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Hao C, Fan E, Wei Z, Radeen KR, Purohit N, Li K, Purohit S, Fan X. Elevated Inflammatory Cytokines Persist in the Aqueous Humor Years After Cataract Surgery. Invest Ophthalmol Vis Sci 2025; 66:12. [PMID: 40183733 PMCID: PMC11977793 DOI: 10.1167/iovs.66.4.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2025] [Accepted: 03/03/2025] [Indexed: 04/05/2025] Open
Abstract
Purpose There is currently limited information regarding inflammation and cytokine levels in the aqueous humor (AH) of adult patients with cataract who have undergone phacoemulsification cataract extraction without other ocular comorbidities. Methods AH samples were collected from healthy, non-surgical donors and donors with a history of cataract surgery performed 3 to 12 years prior. Sixty-three cytokines and growth factors were measured using bead-based ProcartaPlex immunoassays. Data analysis included normal distribution assessment, pairwise correlation, logistic regression, and ridge regression. Results Of the 63 molecules analyzed, 34 were selected for further study. Cytokines, such as CD40L, IL-7, MIP-1α, and LIF, were found at significantly higher concentrations in AH samples from donors with a history of cataract surgery compared with non-cataract controls. In contrast, lower concentrations of IL-23, TRAIL, IL-12p70, IFNγ, MIP-3α, and SCF were observed in post-surgical samples. Pairwise correlation analysis identified clusters of significantly correlated molecules, suggesting their potential involvement in the inflammatory environment of AH post-cataract surgery. AH concentration of 34 proteins was combined into a post-cataract surgery inflammation index (PCSII) using ridge regression, which differs significantly between post-cataract surgery donors and non-cataract controls. This PCSII shows that any increase in AH levels of these molecules can stratify cataract surgery donors into low and high-risk of inflammatory groups. Conclusions This study indicates that cataract surgery may lead to a chronic inflammatory state in the AH, which can persist for extended periods post-surgery.
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Affiliation(s)
- Caili Hao
- Department of Cellular Biology and Anatomy, Medical College of Georgia at Augusta University, Augusta, Georgia, United States
| | - Emily Fan
- Department of Cellular Biology and Anatomy, Medical College of Georgia at Augusta University, Augusta, Georgia, United States
- University of Georgia, Athens, Georgia, United States
| | - Zongbo Wei
- Department of Cellular Biology and Anatomy, Medical College of Georgia at Augusta University, Augusta, Georgia, United States
| | - Kazi Rafsan Radeen
- Department of Cellular Biology and Anatomy, Medical College of Georgia at Augusta University, Augusta, Georgia, United States
| | - Neha Purohit
- Department of Cellular Biology and Anatomy, Medical College of Georgia at Augusta University, Augusta, Georgia, United States
- University of Georgia, Athens, Georgia, United States
| | - Kailin Li
- Department of Cellular Biology and Anatomy, Medical College of Georgia at Augusta University, Augusta, Georgia, United States
| | - Sharad Purohit
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, United States
| | - Xingjun Fan
- Department of Cellular Biology and Anatomy, Medical College of Georgia at Augusta University, Augusta, Georgia, United States
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Chen KY, Chan HC, Chan CM. Is Thermal Pulsation Therapy Effective for Dry Eyes Before and After Cataract Surgery? A Systematic Review and Meta-Analysis. Clin Ophthalmol 2025; 19:19-33. [PMID: 39801566 PMCID: PMC11721686 DOI: 10.2147/opth.s498869] [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: 10/01/2024] [Accepted: 12/17/2024] [Indexed: 01/16/2025] Open
Abstract
