Evaluation of Corneal Densitometry and Endothelial Layer in Soft Contact Lens Users.

SIGNIFICANCE: Soft contact lens wear may lead to physiological changes in the cornea. Corneal densitometry is a new software tool that may detect these physiological changes by monitoring their effects on corneal transparency. PURPOSE: This study aimed to assess corneal densitometry values and corneal endothelium in patients using soft contact lenses. METHODS: The study included 36 eyes of 36 subjects with soft contact lens use (group 1) and 36 eyes of 36 healthy control subjects (group 2). Anterior segment parameters and corneal densitometry of all subjects were evaluated using Scheimpflug corneal topography (Pentacam; Oculus Inc., Wetzlar, Germany). A total corneal area of 12 mm was divided into four annular zones (0 to 2, 2 to 6, 6 to 10, and 10 to 12 mm) and into three regions as anterior, central, and posterior for densitometry examination. Cell density, cell distribution, and cell morphology (quadrangular, pentagonal, hexagonal, and other cell percentages) of the endothelial layer were examined in both groups using specular microscopy (Nidek CEM 530; Nidek Co., Gamagori, Aichi, Japan). RESULTS: In group 1, the mean duration of contact lens wear was 4.45 ± 2.15 years. The anterior segment parameters were not significantly different between the two groups (P > .05). The anterior 0- to 2- and 2- to 6-mm corneal densitometry values were significantly higher in group 1 compared with group 2 (23.2 ± 4.7 for group 1 and 17.3 ± 5.6 for group 2 [P = .03]; 22.4 ± 6.4 for group 1 and 17.8 ± 1.4 for group 2 [P = .03], respectively). There were no significant differences between the groups for corneal densitometry values between 6 and 12 mm, or for cell density, cell distribution, and cell morphology (P > .05). CONCLUSIONS: Although the cornea remains transparent in soft contact lens wearers, corneal densitometry may increase in the 0- to 6-mm annular zone of the anterior region.

The effect of endothelin receptor antagonists in the endotoxin-induced uveitis rabbit model.

PURPOSE: To investigate the effect of Bosentan (non-selective endothelin receptor antagonist) and BQ123 (ETA receptor antagonist) on intraocular inflammation in an endotoxin-induced uveitis (EIU) rabbit model. METHODS: Uveitis was induced by intravitreal injection of lipopolysaccharide (LPS). The animals were divided into 7 groups and there were six rabbits in each group (saline, saline and ethanol, bosentan, BQ123, lipopolysaccharide (LPS), bosentan and LPS, BQ123 and LPS-injected groups). Bosentan and BQ123 were applied before LPS injection. Aqueous humour was collected at 24th hour post-injections and enucleation was performed for the evaluation of histopathological changes. RESULTS: BQ123 decreased clinical score, cell counts and protein amount more than bosentan and it was significant for cell counts (p = 0.018). Bosentan significantly diminished inflammatory reactions more than BQ123 as shown in histopathological specimens (p = 0.002). CONCLUSIONS: ETA receptor blockage is effective on uveitis treatment by its protective effect on blood aqueous barrier.

Choroidal thickness measurements in migraine patients during attack-free period.

To identify any structural differences in macular choroidal thickness in migraine patients and compare them with that of control subjects by using spectral domain optic coherence tomography (SD-OCT). In this prospective study, choroidal thicknesses of 32 migraine patients during migraine attack-free period and 32 age- and sex-matched healthy subjects were measured using SD-OCT. All patients underwent a complete ophthalmic examination before the measurements. The migraine patients were classified into the migraine with aura group or the migraine without aura group. Migraine severity was assessed by visual analog scale (VAS), migraine disability questionnaire (Migraine Disability Assessment Score (MIDAS), and Wong-Baker faces pain rating scale. Thirty eyes of 32 subjects (31 female and 1 male) in the migraine group and 32 eyes of 32 subjects (31 female and 1 male) in control group were evaluated. In the study group, 16 patients suffered migraine without aura (MWA) and 16 patients were diagnosed as migraine with aura (MA). The mean subfoveal choroidal thickness (SFCT) was 353.3 ± 66.5 µm in the control group versus 304.3 ± 72.9 µm and 276.1 ± 61.4 µm in MWA and MA groups, respectively. The difference in SFCT between the migraine patients and the controls was significant (p < 0.001). Additionally, a moderate correlation was found between SFCT and the VAS score and W baker score (r = 0.48, p = 0.008 and r = 0.43, p = 0.02, respectively). The choroidal thickness was found to decrease significantly not only in migraine patients with aura but also in those without aura during the attack-free period.

