Ocular Discomfort Research Articles

Evaluation of Meibomian Glands and Tear Film in Pterygium Patients

BACKGROUND
 In this study we wanted to estimate the tear film and meibomian gland abnormalities in pterygium patients, and compare the tear film in pterygium eye with non pterygium eye.
 METHODS
 This was a prospective study conducted in the outpatient department of ophthalmology of Adichunchanagiri institute of Medical sciences, Bellur, Mandya. A TBUT of <10 secs, Schirmer <10 secs and Meibomian glands <1/3 of lid area considered to be abnormal.
 RESULTS
 The Schirmer’s test showed 41.1% of dry eye out of which 28.8% was mild, 12.3% was moderate dry eye disease. And TBUT test showed 51.1% dry eye out of which 31.2% was mild, 8.8% was moderate and 11.1% was severe dry eye disease. 27(30%) patients had grade 1, 26(28.9) patients with grade 2 and 24(26.7) patients with grade 3 meibomian gland disorder. In eyes with pterygium, results were significantly different.
 CONCLUSIONS
 Meibomian gland and tear film may be altered in patients having pterygium, which may lead to ocular discomfort and dry eye.

Evaluation of therapeutic efficacy of Emustil drops for ocular discomfort and tear film osmolarity using different treatment management modes under dry environmental conditions

BackgroundWe aimed to check the efficacy of Emustil (oil in water emulsion) drops on tear film index and ocular surface dynamics in dry environments through protection and relief treatment modalities.MethodsThe subjects were exposed to a dry environment using a Controlled Environment Chamber (CEC) where the relative humidity (RH) was 5% and the temperature was 21 °C and screened for ocular symptoms, tear osmolarity, ocular surface temperature (OST) and tear production using ocular Surface Disease Index questionnaire (OSDI), OcuSense TearLab Osmometer, FLIR System ThermaCAM P620 and Schirmer strips/phenol red test respectively. Tear production was calculated by the Tear Function Index test (TFI).ResultsThe mean tear film osmolarity decreased significantly from 296.8 mOsm/l at 40% RH to 291 mOsm/l at 5%. (p = 0.01). Instillation of Emustil resulted in a significant increase in tear osmolarity in the relief method compared with osmolarity seen at 5% RH when no drop was used. The mean PRT value decreased from 26 ± 9 in normal conditions (40% RH) to 22 ± 4 mm in dry conditions (5% RH). Emustil drops did not induce any significant change in tear production in the PRT test. No significant change was found in OST following exposure to 5% RH. OST did not show a statistically significant change with the emulsion when used for relief (p > 0.05). The mean score of ocular discomfort observed was 70 at 5% RH. Still, the instillation of the oil-in-water emulsion (Emustil) resulted in a noticeable decrease in visual discomfort to 37 (p = 0.00) in protection and 59 in relief (p = 0.05). Emustil drops substantially improved tear film parameters under a desiccating environment, however, tear film parameters respond differently to the management modalities. In the protection method, tear film osmolarity was protected against a dry environment, while in the relief mode, tear production was improved.ConclusionCEC allows for a thorough evaluation of tear film parameters and dry eye treatment protocols in labs, providing greater confidence when applying them to patients. In addition, our study showed that Emustil not only provides protection and relief for dry eyes but also helps to maintain ocular homeostasis in desiccating environments. This indicates a promising potential for improving dry eye treatment protocols.

Effect of Topical Recombinant Human Nerve Growth Factor on Corneal Epithelial Regeneration in Refractory Epithelial Keratopathy

