The effect of topical cyclosporine A treatment on corneal thickness in patients with trachomatous dry eye

Purpose: The purpose of the present study was to evaluate the effect of topical cyclosporine A (CsA) treatment on corneal thickness (CT) in patients with trachomatous dry eye. Methods: Sixty‐four patients with trachomatous dry eye with a Schirmer test showing 5 mm or less and a tear film break‐up time (TFBUT) of five seconds or less were included. Thirty‐two patients were treated with twice daily application of CsA (0.05% ophthalmic emulsion) plus non‐preserved artificial tears, while the remaining 32 patients serving as controls received only non‐preserved artificial tears. CT was measured using ultrasonic pachymetry at five locations of the central (CCT) and mid‐peripheral cornea, at baseline and after one, three and six months of treatment. Results: At the sixth month of treatment, CT measurements were significantly changed in both groups, compared to baseline. In the CsA treatment group, the mean CCT before and after six months of treatment were 517.4 ± 36.2 and 546.5 ± 32.4 µm, respectively (p < 0.001); yielding an average CCT increase of 29.1 ± 8.0 µm (5.62 per cent) from baseline. In the control group, corresponding figures were 520.2 ± 34.2 and 526.0 ± 35.4 µm, respectively (p < 0.01), with an average increase of 5.8 ± 3.1 µm (1.11 per cent). Conclusions: In the present study, the CsA treatment group exhibited significantly greater increases in CT compared to controls. Such an increase may indicate an improvement in the integrity of the ocular surface and resolution of the underlying inflammation as a consequence of topical CsA treatment.     

A study of the association between Vitamin D deficiency and Dry Eye Syndrome (DES) in the Indian population

Purpose:A study of the association between vitamin D deficiency and dry eye syndrome (DES) in the Indian population.Methods:This was a cross-sectional, hospital-based observational study. Sixty patients diagnosed with vitamin D deficiency (<20 ng/dl) who met the inclusion criteria were sent to the Eye OPD from the Endocrinology OPD (case) were compared to 60 subjects with normal vitamin D levels (≥20 ng/dl) who attended the Eye OPD (controls). The examination of the tear film was done using Whatman filter paper in Schirmer test I and Schirmer test I (with anesthesia). The tear film break-up time (TFBUT) was determined by slit-lamp examination using the fluorescein stain, and scoring using the ocular surface disease index (OSDI) was done.Results:A significant difference in the mean values of Schirmer I and Schirmer I test (with anesthesia) (P < 0.001) was seen between the case and control groups. A significant difference in the mean values of TFBUT (P < 0.001) and OSDI scores (P < 0.01) was also seen between the two groups.Conclusion:A positive association was found between vitamin D deficiency and dry eye on comparing the above parameters.     

Two multicenter, randomized studies of the efficacy and safety of cyclosporine ophthalmic emulsion in moderate to severe dry eye disease. CsA Phase 3 Study Group

OBJECTIVE: To compare the efficacy and safety of cyclosporin A ([CsA] 0.05% and 0.1% ophthalmic emulsions) to vehicle in patients with moderate to severe dry eye disease. DESIGN: Multicenter, randomized, double-masked, parallel-group, 6-month, vehicle-controlled. PARTICIPANTS: A total of 877 patients with defined moderate to severe dry eye disease (292 to 293 in each treatment group). METHODS: Two identical clinical trials; patients were treated twice daily with either CsA, 0.05% or 0.1%, or vehicle. The results of these two trials were combined for analysis. MAIN OUTCOME MEASURES: Efficacy: corneal and interpalpebral dye staining, Schirmer tear test (with and without anesthesia), tear break-up time, Ocular Surface Disease Index (OSDI), facial expression, patient subjective rating scale, symptoms of dry eye, investigator's evaluation of global response to treatment, treatment success, and daily use of artificial tears. Safety: occurrence of adverse events, best-corrected visual acuity, intraocular pressure, biomicroscopy, and blood trough CsA concentrations. RESULTS: Treatment with CsA, 0.05% or 0.1%, gave significantly (P < or = 0.05) greater improvements than vehicle in two objective signs of dry eye disease (corneal staining and categorized Schirmer values). CsA 0.05% treatment also gave significantly greater improvements (P < 0.05) in three subjective measures of dry eye disease (blurred vision, need for concomitant artificial tears, and the physician's evaluation of global response to treatment). There was no dose-response effect. Both CsA treatments exhibited an excellent safety profile, and there were no significant topical or systemic adverse safety findings. CONCLUSIONS: The novel ophthalmic formulations CsA 0.05% and 0.1% were safe and effective in the treatment of moderate to severe dry eye disease yielding improvements in both objective and subjective measures. Topical CsA represents a new pharmacologically based treatment for dry eye disease that may provide significant patient benefits.     

