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Chen J, Qin G, Li L, Qi Y, Xia Y, Zhang Q, Wu Y, You Y, Yang L, Guo N, Moutari S, Moore JE, Bu S, Xu L, He W, Yu S, Pazo EE, He X. The Combined Impact of Intense Pulsed Light Combined and 3% Diquafosol Ophthalmic Solution on Evaporative Dry Eye: A Randomized Control Study. Ophthalmol Ther 2023; 12:2959-2971. [PMID: 37589932 PMCID: PMC10640412 DOI: 10.1007/s40123-023-00784-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/26/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION The primary objective of this study is to assess whether the combination of intense pulsed light (IPL) with 3% diquafosol (DQS) ophthalmic solution is more effective than intense pulsed light in alleviating signs and symptoms of dry eye disease (DED). METHODS This randomized study included 66 participants with evaporative dry eye (EDE) who received IPL + DQS therapy (n = 44 eyes), IPL therapy (n = 44 eyes), or sham therapy (n = 44 eyes). All participants were examined at baseline (D0), day 14 (D14), and day 28 (D28) for non-invasive break-up time (NITBUT), tear-film lipid layer (TFLL), corneal conjunctival staining (CS), meibomian gland quality (MGQ), meibomian gland expression (MGEx), and ocular surface disease index (OSDI). RESULTS At day 28, comparison among the IPL + DQS therapy, IPL therapy, and sham therapy found significant differences in the mean NITBUT (12.03 ± 1.27 versus 10.47 ± 3.48 versus 4.57 ± 0.46; p < 0.001), TFLL (2.09 ± 0.29 versus 2.27 ± 0.45 versus 2.89 ± 0.65; p < 0.001), CS (1.43 ± 0.82 versus 1.93 ± 1.32 versus 3.52 ± 1.00; p < 0.001), MGQ (1.55 ± 0.66 versus 1.91 ± 0.77 versus 2.66 ± 0.53; p < 0.001), MGEx (1.27 ± 0.45 versus 1.75 ± 0.44 versus 2.41 ± 0.50; p < 0.001), and OSDI score (19.36 ± 7.01 versus 24.77 ± 4.68 versus 42.61 ± 7.49; p < 0.001); significant improvements in NITBUT, TFLL, CS, MGQ, MGEx, and OSDI were found in the IPL + DQS therapy and IPL therapy, while the sham therapy had no significant improvements. CONCLUSION Combining 3% diquafosol ophthalmic solution with intense pulsed light was superior to IPL therapy alone in relieving the signs and symptoms of patients with severe evaporative DED. TRIAL REGISTRATION Clinical Trials Identifier: NCT05694026.
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Affiliation(s)
- Jiayan Chen
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, 110034, China
| | - Guanghao Qin
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, 110034, China
| | - Liangzhe Li
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, 110034, China
| | - Yifan Qi
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, 110034, China
| | - Yang Xia
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, 110034, China
| | - Qing Zhang
- Tianjin Medical University, Tianjin, China
| | - Yi Wu
- China Medical University, Shenyang, China
| | - Yue You
- Sinqi Eye Hospital, Shenyang, China
| | | | - Naici Guo
- University of St Andrews, St Andrews, UK
| | | | | | | | - Ling Xu
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, 110034, China
| | - Wei He
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, 110034, China
| | - Sile Yu
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, 110034, China
| | - Emmanuel Eric Pazo
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, 110034, China.
| | - Xingru He
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, 110034, China.
- School of Public Health, He University, Shenyang, 110034, China.
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Bekele AG, Alimaw YA, Tegegn MT. Symptomatic Dry Eye Disease and Associated Factors Among Adult Diabetic Patients in Adare General Hospital, Hawassa City, Southern Ethiopia, 2023. Clin Ophthalmol 2023; 17:3429-3442. [PMID: 38026606 PMCID: PMC10656469 DOI: 10.2147/opth.s433679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/04/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Symptomatic dry eye disease is a multifactorial ocular surface condition caused by disruption of the precorneal tear film and is a common clinical finding in diabetic patients. However, there was no study on the prevalence and associated factors of symptomatic dry eye disease among diabetic patients in Ethiopia or in the study area. Purpose This study aimed to investigate the prevalence and associated factors of symptomatic dry eye disease among adult diabetic patients in Adare General Hospital, Hawassa City, Southern Ethiopia, in 2023. Methods A hospital-based cross-sectional study design was conducted on 493 adult diabetic patients who were selected using systematic random sampling, from April 23 to June 8, 2023. Data were collected through a face-to-face interview using an ocular surface disease index questionnaire. Binary logistic regression was performed to identify factors potentially associated with symptomatic dry eye disease. Variable with a P value of <0.05 was considered statistically significant. Results A total of 488 subjects participated in this study with a response rate of 99%. The prevalence of symptomatic dry eye disease was 34.8% (95% CI = 30.6-39.1). College and university educational status (AOR = 5.88, 95% CI = 2.25-15.38), government employed (AOR = 2.22, 95% CI = 1.05-4.68), use of visual display unit >5 hours (AOR = 4.41, 95% CI = 1.51-12.87), duration of diabetes ≥11 years (AOR = 3.57, 95% CI = 1.28-9.90), poor glycemic control (AOR = 2.13, 95% CI = 1.21-3.75), allergic conjunctivitis (AOR = 1.99, 95% CI = 1.12-3.54), and debris in the tear film (AOR = 3.63, 95% CI = 1.53-8.61) were positively associated with symptomatic dry eye disease. Conclusion The study revealed a high prevalence of symptomatic dry eye disease. Higher educational status, government employed, use of visual display unit, longer duration of diabetes, poor glycemic control, allergic conjunctivitis, and tear film debris were significantly associated with symptomatic dry eye disease. Breaks in screen use, good glycemic control, and treatment of ocular morbidities such as allergic conjunctivitis and debris in the tear film were recommended for all diabetic patients.