ABSTRACT Purpose To report the effect of topical application of recombinant human nerve growth factor (rhNGF) eye drops on corneal epithelial regeneration in patients with refractory epitheliopathy. Methods A retrospective chart review was conducted on patients treated with topical rhNGF for refractory epithelial keratopathy due to stage I neurotrophic keratitis (NK). Data regarding demographics and ocular/systemic past medical history was extracted from patient charts. Visual acuity and corneal staining scores were recorded at baseline and subsequent follow-up visits at 8 weeks and 3 months. Measurements from the worse eye were used to compare before and after treatment values. Results We identified 14 patients (median age 68 years, 21% male) who received rhNGF treatment for refractory epithelial keratopathy. After an 8-week treatment with topical rhNGF, the median corneal staining score in the worse eye improved from 4 to 1 (p = 0.001). All patients showed at least one-grade improvement in corneal staining at 8 weeks, with sustained effect in seven patients at 3 months. A better response was observed in eyes with post-radiation epithelial keratopathy, LASIK, and Sjogren’s disease. Those with chronic use of other topical treatments and uncontrolled diabetes mellitus demonstrated incomplete responses. Eight patients reported mild-to-moderate ocular discomfort from drop application that fully resolved after completion of treatment. Conclusions Topical rhNGF was effective and safe for refractory epithelial keratopathy in our small cohort, but sustained effects were seen only in certain etiologies for up to 3 months. Further studies are needed for optimal dosing and duration based on underlying causes.

A Novel Ophthalmic Solution Containing Glicopro® Complex for the Treatment of Patients with Dry Eye Disease: Results from a Pilot Study.

(1) Background: Dry eye disease (DED) is a multifactorial ocular surface disease characterized by an imbalance in ocular surface homeostasis, and tear substitutes constitute the first line of treatment. The present study aimed to evaluate the changes in the signs and symptoms of patients with DED treated with a novel tear substitute containing the GlicoPro® complex. (2) Methods: Patients with DED not successfully responding to other tear substitutes were enrolled and treated with a novel ophthalmic solution (two drops four times daily). Patients were examined before starting the study treatment (T0) and after 30 (T1) and 60 (T2) days of treatment by means of Keratograph for the evaluation of the following: (i) tear meniscus height (TMH); (ii) noninvasive Keratograph break-up time (NIKBUT); (iii) bulbar redness; and (iv) infrared meibography. The SANDE questionnaire was administered to assess ocular discomfort symptoms. Analysis of the tear content of proenkephalin and Met/Leu-enkephalin was also performed. (3) Results: At T2, a significant improvement in NIKBUT first, average, and class, TMH, and SANDE score was found. The tear content of proenkephalins was significantly higher at T1, whereas processed active Met/Leu-enkephalins increased at both T1 and T2. (4) Conclusions: Our novel tear substitute based on GlicoPro® resulted in a significant improvement in ocular discomfort symptoms, tear volume, and stability in the patients treated. The increase in active peptides processed in tears may represent the pathophysiological substrate underlying this finding.

Conventional Pterygium Excision with Conjunctival–Limbal Autograft Compared with Supra-Tenon Excision of Pterygium Along with Small Limbal Autograft

ABSTRACT Context: New pterygium surgery methods have been developed over the years because recurrence is high (30–70%) after simple excision. Aims: To compare the surgical time, ocular discomfort score, and recurrence rate in conventional pterygium surgery, where excision of pterygium and Tenon’s capsule is performed and the area is covered using conjunctival–limbal autograft (CLAU) with supra-Tenon excision of pterygium (STEP) along with small limbal autograft in patients with primary pterygium. Settings and Design: A Prospective comparative study was conducted at a rural medical college–hospital from November 1, 2017, to October 31, 2019, among 110 participants after ethical approval from Institutional Ethics Committee. Materials and Methods: All participants had primary pterygium of grades I and II depending on corneal encroachment and Tan’s stages T1 and T2 morphologically. Fifty-five underwent conventional surgery with CLAU (group A), and STEP with small limbal autograft (group B) was performed in the remaining fifty-five. The follow-up period was one year. The ocular problem, comfort of subject, recurrence, or other complications were documented, and statistical analysis was carried out with Statistical Package for the Social Sciences (SPSS) software version 21. Results: The mean surgical time was significantly less in group B (38.79 vs. 42.04 minutes) (Z = 11.38, P = 0.001 with confidence interval 10.81–13.38) and ocular discomfort score (ODS) was lower in group B as compared with group A (P < 0.05). Group B had two eyes with recurrence, though not statistically significant (P = 0.49). Conclusion: STEP with small limbal autograft is worth consideration for primary pterygium management.

