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Rajan R, Makrai E, Lee JH, Singh S, Chinnery HR, Downie LE. Evaluating the efficacy and safety of therapeutic interventions for corneal neuropathy: A systematic review. Ocul Surf 2024; 33:80-98. [PMID: 38688453 DOI: 10.1016/j.jtos.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/02/2024]
Abstract
Corneal neuropathy involves corneal nerve damage that disrupts ocular surface integrity, negatively impacting quality-of-life from pain and impaired vision. Any ocular or systemic condition that damages the trigeminal nerve can lead to corneal neuropathy. However, the condition currently does not have standardized diagnostic criteria or treatment protocols. The primary aim of this systematic review was to evaluate the efficacy and safety of interventions for treating corneal neuropathy. Randomized controlled trials (RCTs) that investigated corneal neuropathy treatments were eligible if the intervention(s) was compared to a placebo or active comparator. Comprehensive searches were conducted in Ovid MEDLINE, Ovid Embase and clinical trial registries from inception to July 2022. The Cochrane Risk-of-Bias 2 tool was used to assess study methodological quality. Certainty of the body of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Overall, 20 RCTs were included. Evaluated interventions comprised regenerative therapies (n = 6 studies), dietary supplements (n = 4), anti-glycemic agents (n = 3), combination therapy (n = 3), supportive therapies (n = 2) and systemic pain pharmacotherapies (n = 2). Nine RCTs were judged at high risk of bias for most outcomes. Definitions for corneal neuropathy in the populations varied substantially across studies, consistent with lack of consensus on diagnostic criteria. A diverse range of outcomes were quantified, likely reflecting absence of an agreed core outcome set. There was insufficient evidence to draw definitive conclusions on the efficacy or safety of any intervention. There was low or very low certainty evidence for several neuroregenerative agents and dietary supplements for improving corneal nerve fiber length in corneal neuropathy due to dry eye disease and diabetes. Low or very low certainty evidence was found for neuroregenerative therapies and dietary supplements not altering corneal immune cell density. This review identifies a need to standardize the clinical definition of corneal neuropathy and define a minimum set of core outcome measures. Together, this will provide a foundation for improved phenotyping of clinical populations in studies, and improve the capacity to synthesize data to inform evidence-based care. Protocol registration: PROSPERO ID: CRD42022348475.
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Affiliation(s)
- Rajni Rajan
- Department of Optometry and Vision Sciences, University of Melbourne, Carlton, Victoria, Australia
| | - Eve Makrai
- Department of Optometry and Vision Sciences, University of Melbourne, Carlton, Victoria, Australia
| | - Ji-Hyun Lee
- Department of Optometry and Vision Sciences, University of Melbourne, Carlton, Victoria, Australia
| | - Sumeer Singh
- Department of Optometry and Vision Sciences, University of Melbourne, Carlton, Victoria, Australia
| | - Holly R Chinnery
- Department of Optometry and Vision Sciences, University of Melbourne, Carlton, Victoria, Australia
| | - Laura E Downie
- Department of Optometry and Vision Sciences, University of Melbourne, Carlton, Victoria, Australia.
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Song Y, Deng S, Lyv X, Xu Y, Zhang F, Guo N. Corneal subbasal nerve plexus reinnervation and stromal cell morphology with different cap thicknesses in small incision lenticule extraction. EYE AND VISION (LONDON, ENGLAND) 2024; 11:15. [PMID: 38584290 PMCID: PMC11000360 DOI: 10.1186/s40662-024-00381-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/10/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE The corneal cap thickness is a vital parameter designed in small incision lenticule extraction (SMILE). The purpose was to investigate the changes in corneal subbasal nerve plexus (SNP) and stromal cells with different cap thicknesses and evaluate the optimized design for the surgery. METHODS In this prospective, comparative, non-randomized study, a total of 108 eyes of 54 patients who underwent SMILE were allocated into three groups with different corneal cap thicknesses (110 μm, 120 μm or 130 μm group). The SNP and stromal cell morphological changes obtained from in vivo corneal confocal microscopy (IVCCM) along with their refractive outcomes were collected at 1 week, 1 month, 3 months and 6 months postoperatively. One-way analysis of variance (ANOVA) was used to compare the parameters among the three groups. RESULTS The SNPs in the three groups all decreased after surgery and revealed a gradual increasing trend during the 6-month follow-up. The values of the quantitative nerve metrics were significantly lower in the 110 μm group than in the 120 μm and 130 μm groups, especially at 1 week postoperatively. No difference was detected between the 120 μm and 130 μm groups at any time point. Both Langerhans cells and keratocytes were activated after surgery, and the activation was alleviated during the follow-up. CONCLUSIONS The SMILE surgeries with 110 μm, 120 μm or 130 μm cap thickness design achieved good efficacy, safety, accuracy and stability for moderate to high myopic correction while the thicker corneal cap was more beneficial for corneal nerve regeneration.
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Affiliation(s)
- Yanzheng Song
- Beijing Ophthalmology and Visual Sciences Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Shijing Deng
- Beijing Ophthalmology and Visual Sciences Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Xiaotong Lyv
- Beijing Ophthalmology and Visual Sciences Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Yushan Xu
- Beijing Ophthalmology and Visual Sciences Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Fengju Zhang
- Beijing Ophthalmology and Visual Sciences Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
| | - Ning Guo
- Beijing Ophthalmology and Visual Sciences Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
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Petropoulos IN, John K, Al-Shibani F, Ponirakis G, Khan A, Gad H, Mahfoud ZR, Altarawneh H, Rehman MH, Al-Merekhi D, George P, Ibrahim F, Francis R, Canibano B, Deleu D, El-Sotouhy A, Vattoth S, Stettner M, Own A, Shuaib A, Akhtar N, Kamran S, Malik RA. Corneal immune cells as a biomarker of inflammation in multiple sclerosis: a longitudinal study. Ther Adv Neurol Disord 2023; 16:17562864231204974. [PMID: 37915502 PMCID: PMC10617262 DOI: 10.1177/17562864231204974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/12/2023] [Indexed: 11/03/2023] Open
Abstract
Background Corneal immune cells (ICs) are antigen-presenting cells that are known to increase ocular and systemic inflammatory conditions. Objective We aimed to assess longitudinal changes in corneal IC in patients with multiple sclerosis (MS) and relation to disability and ongoing treatment. Design Prospective observational study conducted between September 2016 and February 2020. Methods Patients with relapsing-remitting MS (RRMS) (n = 45) or secondary progressive MS (SPMS) (n = 15) underwent corneal confocal microscopy (CCM) at baseline and 2-year follow-up for estimation of corneal IC density [dendritic cells with (DCF) (cells/mm2) or without nerve fiber contact (DCP); and non-dendritic cells with (NCF) or without nerve fiber contact (NCP)]. Optical coherence tomography, neuroimaging, and disability assessments were additionally performed. Healthy controls (n = 20) were assessed at baseline. Results In both RRMS and SPMS compared to controls, DCP (p < 0.001 and p < 0.001, respectively) and DCF (p < 0.001 and p = 0.005) were higher and NCF (p = 0.007 and p = 0.02) was lower at baseline. DCP showed excellent performance in identifying patients with MS (sensitivity/specificity = 0.88/0.90) followed by DCF (0.80/0.75) and NCF (0.80/0.85). At follow-up compared to baseline, DCP (p = 0.01) was significantly reduced, and NCP (p = 0.004) and NCF (p = 0.04) were increased. Subgroup analysis showed that baseline NCP and NCF were significantly higher (p = 0.04-0.05) in patients who switched disease-modifying treatment, and baseline NCP (p = 0.05) was higher in patients on interferon. Conclusion Baseline and change in corneal IC were related to axonal degeneration and treatment status. Evaluation of corneal IC using CCM may allow an assessment of ongoing inflammation, disease progression, and the effect of treatment in MS.
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Affiliation(s)
| | - Karen John
- Division of Research, Weill Cornell Medicine, Doha, Qatar
| | | | | | - Adnan Khan
- Division of Research, Weill Cornell Medicine, Doha, Qatar
| | - Hoda Gad
- Division of Research, Weill Cornell Medicine, Doha, Qatar
| | - Ziyad R. Mahfoud
- Division of Medical Education, Weill Cornell Medicine, Doha, Qatar
- Division of Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | | | | | | | - Pooja George
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Faiza Ibrahim
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Reny Francis
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Dirk Deleu
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Surjith Vattoth
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mark Stettner
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
| | - Ahmed Own
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
- Department of Medicine, University of Alberta, Edmonton, Qatar
| | - Naveed Akhtar
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Rayaz A. Malik
- Weill Cornell Medicine-Qatar of Cornell University, Research Division, Qatar Foundation, Education City, Al-Luqta street, Doha 24144, Qatar
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McDonald M, Janik SB, Bowden FW, Chokshi A, Singer MA, Tighe S, Mead OG, Nanda S, Qazi MA, Dierker D, Shupe AT, McMurren BJ. Association of Treatment Duration and Clinical Outcomes in Dry Eye Treatment with Sutureless Cryopreserved Amniotic Membrane. Clin Ophthalmol 2023; 17:2697-2703. [PMID: 37720008 PMCID: PMC10505017 DOI: 10.2147/opth.s423040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/22/2023] [Indexed: 09/19/2023] Open
Abstract
Background While sutureless, cryopreserved amniotic membrane (cAM) has been shown to significantly improve signs and symptoms of dry eye disease (DED), no studies have assessed the association of cAM treatment duration to the differential response in clinical outcomes. Methods A multi-center, retrospective study was conducted on patients with moderate-to-severe DED who were treated with self-retained cAM (Prokera® Slim) for 2 to 7 days. The primary outcome measure was DEWS severity score assessed at 1 week, 1 month, and 3 months. Secondary outcome measures included ocular discomfort, visual symptoms, corneal staining, and visual acuity. Results A total of 89 eyes (77 patients) with moderate-to-severe DED (DEWS severity 3.24 ± 0.56) received treatment with self-retained cAM for 2 days (n = 10), 3 days (n = 15), 4 days (n = 12), 5 days (n = 19), 6 days (n = 6), or 7 days (n = 27). DEWS scores significantly improved at 1 week, 1 month, and 3 months for all treatment duration groups, with no significant difference observed between groups at any timepoint. In addition to an improvement in DEWS severity scores, those receiving cAM treatment for 2 days demonstrated a significant improvement in corneal staining, visual symptoms, and ocular discomfort at 1 week, 1 month, and 3 months. Conclusion This retrospective study suggests that a single placement of self-retained cAM for 2 days can significantly improve signs and symptoms of DED with a lasting benefit observed for up to 3 months.
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Affiliation(s)
| | | | | | | | | | - Sean Tighe
- BioTissue Holdings, Inc, Miami, FL, USA
- Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA
| | | | - Seema Nanda
- Nanda Dry Eye & Vision Institute, Houston, TX, USA
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Chiang JCB, Tran V, Wolffsohn JS. The impact of dry eye disease on corneal nerve parameters: A systematic review and meta-analysis. Ophthalmic Physiol Opt 2023; 43:1079-1091. [PMID: 37357424 DOI: 10.1111/opo.13186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/19/2023] [Accepted: 06/05/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE Dry eye disease (DED) is a growing global health problem with a significant impact on the quality of life of patients. While neurosensory abnormalities have been recognised as a contributor to DED pathophysiology, the potential role of in vivo corneal confocal microscopy in detecting nerve loss or damage remains unclear. This systematic review with meta-analysis (PROSPERO registered CRD42022381861) investigated whether DED has an impact on sub-basal corneal nerve parameters. METHODS PubMed, Embase and Web of Science Core Collection databases were searched from inception to 9 December 2022. Studies using laser scanning confocal microscopy to compare corneal nerve parameters of DED with healthy eyes were included. Study selection process and data extraction were performed by two independent members of the review team. RESULTS Twenty-two studies with 916 participants with DED and 491 healthy controls were included, with 21 of these studies included in subsequent meta-analyses. There was a decrease in total corneal nerve length (-3.85 mm/mm2 ; 95% CI -5.16, -2.55), corneal main nerve trunk density (-4.81 number/mm2 ; 95% CI -7.94, -1.68) and corneal nerve branch density (-15.52 number/mm2 ; 95% CI -27.20, -3.84) in DED eyes compared with healthy eyes, with subgroup analysis demonstrating that these differences were more evident in studies using NeuronJ software, a semi-automated procedure. While this review found evidence of loss of corneal nerve parameters in eyes with DED compared with healthy controls, particularly with the use of a semi-automated image analysis method, it is evident that there is substantial heterogeneity between studies in terms of corneal nerve imaging methodology. CONCLUSIONS Standardisation is required in terms of terminology and analysis, with more research needed to potentially improve the clinical applicability and practicality of corneal nerve imaging. Further investigation is also required to confirm the diagnostic accuracy of this imaging modality and its potential for monitoring DED treatment efficacy.