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Affiliation(s)
- Asnake Gezahegn Bekele
- Department of Ophthalmology, Madda Walabu University Goba Referral Hospital, Goba City, Ethiopia
| | - Yezinash Addis Alimaw
- Department of Optometry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Melkamu Temeselew Tegegn
- Department of Optometry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Chen J, Qin G, Li L, Qi Y, Che H, Huang H, Xia Y, Zhang Q, Wu Y, Yang L, Moutari S, Moore JE, Xu L, He W, Yu S, Pazo EE, He X. Protocol for a parallel assignment prospective, randomised, comparative trial to evaluate the safety and efficacy of intense pulsed light (IPL) combined with 3% diquafosol (DQS) ophthalmic solution in dry eye syndrome. BMJ Open 2023; 13:e073055. [PMID: 37643847 PMCID: PMC10465902 DOI: 10.1136/bmjopen-2023-073055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/27/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Evaporative dry eye (EDE) is common and can lead to ocular pain, decreased visual quality and reduced quality of life. Intense pulsed light (IPL) and 3% diquafosol ophthalmic solution have been found to be beneficial in reducing signs and symptoms of dry eye. METHODS AND ANALYSIS A randomised clinical trial will be performed at He Eye Specialist Hospital in Shenyang. 360 dry eye disease patients will be equally divided randomly into the IPL group, DQS group (3% diquafosol ophthalmic solution eye-drops) and IPL+group (IPL combined with 3% diquafosol eye-drops). All groups will be followed up for 4 weeks. The primary outcome measures will be the non-invasive tear break-up time and the Ocular Surface Disease Index change from the baseline. The secondary outcome measures willincludeconjunctival and cornea staining with fluorescein and lissamine, meibomian gland function and secretion quality, tear film lipid layer score, tear meniscus height, conjunctival hyperemia (redness score) changes . Adverse events also will be monitored and documented. DISCUSSION This study aimed to assess whether the combination of IPL with 3% diquafosol ophthalmic solution (study group), IPL+ (study group), is more effective than IPL (active control group) or DQS (active control group) in participants with EDE. ETHICS AND DISSEMINATION Management of dry eye with IPL combined with 3% diquafosol ophthalmic solution, registered on 23 January 2023. Ethics approval number: IRB (2022) K029.01. The study's findings will be shared regardless of the effect's direction. TRIAL REGISTRATION NUMBER NCT05694026.
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Affiliation(s)
- Jiayan Chen
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Guanghao Qin
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Liangzhe Li
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Yifan Qi
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Huixin Che
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - He Huang
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Yang Xia
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Qing Zhang
- Department of Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Yi Wu
- Department of Ophthalmology, China Medical University Second Hospital, Shenyang, China
| | - Lanting Yang
- Department of Ophthalmology, Wenzhou Medical University Eye Hospital, Wenzhou, China
| | - Salissou Moutari
- School of Mathematics and Physics, Queen's University Belfast, Belfast, UK
| | | | - Ling Xu
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Wei He
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Sile Yu
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
- School of Public Health, He University, Shenyang, China
| | - Emmanuel Eric Pazo
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Xingru He
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
- School of Public Health, He University, Shenyang, China
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Almohammed BA, Alnafeesah AA, Aldharman SS, Alenzi MH, Mahjari AA, Albalawi FA, Amer KA, Alkhathami GH, Al Taisan AA. Prevalence and Severity of Dry Eye Disease Symptoms Among Diabetics: A Nationwide Survey. Cureus 2022; 14:e30981. [DOI: 10.7759/cureus.30981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 11/07/2022] Open
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Fan F, Li X, Li K, Jia Z. To Find Out the Relationship Between Levels of Glycosylated Hemoglobin with Meibomian Gland Dysfunction in Patients with Type 2 Diabetes. Ther Clin Risk Manag 2021; 17:797-807. [PMID: 34393486 PMCID: PMC8355550 DOI: 10.2147/tcrm.s324423] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/21/2021] [Indexed: 12/14/2022] Open
Abstract
Aim The aim of this study was to investigate the relationship between levels of glycosylated hemoglobin (HbA1c) with meibomian gland dysfunction (MGD) in patients with type 2 diabetes mellitus (T2DM) and to further explore the related influencing factors. Methods Totally, 167 patients with T2DM and 68 non-diabetic subjects were selected. Further, T2DM patients were divided into 2 groups based on 7% HbA1c. Standard patient evaluation of eye dryness (SPEED), lipid layer thickness (LLT), partial blink (PB) ratio, percentage of partial glands (MGP), meibomian gland yielding liquid secretion (MGYLS), meibomian gland yielding secretion score (MGYSS), line of marx (LOM), tear break up time (TBUT), tear meniscus height (TMH) and Schirmer I test (SIT) were applied to evaluate meibomian gland function. Finally, the correlation between HbA1c and various indicators was also analyzed. Results Between HbA1c≥7% group and HbA1c<7% group, the differences in LLT (P=0.003), MGP (P<0.001), MGYLS (P=0.014) and TBUT (P=0.015) were all statistically significant. Compared with the non-diabetic group, LLT (P=0.020), MBP (P<0.001), MGYS (P< 0.001), TBUT (P<0.001), SIT (P=0.001), TMH (P=0.017) and LOM (P<0.001) were significantly different in HbA1c≥7% group, while the differences of MBP (P=0.031), MGYSS (P<0.001), SIT (P=0.001) and LOM (P<0.001) in HbA1c≤7% group were statistically significant. Besides, the prevalence of MGD in HbA1c≥7% group was evidently higher than that in non-diabetic group (P=0.002). Correlation analysis showed that HbA1c was significantly associated with the LTT and MGP. Conclusion HbA1c≥7% is likely to result in meibomian gland function dysfunctions in T2DM patients, especially related to LLT and MGP.
