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In vivo confocal microscopy morphometric analysis of corneal subbasal nerve plexus in dry eye disease using newly developed fully automated system
摘要： Purpose To evaluate in vivo confocal microscopy (IVCM) features of corneal subbasal nerve plexus (SNP) in the setting of dry eye disease (DED) using fully automated software BACCMetrics,^ and to further investigate its diagnostic performance in discriminating DED patients. Methods IVCM exams of SNP in DED patients and matched control subjects were performed using Heidelberg Retina Tomograph with the Rostock Cornea Module. The following parameters were obtained with ACCMetrics: corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length (CNFL), corneal nerve total branch density (CTBD), corneal nerve fiber area (CNFA), corneal nerve fiber width (CNFW), and corneal nerve fractal dimension (CNFrD). The Mann–Whitney U test was used to compare variables. Receiver operating characteristic curves with calculations of the area under the curve (AUC) were used to describe the accuracy of IVCM parameters for discriminating DED patients from controls. Results Thirty-nine DED patients and 30 control subjects were included. Significantly, lower values of CNFD, CNBD, and CNFL and higher value of CNFW were found in DED patients compared to controls (respectively, 20.5 ± 8.7 vs 25.4 ± 6.7 n/ mm2; 25.6 ± 20.1 vs 37.6 ± 21.5 n/mm2; 12.6 ± 4.4 vs 14.5 ± 2.9 mm/mm2; 0.021 ± 0.001 vs 0.019 ± 0.001 mm/mm2; always p < 0.024). CNFW value had the highest diagnostic power in discriminating DED patients (AUC = 0.828). When the diagnosis of DED was made based on either CNFW or CNBD, the sensitivity was 97.4% and the specificity 46.7%. Conclusions The software ACCMetrics was able to rapidly detect SNP alterations occurring in the setting of DED and showed good diagnostic performance in discriminating DED patients.
关键词： Dry eye,Sub-basal nerve plexus,Automated analysis,ACCMetrics,In vivo confocal microscopy
更新于2025-09-23 15:22:29
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Dynamic Change of Optical Quality in Patients With Dry Eye Disease
摘要： PURPOSE. To evaluate the dynamic changes of optical quality in patients with dry eye disease (DED) by using a double-pass system. METHODS. Fifty-six patients with DED and 35 control subjects were included in this study. Each patient underwent an evaluation of the ocular surface, using the Ocular Surface Disease Index, tear ?lm breakup time (TBUT), corneal and conjunctival staining (Oxford scale), and Schirmer I test. Using the tear ?lm analysis program of the Optical Quality Analysis System, we recorded the objective scatter index (OSI) every 0.5 seconds within a 20-second period with the subjects asked to blink freely. Several parameters were established to evaluate the dynamic alterations of optical quality and the effects of blinks: OSI standard deviation (SD), DOSI, DOSI/time, blinking change (BC), blinking frequency (BF), and tolerant limitation (TL). RESULTS. Patients with DED had signi?cant alterations of optical quality compared to control subjects. The DOSI, DOSI/time, BC, and BF were signi?cantly higher and TL was signi?cantly lower in DED patients than controls. Furthermore, the DOSI and DOSI/time were also signi?cantly higher in patients with severe DED than patients with mild disease. In univariate analysis, both TBUT and corneal staining were correlated with DOSI, DOSI/time, and BC. In multivariate analysis, DOSI/time was correlated to the corneal staining score. CONCLUSIONS. The double-pass system allowed the monitoring of the dynamic changes of optical quality in patients with DED. Optical quality should be evaluated in patients with DED because these alterations cannot be determined from the classical DED clinical tests.