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Affiliation(s)
- Jeremy Chung Bo Chiang
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Vincent Tran
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - James S Wolffsohn
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK
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Boga A, Stapleton F, Chapman M, Golebiowski B. Effects of elevated serum estrogen on dry eye in women undergoing in vitro fertilisation. Ocul Surf 2023; 29:511-520. [PMID: 37422153 DOI: 10.1016/j.jtos.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE Sex hormones impact inflammatory and immune-mediated diseases. During IVF (in vitro fertilisation) treatment, circulating estrogen levels increase dramatically (10-50x) alongside changes in other hormones. This study examined changes in dry eye with IVF and its relationship with sex hormones. METHODS A two visit study was conducted on first day of menstruation when estrogen levels are lowest (baseline visit), and on day 9-11 (peak estrogen visit (PO)) of IVF. Symptoms of dry eye and ocular pain and signs of dry eye were examined. Serum hormone levels were assessed using mass spectrometry and immunoassay. Changes in signs and symptoms and associations were explored. Hierarchical multiple regression analysis assessed factors contributing to signs and symptoms. RESULTS 40 women (36.2 ± 4.0 years) completed the study. Baseline and PO oestradiol (E2) levels were 28.9 pg/ml (20) (median (IQR)); 1360 pg/ml (1276) respectively. Ocular pain and dry eye symptoms worsened (p = 0.02 and p < 0.01) and tear break up and tear secretion values decreased (p = 0.005 and 0.01) at PO. Higher E2 and lower luteinizing hormone (LH) were associated with worsening of dry eye symptoms (ρ = 0.34 p = 0.03, ρ = -0.49 p = 0.001). Reduction in LH and increase in progesterone (P4) were associated with increased ocular pain (ρ = 0.45, p = 0.004 and ρ = 0.39, p = 0.01). Dry eye symptoms were predicted by LH and tear break up (p = 0.02; R2 = 0.18). CONCLUSIONS IVF treatment resulted in significantly increased ocular symptoms and tear film alterations although these changes were not clinically significant. Dry eye signs and symptoms were poorly predicted by hormone levels.
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Affiliation(s)
- Archana Boga
- School of Optometry and Vision Science, UNSW Sydney, Australia.
| | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW Sydney, Australia.
| | - Michael Chapman
- St.George's Hospital and School of Women's & Children's Health UNSW Sydney, Australia; IVF Australia, Southern Sydney, Australia.
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Kang Y, Hu Q, Li X, Guo Z, Wu Q, Zhang H. Role of tear vasoactive intestinal peptide on dry eyes after laser keratorefractive surgery. BMC Ophthalmol 2023; 23:167. [PMID: 37081425 PMCID: PMC10116093 DOI: 10.1186/s12886-023-02857-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 03/13/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND To explore the changes in vasoactive intestinal peptide (VIP) concentration in tears post laser-assisted sub-epithelial keratomileusis (LASEK) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK) surgeries and related factors, possible association between postoperative dry eye symptoms and VIP concentration in tears, and factors influencing dry eye symptoms after different periods post LASEK and FS-LASIK surgeries. METHODS In this prospective, non-randomized, longitudinal cohort study, 23 and 22 subjects were recruited and underwent LASEK and FS-LASIK, respectively. After conducting an intact ophthalmic examination and collecting relevant surgical data, all subjects were examined for VIP concentration in their tears using ELISAs, tear-film breakup time, ocular staining and ocular surface disease index questionnaire before surgery and 1 day, 1 week, and 1 month post-surgery. RESULTS Tear VIP concentration increased significantly after both LASEK and FS-LASIK, with the highest concentration observed 1 week post-surgery (P ≤ 0.05). Tear VIP concentration correlated negatively with corneal ablation depth (AD). The extent of dry eyes was related to the operation method employed and postoperative recovery period. In FS-LASIK and LASEK subjects, dry eyes were mainly affected by the basic ocular surface status before surgery, and VIP concentration. Furthermore, in LASEK subjects, dry eyes were negatively correlated with AD. CONCLUSION VIP was stimulated and mobilized as an emergency protection post-refractive surgery and a trauma model affected by AD. It can indirectly indicate the inevitable relationship between postoperative dry eye and nerve injury. Elevated post-surgery tear VIP relieves dry eye symptoms, showing its neuroimmune role in regulating adverse injury stimulation. The present study provides a solution to the pathogenesis of postoperative dry eyes. TRIAL REGISTRATION The trial registration number: 2021JS22. Date of registration: 10 May 2021.
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Affiliation(s)
- Yang Kang
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, No. 143, Yiman Street, 150001, Harbin, Heilongjiang Province, People's Republic of China
| | - Qi Hu
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, No. 143, Yiman Street, 150001, Harbin, Heilongjiang Province, People's Republic of China
| | - Xue Li
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, No. 143, Yiman Street, 150001, Harbin, Heilongjiang Province, People's Republic of China
| | - Zidan Guo
- Outpatient department of Harbin Medical University, Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China
| | - Qiong Wu
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, No. 143, Yiman Street, 150001, Harbin, Heilongjiang Province, People's Republic of China
| | - Hong Zhang
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, No. 143, Yiman Street, 150001, Harbin, Heilongjiang Province, People's Republic of China.
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Recchioni A, Barua A, Dominguez-Vicent A. Enhancing Clinical Decision-Making in Complex Corneal Disorders: The Role of In-Vivo Confocal Microscopy. Life (Basel) 2023; 13:life13030679. [PMID: 36983835 PMCID: PMC10059758 DOI: 10.3390/life13030679] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
This study aims to describe how in-vivo confocal microscopy (ICVM) results improved diagnosis and treatment in three patients with complex corneal disorders at a single institution. Case one was a 36-year-old woman contact lens wearer referred to the hospital eye service (HES) by her community optician for a suspected corneal ulcer in her left eye. The case demonstrated that where laboratory cell culture was inconclusive, IVCM imaging improved diagnosis and more importantly adjusted the initial treatment till the complete resolution of the case. Case two was a shared-care 66-year-old keratoconus patient under a complex immunosuppression regime who had developed a recent series of post-surgical complications of fungal origin and was experiencing eye pain. IVCM was able to differentiate between an immune-mediated response and fungal keratitis and guide the clinicians towards an optimized treatment. Case three was a long-standing dry eye disease in a 64-year-old woman diagnosed with primary Sjögren’s syndrome where previous treatments failed to improve her symptomatology. IVCM was crucial for prescribing allogeneic serum eyedrops by anticipating early immune changes in the sub-basal corneal nerve plexus. In-vivo confocal microscopy can be an essential non-invasive imaging technique for improving clinicians’ diagnostic precision by adding a layer of certainty that other techniques may lack. Additionally, IVCM allows adjustment of the treatment accordingly, by instantly following any pathologic changes at the cellular level.
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Affiliation(s)
- Alberto Recchioni
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2SQ, UK
- Optometry & Vision Sciences Group, School of Life & Health Sciences, Aston University, Birmingham B4 7ET, UK
| | - Ankur Barua
- Department of Ophthalmology, Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK
| | - Alberto Dominguez-Vicent
- Division of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institute, 171 77 Stockholm, Sweden
- Correspondence:
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Recovery of Corneal Innervation after Treatment in Dry Eye Disease: A Confocal Microscopy Study. J Clin Med 2023; 12:jcm12051841. [PMID: 36902628 PMCID: PMC10003258 DOI: 10.3390/jcm12051841] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023] Open
Abstract
PURPOSE To analyze the changes in corneal innervation by means of in vivo corneal confocal microscopy (IVCM) in patients diagnosed with Evaporative (EDE) and Aqueous Deficient Dry Eye (ADDE) and treated with a standard treatment for Dry Eye Disease (DED) in combination with Plasma Rich in Growth Factors (PRGF). METHODS Eighty-three patients diagnosed with DED were enrolled in this study and included in the EDE or ADDE subtype. The primary variables analyzed were the length, density and number of nerve branches, and the secondary variables were those related to the quantity and stability of the tear film and the subjective response of the patients measured with psychometric questionnaires. RESULTS The combined treatment therapy with PRGF outperforms the standard treatment therapy in terms of subbasal nerve plexus regeneration, significantly increasing length, number of branches and nerve density, as well as significantly improving the stability of the tear film (p < 0.05 for all of them), and the most significant changes were located in the ADDE subtype. CONCLUSIONS the corneal reinnervation process responds in a different way depending on the treatment prescribed and the subtype of dry eye disease. In vivo confocal microscopy is presented as a powerful technique in the diagnosis and management of neurosensory abnormalities in DED.
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Zhang Y, Lin L, Zhu Y, Yang S, Huang X. Long-Term Clinical Outcome of Low-Temperature Plasma Ablation Treatment for Recurrent Corneal Erosions. J Clin Med 2022; 11:jcm11216280. [PMID: 36362507 PMCID: PMC9654815 DOI: 10.3390/jcm11216280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/16/2022] [Accepted: 10/19/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose: To observe the therapeutic effect of low-temperature plasma ablation in treating patients with recurrent corneal erosions (RCEs). Materials and Methods: From 2020 to 2022, 35 participants with unilateral RCEs voluntarily enrolled. Here, 35 eyes of 35 patients were treated with low-temperature plasma ablation (coblation). All surgeries were performed by the same doctor (X.H.). The coblation went back and forth over the entire erosion area around five times for about five minutes. After the operation, patients were scheduled for follow-up visits at the outpatient clinic after 1 month, 3 months, 6 months, and 12 months, and at the end of the trial. During every visit, each patient underwent an evaluation of their ocular symptoms utilizing the following: pain score, intraocular pressure, slit lamp biomicroscopic examination, dry eye analysis, corneal topography, and corneal in vivo confocal microscopy (IVCM). Results: The mean follow-up time was 12.4 ± 6.1 months, ranging from 6 to 29 months. Of the 35 patients who had low-temperature plasma ablation, 32 eyes (91.43%) were completely symptom-free and three (8.57%) eyes had repeated episodes of recurrent corneal erosions after the surgery, at 3, 10, and 12 months, respectively. The typical RCE morphologic abnormalities observed in IVCM included the deformation and relaxation of the corneal epithelium, disorganized stromal fibers, reduced nerve fiber density, and disordered organization. After low-temperature plasma ablation, the loose cysts disappeared, and the epithelium became solid and tight. There was no obvious difference in the intraocular pressure (p = 0.090) or corneal astigmatism (p = 0.175) before and after treatment. The mean pain score decreased significantly, with a preoperative score of 7.7 ± 2.4 and postoperative score of 1.1 ± 1.8 (p < 0.001). The mean corneal thickness decreased from 562.6 ± 42.2 mm to 549.6 ± 26.9 mm (p = 0.031). The mean non-invasive keratograph tear meniscus height (NIKTMH) decreased from 0.210 ± 0.054 mm to 0.208 ± 0.045 mm (p = 0.001), and the mean TBUT decreased from 6.191 ± 2.811 s to 5.815 ± 2.802 s (p < 0.001), which manifested as a slight worsening of dry eyes. In one case, the patient’s corneal astigmatism became more severe, which may be related to the high instantaneous energy when the operation did not flush in a timely manner, and it was recovered after 6 months. Conclusions: Low-temperature plasma ablation is an effective and safe procedure to treat patients with recurrent corneal erosions.
