A review of meibography for a refractive surgeon

Refractive surgery has evolved from being a therapeutic correction of high refractive errors to a cosmetic correction. The expectations associated with such a surgery are enormous and one has to anticipate all possible complications and side-effects that come with the procedure and prepare accordingly. The most common amongst these is post-refractive surgery dry eye of which Meibomian gland dysfunction is a commonly associated cause. We present an understanding of various diagnostic imaging modalities that can be used for evaluating meibomian glands which can also serve as a visual aid for patient understanding. We also describe various common conditions which can silently cause changes in the gland architecture and function which are to be considered and evaluated for.     

Luz pulsada intensa: resultados en ojo seco crónico tras LASIK

A report is presented on the visual and clinical results from a retrospective case series of patients with chronic, evaporative, dry eye syndrome (DES), after refractive surgery, and treated with intense pulsed light treatment (IPL). Four sessions were performed, and the Ocular Surface Disease Index (OSDI) questionnaire was completed before initiating treatment and after the last session. Pre- and post-treatment data included: visual acuity (VA), refraction, clinical evaluation (DEWS severity grading, and Oxford corneal staining), and Orbscan topography. Twenty eyes were treated and the following data recorded: Schirmer I 14.7 ± 5.6; 15.6 ± 3.4 mm, tear breakup time (TBUT) 3.4 ± 1.6; 5.1 ± 1.2 s (P > .003), DEWS 3.4 ± 0.5; 1.6 ± 0.7 (P < .003), Oxford grade 0.8 ± 0.77; 0.4 ± 0.75 (P > .003), VA 0.67 ± 0.26; 0.90 ± 0.15 (P < .0001), best corrected VA 0.83 ± 0.18; 0.92 ± 0.14 (P > .003), spherical equivalent −0.31 ± 0.6; −0.08 ± 0.38 D (P > .003), OSDI 34 ± 16; 28 ± 11.0 points (P > .003), frequency artificial tear use 3.4 ± 2.0; 2.5 ± 1.9 times/day (P > .03). A significant clinical and visual improvement was observed, together with a decreased frequency in artificial tear use, in LASIK patients with chronic DES after IPL treatment.     

糖尿病视网膜病变患者泪膜脂质层厚度与黄斑微血管改变的相关性

目的:分析糖尿病视网膜病变患者泪膜脂质层厚度(LLT)与黄斑区微血管结构参数的相关性。方法:选取2018-01/12于我院确诊的2型糖尿病合并非增生期(NPDR组)和增生期(PDR组)糖尿病视网膜病变患者各60例60眼,另选取年龄、性别相匹配的健康志愿者60例60眼作为正常对照组。三组受检者均经Lipiview眼表面干涉仪检查LLT,OCT血流成像仪(OCTA)检查黄斑无血管区面积(FAZ)、视网膜浅层毛细血管层(SCL)和视网膜深层毛细血管层(DCL)血管密度,比较各参数之间的差异和相关性。结果:正常对照组受检者LLT(69.87±11.401nm)高于NPDR(54.87±7.453nm)和PDR组(42.67±5.246nm),FAZ(0.312±0.021mm^2)小于NDPR组(0.389±0.037mm^2)和PDR组(0.437±0.032mm^2),SCL血管密度(51.977%±4.164%)显著高于NPDR(47.067%±4.757%)和PDR组(41.865%±5.512%),DCL血管密度(49.578%±2.619%)高于NPDR组(46.032%±2.622%)和PDR组(40.598%±2.671%)(均P<0.01)。正常受检者LLT与FAZ、SCL和DCL血管密度无相关性;NPDR组和PDR组患者LLT与FAZ均呈负相关关系(r=-0.922、-0.923,均P<0.01),与SCL血管密度均呈正相关关系(r=0.798、0.902,均P<0.01),与DCL血管密度均无相关性(r=0.140、0.073,P=0.285、0.581)。结论:糖尿病视网膜病变患者泪膜脂质层厚度降低,泪膜稳定性下降,并与黄斑微血管结构改变存在相关关系。     

Efficacy and retention of silicone punctal plugs for treatment of dry eye in patients with and without ocular graft-versus-host-disease

