Easy and effective test to evaluate tear-film stability for self-diagnosis of dry eye syndrome: blinking tolerance time (BTT).

BACKGROUND: The tear film breakup time (tBUT) is a clinical evaluation of evaporative dry eye disease assessed by instilling topical fluorescein into the eyes. In the present study, we introduce a new diagnostic test, blinking tolerance time (BTT), for self-evaluation of tear-film stability. We compared the results with the tBUT and validated the BTT test for self-assessment of tear film instability. METHODS: This was a prospective controlled study involving 212 eyes of 106 participants 20-79 years of age. A total of 114 eyes of 57 dry eye patients and 98 eyes of 49 healthy subjects were included in the study. All patients and subjects were administered the following tests to diagnose dry eye disease: Ocular Surface Disease Index, BTT, tBUT, slit-lamp examination, corneal stain score, and Schirmer I test (without anesthesia). Patients and subjects were instructed not to blink for as long possible after reset blinking. The time interval between the reset blink and the next blink was measured. The mean of 3 tBUT values in both the right and left eyes was defined as tBUTBE. Correlations between the BTT and tBUTBE were also evaluated. To evaluate the diagnostic efficacy of the BTT and tBUT tests, receiver operating characteristic (ROC) curves were generated to obtain a cutoff score, and the sensitivities of the tests against the specificity at all possible thresholds were plotted. RESULTS: Spearman's correlation analysis revealed a significant weakly positive correlation between BTT and tBUTBE (r = 0.447; p = 0.000). The intraclass correlation coefficient (ICC) of the tBUT was 0.679 (95% confidence interval [CI]: 0.575-0.765) and the ICC of the BTT was 0.904 (95% CI: 0.867-0.932). The area under the ROC curve did not significantly differ between the tBUTBE (0.678) and BTT (0.628, p = 0.641). When the cutoff value of the BTT test was set to 8.1 s, the sensitivity was 63.3% and the specificity was 56.1%. CONCLUSION: The BTT test is a simple, inexpensive, and effective method for self-diagnosing dry eye that can also be used in the clinical setting.

Effect of diabetic retinopathy and diabetes on the intraocular straylight in pseudophakic eyes.

BACKGROUND: The aim of this study was to prove the relationship between the intraocular straylight level and diabetic retinopathy (DR) according to disease severity. Also, we aimed to evaluate whether diabetes mellitus (DM) per se could be a risk factor of increased intraocular straylight although we did not rely on a definite sign of DR in this study. METHODS: In this prospective comparative study, ninety three eyes were enrolled and divided into four groups as follows: Group 1 (26 eyes), without DR or DM; Group 2 (25 eyes), with DM but without DR; Group 3 (21 eyes), mild to moderate non-proliferative DR; and Group 4 (21 eyes), severe non-proliferative DR. To measure the intraocular straylight in an objective manner, the C-quant straylight meter was used to preoperatively and 2 months postoperatively in all patients who underwent phacoemulsification surgery. All the patients also underwent a macular optical coherence tomography and hemoglobin A1c (HbA1c) analysis. A comparison of straylight levels adjusted by age among four groups was performed postoperatively. RESULTS: The postoperative level of intraocular straylight was statistically significantly different among four groups (P <0.05). When adjusted for ages, Group 4 showed the highest straylight level when compared with Group 3 and the other two groups (P <0.05). Group 1 showed the lowest straylight level in comparison with Group 2 and the other two groups (P <0.05). There was no significant correlation between HbA1c level, duration of diabetes and postoperative straylight level. CONCLUSIONS: The level of intraocular straylight at 2 months postoperatively had a tendency to increase as the severity of DR increased. Additionally, the straylight level was higher in DM patients without DR than in patients without DM. Therefore, the severity of DR seemed to influence the intraocular straylight level. Although there is no definite sign of DR, DM per se can be a risk factor for increasing intraocular straylight. In conclusion, the level of intraocular straylight seems to be a sensitive test for detecting early retinal damage secondary to DM.

Efficacy, predictability, and safety of small incision lenticule extraction: 6-months prospective cohort study.

