ABSTRACT
Dry eye is a multifactorial and common age-related ocular surface disease. Dyslipidemia has been reported to be involved in meibomian gland dysfunction (MGD). However, it has not been clearly identified which lipid abnormality is responsible for MGD. In this systematic review and meta-analysis, we discuss how lipid profile changes with aging is responsible for MGD development. METHODS: An article search was performed in PubMed, EMBASE, and Web of Science. Eleven studies involving dyslipidemia in patients with MGD were identified. Five out of eleven studies were further analyzed with meta-analysis. The preferred reporting items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines were followed. Study-specific estimates (prevalence of dyslipidemia in MGD patients) were combined using one-group meta-analysis in a random-effects model. RESULTS: Meta-analysis revealed that high total cholesterol (TC) and high triglycerides (TG) were significantly associated with MGD prevalence, with odds ratios of 5.245 (95% confidence interval [CI]: 1.582-17.389; p < 0.001) and 3.264 (95% CI: 1.047-10.181; p < 0.001), respectively, but high low-density lipoprotein (LDL) and low high-density lipoprotein (HDL) were not identified. Systematic review found that the percentage of MGD patients with TC ≥ 200 mg/dL ranged from 20.0-77.6%, TG ≥ 150 mg/dL ranged from 8.3-89.7%, whereas, in the aged-match-adjusted controls, TC range of 200 mg/dL or higher and TG range of 150 mg/dL was 6.1-45.1% and 1.1-47.8%, respectively. The severity of MGD was higher with dyslipidemia. CONCLUSION: Dyslipidemia and higher TC and TG are significant risk factors for MGD.
ABSTRACT
Here, we report a rare case of recurrent fungal keratitis (FK) post-amniotic membrane transplantation (AMT) for corneal perforation. A 75-year-old female who had undergone systemic 15 mg prednisolone administration for interstitial pneumonia developed FK in her left eye following treatment for herpetic epithelial keratitis at another clinic. The FK was effectively cured via an oral and local antifungal treatment. However, 1 year later, FK recurred in her left eye, and she was subsequently referred to our hospital since fungal infection had penetrated deep into the cornea. Upon examination, her best-corrected visual acuity was 20/20 OD and hand motion OS. Slit-lamp examination revealed infiltration of corneal ulcers and posterior corneal deposits in her left eye, so she was treated with 0.1% miconazole eye drops in addition to oral miconazole and 1% pimaricin ointment. However, corneal perforation occurred 1 week later, so debridement and AMT were performed, which resulted in a successful outcome. At the 4-month postoperative period, the antifungal eye-drop treatment was discontinued due to no clinical signs of infection with scar formation. However, at the 6-month postoperative period, increased white deposits and the emergence of keratic precipitates were observed around the AMT graft. Recurrent FK was suspected, and anterior-chamber irrigation was performed. Immunostaining revealed a yeast-type fungus, and a cultivation test revealed Candida sp. Thus, penetrating keratoplasty was performed, and there has been no recurrence of FK for 1.5 years. In FK cases, AMT should be carefully considered for surgical indications, with strict follow-up in order to detect any possibility of FK recurrence.