高浓度玻璃酸钠滴眼液治疗中重度干眼的临床研究

目的：观察高浓度玻璃酸钠滴眼液治疗中重度干眼的临床疗效。方法：中重度干眼患者40例随机分成试验组和对照组,每组各20例。试验组用玻璃酸钠滴眼液（3g/L）、对照组玻璃酸钠滴眼液（1g/L）联合重组人表皮生长因子滴眼液治疗,治疗前和治疗2wk后,通过症状评分、眼表疾病指数（OSDI）评分、泪膜破裂时间（BUT）、泪液分泌试验（Schirmer Ⅰ test,SⅠt）、角膜荧光素染色评分（FL）等评价两组疗效。结果：治疗前,两组各项指标差异均无统计学意义。治疗2wk后,除SⅠt外,两组的其他指标和治疗前相比,差异均有统计学意义; 两组间相比,除症状评分和OSDI差异有统计学意义,余无统计学差异。结论：高浓度玻璃酸钠滴眼液治疗中重度干眼,能有效缓解眼部不适症状,提高患者生存质量。     

The conjunctival epithelium in dry eye subtypes: effect of preserved and non-preserved topical treatments

PURPOSE: To determine the effect of topical treatments on the conjunctiva in dry eye. METHODS: N = 134 dry eye subjects were diagnosed using a protocol of McMonnies dry eye symptom survey score > 14, fluorescein break up time (FBUT) < 10 s and presence of rose Bengal staining. Differential diagnosis of dry eye subtypes was based on biomicroscopic signs and ocular/medical history. Superficial perilimbal bulbar conjunctival epithelial samples were collected using impression cytology. The nucleo-cytoplasmic ratio (N/C), goblet cell density (GCD) and expression of monoclonal antibodies HLA DR and CD23 were determined. The ocular surface characteristics of untreated subjects, those receiving preserved dry eye treatments and those receiving non-preserved treatments were compared with each other and with controls. Ocular surface characteristics of dry eye subtypes were also examined. RESULTS: An increase in N/C (p = 0.011), reduction in GCD (p = 0.0001) and increase in expression of HLA DR (p = 0.0001) and CD23 (p = 0.0001) were detected in the untreated group compared to controls. No significant differences were found between the group receiving non-preserved dry eye treatments and untreated dry eye group. The group receiving preserved treatments had a reduced GCD (p = 0.0003) and increased expression of HLA DR (p = 0.0003) and CD23 (p = 0.0001) compared to the group receiving non-preserved treatments. Dry eye subtype specific differences in HLA DR and CD23 expression were noted. CONCLUSIONS: The conjunctival inflammation and reduced goblet cell density of dry eye is exacerbated by use of preserved topical agents, and is not significantly improved by use of non-preserved artificial tear supplements alone. Therapeutic strategies for dry eye should aim to increase goblet cell density and control ocular surface inflammation.     

Diseases associated with ocular surface abnormalities: the importance of reflex tearing

AIM—To investigate the correlation between tear function tests and ocular surface integrity in patients with dry eye.METHODS—297 dry eye patients (55 Sjögren''s syndrome, two male and 53 female, average age 52.4 (SD 15.0) years, and 242 non-Sjögren''s syndrome, 41 male and 201 female, average age 53.5 (14.1) years) were examined. The following tear function tests were performed: (1) cotton thread test, (2) Schirmer test with topical anaesthesia, (3) Schirmer test without anaesthesia, (4) Schirmer test with nasal stimulation, (5) tear clearance test, and (6) tear break up time (BUT). The ocular surface was evaluated by rose bengal and fluorescein staining. Correlation analysis was performed between each tear function index and vital staining scores.RESULTS—Among the six tear function tests, the Schirmer test with nasal stimulation correlated most with both of the vital stains (ρ=0.530 for rose bengal and 0.393 for fluorescein). The Schirmer test with or without anaesthesia correlated slightly with rose bengal staining, whereas tear clearance test and tear break up time slightly correlated with fluorescein staining.CONCLUSION—Vital staining of the ocular surface correlates most with reflex tearing measured by the Schirmer test with nasal stimulation.     