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Liu SH, Saldanha IJ, Abraham AG, Rittiphairoj T, Hauswirth S, Gregory D, Ifantides C, Li T. Topical corticosteroids for dry eye. Cochrane Database Syst Rev 2022; 10:CD015070. [PMID: 36269562 PMCID: PMC9586197 DOI: 10.1002/14651858.cd015070.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Dry eye disease (DED), arising from various etiologic factors, leads to tear film instability, ocular surface damage, and neurosensory changes. DED causes symptoms such as ocular dryness, burning, itching, pain, and visual impairment. Given their well-established anti-inflammatory effects, topical steroid preparations have been widely used as a short-term treatment option for DED. Because of potential risks of ocular hypertension, cataracts, and infections associated with the long-term use of topical steroids, published trials comparing the efficacy and safety of topical steroids (versus placebo) have mostly been of short duration (three to eight weeks). OBJECTIVES To evaluate the effectiveness and safety of topical corticosteroids compared with no treatment, placebo, other steroidal or non-steroidal therapies, or a combination of therapies for DED. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, which contains the Cochrane Eyes and Vision Trials Register; 2021, Issue 8); Ovid MEDLINE; Ovid Embase; Latin American and Caribbean Health Sciences database (LILACS); ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), without restriction on language or year of publication. The date of the last search was 20 August 2021. SELECTION CRITERIA We included randomized controlled trials (RCTs) in which topical corticosteroids, alone or in combination with tobramycin, were compared with no treatment, artificial tears (AT), vehicles, AT plus tobramycin, or cyclosporine A (CsA). DATA COLLECTION AND ANALYSIS We applied standard Cochrane methodology. MAIN RESULTS We identified 22 RCTs conducted in the USA, Italy, Spain, China, South Korea, and India. These RCTs reported outcome data from a total of 4169 participants with DED. Study characteristics and risk of bias All trials recruited adults aged 18 years or older, except one trial that enrolled children and adolescents aged between 3 and 14 years. Half of these trials involved predominantly female participants (median 79%, interquartile range [IQR] 76% to 80%). On average, each trial enrolled 86 participants (IQR 40 to 158). The treatment duration of topical steroids ranged between one week and three months; trial duration lasted between one week and six months. Eight trials were sponsored exclusively by industry, and four trials were co-sponsored by industry and institutional or governmental funds. We assessed the risk of bias of both subjective and objective outcomes using RoB 2, finding nearly half of the trials to be at high risk of bias associated with selective outcome reporting. Findings Of the 22 trials, 16 evaluated effects of topical steroids, alone or in combination with tobramycin, as compared with lubricants (AT, vehicle), AT plus tobramycin, or no treatment. Corticosteroids probably have a small to moderate effect on improving patient-reported symptoms by 0.29 standardized mean difference (SMD) (95% confidence interval [CI] 0.16 to 0.42) as compared with lubricants (moderate certainty evidence). Topical steroids also likely have a small to moderate effect on lowering corneal staining scores by 0.4 SMDs (95% CI 0.18 to 0.62) (moderate certainty evidence). However, steroids may increase tear film break-up time (TBUT) slightly (mean difference [MD] 0.70 s, 95% CI 0.06 to 1.34; low certainty evidence) but not tear osmolarity (MD 1.60 mOsm/kg, 95% CI -10.47 to 13.67; very low certainty evidence). Six trials examined topical steroids, either alone or in combination with CsA, against CsA alone. Low certainty evidence indicates that steroid-based interventions may have a small to moderate effect on improving participants' symptoms (SMD -0.33, 95% CI -0.51 to -0.15), but little to no effect on corneal staining scores (SMD 0.05, 95% CI -0.25 to 0.35) as compared with CsA. The effect of topical steroids compared to CsA alone on TBUT (MD 0.37 s, 95% CI -0.13 to 0.87) or tear osmolarity (MD 5.80 mOsm/kg, 95% CI -0.94 to 12.54; loteprednol etabonate alone) is uncertain because the certainty of the evidence is low or very low. None of the included trials reported on quality of life scores. Adverse effects The evidence for adverse ocular effects of topical corticosteroids is very uncertain. Topical corticosteroids may increase participants' risk of intraocular pressure (IOP) elevation (risk ratio [RR] 5.96, 95% CI 1.30 to 27.38) as compared with lubricants. However, when compared with CsA, steroids alone or combined with CsA may decrease or increase IOP elevation (RR 1.45, 95% CI 0.25 to 8.33). It is also uncertain whether topical steroids may increase risk of cataract formation when compared with lubricants (RR 0.34, 95% CI 0.01 to 8.22), given the short-term use and study duration (four weeks or less) to observe longer-term adverse effects. AUTHORS' CONCLUSIONS: Overall, the evidence for the specified review outcomes was of moderate to very low certainty, mostly due to high risk of bias associated with selective results reporting. For dry eye patients whose symptoms require anti-inflammatory control, topical corticosteroids probably provide small to moderate degrees of symptom relief beyond lubricants, and may provide small to moderate degrees of symptom relief beyond CsA. However, the current evidence is less certain about the effects of steroids on improved tear film quality or quantity. The available evidence is also very uncertain regarding the adverse effects of topical corticosteroids on IOP elevation or cataract formation or progression. Future trials should generate high certainty evidence to inform physicians and patients of the optimal treatment strategies with topical corticosteroids in terms of regimen (types, formulations, dosages), duration, and its time-dependent adverse profile.
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Affiliation(s)
- Su-Hsun Liu
- Department of Ophthalmology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Ian J Saldanha
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Alison G Abraham
- Department of Epidemiology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Thanitsara Rittiphairoj
- Department of Ophthalmology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Scott Hauswirth
- Department of Ophthalmology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Darren Gregory
- Department of Ophthalmology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Cristos Ifantides
- Department of Ophthalmology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Tianjing Li
- Department of Ophthalmology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
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Ren X, Chou Y, Wang Y, Jing D, Chen Y, Li X. The Utility of Oral Vitamin B1 and Mecobalamin to Improve Corneal Nerves in Dry Eye Disease: An In Vivo Confocal Microscopy Study. Nutrients 2022; 14:nu14183750. [PMID: 36145126 PMCID: PMC9504679 DOI: 10.3390/nu14183750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/03/2022] [Accepted: 09/08/2022] [Indexed: 11/24/2022] Open
Abstract
Our purpose is to demonstrate the changes in cornea nerve parameters and symptoms and signs in dry eye disease (DED) patients after oral vitamin B1 and mecobalamin treatment. In this randomized double-blind controlled trial, DED patients were randomly assigned to either the treatment group (oral vitamin B1 and mecobalamin, artificial tears) or the control group (artificial tears). Corneal nerve parameters via in vivo confocal microscopy (IVCM), DED symptoms, and signs were assessed at baseline and 1 and 3 months post-treatment. In total, 398 eyes from 199 patients were included. In the treatment group, there were significant improvements in corneal nerve length, width, and neuromas, the sign of conjunctival congestion score (CCS), symptoms of dryness, pain, photophobia, blurred vision, total symptom score, and OSDI (OSDI) at 1/3 months post-treatment (all p < 0.05). Patients who received vitamin B1 and mecobalamin showed greater improvement in CCS, dryness scores at 1 month (p < 0.05), corneal fluorescein staining (CFS) (p = 0.012), photophobia (p = 0.032), total symptom scores (p = 0.041), and OSDI (p = 0.029) at 3 months. Greater continuous improvement in CFS (p = 0.045), dryness (p = 0.033), blurred vision (p = 0.031) and total symptom scores (p = 0.023) was demonstrated at 3 months than at 1 month post-treatment in the treatment group. We found that oral vitamin B1 and mecobalamin can improve corneal nerve length, width, reflectivity and the number of neuromas in IVCM, thereby repairing epithelial cells and alleviating some ocular symptoms. Thus, vitamin B1 and mecobalamin are potential treatment options for patients with DED.
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Affiliation(s)
- Xiaotong Ren
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
| | - Yilin Chou
- Department of Ophthalmology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Yuexin Wang
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
| | - Dalan Jing
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
| | - Yanyan Chen
- Department of Ophthalmology, Daqing Oilfield General Hospital, Daqing 163311, China
| | - Xuemin Li
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
- Correspondence: ; Tel.: +86-15611908409
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Mussi N, Stuard WL, Sanches JM, Robertson DM. Chronic Hyperglycemia Compromises Mitochondrial Function in Corneal Epithelial Cells: Implications for the Diabetic Cornea. Cells 2022; 11:cells11162567. [PMID: 36010643 PMCID: PMC9406817 DOI: 10.3390/cells11162567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Mitochondrial dysfunction is a major pathophysiological event leading to the onset of diabetic complications. This study investigated the temporal effects of hyperglycemia on mitochondrial metabolism in corneal epithelial cells. To accomplish this, human telomerase-immortalized corneal epithelial cells were cultured in a defined growth medium containing 6 mM glucose. To simulate hyperglycemia, cells were cultured in a medium containing 25 mM D-glucose, and control cells were cultured in mannitol. Using metabolic flux analysis, there was a hyperosmolar-mediated increase in mitochondrial respiration after 24 h. By day 5, there was a decrease in spare respiratory capacity in cells subject to high glucose that remained suppressed throughout the 14-day period. Although respiration remained high through day 9, glycolysis was decreased. Mitochondrial respiration was decreased by day 14. This was accompanied by the restoration of glycolysis to normoglycemic levels. These changes paralleled a decrease in mitochondrial polarization and cell cycle arrest. Together, these data show that chronic but not acute hyperglycemic stress leads to mitochondrial dysfunction. Moreover, the hyperglycemia-induced loss of spare respiratory capacity reduces the ability of corneal epithelial cells to respond to subsequent stress. Compromised mitochondrial function represents a previously unexplored mechanism that likely contributes to corneal complications in diabetes.
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Chen Z, Yin X, Lin L, Shi G, Mo J. Centerline extraction by neighborhood-statistics thinning for quantitative analysis of corneal nerve fibers. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac7b63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/22/2022] [Indexed: 11/11/2022]
Abstract
Abstract
Objective. Corneal nerve fiber (CNF) has been found to exhibit morphological changes associated with various diseases, which can therefore be utilized to aid in the early diagnosis of those diseases. CNF is usually visualized under corneal confocal microscopy (CCM) in clinic. To obtain the diagnostic biomarkers from CNF image produced from CCM, image processing and quantitative analysis are needed. Usually, CNF is segmented first and then CNF’s centerline is extracted, allowing for measuring geometrical and topological biomarkers of CNF, such as density, tortuosity, and length. Consequently, the accuracy of the segmentation and centerline extraction can make a big impact on the biomarker measurement. Thus, this study is aimed to improve the accuracy and universality of centerline extraction. Approach. We developed a new thinning algorithm based on neighborhood statistics, called neighborhood-statistics thinning (NST), to extract the centerline of CNF. Compared with traditional thinning and skeletonization techniques, NST exhibits a better capability to preserve the fine structure of CNF which can effectively benefit the biomarkers measurement above. Moreover, NST incorporates a fitting process, which can make centerline extraction be less influenced by image segmentation. Main results. This new method is evaluated on three datasets which are segmented with five different deep learning networks. The results show that NST is superior to thinning and skeletonization on all the CNF-segmented datasets with a precision rate above 0.82. Last, NST is attempted to be applied for the diagnosis of keratitis with the quantitative biomarkers measured from the extracted centerlines. Longer length and higher density but lower tortuosity were found on the CNF of keratitis patients as compared to healthy patients. Significance. This demonstrates that NST has a good potential to aid in the diagnostics of eye diseases in clinic.
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Corneal nerves and their role in dry eye pathophysiology. Exp Eye Res 2022; 222:109191. [PMID: 35850173 DOI: 10.1016/j.exer.2022.109191] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/15/2022] [Accepted: 07/11/2022] [Indexed: 12/11/2022]
Abstract
As the cornea is densely innervated, its nerves are integral not only to its structure but also to its pathophysiology. Corneal integrity depends on a protective tear film that is maintained by corneal sensation and the reflex arcs that control tearing and blinking. Furthermore, corneal nerves promote epithelial growth and local immunoregulation. Thus, corneal nerves constitute pillars of ocular surface homeostasis. Conversely, the abnormal tear film in dry eye favors corneal epithelial and nerve damage. The ensuing corneal nerve dysfunction contributes to dry eye progression, ocular pain and discomfort, and other neuropathic symptoms. Recent evidence from clinical studies and animal models highlight the significant but often overlooked neural dimension of dry eye pathophysiology. Herein, we review the anatomy and physiology of corneal nerves before exploring their role in the mechanisms of dry eye disease.
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Chen Y, Wang S, Alemi H, Dohlman T, Dana R. Immune regulation of the ocular surface. Exp Eye Res 2022; 218:109007. [PMID: 35257715 PMCID: PMC9050918 DOI: 10.1016/j.exer.2022.109007] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/10/2022] [Accepted: 02/20/2022] [Indexed: 01/01/2023]
Abstract
Despite constant exposure to various environmental stimuli, the ocular surface remains intact and uninflamed while maintaining the transparency of the cornea and its visual function. This 'immune privilege' of the ocular surface is not simply a result of the physical barrier function of the mucosal lining but, more importantly, is actively maintained through a variety of immunoregulatory mechanisms that prevent the disruption of immune homeostasis. In this review, we focus on essential molecular and cellular players that promote immune quiescence in steady-state conditions and suppress inflammation in disease-states. Specifically, we examine the interactions between the ocular surface and its local draining lymphoid compartment, by encompassing the corneal epithelium, corneal nerves and cornea-resident myeloid cells, conjunctival goblet cells, and regulatory T cells (Treg) in the context of ocular surface autoimmune inflammation (dry eye disease) and alloimmunity (corneal transplantation). A better understanding of the immunoregulatory mechanisms will facilitate the development of novel, targeted immunomodulatory strategies for a broad range of ocular surface inflammatory disorders.
