Professor GAO Wei-bin's clinical experience of using electroacupuncture for dry eye / 中国针灸

The academic thoughts of professor GAO Wei-bin regarding the use of electroacupuncture in the treatment of dry eye are introduced. Professor GAO believes that the occurrence of dry eye is mainly related to the stagnation of qi and blood in the eye meridians, leading to inadequate nourishment of the eyes. The acupuncture treatment principle focuses on promoting blood circulation, clearing and benefiting the eye orifices. By integrating traditional acupuncture theory with modern neuroanatomy, the treatment approach centers on stimulating the lacrimal gland, emphasizing the importance of promoting, addressing symptoms as a priority, and considering both the root cause and symptoms.The precise acupoint selection is emphasized. Acupoints of periocular region, such as Taiyang (EX-HN 5) and Leixian point are selected along with Fengchi (GB 20) and Gongxue point to treat dry eye. Attention is also given to the use of electroacupuncture and the selection of its frequencies, emphasizing specific needling techniques based on the severity and classification of the disease.

Acupuncture for aqueous deficiency dry eye: a randomized controlled trial / 中国针灸

OBJECTIVES@#To compare the clinical efficacy and safety of acupuncture and sodium hyaluronate eye drop in the treatment of aqueous deficiency dry eye.@*METHODS@#A total of 60 patients (120 eyes) with aqueous deficiency dry eye were randomly divided into an observation group (30 cases, 1 case dropped out) and a control group (30 cases, 1 case dropped out). In the control group, sodium hyaluronate eye drop were used, one drop at a time, 4 times a day, for 14 consecutive days. In the observation group, acupuncture was applied at bilateral Shangjingming (Extra), Cuanzhu (BL 2), Sizhukong (TE 23), Taiyang (EX-HN 5), and Tongziliao (GB 1) , once a day, treatment for 6 days with the interval of 1 day was required, for 14 consecutive days. The tear meniscus height (TMH), Schirmer Ⅰ test (SⅠT), ocular surface disease index (OSDI) score, non-invasive tear break-up time (NIBUT), and corneal fluorescein sodium staining (FLS) score were compared between the two groups before and after treatment, and the safety of the treatment of the two groups was observed.@*RESULTS@#Compared with those before treatment, after treatment, TMH, SⅠT and NIBUT were increased (P<0.01, P<0.05), and FLS scores were decreased (P<0.01) in the two groups; the score of OSDI was reduced (P<0.01) in the observation group. After treatment, in the observation group, TMH and SⅠT were higher than those in the control group (P<0.01), and the score of OSDI was lower than that in the control group (P<0.01). No adverse reactions and adverse events were observed in the two groups.@*CONCLUSIONS@#Acupuncture and sodium hyaluronate eye drop can both effectively treat aqueous deficiency dry eye, acupuncture has obvious advantages in improving TMH and basic tear secretion, and reducing the subjective symptoms of patients. Acupuncture for dry eye is safe.

Síndrome do olho seco / Dry eye syndrome

A Síndrome do Olho Seco é uma condição ocular crônica, de origem multifatorial, caracterizada pelo círculo vicioso de instabilidade do filme lacrimal e sua hiperosmolaridade, que causam inflamação da superfície ocular e anormalidades neurossensoriais (NELSON et al., 2017; TSUBOTA et al., 2017; ZEMANOVÁ, 2021). A doença é classificada em dois subtipos, sendo: deficiência aquosa, quando há produção lacrimal reduzida ou hiperevaporativo, em que o filme lacrimal se evapora de forma excessiva em decorrência de alteração na produção de algum dos componentes da lágrima por disfunção da glândula meibomiana (MGD). Cerca de 10% dos indivíduos apresentam deficiência aquosa e mais de 80% a hiperevaporação. No entanto, também pode ocorrer uma combinação de ambos (MESSMER, 2015)

Dry Eye Syndrome is a chronic eye condition, of multifactorial origin, characterized by the vicious circle of tear film instability and its hyperosmolarity, which cause ocular surface inflammation and neurosensory abnormalities (NELSON et al., 2017; TSUBOTA et al., 2017; ZEMANOVÁ, 2021). The disease is classified into two subtypes, namely: water deficiency, when there is reduced tear production, or hyperevaporative, in which the tear film evaporates from excessive form due to alteration in the production of some of the tear components due to meibomian gland dysfunction (MGD). About 10% of individuals have water deficiency and more than 80% have hyperevaporation. However, a combination of both can also occur (MESSMER, 2015)

Clinical observation of Tiaoshen acpuncture for dry eye syndrome with yin deficiency of liver and kidney / 中国针灸