Background Meibomian gland dysfunction (MGD) is a primary cause of evaporative dry eye disease (DED), which is often exacerbated by cataract surgery due to surgical trauma and inflammation. Thermal pulsation therapy (TPT) aims to enhance meibomian gland function and relieve dry eye symptoms. We conducted a systematic review and meta-analysis to evaluate the effectiveness of TPT in managing dry eye symptoms associated with cataract surgery. Methods A systematic search was performed in December 2024 across PubMed, ScienceDirect, CINAHL, and the Cochrane Central Register of Controlled Trials to identify original research on the efficacy of TPT in addressing cataract surgery-related dry eye symptoms. The quality of the included studies was evaluated using the Risk of Bias in Non-Randomized Studies of Interventions tool, with results visualized through the Robvis 2.0 tool developed by the Cochrane Collaboration. Results The search yielded 365 records, of which seven studies met the inclusion criteria for this meta-analysis. Key outcomes analyzed included the meibomian gland yielding liquid secretion (MGYLS) score, tear break-up time (TBUT), ocular surface disease index (OSDI) score, and lipid layer thickness (LLT). The meta-analysis revealed a moderate effect of TPT, with a small but clinically significant improvement observed in MGYLS scores (Cohen's d = 0.29, p = 0.033) and TBUT (Cohen's d = 0.15, p = 0.029). However, the effects on OSDI scores and LLT were not statistically significant. Study heterogeneity varied, with some outcomes exhibiting considerable variability. Conclusion TPT provides moderate and clinically meaningful improvements in MGYLS scores and TBUT for patients experiencing dry eye symptoms after cataract surgery, although improvements in OSDI scores and LLT did not achieve statistical significance. The variability in study quality and heterogeneity highlights the need for well-designed, high-quality research to confirm these findings and evaluate the durability of TPT's therapeutic effects both before and after cataract surgery.
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Affiliation(s)
- Kai-Yang Chen
- Department of Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hoi-Chun Chan
- Department of Pharmacy, School of Pharmacy, China Medical University, Taichung, Taiwan
| | - Chi Ming Chan
- Department of Ophthalmology, Cardinal Tien Hospital, New Taipei City, Taiwan
- Department of Ophthalmology, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
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Roca D, Jain S, Mun C, Akbar Sarwar M, Shorter E, Ortiz-Morales G, Tarib I, De La Cruz J. Novel Management of Ocular Surface Inflammation in Patients With Ocular Graft-Versus-Host Disease in the Setting of Cataract Surgery. Eye Contact Lens 2024; 50:189-193. [PMID: 38350098 DOI: 10.1097/icl.0000000000001076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 02/15/2024]
Abstract
PURPOSE To report the outcomes of cataract surgery in patients with ocular graft-versus-host disease (oGVHD) using a novel preoperative immunomodulatory regimen in a collaborative subspecialty care setting. METHODS Retrospective case series of patients with oGVHD who underwent cataract surgery using a novel preoperative immunomodulatory regimen in a collaborative care setting. A preoperative regimen consisting of pooled human immune globulin 1%, autologous serum 50%, and methylprednisolone 1% eye drops was prescribed. Outcome measures included visual acuity (VA), ocular surface disease index (OSDI) score, lissamine green staining, and complications with a minimum of 2 years of follow-up. RESULTS Thirty-five eyes from 20 patients with oGVHD were studied. The mean age was 59 years (range 30-70 years). A healthy comparison group included 35 eyes from 24 patients with a mean age of 63 years (range 44-74 years). At the 2-year follow-up, the mean corneal staining score was 2.3/15, the mean OSDI score was 37.5, and the mean VA was 20/30 (logarithm of the minimal angle of resolution 0.17). The global complication rate was 2.8% at the last follow-up with no difference versus a healthy comparison group. CONCLUSIONS A collaborative care model improving ocular surface health before cataract surgery with dry eye and cataract subspecialists can optimize outcomes in patients with oGVHD.
