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Abstract
PURPOSE To evaluate dry eye and anterior segment inflammation after small incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK), and investigate their association. METHODS This prospective and observational study included 96 eyes from 48 myopic patients. The evaluation was performed at baseline, postoperative day 1, week 1, month 1 and month 3. Outcome measures included anterior chamber flare, bulbar redness (BR), limbal redness (LR), ocular surface disease index (OSDI), tear meniscus height (TMH), the first and average noninvasive breakup time (NIBUT-1, NIBUT-a), fluorescein breakup time (FBUT), corneal fluorescein staining (CFS), and Schirmer I. Generalized estimating equations (GEEs) were applied to explore the correlation between flare and ocular surface parameters. RESULTS Flare increased significantly in both groups at day 1 and week 1 and then returned to baseline at month 1. In both groups, BR decreased on day 1 and then gradually increased towards the baseline. In FS-LASIK, LR was lower than baseline at day 1 and month 3. An increase in OSDI was found in the SMILE group on day 1, and in the FS-LASIK group at day 1 to month 1. NIBUT-1 and NIBUT-a decreased significantly on day 1 in both groups. At month 3, NIBUT-a did not return to baseline in FS-LASIK. CFS increased significantly at week 1 in both groups. All parameters were comparable between SMILE and FS-LASIK except for OSDI and NIBUT-a. Time and spherical equivalent showed a correlation with flare. CONCLUSIONS Both SMILE and FS-LASIK induced elevated anterior chamber flare and dry eye. However, flare might not be considered a factor determining perioperative dry eye.Key MessagesDry eye disease is common after corneal refractive surgery. Signs and symptoms of dry eye disease persist longer after FS-LASIK compared with SMILE.Both FS-LASIK and SMILE transiently disrupted blood-aqueous barrier integrity, leading to anterior segment inflammation.Anterior chamber flare might not be considered a factor explaining perioperative dry eye, other biomarkers remain for future exploration.
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Affiliation(s)
- Jian Zhao
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, P.R. China.,National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, P.R. China
| | - Yuan Li
- New England College of Optometry, Boston, MA, USA
| | - Tianyun Yu
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Wenhao Wang
- Department of Ophthalmology, Affiliated People's Hospital of Ningbo University, Ningbo, P.R.China
| | - Mutsvene Tinashe Emmanuel
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, P.R. China.,National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, P.R. China
| | - Qianwen Gong
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, P.R. China.,National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, P.R. China
| | - Liang Hu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, P.R. China.,National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, P.R. China
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Or C, Lajevardi S, Ghoraba H, Park JH, Onghanseng N, Halim MS, Hasanreisoglu M, Hassan M, Uludag G, Akhavanrezayat A, Nguyen QD. Posterior Segment Ocular Findings in HLA-B27 Positive Patients with Uveitis: A Retrospective Analysis. Clin Ophthalmol 2023; 17:1271-1276. [PMID: 37152636 PMCID: PMC10162386 DOI: 10.2147/opth.s408728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/17/2023] [Indexed: 05/09/2023] Open
Abstract
Purpose To describe the prevalence and characteristics of posterior segment manifestations in patients with HLA-B27-associated uveitis using wide field imaging. Methods Medical records of patients diagnosed with HLA-B27-associated uveitis from a tertiary uveitis clinic were reviewed. Posterior segment involvements including but not limited to peripheral vasculitis, optic disc inflammation, and macula edema documented based on medical records and various imaging modalities including wide field fluorescein angiography and optical coherence tomography, were noted. Demographic characteristics, accompanied with systemic diseases as well as duration and chronicity of uveitis, were also evaluated. Patients with significant systemic and ocular comorbidities were excluded. Statistical analyses including chi-squared tests and paired t-tests were employed. Results Of the 44 patients with HLA-B27 associated uveitis, 22 patients (50%) were noted to demonstrate posterior segment involvement. Disc leakage and peripheral vasculitis were the most common findings of posterior involvement. Those with anterior chamber inflammation were found to have a significantly increased risk of posterior involvement. Those with posterior involvement were also noted to have a statistically significant decreased visual acuity. No significant association was found between documented duration of disease and posterior segment involvement. Conclusion The prevalence of posterior segment involvement in HLA-B27 associated uveitis is higher compared to previous reports when evaluated with wide angle imaging modalities. Careful examination of the posterior segment is required in patients with HLA-B27 associated uveitis.
