Comparison between Tear Film Osmolar Cocentration and Other Tear Film Function Parameters in Patients with Diabetes Mellitus

PURPOSE: To evaluate tear film function in patients with diabetes mellitus (DM) using tear film osmolarity (TFO) measurements compared to other tear film function tests. METHODS: DM patients without any history of ocular surface disorder but with potential effects on the tear film were enrolled in this cross-sectional study. Data including dry eye symptoms, duration of DM, stage of diabetic retinopathy and blood hemoglobin A1c levels were recorded. Tear film break-up time (TBUT) and basic tear secretion (Schirmer test) were assessed. TFO was determined using the Tearlab Osmolarity System. The outcome measures were the difference between the mean values of TBUT, basic tear secretion and TFO in both the study and control groups. RESULTS: We recruited 51 DM patients and 20 control subjects with a mean age of 51.2 (range, 21 to 70) and 48.5 (range, 24 to 70) years, respectively. A total of 27 patients (53%) and 11 controls (55%) reported dry eye symptoms (p = 0.668). The mean TBUT was 10.2 ± 4.8 seconds in the study group versus 10.5 ± 2.8 seconds in controls, which was not significantly different (p = 0.747). The mean Schirmer test score was 8.1 ± 4.3 mm in the patients versus 10.1 ± 3.0 mm in the controls (p = 0.069). The mean TFO was 294.1 ± 12.9 mosmol/L in the patients versus 291.4 ± 14.5 mosmol/L in the controls (p = 0.456). It was significantly higher in patients with poor glycemic control determined by hemoglobin A1c > 8% (p = 0.003). TFO had a positive correlation with the duration of DM (p = 0.030) but not with the stage of diabetic retinopathy (p = 0.944). However, TFO showed a significant relationship with dry eye symptoms (p = 0.001). CONCLUSIONS: TFO is impaired in patients with uncontrolled DM and is better correlated with glycemic control and dry eye symptoms than the TBUT and Schirmer tests.

effect of intravitreal bevacizumab injection on the corneal endothelial cells: systematic review

Introduction:Bevacizumab [Avastin], as an effectiveness treatment modality, is currently used in patients with various ocular disease. However the results have been promising, the use of bevacizumab in the treatment of ocular disease is an off-label application. Hence, the aim of this study was to systematically review the effectiveness of intravitreal injection of bevacizumab on various ocular tissues, especially corneal endothelial cells

Methods: The articles related to the effect of application of Avastin in the treatment of ophthalmic diseases and especially its effect on corneal endothelial cells were collected and reviewed. We searched PubMed, Google scholar, and Scopus databases and used Avastin, ocular diseases and corneal endothelial cells as search keywords

Result: Of all 55 articles found in all databases, only 10 were relevant to the purpose of this study, and 45 articles were excluded in several step by step process of article selection according to the inclusion/exclusion criteria. The results revealed that intracameral bevacizumab injection caused no changes in specular microscopy and corneal pachymetry. Moreover, it had no significant toxicity on corneal endothelial cells

Discussion: Effectiveness of bevacizumab as a new modality in the treatment of different ophthalmic diseases have been suggested. Recent data on both human and animal models showed that intravitreal injection of bevacizumab resulted in no significant toxicity on various ocular cells, and it could be considered as a suitable therapeutic approach in clinical use

Conclusion: According to the results of included documents, bevacizumab was not toxic to corneal endothelial cells at various clinically relevant doses