EPIRETINAL MEMBRANES IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: Effect on Outcomes of Anti-vascular Endothelial Growth Factor Therapy.

PURPOSE: To iatients with neovascular age-related macular degenernvestigate the role of epiretinal membrane (ERM) on outcomes of anti-vascular endothelial growth factor therapy in pation (nAMD). METHODS: This study is a retrospective observational case series and was conducted at the Gazi University School of Medicine, Ankara, Turkey. The reports of the patients with a diagnosis of new-onset nAMD, who were aged at least 50 years and treated with intravitreal anti-vascular endothelial growth factors (ranibizumab or bevacuzimab) between October 2010 and September 2013 in our retina clinic, were reviewed for the vitreomacular interface changes. RESULTS: The study included 90 eyes of 90 patients with nAMD. The mean age of the patients was 70 ± 7.5 years, with 35 (38.9%) being male and 55 (61.1%) being female. According to the examinations with optical coherence tomography and B-mode ultrasonography, 43 patients had "concurrent" vitreomacular adhesion (30 focal, 13 broad; Group 1). Twenty-nine patients had complete posterior vitreous detachment (Group 2) and 18 patients (Group 3) had ERM. The number of injections was highest for the patients with ERM (Group 3), and this difference was statistically significant (P < 0.001). The mean interval between injections and the mean longest interval were shorter in Group 3 (P < 0.05). CONCLUSION: The presence of ERM in association with nAMD seems to increase the number of anti-vascular endothelial growth factor injections and decrease the injection intervals for the treatment of nAMD. Although the anatomical and functional results are similar in eyes with or without ERM, the increased need for anti-vascular endothelial growth factors may mean that these membranes may decrease the penetration of the drugs through these membranes, which may act as a physical barrier. Additionally, increased inflammation in patients with ERM probably requires more frequent injections.

Macular choroidal thickness measurements in patients with obstructive sleep apnea syndrome.

PURPOSE: The purpose of this study is to assess macular choroidal thickness measurements in patients with different severities of obstructive sleep apnea syndrome (OSAS) versus normal controls by using enhanced depth imaging optical coherence tomography (EDI-OCT). DESIGN: This paper is a descriptive study. MATERIALS AND METHODS: In this prospective study, the macular area of 74 patients with OSAS and 33 controls were evaluated. All subjects underwent complete ophthalmic examination and macular choroidal thickness (CT) measurements by enhanced depth imaging method of the Spectralis optical coherence tomography system. Choroidal thickness (CT) was measured at the fovea and at 1,000-µm intervals from the foveal center in both temporal and nasal directions by two masked observers. RESULTS: The mean age was not significantly different between patients with OSAS and controls. Patients were grouped as mild (n = 15), moderate (n = 28), and severe (n = 31) according to apnea-hypopnea index (AHI) scores. The mean subfoveal choroidal thickness (SFCT) was 338.0 ± 85.2 µm in the control group versus 351.3 ± 90, 307.8 ± 65.5, and 325.4 ± 110.2 µm in mild, moderate, and severe groups, respectively (p = 0.416). There was no significant correlation between the severity of OSAS and choroidal thickness. CONCLUSIONS: The patients with OSAS seem to protect the choroidal thickness despite hypoxia. The role of OSAS in the pathophysiology of choroidal blood flow and choroidal structure needs further investigation.

Ciliary body toxicities of systemic oxcarbazepine and valproic acid treatments: electron microscopic study.

