Ocular Surface Parameters Research Articles

Assessment of meibomian glands and tear film in post‐refractive surgery patients

Corneal refractive surgery may impact meibomian gland and tear film in post-refractive surgery patients. To compare ocular surface parameters between post-refractive surgery patients and normal controls. Cross-sectional single centre study. A total of 120 eyes of 120 subjects were divided into three groups: (i) 60 controls and 60 patients underwent corneal refractive surgery at least 12 months ago; (ii) 30 post-laser in-situ keratomileusis (LASIK) patients and (iii) 30 post-laser epithelial keratomileusis (LASEK)/photo-refractive keratectomy (PRK) patients. Tear meniscus height, non-invasive keratographic tear film break-up time and meibography were measured using the Keratograph® 5M. Fluorescein break-up time, ocular surface staining, examination of lid margins and meibomian glands, Schirmer's test and Ocular Surface Disease Index questionnaire were performed. Ordinary logistic regression was performed to evaluate the impact of clinical variables including refractive surgery on the meiboscores. In post-LASIK patients, ocular surface parameters including Ocular Surface Disease Index scores, fluorescein break-up time and staining scores, except Schirmer's scores, were significantly worse than those in controls (P < 0.050). Ocular surface staining scores in post-LASEK/PRK patients was higher than that in the controls (P = 0.001). In post-refractive surgery patients, grade of meibomian gland parameters and meiboscores were worse than those of controls (all P < 0.050). Histories of refractive surgery were associated with high meiboscore (β = 1.100, P = 0.043 for LASIK and β = 1.039, P = 0.042 for LASEK/PRK). Corneal refractive surgery may adversely affect the ocular surface, and a reduction of functional meibomian glands can contribute to chronic tear film dysfunction after corneal refractive surgery.

Risk factors for bleb-related infection following trabeculectomy surgery: ocular surface findings—a case–control study

PurposeBleb-related infection (BRI) is a devastating complication of trabeculectomy surgery. The aim of this study was to identify ocular risk factors for BRI with specific emphasis on ocular surface parameters....

Ocular surface analysis in hematological patients before and after allogeneic hematopoietic stem cell transplantation: implication for daily clinical practice

PurposeTo evaluate ocular surface parameters before and after hematopoietic stem cell transplantation (HSCT) and to correlate them with clinical and transplant variables.MethodsThis is a retrospective analysis of data from 93 patients affected by hematological malignancies undergoing HSCT. Values from Ocular Surface Disease Index, Schirmer test, Break-up Time, ocular surface staining, and Meibomian Gland Dysfunction score obtained before HSCT and 3-6 months after were retrieved from charts. Diagnosis and staging of dry eye (DE) disease was performed according to Dry Eye WorkShop criteria. Graft-versus-host-disease (GVHD) was classified according to the NIH criteria. Odds ratios for DE onset after HSCT were estimated for demographic, ocular, hematological and transplant variables.ResultsDE was diagnosed before HSCT in 50 (53%) of the patients, mostly of hyperevaporative profile. After HSCT, all ocular parameters significantly worsened with no change in DE profile. A 51% incident cases (22 of the 43 non-DE subjects) were reported. Increasing recipient age and female sex, higher CD34+ cells infused, donor-recipient sex mismatch (males receiving from females), related donors, and peripheral blood cells as stem cell source were associated with a significant higher incidence of DE after HSCT. Systemic chronic GVHD was diagnosed in 42% while ocular GVHD in 35.5% of the patients, which decreased to 12% when taking into account only incident cases.ConclusionsHigh DE prevalence was shown already before HSCT. A pre-HSCT ocular surface assessment is recommended for early DE diagnosis and treatment. This new protocol also influences the prevalence of ocular GVHD.

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.

Ocular Surface Parameters Predicting Patient Satisfaction After a Single Vectored Thermal Pulsation Procedure for Management of Symptomatic Meibomian Gland Dysfunction.