PurposeTo examine the retention rates and efficacy of silicone punctal plugs for the treatment of dry eye disease (DED) in patients with ocular graft-versus-host-disease (oGVHD) in comparison to dry eye disease due to non-oGVHD etiologies.MethodsWe reviewed the case-records of 864 consecutive patients with DED who were symptomatic despite topical therapy and had silicone punctal plugs placed over an eight-year- period at a single academic center. We compared plug retention rates in oGVHD and non-oGVHD DED patients using Kaplan–Meier analyses. Furthermore, we analyzed changes in objective ocular surface parameters including tear breakup time (TBUT), Schirmer's test, and corneal fluorescein staining (CFS) score in plug-retaining patients at two-, six- and twelve-month follow-up.ResultsMedian age of dry eye patients was 58 years, and 606 (70%) of patients were women. In the cohort, 264 (31%) patients were diagnosed with oGVHD. Plug retention was significantly lower in oGVHD-DED patients compared to non-oGVHD-DED patients (p < 0.0001). We observed significant improvement in CFS scores in plug retaining-oGVHD and non-oGVHD DED patients at all time points. Tear break-up time was significantly prolonged at six- and twelve-months follow-up in non-oGVHD patients, whereas significant change in TBUT in oGVHD patients was recorded only at twelve months post plug placement. Schirmer's score improved significantly in plug retaining-non-oGVHD DED patients at six- and twelve-months follow-up, however no significant change was observed in Schirmer's score in oGVHD DED patients.ConclusionsAn improvement in ocular surface disease parameters was observed in both plug-retaining oGVHD and non-oGVHD DED patients. However, a majority of oGVHD DED patients spontaneously lost their punctal plugs within 90 days of placement. Therefore, regular follow-up after plug placement is recommended to detect plug loss and ensure adequate disease control.     

Characterising the ocular surface and tear film in a population-based birth cohort of 45-year old New Zealand men and women

PurposeTo assess the prevalence of dry eye disease, aqueous tear deficiency, meibomian gland dysfunction, and asymptomatic ocular surface disease in a population-based cohort of 45-year-old New Zealand men and women.MethodsThis cross-sectional study of 885 participants (442 females, 443 males) was based on a population-representative birth cohort of individuals born between April 1 1972 and March 31 1973 in Dunedin, New Zealand (the Dunedin Multidisciplinary Health and Developmental Study). Participants were assessed at 45 years of age, and dry eye symptomology, ocular surface characteristics, and tear film quality were evaluated for each participant within a single clinical session. The diagnosis of dry eye disease was made according to the validated rapid non-invasive dry eye assessment algorithm.ResultsClinical dry eye signs were present in 402 (45%) participants, of which 78 (9%) participants fulfilled the diagnostic criteria for dry eye disease, and 322 (37%) had asymptomatic ocular surface disease. Among participants with dry eye disease, 22 (2%) exhibited aqueous tear deficiency, and 65 (7%) had meibomian gland dysfunction. Females were more likely to be affected by dry eye disease, meibomian gland dysfunction, and asymptomatic ocular surface disease (all p < 0.05).ConclusionsClinical dry eye signs were present in almost half of this population-based cohort of 45-year-old New Zealanders, although only 9% of participants fulfilled the diagnostic criteria for dry eye disease. The high prevalence of asymptomatic ocular surface disease presents an opportunity for preventative public health intervention.     

Evaluation of use of essential fatty acids in topical ophthalmic preparations for dry eye

PurposeEssential fatty acids (EFAs) as dietary supplements are used in treating dry-eye for reducing inflammation at the ocular surface. Their topical application in eye drops to deliver fatty acid (FA) directly to the ocular surface requires thorough investigation. Being lipids in nature EFAs can interact with tear lipids and affect tear stability. This study aimed at investigating the biophysical interactions of EFAs with Meibomian lipids.MethodsRheology of mixtures of Human Meibomian lipids with EFAs (LA-linoleic acid, ALA-alpha-linolenic acid), OA (oleic acid), and GLA (gamma-linolenic acid) was studied using Langmuir trough technology on an artificial tear solution at the ocular surface temperature. Pressure-area profiles were used to determine compressibility and elasticity of the mixed films.ResultsLA enhanced spreading of Meibomian lipids and increased their compressibility and elasticity which can be beneficial for tear stability. ALA condensed Meibomian lipids film with less elasticity deemed unfavourable for tear stability. OA expanded Meibomian lipids but decreased elasticity at high compressions making films less stable. GLA had little or no favourable effect on tear stability. Higher concentrations of FAs made films less stable.ConclusionsEFAs or OA in topical ophthalmic preparations can affect spread and stability of the tear film lipid layer. Rheology of mixed films should be tested using Langmuir trough technology to determine suitable type and amount of a lipid additive for therapeutic eye drops. In topical applications, the omega-6 LA (not omega-3 FA) at low concentrations (20 mol%) can be beneficial for enhancing tear stability in dry eye patients.     

