Alcohol consumption and dry eye syndrome: a Meta-analysis.

AIM: To quantify the association between alcohol consumption and dry eye syndrome (DES) with Meta-analysis of published case-control and cross-sectional studies. METHODS: Three databases were screened for potentially eligible studies through Nov. 30, 2015, PubMed, Web of Science, and the Cochrane Library. Odds ratios (ORs) were pooled with 95% confidence intervals (CIs) to evaluate the relationship between alcohol consumption and DES risk. Subgroup analyses were performed according to diagnostic criteria, publication year, sample size, alcohol intake and adjusted factors. RESULTS: A total of 10 (9 case-control and 1 cross-sectional) studies from 8 articles were included in this Meta-analysis. The pooled results showed that alcohol consumption would significantly increase the risk of DES (OR 1.15, 95% CI: 1.02-1.30), and the results were independent of smoking, hypertension, diabetes and thyroid disease history. And the results of subgroup analyses indicated an increased incidence of DES diagnosed by typical DES symptoms and positive objective tests together (OR 1.18, 95% CI: 1.01-1.39) among drinkers, but not by typical DES symptoms alone (OR 1.11, 95% CI: 0.94-1.32). What's more, any drinkers were at higher risk of suffering from DES (OR 1.33, 95% CI: 1.31-1.34), while heavy drinkers not (OR 1.01, 95% CI: 0.86-1.18). CONCLUSION: The present Meta-analysis suggests that alcohol consumption may be a significant risk factor for DES. Alcohol-induced peripheral neuropathymay falsely reduce the prevalence of DES among heavy drinkers. Future prospective studies of alcohol consumption and DES risk are needed to confirm our results.

Myopic Macular Retinoschisis in Teenagers: Clinical Characteristics and Spectral Domain Optical Coherence Tomography Findings.

To investigate the morphological characteristics of myopic macular retinoschisis (MRS) in teenagers with high myopia, six male (9 eyes) and 3 female (4 eyes) teenagers with typical MRS identified from chart review were evaluated. All cases underwent complete ophthalmic examinations including best corrected visual acuity (BCVA), indirect ophthalmoscopy, colour fundus photography, B-type ultrasonography, axial length measurement, and spectral-domain optical coherence tomography (SD-OCT). The average age was 17.8 ± 1.5 years, average refractive error was -17.04 ± 3.04D, average BCVA was 0.43 ± 0.61, and average axial length was 30.42 ± 1.71 mm. Myopic macular degenerative changes (MDC) by colour fundus photographs revealed Ohno-Matsui Category 1 in 4 eyes, and Category 2 in 9 eyes. Posterior staphyloma was found in 9 eyes. SD-OCT showed outer MRS in all 13 eyes, internal limiting membrane detachment in 7 eyes, vascular microfolds in 2 eyes, and inner MRS in 1 eye. No premacular structures such as macular epiretinal membrane or partially detached posterior hyaloids were found. Our results showed that MRS rarely occurred in highly myopic teenagers, and was not accompanied by premacular structures, severe MDC, or even obvious posterior staphyloma. This finding indicates that posterior scleral expansion is probably the main cause of MRS.

In Vivo and Cadaver Studies of the Canalicular/Lacrimal Sac Mucosal Folds.

Purpose. The study aimed to investigate canalicular/lacrimal sac mucosal folds (CLS-MFs) in vivo and in cadavers in order to explore their functional roles in the lacrimal drainage system. Method. The observations of CLS-MFs in vivo were performed on 16 patients with chronic dacryocystitis after undergoing an endonasal endoscopic dacryocystorhinostomy (EE-DCR). The lacrimal sacs and common canaliculi of 19 adult cadavers were dissected. The opening/closing of an orifice and mucosal fold was recorded. All of the specimens were subjected to a histological examination. Results. The upper and lower lacrimal canaliculi in all of the samples united to form a common canaliculus that opened to the lacrimal sac. CLS-MFs were observed in 10 of the 16 patients (62.5%) and 9 of the 19 cadavers (47.4%). The orifices or mucosal folds could be opened or closed when related muscles contracted or relaxed. Histological sections showed a mucosal fold at one side of an orifice. Conclusion. Common canaliculus is the most common type that the canaliculus opens to lacrimal sac. CLS-MFs exist in a certain ratio that can be opened/closed with the movement of the orifices. They may be involved in the drainage of tears or the pathogenesis of acute dacryocystitis or lacrimal sac mucocele.

Ocular pharmacokinetics of bevacizumab in vitrectomized eyes with silicone oil tamponade.

PURPOSE: We characterized the ocular pharmacokinetics of bevacizumab in vitrectomized eyes with silicone oil tamponade. METHODS: A total of 18 pigmented rabbits underwent vitrectomy and silicone oil tamponade before an intra-silicone oil injection of 1.25 mg bevacizumab. At post-injection days 1, 7, 14, 28, 42, and 56, 3 rabbits were sacrificed and enucleated, and bevacizumab concentrations were measured in various ocular tissues and plasma. RESULTS: The bevacizumab peak concentration was reached at day 14 in the aqueous humor (4030.70 ng/mL), retina (42,171.7 ng/g), and choroid (56,243.33 ng/g). In the iris/ciliary body and plasma, the peak concentration was reached at day 7 with 52,648.30 ng/g and 197.70 ng/mL, respectively. The choroid had the maximum exposure to bevacizumab with an area under the curve calculated from time zero to the last observed time (AUC(last)) of 1,151,633.40 ng/day/g and the aqueous humor had the minimum exposure (AUC(last) = 74,611.28 ng/day/g) among the ocular tissues, while the drug exposure to the plasma was the smallest of all tissues studied (AUC(last) = 3795.17 ng/day/g). The terminal half-lives and the mean residence time of bevacizumab in the ocular tissues ranged from 3-5 and 10-13 days, respectively. CONCLUSIONS: The peak concentration of bevacizumab in various ocular tissues and plasma was delayed and lower than that found in normal rabbit eyes; however, the terminal half-lives were similar to those found in the eyes with native vitreous following an intravitreal injection. Oil may have impacted the distribution of bevacizumab and led to an altered profile of drug level in the ocular tissues.

