Ocular Changes Research Articles

Posterior ocular structural changes and glaucoma susceptibility in patients with hemifacial spasm.

To evaluatethe changes in the posterior ocular structures and glaucoma susceptibility in patients with hemifacial spasm (HFS). Prospective observational clinical study. This study included 46 long-standing HFS patients with a minimum follow-up of 12months. The participants' eyes were divided into three groups: (1) 46 affected eyes of patients with clinical HFS; (2) 46 unaffected fellow eyes and, (3) 46 eyes of healthy sex and age-matched controls. All participants were assessed by a detailed clinical examination and optical coherence tomography (OCT) with enhanced depth imaging (EDI). EDI-OCT images were binarized using ImageJ software. Peripapillary retinal nerve fiber layer (RNFL), ganglion cell complex (GCC), choroidal thickness (CT), and choroidal vascularity index (CVI) were used to compare the structural characteristics of the affected eyes with fellow and control eyes. The CT measurements were performed from the subfoveal and locations at 750μm and 3000μm intervals from the foveal center, and the average of CT measurements at 5 locations was accepted as mean CT. The demographic and clinical characteristics among the groups were similar (for all, P > 0.05). Mean peripapillary RNFL thickness of the inferior quarter was significantly lower in affected eyes, compared to fellow eyes (P = 0.023) and control eyes (P = 0.040). Mean GCC thickness significantly decreased in affected eyes, compared to fellow eyes (P = 0.019) and healthy controls (P = 0.008). Mean CT thickness significantly decreased in affected eyes, compared to fellow eyes (P = 0.002) and healthy controls (P < 0.001). Mean subfoveal CVI (65.94% ± 1.46) was found to be significantly thinner than the unaffected fellow (68.19% ± 1.84, P = 0.011) eyes and control eyes (67.23% ± 0.84, P = 0.044). This study's outcomes show that long-standing HFS is associated with glaucoma-associated morphological OCT findings and decreased both CT and subfoveal choroidal vascularity. These findings may be related to the fact that the posterior ocular structures are affected by long-lasting paroxysmal orbicularis contractions.

Effects of Glaucoma Medication on Dry Eye Syndrome and Quality of Life in Patients with Glaucoma.

PurposeTo investigate ocular surface diseases and changes in the quality of life of patients using glaucoma medications.MethodsParticipants were divided into the normal (31 individuals, 62 eyes) and glaucoma medication (30 patients, 60 eyes) groups. Changes in tear break-up time, lipid layer thickness (LLT), corneal and conjunctival staining scores, ocular surface disease index (OSDI), and Visual Function Questionnaire 25 (VFQ-25) score were assessed for 1 year.ResultsThe change in mean LLT was lower in glaucomatous eyes than in control eyes (p = 0.019) after 1 year. The results of OSDI deteriorated (p’ = 0.008), but conjunctival staining and Schirmer test results showed improvement in glaucomatous eyes compared to those in control eyes (p’ =0.035 and 0.009, respectively). The average LLT decreased at 6 and 12 months, but there was no change at 24 months. In pairwise analysis, the decrease in LLT over the first 6 months was statistically significant (p < 0.001) and remained unchanged until 24 months. Among the VFQ items, scores for near activity and social function deteriorated over 1 year in the medication group (p’ = 0.033 and 0.015, respectively). However, there was no difference in the total VFQ score.ConclusionsSignificant reduction in LLT and deterioration of OSDI were observed in the medication group compared to the control group. However, this deterioration was observed only in the first 6 months. There was no significant difference in the VFQ total score. Nonetheless, there were significant differences in near activity and social function between the control and medication groups. Therefore, the results of this study showed that although glaucoma medication worsened eye dryness, the change was limited and did not worsen the quality of life. Glaucoma medication should be used with the consideration that they can limit near activity and social functioning.