Randomised double-masked placebo-controlled trial of the cumulative treatment efficacy profile of intense pulsed light therapy for meibomian gland dysfunction

PurposeTo assess long-term cumulative treatment effects of intense pulsed light (IPL) therapy in meibomian gland dysfunction (MGD).MethodsEighty-seven symptomatic participants (58 female, mean ± SD age, 53 ± 16 years) with clinical signs of MGD were enrolled in a prospective, double-masked, parallel-group, randomised, placebo-controlled trial. Participants were randomised to receive either four or five homogeneously sequenced light pulses or placebo treatment to both eyes, (E-Eye Intense Regulated Pulsed Light, E-Swin, France). Visual acuity, dry eye symptomology, tear film parameters, and ocular surface characteristics were assessed immediately before treatment on days 0, 15, 45, 75, and four weeks after treatment course completion on day 105. Inflammatory and goblet cell function marker expression, and eyelid swab microbiology cultures were evaluated at baseline and day 105.ResultsSignificant decreases in OSDI, SPEED, and SANDE symptomology scores, and meibomian gland capping, accompanied by increased tear film lipid layer thickness, and inhibited Corynebacterium macginleyi growth were observed in both treatment groups (all p < 0.05). Sustained clinical improvements occurred in both treatment groups from day 75, although significant changes from day 45, in lipid layer quality, meibomian gland capping, OSDI and SANDE symptomology, were limited to the five-flash group (all p < 0.05).ConclusionsIPL therapy effected significant improvements in dry eye symptomology, tear film lipid layer thickness, and meibomian gland capping in MGD patients. Five-flash IPL treatment showed superior clinical efficacy to four-flash, and an initial course of at least four treatments is suggested to allow for establishment of sustained cumulative therapeutic benefits prior to evaluation of overall treatment efficacy.Trial registration numberACTRN12616000667415.     

过敏性结膜炎与干眼症的相关性临床分析

目的通过对过敏性结膜炎的泪膜功能变化的观察,分析其与干眼症之间的相关性。方法选取江苏省江阴市人民医院2013年1月至2013年6月门诊诊断为过敏性结膜炎者42例(84只眼)为观察组,正常者42例(84只眼)为对照组,分别进行裂隙灯检查、泪膜破裂时间(break-up time,BUT)检查、角膜荧光素染色试验(fluorescein,FL)、基础泪液分泌试验(schirmer I test,SIt)。所有受检对象年龄、性别之间不存在统计学差异,且排除全身及其他眼表疾患。结果过敏性结膜炎患者的泪膜功能都存在不同程度的异常,SIt、BUT、FL三项指标与对照组之间相比均存在显著的统计学差异(P<0.05)。结论过敏性结膜炎会导致泪膜稳定性降低,导致干眼症的发生。     

正交试验优选复方参芪软胶囊的醇沉工艺

优选复方参芪软胶囊的醇沉工艺。方法：采用正交试验设计,以药液中总多糖的含量和干膏得率为指标,考察浓缩液的相对密度、醇沉浓度、静置时间、醇沉温度对醇沉效果的影响。结果：最佳醇沉工艺为药液浓缩至相对密度1.10,加95％乙醇至含醇量为60％,室温下静置48h。结论：优选的复方参芪软胶囊醇沉工艺简便易行,适用于实际生产配制。     

Systems pharmacology dissection of the mechanisms and therapeutic potential of Cassiae semen for hepatoprotection and brightening eyes

Cassiae semen has been shown to play significant roles in reversing “liver fire” to improve vision. The systems mechanism of Cassiae semen for hepatoprotection and brightening eyes has not been fully explored. The systems pharmacology approach is proposed to dissect the potential pharmacological mechanism of Cassiae semen for hepatoprotection and brightening eyes. The results showed that 26 active components of Cassiae semen that connected with 230 targets were obtained. Gene ontology enrichment, network and pathway analysis explored that Cassiae semen is responsible for hepatoprotection and brightening eyes. The current study will contribute to the research and development of functional foods.