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Navel V, Labetoulle M, Lazreg S, Brémond-Gignac D, Chiambaretta F. COVID-19 pandemic and impact of universal face mask wear on ocular surface health and risk of infection. J Fr Ophtalmol 2024; 47:104170. [PMID: 38569271 DOI: 10.1016/j.jfo.2024.104170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/17/2024] [Indexed: 04/05/2024]
Abstract
Universal mask wear is an effective public health intervention to reduce SARS-Cov-2 transmission, especially in enclosed public spaces and healthcare environments. Concerns have been raised about possible transmission of the SARS-Cov-2 through ocular secretions, leading to enhanced protective measures during ophthalmic procedures. However, there is some evidence for air jets from the upper edge of the surgical mask to the ocular surface, especially when the mask is not well fit. Prolonged airflow towards the ocular surface during expiration may alter tear-film stability, leading to hyperosmolarity and ocular surface inflammation. This also raises the question of whether the ocular surface is contaminated with oral flora from airflow directed toward the eyes, thus increasing the risk of ocular infection. Herein we review the impact of patient face mask wear on the ocular surface, eyelids and risk of ocular infection, particularly during ocular surgery. There is some evidence for increased incidence of dry eye or eyelid disease during periods of mandatory face mask wear. While high daily exposure is consistent with a direct association, this should be mitigated by various cofounding factors which could also affect the ocular health during the COVID-19 pandemic. An increased risk of post-intravitreal injection endophthalmitis, possibly due to face mask wear by the patient, including culture-positive endophthalmitis, has been reported in one retrospective study. Several measures have been shown to prevent or limit the risk of developing dry eye disease or exacerbation, eyelid cyst, and ocular infection during intravitreal injections.
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Affiliation(s)
- V Navel
- CHU Gabriel-Montpied, Clermont-Ferrand, France
| | - M Labetoulle
- Service d'ophtalmologie, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | - S Lazreg
- Centre d'ophtalmologie Lazreg, Blida, Algeria
| | - D Brémond-Gignac
- Hôpital universitaire Necker-Enfants Malades, AP-HP, Paris, France
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Uzzan J, Haddad M, Salamé N. [Quality of life survey of 3,738 patients treated with intravitreal injections for age-related macular degeneration]. J Fr Ophtalmol 2024; 47:104075. [PMID: 38368762 DOI: 10.1016/j.jfo.2024.104075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/03/2023] [Indexed: 02/20/2024]
Abstract
PURPOSE To evaluate the peri- and post-intravitreal injection (IVI) symptoms reported by patients who have been repeatedly injected for age-related macular degeneration (AMD) and to analyze these according to the protocols of the injector. MATERIALS AND METHODS Multi-center, cross-sectional, consecutive, analytical survey. RESULTS The IVI protocols of 106 injectors differed in terms of the number of instillations of povidone-iodine, its contact time, and rinsing of the ocular surface post-injection. In total, 3,738 patients responded to the survey, 60.1% of whom were women; 36.4% had received more than 20 IVIs; 50.7% of patients reported irritation upon application of povidone-iodine. Post-IVI, depending on the symptom in question, between 44.8% and 57.4% of patients reported symptoms of ocular surface change. The number of instillations of povidone-iodine, its contact time with the ocular surface, and abundant rinsing post-IVI increased the immediate symptoms. Patients who received more IVIs were more prone to experiencing gritty eyes, and the incidence of acute pain increased in patients who had previously received over 20 IVIs. Women and patients previously treated for dry eye or glaucoma were at greater risk of worse symptoms. CONCLUSION Comparing injecting centers' practices with patients' self-assessments showed an aggravation of symptoms of ocular surface changes related to povidone-iodine. This survey contributes to providing data for the implementation of a protocol to improve the quality of life of patients injected repeatedly for AMD.
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Affiliation(s)
- J Uzzan
- Clinique Mathilde Gpe Vivalto, 4, rue de Lessard, 76100 Rouen, France
| | - M Haddad
- Hôpital privé de la Baie, avenue du Quesnoy, 50300 Avranches, France
| | - N Salamé
- CHP Saint-Martin, 18, rue des Roquemonts, 14000 Caen, France.
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Amatu JB, Baudouin C, Trinh L, Labbé A, Buffault J. [Corneal epithelial biomechanics: Resistance to stress and role in healing and remodeling]. J Fr Ophtalmol 2023; 46:287-299. [PMID: 36759249 DOI: 10.1016/j.jfo.2022.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 09/29/2022] [Accepted: 09/29/2022] [Indexed: 02/10/2023]
Abstract
The corneal epithelium is one of the first tissue barriers of the eye against the environment. In recent years, many studies provided better knowledge of its healing, its behavior and its essential role in the optical system of the eye. At the crossroads of basic science and clinical medicine, the study of the mechanical stresses applied to the cornea makes it possible to learn the behavior of epithelial cells and better understand ocular surface disease. We describe herein the current knowledge about the adhesion systems of the corneal epithelium and their resistance to mechanical stress. We will also describe the involvement of these mechanisms in corneal healing and their role in epithelial dynamics. Adhesion molecules of the epithelial cells, especially hemidesmosomes, allow the tissue cohesion required to maintain the integrity of the corneal epithelium against the shearing forces of the eyelids as well as external forces. Their regeneration after a corneal injury is mandatory for the restoration of a healthy epithelium. Mechanotransduction plays a significant role in regulating epithelial cell behavior, and the study of the epithelium's response to mechanical forces helps to better understand the evolution of epithelial profiles after refractive surgery. A better understanding of corneal epithelial biomechanics could also help improve future therapies, particularly in the field of tissue engineering.
