Impact of tear metrics on the reliability of perimetry in patients with dry eye.

BACKGROUND: The application of artificial tears before performing perimetry can improve the reliability and results of perimetry in patients with glaucoma and dry eye (DE). However, the effects of ocular surface and tear film conditions on perimetry measurements and reliability have not been fully characterized. METHODS: This prospective, cross-sectional, multicenter study investigated tear metrics in perimetry and assessed the relationships that existed among ocular surface condition, tear condition, and perimetry reliability. Forty-three eyes (43 patients) with DE disease according to the 2016 Japanese diagnostic criteria of DE and 43 eyes (43 subjects) of age- and visual field mean deviation-matched normal control subjects were studied. Perimetry was performed using the Humphrey Field Analyzer (30-2 SITA-Standard). Schirmer's test, strip meniscometry value, blink rate, tear film break-up time (TFBUT), fluorescein staining of ocular surface, and Dry Eye-related Quality of Life Score (DEQS) were measured. Blink rate was re-measured during perimetry. TFBUT and fluorescein staining were re-evaluated after perimetry. Perimetry reliability was evaluated with fixation loss, false-positive, and false-negative rates. RESULTS: Blink rate during perimetry was significantly lower for both patients with DE and normal controls (both P<0.001). TFBUT after perimetry was significantly higher than before perimetry in patients with DE (P<0.001). Fluorescein staining of ocular surface was significantly increased in patients with DE and normal control subjects (P = 0.002 and P<0.001, respectively). Spearman correlation analysis revealed that blink rate during perimetry was negatively correlated with fixation-loss rate (r = -0.393, P = 0.009) in patients with DE. CONCLUSIONS: Performing perimetry was associated with a significant change in tear condition and ocular surface condition in both patients with DE and normal control subjects. The changes in tear condition and ocular surface condition may impact the reliability of perimetry in patients with DE.

Impact of Topically Administered Steroids, Antibiotics, and Sodium Hyaluronate on Bleb-Related Infection Onset: The Japan Glaucoma Society Survey of Bleb-Related Infection Report 4.

PURPOSE: To investigate the impact of topically administered ophthalmic medications on the onset and severity of bleb-related infections. METHODS: Data obtained from 104 eyes of 104 patients with bleb-related infections were analyzed. We assigned an infection stage to each eye (stage 1-4) and analyzed the onset severity. RESULTS: Steroids and antibiotics were routinely administered to 13 (12.5%) and 42 (40.4%) eyes, respectively. The median stage of steroid-administered eyes was 3 versus 1 for eyes without steroid administration (P = 0.012). The median duration from surgery to infection for the steroid-administered eyes was 2.0 years versus 5.8 years for eyes without steroid administration (P = 0.030). The median duration from surgery to infection for the antibiotic-administered eyes was 6.4 years versus 3.9 years for eyes without antibiotic administration (P = 0.025). Multiple logistic regression analysis revealed that infections were severe in the steroid-administered eyes (odds ratio: 4.57). No infections developed within 16 weeks postoperatively. No relationship was detected between sodium hyaluronate and the analyzed factors. CONCLUSIONS: Topical steroid administration beyond the immediate postoperative period may affect severe and earlier onset bleb-related infections. Conversely, topical antibiotic administration may be effective in suppressing earlier onset bleb-related infections.

Seasonal Variation in the Incidence of Late-onset Bleb-related Infection After Filtering Surgery in Japan: The Japan Glaucoma Society Survey of Bleb-related Infection Report 3.

PURPOSE: To investigate seasonal variations in the incidence of late-onset bleb-related infection after filtering surgery in Japan and the relationship between season and other factors. PATIENTS AND METHODS: This multicenter, prospective study is part of a 5-year-long Japan Glaucoma Society survey of bleb-related infection. We analyzed 156 cases of first-time infections (106 men, 50 women) encountered over 5 years to determine the seasonal variation using the Roger test and the relationships between season, sex, and age by logistic regression analysis. RESULTS: We noted significant monthly seasonal variation in the incidence of infection, which was the highest in January and February (23 and 18 infections, respectively; P=0.018) and lowest from August to November (9, 9, 11, and 8 infections, in that order). Multiple logistic regression analysis revealed that infections were most frequent among women in spring (odds ratio, 8.43; P=0.005). Staphylococcus aureus and Streptococcus spp. infections were more frequent in warmer seasons than in winter. Less virulent species, namely, coagulase-negative Staphylococcus spp., Corynebacterium spp., and Enterococcus spp., were frequently detected in winter. Coagulase-negative Staphylococcus spp. and Haemophilus influenzae were more frequent in women and men, respectively. CONCLUSIONS: The incidence of late-onset bleb-related infection showed significant seasonal variation and sex differences. The climate in Japan may influence the incidence of bleb-related infection. Moreover, besides climate, physical activity level and lifestyle may contribute to the seasonal variation in the incidence and sex differences in the involved bacterial agents of bleb-related infections in Japan.

Treatment with sodium hyaluronate eye drops in a patient who had early-onset bleb leakage after trabeculectomy with mitomycin C.

