Break-up Time Research Articles

Short-term variability in ocular biometry and the impact of preoperative dry eye.

This study aimed to investigate the short-term variability of ocular biometric measurements and to analyze the factors associated with high variability of biometric values in patients with cataract. This retrospective study included 60 eyes of 60 patients who underwent ocular biometry twice with the IOLMaster 700 (March to November 2023). Ocular surface parameters included tear film break-up time (TBUT), corneal and conjunctival staining scores (CSS/ConSS). Refractive surprise was defined as a mean absolute error exceeding 0.5 diopter (D). Participants included 22 men and 38 women with a mean age of 70.6 ± 8.4 years. The variability of mean keratometric (K) values and astigmatism showed notable variability compared to axial length (mean K: 0.18 ± 0.17D, astigmatism: 0.21 ± 0.26D, axial length: 0.01 ± 0.01mm). A decreased TBUT and increased CSS were significantly associated with high variability (≥ 0.25D) of mean K (p = 0.040/0.008). The high K variability group (≥ 0.25D) revealed a significantly higher incidence of refractive surprise (> 0.5D) compared with the low K variability group (< 0.25D) (45.5%/17.9%, p = 0.037). Preoperative lower TBUT and higher CSS influenced the variability of K values in ocular biometry and may be related with postoperative refractive surprise due to erroneous K values.

In vivo lacrimal gland imaging artefact assessment based on swept-source optical coherence tomography for dry eye disease.

This study aimed to characterise imaging artefacts in the lacrimal gland using swept-source optical coherence tomography (SS-OCT) in patients with dry eye disease (DED) and healthy participants and identify risk factors for these artefacts. In total, 151 eyes, including 104 from patients with DED and 47 from non-DED participants, were analysed. Demographic data collection, comprehensive ocular examinations and SS-OCT imaging of the palpebral lobe of the lacrimal gland were performed. Artefacts were classified into distinct categories with different severities. Univariate and multivariate logistic regression analyses were performed to evaluate the association of age, gender, best-corrected visual acuity, intraocular pressure (IOP) and the presence of DED with the presence of artefacts. Eight artefact types and severity grading were defined by analysing 1208 lacrimal SS-OCT images. The three most prevalent artefacts were defocus (75.83%), cliff (67.47%) and Z-off (58.44%). The presence of artefacts was significantly associated with the presence of DED (OR=9.13; 95% CI, 2.39 to 34.88; p=0.001) and higher IOP (OR=1.34; 95% CI, 1.14 to 1.58; p<0.001). Furthermore, multivariate logistic analyses showed that lower tear film breakup time (OR=0.71; 95% CI, 0.55 to 0.92; p=0.009) and higher meibum quality score (OR=2.86; 95% CI, 1.49 to 5.48; p=0.002) were significantly associated with higher odds for the presence of artefacts. DED eyes had more SS-OCT image artefacts than normal eyes. Stringent standardised image quality control should be implemented before further image analysis when using SS-OCT to assess lacrimal gland image.

Phospholipid Nanoemulsion-Based Ocular Lubricant for the Treatment of Dry Eye Subtypes: A Multicenter and Prospective Study.

Dry eye disease (DED) is a multifactorial condition of the ocular surface (OS) characterized by loss of tear film homeostasis, ocular discomfort, and vision disturbances. Most available ocular lubricants target the aqueous deficiency of the tear, restoring only this layer, leaving the tear lipid stratum deficient, as occurs in most patients with evaporative DED. An innovative propylene glycol-hydroxypropyl guar enriched with a phospholipid nanoemulsion (PG-HPG-PH-N) is indicated to restore deficiencies in both the lipid and aqueous layers of the tear film, and its composition was designed to increase lubricant retention on the OS. The purpose of this study was to evaluate, through the Ocular Surface Disease Index (OSDI) and clinical assessment, the treatment of patients who had DED due to aqueous deficiency arising from mixed or evaporative DED subtypes with a PG-HPG-PH-N ocular lubricant at a reduced frequency of twice a day, in a prospective, multicenter, and single-arm study. Patients were screened from days - 7 to 0, and from day 1 (baseline and first day of treatment) to day 28 of treatment with this lubricant. After visit 1 (screening visit, days - 7 to 0), designed as pre-treatment OS assessment, patients returned to their research center on days 14 and 28 of treatment for a complete assessment, including anamnesis, the OSDI, corrected visual acuity, tear breakup time (TFBUT), OS staining evaluation, tolerability index, and environmental exposure questionnaire. Seventy patients were enrolled in this study (60 women, 10 men), with a mean age of 45 (range 27-64) years. TFBUT results showed an improvement in tear film stability as vital dyes sodium fluorescein and lysamine green showed a decrease in corneal staining after 14 and 28days of treatment. No significant adverse events were reported, demonstrating the good tolerability of the lubricant. The PG-HPG-PH-N nanoemulsion can be considered to be a safe and effective ocular lubricant for treating DED due to aqueous deficiency, both mixed and evaporative subtypes. Brazilian National Research Ethics Commission (ReBEC registration number 16055).

