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@#In the past few years, with the valid development of computer science and the advancement of interdisciplinary integration, the application of artificial intelligence(AI)in the medical field has increased rapidly. Previously, most AI-related research in ophthalmology focused on posterior segment such as diabetic retinopathy and age-related macular degeneration. Recent years, with refinement of learning algorithms and availability of big data, there are more and more research about AI applied to ocular surface diseases. This article reviews the related research and application of AI in ocular surface diseases, which discussing the current challenges as well as the opportunities of AI-related application of ophthalmology.
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La enfermedad de la superficie ocular incluye a un grupo de patologías con diversas etiologías, síntomas y hallazgos clínicos que comparten la producción de reacción inflamatoria y daño de esta superficie. El uso de derivados hemáticos para el tratamiento de patologías de la superficie ocular se ha incrementado en el área de la oftalmología, ya que su composición es análoga a la de la lágrima natural. Con el objetivo de mostrar la terapia celular como una nueva disciplina científica a aplicar en nuestro medio, se realizó una búsqueda automatizada sobre el tema, teniendo en cuenta las publicaciones de los últimos 5 años. Se utilizó la plataforma Infomed, cuya información fue resumida para la elaboración del informe final, donde se expone que los colirios de hemoderivados proveen estrategias de tratamiento eficaces y seguras para pacientes con afecciones oftálmicas. El colirio de plasma rico en plaquetas ofrece una opción exitosa de tratamiento en numerosas afecciones de la superficie ocular. Sin embargo, estudios adicionales son necesarios para establecer la seguridad y la eficacia de este tipo de terapias(AU)
Ocular surface diseases are a group of conditions of different etiologies, symptoms and clinical findings with the common features of developing an inflammatory reaction and damaging the ocular surface. Use of blood-derived products for the treatment of ocular surface disorders has increased in ophthalmic care, since their composition is similar to that of natural tears. With the purpose of presenting cell therapy as a new scientific discipline that could be used in our environment, an automated search was conducted about the topic which included publications from the last five years. The search was performed on the Infomed platform, and the information obtained was summarized into a final report stating that blood-derived eye drops provide effective and safe treatment strategies for patients with ophthalmic conditions. Platelet-rich plasma eye drops are a potentially successful treatment option for many ocular surface disorders. However, further studies are required to establish the safety and effectiveness of this type of therapy(AU)
Subject(s)
Humans , Ophthalmic Solutions/adverse effects , Blood-Derivative Drugs , Platelet-Rich Plasma/drug effects , Review Literature as Topic , Databases, Bibliographic , Research ReportABSTRACT
ABSTRACT Purpose: To investigate the use of preoperative steroid eyedrops in glaucoma patients undergoing trabeculectomy for ocular surface disease. Methods: A total of 31 eyes of 31 glaucoma patients were included. Only glaucoma patients who had been using at least three topical intraocular pressure-lowering medications for longer than 6 months were included. All patients were treated with loteprednol etabonate ophthalmic suspension 0.5% four times per day for 1 week before trabeculectomy. Data from baseline (day of surgery) and the follow-up visit (2 weeks after surgery) were included. All patients underwent a detailed ophthalmologic examination. Ocular surface disease was evaluated using the Ocular Surface Disease Index questionnaire and clinical measures, including tear breakup time, conjunctival hyperemia, and biomicroscopy to detect the presence or absence of keratitis. Ocular Surface Disease Index scores greater than 13 indicated a clinically relevant presence of ocular surface disease. In addition, all patients underwent keratograph analysis. The comparison of ocular surface disease before and after trabeculectomy was assessed using a paired test. Results: The mean age of the glaucoma patients was 69.90 ± 10.77 years. The average visual acuity was 0.40 ± 0.34 logMAR. The overall Ocular Surface Disease Index prevalence rate was 27.20 ± 17.56 units. Clinical assessment revealed no significant difference in bulbar redness, breakup time, or keratitis before and after surgery (p>0.05 for all comparisons). Keratograph analysis showed that the only two parameters that were significantly different before and after trabeculectomy ewere the bulbar redness by keratograph (BR-K) and the average noninvasive tear breakup time. Patients presented more conjunctival hyperemia and shorter noninvasive tear breakup time after trabeculectomy as compared with before surgery (p=0.013 and p=0.041, respectively). Conclusions: The present study not only confirms the high prevalence of clinical findings of ocular surface disease in glaucoma patients but also reveals new objective parameters measured by keratograph analysis. Apart from using loteprednol etabonate ophthalmic suspension 0.5% 1 week before the surgery, our sample presented a worsening of conjunctival hyperemia (bulbar redness by keratograph) and also a shorter noninvasive tear breakup time postoperatively.
