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Purpose: This present prospective, cross-sectional study aims to comprehensively evaluate the ocular surface in asymptomatic patients with diffuse blebs after trabeculectomy versus chronic anti?glaucoma medication use and compare it with the age?matched normal population. Methods: Objective clinical evaluation was done by tear film break?up time (TBUT) and Schirmer’s test (ST) in the three groups– trabeculectomy >6 months with a diffuse bleb (Wurzburg bleb classification score ?10), chronic anti?glaucoma medication (AGM >6 months) group, and normal population. In all groups, tear film osmolarity was checked with the TearLab® device (TearLab Corp., CA, USA), and subjective evaluation was performed by administering Ocular Surface Disease Index (OSDI) questionnaire. Patients already on chronic lubricants or any other drug for the treatment of dry eyes (viz. steroids, cyclosporin) or having symptoms suggestive of an abnormal ocular surface, who had undergone refractive or intraocular surgery, and contact lens users were excluded. Results: In total, 104 subjects/eyes were recruited over 6 weeks. Thirty?six eyes recruited in the trab group were compared with 33 eyes studied in the AGM group, and both these groups were compared to 35 normal eyes. When compared to normals, TBUT and ST were significantly lower (P = 0.003 and 0.014) and osmolarity and OSDI were statistically significantly higher (P = 0.007 and 0.003) in the AGM group, whereas only TBUT was statistically significantly different (P = 0.009) when the trab group was compared to normals. Also, when the trab group was compared to the AGM group, ST was found to be higher (P = 0.003) and osmolarity was lower (P = 0.034). Conclusion: To conclude, ocular surface is affected even in asymptomatic patients on AGM but near normalcy is possible following trabeculectomy when blebs are diffuse.
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Purpose: Dry eye disease (DED) is because of a decrease in the tear film’s volume or a change in the composition of tears. Evaporative dry eye is the most common type, which is due to meibomian gland dysfunction (MGD). In this study, the morphology of meibomian glands was evaluated in all kinds of dry eyes to look for any loss of meibomian glands, assess the function of remaining glands, and investigate the relationship between anatomy, function, and severity of DED. Methods: A total of 300 patients were included in the study, with 150 eyes in the study group and 150 in the control group. Meibomian gland morphology was assessed by examining the tarsal plate after everting the eyelids. Tear film function was evaluated using tear film break?up time (TBUT) and Schirmer’s test (SCH I and II). Meibomian gland morphology was examined with a slit?lamp under magnification, a transilluminator using a small light emitting diode (LED) bulb, and non?contact meibography using an auto refracto?keratometer (ARK). Results: Females had a higher prevalence of dry eyes in our study. In all, 103 eyes (68.6%) in the study group had evaporative dry eye, making it the most prevalent type. Among the 150 controls, 104 controls with 69.3% had no dry eye symptoms, and in those with symptoms, the evaporative type was the most common, with a 28% prevalence. Conclusion: TBUT should be performed in all patients with detectable MG abnormality. Meibography has high specificity and sensitivity to diagnose MGD and in turn dry eyes and should be considered a routine screening modality.
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AIM: To investigate the postoperative ocular surface changes in acute attack eye and contralateral eye with primary angle-closure glaucoma(PACG)and cataract.METHODS: A total of 40 patients with monocular acute PACG combined with cataract who admitted to Zhengzhou Central Hospital Affiliated to Zhengzhou University from January 2021 to January 2022 were selected. Trabeculectomy combined with phacoemulsification and intraocular lens implantation was carried out in the acute attack eyes, and phacoemulsification and intraocular lens implantation were carried out in the contralateral eyes. The ocular surface disease index(OSDI)questionnaire, noninvasive first tear film break-up time(NifBUT), noninvasive average tear film break-up time(NiaBUT)and tear meniscus height(TMH)were assessed preoperatively and 1, 3 and 6mo postoperatively.RESULTS: The OSDI scores of the included patients at 1 and 3mo postoperatively(14.72±3.07, 11.39±2.24)were significantly higher than those preoperatively(9.68±1.98; all P<0.0083), and there was no significant difference between 6mo postoperatively(10.18±1.84)and preoperatively. NifBUT of the acute attack eyes at 1 and 3mo postoperatively was significantly lower than that preoperatively, and NiaBUT of the acute attack eyes at 1, 3 and 6mo postoperatively was significantly lower than that preoperatively(all P<0.0083). The NifBUT and NiaBUT of the contralateral eyes at 1mo postoperatively were significantly lower than those preoperatively(all P<0.0083), and there was no significant difference between 3 and 6mo postoperatively and preoperatively. There was no significant difference in TMH of the attack eyes and the contralateral eyes postoperatively and preoperatively(P>0.05).CONCLUSION: The stability of tear film after surgery of PACG and cataract is decreased. The acute attack eye needs 6mo or even longer to recover, while the contralateral eye needs roughly 3mo.