Corneal sensitivity and ocular surface health in patients undergoing femtosecond LASIK retreatment for residual refraction.

To assess corneal sensitivity and the ocular surface in patients undergoing primary femtosecond laser in situ keratomileusis (FS-LASIK) and those undergoing FS-LASIK retreatment under the same flap due to residual refractive error. Ekol Eye Hospital, Izmir, Turkey. Prospective case series. 19 patients with previous FS-LASIK who had myopic and astigmatic refractive error were included in the study group, and 19 age-matched and sex-matched patients undergoing FS-LASIK for the first time as the control group. Corneal sensitivity, Schirmer test, tear film break-up time (TBUT), Oxford grading scheme for ocular surface staining, and Ocular Surface Disease Index (OSDI) were measured preoperatively and at postoperative 1 week and 1, 3, and 6 months. The mean refractive correction in the study and control groups, respectively, was 2.18 ± 0.78 diopters (D) (range: 1.00 to 3.50) and 2.76 ± 1.20 D (range: 1.00 to 4.50; P = .07). Corneal esthesiometry results in the study and control groups, respectively, were 6.10 ± 12.55 vs 9.90 ± 11.50 mm at 1 week ( P = .001), 41.95 ± 6.98 vs 45.09 ± 5.88 mm at 1 month ( P = .004), 56.09 ± 3.37 vs 56.19 ± 2.52 mm at 3 months ( P = .8), and 58.60 ± 2.01 vs 58.80 ± 1.39 mm at 6 months ( P = .5). Significant difference between the 2 groups in Schirmer test score that disappeared at postoperative 3 months and in TBUT and ocular surface staining that disappeared at 6 months, whereas the statistically significant difference in OSDI score persisted at 6 months ( P = .03) was detected. Corneal surface sensitivity and ocular surface health are more impaired in patients undergoing FS-LASIK retreatment due to residual refractive error.

Pre and postoperative comparative evaluation of tear film stability and conjunctival impression cytology after phacoemulsification using clear corneal temporal incision

Abstract Introduction: Development of significant dry eye symptoms and visual disturbances after successful cataract surgery remains the common and unsatisfying experience for ophthalmologists. Corneal incision site and surgical technique contribute in ocular surface damage after cataract surgery. To assess the pre and post-operative conjunctival impression cytology and tear film stability after phacoemulsification by clear corneal temporal incision. Methodology: This prospective interventional study was conducted in department of ophthalmology at tertiary care teaching hospital. 72 patients were enrolled and the dry eye assessment was done considering the Schirmer’s test, tear meniscus height, tear breakup time and conjunctival impression cytology; preoperatively and then at 1 week and 4 weeks postoperatively. ANOVA and Post Hoc test were used for statistical analysis and p value of &lt;0.05 was considered significant. Results: Mean age of the patients was 59.86±9.56 years and most of the males were employed while females were mostly homemakers. The overall trend for dry eye tests showed significant (P&lt;0.0001 on ANOVA) increase at 1st week postoperatively, while the significant recovery was achieved by 4th week postoperatively. There was a significant decline (p&lt;0.0001) in goblet cell density (GCD) at 1st week, which was reversed by the 4th week postoperatively. Conclusion: The transient dry eye was seen in the patient’s undergoing phacoemulsification by 1st week postoperatively, which resolved spontaneously but partially with routine postoperative care by the 4th week follow up.

