Correlation Analysis between Ocular Surface Parameters with Subjective Symptom Severity in Dry Eye Disease

Purpose@#To evaluate the clinical symptoms of patients with dry eyes, based on the ocular surface disease index (OSDI) and analyze the relationship between OSDI and various ocular surface parameters. @*Methods@#This was a retrospective study that included 45 eyes of 45 dry eye patients who visited the Seoul Nune Eye Hospital from August 2017 to December 2017. The patients were assessed by non-invasive keratography for the first break-up time, lipid layer thickness (LLT), tear osmolarity, tear matrix metalloproteinase-9 immunoassay as well as with the conventional Schirmer I test and fluorescein break-up time. The patient’s symptoms were evaluated by the OSDI questionnaires and correlations were analyzed based on the parameters described above. @*Results@#There were significant negative correlations between OSDI and non-invasive keratography for the first break-up time (p = 0.038, r = -0.330), and LLT (p = 0.005, r = -0.426). However, there were no significant correlations between OSDI and fluorescein break-up time, Schirmer I score, and tear osmolarity (p = 0.173, 0.575, and 0.844 respectively). OSDI was not significantly different between matrix metalloproteinase-9 positive and negative groups (p = 0.768). @*Conclusions@#Non-invasive examinations such as non-invasive keratograph break-up time and interferometry of LLT can be efficient tools for evaluating dry eye symptoms.

Comparison of Hyperopic Photorefractive Keratectomy and LASIK

PURPOSE: We compared the results of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) for the correction of hyperopia. METHODS: Patients who underwent PRK or LASIK, under +6.00 diopters (D) hyperopia and under −2.00 D astigmatism were included. In total, 21 patients (38 eyes) underwent PRK surgery and 25 patients (41 eyes) underwent LASIK surgery. We compared the visual acuity, refractive error, safety, and efficacy between the two groups. RESULTS: The manifest refractive spherical equivalent (MRSE) of the PRK and LASIK groups at 1 and 3 months after surgery was significantly different between the two groups (p < 0.05). However, the MRSE was not significantly different at postoperative 6 and 12 months between the two groups. The uncorrected visual acuity (UCVA) of the PRK and LASIK groups at 1 month after surgery was significantly different between the two groups (p < 0.05). However, the UCVA was not significantly different at postoperative 3, 6, and 12 months between the two groups. The best-corrected visual acuity was not significantly different at postoperative 1, 3, 6, and 12 months between the two groups. The safety index was not significantly different between the two groups at postoperative 1, 3, 6, and 12 months. The efficacy index of the PRK group was lower than that of the LASIK group at 1 month after surgery. However, the efficacy index was not significantly different at postoperative 3, 6, and 12 months between the two groups. There was no statistically significant difference between the predictability of the two groups at postoperative 1 year. CONCLUSIONS: After PRK treatment, temporary myopic deviation was observed after 1 month, but there was no significant difference between the two treatments after 3 months of follow-up. In the correction of hyperopia, there was no significant difference between PRK and LASIK in efficacy or safety.

Effect of 3% Diquafosol Tetrasodium on Tear Film Stability after Laser-assisted in situ Keratomileusis

PURPOSE: To evaluate the efficacy of 3% diquafosol tetrasodium (DQ) after laser-assisted in-situ keratomileusis (LASIK). METHODS: This prospective randomized study included 150 eyes in 75 patients who were scheduled for LASIK. The patients in the 3% diquafosol tetrasodium (DQ) group (37 patients, 74 eyes) were instructed to apply one drop of DQ, six times daily post-op, while the patients in the 0.3% sodium hyaluronate (HA) group (38 patients, 76 eyes) were instructed to apply one drop of HA, six times daily post-op. A Schirmer test, tear film break-up time (BUT), corneal and conjunctival fluorescein staining score (FLSS), and ocular surface disease index (OSDI) were evaluated pre-op and at 1, 4, and 12 weeks post-op while the tear osmolarity was evaluated pre-op and at 4 and 12 weeks post-op. RESULTS: There was no significant difference between the two groups regarding Schirmer test results or tear osmolarity and conjunctival FLSS. The BUT was significantly higher in the DQ group at 1 week and 12 weeks post-op. The corneal FLSS was significantly lower in the DQ group at 1 week, 4 weeks and 12 weeks post-op. The OSDI was significantly lower in the DQ group at 1 week post-op. CONCLUSIONS: Use of 3% diquafosol tetrasodium after surgery improved ocular dryness and increased the tear film stability.

The Effect of Topical Cyclosporine 0.05% on Tear Osmolarity for Dry Eye Syndrome

PURPOSE: To evaluate the effect of topical cyclosporine 0.05% (Restasis; Allergan, Irving, CA, USA) on tear osmolarity in patients with dry eye disease. METHODS: The present study was a single-center, randomized, prospective, and longitudinal trial. Patients who had been using artificial tears to treat dry eye disease were prescribed cyclosporine 0.05% and evaluated using tear osmolarity, tear break-up time, ocular surface staining score, Schirmer test, and the Ocular Surface Disease Index for symptomatic improvement. Clinical measurements of commonly used objective tests were performed at baseline and after 1, 3, and 6 months. RESULTS: At the end of the study, patients demonstrated statistically significant improvement in tear break-up time (6.26 +/- 1.26 sec at 3 months vs. 4.41 +/- 1.63 sec at baseline, p = 0.022) and OSDI (34.98 +/- 20.19 at 3 months vs. 45.02 +/- 22.38 at baseline, p = 0.032) only at 3 months. Other measures such as Schirmer test, ocular surface grade, and tear osmolarity also showed improvement. However, the differences were not significant. CONCLUSIONS: Over a 6-month period, topical cyclosporine 0.05% showed beneficial effects on symptoms and other commonly used signs of dry eye disease for 3 months; however, the tear osmolarity values were not significantly improved.