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Affiliation(s)
- J-B Amatu
- Department of Ophthalmology III, CHNO des Quinze-Vingts, IHU FOReSIGHT, 28, rue de Charenton, 75012 Paris, France.
| | - C Baudouin
- Department of Ophthalmology III, CHNO des Quinze-Vingts, IHU FOReSIGHT, 28, rue de Charenton, 75012 Paris, France; Institut de La Vision, Sorbonne Université, Inserm, CNRS, IHU FOReSIGHT, 17, rue Moreau, 75012 Paris, France; Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, Boulogne-Billancourt, France
| | - L Trinh
- Department of Ophthalmology III, CHNO des Quinze-Vingts, IHU FOReSIGHT, 28, rue de Charenton, 75012 Paris, France
| | - A Labbé
- Department of Ophthalmology III, CHNO des Quinze-Vingts, IHU FOReSIGHT, 28, rue de Charenton, 75012 Paris, France; Institut de La Vision, Sorbonne Université, Inserm, CNRS, IHU FOReSIGHT, 17, rue Moreau, 75012 Paris, France; Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, Boulogne-Billancourt, France
| | - J Buffault
- Department of Ophthalmology III, CHNO des Quinze-Vingts, IHU FOReSIGHT, 28, rue de Charenton, 75012 Paris, France; Institut de La Vision, Sorbonne Université, Inserm, CNRS, IHU FOReSIGHT, 17, rue Moreau, 75012 Paris, France; Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, Boulogne-Billancourt, France
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Rousseau A, Vauloup-Fellous C, Haigh O, Pavy S, Molinari D, Jauréguiberry S, Angoulvant A, Labetoulle M. Conjunctival conveyance of SARS-CoV-2 in asymptomatic and non-severe symptomatic COVID-19 patients. J Fr Ophtalmol 2023; 46:101-105. [PMID: 36635207 PMCID: PMC9812824 DOI: 10.1016/j.jfo.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/13/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The prevalence of ocular conveyance of SARS-CoV-2 has been well described for severe/hospitalized cases, but scarcely reported in asymptomatic and non-severe patients, who are unaware that they are carriers. MATERIAL & METHODS This prospective cross-sectional study quantitatively evaluated SARS-CoV-2 shedding on the ocular surface (OS). Conjunctival testing was suggested to all hospital personnel being screened by nasopharyngeal (NP) SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR). Disease symptoms were evaluated using a standardized questionnaire and telephone follow-up 6±3 months later for disease evolution (recovery with/without severe disease). RESULTS Four hundred and eighty seven patients were included. From 46 NP SARS-CoV-2-positive subjects (cycle threshold [CT]=24.2±7.1), 13% tested positive at the OS (CT=36.4±2.8). Most SARS-CoV-2-positive subjects were symptomatic (n=40, 87%), while 6 were asymptomatic (being tested as contact cases). Systemic symptoms were not significantly different in OS-positive vs OS-negative subjects, although headache tended to be more frequent in OS-positives (83% vs 54%, P=0.06). None of the OS-positive subjects reported ocular symptoms and none developed severe disease requiring hospitalization or oxygen therapy. CONCLUSION SARS-CoV-2 shedding at the OS may occur in asymptomatic and non-severe COVID-19 individuals (including those absent of ocular symptoms). However, the high RT-PCR CT values attained may indicate a low risk of transmissibility via this route.
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Affiliation(s)
- A Rousseau
- Department of Ophthalmology, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, French Reference network for rare Ophthalmologic diseases (OPHTARA), Le Kremlin-Bicêtre, France; Immunology of viral and autoimmune disease, IMVA, IDMIT, U1184, CEA, Fontenay aux Roses, France
| | - C Vauloup-Fellous
- Division of Virology, Dept of Biology Genetics and PUI, Paris-Saclay University Hospital, APHP, Villejuif, France; Inserm U1193, Université Paris-Saclay, Villejuif, France
| | - O Haigh
- Immunology of viral and autoimmune disease, IMVA, IDMIT, U1184, CEA, Fontenay aux Roses, France
| | - S Pavy
- Department of Rheumatology, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - D Molinari
- Clinical Research Unit, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - S Jauréguiberry
- Department of Infectious and tropical diseases, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France; Université de Paris Saclay, INSERM, CESP (Centre de Recherche en Epidémiologie et Santé des Populations), Villejuif, France
| | - A Angoulvant
- Department of Infectious and tropical diseases, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, Le Kremlin-Bicêtre, France; QE-Le Moulon, INRA-Université Paris-Saclay-CNRS-AgroParisTech, 91400 Orsay, France
| | - M Labetoulle
- Department of Ophthalmology, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, French Reference network for rare Ophthalmologic diseases (OPHTARA), Le Kremlin-Bicêtre, France; Immunology of viral and autoimmune disease, IMVA, IDMIT, U1184, CEA, Fontenay aux Roses, France
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Lazreg S, Garout R, Boulanab F, Aberkane D, Djabour M, Boudedja H, Acheli A, Derdour A, Zine El Abidine N, Ghemri N. [Ocular surface disease in glaucoma patients: Expert opinion and management algorithm in Algeria]. J Fr Ophtalmol 2023; 46:152-162. [PMID: 36642596 DOI: 10.1016/j.jfo.2022.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/23/2022] [Accepted: 07/25/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The main goal of treatment for any glaucoma patient is to reduce the intraocular pressure. Unfortunately, the long-term use of glaucoma medications causes deleterious effects on the ocular surface, leading to impaired quality of life and failed glaucoma surgery. In addition, adverse effects of medications are a barrier to adherence and compliance, and this directly affects efficacy. It is therefore essential to regularly assess the ocular surface of glaucoma patients in order to detect any signs of damage early and act accordingly. Although the TFOS DEWS 2 now offers a strategy for diagnosing ocular surface pathologies, some examinations are unfortunately not feasible in Algeria due to lack of time and/or knowledge on the part of some ophthalmologists or are simply inaccessible to others. METHODS Algerian experts (members of the ACOS club) met for the purpose of proposing an algorithm for the management of Algerian glaucoma patients, based on the recommendations of the DEWS, their own practice and the results of a preliminary national survey of ophthalmologists. RESULTS The proposed algorithm allows evaluation of the ocular surface of the glaucoma patient in current practice by any Algerian ophthalmologist. CONCLUSION Management of glaucoma patients should include a systematic examination of the ocular surface. The choice of treatment should be determined by the ocular surface condition of the glaucoma patient.