Short-term outcomes of collagen crosslinking for early keratoconus

To assess the efficacy of collagen crosslinking with riboflavin and ultraviolet A [UVA] radiation for treatment of early keratoconus. Thirty-one eyes of 22 patients with early keratoconus were included in this study. All patients underwent slit lamp examination and assessment of uncorrected visual acuity [UCVA], best spectacle-corrected visual acuity [BSCVA], intraocular pressure, corneal topography and pachymetry. Collagen crosslinking was performed without epithelial removal. Riboflavin was applied to the cornea every 3 minutes 30 minutes before UVA irradiation and every 5 minutes thereafter. Patients were re-assessed 1, 3, and 6 months after treatment. Postoperatively, UCVA increased by 2 Snellen lines and BSCVA was improved by 1.7 Snellen lines [P < 0.001]. Spherical equivalent refractive error was reduced by 0.55 D, and maximum and mean K values were decreased by 0.65 D and 0.51 D respectively [P < 0.05 for all comparisons]. Evidence of regression was present in 71% of treated eyes. Collagen crosslinking demonstrated significant improvement in vision with reduction in corneal power and spherical equivalent refractive error in eyes with early keratoconus

Mycotic keratitis, a study on etiologic agents, predisposing factors and the result of treatment among 44 patients

Mycotic Keratitis is a suppurative, usually ulcerative, and sight threatening infection of cornea that sometimes leads to loss of vision. The peak of incidence is observed in the tropical and subtropical regions. To investigate the etiological agent, predisposing factors and treatment follow up of mycotic keratitis; this study was undertaken over a period of 2 years in Mashhad. In this prospective, cross sectional study, among 466 individuals suffering from keratitis,65 patients, highly suspected to mycotic keratitis were examined by direct fresh smear [KOH 10%] and culture in Mycology Media. The results were analyzed by SPSS method. Among 65 clinically suspected individuals, the results of direct smear and culture of 44 patients were positive, of patients, 21 were male [47.1%] and 24 were female [52.3%]. The patients were between 8 to 84 years old. More than 40% of them were farmers. Trauma was the most common predisposing factor in more than 47% of cases due to vegetable materials. Molds and Yeasts were isolated from 86.4% and 13.6% of the samples respectively. Fusarium spp. were the most frequent isolates [44.4%].Others included Aspergillus spp. [21.8%], Acremonium spp. [8.3%], Penicillium spp. [5.6%] and Candida albicam [13.9%]. Tearing and redness were the most common symptoms observed [93.2%]. Amphotricin B was used in patients with Aspergillus and Candida Keratitis., but for Fusarium and other molds keratitis, Natamycin was used for 6 to 12 weeks. In one patient with Fusarium Keratitis, medical therapy was failed and therapeutic penetrating keratoplasty was performed. Six months follow up showed that prognosis was good in all of the patients. In relation to the last decade, the incidence of Mycotic Keratitis is increased in Mashhad. Keratitis due to the molds is more prevalent than yeast keratitis. Entrance of foreign body [Plant particles] is the most common predisposing factor. However, it needs long term therapy but the prognosis is good

Prevalence of visual impairment in low birth weight and normal birth weight school age children

Studies demonstrated that 5-10% of preschool children have visual impairment. By age seven, up to 13% of children will have some defect in visual acuity. Both prematurity and low birth weight have been associated with an increased incidence of ophthalmic disorders. In this study we determined prevalence of visual impairment in low birth weight and normal birth weight school age children in Mashhad. This is a cross sectional study. The target population consisted of all children referred to educational organizations for screening before entering school in Mashhad, Iran. 2400 children enrolled in the study and were evaluated for amblyopia, refractive errors, color vision disturbance and optic nerve problems. Data were analyzed by SPSS. Prevalence of ophthalmic problems in all children was 5.43% and in low birth weight and normal birth weight 8.29% and 5.74% respectively. Incidence of ophthalmic problems was significantly [P=0.029] higher in low birth weight children than in normal birth weight children. The most common ophthalmic disease in both low birth weight and normal birth weight children was refractive errors 81.5% vs. 68.8% [P<0.05]. Prevalence of myopia, amblyopia and color vision disturbance was also higher in low birth weight than in normal birth weight children. Low birth weight children are at greater risk of the visual impairment that may occur at an early age and result in long term morbidity. Visual outcome of low birth weight neonates should be evaluated routinely