Minimal detectable change of the disc‐fovea angle for ocular torsion assessment

AbstractPurposeThe disc‐fovea angle (DFA) is used as a relevant indicator of ocular torsion change in cyclovertical strabismus. However, interpretation of the variation in time must differentiate whether a real change has occurred or if the disparity is due to random measurement error. The aim of the study was to obtain the minimal detectable change (MDC) of the DFA. It represents the minimal variation between two measurements that may be considered a real ocular torsion change.MethodsA prospective cross‐sectional study was conducted in San Carlos Clinical Hospital of Madrid, Spain. Sixty healthy right eyes from 60 patients (31 men and 29 women) were recruited. Three digital fundus photographs were obtained, and between measurements, the patient moved their head away from the head support and then returned. Two observers quantified the DFA with software designed with MATLAB. Test‐retest and interrater reliability were calculated.ResultsMean participant age was 56.1 years (SD 16.6, range 25–85). Mean DFA was 8.1° (SD 3.5, range 1.3–18.5). Test‐retest reliability for Observer 1 (Ob1), Observer 2 (Ob2) and interrater reliability were excellent (ICC 0.80, 0.83 and 0.95, respectively). Precision was 2.9° (Ob1) and 3.0° (Ob2), and the MDC95 was 4.1° (Ob1) and 4.2° (Ob2). Bland‐Altman analysis revealed an absence of bias and a homoscedastic distribution of the differences.ConclusionsThe MDC of the DFA in fundus photography was 4°, which represents the minimal change that may be considered a real change in ocular torsion. This result may improve the interpretation of ocular torsion changes in surgery and clinical scenarios.

Posterior ocular structural and vascular alterations in severe COVID-19 patients.

PurposeThis study aimed to evaluate posterior ocular structural and vascular changes in severe coronavirus disease 2019 (COVID-19) patients.MethodsThis was an observational, prospective, and controlled study including 106 eyes of 53 severe COVID-19 patients, compared to after recovery and 106 eyes of 53 age- and gender-matched healthy controls. All subjects were previously healthy adults and were assessed using spectral domain optical coherence tomography (SD-OCT) and ImageJ software. Subfoveal over a 1500-μm span and macular over a 6000-μm span cross-sectional areas of the vascular, stromal, and total choroid were measured.ResultsOf the 53 included patients, 28 (52.8%) were male, and 25 (47.2%) were female, with a mean age of 50.2 ± 7.4 years. In the active period of the disease, compared to after recovery and healthy controls, the outer plexiform layer thickness showed a significant increase (p = 0.004), and mean choroidal thickness was significantly higher (p < 0.0001); however, choroidal vascularity was significantly lower (p < 0.0001). The stromal area to vascular area (S/V) ratio of the choroid was significantly increased (p < 0.0001). All quadrants of the peripapillary retinal nerve fiber layer (RNFL) thicknesses were significantly increased (for all, p < 0.05). The reflectivity of OCT echo of the choroid and peripapillary RNFL was significantly higher (p = 0.023, p < 0.0001, respectively).ConclusionThis study detected significant posterior ocular structural and vascular alterations in patients with severe COVID-19 infections. These findings may be associated with direct host-virus interaction or linked to an autoimmune process, vasculopathy, or viral-mediated inflammation.

Corneal in vivo confocal microscopy to detect belantamab mafodotin-induced ocular toxicity early and adjust the dose accordingly: a case report

BackgroundNew targeted antibody–drug conjugates (ADCs) against multiple myeloma are known to induce adverse effects that may lead to treatment discontinuation. Preclinical studies reported early severe ocular damage related to the use of belantamab mafodotin (belamaf), including ocular surface inflammation, severe dry eye, and a specific toxicity to the cornea, namely microcystic keratopathy. While belamaf-induced ocular changes have not been prospectively studied, a better understanding of mechanisms involved as well as kinetics may aid in anticipating dose adjustment rather than stopping the treatment once clinical ocular damage is too severe.Case presentationA 61-year-old woman scheduled for belamaf as a fifth-line treatment against multiple myeloma was prospectively included. Clinical examinations were performed before and every 3 weeks afterward, together with in vivo confocal microscopy (IVCM) of the cornea. Visual acuity, symptoms, slit-lamp examination, and ultrastructural changes of the cornea were recorded according to the received dose of belamaf. More precisely, kinetics, shape, density, and location of the toxic corneal lesions have been followed and analyzed using IVCM. Also, specific lesions at the sub-basal nerve plexus layer were detected and characterized for the first time. This advanced approach allowed a better understanding of the belamaf-induced toxicity, further balancing the dose to maintain good vision and eye health while continuing the treatment.ConclusionsSystematic ultrastructural analysis and follow-up of the corneal state during ADCs treatment for multiple myeloma may open new avenues in the therapeutic approach. Early preclinical detection of ocular damage may accurately contribute to finding the correct dose for each patient and not stopping the treatment due to severe ocular adverse effects.