Vitrectomy and internal limiting membrane peeling with perfluoropropane tamponade or balanced saline solution for myopic foveoschisis.

PURPOSE: The purpose of the study was to evaluate visual and anatomical outcomes in patients with myopic foveoschisis who underwent vitrectomy and internal limiting membrane (ILM) peeling with perfluoropropane (C3F8) tamponade or balanced saline solution in the vitreous cavity. METHODS: Retrospective comparison of a consecutive surgical series. Eighteen eyes of 17 patients scheduled for myopic foveoschisis surgery were recruited at the affiliated Eye Hospital of Wenzhou Medical College, Zhejiang, China. Pars plana vitrectomy and ILM peeling with indocyanine green staining were performed in all patients. Refractive lens exchange was simultaneously performed in 12 phakic eyes. Finally, the vitreous cavity was filled with balanced saline solution in seven eyes of seven patients (Group A). Fluid-air exchange was performed in another 11 eyes of 11 patients (Group B), followed by injection of 18% C3F8. Patients were evaluated using best-corrected visual acuity (BCVA) testing and optical coherence tomography scans. RESULTS: All patients completed more than 6 months of follow-up. In two groups, preoperative factors were not significantly different. In Group B, the postoperative BCVA was significantly greater than the preoperative BCVA (t = 4.401, P = 0.001) but not significantly different in Group A (t = 1.970, P = 0.096). The BCVA change in Group B was significantly greater than Group A at the last visit (Z = 2.23, P = 0.025). In both groups, the BCVA change was significantly correlated with the preoperative BCVA, respectively. The BCVA was improved by 0.2 logarithm of the minimum angle of resolution or more in 10 eyes (91%) in Group B and 4 eyes (56%) in Group A. All eyes in both groups did not have decreases in the postoperative BCVA. In 3 months after vitrectomy, 6 eyes in Group A did not have anatomical resolutions. However, it was interesting to see that the height of retinoschisis at the central macular region gradually decreased until anatomical resolution was achieved. In Group B, all eyes had anatomical resolutions in 3 months after vitrectomy. None of the eyes developed macular hole during the surgery and the period of routine follow-up period. CONCLUSION: Vitrectomy with ILM peeling does not increase the risk of iatrogenic macular hole formation. The poor elasticity of the ILM and the traction of membranous structure on the surface of the ILM play important roles in the development of myopic foveoschisis. In eyes undergoing vitrectomy and ILM peeling for myopic foveoschisis, C3F8 tamponade results in more rapid anatomical resolution and greater improvement in BCVA than balanced saline solution.

Intraocular and systemic pharmacokinetics of triamcinolone acetonide after a single 40-mg posterior subtenon application.

PURPOSE: To characterize the pharmacokinetics of triamcinolone acetonide (TA) in aqueous, vitreous, and systemic circulation after a single subtenon injection. DESIGN: Prospective interventional case series. PARTICIPANTS: Thirty-six patients (36 eyes) who received a single posterior subtenon injection of TA (40 mg in 0.4 ml). METHODS: Aqueous, vitreous, and blood samples were obtained at 1-hour, 1-day, 3-day, 5-day, 10-day, 14-day, 21-day, and 28-day time points after the posterior subtenon TA injection. At each time point, there were 3 to 6 eyes (patients). The concentrations of TA in the aqueous, vitreous, and plasma were analyzed using ultra-performance liquid chromatography coupled with tandem mass spectrometry. MAIN OUTCOME MEASURES: Triamcinolone acetonide concentration in the samples was measured, and pharmacokinetic parameters were calculated. RESULTS: The TA concentration-time profile in aqueous consisted of a fast distribution phase during the first 24 hours and a slow elimination phase thereafter. In contrast, the TA concentration-time profile in vitreous consisted of an absorption phase during the first 24 hours followed by a slow elimination phase. The TA in plasma followed a mono-exponential elimination during the study course. The TA concentration peak time for aqueous and plasma was at 1 hour and 24 hours, for vitreous after subtenon injection. The terminal elimination half-life in aqueous, vitreous, and plasma was 11.8, 17.1, and 25 days, respectively. The integral of the area under the concentration time curve (AUC(0-∞)) was 862 ng/day/ml for aqueous, 1262 ng/day/ml for vitreous, and 17.4 ng/day/ml for plasma. The total TA exposure to vitreous was 46% more than total TA exposure to the aqueous. The TA concentration in vitreous was 70- to 98-fold higher than that in plasma. CONCLUSIONS: Posterior subtenon TA application can provide a sustained high local ocular TA level while also resulting in a very low systemic TA level, which may be well below the normal glucocorticoid level in humans.