Different concentrations of fluorometholone eye drops on the treatment of children with severe mixed vernal keratoconjunctivitis / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To observe the clinical effect of different concentration of fluorometholone eye drops on severe mixed vernal keratoconjunctivitis in children.METHODS: A total of 50 cases(100 eyes)of children with severe mixed vernal keratoconjunctivitis treated in the outpatient department of our hospital from March to September, 2022 were selected and randomly divided into two groups. Group A consisted of 25 cases(50 eyes)who were treated with 0.1% fluorometholone eye drops combined with 0.05% cyclosporine eye drops(Ⅱ), while 25 patients(50 eyes)in group B were treated with 0.02% fluorometholone eye drops combined with 0.05% cyclosporine eye drops(Ⅱ). After 1mo of treatment, SPEED questionnaire score, corneal fluorescein staining(FL)score, tear break-up time(TBUT), Schirmer I test(SⅠt), R-scan, non-invasive tear meniscus height(NIKTMH), corneal optical density and other ocular parameters of the two groups were observed, and the occurrence of adverse reactions were recorded.RESULTS: After 1mo of treatment, there were significant differences in SPEED score, FL score and R-scan results between the two groups(all P<0.05), and no differences in TBUT, SⅠt and NIKTMH results(all P>0.05). However, there were statistical significance in corneal optical density in different corneal depth and diameter ranges(all P<0.05). After 1mo of treatment, there was no significant difference in intraocular pressure between the two groups(16.21±2.90mmHg vs. 16.05±2.75mmHg, P>0.05), and no obvious adverse reactions occurred during treatment.CONCLUSION: The 0.1% fluorometholone eye drops can effectively treat severe mixed vernal keratoconjunctivitis in children, and its effect is better than 0.02% fluorometholone eye drops.

Efficacy of optimal pulse technology in the treatment of demodex blepharitis and its effect on ocular surface function / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the efficacy of optimal pulse technology(OPT)in the treatment of demodex blepharitis and its influence on ocular surface function.METHODS: A retrospective study was conducted from February 2018 to October 2020. A total of 127 patients(254 eyes)with demodex blepharitis were assigned to the observation group and the control group according to the treatment method. The control group(63 patients, 126 eyes)were given conventional hot compress, eye cleansing and drug therapy. On this basis, the observation group(64 patients, 128 eyes)was treated with OPT. Both groups were given 6wk of continuous treatment. Demodex count, Marx's line scores, meibum character scores, ocular surface disease index(OSDI)scores, non-invasive tear break-up time(NIBUT), non-invasive tear meniscus height(NITMH)and lipid layer thickness(LLT)were compared between the two groups, and safety was evaluated.RESULTS: After 6wk of treatment, demodex count, Marx's line scores, meibum character scores and OSDI scores of the two groups decreased. NIBUT, NITMH and LLT increased. Meanwhile, demodex count, Marx's line scores, meibum character scores and OSDI scores of the observation group were significantly lower than those in the control group. NIBUT, NITMH and LLT were longer/larger than those in the control group(P<0.001). No obvious abnormality of intraocular pressure or conjunctival/corneal injury was observed in either group.CONCLUSION:OPT is effective and safe in the treatment of demodex blepharitis.