To evaluate the ocular surface parameters that could predict patient satisfaction after single application of vectored thermal pulsation (VTP). This is a retrospective interventional case series; it included consecutive patients who underwent bilateral VTP for management of symptomatic meibomian gland dysfunction (MGD). Patients received a full ocular surface evaluation. The outcome was patient subjective improvement during the first 3-4 months after 3 follow-up visits. For analysis, patients were divided into responders and nonresponders. Forty-nine patients received bilateral treatment, with 32 patients (65.3%) reporting subjective improvement after treatment. Responders had lower tear production (6.9 ± 5.9 mm vs. 13.6 ± 6.8 mm; t test P = 0.002), a higher corneal staining score (4.4 ± 5.0 vs. 0.43 ± 1.1; t test P = 0.003), and a higher conjunctival staining score (3.1 ± 2.4 vs. 1.5 ± 1.8; t test P = 0.023) and presented with a higher tear osmolarity (319.7 ± 23.22 mOsm/L vs. 306.9 ± 9.0 mOsm/L; t test P = 0.029) than the nonresponder group. We found no association between patient age, tear breakup time, Ocular Surface Disease Index score, tear lipid layer thickness, or MGD grading score, as measured before intervention, with patient-perceived success of treatment. No complications to treatment were noted, and no patient reported worsening of preexisting symptoms on follow-up. VTP can be effective in treating dry eye symptoms of patients with MGD. Our data show that objective findings of dry eye, as evidenced by lower tear production, higher corneal and conjunctival staining scores, and higher osmolarity, tend to be markers present in the group of patients responding positively to VTP.

Tear cytokine profile of glaucoma patients treated with preservative-free or preserved latanoprost

PurposeTo determine variations in cytokine levels of glaucoma patients treated either with preservative-free latanoprost or preserved latanoprost, relative to healthy individuals. MethodsTear samples were collected from 39 healthy subjects, 20 glaucoma patients treated with preserved latanoprost, and 20 patients treated with preservative-free latanoprost. A set of 27 inflammatory cytokines was analyzed in each group, including interleukin (IL)-1β, IL-1ra, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL9, IL-10, IL-12 (p70), IL-13, IL-15, IL-17, eotaxin, fibroblast growth factor (FGF) basic, granulocyte colony stimulating factor (G-CSF), granulocyte monocyte colony stimulating factor (GM-CSF), interferon (IFN)-γ, interferon gamma-induced protein (IP)-10, monocyte chemo attractant protein (MCP)-1MCAF, macrophage inflammatory protein (MIP)-1α, MIP-1β, platelet-derived growth factor (PDGF)-BB, regulated on activation, normal T cell expressed and secreted (RANTES), tumor necrosis factor (TNF)-α and vascular endothelial growth factor (VEGF). Cytokine concentrations were obtained by the Bio-Plex Human Cytokine Immunoassay. Non-invasive tear breakup time (NI-TBUT), tear meniscus height, corneal fluorescein staining, conjunctival hyperemia and ocular surface disease index (OSDI) were assessed in patients treated with preservative-free and preserved latanoprost. ResultsThe levels of IL-2, IL-5, IL-10, IL-12 (p70), IL-13, IL-15, IL-17, FGF basic, PDGF-BB, and TNF-α were significantly higher in patients receiving preserved latanoprost, compared to normal controls (p < 0.05). The expression of all the cytokines studied remained statistically invariable in patients receiving preservative-free latanoprost, compared to healthy subjects (p > 0.05). Ocular surface parameters were not significantly different in both glaucoma groups, and no correlation between these clinical parameters and cytokine levels was observed. ConclusionsTreatment with preserved latanoprost has a direct impact on tear cytokine levels, whereas this effect is not observed upon preservative-free latanoprost instillation.

Assessment of the Tear Meniscus by Strip Meniscometry and Keratograph in Patients With Dry Eye Disease According to the Presence of Meibomian Gland Dysfunction

We aimed to compare the tear meniscus measurements using strip meniscometry (SM) and Keratograph5M (K5M) between 3 subtypes of dry eye disease patient groups, classified according to the presence of meibomian gland dysfunction (MGD), and normal subjects. We enrolled 145 eyes from 145 subjects and measured the tear meniscus using SM and K5M, tear film breakup time, ocular surface staining, and ocular surface disease index; the Schirmer test; and examined lid margins and meibomian glands. Correlation of tear meniscus parameters with other parameters and efficacy of the 2 measurements were evaluated. The SM and K5M results were significantly lower in the non-Sjögren syndrome aqueous-deficient dry eye (non-SS ADDE) with and without MGD groups than in the MGD-only group and normal subjects. The SM or K5M results correlated with each other and with other ocular surface parameters. The area under the curve (AUC) of the SM and K5M results was 0.637 (P = 0.012) and 0.610 (P = 0.042), respectively. Except for the MGD group, the AUC of the SM and K5M results were 0.721 (P < 0.001) and 0.694 (P = 0.001), respectively. The AUC of SM and K5M were 0.947 (P < 0.001) and 0.784 (P = 0.002), differentiating non-SS ADDE-only patients from those with normal eyes. Tear meniscus measurements using SM and K5M can compensate for detection of aqueous-deficient components of dry eye. These results should be interpreted according to the presence or absence of MGD.