Pharmacogenomic Analysis of Response to Topical Tumor Necrosis Factor α Antagonist Licaminlimab (OCS-02) in Dry Eye Disease [RETRACTED

The purpose of this study was to evaluate the pharmacogenomics of response to topical ocular tumor necrosis factor α (TNFα) inhibitor licaminlimab in patients with DED. Three single-nucleotide polymorphisms (SNPs) associated with Sjögren syndrome, 3 in the TNFα gene and 1 in the TNF receptor 1 (TNFR1) gene, were assessed for association with response to licaminlimab in participants from a randomized, vehicle-controlled, Phase 2 study in which adults with DED and severe ocular discomfort persisting despite treatment with artificial tears received licaminlimab or vehicle for 6 weeks. Response was assessed for change from baseline in Global Ocular Discomfort score at Day 29 of treatment. The pharmacogenomic analysis was a prospectively specified exploratory objective of the study. mRNA expression for TNFα, interleukin (IL) 1β, and IL8 in conjunctival epithelium cells was determined. The relationship between SNPs and response to licaminlimab was assessed using a mixed model repeated measures analysis. SNP rs1800693 in the TNFR1 gene showed a significant effect on response to licaminlimab ( P < 0.0001, initial association test); no effect was seen for any of the other SNPs tested. The CC genotype of rs1800693 was associated with much greater response to licaminlimab than the CT or TT genotypes: LS mean changes from baseline to Day 29 in Global Ocular Discomfort score were -29.5, -0.09, and -3.90, in patients with the CC, CT, and TT genotypes, respectively ( P < 0.0001). No significant effect was observed in vehicle-treated patients. Improvements from baseline were seen in 3/4 licaminlimab-treated participants with the CC genotype. Conjunctival epithelium cell levels of mRNA for TNFα, IL1β, and IL8 decreased from baseline in participants with the CC genotype, but not with the CT or TT genotypes. Between-genotype differences in mRNA levels were not observed in participants receiving vehicle. The CC genotype of rs1800693, relatively common in patients with DED, was strongly associated with response to licaminlimab and decreased inflammatory cytokine gene expression in ocular surface cells during treatment. This study is one of the first to our knowledge to investigate pharmacogenomics in the treatment of DED.

Quasi-3D: reducing convergence effort improves visual comfort of head-mounted stereoscopic displays

The diffusion of virtual reality urges to solve the problem of vergence-accommodation conflict arising when viewing stereoscopic displays, which causes visual stress. We addressed this issue with an approach based on reducing ocular convergence effort. In virtual environments, vergence can be controlled by manipulating the binocular separation of the virtual cameras. Using this technique, we implemented two quasi-3D conditions characterized by binocular image separations intermediate between 3D (stereoscopic) and 2D (monoscopic). In a first experiment, focused on perceptual aspects, ten participants performed a visuo-manual pursuit task while wearing a head-mounted display (HMD) in head-constrained (non-immersive) condition for an overall exposure time of ~ 7 min. Passing from 3D to quasi-3D and 2D conditions, progressively resulted in a decrease of vergence eye movements—both mean convergence angle (static vergence) and vergence excursion (dynamic vergence)—and an increase of hand pursuit spatial error, with the target perceived further from the observer and larger. Decreased static and dynamic vergence predicted decreases in asthenopia trial-wise. In a second experiment, focused on tolerance aspects, fourteen participants performed a detection task in near-vision while wearing an HMD in head-free (immersive) condition for an overall exposure time of ~ 20 min. Passing from 3D to quasi-3D and 2D conditions, there was a general decrease of both subjective and objective visual stress indicators (ocular convergence discomfort ratings, cyber-sickness symptoms and skin conductance level). Decreased static and dynamic vergence predicted the decrease in these indicators. Remarkably, skin conductance level predicted all subjective symptoms, both trial-wise and session-wise, suggesting that it could become an objective replacement of visual stress self-reports. We conclude that relieving convergence effort by reducing binocular image separation in virtual environments can be a simple and effective way to decrease visual stress caused by stereoscopic HMDs. The negative side-effect—worsening of spatial vision—arguably would become unnoticed or compensated over time. This initial proof-of-concept study should be extended by future large-scale studies testing additional environments, tasks, displays, users, and exposure times.

