Consequences of exposure to particulate matter on the ocular surface: Mechanistic insights from cellular mechanisms to epidemiological findings.

Exposure to air pollutants, especially in the case of particulate matter (PM), poses significant health risks throughout the body. The ocular surface is directly exposed to atmospheric PM making it challenging to avoid. This constant exposure makes the ocular surface a valuable model for investigating the impact of air pollutants on the eyes. This comprehensive review assembles evidence from across the spectrum, from in vitro and in vivo investigations to clinical studies and epidemiological studies, offering a thorough understanding of how PM10 and PM2.5 affect the health of the ocular surface. PM has been primarily found to induce inflammatory responses, allergic reactions, oxidative stress, DNA damage, mitochondrial impairment, and inhibit the proliferation and migration of ocular surface cells. In toto these effects ultimately lead to impaired wound healing and ocular surface damage. In addition, PM can alter tear composition. These events contribute to ocular diseases such as dry eye disease, blepharitis, conjunctivitis, keratitis, limbal stem cell deficiency and pterygium. Importantly, preexisting ocular conditions such as dry eye, allergic conjunctivitis, and infectious keratitis can be worsened by PM exposure. Adaptive responses may partially alleviate the mentioned insults, resulting in morphological and physiological changes that could be different between periods of short-term and long-term exposure. Particle size is not the only determinant of the ocular effect of PM, the composition and solubility of PM also play critical roles. Increasing awareness of how PM affects the ocular surface is crucial in the field of public health, and mechanistic insights of these adverse effects may provide guidelines for preventive and therapeutic strategies in dealing with a polluted environment.

Intraocular foreign body: Characteristics, visual outcomes, and predictive values of ocular trauma score.

Introduction: Retained intraocular foreign body (IOFB) remains an important cause of acquired visual impairment. The visual prognosis following treatments for eyes with retained IOFB was observed to be distinct from other mechanisms of open globe injury due to the specific nature and associated circumstances. This study evaluated the risk behaviors, visual results, and predictive values of Ocular Trauma Score (OTS) in determining visual outcomes in patients with IOFB that were not related to terrorism. Methods: Medical records of patients who underwent surgical interventions between January 2015 and December 2020 were retrospectively reviewed. Results: A total of one hundred and sixty-one patients (162 eyes) were recruited. The patients had a mean (standard deviation) age of 47.6 (14.0) years with working male predominance (93.2%). The majority of patients were injured by activities related to grass trimming (63.4%) and metallic objects were the main materials causing injuries (75.7%). Following treatments, the proportion of eyes having vision worse than 20/400 decreased from 126 eyes (77.8%) to 55 eyes (33.9%) at final visit. Ocular trauma score (OTS) had a high potential prediction for final vision in eyes in OTS categories 4 and 5. However, the discordance of final visual acuity distribution was observed in some subgroups of eyes in OTS categories 1 to 3. Conclusion: This study highlights the significance of IOFB related eye injuries in a tertiary care setting. Decision making on treatments should be carefully considered, particularly in eyes in lower OTS categories, in light of a rise in the proportion of patients who experience improved vision after IOFB removal.

Pulsed Oral Azithromycin vs 6-Week Oral Doxycycline for Moderate to Severe Meibomian Gland Dysfunction: A Randomized Clinical Trial.

