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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: To study ocular surface signs, symptoms, and tear film composition following prophylactic thermal pulsation therapy (TPT) prior to refractive surgery, and to compare these outcomes with those who underwent TPT after refractive surgery. Methods: Patients with mild?to?moderate evaporative dry eye disease (DED) and/or meibomian gland dysfunction (MGD) undergoing refractive surgery were included. Group 1 patients received TPT (LipiFlow) prior to laser?assisted in situ keratomileusis (LASIK; n = 32, 64 eyes), and Group 2 patients received TPT three months after LASIK (n = 27, 52 eyes). Ocular Surface Disease Index (OSDI) score, Schirmer’s test (ST1, ST2), Tear Breakup Time (TBUT), meibography, and tear fluid were obtained preoperatively and at three months postoperatively in Groups 1 and 2. Additional postoperative evaluation was performed three months after TPT in Group 2. Tear soluble factor profile was measured by multiplex enzyme?linked immunosorbent assay (ELISA) using flow cytometry. Results: Postoperative OSDI score was significantly lower and TBUT was significantly higher when compared with matched preoperative values of Group 1 participants. On the other hand, the postoperative OSDI score was significantly higher and TBUT significantly lower when compared with matched preoperative values of Group 2 participants. TPT significantly reduced the postoperative elevation in OSDI and significantly reduced the postoperative reduction in TBUT in Group 2 participants. Tear Matrix metalloproteinase?9/ Tissue inhibitor matrix metalloproteinase 1 (MMP?9/TIMP1) ratio was significantly higher, postoperatively, when compared with matched preoperative levels in Group 2. However, MMP9/TIMP1 ratio remained unaltered in Group 1 participants. Conclusion: TPT prior to refractive surgery improved postsurgical ocular surface signs and symptoms and reduced tear inflammatory factors, thereby suggesting the plausibility of reduced post?refractive surgery DED in patients.
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Aims: To compare the diagnostic values of the OSDI, the Schirmer’s and tear film breakup time test to check for dry eye in healthy adult students using computers and contact lenses.Methodology: Our sample consisted of hundred (100) eyes from fifty (50) healthy adults aged 18-24 years students at the University of West Attica (25 participants were contact lens wearers, while the remaining 25 were not). All participants were exposed to a computer screen or a mobile screen. Qualitative tear measurement was performed with Tear Break-Up Time Test (TBUT), quantitative measurement of tears with Schirmer Test and use of the Ocular Surface Disease Index (OSDI).Results: During the analysis of the results, it was found that OSDI was inversely proportional to the TBUT test and the Schirmer test. 60% did not have dry eye, 34% had a mild dry eye, 4% had moderate dry eye and 2% had severe dry eye. ? statistically significant relationship existed between OSDI and the other variables as well as the TBUT test with Schirmer test (p-value <0.05).Conclusion: The OSDI questionnaire, used in conjunction with the TBUT test, was easy to perform and could be helpful in supporting the diagnosis of dry eye syndrome.
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Objectives@#To describe the population of dry eye disease (DED) patients seen at the Philippine General Hospital (PGH) Dry Eye Clinic, and to compare the diagnosis, type, and severity of DED using Oculus Keratograph® 5M (Oculus GmbH, Wetzlar, Germany) with clinical diagnosis.@*Methodology@#This was a single-center comparative, cross-sectional study. Newly-diagnosed DED patients were recruited for the dry eye group. A subset of healthy volunteers without DED was also recruited for the control group. The clinical data for both groups were collected, and the Ocular Surface Disease Index (OSDI) questionnaire was administered. Standard clinical dry eye testing and Keratograph testing were subsequently done. The PGH Dry Eye Clinic definitions were used to classify the types of dry eye. @*Results@#Eighty (80) eyes of 40 patients per group were examined. For the dry eye group, the mean age and OSDI scores were significantly higher, while the average tear break up time (TBUT) was significantly lower. There was no significant difference in average basal secretion test (BST) and Schirmer 1 measurements between the two groups. 73% had evaporative type dry eye, while 27% had mixed type. Majority of the DED patients were females of >50 years old with mild evaporative type. Foreign body sensation was the most common symptom. Overall, there was poor agreement between clinical and Keratograph assessments of diagnosis and severity among patients in the dry eye group, but there was acceptable agreement when assessment was done in the control group.@*Conclusions@#DED patients at the PGH have similar characteristics to reported DED of other Asian populations. Evaporative or short TBUT type dry eye is the most frequently seen. Further formal validity study is needed for Oculus Keratograph® 5M to increase the value of its data to be included in routine dry eye screening.
