Comparison of Intense Pulsed Light Treatments including Upper Lid or Lateral Canthus in Patients of Meibomian Gland Dysfunction.

Background: To determine the differences in the effects of intense pulsed light (IPL) treatment when including the upper and lower lid or lateral canthus area in patients with meibomian gland dysfunction (MGD). Methods: Patients who underwent three IPL treatment sessions at 3-week intervals were divided into three groups according to the treatment sites: group A, lower lid; group B, upper and lower lids; and group C, lower lid and lateral canthal area. Before and after the IPL treatment sessions, we obtained the lid abnormality score (LAS), meibum expressibility (ME), meibum quality (MQ), lipid layer thickness (LLT), type I Schirmer test (ST), tear break-up time (TBUT) test, corneal fluorescein staining scores (CFSs), and Ocular Surface Disease Index (OSDI). Results: IPL treatment significantly improved LASs, ME, MQ, TBUT, CFS, and OSDI values in all groups. Differences in LAS values before and after IPL treatment were significantly greater in groups B and C than those in group A. Conclusions: IPL treatment encompassing the upper lid and lateral canthus together with the lower lid elicited additional improvement in patients with MGD. The additional effect on treating the lateral canthus was similar to the effect observed on the additional treatment of the upper lid.

Evaluation of angle-to-angle and spur-to-spur using swept source optical coherence tomography in different refractive error.

PURPOSE: To measure angle-to-angle (ATA) and spur-to-spur (STS) distances along six meridians using swept-source optical coherence tomography (SS-OCT) and compare with horizontal white-to-white (WTW) distance in different refractive error. METHODS: Overall, 126 eyes were assessed with the Anterion SS-OCT (Heidelberg Engineering, Heidelberg, Germany). ATA and STS distances were obtained using SS-OCT at 0, 30, 60, 90, 120, and 150 degrees. WTW was measured at 0 degree with built-in infrared camera. One way ANOVA test, pearson correlation coefficient, and stepwise multivariate regression analysis were used to compare ATA and STS distances with age, anterior chamber depth (ACD), axial length (AL), and simulated keratometric values (Sim K) in different refractive error groups. RESULTS: The mean MRSE refraction was +0.05 ± 0.23 D in the emmetropic group (41 eyes), -3.42 ± 3.04 D in the myopic group (44 eyes), and +1.33 ± 0.64 D in the hyperopic group (31 eyes). There was no statistical difference in the WTW of the emmetropic (11.62 ± 0.44 mm), myopic (11.79 ± 0.46 mm), and hyperopic groups (11.80 ± 0.49 mm) using one-way ANOVA (p = 0.007). ATA and STS were vertically oval in all groups. The correlation between ATA, STS and age, ACD, AL, and K values showed different significance for each meridian according to the refractive error. ATA increased as the horizontal WTW, ACD, and AL increased and Sim K decreased. STS shows relatively smaller explanatory power than ATA in the stepwise multivariate regression analysis. CONCLUSIONS: This study is the first to analyze the relationship between ATA and STS compared to WTW by different refractive error. The difference between the horizontally oval WTW and vertically oval anterior chamber can be large, especially in myopia. ATA showed a greater positive correlation than STS with AL and ACD.

Anterior segment characteristics in normal and keratoconus eyes evaluated with a new type of swept-source optical coherence tomography.