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Affiliation(s)
- Yihe Chen
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, 02114, USA.
| | - Shudan Wang
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, 02114, USA
| | - Hamid Alemi
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, 02114, USA
| | - Thomas Dohlman
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, 02114, USA
| | - Reza Dana
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, 02114, USA
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Zhang Y, Wu Y, Li W, Huang X. Semiautomated and Automated Quantitative Analysis of Corneal Sub-Basal Nerves in Patients With DED With Ocular Pain Using IVCM. Front Med (Lausanne) 2022; 9:831307. [PMID: 35223926 PMCID: PMC8873156 DOI: 10.3389/fmed.2022.831307] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/12/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Investigate the correlation and agreement between the results of semiautomated and fully automated quantitative analysis of the corneal sub-basal nerve plexus (SNP) in patients with dry eye disease (DED) with ocular pain using in vivo confocal microscopy (IVCM). Method A total of 50 voluntary participants were enrolled in this study, i.e., 25 DED patients with ocular pain and 25 healthy controls. Each patient underwent an evaluation of ocular symptoms that utilized: the Ocular Surface Disease Index (OSDI), the Ocular Pain Assessment Survey (OPAS), the tear film breakup time (TBUT) test, the Schirmer test, corneal staining, and IVCM. Five SNP images of the cornea of each eye were selected and analyzed using a semiautomated analysis software (NeuronJ) and a fully automated method (ACCMetrics) to quantify corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), and corneal nerve fiber length (CNFL). Results The intraclass correlation coefficient (ICC) of the CNFD (0.460 [0.382–0.532], p < 0.001), CNBD (0.608 [0.545–0.665], p < 0.001), and CNFL (0.851 [0.822–0.875], p < 0.001) represents the repeatability and consistency of measurements by the NeuronJ and ACCMetrics software. The CNFL values (r = 0.881, p < 0.001) obtained using the two methods have extremely high correlation, and similarly, the CNFD values (r = 0.669, p < 0.001) and CNBD values (r = 0.703, p < 0.001) are highly correlated. The CNFL had the biggest area under the curve (AUC; 0.747 [0.700–0.793], p < 0.001) when using ACCMetrics. In DED patients with ocular pain, the mean CNFD values for semiautomated and fully automated quantization were 23.5 ± 8.1 and 23.8 ± 8.6 n/mm2; the mean CNBD values were 46.0 ± 21.3, 35.7 ± 23.3 n/mm2; and the mean CNFL values were 19.3 ± 4.3 and 15.2 ± 3.8 mm/mm2, which were significantly lower than healthy subjects (p < 0.001). Conclusion There is a significant correlation between the measurements obtained via ACCMetrics and NeuronJ, especially for CNFL, which can be considered as the primary indicator in the diagnosis of DED with ocular pain. The SNP of the disease was significantly lower than that of healthy subjects.
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Hwang DDJ, Lee SJ, Kim JH, Lee SM. The Role of Neuropeptides in Pathogenesis of Dry Dye. J Clin Med 2021; 10:4248. [PMID: 34575359 PMCID: PMC8471988 DOI: 10.3390/jcm10184248] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/07/2021] [Accepted: 09/14/2021] [Indexed: 12/29/2022] Open
Abstract
Neuropeptides are known as important mediators between the nervous and immune systems. Recently, the role of the corneal nerve in the pathogenesis of various ocular surface diseases, including dry eye disease, has been highlighted. Neuropeptides are thought to be important factors in the pathogenesis of dry eye disease, as suggested by the well-known role between the nervous and immune systems, and several recently published studies have elucidated the previously unknown pathogenic mechanisms involved in the role of the neuropeptides secreted from the corneal nerves in dry eye disease. Here, we reviewed the emerging concept of neurogenic inflammation as one of the pathogenic mechanisms of dry eye disease, the recent results of related studies, and the direction of future research.
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Affiliation(s)
- Daniel Duck-Jin Hwang
- Department of Ophthalmology, HanGil Eye Hospital, Incheon 21388, Korea;
- Department of Ophthalmology, College of Medicine, Catholic Kwandong University, Incheon 21388, Korea
| | - Seok-Jae Lee
- Fight against Angiogenesis-Related Blindness (FARB) Laboratory, Clinical Research Institute, Seoul National University Hospital, Seoul 03080, Korea; (S.-J.L.); (J.-H.K.)
- Department of Biomedical Sciences, College of Medicine, Seoul National University, Seoul 03080, Korea
| | - Jeong-Hun Kim
- Fight against Angiogenesis-Related Blindness (FARB) Laboratory, Clinical Research Institute, Seoul National University Hospital, Seoul 03080, Korea; (S.-J.L.); (J.-H.K.)
- Department of Biomedical Sciences, College of Medicine, Seoul National University, Seoul 03080, Korea
- Department of Ophthalmology, College of Medicine, Seoul National University, Seoul 03080, Korea
- Advanced Biomedical Research Center, Korea Research Institute of Bioscience & Biotechnology, Daejeon 34141, Korea
| | - Sang-Mok Lee
- Department of Ophthalmology, HanGil Eye Hospital, Incheon 21388, Korea;
- Department of Ophthalmology, College of Medicine, Catholic Kwandong University, Incheon 21388, Korea
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Chen Y, Dana R. Autoimmunity in dry eye disease - An updated review of evidence on effector and memory Th17 cells in disease pathogenicity. Autoimmun Rev 2021; 20:102933. [PMID: 34509656 DOI: 10.1016/j.autrev.2021.102933] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/16/2021] [Indexed: 12/27/2022]
Abstract
The classic Th1/Th2 dogma has been significantly reshaped since the subsequent introduction of several new T helper cell subsets, among which the most intensively investigated during the last decade is the Th17 lineage that demonstrates critical pathogenic roles in autoimmunity and chronic inflammation - including the highly prevalent dry eye disease. In this review, we summarize current concepts of Th17-mediated disruption of ocular surface immune homeostasis that leads to autoimmune inflammatory dry eye disease, by discussing the induction, activation, differentiation, migration, and function of effector Th17 cells in disease development, highlighting the phenotypic and functional plasticity of Th17 lineage throughout the disease initiation, perpetuation and sustention. Furthermore, we emphasize the most recent advance in Th17 memory formation and function in the chronic course of dry eye disease, a major area to be better understood for facilitating the development of effective treatments in a broader field of autoimmune diseases that usually present a chronic course with recurrent episodes of flare in the target tissues or organs.
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Affiliation(s)
- Yihe Chen
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114, USA
| | - Reza Dana
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114, USA.
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Cox SM, Kheirkhah A, Aggarwal S, Abedi F, Cavalcanti BM, Cruzat A, Hamrah P. Alterations in corneal nerves in different subtypes of dry eye disease: An in vivo confocal microscopy study. Ocul Surf 2021; 22:135-142. [PMID: 34407488 DOI: 10.1016/j.jtos.2021.08.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate corneal subbasal nerve alterations in evaporative and aqueous-deficient dry eye disease (DED) as compared to controls. METHODS In this retrospective, cross-sectional, controlled study, eyes with a tear break-up time of less than 10 s were classified as DED. Those with an anesthetized Schirmer's strip of less than 5 mm were classified as aqueous-deficient DED. Three representative in vivo confocal microscopy images were graded for each subject for total, main, and branch nerve density and numbers. RESULTS Compared to 42 healthy subjects (42 eyes), the 70 patients with DED (139 eyes) showed lower total (18,579.0 ± 687.7 μm/mm2 vs. 21,014.7 ± 706.5, p = 0.026) and main (7,718.9 ± 273.9 vs. 9,561.4 ± 369.8, p < 0.001) nerve density, as well as lower total (15.5 ± 0.7/frame vs. 20.5 ± 1.3, p = 0.001), main (3.0 ± 0.1 vs. 3.8 ± 0.2, p = 0.001) and branch (12.5 ± 0.7 vs. 16.5 ± 1.2, p = 0.004) nerve numbers. Compared to the evaporative DED group, the aqueous-deficient DED group showed reduced total nerve density (19,969.9 ± 830.7 vs. 15,942.2 ± 1,135.7, p = 0.006), branch nerve density (11,964.9 ± 749.8 vs. 8,765.9 ± 798.5, p = 0.006), total nerves number (16.9 ± 0.8/frame vs. 13.0 ± 1.2, p = 0.002), and branch nerve number (13.8 ± 0.8 vs. 10.2 ± 1.1, p = 0.002). CONCLUSIONS Patients with DED demonstrate compromised corneal subbasal nerves, which is more pronounced in aqueous-deficient DED. This suggests a role for neurosensory abnormalities in the pathophysiology of DED.
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Affiliation(s)
- Stephanie M Cox
- Center for Translational Ocular Immunology and Cornea Service, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Ahmad Kheirkhah
- Ocular Surface Imaging Center, Cornea & Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Shruti Aggarwal
- Ocular Surface Imaging Center, Cornea & Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Farshad Abedi
- Ocular Surface Imaging Center, Cornea & Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Bernardo M Cavalcanti
- Ocular Surface Imaging Center, Cornea & Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Andrea Cruzat
- Ocular Surface Imaging Center, Cornea & Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Pedram Hamrah
- Center for Translational Ocular Immunology and Cornea Service, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA; Ocular Surface Imaging Center, Cornea & Refractive Surgery Service, Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
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Yang C, Zhou X, Zhu W, Xiang D, Chen Z, Yuan J, Chen X, Shi F. Multi-discriminator adversarial convolutional network for nerve fiber segmentation in confocal corneal microscopy images. IEEE J Biomed Health Inform 2021; 26:648-659. [PMID: 34242175 DOI: 10.1109/jbhi.2021.3094520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Quantitative measurements of corneal sub-basal nerves are biomarkers for many ocular surface disorders, and are also important for early diagnosis and assessment of progression of neurodegenerative diseases. This paper aims to develop an automatic method for nerve fiber segmentation from in vivo corneal confocal microscopy (CCM) images, which is fundamental for nerve morphology quantification. A novel multi-discriminator adversarial convolutional network (MDACN) is proposed, where both the generator and the two discriminators emphasize multi-scale feature representations. The generator is a U-shaped fully convolutional network with multi-scale split and concatenate blocks, and the two discriminators have different effective receptive fields, sensitive to features of different scales. A novel loss function is also proposed which enables the network to pay more attention to thin fibers. The MDACN framework was evaluated on four datasets. Experiment results show that our method has excellent segmentation performance for corneal nerve fibers and outperforms some state-of-the-art methods.
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Lasagni Vitar RM, Rama P, Ferrari G. The two-faced effects of nerves and neuropeptides in corneal diseases. Prog Retin Eye Res 2021; 86:100974. [PMID: 34098111 DOI: 10.1016/j.preteyeres.2021.100974] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 12/16/2022]
Abstract
Corneal nerves are instrumental to maintain cornea integrity through regulation of key physiological functions such as tear secretion, blink reflex, and neuropeptide turnover. Corneal nerve injury/stimulation can follow many insults including mechanical/chemical trauma, infections and surgeries. Nerve disruption initiates a process named neurogenic inflammation which leads to edema, pain, and recruitment and activation of leukocytes. Interestingly, leukocyte influx in the cornea can further damage nerves by releasing inflammatory mediators-including neuropeptides. The clinical outcome of neuroinflammation can be beneficial or detrimental to corneal integrity. On one side, it ensures prompt wound healing and prevents infections. On the other, prolonged and/or deranged neuroinflammation can permanently disrupt corneal integrity and impair vision. The cornea is an ideal site to study peripheral neuroinflammation and neurogenic inflammation since it receives the highest density of sensory nerves of the entire body. We will review the corneal nerve anatomy and neurochemistry, discuss the beneficial and detrimental effects of neurogenic inflammation in corneal wound healing, inflammatory processes, and pain. We will also examine the emerging remote impact of corneal nerve disruption on the trigeminal ganglion and the brain, highlighting the key role of neuropeptide Substance P. Finally, we will discuss the clinical relevance of such neuroinflammatory network in the context of severe and highly prevalent ocular diseases, including potential treatments.
