Relation between office intraocular pressure and 24-hour intraocular pressure in patients with primary open-angle glaucoma treated with a combination of topical antiglaucoma eye drops

PURPOSE: To determine the relation between office intraocular pressure (IOP) and 24-hour IOP in patients with primary open-angle glaucoma (POAG) treated with 3 kinds of antiglaucoma eye drops. PATIENTS AND METHODS: Subjects were 42 patients with POAG (71 eyes). All were being treated with 3 different topical antiglaucoma eye drops (latanoprost, beta-blocker, and carbonic anhydrase inhibitor). Twenty-four-hour IOP values were obtained in the sitting position with a Goldmann applanation tonometer at 3-hour intervals. RESULTS: Maximum 24-hour IOP (mean+/-SD) was 19.76+/-5.65 mm Hg, minimum 24-hour IOP was 13.06+/-4.75 mm Hg, mean 24-hour IOP was 16.30+/-4.90 mm Hg, and 24-hour IOP fluctuation was 6.70+/-2.81 mm Hg. Office IOP was 16.23+/-4.58 mm Hg, and office IOP fluctuation was 2.75+/-1.68 mm Hg. There was no significant difference between office IOP and mean 24-hour IOP (P=0.93). There was no correlation between office IOP and 24-hour IOP fluctuation (r=0.15; P=0.25) or between office IOP fluctuation and 24-hour IOP fluctuation (r=0.19; P=0.17). Maximum 24-hour IOP occurred during office hours in 22 eyes (33.8%). The frequency of maximum 24-hour IOP occurring during office hours was significantly less than that of minimum 24-hour IOP (P<0.001). CONCLUSIONS: In POAG patients treated with 3 kinds of antiglaucoma eye drops, office IOP was similar to mean 24-hour IOP. However, it was difficult to estimate 24-hour IOP fluctuation and maximum 24-hour IOP on the basis of office IOP.     

Incidence of presumed steroid response in contralateral eye of patients who underwent glaucoma filtration surgery

Purpose:The aim of this study was to report the incidence of presumed steroid response in contralateral eye of patients who underwent glaucoma filtration surgery.Methods:We reviewed records of 298 glaucoma patients (147 PACG [primary angle-closure glaucoma], 129 POAG [primary open-angle glaucoma], and 22 JOAG [juvenile open-angle glaucoma]) who underwent either trabeculectomy alone or trabeculectomy with cataract extraction. All patients received prednisolone acetate 1% eye drop postoperatively in the operated eye for up to 6 to 8 weeks. The contralateral eye received the same antiglaucoma medications as before. Information collected included age, sex, number of antiglaucoma medications in the fellow eye preoperatively, and VFI (visual field index). The preoperative intraocular pressure (IOP) in the contralateral eye was taken as the baseline. The maximum IOP recorded postoperatively up to a follow-up period of 6 to 8 weeks was noted. A steroid response was defined as rise in the IOP by ≥6 mmHg.Results:In this study, 298 eyes of 298 glaucoma patients were included. The mean age of patients was 60.1 ± 13.7 years. The mean number of antiglaucoma medications in the fellow eye pre-operatively was 2.4 ± 1.2. Mean preoperative and postoperative IOP in the fellow eye were 17.46 ± 7 and 19.37 ± 7.1 mmHg, respectively. Sixty-three eyes out of 298 eyes (21.14%) showed a rise in IOP by 6 mmHg. The maximum IOP difference noted was 15 mmHg. The average time interval to the defined steroid response was 16.13 days. The majority showed a steroid response within 19 days.Conclusion:Steroid response is a significant factor leading to elevated IOP postoperatively in the contralateral eye as well.     

The effect of previous surgery and topical eye drops for primary open-angle glaucoma on cytokine expression in aqueous humor

Purpose

To evaluate cytokine expression in the aqueous humor of patients with primary open-angle glaucoma (POAG) after previous glaucomatous and/or cataract surgery, and to determine the effect of intraocular pressure (IOP)-lowering eye drops on cytokine expression.