The Use of Venous Catheter and Irrigation with Povidone-Iodine 0.6% in Patients with Punctal and Proximal Canalicular Stenosis: Preliminary Report.

Background: This study aimed to evaluate the safety and efficacy of povidone-iodine 0.6% (PVI) irrigation for preventing recurrence of stenosis after punctoplasty in patients with punctal and proximal canalicular stenosis treated using a venous catheter as a stent. Methods: Twenty patients were enrolled and divided into two groups. Group 1 received irrigation of 1 mL 0.6% PVI, while Group 2 received 1 mL of balanced salt solution (BSS). The patients underwent baseline, 15-, 30-, and 90-day assessments using the Ocular Surface Disease Index (OSDI) questionnaire, Symptoms Assessment in Dry Eye (SANDE), Schirmer I test, tear meniscus height (TMH), bulbar redness, meibography, and non-invasive breakup time (NIKBUT) through Keratograph 5M (Oculus, Germany). Results: At three months, both groups demonstrated statistically significant improvements in symptoms and ocular surface parameters. However, Group 1 showed statistically significant improvements in OSDI, SANDE scores, bulbar redness, and NIKBUT compared to Group 2. Additionally, no patients in Group 1 presented a recurrence of stenosis, while three patients in Group 2 demonstrated stenosis relapse at the end of the follow-up period. Conclusions: The application of a venous catheter and PVI 0.6% irrigations proved to be effective in treating proximal lacrimal duct stenosis, reducing the risk of recurrence and improving tear film stability, ocular discomfort symptoms, and ocular surface parameters.

Two-Year Progression of Dry Eye Disease in Dry Eye Assessment and Management Study.

The purpose of this study was to evaluate the progression of dry eye disease (DED) symptoms and signs over 2 years through a secondary analysis of data collected from the Dry Eye Assessment and Management study. Participants who were assigned to omega-3 fatty acid in the first year were rerandomized in the second year to either continue with omega-3 fatty acid or switch to placebo. At baseline, 3, 6, 12, 18, and 24 months, DED symptoms were evaluated by using the Ocular Surface Disease Index and the Brief Ocular Discomfort Index (BODI). DED signs were assessed using conjunctival staining, corneal staining, tear break-up time, Schirmer testing, and keratography measures. Medication usage was documented at each visit. Because the treatment and placebo groups displayed no statistical differences in both signs and symptoms, data from the 43 participants were combined to assess longitudinal changes in symptoms and signs. At 3 months after omega-3 fatty acid treatment, there were significant improvements from baseline in Ocular Surface Disease Index and Brief Ocular Discomfort Index scores (all P ≤ 0.002) and less use of artificial tears or gel ( P = 0.02), but between 3 and 24 months, no significant changes in symptoms and treatments were observed ( P ≥ 0.06). Except for a significant improvement in conjunctival staining score over 2 years ( P = 0.001), there were no significant sign changes in corneal staining ( P = 0.32), tear break-up time ( P = 0.43), Schirmer test ( P = 0.09), and additional measures (all P ≥ 0.07). We did not observe a progression of DED signs or symptoms over a 2-year period, except for a probable placebo response in symptoms in the first 3 months and an improvement in conjunctival staining score.

Clinical evaluation of tear substitute utility after anti-VEGF intravitreal injection.

The purpose of this study is to evaluate the role of a polyethylene glycol 400 - propylene glycol - hydroxypropyl guar - hyaluronic acid eye drops in relieving the symptoms of dry eye syndrome after anti-VEGF intravitreal injection. In this randomized, parallel-group study, patients were randomized to receive standard therapy alone or study eye drops plus standard therapy. Patients enrolled were older than 50 with exudative age-related macular degeneration, who have never had intravitreal injections, and without severe dry eye condition or severe ocular or systemic conditions. Patients had baseline preoperative evaluation (V0), and successively after 15 (V1) and 30 (V2) days. At VO and V1 T-BUT, Schirmer's test, fluorescein staining, DEQ5 and OSDI questionnaires were performed and at V2 (30) the OSDI questionnaire was administered. 80 patients were included in the study, of them 40 received standard therapy plus study eye drops. DEQ5 questionnaire showed an increase in the control group between the values at V0 and V1, while in the study group a decrease was observed. No changes in T-BUT, Schirmer, and fluorescein staining values between V0 and V1 were observed in both groups. OSDI data in the control group showed no statistically significant differences, while in the study group they showed a statistically significant difference. In our study patients undergoing for the first time intravitreal treatment presented dry eye symptoms in the postoperative period: in this group of patients the use of a tears substitute reduces postoperative ocular discomfort.