BACKGROUND: To report our experience with small incision lenticule extraction ("SMILE") for myopia treatment. METHODS: In this prospective clinical study, we evaluated 447 eyes from 224 patients with myopia, with and without astigmatism. We followed the patients for 6 months after SMILE. RESULTS: The mean (±standard deviation, SD) spherical equivalent was -6.75 ± 1.65 diopters (D) preoperatively and -0.21 ± 0.37 D at 6 months postoperatively. Our data showed that 97.9% of eyes were within ±1.0 D and 86.1% were within ±0.5 D of the intended correction. Furthermore, 79.8% had an uncorrected distance visual acuity (UDVA) of 0 logMAR or less (20/20 or better in the Snellen equivalent) 6 months after surgery. Additionally, 48.5% remained unchanged, 41% gained one line of corrected distance visual acuity (CDVA), 7.2% gained two lines of CDVA, 3.3% lost one line of CDVA, and 0.3% lost two or more lines of CDVA. Age was the only predictor for worsening UDVA at 6 months postoperatively in linear regression analyses (0.07 decrease logMAR per increased 10 years of age; P < 0.05). No predictor showed an association with error in spherical equivalent refraction at 6 months postoperatively. CONCLUSIONS: SMILE is an effective and safe refractive surgery. Age was the only predictor that influenced visual outcome, but its effect appeared clinically insignificant. Faster visual recovery is also expected with improved surgical technique.

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.

Effect of ethanol-treated mid-peripheral epithelium on corneal wound healing in rabbits.

BACKGROUND: To determine the effect of an ethanol-treated mid-peripheral epithelium on wound healing of the corneal epithelium. METHODS: Epithelial removal was performed on 18 rabbit eyes, which were divided into three groups of six eyes each as follows: group 1, an 8.0-mm diameter treated with balanced salt solution (BSS) and an 8.0-mm removal; group 2, an 8.0-mm diameter treated with 20% ethanol for 30 seconds and an 8.0-mm removal; and group 3, a 9.0-mm diameter treated with ethanol and an 8.0-mm removal (barrier zone setting group). The corneal defect area was analyzed post-operatively. The concentrations of vascular endothelial growth factor (VEGF) and epidermal growth factor (EGF) in tears were determined pre-operatively and post-operatively. Healed corneal tissues were examined with light and electron microscopy. Immunohistochemical analysis was also performed to estimate the expression of EGF receptors in healed corneal tissue. RESULTS: The epithelial healing rate in group 3 was faster than that in the two other groups (p < 0.05). The expression of VEGF and EGF in group 3 was higher than that in the other two groups (p < 0.05). Light microscopy revealed clear healing of the corneal epithelium in all groups except for some cases in group 1. Electron microscopy revealed a relatively intact microstructure of the healed corneal tissues, especially in group 2 and 3 when compared with group 1. Meanwhile, in the immunohistochemistry, group 3 showed significantly higher expression of EGFR when compared with the other groups. Furthermore, EGFR expression had a tendency to be stronger in the mid-peripheral corneal area than in the central corneal area. CONCLUSIONS: The preserved mid-peripheral epithelial layer treated with ethanol (barrier zone) promoted corneal epithelial healing. It appeared to be correlated with elevated tear VEGF and EGF levels in the post-operative period.

Persimmon Leaves (Diospyros kaki) Extract Enhances the Viability of Human Corneal Endothelial Cells by Improving Na+-K+-ATPase Activity.

The Na+/K+-ATPase, present in the basolateral membrane of human corneal endothelial cells (HCECs), is known to play an important role for corneal transparency. Na+/K+-ATPase dysfunction is one of the major causes of corneal decompensation. The ethanol extract of Diospyros kaki (EEDK) has been reported to increase corneal cell viability. Thus, we treated HCECs with EEDK and studied its effects on HCECs survival and Na+/K+-ATPase against cytotoxic drugs like staurosporine (ST) and ouabain (OU). Firstly, survival assays, (MTT assay and live dead-imaging) showed that decreased HCECs viability by ST and OU was significantly recovered by EEDK co-treatment. Secondly, Na+/K+-ATPase activity assays revealed that EEDK enhanced Na+/K+-ATPase enzymatic activity (* p < 0.01) with/without ST and OU. Finally, Na+/K+-ATPase expression analysis (Western Blot and confocal microscopy) demonstrated that EEDK treatment with/without ST and OU facilitates Na+/K+-ATPase expression in HCECs. Taken together, our findings led us to the conclusion that EEDK might aid HCECs survival in vitro by increasing the activity and expression of Na+/K+-ATPase enzyme. Since Na+/K+-ATPase activity is important to maintain cellular function of HCECs, we suggest that EEDK can be a potential effective agent against corneal edema and related corneal disorders.