Methods

This prospective consecutive case study included 32 eyes diagnosed with POAG (19 with previous surgery and 13 without previous surgery, treated with topical antiglaucoma medication) and 12 eyes without signs of glaucoma. The Luminex 200 multiplex bead immunoassay was used to measure 27 cytokines in aqueous humor.

Results

Eyes suffering from POAG, with previous surgery, had significantly elevated concentrations of IL-6, IL-8, CCL2, CXCL9, and HGF, and a significantly lower concentration of CCL5, compared to POAG eyes without previous surgery, treated only with topical antiglaucoma medication. When compared with cataract controls, eyes with POAG and previous surgery had significantly elevated levels of G-CSF, IL-8, IL-12, CXCL10, and HGF, and significantly decreased concentrations of IL-17, CCL5, and VEGF in aqueous humor. In a comparison between POAG eyes without previous surgery and cataract controls, the cataract control eyes had significantly higher levels of IL-6 and CCL2, as the only significant difference.

Conclusions

POAG is associated with an aqueous inflammatory response in the aqueous humor, which is significantly elevated in eyes with previous surgery. In contrast, preoperative IOP-lowering eye drops did not significantly alter the anterior chamber milieu. The results of the current study indicate that filtration surgery has a higher success rate in eyes that have not experienced previous surgery.     

LASIK and dry eye

Dry eye is one of the most common complications after laser-assisted in situ keratomileusis (LASIK). The clinical signs of post-LASIK dry eye include positive vital staining of ocular surface, decreased tear film breakup time and Schirmer test, reduced corneal sensitivity, and decreased functional visual acuity. The symptoms and signs last at least 1 month after LASIK. Although the mechanisms for developing post-LASIK dry eye are not completely understood, loss of corneal innervation by flap-making may affect the reflex loops of the corneal-lacrimal gland, corneal-blinking, and blinking-meibomian gland, and blinking-meibomian gland, resulting in decreased aqueous and lipid tear secretion and mucin expression. As LASIK enhancement by flap-lifting induces less dry eye symptoms and signs than first surgery, it is suggested that other factors rather than loss of neurotrophic effect may be involved in the mechanisms of post-LASIK dry eye. The treatments of dry eye include artificial tears, topical cyclosporine, hot compress, punctal plugs, and autologous serum eye drops. For patients with severe preoperative dry eye, a combination of punctal plugs and serum eye drops is required to be used before surgery.     

The relationship between dry eye and sleep quality

PurposeSleep is an important determinant of health and quality of life. This study aimed to clarify the association between dry eye and sleep quality using a large population-based cohort.Methods71,761 participants (19–94 yrs, 59.4% female) from the Lifelines cohort in the Netherlands were assessed for dry eye using the Women's Health Study Dry Eye Questionnaire. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Logistic regression was used to examine the relationship between poor sleep quality (PSQI score >5) and dry eye, while correcting for age, sex, BMI, education, income, and 51 possible confounding comorbidities, including autoimmune diseases and psychiatric disorders.ResultsOverall, 8.9% of participants had dry eye. Of these, 36.4% had poor sleep quality compared to 24.8% of controls (OR 1.52 (95%CI 1.44–1.60), P < 0.0001, corrected for age and sex). After correcting for all comorbidities, dry eye was still associated with poor sleep (OR 1.20 (95%CI 1.11–1.28), P < 0.0001). This relationship was seen across all ages and sexes. Patients with dry eye scored worse on all subcomponents of the PSQI. Almost one-in-two (44.9%) persons with dry eye symptoms “often” or “constantly” had poor sleep quality. This proportion was similar to participants with sleep apnea and osteoarthritis. Additionally, increasing symptom frequency was tied to increased prevalence of poor sleep quality.ConclusionsAll components of sleep quality were significantly reduced in participants with dry eye, even after correcting for comorbidities. These results indicate the substantial impact of dry eye on patients' lives, especially for those with frequent symptoms.     