Comparison of Clinical Results between Transepithelial Photorefractive Keratectomy and Brush Photorefractive Keratectomy

PURPOSE: To compare the results of transepithelial photorefractive keratectomy (trans PRK) and brush-assisted photorefractive keratectomy (brush PRK) for the treatment of myopia. METHODS: A total of 146 eyes from 78 patients who received brush PRK or trans PRK with the Schwind Amaris laser platform were included in the present study. Uncorrected distance visual acuity (UDVA) and manifest refraction spherical equivalent (MRSE) at postoperative 1 week, 1, 3, 6, and 12 months were compared between the 2 groups as well as epithelial healing time. RESULTS: The mean time to complete epithelial healing was 3.27 +/- 0.75 days in the trans PRK group and 3.67 +/- 0.93 days in the brush PRK group (P < 0.05). At 1 week after surgery, UDVA recovered more rapidly after trans PRK than brush PRK (brush PRK: 0.13 +/- 0.12 log MAR units, trans PRK: 0.09 +/- 0.08 log MAR units, P < 0.05), however, UDVA was not significantly different at 1, 3, 6, and, 12 months postoperatively between the 2 groups. CONCLUSIONS: Re-epithelialization and visual recovery were faster in the trans PRK group while visual outcome and postoperative complications were equivalent to the brush PRK group.

A Comparision of Short Term use Effects and Satety of Timoptic(R) with those of Cosopt(R) in Normal Korean

PURPOSE: This study is to compare the clinical effects and safety of 0.5% timolol maleate and 2% dorzolamide hydrochloride combinationis (Cosopt(R)) with those of 0.5% timolol maleate (Timoptic(R)) in normal Korean. METHODS: We instilled Timoptic(R) eye drops two time a day into one eye and Cosopt(R) eyedrops two times a day into the other eye for thirty days and measured the intraocular pressure (IOP) and side effects in normal Korean volunteers. RESULTS: Cosopt(R) was superior to Timoptic(R) in reducing IOP, but had more frequent side effects such as burning, blurred vision, tearing, ocular pain, injection than those of Timoptic(R). However side effects of Cosopt(R) were tolerable enough to refrain from discontinuation. CONCLUSIONS: Due to the greater IOP lowering efficacy of CosoptR compared to that of Timoptic(R), it can be used as an effective substitute in case of uncontrolled IOP with beta blockers alone.

The Change of Eyeball Contour and Factors Affecting Corneal Flap using Automated Microkeratome in LASIK

PURPOSE: To evaluated the effect of suction ring on eyeball contour and its influence on the corneal flap made in LASIK(laser in situ keratomileusis). METHODS: We measured corneal thickness and axial length of 47 eyes, before and during application of the suction ring, in those which had undergone LASIK. The diameter and thickness of corneal flap made with Automated Corneal Shaper(R) were also measured in operation room. RESULTS: When applying suction ring while making a corneal flap, corneal thickness and axial length were decreased significantly(p<0.05), and the diameter of the flap was decreased as preoperative corneal curvature decreased(p<0.05). CONCLUSIONS: Careful attention is needed not to give an eyeball unnecessary pressure which may result in intraocular damage or flap complications such as free cap especially when their corneal curvature is too flat.

The Effect of Mitomycin-C on Postoperative Corneal Astigmatism in Trabeculectomy and Triple Procedure

Mitomycin-C is known to delay wound healing and it may have influence upon the post operative astigmatism changes. We calculated the postoperative induced astigmatism of patients who underwent trabeculectomy or triple procedures with or without the use of mitomycin-C. And the vector analysis method was used. To compare the induced astigmatism between the groups we calculated the induced astigmatism corresponding to the 180degree axis. The patients who underwent triple procedure without and with mitomycin-C showed a mean induced astigmatism of -4.50D, -1.81D, respectively, after 7 days(p<0.05) and -0.13D, 1.73D, respectively, after 12 months (p<0.05). Those who underwent trabeculectomy without mitomycin-C and with mitomycin-C showed a mean induced astigmatism of -2.63D, -1.01D, respectively, after 1 month(p<0.05) and -1.42D, 0.34D, respectively, after 12 months(p<0.05). The use of mitomycin-C reduces the total amount of astigmatism in trabeculectomy patients. However, in the triple procedure patients it increases the total amount of astigmatism. The entire amount of against the rule astigmatic change was similar between the mitomycin-C applied group and non-applied group. The astigmatic shift of the group without mitomycin-C, reached a plateau after 3 months. However, the other group showed continuous against the rule shift until 12 months.