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ABSTRACT Purpose: To evaluate the effects of suturing 23-gauge pars plana vitrectomies on ocular discomfort and tear film dynamics. Methods: This retrospective chart review involved data from 50 procedures in 50 patients who underwent 23-gauge pars plana vitrectomy from January to November 2016. We divided the eyes into two groups according to the presence or absence of sutures; 35 eyes underwent sutureless vitrectomies (Group 1), and 15 eyes underwent vitrectomy with at least one sclerotomy suture site (Group 2). In each group, we assessed objective variables including tear film break-up time, Schirmer test I, corneal surface grading with Oxford system, and a quantitative method evaluating subjective dry eye symptoms using ocular surface disease index questionnaires preoperatively 1 week, and 1 and 3 months after surgery. Results: The tear film break-up time showed a significant difference at the 3-months follow-up (p=0.026). The Schirmer test I and corneal surface staining score showed no statistically significant differences between two groups at any time after the operations. The ocular surface disease index score was significantly lower in Group 1 than in Group 2 at 1 week (p=0.032), 1 month (p=0.026), and 3 months (p=0.041) after the operation. Conclusion: Sclerotomy suturing caused ocular discomfort and had a negative effect on tear film dynamics during the late postoperative period. Sclerotomies without suturing seem to reduce the ocular surface changes.
RESUMO Objetivo: Avaliar os efeitos da sutura da vitrectomia via pars plana de 23-gauge sobre o desconforto ocular e a dinâmica do filme lacrimal. Métodos: Esta revisão retrospectiva de prontuários envolveu dados de 50 casos em 50 pacientes submetidos à vitrectomia via pars plana de 23-gauge, de janeiro a novembro de 2016. Dividimos os olhos em dois grupos de acordo com a presença ou ausência de suturas; 35 olhos foram submetidos à vitrectomia sem sutura (Grupo 1) e 15 olhos foram submetidos à vitrectomia com pelo menos um ponto de sutura no local da esclerotomia (Grupo 2). Em cada grupo, avaliamos variáveis objetivas incluindo tempo de ruptura do filme lacrimal, teste de Schirmer I, gradação da superfície corneana com o sistema Oxford e um método quantitativo avaliando sintomas subjetivos de olho seco usando questionários de índice de doença da superfície ocular nos períodos: 1 semana do pré-operatório, 1 mês e 3 meses após a cirurgia. Resultados: O tempo de ruptura do filme lacrimal apresentou diferença significativa no seguimento de 3 meses (p=0,026). O teste de Schirmer I e o escore da coloração da superfície da córnea não mostraram diferenças estatisticamente significativas entre os dois grupos em nenhum momento após as operações. O escore do índice de doença da superfície ocular foi significativamente menor no Grupo 1 em relação ao Grupo 2 no período de 1 semana (p=0,032), 1 mês (p=0,026) e 3 meses (p=0,041) após a cirurgia. Conclusão: A sutura da esclerotomia causou desconforto ocular e teve um efeito negativo na dinâmica do filme lacrimal durante o período pós-operatório. Esclerotomias sem sutura parecem reduzir as alterações da superfície ocular.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Tears/physiology , Vitrectomy/adverse effects , Sclerostomy/adverse effects , Suture Techniques/adverse effects , Postoperative Complications/etiology , Time Factors , Vitrectomy/methods , Sclerostomy/methods , Dry Eye Syndromes/etiology , Dry Eye Syndromes/physiopathology , Surveys and Questionnaires , Retrospective Studies , Follow-Up Studies , Suture Techniques/instrumentation , Treatment Outcome , Statistics, NonparametricABSTRACT