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Affiliation(s)
- Romina Mayra Lasagni Vitar
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Rama
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulio Ferrari
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Li F, Zhang Q, Ying X, He J, Jin Y, Xu H, Cheng Y, Zhao M. Corneal nerve structure in patients with primary Sjögren's syndrome in China. BMC Ophthalmol 2021; 21:211. [PMID: 33980205 PMCID: PMC8117565 DOI: 10.1186/s12886-021-01967-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 04/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background The aim of this study was to evaluate the in vivo confocal microscopic morphology of corneal subbasal nerves and its relationship with clinical parameters in patients with primary Sjögren’s syndrome in China. Methods This was a case control study of 22 dry eye disease (DED) patients with primary Sjögren’s syndrome (pSS) and 20 control subjects with non-Sjögren dry eye disease (NSDE). Each patient underwent an evaluation of ocular surface disease using the tear film break-up time (TBUT), noninvasive tear film break-up time (NIKBUT), noninvasive tear meniscus height (NIKTMH), corneal staining (National Eye Institute scale, NEI), Schirmer I test, meibography, and corneal subbasal nerve analysis with in vivo confocal microscopy (IVCM). The right eye of each subject was included in this study. Results SS patients showed a shorter TBUT (P = 0.009) and Schirmer I test results (P = 0.028) than the NSDE group. However, there was no significant difference in NIKBUT between the two groups (P = 0.393). The nerve density of subbasal nerves, number of nerves and tortuosity of the SS group were significantly lower than those of the NSDE group (P = 0.001, P < 0.001 and P = 0.039, respectively). In the SS group, the mean nerve length was correlated with age and the Schirmer I test (r = − 0.519, P = 0.013 and r = 0.463, P = 0.035, respectively). Corneal staining was correlated with nerve density and the number of nerves (r = − 0.534, P = 0.013 and r = − 0.487, P = 0.025, respectively). Conclusions Sjögren syndrome dry eye (SSDE) patients have more severe clinical dry eye parameters than non-Sjögren dry eye disease (NSDE) patients. Compared with NSDE patients, we found that SSDE patients showed decreased corneal subbasal nerve density and numbers. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-01967-7.
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Affiliation(s)
- Fangting Li
- Department of Ophthalmology, Peking University People's Hospital, Eye Diseases and Optometry Institute, 11 Xizhimen South Street, Beijing, 100044, Xicheng District, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Qin Zhang
- Department of Ophthalmology, Peking University People's Hospital, Eye Diseases and Optometry Institute, 11 Xizhimen South Street, Beijing, 100044, Xicheng District, China
| | - Xin Ying
- Department of Ophthalmology, Peking University People's Hospital, Eye Diseases and Optometry Institute, 11 Xizhimen South Street, Beijing, 100044, Xicheng District, China
| | - Jing He
- Department of Rheumatology, Peking University People's Hospital, Beijing, China
| | - Yuebo Jin
- Department of Rheumatology, Peking University People's Hospital, Beijing, China
| | - Huiwen Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Yaobin Cheng
- Department of Rheumatology, Peking University People's Hospital, Beijing, China
| | - Mingwei Zhao
- Department of Ophthalmology, Peking University People's Hospital, Eye Diseases and Optometry Institute, 11 Xizhimen South Street, Beijing, 100044, Xicheng District, China.
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Korenfeld M, Nichols KK, Goldberg D, Evans D, Sall K, Foulks G, Coultas S, Brazzell K. Safety of KPI-121 Ophthalmic Suspension 0.25% in Patients With Dry Eye Disease: A Pooled Analysis of 4 Multicenter, Randomized, Vehicle-Controlled Studies. Cornea 2021; 40:564-570. [PMID: 32826644 DOI: 10.1097/ico.0000000000002452] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/30/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE The safety of KPI-121 0.25%, an ophthalmic nanoparticle suspension of loteprednol etabonate, was evaluated in subjects with dry eye disease (DED) in one phase 2 and three phase 3 randomized trials of similar design. METHODS Adults with DED received KPI-121 0.25% or vehicle drops 4 times daily (QID) for ≥2 weeks; 1430 subjects received KPI-121 0.25% and 1438 subjects received vehicle drops. Main safety assessments were adverse events (AEs) and intraocular pressure (IOP). As a common side effect associated with the use of ocular corticosteroids is elevated IOP, subjects with a history of or current diagnosis of glaucoma were excluded. RESULTS Instillation site pain was the most common AE, reported by 5.2% of subjects in the KPI-121 0.25% group and 4.4% of subjects in the vehicle group; other AEs were reported by ≤0.8% of subjects in the KPI-121 group. IOP elevations, a side effect associated with the use of ophthalmic corticosteroids, were observed with low incidence: 0.6% and 0.2% of subjects in the KPI-121 and vehicle groups, respectively. An IOP elevation was defined as an increase from baseline of >5 mm Hg that resulted in an IOP of ≥21 mm Hg in either eye during use of the study product. CONCLUSIONS KPI-121 ophthalmic suspension 0.25% seemed to be safe and well tolerated when dosed QID for 2 to 4 weeks in those DED subjects included in the 4 trials.
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Affiliation(s)
| | | | | | | | - Ken Sall
- Sall Research Medical Center, Artesia, CA
| | - Gary Foulks
- Department of Ophthalmology, University of Louisville, Louisville, KY; and
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25
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Mikalauskiene L, Grzybowski A, Zemaitiene R. Ocular Surface Changes Associated with Ophthalmic Surgery. J Clin Med 2021; 10:jcm10081642. [PMID: 33921534 PMCID: PMC8069708 DOI: 10.3390/jcm10081642] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 01/13/2023] Open
Abstract
Dry eye disease causes ocular discomfort and visual disturbances. Older adults are at a higher risk of developing dry eye disease as well as needing for ophthalmic surgery. Anterior segment surgery may induce or worsen existing dry eye symptoms usually for a short-term period. Despite good visual outcomes, ocular surface dysfunction can significantly affect quality of life and, therefore, lower a patient’s satisfaction with ophthalmic surgery. Preoperative dry eye disease, factors during surgery and postoperative treatment may all contribute to ocular surface dysfunction and its severity. We reviewed relevant articles from 2010 through to 2021 using keywords “cataract surgery”, ”phacoemulsification”, ”refractive surgery”, ”trabeculectomy”, ”vitrectomy” in combination with ”ocular surface dysfunction”, “dry eye disease”, and analyzed studies on dry eye disease pathophysiology and the impact of anterior segment surgery on the ocular surface.
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Affiliation(s)
- Lina Mikalauskiene
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, 44037 Kaunas, Lithuania;
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, 10719 Olsztyn, Poland;
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, 61553 Poznan, Poland
| | - Reda Zemaitiene
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, 44037 Kaunas, Lithuania;
- Correspondence:
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Ross E, Furniss E, Chandramohan N, Markoulli M. The multi-faceted approach to dry eye disease. Clin Exp Optom 2021; 104:417-420. [PMID: 33689611 DOI: 10.1080/08164622.2021.1877534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Emilie Ross
- School of Optometry & Vision Science, University of New South Wales, Sydney, Australia
| | - Emma Furniss
- School of Optometry & Vision Science, University of New South Wales, Sydney, Australia.,The Dry Eye Institute, Sydney, Australia
| | - Nivaasheni Chandramohan
- School of Optometry & Vision Science, University of New South Wales, Sydney, Australia.,Macular Disease Foundation, Sydney, Australia
| | - Maria Markoulli
- School of Optometry & Vision Science, University of New South Wales, Sydney, Australia
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27
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Baksh BS, Garcia JC, Galor A. Exploring the Link Between Dry Eye and Migraine: From Eye to Brain. Eye Brain 2021; 13:41-57. [PMID: 33692643 PMCID: PMC7939506 DOI: 10.2147/eb.s234073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/17/2021] [Indexed: 11/23/2022] Open
Abstract
Dry eye and migraine are common diseases with large societal and economic burdens that have recently been associated in the literature. This review outlines the link between dry eye and migraine, which may have implications for reducing their respective burdens. We highlight possible shared pathophysiology, including peripheral and central sensitization, as the potential link between dry eye and migraine. Finally, therapies targeting similar pathophysiological mechanisms between dry eye and migraine are discussed.
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Affiliation(s)
- Brandon S Baksh
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Julia Costa Garcia
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Faculdade de Medicina (FMB) da Universidade do Estado de São Paulo (UNESP), Botucatu, Brazil
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA
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Abstract
A biomarker is a "characteristic that is measured as an indicator of normal biological processes, pathogenic processes, or responses to an exposure or intervention, including therapeutic interventions." Recently, calls for biomarkers for ocular surface diseases have increased, and advancements in imaging technologies have aided in allowing imaging biomarkers to serve as a potential solution for this need. This review focuses on the state of imaging biomarkers for ocular surface diseases, specifically non-invasive tear break-up time (NIBUT), tear meniscus measurement and corneal epithelial thickness with anterior segment optical coherence tomography (OCT), meibomian gland morphology with infrared meibography and in vivo confocal microscopy (IVCM), ocular redness with grading scales, and cellular corneal immune cells and nerve assessment by IVCM. Extensive literature review was performed for analytical and clinical validation that currently exists for potential imaging biomarkers. Our summary suggests that the reported analytical and clinical validation state for potential imaging biomarkers is broad, with some having good to excellent intra- and intergrader agreement to date. Examples of these include NIBUT for dry eye disease, ocular redness grading scales, and detection of corneal immune cells by IVCM for grading and monitoring inflammation. Further examples are nerve assessment by IVCM for monitoring severity of diabetes mellitus and neurotrophic keratitis, and corneal epithelial thickness assessment with anterior segment OCT for the diagnosis of early keratoconus. However, additional analytical validation for these biomarkers is required before clinical application as a biomarker.
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van Setten GB, Stachs O, Dupas B, Turhan SA, Seitz B, Reitsamer H, Winter K, Horwath-Winter J, Guthoff RF, Müller-Lierheim WGK. High Molecular Weight Hyaluronan Promotes Corneal Nerve Growth in Severe Dry Eyes. J Clin Med 2020; 9:jcm9123799. [PMID: 33255350 PMCID: PMC7760610 DOI: 10.3390/jcm9123799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/19/2020] [Accepted: 11/22/2020] [Indexed: 12/31/2022] Open
Abstract
The purpose of this study was to investigate the effect of high molecular weight hyaluronan (HMWHA) eye drops on subbasal corneal nerves in patients suffering from severe dry eye disease (DED) and to evaluate the damage of subbasal corneal nerves associated with severe DED. Designed as an international, multicenter study, 16 patients with symptoms of at least an Ocular Surface Disease Index (OSDI) score of 33, and corneal fluorescein staining (CFS) of at least Oxford grade 3, were included and randomized into two study arms. The control group continued to use their individual optimum artificial tears over the study period of eight weeks; in the verum group, the artificial tears were substituted by eye drops containing 0.15% HMWHA. At the baseline visit, and after eight weeks, the subbasal nerve plexus of 16 patients were assessed by confocal laser scanning microscopy (CSLM). The images were submitted to a masked reading center for evaluation. Results showed a significant increase of total nerve fiber lengths (CNFL) in the HMWHA group (p = 0.030) when compared to the control group, where the total subbasal CNFL did not significantly change from baseline to week 8. We concluded that in severe DED patients, HMWHA from topically applied eye drops could cross the epithelial barrier and reach the subbasal nerve plexus, where it exercised a trophic effect.
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Affiliation(s)
- Gysbert-Botho van Setten
- Department of Clininical Neuroscience, St. Eriks Eye Hospital, Karolinska Institutet, 11282 Stockholm, Sweden;
| | - Oliver Stachs
- Department of Ophthalmology, University Medical Center Rostock, 18057 Rostock, Germany; (O.S.); (R.F.G.)
| | - Bénédicte Dupas
- Quinze-Vingts National Eye Hospital & Vision Institute, 75571 Paris, France;
| | - Semra Akkaya Turhan
- Department of Ophthalmology, Marmara University School of Medicine, 34899 Istanbul, Turkey;
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, 66421 Homburg/Saar, Germany;
| | - Herbert Reitsamer
- Department of Ophthalmology & Department of Experimental Ophthalmology and Glaucoma Research, University Clinic Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Karsten Winter
- Institute of Anatomy, Medical Faculty, University of Leipzig, 04103 Leipzig, Germany;
| | | | - Rudolf F. Guthoff
- Department of Ophthalmology, University Medical Center Rostock, 18057 Rostock, Germany; (O.S.); (R.F.G.)
