bleat bleat

For those wondering what's going on back at Petris Farm - and who haven't already been pelted with my photos on facebook or email....

Our VERY FIRST LAMBS ever arrived yesterday afternoon. They are just the most precious creatures imaginable. My daughter calls them Tiger and Sugarlips. We found them wobbling around by mama Noah yesterday when we got home - probably not more than an hour old. I was so thankful that they were born when they were... in a nice quiet sunny spell, after the overnight rainstorm that dumped more than an inch of water, and before the predicted thunderstorms and wet snow of yesterday evening/night. They got a nice dry interval to recover from the ordeal of coming into the world.

Resting with Mama...

Tiger...

Sugarlips...

Dinner...

Abstract: Smart plugs vs punctal plugs.

A study about smart plugs that makes no reference whatsoever to the very serious complications that have presented a clear trend over their ten years on the market. Great, just great.

What this study DOES say however is that in terms of clinical efficacy (without reference to safety) SmartPlugs and ordinary punctal plugs were not noticeably different... rather sounds like the authors are defending SmartPlugs, but really, if they do not outperform other plugs, it just eliminates even more potential rationale for using them at all.

When is the FDA going to do the right thing and withdraw approval for this !@#$ device? When are the doctors treating the complications patients going to demand it? I am sick and tired of seeing people continue to be harmed unnecessarily.

Collared Silicone Punctal Plugs Compared to IntracanalicularPlugs for the Treatment of Dry Eye.

Aim:
To compare collared silicone punctal plugs to intracanalicular SmartPlugs for the treatment of moderate to severe dry eye.
 Materials and methods:
In this prospective, randomized, single blind, clinical study, 30 patients (60 eyes) who had been diagnosed with moderate to severe dry eye syndrome were enrolled. Study group I (n = 30 eyes) received collared silicone punctal plugs and group II (n = 30 eyes) received intracanalicular SmartPlugs. Data for the Schirmer I test, tear break-up time, vital staining, subjective symptoms and frequency of artificial tear application were recorded at baseline and 3 months after punctal occlusion.
 Results:
There was no statistical significant difference for these values between group I and II.
 Conclusions:
Although published data show free flow with irrigation and probing after SmartPlug insertion, the clinical effect in the treatment of dry eye appears to be the equally well to collared silicone punctal plugs. It seems likely that difference of design and localization between the treatment groups were of minor importance concerning impeding of natural and supplemental moisture.

Curr Eye Res. 2013 Feb 12. [Epub ahead of print]

Rabensteiner DF, Boldin I, Klein A, Horwath-Winter J.

Department of Ophthalmology, Medical University of Graz , Austria.

Abstract: How many blinks could a dry eye blink if....

One of those "Ya think?" studies. :-)

Speaking of which, y'oughtta see my blink rate this time of night while looking at a computer. More frequent than once per second, I guarantee.

The interblink interval in normal and dry eye subjects.

PURPOSE:
Our aim was to extend the concept of blink patterns from average interblink interval (IBI) to other aspects of the distribution of IBI. We hypothesized that this more comprehensive approach would better discriminate between normal and dry eye subjects.
 METHODS:
Blinks were captured over 10 minutes for ten normal and ten dry eye subjects while viewing a standardized televised documentary. Fifty-five blinks were analyzed for each of the 20 subjects. Means, standard deviations, and autocorrelation coefficients were calculated utilizing a single random effects model fit to all data points and a diagnostic model was subsequently fit to predict probability of a subject having dry eye based on these parameters.
 RESULTS:
Mean IBI was 5.97 seconds for normal versus 2.56 seconds for dry eye subjects (ratio: 2.33, P = 0.004). IBI variability was 1.56 times higher in normal subjects (P < 0.001), and the autocorrelation was 1.79 times higher in normal subjects (P = 0.044). With regard to the diagnostic power of these measures, mean IBI was the best dry eye versus normal classifier using receiver operating characteristics (0.85 area under curve (AUC)), followed by the standard deviation (0.75 AUC), and lastly, the autocorrelation (0.63 AUC). All three predictors combined had an AUC of 0.89. Based on this analysis, cutoffs of ≤3.05 seconds for median IBI, and ≤0.73 for the coefficient of variation were chosen to classify dry eye subjects.
 CONCLUSION:
(1) IBI was significantly shorter for dry eye patients performing a visual task compared to normals; (2) there was a greater variability of interblink intervals in normal subjects; and (3) these parameters were useful as diagnostic predictors of dry eye disease. The results of this pilot study merit investigation of IBI parameters on a larger scale study in subjects with dry eye and other ocular surface disorders.