Bacterial distribution on the ocular surface of patients with primary Sjögren's syndrome.

Many studies have shown that gut microbial dysbiosis is a major factor in the etiology of autoimmune diseases but none have suggested that the ocular surface (OS) microbiome is associated with Sjögren's syndrome (SS). In this prospective study, we analyzed bacterial distribution on the OS in patients with primary SS. Among the 120 subjects included in this study, 48 patients (group A) had primary SS, whereas 72 subjects (group B) had dry eye symptoms that were unrelated to SS. We evaluated clinical dry eye parameters such as the OS disease index, ocular staining score (OSS), Schirmer's I test, and tear break-up time (TBUT). Conjunctival swabs were used to analyze the microbial communities from the two groups. Bacterial 16S rRNA genes were sequenced using the Illumina MiSeq platform, and the data were analyzed using the QIIME 1.9.1 program. The Shannon index was significantly lower in group A than in group B microbiota (p < 0.05). An analysis of similarity using the Bray-Curtis distance method found no difference in beta-diversity between the two groups (p > 0.05). In group A, Actinobacteria at the phylum level and Corynebacteria at the genus level exhibited low abundance than group B, but the differences were not statistically significant (p > 0.05). SS apparently decreases the diversity of the OS microbial community. These observations may be related to the pathophysiology of SS and should be investigated in future studies.

3D Reconstruction of a Unitary Posterior Eye by Converging Optically Corrected Optical Coherence and Magnetic Resonance Tomography Images via 3D CAD.

Purpose: In acquiring images of the posterior eye, magnetic resonance imaging (MRI) provides low spatial resolution of the overall shape of the eye while optical coherence tomography (OCT) offers high spatial resolution of the limited range. Through the merger of the two devices, we attempted to acquire detailed anatomy of the posterior eye. Methods: Optical and display distortions in OCT images were corrected using the Listing reduced eye model. The 3.0T orbital MRI images were placed on the three-dimensional coordinate system of the computer-aided design (CAD) program. Employing anterior scleral canal opening, visual axis, and scleral curvature as references, original and corrected OCT images were ported into the CAD application. The radii of curvature of the choroid-scleral interfaces (Rc values) of all original and corrected OCT images were compared to the MRI images. Results: Sixty-five eyes of 33 participants (45.58 ± 19.82 years) with a mean Rc of 12.94 ± 1.24 mm on axial MRI and 13.66 ± 2.81 mm on sagittal MRI were included. The uncorrected horizontal OCT (30.51 ± 9.34 mm) and the uncorrected vertical OCT (34.35 ± 18.09 mm) lengths differed significantly from the MRI Rc values (both P < 0.001). However, the mean Rc values of the corrected horizontal (12.50 ± 1.21 mm) and vertical (13.05 ± 1.98 mm) images did not differ significantly from the Rc values of the corresponding MRI planes (P = 0.065 and P = 0.198, respectively). Conclusions: Features identifiable only on OCT and features only on MRI were successfully integrated into a unitary posterior eye. Translational Relevance: Our CAD-based converging method may establish the collective anatomy of the posterior eye and the neural canal, beyond the range of the OCT.

Effect of anti-vascular endothelial growth factor on the surgical outcome of neovascular glaucoma: An overview and meta-analysis.