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Affiliation(s)
- Daniela Roca
- Department of Ophthalmology and Visual Sciences (D.R., S.J., C.M., M.A.S., E.S., I.T., J.D.L.C.), University of Illinois Chicago, Chicago, IL; and Tecnologico de Monterrey (G.O.-M.), School of Medicine and Health Sciences, Monterrey, Mexico
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Xiong F, Pula D, Akpek EK, Bunya VY, Shiboski CH, Lietman TL, Gonzales JA. Sjögren's Versus Non-Sjögren's Ocular Features: Similar Symptoms, But Significantly Worse Signs. Invest Ophthalmol Vis Sci 2024; 65:23. [PMID: 38193760 PMCID: PMC10784845 DOI: 10.1167/iovs.65.1.23] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/20/2023] [Indexed: 01/10/2024] Open
Abstract
Purpose To examine the ocular signs and symptoms in participants of the Sjögren's International Collaborative Clinical Alliance cohort, and to compare them across Sjögren's disease (SjD) status. Methods Our study population comprised 3380 Sjögren's International Collaborative Clinical Alliance participants who had no missing data relevant to this study. Participants' SjD status was assessed using the updated 2016 American College of Rheumatism/European League Against Rheumatism SjD classification criteria. Participants completed baseline questionnaires of ocular symptoms and underwent ocular examinations. Differences in the ocular signs and symptoms between SjD and non-SjD groups were assessed. We used multivariable linear and linear mixed-effects models to investigate the impact of SjD on Ocular Surface Disease Index-6 and OSS. Results Among 1532 participants classified as SjD, their Ocular Surface Disease Index-6 did not clinically differ from those classified as non-SjD (adjusted difference, -0.97; 95% confidence interval, -1.52 to -0.41). However, SjD participants exhibited an elevated ocular staining score (adjusted difference, 3.47; 95% confidence interval, 3.36-3.57; P < 0.001) compared with non-SjD participants. In addition, SjD was associated with increased odds of ocular signs, such as reduced tear break-up time, abnormal Schirmer I test, and corneal abnormalities, and was strongly related to more intense corneal and conjunctival staining, as well as additional corneal staining points. Conclusions SjD is associated with a higher risk of ocular signs and pathology compared with non-SjD, whereas ocular symptoms remain similar. In addition, corneal abnormalities and corneal staining patterns could serve as a potential biomarker in identifying SjD-related dry eye.
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Affiliation(s)
- Fanxiu Xiong
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States
| | - Douglas Pula
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States
| | - Esen K. Akpek
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States
| | - Vatinee Y. Bunya
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Caroline H. Shiboski
- Department of Oral Medicine, University of California, San Francisco, San Francisco, California, United States
| | - Thomas L. Lietman
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, United States
| | - John A. Gonzales
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, United States
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Kanclerz P, Tuuminen R. Advancements in Postoperative Care after Cataract Surgery. J Clin Med 2022; 11:jcm11113162. [PMID: 35683549 PMCID: PMC9181706 DOI: 10.3390/jcm11113162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 05/29/2022] [Indexed: 11/16/2022] Open
Abstract
Cataract surgery is one of the most frequently performed surgical procedures in many countries [...].
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Affiliation(s)
- Piotr Kanclerz
- Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
- Hygeia Clinic, 80-286 Gdańsk, Poland
- Correspondence: (P.K.); (R.T.); Tel.: +48-58-776-40-46 (P.K.); +358-50-411-3870 (R.T.); Fax: +48-58-776-40-46 (P.K.); +358-9-2411-227 (R.T.)
| | - Raimo Tuuminen
- Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
- Department of Ophthalmology, Kymenlaakso Central Hospital, 48210 Kotka, Finland
- Correspondence: (P.K.); (R.T.); Tel.: +48-58-776-40-46 (P.K.); +358-50-411-3870 (R.T.); Fax: +48-58-776-40-46 (P.K.); +358-9-2411-227 (R.T.)