Clin Ophthalmol. 2013;7:253-9. doi: 10.2147/OPTH.S39104. Epub 2013 Feb 1.

Johnston PR, Rodriguez J, Lane KJ, Ousler G, Abelson MB.

Ora, Inc, Andover, MA, USA.

Abstract: Effect of pterygium surgery on tear osmolarity

Effect of pterygium surgery on tear osmolarity.

Purpose.
To investigate changes of dry eye test results in patients who underwent pterygium surgery.
 Methods.
Seventy-four patients who underwent primary pterygium surgery were enrolled in this study. At the baseline, 3-, 12-, and 18-month visits, measurements of tear osmolarity, BUT, and Schirmer test were performed. The patients were divided into 2 groups: Group 1, which consisted of patients in whom pterygium did not recur, and Group 2, which consisted of patients in whom pterygium recurred after surgery.
 Results.
The patients in Group 1 had lower tear osmolarity levels after surgery than those at baseline (all P < 0.001). In Group 2 the tear osmolarity levels did not differ from baseline after 18 months (P = 0.057). The prevalence rates of dry eye syndrome (DES) were lower than that at baseline and 18 months after surgery in Group 1 (P = 0.002). In Group 2, the incidence of DES was lower after 3 months than at baseline (P = 0.03) but was similar to the baseline rate after 12 and 18 months (both P > 0.05).
 Conclusions.
Anormal tear film function associated with pterygium. Pterygium excision improved tear osmolarity and tear film function. However, tear osmolarity deteriorated again with the recurrence of pterygium.

J Ophthalmol. 2013;2013:863498. doi: 10.1155/2013/863498. Epub 2013 Jan 20.

Türkyılmaz K, Oner V, Sevim MŞ, Kurt A, Sekeryapan B, Durmuş M.

Source

Department of Ophthalmology, Recep Tayyip Erdoğan University Medical School, 53100 Rize, Turkey.

Abstract: Tacrolimus in extreme dry eye cases

Application for Tacrolimus Ointment in Treating RefractoryInflammatory Ocular Surface Diseases.

PURPOSE:
To evaluate the therapeutic effects of topical tacrolimus ointment on refractory inflammatory ocular surface diseases.
 DESIGN:
Retrospective interventional consecutive case series.
 METHODS:
In Severance Hospital, Seoul, South Korea, 0.02% tacrolimus ointment was topically applied 1 to 3 times per day, depending on disease severity, for up to 31 months in eyes of 12 consecutive patients with refractory inflammatory ocular surface diseases who had previously been treated with steroid therapy. Seven patients had chronic cicatrizing conjunctivitis (6 cases caused by Stevens-Johnson syndrome and 1 attributable to ocular cicatricial pemphigoid); 4 had scleritis (3 necrotizing scleritis, 1 recurrent nodular scleritis); and 1 patient had Mooren ulcer with corneal perforation. The therapeutic outcomes after tacrolimus treatment were evaluated according to the following criteria: change in clinical findings (eg, decrease of hyperemia, ocular pain, epithelial defect, and pseudomembrane), intraocular pressure (IOP), and need for steroid therapy.
 RESULTS:
In all 3 groups, tacrolimus showed an immunosuppressive effect, especially on scleritis and Mooren ulcer. These effects included suppression of corneoscleral melting and reduction of hyperemia. In chronic cicatrizing conjunctivitis, simultaneous topical tacrolimus while tapering steroid therapy suppressed inflammatory relapse. The elevated IOP in steroid responders recovered to normal range after successful tapering of steroid. No adverse side effects were noted after 1.5 to 31 months of continuous tacrolimus treatment.
 CONCLUSION:
The use of topical tacrolimus ointment is effective in controlling refractory inflammatory ocular surface disease, and can reduce the need for steroid use while reducing inflammation recurrence.

