
Abstract
The possible complications of anophthalmic eye sockets can occur due to many different pathomechanisms. A differentiation is made between allergic, infectious, inflammatory or mechanical causes. This article gives an overview on the different etiologies of socket complications with their pathophysiology and treatment options.
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Affiliation(s)
- Rebecca Lauber
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Aachen-Bonn-Köln-Düsseldorf, Köln, Deutschland
| | - Adam Kopecky
- Klinik für Augenheilkunde, Universitätskrankenhaus Ostrava, Ostrava, Tschechien.,Medizinische Fakultät, Abteilung für kraniofaziale Chirurgie, Universität zu Ostrava, Ostrava, Tschechien
| | - Philomena A Wawer Matos
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Aachen-Bonn-Köln-Düsseldorf, Köln, Deutschland
| | - Michael Simon
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Aachen-Bonn-Köln-Düsseldorf, Köln, Deutschland
| | - Alexander C Rokohl
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland. .,Centrum für Integrierte Onkologie (CIO) Aachen-Bonn-Köln-Düsseldorf, Köln, Deutschland.
| | - Ludwig M Heindl
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Aachen-Bonn-Köln-Düsseldorf, Köln, Deutschland
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8
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[Current aspects of prosthetic eye care : Surgical techniques, complications of prosthetic eye wearing, and special challenges in children]. DIE OPHTHALMOLOGIE 2023; 120:124-125. [PMID: 36735024 DOI: 10.1007/s00347-022-01795-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 02/04/2023]
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9
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Rokohl AC, Pine NS, Adler W, Bartenschlager LAK, Wawer Matos PA, Trester M, Pine KR, Pförtner TK, Heindl LM. Health Literacy in Patients Wearing Prosthetic Eyes: A Prospective Cross-Sectional Study. Curr Eye Res 2023; 48:11-17. [PMID: 36305786 DOI: 10.1080/02713683.2022.2141783] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To investigate general and electronic health literacy (HL) levels in prosthetic eye wearing patients, to define factors associated with reduced HL, and to identify a potential healthcare gap. METHODS In this prospective cross-sectional study 148 prosthetic eye wearers were screened using the 16-item European Health Literacy Survey Questionnaire (HLS-EU-Q16) and the 8-item electronic Health Literacy Scale (eHEALS). HLS-EU-16 and eHEALS scores were correlated to health levels, vision functioning, and sociodemographic factors. RESULTS A total of 85 patients (57%) had adequate, 38 (26%) problematic, and 9 (6%) inadequate general HL, while 16 (11%) had no valid HLS-EU-Q16 score. General HL was positively correlated with physical health (p = 0.009) and negatively with a migration background (p = 0.023). There was a positive correlation between electronic HL and educational level (p < 0.001), social status (p = 0.048), and mental health (p = 0.013). Higher age was associated with lower electronic HL (p < 0.001). CONCLUSIONS More than 30% of the prosthetic eye wearers had problematic or even inadequate general HL, suggesting a significant health care gap. To identify patients with reduced HL, a standardized screening tool should be implemented as part of routine clinical care. Within integrated care, patients with insufficient HL should be offered barrier-free advisory services and information brochures in various languages.
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Affiliation(s)
- Alexander C Rokohl
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.,Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Dusseldorf, Cologne, Germany
| | - Nicola S Pine
- Auckland District Health Board, Auckland, New Zealand.,School of Psychology, Massey University, Wellington, New Zealand
| | - Werner Adler
- Department of Medical Informatics, Biometry, and Epidemiology, Friedrich-Alexander- University Erlangen-Nürnberg, Erlangen, Germany
| | - Lisa A K Bartenschlager
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Philomena A Wawer Matos
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.,Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Dusseldorf, Cologne, Germany
| | - Marc Trester
- Trester Institute for Ocular Prosthetics and Artificial Eyes, Cologne, Germany
| | - Keith R Pine
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Timo-Kolja Pförtner
- Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Ludwig M Heindl
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.,Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Dusseldorf, Cologne, Germany
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10
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Volpe G, De Piano M, Mazzone G, Micera A, Bonini S, Modugno AC. Should we care about the ocular surface in the anophthalmic patient? Eur J Ophthalmol 2021; 32:1924-1933. [PMID: 34617482 DOI: 10.1177/11206721211048803] [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: 12/29/2022]
Abstract
PURPOSE To assess clinical and biomolecular changes of the conjunctival epithelium in anophthalmic patients wearing an ocular prosthesis. METHODS Thirty-five unilateral anophthalmic patients were enrolled. Patients with blepharitis, lid abnormalities, and topical/systemic medication affecting the ocular surface were excluded. Symptom Assessment in Dry Eye (SANDE) questionnaire and tear function test (Schirmer Test Type I) were recorded. Conjunctival inflammation and meibomian gland dysfunction (MGD) were graded in the anophthalmic side and fellow eye. Impression cytology sampling of the upper, lower tarsal, and posterior/bulbar conjunctiva from the anophthalmic socket were collected and compared to healthy controls. RESULTS Patients had significantly higher SANDE (p < 0.001), Schirmer I test (p = 0.004), conjunctival inflammation (p < 0.001), and MGD scores (p < 0.001) on the anophthalmic side compared to the fellow eye. Mucin 5AC, inflammatory markers (MMP-9, ICAM-1) expression (p < 0.001), and response to oxidative stress (NRF2-KEAP1 signaling pathway) (p < 0.05) were significantly upregulated in the posterior conjunctival surface in the anophthalmic socket. CONCLUSIONS Anophthalmic patients complained of more pronounced dry eye symptoms and presented more significant signs of inflammation and MGD on the anophthalmic side. The bulbar conjunctiva, behind the prosthesis, showed more significant hyperexpression of mucins, markers of inflammation, and increased response to oxidative stress compared to the tarsal conjunctiva. Patients wearing ocular prosthesis had signs of inflammation resembling dry eye disease.