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Trattler W, Karpecki P, Rapoport Y, Sadri E, Schachter S, Whitley WO, Yeu E. The Prevalence of Demodex Blepharitis in US Eye Care Clinic Patients as Determined by Collarettes: A Pathognomonic Sign. Clin Ophthalmol 2022; 16:1153-1164. [PMID: 35449733 PMCID: PMC9017705 DOI: 10.2147/opth.s354692] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/09/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Patients and Methods Results Conclusion
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Affiliation(s)
| | | | | | - Ehsan Sadri
- Visionary Eye Institute, Newport Beach, CA, USA
| | | | | | - Elizabeth Yeu
- Virginia Eye Consultants, Norfolk, VA, USA
- Correspondence: Elizabeth Yeu, Virginia Eye Consultants, 241 Corporate Boulevard, Suite 210, Norfolk, VA, 23502, Tel +1 757 793 4942, Fax +1 757 319 2493, Email
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Yeu E, Hashem O, Sheha H. Treatment of Epithelial Basement Membrane Dystrophy to Optimize the Ocular Surface Prior to Cataract Surgery. Clin Ophthalmol 2022; 16:785-795. [PMID: 35321046 PMCID: PMC8935016 DOI: 10.2147/opth.s356421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/23/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the effectiveness of cryopreserved amniotic membrane (CAM) after debridement in treating epithelial basement membrane dystrophy (EBMD) prior to cataract surgery. Methods This pilot study included 2 treatment groups: a prospective study group of 9 subjects with significant EBMD who received debridement followed by self-retained CAM, and a retrospective, control group of 10 consecutive subjects who received debridement followed by a bandage contact lens (BCL). Slit-lamp photography after fluorescein staining were used to monitor healing. Corneal topography and IOL calculation were compared at baseline and 1 month after the procedure. Refraction and ocular surface stability were also compared after cataract surgery. Results Corneal reepithelialization after debridement occurred in 4.6 ± 0.8 days in the study group and 6.8 ± 0.6 days in the control (p < 0.05). Corneal topography showed changes in curvature from 43.5 ± 1.2D at baseline to 44.6 ± 1.2D at 1 month in the study group and from 45.0 ± 0.6D to 45.7 ± 0.8D in the control (p = 0.38). Average change in IOL calculation was 1.56 D in the study group, compared to 0.95 D in control (p = 0.29). Post-cataract refraction in both groups was within ±0.5 Diopter of the anticipated, and corneal surface remained stable without EBMD recurrence. Conclusion Management of ocular surface disorders prior to cataract surgery stabilizes IOL calculation and reduces postoperative refractive surprises. CAM relatively accelerated healing after debridement; however, it was not better than BCL in stabilizing the ocular surface and improving visual outcome. The use of CAM in cases of EBMD remains speculative.
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Affiliation(s)
- Elizabeth Yeu
- Virginia Eye Consultants, Norfolk, VA, USA
- Eastern Virginia Medical School, Norfolk, VA, USA
| | - Omar Hashem
- Research Institute of Ophthalmology, Cairo, Egypt
| | - Hosam Sheha
- Research Institute of Ophthalmology, Cairo, Egypt
- Florida International University Herbert Wertheim College of Medicine, & Glaucoma Research Organization, Miami, FL, USA
- Manhattan Eye, Ear and Throat Hospital, Hofstra Northwell School of Medicine, New York, NY, USA
- Correspondence: Hosam Sheha, Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, 210 E 64 Street, New York, NY, 10065, USA, Tel +1 917-810-9555, Email