BACKGROUND: Bevacizumab is known to be very effective in inhibiting ocular neovascularization in neovascular glaucoma (NVG). The purpose of this study is to evaluate the effect of anti-vascular endothelial growth factor on the surgical outcome of Ahmed glaucoma valve implantation (AGVI) in NVG. METHODS: An extensive search of PubMed, EMBASE, and the Cochrane Library was carried out in January 2021 to select relevant studies. The weighted mean difference of the intraocular pressure reduction percentage from baseline to endpoint was used for the primary efficacy estimate. Mantel-Haenszel odds ratios and 95% confidence intervals (CIs) for success rate were employed as secondary efficacy estimates. The number of postoperative interventions and the tolerability estimate for adverse events were also measured using odds ratios. We conducted meta-analyses of fixed effects models using comprehensive meta-analysis software to pool the results of the included studies. Heterogeneity was assessed using Q-value and I2 measures. RESULTS: Nine studies were included in the analysis, encompassing a total of 410 eyes. There was no significant difference in intraocular pressure reduction percentage between the AGVI-only group and the AGVI with adjuvant bevacizumab group (estimate 0.324; 95% CI, -0.278-0.926; P = .244). However, the success rate favored the AGVI with adjuvant bevacizumab group (estimate 0.561; 95% CI, 0.097-1.025, P = .018). CONCLUSIONS: AGVI with adjuvant bevacizumab had no significant effect on lowering IOP in patients with neovascular glaucoma compared with AGVI alone. However, the final success rate was higher for AGVI with adjuvant bevacizumab treatment than with AGVI alone.

Machine learning prediction of pathologic myopia using tomographic elevation of the posterior sclera.

Qualitative analysis of fundus photographs enables straightforward pattern recognition of advanced pathologic myopia. However, it has limitations in defining the classification of the degree or extent of early disease, such that it may be biased by subjective interpretation. In this study, we used the fovea, optic disc, and deepest point of the eye (DPE) as the three major markers (i.e., key indicators) of the posterior globe to quantify the relative tomographic elevation of the posterior sclera (TEPS). Using this quantitative index from eyes of 860 myopic patients, support vector machine based machine learning classifier predicted pathologic myopia an AUROC of 0.828, with 77.5% sensitivity and 88.07% specificity. Axial length and choroidal thickness, the existing quantitative indicator of pathologic myopia only reached an AUROC of 0.758, with 75.0% sensitivity and 76.61% specificity. When all six indices were applied (four TEPS, AxL, and SCT), the discriminative ability of the SVM model was excellent, demonstrating an AUROC of 0.868, with 80.0% sensitivity and 93.58% specificity. Our model provides an accurate modality for identification of patients with pathologic myopia and may help prioritize these patients for further treatment.

Evaluation of Systemic Renin and Angiotensin II Levels in Normal Tension Glaucoma.

The purpose of this study was to investigate the function of the renin-angiotensin-aldosterone system (RAAS) in normal tension glaucoma (NTG) patients by measuring the level of renin and angiotensin II (AngII) in the plasma. Twenty-four patients with NTG and 38 control subjects were included in this study. Renin and AngII were measured in the blood samples of all subjects by enzyme-linked immunosorbent assay (ELISA). No significant differences were found in the complete blood count, fasting glucose, low-density lipoprotein (LDL), and high-sensitivity C-reactive protein (hs-CRP) levels between the control and NTG groups. The systemic concentration and variability of the renin concentration in the blood was significantly higher in the NTG group (p = 0.005 and 0.005, respectively). According to multivariate logistic regression analysis, the variability of the renin concentration was associated with NTG (p = 0.006). In conclusion, the systemic concentration and variability of renin levels were elevated in NTG patients. An altered renin concentration could represent a difference in RAAS function in NTG patients.

Characteristics of diabetic macular edema patients with serous retinal detachment.

To determine characteristics of diabetic macular edema patients with serous retinal detachment (SRD).We classified naïve diabetic macular edema (DME) patients with or without SRD, and compared their baseline characteristics; intravitreal bevacizumab (IVB) responsiveness; aqueous concentrations of IL (interleukin)-1ß, -2, -8, -10, -17, placental growth factor (PlGF), and vascular endothelial growth factor (VEGF). In addition, factors associated with the existence of SRD were identified.Of the 64 DME patients, 14 had SRD. The average levels of aqueous VEGF and PlGF were significantly higher in the SRD group than in the control group (P = .022 and P = .041, respectively). The best-corrected visual acuity (BCVA) and central subfield thickness (CST) did not differ significantly between the 2 groups at baseline or after 3 consecutive monthly IVBs. In multivariate logistic regression analysis, the level of aqueous VEGF was the only factor associated with the existence of SRD (odds ratio: 1.03; P = .038).Rather than aqueous inflammatory cytokines, levels of aqueous VEGFs were associated with the occurrence of SRD in DME patients. In terms of prognosis, the existence of SRD was not related with BCVA or CST changes.