Ciliary body is responsible for humour aqueous production in posterior chamber. Valproic acid (VPA) has been widely used for the treatment of epilepsy and other neuropsychiatric diseases such as bipolar disease and major depression. Oxcarbazepine (OXC) is a new anti-epileptic agent that has been used recently for childhood epilepsies such as VPA. In this study, we aimed to investigate the effects of VPA and OXC treatments used as antiepileptic in ciliary body by electron microscopy. In our study, 40 Wistar rats (21 days old) were divided equally into four groups which were applied saline (group 1), VPA (group 2), OXC (group 3) and VPA + OXC (group 4). The as-prepared ocular tissues were characterized by transmission electron microscopy (TEM) technique in scanning and transmission electron microscopy (SEM-TEM) (Carl Zeiss EVO LS10). The results confirmed that VPA caused dense ciliary body degeneration. Additionally, ciliary body degeneration in group 4 was supposed to be due to VPA treatment. Ciliary body damage and secondary outcomes should be considered in patients with long-term VPA therapy.

Isolated foveal hypoplasia: clinical presentation and imaging findings.

PURPOSE: To describe the clinical presentation and imaging findings of a patient with isolated foveal hypoplasia. CASE REPORT: A 16-year-old teenager presented to our clinic with mild to moderate visual impairment since early childhood. Lack of foveal depression was noted on both clinical examination and optical coherence tomography, and absence of the foveal avascular zone was demonstrated on fluorescein angiography. His ocular examination was otherwise unremarkable. CONCLUSIONS: Isolated foveal hypoplasia should be considered in the differential diagnosis of early-onset bilateral visual impairment, especially when the foveal reflexes seem absent.

Effect of the Toll-like receptor 4 antagonist eritoran on retinochoroidal inflammatory damage in a rat model of endotoxin-induced inflammation.

PURPOSE: We investigated the effect of eritoran, a Toll-like receptor 4 antagonist, on retinochoroidal inflammatory damage in an endotoxin-induced inflammatory rat model. METHODS: Endotoxin-induced inflammatory model was obtained by intraperitoneal injection of 1.5 mg/kg lipopolysaccharide (LPS). Group 1 had control rats; in groups 2-3 LPS and 0.5 mg/kg sterile saline were injected; and in groups 4-5 LPS and 0.5 mg/kg eritoran were injected. Blood samples were taken and eyes were enucleated after 12 hours (h) (groups 2 and 4) or 24 hours (Groups 3 and 5). Tumor necrosis factor-α (TNF-α) and malondialdehyde (MDA) levels in the serum and retinochoroidal tissue and nuclear factor kappa-B (NFκB) levels in retinochoroidal tissue were determined. Histopathological examination was performed and retinochoroidal changes were scored. RESULTS: Eritoran treatment resulted in lower levels of TNF-α, MDA, and NFκB after 12 h which became significant after 24 h. Serum TNF-α and retinochoroidal tissue NFκB levels were similar to control animals at the 24th h of the study. Eritoran significantly reversed histopathological damage after 24 h. CONCLUSIONS: Eritoran treatment resulted in less inflammatory damage in terms of serum and retinochoroidal tissue parameters.

Congenital glaucoma as an ophthalmic manifestation of Frank-Ter Haar syndrome.

We report on a patient with Frank-Ter Haar syndrome that is associated with high intraocular pressures. A 21-day-old male patient was referred to our clinic for surgical treatment of congenital glaucoma. On ophthalmic examination, he had buphthalmos, mild corneal edema and high IOP readings in both eyes. The patient underwent uneventful trabeculotomy surgery, bilaterally. Marked bilateral anterior iris insertion was noted during the surgery. Childhood glaucoma may be associated with Frank-Ter Haar syndrome.

Predicting Success in Descemet Membrane Endothelial Keratoplasty Surgery Using Machine Learning.