RESUMO Objetivo: Investigar a ação de colírios esteróides na doença de superfície ocular em pacientes a serem submetidos a cirurgia de trabeculectomia. Métodos: Foram incluídos 31 olhos de 31 pacientes com glaucoma em uso de pelo menos 3 medicações tópicas anti- hipertensivas há mais de 6 meses. Todos os pacientes foram tratados com colírio de etabonato de loteprednol 0,5% (1 gota a cada 6 horas) durante os 7 dias precedentes à cirurgia de trabeculectomia. Além disso, foram submetidos a exame oftalmológico completo e responderam questionário validado que visa avaliar parâmetros subjetivos correlacionados a doenças da superfície ocular (Ocular Surface Disease Index). Os aspectos clínicos avaliados foram: tempo de ruptura lacrimal, coloração da córnea após colírio de fluoresceína (ceratite) e hiperemia conjuntival. Os pacientes foram, ainda, submetidos à análise da superfície ocular através de novo software tecnológico denominado "Keratographic", tecnologia não invasiva que permite avaliar a doença da superfície ocular. A comparação da doença de superfície ocular antes e após a trabeculectomia foi avaliada estatisticamente através do teste pareado. Resultados: A média de idade dos participantes foi de 69,90 ± 10,77 anos. A AV média foi de 0,40 ± 0,34 logMAR. A taxa de prevalência global da Ocular Surface Disease Index foi de 27,20 ± 17,56 unidades. Em relação à avaliação clínica, não houve diferença significativa em relação hiperemia, ruptura lacrimal e ceratite antes e após a cirurgia (p>0,05 para todas as comparações). Em relação à análise com o "keratograph (menisco lacrimal, hiperemia, tempo de ruptura do filme lacrimal, meibografia para a pálpebra superior e inferior), os dois únicos parâmetros que diferiram significativamente antes e após a trabeculectomia, foram hiperemia e a média do tempo de rupture do filme lacrimal. Após a cirurgia de trabeculectomia, os pacientes apresentaram aumento da hiperemia conjuntival e diminuição do tempo de ruptura do filme lacrimal (p=0,013 e p=0,041, respectivamente). Conclusões: O presente estudo, não somente confirma a elevada prevalência da doença de superfície ocular em pacientes com glaucoma, como também demonstra que a mesma pode ser mensurada objetivamente através de parâmetros mensurados pelo Keratograph. Apesar de ter utilizado etabonato de loteprednol 0,5% uma semana antes da cirurgia, nossa amostra apresentou piora da hiperemia conjuntival e diminuição no tempo de ruptura do filme lacrimal no pós-operatório.
Subject(s)
Aged , Aged, 80 and over , Humans , Middle Aged , Trabeculectomy , Glaucoma , Ophthalmic Solutions , Steroids , Glaucoma/surgery , Prospective Studies , Intraocular PressureABSTRACT
@#Ocular Demodex infection is mainly manifested as ocular surface diseases, including meibomian gland dysfunction, dry eye disease, Demodex blepharitis, chalazion, keratoconjunctivitis,<i> etc</i>. The diagnosis is relatively simple and can be realized under the microscope, but it is easy to be misdiagnosed due to the subjective and objective factors such as similar symptoms, missing examination, experience diagnosis and treatment. There are many treatment methods for ocular Demodex infection, including external tea tree oil and other plant extracts, oral or external drugs, physical therapy(represented by strong pulse light therapy, moxibustion therapy), combined therapy,<i> etc</i>. In this paper, we reviewed the diagnosis and treatment of Demodex related ocular surface diseases, and discussed the latest research trends of this disease.