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31
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Latifi G, Banafshe Afshan A, Houshang Beheshtnejad A, Zarei-Ghanavati M, Mohammadi N, Ghaffari R, Ghassemi H, Mohammadi SS, Kheirkhah A. Changes in Corneal Subbasal Nerves after Punctal Occlusion in Dry Eye Disease. Curr Eye Res 2020; 46:777-783. [PMID: 33092431 DOI: 10.1080/02713683.2020.1833349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE To evaluate corneal subbasal nerve plexus by in vivo confocal microscopy (IVCM) following punctal occlusion in patients with moderate to severe dry eye disease (DED). MATERIALS AND METHODS Patients with grade 3 or 4 severity of DED based on Delphi Panel dry eye severity grading scheme were enrolled in the study. Permanent inferior punctal occlusion was performed. A comprehensive ophthalmic evaluation, including Ocular Surface Disease Index (OSDI) questionnaire, tear break-up time (TBUT), corneal fluorescein staining, conjunctival Rose bengal staining, Schirmer's test, and corneal sensation by Cochet-Bonnet esthesiometry, were performed at baseline, and 1 and 3 months after punctal occlusion. Furthermore, density and number of corneal subbasal nerves were evaluated by IVCM. RESULTS Forty-one eyes of 23 patients with a mean age of 46.3 ± 9.0 years were enrolled. Corneal fluorescein staining, Rose bengal staining, and TBUT significantly improved at 3 months following punctal occlusion (p < .015). Corneal esthesiometry significantly increased at both postoperative visits (p < .03), and OSDI scores improved only at 3-month follow-up (p < .005). Nerve density and total number significantly increased 3 months after punctal occlusion (p < .045). Baseline nerve density had significant correlations with TBUT, fluorescein staining, Rose bengal staining (p < .012), but not with esthesiometry, Schirmer scores, or OSDI scores (p > .329). CONCLUSIONS Corneal subbasal nerve density and total number increased following punctal occlusion in patients with moderate to severe DED. These findings were associated with improvements in corneal sensation, and signs and symptoms of DED. This emphasizes the effect of punctal occlusion in regeneration of corneal subbasal nerve plexus.
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Affiliation(s)
- Golshan Latifi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Neda Mohammadi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Ghaffari
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Ghassemi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - S Saeed Mohammadi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Kheirkhah
- Ocular Surface Imaging Center, Cornea and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
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Patel S, Hwang J, Mehra D, Galor A. Corneal Nerve Abnormalities in Ocular and Systemic Diseases. Exp Eye Res 2020; 202:108284. [PMID: 33045221 DOI: 10.1016/j.exer.2020.108284] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/04/2020] [Accepted: 09/23/2020] [Indexed: 12/19/2022]
Abstract
The trigeminal nerve gives rise to the corneal subbasal nerve system, which plays a crucial role in sensations of touch, pain, and temperature and in ocular healing processes. Technological advancements in instruments, in particular in vivo confocal microscopy and aethesiometry, have allowed for the structural and functional evaluation of corneal nerves in health and disease. Through application of these technologies in humans and animal models, structural and functional abnormalities have been detected in several ocular and systemic disorders, including dry eye disease (DED), glaucoma, migraine, and fibromyalgia. However, studies across a number of conditions have found that structural abnormalities do not always relate to functional abnormalities. This review will discuss instruments used to evaluate corneal nerves and summarize data on nerve abnormalities in a number of ocular and systemic conditions. Furthermore, it will discuss potential treatments that can alleviate the main manifestations of nerve dysfunction, namely ocular surface pain and persistent epithelial defects.
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Affiliation(s)
- Sneh Patel
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA; Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Jodi Hwang
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA; Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Divy Mehra
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA; Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Anat Galor
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA; Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA; Research Services, Miami Veterans Affairs Medical Center, Miami, FL, USA.
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Effects of Oral Vitamin B1 and Mecobalamin on Dry Eye Disease. J Ophthalmol 2020; 2020:9539674. [PMID: 33005449 PMCID: PMC7508221 DOI: 10.1155/2020/9539674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/28/2020] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To assess the effects of oral vitamin B1 and mecobalamin on dry eye disease (DED) and patient satisfaction with treatment. METHODS In this randomized controlled study, DED patients were divided into 4 groups based on treatment: group 1, only artificial tears; group 2, corticosteroid eye drops and artificial tears; group 3, oral vitamin B1, mecobalamin, and artificial tears; and group 4, oral vitamin B1, mecobalamin, corticosteroid eye drops, and artificial tears. DED symptoms, signs, and patient satisfaction with treatment were assessed at baseline and at 1 and 2 months after treatment. RESULTS In total, 152 eyes from 76 patients (age, 55.25 ± 18.16 years) were included. In group 3, there were significant differences in dryness, foreign body sensation, burning, and tear film breakup time first (TBUTF) between 1 and 2 months after treatment and in satisfaction scores before and after treatment (P < 0.05). In group 3, there were also significant differences in dryness, foreign body sensation, photophobia, and TBUTA and between baseline and 2 months after treatment (P < 0.05). There was a significant difference in foreign body sensation between 1 and 2 months after treatment in groups 3 and 4 (P < 0.05). Furthermore, we also find obvious improvement in corneal nerve fiber density (CNFD) between baseline and 1 and 2 months after treatment in groups 3 and 4 (P < 0.05). CONCLUSIONS Oral vitamin B1 and mecobalamin can relieve some dry eye symptoms such as dryness, pain, and photophobia and improve DED signs and patient satisfaction. Thus, vitamin B1 and mecobalamin are potential treatment options for patients with DED.
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Noor NA, Rahayu T, Gondhowiardjo TD. Prevalence of Dry Eye and its Subtypes in an Elderly Population with Cataracts in Indonesia. Clin Ophthalmol 2020; 14:2143-2150. [PMID: 32801623 PMCID: PMC7399451 DOI: 10.2147/opth.s240057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/01/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe the prevalence of dry eye disease (DED) and its subtypes in elderly population with cataracts prior to surgery in Jakarta, Indonesia. Patients and Methods Forty-nine eyes of 49 patients (16 males, 33 females; mean age: 66.6 years) planned for phacoemulsification surgery were consecutively recruited from two tertiary eye hospitals in this hospital-based cross-sectional study. Symptoms were assessed using the Ocular Surface Disease Index (OSDI) questionnaire, and the patient was defined as symptomatic if their OSDI score was ≥13. Objective examinations included the noninvasive tear film break up time (NIBUT) and Schirmer tests. The results were deemed abnormal if they were <10 seconds and <10 mm for NIBUT and Schirmer, respectively. Results Participants were classified into four groups: DED (positive symptoms and short NIBUT), preclinical dry eye (positive symptoms without short NIBUT), predisposition to dry eye (short NIBUT without symptoms), and normal group. Median OSDI score was 12.5 (0–45.0), NIBUT was 10.4 (5.1–28.9) seconds, and Schirmer score was 8.0 (2.0–28.0) mm. The prevalence of DED, preclinical dry eye, and predisposition to dry eye were 22.5%, 22.5%, and 26.5%, respectively, while the other 28.5% subjects were normal. The DED group had significantly lower Schirmer test results (4.0 [2–17] mm) compared to all other groups. Older age (>70 years) was associated with poorer NIBUT and Schirmer test results and a significant difference between age groups was observed, especially in males. Conclusion Dry eye is a common problem among the elderly population with cataracts in Indonesia. Almost half of the subjects presented with dry eye symptoms and either categorized as DED or preclinical dry eye, while more than one quarter were predisposed to dry eye. Care must be taken prior to cataract surgery to rule out existing dry eye with additional attention on those presenting without any symptoms as dry eye may develop after surgery.
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Affiliation(s)
| | - Tri Rahayu
- JEC Eye Hospitals and Clinics, Jakarta, Indonesia.,Ophthalmology Department, Cipto Mangunkusumo Kirana Hospital, Jakarta, Indonesia
| | - Tjahjono D Gondhowiardjo
- JEC Eye Hospitals and Clinics, Jakarta, Indonesia.,Ophthalmology Department, Cipto Mangunkusumo Kirana Hospital, Jakarta, Indonesia
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Corneal In Vivo Laser-Scanning Confocal Microscopy Findings in Dry Eye Patients with Sjögren's Syndrome. Diagnostics (Basel) 2020; 10:diagnostics10070497. [PMID: 32698387 PMCID: PMC7400289 DOI: 10.3390/diagnostics10070497] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To evaluate the changes in cornea in Sjögren's syndrome (SS) with a novel confocal microscopy device. METHODS Twenty-three right eyes of patients with SS (23 women; mean age, 65.4 ± 11.4 years) and 13 right eyes of 13 age- and sex-matched control subjects (13 women; mean age, 68.8 ± 9.8 years) were studied. Furthermore, eight right eyes of patients with SS (8 women; mean age, 66.9 ± 9.6 years) were studied to evaluate the corneal microscopic alterations after the treatment with topical 3% diquafosol sodium eye drops. All cases had tear quantity, tear breakup time (BUT), ocular surface staining measurements, and corneal in vivo laser-scanning confocal microscopy examinations. The density and area of corneal epithelial cells (superficial, wing, and basal), density of corneal stromal cells (anterior, intermediate, and posterior), density and area of corneal endothelial cells, density and morphology of corneal sub-basal nerve plexus, density of corneal sub-basal inflammatory cells were also assessed. RESULTS The tear quantity, stability, and vital staining scores were significantly worse in patients with SS than in control subjects (p < 0.0001). Corneal superficial epithelial cell density was significantly lower in SS compared with control subjects (p < 0.0001). Corneal superficial epithelial cell area was significantly larger in SS compared with control subjects (p = 0.007). Corneal sub-basal nerve fiber density was lower in SS compared with control subjects (p < 0.0001). Morphological abnormality of nerve fibers was observed in SS patients. Corneal sub-basal inflammatory cell density was significantly higher in SS patients compared with control subjects (p < 0.0001). Furthermore, the mean corneal superficial epithelial cell density and area, inflammatory cell density, corneal sub-basal nerve fiber density, and morphological abnormality of nerve fibers, were improved with topical 3% diquafosol sodium treatment in the dry eye patients with SS (p < 0.05). CONCLUSIONS The diagnostic modality using in vivo laser-scanning confocal microscopy was a useful method for the evaluation of the corneal cell density and area, nerve fiber density and morphology, and inflammatory cell density in patients with SS and also a useful tool in the assessment of treatment effect with topical 3% diquafosol sodium in the SS patients.
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Moein HR, Akhlaq A, Dieckmann G, Abbouda A, Pondelis N, Salem Z, Müller RT, Cruzat A, Cavalcanti BM, Jamali A, Hamrah P. Visualization of microneuromas by using in vivo confocal microscopy: An objective biomarker for the diagnosis of neuropathic corneal pain? Ocul Surf 2020; 18:651-656. [PMID: 32663518 DOI: 10.1016/j.jtos.2020.07.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE The diagnosis of neuropathic corneal pain (NCP) is challenging, as it is often difficult to differentiate it from conventional dry eye disease (DED). In addition to eye pain, NCP can present with similar signs and symptoms of DED. The purpose of this study is to find an objective diagnostic sign to identify patients with NCP, using in vivo confocal microscopy (IVCM). METHODS This was a comparative, retrospective, case-control study. Patients with clinical diagnosis of NCP (n = 25), DED (n = 30), and age- and sex-matched healthy controls (n = 16), who underwent corneal imaging with IVCM (HRT3/RCM) were included. Central corneal IVCM scans were analyzed by 2 masked observers for nerve density and number, presence of microneuromas (terminal enlargements of subbasal corneal nerve) and/or nerve beading (bead-like formation along the nerves), and dendritiform cell (DC) density. RESULTS There was a decrease in total nerve density in both NCP (14.14 ± 1.03 mm/mm2) and DED patients (12.86 ± 1.04 mm/mm2), as compared to normal controls (23.90 ± 0.92 mm/mm2; p < 0.001). However, total nerve density was not statistically different between NCP and DED patients (p = 0.63). Presence of nerve beading was not significantly different between patients and normal controls (p = 0.15). Interestingly, microneuromas were observed in all patients with NCP, while they were not present in any of the patients with conventional DED (sensitivity and specificity of 100%). DC density was significantly increased in both NCP (71.89 ± 16.91 cells/mm2) and DED patients (111.5 ± 23.86 cells/mm2), as compared to normal controls (24.81 ± 4.48 cells/mm2 (p < 0.05). However, there was no significant difference in DC density between DED and NCP patients (p = 0.31). CONCLUSION IVCM may be used as an adjunct diagnostic tool for the diagnosis of NCP in the presence of neuropathic symptoms. Microneuromas may serve as a sensitive and specific biomarker for the diagnosis of NCP.