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Affiliation(s)
| | | | | | | | - Mustapha Djabour
- Service d'ophtalmologie, CHU Mohamed Lamine Debaghine, Alger, Algérie
| | - Hakim Boudedja
- Service d'ophtalmologie, CHU Nafissa Hamoud, Alger, Algérie
| | - Asma Acheli
- Service d'ophtalmologie, CHU Mustapha Pacha, Alger, Algérie
| | - Amine Derdour
- Service d'ophtalmologie, EHS Hammou Boutlelis, Oran, Algérie
| | | | - Nadia Ghemri
- Service d'ophtalmologie, CHU Issad Hassani, Alger, Algérie
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Aydin Kurna S, Oflaz Hacisalihoglu A, Altun A, Ozbay Ozel N, Uruc F, Kanar HS, Karatay Arsan A. Effects of systemic anti-androgen drugs on the ocular surface. J Fr Ophtalmol 2022; 45:619-627. [PMID: 35489988 DOI: 10.1016/j.jfo.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the effect of systemic anti-androgen drugs on tear function tests and the ocular surface. METHODS Sixty-four male subjects were included in this study. Subjects who were on anti-androgen treatment for prostate cancer (Group A, n: 31) and those who had received only surgical treatment for prostate cancer (Group B, n: 17) were recruited from the department of urology. Age-matched subjects who had never received anti-androgen treatment (Group C, n: 16) constituted the control group. Group A was divided into two subgroups according to the number of anti-androgen drugs used (Group A1: one drug, Group A2: two drugs). All cases underwent a complete ocular examination, including tear film break up time (TBUT), corneal and conjunctival staining, Schirmer 1 test, conjunctival impression cytology, and ocular surface disease index (OSDI) questionnaire. RESULTS The mean Schirmer's values were 6.87mm, 11.41mm, and 13.03mm in Groups A, B, and C, respectively (P=0.001). TBUT was 5.45±2.01, 9.85±2.52 and 9.81±1.96seconds in Groups A, B, and C, respectively (P=0.001). Schirmer and TBUT were significantly lower, and corneal staining and OSDI questionnaire scores were higher in Group A compared to groups B and C (P<0.01). Conjunctival impression cytology results according to the Nelson grading system revealed no statistically significant difference between the groups (P=0.422). CONCLUSION Anti-androgen drugs alter tear function tests, cause increased corneal and conjunctival staining scores and worsen complaints of dry eye in patients with prostate cancer.
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Affiliation(s)
- S Aydin Kurna
- University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Ophthalmology Department, Istanbul, Turkey.
| | - A Oflaz Hacisalihoglu
- Kartal Lütfü Kırdar Training and Research Hospital Ophthalmology Department, Istanbul, Turkey
| | - A Altun
- University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Ophthalmology Department, Istanbul, Turkey
| | - N Ozbay Ozel
- University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Pathology Department, Istanbul, Turkey
| | - F Uruc
- University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Urology Department, Istanbul, Turkey
| | - H S Kanar
- Kartal Lütfü Kırdar Training and Research Hospital Ophthalmology Department, Istanbul, Turkey
| | - A Karatay Arsan
- Kartal Lütfü Kırdar Training and Research Hospital Ophthalmology Department, Istanbul, Turkey
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Bozkurt E, Muhafiz E, Erat YE, Arslan EÖ, Bozkurt HB, Erguven M. Evaluation of the Ocular Surface, Conjunctival Impression Cytology and Meibomian Gland Dropout in Patients with Familial Mediterranean Fever. J Fr Ophtalmol 2021; 44:1319-25. [PMID: 34561094 DOI: 10.1016/j.jfo.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/23/2021] [Accepted: 05/26/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE Familial Mediterranean fever (FMF) is an idiopathic disease with chronic inflammation. We aimed to determine the changes caused by the chronic inflammatory nature of FMF on the ocular surface, meibomian glands (MG), and conjunctiva via conjunctival impression cytology (CIC). MATERIAL-METHOD Forty-two FMF patients with a mean age of 11.93±3.92 years and 36 control patients with a mean age of 11.83±3.38 years were included in the study. Ocular surface anomalies of the patients were evaluated using Schirmer II, TBUT and OSDI. MG function (meibum quality), morphology (meiboography), and CIC were evaluated. RESULTS Although there was a significant difference between the groups in terms of Schirmer II and TBUT, OSDI scores did not significantly differ (P=0.022, 0.010, and 0.099 respectively), and no significant dry eye sign was observed in either group. There was significant difference between the groups in terms of the percent area of MG dropout, MG density, meiboscore (P=0.020, 0.023, and 0.031 respectively), but no significant difference was observed in relation to MG quality (P=0.650). Although conjunctival impression cytology was of a higher grade in the patients with FMF according to Nelson's classification, no significant difference was observed between the groups (P=0.109). CONCLUSION Although there was a decrease in the number of MGs in FMF patients, no significant deterioration was observed in conjunctival cytology. In these patients, tear film stability may deteriorate in particular. Clinicians should be aware of the possibility of ocular surface disease secondary to MG dropout in patients with FMF.
