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Eye - Figure 3 for article: In vivo detection of clinically non-apparent ocular surface inflammation in patients with meibomian gland dysfunction-associated refractory dry eye symptoms: a pilot study

Eye is the official journal of the Royal College of Ophthalmologists. It aims to provide the practising ophthalmologist with information on the latest clinical and laboratory-based research.

http://www.nature.com

 

 

 

1. Eye (Lond). 2015 Jun 19. doi: 10.1038/eye.2015.103. [Epub ahead of print]

Author information: 

  • 1Ocular Surface Imaging Center, Cornea Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
  • 2Korb Associates, Boston, MA, USA.

 

Abstract

Purpose

The utility of in vivo confocal microscopy (IVCM) in the investigation of palpebral conjunctival and corneal inflammation in patients with meibomian gland dysfunction (MGD)-associated refractory dry eye symptoms following gland expression, despite objective clinical improvement.

Methods

A retrospective, observational pilot study was conducted evaluating five patients with MGD-associated refractory dry eye symptoms and three control groups: symptomatic untreated MGD patients (n=3), treatment-responsive MGD patients with improved symptoms (n=3) and asymptomatic healthy normals (n=11). Ocular surface disease index (OSDI) scores, tear break-up time (TBUT), the number of meibomian glands yielding liquid secretion (MGYLS), palpebral conjunctival epithelial and substantia propria immune cell (EIC, SIC), and corneal dendritic cell (DC) densities were measured.

Results

Despite clinical improvement (TBUT: 6.4±1.2 s to 10.1±2.1 s, P=0.03; MGYLS: 3.5±0.8 glands to 7.0±1.1 glands, P=0.13) and a normal clinical examination post treatment, MGD patients remained symptomatic. IVCM revealed increased immune cells in the palpebral conjunctiva (refractory MGD EIC=592.6±110.1 cells/mm2; untreated MGD EIC=522.6±104.7 cells/mm2, P=0.69; responsive MGD EIC=194.9±119.4 cells/mm2, P<0.01; normals EIC=123.7±19.2 cells/mm2, P< 0.001), but not the cornea (refractory MGD DC=60.9±28.3 cells/mm2; normals DC=25.9±6.3 cells/mm2; P=0.43). EIC did not correlate with TBUT (Rs=-0.26, P=0.33). OSDI scores correlated with both EIC (Rs=0.76, P<0.001) and TBUT (Rs=-0.69, P<0.01) but not SIC. Intraglandular immune cells were also seen.

Conclusion

MGD-associated refractory symptoms and the symptom-sign disparity may be explained by clinically non-apparent, active inflammation of the palpebral conjunctiva as detected by IVCM. These patients may benefit from anti-inflammatory therapy.

Eye advance online publication, 19 June 2015; doi:10.1038/eye.2015.103.

  PMID: 26088680 [PubMed - as supplied by publisher]
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2. Ophthalmology. 2015 Jun 15. pii: S0161-6420(15)00507-2. doi: 10.1016/j.ophtha.2015.05.024. [Epub ahead of print]

Author information: 

  • 1Department of Ophthalmology at Kyorin University School of Medicine, Tokyo, Japan.
  • 2Department of Ophthalmology at Kyorin University School of Medicine, Tokyo, Japan. Electronic address: aokada@eye-center.org.
  • 3Department of Ophthalmology at Fukushima Medical University, Fukushima, Japan.
  • 4Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan.

 

Abstract
PURPOSE: 

To investigate 1-year outcomes of intravitreal aflibercept for polypoidal choroidal vasculopathy (PCV).

DESIGN: 

Retrospective, multicenter, consecutive case series.

PARTICIPANTS: 

A total of 90 eyes of 87 patients with treatment-naïve PCV followed at 3 tertiary centers.

METHODS: 

Clinical records were reviewed and imaging studies were analyzed of eyes with PCV that underwent 3 consecutive monthly aflibercept injections followed by injections every 2 months. Additional (rescue) injections were performed for worsening.

MAIN OUTCOME MEASURES: 

Best-corrected visual acuity (BCVA), optical coherence tomography (OCT), and angiographic findings at 1 year.