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Affiliation(s)
- Hamid-Reza Moein
- Center for Translational Ocular Immunology and, USA; Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Anam Akhlaq
- Center for Translational Ocular Immunology and, USA; Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Gabriela Dieckmann
- Center for Translational Ocular Immunology and, USA; Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Alessandro Abbouda
- Center for Translational Ocular Immunology and, USA; Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | | | - Zeina Salem
- Center for Translational Ocular Immunology and, USA; Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Rodrigo T Müller
- Center for Translational Ocular Immunology and, USA; Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Andrea Cruzat
- Ocular Surface Imaging Center, Cornea and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Bernardo M Cavalcanti
- Ocular Surface Imaging Center, Cornea and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Arsia Jamali
- Center for Translational Ocular Immunology and, USA; Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Pedram Hamrah
- Center for Translational Ocular Immunology and, USA; Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA; Ocular Surface Imaging Center, Cornea and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
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Schlereth SL, Hos D, Matthaei M, Hamrah P, Schmetterer L, O'Leary O, Ullmer C, Horstmann J, Bock F, Wacker K, Schröder H, Notara M, Haagdorens M, Nuijts RMMA, Dunker SL, Dickman MM, Fauser S, Scholl HPN, Wheeler-Schilling T, Cursiefen C. New Technologies in Clinical Trials in Corneal Diseases and Limbal Stem Cell Deficiency: Review from the European Vision Institute Special Interest Focus Group Meeting. Ophthalmic Res 2020; 64:145-167. [PMID: 32634808 DOI: 10.1159/000509954] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/30/2020] [Indexed: 11/19/2022]
Abstract
To discuss and evaluate new technologies for a better diagnosis of corneal diseases and limbal stem cell deficiency, the outcomes of a consensus process within the European Vision Institute (and of a workshop at the University of Cologne) are outlined. Various technologies are presented and analyzed for their potential clinical use also in defining new end points in clinical trials. The disease areas which are discussed comprise dry eye and ocular surface inflammation, imaging, and corneal neovascularization and corneal grafting/stem cell and cell transplantation. The unmet needs in the abovementioned disease areas are discussed, and realistically achievable new technologies for better diagnosis and use in clinical trials are outlined. To sum up, it can be said that there are several new technologies that can improve current diagnostics in the field of ophthalmology in the near future and will have impact on clinical trial end point design.
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Affiliation(s)
- Simona L Schlereth
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany, .,Center for Molecular Medicine (CMMC) University of Cologne, Cologne, Germany,
| | - Deniz Hos
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Center for Molecular Medicine (CMMC) University of Cologne, Cologne, Germany
| | - Mario Matthaei
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Pedram Hamrah
- Cornea Service and Center for Translational Ocular Immunology, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore.,Institute for Health Technologies, Nanyang Technological University, Singapore, Singapore.,School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore.,Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.,Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.,Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
| | - Olivia O'Leary
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Christoph Ullmer
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Jens Horstmann
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Felix Bock
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Katrin Wacker
- Eye Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Maria Notara
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Michel Haagdorens
- Faculty of Medicine and Health Sciences, Department of Ophthalmology, Visual Optics and Visual Rehabilitation, University of Antwerp, Antwerp, Belgium.,Department of Ophthalmology, Antwerp University Hospital, Antwerp, Belgium
| | - Rudy M M A Nuijts
- University Eye Clinic, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Suryan L Dunker
- University Eye Clinic, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mor M Dickman
- University Eye Clinic, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sascha Fauser
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Hendrik P N Scholl
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland.,Department of Ophthalmology, University of Basel, Basel, Switzerland.,Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
| | - Thomas Wheeler-Schilling
- European Vision Institute EEIG, Brussels, Belgium.,Institute for Ophthalmic Research, University of Tuebingen, Tuebingen, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Center for Molecular Medicine (CMMC) University of Cologne, Cologne, Germany
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Wei S, Shi F, Wang Y, Chou Y, Li X. A Deep Learning Model for Automated Sub-Basal Corneal Nerve Segmentation and Evaluation Using In Vivo Confocal Microscopy. Transl Vis Sci Technol 2020; 9:32. [PMID: 32832205 PMCID: PMC7414615 DOI: 10.1167/tvst.9.2.32] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 05/06/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose The purpose of this study was to establish a deep learning model for automated sub-basal corneal nerve fiber (CNF) segmentation and evaluation with in vivo confocal microscopy (IVCM). Methods A corneal nerve segmentation network (CNS-Net) was established with convolutional neural networks based on a deep learning algorithm for sub-basal corneal nerve segmentation and evaluation. CNS-Net was trained with 552 and tested on 139 labeled IVCM images as supervision information collected from July 2017 to December 2018 in Peking University Third Hospital. These images were labeled by three senior ophthalmologists with ImageJ software and then considered ground truth. The areas under the receiver operating characteristic curves (AUCs), mean average precision (mAP), sensitivity, and specificity were applied to evaluate the efficiency of corneal nerve segmentation. The relative deviation ratio (RDR) was leveraged to evaluate the accuracy of the corneal nerve fiber length (CNFL) evaluation task. Results The model achieved an AUC of 0.96 (95% confidence interval [CI] = 0.935-0.983) and an mAP of 94% with minimum dice coefficient loss at 0.12. For our dataset, the sensitivity was 96% and specificity was 75% in the CNF segmentation task, and an RDR of 16% was reported in the CNFL evaluation task. Moreover, the model was able to segment and evaluate as many as 32 images per second, much faster than skilled ophthalmologists. Conclusions We established a deep learning model, CNS-Net, which demonstrated a high accuracy and fast speed in sub-basal corneal nerve segmentation with IVCM. The results highlight the potential of the system in assisting clinical practice for corneal nerves segmentation and evaluation. Translational Relevance The deep learning model for IVCM images may enable rapid segmentation and evaluation of the corneal nerve and may provide the basis for the diagnosis and treatment of ocular surface diseases associated with corneal nerves.
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Affiliation(s)
- Shanshan Wei
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Faqiang Shi
- State Key Laboratory of Virtual Reality Technology and Systems, School of Computer Science and Engineering, Beihang University, Beijing, China.,Beijing Advanced Innovation Center for Big Data and Brain Computing (BDBC), Beihang University, Beijing, China.,Hangzhou Innovation Research Institute, Beihang University, Hangzhou, China
| | - Yuexin Wang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Yilin Chou
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Xuemin Li
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
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Beckman K, Katz J, Majmudar P, Rostov A. Loteprednol Etabonate for the Treatment of Dry Eye Disease. J Ocul Pharmacol Ther 2020; 36:497-511. [PMID: 32391735 PMCID: PMC7482125 DOI: 10.1089/jop.2020.0014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Dry eye disease (DED) is a common ocular condition that can impair vision and may adversely impact quality of life. Due to the inflammatory nature of this disorder, topical corticosteroids are an effective treatment option, particularly for moderate-to-severe DED when first-line treatments, such as ocular lubricants, are insufficient. Loteprednol etabonate (LE) is a retrometabolically designed corticosteroid with a low propensity to cause corticosteroid-related adverse effects, such as elevated intraocular pressure (IOP). This review was conducted to provide an assessment of published studies on the use of LE for treatment of inflammation associated with DED. Twelve prospective and 2 retrospective studies evaluating LE ophthalmic suspension 0.5% and 2 prospective studies evaluating LE ophthalmic gel 0.5% were identified. LE given as monotherapy or with artificial tears (AT) improved signs of DED, especially among patients with a more pronounced inflammatory component, and also improved DED symptoms compared to baseline and/or control. Treatment with LE before cyclosporine A (CsA) therapy reduced stinging upon CsA initiation and provided more rapid relief of DED signs and symptoms than CsA plus AT alone. In patients with meibomian gland dysfunction, LE alone, or in addition to eyelid scrubs/warm compresses, reduced clinical signs and symptoms, and tear proinflammatory cytokine levels. Overall, LE was safe and well tolerated, with minimal effects on IOP. While larger and longer-term studies are warranted, these data support the use of LE as a safe and effective treatment option for DED.
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Affiliation(s)
- Kenneth Beckman
- Comprehensive Eyecare of Central Ohio, Westerville, Ohio, USA.,Department of Ophthalmology, Ohio State University, Columbus, Ohio, USA
| | - James Katz
- The Midwest Center for Sight, Des Plaines, Illinois, USA
| | - Parag Majmudar
- Chicago Cornea Consultants, Hoffman Estates, Illinois, USA
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40
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Modugno RL, Scalora T, Bonaldo A, Lazzarini D, Leonardi A. Corneal Microstructural Changes by Confocal Microscopy in Vernal Keratoconjunctivitis Patients Treated with Topical Cyclosporine. Ocul Immunol Inflamm 2020; 29:1599-1605. [DOI: 10.1080/09273948.2020.1745243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Rocco Luigi Modugno
- Department of Neuroscience, Ophthalmology Unit, University of Padua, Padua, Italy
| | - Tania Scalora
- Department of Neuroscience, Ophthalmology Unit, University of Padua, Padua, Italy
| | - Alex Bonaldo
- Department of Neuroscience, Ophthalmology Unit, University of Padua, Padua, Italy
| | - Daniela Lazzarini
- Department of Neuroscience, Ophthalmology Unit, University of Padua, Padua, Italy
| | - Andrea Leonardi
- Department of Neuroscience, Ophthalmology Unit, University of Padua, Padua, Italy
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41
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Fung AT, Tran T, Lim LL, Samarawickrama C, Arnold J, Gillies M, Catt C, Mitchell L, Symons A, Buttery R, Cottee L, Tumuluri K, Beaumont P. Local delivery of corticosteroids in clinical ophthalmology: A review. Clin Exp Ophthalmol 2020; 48:366-401. [PMID: 31860766 PMCID: PMC7187156 DOI: 10.1111/ceo.13702] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/21/2019] [Accepted: 12/09/2019] [Indexed: 12/22/2022]
Abstract
Locally administered steroids have a long history in ophthalmology for the treatment of inflammatory conditions. Anterior segment conditions tend to be treated with topical steroids whilst posterior segment conditions generally require periocular, intravitreal or systemic administration for penetration. Over recent decades, the clinical applications of periocular steroid delivery have expanded to a wide range of conditions including macular oedema from retino-vascular conditions. Formulations have been developed with the aim to provide practical, targeted, longer-term and more efficacious therapy whilst minimizing side effects. Herein, we provide a comprehensive overview of the types of periocular steroid delivery, their clinical applications in ophthalmology and their side effects.
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Affiliation(s)
- Adrian T. Fung
- Westmead Clinical SchoolDiscipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, New South WalesAustralia
- Department of Ophthalmology, Faculty of Medicine and Health SciencesMacquarie UniversitySydneyNew South WalesAustralia
- Save Sight InstituteCentral Clinical School, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, New South WalesAustralia
| | - Tuan Tran
- Save Sight InstituteCentral Clinical School, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, New South WalesAustralia
| | - Lyndell L. Lim
- Royal Victorian Eye and Ear HospitalMelbourneVictoriaAustralia
- Centre for Eye Research AustraliaMelbourneVictoriaAustralia
- University of MelbourneMelbourneVictoriaAustralia
| | - Chameen Samarawickrama
- Westmead Clinical SchoolDiscipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, New South WalesAustralia
- Save Sight InstituteCentral Clinical School, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, New South WalesAustralia
- Liverpool Clinical School, Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | | | - Mark Gillies
- Save Sight InstituteCentral Clinical School, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, New South WalesAustralia
| | - Caroline Catt
- Save Sight InstituteCentral Clinical School, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, New South WalesAustralia
- Children's Hospital WestmeadWestmeadNew South WalesAustralia
| | | | | | | | - Lisa Cottee
- Eye Doctors Mona ValeSydneyNew South WalesAustralia
| | - Krishna Tumuluri
- Westmead Clinical SchoolDiscipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, New South WalesAustralia
- Department of Ophthalmology, Faculty of Medicine and Health SciencesMacquarie UniversitySydneyNew South WalesAustralia
- Save Sight InstituteCentral Clinical School, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, New South WalesAustralia
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Liu L, Dana R, Yin J. Sensory neurons directly promote angiogenesis in response to inflammation via substance P signaling. FASEB J 2020; 34:6229-6243. [PMID: 32162744 DOI: 10.1096/fj.201903236r] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 12/14/2022]
Abstract
Blood vessels and nerves travel together to supply most tissues in the body. However, there is a knowledge gap in the mechanisms underlying the direct regulation of angiogenesis by nerves. In the current study, we examined the regulation of angiogenesis by sensory nerves in response to inflammation using the cornea, a normally avascular and densely innervated ocular tissue, as a model. We used desiccating stress as an inflammatory stimulus in vivo and found that sub-basal and epithelial nerve densities in the cornea were reduced in dry eye disease (DED). We established a co-culture system of trigeminal ganglion sensory neurons and vascular endothelial cells (VEC) and found that neurons isolated from mice with DED directly promoted VEC proliferation and tube formation compared with normal controls. In addition, these neurons expressed and secreted higher levels of substance P (SP), a proinflammatory neuropeptide. SP potently promoted VEC activation in vitro and blockade of SP signaling with spantide I, an antagonist of SP receptor Neurokinin-1, significantly reduced corneal neovascularization in vivo. Spantide I and siRNA knockdown of SP abolished the promotion of VEC activation by DED neurons in vitro. Taken together, our data suggested that sensory neurons directly promote angiogenesis via SP signaling in response to inflammation in the cornea.