A study to evaluate ocular changes in patients undergoing spine surgery in the prone position.

Background and Aims:AA present prospective study was conducted to evaluate ocular changes occurring in patients undergoing spine surgery in the prone position.Material and Methods:A total of 44 patients of either sex, belonging to American society of Anaesthesiology I and II (aged 18-60 years) scheduled for elective spine surgery in prone position were enrolled in the study. Baseline IOP and MAP measurement were taken prior to induction. After induction of anaesthesia patients were intubated using flexo-metallic tube of appropriate size. IOP and MAP were recorded after induction of anaesthesia, following completion of surgery and immediately after turning the patient supine and 30 min following extubation. Blood loss and duration of surgery was also noted. The OPP was derived using the formula (OPP = MAP-IOP). Ophthalmic examination was also performed using direct and indirect ophthalmoscopy on the day prior to surgery and on first post-operative day to rule out anterior ischemic optic neuropathy (AION), posterior ischemic optic neuropathy (PION), and retinal ischemia.Results:Mean IOP significantly increased (18.91 ± 3.56 mm Hg) (P < 0.001) at the end of surgery as compared to baseline value 12.85 ± 3.07 mm Hg. As a result mean OPP significantly reduced (75.12 ± 16.45) (P = 0.0018) at the end of the procedure.Conclusion:In patient’s undergoing spine surgery in the prone position, careful patient positioning with no extrinsic pressure on the eyes, minimal surgical time and blood loss, and prevention of intraoperative hypotension, should be ensured to prevent the IOP rise and a reduction in OPP which can further prevent post-operative visual disturbance.

Long-Term Visual and Refractive Stability and Ocular Biometric Changes after Laser-Assisted Subepithelial Keratomileusis for Correction of Myopia: An 8-Year Follow-Up.

Purpose:To assess the long-term visual and refractive stability and ocular biometric changes in low to moderate myopic subjects treated by laser-assisted subepithelial keratomileusis (LASEK).Methods:It is a prospective, interventional study. Included were 70 eyes of 35 patients who underwent LASEK for correction of ≤6 diopters (D) myopia. The uncorrected and corrected distance visual acuity (UDVA and CDVA), manifest refractions, and ocular biometric indices (by Lenstar-LS900, Haag-Streit AG, Koeniz, Switzerland) including keratometry, anterior chamber depth (ACD), aqueous depth (AD), axial length (AL), central corneal thickness (CCT), and lens thickness (LT) were assessed preoperatively and after 6 months and 8 years.Results:Mean preoperative spherical equivalent was −3.99 (standard deviation [SD] =1.38) D which improved to 0.02 (SD = 0.27, P < 0.001) D and −0.10 (SD = 0.31, P < 0.001) D at 6 months and 8 years, respectively. The preoperative AL was not different from postoperative measures at 6 months (P = 0.15) and 8 years (P = 0.47). The ACD and AD decreased during 8 years, while LT increased (all P ≤ 0.001). The changes of LT inversely correlated with changes of ACD (rs = −0.67, P = 0.001 at 6 months and rs = −0.87, P < 0.001 at 8 years) and AD (rs = −0.76, P < 0.001 at 6 months and rs = −0.86, P < 0.001 at 8 years). The CCT and keratometry values reduced at 6 months postoperatively (all P < 0.001) and then did not change up to 8 years (0.21 ≤ P ≤ 0.87).Conclusions:The post-LASEK myopic regression is 0.1 D over 8 years. Ocular biometric values like keratometry, CCT, ACD, AD, and LT have been changed for a long period after LASEK in low to moderate myopia except AL.

Intraocular pressure during handgrip exercise: The effect of posture and hypercapnia in young males.