OBJECTIVE@#To compare the curative effect of Tiaoshen acupuncture combined with artificial tears and artificial tears alone for dry eye syndrome with yin deficiency of liver and kidney.@*METHODS@#A total of 70 patients of dry eye syndrome with yin deficiency of liver and kidney were randomized into an acupuncture combined with medication group (35 cases, 2 cases dropped off) and a medication group (35 cases, 3 cases dropped off). In the medication group, 0.1% sodium hyaluronate eye drop was applied, 3 times a day, 1 drop each time. On the basis of the treatment as the medication group, Tiaoshen acupuncture was applied at Shenting (GV 24), Shenmen (HT 7), Benshen (GB 13), Taixi (KI 3), Taichong (LR 3), Guangming (GB 37), Fengchi (GB 20), Tongziliao (GB 1), Yuyao (EX-HN 4) in the acupuncture combined with medication group, Tongziliao (GB 1) and Yuyao (EX-HN 4) were connect with electroacupuncture, the needles were retained for 30 min, once a day, 6 times a week. Both groups were treated for 2 weeks. Before and after treatment, the clinical symptom score, SchirmerⅠtest (SⅠT), break-up time (BUT), corneal fluorescein staining (FL) score and Hamilton anxiety scale (HAMA) score were observed in the two groups, and the clinical efficacy was compared in the two groups.@*RESULTS@#Compared before treatment, the clinical symptom scores, corneal FL and HAMA scores were decreased (P<0.05), the levels of SⅠT and BUT were increased after treatment in the two groups (P<0.05). After the treatment, the clinical symptom score, FL and HAMA scores in the acupuncture combined with medication group were lower than the medication group (P<0.05), the levels of SⅠT and BUT in the acupuncture combined with medication group were higher than the medication group (P<0.05). The total effective rate in the acupuncture combined with medication group was 90.9% (30/33), which was higher than 71.9% (23/32) in the medication group (P<0.05).@*CONCLUSION@#Tiaoshen acupuncture combined with artificial tears could promote the secretion of tears for patients of dry eye syndrome with yin deficiency of liver and kidney, repair corneal defect and prolong tear film break-up time, and alleviate anxiety state, its curative effect is better than simple artificial tears.

Design and Implementation of User-oriented Auxiliary Treatment Instrument for Meibomian Gland Dysfunction / 中国医疗器械杂志

Dry eye is a common ophthalmic disease caused by eye maladjustment due to meibomian gland dysfunction (MGD), which is often accompanied by symptoms such as increased tear film osmotic pressure and ocular surface inflammation. In the treatment of dry eye patients, dredging gland obstruction caused by meibomian gland secretion is an effective treatment method. Based on electrothermal effect and hyperelasticity of the silicone, an auxiliary treatment instrument for MGD is designed, which can improve the blood circulation of the glands through heat compress and massage to achieve the purpose of dredging the meibomian glands. The therapy device can display the temperature and pressure during the treatment in real time, so that the surgeon can grasp the progress of the treatment in real time. The therapy device constructs a user-oriented interactive interface based on parametric modeling method, which can be customized by 3D printing according to the user's eyeball geometric parameters. The designed therapeutic device was finally tested on New Zealand white rabbits. The experimental results show that the therapeutic device has significant effectiveness and safety, as well as clinical application prospects.

Evaluación funcional de los parámetros del Oculus KERATOGRAPH 5M posterior a la realización de luz pulsada intensa (IPL). Pacientes con disfunción de la glándula de Meibomio (período de enero a diciembre del 2018). En el Instituto Scorsetti / FUNCTIONAL EVALUATION OF THE PARAMETERS OF OCULUS KERATOGRAPH 5M AFTER THE REALIZATION OF INTENSE PULSED LIGHT in patients with gland dysfunction Mebomio during the period January-December 2018 in the Institute Scorsetti

