The effect of pregnancy on meibomian gland, tear film, cornea and anterior segment parameters

A Bibliometric Analysis of Pregnancy-Related Eye Disease from 1999 to 2022

OBJECTIVE

This systematic review and bibliometric analysis investigated the keywords appearing most in the pregnancy-related eye disease field to elucidate the current state and trends of pregnancy-related eye disease research.

METHODS

A systematic literature analysis of pregnancy-related eye disease was performed using the Web of Science Core Collection (WOS) databases. We used the keywords "ocular" OR "eye*" and "pregnancy" OR "pregnant" OR "gestation" to search for articles published from 1999 to 2022. Study data were analyzed and visualized using VOSviewer and CiteSpace.

RESULTS

We analyzed 929 articles published from 1999 to 2022. From 1999 to 2012, the article number increased slowly, with a marked acceleration in publication frequency after 2013, original papers accounted for 780 (84%) of the total number of articles published. David A. Mackey was the most prolific writer, and Margaret A. Honein contributed the most citations. The American Journal of Ophthalmology, PLOS One, and the European Journal of Ophthalmology published the most articles. The American Journal of Ophthalmology, Ophthalmology, British Journal of Ophthalmology, Investigative Ophthalmology and Visual Science were the four most commonly cited journals. The University of Western Australia, the University of Sao Paulo, and the University of Melbourne were highly prolific institutions. Five co-cited references had a citation burst up to 2022, analyzed by CiteSpace. Keyword analysis (VOSviewer) yielded recent key themes (pregnancy, women, eye, risks and diagnosis) and suggested future research directions.

CONCLUSIONS

The current results laid the foundation of bibliometrics for scholars and identified researchers, scientific journals, countries, keyword clustering, hot topics, and trends in the literature. High-impact-factor journals contain the most keyword-clustering research and open new horizons for research in the pregnancy-related eye disease nursing field, providing research inspiration for investigators in this field.

Physiological and pathological changes to the eye and vision during and after pregnancy

Pregnancy introduces a multitude of changes in the body, including hormonal fluctuations and metabolic changes, which can lead to atypical ocular signs and symptoms. Ocular manifestations range from fluctuations in vision, to microstructural changes in the retina and choroid, to dry eye disease. This narrative review highlights the range of pregnancy-related effects on the eye and vision that are likely to present in the context of routine eyecare. Specifically, physiological ocular changes and pathological ocular changes that manifest for the first time, or are exacerbated, in uncomplicated pregnancy are discussed. The literature has evolved from simply noting differences in the eye between pregnant and non-pregnant groups, to refining knowledge of the proposed underlying pathophysiology with the advent of newer technologies in eyecare. A particular focus of this review is navigating when pregnancy changes in the eye occur or peak during the gestational period, and whether the changes are short-lived or might extend past pregnancy. While many pregnancy-associated changes are temporary and resolve post-partum, it is also recognised that some changes persist after pregnancy, with a notable absence of literature on ocular changes with loss or termination of pregnancy. Currently or previously pregnant women (or those planning to become pregnant), and other health professionals, should be educated about the importance of seeking eyecare before, during and after pregnancy.

Myopic shift in female mice after ovariectomy

Myopia is a global public health concern, with a higher prevalence in women than that in male. As the relationship between sex hormone and myopia remains unclear, we aimed to reveal the relationship between sex hormone and myopia by removing the ovaries of mice and measuring changes in ocular parameters related to myopia. Lens-induced myopia (LIM) surgeries were performed on 3-week-old male mice and age-matched female mice to evaluate the effects of sex on myopia development, which indicated a high degree of myopia and rapid progression of axial elongation in male mice. Bilateral ovariectomy (OVX) performed on 4-week-old female mice induced myopic refraction status in ovariectomized mice. Although axial length elongation was larger in ovariectomized mice than that in sham control mice, the result was insignificant. To further reveal the relationship between female sex hormones and myopia, LIM combined with OVX was performed, which revealed a magnified myopic refraction status in ovariectomized mice. Nevertheless, elongation of the anterior chamber depth in the - 30 D lens-treated eyes significantly increased in LIM + OVX mice compared with the frame-treated eyes in LIM + OVX mice and - 30 D lens-treated eyes in LIM + Sham surgery mice. Sex hormones play a role in regulating myopia development in female mice.

Evaluation of dry eye and meibomian gland function in pregnancy

PURPOSE

To evaluate the signs and symptoms of dry eye in healthy pregnant women and investigate the effect of pregnancy on meibomian gland loss using non-contact meibography.