We present the case of a 47-year-old man who had bilateral proliferative diabetic retinopathy and neovascular glaucoma. Schirmer I test revealed tear secretions of 5 mm and 3 mm in the right and left eyes, respectively. Tear breakup times in the right and left eyes were 7 and 8 seconds, respectively. The ocular surface staining in both eyes was scored as Grade 1 as per the Oxford scheme. Retinal photocoagulation was performed for correction of the proliferative diabetic retinopathy and rubeosis iridis, which resolved with treatment. However, the intraocular pressure in the left eye could not be adequately controlled. Therefore, trabeculectomy with mitomycin C using limbal-based conjunctival flap was performed. Three hours after the surgery, the patient developed a large and diffuse filtering bleb, but no leakage occurred from the conjunctival scar. However, on the first postoperative day, leakage was noted and the conjunctiva was at the leakage point. The leakage resolved transiently, but recurred the next day. Severe keratoconjunctival epithelial failure was detected, and the patient was administrated 0.1% sodium hyaluronate eye drops six times daily. The epithelial failure improved, and many microcysts were detected on the bleb surface where the epithelial failure improved. The leakage resolved 2 days after initiation of the sodium hyaluronate eye drops. The microcysts disappeared and the bleb surface became smooth 1 month later.

Meibomian gland loss due to trabeculectomy.

PURPOSE: To evaluate meibomian gland loss after trabeculectomy with mitomycin C (MMC). METHODS: This cross-sectional observational case study involved 55 eyes in 39 patients who had undergone trabeculectomy with MMC administered to the upper area of the eye. We used a mobile pen-shaped noncontact meibography system to access the morphology and determine loss of the meibomian glands. Meibomian gland loss was scored (meiboscore) from grade 0 (no loss of the meibomian glands) through grade 3 (loss of more than two-thirds of the total area) in the bleb-contacting and bleb-noncontacting upper eyelid areas in the primary position and in the lower eyelid. The tear film breakup time (BUT) was also measured. RESULTS: The median duration from trabeculectomy to examination was 7.4 years (interquartile range 3.1-14.2). The meiboscores of the bleb-contacting upper eyelid areas were significantly higher than those for the bleb-noncontacting upper eyelid areas (P < 0.001). The meiboscores for both the bleb-contacting and the bleb-noncontacting upper eyelid areas were significantly higher when the bleb was avascular (P = 0.011 and P = 0.008, respectively). The meiboscores of the bleb-contacting and bleb-noncontacting upper eyelid areas showed a significant negative correlation with the BUT (r = -0.330, P = 0.014 and r = -0.296, P = 0.028, respectively). CONCLUSION: Blebs that occur after trabeculectomy with MMC may be the cause of meibomian gland loss, particularly when the bleb is avascular. The presence of an avascular bleb warrants extra vigilance for decreased meibomian gland secretions because this decrease can lead to tear dysfunction and ocular surface damage, including bleb-wall damage.

Conservative treatment for late-onset bleb leaks after trabeculectomy with mitomycin C in patients with ocular surface disease.

BACKGROUND: Sodium hyaluronate and autologous serum eye drops are used to treat ocular surface disease (OSD) and are reported to prevent and treat late-onset bleb leaks following trabeculectomy with mitomycin C. In this study, we evaluated the efficacy of a combination of sodium hyaluronate and autologous serum eye drops and treatment for obstructive meibomian gland dysfunction as a therapy for late-onset bleb leaks after trabeculectomy with mitomycin C. METHODS: This was a retrospective, interventional, nonsimultaneous study of 12 subjects (12 eyes) of mean age of 64.3 ± 18.3 years with OSD and apparent late-onset bleb leaks following trabeculectomy with mitomycin C between 1998 and 2008. We compared patients diagnosed with leakages before July 2005, who had been treated with separate eye drop solutions containing 0.1% sodium hyaluronate, 50% autologous serum, and 0.3% ofloxacin (sodium hyaluronate and autologous serum group, n = 7), with patients diagnosed from August 2005 to December 2008, who were treated with a combination of eye drops (0.1% sodium hyaluronate, 50% autologous serum, and 0.08% levofloxacin hydrate) and eyelid massage and warm compresses for obstructive meibomian gland dysfunction (combination eye drop group, n = 5). RESULTS: Leakage was resolved in one patient (14.3%) in the separately treated sodium hyaluronate and autologous serum eye drop group and in five patients (100%) in the combination eye drop group (P = 0.015). The period after resolution of leakage with conservative treatment was 23 months in the one eye in the sodium hyaluronate and autologous serum group and 36-61 (mean 52.4 ± 10.1) months in the five eyes in the combination eye drop group. CONCLUSION: Late-onset bleb leaks following trabeculectomy with mitomycin C can be treated effectively using a combination of sodium hyaluronate and autologous serum eye drops, eyelid massage, and warm compresses. Furthermore, combining eye drops may improve patient adherence to the drug regimen by decreasing the frequency of administration.

[Measuring accommodation time with a laptop computer].

PURPOSE: Presently, there are no completely reliable examinations such as focus from a distant place to a near place during daily work. We developed a simple testing system for accommodation time using a 5 m chart and a laptop computer. MATERIAL AND METHODS: We studied 177 healthy peoples. They turned their eyes from the 5 m chart to the display of the personal computer at about 70 cm in front of the eyes. We measured the minimum time(MTC) for recognizing three Kanji(Chinese characters) randomly chosen from a total of 15 characters on the display. RESULT: The MTCs with + 1.25 D added were shorter than those with complete correction. The MTCs in both conditions extended with age. In subjects less than 40 years old, the MTCs measured with both eyes were significantly shorter than those with a single eye completely corrected. In subjects over 40 years old, there was no difference. The MTCs were shorter significantly with complete correction than with + 1.25 D added. The MTCs decreased as the accommodative amplitude increased. CONCLUSION: There is significant correlation between the accommodative amplitude and the MTCs. We can use the MTCs as one method of measuring time of accommodation.