Medication use and dry eye symptoms: A large,hypothesis-free,population-based study in the Netherlands

PurposeTo date, population-based studies reporting associations between dry eye disease and medications were hypothesis-driven, did not take into account underlying comorbidities, and did not investigate individual drugs. The purpose of this study was to clarify the association of dry eye symptoms with medication classes and individual drugs, using a hypothesis-free approach.Methods79,606 participants (age 20–97 years, 59.2% female) from the population-based Lifelines cohort in the Netherlands were cross-sectionally assessed for dry eye symptoms using the Womens’ Health Study dry eye questionnaire. All medications used were coded with the ATC classification system. Logistic regression was used to assess the risk of the 59 most-used therapeutic/pharmacological subgroups and the 99 most-used individual drugs (all n > 200) on dry eye symptoms, correcting for age, sex, body mass index, and 48 comorbidities associated with dry eye.ResultsThirty-eight (64%) medication subgroups and fifty-two (53%) individual drugs were associated with dry eye symptoms (P < 0.05), after correction for age and sex only. A multivariable model correcting for comorbidities revealed highly significant associations between dry eye symptoms and drugs for peptic ulcer (particularly proton pump inhibitors (PPIs)), antiglaucoma and anticholinergic medications.ConclusionsThis study underlines that medication use is highly informative of risk of dry eye symptoms. Correction for underlying comorbidities is critical to avoid confounding effects. This study confirms suggested associations between medications and dry eye symptoms at a population level and shows several new associations. The novel link between PPIs and dry eye symptoms deserves particular attention given how commonly they are prescribed.     

氧化应激因素在干眼中的临床研究

干眼是由于泪液的量或质的异常引起的泪膜不稳定和眼表面的损害，从而导致眼不适症状的一类疾病。干眼与多种因素相关。本文主要探讨氧化应激因素对干眼的影响及临床治疗。针对氧化应激因素，干眼周期概念、干眼的眼表炎症和蛋白质组学相关研究证明了两者的相关性，有利于进行针对性临床治疗。针对氧化应激因素的治疗是干眼的潜在治疗方式，无防腐剂眼药水的使用、碘离子电渗疗法及其他蛋白质组学方法的临床试验证明了其合理性与有效性。随着近年来对抗老化药物、预防性整体健康以及环境科学作用的重视，对眼表氧化应激的研究可能会在未来几年产生越来越大的影响。     

Prevalence of dry eye subtypes in clinical optometry practice.

BACKGROUND: Dry eye conditions are now recognized as having multiple causes. A subtype-based dry eye diagnostic protocol was developed to determine the prevalence of dry eye and dry eye subtypes, and the effects of age and gender, in subjects presenting to clinical optometry practice. METHODS: Dry eye diagnostic criteria were: presence of one or more McMonnies dry eye survey primary symptoms, fluorescein tear break time < 10 s and rose bengal ocular surface staining. Dry eye subtype differential diagnosis was made predominantly on the basis of biomicroscopic signs. Subtype categories were: lipid anomaly dry eye (LADE), aqueous tear deficiency (ATD), primary mucin anomalies, allergic/toxic dry eye (ADE), primary epitheliopathies and lid surfacing/blinking anomalies (LSADE). RESULTS: Dry eye prevalence was 10.8% for n = 1584 subjects. Dry eye was significantly more prevalent in subjects 40 years or older (18.1%) compared with those < 40 years (7.3%) (p = 0.001). LADE was the most prevalent subtype (4.0%), followed by ADE at 3.1%, LSADE at 1.8%, and ATD at 1.7%. ATD was the only subtype with a significant gender prevalence difference, being more prevalent in women (p = 0.0023). The prevalence of LADE and ATD were significantly greater in those 40 years or older (p = 0.001 and p = 0.0023 respectively). CONCLUSIONS: The results of this study support a subtype-based approach to dry eye diagnosis and management in clinical practice.     