关键词： scattering,optical quality,double-pass system,dry eye disease
更新于2025-09-23 15:21:21
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Agreement of non-invasive tear break up time measurement between Tomey RT-7000 Auto Refractor-Keratometer and Oculus Keratograph 5M
摘要： Background: It is difficult to standardize assessment of dry eye in different clinical settings. Increasingly, tear stability is recognized to be important for the definition and assessment of patients with dry eye. Recently, two commercially available instruments have been made available for objectively measuring noninvasive tear break-up time (NIBUT), as an indicator of tear stability: the Tomey RT-7000 Auto Refractor-Keratometer and Oculus Keratograph (K)5M. We aim to assess the agreement of NIBUT measurements using these modalities. Methods: This prospective cross-sectional study was carried out in a tertiary referral eye center and involved 126 consecutive dry eye patients. NIBUT assessment was performed on the right eyes of participants with both the RT-7000 and the K5M techniques, with the order of assessment randomized. The Standardized Patient Evaluation of Eye Dryness (SPEED) questionnaires were administered to assess dry eye symptoms in the 2 weeks before assessment. Results: The age of the participants was 56.0±14.3 years (69.84% females). Measurements for both modalities were non-normally distributed (right-skewed). The median RT-7000 and K5M readings were 4.2 (range 0.1–10.0) and 6.4 (0.1–24.9) seconds, respectively. RT-7000 and K5M readings were poorly correlated (ρ=0.061, P=0.495). Intraclass correlation coefficient between the modalities was 0.187 (95% confidence interval -0.097 to 0.406). The Bland–Altman plot showed no systematic differences between the readings with these machines. The agreement between machines was not different in different SPEED categories. Conclusion: While there are theoretical and practical benefits of NIBUT for assessment of tear stability over dye-based methods, the agreement between the two modalities was poor. Hence, studies and trials assessing NIBUT should avoid using these modalities interchangeably for NIBUT assessment. More research is needed to improve consensus on how to determine NIBUT.
关键词： tear film,tear break-up time,Tomey RT-7000,dry eye,Oculus Keratograph
更新于2025-09-23 15:21:01
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Irregular Astigmatism and Higher-Order Aberrations in Eyes With Dry Eye Disease
摘要： Visual disturbances were included in the de?nition of dry eye disease in the 2007 Dry Eye Workshop report. As a result, quality of vision (QoV) in dry eye patients has received increased attention. Corneal topography and wavefront sensors have been used to objectively and quantitatively evaluate optical quality, with data showing increases in irregular astigmatism and higher-order aberrations (HOAs) in dry eye patients. Furthermore, ocular optical characteristics are in?uenced by the tear ?lm, which constantly ?uctuates over time. Therefore, dynamic quantitative assessments of optical quality with continuous measurements are essential to understanding QoV in dry eye patients. This review summarizes what is known and what advances have been made in evaluating and understanding QoV in dry eye patients. In particular, corneal topographic and wavefront analyses, conducted both overseas and in Japan, are described.
关键词： wavefront sensor,dry eye,higher-order aberrations,corneal topography,irregular astigmatism
更新于2025-09-23 15:21:01
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Evaluation of tear meniscus dimensions using anterior segment optical coherence tomography in video terminal display workers
摘要： Background: To evaluate tear meniscus height and tear meniscus area measured by optical coherence tomography (OCT) and to determine the prevalence of dry eye disease in video display terminal (VDT) users. Methods: This was a case–control study performed on VDT users. The case group consisted of 53 subjects who vocationally use VDT more than six hours per day and the control group consisted of 49 subjects who used VDT not more than one hour per day. The pre-vocational and post-vocational tear meniscus height and tear meniscus area measurements were performed twice in one day using OCT. Tear-film break-up time, Schirmer’s test, Ocular Surface Disease Index score and corneal staining score measurements were performed in all subjects. Results: The mean age was 38.9 (cid:1) 5.5 years in VDT users and 37.8 (cid:1) 5.8 years in the control group (p = 0.426). Twenty patients (37.7 per cent) had dry eye disease in VDT users and five patients (10.2 per cent) had dry eye disease in the control group (p = 0.001). The mean tear meniscus height and tear meniscus area values (pre-vocational and post-vocational) were significantly lower in VDT users than in the control group (p < 0.001, p < 0.001, p = 0.024 and p < 0.001, respectively). The Schirmer’s test results, Ocular Surface Disease Index scores, corneal staining scores and tear-film break-up time values revealed significant differences between VDT users and control subjects (p = 0.002, p = 0.006, p < 0.001 and p < 0.001, respectively). In addition, significant correlations were demonstrated between Schirmer’s test results, Ocular Surface Disease Index scores, corneal staining scores, tear-film break-up time measurements, tear meniscus height results and tear meniscus area values. Conclusion: Tear meniscus evaluation using OCT is an effective, non-invasive and sensitive method for detection of dry eye disease in VDT users.
