Search Results (60)

Objectives: To examine the rate of meniscal re-tear in patients with concomitant ACL reconstruction, with specific focus on surgical factors and patient demographic factors. Methods: A retrospective chart review was performed on all patients who underwent meniscal repair with concomitant ACL reconstruction at our institution over a seven-year period. Demographic and case variables were assessed, including sex, age, height, weight, BMI, medial versus lateral repairs, ACL graft type, ACL reconstruction technique, meniscus repair technique, and post-operative weight bearing status. Failure of repair was defined as need for repeat surgery on the same meniscus. Results: There were 191 patients included in the study; of those 118 did not need further surgery on the meniscus at a minimum of 2 years post operation while 73 did have a re-operation on the same meniscus (rate of failure 38.2%). There were significant differences between re-operation and non-re-operation groups based on ACL graft type (54% failure for allograft vs. 30/23% failure for both autograft cohorts) and meniscal repair side (46% re-tear rate for medial meniscus vs. 17% for lateral meniscus). The pediatric (under 18 years old) cohort included 57 patients; 28 patients required additional meniscal surgery and 29 did not (rate of re-operation 49%). Conclusions: The overall failure rate of meniscus repair was nearly 40%. Risk factors for re-tear of the meniscus were repair of the medial meniscus and allograft usage for ACL reconstruction. The rate of re-tear in patients under 18 was nearly 50%, which is higher than in the adult population. Full article

Background and Objectives: To clinically validate a semi-automatic measurement of Tear Meniscus Central Area (TMCA) to differentiate between Non-Aqueous Deficient Dry Eye (Non-ADDE) and Aqueous Deficient Dry Eye (ADDE) patients. Materials and Methods: 120 volunteer participants were included in the study. Following TFOS DEWS II diagnostic criteria, a battery of tests was conducted for dry eye diagnosis: Ocular Surface Disease Index questionnaire, tear film osmolarity, tear film break-up time, and corneal staining. Additionally, lower tear meniscus videos were captured with Tearscope illumination and, separately, with fluorescein using slit-lamp blue light and a yellow filter. Tear meniscus height was measured from Tearscope videos to differentiate Non-ADDE from ADDE participants, while TMCA was obtained from fluorescein videos. Both parameters were analyzed using the open-source software NIH ImageJ. Results: Receiver Operating Characteristics analysis showed that semi-automatic TMCA evaluation had significant diagnostic capability to differentiate between Non-ADDE and ADDE participants, with an optimal cut-off value to differentiate between the two groups of 54.62 mm² (Area Under the Curve = 0.714 ± 0.051, p < 0.001; specificity: 71.7%; sensitivity: 68.9%). Conclusions: The semi-automatic TMCA evaluation showed preliminary valuable results as a diagnostic tool for distinguishing between ADDE and Non-ADDE individuals. Full article

Background and Objectives: This study reports an association between nasolacrimal duct obstruction (NLDO) and perinasal uptake on radioactive iodine (RAI) whole-body scan. Materials and Methods: This is a retrospective study of 37 patients from May to November 2017 who underwent thyroidectomy and I-131 ablation for papillary thyroid cancer (PTC) and had a follow-up I-123 diagnostic WBS and dacryoscintigraphy. Ophthalmic examinations assessed punctal stenosis, NLDO, tear film break-up time, Schirmer’s test, punctate keratopathy, tear meniscus height, epiphora, and ocular dryness. Perinasal and nasal uptake on whole-body scans (WBSs) were assessed as negative (no uptake) or positive (focal uptake). The associations between perinasal uptake on WBS, dacryoscintigraphy findings, and ophthalmic assessments were assessed. Results: Nasal uptake on I-131 post-ablation WBS were observed in 60 eyes (81%); perinasal uptake was observed in 8 eyes (11%). Nasal uptake on I-123 post-ablation WBS were observed in all eyes; perinasal uptake was observed in 15 eyes (20%). Perinasal and nasal uptake on I-131 post-ablation WBS were significantly associated with delayed excretion on dacryoscintigraphy (p < 0.001 and p = 0.03, respectively). Perinasal uptake on I-123 WBS was associated with both abnormal dacryoscintigraphy findings and ocular dryness (p < 0.001 and p = 0.02, respectively). Conclusions: Perinasal uptake on I-131 post-ablation and I-123 diagnostic WBS was significantly associated with delayed excretion on dacryoscintigraphy, suggesting NLDO. Full article

