Fluorescein Staining Of Cornea Research Articles

Evaluation of Dry Eye Parameters Among Electronic Cigarette Smokers.

Introduction The emergence of electronic cigarettes as the "healthier" version of smoking has been popular, especially among young adults. However, knowledge about the potential effects of e-cigarettes on ocular structures is scarce. Objective To compare the mean change in dry eye parameters between e-cigarette smokers and non-smokers and to correlate between dry eye parameters with device power output. Methodology A cross-sectional, single-visit study was conducted involving 85 e-cigarette smokers and 85 non-smokers. All participants were evaluated on dry eye parameters, including the Ocular Surface Disease Index (OSDI) score, tear meniscus height (TMH), tear break-up time (TBUT), cornea fluorescein staining, and Schirmer's I test. The mean change in dry eye parameters was compared between e-cigarette smokers and non-smokers. The correlation between dry eye parameters with device power output was analyzed. Results Specifically, 32.94% of e-cigarette smokers were found to have a TMH <0.2 mm, compared to only 5.88% of non-smokers (p<0.001). A significant change in mean TBUT was found between the e-cigarette smokers (10.41+2.65 seconds) and non-smokers (12.66+3.14 seconds, p<0.001). The lower mean Schirmer's I test was found among e-cigarette smokers (12.75+7.24 mm, p<0.001). No significant change in the median OSDI score and corneal fluorescein staining. The OSDI score and device power output were found to have a significant positive correlation (p=0.003). There was a significant association between dry eye signs and device power output, including TMH (p=0.047), TBUT (p=0.002), Schirmer's I test (p<0.001), and corneal fluorescein staining (p<0.001). Conclusion Electronic cigarette smokers are prone to develop dry eyes. Concern should be raised on the risk of electronic cigarette use on ocular health, and regulation on e-cigarette ban should be revisited.

Quantitative Assessment of Lid Margin Vascularity Using Swept-Source Optical Coherence Tomography Angiography.

To evaluate the ability of swept-source optical coherence tomography angiography (SS-OCTA) to assess lid margin vascularity. This prospective, cross-sectional trial enrolled 125 participants, including 15 control subjects and 110 meibomian gland dysfunction (MGD) patients. Lid margin blood flow density (LMBFD) was obtained using SS-OCTA. LMBFD was assessed for repeatability in 54 of 125 participants and for reproducibility in 23 of 125 participants. The efficacy of LMBFD was validated in the 125 participants, who were divided into mild (n = 46), moderate (n = 42), and severe groups (n = 37) according to the lid margin vascularity severity shown in the slit-lamp photographs. Correlations between LMBFD and MG-related parameters, such as ocular surface disease index (OSDI), fluorescein tear break-up time (FTBUT), cornea fluorescein staining (CFS), lid margin score (LMS), and meibomian gland expressibility (ME), were analyzed in all 125 participants. Repeatability and reproducibility coefficients were satisfactorily high in the scan mode with a scan area of 6 mm × 6 mm (intraclass correlation coefficient [ICC] repeatability = 0.905; ICC reproducibility = 0.986) and a scan area of 9 mm × 9 mm (ICC repeatability = 0.888; ICC reproducibility = 0.988). The LMBFD gradually increased in the mild, moderate, and severe groups (P < 0.001). LMBFD was significant correlated with OSDI (r = 0.290, P = 0.001), FTBUT (r = -0.195, P = 0.030), CFS (r = 0.352, P < 0.001), ME (r = 0.191, P = 0.033), and LMS (r = 0.370, P < 0.001). LMBFD may be a noninvasive, repeatable, reproducible, and efficient index for the quantitative evaluation of eyelid margin vascularity in the future. We demonstrated that SS-OCTA has the potential to evaluate the eyelid margin vascularity in MGD patients and guide future treatment strategies in clinics.

Quantum molecular resonance electrotherapy (Rexon-Eye) for recalcitrant dry eye in an Asian population.