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Rousseau A, Fenolland JR, Labetoulle M. [SARS-CoV-2, COVID-19 and the eye: An update on published data]. J Fr Ophtalmol 2020; 43:642-652. [PMID: 32631687 PMCID: PMC7260525 DOI: 10.1016/j.jfo.2020.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 01/08/2023]
Abstract
La pandémie de COVID-19 a bouleversé notre quotidien d’ophtalmologiste. Cette revue générale propose dans un premier temps de mieux faire connaissance avec le virus responsable de la pandémie, le SARS-CoV-2, et des atteintes cliniques du COVID-19. La seconde partie détaille la physiopathologie, les signes cliniques et les enjeux des atteintes oculaires, finalement rares et qui semblent peu sévères sur le plan fonctionnel, mais qui sont potentiellement source de contamination. Enfin, nous abordons les mesures préventives à mettre en place pour éviter toute dissémination virale en consultation d’ophtalmologie.
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Affiliation(s)
- A Rousseau
- Service d'ophtalmologie, CHU Bicêtre, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, université Paris-Saclay, réseau OPHTARA : maladies rares en ophtalmologie, Le Kremlin-Bicêtre, France; Département immunologie des maladies virales, auto-immunes, bactériennes et hématologiques. UMR 1184, CEA, Fontenay-Aux-Roses, France.
| | - J-R Fenolland
- Service d'ophtalmologie, hôpital d'instruction des Armées Bégin, Saint-Mandé, France
| | - M Labetoulle
- Service d'ophtalmologie, CHU Bicêtre, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, université Paris-Saclay, réseau OPHTARA : maladies rares en ophtalmologie, Le Kremlin-Bicêtre, France; Département immunologie des maladies virales, auto-immunes, bactériennes et hématologiques. UMR 1184, CEA, Fontenay-Aux-Roses, France
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Robin M, Liang H, Baudouin C, Labbé A. [In vivo Meibomian gland imaging techniques: A review of the literature (French translation of the article)]. J Fr Ophtalmol 2020; 43:484-93. [PMID: 32409228 DOI: 10.1016/j.jfo.2019.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/15/2019] [Accepted: 10/18/2019] [Indexed: 11/21/2022]
Abstract
Meibomian gland dysfunction (MGD) encompasses a group of complex pathologies of the ocular surface. They represent one of the main etiologies of dry eye but also one of the leading causes of consultation in ophthalmology. Conventional clinical tests (dry eye symptoms, tear film rupture time, glandular expressiveness assessment, or Schirmer's test) allow only an indirect assessment of Meibomian gland function and physiology. Various in vivo investigation methods have therefore been developed to image the meibomian glands such as meibography, optical coherence tomography, ultrasound or in vivo confocal microscopy. Some are accessible in clinical practice, while others remain in the field of clinical research. All these techniques aim to develop a direct structural analysis of the Meibomian glands to help in the diagnosis of DGM but also to better understand the pathophysiology of Meibomian glands. This review of the literature aims to provide an overview of existing imaging modalities and their interest in the evaluation of Meibomian glands and MGD.
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Labetoulle M, Rousseau A, Baudouin C. Management of dry eye disease to optimize cataract surgery outcomes: Two tables for a daily clinical practice. J Fr Ophtalmol 2019; 42:907-912. [PMID: 31351686 DOI: 10.1016/j.jfo.2019.03.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 03/11/2019] [Indexed: 12/23/2022]
Abstract
The increase in life expectancy has resulted in a greater number of patients presenting for cataract surgery as well as an increasing prevalence of dry eye disease (DED) symptoms or signs noted in these patients. Low grade and/or non-symptomatic DED is common and can be exacerbated after surgery. DED can induce errors in IOL power calculation. DED can impair the visual prognosis and patient comfort after cataract surgery, leading to dissatisfaction of both the patient and the surgeon. Hence, preoperative evaluation for DED for all cataract candidates is crucial to mitigate these risks. To optimize clinical efficiency during the screening examination, we propose a strategy of three levels of DED screening, according to a patient's risk of DED given his or her history. We also propose a summary of the main clinical points before, during and after cataract surgery in eyes with DED.
