ABSTRACT
PURPOSE: To measure dry eye disease (DED) activity in rheumatoid arthritis (RA) patients, correlate it with the activity and duration of RA, and objectively measure the degree extent of DED in RA active cases. METHODS: The paper studied the meibomian gland of 30 RA cases referred by the Rheumatology Department, Sohag University Hospitals to Sohag Cornea and Refractive Center, Sohag, Egypt, by infrared non-contact meibography in the Scheimpflug topographer (Sirius, CSO, Italy) from July 2021 to July 2022. The cases fulfilled the RA classification criteria according to the 2010 American College of Rheumatology and European League and underwent full lab investigations. They were distributed to two groups based on the DAS-28 questionnaire. The patients were distributed into low to moderate activity (3.2 < score < = 5.1) and high activity groups (score > 5.1). RESULTS: This study included 60 eyes of 30 RA patients. They scored a mean age of (44 ± 10 years), number of swollen joints (3 ± 3), number of tender joints (5 ± 3), duration of disease (8 ± 4), activity of the disease measured by DAS-28 (4.4 ± 0.9), and sex (males were 9.7% vs females 90.3%). The number of swollen joints, tender joints, ESR and DAS-28 were more in the high activity group with the p-value of (0.018, 0.001, < 0.003 and < 0.004), respectively. There are no statistically significant differences between both groups as regards disease duration (p-value of 3.8). The high activity group showed significant affection regarding the mebioscore of the lower and upper lids, total mebioscore, percentage of meibomian glands in upper and lower lids, first non-invasive break-up time test (NIV-BUT) of the tear film, as well as average non-invasive break-up time test (NIavg-BUT). There were moderate correlations between the activity of the disease represented by (DAS-28) and different parameters evaluating eye dryness (meiboscore of the lower and upper lids, total meiboscore, percentage of meibomian glands in upper and lower lids, NIV-BUT of the tear film, and NIavg-BUT of the tear film). CONCLUSION: There was no correlation with duration of RA but moderate correlations between the activity of the disease represented by (DAS-28) and different parameters evaluating eye dryness in RA patients with valuable use of noncontact Meibography to evaluate eye dryness in RA cases. Both Meiboscore and Meiboscale of Non-contact Meibography were found to be useful tools in grading of dry eye disease in different activity grades of Rheumatoid Arthritis.
Subject(s)
Arthritis, Rheumatoid , Dry Eye Syndromes , Male , Female , Humans , Adult , Middle Aged , Meibomian Glands/diagnostic imaging , Physical Examination , Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/diagnosis , Dry Eye Syndromes/diagnosis , TearsABSTRACT
Purpose: To compare simple punctal dilation versus punctal dilation augmented by insertion of Punctal Plug Insertion (PPP) with assessing the effect on resolving epiphora and punctum size improvement by an objective method, high-resolution AS-OCT imaging comparing punctal parameters of the patients before and after both techniques. Patients and Methods. It is a prospective, interventional, double-blinded controlled randomized study, which was conducted on two groups of patients, the first epiphora group (EG1 25 eyes), who had acquired punctal stenosis and epiphora and managed by simple punctal dilatation. The second epiphora group (EG2 20 eyes) who managed by punctal dilatation augmented with an application of perforated punctal plugs for two months. Spectral Domain Anterior Segment-OCT Image Acquisition. AS-OCT for lower puncti was performed using RTVue (Optovue Inc., Fermont, CA). OCT images of the width and length of the lower puncti of the participants were captured by the same operator on the same machine. Measuring of punctal size (diameter and length) was performed before treatment, one week, one month, and three months later objectively by using AS-OCT. Results: The study included 45 eyes of 50 subjects; the total coverage of epiphora patients fulfilled inclusion criteria and presented to the ophthalmology clinics of Sohag University Hospitals in the period between June 2021 and December 2021. Both groups were comparable regarding mean age (39 ± 11 vs 50 ± 12 years, P value = 0.4) and sex (males were 36% vs 40%, female were 64% vs 60%, P value = 0.5) respectively with no statistically significant difference between both groups. The mean duration of epiphora was measured in both groups before treatment (EG1 = 1.656 ± 0.41 months, EG2 = 1.73 ± 0.32 months) with no statistically significant difference (P value = 0.436). There was marked improvement of the outer punctual diameter and length between outer and inner puncti in EG1 (EG1 391um ± 122 um, EG2 692 ± 226 um (P value < 0.007) and EG1 189 ± 43 um, 380 ± 169 um (P value < 0.0002) during the follow-up period. EG2 showed more improvement than EG1 when compared during the follow-up period in both outer punctual diameter and length between outer and inner puncti with (P value < 0.003 and < 0.0002) in favor of EG2. However; both groups show improvement with the statistically significant difference in both groups by using AS-OCT. Conclusions: Punctal dilation augmented by insertion of PPP was an effective method in treating cases of inflammatory punctual stenosis as found by monitoring of punctal parameters changes by AS-OCT. AS-OCT was found a useful method for the evaluation of the lacrimal punctal parameters, especially with different treatment modalities in epiphora cases.