玻璃酸钠滴眼液联合鱼腥草滴眼液治疗干眼症的疗效观察

目的:研究单纯玻璃酸钠滴眼液,及其联合鱼腥草滴眼液治疗干眼症的临床疗效。方法:选取确诊的干眼症患者125例198眼,随机分为单纯玻璃酸钠滴眼液组(A组)63例100眼和玻璃酸钠滴眼液联合鱼腥草滴眼液组(B组)62例98眼。A组用1g/L玻璃酸钠滴眼液治疗;B组交替给予1g/L玻璃酸钠滴眼液和鱼腥草滴眼液治疗。连续治疗2mo后,比较两组治疗前后的临床症状、泪液基础分泌试验(SⅠt)、泪膜破裂时间(BUT)及角膜荧光素染色(FL)程度。结果:两种治疗方法均可明显改善干眼症患者的临床症状、SⅠt,BUT和FL程度;但B组的主观症状、SⅠt,BUT和FL的改善程度明显优于A组。结论:玻璃酸钠滴眼液联合鱼腥草滴眼液可明显改善干眼症患者的临床症状,提高疗效。     

Allergic conjunctivitis and dry eye.

AIMS: Differential diagnosis of allergic conjunctivitis or dry eye is sometimes very difficult to diagnose by symptoms and clinical examination alone, especially in older patients. It was hypothesised that clinically allergic patients who were serum antigen specific IgE negative were candidates for dry eye. METHODS: Sixty patients were studied prospectively who were clinically diagnosed with allergic conjunctivitis by their itchy sensation and papilla formation of conjunctiva. They consisted of 30 serum antigen specific IgE positive and 30 IgE negative patients, with no significant differences in age. Dry eye examination and serum total IgE were performed on these two groups. RESULTS: No significant differences were seen between the two groups with regard to age (p = 0.76) and sex ratio. The antibody negative group had lower Schirmer's test scores (p = 0.002), lower tear clearance (p = 0.0001), lower tear function index (p = 0.0001), and lower serum total IgE (p = 0.04) than the antibody positive group. CONCLUSION: This study suggests that the evaluation of serum antigen specific IgE and tear dynamics are important for the differential diagnosis of patients with allergic conjunctivitis and dry eye. Clinically diagnosed allergic conjunctivitis with negative serum antigen specific and total IgE can be one form of dry eye.     

Fluorophotometry as a diagnostic tool for the evaluation of dry eye disease

Background  

Dry eye disease is a common debilitating ocular disease. Current diagnostic tests used in dry eye disease are often neither sensitive nor reproducible, making it difficult to accurately diagnose and determine end points for clinical trials, or evaluate the usefulness of different medications in the treatment of dry eye disease. The recently developed fluorophotometer can objectively detect changes in the corneal epithelium by quantitatively measuring its barrier function or permeability. The purpose of the study is to investigate the use of corneal fluorescein penetration measured by the fluorophotometer as a diagnostic tool in the evaluation of dry eye patients.     

Systemic risk factors of dry eye disease subtypes: A New Zealand cross-sectional study