Importance: The treatment of moderate to severe meibomian gland dysfunction (MGD) with oral doxycycline requires a 6-week course of treatment and has frequent adverse effects (AEs), which may be associated with poor compliance. Objective: To determine if the AEs of a 3-week course of oral azithromycin were equivalent to the AEs of a 6-week course of oral doxycycline. Design, Setting, and Participants: This double-masked randomized clinical trial was conducted at a referral center in Thailand from September 2018 to May 2022. Participants with moderate to severe MGD judged unresponsive to conservative management were included. Interventions: Patients were randomized 1:1 to receive oral azithromycin (1 g once per week for 3 weeks) or oral doxycycline (200 mg daily for 6 weeks). Main Outcomes and Measures: After initiating therapy, the study team assessed the total MGD score and Ocular Surface Disease Index (OSDI) score at the initial visit, at 6 weeks, and at 8 weeks, and assessed AEs at 6 weeks and 8 weeks. The prespecified equivalence margins for MGD score and OSDI score were set at ±2 and ±9, respectively. Results: A total of 137 eyes from 137 patients were randomized into groups, 68 eyes in the azithromycin group and 69 eyes in the doxycycline group (female, 66.4%; mean age, 62.0 [SD, 15.1] years). The adjusted mean difference of total MGD scores between groups at week 6 and week 8 were -0.33 (95% CI, -1.70 to 1.03; P for equivalence = .01) and 0.13 (95% CI, -1.59 to 1.84; P for equivalence = .02), respectively. The adjusted mean difference of OSDI between groups score at week 6 and week 8 was -1.20 (95% CI, -5.31 to 2.91; P for equivalence < .001) and -1.59 (95% CI, -5.73 to 2.55; P for equivalence < .001), respectively. In addition, patients treated with azithromycin had fewer gastrointestinal AEs (4.4% vs 15.9%; risk difference, 11.5%; 95% CI 1.6%-21.4%; P = .03). Conclusions and Relevance: These data support an equivalency of effects of azithromycin as compared with doxycycline for MGD score and OSDI score at both follow-up times. The study did not show more gastrointestinal AEs in the azithromycin group. The reduced dosing and potentially fewer gastrointestinal AEs associated with azithromycin support its use as an alternative to doxycycline for at least 6 weeks. Trial Registration: ThaiClinicalTrials.org Identifier: TCTR20180810001.

Inadvertent filtering bleb due to extracapsular cataract extraction wound reopening after mitomycin C use: a case report.

BACKGROUND:  Mitomycin C has been used adjunctively in various procedures, including pterygium excision. Delayed wound healing, the long-term complication of mitomycin C, can occur several years later and may rarely cause a subsequent inadvertent filtering bleb. However, conjunctival bleb formation from the reopening of an adjacent surgical wound after mitomycin C use has not been reported. CASE PRESENTATION: A 91-year-old Thai woman had undergone pterygium excision 26 years ago, with adjunctive mitomycin C, as well as an uneventful extracapsular cataract extraction in the same year. The patient developed a filtering bleb without glaucoma surgery or trauma approximately 25 years later. Anterior segment ocular coherence tomography illustrated a fistula connected between the bleb and anterior chamber at the scleral spur. The bleb was observed without further management, as no hypotony or bleb-related complications occurred. The symptoms/signs of bleb-related infection were advised. CONCLUSIONS:  This is a case report of a rare novel complication of mitomycin C application. Conjunctival bleb formation from the reopening of surgical wound, which was related to the previous mitomycin C use, could occur after a few decades.

Comparison of Efficacy and Safety of Two Commercial Artificial Tears Between 0.18% and 0.3% Sodium Hyaluronate for Corneal Epithelial Healing in Pterygium Excision with Conjunctival Autograft Transplantation: A Study Protocol for a Randomized Controlled Trial.

Purpose: To compare the efficacy, safety, and rate of healing on the corneal epithelial defect after pterygium surgery through the application of either 0.18% or 0.3% sodium hyaluronate (SH). Methods: A randomized, double-blind clinical trial was performed on patients who had pterygium surgery. Eighty-six patients were randomized to 2 groups that would receive either 0.18% SH or 0.3% SH. Measurements of area of the corneal epithelial defect using ImageJ freeware were performed. All corneal epithelial defects were measured immediately after the operation (Day 0) and for the next 3 days. Results: The mean and SD of the area of corneal epithelial defect measured on postoperative Day 0, 1, and 2 were 9.13 ± 3.09 mm2, 5.61 ± 3.26 mm2, and 3.39 ± 2.70 mm2 for 0.18% SH group, and 8.96 ± 3.17 mm2, 4.03 ± 1.99 mm2, and 1.55 ± 1.23 mm2 for 0.3% SH group. There was no statistically significant difference of the initial area of the corneal epithelial defect on Day 0 between 0.18% and 0.3% SH group (p = 0.802). The area of the defects in the 0.3% SH group was significantly smaller than that of the 0.18% SH group on both Day 1 and Day 2 (p = 0.007, p < 0.001), respectively. Similarly, the 0.3% SH group exhibited a statistically significant higher (p < 0.001) rate of healing of the corneal epithelial defect over days 0 and 1 (4.94 ± 2.16 mm²/day) when compared to that of the 0.18% SH group (3.53 ± 1.66 mm²/day). Conclusion: With two commercial artificial tears, the corneal epithelial wound healing after pterygium surgery was faster in the 0.3% SH group than that of the 0.18% SH group. Superiority of 0.3% SH may be supported by the presence of epsilon-aminocaproic acid in this drug preparation. No significant adverse effects were exhibited during the short-term follow-up.