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Affiliation(s)
- Giulio Volpe
- Ophthalmology Operative Complex Unit, University Campus Bio-Medico, Rome, Italy
| | - Maria De Piano
- Research and Development Laboratory for Biochemical, Molecular and Cellular Applications in Ophthalmological Sciences, IRCCS Fondazione Bietti, Rome, Italy
| | | | - Alessandra Micera
- Research and Development Laboratory for Biochemical, Molecular and Cellular Applications in Ophthalmological Sciences, IRCCS Fondazione Bietti, Rome, Italy
| | - Stefano Bonini
- Ophthalmology Operative Complex Unit, University Campus Bio-Medico, Rome, Italy
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11
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Quaranta-Leoni FM, Fiorino MG, Quaranta-Leoni F, Di Marino M. Anophthalmic Socket Syndrome: Prevalence, Impact and Management Strategies. Clin Ophthalmol 2021; 15:3267-3281. [PMID: 34393477 PMCID: PMC8354770 DOI: 10.2147/opth.s325652] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/21/2021] [Indexed: 11/23/2022] Open
Abstract
Anophthalmic socket syndrome determines functional deficits and facial deformities, and may lead to poor psychological outcomes. This review aims to comprehensively evaluate the features of the syndrome, based on literature review and authors’ clinical and surgical experience. An electronic database (PubMed,MEDLINE and Google Scholar) search of all articles written in English and non-English language with abstract translated to English on anophthalmic socket syndrome was performed. Data reviewed included demographics, presentations, investigations, management, complications and outcomes. Different types of orbital implants were evaluated; the management of implant exposure was examined; different orbital volume enhancement procedures such as secondary implantation, subperiosteal implants and the use of fillers in anophthalmic patients were described; the problems related to socket contraction were outlined; the treatment options for chronic anophthalmic socket pain and phantom eye syndrome were assessed; the most recent advances in the management of congenital anophthalmia were described. Current clinical evidence does not support a specific orbital implant; late exposure of porous implants may be due to pegging, which currently is seldom used; filler absorption in the orbit appears to be faster than in the dermis, and repeated treatments could be a potential source of inflammation; socket contraction results in significant functional and psychological disability, and management is challenging. Patients affected by anophthalmic socket pain and phantom eye syndrome need specific counseling. It is auspicable to use a standardized protocol to treat children affected by clinical congenital anophthalmia; dermis fat graft is a suitable option in these patients as it helps continued socket expansion. Dermis fat graft can also address the volume deficit in case of explantation of exposed implants and in contracted sockets in both children and adults. Appropriate clinical care is essential, as adequate prosthesis wearing improves the quality of life of anophthalmic patients.
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Affiliation(s)
- Francesco M Quaranta-Leoni
- Orbital and Adnexal Service, Villa Tiberia Hospital - GVM Care & Research, Rome, 00137, Italy.,Oftalmoplastica Roma, Rome, 00197, Italy
| | - Maria Grazia Fiorino
- Orbital and Adnexal Service, Villa Tiberia Hospital - GVM Care & Research, Rome, 00137, Italy
| | | | - Matteo Di Marino
- Orbital and Adnexal Service, Villa Tiberia Hospital - GVM Care & Research, Rome, 00137, Italy
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