METHODS

Healthy pregnant women and age-matched healthy non-pregnant women were included in the study. Subjective symptoms were assessed using the Ocular Surface Disease Index (OSDI). The first and average non-invasive break-up times (first-NIBUT and avg-NIBUT, respectively) were determined, and the Schirmer test was applied. Non-contact meibography was performed.

RESULTS

The study included a total of 62 women, 30 pregnant (study group) and 32 non-pregnant (control group). There was no significant difference between the groups in terms of OSDI score and the Schirmer test (p > 0.05). The mean first-NIBUT and avg-NIBUT values of the study group (13.1 ± 5.3 and 13.7 ± 4.5 s) were significantly lower than the control group (16.0 ± 2.4 and 16.4 ± 1.5 s) (p: 0.015 and p: 0.040, respectively). The mean meibomian gland losses in the upper and lower eyelids were significantly higher in the study group (16.9 ± 8.2% and 11.6 ± 10.2%) compared to the control group (9.7 ± 6.2% and 5.6 ± 4.7%) (p < 0.001 and p: 0.011, respectively).

CONCLUSIONS

It is considered that loss of the meibomian glands may occur during pregnancy, and this may predispose pregnant women to evaporative dry eye. Although dry eye does not cause significant ocular surface symptoms in pregnancy, NIBUT and non-contact meibography can be considered as effective diagnostic methods for the detection of dry eye in pregnant women.

Evaluation of the Effect of İnfection and İmmunity on the Tear Film by Scheimpflug-Placido Disc Topography- A Case Control Study

PURPOSE

We aimed to compare the tear film stability of individuals who had recovered from coronavirus disease (COVID-19), that of individuals vaccinated against COVID-19 and that of healthy individuals in a control group.

METHODS

This study included 61 eyes of 61 post-COVID-19 patients, 63 eyes of 63 participants who had received at least two doses of the SARS-CoV-2 mRNA BNT162b2 (Pfizer-BioNTech) vaccine, and 57 eyes of healthy individuals in a control group. We compared the groups' tear film stability.

RESULTS

The mean non-invasive first tear break-up time (NIF-BUT) value was 4.1±2.7 seconds in the post-COVID-19 group, 4.7±2.9 seconds in the vaccinated group, and 5.8±2.8 seconds in the control group. This value was statistically significantly lower in the post-COVID-19 and vaccinated groups than in the control group (p= 0.007). The rate of superotemporal (ST) quadrant breakup, statistically significantly higher in the vaccinated group than in the other two groups (p=0.001). According to a qualitative examination of the results, at least one breakup occurred in 47 (77%) of the post-COVID-19 participants' eyes, 50 (79.4%) of the vaccinated group's eyes, and 33 (57.9%) of the control group's eyes. In terms of this qualitative value, the post-COVID-19 and vaccinated groups had significantly higher breakup rates than the control group (p=0.018).

CONCLUSIONS

Destabilization in the tear film was more common in both the post covid group and the vaccinated group. In addition to individuals who have post-Covid, we think that post-vaccination individuals should be followed closely in terms of ocular surface diseases.

Changes caused by fluorescein in tear film by hybrid break-up time test- part one; on quantitative values

PURPOSE

To examine the effect of fluorescein on the tear film by measuring tear break-up time (BUT).

METHODS

In this prospective study, after determining the natural BUT value of the tear with the non-invasive break-up time (NI-BUT) method, we re-evaluated the changes in the tear film stained with fluorescein using the topographical method. The topographic evaluation of tears stained with fluorescein was called as Hybrid-BUT (H-BUT) test. The first BUT (BUT₁), the second BUT (BUT₂), the third BUT (BUT₃), the fourth BUT (BUT₄), and the fifth BUT (BUT₅) values of each participant's NI-BUT and H-BUT tests were compared.

RESULTS

The present study was conducted with 82 participants. Although the mean BUT₁ value was 4.1 ± 2.7 s in the NI-BUT test, it was 5.1 ± 3.2 s in the H-BUT test (p = 0.029). The mean BUT₂ value was 5.0 ± 3.0 s in the NI-BUT test, and 6.2 ± 3.3 s in the H-BUT test (p = 0.029). The mean BUT₃ value in the NI-BUT test was 5.8 ± 3.4 s, and 7.2 ± 3.7 s in the H-BUT test (p = 0.021). The mean BUT₄ value in the NI-BUT test was 6.2 ± 3.4 s and 7.9 ± 3.9 s in the H-BUT test (p = 0.009).

CONCLUSIONS

Fluorescein causes changes in the break-up time test, and depending on this, in the tear film pattern. These changes can be compared and detected quantitatively and objectively of the fluorescein-stained tear film with the NI-BUT test and the topographic devices by using the H-BUT test.