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Affiliation(s)
- M Labetoulle
- Service d'Ophtalmologie, hôpital Bicêtre, AP-HP, Université Paris Sud, 94275 Le Kremlin-Bicêtre, France; Center for Immunology of Viral infections and Autoimmune diseases (IMVA). IDMIT Infrastructure (http://www.idmitcenter.fr). CEA, Université Paris Sud, Inserm U1184, 18, route du Panorama, 92265, Fontenay-aux-Roses cedex, France.
| | - A Rousseau
- Service d'Ophtalmologie, hôpital Bicêtre, AP-HP, Université Paris Sud, 94275 Le Kremlin-Bicêtre, France; Center for Immunology of Viral infections and Autoimmune diseases (IMVA). IDMIT Infrastructure (http://www.idmitcenter.fr). CEA, Université Paris Sud, Inserm U1184, 18, route du Panorama, 92265, Fontenay-aux-Roses cedex, France
| | - C Baudouin
- Centre Hospitalier des Quinze-Vingts, Service III, 28, rue de Charenton, 75012 Paris France; Institut de la Vision, 17, rue Moreau, 75012 Paris France; Hôpital Ambroise Paré, AP-HP, Boulogne, Université Versailles Saint-Quentin en Yvelines, 9 avenue Charles-de-Gaulle, 92104 Boulogne-Billancourt, France
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Ouffoue GY, Boni S, Ouattara AO, Gbe K, Kouassi LJK, Konan AJ, Gombe E, Ouonnebo L, Agbohoun RP, Fanny A, Cheucheu WJ. [Contribution of break up time in the diagnosis and the treatment of dry eye syndrome in tropic area: about 234 patients in Abidjan]. J Fr Ophtalmol 2019; 42:716-721. [PMID: 31133400 DOI: 10.1016/j.jfo.2018.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 08/26/2018] [Accepted: 08/29/2018] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Dry eye disease (DED) can be evaluated clinically by the tear film break up time (BUT). There is a discrepancy between symptoms in relationship with dry eye disease and objectives measures of BUT. So we tried to evaluate the reliability of BUT in the diagnosis and treatment of this disease in black African people. METHODS We carried out a prospective study of 6 months where melanoderms adults presenting subjective symptoms of dry eye disease according a questionnaire of 7 items were included. Then the measure of BUT is performed after ocular instillation of fluorescein eyedrop. This measured is done by recording the time elapsed from the last complete palpebral blink to the appearance of the first dry spot. Patients with subjective symptoms and time of BUT lower than 10seconds were called concordants (suffering really of DED). The discrepant group was represented by a BUT upper than 10seconds despite the fact that these patients answered positively to the questionnaire. RESULTS This survey included 234 patients and the average age was 49.1 years. Sex-ratio was 0.68 and we noticed predominance of BUT between 5 and 10seconds in 42.3% of cases. Subjective symptoms were strengthened clinically by a BUT lower to 10seconds in 149 patients. Therefore, the reliability of BUT as clinic tool for the diagnosis after symptoms in relationship with DED was 63.7%. In the group of concordants, women were more likely than men to experience symptoms of DED (P=0.0005). Age upper than 50 years and computer usage were risk factors of DED (P<0.01). DISCUSSION Dry eye disease is a multifactorial affection of tear and ocular surface frequently seen in female and people using computer and older than 50. The reliability of BUT near to 65% is a reason to perform this test in our daily practice. CONCLUSION Tear BUT is a reliable clinical test which must be performed systematically to assess the diagnosis of DED in black African people.
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Affiliation(s)
- G Y Ouffoue
- Service d'ophtalmologie du CHU de Treichville, Abidjan, Cote d'Ivoire; Université Felix-Houphouet-Boigny, 25 bp 1455 Abidjan 25, Côte d'Ivoire.
| | - S Boni
- Service d'ophtalmologie du CHU de Treichville, Abidjan, Cote d'Ivoire; Université Felix-Houphouet-Boigny, 25 bp 1455 Abidjan 25, Côte d'Ivoire
| | - A O Ouattara
- Service d'ophtalmologie du CHU de Treichville, Abidjan, Cote d'Ivoire; Unité d'épidémiologie, institut Pasteur de Côte d'Ivoire, Abidjan, Côte d'Ivoire; Université Felix-Houphouet-Boigny, 25 bp 1455 Abidjan 25, Côte d'Ivoire
| | - K Gbe
- Service d'ophtalmologie du CHU de Treichville, Abidjan, Cote d'Ivoire; Université Felix-Houphouet-Boigny, 25 bp 1455 Abidjan 25, Côte d'Ivoire
| | - L J K Kouassi
- Service d'ophtalmologie du CHU de Treichville, Abidjan, Cote d'Ivoire; Université Felix-Houphouet-Boigny, 25 bp 1455 Abidjan 25, Côte d'Ivoire
| | - A J Konan
- Service d'ophtalmologie du CHU de Treichville, Abidjan, Cote d'Ivoire; Université Felix-Houphouet-Boigny, 25 bp 1455 Abidjan 25, Côte d'Ivoire
| | - E Gombe
- Université Felix-Houphouet-Boigny, 25 bp 1455 Abidjan 25, Côte d'Ivoire; Université Felix-Houphouet-Boigny, 25 bp 1455 Abidjan 25, Côte d'Ivoire
| | - L Ouonnebo
- Service d'ophtalmologie du CHU de Treichville, Abidjan, Cote d'Ivoire; Université Felix-Houphouet-Boigny, 25 bp 1455 Abidjan 25, Côte d'Ivoire
| | - R P Agbohoun
- Service d'ophtalmologie du CHU de Treichville, Abidjan, Cote d'Ivoire; Université Felix-Houphouet-Boigny, 25 bp 1455 Abidjan 25, Côte d'Ivoire
| | - A Fanny
- Service d'ophtalmologie du CHU de Treichville, Abidjan, Cote d'Ivoire; Université Felix-Houphouet-Boigny, 25 bp 1455 Abidjan 25, Côte d'Ivoire
| | - W J Cheucheu
- Service d'ophtalmologie du CHU de Treichville, Abidjan, Cote d'Ivoire; Université Felix-Houphouet-Boigny, 25 bp 1455 Abidjan 25, Côte d'Ivoire
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12
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Herbaut A, Liang H, Denoyer A, Baudouin C, Labbé A. [Tear film analysis and evaluation of optical quality: A review of the literature (French translation of the article)]. J Fr Ophtalmol 2019; 42:226-243. [PMID: 30879832 DOI: 10.1016/j.jfo.2018.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/15/2018] [Accepted: 10/22/2018] [Indexed: 01/20/2023]
Abstract
Dry eye is a complex multifactorial disease of the ocular surface and tears. It is associated with ocular surface symptoms and is one of the most common causes for ophthalmologic consultation. Despite their frequent use in clinical practice, the usual tests to evaluate dry eye and ocular surface disease-history of symptoms, tear break-up time (TBUT), Meibomian gland evaluation, corneal fluorescein staining, Schirmer test-have shown low reproducibility and reliability. In addition, subjective symptoms are often weakly or poorly correlated with objective signs. Since the tear film is the first system through which light must pass, the optical quality of the eye is highly dependent on the homogeneity of the tear film. Various investigative methods have been developed to evaluate both the structural and functional quality of the tear film, such as corneal topography, interferometry, tear meniscus measurement, evaporation rate, tear osmolarity and even aberrometry. Some are easily accessible to clinicians, while others remain in the field of clinical research. All of these tests provide a better understanding of the pathophysiology of the tear film. This review hopes to provide an overview of the existing tests and their role in evaluating the significance of the tear film in visual function.