PurposeAs part of our investigations of intraocular pressure (IOP) as a potential contributing factor to the spaceflight‐associated neuro‐ocular syndrome using the 6° head‐down tilt (6°HDT) bed rest experimental model, we compared the effect of rest and isometric exercise in prone and supine 6°HDT positions on IOP with that observed in the seated position.MethodsTen male volunteers (age = 22.5 ± 3.1 yrs) participated in six interventions. All trials comprised a 10‐min rest period, a 3‐min isometric handgrip exercise at 30% of participant's maximum, and a 10‐min recovery period. The trials were conducted under normocapnic (NCAP) or hypercapnic (FICO2 = 0.01; HCAP) conditions, the latter mimicking the ambient conditions on the International Space Station. IOP, systolic and diastolic pressures, and heart rate (HR) were measured during the trials.ResultsIsometric exercise‐induced elevations in HR and mean arterial blood pressure. IOP in the prone 6°HDT position was significantly higher (p < 0.001) compared to IOP in supine 6°HDT position and seated trials at all time points. IOP increased with exercise only in a seated HCAP trial (p = 0.042). No difference was observed between trials in NCAP and HCAP. IOP in the prone 6°HDT position was constantly elevated above 21 mmHg, the lower limit for clinical ocular hypertension.ConclusionsIOP in the prone 6°HDT position was similar to IOP reported in astronauts upon entering microgravity, potentially indicating that prone, rather than supine 6°HDT position might be a more suitable experimental analog for investigating the acute ocular changes that occur in microgravity.

Factors Associated with Ocular Injury in Orbital Fracture Patients: Who Requires Urgent Ophthalmic Evaluation?

Importance: Create validated criteria to identify orbital fracture patients at higher risk for significant ocular injuries. Objective: Determine history and physical examination findings in orbital fracture patients who are associated with ocular injury and warrant urgent assessment by an ophthalmologist. Design, Setting, and Participants: Retrospective chart review of 535 adult orbital fracture patients evaluated at a Level I emergency department between 2014 and 2017, without prior history of orbital fracture, ocular injury, or ocular/orbital surgery. Main Outcomes and Measure: Presence of ocular injury. Results: In total, 195 (36%) patients had an ocular injury. Those with and without ocular injury were compared in a multivariate logistic regression model including demographics, fracture characteristics, injury mechanism, and physical examination findings. Visual acuity change, radiographic retrobulbar hemorrhage, abnormal pupillary reaction, and inability to open the injured eye all had significant associations with ocular injury when other findings were controlled. Conclusion: This study shows a significant association between ocular injury and visual acuity change, retrobulbar hemorrhage, abnormal pupillary reaction, and inability to open the injured eye. These factors can help triage when to obtain an urgent ophthalmology consult.

Integrating Clinical Data and Tear Proteomics to Assess Efficacy, Ocular Surface Status, and Biomarker Response After Orthokeratology Lens Wear.

PurposeThis study evaluated the efficacy and ocular surface status of Breath-O Correct, novel orthokeratology (OK) lenses, worn overnight for 3 months. Lens-induced changes in the tear proteome were evaluated.MethodsThirty-one subjects, aged 19 to 26 years with refractive error from −1.00 to −5.00 D, were randomly assigned 1:1 to the treatment or control group. Refraction, visual acuity, corneal integrity, biomechanics and endothelial health, ocular surface changes, and subjective symptoms were assessed at the baseline, one-month, and three-month visits. The tear proteome was characterized over time using sequential window acquisition of all theoretical ion spectra mass spectrometry.ResultsLenses improved uncorrected visual acuity and reduced spherical powers with similar efficacy to other OK lenses. Significant reductions (P < 0.05) in corneal hysteresis (11.12 ± 1.12 to 10.38 ± 1.36 mm Hg) and corneal resistance factor (11.06 ± 1.32 to 9.90 ± 1.45 mm Hg) were observed in the treatment group after one month of lens wear, whereas other assessed factors remained unchanged. Thirteen and eight differentially expressed proteins were found after one month and three months of lens wear, respectively. Two proteins (proline-rich protein 27 and immunoglobulin V regions) were differentially expressed at both visits.ConclusionsOver a three-month period, Breath-O Correct lenses were overall safe, well tolerated, efficacious in refractive power reduction, and comparable with other OK lenses. Furthermore, their use caused only minor noninflammatory protein expression changes in the tear proteome.Translational RelevanceThis study investigated the safety of orthokeratology contact lenses on the ocular surface in molecular aspects and standard clinical parameters.