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Garg P, Gupta A, Tandon N, Raj P. Dry Eye Disease after Cataract Surgery: Study of its Determinants and Risk Factors. Turk J Ophthalmol 2021; 50:133-142. [PMID: 32630999 PMCID: PMC7338747 DOI: 10.4274/tjo.galenos.2019.45538] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Objectives To study the incidence of dry eye and its determinants in patients undergoing cataract surgery. Materials and Methods One hundred twenty patients with senile cataract underwent Schirmer's test, tear break-up time (TBUT) test, lissamine green staining of the cornea and conjunctiva, and Ocular Surface Disease Index (OSDI) for evaluation of dry eye preoperatively and again at first and second follow-up examinations at 1 week and 1 month after cataract surgery. Results Mean age of the patients was 59.25+9.77 years and 73 (60.8%) were men. None of the patients had dry eye at the time of enrollment as per the criteria of our study. Postoperatively, Schirmer's test values ranged from 12-35 mm and 8-24 mm at first and second follow-ups, respectively. Mean TBUT was 13.16±2.45 and 9.64±2.20 seconds, while lissamine green staining score was 3 in 67 (55.8%) and 1 in 67 (55.8%) subjects at first and second follow-up, respectively. OSDI values ranged from 1-30 and 10-33 with a mean of 25.97±5.34 and 11.96±7.47 respectively at first and second follow-up. At first follow-up, 89.1% of the 56 patients who underwent phacoemulsification were found to have grade 2 dry eye (p<0.001), while 92.2% of the 64 patients who underwent small-incision cataract surgery (SICS) had grade 2 dry eye (p<0.001). At second follow-up, grade 0 dry eye was observed in 92.2% of the patients who underwent phacoemulsification and 82.1% of the patients who underwent SICS (p<0.001). Conclusion The incidence of dry eye after cataract surgery was high and mostly independent of demographic and anthropometric profile, type of surgical procedure, time of microscope exposure, and amount of energy used. This dryness was transient in nature and showed a declining trend, tending to achieve normalization by the end of 1 month.
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Affiliation(s)
- Pragati Garg
- Era's Lucknow Medical College and Hospital, Clinic of Ophthalmology, Lucknow, India
| | - Aditi Gupta
- Era's Lucknow Medical College and Hospital, Clinic of Ophthalmology, Lucknow, India
| | - Nishi Tandon
- Era's Lucknow Medical College and Hospital, Clinic of Pathology, Lucknow, India
| | - Priyanka Raj
- Era's Lucknow Medical College and Hospital, Clinic of Ophthalmology, Lucknow, India
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Labetoulle M, Rousseau A, Baudouin C. Management of dry eye disease to optimize cataract surgery outcomes: Two tables for a daily clinical practice. J Fr Ophtalmol 2019; 42:907-912. [PMID: 31351686 DOI: 10.1016/j.jfo.2019.03.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 03/11/2019] [Indexed: 12/23/2022]
Abstract
The increase in life expectancy has resulted in a greater number of patients presenting for cataract surgery as well as an increasing prevalence of dry eye disease (DED) symptoms or signs noted in these patients. Low grade and/or non-symptomatic DED is common and can be exacerbated after surgery. DED can induce errors in IOL power calculation. DED can impair the visual prognosis and patient comfort after cataract surgery, leading to dissatisfaction of both the patient and the surgeon. Hence, preoperative evaluation for DED for all cataract candidates is crucial to mitigate these risks. To optimize clinical efficiency during the screening examination, we propose a strategy of three levels of DED screening, according to a patient's risk of DED given his or her history. We also propose a summary of the main clinical points before, during and after cataract surgery in eyes with DED.
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Affiliation(s)
- M Labetoulle
- Service d'Ophtalmologie, hôpital Bicêtre, AP-HP, Université Paris Sud, 94275 Le Kremlin-Bicêtre, France; Center for Immunology of Viral infections and Autoimmune diseases (IMVA). IDMIT Infrastructure (http://www.idmitcenter.fr). CEA, Université Paris Sud, Inserm U1184, 18, route du Panorama, 92265, Fontenay-aux-Roses cedex, France.