PurposeTo evaluate systemic risk factors of dry eye disease, aqueous tear deficiency, and meibomian gland dysfunction.MethodsThree hundred and seventy-two community residents (222 females, 150 males; mean ± SD age, 39 ± 22 years) were recruited in a cross-sectional study. Past medical history, 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, aqueous tear deficiency, and meibomian gland dysfunction were based on the global consensus recommendations of the Tear Film and Ocular Surface Society's Dry Eye Workshop II (TFOS DEWS II) and International Workshop on Meibomian Gland Dysfunction.ResultsOverall, 109 (29%) participants fulfilled the TFOS DEWS II criteria for dry eye disease, 42 (11%) had aqueous tear deficiency, and 95 (26%) had meibomian gland dysfunction. Multivariate logistic regression analysis demonstrated that systemic rheumatologic disease and antidepressant medication were independently associated with aqueous tear deficiency (both p < 0.05). Significant risk factors for meibomian gland dysfunction included age, East Asian ethnicity, migraine headaches, thyroid disease, and oral contraceptive therapy (all p ≤ 0.01).ConclusionsBoth etiological subtypes of dry eye disease were associated with a number of systemic risk factors. These findings would support routine systemic inquiry of dry eye disease and associated systemic conditions and medications, in order to facilitate opportunistic screening and timely inter-disciplinary referral where necessary.     

角膜移植术后干眼的研究进展

由于角膜移植手术对眼表结构的破坏和长期滴眼液的应用,使得干眼成为较为常见的移植术后并发症,长期干眼会导致角膜上皮缺损,影响植片的存活。为提高对于角膜移植术后干眼的认识,本文通过查阅国内外相关文献,对于角膜移植术后干眼的发病机制、临床表现、治疗和预防进行综述,为临床应用提供参考。     

药源性干眼症

药源性干眼症是近年来逐渐被认识的一类药源性眼病,引起此病的药物有十余类上百种,其中常见的有抗胆碱能受体药、抗组胺药、抗抑郁症类药、抗精神病类药、激素类药、抗青光眼类药等。主要机制是药物影响副交感或交感神经系统,支配腺体分泌的通路受到阻断;或药物局部使用引起泪膜不稳定及眼表面异常。防治此类干眼症主要采用停药或换药,对因治疗以及对症处理。     

充分认识儿童过敏性结膜炎的干眼症问题

儿童过敏性结膜炎以春季角结膜炎为主。儿童过敏性结膜炎合并的干眼症的发生与泪膜稳定性降低有关。嗜酸性粒细胞活化、炎性因子释放以及结膜上皮细胞和杯状细胞受损、丢失，粘液层缺乏，导致泪膜稳定性下降及干眼症。此种干眼症的症状以瞬目次数增加为主，其次是眼痒、眼红和畏光。诊断儿童过敏性结膜炎时应考虑是否合并干眼症，给予恰当的处理可避免其引起的严重眼表损害。     

联合应用普拉洛芬和玻璃酸钠治疗干眼症

目的：：观察联合应用普拉洛芬和玻璃酸钠治疗干眼症的临床疗效,为临床治疗干眼症提供依据。方法：选取我院2012-01/2015-01干眼症患者106例进行试验观察,并按照数字表法将患者分为观察组与对照组,每组53例,对照组使用常规治疗方法加上单玻璃酸钠滴眼液治疗,观察组在常规治疗方法的基础上联合应用普拉洛芬滴眼液和玻璃酸钠滴眼液治疗,比较两组患者的临床治疗效果、治疗前后的干眼症评分与荧光素染色的评分、泪液分泌试验以及观察患者的泪膜破裂时间。结果：观察组与对照组患者的治疗有效率分别为94.3％(50/53)、84.9％(45/53);观察组治疗前后的干眼症评分为3.24±0.52、0.32±0.06分,对照组治疗前后的干眼症评分为3.26±0.48、0.75±0.24分;观察组治疗前后的泪膜破裂时间为5.67±3.052、12.95±2.865s,对照组治疗前后的泪膜破裂时间为6.23±2.985、9.85±2.714s,两组患者在各方面的差异具有统计学意义(P<0.05)。结论：联合应用普拉洛芬和玻璃酸钠在治疗干眼症方面具有较高的临床疗效,具有较高的安全性和保水性,改善患者的干眼症状,提高患者的生活质量。     

Meibomian gland dysfunction is the primary determinant of dry eye symptoms: Analysis of 2346 patients