Background: To determine short-term changes in tear film volume and stability after various treatments for dry eye disease in healthy participants. Methods: 36 healthy participants aged from 18 to 35 years were recruited for a single-session examination and randomly assigned to one of three treatment groups (1:1:1 treatment, 1:1 eye): Group 1 (artificial tears ‘Comfort Drops’), Group 2 (eyelid wipes ‘Systane Lid Wipes’), and Group 3 (ocular bath ‘Acuaiss’). Tear Meniscus Height (TMH) was assessed at baseline, 2, 5, 10, 15, and 20 min, and Non-Invasive Break-Up Time (NIBUT) at baseline, 2, 10, and 20 min, all using the OCULUS Keratograph 5M by one examiner. Results: Of the initially recruited participants, 35 were analyzed; one was excluded for reflex tearing. Group 1 (n = 12) showed a significant TMH increase at 2 min compared to 10 and 20 min (Friedman, p = 0.004; Bonferroni, p ≤ 0.028). Group 3 (n = 12) showed a significant increase at 2 and 5 min compared to baseline and decrease at 10 min against 2 and 5 min (Friedman, p < 0.001; Bonferroni, p ≤ 0.034). Group 2 (n = 11) showed no significant changes over time (Friedman, p = 0.108). NIBUT showed no significant differences at any time-point in any group (Friedman, p ≥ 0.231). Basal TMH differed between groups (ANOVA, p = 0.048), but post hoc analysis found no significance (Bonferroni, all p ≥ 0.088). No significant differences in TMH at other time-points (Kruskal–Wallis/ANOVA, p ≥ 0.265) or in NIBUT between groups (Kruskal–Wallis/ANOVA, p = 0.108) were found. Conclusions: In healthy participants, artificial tears and ocular baths temporarily increase TMH, while eyelid wipes do not. Neither has an immediate impact on NIBUT. Full article

Background/Objectives: We aimed to evaluate the effectiveness of a 0.1% cyclosporin A cationic emulsion (CsA-CE) for dry eye disease (DED) post-cataract surgery using the DED index measured with a Placido tear film analyzer. Methods: We retrospectively reviewed the medical records of patients who underwent simple cataract surgery. All patients used 0.5% moxifloxacin and 1% prednisolone acetate eye drops four times daily postoperatively. They were divided into the CsA-CE and control groups based on whether they had used CsA-CE 1 week after surgery. Subjective and objective assessments were performed at the baseline and 1 month postoperation. The non-invasive tear meniscus height, non-invasive tear break-up time, conjunctival redness, meibomian gland morphology, and lipid layer thickness were assessed using the Keratograph 5M (Oculus). Results: No differences were observed in the preoperative dry eye parameters between the groups. The ocular surface disease index decreased from 19.26 to 14.58 (p = 0.046) at 1 month postoperation for the CsA-CE group, and the average non-invasive tear break-up time significantly increased from 10.97 to 13.00 s (p = 0.002). No such differences were observed for the control group. Nasal bulbar conjunctival hyperemia increased (p < 0.001) for the control group. Nasal limbal hyperemia and overall limbal hyperemia increased for both groups (CsA-CE, p = 0.005, 0.017; control, p = 0.001, 0.012). The lipid layer thickness increased from 70.29 to 86.41 nm for the CsA-CE group (p < 0.001), whereas no significant change was noted for the control group. Conclusions: CsA-CE (0.1%) is effective for treating DED after cataract surgery and improves the tear lipid layer. Full article