To assess the safety, efficacy, patients' satisfaction and acceptability of Rexon-Eye electrotherapy in treating Asian severe dry eye disease (DED) patients. Prospective parallel-arm pilot study recruiting 40 DED Chinese patients with >moderate recalcitrant DED (Contact Lens Research Unit [CCLRU] > grade 2). Subjects were randomized into 2 groups, undergoing four weekly treatment sessions each: group 1 received full treatment power; group 2 received control treatment (power 1 treatment). Non-invasive tear break-up time (NIBUT), cornea fluorescein staining graded via CCLRU and Schirmer's I test were compared pre- and 2 months post-treatment. The SPEED and QUEST questionnaires that evaluated subjective symptoms and treatment satisfaction, respectively, at baseline and 2 weeks post-treatment were carried out. Tear cytokine levels in both groups were examined at 2 weeks post-treatment. The amount of improvement in post-treatment corneal staining in the inferior corneal zone was significant in Group 1 (p = 0.038) but not in Group 2 (p = 0.832). Group 1 eyes with worse baseline staining (total score >9.8) had a significantly greater reduction of corneal staining than those with better baseline staining (-11.7 ± 1.98 vs. -4.6 ± 2.89, p < 0.001). There were no other significant differences in NIBUT, Schirmer's 1 and cornea fluorescein staining grading within or between the groups.: Group 1 (n = 24) had improved subjective dryness scores compared to Group 2 (n = 16) (SPEED score: 6.38 + 4.16 vs. 10.0 + 6.36, p = 0.04). No significant differences were seen in 11 tear cytokine levels at 2 weeks post-treatment between the 2 groups. In Asian DED patients treated with Rexon-Eye, inferior cornea staining showed significant improvement compared to placebo, and eyes with greater cornea staining at baseline achieved a greater improvement in staining. There were no other significant improvements in NIBUT and Schirmer's 1. Rexon-Eye also improved subjective DED scores in 41.7% of eyes without any adverse effects.

Auricular Acupressure for Dry Eye Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background and Objectives: The purpose of this systematic review was to summarize the current evidence to examine the safety and effectiveness of auricular acupressure on dry eye diseases. Materials and Methods: Twenty databases were searched from their inception until November 2022. Only randomized controlled trials (RCTs) in which auricular acupressure was used for dry eye diseases were included. The selection process, data extraction and quantitative were conducted according to the guidelines. Results: Seven RCTs met the inclusion criteria. Meta-analysis showed that compared to artificial tears, auricular acupressure had a favorable effect on prolonging tear breakup time (TBUT), improving the Schirmer I test (SIT) score and the score of symptoms (SOS) of patients with dry eye disease (p &lt; 0.05). Furthermore, compared to the artificial tears alone, auricular acupressure plus artificial tears had a significantly greater SIT score (p &lt; 0.001) and response rate (p = 0.006), significantly longer TBUT (p &lt; 0.001), and significantly lower Ocular surface disease index (OSDI) (p = 0.02) and SOS (p = 0.03). However, there was no statistically significant difference between the auricular acupressure plus artificial tears group and the artificial tears group in terms of cornea fluorescein staining (CFS) (p = 0.09). Conclusions: Auricular acupressure, as a sole intervention or in combination with artificial tears, may have a beneficial effect on dry eye disease. However, more high-quality RCTs need to be included in the future to further prove the positive effects of auricular acupressure on patients with dry eye disease.

Advanced Diagnosis Method Analysis of the Dry Eye Disease: A Bibliographic Study (2012-2022)

Dry eye disease (DED) is one of the most common eye diseases. There is at least one DED patient in almost every five people. Especially in the era of COVID-19, the rate of DED is inevitably increasing. The reason falls on the frequency of screen use, the inappropriate way of mask-wearing, etc. Thus, based on the international and national literature databases, this study utilizes a systematic review method on DED diagnosis. 2131 unduplicated records are extracted from Web of Science (WOS) and Scopus databases. The most contributed countries, authors, journals, references, disciplines, and keywords are recognized. Findings show that DED research has burst in 2018. China is the second contributing country in this field. Interdisciplinary is involved in this topic, including ophthalmology, medicine, healthcare, and neurology. According to the publications of the most cited authors, the most contribution falls on the DED diagnosis standard. According to the hot topics, DED has a deep relation to human daily habits, ages, chronic disease, eye infection, and trauma. Furthermore, the major diagnosing methods are clustered as 12 clusters, which are Tear break-up time (TBUT), Schirmer I test (SIT), cornea fluorescein staining (CFS), Interferometry and slit-lamp images, in vivo confocal microscopy (IVCM) images, Meibometry images, Tear osmolarity, Proteomic analysis, Optical Coherence Tomography (OCT) images, traditional Chinese medicine (TCM) diagnosis, subjective diagnosis, and demographic factors. Finally, challenges and future perspectives are discussed.