Raman spectroscopy to investigate early biochemical alterations in human tears caused by contact lenses

ABSTRACT Clinical relevance The interaction between contact lenses and tear film plays a critical role in lens biocompatibility and can influence discomfort during wear. Early detection of biochemical changes is important for improving ocular surface health, preventing complications, and developing advanced lens materials to enhance long-term comfort. Background The pursuit of biocompatible lens materials requires a thorough understanding of their interaction with tear environment. The aim of this study is to evaluate different approaches to investigate early alterations in tear biomolecular profiles induced by lens wear. Methods Two participants wore different CLs and underwent ocular analysis before CL insertion (T0), after 2-hour wear (T2), and two hours after removing the CL (T4), evaluating non-invasive tear break-up time (NIBUT), tear meniscus height (TMH), and osmolarity. Forty CLs were used. At the same time points, tears were collected and analysed by Raman spectroscopy. Results Tear film stability, as measured by NIBUT, decreased post-lens wear (T0 vs T2, p = 0.034 and 0.025 for S1 and S2, respectively) but showed recovery within 2 hours (T0 vs T4, p > 0.05 for both S1 and S2), while TMH and osmolarity remained unchanged (T0 vs T2 vs T4, p > 0.05 for both S1 and S2). Raman spectroscopy highlighted notable changes in the biomolecular profile of tears after lens wear, particularly in the 2700–3200 cm−1 spectral window related to C-H stretching, which is sensitive to CH, CH2 and CH3 groups, their functional chemistry group, and the surrounding microenvironment. Conclusions Contact lens wear induces subtle biochemical, subclinical alterations in tears that can be detected early by Raman spectroscopy. The method is promising for analysing the subject-specific responses to lenses, also with possible individual variability in the timing of these changes. In addition, this approach can provide insights for designing biocompatible materials and for the early detection of subclinical biomarkers.

A comparative study on the lipid layer thickness analysis of medical staff before and after work.

To study the change of the lipid layer thickness analysis in medical staff (MS) before and after work, and to explore the significance of measuring lipid layer thickness (LLT) respectively in four quadrants. Ocular Surface Disease Index (OSDI) questionnaire and video display terminal using time for 55 MS were collected (the informed consent was obtained from all patients). Noninvasive tear break-up time, LLT, tear meniscus height (TMH), meibomian glands (MG) dropout, and blink pattern before and after work (worked for more than 4 h) of 110 eyes were measured by Gaush iDea Ocular surface analyzer. Lid margin abnormalities were evaluated by the slit-lamp microscopy. The average OSDI score of 55 MS was 25.68 ± 14.91. The average LLT of 110 eyes after work (65.12 ± 3.63 nm) was significantly reduced compared to before work (66.54 ± 4.16 nm), p < 0.05. The LLT in the superior quadrant was significantly thinner than that in the other three quadrants, p < 0.01. The average LLT was positively correlated with the LLT in the inferior (r = 0.822, p < 0.001), nasal (r = 0.261, p < 0.001), and temporal quadrant (r = 0.372, p < 0.001), while was negatively correlated with the MG dropout in lower lid (r = -0.209, p = 0.002). There was a significant correlation between the LLT in the inferior quadrant and the VDTt (r = -0.173, p = 0.01). The LLT of inferior quadrant were positively related to the TMH (r = 0.149, p = 0.027) and negatively related to MG dropout in lower lid (r = -0.162, p = 0.017). The LLT significantly decreases after work in MS. The distribution of the lipid layer on the ocular surface is uneven. It is unreasonable for current detection instruments to measure the inferior quadrant LLT alone to represent average LLT.

Umbilical Cord Blood-Derived Products in Autoimmune Systemic Syndromes with Severe Dryness: A Pilot Study