Am J Ophthalmol. 2013 Feb 6. pii: S0002-9394(12)00863-X. doi: 10.1016/j.ajo.2012.12.009. [Epub ahead of print]

Lee YJ, Kim SW, Seo KY.

Source

Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea.

Abstract: Clinical characteristics of short TBUT dry eye

[Clinical characteristics of short tear film breakup time(BUT) -type dry eye].

[Article in Japanese]

PURPOSE:
To evaluate the clinical characteristics and management of short tear film breakup time (BUT) -type dry eye.
 METHODS:
Clinical background and post-treatment changes of symptoms in 77 patients with short BUT -type dry eye were investigated. Treatment consisted of artificial-tear eye-drop instillation and, if necessary, the addition of a low-density-level steroid, hyaluronic acid, a low-density-level cyclopentolate prepared by ourselves and punctal plugs inserted into the upper and lower lacrimal puncta.
 RESULTS:
There were three times more women than men among the patients, and the peak age of occurrence was in the twenties in the men and in the sixties in the women. Our findings show that visual display terminal (VDT) work, contact lens (CL) wear, and changes in the sex hormones may initiate subjective symptoms. Some patients had simultaneous conjunctivochalasis, allergic conjunctivitis, and meibomian gland dysfunction. Nineteen patients (24.7%) were effectively treated with eye-drop instillation alone. Thirty-seven patients (48.1%) required punctal-plug insertion, which was completely effective in only 8 of them (21.6%).
 CONCLUSION:
Mainly young men and menopausal women contract short BUT -type dry eye. Changes in sex hormones, VDT work and CL wear may be causal, and the disease cannot be controlled by eyedrop and punctal-plug treatment alone.

Nihon Ganka Gakkai Zasshi. 2012 Dec;116(12):1137-43.

Yamamoto Y, Yokoi N, Higashihara H, Inagaki K, Sonomura Y, Komuro A, Kinoshita S.

Source

Department of Ophthalmology, Fukuchiyama City Hospital, Japan.

Abstract: Conjunctivchalasis contributing to OSD in glaucoma patients

Conjunctivochalasis as a Contributing Factor for theDevelopment of Ocular Surface Disease in Medically Treated Glaucoma Patients.

PURPOSE::

To evaluate the impact of conjunctivochalasis (CCh) and its severity on the ocular surface parameters of glaucoma subjects treated with topical antiglaucomatous medication.

MATERIALS AND METHODS::

One hundred patients with the clinical diagnosis of glaucoma were recruited for this study. CCh was graded based on the extent of inferior lid margin involvement as follows: 1=single (temporal) location, 2=two locations (nasal and temporal), and 3=whole lid. For all the subjects, the break-up time (BUT), lissamine green (LG) staining, and Schirmer test (under topical anesthesia) was performed for both eyes. Ocular Surface Disease Index (OSDI) questionnaire scores were also noted for each subject. Student t test, Mann-Whitney U test, and Kruskal-Wallis test was used for statistical evaluations.

RESULTS::

Sixty-three subjects had evidence of CCh; 32 had grade 1, 24 had grade 2, 7 had grade 3 CCh, and 37 glaucoma patients had no evidence of CCh. There were significant differences in the BUT scores (7.2±2.7 vs. 10.1±2.4 s, P < 0.001), Schirmer values (7.7±3.9 vs. 13.3.±4.0 mm, P < 0.001), LG staining score (1.6±1.0 vs. 0.3±0.5, P < 0.001), and the OSDI scores (19.4±17.2 vs. 6.7±5.2, P < 0.001) between patients who had CCh and those without CCh. The BUT scores and Schirmer test values of patients with grades 2 and 3 CCh were significantly lower than those of grade 1 CCh and those without CCh (P < 0.001). The LG grading and OSDI scores were significantly higher in grade 2 and 3 patients as compared with those with grade 1 CCh and those without CCh (P < 0.001).

CONCLUSIONS::

The functional characteristics of the ocular surface appear to be adversely influenced by the presence and the extent of CCh in glaucoma patients.

J Glaucoma. 2013 Jan 31. [Epub ahead of print]

Kocabeyoglu S, Mocan MC, Irkec M, Orhan M, Karakaya J.

Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey.

Abstract: Drier + environmental stress = worse allergic reactions

Exacerbation of signs and symptoms of allergicconjunctivitis by a controlled adverse environment challenge in subjects with ahistory of dry eye and ocular allergy.

BACKGROUND:
The goal of this study was to assess the effect of a controlled adverse environment (CAE) challenge on subjects with both allergic conjunctivitis and dry eye.
METHODS:
Thirty-three subjects were screened and 17 completed this institutional review board-approved study. Subjects underwent baseline ocular assessments and conjunctival allergen challenge (CAC) on days 0 and 3. Those who met the ocular redness and itching criteria were randomized to receive either the controlled adverse environment (CAE) challenge (group A, n = 9) or no challenge (group B, n = 8) at day 6. Thirty minutes after CAE/no-CAE, subjects were challenged with allergen and their signs and symptoms graded. Exploratory confocal microscopy was carried out in a subset of subjects at hourly intervals for 5 hours post-CAC on days 3 and 6.
RESULTS:
Seven minutes post-CAC, subjects exposed to the CAE had significantly greater itching (difference between groups, 0.55 ± 0.25, P = 0.028), conjunctival redness (0.59 ± 0.19, P = 0.002), episcleral redness (0.56 ± 0.19, P = 0.003) and mean overall redness (mean of conjunctival, episcleral, and ciliary redness, 0.59 ± 0.14, P < 0.001). The mean score at 7, 15, and 20 minutes post-CAC for conjunctival redness (0.43 ± 0.17, P = 0.012), episcleral redness (0.49 ± 0.15, P = 0.001), mean overall redness in all regions (0.43 ± 0.15, P = 0.005), and mean chemosis (0.20 ± 0.08, P = 0.017) were also all significantly greater in CAE-treated subjects. Confocal microscopic images of conjunctival vessels after CAC showed more inflammation in CAE-treated subjects.
CONCLUSION:
In subjects with both dry eye and allergic conjunctivitis, exposure to adverse environmental conditions causes an ocular surface perturbation that can intensify allergic reactions.

Clin Ophthalmol. 2013;7:157-65. doi: 10.2147/OPTH.S38732. Epub 2013 Jan 20.

Gomes PJ, Ousler GW, Welch DL, Smith LM, Coderre J, Abelson MB.

Ora Inc, Andover, MA.

And now, at last

I've got my blog caught up all the way to... seven days ago! 

And I've only ignored 12 phone calls in the process! If yours was one or more of them, do forgive me!

I'm going to go indulge my favorite self-reward (see below) for a moment, then I'll start trying to catch up on the calls. 

Ever feel like a gerbil on the wheel?

Abstract: And, a brief word from developing diagnostics...

A Novel Fluorescent Lipid Probe for Dry Eye- Retrieval by Tear Lipocalin in Humans.

PURPOSE.
A fluorescent probe was used to identify mucin depleted areas on the ocular surface and test the hypothesis that tear lipocalin retrieves lipids from the eyes of normal and dry eye subjects.
 METHODS. Fluorescein labeled octadecyl ester, FODE, was characterized by mass spectrometry and absorbance spectrophotometry. The use of FODE to define mucin defects was studied with impression membranes under conditions that selectively deplete mucin. The kinetics of FODE removal from the ocular surface was analyzed by sampling tears from control and dry eye patients at various times. The tear protein-FODE complexes were isolated by gel filtration and ion exchange chromatographies, monitored with absorption and fluorescent spectroscopies and analyzed by gel electrophoresis. Immunoprecipitation verified FODE complexed to tear lipocalin in tears.
 RESULTS.
FODE exhibits an isosbestic point at 473nm, pKa of 7.5, and red shift relative to fluorescein. The low solubility of FODE in buffer is enhanced with 1% Tween 80 and ethanol. FODE adheres to the ocular surface of dry eye patients. FODE produces visible staining at the contact sites of membranes, which correlates with removal of mucin. Despite the fact that tear lipocalin is reduced in dry eye patients, FODE removal follows similar rapid exponential decay functions for all subjects. FODE is bound to tear lipocalin in tears.
 CONCLUSIONS.
Tear lipocalin retrieves lipid rapidly from the human ocular surface in mild to moderate dry eye disease and controls. With improvements in solubility, FODE may have potential as a fluorescent probe to identify mucin depleted areas.