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AIM: To explore the difference of tear film stability among different lipid layer thickness.METHOD: A total of 194 dry eye patients(384 eyes)admitted to our hospital from June 2020 to December 2021 were enrolled in this study. The tear meniscus height, the first tear film break-up time and lipid layer thickness were measured by corneal topographer. The tear meniscus height and the first tear film break-up time among different lipid layer thickness were compared and the correlation between them was analyzed.RESULTS: The included patients(384 eyes)were divided into lipid rich group(49 eyes), lipid balance group(27 eyes), slight lipid deficiency group(266 eyes)and significant lipid deficiency group(42 eyes)according to the lipid layer thickness. The differences of the tear meniscus height were statistically different(P=0.022), while the differences of the first tear film break-up time were not statistically different(P=0.322). The lipid layer thickness was positively correlated with tear meniscus height(rs=0.143, P=0.006). There was no correlation between lipid layer thickness and the first tear film break-up time(rs=-0.090, P=0.083), nor was there correlation between tear meniscus height and the first tear film break-up time(rs=0.038, P=0.460).CONCLUSION: There was no significant difference in tear film stability in dry eye patients with different lipid layer thickness.
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@#AIM: To analyze the effectiveness and safety of different concentrations of tea tree essential oil in the treatment of Demodex blepharitis. <p>METHODS: The clinical data of 120 patients(240 eyes)with blepharitis caused by Demodex infection in our hospital from June 2017 to June 2019 were retrospectively analyzed. According to the use of tea tree essential oil concentrations of 10%, 15%, 20% and 25%, patients were divided into 4 groups(group A, group B, group C, group D), each group with 30 people. All patients were given meibomian gland massage, eyelid margin cleaning, and then scrubbed with different concentrations of tea tree oil to clean the eyelid margin. The number of demodex mites, clinical symptom score, clinical sign score, tear film break-up time(BUT), corneal fluorescein staining(FL)and SchirmerⅠtest(SⅠt)were compared before and 2, 4wk after treatment.<p>RESULTS: The number of Demodex mites, clinical symptom score, clinical sign score, BUT, FL and SⅠt were not statistically significant in the four groups before treatment(<i>P</i>>0.05). After treatment, the number of Dmodex mites, clinical symptom score, and clinical sign score in each group were lower than those before treatment, and the number of Demodex mites, clinical symptom score, and clinical sign score after 4wk of treatment in each group were lower than those after 2wk of treatment(all <i>P</i><0.008). After 2 and 4wk of treatment, the number, clinical symptom score and clinical signs score of Demodex mites in group A were the highest, while those in group D were the lowest(all <i>P</i><0.008). After treatment, the BUT of each group was higher than before treatment, and reached the peak in the 4wk. After 2 and 4wk of treatment, BUT among groups was highest in group D and lowest in group A(all <i>P</i><0.008). After treatment, FL and S I t of each group were lower than before treatment, and reached the lowest value in the 4wk. After 2 and 4wk of treatment, FL among the groups was the lowest in group D and the highest in group A(all <i>P</i><0.008). <p>CONCLUSION: Compared with 10% tea tree essential oil, 15% tea tree essential oil can effectively repel mites, relieve clinical symptoms and eye signs in patients with Demodex blepharitis, and is safer than 20% and 25% tea tree essential oils. As the preferred concentration of tea tree essential oil against Demodex blepharitis.