Background and Objectives: Human umbilical cord blood serum (HUCBS) stands out as a potent adjunct to conventional therapies for ocular surface disorders (OSDs) caused by, among many, autoimmune systemic syndromes. By expediting ocular surface regeneration and fostering epithelial integrity, HUCBS not only enhances subjective patient experiences but also improves objective clinical indicators. This makes it particularly useful in patients with corneal ulcers through ocular surface regeneration and anti-inflammatory activity. This study aims to explore the efficacy of HUCBS in patients who had previously received other treatments unsuccessfully. Materials and Methods: This study was a prospective, non-comparative, interventional case series study involving 49 patients (30 females and 19 males) aged 15–82 years with severe OSDs who were unresponsive to standard treatments. The study was conducted at the San Marco Hospital, Catania, Italy. Patients were categorized into four groups based on the etiology of their severe OSDs: Group I consisted of twenty four patients with filamentary keratitis and corneal ulcers associated with rheumatologic diseases such as Sjogren’s syndrome and systemic sclerosis; Group II comprised thirteen patients with graft-versus-host disease; Group III consisted of nine patients with corneal neurotrophic ulcers; and Group IV included three patients with Steven–Johnson syndrome. The outcomes were evaluated before and after treatment using the following assessments: OSDI (Ocular Surface Disease Index) and SANDE (Symptom Assessment in Dry Eye) questionnaires, VAS (Visual Analog Scale), Slit Lamp Examination, Esthesiometry, Lissamine Green Staining, NIBUT (Non-Invasive Break-Up Time), BUT (Break-Up Time), Fluorescein Staining with Photography and Oxford Classification, The Schirmer Test, Best-Corrected Visual Acuity (BCVA), and Meibography. Results: We observed a significant improvement in the outcomes from the SANDE, VAS, and OSDI questionnaires, The Schirmer Test, BUT, BCVA, and Oxford Classification, after treatment with UCBS. Clinical variables, such as corneal inflammation, conjunctivalization, corneal neovascularization, and pain, were also considered individually. Nevertheless, pain and inflammation reduced markedly over time until complete healing was achieved in all cases. Conclusions: Our pilot study highlights the substantial efficacy of HUCBS in patients with systemic autoimmune diseases who have shown inadequate responses to prior treatments for dry eye. This underscores the need for further comprehensive investigations in this field.

Biomimetic Curcumin-Loaded Liposomes for the Treatment of Dry Eyes and Meibomian Gland Dysfunction: An In Vivo Study

Background/Objectives: Meibomian gland dysfunction (MGD) and dry eye syndrome (DES) are common eye diseases characterized by altered tear film stability and inflammation of the ocular surface, causing significant discomfort and possible visual impairment. This study aimed to investigate the efficacy of curcumin-loaded liposomes (Lipo@Cur) compared to cyclosporine A-loaded liposomes (Lipo@CycA) in experimental rabbit models of MGD and DES, with a focus on their ability to improve tear film stability and reduce ocular surface inflammation. Methods: MGD and DES were induced using complete Freund’s adjuvant (CFA) and treated to evaluate the effect of liposomal formulations on tear break-up time (TBUT), clinical signs of inflammation (telangiectasia, conjunctival hyperemia, meibomian foramen occlusion), and corneal as well as conjunctival histological cells. Results: Lipo@Cur increased TBUT and reduced the signs of ocular surface inflammation, potentially approaching the effectiveness of clinically approved cyclosporine A encapsulated in liposomes (Lipo@CycA). Histological analysis suggested improvements in corneal epithelial thickness and goblet cell density in the treated groups, which may indicate a reversal of DES-induced damage to the ocular surface. Conclusions: Plant-originated curcumin encapsulated in liposomes offers a promising therapeutic strategy for the management of MGD and DES that may improve patient outcomes by addressing the underlying inflammatory mechanisms of these conditions.

Effects of Glaucoma Treatment on Ocular Surface and Tear Functions: Comparison of Trabeculectomy and Antiglaucoma Drops.

To investigate tear function and ocular surface disease (OSD) findings in patients with glaucoma who received antiglaucoma medication in one eye and trabeculectomy surgery in the other eye. The patient group included 38 eyes of 19 patients who had undergone trabeculectomy surgery with mitomycin C (MMC) treatment in one eye at least 6 months prior. These eyes were followed up without medication while the fellow eye continued receiving antiglaucomatous medication. The control group comprised 20 eyes of 20 healthy individuals. Demographic data, follow-up period after trabeculectomy, antiglaucoma medications, number of drops per day, and duration of medication were recorded. Tear break-up time (BUT), corneal and conjunctival fluorescein staining, Schirmer II test, and conjunctival impression cytology were performed. A statistically significant difference was observed in BUT, corneal and conjunctival fluorescein staining, Schirmer II test, and Nelson staging levels in both eyes of patients with glaucoma compared to the control group (p=0.05). Although not statistically significant, BUT, Schirmer II test, punctate staining, and Nelson staging results showed improvement with increasing postoperative time. In our patient group, antiglaucoma medications and trabeculectomy surgery with MMC induced OSD to a similar degree. No superiority was observed between trabeculectomy with MMC and antiglaucoma drops in terms of OSD incidence.