| | - A Rousseau
- Service d'Ophtalmologie, hôpital Bicêtre, AP-HP, Université Paris Sud, 94275 Le Kremlin-Bicêtre, France; Center for Immunology of Viral infections and Autoimmune diseases (IMVA). IDMIT Infrastructure (http://www.idmitcenter.fr). CEA, Université Paris Sud, Inserm U1184, 18, route du Panorama, 92265, Fontenay-aux-Roses cedex, France
| | - C Baudouin
- Centre Hospitalier des Quinze-Vingts, Service III, 28, rue de Charenton, 75012 Paris France; Institut de la Vision, 17, rue Moreau, 75012 Paris France; Hôpital Ambroise Paré, AP-HP, Boulogne, Université Versailles Saint-Quentin en Yvelines, 9 avenue Charles-de-Gaulle, 92104 Boulogne-Billancourt, France
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Hovanesian J, Holland E. Tolerability and toxicity of topically applied nepafenac 0.3% compared with generic ketorolac 0.5%. J Cataract Refract Surg 2019; 45:174-180. [DOI: 10.1016/j.jcrs.2018.08.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/16/2018] [Accepted: 08/21/2018] [Indexed: 11/16/2022]
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Gomes JAP, Azar DT, Baudouin C, Efron N, Hirayama M, Horwath-Winter J, Kim T, Mehta JS, Messmer EM, Pepose JS, Sangwan VS, Weiner AL, Wilson SE, Wolffsohn JS. TFOS DEWS II iatrogenic report. Ocul Surf 2017; 15:511-538. [PMID: 28736341 DOI: 10.1016/j.jtos.2017.05.004] [Citation(s) in RCA: 286] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 05/02/2017] [Indexed: 01/04/2023]
Abstract
Dry eye can be caused by a variety of iatrogenic interventions. The increasing number of patients looking for eye care or cosmetic procedures involving the eyes, together with a better understanding of the pathophysiological mechanisms of dry eye disease (DED), have led to the need for a specific report about iatrogenic dry eye within the TFOS DEWS II. Topical medications can cause DED due to their allergic, toxic and immuno-inflammatory effects on the ocular surface. Preservatives, such as benzalkonium chloride, may further aggravate DED. A variety of systemic drugs can also induce DED secondary to multiple mechanisms. Moreover, the use of contact lens induces or is associated with DED. However, one of the most emblematic situations is DED caused by surgical procedures such as corneal refractive surgery as in laser-assisted in situ keratomileusis (LASIK) and keratoplasty due to mechanisms intrinsic to the procedure (i.e. corneal nerve cutting) or even by the use of postoperative topical drugs. Cataract surgery, lid surgeries, botulinum toxin application and cosmetic procedures are also considered risk factors to iatrogenic DED, which can cause patient dissatisfaction, visual disturbance and poor surgical outcomes. This report also presents future directions to address iatrogenic DED, including the need for more in-depth epidemiological studies about the risk factors, development of less toxic medications and preservatives, as well as new techniques for less invasive eye surgeries. Novel research into detection of early dry eye prior to surgeries, efforts to establish appropriate therapeutics and a greater attempt to regulate and oversee medications, preservatives and procedures should be considered.
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Affiliation(s)
- José Alvaro P Gomes
- Dept. of Ophthalmology and Visual Sciences, Federal University of Sao Paulo/Paulista School of Medicine (UNIFESP/EPM), São Paulo, SP, Brazil.