Histopathologic Analysis of Conjunctival Lymphoproliferative Disease After Topical Brimonidine Use.

Purpose: To describe of histopathological findings of conjunctival lymphoproliferative disease (CLD) after topical brimonidine use. Methods: This is a retrospective medical record review study, including histopathologic description. We reviewed the medical records of 208 patients (415 eyes) who were diagnosed with glaucoma and who were treated with topical brimonidine only for a minimum of 6 months. Of these, the medical records of 19 patients with suspected CLD clinical features were reviewed in detail. When CLD was suspected due to administration of brimonidine, histopathological analysis was performed by biopsy of these lesions. In addition, immunohistochemical staining was performed to analyze lymphocyte markers in some pathological tissues. Results: Nineteen patients had suspected CLD without definite irritative symptoms. Diffuse elevated (11 patients) or follicular lesion (8 patients) of salmon pink appearance was observed in inferior palpebral conjunctiva. Among these patients, 5 patients who agreed to conjunctival biopsy had histopathological findings of CLD such as reactive lymphoid hyperplasia (LH) (2 cases) or atypical LH (2 cases). The mean duration of brimonidine use was 29.00 ± 20.25 months (6-76 months). And follow-up period after discontinuation of brimonidine was 27.93 ± 11.87 months (12-58 months). At the last visit, complete resolution of the lesion was seen in 13 patients, and partial improvement was observed in 6 patients. Conclusions: We found 4 cases of CLD following long-term administration of brimonidine. However, large-scale additional studies should be performed to establish causality, to determine whether these novel side effects were caused by long-term brimonidine treatment.

The Effect of Corneal Higher Order Aberrations on Postoperative Residual Astigmatism after Toric IOL Implantation.

Background: To demonstrate the effect of preoperative higher order aberrations (HOAs) on postoperative residual astigmatism in toric intraocular lens (IOL) implantation. Methods: A retrospective, controlled, comparative study that involved patients who underwent toric IOL implantation. Patients were divided into two groups according to the difference between the estimated residual astigmatism and actual postoperative astigmatism [difference ≤0.5 diopters (D), Group A; difference >0.5 D, Group B]. Corneal astigmatisms with axis, and various aberration values were compared between the two groups. Results: Total RMS and HOA RMS values in Group B were significantly higher than those in Group A (p < .001, = 0.003). The vertical coma value, and its absolute value, in Group B were significantly higher than those in Group A (p < .001, = 0.002). The total RMS and absolute value of the vertical coma showed a positive linear correlation with the degree of residual postoperative astigmatism (R-square = 0.139, 0.131; p = .027, 0.036). Conclusions: If the residual astigmatism after insertion of the toric IOL was greater than expected, corneal aberrations, shown by total RMS and HOA RMS values before surgery, especially of the vertical coma, tended to be high.

The Effect of Prostaglandin Analogues on the Ciliary Zonular Fibers of the Rabbit Crystalline Lens.

PURPOSE: To evaluate the influence of prostaglandin (PG) analogues on the ciliary zonular fibers of the crystalline lens using scanning electron microscopy (SEM) of rabbit eyes, and to measure the matrix metalloproteinase (MMP) and tissue inhibitor of metalloproteinase (TIMP) levels of the aqueous humor and crystalline lens treated with topical PG analogues Methods: Fifty eyes from 25 New Zealand white rabbits were divided into five groups of five rabbits each. In the control group, balanced salt solution was administered via the topical route once a day to the eyes. The benzalkonium chloride (BAC) group was treated with 0.02% BAC, the Latanoprost group with 0.005% latanoprost, the Travoprost group with 0.004% Travoprost, and the Bimatoprost group with 0.03% Bimatoprost for 10 months. We examined the ciliary zonular fibers using SEM. We also measured the MMP and TIMP levels of the aqueous humor and crystalline lens. RESULTS: SEM revealed some splitting of zonular fibers in eyes treated with topical PG analogues when compared with the control and BAC groups. The MMP-1 and TIMP-1 levels after treatment with the PG analogues did not differ significantly from the control and BAC groups (P > 0.05). There was no significant difference in MMP-1, MMP-3, TIMP-1, and MMP-1/TIMP-1 levels in the lens among all five groups. CONCLUSIONS: PG analogues may induce zonular change in rabbits microscopically. There was no association between zonular changes and the levels of certain types of MMP or TIMP in the aqueous humor or crystalline lens after topical treatment with PG analogues.

