Thursday, April 11, 2013
Wednesday, April 10, 2013
Some people with chronic dry eye suffer from chronic redness. In some of those cases, the redness is much more noticeable to themselves than to anyone else, but in others it's obvious and unsightly and can be very distressing. Not a lot of fun to have others (think: potential employers?) think you're stoned. The emotional impact of chronic redness makes people quite vulnerable to promises of improvement through surgeries. They figure, the worst that can happen is that it just doesn't work or doesn't last.
Here's a good reason to resist the temptation.
We report necrotizing scleritis as a serious complication of a cosmetic eye whitening procedure that involves the use of intraoperative and postoperative topical mitomycin C.
This is a single case report. A 59-year-old Caucasian male with a history of blepharitis status post uncomplicated LASIK refractive surgery reported chronic conjunctival hyperemia for 15 years prior to undergoing a cosmetic eye whitening procedure. He presented to our clinic 12 months after the cosmetic eye whitening procedure with progressive bilateral necrotizing scleritis and scleral calcification.
Chronic conjunctival hyperemia may prompt patients to seek surgical correction with cosmetic eye whitening procedures. However, conjunctival hyperemia secondary to tear deficiency and evaporative dry eye may predispose to poor wound healing. Serious complications including necrotizing scleritis may result from cosmetic eye whitening procedures and the use of topical mitomycin C.
J Ophthalmic Inflamm Infect. 2013 Feb 22;3(1):39. doi: 10.1186/1869-5760-3-39.
Leung TG, Dunn JP, Akpek EK, Thorne JE.
The Division of Ocular Immunology, The Wilmer Eye Institute, Johns Hopkins School of Medicine, 600 North Wolfe Street, Woods Building, Room 476, Baltimore, MD 21287, USA. firstname.lastname@example.org.
It's really good to see a study spanning a variety of indications for PROSE.
To determine the type and distribution of ocular conditions cared for in a clinic dedicated to scleral devices and to report the clinical outcomes afforded by this approach.
Fifty-one charts of patients fitted unilaterally or bilaterally with a scleral device (Prosthetic Replacement of the Ocular Surface Ecosystem - PROSE) in a two year period were retrospectively reviewed. Patient demographics, ocular diagnoses, associated systemic conditions, best corrected visual acuity (BCVA) before and after fitting, Visual Function Questionnaire score (VFQ-25), and ocular surface disease index (OSDI) score were collected.
All 51 patients were successfully wearing the PROSE device for a period of anywhere from weeks to years. The most common reasons for fitting were to relieve symptoms of moderate to severe dry eye syndrome ("DES", n = 25), management of refractive problems ("refractive", n = 23) with keratoconus being the most common (n = 14), and to manage other anomalies ("other", n = 3). Best corrected visual acuity (logMAR) improved with the wearing of the PROSE device for both the DES (17 letters) and the refractive group (10 letters), but not the "other" group. No serious complications were recorded for any of the patients.
The PROSE device is a useful option not only for the management of ocular surface disease and optical imperfections, but also for other ophthalmic conditions. Moderate to severe dry eye was the most common anomaly managed, followed by eyes with irregular corneal astigmatism. DES and refractive patients experienced improvement in visual acuity with wearing of the PROSE device.
Cont Lens Anterior Eye. 2013 Mar 14. pii: S1367-0484(13)00031-3. doi: 10.1016/j.clae.2013.02.004. [Epub ahead of print]
Dimit R, Gire A, Pflugfelder SC, Bergmanson JP.
Alkek Eye Center, Baylor College of Medicine, Houston, TX, USA. Electronic address: email@example.com.
Nice to see more progressive treatments increasingly mentioned in literature on GvHD.