Background Meibomain gland is a specially differentiated sebaceous gland lying in the tarsus of upper and lower eyelid.The morphological changes of the gland is associated with a variety of ocular surface diseases.Studying the relationship of morphological and functional change of meibomain gland with ocular surface is of great significance.Objective This study was to observe the change of morphology,structure and function of meibomain gland over aging and investigate the assocation of meibomain gland abnormality with ocular surface.Methods A prospectively cases-observational study was performed.Ninety-three eyes of 93 patients with age-related cataract aged 45 and older were enrolled in Shanxi Eye Hospital from March to September 2016 under the informed consent.The patients were divided into 45 to 59-year group and ≥60-year group according to age or meibomian gland loss ≥ 1/3 group and meibomian gland loss ＜ 1/3 group.The ocular anterior segment,lid margin,meibomian gland orifices and lipids traits were examined by slit-lamp microscope.The ocular surface symptoms were assessed and scored by Ocular Surface Disease Index (OSDI) scale.The break-up time of tear film (BUT),tear meniscus height,meibomian gland dropout degree,conjunctival hyperemia and corneal fluorescence staining scores were measured using ocular surface analyzer.Results No dry eye symptom was complained in all the subjects,and their OSDI scores were ＜12.No abnormal changes at the lid margin and the muco-cutaneous junction were observed.No abnormality of the meibomian gland orifices,the lipids traits and drainage was observed under the slit-lamp microscope.BUT was shortened in 42 eyes (45.16％);tear meniscus height was lowed in 52 eyes (55.91％);meibomian gland loss range was ≥1/3 in 58 eyes (62.27％).The meibomian gland loss scores were 1.65±0.79 in the 45 to 59-year group and 1.86±0.72 in the ≥60-year group,showing an insignificant difference between them (t =1.301,P =0.197).But when coming to the correlation analysis,a positive correlation was found between meibomian gland loss scores and age (rs =0.323,P=0.002),and no correlations were seen between age and BUT or tear meniscus height (rs =0.154,P =0.141;rs=-0.024,P =0.821).In addition,meibomian gland loss scores showed a negative correlation with mean BUT (rs =-0.251,P =0.015).The eye number of BUT abnormality in the meibomian gland loss ≥ 1/3 group was more than that in meibomian gland loss ＜1/3 group (P =0.018).Conclusions Meibomian gland loss is more serious over aging in middle aged and elderly population,and serious meibomian gland loss increases the risk of tear film instability.The early meibomain gland dysfunction-like signs occur prior to symptoms,which should raise concern in clinical work.
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ABSTRACT Purpose: Polycystic ovary syndrome (PCOS) is an endocrine disease characterized by chronic anovulation and hyperandrogenism. Hormonal changes can affect tear function. This study evaluates tear function and impact of hyperandrogenism on it in PCOS patients. Methods: Fifty patients with PCOS and thirty control volunteers were examined for tear break-up time, Schirmer-I and tear osmolarity. Also, serum levels of total testosterone, FSH, LH and AMH were determined in venous blood samples in the early follicular phase. PCOS patients were divided into two groups by plasma total testosterone level: Group A with normal (≤0.513 ng/ml;n=27), Group B with higher hormone level (>0.513 ng/ml;n=23). Healthy control group indicated as Group C (n=30). Results: LH, total testosterone levels were higher in the PCOS group than in the control group (p=0.012; p=0.025). Mean values of tear break-up time and Schirmer-I were different between groups and especially Group A and C were near to each other differing from B (p>0.05). Tear osmolarity results were higher in Group B, compared to A and C (p=0.049; p=0.033). No significant difference detected in tear osmolarity value means of Group A and C (p=0.107). AMH levels were higher in Group B, compared to A and C (p=0.002; p=0.001). AMH levels in Group A were higher than that of C (p=0.002). Positive correlation between levels of total testosterone and AMH was detected in all PCOS patients (n=50;Pearson's r=0.579; p<0.001). Conclusion: Tear function can be affected in PCOS patients with hyperandrogenism. Tear osmolarity is the most sensitive and objective assessment method for ocular surface changes in PCOS.