 Invest Ophthalmol Vis Sci. 2013 Jan 29. pii: iovs.12-10817v1. doi: 10.1167/iovs.12-10817. [Epub ahead of print]

Yeh PT, Casey R, Glasgow BJ.

Source

Departments of Ophthalmology, Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Jules Stein Eye Institute, Los Angeles, CA, United States.

Abstract: Refining the hypotheses of dry eye....

Dry eye as a mucosal autoimmune disease.

Dry eye is a common ocular surface inflammatory disease that significantly affects quality of life. Dysfunction of the lacrimal function unit (LFU) alters tear composition and breaks ocular surface homeostasis, facilitating chronic inflammation and tissue damage. Accordingly, the most effective treatments to date are geared towards reducing inflammation and restoring normal tear film. The pathogenic role of CD4+ T cells is well known, and the field is rapidly realizing the complexity of other innate and adaptive immune factors involved in the development and progression of disease. The data support the hypothesis that dry eye is a localized autoimmune disease originating from an imbalance in the protective immunoregulatory and proinflammatory pathways of the ocular surface.

Int Rev Immunol. 2013;32(1):19-41. doi: 10.3109/08830185.2012.748052.

Stern ME, Schaumburg CS, Pflugfelder SC.

Source

Biological Sciences, Inflammation Research Program, Allergan Inc. , Irvine, CA , USA.

Abstract: Come ON, docs, that baby shampoo is soooo 1990s!

This "baby" shoulda been put to bed a long, long time ago.

Really, we ought to take a clue from the label itself: "No More Tears". As if we don't need all we can get!

Baby shampoo is not only a poor tool for the job of lid hygiene compared to the MANY other things available specifically for the purpose, but it's also irritating to the eyes of a great many of us.

[Eyelid hygiene for contact lens wearers with blepharitis : Comparative investigation of treatment with baby shampoo versus phospholipid solution.]

BACKGROUND:
Blepharitis due to Meibom gland dysfunction (MGD) is presumed to be one of the main reasons for dry eye symptoms which occur in up to 50% of contact lens users. Thus, MGD presumably plays an important role in dry eye in contact lens wearers. In the present prospective, randomized and double blind trial the efficacy of two established treatment options for MGD and blepharitis was evaluated in symptomatic contact lens wearers.
METHODS:
In this prospective, randomized 2-centre trial 53 symptomatic contact lens wearers suffering from blepharitis were included. Patients were randomly selected for two treatment groups: group A performed lid margin hygiene using the commonly recommended mild baby shampoo (Bübchen Kinder Shampoo-extra augenmild, Bübchen Werk Ewald Hermes Pharmazeutische Fabrik GmbH, Soest, Germany) and group B performed lid margin hygiene using a phospholipid-liposome solution specially designed for lid hygiene (Blepha Cura, Optima, Moosburg/Wang, Germany), each for 4 weeks. Before as well as 4 weeks after initiation of this study the following tests were performed: standardized subjective assessment using the ocular surface disease index, non-invasive break-up time (NIBUT) and objective evaluation of lid-parallel conjunctival folds (LIPCOF) and further lid margin criteria by double blinded evaluation of slit lamp photographs.
RESULTS:
Of the 53 symptomatic contact lens wearers suffering from blepharitis 21 (39,6%) were randomly selected for treatment group A and 32 (60.4%) for group B. In both treatment groups there was objective and subjective improvement of symptoms of dry eye in contact lens wearers. Interestingly, there was a significantly greater improvement, subjective as well as objective, in treatment group B which used the phospholipidliposome solution for lid margin hygiene compared to group A using baby shampoo.
CONCLUSIONS:
Although both therapies improved symptoms of dry eye due to blepharitis in symptomatic contact lens wearers, patients using phospholipid-liposomal solution for lid margin hygiene demonstrated a significantly greater clinical benefit from the therapy. Thus, clinical practice recommending just baby shampoo for lid margin hygiene should be re-considered, as phospholipid-liposomal solution for lid margin hygiene appears to yield greater and faster clinical benefits for symptomatic contact lens wearers suffering from dry eye symptoms.

