Tuesday, January 1, 2008

Study: Punctal plugs in an empty socket

I thought this was kind of interesting. People without corneas need tears too... I wonder if they get into the "cesspool effect" debate like us.

Favorable effects of lacrimal plugs in patients with an anophthalmic socket.
Vardizer Y, Lang Y, Mourits MP, Briscoe MD.
Orbit. 2007 Dec;26(4):263-6

Background: The use of punctal plugs in the treatment of dry eyes is well established. Anophthalmic patients have less tears in the anophthalmic socket in comparison to their normal side, due to an absent corneal reflex.... Many of those patients complain of dry eye symptoms, even when they are treated with tear replacement therapy. The authors wished to examine whether they could improve their dry socket complaints with punctal plugs.
Purpose: To evaluate the clinical efficacy and tolerability of punctal plug (Smart Plugs(R)) insertion in anophthalmic patients with symptoms of dry eye.
Patients and methods: Interventional case series. Fifteen anophthalmic patients with dry eye symptoms, a Schirmer test of less than 3 mm and an open lacrimal passage were examined before and after insertion of punctal plugs. The patients were asked for their subjective evaluation of the treatment and were examined to evaluate the change. Schirmer tests were compared. Bacterial cultures were taken at both visits.
Results: Schirmer results of less than 3 mm in the anophthalmic socket were obtained in 75% of patients with dry eyes symptoms; 87% of patients in whom punctal plugs were inserted reported an improvement in dry eye sensation. More than half of the patients demonstrated less discharge.... Schirmer tests improved from 1.4 mm to 1.9 mm.... Patients with a Schirmer outcome of 2 mm or more tended to have less pathogenic bacterial cultures....
Conclusion: Punctal plugs improve the symptoms and signs of dry socket. Punctal plugs seem to reduce the pathogenic bacterial growth in the anophthalmic socket.

Study: Post lasik woe referrals

Any LASIK patient out there who has felt like they got the big brush-off about their postop complaints may find this interesting study validating. I don't think it needs commentary - the facts are pretty straightforward.

Referrals to the Wills Eye Institute Cornea Service after laser in situ keratomileusis: Reasons for patient dissatisfaction.
Levinson BA, Rapuano CJ, Cohen EJ, Hammersmith KM, Ayres BD, Laibson PR.
J Cataract Refract Surg. 2008 Jan;34(1):32-9

PURPOSE: To review the symptoms, findings, and management options in patients referred to the Cornea Service who were unsatisfied with results after laser in situ keratomileusis (LASIK).
SETTING: Cornea Service, Wills Eye Institute, Philadelphia, Pennsylvania, USA.
METHODS: A retrospective chart review was conducted of all patients seen for consultation between January 1, 2004, and December 31, 2006, who had LASIK performed elsewhere. The parameters extracted were demographic data, history, symptoms, postoperative best corrected and uncorrected visual acuities, surgical complications, examination findings, and treatment recommendations. The data were also compared with previously unpublished data collected at Wills Eye from 1998 to 2003.
RESULTS: One hundred fifty-seven eyes of 109 patients seen in consultation after LASIK were identified. Twenty-eight percent were referred by the LASIK surgeon and 54%, by another eye doctor; 17% were self-referred. The most common chief complaints were poor distance vision (63%), dry eyes (19%), redness/pain (7%), and glare and halos (5%). Forty-four eyes (28%) had surgical complications or enhancements. The most common diagnoses were dry eye or blepharitis (27.8%), irregular astigmatism (12.1%), and epithelial ingrowth (9.1%). Eleven percent were referred in the first month after LASIK; 23% and 10% were referred between 1 and 6 months and 7 and 12 months, respectively. Medical management (eg, artificial tears, steroids, other dry-eye treatment) was offered in 39% of cases, surgical intervention in 27%, and observation only in 7%. Nonsurgical therapy was offered in 73% of cases.
CONCLUSIONS: Most patients who came for consultation were referred by a doctor other than their LASIK surgeon. Poor distance vision, dry eye, redness/pain, and glare and halos were the most common chief complaints and dry eye or blepharitis, irregular astigmatism, and epithelial ingrowth, the most common diagnoses.

Study: What's different about MGD

This study is no less welcome for having results that are kind of self-evident, i.e. if you've got MGD, your oil composition will be different. If it helps lead to a better diagnostic methodology that picks up on MGD, so much the better, though I still say, docs really oughtta get more hands-on teaching about the physical signs of lid margin disease in school.

Differences in meibomian fatty acid composition in patients with meibomian gland dysfunction and aqueous-deficient dry eye.
Joffre C, Souchier M, Grégoire S, Viau S, Bretillon L, Acar N, Bron AM, Creuzot-Garcher C.
Br J Ophthalmol. 2008 Jan;92(1):116-9

AIMS: To evaluate the differences in meibomian fatty acid composition in healthy subjects and in patients suffering from meibomian gland dysfunction or aqueous-deficient dry eye.
METHODS: We collected meibomian oil using a sterile Schirmer paper in healthy individuals (n = 20), dry eye patients (aqueous-deficient) (n = 32) and meibomian gland dysfunction (MGD) patients (n = 25) after gentle massage of the lid margin. Meibomian fatty acids were directly transmethylated and analysed using gas chromatography (GC) and GC mass spectrometry.
RESULTS: Meibomian fatty acids were similar in healthy individuals and in dry eye patients but were different in MGD patients, who showed significantly higher levels of branched-chain fatty acids (29.8% vs 20.2%) (p<0.0001) and lower levels of saturated fatty acids (9.3 vs 24.6%) (p<0.0001), in particular lower levels of palmitic (C16) and stearic (C18) acids.
CONCLUSION: The increase in branched-chain fatty acids may reflect greater quantities of wax and cholesterol esters and triglycerides in meibomian gland excreta. Since wax and cholesterol esters are the main lipids of meibum, these differences may have physical consequences for tear-film lipid-layer fluidity and stability. Meibomian fatty acid composition and particularly the increase in branched chains could be a marker for meibomian gland dysfunction.