Dual-Atom Nanozyme Eye Drops Attenuate Inflammation and Break the Vicious Cycle in Dry Eye Disease

HighlightsA dual-atom nanozyme (DAN) was successfully prepared based on Fe and Mn bimetallic single-atom embedded in N-doped carbon material and modified with hydrophilic polymer.The DAN possess excellent enzyme catalytic activity and attenuate dramatically inflammation by inhibiting the reactive oxygen species (ROS)/NLRP3 signal axis.The DAN break the vicious cycle in dry eye disease and is a potential strategy for treating dry eye disease.

A RARE CASE OF STERILE ENDOPHTHALMITIS FOLLOWING INTRAVITREAL TRIAMCINOLONE ACETONIDE INJECTION IN VITRECTOMIZED EYE

Introduction : Intravitreal Triamcinolone Acetonide (IVTA) has been widely used to treat Diabetic Macular Edema (DME). Sterile endophthalmitis is one of the major related complications after IVTA which occurs between 0.20% and 6.73% of the injections. We present a case of sterile endophthalmitis following IVTA injection in a patient with a vitrectomized eye and DME.&#x0D; Case Illustration : A 53?year?old female patient with a history of vitrectomy due to high-risk characteristic proliferative diabetic retinopathy on her right eye underwent IVTA for DME. One day after the injection, the visual acuity (VA) improved from 6/45 to 6/12 without any complication. Three days later, she complained of ocular discomfort and sudden diminution of vision. The VA had dropped to hand movement, with conjunctival injection, hypopyon, anterior chamber reaction, and an inaccessible fundus. The patient was treated with topical antibiotics, corticosteroids, and cycloplegic, followed by intravitreal antibiotics injection. Furthermore, vitrectomy and vitreous tap were performed. On one- week follow-up, the VA was improved to 6/60 with normal IOP. The anterior chamber and the vitreous cavity remained clear.&#x0D; Discussion : The etiology of sterile endophthalmitis following IVTA injection remains unclear. Compared to infectious endophthalmitis, the patient is usually in less pain, and the eye is less injected. Although it generally has a benign course, some studies have shown serious complications such as vitreous hemorrhage and retinal detachment. Therefore, caution should be taken to prevent such complications from developing.&#x0D; Conclusion : In presumed sterile endophthalmitis, a careful diagnosis and intervention must be reconsidered to avoid potential long-term visual loss due to its related complications.

Sudden Ocular Complication after Snake Bite

Introduction : A snakebite constitutes a common acute medical emergency and has several systemic and even ocular consequences. Snake venom neurotoxins act mainly on the peripheral nervous system at the neuromuscular junction and can affect the cranial nerves. Neurological symptoms that relate to cephalic muscle paralysis include exotropia, ptosis, diplopia and ophthalmoplegia.&#x0D; Case Illustration : A 17 years old man came to emergency department with painful swelling on his left hand and sudden blurred vision right after his left hand were bitten by venomous snake in the rice field. Diplopia and ptosis were developed several hours after admission. On eye examination, visual acuity was 0,05 on right eye and 0,8 on left eye, abnormal pupillary reflects on both eyes were present, pupil dilatation, limited eye movement and ptosis were present, Intraocular pressure were 23,7 mmHg on right eye and 24,5 mmHg on left eye. Antivenom was administered immediately. He received cycloplegic, timolol eyedrop, and prednisolone eyedrop for ocular treatment&#x0D; Discussion : Ocular complications are rare and uncommon but they may lead to sight-threatening conditions. Snake venom neurotoxins act mainly on the peripheral nervous system at the neuromuscular junction and can affect the cranial nerves. Mild neurological symptoms that relate to cephalic muscle paralysis include exotropia, ptosis, diplopia and ophthalmoplegia.&#x0D; Conclusion : This study presented a rare case of systemic ocular complication as a result of a snake bite. Ophthalmoplegia induced ocular discomfort for an extended period is a rare symptom of snake-bites. Combined treatment of steroid with antivenom may improve the recovery from sudden ocular manifestation in snake bite.