Effects of Rebamipide for Dry Eye on Optical Quality and Efficacy: A Systematic Review and Meta-Analysis.

Purpose: To evaluate the effects of rebamipide ophthalmic suspension on optical quality and efficacy of patients with dry eye under different conditions. Methods: A comprehensive search across five databases (PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure, and Wan Fang) was conducted for studies published through May 13, 2024, focusing on rebamipide for dry eye treatment. Results: A total of 11 studies including 334 patients with dry eye were included. Tear breakup time (TBUT) values of patients with dry eye increased significantly after 2 weeks (standardized mean difference [SMD] =1.07, 95% confidence interval [CI] = [0.05, 2.09]), 4 weeks (SMD = 1.26, 95% CI = [0.77, 1.75]), and 12 weeks (SMD = 1.04, 95% CI = [0.37, 1.71]) of rebamipide treatment. Subgroup analysis revealed that patients with dry eye wearing soft contact lens (SCL) exhibited higher TBUT values after 4 weeks of rebamipide treatment compared with those who received rebamipide alone. In addition, rebamipide significantly improved fluorescein staining score of patients with dry eye after 4 weeks of treatment (SMD = -0.34, 95% CI = [-0.63, -0.06]). However, 4 weeks of rebamipide treatment showed no significant effect on Schirmer I test values (SMD = -0.04, 95%, CI = [-0.43, 0.35]) and higher-order aberrations (SMD = -0.73, 95% CI = [-1.77, 0.30]). Conclusions: These results indicate a significant improvement in the efficacy of rebamipide treatment for patients with dry eye, particularly for those wearing SCL. The effect of rebamipide on visual quality was found to correlate with the underlying dry eye status.

Comparative Analysis of Intense Pulsed Light Therapy in Patients with Meibomian Gland Dysfunction, with and Without Glaucoma Medication

Background: This study assessed the efficacy of intense pulsed light (IPL) therapy for treating meibomian gland dysfunction (MGD), a key contributor to evaporative dry eye disease (DED), by comparing outcomes in patients with idiopathic MGD versus those with MGD induced by glaucoma medications. Methods: In a retrospective analysis of 45 patients, divided into groups based on glaucoma medication use (20 patients) and non-use (25 patients), all underwent four IPL sessions combined with meibomian gland expression (MGX) at 3-week intervals. Key metrics evaluated included Ocular Surface Disease Index (OSDI) scores, tear breakup time (TBUT), Schirmer I test scores, and meibography scores, pre- and post-treatment. Results: Significant improvements were observed in both groups across all parameters post-treatment, indicating enhanced tear film stability and meibomian gland function. The non-glaucoma group showed slightly greater improvements, suggesting the potential impact of glaucoma medications on MGD management. Conclusions: These findings underscore IPL therapy’s effectiveness in improving DED symptoms and meibomian gland function, highlighting its utility as a treatment option for patients with MGD, including those on glaucoma medications.

Preliminary investigation on the establishment of a new meibomian gland obstruction model and gene expression

Meibomian gland dysfunction is a chronic ocular surface disease with a complex pathogenesis, whose main clinical manifestations are meibomian gland obstruction or/and lipid abnormalities. To explore the mechanism of MGD due to meibomian gland obstruction (MGO), we established a rat model of MGO by cauterizing the meibomian gland orifice. The morphology of the lid margins and meibomian gland orifices were visualized by slit lamp. The tear production of rats was measured by phenol red cotton thread, the tear film breakup time and corneal fluorescein staining scores of rats were detected under cobalt blue light of slit lamp. Changes in the histological structure of the meibomian gland (MG) were observed by HE staining, Oil Red O staining and immunofluorescence staining (collagen IV). RNA sequencing was used to detect differentially expressed genes in MGO and normal rats, which were validated by qPCR. In the MGO group after 4, 8, and 16 weeks, the meibomian gland orifices were closed, tear film break-up time decreased and corneal fluorescein staining score increased (p < 0.05). MG acini was smaller at 8-week and 16-week MGO rats in HE staining. Oil Red O staining showed less condensed staining in the 8- and 16-week MGO groups, while more condensed staining in the 4-week MGO group. Additionally, the basement membrane was destroyed in 16-week MGO group by immunofluorescence staining of collagen IV. Meanwhile, RNA sequencing and qPCR showed that lipid peroxidation (LPO), transient receptor potential vanilloid-3 (TRPV3) and genes in PPAR signaling pathway were differentially expressed in 16-week meibomian gland obstructive rats (p < 0.05). Consequently, meibomian gland obstruction model rats were established successfully with corneal damage and lower tear film stability. Meibomian gland obstruction is a causative factor of MGD, which led to abnormal histological structure in MG, differential expression of PPAR signaling pathway and TRPV3.