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@#AIM: To compare the non-invasive tear film break-up time(NIBUT), tear break up time(TBUT), basal tear secretion(BTS)and blink rate in four ethnic groups: Malay, Chinese, Indian and Nigerian.<p>METHODS: Totally 120 healthy(61 males and 59 females)subjects(without dry eye symptoms and ocular surface disorder)with the age 20 to 39 years were recruited; 30 were Malays, 30 were Chinese, 31 were Indians and 29 were Nigerians. Based on McMonnies questionnaire and clinical examination, normal subjects were selected. NIBUT, TBUT, BTS were assessed in only one eye(right)of each subject and blink rate was also assessed.<p>RESULTS: There was significant difference in the NIBUT, TBUT, BTS and blink rate among 4 different ethnic groups(<i>P</i>=0.018),(<i>P</i>=0.001),(<i>P</i>=0.011), and(<i>P</i>=0.004)respectively. No statistically significant difference of NIBUT, TBUT, BTS and blink rate was found between the genders among different ethnic groups. Indian had higher median for NIBUT(10±6s), TBUT(7±5s)and BTS(20±20 mm)than others races. Chinese had lower median for NIBUT(7.5±4s)and TBUT(4±2s)while Malay had low BTS(9.5±16 mm)among the groups. There was no significant correlation of blink rate with NIBUT, TBUT and BTS(<i>r</i>= -0.119, <i>P</i>=0.195),(<i>r</i>=-0.086, <i>P</i>=0.352),(<i>r</i>= -0.123, <i>P</i>=0.180)respectively.<p>CONCLUSION: This study showed the variability in tear-film measurements values in four ethnic groups.
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@#AIM: To evaluate ocular surface functions in pregnant women with gestational diabetes mellitus(GDM)using Keratogragh 5M. <p>METHODS: Pregnant women with GDM and normal pregnant women were enrolled. All subjects were asked to answer ocular surface disease index(OSDI)questionnaire survey, and then underwent ophthalmic examination including tear meniscus height(TMH), average noninvasive Keratograph tear film break-up time(NIKBUTav), ocular redness analysis, and meibomial gland analysis.<p>RESULTS: There were no statistically significant differences in OSDI, TMH, NIKBUTav, eye redness analysis and meibomial gland analysis between the GDM group and the normal pregnant group(<i>P</i>>0.05). The OSDI scores were 8.02±4.25 and 7.50±4.28(<i>P</i>=0.557), TMH values were 0.22±0.05 and 0.20±0.04mm(<i>P</i>=0.158), NIKBUTav values were 8.01±2.15s and 8.02±1.53s(<i>P</i>=0.971).<p>CONCLUSION: There was no statistically significant difference between the GDM group and the normal pregnant group in ocular surface indexes. GDM had no negative effects on ocular surface, which may be related to good controlling of the blood glucose.
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@#AIM: To investigate the effect of strabismus surgery on tear film and the incidence of dry eye.<p>METHODS: A total of 66 eyes of 58 patients admitted and underwent surgery in our hospital between September 2018 to September 2019 with concomitant strabismus were enrolled. The patients were divided into two groups based on surgical methods: Group 1 included 25 cases(33 eyes)who underwent a single horizontal rectus cut; Group 2 included 33 cases(33 eyes)who underwent both horizontal rectus cut in. The noninvasive tear film break-up time(NIBUT)was examined with sirius anterior analysis system at the time of 1d preoperatively and 3d, 1wk, 2wk and 3wk after operation. In addition, the tear film break-up time(BUT), Schirmer I test(SⅠt)and corneal fluorescein examination were tested. The patients were diagnosed with dry eye in both groups according to the consensus of clinical experts specialized in the diagnosis and treatment of dry eye. <p>RESULTS: There were no statistically significant differences when compared to SⅠt between the two groups before and after surgery(<i>P</i>>0.05). The BUT of group 1 was higher than group 2 at postoperative 3d, 1wk and 2wk(<i>P</i><0.05), while there was no difference between the two groups at 3wk postoperative(<i>P</i>>0.05); BUT returned to baseline by 2wk after surgery in group 1 and by 3wk after surgery in group 2. There were no differences between the NIBUT measured by sirius anterior segment analysis system and the BUT measured by traditional method before and after operation(<i>P</i>>0.05). The lowest incidence of dry eye was found at postoperative 2wk and 3wk in group 1(24%, 18%). The lowest incidence of dry eye was found at postoperative 3wk in group 2(15%). Besides, the incidence of dry eye in group 2 was higher than that in group 1 at postoperative 2wk(52% <i>vs</i> 24%, <i>P</i><0.05). <p>CONCLUSION: There was no obvious influence on the SⅠt after strabismus surgery; the surgical effect on tear film was mainly reflected in BUT. The fewer muscles operated, the lesser tear film was affected and the tear film was recovered faster. The incidence of dry eye decreased as time went by.