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Affiliation(s)
- Fang Fan
- Department of Ophthalmology, Hebei General Hospital, Shijiazhuang, 050051, People's Republic of China
| | - Xiaodan Li
- Department of Ophthalmology, Shijiazhuang People's Hospital, Shijiazhuang, 050000, People's Republic of China
| | - Kejun Li
- Department of Ophthalmology, Hebei General Hospital, Shijiazhuang, 050051, People's Republic of China
| | - Zhiyang Jia
- Department of Ophthalmology, Hebei General Hospital, Shijiazhuang, 050051, People's Republic of China
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Błochowiak K, Celichowski P, Kempisty B, Iwanik K, Nowicki M. Transcriptomic Profile of Genes Encoding Proteins Involved in Pathogenesis of Sjögren's Syndrome Related Xerostomia-Molecular and Clinical Trial. J Clin Med 2020; 9:jcm9103299. [PMID: 33066537 PMCID: PMC7602267 DOI: 10.3390/jcm9103299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/01/2020] [Accepted: 10/10/2020] [Indexed: 01/14/2023] Open
Abstract
Sjögren’s syndrome (SS) is characterized by xerostomia. We aimed to investigate and compare gene expressions in the labial salivary glands of SS patients with xerostomia SS (sicca) and without xerostomia SS (non-sicca) and of healthy subjects (HS) by means of microarray analysis, and to find genes involved in xerostomia. The study group comprised 11 SS patients (3 SS (sicca) and 8 SS (non-sicca)) and 9 HS. The relative gene expression changes were validated with RT-qPCR in the larger study group. Among the differently expressed genes belonging to the “secretion” ontology group with a fold change >2 and with a p value < 0.05, the Transmembrane P24 Trafficking Protein 10 (TMED10), Protein Disulfide Isomerase Family A Member 4 (PDIA4), Calnexin (CANX), Amyloid Beta Precursor Protein (APP), and Transmembrane BAX Inhibitor Motif Containing 6 (TMBIM6) gene expressions in both SS (sicca) and SS (non-sicca) groups were lower than in HS. Significant correlations were observed between TMED10, PDIA4, and CANX gene expression in SS (sicca) patients compared to the controls. There were no differences between the SS (sicca) and SS (non-sicca) study groups in the expression of the aforementioned genes. Results indicate their role in the endoplasmic reticulum system, their overlapping function and the loss of the APP neuroprotective function in xerostomia. It has a multifactorial origin and can be triggered by disturbances to the various signaling pathways in saliva secretion.
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Affiliation(s)
- Katarzyna Błochowiak
- Department of Oral Surgery and Periodontology, Poznan University of Medical Sciences, 61-812 Poznan, Poland
- Correspondence: ; Tel.: +48-608-836-850
| | - Piotr Celichowski
- Department of Histology and Embryology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (P.C.); (B.K.); (M.N.)
| | - Bartosz Kempisty
- Department of Histology and Embryology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (P.C.); (B.K.); (M.N.)
- Department of Anatomy, Poznan University of Medical Sciences, 61-701 Poznan, Poland
- Department of Veterinary Surgery, Institute of Veterinary Medicine, Nicolaus Copernicus University in Torun, 87-100 Torun, Poland
| | - Katarzyna Iwanik
- Department of Clinical Pathomorphology, Poznan University of Medical Sciences, 60-355 Poznan, Poland;
| | - Michał Nowicki
- Department of Histology and Embryology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (P.C.); (B.K.); (M.N.)