Efficacy observation of acupuncture for dry eye syndrome of lung-yin deficiency pattern / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of combining two needling manipulations, Er Long Xi Zhu (two dragons playing with a pearl) and Guo Yan Re (heat produced to reach the eyes), in treating dry eye syndrome (DES) of lung-yin deficiency pattern. Methods: Fifty-six eligible DES patients of lung-yin deficiency were randomized into an observation group and a control group, with 28 cases in each group. Same acupoints were selected in the two groups: Cuanzhu (BL 2), Sizhukong (TE 23), Taiyang (EX-HN 5) and Fengchi (GB 20) were chosen as the major points and Feishu (BL 13) and Chize (LU 5) as the adjuvant. Er Long Xi Zhu and Guo Yan Re needling manipulations were applied in the observation group while twirling reinforcing manipulation was used in the control group. Treatment was conducted once per day in both groups, for two sets of 15 consecutive days at a 2-day interval. Changes in the symptom score, tear break-up time (BUT) and tear production were observed afterwards, and the clinical efficacy was also compared between the two groups. Results: The total effective rate was 92.8％ in the observation group, higher than 71.4％ in the control group, and the between-group difference was statistically significant (P<0.05). After treatment, the symptom score, tear BUT and tear production showed significant improvements in both groups (all P<0.05); the symptom score, BUT and tear production in the observation group were significantly different from those in the control group (all P<0.05). Conclusion: Given the same acupoint selection, combining Er Long Xi Zhu and Guo Yan Re needling manipulations can produce more significant clinical efficacy than twirling reinforcing manipulation in treating DES of lung-yin deficiency pattern.

Effect of acupuncture on expression of transfer growth factor-β1 in lacrimal gland of rabbits with dry eye / 针刺研究

OBJECTIVE: To observe the effect of acupuncture on expression of transforming growth factor-β1(TGF-β1) in lacrimal gland of rabbits with dry eye, so as to explore its underlying mechanism in improving dry eye. METHODS: Healthy male New Zealand rabbits were randomly assigned to 5 groups (n=6 in each group), namely, blank group, model group, western medicine group, acupuncture group and sham acupuncture group. The dye eye rabbit model was estabilished by subcutaneous injection of Scopolamine Hydrobromide solution for 21 days. After modeling, rabbits in the western medicine group were treated with Flumirone eye drops in their eyes 3 times a day, one drop each time. Rabbits of the acupuncture group reveived electroacupuncture(4 Hz/20 Hz, 1 mA) at "Cuanzhu"(BL2) and "Tongziliao"(GB1) for 15 min, and received acupuncture at "Jingming"(BL1), "Taiyang" (EX-HN5) and "Sizhukong"(TE23) for 15 min, once a day. Rabbits of the sham acupuncture group received blunt acupuncture at the surface of the same acupoints once a day. All the treatments were conducted for 14 days. The changes of tear flow, tear film break-up time (BUT) and lacrimal gland morphology in each group were observed. The expression of TGF-β1 protein and mRNA in lacrimal gland were detected by Western blot and quantitative real-time fluorescence PCR respectively. RESULTS: Following modeling, except for the blank group, the tear flow and BUT in other 4 groups decreased significantly (P<0.01). Compared with their own pretreatment, the tear flow and BUT in western medicine group and acupuncture group increased after the treatment (P<0.05). Compared with the model group, the tear flow and BUT increased in the western medicine group and the acupuncture group(P<0.05). Atrophic lacrimal epithelial cells and the stroma of mucous membrane infiltrated by lymphocytes and plasma cells were found in rabbits of the model group and the sham acupuncture group. By contrast, in the western medicine group and the acupuncture group, the structure of lacrimal epithelial cells was basically normal, and the infiltration of lymphocytes and plasma cells were scattered in the stroma of mucous membrane. In comparison with the blank group, the expression of TGF-β1 protein and mRNA in lacrimal gland were significantly up-regulated in the model and sham acupuncture groups (P<0.01). Compared with the model group, the expression of TGF-β1 protein and mRNA were significantly down-regulated in the western medicine and acupuncture groups (P<0.01, P<0.05). CONCLUSION: Acupuncture intervention can increase tear flow and BUT in rabbits with dry eye, which may be related to the regulation of TGF-β1 expression in lacrimal gland.

Tear film measurements in four different ethnic groups: Malay, Chinese, Indian and Nigerian / 国际眼科杂志(Guoji Yanke Zazhi)

@#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.