| | - Dimitri T Azar
- University of Illinois College of Medicine, Chicago, IL, USA
| | | | - Nathan Efron
- School of Optometry and Vision Science, Queensland University of Technology, Queensland, Australia
| | - Masatoshi Hirayama
- Department of Ophthalmology, School of Medicine, Keio University, Tokyo, Japan
| | | | - Terry Kim
- Duke University School of Medicine, Durham, NC, USA; Duke University Eye Center, Durham, NC, USA
| | | | - Elisabeth M Messmer
- Department of Ophthalmology, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Jay S Pepose
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Steven E Wilson
- Cole Eye Institute, The Cleveland Clinic, Cleveland, OH, USA
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Kwon JW, Choi JA, Shin EY, La TY, Jee DH, Chung YW, Cho YK. Effect of trapping vascular endothelial growth factor-A in a murine model of dry eye with inflammatory neovascularization. Int J Ophthalmol 2016; 9:1541-1548. [PMID: 27990354 DOI: 10.18240/ijo.2016.11.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/27/2016] [Indexed: 01/17/2023] Open
Abstract
AIM To evaluate whether trapping vascular endothelial growth factor A (VEGF-A) would suppress angiogenesis and inflammation in dry eye corneas in a murine corneal suture model. METHODS We established two groups of animals, one with non-dry eyes and the other with induced dry eyes. In both groups, a corneal suture model was used to induce inflammation and neovascularization. Each of two groups was again divided into three subgroups according to the treatment; subgroup I (aflibercept), subgroup II (dexamethasone) and subgroup III (phosphate buffered saline, PBS). Corneas were harvested and immunohistochemical staining was performed to compare the extents of neovascularization and CD11b+ cell infiltration. Real-time polymerase chain reaction was performed to quantify the expression of inflammatory cytokines and VEGF-A in the corneas. RESULTS Trapping VEGF-A with aflibercept resulted in significantly decreased angiogenesis and inflammation compared with the dexamethasone and PBS treatments in the dry eye corneas (all P<0.05), but with no such effects in non-dry eyes. The anti-inflammatory and anti-angiogenic effects of VEGF-A trapping were stronger than those of dexamethasone in both dry eye and non-dry eye corneas (all P<0.05). The levels of RNA expression of VEGF-A, TNF-alpha, and IL-6 in the aflibercept subgroup were significantly decreased compared with those in the PBS subgroup in the dry eye group. CONCLUSION Compared with non-dry eye corneas, dry eye corneas have greater amounts of inflammation and neovascularization and also have a more robust response to anti-inflammatory and anti-angiogenic agents after ocular surface surgery. Trapping VEGF-A is effective in decreasing both angiogenesis and inflammation in dry eye corneas after ocular surface surgery.
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Affiliation(s)
- Jin Woo Kwon
- Department of Ophthalmology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93 Ji-Dong, Paldal-Gu, Suwon, Gyeonggi-Do 16247, South Korea
| | - Jin A Choi
- Department of Ophthalmology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93 Ji-Dong, Paldal-Gu, Suwon, Gyeonggi-Do 16247, South Korea
| | - Eun Young Shin
- Research Institute of Medical Science, St. Vincent's Hospital, The Catholic University of Korea, 93 Ji-Dong, Paldal-Gu, Suwon, Gyeonggi-Do16247, South Korea
| | - Tae Yoon La
- Department of Ophthalmology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93 Ji-Dong, Paldal-Gu, Suwon, Gyeonggi-Do 16247, South Korea
| | - Dong Hyun Jee
- Department of Ophthalmology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93 Ji-Dong, Paldal-Gu, Suwon, Gyeonggi-Do 16247, South Korea
| | - Yeon Woong Chung
- Department of Ophthalmology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93 Ji-Dong, Paldal-Gu, Suwon, Gyeonggi-Do 16247, South Korea
| | - Yang Kyung Cho
- Department of Ophthalmology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93 Ji-Dong, Paldal-Gu, Suwon, Gyeonggi-Do 16247, South Korea
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Emerging Technology in Refractive Cataract Surgery. J Ophthalmol 2016; 2016:7309283. [PMID: 27433353 PMCID: PMC4940542 DOI: 10.1155/2016/7309283] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 05/16/2016] [Indexed: 12/19/2022] Open
Abstract
Technology in cataract surgery is constantly evolving to meet the goals of both surgeons and patients. Recent major advances in refractive cataract surgery include innovations in preoperative and intraoperative diagnostics, femtosecond laser-assisted cataract surgery (FLACS), and a new generation of intraocular lenses (IOLs). This paper presents the latest technologies in each of these major categories and discusses how these contributions serve to improve cataract surgery outcomes in a safe, effective, and predictable manner.