PURPOSE: This study aimed to evaluate and compare the discriminating ability of corneal elevation maps generated using a swept-source optical coherence tomography (SS-OCT) (SS-OCT ANTERION, Heidelberg Engineering, Heidelberg, Germany), which was estimated with different reference surfaces, to distinguish normal corneas from those with keratoconus and keratoconus suspect. METHODS: A total of 126 eyes of patients, which comprised 43, 37, and 46 keratoconus, keratoconus suspects, and normal controls, respectively, were included in this study. The anterior and posterior elevations at the thinnest point under the best-fit sphere (BFS) and toric-ellipsoid (BFT), respectively, and other corneal parameters were measured using the SS-OCT. In addition, the receiver operating characteristic (ROC) curve analysis and cut-off value were calculated to evaluate the diagnostic ability of the corneal elevation values in differentiating keratoconus and keratoconus suspects from normal eyes. RESULTS: The mean total keratometric and corneal elevation values were significantly higher in the keratoconus group than in the other groups. Pachymetric parameters exhibited the lowest values for keratoconus. In addition, ROC curve analyses showed a high accuracy of the thinnest point anterior and posterior BFT for both keratoconus and keratoconus suspects and normal controls (area under the ROC were 0.969 and 0.961, respectively). Furthermore, the optimal cut-off point of the posterior elevation at the thinnest point under BFT was 16.44 µm (sensitivity and specificity of 86% and 98%, respectively) for differentiating keratoconus from normal and keratoconus suspect eyes. CONCLUSIONS: The elevation map using the BFS and BFT references measured with the anterior segment SS-OCT is considered an effective indicator for keratoconus diagnosis. Therefore, the anterior segment SS-OCT can effectively differentiate keratoconus from suspected keratoconus and normal corneas by measuring parameters such as posterior and anterior elevations, pachymetry, and keratometry.

Skin temperature change in patients with meibomian gland dysfunction following intense pulsed light treatment.

Purpose: We investigated the change in skin temperature of treated areas during intense pulsed light (IPL) treatment in patients who have meibomian gland dysfunction (MGD) to determine whether there is superficial telangiectatic blood vessel ablation. Methods: The medical records of 90 patients (90 eyes) with MGD who underwent IPL treatment were reviewed. The patients had undergone IPL treatment four times every 4 weeks. Ocular Surface Disease Index (OSDI) scores, dry eye (DE), and MGD parameters were obtained before the first and after the fourth IPL treatments. The skin temperatures of the upper and lower lids were measured before every IPL treatment. Results: The skin temperatures of the lower lids were 31.89 ± 0.72°C at the first IPL (IPL#1), 30.89 ± 0.63°C at the second IPL (IPL#2), 30.14 ± 0.95°C at the third IPL (IPL#3), and 29.74 ± 0.87°C at the fourth IPL (IPL#4) treatments. The skin temperatures of upper lids were 32.01 ± 0.69°C at IPL#1, 31.13 ± 0.75°C at IPL#2, 30.34 ± 1.07°C at IPL#3, and 29.91 ± 0.76°C at IPL#4. The skin temperature of the upper and lower lids significantly decreased with every IPL treatment. Schirmer 1 test (ST) result was 12.97 ± 10.22 mm before IPL#1 and 14.45 ± 9.99 mm after IPL#4. Tear break-up time (TBUT) was 3.15 ± 1.38 s before IPL#1 and 5.53 ± 2.34 s after IPL#4. Corneal staining scores (CFS) was 1.61 ± 3.09 before IPL#1 and 0.50 ± 0.78 after IPL#4. Lipid layer thickness (LLT) was 71.88 ± 26.34 nm before IPL#1 and 68.38 ± 24.16 nm after IPL#4. Lid margin abnormality score (LAS) was 1.96 ± 0.62 before IPL#1 and 0.86 ± 0.67 after IPL#4. Meibum expressibility (ME) was 1.67 ± 0.87 before IPL#1 and 1.03 ± 1.67 after IPL#4. Meibum quality (MQ) was 18.18 ± 6.34 before IPL#1 and 10.16 ± 5.48 after IPL#4. OSDI was 35.38 ± 19.97 before IPL#1 and 15.48 ± 34.32 after IPL#4. OSDI scores, DE, and MGD parameters significantly improved after the fourth IPL treatment but not ST and LLT. Conclusion: Our study showed that the occurrence of superficial telangiectatic vessels were indirectly reduced by the decrease in skin temperature accompanying IPL treatments in patients with MGD.