A Study on the Assessment of Correlation among Vitiligo and Dry Eye Diseases

Objective: The aim of this research work was the assessment of the association of vitiligo disease and DED (Dry Eye Disease) with the help of different objective parameters. Methodology: This research work was performed on 30 patients of vitiligo and 31 patients present with refractory complaints of non-complicated nature. Ophthalmologic examination was carried out on all the patients which included Schirmer Test-I, FBU (Fluorescein Break-up Time) and CFS (Cornea Fluorescein Staining). Different OSDI means (Ocular Surface Disease Index) were in utilization for the assessment of the dry eye status. Results: Participants of both groups were same about the gender and age distribution. The patients of the vitiligo disease group were present with high scores of OSDI (24.10±13.70 versus 12.50±3.20, T-test, P&lt;.0010), shorter FBU scores (5.6±2.7 versus 7.60±2.20, Mann's-Whitney U test, P=.0050) and higher positivity of CFS (18/30 versus 3/31, by Chi-square test, P&lt;.0010) as related to the patients of control group. The patients of both groups were present with much similar results regarding the Schirmer and MGD outcomes. There was presence of peri-ocular involvement in 44.68% (n: 14) patients of vitiligo disease. Thorough analysis within the patients of vitiligo showed that the values of Schirmer test and FBU were much less in the patients present with peri-ocular involvement, MGD status and scores of OSDI were much similar. Conclusion: This research work concluded that there is a possible correlation of vitiligo and DED. The tools of diagnosis for dry eye complication are in decent association with one another. For follow-up and diagnostic purposes, OSDI questionnaire seems much pragmatic. Keywords: Metabolism, Dry Eye Disease, Hypochromic, Diagnosis, Refractory, Vitiligo

Efficacy and Safety of 1% Progesterone Gel to the Forehead for Ocular Chronic Graft-versus-Host Disease

There is no Food and Drug Administration-approved treatments for ocular chronic graft-versus-host disease (oGVHD) to date, and current therapeutic options are limited. Forehead application of 1% progesterone gel provides corneal antinociception in preclinical models, suggesting it may be useful in alleviating ocular irritations. This study was conducted to evaluate the efficacy and safety of 1% progesterone gel in treating moderate to severe symptomatic oGVHD. Thirty-three patients with oGVHD following allogeneic stem cell transplantation were enrolled in this single-center, sponsor-initiated, prospective exploratory randomized double-masked placebo-controlled phase II clinical trial. The inclusion criteria included a National Institutes of Health consensus score of ≥2, moderate to severe ocular discomfort level, and receipt of a stable immunosuppression regimen. Twenty-one of the 22 patients in the progesterone arm and all 11 patients in the placebo arm completed the course of twice-daily forehead drug application for 10 weeks. The changes from baseline of self-reported ocular symptom scores and physician-recorded cornea fluorescein staining scores were analyzed using mixed-model repeated-measures regression model in an intention-to-treat population. The 33 patients included 12 women and 21 men, with a median age of 66 years (range, 24 to 75 years). At 10 weeks, there was a significant reduction in ocular symptoms from baseline in the progesterone group compared with the placebo group in symptom frequency (-30.7 versus -2.2; P < .001) and severity (-19.8 versus +1.6; P=.005). At 10 weeks, there was also greater reduction of cornea fluorescein staining centrally (-1.2 versus +.1; P=.001) and inferiorly (-1.4 versus -0.2; P=.005). No difference was noted in superior cornea staining. There were no severe adverse events in the progesterone group. Foreheadapplicationof 1% progesterone gelsignificantlyimproved ocular signs and symptoms within 10 weeks. It appears to be a safe and effective new therapy for oGVHD, and a novel mechanism for neuroaxis drug delivery. A multicenter phase III clinical trial is planned for further validation.

Leptin's concentration in tears and dry eye: a clinical observational study.

To investigate the concentration of leptin in tears and its correlation with dry eye symptoms and signs. The study enrolled individuals (n=39) responding to an advertising or dry eye patients (n=58) from the Ophthalmology Department. Tear samples were collected for leptin concentration measuring. Ocular Surface Disease Index (OSDI), tear meniscus height (TMH), tear break up time (TBUT), cornea fluorescein staining, Schirmer test (ST) and impression cytology (IC) were assessed. Leptin concentration in tears of dry eye patients and healthy controls, and its correlation with clinical features of dry eye disease (DED) were analyzed. Age, body mass index (BMI), OSDI scores and cornea fluorescein staining scores showed a negative correlation with leptin concentration in tears (r=-0.340, P=0.001; r=-0.332, P=0.001; r=-0.258, P=0.011; r=-0.424, P<0.001, respectively). ST showed positive correlation with leptin concentration in tears (r=0.206, P=0.045). No significant difference was observed in leptin concentration between dry eye patients and controls (P=0.682). Multivariate linear regression analysis revealed that dry eye, OSDI, corneal fluorescein staining scores and ST correlated with leptin concentration in tears. This is the first study measuring leptin concentration in tears. The correlation between leptin concentration and DED symptoms and signs reveal that leptin level correlated with the dry eye, potentially contributing to repair of ocular damage and dry eye improvement.