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Abstract
PURPOSE OF REVIEW To provide a summary of the mechanisms that may cause dry eye after cataract surgery and discuss available and upcoming treatment modalities. RECENT FINDINGS Development or worsening of dry eye symptoms after cataract surgery is multifactorial with corneal nerve transection, inflammation, goblet cell loss, and meibomian gland dysfunction commonly cited as underlying disorders. With increasing awareness of the prevalence of dry eye disease, current surgical techniques are being analyzed for their contribution to the issue. Although many classic interventions, such as artificial tears and anti-inflammatory drops, remain first-line treatment options, they may not adequately address abnormalities of the tear film. The trend has been to create new drugs and technologies that target meibomian gland deficiencies and restore goblet cell numbers. SUMMARY Therapy for postoperative dry eye symptoms should be determined based on symptom severity and which underlying cause is most prominent at a given time. Patients with high-level risk factors for dry eye should be evaluated preoperatively to determine whether they have preexisting dry eye disease or if they are susceptible to developing disease after surgery.
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Kwon JW, Chung YW, Choi JA, La TY, Jee DH, Cho YK. Comparison of postoperative corneal changes between dry eye and non-dry eye in a murine cataract surgery model. Int J Ophthalmol 2016; 9:218-24. [PMID: 26949638 DOI: 10.18240/ijo.2016.02.06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 07/10/2015] [Indexed: 01/17/2023] Open
Abstract
AIM To compare the effects of the surgical insult of cataract surgery on corneal inflammatory infiltration, neovascularization (NV) and lymphangiogenesis (LY) between the dry eye and non-dry eye in murine cataract surgery models. METHODS We established two groups of animals, one with normal eyes (non-dry eye) and the second with induced dry eyes. In both groups, we used surgical insults to mimic human cataract surgery, which consisted of lens extraction, corneal incision and suture. After harvesting of corneas on the 9(th) postoperative day and immunohistochemical staining, we compared NV, LY and CD11b+ cell infiltration in the corneas. RESULTS Dry eye group had significantly more inflammatory infiltration (21.75%±7.17% vs 3.65%±1.49%; P=0.049). The dry eye group showed significantly more NV (48.21%±4.02% vs 26.24%±6.01%; P=0.016) and greater levels of LY (9.27%±0.48% vs 4.84%±1.15%; P=0.007). In corneas on which no surgery was performed, there was no induction of NV in both the dry and non-dry group, but dry eye group demonstrated more CD11b+ cells infiltration than the non-dry eye group (0.360%±0.160% vs 0.023%±0.006%; P=0.068). Dry eye group showed more NV than non-dry eye group in both topical PBS application and subconjunctival PBS injection (P=0.020 and 0.000, respectively). CONCLUSION In a murine cataract surgery model, preexisting dry eye can induce more postoperative NV, LY, and inflammation in corneal tissue.
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Affiliation(s)
- Jin Woo Kwon
- Department of Ophthalmology, St.Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon 442723, Gyeonggi-Do, Korea
| | - Yeon Woong Chung
- Department of Ophthalmology, St.Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon 442723, Gyeonggi-Do, Korea
| | - Jin A Choi
- Department of Ophthalmology, St.Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon 442723, Gyeonggi-Do, Korea
| | - Tae Yoon La
- Department of Ophthalmology, St.Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon 442723, Gyeonggi-Do, Korea
| | - Dong Hyun Jee
- Department of Ophthalmology, St.Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon 442723, Gyeonggi-Do, Korea
| | - Yang Kyung Cho
- Department of Ophthalmology, St.Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon 442723, Gyeonggi-Do, Korea
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Affiliation(s)
- Samuel C Yiu
- Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University, 400 N Broadway/Smith Bldg. 6041, Baltimore, MD 21231, United States
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