Treatment Effect and Pain During Treatment With Intense Pulsed-Light Therapy According to the Light Guide in Patients With Meibomian Gland Dysfunction.

PURPOSE: We investigated whether there is a difference in the treatment effect and pain during the treatment of meibomian gland dysfunction (MGD) with intense pulsed-light (IPL) between new light guide and conventional light guide. METHODS: We retrospectively reviewed medical records of 85 patients (170 eyes) who underwent IPL treatment of the upper and lower eyelids 3 times, at 3-week intervals, for MGD. Patients treated with the 6-mm or 8 × 15-mm cylindrical light guide were designated as group A or group B, respectively. The ocular surface disease index (OSDI), dry eye (DE), and MGD parameters were obtained before the first and after the third IPL treatments. Visual analog scale (VAS) scores were obtained at every IPL treatment. OSDI, DE, and MGD parameters and VAS scores were compared between the groups. RESULTS: VAS scores at the first, second, and third IPL treatments were lower in group A than in group B. OSDI, DE, and MGD parameters were improved after 3 IPL treatments in both groups. There were no significant differences in OSDI, DE symptoms, and MGD parameters between before the first IPL treatment and after the third IPL treatment between the groups. CONCLUSIONS: Using the new 6-mm cylindrical light guide for IPL treatment in patients with MGD induced less pain during treatment and had similar treatment effects to the conventional 8 × 15-mm light guide. The new 6-mm cylindrical light guide can be useful when treating patients with dark or hyperpigmented skin and for pediatric patients with low compliance.

Sutureless Transplantation of Amniotic Membrane Using a Visible Light-Curable Protein Bioadhesive for Ocular Surface Reconstruction.

The conjunctiva is a thin mucous membrane of the eye. Pterygium, a commonly appearing disease on the ocular surface, requires surgery to excise the conjunctiva to prevent visual deterioration. Recently, transplantation of the amniotic membrane (AM), which is the innermost membrane of the placenta, has been highlighted as an efficient method to cure conjunctiva defects because of its advantages of no side effects compared to mitomycin C treatment and not leaving additional scars on donor site compared to conjunctival autografting. However, to minimize additional damage to the ocular surface by suturing, AM transplantation (AMT) needs to be simplified by using a less invasive, time-saving method. In this work, a visible light-curable protein bioadhesive (named FixLight) for efficient sutureless AMT is applied. FixLight, which is based on bioengineered mussel adhesive protein (MAP), is easily applied between damaged ocular surfaces and transplanted AM, and rapidly cured by harmless blue light activation. Through in vivo evaluation using a rabbit model, the authors demonstrated that FixLight enabled facile, fast, and strong attachment of AM on sclera and promoted ocular surface reconstruction with good biocompatibility. Thus, FixLight can be successfully used as a promising clinical bioadhesive in opthalmological surgeries that require sutureless and rapid operation.

A Novel Approach to Enhancement Linked Laser Asymmetric Keratectomy Using Semi-Cylindrical Ablation Pattern in Patients with Myopic Regression After Laser Refractive Surgery.