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Síndromes de Ojo Seco , FilipinasRESUMEN
@#The aim of this study was to examine tear stability of contact lens wearers (CLW) in young Malay adults aged 18 and above and to compare the results with non-contact lens wearers (NCLW). Corneal staining and McMonnies Dry Eye Questionnaires (MDEQ) scores between habitual soft CLW and NCLW were also compared. It also aimed to find correlation between tear stability and MDEQ scores. Quasi-experimental and case control study was conducted among 53 participants (53 right eyes) at UiTM Vision Care, UiTM Puncak Alam Campus. Twenty six participants were habitual soft CLW and twenty seven were NCLW. Tear stability was measured using non-invasive tear break-up time (NIBUT) and invasive tear break-up time (TBUT). Corneal staining was measured using Efron Grading Scale and dry eye symptoms evaluated using MDEQ. Mean scores of NIBUT and TBUT for CLW were 5.23 ± 7.3 sec and 2.19 ± 2.41 sec respectively; for NCLW were 8.71 ± 4.33 sec and 3.00 ± 1.69 sec respectively. There were significant differences in NIBUT (Mann-Whitney U, p=0.0001) and TBUT (Mann-Whitney U, p=0.001) between the CLW and NCLW. There was also significant difference in percentage of corneal staining found between the CLW (22.6%) and NCLW (7.5%), (Chi-square, p=0.013). However no significant difference was found in MDEQ scores between the CLW (7.54 ± 3.62) and the NCLW (8.15 ± 3.38) group, (Mann-Whitney U, p=0.42). There were also no correlations found between tear stability and MDEQ scores in the two groups. The results of this study showed NIBUT and TBUT values were significantly higher in NCLW than in CLW and corneal staining was more extensive in CLW. Contact lens practitioners need to be aware of changes in tear stability as results of contact lens wear and take the necessary action to improve on the management of their patients during aftercare consultation.
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Background: Dry eye disease (DED) is the very common and underdiagnosed ocular condition affecting vision, quality of life, and the outcomes of cataract or refractive surgery. Dry eye disease (DED), either alone or in combination with other conditions, is a frequent cause of ocular irritation that leads the patients to seek ophthalmic care. Due to a wide variety of presenting symptoms, it is often unrecognized and this causes great frustration of the patient and treating physician. While these symptoms often improve with appropriate treatment, usually in majority of the cases the disease may not be curable. Aim of the study was to compare the efficacy of tacrolimus and cyclosporine in dry eye disease.Methods: This was a single centred, 3 months prospective study. Patients with unilateral or bilateral dry eye disease and an ocular surface disease index score >12, atleast one eye with schirmer score <5mm and TBUT <10 s were enrolled in the study. The enrolled patients were randomly divided into two groups, twenty-five patients in Group 1 and twenty three patients in Group 2 completed the follow up. Group 1(n =25) who received 0.03% tacrolimus eye ointment twice daily for consecutive 3 months and Group 2 (n= 23) received 0.05% cyclosporine eye drops twice daily for consecutive 3 months the primary efficacy outcome was Schirmer score after 3 months. The secondary outcomes were TBUT and adverse effects.Results: After 3 months, both the treatment groups showed significant improvement in mean Schirmer score (p<0.001) and mean TBUT (p <0.0001). However, on comparing both the groups, mean Schirmer score and mean TBUT, results were comparable. No patient discontinued treatment because of minor ocular adverse effects.Conclusions: Dry eye patients demonstrated improvement in Schirmer score and TBUT after 3 months of treatment with tacrolimus 0.03% ointment and cyclosporine 0.05% eye drops.