Objetivo: Evaluar los cambios funcionales obtenidos en el KERATOGRAPH 5M posterior a la terapia de luz pulsada intensa (IPL), durante el periodo de enero a diciembre del 2018 en el Instituto Scorsetti de la Ciudad de Buenos Aires ­ Argentina Introduccion: El ojo seco es una patología crónica muy frecuente en la edad adulta que puede ocasionar disminución en la productividad y es de muy alto costo en nuestro medio, existen diferentes terapias para el manejo del ojo seco (1); Este trabajo está enfocado al ojo seco de tipo evaporativo con disfunción de la glándulas de Meibomio y su manejo con la terapia de luz pulsada intensa con el equipo Thermaeyes que ha mostrado muy buenos resultados en algunos artículos científicos (Toyos R,Mcgill W, Briscoe D. . Tratamiento con luz pulsada intensa para la enfermedad de ojo seco debido a disfunción de la glándula de Meibomio)(2) Diseño: Estudio retrospectivo de cohorte trasversal de fuentes secundarias. Materiales y métodos: Este estudio fue realizado en el Instituto Scorsetti de la Ciudad de Buenos Aires ­ Argentina de la base de dato del OCULUS KERATOGRAPH 5M durante el año 2018, que incluyo 50 ojos de 25 paciente con antecedentes de ojo seco evaporativo y disfunción de la glándulas de Meibomio con un rango de edad de 50-80 años, de diferentes sexos, que realizaron terapia completa de IPL durante el periodo del 2018. Resultados: En la medición de la altura del menisco lagrimal: El 64% presentaron mejoría posterior a la terapia con luz pulsada, 24% no mostraron cambios significativos y 12% empeoraron. En el tiempo de ruptura de la lagrimal: 52% mostraron una mejoría posterior a la terapia con luz pulsada, 40% no obtuvo cambio y 8% empeoraron. En el enrojecimiento conjuntival: el 48% mostraron una mejoría posterior a la terapia con luz pulsada, 48% no obtuvo cambio y 4% empeoró. Y en la encuesta sintomática (DEQ ): el 48% mostraron una mejoría posterior a la terapia con luz pulsada, 32% no obtuvo cambio y 20% empeoraron. Conclusiones: La terapia de IPL es una excelente opción de tratamiento del el ojo seco evaporativo con disfunción de la glándula de meibonio mostrando mejoría objetiva con estabilización de la película lagrimal, en la altura del menisco lagrimal, enrojecimiento conjuntival, tinción de superficie, así como también mejoría subjetiva en los síntomas.

Objective: To evaluate the functional changes obtained in the KERATOGRAPH 5M after intense pulsed light therapy (IPL), during the period from January to December 2018 in the Ophthalmological Institute Prof. Dr. Daniel Scorsetti of the City of Buenos Aires ­ Argentina Introduction: The dry eye is a chronic pathology very frequent in adulthood that can cause decrease in productivity and is very high cost in our environment, there are different therapies for the management of dry eyes; This work is focused on evaporative dry eye with dysfunction of the meibomian glands and its management with intense pulsed light therapy with Thermaeyes equipment that has shown very good results in some scientific articles. Design: Retrospective study of cross-sectional cohort of secondary sources. Materials and methods: This study was conducted in the Ophthalmological Institute Prof. Dr. Daniel Scorsetti of the City of Buenos Aires - Argentina of the data base of OCULUS KERATOGRAPH 5M during the year 2018, which included 50 eyes of 25 patients with a history of evaporative dry eye and dysfunction of the meibomian glands with an age range of 50-80 years, of different sexes, who performed complete IPL therapy during the period of 2018. Results: In the measurement of tear meniscus height: 64% showed improvement after pulsed light therapy, 24% did not show significant changes and 12% worsened. At the time of rupture of the lacrimal: 52% showed a subsequent improvement to the therapy with pulsed light, 40% did not obtain change and 8% worsened. In the conjunctival redness: 48% showed an improvement after the pulsed light therapy, 48% did not change and 4% got worse. And in the symptomatic survey (DEQ ): 48% showed an improvement after pulsed light therapy, 32% did not change and 20% worsened. Conclusions: IPL therapy is an excellent treatment option for evaporative dry eye with dysfunction of the meibonio gland, showing objective improvement with stabilization of the lacrimal film, in the height of the lacrimal meniscus, conjunctival reddening, surface staining, as well as also subjective improvement in symptoms.

Os efeitos a longo prazo do uso de concentrado de plaquetas em olho seco diabético: uma série de casos / The long-term effects of platelet-rich plasma in diabetic dry eye: a series of cases