Discomfort is one of the leading causes associated with contact lens dropout. This study investigated changes in the tear film parameters induced by lens wear and their relationship with ocular symptomology. Thirty-four lens wearers (32.9 ± 9.1 years, 7 men) and thirty-three non-lens wearers (29.4 ± 6.8 years, 12 men) participated in this clinical setting. Subjects were categorised into asymptomatic (n = 11), moderate (n = 15), or severe symptomatic (n = 8). Clinical evaluations were performed in the morning, including blink frequency and completeness, pre-corneal (NIBUT) and pre-lens non-invasive break-up (PL-NIBUT), lipid interference patterns, and tear meniscus height. Contact lens wearers had a higher percentage of incomplete blinks (37% vs. 19%, p < 0.001) and reduced tear meniscus height compared to controls (0.24 ± 0.08 vs. 0.28 ± 0.10 mm, p = 0.014). PL-NIBUT was shorter than NIBUT (7.6 ± 6.2 vs. 10.7 ± 9.3 s. p = 0.002). Significant statistical differences between the groups were found in the PL-NIBUT (p = 0.01) and NIBUT (p = 0.05), with asymptomatic recording higher times than symptomatic. Long-term use of silicone–hydrogel lenses can affect tear stability, production, and adequate distribution through blinking. Ocular symptomology correlates with tear stability parameters in both lens wearers and non-wearers. Full article

Background: Dry eye disease (DED) is currently recognized as a global health concern, with a prevalence that ranges from 5% to 75%. Given the severity of dry eye in diabetic patients and the global prevalence of diabetes, it is crucial to evaluate new treatments that potentially improve tear film stability in this patient population. Methods: Single-center, open-label, single-arm, and interventional study in adult patients with type-2 diabetes mellitus and all DED subtypes evaluating a propylene glycol-hydroxypropyl guar nanoemulsion that has shown in previous studies to improve tear film stability in nondiabetic patients. Results: After 28 days of treatment, the Ocular Surface Disease Index (OSDI) scores showed significant improvement, decreasing from a baseline mean of 42.72 ± 17.69 to 25.53 ± 17.14 on Day 28 (p < 0.001); Non-Invasive Keratograph Break-Up Time (NIKBUT) also improved significantly, increasing from 3.45 ± 1.17 s at baseline to 5.94 ± 1.48 s on Day 28 (p < 0.001). No significant changes were observed in the infrared meibography score (baseline: 1.48 ± 0.93 vs. Day 28: 1.47 ± 0.92, p = 0.279), tear meniscus height (TMH) (baseline: 0.25 ± 0.10 mm vs. Day 28: 0.25 ± 0.08 mm, p = 0.086), or meibomian gland expressibility score (MGES). The redness score significantly decreased from 1.88 ± 0.68 at baseline to 1.40 ± 0.59 on Day 28 (p < 0.001). Conclusions: These findings suggest notable improvements in both signs and symptoms of dry eye disease in diabetic patients with all DED subtypes and severity categories. Full article

Background: Scleral lenses (SLs) are recommended in DEWS II to treat dry eye (DE) patients that do not respond well to conventional therapies. This study aimed to evaluate the short-term (one month) efficacy and safety of SLs in the management of severe DE. Methods: This single-center prospective study enrolled 15 patients (22 eyes) who were diagnosed with severe DE. The Ocular Surface Disease Index (OSDI), the Chinese version of the 25-item National Eye Institute Visual Function Questionnaire (CHI-VFQ-25), and LogMAR best-corrected visual acuity (BCVA) were evaluated at baseline and one month following SL fitting. DE-related parameters were obtained and analyzed before and after one month of SL treatment, including tear-film breakup time (TBUT), corneal fluorescein staining (CFS), non-invasive breakup time (NIBUT), tear meniscus height (TMH), Schirmer I test (SIT), and meibomian gland (MG) dropout. Complications and adverse events were monitored. Results: OSDI scores (53.9 ± 28.1 vs. 10.4 (4.2–25), p = 0.0001) and CFS scores (10.2 ± 3.9 vs. 7 (0–12), p = 0.001) decreased after one month of SL therapy, while CHI-VFQ-25 scores (74.4 (54.8–83.8) vs. 95 (78.7–98), p = 0.0001) and TBUT (0.6 ± 0.5 vs. 2.2 ± 1.0, p < 0.0001) increased significantly. LogMAR BCVA improved from 0 (0–0.1) to 0 (0–0) (p = 0.0147). The average types of medications per eye decreased from 2.82 ± 1.01 to 1.32 ± 0.64 (p = 0.025), and the proportion of eyes using glucocorticoids significantly decreased from 63.6% to 13.6% (p = 0.001). No severe SL-related adverse events were reported. Conclusions: SL treatment quickly alleviated subjective symptoms as well as clinical signs of DE with good safety and enhanced the visual function and vision-related quality of life, showing its usefulness in the management of severe DE. Full article