A study of ocular surface disease in patients using topical antiglaucoma medication at a tertiary care centre

Aim: To study the ocular surface disease in patients being treated with topical antiglaucoma medication. And also study the relationship between the OSD and topical antiglaucoma medication. Methodology: It was a A prospective study, carried out during the year from November 2019 to October 2020 Patients of age group 30 - 50 years who are diagnosed with glaucoma and started on topical antiglaucoma medication at glaucoma unit in Sarojini Devi eye Hospital, Hyderabad. Before starting topical antiglaucoma medication Patient is evaluated by measuring tear film break-up time, fluorescein staining of cornea, schirmer test and impression cytology. After starting topical antiglaucoma medication, the patient is evaluated again at 1 month, 3 months, 6 months and 1 year for any ocular surface changes or at any time if the patient develops symptoms of OSD. Results: A total of 100 patients with glaucoma were included in the study, among them 56% were males and 44% were females. Mean age of the patients is 43.8 years, ranging from 37 to 50 years. Of the 100 patients, 21patients had primary open angle glaucoma, 60 patients had primary angle closure glaucoma, 19 patients had combined mechanism glaucoma. TBUT was significantly reduced in 60% patients, Schirmer’s test showed that 84% patients had reduced tear production and 28% patients showed positive fluorescein staining. The prevalence of OSD among users of preserved topical antiglaucoma medications was significantly higher than among nonusers as assessed by FTBUT (83.5% vs. 57.3%; P

Some questions about the state of the eye surface in patients before cataract surgery

Introduction. Ocular surface status is a main risk factor for the development of postoperative complications and lead to the decrease of life quality.&#x0D; Purpose of the study.The condition of the surface of the eye in patients before cataract surgery was study.&#x0D; Material and methods. 320 patients preoperative the cataract surgery were investigated, among them 172 patients were female, 148 – were male. Patients with any previous ocular surgery or concomitant ocular diseases were excluded. The structure of common non-ocular comorbidities, subjective signs of ocular surface damage (redness, foreign body sensation, dryness, burning) and objective symptoms (tear break up time, cornea fluorescein staining) were carried out. Patients with asymptomatic forms of cornea staining were identified.&#x0D; Results. It was found that 100 patients (31,2%) had subjective signs (specific complains) of ocular surface damage and 135 patients (35,5%) had positive corneal staining. Specific complains and obvious ocular surface damage were revealed in 17,7% and latent ocular surface damage – in 16,9% of patients. Thus 49% of patients had asymptomatic form of ocular surface damage. In the group of patients with diabetes mellitus healthy ocular surface was observed only in 35,6% cases, asymptomatic form of ocular surface damage consisted 72,9% and obvious damage – 16,9% among all patients.&#x0D; Conclusion. Ocular surface dysfunction is common among patients before cataract surgery, especially in diabetes mellitus. Clinicians should be aware of this high prevalence and consider ocular surface screening before cataract surgery.

A Novel Transdermal Treatment of Chronic Ocular Graft-Vs-Host Disease (oGvHD): A Phase II Clinic Trial

Chronic GvHD affects about 30-60% of patients after allogeneic hematopoietic cell transplant (allo-HCT), and a majority exhibit ocular manifestations with significant impact on quality of life. In severe cases, oGvHD can lead to permanent vision loss. There is no FDA-approved treatment to date as the current options are limited and mostly ineffective. Forehead application of 1% progesterone gel (Pro-ocular^TM) increases resistance to painful corneal stimuli in animal studies, as well as improves tear film in human volunteer studies. While the precise mechanism of action is unclear, a cranial nerve V1 mediated neuro-pathway has been implicated. We conducted a prospective, randomized, placebo-controlled, double-masked phase II clinical trial of adult patients with chronic oGvHD who underwent allo-HCT at Dana-Farber/Brigham and Women's Hospital sponsored by Glia LLC. All subjects had moderate to severe eye symptoms, were free of other major ocular comorbidities, and remained on previous ocular treatments and systemic immune suppression through the trial. Subjects were randomized in a 2:1 treatment to placebo fashion. The trial drug or placebo was self-applied to the forehead in the home settings twice a day for a total of 10 weeks. All subjects kept daily diaries to document their medication use and symptoms, and were evaluated in the clinic at baseline, 2 weeks, 6 weeks and 10 weeks. The endpoints of the study were patient reported ocular symptoms and physician recorded ocular signs such as ocular surface staining and tear film. Safety assessments included blood tests of hematology, chemistry and endocrine panels. A total of 33 patients were enrolled. 21 out of 22 patients in the active arm and all 11 patients in the placebo arm completed the trial. Only 1 was lost to follow-up. Treatment was well tolerated and compliance was high. There was no severe adverse event in the active arm. There was a significant reduction of inferior (-1.38 vs -0.19, p=0.0055) and central cornea (-1.18 vs -0.10, p=0.0010) fluorescein staining in the active arm compared to placebo at 10 weeks (Figure 1). No difference was noted in superior cornea staining. The Symptom Assessment Questionnaire iN Dry Eye (SANDE) quantifies ocular symptoms on a visual analog scale filled by the patients. Strikingly, the reduction of global score (-25.87 vs +1.04, p = 0.0006), symptom frequency (-30.72 vs -2.18, p = 0.0002) and severity (-19.82 vs +1.64, p=0.0048) were all significantly superior in the active arm at 10 weeks (Figure 2). Other endpoints are currently under analysis. All subjects in the placebo arm have chosen to receive active treatment in the ongoing open label study. In conclusion, forehead application of 1% progesterone gel significantly improved ocular symptoms and signs in just 10 weeks. It appears to be a safe and effective novel treatment for chronic oGvHD. A larger randomized phase III trial to confirm the results is warranted.