Resumo Objetivo: Avaliar a eficácia a longo prazo após 6 meses de uso do colírio de concentrado de plaquetas (CCP) autólogo no olho seco sintomático de pacientes diabéticos. Métodos: Um estudo de intervenção com único grupo prospectivo tipo série de casos; dez pacientes diabéticos com doença do olho seco refratário que usaram o CCP e foram reavaliados 6 meses após suspensão do tratamento. Na etapa inicial 221 pacientes diabéticos foram avaliados quanto a olho seco, destes 12 foram submetidos ao CCP, e avaliados para sintomas, escore de OSDI (Ocular Surface Disease Index), TFBUT (Tear Film Break Up Time) e Teste de Schirmer. Nesta etapa do estudo os pacientes foram reconvocados após 6 meses de suspensão do CCP, e o escore de OSDI, TFBUT e teste de Schirmer foram revistos. Resultados: Houve diferença estatisticamente significante nos escores de OSDI e TFBUT entre o basal (antes do tratamento com CCP) e após 1 mês do uso do CCP ; entre o basal e após 6 meses de suspensão do uso do CCP, e entre os valores após 1 mês de uso e após 6 meses sem uso (p= 0,005, p=0,010 e p= 0,028, p=0,04, p= 0,03 e p=0,02 respectivamente). Nos resultados do Teste de Schirmer não houve diferença significativa em nenhuma das comparações (p=0,09, p= 0,26, p=0,47 respectivamente). Conclusões: O CCP após 6 meses de uso apresenta evidências de que ainda seria eficaz mesmo com a suspensão do colírio.

Abstract Objective: To evaluate the long-term efficacy of autologous platelet -rich plasma (PRP) in the symptomatic dry eye of diabetic patients after 6 months of treatment suspension. Methods: A single intervention group, prospective study, series of cases; ten diabetic patients with refractory dry eye disease who used PRP and were reassessed 6 months after discontinuation of treatment. At the initial stage 221 diabetic patients were evaluated for dry eye, of these 12 were submitted to CPC, and evaluated for symptoms, Ocular Surface Disease Index (OSDI), TFBUT (Tear Film Break Up Time) and Schirmer's Test. At this stage of the study, patients were recruited after 6 months of CCP suspension, and the OSDI, TFBUT and Schirmer test scores were reviewed. Results: There was a statistically significant difference in the OSDI and TFBUT scores between the baseline (before PRP treatment) and after 1 month of PRP use; between the baseline and after 6 months of PRP use, and between the values after 1 month of use and after 6 months of non-use (p = 0.005, p = 0.010 and p = 0.028, p = 0.04, p = 0 , 03 and p = 0.02, respectively). Schirmer test values had no significant difference in any of the comparisons (p = 0.09, p = 0.26, p = 0.47 respectively). Conclusions: PRP after 6 months of use presents evidence that it would still be effective even with suspension of eye drops.

Eyelid margin cleaning using Deep Cleaning Device for the treatment of meibomian gland dysfunction-associated dry eye: a preliminary investigation / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

OBJECTIVE@#To evaluate the safety and effectiveness of eyelid margin cleaning using Deep Cleaning Device for the treatment of meibomian gland dysfunction-associated dry eye.@*METHODS@#This was a prospective, randomized, open-label, investigator-masked, and self-controlled study. We randomly assigned one eye of patients with meibomian gland dysfunction-associated dry eye to the treatment group, and the other eye to the control group. Both groups received artificial tears and lid warming; the treatment group received an additional one-time in-office eyelid margin cleaning using Deep Cleaning Device. Non-invasive tear break-up time (NITBUT) and tear meniscus height (TMH) of each eye, and Standard Patient Evaluation for Eye Dryness II (SPEED II) score of each patient were evaluated before and at one week after treatment.@*RESULTS@#Thirty eyes of 15 patients were enrolled. No adverse effects occurred during the treatment. Compared with the baseline values, the SPEED score decreased significantly at one week after treatment (mean±95% confidence interval, 11.00±0.99 vs. 5.67±1.67, P<0.0001), the NITBUT-first in the treatment group increased significantly at one week after treatment ((4.74±1.27) s vs. (7.49±2.22) s, P=0.01). The NITBUT-first was significantly longer in the treatment group ((7.49±2.22) s) than in the control group ((5.17±0.91) s) at one week after treatment (P=0.042). No significant differences were found in other tear film parameters between the two groups.@*CONCLUSIONS@#Eyelid margin cleaning using the novel Deep Cleaning Device is a convenient, effective, and safe treatment for patients with meibomian gland dysfunction-associated dry eye.