Background: The aim of the present study was to establish a cut-off value of the Lipid Layer Pattern (LLP) between participants with different subtypes of Dry Eye Disease (DED) including Deficient Dry Eye (ADDE), Evaporative Dry Eye (EDE), and Mixed Dry Eye (MDE). Methods: 240 participants diagnosed with DED according to the Tear Film and Ocular Surface Society in the Dry Eye Workshop II guidelines were included in the study. Tear Meniscus Height (TMH) using the Tearscope illumination and Meibomian Gland Loss Area (MGLA) using the Keratograph 5M were assessed to categorize the participants into an ADDE group, EDE group, or MDE group. Then, the LLP was assessed using the Tearscope following the Guillon (LLP-G) and Colour (LLP-C) schemes. Results: Receiver Operating Characteristics (ROC) showed that both LLP-G and LLP-C have no diagnostic potential in distinguishing between ADDE and EDE participants (both p ≥ 0.724). However, to differentiate the ADDE participants from the MDE, ROC procedures showed a good diagnostic potential with cut-off values of Closed Meshwork-Wave (AUC ± SD = 0.609 ± 0.049, p = 0.038, sensitivity: 23.9%; specificity: 76.1%) and Grey-White (AUC ± SD = 0.611 ± 0.050, p = 0.034, sensitivity: 40.7%; specificity: 73.9%) for LLP-G and LLP-C, respectively. Also, a significant potential to distinguish between the EDE from MDE participants was found, with cut-off values of Closed Meshwork (AUC ± SD = 0.604 ± 0.049, p = 0.043, sensitivity: 40.8%; specificity: 76.1%) and Grey-White (AUC ± SD = 0.604 ± 0.051, p = 0.038, sensitivity: 44.7%; specificity: 73.9%) for LLP-G and LLP-C, respectively. Conclusions: Using the Tearscope, both LLP-G and LLP-C has diagnostic potential to distinguish MDE participants from the other subtypes of DED. Full article

Background: This study aimed to evaluate the impact of image enhancement techniques on the interobserver reliability of tear break-up time (TBUT), tear meniscus height (TMH), corneal fluorescein staining (CFS) scoring, and conjunctivochalasis detection using the Smart Eye Camera (SEC), a portable device for anterior segment examination. Methods: A retrospective analysis was conducted on video recordings captured by the SEC from 46 patients with dry eye disease (DED). Separate sets of images were created for each level of enhancement: unenhanced (G0), mildly enhanced (G3), and strongly enhanced (G7). These sets were not intermixed, ensuring that each enhancement level was assessed independently. Three observers—two DED specialists and one general ophthalmologist—assessed TBUT, TMH, CFS scores, and conjunctivochalasis. Interobserver reliability was evaluated using intraclass correlation coefficients (ICCs) for each image set. Results: Interobserver reliability for CFS scores significantly improved with G3, yielding an ICC of 0.8413. In contrast, G7 improved reliability for TBUT measurements (ICC = 0.7381), but led to a notable decrease in reliability for both CFS scoring (ICC = 0.2259) and conjunctivochalasis detection (ICC = 0.0786). Furthermore, the assessment of TMH demonstrated a progressive decline in accuracy with increasing levels of image enhancement. Conclusions: Image enhancement using the SEC improved the diagnostic consistency of dry eye specialists and general ophthalmologists, especially for TBUT and CFS assessments. However, excessive enhancement may obscure key diagnostic features, indicating the need for careful optimization of image processing techniques depending on the diagnostic focus. Full article