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Affiliation(s)
- A Herbaut
- Service d'ophtalmologie III, CHNO des Quinze-Vingts, IHU Sight Restore, Paris, France
| | - H Liang
- Service d'ophtalmologie III, CHNO des Quinze-Vingts, IHU Sight Restore, Paris, France; CHNO des Quinze-Vingts, IHU ForeRestore, INSERM-DHOS CIC 1423, Paris, France; Inserm, U968; UPMC Université Paris 06, UMR_S968, institut de la Vision; CNRS, UMR 7210; CHNO des Quinze-Vingts, INSERMDHOS CIC 503, Paris, France
| | - A Denoyer
- Inserm, U968; UPMC Université Paris 06, UMR_S968, institut de la Vision; CNRS, UMR 7210; CHNO des Quinze-Vingts, INSERMDHOS CIC 503, Paris, France; Service d'ophtalmologie, CHU Robert Debré, Université Reims, Champagne-Ardenne, Reims, France
| | - C Baudouin
- Service d'ophtalmologie III, CHNO des Quinze-Vingts, IHU Sight Restore, Paris, France; CHNO des Quinze-Vingts, IHU ForeRestore, INSERM-DHOS CIC 1423, Paris, France; Inserm, U968; UPMC Université Paris 06, UMR_S968, institut de la Vision; CNRS, UMR 7210; CHNO des Quinze-Vingts, INSERMDHOS CIC 503, Paris, France; Service d'ophtalmologie, hôpital Ambroise-Paré, AP-HP, université de Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - A Labbé
- Service d'ophtalmologie III, CHNO des Quinze-Vingts, IHU Sight Restore, Paris, France; CHNO des Quinze-Vingts, IHU ForeRestore, INSERM-DHOS CIC 1423, Paris, France; Inserm, U968; UPMC Université Paris 06, UMR_S968, institut de la Vision; CNRS, UMR 7210; CHNO des Quinze-Vingts, INSERMDHOS CIC 503, Paris, France; Service d'ophtalmologie, hôpital Ambroise-Paré, AP-HP, université de Versailles Saint-Quentin-en-Yvelines, Versailles, France.
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Abstract
INTRODUCTION Tear fluid osmolarity has been increasingly accepted as an accessible parameter in the diagnosis of ocular surface and dry eye disease. After having been proposed as the gold standard, recent results have put this into question. However, the most recent guidelines for dry eye disease identify specific values of osmolarity as thresholds to help to differentiate between various stages of severity of ocular surface disease. The limits of this approach were investigated to propose a new concept, that of osmokinetics. MATERIALS AND METHODS Available data on tear fluid osmolarity in normal and diseased eyes were compared. The possibility of normo-osmolar dry eye was investigated and repeated measurements of osmolarity performed. RESULTS The currently applied static model of a threshold value of osmolarity for diagnosing dry eye disease is apparently insufficient. Not only does it not take into account normo-osmolar dry eye, but it also applies too much significance to a single parameter. Instead, it was found that there is a daily variation in osmolarity (DVO), which appears to be higher in eyes with tear film deficiencies than in healthy eyes. DISCUSSION Tear film osmolarity does vary considerably throughout the day. Its value should be considered in a kinetic model taking into account the dynamics of osmolarity changes moreso than the current static model. The terms of osmotic stress and diurnal variation of osmolarity were found to offer a more physiological understanding of osmolarity. CONCLUSION A more dynamic model for osmolarity is presented in which not the value itself but the daily variation of osmolarity is identified. It is suggested that the amplitude of change in osmolarity over the course of a day or even shorter time periods could play a decisive role as a stress factor for the surface cells. The varying osmolar stress could be one of the key mechanisms leading to the cell death, inflammation, apoptosis, and goblet cell disappearance as observed in dry eye disease. Perhaps it is the mean osmolarity level at which these changes occur together with the magnitude of DVO which could identify the level of severity of dry eye disease.
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Affiliation(s)
- G-B van Setten
- St Eriks Eye Hospital, Karolinska Institutet, Polhemsgatan 50, 11282 Stockholm, Sweden.