OCULAR CHANGES IN PATIENTS ON LONG TREATMENT WITH HYDROXYCHLOROQUINE

Introduction: To study the ocular changes in patients on long term treatment with Hydroxychloroquine (HCQ); and detect means for early detection of toxicity.Methods: We conducted a cross-sectional observational study at a tertiary care hospital, in which 100 patients, male and female, aged 35 years or more, taking HCQ for 5 years or more were included. Patients with any known ocular or systemic diseases were not included. Indication, dosage, duration and cumulative dose of HCQ intake were recorded. History of ocular symptoms, visual acuity, colour vision, complete ophthalmic examination, visual field using Amsler grid and 10-2 Humphrey’s automated fields (HVF), Spectral Domain Optical Coherence Tomography (SD-OCT), colour fundus photography, fundus fluorescein angiography (FFA) and fundus autofluorescence (FAF) were recorded. The data was analyzed using descriptive and inferential analysis.Result: 15% of the study population showed signs of HCQ related ocular toxicity. 17%, 21% and 10% patients had abnormal SD-OCT, HVF and FAF findings respectively.Conclusion: HCQ related ocular toxicity has been found in patients in the absence of symptoms. Objective tests like HVF, SD- OCT and FAF were more useful in early detection of toxicity than subjective tests such as Amsler grid, colour vision and FFA.

Role Of Colour Doppler Imaging In Early Diagnosis Of Diabetic Retinopathy

Diabetic retinopathy is the most common cause of vision loss among people with diabetes and a leading cause of blindness among working-age adults in India. It is a form of microangiopathy, and is the most common ocular complication seen in diabetic patients. Diabetic retinopathy progresses from non proliferative to proliferative retinopathy. The non proliferative retinopathy is the milder form and it is reversible. As the progression to proliferative retinopathy happens, the patients are symptomatic and become irreversible. Vascular changes and subsequent ocular hemodynamic changes are critical events in the pathogenesis of diabetic retinopathy. Colour doppler imaging is one of the most widely used and well-established techniques for assessing ocular blood flow velocities in the retro bulbar vessels. This is a non-invasive, painless imaging method with highly reproducibility. Estimation of orbital blood flow velocity from colour doppler imaging of the ophthalmic artery and central retinal artery is a technique offering great potential for the identification of early retinopathy in diabetic patients.

Age-related changes in the rhesus macaque eye

PurposeTo assess age-related changes in the rhesus macaque eye and evaluate them to corresponding human age-related eye disease. MethodsData from eye exams and imaging tests including intraocular pressure (IOP), lens thickness, axial length, and retinal optical coherence tomography (OCT) images were evaluated from 142 individuals and statistically analyzed for age-related changes. Quantitative autofluorescence (qAF) was measured as was the presence of macular lesions as related to age. ResultsAges of the 142 rhesus macaques ranged from 0.7 to 29 years (mean = 16.4 years, stdev = 7.5 years). Anterior segment measurements such as IOP, lens thickness, and axial length were acquired. Advanced retinal imaging in the form of optical coherence tomography and qAF were obtained. Quantitative assessments were made and variations by age groups were analyzed to compare with established age-related changes in human eyes. Quantitative analysis of data revealed age-related increase in intraocular pressure (0.165 mm Hg per increase in year of age), ocular biometry (lens thickness 7.2 μm per increase in year of age; and axial length 52.8 μm per increase in year of age), and presence of macular lesions. Age-related changes in thicknesses of retinal layers on OCT were observed and quantified, showing decreased thickness of the retinal ganglion cell layer and inner nuclear layer, and increased thickness of photoreceptor outer segment and choroidal layers. Age was correlated with increased qAF by 1.021 autofluorescence units per increase in year of age. ConclusionsThe rhesus macaque has age-related ocular changes similar to humans. IOP increases with age while retinal ganglion cell layer thickness decreases. Macular lesions develop in some aged animals. Our findings support the concept that rhesus macaques may be useful for the study of important age-related diseases such as glaucoma, macular diseases, and cone disorders, and for development of therapies for these diseases.

Congenital Cataracts and Microphakia with Retinal Dysplasia and Optic Nerve Hypoplasia in a Calf

Case Description. A two-month-old, female, Aberdeen-Angus calf was presented for congenital cataracts and blindness in both eyes (OU). The dam had a reported history of visual defects (not specified) and had produced other affected calves (per owner history). Ophthalmic examination revealed mature bilateral cataracts, attenuation of the iridic granules, persistent pupillary membranes, and dyscoric pupils. Additionally, the calf had a poor body condition, prognathism, dome-shaped head, excessive nasal drainage, limb contracture, and fever. Histopathology of both eyes revealed lenticular degeneration (congenital cataracts), retinal dysplasia, and optic nerve hypoplasia. BVDV IHC detected antigen within only the left eye (OS), consisting of intrahistiocytic and endothelial immunoreactivity within the ciliary body, iris, and choroid. No BVDV immunoreactivity could be detected in the right eye (OD). This case highlights the unique ocular changes present in in utero BVDV infection of cattle with a different immunohistochemical staining profile than previously described.