Impact of Unilateral Orbital Radiotherapy on the Structure and Function of Bilateral Human Meibomian Gland.

Background Radiotherapy (RT) has widely been used to treat ocular tumors, yet the impact of orbital radiation to the meibomian gland has rarely been studied. Our study aims at evaluating the bilateral meibomian gland structure and function 12 months after unilateral orbital RT in patients with ocular tumors. Methods An observational case-control study. A total of 10 eyes 12 months after unilateral orbital RT, 10 contralateral eyes, and 10 normal controls were enrolled. Meibomian gland loss (MGL), lipid layer thickness (LLT), tear film breakup time (TBUT), Schirmer I test, and cornea fluorescein staining were measured. Ocular Surface Disease Index (OSDI) of the RT patients was assessed and compared with normal controls. Results The cumulative median radiotherapy dosage for the patients was 45 (range: 30, 70) Gy. The OSDI score of the patients was significantly greater than the normal controls (22.92 (range: 10.42, 37.50) vs 6.25 (range: 2.08, 10.42), p ≤ 0.001). Significant differences of upper MGL, lower MGL, LLT, and TBUT were found between the diseased eyes and normal controls (37.79% (range: 12.87, 92.41) vs 12.63% (range: 6.13, 42.34), p=0.007; 61.31% (range: 44.67, 87.98) vs 15.53% (range: 7.65, 45.13), p ≤ 0.001; 40 ICU (range: 23, 100) vs 81.5 ICU (range: 54, 100), p=0.007; 3.5 s (range: 2, 8) vs 6.5 s (range: 5, 10), p=0.002). The upper MGL and TBUT of the contralateral eyes were also considerably damaged compared with normal controls. Lower eyelid MGL and cornea staining score of the diseased eye were significantly correlated with radiation dosage (r = 0.913 and 0.680; p=0.001 and 0.044, respectively). Conclusion Orbital radiotherapy could cause significant damage to the meibomian gland structure and function, not only the diseased eyes but also the contralateral eyes.

Intense Pulsed Light Applied Directly on Eyelids Combined with Meibomian Gland Expression to Treat Meibomian Gland Dysfunction.

To determine the efficacy and safety of intense pulsed light (IPL) applied directly on the eyelids and meibomian gland expression (MGX) in treating meibomian gland dysfunction (MGD). IPL application on the periocular skin effectively improves meibomian gland secretion and tear film break-up time (TBUT) in patients with MGD/dry eye. This prospective, randomized, double-masked, controlled study involved 44 patients. One eye was randomly selected for IPL treatment; the other served as a control. Study eyes received three IPL treatments at 4-week intervals; IPL was applied directly on the eyelids, and the eye was protected with a Jaeger lid plate. Control eyes received sham IPL treatments. Both eyes received MGX and artificial tears. Meibomian gland yielding secretion score (MGYSS), TBUT, Standard Patient Evaluation of Eye Dryness (SPEED), cornea fluorescein staining (CFS), meibography, best corrected visual acuity (BCVA), intraocular pressure (IOP), and fundus examination were performed. Compared to the baseline, MGYSS, TBUT, and SPEED and CFS scores improved in the study eyes, while only SPEED and CFS scores improved in the control eyes (p < 0.001 for all). Changes in MGYSS and TBUT were higher in the study eyes than in the control eyes (p < 0.05), but changes in SPEED and CFS scores were similar (p > 0.05). BCVA and IOP improved in both the study and control eyes (p < 0.05). Five patients experienced mild pain and burning during IPL treatment. One patient suffered partial eyelash loss. IPL combined with MGX safely and effectively treated MGD.