RESUMO Objetivo: A síndrome do ovário policístico (SOP) é uma doença endócrina caracterizada por anovulação crônica e hiperandrogenismo. As alterações hormonais podem afetar a função cardíaca. Este estudo avalia a função lacrimal e o impacto do hiperandrogenismo sobre ela em pacientes com SOP. Métodos: Cinquenta pacientes com SOP e trinta voluntárias de controle foram examinadas para tempo de ruptura lacrimal, Schirmer-I e osmolaridade lacrimal. Além disso, os níveis séricos de testosterona total, FSH, LH e HAM foram determinados em amostras de sangue venoso na fase folicular precoce.As pacientes com SOP foram divididas em dois grupos por nível de testosterona plasmática total: Grupo A com nível normal (≤0.513 ng/ml; n = 27), Grupo B com nível superior de hormônio (> 0,513 ng/ml; n = 23). Grupo de controle saudável indicado como Grupo C (n = 30). Resultados: Os níveis de LH e testosterona total foram maiores no grupo com SOP do que no grupo controle (p = 0,012; p = 0,025). Os valores médios de tempo de ruptura lacrimal e Schirmer-I foram diferentes entre os grupos, e especialmente os Grupos A e C estavam próximos um do outro, diferente do B (p > 0,05). Os resultados de osmolaridade lacrimal foram maiores no Grupo B, em comparação com A e C (p = 0,049; p = 0,033). Não houve diferença significativa detectada em valor médio de osmolaridade lacrimal nos Grupos A e C (p = 0,107). Os níveis de HAM foram maiores no Grupo B, em comparação com A e C (p = 0,002; p = 0,001). Os níveis de AMH no Grupo A foram superiores aos de C (p = 0,002). Uma correlação positiva entre os níveis de testosterona total e AMH foi detectada em todas as pacientes com SOP (n = 50; Pearson's r = 0,579; p < 0,001). Conclusão: a função lacrimal pode ser afetada em pacientes com SOP com hiperandrogenismo. A osmolaridade lacrimal é o método de avaliação mais sensível e objetivo para alterações da superfície ocular em SOP.
Subject(s)
Humans , Female , Adult , Osmolar Concentration , Polycystic Ovary Syndrome/complications , Tears/physiology , Hyperandrogenism/complications , Meibomian Glands/physiology , Tears/metabolism , Testosterone/blood , Luteinizing Hormone/blood , Dry Eye Syndromes/diagnosis , Dry Eye Syndromes/etiology , Hyperandrogenism/etiology , Anti-Mullerian Hormone/blood , Slit Lamp Microscopy , Follicle Stimulating Hormone/bloodABSTRACT
Background The incidence of dry eye is increasing among young adults because of wide usage of video display terminal.But the early diagnosis of dry eye still presents challenge to medical practitioners.The accurate diagnosis and treatment of the dry eye,therefore,is a topic of high interest to researchers.Previous examination outcome of dry eye is interferred primarily due to invasive procedure.It is very important to search an examination approach.Objective This study was to use Keratograph 5M,a non-invasive ocular surface analyzer to evaluate the influence of watching video display terminal on ocular surface and tear film.Methods Eighty-one eyes of 81 health volunteers among 18-30 years were enrolled in Affiliated Eye Hospital of Nanchang University from March 1,2015 to November 10,2015 under the informed consent,including 39 males and 42 females.The subjects watched the computer for continuously 3 hours under the nature light,and ocular surface related examinations were performed and compared before and after video display terminal exposure,including non-invasive tear film break-up time (NITBUT),tear meniscus height,conjunctival hyperemia scoring,limbal congestion scoring,corneal fluorescein staining scoring,meibomian gland imaging and lipid layer analysis.Results The number of eyes with visual fatigue,dryness,pain,blurring and conjunctival congestion was significantly increased after 3-hour video display terminal exposure in comparison with before (all at P＜0.01).The initial NITBUT and mean NITBUT were (6.086± 3.701) s and (9.103 ± 4.680) s,and tear meniscus height was (0.190 ± 0.032) mm after trail,which were significantly lower than (11.445 ±4.964) s,(14.626 ±4.467) s and (0.212 ±0.040) mm of before trail,respectively;The conjunctical hyperemia scoring and limbal congestion scoring were 0.869 ±0.311 and 0.572 ±0.276 after trial,which were significantly higher than 0.780 ± 0.306 and 0.509 ± 0.266 before trail,showing significant differences before and after exposure of video display terminal (all at P＜0.01).The intraocular pressure and the eye number of different scores of corneal fluorescence staining,abnormal meibomian gland and different morphological lipid layer of tear were unchanged before and after exposure of video display terminal.Conclusions Long-term exposure of video display terminal results in significant and temporary adverse influence on tear film and ocular surface.Keratograph 5M non-invasive ocular sudace analyzer can objectively assess overall ocular surface conditions.
