Peripapillary retinal nerve fibre layer thickness measurement with SD-OCT in normal and glaucomatous eyes:distribution and correlation with age

AIM:To determine peripapillary retinal fiber layer thickness (RNFL) measured with spectral domain optical coherence tomography (SD-OCT) in normal and glaucomatous eyes in a large sample of exclusively white population and compare results with other similarly constructed studies.METHODS:Average, maximum, minimum and per quadrant RNFL thickness were measured in normal and glaucomatous Greek patients with a scanning laser ophthalmoscope (SLO)/SD-OCT device. The effect of age in normal RNFL thickness was also determined.RESULTS: A total of 278 normal (278 patients) and 67 glaucomatous (67 patients) eyes were included in the study. Average RNFL thickness was 114.8±13.3μm in normal and 92.1±18.5μm in glaucomatous eyes (P<0.001). In normal discs, superior quadrant was the thickest, followed by the inferior, nasal and temporal. Decline of normal RNFL thickness with age was statistically significant for average RNFL thickness (1.92μm per decade of life) and for the superior and inferior quadrants of the disc.CONCLUSION:SD-OCT peripapillary RNFL measurements can be used to distinguish between normal and glaucomatous eyes and establish normative databases, since normal disc measurements differ between different ethnic groups and between different SD-OCT devices.     

Subjective versus objective dry eye disease in patients with moderate-severe thyroid eye disease

Purpose

To compare the subjective versus Objective dry eye disease (DED) in patients with moderate-severe thyroid eye disease (TED).

共焦显微镜评价长期配戴角膜接触镜对眼角膜组织的影响

目的应用共焦显微镜对长期配戴角膜接触镜患眼在不同时期的角膜组织的变化进行观察和分析。方法选择于大连医科大学附属一院眼科门诊进行检查的戴角膜接触镜患者47例（93眼1，年龄为17-38岁，屈光度为-1．75- 10．00D．平均日戴时间超过8h，戴镜时间为1～18年。分为三组：第一组（G1），戴镜时间5年以内者（含5年）；第二组（G2），戴镜时间5～10年者（含10年）；第三组（G3），戴镜时间10年以上者。另选择未戴角膜接触镜者15例（30眼）为第四组（G4），年龄为18～40岁，屈光度为-0．75～8．00D。共焦显微镜记录各层角膜图像,并对各层组织细胞形态、细胞密度等进行自动分析。四组间统计学分析采用单因素方差分析。结果①四组的角膜中央区Langerhans细胞密度分别为：（206．0±21．7）个/μm^2、（229．0±28．0）个／μm^2、（251．0±50．8）个／μm^2（154．0±36．7）个／μm^2。四组的角膜缘Langerhans细胞密度分别为：（308．0±76．4）个／μm^2、（364．0±53．9）个／μm^2．（417．0±83．6）个／μm^2、（254．0±127．0）个／μm^2。四组之间差异有统计学意义（P〈0．05）。②四组的角膜上皮厚度分别为：（51．2±4．5）μm、（45．6±2．7）μm、（43．5±5．0）μm、（53．6±2．5）μm。四组的前基质角膜细胞密度分别为：（1157．0±120．5）个／μm^2、（1094．0±103．0）个／μm^2、（1011．0±197．8）个／μm^2、（1187．0±139．0）个／μm^2。四组之间差异有统计学意义（P〈0．05）③四组的多形性内皮细胞百分比分别为：（36．2±1．7）％、（33．7±1．7）％、（32．8±1．5）％、（45．1±9．1）％四组的内皮细胞异形性百分比分别为：（56．5±3.4）％、（63．3±3．7）％、（64．2±7．11％、（45．8±12．2）％四组之间差异有统计学意义（P〈0．05）④四组的角膜全层厚度、后?     