Evaluation of short-term effect of intense pulsed light combined with meibomian gland expression in the treatment of meibomian gland dysfunction

Objective: To explore short-term effect of intense pulsed light (IPL) combined with meibomian gland expression in treating meibomian gland dysfunction (MGD). Methods: This study was a prospective, randomized, double-masked, controlled study. Forty-four MGD patients were enrolled in the study and received three consecutive IPL treatments with an interval of 4 weeks. One eye of each patient was randomly assigned as the study eye receiving the IPL therapy with an energy of 14-16 J/cm(2), and the fellow eye was as the control eye receiving a placebo therapy with 0 J/cm(2). Meibomian gland expression was immediately performed after the IPL treatment in both eyes. Efficacy was evaluated through assessment of the meibomian gland yielding secretion score (MGYSS) , SPEED questionnaire, tear film break-up time (TBUT), cornea fluorescein staining and infrared meibography. Safety was evaluated through best spectacle corrected visual acuity, intraocular pressure, slit lamp examination and fundus examination. These examinations were performed before and after each treatment. Results: Significant improvements were observed in the MGYSS and TBUT after IPL treatments (P<0.05). The improvements compared to the baseline of MGYSS at the upper eyelid in the treatment eyes were significantly higher than those in the control eyes after the first treatment (Z=-2.036, P=0.003). The improvements compared to baseline of MGYSS at the lower eyelid and the TBUT in the treatment eyes were significantly higher than those in the control eyes after the second treatment (Z=-2.999 and -2.036, respectively P=0.007 and 0.042, respectively). SPEED and cornea fluorescein staining were decreased in both eyes after IPL treatments, but there was no statistical difference between the two eyes. No obvious complication was observed in the study. Conclusions: IPL treatment combined with meibomian gland expression is an efficient and safe therapy, and can increase meibomian gland yielding secretion, increase the TBUT, relieve the symptoms and repair the corneal epithelium defects for MGD eyes. (Chin J Ophthalmol, 2017, 53: 675-681).

Early central and peripheral corneal microstructural changes in type 2 diabetes mellitus patients identified using in vivo confocal microscopy: A case-control study.

The aim of this study was to find early central and peripheral corneal microstructural changes in healthy subjects and type 2 diabetes mellitus (T2DM) patients with/without cornea fluorescein dot staining.This is a prospective case-control study of T2DM patients with/without cornea fluorescein dot staining. Age, sex, duration of diabetes, and serum glycosylated hemoglobin A1c (HbA1c) levels were recorded. Keratograph 5 M (K5 M) and in vivo confocal microscopy were performed on all subjects. The cornea was divided into 5 zones: central, superior, temporal, nasal, and inferior. Basal epithelial cell (BEC) density, the area of BEC, sub-basal nerve plexus (SBN) density, Langerhans cell (LC), and endothelial cell (EC) density were quantitatively analyzed.This study included a total of 87 individuals (28 males and 59 females; mean age, 62.30 ± 9.93 years) with T2DM, without (n = 48; T2DM group 1) and with (n = 39; T2DM group 2) cornea fluorescein staining, as well as 51 age- and sex-matched healthy subjects (18 males and 33 females; mean age, 61.53 ± 10.15 years). Ocular Surface Disease Index scores, Schirmer Ι test, tear meniscus height, the first breakup of tear film occurrence (NIKBUT-first), and the average time of all breakup incidents (NIKBUT-average) values were significantly lower for the T2DM groups than for the healthy group. The corneal sensations of all cornea positions in the T2DM groups were significantly different from the control group. The HbA1c in the T2DM groups showed a negative correlation with central BEC density (R = 0.348, P = .015; R = 0.91, P = .001); there was no correlation of HbA1c with BEC density in the control group. The BEC density, the area of BEC, SBN, and LC density of T2DM group 1 and T2DM group 2 were significantly different compared with the control group in all corneal positions (P < .001). The BEC density of T2DM group 2 was significantly different from T2DM group 1 in the central (P = .044) and inferior (P = .013) zones. The area of BEC in T2DM group 2 was significantly different from T2DM group 1 in inferior zone (P = .014) and other corneal positions showed was no significant difference (P > .05). The SBN density of T2DM group 2 was not significantly different from T2DM group 1 in all corneal positions (P > .05). The LC density of T2DM group 2 was significantly different from T2DM group 1 in the central (P = .006) and inferior (P = .006) zones. Although the LC density in the T2DM groups showed no significant difference in all corneal zones (P > .05), the LC density in the central zone was significantly lower compared with the peripheral zone in the control group (P = .001). The central ECs in the 3 groups were not significantly different (P > .05).LC induced an immune-mediated contribution to corneal nerve damage and may influence the early stages of BEC proliferation and differentiation in T2DM. BEC density was the reliable index for evaluating the early condition of diabetic corneal epitheliopathy. The BEC density of the central and inferior corneal zones was more sensitive.