Correlation between Tear Osmolarity and Other Ocular Surface Parameters in Primary Sjögren's Syndrome.

PurposeTo investigate the relationships between tear osmolarity and other ocular surface parameters and to determine the diagnostic value of tear osmolarity in primary Sjögren's syndrome (SS) using tear film break-up time, Schirmer I test, and cornea/conjunctiva staining.MethodsWe included 310 eyes of 155 patients diagnosed with dry eye disease (39 primary SS and 116 non-Sjögren dry eye disease) at Seoul St. Mary's Hospital from August 2010 to January 2015. All subjects completed the Ocular Surface Disease Index (OSDI) questionnaire and underwent ocular examinations including tear osmolarity (TearLab Osmolarity System), Schirmer I test, slit lamp examination for tear film break-up time, and corneal and conjunctival fluorescein staining. We used the mean value of both eyes for all parameters. Fluorescein staining was assessed using the Sjögren's International Collaborative Clinical Alliance ocular staining score (OSS).Results In primary SS patients (n = 39), the mean subject age was 52.5 ± 11.9 years, and 94.9% of the subjects were women. Mean tear osmolarity in SS was 311.1 ± 16.4 mOsm/L, with 16 (41.0%) subjects having values ≥316 mOsm/L. In SS, there was a positive correlation between mean tear osmolarity and OSDI score (ρ = 0.405, p = 0.011) and OSS (ρ = 0.592, p < 0.001). There was a negative correlation between mean tear osmolarity and the Schirmer I test (ρ = −0.625, p < 0.001). There was no significant correlation between mean tear osmolarity and tear film break-up time in SS (ρ = 0.110, p = 0.505).ConclusionsTear osmolarity measurements using the TearLab Osmolarity System can reflect both symptom severity (OSDI) and objective signs (Schirmer test and OSS) in SS.

Tear film and ocular surface dysfunction in diabetes mellitus in an Indian population.

Purpose:Ophthalmic complications in diabetes such as retinopathy, cataract, and infections have been extensively studied. Recently, attention has been drawn toward ocular surface changes in diabetes mellitus (DM). This study has been carried out to investigate the tear film and ocular surface abnormalities in type II DM patients.Materials and Methods:A total of 83 participants (130 eyes) were enrolled: 53 diabetics (80 eyes) and 30 healthy controls (50 eyes). Of the 53 diabetics, 24 patients (42 eyes) had some diabetic retinopathy. The tear film and ocular surface were evaluated using Schirmer test, tear film break-up time (TBUT), keratoepitheliopathy score (KES), Rose Bengal Staining (RBS) test, and conjunctival impression cytology.Results:When compared with the healthy controls, diabetics showed significantly reduced Schirmer, TBUT measurements and the higher grades of KES and RBS test (P < 0.001). Impression cytology analysis showed goblet cell loss and conjunctival squamous metaplasia in diabetics.Conclusion:Tear film abnormality is a significant feature of diabetic ocular surface diseases. These abnormalities are likely on account of poor quality and function of tears, combined with the subnormal ocular surface. Therefore, all diabetic patients especially those with evidence of retinopathy changes should undergo routine early examination and follow-up of tear function and ocular surface parameters.

24-Hour Efficacy and Ocular Surface Health with Preservative-Free Tafluprost Alone and in Conjunction with Preservative-Free Dorzolamide/Timolol Fixed Combination in Open-Angle Glaucoma Patients Insufficiently Controlled with Preserved Latanoprost Monotherapy.