Ophthalmologe. 2013 Jan 27. [Epub ahead of print]

[Article in German]

Khaireddin R.

Augenarzt im JosefCarrée Bochum, St.Josef-Hospital,Universitätsklinikum der Ruhruniversität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland, augenarzt@klinikum-bochum.de. 

Conjunctivochalasis vs dry eye

Little newsclip from Hawaiian Eye 2013 caught my eye:

Recognizing conjunctival chalasis avoids dry eyemisdiagnosis

By all means, let's talk about conjunctival chalasis and the overlap of symptoms it can have with dry eye...

WAIKOLOA, Hawaii — Recognizing conjunctival chalasis depends on listening to the patient’s symptoms and investigating any report of a specific site of discomfort or foreign body sensation, a speaker said.
“Conjunctival chalasis occurs when there is a degeneration of Tenon’s fascia that ordinarily tethers the bulbar conjunctiva to the globe,” OSN Cataract Surgery Section Editor John A. Hovanesian, MD, FACS, said at Hawaiian Eye 2013. “This allows stretching and redundancy of the conjunctiva, which bunches up at the inferior lid margin, and sometimes elsewhere, and causes a foreign body sensation especially when the patient blinks.”

Conjunctival chalasis, which is a common and frequently misdiagnosed condition that mimics dry eye, is accompanied by signs of conjunctival redundancy.
Hovanesian recommends performing a “thumb test,” wherein the clinician, pressing gently on the lower lid externally over the area of discomfort, puts light pressure against the globe and asks the patient to move the eye back and forth in a direction that would deliberately cause gathering of the bulbar conjunctiva and pinching between the globe and the eyelid margin.
“When the patient complains of a specific site of pain, and there is evidence of conjunctival laxity, and there is a positive ‘thumb test,’ you’ve got your diagnosis of conjunctival chalasis,” Hovanesian said.

Fair enough. Getting a detailed thorough diagnosis is really, really important in any ocular surface disease, especially when there's a lot of chronic pain going on.

Which then leads us to the inevitable dilemma about treatment. Do we slice & dice?

After making an attempt at lubrication with artificial tears, Hovanesian recommends surgical excision with ocular surface reconstruction with amniotic membrane. The technique is highlighted on his website at http://www.bettereyesurgery.com/video-library/.

This is where I start getting worried... having come across far too many people over the years who had high ocular surface pain levels and were highly motivated to pursue any and all treatment. They had ocular surface reconstruction with amniotic membrane, and they felt and looked great... for six months. At some point later, back to square one. Maybe $10k poorer.

Often these people have had a slightly different diagnosis from every doctor they went to. No one was ever really able to help then. Suddenly, an exciting and totally different diagnosis! Better yet, I can fix you! One little surgery and all that will be gone!

How do you not succumb?

Caution, folks, caution. Fine, suppose we've established your conj is a mess BUT have we established, do we have sufficient reason to believe that's what's your pain source or even tipping point is? Really?

Naturally, my views will be biased because I hear far more from unhappy patients than happy patients (nature of the beast). Nevertheless, I think my concern is valid. It's so tempting for a doctor when they see a nail that looks like a great match for their hammer, to hammer away. But whenever we're talking about ocular surface pain, you've got to appreciate how little is really known about corneal pain, and not set patients up to expect miracle cures when at the end of the day we don't really know.

Abstract: Contamination of standard serum eye drop containers

Eek. 28.9% contamination rate for standard autologous serum containers after just 7 days of treatment.

Autologous serum users take note, re the difference special filters made in keeping serum drop containers from getting contaminated. I have no idea what the cost implications are, but this might be a nice study to copy and talk over with your doctor.

Use of containers with sterilizing filter in autologous serum eyedrops.