Rates of endophthalmitis before and after transition from povidone-iodine to aqueous chlorhexidine asepsis for intravitreal injection

ObjectiveTo assess the rate of post-intravitreal injection endophthalmitis between 2 asepsis groups: aqueous chlorhexidine 0.1% and povidone-iodine 5%. DesignRetrospective, observational cohort study. ParticipantsPatients with infectious endophthalmitis post intravitreal injection (n = 58) at a single centre from July 2009 to July 2022. MethodsRetrospective chart review of all patients receiving intravitreal injections (216 593 injections) at a single centre over 14 years. Patients from July 2009 to February 2017 received povidone-iodine 5%, and patients from March 2017 to July 2022 received aqueous chlorhexidine 0.1%. Assessed characteristics of endophthalmitis cases included demographics, visual function, intervention type, and microbiological results. ResultsThe rate of endophthalmitis was comparable for povidone-iodine (1.4:5000) and aqueous chlorhexidine (1.3:5000) (p = 0.77). Vitreous cultures were negative for 55% of patients. Visual acuity (VA) outcomes did not differ between asepsis groups nor between culture positive/negative groups. Patients having vitrectomy (PPV) had worse final vision (p = 0.08) but there was no VA difference between early and late PPV. ConclusionsAqueous chlorhexidine 0.1% is a viable and safe alternative to povidone-iodine 5% for post-intravitreal injection endophthalmitis prophylaxis and may reduce ocular surface adverse events and discomfort.

Noninvasive screening of ocular surface disease in otherwise healthy patients scheduled for cataract surgery.

To evaluate prevalence and characteristics of pathological ocular surface findings in healthy patients undergoing cataract surgery using a noninvasive ocular surface workup and a validated questionnaire. Prospective single-centre study (sub-analysis clinical trial no. NCT05754437). Healthy patients undergoing senile cataract surgery were screened preoperatively by Oculus Keratograph (K5 M; Oculus GmbH, Wetzlar, Germany) for the evaluation of tear meniscus height (TMH), non-invasive keratograph break-up time (NIKBUT), and meibomian gland dropout. Ocular discomfort symptoms were scored by ocular surface disease index (OSDI) questionnaire. 120 eyes of 120 patients (62 females, 58 males; mean age 73.85 years, range 47-91 years) were included. All patients had at least 1 abnormal finding, while 19 (15.8%; 95% CI [0.09-0.22]) had alterations of all parameters. In detail, 39 patients (32.5%; 95% CI [0.24-0.41]) had pathological TMH (mean 0,15 mm [0.03 SD]), 102 (85%; 95% CI [0.79-0.91]) had pathological NIKBUT (mean 3.64 s [2.63 SD]), 117 (97.5%; 95% CI [0.95-1]) had some degree of gland dropout (mean 1.62 [0.70 SD]), 78 patients (65%; 95% CI [0.56-0.74]) had pathological OSDI scores (mean 28.63 [15.08 SD]). Using TFOS DEWS II criteria, 66 patients (55%; 95% CI [0.42-0.60]) resulted affected by dry eye. This quick noninvasive screening documented the high prevalence of pathological ocular surface parameters in patients without risk factors or previous diagnosis of dry eye who are scheduled for cataract surgery.