Quality of Life in Patients with Chronic Thyroid Eye Disease in the United States.

IntroductionThyroid eye disease (TED) is an autoimmune condition producing ocular pain, dysmotility, and ocular structure and function changes. As disease activity changes, redness, swelling, and pain can improve, but eye comfort, appearance, and motility alterations often persist. There are limited data on chronic TED patient-reported outcomes. This study examined chronic US TED patient-reported symptoms and quality of life (QOL).MethodsExisting data from an online survey regarding chronic TED signs/symptoms and patient QOL were retrospectively examined. The Graves’ Ophthalmopathy QOL instrument (GO-QOL; 0–100, 100 = highest QOL) evaluated overall, appearance, and vision-related QOL. Influencing factors were examined by stratifying patients into low (overall QOL ≤ 50), moderate (> 50 and < 75), and high (≥ 75) QOL categories.ResultsOne hundred patients (47 women, 81 Caucasian, 45.2 ± 7.6 years) were included. The duration of inactive TED was 3.0 ± 4.6 years and total duration of TED was 5.8 ± 5.9 years. Patients reported an average of 20 doctor visits/year and high prevalence of anxiety (34%) and depression (28%). Prior TED treatments for the polled population included systemic corticosteroids during active TED (25%), orbital radiation (5%), and surgery (25%). The overall GO-QOL score was 60.5 ± 21.8 (vision-related: 58.6 ± 24.0, appearance-related: 62.3 ± 25.1). Patients with low QOL more frequently reported hypothyroidism, anxiety, and a larger number of chronic TED signs/symptoms (average: 4.2). Compared to high QOL patients, low QOL patients had more pain (39% vs. 13%), blurry vision (30% vs. 17%), and diplopia (27% vs. 3%, all p ≤ 0.025). Additionally, the low QOL group more often had TED-specific surgical history (45% vs. 10%, p = 0.002), more often reported disability/unemployment (21% vs. 3%, p = 0.055), and had a higher number of doctor visits (40 vs. 5 visits/person/year, p < 0.001).ConclusionTED severely impacts patient QOL, despite becoming stable and chronic. Patients reported vision and appearance impairment and psychosocial impact long after acute TED had subsided.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40123-021-00385-8.

Ocular Parameter Changes in Pediatric Patients with Nephrotic Syndrome

Abstract Background: Nephrotic syndrome has a relapsing nature that necessitates prolonged use of steroids and other immu-nosuppressive drugs. Systemic steroid administration is asso-ciated with multiple ocular side effects. This study was conducted to report various ocular manifestations in pediatric patients with nephrotic syndrome. Aim Study: The aim of our study is to report various ocular manifestations in children with idiopathic nephrotic-syndrome. Patients and Methods: This cross-sectional case control study included 100 cases diagnosed with nephrotic syndrome and 50 healthy controls. All subjects were subjected to detailed history taking, general examination, and laboratory investiga-tions. Also, comprehensive ophthalmological examination (including visual acuity, slit lamp microscopy, intraocular pressure measurement, and fundus examination) were per-formed. Results: Unaided visual acuity was significantly increased in cases compared to controls, and that was evident in both right and left eyes. IOP was significantly elevated in cases compared to controls (p 0.05). Conclusion: There is an increased incidence of ocular complications in pediatric cases with nephrotic syndrome. It is recommended that these cases should have regular ophthal-mological examination for early detection of these compli-cations.

A clinical study on the correlation between demodex infestation and ocular surface changes in patients with meibomian gland dysfunction.