The Possible Positive Mechanisms of Pirenoxine in Cataract Formation.

Cataract is the leading cause of blindness worldwide. A diverse range of medication has been invented to prevent or treat cataract. Pirenoxine (PRX), a drug with strong antioxidant properties, has been used topically to treat cataract, and there is much evidence to demonstrate the beneficial effects of PRX on lens opacity from in vitro and in vivo models. In clinical use, PRX has been prescribed worldwide by ophthalmologists for over six decades; however, there is still controversy with regard to its efficacy, and thus PRX remains an off-label use for cataract treatment. This comprehensive review summarizes and discusses evidence pertinent to the mechanisms of PRX and its efficacy mainly on cataract models. The issues that have been deemed uncertain over the six-decade use of PRX are examined. The information summarized in this review should provide insights into contriving novel approaches for the treatment of cataract.

A Randomized Controlled Trial to Manage Postoperative Ocular Pain after Pterygium Excision with Conjunctival Autograft Transplantation with a Single Application of 2% Sodium Hyaluronate.

Purpose: To assess the effectiveness of a single application of 2% sodium hyaluronate (SH) in controlling pain after pterygium excision as compared with that of a control group. Methods: We performed a prospective randomized controlled trial in the patients who underwent pterygium excision. The outcome of topical application of 2.0% SH was measured using the visual analogue scale (VAS), in comparison with that observed in a control group (without SH). The area of ocular surface defects was assessed by ImageJ freeware. Analysis of pain scores and ocular surface defects were observed from both groups immediately after the operation, Day 0, and 3 subsequent days. Results: Thirty patients were randomly divided into control group and SH treatment group. The initial area of the ocular surface defect on Day 0 was approximately the same for both groups (p=0.242). The medians of pain score assessed by the VAS on Days 0, 1, and 2 were 5, 3, and 0 for the SH group and 6, 5, and 3 for the control group, respectively. The pain score was statistically significantly decreased in the SH group compared to the control group on Day 1 (p < 0.001) and Day 2 (p < 0.001). The pain level of both groups was nearly the same on Day 3 (p=0.141). The area of ocular surface defects was significantly different between two groups on Day 1 (p < 0.001) and Day 2 (p < 0.001). Postoperative complications were not observed. Conclusion: A single topical application of 2% SH in pterygium excision was effective in relieving pain in the early postoperative period without any adverse effects. This innovation may provide alternative pain control in pterygium surgery.

Pseudomonas aeruginosa Scleritis following Pterygium Surgery with Mitomycin C or Beta Irradiation: Three-Case Report.

Purpose: To report three cases of culture-positive Pseudomonas aeruginosa scleritis following pterygium surgery. Patients and Methods. A retrospective study of all patients of Pseudomonas aeruginosa scleritis after pterygium surgery presented from May 2017 to May 2020 was performed. Patient demographics and clinical characteristics included age, gender, time between prior surgery and onset, adjunctive therapy, risk factors, initial visual acuity, final visual acuity, clinical features, medical treatment, and surgical intervention were analyzed. Results: Three eyes of three patients with clinical characteristics and laboratory-confirmed Pseudomonas aeruginosa scleritis were identified. Two patients were related with mitomycin C application after pterygium surgery, and only one had beta irradiation. Antibiotic administration and scleral debridement were required in 3 patients. One eye was enucleated. Final visual outcomes of two patients were improved. Conclusions: Pseudomonas aeruginosa scleritis after pterygium surgery is a crucial ophthalmic disease. An early diagnosis with a prompt intensive antibiotic treatment in combination with surgical interventions may improve visual outcome.

Self-Reported Computer Vision Syndrome among Thai University Students in Virtual Classrooms during the COVID-19 Pandemic: Prevalence and Associated Factors.