ABSTRACT
PURPOSE: To evaluate the role of medical treatment and assessing its effect on resolving epiphora and improving punctum size by high resolution AS-OCT imaging comparing punctal parameters in patients before and after treatment with topical combined antibiotic and steroid treatment in cases of inflammatory punctual stenosis. Patients and Methods. Double-blinded controlled randomized study which was conducted on two groups of patients who had acquired punctal stenosis and epiphora presented to Ophthalmology Clinics of Sohag University Hospitals in the period between Jan 2021 and April 2021. The study included 44 eyes of 50 subjects complaining of epiphora. They were divided into two groups, the epiphora group one (EG1) received eye drops containing combination of antibiotics and steroids (orchadexoline eye drops, each ml contains 5 mg chloramphenicol, 1 mg dexamethasone sodium phosphate, 0.25 mg tetryzoline hydrochloride, 2 mg hydroxypropyl methyl cellulose, 10 mg α-tocopherol acetate (vitamin E), and 8 mg macrogol 400), 5 times daily for the first week, three times daily for the next two weeks, and one time daily for another one week. The second epiphora group (EG2) received preservative-free artificial tears (sodium hyaluronate-, polyethylene-, and propylene glycol-based), three times daily for four weeks. The patients were examined before treatment, one week, one month, and one and half months later. RESULTS: Both groups were comparable regarding mean age (49 ± 13 vs 53 ± 11 years, P value = 0.2) and sex (males were 38.6% vs 31.8%, female were 61.4% vs 68.2%, P value = 0.6), respectively, with no statistically significant difference between both groups. Both groups were comparable regarding outer punctual diameter and length between the puncti before treatment. Outer punctal diameters were (EG1 228 ± 113 um, EG2 241 ± 115 um, P value = 0.5). Length between the puncti were (EG1 129 ± 73 um, EG2 137 ± 72 um, P value = 0.6). There was marked improvement of the outer punctual diameter (EG1 373 um ± 92 um, EG2 240 ± 109 um, (P value < 0.0001) and length between the puncti (EG1 217 ± 109 um, 136 ± 71 um (P value < 0.0002)) during the follow-up period. EG1 showed more improvement than EG2 when compared during the follow-up period. CONCLUSIONS: Topical combined antibiotic and steroid treatment was an effective method in treating cases of inflammatory punctual stenosis as found by monitoring of punctal parameter changes by AS-OCT. AS-OCT was found to be a useful method for evaluation of the lacrimal punctal parameters especially with different treatment modalities in epiphora cases.
ABSTRACT
With the number of coronavirus disease 2019 (COVID-19) infected patients increasing all over the world, a large number of survivors have reported changes in their quality of life or experienced re-infection. So, we aimed to detect the percentage, type, and risk factors of persistent symptoms after improvement from acute COVID-19 infection and to detect the percentage of COVID-19 re-infection and degree of severity of the second infection. One hundred seventy-two (59 male, 113 female) patients who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were followed up via mobile phone every 2 months for 8 to 10 months. After recovery, 105 patients (61%) (30 male, 75 female) reported one or more COVID-19 persistent symptoms. Fatigue, dyspnea, and depression were the most common persistent symptoms representing 37.3%, 22%, 22%, respectively. We found that age was independently related to the persistence of symptoms. During the follow-up, six females (3.5%) had laboratory-confirmed COVID-19 re-infection. Their mean age was 35.7 ± 11 years. The mean interval from the complete recovery of the first infection to the onset of the second one was 53 ± 22.2 days and ranged from 30 to 90 days. The second infection was milder in severity than the first infection in 83.33% of cases. There was a high percentage of patients who complained of persistent symptoms after recovery from COVID-19. Fatigue and headache were the most common persistent symptoms. Age was considered a risk factor for persistent symptoms. Re-infection with SARS-CoV-2 can occur after recovery.