RESULTS: 

The mean BCVA (logarithm of the minimum angle of resolution units) of the 90 eyes improved from 0.31 at baseline to 0.17 at 12 months (P < 0.001). The mean central retinal thickness decreased from 315 μm at baseline to 204 μm at 12 months (P < 0.001). At 12 months, 64 eyes (71.1%) achieved a dry macula, defined as absence of intraretinal or subretinal fluid on OCT. Of 83 eyes that underwent indocyanine green angiography at both baseline and 12 months, 46 (55.4%) showed complete and 27 (32.5%) showed partial resolution of polypoidal lesions. Eleven of 82 eyes (13.4%) showed decreased size of branching choroidal vascular networks.

CONCLUSIONS: 

Intravitreal aflibercept administered over 1 year improved both visual acuity and macular morphology in a large number of treatment-naïve eyes with PCV.

Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  PMID: 26088619 [PubMed - as supplied by publisher]
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3. Int J Ophthalmol. 2015 Jun 18;8(3):544-9. doi: 10.3980/j.issn.2222-3959.2015.03.19. eCollection 2015.

Author information: 

  • 1Ophthalmology Clinic, Ankara Ataturk Training and Research Hospital, Ankara 06800, Turkey.
  • 2 Dermatology Clinic, Ankara Ataturk Training and Research Hospital, Ankara 06800, Turkey.

 

Abstract
AIM: 

To compare the effectiveness of topical cyclosporine A emulsion with that of oral doxycycline for rosacea associated ocular changes and dry eye complaints.

METHODS: 

One hundred and ten patients with rosacea were screened. Thirty-eight patients having rosacea associated eyelid and ocular surface changes and dry eye complaints were included in the study. Patients were randomly divided into two groups: nineteen patients were given topical cyclosporine twice daily and nineteen patients were given oral doxycycline 100 mg twice daily for the first month and once daily for the following two months. Symptom and sign scores, ocular surface disease index questionnarie and tear function tests were evaluated at baseline and monthly for 3mo. Three months after results were compared with that of baseline.

RESULTS: 

Mean values of symptom, eyelid sign and corneal/conjunctival sign scores of each treatment group at baseline and 3mo after treatments were compared and both drugs were found to be effective on rosacea associated ocular changes (P<0.001). Cyclosporine was more effective in symptomatic relief and in the treatment of eyelid signs (P=0.01). There was statistically significant increase in the mean Schirmer score with anesthesia and tear break up time scores in the cyclosporine treatment group compared to the doxycycline treatment group (P<0.05).

CONCLUSION: 

Cyclosporine as a topical drug can be used in the treatment of rosacea associated ocular complications because it is more effective than doxycycline. In addition ocular rosacea as a chronic disease requires long term treatment and doxycycline has various side effects limiting its long term usage.

  PMID: 26086005 [PubMed]
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4. Vestn Oftalmol. 2015 Mar-Apr;131(2):81-6, 88.
[Article in Russian]
Abstract
AIM: 

To evaluate the efficacy of conservative treatment in dry AMD patients by means of 3D computer-automated threshold Amsler grid testing (3D-CTAG; Fink & Sadun, 2004).

MATERIAL AND METHODS: 

The study included 90 patients (180 eyes) with dry AMD divided into three groups. Group 1 (n = 30) was prescribed Vitrum Vision forte, 1 tablet b.i.d., group 2 (n = 30)--Vitrum Vision forte, 1 tablet b.i.d. and Vitrum Cardio Omega-3, 1 capsule b.i.d. Group 3 (n = 30), the controls, received Taurine 250 mg, 1 tablet b.i.d. Besides standard ophthalmic examination, all patients underwent 3D-CTAG before and after the treatment. The number of defects per eye (ND) and volume lost relative to the hill-of-vision (VLRH) were chosen as evaluation criteria.