During the COVID-19 pandemic, computer vision syndrome (CVS) related to online classrooms were unavoidable. This cross-sectional study aimed to explore the prevalence, characteristics and associated factors of CVS. A total of 527 students who were currently studying in a virtual classroom (70.40% female, mean (standard deviation; SD) age of 20.04 (2.17) years) were included. The prevalence of CVS assessed by an online CVS-Questionnaire was 81.0% (427/527). Comparing with those in the period before the online study, an increase in screen time (interquartile range) in students with and without CVS was 3 (0−3) and 2 (1−5) h, respectively. Overall, 516 students (97.9%) experienced at least one symptom. The most frequent symptom in CVS subjects was eye pain (96.5%). The most intense symptoms were the feeling of worsening eyesight (15.9%). The factors associated with CVS were female (p < 0.001), age (p = 0.010), atopic diseases (p = 0.020), prior ocular symptoms (p < 0.001), astigmatism (p = 0.033), distance from display <20 cm (p = 0.023), presence of glare or reflection on screen (p < 0.001), low screen brightness (p = 0.045), sleep duration (p = 0.030), inadequate break time between classes (p < 0.001) and increased screen time usage during online study (p < 0.001). Recommendations to prevent CVS based on the adjustable factors might reduce the burden of online study.

Timing of Complete Polypoidal Regression after Intravitreous Aflibercept Treatments in Polypoidal Choroidal Vasculopathy.

PURPOSE: To understand timing of complete polypoidal regression on indocyanine green angiography (ICGA) after aflibercept injections for polypoidal choroidal vasculopathy (PCV). DESIGN: Multicenter prospective study. PARTICIPANTS: Adults with treatment-naïve PCV. METHODS: After institutional review board approval, participants were enrolled and followed up for 1 year, from Apr 1, 2016, through Dec 30, 2018, at 2 university-based centers in Thailand. Diagnosis of PCV was based on the Efficacy and Safety of Verteporfin Photodynamic Therapy in Combination with Ranibizumab or Alone versus Ranibizumab Monotherapy in Patients with Symptomatic Macular Polypoidal Choroidal Vasculopathy criteria. Eligible eyes received fixed-dose aflibercept injections (3 monthly then every 8 weeks), or monthly if fluid persisted on OCT. Photodynamic therapy (PDT) was administered when fluid persisted despite 6 consecutive injections. Indocyanine green angiography was performed at baseline and then every 8 weeks. The 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was administered at baseline, 6 months, and 1 year. Two retina specialists reviewed posttreatment ICGA, categorized into: complete regression (complete disappearance of polypoidal lesions), partial regression (reduced in size or number), or no regression. Disagreements were resolved through open adjudication. MAIN OUTCOME MEASURES: Timing of complete regression over 1 year. RESULTS: Final analysis included 40 eyes (39 participants; 100% Thai, 59% women; mean age±standard deviation, 64 ± 8.3 years). At baseline, 90% had 5 or more polypoidal lesions. Ninety-five percent received aflibercept monotherapy, and 5% received rescue PDT per protocol. Polypoidal statuses at 1 year were 55% complete, 40% partial, and 5% no regression. Cumulative rates of complete regression at 2, 4, 6, and 12 months were 28%, 33%, 43%, and 55%. Of 22 eyes with complete regression at 1 year, complete regression was identified first at 2, 4, 6, 8, 10, 12 months in 50%, 9%, 18%, 5%, 9%, and 9%, respectively. Cumulative rates of complete regression among these eyes at 2, 6, and 12 months were 50%, 77%, and 100%, respectively. Median duration of complete regression was 3 months (interquartile range, 2-6 months). Median visual acuity improved from 20/125 (Snellen equivalent) to 20/50; median NEI VFQ-25 scores improved from 80 to 93 from baseline to 1 year. CONCLUSIONS: Complete polypoidal regression could occur as early as 2 months after aflibercept injections. Most PCV eyes with complete polypoidal regression at 1 year already showed complete regression within the first 6 months. These findings support consideration of aflibercept for PCV to achieve both anatomic and visual outcomes.

The Clinical Features and Prognostic Factors for Treatment Outcomes of Dematiaceous Fungal Keratitis over 9 Years at a Tertiary Eye Care in Northern Thailand.

Dematiaceous fungal keratitis is an important etiology of visual loss, particularly in an agricultural society. From a retrospective review of medical records from 2012 to 2020, 50 keratitis cases of cultured-positive for dematiaceous fungi were presented at a tertiary care hospital in Northern Thailand. The study aimed to identify the isolated causative dematiaceous species using the PCR technique and to explore their related clinical features, including treatment prognoses. Sequencing of the amplified D1/D2 domains and/or ITS region were applied and sequenced. Of the 50 dematiaceous fungal keratitis cases, 41 patients were males (82%). In most cases, the onset happened during the monsoon season (June to September) (48%). The majority of the patients (72%) had a history of ocular trauma from an organic foreign body. The most common species identified were Lasiodiplodia spp. (19.35%), followed by Cladosporium spp. and Curvularia spp. (12.90% each). About half of the patients (52%) were in the medical failure group where surgical intervention was required. In summary, ocular trauma from an organic foreign body was the major risk factor of dematiaceous fungal keratitis in Northern Thailand. The brown pigmentation could be observed in only 26%. Significant prognostic factors for medical failure were visual acuity at presentation, area of infiltrate, depth of the lesions, and hypopyon.