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Inanc M, Kiziltoprak H, Hekimoglu R, Tekin K, Ozalkak S, Koc M, Bayramoglu E, Zirh S, Yuruker S, Aycan Z. Alterations of Tear Film and Ocular Surface in Children with Type 1 Diabetes Mellitus. Ocul Immunol Inflamm 2020; 28:362-369. [PMID: 30806526 DOI: 10.1080/09273948.2019.1571212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To investigate whether diabetes mellitus (DM) affects ocular surface of children with well-controlled type 1 DM.Methods: Sixty-five diabetic patients and 55 age-matched controls enrolled to study. Detailed ocular surface assessment including, ocular surface disease index (OSDI) questionnaire, tear film break-up time (TBUT) analysis, Schirmer test, and conjunctival impression cytologic analysis were performed.Results: Schirmer test and TBUT results were significantly lower in DM group than controls (p = 0.001, for all). OSDI scores of all participants were within normal range. Impression cytology analysis showed grade 0 changes in all participants and there was no difference between groups for goblet cell density (p > 0.05). The TBUT results were significantly associated with duration of DM (r = -0.309, p = 0.036).Conclusion: Diabetic children without symptoms, signs, and definite diagnosis of dry eye still had lower TBUT and Schirmer test results than controls; however, impression cytology analysis was similar in both groups.
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Affiliation(s)
- Merve Inanc
- Ophthalmology Department, Ercis State Hospital, Van, Turkey
| | - Hasan Kiziltoprak
- Department is Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Rumeysa Hekimoglu
- Histology and Embryology Department, Kastamonu University, Kastamonu, Turkey
| | - Kemal Tekin
- Ophthalmology Department, Ercis State Hospital, Van, Turkey
| | - Servan Ozalkak
- Department of Pediatric Endocrinology, Dr. Sami Ulus Children's Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Mustafa Koc
- Department is Ophthalmology, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Elvan Bayramoglu
- Department of Pediatric Endocrinology, Dr. Sami Ulus Children's Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Selim Zirh
- Histology and Embryology Department, Hacettepe University, Ankara, Turkey
| | - Sinan Yuruker
- Histology and Embryology Department, Usak University, Usak, Turkey
| | - Zehra Aycan
- Department of Pediatric Endocrinology, Dr. Sami Ulus Children's Health and Disease Training and Research Hospital, Ankara, Turkey
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Yu T, Han XG, Gao Y, Song AP, Dang GF. Morphological and cytological changes of meibomian glands in patients with type 2 diabetes mellitus. Int J Ophthalmol 2019; 12:1415-1419. [PMID: 31544036 DOI: 10.18240/ijo.2019.09.07] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/21/2019] [Indexed: 12/28/2022] Open
Abstract
AIM To observe the changes of microcellular structure of meibomian glands (MGs) in type 2 diabetes mellitus (DM), and to explore its correlation with the duration of diabetes. METHODS The study assessed 132 eyes of 132 patients with type 2 diabetes mellitus (DM group) and 100 eyes of 100 non-diabetic participants (NDM group). All patients underwent the examination of the Keratograph 5M system to obtain the meibography which were used to evaluate the structure dropout of the MGs. And then laser scanning confocal microscopy (LSCM) was performed for observing the acinar cells and ducts of the MGs to obtain the following parameters: the MG acinar unit density (MGAUD), MG acinar longest diameter (MGALD) and MG acinar shortest diameter (MGASD). The examination results of the right eye were selected for analysis. RESULTS Compared with that in NDM group, the meiboscore was significantly higher (Z=-4.057, P<0.001), and there were more MGs dropout in DM group. With the prolongation of the course of diabetes, the absence of MGs aggravated and the MGs dropout score increased (r=0.596; P<0.001). LSCM showed that there were various cytological alterations in acinar cells of MGs with the progress of diabetes duration, such as expansion, atrophy or fibrosis of MG acinar units, decreased density of MG acinar units, deposition of lipid substances, infiltration of inflammatory cells, proliferation of fibrous tissues, etc. And the opening of the glandular duct changed from smooth at the beginning to narrow, blocked, fibrotic and so on. Compared with that in NDM group, the MGAUD in DM group was significantly lower (Z=-9.713; P<0.001), the MGALD and MGASD were significantly larger (Z=-9.751, -6.416; P<0.001). With the duration of diabetes, the MGAUD reduced, the MGASD increased (r=0.860, 0.364, P<0.001); but the MGALD had no correlation with diabetic duration (r=0.133, P=0.151). CONCLUSION With the progress of diabetes, the meibomian glandular acinar cells of diabetic patients show various manifestations. Those changes may result in the dysfuction of the MGs, tear film instability and dry eye symptoms in patients with type 2 DM.
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Affiliation(s)
- Tao Yu
- Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated with Shandong First Medical University, Jinan 250014, Shandong Province, China
| | - Xu-Guang Han
- Jinan Aier Ophthalmology Hospital, Aier Eye Hospital Group, Jinan 250014, Shandong Province, China
| | - Yang Gao
- Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated with Shandong First Medical University, Jinan 250014, Shandong Province, China
| | - Ai-Ping Song
- Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated with Shandong First Medical University, Jinan 250014, Shandong Province, China
| | - Guang-Fu Dang
- Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated with Shandong First Medical University, Jinan 250014, Shandong Province, China
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Heidari M, Noorizadeh F, Wu K, Inomata T, Mashaghi A. Dry Eye Disease: Emerging Approaches to Disease Analysis and Therapy. J Clin Med 2019; 8:jcm8091439. [PMID: 31514344 PMCID: PMC6780511 DOI: 10.3390/jcm8091439] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/01/2019] [Accepted: 09/06/2019] [Indexed: 12/11/2022] Open
Abstract
Dry eye disease (DED) is among the most common ocular disorders affecting tens of millions of individuals worldwide; however, the condition remains incompletely understood and treated. Valuable insights have emerged from multidisciplinary approaches, including immunometabolic analyses, microbiome analyses, and bioengineering. Furthermore, we have seen new developments in clinical assessment approaches and treatment strategies in the recent past. Here, we review the emerging frontiers in the pathobiology and clinical management of DED.