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Background: The aim was to study the demographic profile and analyze risk factor associated with dry eye disease in North West Rajasthan, India.Methods: This was a hospital-based study conducted in Department of Ophthalmology, Sardar Patel Medical College, Bikaner, Rajasthan. Sample size of this study was 100 patients. All participants underwent a general ophthalmic assessment including history of any previous ocular and systemic illness along with ocular examination on slit lamp and specific tests for dry eye (Schirmer's test and Tear film break up time) were performed.Results: Dry eye were seen maximum in age group 46 to 60 years (41%), followed by 61-75 years (23%). Female’s preponderance was seen compared with male. Dry eye patients belong from rural areas were (57%) while remaining (43%) from urban areas and among these highest were farmer/labourers (32%). Several known risk factors were found in this study which include post-menopause. Climatic condition like excessive wind, high temperature and computers users had strong association with dry eye. In Systemic disease rheumatoid arthritis was commonly associated with dry eye were. Smoking contact lens use were also associated with increased risk of developing dry eye.Conclusions: Dry eye disease are more common in older age group patients. Female’s preponderance were found in the study especially postmeopausal women. Dry eye disease are more common in patients belongs to rural areas. Risk factor associated with dry eye were Climatic condition like excessive wind, high temperature and computers users, systemic disease like rheumatoid arthritis Smoking, contact lens users.
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@#AIM: To compare the effects of trabeculectomy and phacotrabeculectomy on the ocular surface using ocular Keratograph 5M.<p>METHODS: Totally 62 eyes of 62 patients with coexisting primary angle-closure glaucoma(PACG)and cataract were recruited. Thirty-two eyes accepted trabeculectomy, and the remaining thirty eyes accepted phacotrabeculectomy. Ocular surface parameters, including noninvasive first tear film break-up time(NifTBUT), noninvasive average tear film break-up time(NiaTBUT), corneal fluorescein staining scores(CFS)and tear meniscus height(TMH), were analyzed preoperatively, 3d, 1mo and 3mo postoperatively, with ocular Keratograph 5M.<p>RESULTS: There was no significant difference in ocular surface parameters between the two groups preoperatively(<i>P</i>>0.05). The values of NifTBUT, NiaTBUT, CFS and TMH in phacotrabeculectomy eyes were at the worse levels, <i>i.e.</i> 10.13±1.48s, 12.59±1.96s, 0.80±0.22 and 0.31±0.02mm, respectively at 3d postoperatively, then improved gradually at 1mo postoperatively, but did not return to the preoperative levels at 3mo postoperatively.<p>CONCLUSION: Ocular Keratograph 5M can be used to evaluate the changes of tear film in combined anti-glaucoma surgery accurately. The effects of phacotrabeculectomy on ocular surface are worse than that of trabeculectomy during 3mo after surgery. It is suggested that more eye care should be paid during that period of time.