飞秒激光制瓣LASIK术后泪膜变化及相关性分析

目的 观察飞秒激光制瓣准分子激光原位角膜磨镶术后泪膜的变化,BUT、泪液分泌试验和泪河高度的相关性.方法 临床病例系列研究.收集2013年8～9月长春爱尔眼科医院行飞秒激光制瓣LASIK术并随访3个月的患者120例(240只眼),观察术前、术后1周、1、2和3个月患者的荧光素检查的泪膜破裂时间(BUT)、Oculus角膜地形图仪检查的BUT、泪液分泌试验(S Ⅰ t)、Oculus角膜地形图仪检查的泪河高度(TMH)的变化,同时观察荧光素BUT和Oculus BUT、泪液分泌试验和Oculus泪河高度的相关性.结果 Oculus BUT:术后1周与术前相比有差异有统计学意义(P=0.00＜0.05),术后1、2、3个月与术前相比差异无统计学意义(P =0.556,0.663,0.087＞0.05).荧光素BUT:术前荧光素BUT与术后1周、l、2、3个月相比均差异有统计学意义(P =0.033,0.025,0.004,0.000＜ 0.05).Schirmer Ⅰ试验:术后1周、1个月与术前差异有统计学意义(P =0.000,0.002＜0.05),术后2、3个月与术前差异无统计学意义(P=0.776,0.753＞0.05).泪河高度:术后1周、1个月与术前相比差异有统计学意义(P =0.00＜0.05),术后2、3个月与术前相比差异无统计学意义(P =0.096,0.229＞0.05).Oculus BUT和荧光素BUT相关分析:相关关系为正相关.泪河高度和Schirmer Ⅰ相关分析:无相关关系.结论 飞秒激光制瓣准分子激光原位角膜磨镶术术后早期影响泪膜的稳定性;Oculus角膜地形图仪非侵入性BUT检查具有可靠性,重复性较好,可以作为临床干眼诊断的一个参考标准.     

Morphology of corneal nerves in soft contact lens wear. A comparative study using confocal microscopy

The aim of this study was to evaluate corneal innervation in soft contact lens wearers using the Tomey Confoscan confocal microscope (40x/0.75 objective lens). Three distinct age- and sex-matched subject groups were involved, including extended soft (hydrogel and silicone-hydrogel) contact lens wearers, overnight soft (hydrogel) contact lens wearers, and non contact lens wearers. A number of variables were objectively measured, subjectively evaluated, or graded in order to investigate the distribution and morphology of corneal nerves. For most of the evaluated parameters, no statistically significant differences were found. However, qualitative observations showed noticeable differences in corneal nerve appearance among the different subject groups; the degree of corneal oedema was suggested as the main causative factor. In conclusion, neither the short-term (overnight wear) nor the long-term (12-month extended wear) soft contact lens wear appeared to affect the morphology and/or distribution of corneal nerves as viewed with confocal microscopy.     

羊膜移植联合亲水性软性角膜接触镜治疗早期眼烧伤

目的 观察羊膜移植联合亲水角膜接触镜治疗早期眼烧伤的临床疗效.方法 21例（21眼）早期眼烧伤患者,采用羊膜移植并佩戴亲水性软性角膜接触镜治疗,术后随访3月.结果 所有患眼术后症状均有不同程度缓解;20例眼表基本稳定,视力不同程度提高;2例角膜云翳;l例眼结膜表层重建,但发生角膜斑翳.无严重眼部并发症发生.结论 羊膜移植联合亲水性角膜接触镜治疗各种早期眼烧伤安全、有效,值得在临床上广泛推广使用.     

Is there a question of safety with continuous wear?

The availability of silicone‐containing hydrogel contact lenses (SCHCLs) has refocused attention on the risks associated with continuous wear (CW). The major barrier to optometrists prescribing CW in Western societies is a perceived danger of microbial keratitis (MK). This perception has been shaped largely by educators who have developed their opinions from case reports in the ophthalmic literature, sensationalist lay press reports and later epidemiological studies and from prominent physicians in tertiary referral centres, following an increased incidence of MK with extended wear (EW) of traditional hydrogel materials. The basis for the perceived lack of safety is the higher risk of MK with EW compared to daily wear and incidence figures that suggest an unacceptable level of MK in a population at risk, albeit a small risk on an individual basis. In this paper, I re‐evaluate die validity of the previous data and challenge the conclusions regarding the nature of the risk with traditional hydrogel lens materials. Areas under scrutiny include diagnostic criteria, morbidity caused by different micro‐organisms, potential bias in studies and reports, analysis of visual outcomes and cost to the community, and improvements over time in the understanding and handling of contact lens‐related complications. Significant loss of vision with EW appears to be less frequent than is the common perception. When the risks are placed in the perspective of other data such as that for refractive surgery, the arguments against EW do not seem so compelling. The high oxygen transmissibility of SCHCLs may enable safe CW but a large‐scale epidemiological study is needed to allay remaining doubts. Any such future studies should note the points outlined in this document.     