Comparison of non-invasive tear break-up time and tear meniscus height in healthy eyes and keratoconus using Oculus Keratograph 5M / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To compare the non-invasive tear break-up time (NITBUT) and tear meniscus height (TMH) measurements in keratoconus patients and normal subjects, and to determine the relationship between these measurements with keratoconus disease by the Oculus Keratograph 5M (K5M).METHODS:Fifty keratoconus patients (100 eyes) and 50 healthy subjects (100 eyes) participated in the study.The age range in keratoconus group was 15-60(mean ± standard deviation=28.33±8.60) y, and in control group was 18-60(26.25±1.11) y.The measurements of NITBUT and TMH were performed using the K5M.RESULTS:The mean value of NITBUT between the keratoconus group and the control group showed no statistically significant different (P=0.58).Also, the mean of TMH between two groups was not significantly different (P=0.69).The results of correlation coefficient between the variables of the study demonstrated that there was no significant relationship between the NITBUT and TMH measurements with the two groups (keratoconus group:r=0.053, P=0.721;control group;r=-0.0501, P=0.7098).CONCLUSION:Our study shows that the presence of keratoconus has no clinically significant impact on the quality and quantity of tear film.

Effect of different types of pterygium surgery and on tear film in patients with type 2 diabetes mellitus / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To compare the effect of three types of pterygium surgery and on tear film in patients with type 2 diabetes mellitus. ·METHODS:A total of 102 patients ( 102 eyes ) with pterygium combined with type 2 diabetes mellitus treated in our hospital from March 2013 to March 2016 were analyzed retrospectively. The patients were divided into three groups including the 34 cases ( 34 eyes ) with simple excision of pterygium ( resection group ) , pterygium excision combined with conjunctival flap transplantation in 34 cases (34 eyes, as conjunctival flap group ) and pterygium excision combined with limbal stem cell transplantation in 34 cases ( 34 eyes, as stem cell group ) . The wound repair time, complications, recurrence rate, uncorrected visual acuity (UCVA), tear film break-up time ( BUT ) and basal tear secretion test (SⅠt) were observed before, and 6 and 12mo after surgery in the three groups, respectively. ·RESULTS:The postoperative UCVA of the three groups was significantly higher than that preoperation ( P =0. 039, 0. 013, 0. 024 ), and there was no significant difference among the three groups ( P = 0. 317 ). The wound repair time was 5. 67 ± 1. 45d in the resection group, which was significantly higher than that in the conjunctival flap group (4. 18 ± 0. 76d) and the stem cell group (4. 09±0. 79 d) (P<0. 001), there was no significant difference between the conjunctival flap group and the stem cell group ( P = 0. 937 ). There were 4 cases in resection group reappeared, and the recurrence rate was 11. 8%, which was significantly higher than the other two groups ( P = 0. 037 ). There were 1 recurrences in the conjunctival flap group, and the recurrence rate was 2. 9%, while the patients in the stem cell group had no obvious recurrence. SⅠt and BUT increased significantly after operation (P<0. 05), especially in conjunctival flap group and stem cell group (P<0. 001). There was no significant difference between the conjunctival flap group and the stem cell group (P=0. 845, 0. 894). · CONCLUSION: Pterygium excision combined with conjunctival flap transplantation or limbal stem cell transplantation for the treatment of type 2 diabetic patients with normal blood glucose and tear film function has the similar effect, and is better than simple pterygium excision.