OBJECTIVE:
To assess the effect of the use of containers with an adapted sterilizing filter on the contamination of autologous serum eyedrops.
DESIGN:
Prospective, consecutive, comparative, and randomized study.
PARTICIPANTS:
Thirty patients with Sjögren syndrome.
METHODS:
One hundred seventy-six autologous serum containers used in home therapy were studied; 48 of them included an adapted filter (Hyabak; Thea, Clermont-Ferrand, France), and the other 128 were conventional containers. Containers equipped with a filter were tested at 7, 14, 21, and 28 days of use, whereas conventional containers were studied after 7 days of use. In addition, testing for contamination was carried out in 14 conventional containers used during in-patient therapy every week for 4 weeks. In all cases, the preparation of the autologous serum was similar. Blood agar and chocolate agar were used as regular culture media for the microbiologic studies, whereas Sabouraud agar with chloramphenicol was the medium for fungal studies.
MAIN OUTCOMES MEASURES:
Microbiologic contamination of containers with autologous serum eyedrops.
RESULTS:
Only one of the containers with an adapted sterilizing filter (2.1%) became contaminated with Staphylococcus epidermidis after 1 month of treatment, whereas the contamination rate among conventional containers reached 28.9% after 7 days of treatment. The most frequent germs found in the samples were coagulase-negative Staphylococcus (48.6%). With regard the containers used in the in-patient setting, 2 (14.3%) became contaminated after 2 weeks, 5 (35.7%) became contaminated after 3 weeks, and 5 (50%) became contaminated after 4 weeks, leaving 7 (50%) that did not become contaminated after 1 month of treatment.
CONCLUSIONS:
Using containers with an adapted filter significantly reduces the contamination rates in autologous serum eyedrops, thus extending the use of such container by the patients for up to 4 weeks with virtually no contamination risks.

Ophthalmology. 2012 Nov;119(11):2225-30. doi: 10.1016/j.ophtha.2012.06.028. Epub 2012 Aug 4.

López-García JS, García-Lozano I.

Source

Ophthalmology Service, Hospital Cruz Roja, Madrid, Spain. docsantilopez@hotmail.com

Abstract: Ah me, the complexity of it all

Here's another one of those abstracts that underscores why dry eye disease can be such a difficult and baffling disease to try to understand and treat. 

They just took a bunch of people and evaluated them in great detail now and 6 weeks into treatment and had a look at how their clinical signs changed versus how their symptoms changed. 

Correlations among symptoms, signs, and clinical tests inevaporative-type dry eye disease caused by Meibomian gland dysfunction (MGD).

PURPOSE:
To evaluate changes in symptoms, objective tests, and signs after medical treatment of subjects with evaporative-type dry eye disease (EDE) caused by Meibomian gland dysfunction (MGD), and to analyze correlations among symptoms, signs and test results in the worse eyes (W-eyes) of the subjects.
METHODS:
Prospective clinical study of 21 symptomatic subjects with EDE caused by MGD. Subjects who were diagnosed with EDE in a first visit were treated for 6 weeks and re-evaluated in a second visit. The differences between initial and second visits were evaluated. Correlations among clinical symptoms, signs, and test results were performed using the data of the W-eyes. Variables evaluated included: dry eye symptoms, best corrected visual acuity (BCVA), contrast sensitivity, conjunctival hyperemia, phenol red thread test, tear break-up time (TBUT), tear meniscus height (TMH), corneal fluorescein and conjunctival rose Bengal staining, tear lysozyme concentration, Schirmer test, and lid margin assessment.
RESULTS:
All items evaluated improved after treatment, but only conjunctival hyperemia and TMH improved significantly. TBUT and lid margin changes improved, but still remained abnormal. There were significant correlations among symptoms questionnaires and some clinical tests (TBUT, conjunctival hyperemia, TMH, and conjunctival rose Bengal staining).
CONCLUSION:
Despite the instability of the tear film and lid margin alterations that continued after treatment, subjects with MGD improved symptomatically. The low degree of correlations among W-eye signs, symptoms, and tests reflects the independency of symptoms and signs in this complex pathology.

Curr Eye Res. 2012 Oct;37(10):855-63. doi: 10.3109/02713683.2012.683508. Epub 2012 May 25.

Cuevas M, González-García MJ, Castellanos E, Quispaya R, Parra Pde L, Fernández I, Calonge M.

Ocular Surface Group, Institute of Applied OpthalmoBiology (IOBA), University of Valladolid, Valladolid, Spain.