IntroductionThe aim of the present study was to evaluate the 24-h efficacy, tolerability, and ocular surface health with preservative-free (PF) tafluprost and a PF triple drug regimen comprising tafluprost and dorzolamide/timolol fixed combination (DTFC) in open-angle glaucoma patients who were insufficiently controlled with preserved branded or generic latanoprost monotherapy and who exhibited signs or symptoms of ocular surface disease (OSD).MethodsProspective, observer-masked, crossover, comparison. Eligible consecutive open-angle glaucoma patients were randomized to either PF tafluprost or the triple PF regimen for 3 months. They were then crossed over to the opposite therapy for another 3 months. At the end of the latanoprost run-in period and after each PF treatment period, patients underwent habitual 24-h intraocular pressure (IOP) monitoring with Goldmann tonometry in the sitting position (at 10:00, 14:00, 18:00, and 22:00) and Perkins tonometry in the supine position (at 02:00 and 06:00). Tolerability and selected ocular surface parameters were evaluated at baseline and the end of each treatment period.ResultsForty-three open-angle glaucoma patients completed the trial. Mean 24-h IOP on preserved latanoprost was 22.2 ± 3.9 mmHg. Compared with latanoprost monotherapy, PF tafluprost obtained a greater reduction in mean, peak, and fluctuation of 24-h IOP including the 02:00 and 06:00 time points (P < 0.05). With the exception of 24-h fluctuation, the triple PF regimen provided significantly lower IOP parameters than latanoprost or PF tafluprost (P < 0.001). Finally, PF tafluprost therapy displayed significantly improved tear film break-up times (6.7 vs 6.0 s), corneal staining (1.3 vs 2.2), and Schirmer I test results (9.1 vs 8.2 mm) compared with the preserved latanoprost baseline (all P < 0.01). The triple PF regimen demonstrated similar tear film break-up times (6.1 vs 6.0 s) and Schirmer I test results (8.2 vs 8.2 mm) to latanoprost, but revealed a significant improvement in the corneal stain test (1.7 vs 2.2; P < 0.001).ConclusionsIn this trial PF tafluprost therapy provided statistically greater 24-h efficacy and improved tolerability compared with preserved latanoprost. The combination of PF tafluprost and PF dorzolamide/timolol fixed combination was statistically and clinically more efficacious than both monotherapies and demonstrated similar ocular surface characteristics to preserved latanoprost monotherapy.Trial registrationClinicalTrials.gov (NCT02802137).FundingSanten.

Orbital Involvement and Ocular Surface Changes in IgG4-Related Systemic Disease

To evaluate ophthalmic involvement of systemic immunoglobulin-G4-related disease (IgG4-RD) and describe the changes in both ocular surface parameters and corneal subbasal nerve plexus. Twenty eyes of 10 patients with systemic IgG4-RD and 20 eyes of 10 control subjects were enrolled in this study. Demographic information, medical history, serum IgG4 levels, orbital imaging, and follow-up data of subjects were recorded. Ocular surface tests were carried out in the order of tear break-up time (BUT), lissamine green (LG) staining, Schirmer I test with anesthesia, and ocular surface disease index (OSDI) questionnaire for all participants. Corneal subbasal nerves and basal epithelial cell layer were evaluated using in vivo confocal microscopy. Among the 10 patients with IgG4-RD, 11 eyes of 7 patients had orbital involvement. Among these 7 patients with IgG4-related ophthalmic disease, 4 presented with painless eyelid or periorbital swelling, 2 with diplopia and restricted ocular motility, and 1 with proptosis. Patients with IgG4-RD had higher OSDI (5.9 ± 6.6 vs. 1.7 ± 2.4, P < 0.001) and LG staining scores (0.7 ± 1.0 vs. 0.0 ± 0.0, P = 0.011) and lower BUT (5.6 ± 1.4 vs. 10.2 ± 1.0, P < 0.001) and Schirmer values (11.9 ± 10.3 vs. 18.3 ± 4.4, P = 0.021) as compared with those of control subjects. Total nerve density and nerve fiber length were found to be significantly lower in patients with IgG4-RD. The orbit is frequently involved during the course of IgG4-RD. These patients should be evaluated in terms of ocular surface disease and dry eye, which may be associated with lacrimal gland and/or orbital nerve involvement.