A simplified xeroscope for the noninvasive measurement of tear break-up time

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To develop and validate a noninvasive method for measuring tear break-up time (NIBUT) using readily available materials and comparing it to the standard fluorescein tear break-up time (TBUT) assessment.</p> <p style="text-align: justify;"><strong>METHODS:</strong> A prototype xeroscope was made from an ordinary round plastic lid. At its inner lining, a fluorescent green sticker paper printed with black circular concentric grid pattern was fixed to simulate modified placido rings on the precorneal reflection. A central rectangular cut-out measuring 2 cm x 1 cm was made into the base frame serving as the viewfinder for the device through which the precorneal grid reflection was observed. A 30-LED blue light strip was fixed in the inner rim of the lid using a double-sided adhesive tape and was powered by a multi-voltage AC-DC power adapter set at 6-volts at 350mA (2 watts). The prototype device was tested on fifty (50) patients (100 eyes), aged 21 to 65 years old, with no apparent ocular surface disorders and eyelid abnormalities. Measurement of NIBUT was done on both eyes using the prototype xeroscope followed by fluorescein TBUT measurement. The two values were compared and their correlation determined by linear-regression.</p> <p style="text-align: justify;"><strong>RESULTS:</strong> Fifty (50) patients (100 eyes) were enrolled into the study. The mean age was 48.52 years (range 21 to 62 years). The mean NIBUT for both eyes was 20.10 secs, ranging from 11.56 to 36.17 secs, and the mean TBUT was 18.70 secs, ranging from 10.20 to 30.40 secs. The mean difference between NIBUT and TBUT was 1.40 sec. Regression analysis revealed a strong positive linear correlation between the 2 measurements with a computed R-squared value of 0.9697.</p> <p style="text-align: justify;"><strong>CONCLUSION:</strong> The noninvasive technique using the prototype device provided a good alternative approach for measuring tear film stability without disturbing normal tear physiology and dynamics at at fraction of the cost of current commercially-available xeroscopes and tearscopes.</p>

Measurement of Precorneal Tear Film Using Scheimpflug Camera and Relationship with Parameters for Dry Eye

PURPOSE: To compare the anterior segment parameters including precorneal tear film thickness (PTFT) using Pentacam(R) (Oculus, Wetzlar, Germany) between normal control and dry eye groups and to examine the relationships between the PTFT and other parameters for dry eye. METHODS: The present study included 23 normal controls (31 eyes) and 25 patients with dry eyes (31 eyes). We compared measurements including PTFT, corneal thickness and astigmatism using Pentacam(R) and analyzed the correlations among the PTFT and fluorescein tear break-up time (FBUT), Schirmer I test (without anesthesia), and ocular surface disease index (OSDI). RESULTS: The mean PTFT in dry eyes (21.1 +/- 2.0 microm) was significantly thinner than in normal eyes (37.6 +/- 2.0 microm; p < 0.01). In the dry eye group, the corneal thickness was thicker than in the normal eye group but there were no clinically significant differences. The dry eye group experienced more frequent and severe corneal astigmatism compared with the normal group. OSDI scores showed a weak negative correlation with objective clinical measures of dry eye (FBUT, Schirmer I test) but was not statistically significant. However, OSDI was statistically significantly negatively correlated with PTFT (r = -0.46, p < 0.01). The PTFT showed a weak positive correlation with FBUT and Schirmer I test without statistical significance. CONCLUSIONS: The mean PTFT using Pentacam(R) in the dry eye group was thinner than in the normal group. Additionally, the PTFT was correlated with subjective symptoms. Therefore, the PTFT measurement using Pentacam(R) could be considered a useful method for diagnosis and treatment of dry eye.

To investigate the effect of the mild conjunctivitis complication on the tear break-up time in patients with dry eye / 重庆医学

Objective To investigate the effect of the mild conjunctivitis complication on the tear break-up time(BUT) in pa-tients with dry eye .Methods 93 patients with dry eye from Sep .2007 to Sep .2011 were selected .For all of them the BUT was 5 seconds or less than 5 seconds after corneal fluorescein staining .They were divided into experimental group (with mild conjunctivi-tis) and control group (without mild conjunctivitis) .We checked the BUT and compared the difference of BUT between experimen-tal group and control group .Results The average BUT of the 54 patients with complicated mild conjunctivitis ,of which conjuncti-val papillae was found in 40 cases ,was (3 .54 ± 1 .02)s ,the average BUT of the 39 patients without conjunctivitis was(3 .41 ± 1 .04) s .There was no significant difference between two groups .Conclusion Dry eyes complicated mild conjunctivitis had no effect on BU T .