Implante de plug lacrimal termosensível para tratamento da síndrome da disfunção lacrimal / Thermo sensitive punctum plug implant for the treatment of dysfunctional tear syndrome

OBJETIVO: Avaliar os resultados da oclusão de ponto lacrimal reversível com o uso de plugs termosensíveis para o tratamento da síndrome da disfunção lacrimal. MÉTODOS: Dezoito olhos de 9 pacientes com diagnóstico de olho seco foram selecionados e submetidos à oclusão reversível de ponto lacrimal com o uso de plugs termosensíveis, e acompanhados por 60 dias através de questionário OSDI e testes com fluoresceína, rosa bengala e Schirmer. RESULTADOS: Em todos os pacientes estudados houve melhora nos sintomas de olho seco e melhora nos parâmetros oftalmológicos pesquisados. Em apenas 1 dos pacientes a melhora dos sintomas foi pequena, e não houve diminuição na dependência de colírio lubrificante. Nos outros 8 pacientes houve diminuição no uso de colírio. Durante o estudo não ocorreram complicações infecciosas ou de extrusão. CONCLUSÃO: Oclusão temporária do ponto lacrimal com SmartPlug tm parece ser uma opção efetiva para o tratamento da síndrome da disfunção lacrimal quando o uso de lubrificantes não é suficiente. Sua colocação é relativamente simples e segura, porém estudos mais longos são necessários.

PURPOSE: To evaluate the results of occlusion of the lacrimal punctum reversible with the use of thermosensitive plugs to treat the dysfunctional tear syndrome. METHODS: Eighteen eyes of 9 patients with dry eye were selected and subjected to reversible occlusion of the lacrimal punctum with the use of thermosensitive plugs and were followed for 60 days through the OSDI questionnaire, fluorescein staining, rose bengal staining and Schirmer's test. RESULTS: in all studied patients there was improvement in dry eye symptoms and in ophthalmic parameters studied. In only 1 of the patients, symptom improvement was small, and no decrease in dependence on lubricating drops. In the other 8 patients there was a decrease in the use of eye drops. During the study there were no infectious complications or extrusion. CONCLUSION: Temporary occlusion of the lacrimal punctum with SmartPlug tm seems to be an effective option for treating the dysfunctional tear syndrome when the use of lubricants is not enough. Its placement is relatively simple and safe, but longer studies are needed.

Síndrome do olho seco / Dry eye syndrome

A síndrome do olho seco é uma entidade muito comum na pratica medica e, por apresentar uma sintomalogia muito inespecífica, compartilhada por diversas outras doenças oculares, costuma ser subdiagnosticada. Atualmente, o termo olho seco é definido como “uma doença multifatorial do sistema lacrimal caracterizada por sintomas de desconforto, distúrbios visuais, com potencial dano à superfície ocular. É acompanhado de alteração de alterações na osmolaridade do filme lacrimal e inflamação da superfície ocular”.

Influência da terapia hormonal sobre o filme lacrimal em mulheres na pós-menopausa / The influence of the hormone therapy on the lacrimal film in postmenopausal women

Objetivo: Avaliar se a terapia hormonal (TH) administrada para mulheres na pós-menopausa, exerce algum efeito sobre os sintomas do "olho seco". Métodos: Foram avaliadas 14 pacientes na pós-menopausa, antes e 3 meses após introdução da terapia hormonal. Os parâmetros avaliados foram: idade, tempo de menopausa, presença de doenças e uso de medicações associadas, sinais e sintomas oculares e fatores de exposição ambiental. O exame oftalmológico incluiu topografia corneana, Teste de Schirmer I, tempo de quebra do filme lacrimal (break up time) e exame biomicroscópico completo. Os dados obtidos foram submetidos à análise estatística. Resultados: A média de idade das pacientes foi de 53,8. As principais queixas encontradas foram sensação de corpo estranho (35,7 por cento) e lacrimejamento (28,5 por cento), tanto antes, quanto depois da terapia hormonal. As topografias corneanas mostraram alterações inespecíficas, e os testes de Shirmer I e quebra do filme lacrimal não apresentaram diferença estatisticamente significativa, antes e depois da introdução da medicação. Conclusão: Usando a metodologia proposta, não se observou influência da terapia hormonal, usada durante 3 meses, sobre o filme lacrimal em mulheres na pós-menopausa.

Ojo seco / Dry eye

La deficiencia acuosa es la alteración más frecuente de la película lagrimal que determina ojo seco. A los síntomas clásicos de ardor, sensación de arenilla, fotofobia. etc., se agregan signos como disminución del menisco lagrimal, secreción mucosa, queratitis punctata, filamentos y otros, que junto a los colorantes vitales y exámenes específicos, hacen que el diagnóstico no sea problemático. Los pacientes más difíciles de tratar son los que presentan un síndrome de Sjögren, porque hay además un compromiso inmunológico. En ellas las lágrimas de sustitución, la oclusión de los puntos lagrimales, los mucolíticos, la vitamina A, la ciclosporina, etc., a veces no dan el resultado esperado y nos vemos obligados a realizar tarsorrafia, resección de conjuntiva o tratar de perforación corneal. Finalmente, es posible tener áreas de desecación si hay blefaropatías y/o irregularidades de la superficie ocular