A rabbit dry eye model induced by topical medication of a preservative benzalkonium chloride

PURPOSE: To establish a rabbit dry eye model with topical medication of the ocular preparation preservative benzalkonium chloride (BAC). METHODS: Sixteen white rabbits were used. One eye of each rabbit was chosen randomly for topical administration of 0.1% BAC twice daily for 14 days. The other untreated eyes served as controls. Schirmer test, fluorescein, and rose bengal staining were performed before and after BAC treatment on days 3, 5, 7, and 14. Conjunctiva impression cytology specimens were collected on days 0, 7, and 14. The rabbits were killed after day 14. Immunofluorescence staining was performed to detect mucin-5 subtype AC (MUC5AC) on conjunctival cryosections. Cornea and conjunctiva structures were evaluated by light and electron microscopy. RESULTS: Compared with untreated controls, BAC-treated eyes showed significant decreases in Schirmer scores (P = 0.01) and increases in fluorescein scores (P < 0.001) on days 5, 7, and 14. A significant increase in rose bengal scores was noticed as early as day 3 (P = 0.001). Decreases in goblet cell density occurred on days 7 and 14 (P = 0.001). Decreased MUC5AC and histopathologic and ultrastructural disorders of the cornea and conjunctiva were also observed in the BAC group. CONCLUSIONS: These findings demonstrated that an ophthalmic preservative, benzalkonium chloride, induced a dry eye syndrome in rabbits with damage to the cornea and conjunctiva, decreased aqueous tear basal secretion, goblet cell loss, and MUC5AC deficiency. This rabbit model was consistent with human dry eye syndrome in both aqueous tear and mucin deficiency and may be appropriate for studying dry eye syndrome.     

Association between the levels of prostaglandin E2 in tears and severity of dry eye

AIM: To investigate the relationship between the levels of prostaglandin E2 (PGE2) in tears and dry eye disease severity based on both clinical symptoms and signs. METHODS: Tear samples were collected from 36 non-Sjögren syndrome dry eye patients (10 males and 26 females, mean age 50.11±11.17y). All participants completed the Ocular Surface Disease Index (OSDI) questionnaire and underwent a detailed ophthalmic examination including, tear film breakup time (TBUT), ocular surface fluorescein staining, Schirmer I test, and meibomian gland assessment. The level of PGE2 in tears was measured using enzyme-linked immunosorbent assay (ELISA). The independent associations between tear PGE2 levels and other variables including demographics, OSDI scores, TBUT, Schirmer scores, ocular surface staining scores, and stage of meibomian gland dysfunction (MGD) were evaluated using linear regression analysis. RESULTS: The mean PGE2 level in tears of dry eye patients was 537.85±234.02 pg/mL. The tear PGE2 levels significantly positively correlated with OSDI scores (R=0.608, P<0.001), however, they did not significantly associate with TBUT (R=0.153, P=0.373), Schirmer scores (R=-0.098, P=0.570), ocular surface staining scores (R=0.282, P=0.095), and stage of MGD (R=-0.107, P=0.535). Male sex was significantly negatively correlated with tear PGE2 levels. CONCLUSION: The levels of PGE2 in tears are positively correlated with dry eye symptoms. However, no significant association was found between tear PGE2 levels and the results of other common dry eye diagnostic tests.     

Evaluation of retinoic acid ophthalmic emulsion in dry eye

PURPOSE: An oil in water emulsion of 0.01% all-trans-retinoic acid (tretinoin) was prepared and clinically evaluated in dry eye patients. METHODS: The ophthalmic emulsion consisted of 10% of arachis oil and 90% of the hydrogel of Carbopol 940. To evaluate retinoic acid emulsion clinically, a placebo-controlled, open-labeled, randomized study was performed with 22 dry-eye patients. Symptoms were recorded before and after the treatments. The Schirmer I test, measurement of tear film break-up time (BUT), rose Bengal and fluorescein staining of cornea and conjunctiva, and mucus fern test were done. RESULTS: Retinoic acid did not improve the dryness, photophobia and foreign body sensation more than placebo. Schirmer test and BUT were significantly improved by retinoic acid treatment. Corneal and conjunctival epithelium maintained their characteristics during the use of retinoic acid, as indicated by rose Bengal and fluorescein staining. CONCLUSIONS: Ophthalmic emulsion of retinoic acid can be suggested as a promising approach for the treatment of dry eye.     