Efficacy of two kinds of eye drops in stabilizing tear film and relieving dry eye after cataract surgery

Objective To compare the efficacy of recombinant bovine basic fibroblast growth factor (rb-bFGF) eye drops and hypromellose 2910 dextran 70 and glycerol eye drops in maintaining the tear film stability and relieving dry eye symptoms after age-related cataract surgery. Methods The data of 131 eyes of 100 patients with age-related cataract were selected, and they were divided randomly into the rb-bFGF group, 64 eyes of 50 cases; and the hydroxyl indican group, 67 eyes of 50 cases. All patients underwent phacoemulsification combined with intraocular lens implantation. After surgery, rb-bFGF group were treated with rb-bFGF eye drops and the hydroxyl indican group were treated with hydroxyl indican eye drops. All patients were followed up for 3 months, and efficacy were compared between the two groups. Results The schirmer I test (SIT) in rb-bFGF group 3 months after surgery was (14.47±4.69)mm and the break-up time (BUT) was(13.96±2.84)s, in hydroxyl indican group was (12.03±4.76) mm and (12.35±3.27) s. The difference were significant between the two groups (P=0.004, 0.003). The scores of cornea fluorescein staining (CFS) and dry eye symptoms in rb-bFGF group were significantly lower than those in hydroxyl indican group(P=0.011, 0.000). Conclusion Both rb-bFGF eye drops and hydroxyl indican eye drops can prolong BUT, improve tear film stability, relieve dry eye symptoms, and promote the repair and regeneration of corneal epithelial cells after age-related cataract surgery. Rb-bFGF eye drops have better effects. Key words: Cataract, age-related; Phacoemulsification; Lens, intraocular; Eye drops, recombinant bovine basic fibroblast growth factor (rb-bFGF), hypromellose 2910, dextran 70 and glycerol

Analysis of Th17-associated cytokines and clinical correlations in patients with dry eye disease.

We aimed to investigate the expressions of three Th17-associated cytokines, interleukin (IL)-17A, IL-6 and IL-23, in protein and mRNA levels and their correlations with ocular surface parameters in patients with dry eye disease (DED) through a small sample size case control study. A total of 45 female subjects were divided into Sjögren’s syndrome (SS) DED group, non-Sjögren’s syndrome (non-SS) DED group and control group. Ocular surface disease index (OSDI) was self-answered and clinical tests including tear-film breakup time (BUT), Schirmer I test, cornea fluorescein staining (CFS) were performed. The conjunctival mRNA expressions of these cytokines were investigated by real-time polymerase chain reaction (PCR) and the levels of protein in tears were measured by mutiplex bead analysis. The correlations between cytokines and ocular surface parameters were analyzed. Results show that the expressions of IL-17A and IL-6 in protein and mRNA levels were both significantly increased in the DED group (P<0.05), and also higher in SS group comparing to the non-SS group (P<0.05). Moreover, IL-17A and IL-6 correlated well with ocular surface parameters (all P<0.05, R values range from 0.5–0.8). Despite the expression of IL-23 was significantly increased in the DED group (P<0.05), there was no significant difference found between the expressions of IL-23 in SS group and non-SS group (P>0.05) and no correlation found between the IL-23 and any ocular surface parameter (P>0.05). These findings indicates that the three Th17-associated cytokines, IL-17A, IL-6 and IL-23, play roles in the pathogenesis of DED and the expressions of IL-17A and IL-6 in tears have potential to be diagnostic biomarkers for DED.

Prevalence and treatment effects of Demodex species in eyelash follicles in patients with meibomian gland dysfunction