Objective: To evaluate the accuracy of diagnosing dry eye disease (DED) by using the Visionix VX120+, to establish reference values for tear meniscus height (TMH) and non-invasive break-up time (NIBUT), and to compare the NIBUT measurements with the fluorescein tear break-up time (FBUT), Methods: fifty-eight subjects (34 dry eye and 24 control) were enrolled. The TMH, first NIBUT, and NIBUT50% were evaluated with the Visionix VX120+, and the FBUT was measured with a slit-lamp. The Receiver Operating Characteristic (ROC) curve was used to evaluate the diagnostic performance, and the Bland–Altman method was performed to analyze the agreement. Results: The areas under the curve were 0.62, 0.60, and 0.70 for the TMH, first NIBUT, and NIBUT50%, respectively. The optimal cut-off values (sensitivity, specificity) were 0.29 (0.62, 0.67), 5.05 (0.85, 0.46), and 7.35 (0.65, 0.79) for the TMH, first NIBUT, and NIBUT50%, respectively. The mean differences (lower, upper limits of agreement) were −1.10 (−8.78, 6.58) and 1.55 (−5.68, 8.78) for the first NIBUT vs. FBUT and the NIBUT50% vs. FBUT, respectively. Conclusions: In conclusion, the NIBUT50% can be a useful tool for dry eye screening, with acceptable values of sensitivity and specificity. First, the NIBUT and NIBUT50% should not be used interchangeably with the FBUT. Full article

Background and Objectives: Infrared light is used to image the Meibomian glands through their thermal profile. This study aimed to investigate the effects of a combination of heating and an eyelid massage on Meibomian gland visibility and tear film parameters. Materials and Methods: Twenty-four participants (26 ± 6.9 years) were enrolled in this prospective study, which involved imaging the Meibomian glands of both the lower and upper eyelid and assessing the non-invasive breakup time (NIBUT), tear meniscus height (TMH), and blink rate (using the CA-800, Topcon) at baseline after five minutes of eyelid warming followed by a five-minute eyelid massage. The second session, which was randomised in sequence, repeated the same measurements but without the inclusion of any eyelid warming or massage as the control condition. Results: While there was no change in lower lid Meibomian gland appearance as a result of eyelid heating, eyelid massage, or multiple lid eversion (median 2.0, range 0.0 to 4.0; p = 0.782), there was a change in upper lid appearance 5 min after heating and lid massage (p = 0.025), but again, multiple lid eversion had no effect (p > 0.05). The NIBUT decreased on second lid eversion (p = 0.049), although this was not evident on the third lid eversion (p = 0.090). The effect on NIBUT was also apparent with heating (p = 0.034 immediately after) but was sustained with 5 min of eyelid massage (p = 0.031). The TMH increased with heating (p < 0.001), and this effect was sustained with 5 min of eyelid massage (p = 0.011), but there was no lid eversion effect (p > 0.05). The blink rate was unaffected by heating, eyelid massage, or multiple eversions of the eyelids (median 24 blinks/min, range 8 to 59 blinks/min; p = 0.61). Conclusions: Eyelid warming can increase the visibility of the Meibomian glands, although this effect was only observed with upper lid imaging and the effect dissipated after 5 min of eyelid massage. Warming and massage also disrupt the tear film, as does multiple lid eversion, emphasising the need to use the least invasive tear film assessment techniques first. Full article