Ocular surface changes in keratoconjunctivitis sicca with silicone punctum plug occlusion

PURPOSE: To evaluate histopathologic and clinical response to silicone plug insertion in dry eye patients. METHODS: Punctal plugs were placed in 32 eyes of 18 dry eye patients with aqueous deficiency who were on maximum medical therapy and who had Schirmer testing with topical anesthetic measuring less than 5 mm. Pre-treatment and post-treatment (6 weeks and 1 year) evaluations included temporal and inferior quadrant impression cytology examinations, Schirmer-1, BUT, corneal fluorescein and rose-bengal staining patterns and questionnaire scores. The cytology samples were graded according to the method described by Nelson. RESULTS: There was an improvement in subjective symptoms of patients 6 weeks after punctal occlusion. Corneal fluorescein and rose-bengal staining scores decreased from a mean of 5.33 +/- 1.74 to 1.37 +/- 1.48 and from 5.90 +/- 1.2 to 2.45 +/- 1.89 (p < 0.05) respectively. BUT values increased from 2.98 +/- 1.1 to 11.3 +/- 3.1 seconds (p < 0.05) at 6 weeks post-treatment. Increase in goblet cell density was observed after punctal occlusion at 6 weeks (p < 0.05) and at 1 year (p < 0.05) compared to the pre-treatment values. After occlusion, 3% of temporal specimens had Grade 0 squamous metaplasia, 63% had Grade 1, 34% had Grade 2; while 25% of inferior specimens had Grade 0, 56% had Grade 1, 19% had Grade 2 squamous metaplasia. CONCLUSIONS: Punctum plug occlusion in keratoconjunctivitis sicca provides improvement of tear film stability, ocular surface staining scores, conjunctival squamous metaplasia grades and goblet cell density. Increased ocular surface exposure to essential tear components with punctal occlusion may be important for the genesis of these changes.     

Value of lipid layer thickness and blinking pattern in approaching patients with dry eye symptoms

ObjectiveTo analyze the relationship between dry eye symptoms and modern dry eye tests, including the Schirmer I test, lipid layer thickness (LLT), and blinking pattern by LipiView interferometer.DesignCross-sectional study.Participants115 dry eye outpatients.MethodsDry eye symptoms were quantified by questionnaire scores, such as Ocular Surface Disease Index (OSDI) and Standard Patient Evaluation of Eye Dryness (SPEED). LLT, complete, and incomplete blinking rate were recorded by the LipiView interferometer.Results115 patients (229 eyes, mean age = 60.5 ± 13.6 years) were enrolled in this study. The mean value of the SPEED and OSDI scores was 9.5 and 10.2, respectively. A total of 44.3% of all subjects had severe dry eye syndrome (SPEED, OSDI ≥ 10). LLT (mean = 71.2 nm) was inversely correlated with both the SPEED and OSDI (p = 0.003 and 0.004, respectively). The incomplete-to-complete ratio of blinking rate (i/c ratio) was correlated with both the SPEED and OSDI (p = 0.0048 and 0.0234, respectively). Patients with LLT less than 69 nm were more likely to have severe dry eye syndrome. There was no significant relationship between the Schirmer I test and the SPEED or OSDI. However, LLT was inversely related to the Schirmer I test (linear regression, p = 0.0002, r = ?0.1857).ConclusionsLLT and the i/c ratio were significantly correlated to dry eye symptoms. Eyes with thinner LLT are more likely to have better aqueous tear production. The role of the reciprocal influence between each tear component in the maintenance of tear function warrants further investigation.     

Clinical efficacy of combined topical 0.05% cyclosporine A and 0.1% sodium hyaluronate in the dry eyes with meibomian gland dysfunction