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@#AIM: To explore the difference of dry eyes between children and adults in terms of symptoms and laboratory examinations.<p>METHODS: Patients in 2018-06/2019-02 with the subjective symptoms of dry eye, and served in Xi'an First Hospital, including 52 children clinic cases(52 eyes)and 55 adult patients cases(55 eyes), all the cases were consulted and examined by slit lamp microscope in anterior segment. Both eyes of tear meniscus height(TMH), the first tear film break-up time(BUTf), the average tear film break-up time(BUTave), lipid layer thickness(LLT)and mesangial gland loss rate were measured by a Keratograph 5M non-invasive ocular surface analyzer.<p>RESULTS: In children, patients' TMH(0.15±0.04mm), BUTf(3.22±1.24s), BUTave(4.27±1.67s), and the rate of meibomian gland loss \〖0.00%(0.00%, 5.03%)\〗 were significantly lower than those in the adult group [0.20±0.05mm, 4.36±1.93s, 5.15±1.49s, 9.90%(5.30%, 18.40%), all <i>P</i><0.01]. The LLT in the children was higher than that of the adult group, and the difference was not statistically significant(72.31±22.20nm <i>vs</i> 68.58±21.05nm, <i>P</i>>0.05). Both groups of patients had positive correlation sympathise with BUTf and BUTave, with no correlation between LLT and meibomian gland loss rate in children(<i>r</i>s=-0.23,<i>P</i>=0.10), and adult group patients with negative correlation of LLT and meibomian gland loss rate(<i>r</i>s=-0.28,<i>P</i><0.05).<p>CONCLUSION: Children's dry eyes and adult dry eyes in the symptoms, clinical manifestations and examination are different. The main symptom is the increase in the number of blinks. The inspection is mainly characterized by a short BUT. With the decrease of TMH, the rate of meibomian gland loss is relatively insignificant.
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Objeetive To investigate tear film lipid layer thickness (LLT) and its association with clinical symptom and sign in different types of dry eye patients.Methods A serial case-observational study was carried out.Three hundred and six eyes of 306 dry eye patients were included in Beijing Tongren Hospital from April to August 2016.Ocular surface disease index (OSDI) questionnaire,eyelid slit lamp examination,the measurement of tear film lipid thickness (LLT),tear film break-up time (TBUT),Schirmer Ⅰ test (S Ⅰ t) and the infrared meibomian photography were performed on the patients.The 157 patients with OSDI ＞12 and eyelid score ≥2 served as the MGD group;53 patients with OSDI ＞12 and S Ⅰ t value ＜ 5 mm/5 minutes served as ADDE group;96 patients with OSDI＞12,eyelid score ≥2 and S Ⅰ t value ＜ 5 mm/5 minutes served as MGD/ADDE group.Tear film LLT was detected with LipiView(R) ocular surface interferometer and the association of LLT with clinical characteristics of the patients was analyzed.This study protocol was approved by Ethic Committee of Beijing Tongren Hospital and written informed consent was obtained from each patient prior to any relative medical examination.Results Tear film LLT of the participants was normally distributed with the average was (60.41±18.57)nm.LLT in the MGD group,ADDE group,MGD/ADDE group were (57.04 ± 18.26),(63.52 ± 18.44) and (60.56 ± 18.71) nm,respectively,with a significant difference among the three groups (F =2.347,P =0.035),and the LLT value was significantly lower in the MGD group than that in the ADDE group (t =2.077,P =0.039).The LLT value showed negative correlations with the severity of dry eye symptom,S Ⅰ t and meibomian gland loss rate (r=-0.201,P=0.003;r=-0.146,P=0.005;r=-0.156,P=0.046).OSDI score was significantly correlated with LLT only in the MGD group (r =-0.285,P =0.000).No significant correlation was seen between LLT and S I t in all the groups (all at P＞0.05).In the MGD/ADDE group and MGD group,the correlation between LLT and meibomian gland loss rate was significantly greater than the overall correlation (r=-0.335,-0.248,-0.156).The dry eye symptoms in OSDI questionnaire like foreign body sensation,eye pain,discomfort when watching TV or computer showed significant correlations with LLT (r =-0.243,-0.205,-0.223,-0.258,all at P ＜0.05).Conclusions The tear LLT is appeared to be varied in different types of dry eye.The LLT is thinner in the dry eyes with MGD and thicker in the dry eyes with ADDE.There are association between tear LLT and foreign body sensation,eye pain,discomfort when watching TV or computer.