Should test for dry eyes be done before age-related cataract surgery?

Objectives: This study aimed to determine if tests for dry eyes should be done routinely before age-related cataract surgery. Materials and Methods: This was a hospital-based observational prospective study. Patients 50 years and above with age-related cataracts that met the inclusion criteria scheduled for manual small incision cataract surgery (MSICS) were assessed for dry eye disease (DED) before and after surgery. Numerical variables were described using the mean and standard deviation (SD) with a 95% confidence interval and P &lt; 0.05. Results: A total of 81 patients were studied: 60.5% (49) males and 39.5% (32) females. The mean pre-operative Schirmer’s test value was 14.09 mm (SD = 10.7 mm). Post-operative schirmer’s test values were 18.12mm (SD = 11.81mm) at 1 week, 14.98mm (SD = 11.26mm) at 4 weeks and 16.20 mm (SD = 11.06 mm) at 6 weeks. Pre-operative mean tear break-up time (TBUT) was 10.05 (SD = 5.13 s), 9.46 s (SD = 4.18 s) at 1 week, 10.13 s (SD = 4.29 s) at 4 weeks and 9.80 s (SD = 4.33 s) at 6 weeks postoperatively. Lissamine green staining score (LGSS) Grade 0 was 80% at 1 week post-operative, Grade 0 increased to 85%, 90% at 4 weeks and 91% at post-operative 6 weeks. Conclusion: This study showed that DED is not associated with MSICS, and it is not associated with objective worsening of previously diagnosed DED. Testing for DED preoperatively plays a significant role in the pre-operative evaluation of patients and symptomatic expectations, but its testing before MSICS might not always be necessary.

The Proportion of Ocular Involvement and Characteristics of Dry Eye Parameters in Primary Sjögren's Syndrome Referred from the Rheumatology Department.

To report the proportion of ocular involvement in primary Sjögren's syndrome (pSS) and to analyze various dry eye indexes and serum titers of markers depending on whether ocular involvement has occurred or not. This retrospective study considered 214 patients referred from the rheumatology department for pSS workup. Symptom questionnaires, ocular surface stain score (OSS), Schirmer test, tear break-up time (TBUT), meibomian gland (MG) dropout, meibum quality, meibum expressibility, lid margin abnormalities, and lipid layer thickness were evaluated. Anti-Ro Ab, anti-La Ab, ANA, RF, ESR, and CRP were included as systemic serum titers of markers. Patients with (Group 1) and without (Group 2) ocular involvement were compared. We conducted a further subgroup analysis of group 1 by dividing it into two groups based on whether or not the cases met all the ocular criteria for pSS diagnosis. Among the 214 referred patients, 118 were diagnosed as pSS: 87 out of 118 (74%) in group 1 and 31 (25%) in group 2. Group 1 showed higher meibum quality scores (p=0.016), meibum expressibility (p=0.01), and lid margin abnormalities on the lower lid (p=0.029) and lower TBUT (p=0.016) than group 2. Among the serum titers of markers, anti-Ro Ab negatively correlated with TBUT (r=-0.211, p=0.028). OSS, TBUT, and the schirmer test statistically differed between the patients who satisfied both ocular criteria (N=46) and those who satisfied only one criterion (N=41) (p=<0.001, 0.041, 0043, respectively). There were no statistical differences in serum titers of markers between the two groups. About half of patients referred from the rheumatology department for diagnosis of pSS were diagnosed with pSS. The proportion of ocular involvement in the pSS patients was 74%, and half of these patients met both ocular criteria. Only anti-Ro Ab negatively correlated with TBUT. Also, OSS, TBUT, and schirmer test were statistically different between the two subgroups.