PurposeTo determine relative contributions of various ocular surface clinical signs and predisposing factors to the magnitude of dry eye symptoms.MethodsClinical audit data were prospectively collected for newly referred dry eye patients. All 2346 patients had an initial visit evaluation of the Ocular Surface Disease Index (OSDI), and a detailed ophthalmic examination including tear breakup time (TBUT), ocular surface fluorescein staining, Schirmer's I test. Among the participants, 1414 had number of liquid meibum expressing glands (NLMEG) evaluated on standard force expression. Other variables collected included history of glaucoma or glaucoma surgery, and history of allergies.ResultsIn patients aged 46.2 ± 14.8 years, 77.4% were women and 87.1% Chinese. The mean ± SD OSDI was 35.2 ± 21.7. On univariate analysis, higher OSDI was associated with glaucoma diagnosis (p = 0.003), glaucoma surgery (p = 0.002), greater temporal corneal staining (p = 0.002), reduced NLMEG (p < 0.001), and higher inferior forniceal papillary grade (p < 0.001). OSDI was not significantly associated with gender, TBUT, Schirmer's I test values, or the use of cyclosporine eyedrops. On multivariate regression, higher OSDI scores were associated with fewer NLMEG (p = 0.002) and increased lower eyelid forniceal papillary grading (p = 0.002). Corneal staining, glaucoma status and glaucoma surgery were not significantly associated with OSDI. Logistic regression showed that severe symptoms (OSDI>32) was associated with <2 NLMEG [OR(95%CI): 1.34(1.08–1.66)], and presence of inferior eyelid forniceal papillae [1.50(1.17–1.91)].ConclusionsMeibomian gland dysfunction (MGD) and lower forniceal papillary reaction had significant contributions to the severity of symptoms, in contrast to traditional dry eye signs. MGD should be objectively assessed and treated to improve symptoms.     

Ageing and the natural history of dry eye disease: A prospective registry-based cross-sectional study

PurposeTo investigate the impact of ageing on ocular surface parameters, and empirically determine optimal prognostic cut-off ages for clinical markers of dry eye disease, aqueous tear deficiency, and meibomian gland dysfunction.MethodsA total of 1331 community residents (785 females, 546 males; mean ± SD age, 38 ± 19 years) were recruited in a prospective registry-based cross-sectional study. Dry eye symptomology, ocular surface characteristics, and tear film quality were evaluated for each participant within a single clinical session, in accordance with the global consensus recommendations of the TFOS DEWS II reports.ResultsMultivariate regression analysis demonstrated positive associations between ageing and clinical markers of dry eye disease (all p ≤ 0.001). The Youden-optimal prognostic cut-off ages for signs of meibomian gland dysfunction occurred during the third decade of life (24–29 years); the optimal predictive ages for lid wiper epitheliopathy, tear film instability, hyperosmolarity, and dry eye symptoms occurred during the fourth decade of life (31–38 years); while the optimal prognostic thresholds for signs of aqueous tear deficiency and ocular surface staining occurred in the fifth and sixth decades of life (46–52 years).ConclusionsAdvancing age is a significant risk factor for dry eye disease, which represents a growing public health concern with the ageing population worldwide. Signs of meibomian gland dysfunction appeared earlier in the natural history of disease progression, and the brief delay prior to the development of other clinical dry eye signs might represent a window of opportunity for preventative interventions in the young adult age group.     

Glaukom und trockenes Auge

Purpose

Current concepts and future perspectives for therapy and prevention of dry eye in glaucoma patients are described.

Methods

Own clinical and experimental findings and PubMed based literature search (keywords: glaucoma and dry eye).

Results

Ocular surface disease is the main long-term complication of glaucoma therapy. Prevention of ocular surface inflammation by preservative-free antiglaucoma eye drops and concurrent dry eye therapy are important

Conclusions

It is mandatory to treat dry eye prior to and during glaucoma therapy. Preservative-free glaucoma medication can help to ameliorate the problem.