PURPOSE: This study aimed to predict early graft failure (GF) in patients who underwent Descemet membrane endothelial keratoplasty based on donor characteristics. METHODS: Several machine learning methods were trained to predict GF automatically. To predict GF, the following variables were obtained: donor age, sex, systemic diseases, medications, duration of stay in the intensive care unit, death-to-preservation time (DPT), endothelial cell density of the cornea, tightness of Descemet membrane roll during surgery, anterior chamber tamponade, tamponade used for rebubbling, and preoperative best corrected visual acuity. Five classification methods were experimented with the study data set: random forest, support vector machine, k-nearest neighbor, RUSBoosted tree, and neural networks. In holdout validation, 75% of the data were used in training and the remaining 25% used in testing. The predictive accuracy, sensitivity, specificity, f-score, and area under the receiver operating characteristic curve of the methods were evaluated. RESULTS: The highest classification accuracy achieved during the experiments was 96%. The precision, recall, and f1-score values were 0.95, 0.81, and 0.90, respectively. Feature importance was also computed using analysis of variance. The model revealed that GF risk was related to DPT and the intensive care unit duration (P < 0.05). No significant relationship was found between donor age, endothelial cell density, systemic diseases and medications, graft roll, tamponades, and GF risk. CONCLUSIONS: This study shows a strong relationship between increased intensive care duration, DPT, and GF. Experimental results demonstrate that machine learning methods may effectively predict GF automatically.

Machine learning based endothelial cell image analysis of patients undergoing descemet membrane endothelial keratoplasty surgery.

OBJECTIVES: In this study, we developed a machine learning approach for postoperative corneal endothelial cell images of patients who underwent Descemet's membrane keratoplasty (DMEK). METHODS: An AlexNet model is proposed and validated throughout the study for endothelial cell segmentation and cell location determination. The 506 images of postoperative corneal endothelial cells were analyzed. Endothelial cell detection, segmentation, and determining of its polygonal structure were identified. The proposed model is based on the training of an R-CNN to locate endothelial cells. Next, by determining the ridges separating adjacent cells, the density and hexagonality rates of DMEK patients are calculated. RESULTS: The proposed method reached accuracy and F1 score rates of 86.15 % and 0.857, respectively, which indicates that it can reliably replace the manual detection of cells in vivo confocal microscopy (IVCM). The AUC score of 0.764 from the proposed segmentation method suggests a satisfactory outcome. CONCLUSIONS: A model focused on segmenting endothelial cells can be employed to assess the health of the endothelium in DMEK patients.

Optical quality of the cornea after Descemet membrane endothelial keratoplasty surgery: early results from Türkiye.

Background: Descemet membrane endothelial keratoplasty (DMEK) is increasingly favored in the treatment of endothelial dysfunction due to its benefits, which include swift visual rehabilitation and recovery, a relatively low rejection rate, and superior refractive stability. In this study, we examined alterations in corneal clarity among patients who underwent DMEK and correlated these densitometry findings with other optical parameters of corneal topography. Methods: The study incorporated 35 eyes from 35 patients who had previously undergone DMEK surgery for pseudophakic bullous keratopathy at Ankara Bilkent City Hospital. The results from these patients were compared with those from a healthy control group. The preoperative and postoperative optical parameters of the patients were assessed using Pentacam Scheimpflug topography (Oculus). Results: We observed significant decreases in corneal densitometry in the 0-2 mm and 2-6 mm zones of the anterior, posterior, central, and total layers at the sixth month postoperatively compared to the preoperative period (P<0.05). The corneal densitometry values at postoperative month 6 were elevated in all layers and zones relative to the healthy group (P<0.05). The root mean square of higher-order aberrations in postoperative period was elevated significantly (P<0.001). Conclusions: Six months after operation, the optical quality of the cornea following DMEK surgery did not achieve the level of a healthy cornea.

Corneal characteristics in patients with retinitis pigmentosa.