We aim to evaluate the effectiveness of an acupuncture steam-warming eye mask (ASEM) on dry eye disease (DED) in visual display terminal (VDT) users. This prospective randomized clinical trial included VDT users with DED-related features who were randomly assigned to the ASEM group (ASEM for 2 weeks, 20 participants) or the steam-warming eye mask (SEM) group (SEM for 2 weeks, 20 participants). The tear film break-up time (TBUT), Schirmer test, tear meniscus height, ocular surface staining scores, eyelid and meibomian gland exam, subjective symptoms, and quality of life (QoL) scores before and after treatment were collected. A generalized linear mixed model was applied to compare the improvement of symptoms and signs between the two groups. After the 2-week treatment, all the subjective symptoms and questionnaire scores in the ASEM group improved significantly (all p < 0.05), whereas the feelings of relaxation, comfortable, and refreshment did not change in the SEM group (both p > 0.05). The TBUT, tear meniscus height, and meibum quality in the lower eyelid were significantly better in the ASEM group than the SEM group (all p < 0.05), whereas no significant changes were observed in the Schirmer test and ocular surface staining scores. Compared with the SEM group, the ASEM group experienced a stronger feeling of refreshment (p = 0.013), lower sensation of ocular discharge (p = 0.031), higher TBUT (p = 0.045), better meibomian gland expressibility of both eyelids (both p < 0.05), and better meibum quality of both eyelids (both p < 0.05), even after adjustments for age and sex. In conclusion, comparing with SEM, ASEM can improve some subjective DED symptoms, tear film stability, and meibum status in VDT users. Full article

Background/Objectives: Modern life is inconceivable without visual display terminal (VDT) work, including smartphones, computers, and games for both children and adults. VDT work under air conditioning and low humidity poses a high risk of dry eye and digital eye strain. Methods: Thirty-one participants were randomly divided into two groups using a desktop humidifier with photocatalytic technology, namely the “with mist” (humidifier) group and “without mist” (control) group. Participants performed VDT tasks using the humidifier with or without mist for 1 h. Ocular subjective symptoms and objective tear film parameters were assessed before, immediately after, and 1.5 h after the VDT task with or without mist. (Registry ID: UMIN000054379) Results: Ocular symptom scores improved significantly in the humidifier group immediately after the VDT task and up to 1.5 h later compared to before the task (p < 0.001, =0.006, respectively). Immediately after the VDT task, tear meniscus height was significantly higher and non-invasive breakup time was significantly longer in the humidifier group than in the control group (p < 0.001, =0.040, respectively). Plugging of the meibomian gland orifices was significantly reduced only in the humidifier group immediately after the VDT task compared to before the VDT task and remained significantly reduced up to 1.5 h later (p = 0.004, 0.016, respectively). Conclusions: The use of the photocatalytic desktop humidifier during VDT task resulted in significant improvements in the tear film parameters and subjective symptoms. The photocatalytic desktop humidifier could be effective in alleviating dry eye and eye strain in computer users in a modern office environment. Full article

Background: Dry eye disease (DED) is characterized by the loss of ocular surface homeostasis with specific signs and symptoms. Studying the progression of a multifactorial disease is exceedingly challenging for researchers because several factors can influence it. The present study aims to study changes in tear meniscus height (TMH), lipid layer pattern (LLP), and bulbar hyperemia over time in untreated DED participants. Methods: This retrospective longitudinal study included 73 participants (146 eyes) diagnosed with DED since at least 2013. Participants underwent new examinations between 2021 and 2023, grouped by 8-, 6-, or 4-year follow-up periods. TMH, LLP, and bulbar hyperemia were assessed in both examinations. No participant received pharmacological treatment for DED. Results: Differences in TMH, bulbar hyperemia, and LLP between sessions were obtained in the 8-year group (p ≤ 0.027). Differences in bulbar hyperemia and LLP between sessions were obtained in the 6-year group (p ≤ 0.022). The only differences in LLP between sessions were obtained in the 4-year group (p < 0.005). Conclusion: Changes in TMH were obtained after periods of eight years from the first eye examination. Also, changes in bulbar hyperemia were obtained at periods of 8 and 6 years; however, changes in LLP could be found from 4-year follow-ups. Full article