AIM: To investigate the efficacy of combined topical 0.05% cyclosporine A (CsA; Restasis®, Allergan pharmaceuticals, USA) and 0.1% sodium hyaluronate treatment in dry eyes with meibomian gland dysfunction (MGD). METHODS: In a retrospective analysis, 53 patients (106 eyes) with MGD were enrolled and performed lid warm massage for 10min daily and be instilled preservative free sodium hyaluronate 0.1% eye drops 4 times daily. Patients were divided into subjects treated with topical 0.05% CsA and preservative free sodium hyaluronate vehicle (experimental group, n=74 eyes) and subjects treated with the preservative free sodium hyaluronate vehicle (control group, n=32 eyes). They were evaluated at baseline and 1, 2, and 3mo for subjective symptoms and objective signs including tear film break-up time (tBUT), Schirmer test, corneal staining (CS) score, lid margin telangiectasia (LMT), meibomian gland secretion (MGS), and conjunctival injection (CI). RESULTS: In the short-term treatment, the experimental group showed a statistically significant improvement in the ocular surface disease index (OSDI; P<0.001), tBUT (P=0.004), Schirmer test score (P=0.008) and LMT (P=0.021) by repeated measure ANOVA. Additionally, mean changes from baseline in OSDI (P<0.001), tBUT (P=0.001), Schirmer test score (P=0.029), CS score (P=0.047), LMT (P=0.002), CI (P=0.030) were improved better in the experimental group than in the control group at 3mo. However, there was no significant difference between the two groups in MGS (P=0.67). CONCLUSION: In dry eyes with MGD, 0.05% CsA improves the tear film stability as well as subjective ocular discomfort, and is effective in controlling lid margin inflammation.     

Short term effects of topical cyclosporine and viscoelastic on the ocular surfaces in patients with dry eye

PURPOSE: To compare the short term effects of topical 0.05% cyclosporine (CsA) and a mixture of 0.08% chondroitin sulfate and 0.06% sodium hyaluronate (CS-HA) on dry eye ocular surfaces. METHODS: 36 patients with moderate to severe dry eye (5 mm/5 min or less with Schirmer's test or tear break up time (BUT) less than 6 seconds), were treated with topical application of CS-HA on one eye and CsA on the other 4 times a day for 6-8 weeks. BUT, Schirmer's test without anesthesia, and conjunctival impression cytology (CIC; goblet cell density, nucleus to cytoplasmic ratio, and epithelial cell morphology) were evaluated and compared between eyes before and after treatment (repeated measurement of ANOVA). RESULTS: After treatment, BUT and tear wettings were significantly prolonged in each group. Topical CsA treated eyes had greater increase in BUT (p=0.026); there was no significant difference in tear wetting (p=0.132). While the 3 parameters of CIC improved in both groups, goblet cell density was significantly higher in eyes treated with CsA (p=0.033). CONCLUSIONS: While both CS-HA and 0.05% CsA eyedrops improve ocular surfaces, topical CsA may have a better effect on enhancing tear film stability and goblet cell density.     

视屏终端工作者泪液中基质金属蛋白酶-9、组织金属蛋白酶抑制剂-1活性研究

目的 观察视屏终端工作者泪液中基质金属蛋白酶-9（matrix metalloproteinase-9,MMP-9）、组织金属蛋白酶抑制剂-1（tissue inhibitors of matrix metalloproteinase-1,TIMP-1）活性变化。设计 横断面研究。研究对象 视屏终端工作者45例（45眼）。方法 按照视频终端工作日平均时间将受试者分为三组：分别为<4小时者17例（17眼）、4~8小时者13例（13眼）、>8小时者15例（15眼）。采用眼表疾病指数问卷（OSDI）对眼部症状问卷调查。泪膜破裂时间（BUT）、基础泪液分泌试验（Schirmer I）、角膜荧光素染色检查。使用双抗体夹心酶联免疫吸附法（ELISA）检测受试者泪液细胞因子MMP-9、TIMP-1的浓度。主要指标 干眼症状评分、BUT、Schirmer I、角膜染色、泪液中MMP-9、TIMP-1的浓度。结果 45例视屏终端工作者中干眼患病率为13.3%,日平均使用时间<4小时组、4~8小时组、>8小时组OSDI得分分别为（16.47±3.28）、（18.77±4.38）、（21.16±3.76）（F=6.11,P=0.005）,>8小时组OSDI得分较<4小时组高（P=0.003）,而4~8小时组与>8小时组和<4小时组OSDI得分无显著差异（P=0.311,0.319）; BUT、Schirmer I、角膜荧光染色得分三组均无显著性差异（P=0.687、0.122、0.714）。泪液中MMP-9、TIMP-1浓度在>8小时组中分别为（9.579±0.48） ng/ml和（3.174±0.29） ng/ml,明显较<4小时组[分别为（2.111±0.17） ng/ml和（0.391±0.06） ng/ml]和4~8小时组高[分别为（7.403±0.06） ng/ml和（2.286±0.28） ng/ml]（P值均=0.000）。<4小时组和4~8小时组泪液中MMP-9（P=0.72、0.13）、TIMP-1（P=0.21、0.37）工作前后浓度无显著差异。>8小时组中,工作后MMP-9、TIMP-1浓度均高于工作前水平（P=0.04、0.01）。结论 视屏终端工作者中干眼发生普遍。视屏终端工作日平均使用时间越长,泪液中MMP-9、TIMP-1浓度越高,提示泪液中MMP-9、TIMP-1浓度升高与干眼发病有关。     