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14
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Rouimi F, Bouillot A, Baudouin C, Labbé A. [Topical cyclosporine A and risk of ocular surface neoplasia]. J Fr Ophtalmol 2018; 41:122-128. [PMID: 29402465 DOI: 10.1016/j.jfo.2017.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/03/2017] [Accepted: 09/04/2017] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Cyclosporine A (CsA) has well-known cutaneous carcinogenic effects when administered systemically. In ophthalmology, it is increasingly used in the form of eye drops since its indication for moderate to severe eye dry eye. The goal of this review of the literature is to evaluate a possible link between topical ocular CsA use and the occurrence of ocular surface neoplasia. MATERIALS AND METHODS A literature review was performed. Publications evaluating the safety and efficacy of topical CsA as well as studies on the epidemiology and risk factors for conjunctival neoplasia and cases of conjunctival neoplasia were analyzed. Finally, post-market surveillance data from commercially available CsA eye drops were also evaluated. RESULTS Five cases of conjunctival neoplasia in patients treated with systemic and/or topical CsA have been described in the literature, three with systemic administration alone, another with combined systemic and local administration, and one case of local administration alone. In these cases, no direct link with the administration of ocular topical CsA could be determined. Among the numerous prospective studies evaluating the safety and efficacy of topical CsA as well as the case-control studies evaluating the risk factors for developing conjunctival neoplasia, no relationship between the occurrence of conjunctival neoplasia and the use of topical ocular CsA was observed. CONCLUSION Despite plausible pathophysiologic mechanisms, to date there is no evidence of an increased risk of ocular surface neoplasia with the use of topical ocular CsA. Further studies specifically addressing this question and with a longer duration are needed in order to precisely evaluate this theoretical risk.
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Affiliation(s)
- F Rouimi
- Service d'ophtalmologie, hôpital Ambroise-Paré, université de Versailles Saint-Quentin-en-Yvelines, AP-HP, 9, avenue Charles-De-Gaulle, 92100 Boulogne-Billancourt, France
| | - A Bouillot
- Service d'ophtalmologie, hôpital Ambroise-Paré, université de Versailles Saint-Quentin-en-Yvelines, AP-HP, 9, avenue Charles-De-Gaulle, 92100 Boulogne-Billancourt, France
| | - C Baudouin
- Service d'ophtalmologie, hôpital Ambroise-Paré, université de Versailles Saint-Quentin-en-Yvelines, AP-HP, 9, avenue Charles-De-Gaulle, 92100 Boulogne-Billancourt, France; Service d'ophtalmologie, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; CNRS, UMR 7210, Inserm, U968, 75012 Paris, UMR S 968, institut de la vision, université UPMC Paris VI, 75012 Paris, France
| | - A Labbé
- Service d'ophtalmologie, hôpital Ambroise-Paré, université de Versailles Saint-Quentin-en-Yvelines, AP-HP, 9, avenue Charles-De-Gaulle, 92100 Boulogne-Billancourt, France; Service d'ophtalmologie, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; CNRS, UMR 7210, Inserm, U968, 75012 Paris, UMR S 968, institut de la vision, université UPMC Paris VI, 75012 Paris, France.
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Audelan T, Legrand M, M'Garrech M, Best AL, Barreau E, Labetoulle M, Rousseau A. [Ocular surface aging: Pathophysiology and consequences for management]. J Fr Ophtalmol 2018; 41:262-270. [PMID: 29573862 DOI: 10.1016/j.jfo.2017.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 10/24/2017] [Accepted: 12/22/2017] [Indexed: 11/15/2022]
Abstract
All the components of the ocular surface and the lacrimal system are affected by aging. Aging induces lacrimal gland fibrosis, Meibomian gland dysfunction, loss of corneal sensitivity, decreased corneal cell density, impairment of immune defences, increased local inflammation associated with hormonal changes, conjunctivochalasis, lid abnormalities, etc. Furthermore, homeostasis of the ocular surface may be altered by various age-related systemic comorbidities and iatrogenic interventions. Altogether, aging is considered the most predominant risk factor for dry eye disease. The increasing knowledge of the pathophysiology of aging of the ocular surface allows for refinement of the management of ocular surface disease in the elderly.
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Affiliation(s)
- T Audelan
- Service d'ophtalmologie, hôpital de Bicêtre, Assistance publique-Hôpitaux de Paris, DHU vision et handicap, université Paris-Sud, Le Kremlin-Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France
| | - M Legrand
- Service d'ophtalmologie, hôpital de Bicêtre, Assistance publique-Hôpitaux de Paris, DHU vision et handicap, université Paris-Sud, Le Kremlin-Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France
| | - M M'Garrech
- Service d'ophtalmologie, hôpital de Bicêtre, Assistance publique-Hôpitaux de Paris, DHU vision et handicap, université Paris-Sud, Le Kremlin-Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France
| | - A-L Best
- Service d'ophtalmologie, hôpital de Bicêtre, Assistance publique-Hôpitaux de Paris, DHU vision et handicap, université Paris-Sud, Le Kremlin-Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France
| | - E Barreau
- Service d'ophtalmologie, hôpital de Bicêtre, Assistance publique-Hôpitaux de Paris, DHU vision et handicap, université Paris-Sud, Le Kremlin-Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France
| | - M Labetoulle
- Service d'ophtalmologie, hôpital de Bicêtre, Assistance publique-Hôpitaux de Paris, DHU vision et handicap, université Paris-Sud, Le Kremlin-Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France; Immunologie des infections virales et maladies auto-immunes UMR 1184, CEA, Fontenay-aux-Roses, France
| | - A Rousseau
- Service d'ophtalmologie, hôpital de Bicêtre, Assistance publique-Hôpitaux de Paris, DHU vision et handicap, université Paris-Sud, Le Kremlin-Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France; Immunologie des infections virales et maladies auto-immunes UMR 1184, CEA, Fontenay-aux-Roses, France.