关键词： dry eye disease,tear meniscus height,video display terminal,optical coherence tomography,tear meniscus area
更新于2025-09-19 17:15:36
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Randomised double-masked placebo-controlled trial of the cumulative treatment efficacy profile of intense pulsed light therapy for meibomian gland dysfunction
摘要： Purpose: To assess long-term cumulative treatment effects of intense pulsed light (IPL) therapy in meibomian gland dysfunction (MGD). Methods: Eighty-seven symptomatic participants (58 female, mean±SD age, 53±16 years) with clinical signs of MGD were enrolled in a prospective, double-masked, parallel-group, randomised, placebo-controlled trial. Participants were randomised to receive either four or five homogeneously sequenced light pulses or placebo treatment to both eyes, (E-Eye Intense Regulated Pulsed Light, E-Swin, France). Visual acuity, dry eye symptomology, tear film parameters, and ocular surface characteristics were assessed immediately before treatment on days 0, 15, 45, 75, and four weeks after treatment course completion on day 105. Inflammatory and goblet cell function marker expression, and eyelid swab microbiology cultures were evaluated at baseline and day 105. Results: Significant decreases in OSDI, SPEED, and SANDE symptomology scores, and meibomian gland capping, accompanied by increased tear film lipid layer thickness, and inhibited Corynebacterium macginleyi growth were observed in both treatment groups (all p<0.05). Sustained clinical improvements occurred in both treatment groups from day 75, although significant changes from day 45, in lipid layer quality, meibomian gland capping, OSDI and SANDE symptomology, were limited to the five-flash group (all p<0.05). Conclusions: IPL therapy effected significant improvements in dry eye symptomology, tear film lipid layer thickness, and meibomian gland capping in MGD patients. Five-flash IPL treatment showed superior clinical efficacy to four-flash, and an initial course of at least four treatments is suggested to allow for establishment of sustained cumulative therapeutic benefits prior to evaluation of overall treatment efficacy.
关键词： lipid layer,Intense pulsed light,ocular surface,dry eye,tear film,meibomian gland
更新于2025-09-16 10:30:52
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Efficacy and Safety of Intense Pulsed Light in Patients With Meibomian Gland Dysfunction—A Randomized, Double-Masked, Sham-Controlled Clinical Trial
摘要： To study the efficacy and safety of intense pulsed light (IPL) in patients with meibomian gland dysfunction (MGD). This prospective randomized double-masked sham-controlled trial included 114 patients with MGD. Patients were randomized into the IPL or sham group. Either the IPL or sham procedure was performed on days 0, 15, and 45. Ocular Surface Disease Index (OSDI), visual analog scale, visual acuity, tear breakup time, meibum quality and expressibility, meibography grade, ocular surface staining, tear film lipid layer thickness, tear osmolarity, Schirmer test, tear interleukin-1 receptor agonist, and interleukin-6 levels were examined on days 0, 15, and 45 and at months 3 and 6. Subgroup analysis according to stage and the patient’s compliance to conventional treatment were also analyzed. Any adverse events during the study were recorded. A multilevel mixed-effect linear regression model was used. P value less than 0.05 was considered statistically significant. At 6 months, tear breakup time, meibum quality grades, expressibility grades, and OSDI were better in the IPL group (5.23 6 2.91 vs. 3.11 6 0.99 seconds, P , 0.001; 8.74 6 4.74 vs. 13.19 6 5.01, P , 0.001; 0.50 6 0.67 vs. 1.12 6 0.70, P , 0.001; 24.29 6 16.92 vs. 32.71 6 20.07, P , 0.05). OSDI, meibum quality, and expressibility in the IPL group began to improve at day 15 (P , 0.001), whereas the results in the sham group began to improve at day 45 (P , 0001). No adverse event occurred after IPL. IPL is effective and safe for MGD treatment in all stages regardless of compliance.