Observation of Influence of Cataract Surgery on the Ocular Surface

IntroductionTo evaluate meibomian gland function, changes of lacrimal tears and ocular surface parameters and tear inflammatory mediators following cataract surgery.Methods48 eyes of 34 patients who underwent uncomplicated phacoemulsification were involved and divided into 2 groups with those who had preexisting dry-eye before cataract surgery and those who did not. Ocular symptom score, Schirmer I test, tear film break-up time (TBUT), corneal sensitivity threshold, corneal staining, inflammatory cytokine activities, lid margin abnormalities, meibum expressibility, meibum quality and meibomian gland imaging were evaluated preoperatively, at 1 day, 1 and 2 months postoperatively.ResultsOcular symptom scores were worse at 1 and 2 months postoperatively but, TBUT, corneal staining score and corneal sensitivity threshold showed gradual improvements at 1 month and 2 months postoperatively (p<0.05, respectively). Interestingly there were statistically significant improvements in TBUT, corneal staining score and corneal sensitivity threshold at 1 month postoperatively when topical eye drops were used compared to the period without topical therapy which is the months 2 postoperatively. There were statistically significant decreases in IL-1β, IL-6, IL-8, MCP-1, TNF-α and IFN-γ concentrations at 1 and 2 months postoperatively. Lid margin abnormalities, meibum quality and expressibility scores increased significantly (p < 0.05, respectively) at postoperative period. Compared with the no dry eye group, dry eye group revealed significantly higher ocular symptom scores, lower TBUT, higher lid margin abnormalities, meibum quality and expressibility scores after cataract surgery. There were significant correlations between IL-6 and parameters of dry eye, and between MGD parameters and ocular symptom scores.ConclusionsOur study revealed that meibomian gland function is influenced after cataract surgery accompanying structural changes and these were correlated with increased ocular symptom scores. Therefore, it could elucidate the development of dry eye related to cataract surgery.

A distinct cytokines profile in tear film of dry eye disease (DED) patients with HIV infection

PurposeTo investigate the tear cytokine profile in HIV patients with dry eye disease (DED) and study the association between the severity of ocular inflammatory complications and tear cytokines levels. We postulate that HIV-mediated inflammation may be the underlying pathogenic mechanism for HIV-associated DED. MethodsThe current prospective case-control study compared tear film cytokine profiles in DED patients with HIV infection (n=34) and age/gender-matched DED patients without HIV infection [controls (n=32)]. Participants were recruited from tertiary referral eye care centre and communicable disease clinics, Singapore. Ocular surface health was documented using tear film, Schirmer’s test, corneal staining, and conjunctival injection measurements. Tear samples were collected using Schirmer’s strips and analysed for the levels of 41 cytokines using Luminex bead assay. Logistic regression models were performed to determine correlation and significance. ResultsAmong the 41 cytokines analysed, statistically significant differences were observed in the mean values of epithelial growth factor (EGF), growth related oncogene (GRO) and interferon gamma-induced protein 10 (IP-10). EGF and IP-10 levels were higher and GRO levels were lower in the tears of DED patients with HIV infection compared to DED patients without HIV infection. No significant association was found between varying levels of ocular surface parameters and cytokine concentrations in HIV patients with DED (p>0.05). ConclusionsEGF and IP-10 were significantly elevated and GRO levels were lower in the tear profile of HIV patients with DED compared to immunocompetent patients with DED. This study suggests a novel cytokine driven paradigm for ocular inflammatory complications of HIV infection. Additional studies in large organised cohorts can validate the results.

Effects of Pigment Location in Tinted Contact Lenses on the Ocular Surface.

To evaluate the effects of the location of pigments in decorative tinted soft contact lenses on the ocular surface. Thirty test subjects were enrolled in this study. All subjects wore the following types of contact lenses, classified according to the location of the pigment layer, in one eye in three different testing sessions: conventional clear lenses, tinted lenses with a pigment layer embedded in the lens matrix, and tinted lenses with an exposed pigment layer on the surface. Tear samples were collected, the ocular surface status was evaluated, and subjective symptoms were surveyed after lens wear for 8 hours. The tinted lenses with surface pigments resulted in a greater increase in epidermal growth factor and interleukin-8 levels compared with the clear lenses and tinted lenses with embedded pigments (p < 0.050). Ocular surface parameters and subjective symptom scores were significantly different among three lens types (p < 0.050), with the clear lenses showing superior results compared with the two tinted lenses (p < 0.050). The tinted lenses with exposed pigments resulted in a greater degree of conjunctival redness and ocular surface staining and poorer symptom scores compared with the tinted lens with embedded pigments (p < 0.050). Our results suggest that the presence of surface pigments in tinted contact lenses increases ocular inflammation and results in a poorer ocular surface status and greater discomfort compared with clear lenses and tinted lenses with an embedded pigment layer.