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Affiliation(s)
- Lingjia Liu
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.,School of Medicine, Nankai University, Tianjin, China
| | - Reza Dana
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Jia Yin
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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Topical Low Dose Preservative-Free Hydrocortisone Reduces Signs and Symptoms in Patients with Chronic Dry Eye: A Randomized Clinical Trial. Adv Ther 2020; 37:329-341. [PMID: 31741283 DOI: 10.1007/s12325-019-01137-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Dry eye disease (DED) is a highly prevalent ocular condition with a significant burden on affected patients. Regardless of the underlying etiology, DED is associated with increased ocular surface inflammation. We investigated the safety and efficacy of a short-term treatment with topical low dose hydrocortisone in patients with chronic DED and ocular surface inflammation. METHODS A total of 60 patients (mean age 51 ± 14 years) with chronic DED and conjunctival hyperemia greater than grade 2 on the Efron scale were included. Patients were randomized to receive either preservative-free hydrocortisone 0.335% (Softacort, Laboratories Thea, France) for 12 days four times daily followed by 2 days twice daily instillation (intense treatment group) or 8 days three times daily followed by 3 days twice daily treatment (standard treatment group). Ocular redness was assessed at baseline, day 14, and day 28. Measurement of intraocular pressure (IOP) and clinical tests to assess signs and symptoms of DED were performed. RESULTS Conjunctival hyperemia and Ocular Surface Disease Index (OSDI) significantly decreased in both treatment groups (p < 0.001 each) after hydrocortisone treatment. A significant increase in tear film thickness was seen 4 weeks after treatment start (p = 0.03 and p = 0.04, respectively). IOP did not change in either of the two treatment groups (p = 0.45). CONCLUSION Treatment with low dose hydrocortisone 0.335% reduced ocular inflammation and decreased OSDI score. No change in IOP was observed in either of the two treatment schedules. Because of its good safety profile, low dose hydrocortisone may be an interesting alternative to standard corticosteroid treatment in DED. FUNDING Laboratories Thea. TRIAL REGISTRATION Clinicaltrials.gov registry: NCT03907865.
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Corneal nerve fiber loss in diabetes with chronic kidney disease. Ocul Surf 2019; 18:178-185. [PMID: 31770601 DOI: 10.1016/j.jtos.2019.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 11/15/2019] [Accepted: 11/22/2019] [Indexed: 12/19/2022]
Abstract
AIMS Patients with chronic kidney disease (CKD) in type 2 diabetes typically manifest with severe peripheral neuropathy. Corneal confocal microscopy is a novel technique that may serve as a marker of nerve injury in peripheral neuropathy. This study examines the changes that occur in corneal nerve morphology as a result of peripheral neuropathy due to renal dysfunction in people with type 2 diabetes. METHODS Sixty-two participants (mean age, 62 ± 12 years) with type 2 diabetes and 25 age-matched healthy controls underwent a comprehensive assessment of neuropathy using the total neuropathy score (TNS). The corneal sub-basal nerve plexus was imaged using corneal confocal microscopy. Corneal nerve fiber length, fiber density, branch density, total branch density, nerve fractal dimension, inferior whorl length and inferior whorl nerve fractal dimension were quantified. Based on the eGFR, participants were classified into those with diabetic CKD (eGFR < 60; n = 22) and those without CKD (eGFR ≥ 60; n = 40). RESULTS Participants with diabetic CKD had significantly lower corneal nerve fiber density (P = 0.037), length (P = 0.036) and nerve fractal dimension (P = 0.036) compared to those without CKD. Multiple linear regression analysis revealed that reduced corneal nerve fiber density (ß coefficient = 0.098, P = 0.017), length (ß coefficient = 0.006, P = 0.008) and nerve fractal dimension (ß coefficient = 0.001, P = 0.007) was associated with low eGFR levels when adjusted for age, duration of diabetes and severity of neuropathy. CONCLUSION Corneal confocal microscopy detects corneal nerve loss in patients with diabetic CKD and reduction in corneal nerve parameters is associated with the decline of kidney function.
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Zhu L, Titone R, Robertson DM. The impact of hyperglycemia on the corneal epithelium: Molecular mechanisms and insight. Ocul Surf 2019; 17:644-654. [PMID: 31238114 DOI: 10.1016/j.jtos.2019.06.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 06/11/2019] [Accepted: 06/21/2019] [Indexed: 12/15/2022]
Abstract
Type 2 Diabetes Mellitus (T2DM) is reaching epidemic levels worldwide and with it, there is a significant increase in complications associated with the disease. T2DM affects virtually all organ systems including the eye. While frequently overlooked, diabetic keratopathy is the most common ocular complication of diabetes and can manifest in mild to severe forms, the latter of which poses a major threat to vision. As the initial barrier between the environment and the eye, the corneal epithelium functions in innate immune defense. Compromise of this barrier may predispose the cornea to infection and can hinder the refractive capabilities of the eye. The clinical burden in patients with diabetic keratopathy lies primarily in the inability of the corneal epithelium to repair damage and maintain its tight barrier function. Current therapies for diabetic keratopathy are supportive, centering on the prevention of infection and promotion of an optimal healing environment. With no clear disease-modifying agent identified as of yet, a thorough understanding of the pathophysiology that underlies the development of diabetic keratopathy at the cellular level is critical to identify and develop potential therapeutic agents capable of promoting corneal re-epithelialization to accelerate the wound healing process. The focus of this review is to examine what is known regarding the cellular and molecular mechanisms needed to maintain epithelial homeostasis and how it goes awry in diabetes.
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Affiliation(s)
- Luke Zhu
- Department of Ophthalmology, University of Texas Southwestern Medical Center, United States
| | - Rossella Titone
- Department of Ophthalmology, University of Texas Southwestern Medical Center, United States
| | - Danielle M Robertson
- Department of Ophthalmology, University of Texas Southwestern Medical Center, United States.
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Abstract
Purpose Dry eye is a major ocular pathology worldwide. Although dry eye is a multifactorial disease, recent studies have shown that chronic immunologic processes have a pivotal role in its pathogenesis, characterized by the infiltration of immune cells in the lacrimal glands, elevated levels of tear inflammatory cytokines, and increased density of immune cells in the cornea and conjunctiva. This review describes the recent advances in understanding the relationship between dry eye and inflammation. Methods This narrative review is based on searches of recent international literature using terms related to the immune response in dry eye, and includes clinical trials, animal experiments, and expert reviews. Results Although dry eye presents clinically as tear film instability associated with corneal/conjunctival epithelial disorders, Meibomian gland dysfunction, and decreased visual function, recent laboratory and clinical studies have indicated inflammation in the lacrimal glands, Meibomian glands, conjunctiva, cornea, and aqueous tears. Furthermore, inflammation at these locations leads to conjunctival goblet cell apoptosis, corneal epithelial barrier disruption, and corneal nerve damage. These inflammatory outcomes can be exacerbated by intrinsic and extrinsic factors, such as aging, sex steroid hormone, autoimmune diseases, contact lens use, visual display terminals, and dry environment. Conclusions Recent advances in dry eye research have revealed the inflammatory process and its pathogenesis, which has been proposed as an "inflammatory vicious cycle" of dry eye. Comprehensive assessment of dry eye based on inflammation will improve the selection of treatments and help break the inflammatory cycle in clinical settings.
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Affiliation(s)
- Takefumi Yamaguchi
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba, Japan
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47
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Abstract
Measurement of tear film breakup time (TBUT) has become a standard diagnostic procedure in the dry eye clinic. Short TBUT-type dry eye is characterized by TBUT of less than 5 seconds and dry eye symptoms such as ocular fatigue or dryness; the importance of this type has recently been gaining prominence. Patients with this condition show no reduction in tear production and no staining of the ocular surface. The severity of symptoms is almost the same as in dry eye in which the ocular surface is stained with rose bengal or fluorescein. In addition to discomfort, patients suffer from decreased vision due to the unstable tear film, which can be attributed to the relative abnormality of the lipid layer, aqueous layer, and/or mucin layer. The diagnosis should be performed carefully on the basis of the patient's symptoms and the TBUT test, because the ocular surface appears normal and remains unstained.
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Affiliation(s)
- Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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48
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Matsumoto Y, Ibrahim OMA. Application of In Vivo Confocal Microscopy in Dry Eye Disease. Invest Ophthalmol Vis Sci 2019; 59:DES41-DES47. [PMID: 30481805 DOI: 10.1167/iovs.17-23602] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Confocal microscopy is a new, emerging, noninvasive technology that can aid in the in vivo assessment of structural changes in several ocular surface diseases at the cellular level. In the dry eye field, in vivo confocal microscopy has been applied to the examination of the cornea, bulbar and palpebral conjunctiva, Meibomian gland, and lacrimal gland. The device can assess the morphology, including superficial/wing/basal epithelial cell density, stromal keratocyte density, endothelial cell density, nerve fiber density, the number of beadings, nerve tortuosity, nerve reflectivity, and inflammatory cell density in the cornea. Furthermore, the device can not only assess epithelial cell density and area, goblet cell, microcyst, and inflammatory cell density but also the cellular architecture, including nucleocytoplasmic ratio in conjunctiva. The device also can disclose acinar unit density, acinar unit longest diameter, acinar unit shortest diameter, and inflammatory cell density in the Meibomian gland and lacrimal gland by other potential applications. Relevant research in Europe and the United States focused on the morphologic changes in the cornea in the dry eye field, while Japanese research focused on the conjunctival, Meibomian gland, and lacrimal gland alterations. The application of in vivo confocal microscopy in dry eye disease will be a powerful method to evaluate the morphologic change of the ocular surface around the world in the future.
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Affiliation(s)
- Yukihiro Matsumoto
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Osama M A Ibrahim
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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In Vivo Confocal Microscopy Automated Morphometric Analysis of Corneal Subbasal Nerve Plexus in Patients With Dry Eye Treated With Different Sources of Homologous Serum Eye Drops. Cornea 2019; 38:1412-1417. [DOI: 10.1097/ico.0000000000002005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Effects of Polyunsaturated Fatty Acids on Nonspecific Typical Dry Eye Disease: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Nutrients 2019; 11:nu11050942. [PMID: 31027357 PMCID: PMC6566338 DOI: 10.3390/nu11050942] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/21/2019] [Accepted: 04/24/2019] [Indexed: 12/13/2022] Open
Abstract
To investigate the effects of polyunsaturated fatty acids (PUFAs) in patients with dry eye disease (DED), a multifactorial inflammatory disorder, we searched Cochrane Library, EMBASE, PubMed, and Web of Science for randomized clinical trials (RCTs) investigating the effect of PUFAs in patients with DED before March 2019. Two reviewers independently abstracted data of tear breakup time (TBUT), Schirmer’s test, osmolarity, and ocular surface disease index (OSDI). We conducted pairwise meta-analysis using means and standard deviations (SDs) in a random-effects model for continuous outcomes. Thirteen eligible RCTs with 1782 patients with nonspecific typical DED were included. Patients who received PUFA treatment without other eye medications exhibited greater improvements in TBUT (MD = 1.80; p = 0.001), Schirmer test scores (MD = 0.50; p < 0.001), osmolarity (MD = −15.95; p < 0.001), and OSDI scores (MD = −10.19; p < 0.001) than those who received placebo treatment. However, the effects of PUFAs on TBUT (p < 0.001) and OSDI scores (p = 0.03) weakened with treatment duration. PUFAs are effective in treating nonspecific typical DED, particularly as a short-term treatment, with relatively few adverse events. Therefore, in real-world clinical practice, PUFA supplements are worth being suggested to patients with nonspecific typical DED who are not concurrently using other topical or systematic eye medications.
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