BACKGROUND: To evaluate corneal topography and specular microscopic findings in patients with retinitis pigmentosa. METHODS: One hundred and two eyes of 51 patients with retinitis pigmentosa and 60 eyes of 30 healty subjects were included in our study. A detailed ophthalmological examination involving best corrected visual acuity (BCVA) was performed. A rotating Scheimpflug imaging system, was used to evaluate all eyes for topographic and aberrometrics parameters. Specular microscopy measurements were also noted. RESULTS: The retinitis pigmentosa group consisted of 51 patients (29 male and 22 female, mean age of 35.61±13.55 (18-65) years and the control group also consisted of 30 healty subjects (29 male and 22 female, mean age of 33.67±9.92 (20-58) years. There was no difference between the groups in terms of age (p = 0.624) and gender (p = 0.375). Spherical equivalents were higher in the RP group (p<0.001). Central keratoconus index (CKI) (p<0.001), Belin Ambrosio enhanced ectasia display total deviation value (BAD-D) (p = 0.003), index of surface variance (ISV) (p<0.001), index of vertical asymmetry (IVA) (p<0.001), Ambrosio related thickness (ART max) (p = 0.018), index of height asymmetry (IHA) (p = 0.009), index of height decentration (IHD) (p<0.001), maximum anterior elevation (p<0.001), front elevation in thin location (p = 0.05), progression index average (p = 0.015), root mean square (RMS) total (p = 0.010) and RMS-higher order aberration (RMS-HOA) (p<0.001) values were higher in RP group. There was a weak negative correlation between BCVA and ART max measurements (r=-0.256, p = 0.009) in RP group. We detected keratoconus-suspect in 6 eyes and clinically manifest keratoconus in one eye in the RP group. CONCLUSIONS: Patients with retinitis pigmentosa may have corneal morphological disorders that may affect vision. In our study, corneal topographic pathologies including keratoconus and possible keratoconus were detected in RP patients.

Efficacy of cyclic therapy with terpinen-4-ol in Demodex blepharitis : Is treatment possible by considering Demodex's life cycle?

PURPOSE: To describe the effectiveness of cyclic treatment with terpinen-4-ol, a tea tree oil component, on Demodex blepharitis. METHODS: The presence of Demodex was determined by eyelash rotation as proposed by Mastrota. Schirmer test, tear breakup time, ocular surface disease index, lid margin score, meibomian gland expressibility score, and Oxford grade were performed. Patients were advised to apply heat followed by terpinen-4-ol soaked wipes to eyelids twice a day for 2 weeks. At the end of 2 weeks, treatment was interrupted for 7-10 days. The same treatment was repeated once again. The patients were examined after the first and second cycle of treatment and after 1 year. RESULTS: There was a statistically significant improvement in Schirmer test (10.37 ± 4.73 and 13.13 ± 3.44 mm/5 min), tear breakup time (6.47 ± 3.31 and 7.6 ± 2.89 s), ocular surface disease index (47.94 ± 19.77 and 34.28 ± 13.40), lid margin score (3.2 ± 0.7 and 2.63 ± 0.71), meibomian gland expressibility scores (1.93 ± 0.64 and 1.4 ± 0.67), and Oxford grade (0.9 ± 0.8 and 0.5 ± 0.63) after the first cycle of treatment (p < 0.05). The improvement in symptoms and tear function tests of the patients after the second cycle was significantly better than in pre-treatment levels. At 12-month follow-up, symptoms of two patients (93%) relapsed. CONCLUSION: The administration of terpinen-4-ol to the eyelid margins in a cyclic manner in Demodex blepharitis is effective against adult and hatching Demodex and breaks the vicious cycle.

Evolving Techniques and Indications of Descemet Membrane Endothelial Keratoplasty.

Endothelial keratoplasty has replaced traditional penetrating keratoplasty for the treatment of corneal endothelial dysfunction. It offers faster, more predictable, stable visual recovery and low rejection rates while the surgery itself is less invasive. Descemet membrane endothelial keratoplasty (DMEK) is currently the gold standard for the treatment of Fuchs endothelial dystrophy, bullous keratopathy, and corneal edema after cataract surgery. Its favorable long-term outcomes are increasingly reported by large study groups. This review summarizes the current literature on new DMEK techniques, including size and shape modifications, new graft delivery techniques, and surgical pearls for challenging cases like eyes with glaucoma, glaucoma tubes, and failed penetrating keratoplasties.

Comparison of Corneal Densitometry Between Penetrating Keratoplasty and Deep Anterior Lamellar Keratoplasty in Keratoconus Patients.