The efficacy of a netilmicin/dexamethasone gel combination in the treatment of posterior blepharitis in moderate-severe dry eye patients.

To evaluate the safety and efficacy of netilmicin/dexamethasone combination in the treatment of meibomian gland dysfunction (MGD)-associated posterior blepharitis. In this prospective and controlled study were enrolled 40 patients with MGD and symptoms of dry eye disease. Two groups were established: 20 patients (group 1) received netilmicin 3 mg/ml and dexamethasone 1 mg/ml eye gel, whereas in group 2 (20 patients) received vehicle for 15 days. Patients were evaluated at baseline, 15 and 45 days, including SANDE and VARS questionnaire, non-invasive tear film breakup time (NIBUT), tear meniscus height (TMH), ocular redness and meibography score. Moreover, fluorescein tear-film breakup time (TBUT), fluorescein ocular surface staining, lid margin evaluation including hyperemia, edema and meibum expressibility and quality examinations were carried out. Furthermore, intraocular pressure (IOP) and best-corrected visual acuity (BCVA) were considered as safety parameters. In group 1, at 15 and 45 days there were statistically significant changes in VARS and SANDE score (p < 0.0001) as well as lid margin parameters, TBUT and fluorescein ocular surface staining (p < 0.0001). Comparing the two groups, a significant improvement of SANDE score was observed at 15 days in group 1 as well as lid margin parameters, TBUT and fluorescein ocular surface staining at 15 and 45 days (all p < 0.0001). Netilmicin/dexamethasone combination is effective and safe to treat MGD-associated posterior blepharitis improving both symptoms and ocular surface signs.

The Effectiveness of E&gt;Eye Intense Regulated Pulse Light Therapy in Treating Evaporative Dry Eye Disease among Southeast Asian Patients

Objective: Since the effectiveness of E&gt;Eye Intense Regulated Pulsed Light (IRPL) therapy in treating evaporative dry eye condition caused by meibomian gland dysfunction (MGD) has not been reported among the Southeast Asian population, this study aimed to retrospectively report the effectiveness of this treatment in addressing evaporative dry eye due to MGD among this population using Tear Check analyzer after three consecutive treatments.Material and Methods: This is a retrospective study involving 71 male and 107 female patients, aged between 28 and 83 with complaints of dry eye symptoms accompanied by clinical signs of MGD who have been treated with E&gt;Eye IRPL. All patients were treated with IRPL in three consecutive treatments where five overlapping flashes of light were administered on the lower lid and temporal part of each eye on day 1, 15, and 45. Improvement in lower meibomian gland loss, Tear Film Stability Evaluation (TFSE), and non-invasive breakup time (NIBUT) were assessed using the Tear Check analyzer at baseline and after the third treatment session.Results: Repeated-measure ANOVA showed that the percentage of lower meibomian gland loss and TFSE score significantly improved post-treatment, indicating recovery of the meibomian gland and improved tear stability. McNemar Change Test also showed that the percentage of patients having NIBUT of lower than 6 seconds has significantly reduced post-treatment.Conclusion: E&gt;Eye IRPL treatment is effective in evaporative dry eye disease caused by MGD among Southeast Asian patients after three consecutive treatments by restoring meibomian gland and tear stability post-treatment.

A Preservative-Free Combination of Sodium Hyaluronate and Trehalose Improves Dry Eye Signs and Symptoms and Increases Patient Satisfaction in Real-Life Settings: The TEARS Study.

Dry eye disease (DED) is a frequently observed condition characterized by ocular discomfort and visual disturbance. It is highly prevalent and impairs patients' quality of life (QoL). This study assessed the benefit of a preservative-free bioprotectant eye drop formulation containing sodium hyaluronate and trehalose (SH-trehalose) with regards to DED, as well as patient satisfaction, through a large-scale real-life survey. In a multi-center, international, prospective observational study, subjects with DED received SH-trehalose for 84 days. Ocular Surface Disease Index (OSDI), Dry Eye Questionnaire-5 items (DEQ-5), and patient satisfaction were assessed at baseline, day 28, and day 84, and clinical evaluations included ocular surface staining, Schirmer test, tear film break-up time (TBUT), and conjunctival hyperemia at baseline and day 84. A total of 312 patients were evaluated, of whom 82.4% were women. The mean age was 57.9±15.2 years. The mean OSDI score at baseline was 41.7 ± 20.6. After 84 days, the mean OSDI score was 27.3 ± 19.8 (p < 0.001). The percentage of patients with a severe OSDI score decreased from 60.3 to 34.5%. The DEQ-5 score significantly (p < 0.001) improved after 28 and 84 days, as did patient satisfaction. Ocular surface staining, Schirmer test, TBUT, and conjunctival hyperemia scores improved significantly (all p < 0.001) for both eyes with SH-trehalose between baseline and day 84. Tolerance of SH-trehalose was good. SH-trehalose significantly improved the clinical signs and symptoms of DED after 84 days. Moreover, it significantly increased patient satisfaction and was well tolerated. NCT04803240.