Sex and age differences in symptoms and signs of dry eye disease in a Norwegian cohort of patients

PurposeTo investigate sex and age differences in symptoms and signs in a Norwegian clinic-based cohort of patients with dry eye disease (DED).MethodsVisitors at the Norwegian Dry Eye Clinic were examined using Ocular Surface Disease Index (OSDI) questionnaire score, tear osmolarity, tear break-up time (TFBUT), ocular surface staining, corneal sensitivity, Schirmer I test, and meibum expressibility (ME) and quality (MQ). A diagnosis of DED was made by an ophthalmologist based on symptoms and signs, and only DED patients were enrolled in the study: 1823 patients (338 males; mean age 51.2 ± 16.2 years; 1485 females; mean age 52.5 ± 16.0 years). The patients were divided into age subgroups: 20–39 years, 40–59 years and ≥60 years. Sex differences in the aforementioned tests were analyzed. Values were reported as mean ± standard deviation (SD), and intergroup comparisons were performed using Mann-Whitney U test. Multiple regression was used to analyze sex and age influences on symptoms and signs.ResultsWhen patients of all ages were analyzed, females had increased osmolarity, shorter TFBUT, reduced MQ and ME and higher corneal sensitivity. OSDI, Schirmer I test, ocular surface staining and corneal staining were not significantly different between the sexes. Only with TFBUT and ME were the sex difference present in all age subgroups. Multiple regression showed that all parameters were influenced by either sex or age, but only TFBUT and ME were influenced by both sex and age. (all p < 0.05).ConclusionsSex and age differences in dry eye were most consistent in TFBUT and ME, that indicate differences in meibomian gland functionality. Sex and age subgroup stratification is important in future studies investigating DED in other populations.     

小牛血去蛋白提取物眼用凝胶治疗儿童干眼症的疗效

目的:评估小牛血去蛋白提取物眼用凝胶治疗儿童干眼症的效果。方法:干眼症儿童100例200眼被随机平均分为对照组和试验组,对照组用1g/L玻璃酸钠滴眼液4次/d,试验组用小牛血去蛋白提取物眼用凝胶4次/d;两组同时去除病因治疗。对比分析治疗前与治疗后30d的症状评分、SchirmerⅠ、泪膜破裂时间(BUT)、角膜荧光素染色评分。结果:各组治疗前后各项评分比较有统计学意义(P<0.05);两组治疗后各项评分比较有统计学意义(P<0.05)。结论:小牛血去蛋白提取物眼用凝胶能有效治疗儿童干眼症。     

Effects of sequential artificial tear and cyclosporine emulsion therapy on conjunctival goblet cell density and transforming growth factor-beta2 production

PURPOSE: To evaluate the effects of sequential treatment with artificial tears and cyclosporine emulsion on conjunctival goblet cell density and production of transforming growth factor (TGF)-beta2 in patients with dry eye disease. METHODS: Patients with dry eye disease (N = 6) defined by an Ocular Surface Disease Index symptom score >or=25, Schirmer test 1 <10 mm, and corneal fluorescein and conjunctival lissamine green staining scores >or=3 were treated with artificial tears (Refresh Plus; Allergan, Irvine, CA) 4 times a day for 4 weeks, followed by 0.05% cyclosporine emulsion (Restasis; Allergan) twice a day for 12 weeks. Impression cytology was performed on the bulbar conjunctiva of both eyes at baseline, after artificial tear therapy, and after 6 and 12 weeks of cyclosporine therapy. Goblet cells were counted in 5 representative microscopic fields per membrane in those taken from the temporal and inferior bulbar conjunctiva of the worse eye, and membranes taken from the fellow eye were immunostained for TGF-beta2. RESULTS: There were no differences in mean goblet cell density between baseline and 4 weeks of artificial tears in the temporal and inferior bulbar specimens. After 6 weeks of cyclosporine emulsion, goblet cell density was significantly greater than baseline and artificial tears in the inferior bulbar conjunctiva (P < 0.01). After 12 weeks of cyclosporine emulsion, goblet cell density was significantly greater than baseline and artificial tears in both temporal and inferior bulbar sites (P < 0.01). The number of TGF-beta2-positive goblet cells was also noted to increase after 6 and 12 weeks of cyclosporine therapy (P < 0.001). CONCLUSIONS: Cyclosporine emulsion, but not artificial tears, increases goblet cell density and production of the immunoregulatory factor TGF-beta2 in the bulbar conjunctiva in patients with dry eye.     