Graft versus H\host disease (GVHD) can be a devastating complication following bone marrow transplantation. Acute or chronic systemic GVHD can be lethal, and severe damage of different organs and tissues can occur with both types of GVHD. Ocular involvement, either in an acute or chronic presentation, may range from mild to severe with accompanying vision loss present in 60-90 % of patients. Chronic ocular GVHD, the most common form of GVHD, affects mainly the lacrimal gland, meibomian glands, cornea and conjunctiva, mimicking other immunologically mediated inflammatory diseases of the ocular surface without specific symptoms or signs. However, dry eye disease is the main manifestation of GVHD. The long-term treatment of ocular GVHD continues to be challenging and involves a multidisciplinary approach wherein the ophthalmologist plays a major role. Besides systemic immunosuppression and ocular lubricants, topical steroids and topical cyclosporine are commonly prescribed. Newer therapeutic interventions for moderate and severe ocular GVHD include the use of serum eye drops and scleral contact lenses. In this manuscript, we review the mechanisms, clinical findings, and treatment of ocular GVHD.
Espana EM, Shah S, Santhiago MR, Singh AD.
Graefes Arch Clin Exp Ophthalmol. 2013 Mar 17. [Epub ahead of print]
Department of Cornea, External Disease and Refractive Surgery, Department of Ophthalmology, University of South Florida, Tampa, FL, USA.
Effect of a light-emitting timer device on the blink rate of non-dry eye individuals and dry eye patients.
To evaluate blink rate effects by a novel light-emitting diode (LED) timer device (PISC) on non-dry eye (DE) subjects and DE patients during a reading task on liquid crystal display (LCD) screens, in different environmental conditions.
This was a case-control study that included 15 DE patients and 15 non-DE subjects as controls. Participants had their blink rates measured while they read an electronic format text. These tasks were performed in four different conditions: with and without a LED timer device in two visits, and with and without air conditioning. All participants completed the Ocular Surface Disease Index and were examined by best spectacle-corrected visual acuity exam, biomicroscopy, Schirmer test 1, fluorescein staining and break-up time and lissamine green staining (Oxford scale grading).
Outcomes between reading tasks conditions were compared independently for each group and blink rate frequency was higher in tasks with LED timer device, with and without air conditioning, for the DE group (p < 0.0001), and with air conditioning for the control group (p < 0.05).
An LED timer device increased blink frequency for DE and control groups. Further studies need to be carried out in order to evaluate long-term effects of this new device, as well as its assessment with different reading scenarios.
Br J Ophthalmol. 2013 Mar 15. [Epub ahead of print]
Miura DL, Hazarbassanov RM, Yamasato CK, E Silva FB, Godinho CJ, Gomes JA.
School of Medicine, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil.
Funny, I see abstracts about OCT in dry eye diagnosis pretty frequently. I dutifully post some of them. But unlike most other diagnostics covered so prolifically in the literature I hardly seem to hear about this one at all in 'real life'. Am I just out of touch? Who's using this?
Optical Coherence Tomography for Measuring the Tear Film Meniscus: Correlation with Schirmer Test and Tear-Film Breakup Time.
Abstract Purpose: To compare tear meniscus height (TMH) and area (TMA) values obtained by optical coherence tomography (OCT) with the Schirmer test and tear-film break-up time (TBUT) values. Materials and methods: In this prospective cross-sectional study, the right eyes of 300 consecutive patients were studied. All patients underwent routine ophthalmologic examination. Schirmer and TBUT measurements were taken, and tear-film OCT images were obtained. Using OCT, the TMH (i.e. the line connecting the intersection of the meniscus with the cornea and eyelid) and cross-sectional TMA were calculated. Patients were divided into Groups 1 (Schirmer values ≤ 5 mm) and 2 (Schirmer values > 5 mm). Data were analyzed using SPSS 13.0 software. The Mann-Whitney U-test was used for the comparison of groups. Correlations between tear parameters were analyzed. Results: There were no significant differences in age, logMAR, or IOP values (p = 0.480, 0.077 and 0.146, respectively) between the two groups. Mean TBUTs were 5.1 ± 2.9 and 9.5 ± 4.2 s for Groups 1 and 2, respectively (p < 0.001). Mean TMHs were 237.9 ± 108.9 and 324.3 ± 158.9 μm for Groups 1 and 2, respectively (p < 0.001). Mean TMAs were significantly lower in Group 1 compared to Group 2 (p < 0.001; 0.027 ± 0.028 versus 0.055 ± 0.059 mm2, respectively). Correlations between Schirmer values and TMH, and between Schirmer values and TMA, were significant (p = 0.001 and < 0.001, respectively). Conclusions: OCT values were significantly lower in patients with Schirmer values of < 5 mm. Tear meniscus measurements obtained by OCT are reliable for establishing a diagnosis of dry eye.