Objective: To investigate the prevalence and treatment effects of Demodex species in eyelash follicles in patients with meibomian gland dysfunction (MGD). Methods: The MGD patients (MGD group) and normal subjects (control group) were collected from the Ophthalmology Clinic in PUMCH from July 2015 to December 2015. The symptom score of MGD patients was recorded. Eyelash sampling, Demodex counting, tear film break-up time (BUT), cornea fluorescein staining (Fl) and Schirmer test Ia (S Ⅰ aT) were measured for both groups. All the measurements were repeated after 4 weeks of meibomian function treatment for the MGD group. Symptom score, BUT, Fl and S ⅠaT were normally distributed and displayed as mean± standard deviation. Demodex counting was not normally distributed and displayed as median (interquartile range P25, P75). Results: Forty-four MGD patients (88 eyes) and 48 controls (96 eyes) were recruited. For the MGD and control groups, the number of Demodex was 3.5 (2, 7) and 0 (0, 7), respectively (Z =-4.912,P= 0.000). The percentage of Demodex infestation was 86.4% and 39.6%, respectively (χ(2)=35.957, P=0.000). The BUT was (3.57±2.09) s and (10.17±3.25) s, respectively (t=-5.154, P=0.000). The Fl was 2.73±1.23 and 0.85± 0.33, respectively (t=4.583, P=0.000). The SⅠaT was (8.75±5.61) s and (14.51±5.29) s, respectively (t=-2.278, P=0.028). The symptom score of the MGD group before and after treatment was 4.77 ± 3.01 and 2.79 ± 2.01, respectively (t=6.224, P=0.000). The BUT, Fl and number of Demodex of the MGD group after the treatment were (5.43±2.37)s, (1.91±0.66) and 2 (0, 3), respectively, and all had significant difference with the data before the treatment (BUT, t=-4.705, P=0.000. Fl, t =3.902, P =0.000. number of Demodex, Z=-4.623, P =0.000). The S Ⅰ aT of the MGD group after the treatment was 8.86 ± 6.76, with no significant difference with the data before the treatment (t=-0.277, P=0.833). Conclusions: The Demodex infestation has some effects on the pathogenesis of MGD. The treatment of MGD may help to decrease the number of Demodex and thus relieve the ocular discomfort.(Chin J Ophthalmol, 2017, 53:193-197).

Effect of herbal fumigation combined with artificial tears in treatment of patients with evaporative dry eye

Objective To explore effect of herbal fumigation combined with artificial tears in treatment of evaporative dry eye. Methods A total of 168 patients with evaporative dry eye were included, and they were randomly divided into the observation group and control group with 84 in each. The patients in control group were given artificial tears, and the patients in observation group were given herbal fumigation combined with artificial tears. Clinical effect, symptom scores, SIt, break-up time (BUT), cornea fluorescein staining (CFT) of two groups were observed and compared. Results The total effect of observation group (82.14% vs. 61.90%, χ2=8.537, P=0.003) were significantly better than this of the control group. The symptoms scores of eye dryness, foreign body sensation and visual fatigue in the observation group (0.70 ± 0.20 vs. 1.50 ± 0.50, t=13.615, P<0.01; 0.60 ± 0.30 vs. 1.30 ± 0.50, t=11.003, P<0.01; 0.80 ± 0.20 vs.1.50 ± 0.60, t=10.144, P<0.01) were better than those in the control group. The SIt, BUT and CFT in the observation group (6.20 ± 3.30 mm/5 min vs. 4.70 ± 1.50 mm/5 min, t=3.793, P<0.01; 9.50 ± 2.70 s vs. 7.40 ± 2.80 s, t=4.948, P<0.01; 0.70 ± 0.20 vs.1.40 ± 0.30, t=10.144, P<0.01) were significantly higher than those in the control group. Conclusions The herbal fumigation combined with artificial tears showed the good effect on the evaporative dry eye. Key words: Dry eye syndrome; Herbal fumigation; Artificial tears

Dry Eye Changes after Phacoemulsification and Manual Small Incision Cataract Surgery (MSICS)

Purpose: Evaluation of tear film stability and tear secretion after phacoemulsification and manual small incision cataract surgery (MSICS). Design: Prospective comparative randomized clinical study. Subject and methods: 40 Patients included in this study divided into, Group A: 20 eyes with phacoemulsification. Group B: 20 eyes with MSICS. All patients had full ophthalmic examination including Tear film break-up time (TF-BUT), schirmer test, corneal fluorescein staining and dry eye symptoms recorded pre- and post- operatively. All patients were done by the same surgeon randomly selected standard coaxial phacoemulsification or MSICS. Results: The mean age in group A 55.8 ± 15.8 while, 60.65 ± 9.2 in group B. Most of patients in group B were females (90%) versus 45% in group A with statistically significant difference (p-value < 0.05). Grade of dry eye symptoms (DES) has significantly increased 1 week after each procedure and remained increased after 4 weeks of surgery. After 3 months, the grade of DES has decreased again and returned to near baseline data. There was no statistically significant difference between both groups regarding TF-BUT, Cornea fluorescein staining, and Schirmer test. Conclusion: The present study has shown that MSICS is as effective as phacoemulsification with no difference between both techniques as regarding effect on tear film stability and tear secretion.