In Vivo Human Lacrimal Gland Imaging Using an Ultrasound Biomicroscopy.

PURPOSE: In the present study, we introduce human lacrimal gland imaging using an ultrasound biomicroscopy (UBM) with a soft cover and show their findings. METHODS: The representative UBM findings of palpebral lobes in seven subjects (four with non-Sjögren dry eye syndrome, one with Sjögren syndrome, and two healthy subjects) were described in this study. To prolapse the palpebral lobe, the examiner pulled the temporal part of the upper eyelid in the superotemporal direction and directed the subject to look in the inferonasal direction. We scanned the palpebral lobes longitudinally and transversely using UBM. We used an Aviso UBM with a 50 MHz linear probe and ClearScan. RESULTS: In UBM of two healthy subjects, the echogenicity of the lacrimal gland was lower than that of the sclera and homogeneous. But the parenchyma of a patient with Sjögren dry eye syndrome was quite inhomogeneous compared to the healthy subjects. In two patients with dry eye syndrome, we were able to observe some lobules in the parenchyma. We could find excretory ducts running parallel at the surface of the longitudinal section in some subjects. In the longitudinal UBM scan of a subject, we observed a tubular structure at a depth of 1,500 µm that was considered a blood vessel. It ran from the superonasal to the inferotemporal direction. In a subject, we observed a large cyst beneath the conjunctiva. CONCLUSIONS: Lacrimal gland imaging using UBM has both advantages of optical coherence tomography and sonography, and could be useful for evaluating dry eye syndrome.

Cardiovascular outcomes between dapagliflozin versus empagliflozin in patients with diabetes mellitus.

BACKGROUND: Sodium-glucose co-transporter 2 (SGLT2) inhibitors have been demonstrated to decrease cardiovascular adverse events. However, there is little real-world clinical evidence regarding a direct comparison between dapagliflozin and empagliflozin in patients with diabetes mellitus (DM). HYPOTHESIS: A difference in the cardiovascular efficancy of dapagliflozin versus empagliflozin in DM patients was anticipated, aiming to guide the optimal choice of SGLT2 inhibitors based on cardiovascular outcomes. METHODS: From 2014 to 2020, a total of 1549 patients with DM who were prescribed SGLT2 inhibitors such as dapagliflozin or empagliflozin were retrospectively enrolled. We categorized the study population into two groups: dapagliflozin (n = 981) and empagliflozin group (n = 568). The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of all-cause death, myocardial infarction (MI), stroke, or hospitalization for heart failure (HF) over a 3-year period. RESULTS: Propensity-score matching was performed (537 patients in each group). The mean age and hemoglobin A1c were 58.2 ± 13.0 years and 8.4 ± 1.7%, respectively. There was no significant difference between the dapagliflozin and empagliflozin groups in the risk of MACE (3.7% vs. 4.8%, hazard ratio [HR], 1.31; 95% confidence interval [CI], 0.73-2.35; p = 0.349). Furthermore, there were no differences between the two groups in secondary endpoints including all-cause death, MI, stroke, and hospitalization for HF. Prior MI and history of HF were independent predictors of MACE. CONCLUSIONS: Dapagliflozin and empagliflozin showed no significant difference of real-world clinical cardiovascular outcomes in patients with DM over a 3-year period. Further large randomized clinical trials will be warranted for better evaluation.

Ocular parameters associated with visual performance of enhanced monofocal intraocular lens.