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Affiliation(s)
- Mostafa Heidari
- Basir Eye Health Research Center, Tehran 1418643561, Iran.
- Farabi Eye Hospital, Department of Ophthalmology and Eye Research Center, Tehran University of Medical Sciences, Tehran 133661635, Iran.
| | | | - Kevin Wu
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, Ophthalmic Consultation Service, New York, NY 10029, USA
- New York Eye and Ear Infirmary of Mount Sinai, New York, NY 10003, USA
| | - Takenori Inomata
- Department of Ophthalmology, Juntendo University Faculty of Medicine, Tokyo 1130033, Japan.
- Department of Strategic Operating Room Management and Improvement, Juntendo University Faculty of Medicine, Tokyo 1130033, Japan.
| | - Alireza Mashaghi
- Systems Biomedicine and Pharmacology Division, Leiden Academic Centre for Drug Research, Leiden University, 2333CC Leiden, The Netherlands.
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA 02138, USA.
- Department of Ophthalmology, Shanghai Medical College, Fudan University, Shanghai 200000, China.
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Ferdousi M, Petropoulos IN, Kalteniece A, Azmi S, Ponirakis G, Efron N, Soran H, Malik RA. No Relation Between the Severity of Corneal Nerve, Epithelial, and Keratocyte Cell Morphology With Measures of Dry Eye Disease in Type 1 Diabetes. Invest Ophthalmol Vis Sci 2019; 59:5525-5530. [PMID: 30480740 DOI: 10.1167/iovs.18-25321] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Patients with diabetes have a propensity to develop dry eye symptoms (DES), with reduced tear secretion and corneal sensitivity. The underlying pathologic basis of DES was explored in patients with Type 1 diabetes. Methods Forty-two patients with Type 1 diabetes mellitus (T1DM) (age: 49.21 ± 2.53 years, duration of diabetes: 29.98 ± 2.64 years) and 25 control subjects (age: 48.70 ± 2.84 years) underwent assessment of DES using a validated dry eye questionnaire, and tear stability and tear production were assessed using tear breakup time (TBUT) and Schirmer's test, respectively. Corneal confocal microscopy was undertaken to quantify corneal nerve fiber density (CNFD), branch density (CNBD), fiber length (CNFL), keratocyte density (KD), and corneal epithelial basal cell (CEBC) density and area. Results The prevalence of DES was significantly higher (P = 0.03), and TBUT (P = 0.006), corneal sensation (P < 0.0001), CNFD (P = 0.001), CNBD (P = 0.001), CNFL (P = 0.003), and KD (P = 0.04) were significantly lower in patients with T1DM compared to control subjects. However, these measures did not differ significantly between T1DM patients with and without dry eye. There was no correlation between DES and TBUT or corneal nerve keratocyte and CEBC morphology. Conclusions DES and TBUT are significantly increased in patients with T1DM, but are not related to corneal nerve, basal epithelial, or keratocyte cell morphology.
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Affiliation(s)
- Maryam Ferdousi
- Institute of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom
| | - Ioannis N Petropoulos
- Weill Cornell Medicine-Qatar, Research Division, Qatar Foundation, Education City, Doha, Qatar
| | - Alise Kalteniece
- Institute of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom
| | - Shazli Azmi
- Institute of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom
| | - Georgios Ponirakis
- Weill Cornell Medicine-Qatar, Research Division, Qatar Foundation, Education City, Doha, Qatar
| | - Nathan Efron
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Handrean Soran
- Institute of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom
| | - Rayaz Ahmed Malik
- Institute of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom.,Weill Cornell Medicine-Qatar, Research Division, Qatar Foundation, Education City, Doha, Qatar
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11
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Yazdani-Ibn-Taz MK, Han MM, Jonuscheit S, Collier A, Nally JE, Hagan S. Patient-reported severity of dry eye and quality of life in diabetes. Clin Ophthalmol 2019; 13:217-224. [PMID: 30774302 PMCID: PMC6354694 DOI: 10.2147/opth.s184173] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose The purpose of the study was to assess the relationship between patient-reported severity of dry eye disease (DED), quality of life (QoL), presence of diabetic retinopathy (DR) and length of disease duration in people with type 1 diabetes mellitus (DM1) and type 2 diabetes mellitus (DM2). Patients and methods A survey of 152 people (110 with and 42 without diabetes). All participants completed the Ocular Surface Disease Index (OSDI) and Dry Eye-related Quality of Life Score (DEQS) questionnaires. Results Forty-four percent of all diabetic subjects reported dry eye symptoms, compared to 29% in the control group. Patients with DM2 reported dry eye symptoms more frequently than those with DM1 (55% and 27% respectively, P=0.001). Dry eye severity was linked to a significant deterioration in QoL in both types of diabetes (DM1, r=0.609 and P=0.036; DM2, r=0.417 and P=0.011). Irrespective of DR, the presence of DED was significantly higher in DM2 compared to DM1 (with DR, P=0.011; without DR, P=0.018). Conclusion Dry eye symptoms are associated with reduced QoL and are more common in people with DM2 than in DM1, irrespective of DR status. Routine clinical screening for severe DED could potentially allow for a timely and more effective treatment and could contribute to mitigating the dry eye-associated reduction in QoL in those with DM2.