PURPOSE: We aimed to introduce a new technique to reduce regional asymmetry of corneal thickness by assessing its effectiveness in four patients with myopic regression after laser refractive surgery (LRS). PATIENTS AND METHODS: Four patients (four eyes) with myopic regression after LRS were included in this study. A new technique of enhancement with laser epithelial keratomileusis-linked laser asymmetric keratectomy using semi-cylindrical ablation pattern (E-LAK-SCAP) with full integration of the Vision-Up software for analyzing the corneal thickness deviation can be used to create central symmetry by blocking laser ablation on the thin cornea. It reduces the regional asymmetry of the corneal thickness, thus improving corneal symmetry and correcting the refractive power and myopic shift due to E-LAK-SCAP. We measured refraction, visual acuity, intraocular pressure (IOP), central corneal thickness (CCT), corneal irregularities in the 3.0mm, and 5.0 zones on Orbscan maps, the sum of corneal thickness deviations in four directions (SUM), distance between the maximum posterior elevation (best-fit-sphere [BFS]) and the visual axis (DISTANCE), and angle kappa before and after LRS and E-LAK-SCAP. Blurring scores were measured before and after E-LAK-SCAP. RESULTS: The uncorrected far visual acuity (LogMAR) increased after LRS and E-LAK-SCAP. SUM (µm) increased after LRS in three cases, but decreased in all four cases after E-LAK-SCAP. DISTANCE increased after LRS, but decreased after E-LAK-SCAP. The spherical equivalent, CCT, decreased after LRS and E-LAK-SCAP. Blurring scores decreased after E-LAK-SCAP, and angle kappa was similar before and after LRS, but decreased after E-LAK-SCAP. IOP was similar before and after both LRS and E-LAK-SCAP. CONCLUSION: E-LAK-SCAP improved corneal symmetry by reducing the SUM and DISTANCE, showing good postoperative visual acuity, and blurring was reduced postoperatively. There was no myopic regression in the one-year postoperative period.

Comparison of outcomes of laser refractive surgery (LRS) alone and LRS with laser asymmetric keratectomy in patients with myopia: A retrospective study.

ABSTRACT: To compare and analyze the postoperative 1-year outcomes of laser refractive surgery (LRS) alone vs LRS with laser asymmetric keratectomy (LAK), in patients with myopia, for preventing and resolving LRS complications.This retrospective study compared the preoperative and 1-year postoperative outcomes between the control and comparison groups using a sum of deviations in corneal thickness in 4 directions >80 µm. The control group included 41 patients with myopia (41 eyes) who underwent LRS. The comparison group included 33 patients (33 eyes) who received LAK-linked LRS. Age, spherical equivalent (SE), sphere, cylinder, uncorrected distance visual acuity (UDVA), pupil size, kappa angle, central corneal thickness, corneal irregularity in the 3.0 mm zone on Orbscan maps (SUM), distance between the maximum posterior elevation (best-fit-sphere) and the visual axis (DISTANCE), postoperative blurring scores, frequency of postoperative myopic regression, and efficiency index were compared.Preoperative age (P = .198), SE (P = .686), sphere (P = .562), cylinder (P = .883), UDVA (P = .139), pupil size (P = .162), kappa angle (P = .807), central corneal thickness (P = .738), corneal irregularity (P = .826), SUM (P = .774), and DISTANCE (P = .716) were similar between the 2 groups. The 1-year postoperative SE (P = .024), sphere (P = .022), corneal irregularity (P = .033), SUM (P = .000), DISTANCE (P = .04), blurring scores (P = .000), and frequency of postoperative myopic regression (P = .004) were significantly decreased in the comparison group compared to the control group. UDVA (P = .014) and the efficiency index (P = .035) were higher in the comparison group.LAK with LRS improved corneal symmetry by reducing the SUM and DISTANCE. UDVA and efficiency index were also improved and blurring and myopic regression were reduced postoperatively.

Compound heterozygous mutations in TGFBI cause a severe phenotype of granular corneal dystrophy type 2.

We investigated the clinical and genetic features of patients with severe phenotype of granular corneal dystrophy type 2 (GCD2) associated with compound heterozygosity in the transforming growth factor-ß-induced (TGFBI) gene. Patients with severe GCD2 underwent ophthalmic examination (best-corrected visual acuity test, intraocular pressure measurement, slit-lamp examination, and slit-lamp photograph analysis) and direct Sanger sequencing of whole-TGFBI. The patient's family was tested to determine the pedigrees. Five novel mutations (p.(His174Asp), p.(Ile247Asn), p.(Tyr88Cys), p.(Arg257Pro), and p.(Tyr468*)) and two known mutations (p.(Asn544Ser) and p.(Arg179*)) in TGFBI were identified, along with p.(Arg124His), in the patients. Trans-phase of TGFBI second mutations was confirmed by pedigree analysis. Multiple, extensive discoid granular, and increased linear deposits were observed in the probands carrying p.(Arg124His) and other nonsense mutations. Some patients who had undergone phototherapeutic keratectomy experienced rapid recurrence (p.(Ile247Asn) and p.(Asn544Ser)); however, the cornea was well-maintained in a patient who underwent deep anterior lamellar keratoplasty (p.(Ile247Asn)). Thus, compound heterozygosity of TGFBI is associated with the phenotypic variability of TGFBI corneal dystrophies, suggesting that identifying TGFBI second mutations may be vital in patients with extraordinarily severe phenotypes. Our findings indicate the necessity for a more precise observation of genotype-phenotype correlation and additional care when treating TGFBI corneal dystrophies.