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@#Thymosin is a kind of protein that is widely distributed in many tissues. It has many biological activities. Thymosin is divided into three subtypes: thymosin α, thymosin β and thymosin γ. Thymosin β4(Tβ4)is the most widely distributed in normal human body. A large number of studies have confirmed that Tβ4 has the functions of anti-inflammatory, anti-apoptosis and promoting proliferation. Ocular surface diseases are mostly related to ocular surface injury and inflammation. Therefore, promoting wound repair and healing and anti-inflammatory are the key to the treatment of ocular surface diseases. The present review mainly introduces the distribution, structure, synthesis of Tβ4 and its protective effect on ocular surface.
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The corneal contact bandage lens has gained clinicians acceptance for their wearing comfort and definite curative effects in ocular surface protection and damage reparation.Recently,application fields of contact bandage lens are still expanding with continuous exploration and development of new materials and function.To noninfectious ocular surface diseases,bandage lens obviously alleviate irritate symptoms and accelerate tissue healing.The application of bandage lens in infectious ocular surface diseases remains controversial.The bandage lens has become a routine intervention of ocular trauma and corneal perforation.It can also improve ocular surface microenvironment after the surgery of glaucoma,cataract,pterygium,corneal transplantation and refraction.It is an adjuvant therapy for aniridia,dry eye and children ocular surface diseases.This review summarized the history,current corneal contact bandage lens in preventing and treating ocular surface diseases.
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Objective To explore the risk factors for dry eye (DE) and its incidence.Methods Together 564 patients (564 eyes) were included in the study,and questionnaires were used to evaluate the symptoms,signs and general condition of the subjects with dry eye.Data were analyzed by using SPSS 16.0 software.x2 test and t-test were used to analyze the differences among groups,and logistic regression analysis was used to evaluate the relationship between risk factors and dry eye.Results Factors were significantly associated with increased severe DE symptoms included dry mouth (OR =2.89,95％ CI:1.6-5.5;P =0.001) and gastrointestinal ulcer medications (OR =2.60,95％ CI:1.1-5.1;P =O.04).In addition,administration of artificial tears could aggravate the signs of severe dry eye (OR =2.1,95％ CI:1.2-3.2;P =0.01).Risk factors associated with aqueous tear deficiency were dry mouth (OR =1.92,95％ CI:1.02-3.60;P =0.04) and diuretics (OR =6.00,95 ％ CI:1.3-41.0;P =0.02).Risk factors associated with meibomian gland dysflmction included old age (OR =1.02,95％ CI:1.05-1.09;P =0.000),male sex (OR =1.42,95％ CI:1.04-2.6;P =O.02),arthritis (OR =8.00,95％ CI:1.0-59.0;P =0.02),and administration of an antihypertensive drugs (OR =2.85,95％ CI:1.3-5.7;P =0.01).The only risk factor associated with corneal staining was dry mouth (OR =2.21,95％ CI:1.1-5.4;P=0.02).Conclusion Different risk factors have different effects on dry eye,indicating that different subtypes of dry eye have different pathophysiological mechanisms.
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Previous research demonstrated that human tear is a valuable source for biomarker discovery for many ocular surface diseases.Here, we systematically summarized the changes of tear protein profile in many ocular surface diseases, including dry eye, blepharitis, ocular allergy, keratoconus, infectious keratitis, conjunctivochalasis, ocular rosacea, and thyroid-associated ophthalmopathy and other conditions, such as diabetes, ocular surface wounding and refractive surgeries, contact lens wearing, and effects of glaucoma medication on ocular surface, attempting to make ophthalmologists understand the specific changes of tear protein profile in each disease or condition and hold the promise for optimal management of the diseases.