玻璃酸钠滴眼液联合软性角膜接触镜在翼状胬肉切除术后的早期应用

目的:探讨3g/L玻璃酸钠滴眼液联合软性角膜接触镜对翼状胬肉术后早期角膜上皮愈合及局部舒适度的影响.方法:选取90例90眼原发性单眼翼状胬肉患者,行翼状胬肉切除联合自体角膜缘干细胞移植术,术毕随机将患者分为3组,A组(研究组)术毕立即戴软性角膜接触镜,次日给予3g/L玻璃酸钠滴眼液及左氧氟沙星滴眼液点眼(4次/d),妥布霉素地塞米松眼膏涂眼(1次/晚),术后7d取下角膜接触镜;B组(常规用药组)常规予左氧氟沙星滴眼液点眼(4次/d),妥布霉素地塞米松眼膏涂眼(1次/晚);C组在B组的基础上加用3g/L玻璃酸钠滴眼液(4次/d).观察并比较各组术后角膜上皮愈合时间及不同时间点的眼部疼痛评分情况.结果:A组术后6h,1、3d疼痛评分均低于其余两组,差异有统计学意义(P<0.05);术后5、7d,三组疼痛评分无明显差异(P>0.05).术后第1d,三组均无完全愈合者;术后2d,A组的角膜上皮愈合率显著高于B组(P=0.015),而A组和C组及B组和C组比较,差异均无统计学意义(P>0.05);术后3d,A组的角膜上皮完全愈合率均高于其余两组,差异有统计学意义(P<0.05).结论:翼状胬肉术后早期应用3g/L玻璃酸钠滴眼液联合佩戴软性角膜接触镜可以加快角膜上皮缺损修复,减轻局部疼痛,显著改善患眼局部舒适度.     

Incidence and morbidity of hospital‐presenting corneal infiltrative events associated with contact lens wear

Aim : To determine the incidence and morbidity (visual loss) of hospital‐presenting corneal infiltrative events (CIEs) associated with the wearing of current generation contact lenses. Methods : All contact lens wearers presenting with any form of corneal infiltrate/ulcer to a hospital centre in Manchester, UK, were surveyed in this 12‐month, prospective, hospital‐based epidemiological study. A clinical severity matrix was used to quantify the overall severity of presenting signs and symptoms. The size of the hospital catchment population and the wearing modalities (daily wear [DW] or extended wear [EW]) and lens types used in that population were estimated from relevant demographic and market data to facilitate the calculation of incidence. We also attempted to ascertain, from their eye care practitioners, the visual acuity (VA) of patients suffering from CIEs prior to and at about six months following attendance at the hospital. Results : During the survey period, 118 patients presented with CIEs of varying severity. The annual incidence (cases per 10,000 wearers) for all wearing modalities and lens types is 21.3 (95 per cent confidence interval 17.8 to 25.5). The incidence of CIEs for each wearing modality and lens type is: DW rigid, 8.6 (3.9 to 18.7); DW hydrogel daily disposable, 14.0 (9.3 to 21.0); DW hydrogel (excluding daily disposable), 20.4 (15.9 to 26.2); DW silicone hydrogel, 55.9 (9.9 to 309.6); EW rigid, zero (0.0 to 1758.8); EW hydrogel, 144.6 (66.4 to 311.8) and EW silicone hydrogel, 118.6 (75.2 to 186.7). The risk of developing a CIE with EW lenses was 8.1 (5.3 to 12.5) times greater than that with DW lenses (p < 0.0001). Although there was no difference between EW hydrogel and EW silicone hydrogel lenses with respect to the risk of developing CIEs, the clinical severity of CIEs was greater with EW hydrogel lenses (p = 0.04). Results of VA for pre‐and post‐hospital attendance were obtained from 38 patients, none of whom lost more than one line of VA. For the study population, zero patients (95 per cent CI: 0 to 9.2 per cent) suffered a significant loss of VA as a result of developing a CIE. Conclusions : Overall, there is an eight times higher incidence of CIEs in wearers who sleep in contact lenses compared with wearers who use lenses only during the waking hours. For those who choose to routinely or intermittently sleep in soft contact lenses, silicone hydrogels are the lens of first choice because CIEs are less clinically severe with this lens type compared with hydrogel lenses. The rate of significant visual loss as a result of developing a CIE is low.     