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Affiliation(s)
| | - Myint Myint Han
- School of Health and Life Sciences, Glasgow Caledonian University (GCU), Glasgow G4 0BA, UK,
| | - Sven Jonuscheit
- School of Health and Life Sciences, Glasgow Caledonian University (GCU), Glasgow G4 0BA, UK,
| | - Andrew Collier
- School of Health and Life Sciences, Glasgow Caledonian University (GCU), Glasgow G4 0BA, UK, .,Diabetes Day Centre, University Hospital Ayr, Ayr KA6 6DX, UK
| | - Jane E Nally
- School of Health and Life Sciences, Glasgow Caledonian University (GCU), Glasgow G4 0BA, UK,
| | - Suzanne Hagan
- School of Health and Life Sciences, Glasgow Caledonian University (GCU), Glasgow G4 0BA, UK,
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12
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Kwak JY, Choi KR, Han KE, Jun RM. Dry Eye Syndrome and Morphological Changes of Meibomian Glands in Type 2 Diabetic Patients. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.11.1037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ji Yoon Kwak
- Department of Ophthalmology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Kyu Ryong Choi
- Department of Ophthalmology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Kyung Eun Han
- Department of Ophthalmology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Roo Min Jun
- Department of Ophthalmology, Ewha Womans University College of Medicine, Seoul, Korea
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13
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Liu F, Kong H, Kong X. Transforming growth factor-β blocks glucose-induced inflammation and apoptosis in corneal epithelial cells. FEBS Open Bio 2018; 8:1936-1942. [PMID: 30524944 PMCID: PMC6275247 DOI: 10.1002/2211-5463.12529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 09/01/2018] [Accepted: 09/10/2018] [Indexed: 01/14/2023] Open
Abstract
Diabetic retinopathy is the most important ocular complication associated with diabetes. Corneal defects due to diabetes mellitus (DM) may cause severe vision impairments. This study aimed to identify the effect of transforming growth factor‐β (TGF‐β) on biological events, such as apoptosis and inflammation, in the diabetic cornea. High‐glucose treatment induced reactive oxygen species (ROS) production and several biological events, including apoptosis and inflammatory cytokine secretion, in human corneal epithelial cells. However, administration of TGF‐β significantly decreased ROS production, Annexin V‐positive cells, and levels of inflammatory cytokines. Sprague Dawley rats were injected with streptozotocin (STZ) as a model of DM. Inflammatory cytokine secretion, apoptosis, and inflammation were all increased by STZ treatment. However, apoptosis and inflammation were markedly reduced following TGF‐β treatment. In conclusion, TGF‐β can ameliorate the enhancement of apoptosis and inflammation in diabetic cornea in in vivo and in vitro.
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Affiliation(s)
- Fengge Liu
- Department of Ophthalmology Zoucheng People's Hospital China
| | - Hui Kong
- Department of Ophthalmology Zoucheng People's Hospital China
| | - Xiangfeng Kong
- Department of Ophthalmology Zoucheng People's Hospital China
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14
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Badugu R, Jeng BH, Reece EA, Lakowicz JR. Contact lens to measure individual ion concentrations in tears and applications to dry eye disease. Anal Biochem 2017; 542:84-94. [PMID: 29183834 DOI: 10.1016/j.ab.2017.11.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/24/2017] [Accepted: 11/18/2017] [Indexed: 11/18/2022]
Abstract
Dry eye disease (DED) affects millions of individuals in the United States and worldwide, and the incidence is increasing with an aging population. There is widespread agreement that the measurement of total tear osmolarity is the most reliable test, but this procedure provides only the total ionic strength and does not provide the concentration of each ionic species in tears. Here, we describe an approach to determine the individual ion concentrations in tears using modern silicone hydrogel (SiHG) contact lenses. We made pH (or H3O+, hydronium cation,/OH-, hydroxyl ion) and chloride ion (two of the important electrolytes in tear fluid) sensitive SiHG contact lenses. We attached hydrophobic C18 chains to water-soluble fluorescent probes for pH and chloride. The resulting hydrophobic ion sensitive fluorophores (H-ISF) bind strongly to SiHG lenses and could not be washed out with aqueous solutions. Both H-ISFs provide measurements which are independent of total intensity by use of wavelength-ratiometric measurements for pH or lifetime-based sensing for chloride. Our approach can be extended to fabricate a contact lens which provides measurements of the six dominant ionic species in tears. This capability will be valuable for research into the biochemical processes causing DED, which may improve the ability to diagnose the various types of DED.