Ocular surface parameter changes in the untreated fellow eye after unilateral cataract surgery with short-term administration of anti-inflammatory eye drops

This study aimed to investigate the changes in clinical parameters of dry eye disease and meibomian gland dysfunction in both the operated and untreated fellow eyes of patients who underwent unilateral cataract surgery with the short-term administration of anti-inflammatory eye drops in the surgical eye. The medical charts of 57 consecutive patients who underwent unilateral cataract surgery and received 1% prednisolone acetate and non-steroidal anti-inflammatory drug (NSAID, 0.1% bromfenac sodium) eye drops were reviewed. The preoperative ocular surface disease index questionnaire score (38.9 ± 20.5) decreased significantly to 15.2 ± 16.4 at post-surgical 1 week and further to 12.8 ± 11.4 after 1 month. Although meibum quality grade increased and corneal sensitivity decreased at 1 week in operated eyes, corneal erosion scores and Sjogren’s International Collaborative Clinical Alliance ocular staining scores even improved over a month in the untreated fellow eyes. The tear matrix metalloproteinase (MMP)-9 grade decreased in both operated eyes and untreated fellow eyes after 1 month from surgery. In conclusion, the short-term topical anti-inflammatory treatment using steroid and NSAID eye drops in the operated eye after cataract surgery decreased subjective ocular surface discomfort and improved ocular surface staining scores and tear MMP-9 expression in the untreated fellow eyes.

Analysis of Clinical Characteristics and Neuropeptides in Patients with Dry Eye with and without Chronic Ocular Pain after FS-LASIK.

Chronic ocular pain, particularly prevalent in patients with dry eye disease and post-femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) surgery, presents with unclear clinical characteristics and an undefined pathogenesis. In this study, we aimed to compare clinical characteristics and tear neuropeptide concentrations in patients with dry eye disease (DED) with and without chronic ocular pain following FS-LASIK, and investigate correlations between ocular pain, clinical characteristics, and tear neuropeptide levels. Thirty-eight post-FS-LASIK patients with DED were assigned to two groups: those with chronic ocular pain and those without chronic ocular pain. Dry eye, ocular pain, and mental health-related parameters were evaluated using specific questionnaires and tests. The morphology of corneal nerves and dendritic cells (DCs) was evaluated by in vivo confocal microscopy. Function of corneal innervation was evaluated by corneal sensitivity. Concentrations of tear cytokines (interleukin [IL]-6, IL-23, IL-17A, and interferon-γ) and neuropeptides (α-melanocyte-stimulating hormone, neurotensin, β-endorphin, oxytocin, and substance P [SP]) were measured using the Luminex assay. Most patients with chronic ocular pain experienced mild to moderate pain; the most common types included stimulated pain (provoked by wind and light), burning pain, and pressure sensation. More severe dry eye (P < 0.001), anxiety symptoms (P = 0.026), lower Schirmer I test values (P = 0.035), lower corneal nerve density (P = 0.043), and more activated DCs (P = 0.041) were observed in patients with ocular pain. Tear concentrations of SP and oxytocin were significantly higher in patients with ocular pain (P = 0.001, P = 0.021, respectively). Furthermore, significant correlations were observed among ocular pain severity, SP, and anxiety levels. Patients with DED after FS-LASIK who have chronic ocular pain show more severe ocular and psychological discomfort and higher tear levels of neuropeptides. Furthermore, ocular pain severity is correlated with tear SP levels. ClinicalTrials.gov identifier: NCT05600985.

Evaluation of early ocular discomfort after glaucoma surgery: trabeculectomy versus Ahmed glaucoma valve implantation.

This study aims to compare the initial ocular discomfort symptoms resulting from trabeculectomy and Ahmed glaucoma valve implantation surgeries. A prospective comparative study was conducted. The evaluation of ocular discomfort employed a questionnaire designed to identify the frequency and severity of distinct symptoms: ocular pain, general discomfort, tearing, foreign body sensation, and burning. This questionnaire was administered prior to surgery as a baseline, and subsequently at 7, 30, and 90 days post-surgery. Simultaneously, the Ocular Surface Disease Index (OSDI) was applied at these same time intervals. The study encompassed a total of 17 patients (9 undergoing trabeculectomy and 8 undergoing Ahmed glaucoma valve implantation). The Ahmed glaucoma valve implantation group exhibited higher tearing levels at baseline (p=0.038). However, no statistically significant differences in symptoms were observed between the two surgeries at 7 and 30 days post-surgery. At the 90-day mark following surgery, patients who had undergone trabeculectomy reported a significantly higher foreign body sensation (p=0.004). Although OSDI scores did not differ between groups at baseline, the trabeculectomy group showed significantly higher OSDI scores than the Ahmed glaucoma valve implantation group at 7, 30, and 90 days after surgery (p<0.05). Post-surgery, patients who had undergone trabeculectomy experienced increased foreign body sensation. Trabeculectomy appears to cause greater early postoperative ocular discomfort compared to the Ahmed glaucoma valve implantation group.