关键词： intense pulsed light,meibomian gland dysfunction,meibomian gland,dry eye,cytokines
更新于2025-09-12 10:27:22
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Comparing Dry Eye Disease After Small Incision Lenticule Extraction and Laser Subepithelial Keratomileusis
摘要： To compare dry eye disease parameters between small incision lenticule extraction (SMILE) and laser subepithelial keratomileusis (LASEK). This prospective, nonrandomized study included 39 eyes of 39 patients who underwent SMILE (n = 19) and LASEK (n = 20). Dry eye disease parameters included Ocular Surface Disease Index (OSDI), tear breakup time, Schirmer I test (SIT) value, corneal esthesiometry result, tear meniscus area, meibomian gland evaluation result, lipid layer thickness, and blink rate. Evaluations were performed before surgery and at 1 and 6 months after surgery. Compared with the LASEK group, the SMILE group showed lower corneal esthesiometry values at 1 month and higher OSDI scores and lower SIT values at 6 months after surgery. The SMILE group showed significantly higher OSDI scores at 1 and 6 months after surgery than before, but significantly lower OSDI scores at 6 months than at 1 month showed significantly decreased after corneal sensitivity at 1 month after surgery, which increased to the preoperative level 6 months after surgery. The change in OSDI scores at 1 month after surgery positively correlated with changes in the total and partial blink rates, whereas the change in corneal sensitivity at 1 month after surgery negatively correlated with the total and partial blink rates. Both SMILE and LASEK groups showed temporary decreases in corneal sensitivity, which recovered to baseline levels. Although subjective symptoms worsened after SMILE, SIT values improved after LASEK. Compared with SMILE, LASEK yielded better results regarding subjective symptoms, tear production, and corneal sensitivity.
关键词： corneal sensitivity,dry eye disease,small incision lenticule extraction,laser subepithelial keratomileusis
更新于2025-09-12 10:27:22
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Effect of 0.05% Cyclosporine A on the Ocular Surface after Photorefractive Keratectomy
摘要： Purpose: To evaluate the effect of 0.05% cyclosporine A on the ocular surface after photorefractive keratectomy (PRK). Methods: This retrospective study included 50 patients who underwent PRK. Patients were divided into two groups: 25 patients in group I were treated with topical 0.05% cyclosporine A with conventional medication, and 25 patients in group II were treated with conventional medication. Visual acuity (VA), tear break-up time (BUT), fluorescein staining score (F-stain), Schirmer I test, and ocular surface disease index (OSDI) were evaluated before surgery and 2 weeks, 1 month, 2 months, and 3 months after surgery. Results: F-stain was significantly lower in group I than in group II at 2 weeks and 1 month (p < 0.05). There was no significant difference in uncorrected VA, BUT, Schirmer I test, or OSDI between the groups. However, group I showed a more effective pattern in dry eye. Conclusions: Combination treatment with 0.05% cyclosporine A was helpful for early ocular surface stability in patients with dry eye after PRK.
关键词： Dry eye,Cyclosporine A,Ocular surface stability,Refractive surgery,Photorefractive keratectomy
更新于2025-09-10 09:29:36
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Does Dry Eye Affect Repeatability of Corneal Topography Measurements?
摘要： Objectives: The purpose of this study was to assess the repeatability of corneal topography measurements in dry eye patients and healthy controls. Materials and Methods: Participants underwent consecutive corneal topography measurements (Sirius; Costruzione Strumenti Oftalmici, Florence, Italy). Two images with acquisition quality higher than 90% were accepted. The following parameters were evaluated: minimum and central corneal thickness, aqueous depth, apex curvature, anterior chamber volume, horizontal anterior chamber diameter, iridocorneal angle, cornea volume, and average simulated keratometry. Repeatability was assessed by calculating intra-class correlation coefficient. Results: Thirty-three patients with dry eye syndrome and 40 healthy controls were enrolled to the study. The groups were similar in terms of age (39 [18-65] vs. 30.5 [18-65] years, p=0.198) and gender (M/F: 4/29 vs. 8/32, p=0.366). Intra-class correlation coefficients among all topography parameters within both groups showed excellent repeatability (>0.90). Conclusion: The anterior segment measurements provided by the Sirius corneal topography system were highly repeatable for dry eye patients and are sufficiently reliable for clinical practice and research.
关键词： repeatability,Dry eye,corneal topography
更新于2025-09-09 09:28:46