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Affiliation(s)
- Ramachandram Badugu
- Center for Fluorescence Spectroscopy, Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, 725 W. Lombard Street, Baltimore, MD 21201, USA.
| | - Bennie H Jeng
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 W. Redwood Street, Suite 420, Baltimore, MD 21201, USA
| | - E Albert Reece
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD 21201, USA; Department of Biochemistry & Molecular Biology, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD 21201, USA
| | - Joseph R Lakowicz
- Center for Fluorescence Spectroscopy, Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, 725 W. Lombard Street, Baltimore, MD 21201, USA
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15
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Sullivan DA, Rocha EM, Aragona P, Clayton JA, Ding J, Golebiowski B, Hampel U, McDermott AM, Schaumberg DA, Srinivasan S, Versura P, Willcox MDP. TFOS DEWS II Sex, Gender, and Hormones Report. Ocul Surf 2017; 15:284-333. [PMID: 28736336 DOI: 10.1016/j.jtos.2017.04.001] [Citation(s) in RCA: 232] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 04/16/2017] [Indexed: 12/21/2022]
Abstract
One of the most compelling features of dry eye disease (DED) is that it occurs more frequently in women than men. In fact, the female sex is a significant risk factor for the development of DED. This sex-related difference in DED prevalence is attributed in large part to the effects of sex steroids (e.g. androgens, estrogens), hypothalamic-pituitary hormones, glucocorticoids, insulin, insulin-like growth factor 1 and thyroid hormones, as well as to the sex chromosome complement, sex-specific autosomal factors and epigenetics (e.g. microRNAs). In addition to sex, gender also appears to be a risk factor for DED. "Gender" and "sex" are words that are often used interchangeably, but they have distinct meanings. "Gender" refers to a person's self-representation as a man or woman, whereas "sex" distinguishes males and females based on their biological characteristics. Both gender and sex affect DED risk, presentation of the disease, immune responses, pain, care-seeking behaviors, service utilization, and myriad other facets of eye health. Overall, sex, gender and hormones play a major role in the regulation of ocular surface and adnexal tissues, and in the difference in DED prevalence between women and men. The purpose of this Subcommittee report is to review and critique the nature of this role, as well as to recommend areas for future research to advance our understanding of the interrelationships between sex, gender, hormones and DED.
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Affiliation(s)
- David A Sullivan
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
| | - Eduardo M Rocha
- Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Pasquale Aragona
- Department of Biomedical Sciences, Ocular Surface Diseases Unit, University of Messina, Messina, Sicily, Italy
| | - Janine A Clayton
- National Institutes of Health Office of Research on Women's Health, Bethesda, MD, USA
| | - Juan Ding
- Schepens Eye Research Institute, Massachusetts Eye & Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Blanka Golebiowski
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Ulrike Hampel
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Alison M McDermott
- The Ocular Surface Institute, College of Optometry, University of Houston, Houston, TX, USA
| | - Debra A Schaumberg
- Harvard School of Public Health, Boston, MA, USA; University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sruthi Srinivasan
- Centre for Contact Lens Research, School of Optometry, University of Waterloo, Ontario, Canada
| | - Piera Versura
- Department of Specialized, Experimental, and Diagnostic Medicine, University of Bologna, Bologna, Italy
| | - Mark D P Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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16
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Kan S, Acar U, Kizilgul M, Beyazyildiz E, Cankaya A, Ozcelik O, Ozbek M. The effects of blood glucose regulation on tear function tests in diabetic patients. J Fr Ophtalmol 2017; 40:499-504. [DOI: 10.1016/j.jfo.2016.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/05/2016] [Accepted: 10/14/2016] [Indexed: 10/19/2022]
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17
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Wong M, Dodd MM, Masiowski P, Sharma V. Tear osmolarity and subjective dry eye symptoms in migraine sufferers. Can J Ophthalmol 2017; 52:513-518. [PMID: 28985814 DOI: 10.1016/j.jcjo.2017.02.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/22/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Previous studies have suggested an association between dry eye and migraine. In a busy ophthalmologist clinic, quick identification of dry eye in migraine sufferers may improve their quality of life. Tear osmolarity is an objective and reliable tool for diagnosing dry eye. It has not been investigated in any population with migraine. Using tear osmolarity and questionnaires, we aimed to explore the relationship between dry eye and clinical symptoms in patients with migraine. DESIGN Prospective cross-sectional study. PARTICIPANTS Thirty-four adults with migraine sequentially recruited from a single neurologist's practice. METHODS Patients were assessed for subjective and objective signs of migraine and dry eye by using the Migraine Disability Assessment Score, the Ocular Surface Disease Index, and tear osmolarity (TearLab). Headache characteristics were compared by using χ2, Fisher's exact, and Mann-Whitney U tests. Osmolarity scores were compared with scores for headache features. RESULTS Median age of patients was 38 years, and 76.5% were females. Severe migraine disability was reported in 75.6%, and 34.5% reported moderate to severe dry eye symptoms. Objectively, 49.5% had evidence of dry eye, significantly higher than the 20% recognized in the general population (p < 0.0001). Aura was found to occur more frequently with dry eye (43.8% vs 5.9%; p = 0.02). Those with daily headaches were also more likely to have higher tear osmolarity with marginal significance (median osmolarity 310 mOsm/L vs 299 mOsm/L; p = 0.08). CONCLUSIONS Patients with migraine, especially those with aura, appear more likely to have dry eye, as indicated by tear osmolarity. Tear osmolarity may also be greater in those who suffer from daily headaches.