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AIM:To investigate the difference of non - invasive tearfilm break - up time (NIBUT) by Keratograph 5M beforeand after forced eye opening in healthy individuals.METHODS: Prospective case self - control study. Fortynormal volunteers (79 eyes ) were enrolled. Tear filmimages were captured, non-invasive first tear film breakuptime(NIBUTf ), non- invasive average tear film breakuptime (NIBUTav ) and dry eye level were measured byKeratograph 5M automatically before and after forced eyeopening in each subject. For the first time, we checkedthe left eye after the right eye, and the second timechecked the right eye after the left eye.RESULTS: The average of NIBUTf and NIBUTav were9 18士5. 52s, 11. 74 士5. 59s respectively and percentage ofevery level of dry eye were 43% , 37% , 20% respectivelybefore forced eye opening. The average of NIBUTf andNIBUTav were 8. 91士5. 54s, 11. 76士5. 58s and percentage ofdry eye at different levels were 35% , 48% , 16%respectively after forced eye opening. There was nosignificant difference on NIBUT and dry eye level byOculus keratograph 5M in normal subjects (t = 0. 37, P =0 72; t = -0. 038, P = 0. 97; Z = -0. 42, P = 0. 68).CONCLUSION: There is no influence on NIBUT and dryeye level by detected Keratograph 5M before and afterforced eye opening in healthy subjects.
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·AIM:To evaluate the ocular surface in the patients after strabismus surgery. ·METHODS: One hundred and eighty-eight hospitalized patients (240 eyes) with strabismus from May 2015 to October 2016 in Aier Hospital were divided into 3 groups according to the type of incision:85 cases(100 eyes) with the corneal limbus incision in Group A;35 cases(50 eyes) with the cross-muscle incision in Group B; 68 cases (90 eyes) with the adjacent-fornix incision (including Parks incisions and improved Parks incisions) in Group C. And 75 eyes with single extraoeular muscle surgery, 110 eyes with 2 extraoeular muscle surgery, 55 cases with 3 extraoeular muscle surgery. The first noninvasive tear film break-up time (NITBUTf) and the tear meniscus height (TMH) were tested by Oculus anterior segment analyzer preoperatively and 1d, 1, 2 and 4wk postoperatively. The data were studied by statistics. · RESULTS: Comparing with preoperative, TMH increased significantly at post-operatively 1d in all group, NIKBUTf reduced significantly(P<0.05). NIKBUTf was recovered in Group A at post-operative 2wk. NIKBUTf were recovered in Group B and C at post-operative 1wk. TMH were recovered in Group A and B at post-operative 2wk. TMH was recovered in Group C at post-operative 1wk. NIKBUTf and TMH were recovered with the single extraoeular muscle surgery at post-operative 1wk. They were recovered at post-operative 2wk with the 2 and 3 extraoeular muscle surgery. ·CONCLUSION: Surgical incision and surgical muscle number may affect the ocular surface of the people after strabismus surgery. The adjacent fornix conjunctival incision has less effect. The less number of muscles in strabismus surgery,the less effect on ocular surface.
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·AIM: To analyze the relationship between tear film break-up time (BUT) and systemic factors. ·METHODS: From January 2015 to July 2016 in the medical examination center of Fuzhou General Hospital or hospitalized, there were 747 cases included. All participants were observed for systolic and diastolic blood pressure, blood glucose, total cholesterol, high density lipoprotein cholesterol,low density lipoprotein,break-up time equivalent. The relationship between tear film rupture time and systemic factors was analyzed with simple and multiple linear regression analysis by SPSS19.0. ·RESULTS: Simple linear regression analysis results showed that the diastolic pressure and tear break-up time were positively correlated(P<0.05);age,systolic blood pressure, blood glucose, cholesterol, high density lipoprotein, low density lipoprotein was negatively correlated with BUT (P < 0. 05), but no correlation between triglyceride and tear film break up time (P = 0.227). Multiple linear regression analysis suggested that the tear film rupture time was positively correlated with diastolic blood pressure (P<0.001), but negatively correlated with systolic blood pressure (P<0.001), blood glucose (P<0. 001) and high-density lipoprotein (P=0.019). The time of tear film rupture was not related to age, cholesterol, triglyceride, low density lipoprotein.·CONCLUSION: The correlation between blood glucose and tear film BUT is the most significant among all the indexes involved, indicating that ocular surface damage may occur in diabetic patients.