OBJECTIVES: Our aim was to compare corneal densitometry values in keratoconic eyes undergoing deep anterior lamellar keratoplasty with the "big bubble" and manual lamellar dissection techniques, as well as penetrating keratoplasty. MATERIALS AND METHODS: This retrospective study evaluated the postoperative outcomes of 31 eyes treated with big bubble-deep anterior lamellar keratoplasty, 23 eyes with manual lamellar dissectiondeep anterior lamellar keratoplasty, and 37 eyes with penetrating keratoplasty. Corneal densitometry, best corrected visual acuity, and other corneal tomographic parameters were recorded at 1, 6, 12, and 24 months postoperatively. The groups were compared with respect to the outcomes. RESULTS: There were no significant differences between the groups with respect to the anterior, central, and total corneal densitometry values at 0 to 2 mm and 2 to 6 mm. At 1 month postoperatively, the densitometric value in the posterior corneal layer of the 0- to 2-mm and 2- and 6-mm corneal zones was higher in the manual lamellar dissection-deep anterior lamellar keratoplasty group than in the big bubble-deep anterior lamellar keratoplasty and penetrating keratoplasty groups (P = .001). At 6, 12, and 24 months, the manual lamellar dissectiondeep anterior lamellar keratoplasty and penetrating keratoplasty groups had similar values in both zones in the posterior layer. The difference between manual lamellar dissection-deep anterior lamellar keratoplasty and big bubble-deep anterior lamellar keratoplasty in both zones in the posterior layer was statistically significant at 6, 12, and 24 months postoperatively (P < .05). The best corrected visual acuity of big bubble-deep anterior lamellar kerat oplasty and penetrating keratoplasty groups was better than that of the manual lamellar dissection-deep anterior lamellar keratoplasty group (P = .047). CONCLUSIONS: Corneal densitometry values may vary depending on the type of keratoplasty used in keratoconus patients. Higher densitometry values may affect visual quality in keratoplasty patients by decreasing or filtering the light that reaches the retina.

Accelerated corneal cross-linking with hypo-osmolar riboflavin in thin keratoconic corneas: 2-year follow-up.

PURPOSE: This study was performed to evaluate the outcomes of accelerated corneal cross-linking in keratoconic corneas with thinnest pachymetry values of <400 µm. METHODS: The study included 28 eyes of 24 patients. The uncorrected and best-corrected visual acuities (logMAR), flattest and steepest keratometric readings, central corneal thickness at the thinnest point, corneal higher-order aberrations, and contrast sensitivity were assessed before and at 1, 3, 6, 12, and 24 months after corneal cross-linking. RESULT: The mean best-corrected visual acuity and contrast sensitivity increased (p=0.02, p=0.03, respectively), whereas the mean uncorrected visual acuity did not significantly differ (p>0.05) at 24 months after corneal cross-linking, compared with measurements before corneal cross-linking. Although the mean flattest keratometric reading showed no significant change (p=0.58), the mean steepest keratometric reading was reduced when compared with its value before corneal cross-linking (p=0.001). No change was observed in the mean central corneal thickness at the thinnest point at 24 months after corneal cross-linking, compared with its value before corneal cross-linking (p=0.12). CONCLUSION: Accelerated corneal cross-linking in keratoconic eyes with thin corneas could halt the progression of keratoconus in corneas thinner than 400 µm at 24 months after treatment.

The effect of conjunctivochalasis detected by anterior segment optical coherence tomography on tear function in an elderly population.