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Affiliation(s)
- Melody Wong
- College of Medicine, University of Saskatchewan, Saskatoon, Sask
| | | | - Paul Masiowski
- Department of Neurology, University of Saskatchewan, Saskatoon, Sask
| | - Vikas Sharma
- Department of Ophthalmology, Saskatoon City Hospital, Saskatoon, Sask
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18
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Yu T, Shi WY, Song AP, Gao Y, Dang GF, Ding G. Changes of meibomian glands in patients with type 2 diabetes mellitus. Int J Ophthalmol 2016; 9:1740-1744. [PMID: 28003972 DOI: 10.18240/ijo.2016.12.06] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 08/19/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the morphological changes of meibomian glands in patients with type 2 diabetes mellitus (DM). METHODS Of 118 eyes (118 patients) with type 2 DM (DM group) and 100 eyes of 100 control subjects (control group) were enrolled. After completing an ocular surface disease index (OSDI) questionnaire, the non-invasive tear film break-up time (NI-BUT) and the structure of the meibomian glands (MGs, meibography) were assessed by the Keratograph 5M system. Partial or complete loss of MG was scored for each eyelid from grade 0 (no loss) to grade 3 (lost area was >2/3 of the total MG area), which were also examined by laser scanning confocal microscopy (LSCM). The primary outcomes were meibomian gland acinar unit density (MGAUD), meibomian gland acinar longest diameter (MGALD) and meibomian gland acinar shortest diameter (MGASD). RESULTS Compared with control group, the OSDI was significantly higher in DM group (Z=-5.916; P<0.001), while the NI-BUT was significantly lower (Z=-7.765; P<0.001). Keratograph showed that there were more MGs dropout in DM group than that in control group. The meiboscore was significantly higher in DM group compared with control group (Z=-3.937; P<0.001). LSCM revealed that there were cytological alterations of MGs in DM group compared with control group, which included enlargement of MG acinar units and decreased in density of MG acinar units. Specifically, there were lower MGAUD, larger MGALD and MGASD in DM group than control group (Z=-10.120, -9.4442, -7.771; P<0.001). CONCLUSION Compared with the normal control participants, the patients with type 2 DM had more unstable tear films and severe symptoms of dry eye. Using Keratograph 5M system and LSCM, we found that the patients with type 2 DM had more significant morphological and cytological changes and dysfunction in MGs.
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Affiliation(s)
- Tao Yu
- Qingdao University, Qingdao 266071, Shandong Province, China; Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong Province, China
| | - Wei-Yun Shi
- Shandong Eye Hospital, Shandong Eye Institute, Jinan 250021, Shandong Province, China
| | - Ai-Ping Song
- Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong Province, China
| | - Yang Gao
- Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong Province, China
| | - Guang-Fu Dang
- Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong Province, China
| | - Gang Ding
- Jinan Second People's Hospital, Jinan 250012, Shandong Province, China
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19
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Gunay M, Celik G, Yildiz E, Bardak H, Koc N, Kirmizibekmez H, Gunay BO, Yesiltepe Mutlu RG. Ocular Surface Characteristics in Diabetic Children. Curr Eye Res 2016; 41:1526-1531. [DOI: 10.3109/02713683.2015.1136421] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Murat Gunay
- Zeynep Kamil Maternity and Children’s Diseases Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey
| | - Gokhan Celik
- Zeynep Kamil Maternity and Children’s Diseases Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey
| | - Elvin Yildiz
- Haydarpasa Numune Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey
| | - Handan Bardak
- Haydarpasa Numune Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey
| | - Nermin Koc
- Zeynep Kamil Maternity and Children’s Diseases Training and Research Hospital, Department of Pathology, Istanbul, Turkey
| | - Heves Kirmizibekmez
- Umraniye Training and Research Hospital, Department of Pediatric Endocrinology, Istanbul, Turkey
| | - Betul Onal Gunay
- Umraniye Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey
| | - Rahime Gul Yesiltepe Mutlu
- Zeynep Kamil Maternity and Children’s Diseases Training and Research Hospital, Department of Pediatric Endocrinology, Istanbul, Turkey
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20
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Chao W, Belmonte C, Benitez del Castillo JM, Bron AJ, Dua HS, Nichols KK, Novack GD, Schrader S, Willcox MD, Wolffsohn JS, Sullivan DA. Report of the Inaugural Meeting of the TFOS i2 = initiating innovation Series: Targeting the Unmet Need for Dry Eye Treatment. Ocul Surf 2016; 14:264-316. [DOI: 10.1016/j.jtos.2015.11.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 11/09/2015] [Accepted: 11/11/2015] [Indexed: 01/09/2023]
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