A novel murine model for contact lens wear reveals clandestine IL-1R dependent corneal parainflammation and susceptibility to microbial keratitis upon inoculation with Pseudomonas aeruginosa

PurposeContact lens wear carries a risk of complications, including corneal infection. Solving these complications has been hindered by limitations of existing animal models. Here, we report development of a new murine model of contact lens wear.MethodsC57BL/6 mice were fitted with custom-made silicone-hydrogel contact lenses with or without prior inoculation with Pseudomonas aeruginosa (PAO1-GFP). Contralateral eyes served as controls. Corneas were monitored for pathology, and examined ex vivo using high-magnification, time-lapse imaging. Fluorescent reporter mice allowed visualization of host cell membranes and immune cells. Lens-colonizing bacteria were detected by viable counts and FISH. Direct-colony PCR was used for bacterial identification.ResultsWithout deliberate inoculation, lens-wearing corneas remained free of visible pathology, and retained a clarity similar to non-lens wearing controls. CD11c-YFP reporter mice revealed altered numbers, and distribution, of CD11c-positive cells in lens-wearing corneas after 24 h. Worn lenses showed bacterial colonization, primarily by known conjunctival or skin commensals. Corneal epithelial cells showed vacuolization during lens wear, and after 5 days, cells with phagocyte morphology appeared in the stroma that actively migrated over resident keratocytes that showed altered morphology. Immunofluorescence confirmed stromal Ly6G-positive cells after 5 days of lens wear, but not in MyD88 or IL-1R gene-knockout mice. P. aeruginosa-contaminated lenses caused infectious pathology in most mice from 1 to 13 days.ConclusionsThis murine model of contact lens wear appears to faithfully mimic events occurring during human lens wear, and could be valuable for experiments, not possible in humans, that help solve the pathogenesis of lens-related complications.     

Cytomorphological assessment of the lid margin in relation to symptoms,contact lens wear and lid wiper epitheliopathy

Purpose: Lid wiper epitheliopathy (LWE) is insufficiently understood from a cytological perspective. This study explored the relationship between lid margin cytomorphology, LWE, contact lens wear, and lens-related symptoms.Methods: Habitual, symptomatic (n = 20) and asymptomatic (n = 20) soft, rigid gas permeable (n = 18) and non-contact lens wearers (n = 19) were enrolled. LWE was graded using lissamine green and the Korb scale. Subjective symptoms were assessed using the Ocular Surface Disease Index and the Contact Lens Dryness Evaluation Questionnaire. Impression cytology samples obtained from the central upper and lower lid margins of both eyes stained histologically to highlight keratinization and imaged using high-resolution microscopy. A masked investigator digitally delimited and measured the average sagittal width of the lid wiper conjunctiva and mucocutaneous junction using ImageJ. Results:The upper lid wiper conjunctiva measured 424 ± 171 μm, 404 ± 75, 667 ± 219 and 266 ± 64 in asymptomatic soft, symptomatic soft, rigid and non-contact lens wearers, respectively. The corresponding lower lid wiper conjunctivae measured 141 ± 57 μm, 232 ± 150, 519 ± 212 and 225 ± 102, which was significantly narrower than that of the upper eyelid in most cases (p < 0.05). Symptoms were not associated with lid margin changes; however, rigid lens wear and clinical LWE were associated with histologically enlarged lid wiper conjunctival areas and increased keratinization.Conclusion: A novel, exploratory account of histological measures of LWE and cytomorphological change associated with contact lens wear suggests mechanical or frictional cellular insult is occurring at the lid wiper conjunctiva.