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Objective To observe the clinical efficacy of acupuncture at Guangming (GB37) and Diwuhui (GB42) in treating dry eye due to different syndromes. Method Thirty-nine dry eye patients (78 eyes) conforming to syndrome of up-flaming liver fire or liver-kidney yin deficiency were randomized into a distant group and a periocular group, to receive acupuncture at distant acupoints [Guangming (GB37) and Diwuhui (GB42)] and periocular acupoints [Cuanzhu (BL2), Tongziliao (GB1), and Taiyang (EX-HN5)], respectively. Result In the distant group, the total effective rate was 60.0% after 2-week acupuncture and 75.0% after 4-week acupuncture; in the periocular group, the total effective rate was 53.6% after 2-week acupuncture and 65.8% after 4-week acupuncture. There were no significant differences between the two groups (P>0.05). The tear production and tear film break-up time (BUT) were significantly improved in both groups after the intervention (P0.05), while the inter-group difference in the improvement of liver-kidney yin deficiency syndrome score was statistically significant (P<0.05). Conclusion Acupuncture at Guangming and Diwuhui can boost the improvement of dry eye symptoms and tear production, and prolong BUT; dry eye due to up-flaming liver fire achieved a satisfactory therapeutic efficacy in both groups, while liver-kidney yin deficiency type responded better to acupuncture at distant acupoints.
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Objective To compare the dry-eye features of normal cornea and keratoconus at different stages using non-invasive dry-eye integrated analyzer (Keratograph) and it clinical significance.Methods A case-control study was conducted in 35 patients (44 eyes) with keratoconus who were treated in our hospital from May 2015 to December 2016 as keratoconus group and 45 patients (45 eyes) who received laser corneal refractive surgery as normal cornea group;and subjects in the keratoconus group were subgrouped into mild group (19 eyes),moderate group (15 eyes) and severe group (10 eyes) according to Amsler-Krumeich grading method.The first tear break-up time (first BUT),mean BUT,tear meniscus height (TMH) and conjunctival hyperemia scoring (CHS) of the both eyes in all groups were measured by Keratograph,and the diagnostic values of these variables for keratoconus at different stages were analyzed by ROC curve.Results The levels of horizontal central curvature,vertical center curvature,surface variation index,keratoconus index,posterior corneal surface height and CHS of the keratoconus group were higher than those of the normal cornea,and the difference were statistically significant (all P ＜ 0.05).The non-invasive first BUT,mean BUT and TMH in the keratoconus group were significantly lower than those of the normal cornea group,approaching significant difference (all P ＜ 0.05).The differences in horizontal central curvature,vertical center curvature,surface variation index,keratoconus index,posterior corneal surface height,first BUT and mean BUT among subgroups of keratoconus patients had statistically significance (all P ＜ 0.05).The first BUT and mean BUT in the moderate and severe group were lower than those in the mild group,the difference was statistically significant (all P ＜ 0.05),but there was no significant difference between the moderate and severe group (all P ＞ 0.05).In addition,the mean BUT was negatively correlated with horizontal central curvature,vertical center curvature,surface variation index,keratoconus index and posterior corneal surface height,but had no significant correlation with TMH and CHS (all P ＞ 0.05).ROC curve analysis showed that keratoconus index had the highest diagnostic value for keratoconus than other variables (AUC =0.790,95％ CI:0.689-0.892;P ＜ 0.001).Conclusion The Keratograph dry-eye analyzer can effectively measure the dry-eye parameters of the cornea and the mean BUT in the measurement parameters is the most valuable for the diagnosis of keratoconus,and it is more meaningful for the diagnosis of mild keratoconus.