The Impact of Visual Guided Order Picking on Ocular Comfort, Ocular Surface and Tear Function

PurposeWe investigated the effects of a visual picking system on ocular comfort, the ocular surface and tear function compared to those of a voice guided picking solution.DesignProspective, observational, cohort study.MethodSetting: Institutional. Study Population: A total of 25 young asymptomatic volunteers performed commissioning over 10 hours on two consecutive days. Main Outcome Measures: The operators were guided in the picking process by two different picking solutions, either visually or by voice while their subjective symptoms and ocular surface and tear function parameters were recorded.ResultsThe visual analogue scale (VAS) values, according to subjective dry eye symptoms, in the visual condition were significantly higher at the end of the commissioning than the baseline measurements. In the voice condition, the VAS values remained stable during the commissioning. The tear break-up time (BUT) values declined significantly in the visual condition (pre-task: 16.6 sec and post-task: 9.6 sec) in the right eyes, that were exposed to the displays, the left eyes in the visual condition showed only a minor decline, whereas the BUT values in the voice condition remained constant (right eyes) or even increased (left eyes) over the time. No significant differences in the tear meniscus height values before and after the commissioning were observed in either condition.ConclusionIn our study, the use of visually guided picking solutions was correlated with post-task subjective symptoms and tear film instability.

Intolerant contact lens wearers exhibit ocular surface impairment despite 3 months wear discontinuation.

To evaluate ocular surface (OS) parameters recovery in intolerant contact lens (CL) wearers after a period of discontinuation. This is a retrospective analysis of data from 87 intolerant CL wearers who had discontinued their use for an average period of 12weeks because of associated discomfort and failure to successfully refit. Data were collected from clinical charts. Data from 50 matched healthy volunteers served as controls. Clinical tests included subjective discomfort symptoms questionnaire (Ocular Surface Disease Index, OSDI), Schirmer test, break-up time (BUT), corneal esthesiometry and corneo-conjunctival staining. Laboratory tests included scraping and imprint cytology. Tear protein analysis included dosage of total tear protein (TP), lysozyme-C (LYS-C), lactoferrin (LACTO), zinc-α2-glycoprotein (ZAG-2), IgA heavy chain bands (Ig-A), and serum albumin (ALB). Data were correlated to wear parameters. All values were significantly worse in intolerant CL wearers group (p always <0.001). In particular, lower values compared to controls were found for BUT, corneal esthesiometry, goblet cell density, LYS-C, LACTO, ZAG-2, and TP. On the contrary, higher values compared to controls were found for OSDI, staining, imprint cytology, scraping cytology, ALB, IgA-heavy chain. The IgA/LYS-C ratio calculated as an index of the increased activity of the IgA-producing cell was found significantly higher in the intolerant group and in correlation with discomfort symptoms. Ocular surface parameters were altered in intolerant CL wearers, even after a prolonged discontinuation period. Our data suggest that OS recovery necessary to successfully refit lenses may need a discontinuation time longer than 3months.

Meibomian gland dysfunction and tear cytokines after cataract surgery according to preoperative meibomian gland status.

To investigate the possible mechanisms by which cataract surgery aggravates meibomian gland dysfunction (MGD), we evaluated the changes in tear cytokines and ocular surface parameters after cataract surgery according to the preoperative MGD grade. Prospective, observational case series. A total of 50 eyes from 50 patients who underwent cataract surgery were included. Patients were classified into two groups: Group I had no or minimal MGD, and group II had grades 2-4 MGD. Ocular surface parameters were measured, including tear film break-up time, Schirmer I test, ocular surface staining and Ocular Surface Disease Index, and tear cytokine levels were measured. The main outcomes were changes in ocular surface parameters and inflammatory tear cytokine concentrations. In group II, preoperative MGD grade, ocular surface staining, tear film break-up time and Ocular Surface Disease Index were worse, and mean interleukin (IL)-2, IL-6 and TNF-α levels were higher than those of group I. MGD and ocular surface parameters were worsened to a greater degree after surgery in group II than in group I (P < 0.050). In group II, IL-6 and TNF-α levels significantly increased at postoperative 1 month, and there were significant correlations between changes in ocular surface parameters and tear cytokines (IL-2, IL-6 and TNF-α; P < 0.050). The extent to which the MGD grade was aggravated following cataract surgery differed based on preoperative MGD grade. Preoperative MGD and ocular surface status should be carefully evaluated.

Dry Eye Disease Is Already Present in Hematological Patients Before Hematopoietic Stem Cell Transplantation.