RESULTS: 

After 3 months of treatment ND decreased from 0.33 ± 0.02 to 0.22 ± 0.01 in group 1 (p < 0.01) and from 0.33 ± 0.02 to 0.2 ± 0.01 in group 2 (p < 0.01); VLRH decreased from 0.32 ± 0.02% to 0.15 ± 0.01% out of 693,000 [deg2%] in group 1 (p < 0.01) and from 0.32 ± 0.03% to 0.15 ± 0.01% out of 693,000 [deg2%] in group 2 (p < 0.01). In the controls both indices increased: ND from 0.32 ± 0.02 to 0.37 ± 0.02 and VLRH from 0.35 ± 0.24% to 0.49 ± 0.03% out of 693,000 [deg2%] (p < 0.01).

CONCLUSION: 

The positive effect of Vitrum Vision forte in combination with Vitrum Cardio Omega-3 on macular function is comparable to that of monotherapy with Vitrum Vision forte. The maximum effect was achieved in patients with small scotomas (VLRH < 1.5% out of 693,000 [deg2%]).

  PMID: 26080588 [PubMed - in process]
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5. PLoS One. 2014 Sep 22;9(9):e106338. doi: 10.1371/journal.pone.0106338. eCollection 2014.

Author information: 

  • 1Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
  • 2Department of Veterinary Physiology, Faculty of Agriculture, Tottori University, Tottori, Japan.

 

Abstract

Tears are secreted from the lacrimal gland (LG), a dysfunction in which induces dry eye, resulting in ocular discomfort and visual impairment. Honey bee products are used as a nutritional source in daily life and medicine; however, little is known about their effects on dry eye. The aim of the present study was to investigate the effects of honey bee products on tear secretion capacity in dry eye. We selected raw honey, propolis, royal jelly (RJ), pollen, or larva from commercially available honey bee products. Tear secretion capacity was evaluated following the oral administration of each honey bee product in a rat blink-suppressed dry eye model. Changes in tear secretion, LG ATP content, and LG mitochondrial levels were measured. RJ restored the tear secretion capacity and decrease in LG ATP content and mitochondrial levels to the largest extent. Royal jelly can be used as a preventative intervention for dry eye by managing tear secretion capacity in the LG. 

PMCID: PMC4171376 Free PMC Article 
  PMID: 25243778 [PubMed - indexed for MEDLINE]
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6. Am J Nephrol. 2014;40(2):123-30. doi: 10.1159/000365199. Epub 2014 Aug 20.

Author information: 

  • 1Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India.

 

Abstract
BACKGROUND: 

The exact frequency of distal and proximal renal tubular acidosis (RTA) in Sjögren's syndrome is unknown. Other features of Sjögren's syndrome like polyuria, glomerular manifestations, familial occurrence and pregnancy are not widely reported. The aim was to prospectively study the clinical features and outcome of distal and proximal RTA in Sjögren's syndrome and also report on other renal manifestations of Sjögren's syndrome.

METHODS: 

The present study is a prospective consecutive case series of patients who presented with a history suggestive of RTA and Sjögren's syndrome. All patients were followed for 1 year. The diagnosis of RTA was by fractional excretion of bicarbonate. The diagnosis of Sjögren's syndrome was according to the American-European classification system [modified by Tzioufas and Voulgarelis: Best Pract Res Clin Rheumatol 2007;21:989-1010].

RESULTS: 

The total number of RTA patients diagnosed during this period was 149. Sjögren's syndrome accounted for 34.8% (52 of 149) of RTA patients. The important symptoms and laboratory parameters were oral and ocular symptoms in 23 (44.2%), dental caries in 12 (23%), body pains in 47 (90.3%), mean serum pH 7.202 ± 0.03, mean serum bicarbonate, 14.03 ± 1.66 mmol/l, and mean urine pH, 7.125 ± 0.54. There were 30 (57.6%) patients with distal RTA and 22 (42.3%) patients with proximal RTA.

CONCLUSIONS: 

The clinical implication of the present study is that RTA is a common feature of Sjögren's syndrome. It may be missed if the presentation is not due to oral and ocular symptoms. The present study is also the only one with a 1-year follow-up.

© 2014 S. Karger AG, Basel.

  PMID: 25171149 [PubMed - indexed for MEDLINE]
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