ZEISS VISULAS green SLT in primary open‐angle glaucoma and ocular hypertension: 6 month follow up in a real‐world setting

Aims/Purpose: The aim of this study is to report preliminary data of efficacy and safety of ZEISS VISULAS® green Selective Laser Trabeculoplasty (SLT) in primary open‐angle glaucoma (POAG) and ocular hypertension (OHT) in a real‐life clinical setting.Methods: We prospectively collected data of 34 treated eyes in 17 patients during 2022. Patients followed a regular clinical management in our center (San Giuseppe Hospital, University Eye Clinic, IRCCS Multimedica, Milan, Italy). Follow up was of 6 months. Inclusion criteria were adult patients, diagnosis of POAG or OHT. Exclusion criteria were previous laser trabeculoplasty (LT), filtration surgery, and cyclophotocoagulation procedures. Main outcome was ≥20% intraocular pressure (IOP) reduction at 6 months. All the procedures were performed by two doctors (CB, DT). Adverse events were recorded.Results: We included 34 eyes of 17 patients. Mean age was 67.4 ± 11.5 years. Patients were 88.2% Caucasian, 47.1% females, with a diagnosis of OHT (64.7%), mild POAG (29.4%), or moderate POAG (5.9%). The mean IOP was significantly decreased from baseline to 6 months (21.5 ± 2.1 vs 18.0 ± 2.6 mmHg, p &lt; 0.05). Primary outcome (≥ 20% IOP reduction at 6 months) was reached in 52.9% cases. There was no significant increase in glaucoma medical therapy at 6 months (1.1 ± 1.0 vs 1.4 ± 1.0 medication per eye, p = 0.23). No patient received a second SLT treatment or underwent filtration surgery or cyclophotocoagulation procedures during the follow‐up. No major ocular or systemic side effects were found. The most common adverse event was ocular discomfort in 10 cases (29.4%), always mild and transient. SLT treatment was performed with an average of 100.2 ± 6.7 spots, 27.4 ± 4.7 μJ energy, and a 360° distribution for 32 of 34 eyes (2 eyes treated at 270°).Conclusions: We reported the preliminary short‐term data of efficacy and safety of ZEISS VISULAS® green SLT treatment in POAG and OHT. To the best of our knowledge, this is the first report of ZEISS VISULAS® green SLT in a real‐life clinical setting. This technology has been shown to be effective and safe in lowering IOP at 6 months after the treatment. Limits of this study were the small sample size and the short follow‐up time.

An antifouling supramolecular polymer ophthalmic ointment alleviates symblepharon in rat alkali burn eyes.

Symblepharon is an adverse ocular disease resulting in ocular discomfort and impaired vision, severely dragging down a patient's quality of life. Due to the specificity of the ocular surface, the retention time of drugs on it is short, leading to limited therapeutic effects for ocular diseases. Therefore, it is imperative to design a novel drug delivery system, which can not only prolong the retention time of a drug but also play an anti-fibrosis role in symblepharon. Herein, an antifouling supramolecular polymer ophthalmic ointment consisting of poly(N-acryloyl alaninamide) (PNAAA), vitamin C (VitC) and levofloxacin (Levo) was developed (termed PNAVL ophthalmic ointment), which acted as a mucoadhesive and long-acting ocular delivery system. This antifouling PNAVL ophthalmic ointment improved the retention time of VitC and Levo, and simultaneously provided anti-inflammation and anti-fibrosis effects for mitigating symblepharon after ocular alkali burn injury.