Purpose:To observe the effect of demodex infection on the ocular surface changes of patients with meibomian gland dysfunction (MGD) and analyze the correlation between the number of demodex and the changes of the ocular surface.Methods:Hundred patients with MGD aged 18–70 years who visited the dry eye center of Shanghai Aier Eye Hospital were recruited. All patients were examined with in vivo confocal microscopy to quantify the demodex and divided them into two groups (demodex negative group and demodex positive group) according to the number of demodex mites. The subjects underwent questionnaires of ocular surface disease index (OSDI) and a series of examinations. Parameters including the OSDI score, fluorescein tear film break-up time (FBUT), meibum quality, meibum gland expressibility, meibomian gland dropout (MG dropout), and ocular redness were recorded and compared between the two groups. The correlation between the number of demodex and the ocular surface changes was further analyzed.Results:Among 100 patients, 51 were positive for demodex. The demodex-positive group showed significantly increased scores of OSDI (24.41 ± 3.43 vs 20.98 ± 2.31, P = 0.00), ocular redness score (1.38 ± 0.46 vs 1.00 ± 0.30, P = 0.00), and MG dropout (3.00 ± 1.13 vs 2.18 ± 0.64, P = 0.00) and decreased FBUT (6.40 ± 1.63 vs 6.54 ± 1.83, P = 0.00), compared to the demodex-negative group. A significant correlation was noted between the number of demodex and OSDI, ocular redness, and FBUT.Conclusion:Ocular demodex infestation might play a role in the ocular surface discomfort, inflammation, and meibomian gland dropout in MGD patients. It is necessary to pay attention to the examination and treatment of demodex mite in patients with MGD.

Tear dynamics testing and quantitative proteomics analysis in patients with chronic renal failure

Ocular surface changes may develop in patients with chronic renal failure (CRF) undergoing hemodialysis. In recent years, an association of CRF with dry eye syndrome has been emphasized. However, tear proteomics of CRF patients has not been analyzed. Here, we performed systematic profiling of the tear film proteins in CRF patients through use of isobaric tags for relative and absolute quantitative (iTRAQ) MS/MS, aiming to identify associations between dry eye symptoms and expression of tear proteomic changes in patients with CRF undergoing hemodialysis. Twenty CRF patients and ten healthy subjects underwent a series of ophthalmic examinations. Tear samples from the participants were analyzed by iTRAQ approach. A total of 1139 tear proteins were screened, and 212 differentially expressed proteins were identified. The pattern changes included 77 whose expression levels were upregulated (fold increase >1.2) whereas 135 others that were downregulated (fold decrease <1/1.2). Bioinformatics analysis showed that these proteins were significantly enriched in lipid metabolism, inflammatory, and immune response pathways. Furthermore, APOA1, APOA4, APOB, APOE, S100A8, S100A9, S100A4, HSP90B and other molecules were significantly changed. Our study elucidated the characteristics of tear dynamics and protein markers in CRF patients undergoing hemodialysis.Significance: Despite the association of chronic renal failure (CRF) with dry eye disease, there are no reports describing potentially important differentially expressed tear proteins in CRF patients undergoing hemodialysis. It is still a challenge to obtain a comprehensive description of the pathogenesis of dry eye in CRF patients which hinders establishing a patient specific therapeutic scheme. Our study is the first iTRAQ proteomics analysis of the tears of patients with CRF, which reveals the changes in the protein expression profile in CRF patients afflicted with dry eye disease. The identity was verified of some relevant differentially expressed proteins, and they may be candidate diagnostic markers of dry eye disease in patients with CRF. These tear film protein constituents found in hemodialysis patients can be of important clinical significance in treating this condition. SignificanceDespite the association of chronic renal failure (CRF) with dry eye disease, there are no reports describing potentially important differentially expressed tear proteins in CRF patients undergoing hemodialysis. It is still a challenge to obtain a comprehensive description of the pathogenesis of dry eye in CRF patients which hinders establishing a patient specific therapeutic scheme. Our study is the first iTRAQ proteomics analysis of the tears of patients with CRF, which reveals the changes in the protein expression profile in CRF patients afflicted with dry eye disease. The identity was verified of some relevant differentially expressed proteins, and they may be candidate diagnostic markers of dry eye disease in patients with CRF. These tear film protein constituents found in hemodialysis patients can be of important clinical significance in treating this condition.

PRE-RETINOPATHY OF TYPE 1 DIABETES IN THE CONTEXT OF FUNCTIONAL, STRUCTURAL AND MICROCIRCULATORY CHANGES IN THE MACULAR AREA.