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Purpose: To evaluate the microbial etiology and associated risk factors among patients with blebitis following trabeculectomy. Materials and Methods: A retrospective analysis of all culture-proven blebitis was performed in patients who underwent trabeculectomy between January 2004 and December 2008. A standardized form was filled out for each patient, documenting sociodemographic features and information pertaining to risk factors. Swabbing of the infected bleb surface was performed for all suspected cases and further subjected to microbiological analysis. Results: A total of 23 patients with culture-proven blebitis were treated during the study period, with a mean age of 59.2 years (59.2 ± SD: 12.8; range, 30-81 years). Duration of onset was early (≤36 months) in six (26%) cases and late (> 36 months) in 17 (74%) cases with a range between 15 and 144 months (mean, 82.91 months; SD: 41.89). All 23 blebs were located superiorly and of which, 21 (91%) were microcystic avascular, 1 (4%) diffuse avascular, and 1 (4%) vascular flattened. The predominant risk factor identified was bleb leak (35%; 8 of 23) followed by thin bleb (22%; 5 of 23) and blepharitis (17%; 4 of 23). Bleb leaks (100%) were recorded only in patients with late onset (≥ 9 years) of infection (P< 0.001), while the incidence of ocular surface disease (100%) occurred early (≤3 years) (P< 0.001). Use of topical steroids was associated frequently with cases of thin blebs (80%; 4 of 5) (P< 0.001), while topical antibiotics showed bleb leaks (88%; 7 of 8) (P< 0.001). Coagulase-positive staphylococci were frequently recovered from blebitis with thin blebs (71%; 5 of 7) (P = 0.001), Coagulase-negative staphylococci (CoNS) with bleb leak (100%; 8 of 8) (P< 0.001), Corynebacterium with blepharitis (100%; 3 of 3) (P = 0.001), and Streptococci with releasable sutures (75%; 3 of 4) (P = 0.001). Conclusion Bleb leak is the principal risk factor responsible for late-onset blebitis, while early-onset blebitis could be ascribed to ocular surface diseases. Streptococci were mainly responsible for early onset of infection, while the late onset was due to CoNS.
Subject(s)
Adult , Aged , Aged, 80 and over , Blister/epidemiology , Blister/etiology , Eye Infections, Bacterial/epidemiology , Eye Infections, Bacterial/etiology , Glaucoma/epidemiology , Glaucoma/surgery , Humans , India/epidemiology , Middle Aged , Retrospective Studies , Risk Factors , Surgical Wound Infection/epidemiology , Surgical Wound Infection/etiology , Trabeculectomy/adverse effects , Trabeculectomy/statistics & numerical dataABSTRACT
PURPOSE: To describe the clinical outcome of AMT (amniotic membrane transplantation) for corneal ulcers, persistent epithelial defects, corneal perforations, and neurotropic ulcers. METHODS: We performed AMT on 10 cases of corneal ulcer, 5 cases of persistent epithelial defect, 2 cases of corneal perforation, and 3 cases of neurotropic ulcer from Agust 1999 to May 2002. Amniotic membrane was obtained from the women undergoing elective Cesarean section or normal delivery. We had applied one or two layers of fresh amniotic membrane, that is used within 4hours after resection, over the ulcer bed and anchored by interrupted and running suture technique with 10-0 Nylon. After AMT, Topical eye drops was used three times a day. RESULTS: After AMT, Visual acuity was improved in 6 eyes of 10 corneal ulcer patients and maintained in 3 eyes. In all patients the persistent epithelial erosion was healed and pain was subsided between 6 and 12 days after surgery. There were no leakage in corneal perforation patients, and stable ocular surface were achieved after mean period 15.5 days. The ocular surface was restored by AMT in all neurotropic ulcer patients. CONCLUSIONS: The AMT is an effective method for managing corneal ulcer or ocular surface diseases, that are refractory to conventional treatment. The AMT shortened the usage of broad spectrum antibiotics , increased compliance, and decreased corneal opacity and neovascularization.