The Effect of Low-Dose Doxycycline Therapy in Chronic Meibomian Gland Dysfunction

PURPOSE: The aim was to investigate the effect of low dose doxycycline (20 mg) therapy in patients with chronic meibomian gland dysfunction that were refractory to conventional therapy. METHODS: The randomized prospective study enrolled 150 patients (300 eyes) who have chronic meibomian gland dysfunction and who didn't respond to lid hygiene and topical therapy for more than 2 months. All topical therapy was stopped for at least 2 weeks prior to beginning the study. After conducting the tear break up time test (TBUT) and Schirmer test, the authors randomly divided the patients into three groups a high dose group (doxycycline, 200 mg, twice a day), a low dose group (doxycycline, 20 mg, twice a day) and a control group (placebo). After one month, the author repeated the TBUT and Schirmer tests, and analyzed the degree of symptomatic improvement. RESULTS: Compared to the control group, both the high and low dose group showed statistically significant differences after treatment in TBUT, Schirmer test, the number of symptoms reported and the degree of improvement of subjective symptoms. However, there was no statistically significant difference between the high and low dose group after treatment in TBUT (9.42+/-2.87 sec, 9.54+/-1.58 sec, p=0.726), Schirmer test (19.98+/-4.05 mm, 19.65+/-5.02 mm, p=0.624), the number of symptoms reported (1.45+/-0.62, 1.53+/-0.52, p=0.304), as well as the degree of improvement of subjective symptoms (p=0.288). The high dose group (18 patients, 39.13%) reported side effects more frequently than did the low dose group (8 patients, 17.39%) (P=0.002). CONCLUSIONS: Low dose doxycycline (20 mg twice a day) therapy was effective in patients with chronic meibomian gland dysfunction that were refractory to conventional therapy.

The Changes of Tear Break-up Time and Schirmer's Test after Photore fractive Keratectomy

Myopic regression and corneal opacity are well known complications after photorefractive keratectomy(PRK)and some clinical reports suggest the postoperative dry eye syndrome make worse corneal opacity. To investigate the changes in tear secretion and tear film stability after excimer laser PRK for myopia we measured tear break-up time(BUT)and the Schirmer's test on 249 eyes of 126 persons ranging from -2 ~ -11 D(mean -5.40 D)at preoperative 1 month, 6 month and 1 year after PRK. The result shows that the Schirmer's test and BUT values are reduced together at 1 month after PRK, but BUT values return to almost normal levels at postoperative 6 months, whereas Schirmer's test values never come back to initial ones regredless of the presence of preoperative dry eye syndrome and refractive error. So we reach an idea that the decrease of tear secretion due to vague corneal sensation rather than the tear film instability from irregular corneal surface effects on the postoperative dry eye syndrome largely. From this results, we propose that artificial tears should be used at least for an year for the eyes after PRK.

The Significance of Clinical Symptoms in Dry Eye Patients and Statistical Analysis of the Patiants

From April 1 to July 30, 1989, we studied 188 subjects(male 25, female 163) with suspected dry eye based on their clinical symptoms and their response to conventional treatment with artificial tear. Schirmer Test and Tear break-up time measurement(B.U.T.) were performed on each patient. There have been many reports that Schirmer test and B.U.T. measurement can be influenced by many enviromental factors and testing methods so the question of their relative value has not yet been sloved. the purpose of this study was to evaluate the importance of clinical symptoms and signs in diagnosing dry eye. Demographic aspect of dry eye patients in Korea was also analysed. The results were as follows: 1. The sex distribution was 163 females(87%) and 25 males(13%). There were absolutely more females than males. 2. The ages ranged from 15 to 83 years old. The peak age was from 41 to 50 years(29%). 3. Among 163 female patients, the majority 103(63%) were menopausal and postmenopausal females. 4. Among major chief clinical complaints, foreign body sensation showed the highest frequency with 67 patients(35%). 5. Major aggravating factor of the disese was prolonged use of eye which showed highest frequency with 122 patients(65%). 6. There were no statistically significant differences in the mean value of BU.T. and Schirmer test between right left eye(p<0.05). 7. In the majority of the cases 153(82%) the B.U.T. and Schirmer test value were 8 sec and 8mm or below respectively.