Dry Eye and Quantitative and Qualitative Changes of Meibomian Glands in Patients With Pemphigus

Power Scavenging Microsystem for Smart Contact Lenses

On-the-eye microsystems such as smart contacts for vision correction, health monitoring, drug delivery, and displaying information represent a new emerging class of low-profile (≤ 1 mm) wireless microsystems that conform to the curvature of the eyeball surface. The implementation of suitable low-profile power sources for eye-based microsystems on curved substrates is a major technical challenge addressed in this paper. The fabrication and characterization of a hybrid energy generation unit composed of a flexible silicon solar cell and eye-blinking activated Mg-O2 metal-air harvester capable of sustainably supplying electrical power to smart ocular devices are reported. The encapsulated photovoltaic device provides a DC output with a power density of 42.4 µW cm-2 and 2.5 mW cm-2 under indoor and outdoor lighting conditions, respectively. The eye-blinking activated Mg-air harvester delivers pulsed power output with a maximum power density of 1.3 mW cm-2. A power management circuit with an integrated 11 mF supercapacitor is used to convert the harvesters' pulsed voltages to DC, boost up the voltages, and continuously deliver ≈150 µW at a stable 3.3 V DC output. Uniquely, in contrast to wireless power transfer, the power pack continuously generates electric power and does not require any type of external accessories for operation.

Evaluation of Dry Eye Severity and Ocular Surface Inflammation in Patients with Pemphigus and Pemphigoid

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.

The conjunctival extracellular matrix, related disorders and development of substrates for conjunctival restoration

The conjunctiva can be damaged by numerous diseases with scarring, loss of tissue and dysfunction. Depending on extent of damage, restoration of function may require a conjunctival graft. A wide variety of biological and synthetic substrates have been tested in the search for optimal conditions for ex vivo culture of conjunctival epithelial cells as a route toward tissue grafts. Each substrate has specific advantages but also disadvantages related to their unique physical and biological characteristics, and identification and development of an improved substrate remains a priority. To achieve the goal of mimicking and restoring a biological material, requires information from the material. Specifically, extracellular matrix (ECM) derived from conjunctival tissue. Knowledge of the composition and structure of native ECM and identifying contributions of individual components to its function would enable using or mimicking those components to develop improved biological substrates. ECM is comprised of two components: basement membrane secreted predominantly by epithelial cells containing laminins and type IV collagens, which directly support epithelial and goblet cell adhesion differentiation and growth and, interstitial matrix secreted by fibroblasts in lamina propria, which provides mechanical and structural support. This review presents current knowledge on anatomy, composition of conjunctival ECM and related conjunctival disorders. Requirements of potential substrates for conjunctival tissue engineering and transplantation are discussed. Biological and synthetic substrates and their components are described in an accompanying review.

Ocular surface disorders affect quality of life in patients with autoimmune blistering skin diseases: a cross-sectional study

Background

Autoimmune blistering skin diseases (AIBD) are a group of rare chronic autoimmune diseases which are associated with ocular surface diseases especially dry eye disease. This study is designed to investigate the relationship between ocular surface disorders and quality of life among patients with autoimmune blistering skin diseases.

Methods

Twenty-four AIBD patients (18 pemphigus and 7 pemphigoid) and twenty-five non-AIBD controls were included. Ocular surface disease index (OSDI), ocular surface evaluation, including slit-lamp examination, Schirmer I test, tear break-up time, corneal fluorescein staining, lid-parallel conjunctival folds, meibomian gland evaluation, presence of symblepharon and corneal opacity were assessed. Life quality was evaluated by multiple questionnaires, including Medical Outcomes Study 36-Item Short Form Questionnaire (SF-36), Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index (PSQI) and Health Assessment Questionnaire-Disability Index (HAQ-DI). Ocular surface tests and quality of life were compared between AIBD patients and non-AIBD controls. In the AIBD patients, the associations between ocular surface parameters and quality of life were also evaluated.

Results

92% of AIBD patients and 87.5% of age- and sex-matched non-AIBD controls were diagnosed with dry eye in this study. Compared with non-AIBD controls, AIBD patients reported lower SF-36 scores (P < 0.05) and severer OSDI, Schirmer I test, tear break-up time, corneal fluorescein staining, presence of symblepharon and corneal opacity measures (P < 0.05). OSDI, Schirmer I test were correlated with SF-36 composite scores or scores on the SF-36 subscales.