Fungal keratitis at a tertiary eye care in Northern Thailand: Etiology and prognostic factors for treatment outcomes.

PURPOSE: To evaluate etiology and prognostic factors for treatment outcomes of fungal keratitis (FK). METHODS: Culture-positive FK patients between 2012 and 2017 were reviewed. Treatment outcomes were categorized into success (resolved within two weeks), slow response and medication failure (no improvement or required surgery). Etiology and risk factors for poor treatment outcomes were analyzed. RESULTS: A total of 113 eyes of 113 patients (77% males) were recruited. Ocular trauma (69.0%) was the most common predisposing factor. Of this, 80% were exposed to organic foreign bodies. The most common pathogen was Fusarium spp. (45.2%), while dematiaceous fungi were discovered in 29.6%. Medical treatment was successful in 24.8% of eyes, while 29.2% had a slow response and 42.5% failed medication. Therapeutic keratoplasty was performed in 22.1% of eyes and 11.5% eventually required eye removal. Significant risk factors for medication failure were advanced age (P = 0.005), delayed antifungal treatment (P = 0.038) and large-size lesion (P = 0.003). CONCLUSIONS: Ocular trauma was the major predisposing factor of FK in the Northern Thailand. Fusarium was the most common identified pathogen. Many cases were refractory to medications and required surgical intervention. Aging, delayed treatment and a large lesion were predictors for poor outcomes.

Open Globe Injuries Related to Traffic Accidents: A Retrospective Study.

PURPOSE: To evaluate epidemiology, clinical characteristics and outcomes of patients sustained traffic-related open globe injury (OGI). METHODS: The medical records of all OGI patients who were admitted in a tertiary referral center from January 2006 to December 2016 were retrospectively evaluated. Then, the records of injuries related to traffic accidents were identified and reviewed in detail. RESULTS: Among the overall causes of OGI, traffic-related accidents comprised 92/978 (9%) of cases. Nearly half of the injuries (51%) occurred in the 20-39-year-old group and 59% involved automobile transportation. Globe rupture occurred in 48 (47%) eyes. Following treatments, LogMAR visual acuity (VA) significantly improved from a median (interquartile range) of 2.3 (1.9-2.3) to 1.7 (0.3-3.0), at the final appointment. Presence of relative afferent pupillary defect and presence of retinal detachment were predictors for poor final visual outcomes. CONCLUSIONS: Traffic-related OGI had a high prevalence in the young. The risky transportation modes were motorcycles in teenagers and automobiles in young adults. Despite treatment, there was a considerable proportion of impaired final VA. This information could help establish effective safety education and encourage regular adherence to road safety behaviors in the high-risk groups.

Globe rupture: a single-center retrospective study of demographic patterns and outcomes.

Globe rupture is one of the severe mechanisms of eye injury. This study aimed to describe an epidemiologic patterns and visual outcomes of the open globe injury from globe rupture at a tertiary referral centre. Medical records of 167 patients (173 eyes) were retrospectively reviewed. Overall, males were predominant (82%). Road traffic- (26.3%) and work- (23.4%) were the major contributors. However, falling was the main mechanism in the elderly aged over 60 years. At presentation, 91.4% of eyes had initial visual acuity (VA) of worse than 20/200. The mean (SD) VA in logarithm of the minimum angle of resolution (LogMAR) unit at final [1.8 (1.1)] was significantly improved from presenting VA [2.4 (0.6)] (p ˂ 0.001). Predictors for final VA of worse than 20/400 included poor initial VA, presence of relative afferent pupillary defect, and endophthalmitis. In conclusion, this study observed the peak incidence of globe rupture in young teen to early adult patients, with unique characteristics in each age group. Even with significant visual improvement following the treatments, profound visual loss was still a common consequence. Thus, the role of effective prevention along with a multidisciplinary team together with timely and prompt ophthalmic management should be emphasised.