A Selective Melatonin 2 Receptor Agonist, IIK7, Relieves Blue Light-Induced Corneal Damage by Modulating the Process of Autophagy and Apoptosis

This study aims to investigate the effect of the selective MT2 receptor agonist, IIK7, on corneal autophagy and apoptosis, aiming to reduce corneal epithelial damage and inflammation from blue light exposure in mice. Eight-week-old C57BL/6 mice were divided into BL-exposed (BL) and BL-exposed with IIK7 treatment (BL + IIK7 group). Mice underwent blue light exposure (410 nm, 100 J) twice daily with assessments at baseline and on days 3, 7, and 14. Corneal samples were analyzed for MT2 receptor expression, autophagy markers (LC3-II and p62), and apoptosis indicators (BAX expression and TUNEL assay). Then, mice were assigned to normal control, BL, and BL + IIK7. Ocular surface parameters, including corneal fluorescein staining scores, tear volume, and tear film break-up time, were evaluated on days 7 and 14. On day 14, reactive oxygen species (ROS) levels and CD4+ IFN-γ+ T cells percentages were measured. The BL group exhibited higher LC3-II and p62 expression, while the BL + IIK7 group showed reduced expression (p &lt; 0.05). The TUNEL assay showed reduced apoptosis in the BL + IIK7 group compared to the BL group. ROS levels were lower in the BL + IIK7 group. The BL + IIK7 group showed improved ocular surface parameters, including decreased corneal fluorescein staining and increased tear volume. The percentages of CD4+ IFN-γ+ T cells indicated reduced inflammatory responses in the BL + IIK7 group. The MT2 receptor agonist IIK7 regulates corneal autophagy and apoptosis, reducing corneal epithelial damage and inflammation from blue light exposure.

Serial intravitreal injections in age-related macular degeneration patients from the dry eye disease perspective: a cross-sectional study

BackgroundTo evaluate the effects of serial intravitreal injections (IVI) on the ocular surface and meibomian glands in patients with neovascular age-related macular degeneration (nAMD).MethodsPatients receiving anti-vascular endothelial growth factor (anti-VEGF) agent injections for unilateral nAMD were included. Untreated fellow eyes served as the control group. All participants followed a pre-IVI asepsis protocol with povidone-iodine (PI). Ocular surface diseases index (OSDI) questionnaire scores, first and average non-invasive tear break-up time (fNITBUT and avgNITBUT), Schirmer-1 test results, corneal staining score (according to Oxford scale), meibomian gland (MG) loss rates of lower and upper eyelids were recorded four weeks after the last IVI.ResultsForty-two nAMD patients with a mean age of 63.3 ± 19.4 were included in the study. The mean OSDI score was 20.3 and the median of IVI number was 9 (6–22). There were no statistically significant difference between treated and untreated fellow eyes regarding fNITBUT (5.6 vs. 4.5, p = 0.872), avgNITBUT (6.2 vs. 7.2, p = 0.968), Shirmer-1 results (7 vs. 7, p = 0.854), corneal staining (0.3 vs. 0.2, p = 0.341), lower and upper MG loss rate (29.3 vs. 28.4, p = 0.162, and 27.1 vs. 26.9, p = 0.476, respectively). Only significant correlation was observed between age with lower and upper MG loss rate (r:0.396, p = 0.042, and r:0.365, p = 0.047).ConclusionThe results of the present study demonstrated that serial IVI of anti-VEGF agents with PI asepsis is well tolerated by nAMD patients in terms of ocular surface, MG loss and DED measurements.