Comparison between Surgical Outcomes of LASIK with and without Laser Asymmetric Keratectomy to Avoid Conventional Laser Refractive Surgery Adverse Effects.

This study compared one-year postoperative outcomes of laser refractive surgery combined with laser asymmetric keratectomy (LAK) and laser in situ keratomileusis (LASIK)for myopia correction in middle-aged patients (aged 40-49 years) with a total corneal thickness deviation (summed across four directions) ≥ 80 microns. The control group (n = 26; 52 eyes) underwent LASIK; the comparison group (n = 26; 52 eyes) underwent combined laser refractive surgery and LAK. Age, spherical equivalence, uncorrected visual acuity (near and far), corneal irregularity on the Orbscan map, sum of corneal thickness deviations in four directions, corneal thickness distribution, distance between the maximum posterior elevation (best-fit sphere; BFS) and visual axis, and postoperative blurring scores were analysed retrospectively between the groups. Both groups had similar preoperative findings. Postoperatively, the sum of corneal thickness deviations in four directions (p = 0.000), distance between maximum posterior elevation (BFS) and visual axis (p = 0.003),blurring score (p = 0.001), and corneal irregularity in the 3.0 and 5.0 mm zones on the Orbscan map (p = 0.033 and p < 0.0001, respectively) were significantly lower in the comparison group (p = 0.000). LAK reduced total corneal thickness deviation, improved corneal symmetry, and reduced blurring scores significantly, one-year postoperatively. LAK could resolve shortcomings of LASIK, producing better surgical outcomes.

Clinical evaluation of the effect of diquafosol ophthalmic solution in glaucoma patients with dry eye syndrome.

PURPOSE: To investigate the effects of diquafosol on intraocular pressure (IOP) and dry eye symptoms in glaucoma patients with dry eye syndrome (DES). METHODS: This study evaluated a total of 138 glaucoma patients with DES who were treated with diquafosol ophthalmic solution (DIQUAS(®)). Before treatment and 1, 4, 12, 36, and 52 weeks after treatment, IOP, ocular surface disease index (OSDI), tear film break-up time (BUT), Schirmer I test scores, fluorescein staining, conjunctival impression cytology, and adverse drug reactions were evaluated. RESULTS: Throughout the treatment period, the mean IOP for all the patients remained stable after treatment with diquafosol (15.4 ± 2.8 mmHg at baseline and 16.0 ± 2.8 mmHg at 52 weeks). The mean OSDI score improved significantly at 4, 12, and 52 weeks after diquafosol treatment. The BUT and Schirmer I test scores were significantly increased after diquafosol treatment. The Oxford scheme score was significantly decreased at 1, 4, 12, 36, and 52 weeks after diquafosol treatment. A significant improvement in goblet cell density was observed after 4 weeks of treatment with diquafosol. Adverse drug reactions were reported in 22 (15.9 %) patients. There were no serious adverse drug reactions. CONCLUSIONS: Diquafosol was effective in improving objective and subjective symptoms and maintained a stable IOP in glaucoma patients with DES. Therefore, the addition of diquafosol treatment in glaucoma patients with DES or ocular surface side effects using anti-glaucoma medication may be beneficial.