INTRODUCTION: The aim of this study was to evaluate conjunctivochalasis (CCH) and its relationship with tear meniscus and tear function in an elderly population. MATERIALS AND METHODS: This prospective, observational study included 144 eyes of 144 patients aged >65 years who were referred to our clinic for various reasons. The patients were separated into group 1 including 64 eyes of 64 patients with CCH and group 2 including 80 eyes of 80 patients without CCH. All patients in both groups underwent a full ophthalmological examination, and the presence of CCH, fluorescein tear break-up time (FTBUT) test, Schirmer test, ocular surface staining (Oxford grading score) and OSDI (Ocular Surface Disease Index) test results were recorded. Measurements of the conjunctivochalasis area (CCHA), tear meniscus height (TMH) and tear meniscus area (TMA) were taken using anterior segment optic coherence tomography (AS-OCT). RESULTS: Group 1 comprised 34 females and 30 males with a mean age of 71.15 ± 12.34 years. Group 2 comprised 43 females and 37 males with a mean age of 68.16 ± 6.05 years (p = 0.122). The CCH rate was 44.4% in all of the examined patients. The OSDI score and the ocular surface staining test were significantly higher (p < 0.05), and the FTBUT, TMH and TMA were significantly lower (p < 0.05) in group 1 than in group 2. The Schirmer I test results were not significantly different between the two groups. CONCLUSION: The prevalence of CCH is quite high in elderly individuals and may disrupt tear function in these patients.

Intense regulated pulse light for the meibomian gland dysfunction.

PURPOSE: To assess the effect of intense regulated pulse light (E-Eye; E-Swin, France) on the treatment of meibomian gland dysfunction. SETTING: Health Sciences University, Ankara Numune Training and Research Hospital, Department of Ophthalmology. METHODS: A total of 26 patients underwent intense pulsed light treatment (E-Eye; E-Swin), with homogeneously sequenced five light pulses delivered to one eye at 1, 15, and 45 days following baseline evaluation. At each visit, subjective clinical parameters (ocular surface disease index questionnaire and standard patient evaluation of eye dryness questionnaire) and objective clinical parameters (Schirmer I test scores, tear break-up times, Oxford grading, lid margin abnormality score, secretion quality and expressibility degree) were recorded. The subjective and objective parameters at Days 15 and 45 were compared with baseline values. RESULTS: Patients underwent three sessions of intense pulsed light treatment. Schirmer test and tear break-up time improved significantly from baseline to Day (D) 45 (8.53 ± 4.31 mm vs 12.6 ± 3.14 mm, 4.53 ± 1.33 sn vs 11.07 ± 2.87 sn, p = 0.003 and p < 0.001). Ocular surface disease index and standard patient evaluation of eye dryness scores improved from baseline to D15 and baseline to D45 (all with p < 0.05). All the subjects reported reduced symptoms by D45. There were no cases of adverse ocular effects. There was no significant change in Oxford grading, lid margin abnormality score, secretion quality, and expressibility degree. CONCLUSIONS: Intense regulated pulse light seems a safe treatment procedure for meibomian gland dysfunction, improving tear film quality and reducing symptoms of dry eye.

Comparison study of two different topical lubricants on tear meniscus and tear osmolarity in dry eye.

PURPOSE: To compare the effect of single-drop administration of two different ophthalmic solutions on tear meniscus and tear osmolarity in patients with mild to moderate dry eye disease. METHODS: This prospective study comprised of 122 patients with mild to moderate dry eye disease. These patients received a single dose of either unpreserved trehalose 3%, hyaluronic acid 0.15%, carbomer 0.25% (THHA, Thealoz Duo Gel) (Group 1) or hyaluronic acid 0.3% (HA) (Group 2) gel-based lubricants. Tear meniscus (height and depth) were measured using anterior segment optic coherence tomography (AS-OCT) at baseline and 10, 60, 120, and 240 min. after instillation. Tear osmolarity, Schirmer I test, tear break-up time (TBUT), gel properties, and patient comfort were evaluated 240 min. after instillation. RESULTS: Tear meniscus height (TMH) and tear meniscus depth (TMD) showed a significant increase with both lubricants compared to the baseline (p < 0.001). This effect remained significant for up to 60 min. and 120 min. for the THHA and HA 0.3% solutions, respectively (p < 0.05, for both). Mean comfort duration was 115.1 ±â€¯20.1 min. in Group 1 and 148.3 ±â€¯49.0 min in Group 2 (p < 0.001). Tear osmolarity, Schirmer I test, and TBUT were similar between the baseline and 240 min. for each group. CONCLUSIONS: The results of this study demonstrate that 0.3% HA remains on the ocular surface for longer than TH-HA. The longer ocular residency time also seems to correlate with a longer patient comfort duration.