The authors assessed the development of intraocular changes in type 1 diabetes (T1DM) from the onset of the disease leading to diabetic retinopathy (DR). The quote: &#8220;There must be an intermediate stage between the physiological intraocular finding and the diabetic retinopathy itself &#8220;, (prof. Jan Vav&#345;inec). Atwo-year study (2018 and 2019) was conducted at the Department of Ophthalmology of the Teaching Hospital Kralovske Vinohrady in Prague (Czech Republic). There were 54 patients aged 17-42 years, the detection of T1DM ranged between the 1st and 14th year of life, with aduration of 12-35 years. Individual patients were always examined simultaneously by three methods: CS (contrast sensitivity), SD-OCT (spectral domain optical coherence tomography) and OCT-A(optical coherence tomography-angiography). We examined 106 eyes once and in acomprehensive manner. We have shown that there is an intermediate stage between the physiological finding on the retina and DR, so-called diabetic pre-retinopathy (DpR). Subsequent redistribution of the observed into two DpR subgroups was derived from the size of the FAZ, either with its smaller area or with alarger area determining the microvascularity of the central area of the retina. The results of both other methods were assigned to these values. For SD-OCT, the depth of the fovea (the difference between the central retinal thickness and the total average retinal thickness) was determined, which was affected by the increased the macular cubature. In all patients it was on average 10.3 &#956;m3. The retina in the central area was significantly strengthened compared to the healthy population at the level of significance p 0,001. We divided the actual DpR into an image: DpR1 in 26.5% of eyes - condition with an average shallower fovea only by 21.5 &#956;m below the level of the surrounding retina and an average narrower FAZ: 0.165 mm2 and with amore significant decrease in CS; DpR2 in 40.5% of eyes - condition with average deeper fovea by 42 &#956;m, i.e., more significantly and average larger FAZ: 0.325 mm2 with lower decrease of CS. At the same time, other changes in microvascularity were noted, such as disorders in the sense of non-perfusion in the central part of the retina of various degrees. This finding differed significantly from changes in already established (non-proliferative) NPDR in 36% of eyes, when asignificant decrease in CS with normal visual acuity was found 4/4 ETDRS. Statistical differences in CS between DpR1 and DpR2 and NPDR were determined - always p 0.001. The average depth of the fovea was NPDR: 29.5 &#956;m. NPDR had the largest average FAZ: 0.56 mm2. Also significant were the most significant changes in non-perfusion and especially the presence of microaneurysms. These three non - invasive methods helped to monitor the dynamics of the development of ocular changes in T1DM of better quality than the determination of visual acuity and ophthalmoscopic examination. Increased retinal volume induced hypoxia of visual cells with subsequent dual autoregulatory mechanism conditioning two types of diabetic pre-retinopathy before the onset of DR.

Значение гемодинамических расстройств в сосудах сетчатки в течении идиопатических ретиноваскулитов

Relevance of this pathology is since both eyes are affected, characterized by a sluggish, relapsing course, affecting children and adolescents. Since this pathology is based on aseptic inflammation of the vascular wall in the retina of autoimmune origin, leading to hemodynamic disorders, our goal is to study the significance of hemodynamic disorders in various ocular fundus changes in patients with idiopathic retinovasculitis. Special research methods have been performed: autoperimetry, biomicroscopy of the anterior segment and internal structures of the eye, direct and reverse ophthalmoscopy, OCT of optic disc and yellow spot, autofluorescence vascular OCT with central retinal artery and central retinal vein calibrometry, ultrasound Doppler sonography of retinal vessels. Blood tests for antibodies of viral, bacterial and infectious diseases, immune status testing. Results: greater increase in the linear velocity of blood flow in the arteria ophthalmica, central retinal artery and central retinal vein and superior orbital vein in patients with neuroretinopathy: respectively: 64.86±0.46 cm/sec, 62.0±1.03 cm/sec (P&lt;0.01), 21.0±0.7 cm/sec, 20.0±0.76 cm/sec (P&lt;0.05). Angiospasm phenomena prevailed in all patients — RI=0.83±0.010; RI=0.8±0.014 (P&lt;0.05). There were detected venous discirculation in the venous system with increase of linear velocity of blood flow up to 13,5±0,7 cm/sec and 15,0±0,74 cm/sec (P&lt;0,05). In patients with maculodystrophy it was 10.8±0.82 cm/sec and 12.6±0.58 cm/sec (P&lt;0.05). The frequency of hemodynamic disturbances prevailed in neuroretinopathies — 53.1% in arteria ophthalmica, 50% in central retinal artery, 50% in central retinal vein and 39% in superior orbital vein. Conclusion: The major disorders of microcirculation in the retinal arterio-venous system were detected in patients with neuroretinopathies. Microcirculatory disorders detected by ultrasound in patients with idiopathic retinovasculitis allow to determine the tactics, prognosis, and effectiveness of treatment.