BACKGROUND: An enhanced monofocal intraocular lenses (IOLs) (Tecnis Eyhance ICB00 and Tecnis Eyhance Toric DIU) has been developed to enhance intermediate vision while avoiding the disadvantages of multifocal IOLs. Although many studies have demonstrated the improvement of intermediate visual acuity with enhanced monofocal IOLs, it is not known specifically for which patients these IOLs should be recommended or avoided. In this study, we aim to find out which ocular parameters affect vision performance and photic phenomenon of ICB00 or DIU at different distances. METHODS: Patients who underwent cataract surgery with ICB00 or DIU, performed by a single surgeon, were included. Before surgery, the patients' age, gender, axial length, anterior chamber depth, spherical aberration Z (4,0), vertical coma, horizontal coma, angle kappa (κ), angle alpha (α), and other ocular parameters were investigated. One month after surgery, uncorrected near visual acuity (UNVA at 40 cm), uncorrected intermediate visual acuity (UIVA at 66 cm), uncorrected distance logMAR visual acuity (UDVA), IOL decentration, and quality of vision (QoV) questionnaires were conducted. RESULTS: A total of 43 patients (58 eyes) were included. The results of the univariate linear regression analyses showed a negative correlation between spherical aberration and logMAR UNVA and UIVA (p = 0.003, ß=-0.51 and p = 0.018, ß=-0.23, respectively) and a positive correlation between angle α and logMAR UIVA (p = 0.036, ß = 0.19). Deeper anterior chamber depth (ACD) was associated with poorer total QoV (p = 0.018, ß = 14.43), particularly in glare, halo, blur, and fluctuation perception. A higher degree of IOL decentration tended to decrease UNVA and UIVA (Pearson correlation coefficient, r = 0.336 and r = 0.221, respectively); however, no significant effect was observed on UDVA (Pearson correlation coefficient, r = 0.042). CONCLUSIONS: In enhanced monofocal IOLs, a higher level of spherical aberration is associated with better performance in UNVA and UIVA, whereas a larger angle α has a negative impact. A deeper ACD negatively affects the QoV.

Categorization of Meibomian Gland Dysfunction Using Lipid Layer Thickness and Meibomian Gland Dropout in Dry Eye Patients: A Retrospective Study.

PURPOSE: In the present study, we determined the prevalence of obstructive meibomian gland dysfunction (MGD), hyposecretory MGD, grossly normal MG, and hypersecretory MGD in patients with dry eye syndrome using lipid layer thickness (LLT) and MG dropout. METHODS: Eighty-eight patients with dry eye syndrome were included in the study. Patients were categorized into four groups according to the LLT and weighted total meiboscore. The proportion of patients in each group was calculated. The age, sex, Ocular Surface Disease Index, LLT, Schirmer, tear film breakup time, cornea stain, weighted total meiboscore, expressibility, and quality of meibum were compared between the four groups. RESULTS: Fifteen eyes (17.0%) had obstructive MGD, two eyes (2.3%) had hyposecretory MGD, 40 eyes (45.5%) had grossly normal MG, and 17 eyes (19.3%) had hypersecretory MGD. The obstructive MGD group was younger than the grossly normal MG group. In obstructive MGD, the ratio of men to women was higher than that of the other groups. However, Ocular Surface Disease Index, Schirmer, tear film breakup time, and corneal stain did not show statistically significant differences between the four groups. The meibum expressibility of the hyposecretoy MGD group was worse than those of the other groups. The meibum expressibility of the hyposecretoy MGD group was poor than those of the obstructive and hypersecretory MGD group. CONCLUSIONS: This categorization was expected to help determine the best treatment method for dry eye syndrome, according to the MG status.

Comparative Analysis of Optical Quality of Monofocal, Enhanced Monofocal, Multifocal, and Extended Depth of Focus Intraocular Lenses: A Mobile Model Eye Study.

Purpose: To use the revised model eye to observe and compare how the world is perceived by patients with monofocal intraocular lens (IOL), Eyhance, bifocal IOL, and Symfony, and check its performance. Methods: The new mobile model eye consists of an artificial cornea, an IOL, a wet cell, an adjustable lens tube, a lens tube, an objective lens, a tube lens, and a digital single-lens reflex camera. We collected photographs of distant buildings and streets at night, videos of the focusing process, and videos of United States Air Force resolution target from 6 m to 15 cm and analyzed them quantitatively. Results: In this revised model eye using an objective lens, an artificial cornea similar to the human cornea could be used. Using a digital single-lens reflex camera, high-resolution imaging was possible without an additional computer. Fine focusing was possible using an adjustable lens tube. For monofocal IOL, the contrast modulation was 0.39 at 6 m and decreased consistently. It was nearly 0 as the model eye got closer than 1.6 m. For Eyhance, the contrast modulation was 0.40 at 6 m. It then decreased and increased again. At 1.3 m, it was 0.07 and then decreased again. For Symfony, the contrast modulation was 0.18 at 6 m. Symfony showed the characteristics of a bifocal IOL with low add diopter. Halos (234 pixels) were observed around lights, although smaller than those seen with bifocal IOL (432 pixels). Conclusions: We could objectively observe and compare how patients with monofocal IOL, Eyhance, bifocal IOL, and Symfony perceived the world using this revised model eye. Translational Relevance: Data obtained by this new mobile model eye can be used to help patients select their IOLs before cataract surgeries.