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Boujnah Y, Mouchel R, El-Chehab H, Dot C, Burillon C, Kocaba V. [Prospective, monocentric, uncontrolled study of efficacy, tolerance and adherence of cyclosporin 0.1 % for severe dry eye syndrome]. J Fr Ophtalmol 2018; 41:129-135. [PMID: 29449025 DOI: 10.1016/j.jfo.2017.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 08/25/2017] [Accepted: 08/25/2017] [Indexed: 01/21/2023]
Abstract
PURPOSE To evaluate the efficacy, tolerability and treatment adherence of Ikervis® (Santen, SAS) (ciclosporine 0.1 %) for first line therapy or following treatment with Restasis® (Allergan, Inc.) (ciclosporine 0.05 %) for severe dry eye syndrome. MATERIAL AND METHODS A prospective, monocentric, uncontrolled study was conducted between January 2012 and March 2015 on 110 eyes of 55 patients with severe dry eye on first line therapy or previously treated with Restasis® who required the introduction of Ikervis®. Patients' quality of life was assessed before and after treatment was started using a standardized questionnaire (Ocular Surface Disease Index© [OSDI]), clinical efficacy was quantified at the slit lamp, by measurement of the Break Up time Test (BUT) and the Oxford classification. Tolerability and adherence to treatment were measured using a simple questionnaire. RESULTS A total of 72 eyes of 37 patients were included. Etiologies of dry eye syndrome were dominated by Sjögren syndrome (32 %) and severe ocular surface conditions (48 %). The mean age was 57.7 years (±17.45) and mean follow-up was 458 days (±292). The mean BUT increased by 2.043seconds [1.522-2.563] (P<0.0001). Corneal/conjunctival involvement evaluated by the Oxford classification was also improved with a difference in level of 1.68 [1.290-2.071] (P<0.0001). Ocular Surface Disease Index© (OSDI) decreased by 21.7 [16.372-27.024] (P<0.0001). Treatment tolerability was moderate, with more than 50 % of patients experiencing pain on instillation. Overall satisfaction with treatment was good, with more than 60 % of patients feeling better after initiation of treatment. CONCLUSION Ikervis® is an effective treatment of severe dry eye. Its indications tend to evolve towards less severe dry eye. However, the tolerability profile remains poor, and an improvement in this would be desirable.
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Affiliation(s)
- Y Boujnah
- Service d'ophtalmologie, hôpital Édouard-Herriot, Lyon, France
| | - R Mouchel
- Service d'ophtalmologie, hôpital Édouard-Herriot, Lyon, France
| | - H El-Chehab
- Service d'ophtalmologie, hôpital d'instruction des armées Desgenettes, Lyon, France
| | - C Dot
- Service d'ophtalmologie, hôpital d'instruction des armées Desgenettes, Lyon, France; École du Val-de-Grâce, Paris, France
| | - C Burillon
- Service d'ophtalmologie, hôpital Édouard-Herriot, Lyon, France; Université Claude-Bernard Lyon I, Villeurbanne, France
| | - V Kocaba
- Service d'ophtalmologie, hôpital Édouard-Herriot, Lyon, France; Université Claude-Bernard Lyon I, Villeurbanne, France.
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Baumann A, Cochener B. [Meibomian gland dysfunction: a comparative study of modern treatments]. J Fr Ophtalmol 2014; 37:303-12. [PMID: 24656693 DOI: 10.1016/j.jfo.2013.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 11/11/2013] [Accepted: 12/19/2013] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate a thermal pulsation treatment compared to a warming eyelid device for the management of meibomian gland dysfunction. METHODS Thirty patients were randomized into two groups: the first had a treatment with MeiboPatch(®) on a daily basis for three months while the second had a single treatment with LipiFlow(®). The evaluation focused on a classical approach but also on a modern approach of the ocular surface (interferometry lipid layer LipiView(®)), analysis of the tear film by Oquas(®) (osmolarity by TearLab(®)) before treatment, then a month and three months later. RESULTS Both treatments proved to be effective with almost three times more functional meibomian glands at 3 months in the LipiFlow group and almost twice more in the MeiboPatch group (P<0.05) but the LipiFlow allows a more rapid improvement at the first month of treatment. Functional scores and classic exploration of the ocular surface except the Schirmer test also undergo a significant improvement in both groups after three months of treatment. CONCLUSION The combination of heat applied to the inner eyelid surface, together with simultaneous expression of the glands, during a single 12-minute treatment shows to be highly effective in treating cases of meibomian gland disease. Whilst results were excellent, and continued lid hygiene remains advised, the benefit of being able to simultaneous address potential compliance issues relating to ongoing treatment is significant. The convenience of a single 12-minute treatment versus an ongoing daily heating regime was shown to be highly desirable and a welcome relief in our patients' busy lifestyles.
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Affiliation(s)
- A Baumann
- Hôpital Morvan, CHU de Brest, 2, avenue Foch, 29609 Brest, France.
| | - B Cochener
- Hôpital Morvan, CHU de Brest, 2, avenue Foch, 29609 Brest, France
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