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PURPOSE: To evaluate the repeatability of non-invasive tear film break-up time and identify its relationships with dry eye parameters. METHODS: A total of 100 participants (50 with dry eye, and 50 in the control group) were enrolled prospectively. Non-invasive keratograph first (NIKf-BUT) and average (NIKav-BUT) break-up times were evaluated 2 times using Keratograph 4 (Oculus, Wetzler, Germany), and then tear film break-up time with fluorescein (FBUT) was measured. The correlation analyses were performed between non-invasive parameters (NIKf-BUT and NIKav-BUT) and FBUT. Intra-observer agreements of NIKf-BUT and NIKav-BUT were assessed using intraclass correlation coefficients (ICC). The receiver operating characteristic (ROC) curve technique was used to evaluate the non-invasive method in the diagnosis of dry eye. RESULTS: The correlation analyses revealed positive correlation between NIKav-BUT and FBUT in both groups (dry eye; r = 0.66, p < 0.001 and control group; r = 0.77, p < 0.001). The ICCs of NIKf-BUT and NIKav-BUT were 0.72 and 0.94 in the dry eye, respectively, and 0.70 and 0.91 in the control group. NIKav-BUT was not different from FBUT in either group. The areas under the ROC curves of NIKf-BUT and NIKav-BUT were 0.917 and 0.980, respectively. CONCLUSIONS: The high ICCs verified the repeatability of NIKf-BUT and NIKav-BUT. NIKav-BUT showed no difference from FBUT and positive correlation with FBUT. NIK-BUT showed high diagnostic power and can be considered a new parameter to evaluate dry eye syndrome.
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Diagnosis , Dry Eye Syndromes , Fluorescein , Methods , Prospective Studies , ROC Curve , TearsABSTRACT
?AlM: To investigate repeatability and accuracy of a latest Keratograph for evaluating the tear film stability and to compare its measurements with that of traditional examination methods. ?METHODS: The results of noninvasive tear film break-up time ( Nl-BUT ) including the first tear film break-up time ( BUT-f ) and the average tear film break-up time ( BUT - ave ) were measured by Keratograph. The repeatability of the measurements was evaluated by coefficient of variation ( CV ) and intraclass correlation coefficient ( lCC) . Wilcoxon Signed-Rank test was used to compare Nl-BUT with fluorescein tear film break-up time ( FBUT) to confirm the correlation between Nl-BUT and FBUT, Schirmer l test values. Bland-Altman analysis was used to evaluate consistency. ?RESULTS: The study recruited 48 subjects ( 48 eyes ) (mean age 38. 7±15. 2 years). The CV and lCC of BUT-f were respectively 12. 6% and 0. 95, those of BUT-ave were 9. 8% and 0. 96. The value of BUT-f was lower than that of FBUT. The difference had statistical significance ( 6. 16±2. 46s vs 7. 46±1. 92s, P ?CONCLUSlON: Keratograph can provide Nl-BUT data that has a better repeatability and reliability, which has great application prospects in diagnosis and treatment of dry eye and refractive corneal surgery.
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PURPOSE: To evaluate the clinical efficacy of topical diquafosol tetrasodium 3% ophthalmic solution in patients with short tear film break-up time (BUT) dry eye. METHODS: This prospective study involved 30 eyes in 30 patients with dry eye who had tear film BUT values or =5 mm, and showed no improvement with non-preservative sodium hyaluronate (SH) 0.1% artificial tears. All patients were treated with topical diquafosol tetrasodium 3% 6 times a day, in addition to SH 0.1% artificial tears. Schirmer's 1 test, tear film BUT, keratoepitheliopathy score with fluorescein, conjunctival staining score with lissamine green, and Ocular surface disease index (OSDI) score were evaluated at before treatments, and 1 month and 3 months after treatments. RESULTS: Significant improvements of tear film BUT and OSDI were observed at 1 month and 3 months after diquafosol tetrasodium 3% administration. At before treatment, and followed up at 1 and 3 months, tear film BUTs were 3.3 +/- 1.2, 4.4 +/- 1.0 (p < 0.01) and 4.9 +/- 1.1 seconds (p < 0.01), respectively, and OSDI scores were 43.5 +/- 24.4, 34.6 +/- 25.0 (p = 0.01) and 26.7 +/- 21.5 (p < 0.01), respectively. There were no significant changes of Schirmer's score, keratoepitheliopathy, and conjunctival staining score. After diquafosol tetrasodium 3% administration, severe adverse effects were not found in any of the patients. CONCLUSIONS: Topical diquafosol tetrasodium 3% administration was shown to be an effective treatment for improvements of tear film stability and dry eye symptoms.