Guided intracameral air injection based on 3D reconstructed anterior optical coherence tomography images in iatrogenic Descemet's membrane detachment: Case report.

RATIONALE: We emphasize the importance of using anterior optical coherence tomography (OCT) to understand the details of iatrogenic Descemet's membrane detachment (DMD) in 3 dimensions; this allows appropriate air injection into the anterior chamber in terms of both direction and method. PATIENTS CONCERNS: A 74-year-old Korean female presented with progressive visual impairment. On slit-lamp examination, an iridocorneal adhesion was observed, associated with a full-thickness corneal opacity 3.0-mm in diameter. Adherence between the crystalline lens (with moderate cortical cataracts) and the iris was evident near the opacity. Therefore, we decided to perform cataract surgery. DIAGNOSIS: Intraoperatively, iatrogenic DMD occurred during removal of the iridocorneal adhesion, as clearly shown on postoperative OCT. However, slit-lamp examination did not reveal the details of the DMD because of the corneal edema. INTERVENTIONS AND OUTCOMES: The DMD was evaluated via 3-dimensional (3D) reconstruction of multiple anterior OCT images. The reconstructed images were used to guide intracameral sterile air injection from an appropriate direction using an optimal method. The patient was asked to maintain an appropriate head position to allow the injected air to re-attach the DM. LESSONS: Three-dimensional (3D) reconstruction of an iatrogenic DMD developing during intraocular surgery is necessary to establish the details of the injury and allow accurate air injection into the anterior chamber; the air stream effectively re-attached the DM. It is important that the iatrogenic DMD can be treated properly only by confirming the accurate 3-dimensional shape as well as the position, height, and width of the DMD.

Distribution and Diversity of Ocular Microbial Communities in Diabetic Patients Compared with Healthy Subjects.

PURPOSE: The aim of this study was to identify differences in the major (core vs. variable) microbial genera of human subjects with and without diabetes. METHODS: Bacterial 16S rRNA genes obtained from conjunctival swabs of 19 healthy subjects and 30 diabetic patients were sequenced using the Illumina MiSeq platform, and the sequencing data were analyzed using QIIME 1.9.1. To elucidate the microbial diversity in the ocular surface (OS), test programs from various bioinformatics domains were used. RESULTS: Diversity index and rarefaction analysis showed that the microbial community of the diabetic patients was more diverse than that of the healthy subjects. Proteobacteria, Firmicutes, Actinobacteria, Cyanobacteria and Bacteroidetes were the dominant taxa present in the OS, and there was a significant difference in the relative abundance of the bacterial phyla between the diabetic patients and control subjects. Proteobacteria were more abundant in the diabetic group, whereas Firmicutes was more abundant in the control group. Analysis of bacterial taxa at the genus level showed that the core microbiome of diabetic patients comprised Acinetobacter, Burkholderia, Sphingomonas, and Ralstonia, whereas that of the controls comprised Bradyrhizobiaceae, Staphylococcus, Corynebacterium, Pseudomonas, Novosphingobium, Neisseriaceae, and Acinetobacter. CONCLUSIONS: There was a significant difference in the microbial community composition between diabetic patients and healthy subjects. A high abundance of Acinetobacter in the OS of diabetic patients may arise from the unique characteristics of the OS compared with those of other organ surfaces.

Observation of Influence of Cataract Surgery on the Ocular Surface.