Conclusions

AIBD patients experience reduced quality of life and more severe ocular surface disorders including dry eye, symblepharon and corneal opacity. Early treatments of dry eye and collaborations among multidisciplinary physicians are necessary in patients with AIBD.

Dry Eye and Meibomian Gland Dysfunction in Neovascular Age-Related Macular Degeneration Patients Treated with Intravitreal Injections

Objectives:

To determine if patients treated with multiple intravitreal injections for neovascular age-related macular degeneration are more likely to suffer from dry eye and meibomian gland dysfunction.

Materials and Methods:

Sixty eyes of 30 patients were enrolled. One eye of each patient was treated with multiple monthly intravitreal injections for neovascular AMD (Group 1) and the fellow healthy eye received no treatment (Group 2). The presence of dry eye was evaluated using tear film break-up time, Schirmer 1 test, the Oxford scale, and Ocular Surface Disease Index (OSDI). The loss rate of meibomian glands was evaluated by meibography and was graded and scored (meiboscore) from grade 0 (no loss of glands) to grade 3 (loss of >2/3 of total meibomian glands) for each eyelid.

Results:

Group 1 had lower mean Schirmer 1 and tear film break up-time measurements and higher mean OSDI score than Group 2, but the differences were not statistically significant (p=0.257, p=0.113, and p=0.212, respectively). Mean Oxford scale scores and meiboscore of the upper eyelids showed no statistically significant difference between the groups (p=0.594, p=0.663, respectively). The meiboscore of the lower eyelids was significantly higher in Group 1 (p=0.048).

Conclusion:

Multiple factors such as povidone-iodine and the preservatives in topical eye drops may cause inflammation leading to ocular surface damage in patients treated with multiple intravitreal injections. As the treatment requires repeated injections, exposure to these factors might worsen the ocular surface inflammation. The possibility of dry eye and meibomian gland dysfunction should be considered in these patients.

Orthokeratology Lens Wear for 2 Years in Children Did Not Alter Tear Film Lipid Thickness by Non-Invasive Interferometry

Purpose

Previous studies suggest that overnight orthokeratology (OOK) may be detrimental to tear function. We aimed to investigate the effect of OOK on lipid layer thickness (LLT), blink pattern, and meibomian gland and elucidate the relationship of these variables.

Methods

Thirty-seven participants who wore OOK lenses every night for at least 2 years and twenty-four healthy non-contact lens wearers (controls) were enrolled in this retrospective study. LipiView interferometry, blink pattern analysis, the ocular surface status, and morphology and function of the meibomian gland were determined.

Results

The OOK group and healthy controls had similar LLT, blink patterns, ocular surface status, and the function of the meibomian gland. OOK participants demonstrated higher meiboscore in the lower eyelids (p < 0.05) but not in the upper eyelids. Within the OOK group, LLT was significantly impacted by the partial blink rate (p < 0.05) and the total score of the upper meibomian gland (p = 0.10).

Conclusions

Wearing OOK for 2 or more years increased lower eyelid meibomian gland dropout but did not have a reduction of LLT.

Dry eye and Meibomian gland dysfunction evaluation in sarcoidosis patients

PURPOSE

To analyze the relation between Meibomian gland dysfunction, dry eye, and sarcoidosis.

MATERIALS AND METHODS

Twenty eyes of 10 sarcoidosis patients (Group 1) and 20 left eyes of 20 age-sex matched healthy volunteers (Group 2) were included. Presence of dry eye was evaluated with Schirmer 1 test, tear film break-up time (T-BUT), Oxford scale scoring, Ocular Surface Disease Index (OSDI) score assessments. A slit-lamp biomicroscope infrared filter (Topcon, SL-D701, IJssel, The Netherlands) was used to evaluate Meibomian glands. The drop-out ratio according to meibography was scored for each eyelid from grade 0 (no loss) through grade 3 (lost area >2/3 of the total Meibomian gland area).

RESULTS

Among dry eye tests mean Schirmer 1 and T-BUT values were lower and OSDI score was higher in Group 1 compared to Group 2 and the differences were statistically significant (p = 0.017, p = 0.039, p = 0.003, respectively). In addition, the upper, lower and total meiboscores were statistically significantly higher in Group 1 (p = 0.047, p = 0.003, p = 0.005, respectively).

CONCLUSION

A significantly higher presence of dry eye and Meibomian gland drop out ratios was detected in sarcoidosis patients. It is important to monitor sarcoidosis patients for dry eye and Meibomian gland dysfunction and when detected, to treat adequately to prevent ocular surface damage.