Quantitative analysis of cornea endothelial cell damage from enucleation, corneal buttoning, and storage in donor corneas using trypan blue dye staining.

We aimed to quantitatively analyze the corneal endothelial cell damage by measuring the area stained with trypan blue dye, and to confirm the degree of corneal endothelial cell damage resulting from enucleation, corneal buttoning, and storage in donor corneas intended for use in human corneal transplantation. This study was a retrospective analysis of medical records and videos recorded during keratoplasty. Twenty-one corneal buttons of 21 donors that underwent endothelial cell staining using trypan blue for the donor preparation during DALK or DMEK were included in the study. The percentage of stained area in entire corneal endothelia and the percentage of the stained area in the 8-mm diameter circle were quantitatively analyzed using Adobe Photoshop. The mean percentage of the stained area in the entire corneal endothelia in 13 corneas was 8.1 ±â€…13.3% (range, 0.0-56.1%), and the mean percentage of the stained area in a circle with a diameter of 8 mm in 21 corneas was 3.4 ±â€…5.2% (range, 0.0-18.9%). The correlations between the death-to-preservation time, the training duration of the residents who performed donor corneal buttoning, and the percentage of the stained area in the 8-mm diameter circle were not significant(P = .441, P = .495, respectively). Cornea thickness and endothelial cell density did not differ between 10 eyes in the group with the percentage of the stained area in a circle with a diameter of 8 mm <5% and 5 eyes in the group with the percentage more than 5% damage (P = .854, P = .358). The corneal endothelial cell damage could be quantitatively analyzed using trypan blue staining before keratoplasty in donor cornea. The amount of corneal endothelial cell damage in the central 8-mm circle was mostly acceptable, but some cases showed significantly severe endothelial cell damage. The corneal thickness and endothelial cell density did not differ between 10 eyes in the group with the percentage of the stained area in a circle with a diameter of 8 mm <5% and 5 eyes in the group with the percentage more than 5% damage. Therefore, pachymetry and specular microscopy are not sufficient for evaluating donor corneas before keratoplasty.

Comparison of surgically induced astigmatism between anterior and total cornea in 2.2 mm steep meridian incision cataract surgery.

BACKGROUND: This study aimed to compare surgically induced astigmatism (SIA) on the anterior and total cornea during cataract surgery through a 2.2 mm steep meridian incision. METHODS: The study included 69 left eyes of 69 patients who had undergone cataract surgery. The 69 eyes were classified into three subgroups according to the preoperative steep meridian. Following phacoemulsification, an intraocular lens was inserted into the bag. The keratometric measurements were taken 12 months postoperatively, on the anterior cornea (automated keratometer and anterior keratometry [K] from a rotating Scheimpflug camera) and total cornea (equivalent K reading [EKR] 3.0 mm, EKR 4.5 mm, total corneal refractive power (TCRP) 2.0 mm ring, TCRP 3.0 mm zone, TCRP 4.0 mm zone). The SIA was analyzed for each parameter. RESULTS: On the double-angle polar plot, the summated vector mean values of SIA determined by the automated keratometer and Scheimpflug anterior K were 0.28 diopter (axis: 177°) and 0.37 diopter (axis: 175°) in with-the-rule (WTR) astigmatism; 0.03 diopter (axis: 156°) and 0.18 diopter (axis: 177°) in oblique astigmatism; 0.15 diopter (axis: 96°) and 0.17 diopter (axis: 73°) in against-the-rule (ATR) astigmatism. The mean SIAs on the total cornea ranged from 0.31 to 0.42 diopter in WTR astigmatism; from 0.16 to 0.27 diopter in oblique astigmatism; from 0.04 to 0.11 diopter in ATR astigmatism. Mean magnitude SIA ranged from 0.41 to 0.46 diopter on anterior corneal surface and 0.50 to 0.62 diopter on total cornea. J0 and J45 of the posterior cornea showed no significant changes after cataract surgery, and the changes in J0 and J45 did not show any statistical differences between the anterior and total cornea (all p > 0.05). CONCLUSIONS: There were no differences in the summed vector mean values of SIA between the anterior cornea and the total cornea.