To analyze ocular surface parameters in patients before hematopoietic stem cell transplantation (HSCT) and to correlate them with hematological characteristics. This is a retrospective analysis of prospectively collected data from 203 patients undergoing HSCT. Demographic data and hematological parameters (disorder type and stage) were collected from clinical charts. Ocular surface parameters (ocular surface disease index; Schirmer test I; tear film break-up time; corneal esthesiometry; and corneal and conjunctival staining) were analyzed the day before beginning the conditioning treatment for HSCT preparation. A high prevalence of dry eye (DE) was found: 116 patients (57.2%) were diagnosed as not suffering from DE, whereas 87 patients (42.8%) were diagnosed as having DE. Of these, 26 were classified as dry eye workshot (DEWS) severity score 1, 46 as DEWS score 2, and 15 as DEWS score 3. Tear film break-up time was found to be the only parameter statistically worse in the chronic lymphoproliferative disorder group compared with the stem cell malignancy group. Older age [odds ratio (OR) 1.03], female sex (OR 2.03), advanced stage of hematological disease (OR 1.4), and previous auto- or allo-HSCT (OR 1.9) showed a significant positive association in predicting DE onset before transplantation. DE was already present in a significant number of patients suffering from hematological disease before HSCT. Some hematological parameters seemed to influence this percentage. These results highlight the role of ocular surface examination by an ophthalmologist in hematological patients before HSCT, with the aim of diagnosing and, if necessary, treating DE patients early.

The Effects of Gender, Age, and Refractive Error on Corneal and Conjunctival Epithelial and Overall Thicknesses

Objective: To evaluate the corneal, conjunctival epithelial and overall thicknesses measured by anterior segment optical coherence tomography (OCT) in healthy population. Methods: This retrospective study included 134 eyes of 134 healthy individuals who were undergone a Cirrus HD-OCT examination using the Anterior Segment 5 Line Raster protocol. Corneal, conjunctival epithelial and overall thicknesses were measured on OCT images. The average values of four OCT parameters were compared between sexes and among the six subgroups with respect to age. Results: The average corneal epithelial and overall thicknesses were 51.30±4.60 μm and 532.47±37.30 μm, respectively. The average conjunctival epithelial and overall thicknesses were 47.20±8.03 μm and 237.07±40.62 μm, respectively. All of the measurements were thicker in males compared to females, however the significant difference was found for only corneal epithelium (p=0.043). Using the Spearman correlation coefficient, central corneal and conjunctival epithelial thicknesses showed significant negative correlations with age (p=0.006, p=0.005, respectively) and refraction (p=0.040, p=0.033, respectively). Conclusion: Ocular surface parameters measured by anterior segment OCT were gender, age, and refraction-related. Thus, further studies conducted to evaluate the corneal and conjunctival thicknesses should involve gender, age, and refraction-matched control groups. J Clin Exp Invest 2016; 7 (1): 78-82 Key words: Anterior segment optical coherence tomography, epithelial thickness, spherical equivalent

The Effects of Gender, Age, and Refractive Error on Corneal and Conjunctival Epithelial and Overall Thicknesses

Objective: To evaluate the corneal, conjunctival epithelial and overall thicknesses measured by anterior segment optical coherence tomography (OCT) in healthy population. Methods: This retrospective study included 134 eyes of 134 healthy individuals who were undergone a Cirrus HD-OCT examination using the Anterior Segment 5 Line Raster protocol. Corneal, conjunctival epithelial and overall thicknesses were measured on OCT images. The average values of four OCT parameters were compared between sexes and among the six subgroups with respect to age. Results: The average corneal epithelial and overall thicknesses were 51.30±4.60 μm and 532.47±37.30 μm, respectively. The average conjunctival epithelial and overall thicknesses were 47.20±8.03 μm and 237.07±40.62 μm, respectively. All of the measurements were thicker in males compared to females, however the significant difference was found for only corneal epithelium (p=0.043). Using the Spearman correlation coefficient, central corneal and conjunctival epithelial thicknesses showed significant negative correlations with age (p=0.006, p=0.005, respectively) and refraction (p=0.040, p=0.033, respectively). Conclusion: Ocular surface parameters measured by anterior segment OCT were gender, age, and refraction-related. Thus, further studies conducted to evaluate the corneal and conjunctival thicknesses should involve gender, age, and refraction-matched control groups. J Clin Exp Invest 2016; 7 (1): 78-82 Key words: Anterior segment optical coherence tomography, epithelial thickness, spherical equivalent