INTRODUCTION: To evaluate meibomian gland function, changes of lacrimal tears and ocular surface parameters and tear inflammatory mediators following cataract surgery. METHODS: 48 eyes of 34 patients who underwent uncomplicated phacoemulsification were involved and divided into 2 groups with those who had preexisting dry-eye before cataract surgery and those who did not. Ocular symptom score, Schirmer I test, tear film break-up time (TBUT), corneal sensitivity threshold, corneal staining, inflammatory cytokine activities, lid margin abnormalities, meibum expressibility, meibum quality and meibomian gland imaging were evaluated preoperatively, at 1 day, 1 and 2 months postoperatively. RESULTS: Ocular symptom scores were worse at 1 and 2 months postoperatively but, TBUT, corneal staining score and corneal sensitivity threshold showed gradual improvements at 1 month and 2 months postoperatively (p<0.05, respectively). Interestingly there were statistically significant improvements in TBUT, corneal staining score and corneal sensitivity threshold at 1 month postoperatively when topical eye drops were used compared to the period without topical therapy which is the months 2 postoperatively. There were statistically significant decreases in IL-1ß, IL-6, IL-8, MCP-1, TNF-α and IFN-γ concentrations at 1 and 2 months postoperatively. Lid margin abnormalities, meibum quality and expressibility scores increased significantly (p < 0.05, respectively) at postoperative period. Compared with the no dry eye group, dry eye group revealed significantly higher ocular symptom scores, lower TBUT, higher lid margin abnormalities, meibum quality and expressibility scores after cataract surgery. There were significant correlations between IL-6 and parameters of dry eye, and between MGD parameters and ocular symptom scores. CONCLUSIONS: Our study revealed that meibomian gland function is influenced after cataract surgery accompanying structural changes and these were correlated with increased ocular symptom scores. Therefore, it could elucidate the development of dry eye related to cataract surgery.

Two cases of myotonic dystrophy manifesting various ophthalmic findings with genetic evaluation.

We report two cases of myotonic dystrophy in one family; both diagnosed from genetic analysis following ophthalmic indications, but before the manifestation of systemic symptoms. A 39-year-old female visited our clinic for routine examination. Mild ptosis, sluggish pupillary response, and bilateral snowflake cataracts were found. Fundus examination revealed an increased cup-to-disc ratio (CDR) in both eyes and a defect in the retinal nerve fiber layer in the right eye. Intraocular pressure was low, but within the normal range in both eyes. Because cataracts are characteristic of myotonic dystrophy, we suggested that her 14-year-old daughter, who did not have any systemic complaints, undergo ophthalmic examination. She also had mild ptosis and snowflake cataracts. Both patients underwent genetic evaluation and were diagnosed with myotonic dystrophy caused by unstable expansion of cytosine-thymine-guanine trinucleotide repeats in the dystrophia myotonica-protein kinase gene. Ophthalmologists can diagnose myotonic dystrophy based on clinical and genetic findings, before the manifestation of systemic abnormalities.

The Association Between Aqueous Connective Tissue Growth Factor and the Severity of Age-related Cataracts as Graded by the Lens Opacities Classification System III.

PURPOSE: To evaluate the relationship between aqueous humor concentrations of connective tissue growth factor (CTGF) and the severity of age-related cataracts. MATERIALS AND METHODS: We conducted a prospective clinical study on 43 eyes of 43 patients with senile cataracts scheduled to undergo routine phacoemulsification surgery. Before surgery, all patients were graded for cataract severity using the Lens Opacities Classification System III in terms of four features: nuclear opalescence (NO), nuclear color (NC), cortical cataracts (C), and posterior sub-capsular cataracts (P). During surgery, aqueous humor samples were obtained from all patients, and sandwich enzyme-linked immunosorbent assays (ELISAs) were used to determine CTGF concentrations. To assess any relationship between cataract severity and CTGF levels of the aqueous humor, various correlation analyses and multiple linear regression were used. RESULTS: We found a positive correlation between the overall cataract grade and aqueous CTGF level (p < 0.05). In addition, four features of the cataract grade (nuclear opalescence, nuclear color, cortical cataract and posterior sub-capsular cataract) were positively correlated with the aqueous CTGF concentration (p < 0.05). The final regression model identified overall cataract grade as an independent predictor of increased CTGF levels in the aqueous humor (p < 0.05). CONCLUSIONS: CTGF tends to increase in the aqueous humor as the severity of age-related cataracts increases. Therefore, this cytokine may play an important role in the pathogenesis of age-related cataracts. Additional studies are required for clarification of this finding.