Ocular surface disease index for the diagnosis of dry eye syndrome

PURPOSE: Evaluation of ocular surface disease index (OSDI) questionnaire for the diagnosis of dry eye syndrome. METHODS: Sixty-eight patients admitted to the Ophthalmology Polyclinic of the Dumlupinar University between December 2005 and April 2006 were randomly studied. The OSDI questionnaire was performed before, and the Schirmer and tear film breakup time (TBUT) tests were performed after the routine ophthalmologic examination. RESULTS: There was a significant inverse correlation between the OSDI and TBUT test scores, but no correlation between the Schirmer test scores and OSDI (r = -.296, p = .014, r = -.182, p = .138, respectively). Although there was a significant difference between the low and high OSDI having cases according to the TBUT test scores (p = .043), there was not according to the Schirmer test scores. CONCLUSIONS: The OSDI is a standardized instrument to evaluate symptoms, and can easily be performed and used to support the diagnosis of dry eye syndrome.     

Ocular surface in patients with different degrees of myopia

AIM: To investigate the clinical features of the ocular surface in patients with different degrees of myopia. METHODS: A cross-sectional study was conducted involving 122 participants with myopia in Beijing Tongren Hospital from February to June, 2023. After completing the Ocular Surface Disease Index (OSDI) score scale, measurements were taken for refraction, biometric parameters and ocular surface parameters. The prevalence, severity and related parameters of the dry eye among different groups based on axial length (AL) were compared. Correlation analysis was performed between ocular surface parameters and refraction/biometric measurement parameters. RESULTS: Statistically significant differences were observed in refractive error, corneal thickness, anterior chamber depth, and subfoveal choroidal thickness among the groups (all P<0.05). With the increase in AL, the incidence and severity of dry eye increased significantly (P<0.05). Moreover, the tear film break-up time (BUT) shortened (P<0.05), and the corneal fluorescein staining (CFS) points increased significantly (P<0.05). OSDI scores were positively correlated with AL and spherical equivalent (SE; both P<0.05); BUT was negatively correlated with AL, SE, and corneal astigmatism (AST; all P<0.05); Schirmer I test (SIT) results were negatively correlated with AL and SE (both P<0.05). CONCLUSION: AL elongation is a risk factor for dry eye onset in myopic participants. The longer the AL, the more severe the dry eye is, with the increased CFS spots and tear film instability. Additionally, SE and AST exhibit negative correlations with dry eye symptom scores and ocular surface parameters.     

Autologous platelet-rich plasma eye drop versus artificial tear eye drop for symptomatic dry eye disease: A prospective comparative interventional study

Purpose:To evaluate and compare the efficacy of autologous platelet-rich plasma (aPRP) eye drop and artificial tear (AT) eye drop in moderate to severe symptomatic dry eye disease (DED).Methods:This prospective interventional study included 121 eyes of 61 patients of moderate to severe DED. Patients were divided into aPRP (31 patients) and AT (30 patients) group. Ocular Surface Disease Index (OSDI) score, tear film breakup time (TBUT) (s), corneal fluorescein staining (CFS) score, and Schirmer test score (mm) of both the groups were evaluated and compared pre-treatment and post-treatment at the end of 3 months.Results:The mean age of the aPRP group and AT group was 52.8 ± 12.8 years and 55.5 ± 13.4 years, respectively. At the end of 3 months, OSDI score reduced more in the aPRP group as compared to AT group, and the mean difference (−22.7) was statistically significant (P < 0.001). There was no significant difference in post-treatment Schirmer test score between the two groups (P = 0.44). Post-treatment improvement in TBUT and CFS score in the aPRP group was significantly higher in the aPRP group as compared to that in the AT group (P < 0.05). Bruising at the site of blood withdrawal was noted in two patients in the aPRP group.Conclusion:aPRP is safe and more effective than AT in treating patients with moderate to severe symptomatic DED.