Curr Eye Res. 2013 Mar 14. [Epub ahead of print]
Altan-Yaycioglu R, Sizmaz S, Canan H, Coban-Karatas M.
Faculty of Medicine, Adana Teaching & Medical Research Center, Baskent University , 01250 Adana , Turkey.
A Randomized, Multicenter Phase 3 Study Comparing 2%Rebamipide (OPC-12759) with 0.1% Sodium Hyaluronate in the Treatment of DryEye.
To investigate the efficacy of 2% rebamipide ophthalmic suspension compared with 0.1% sodium hyaluronate ophthalmic solution for the treatment of patients with dry eye.
Randomized, multicenter, active-controlled parallel-group study.
One hundred eighty-eight patients with dry eye.
Following a 2-week screening period, patients were allocated randomly to receive 2% rebamipide or 0.1% sodium hyaluronate, administered as 1 drop in each eye 4 or 6 times daily, respectively, for 4 weeks.
MAIN OUTCOME MEASURES:
There were 2 primary end points: changes in the fluorescein corneal staining (FCS) score to determine noninferiority of 2% rebamipide and changes in the lissamine green conjunctival staining (LGCS) score to determine superiority. Secondary objective end points were Schirmer's test results and tear film breakup time (TBUT). Secondary subjective end points were dry eye-related ocular symptoms (foreign body sensation, dryness, photophobia, eye pain, and blurred vision) score and the patients' overall treatment impression score.
In the primary analysis, the mean change from baseline in FCS scores verified noninferiority, indicated significant improvement, and, in LGCS scores, verified the superiority of 2% rebamipide to 0.1% sodium hyaluronate. Values for the Schirmer's test and TBUT were comparable between the 2 groups. For 2 dry eye-related ocular symptoms-foreign body sensation and eye pain-2% rebamipide showed significant improvements over 0.1% sodium hyaluronate. Patients had a significantly more favorable impression of 2% rebamipide than of 0.1% sodium hyaluronate; 64.5% rated treatment as improved or markedly improved versus 34.7%, respectively. No serious adverse events were observed.
Administration of 2% rebamipide was effective in improving both the objective signs and subjective symptoms of dry eye. Those findings, in addition to the well-tolerated profile of 2% rebamipide, clearly show that it is an effective therapeutic method for dry eye.
Ophthalmology. 2013 Mar 12. pii: S0161-6420(12)01203-1. doi: 10.1016/j.ophtha.2012.12.022. [Epub ahead of print]
Kinoshita S, Oshiden K, Awamura S, Suzuki H, Nakamichi N, Yokoi N; Rebamipide Ophthalmic Suspension Phase 3 Study Group(⁎).
Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan. Electronic address: firstname.lastname@example.org.
Computational methods are presented that can automatically detect the length and width of meibomian glands imaged by infrared meibography without requiring any input from the user. The images are then automatically classified. The length of the glands are detected by first normalizing the pixel intensity, extracting stationary points, and then applying morphological operations. Gland widths are detected using scale invariant feature transform and analyzed using Shannon entropy. Features based on the gland lengths and widths are then used to train a linear classifier to accurately differentiate between healthy (specificity 96.1%) and unhealthy (sensitivity 97.9%) meibography images. The user-free computational method is fast, does not suffer from inter-observer variability, and can be useful in clinical studies where large number of images needs to be analyzed efficiently.
J Biomed Opt. 2012 Aug;17(8):086008. doi: 10.1117/1.JBO.17.8.086008.
Koh YW, Celik T, Lee HK, Petznick A, Tong L.
Bioinformatics Institute, 30 Biopolis Street, 07-01, Matrix, Singapore 138671. email@example.com