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Purpose: To evaluate the acute impact of the wildfire smoke episode in 2008 on the ocular surface of subjects living in the Metropolitan Area of Buenos Aires (MABA). Methods: A total of 86 subjects were evaluated: Group 1 comprised patients from a public ophthalmology hospital (N=35) and Group 2 comprised healthy volunteers (N=51). All subjects answered a questionnaire on ocular symptoms and underwent ophthalmologic examination [bulbar conjunctival hyperemia, corneal fluorescein staining, rose bengal vital staining, tear break-up time (TBUT), Schirmer I test, tear lysozyme, and impression cytology] during and after the acute episode. Concentrations of carbon monoxide (CO), nitrogen dioxide (NO2), and particulate matter (PM) were measured before, during, and after the acute episode. Results: Both groups showed a statically significant increase in ocular symptoms and bulbar conjunctival hyperemia and a statically significant decrease in tear break-up time during the acute episode. Group 1 showed more severe symptoms and a statistically significant increase in fluorescein and rose bengal staining intensities during the acute episode. We found a significant negative correlation between ocular symptoms and tear break-up time. During the episode, the levels of CO, NO2, and particulate matter in MABA were four times higher than the usual average levels for the same period in 2007 and 2009. Conclusions: Increased air pollution from the burning of biomass is associated with a decrease in the stability of the tear film (TBUT), generating areas of ocular surface exposure that may be the cause of the increased feeling of irritation. Group 1 was more affected by not having a healthy ocular surface, and thus consulted an ophthalmologist. Cytological changes in the conjunctiva were not observed, which could be due to the short duration of the episode. .
Objetivo: Avaliar os efeitos agudos da fumaça do episódio de incêndio violento ocorrido em 2008, sobre a superfície ocular de sujeitos que vivem na Região Metropolitana de Buenos Aires (MABA). Métodos: Um total de 86 indivíduos foram avaliados: Grupo 1: pacientes de um hospital público de oftalmologia (N=35) e Grupo 2: voluntários saudáveis (N=51). Todos os participantes responderam a um questionário sobre os sintomas oculares e foram submetidos a exame oftalmológico (hiperemia conjuntival bulbar, teste de fluoresceína, corante rosa bengala, tempo de ruptura do filme lacrimal (TBUT), teste de Schirmer I, lisozima lacrimal e citologia de impressão) durante e após o episódio agudo. As concentrações de monóxido de carbono, dióxido de nitrogênio e partículas (PM) foram medidas antes, durante e após o episódio agudo. Resultados: Ambos os grupos apresentaram aumento estatisticamente significativo dos sintomas oculares, hiperemia conjuntival bulbar, e diminuição estatisticamente significativa no tempo de ruptura do filme lacrimal durante o episódio agudo. Grupo 1 apresentou maior intensidade dos sintomas e aumento estatisticamente significativo no teste de fluoresceína e rosa bengala durante o episódio agudo. Encontramos uma correlação negativa significativa entre os sintomas oculares e tempo de ruptura do filme lacrimal. Durante o episódio agudo de 2008, os níveis de CO, NO2 e PM na Região Metropolitana de Buenos Aires foram 4 vezes maiores do que os níveis médios habituais para o mesmo período de 2007 e 2009. Conclusões: O aumento da poluição do ar a partir da queima de biomassa está associado a uma diminuição da estabilidade do filme lacrimal (TBUT) gerando zonas da exposição da superfície ocular, que podem ser a causa do aumento da sensação de irritação. Grupo 1 foi mais afetado por não ter superfície ocular saudável e, portanto, consultaram um oftalmologista. Mudanças citológicas da conjuntiva não foram observadas e isso poderia ser devido ...