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Affiliation(s)
- Chris Or
- Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
| | - Sherin Lajevardi
- Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
| | - Hashem Ghoraba
- Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
| | - Jung Hyun Park
- Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
| | - Neil Onghanseng
- Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
- Department of Ophthalmology, Makati Medical Center, Manila, Philippines
| | | | - Murat Hasanreisoglu
- Department of Ophthalmology, Koç University, School of Medicine, Istanbul, Turkey
| | - Muhammad Hassan
- Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
| | - Gunay Uludag
- Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
| | | | - Quan Dong Nguyen
- Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
- Correspondence: Quan Dong Nguyen, Spencer Center for Vision Research, Byers Eye Institute at Stanford University, 2370 Watson Court, Suite 200, Palo Alto, CA, 94303, USA, Tel +1 650 725 7245, Email
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Liu X, McNally TW, Beese S, Downie LE, Solebo AL, Faes L, Husain S, Keane PA, Moore DJ, Denniston AK. Non-invasive Instrument-Based Tests for Quantifying Anterior Chamber Flare in Uveitis: A Systematic Review. Ocul Immunol Inflamm 2021; 29:982-990. [PMID: 32255392 DOI: 10.1080/09273948.2019.1709650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/15/2019] [Accepted: 12/23/2019] [Indexed: 10/24/2022]
Abstract
Purpose: Anterior chamber (AC) flare is a key sign for anterior uveitis. New instrument-based techniques for measuring AC flare can offer automation and objectivity. This review aims to identify objective instrument-based measures for AC flare.Methods: In this systematic review, we identified studies reporting correlation between instrument-based tests versus clinician AC flare grading, and/or aqueous protein concentration, as well as test reliability.Results: Four index tests were identified in 11 studies: laser-flare photometry (LFP), optical coherence tomography, ocular flare analysis meter (OFAM) and the double-pass technique. The correlation between LFP and clinician grading was 0.40-0.93 and 0.87-0.94 for LFP and protein concentration. The double-pass technique showed no correlation with clinician grading and insufficient information was available for OFAM.Conclusion: LFP shows moderate to strong correlation with clinician grading and aqueous protein concentration. LFP could be a superior reference test compared to clinician AC flare grading for validating new index tests.
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Affiliation(s)
- Xiaoxuan Liu
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Thomas W McNally
- Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sophie Beese
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Laura E Downie
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Australia
| | - Ameenat L Solebo
- Institute of Child Health, University College London, London, UK
| | - Livia Faes
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
- Eye Clinic, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Syed Husain
- Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
- Health Data Research UK, London, UK
| | - David J Moore
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alastair K Denniston
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
- Health Data Research UK, London, UK
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Meduri A, Bergandi L, Oliverio GW, Rechichi M, Acri G, Perroni P, Silvagno F, Aragona P. The cold eye irrigation BSS solution used during phacoemulsification reduces post-surgery patients discomfort preventing the inflammation. Eur J Ophthalmol 2021; 32:11206721211018377. [PMID: 34011203 DOI: 10.1177/11206721211018377] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this study was to assess whether the intraoperative use of the cold eye irrigation balanced salt solution (BSS) could have a protective effect in preventing the anterior chamber flare and conjunctival hyperemia and, thus, in reducing patients discomfort after phacoemulsification. MATERIALS AND METHODS About 214 patients were enrolled and randomly divided into: patients whose eye were irrigated with BSS at ~ 20°C (Group 1) and patients whose eye were irrigated with BSS at 2.7°C (Group 2). Anterior chamber flare, visual analogue score and conjunctival hyperemia were evaluated at 1, 3, 5, and 30 days after surgery. RESULTS In patients of Group 2 the anterior chamber flare, the visual analogue score and the conjunctival hyperemia, used as parameters to evaluated clinical inflammation, at 1 day after surgery were significantly lower than those in Group 1 who received BSS solution at operating room temperature (p < 0.001), while at day 3, 5, and 30 there were not any significant differences. CONCLUSION Our study provided evidence supporting the efficacy of the treatment with cold irrigation solution on reduction of anterior chamber flare, pain and conjunctival hyperemia already at 1 day after phacoemulsification, suggesting that cooling procedure was fully effective at controlling early post-operative inflammation.
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Affiliation(s)
- Alessandro Meduri
- Biomedical, Dental and Morphological and Functional Images Sciences Department, University of Messina, Messina, Italy
| | | | - Giovanni William Oliverio
- Biomedical, Dental and Morphological and Functional Images Sciences Department, University of Messina, Messina, Italy
| | - Miguel Rechichi
- Centro Polispecialistico Mediterraneo, Sellia Marina, Catanzaro, Italy
| | - Giuseppe Acri
- Biomedical, Dental and Morphological and Functional Images Sciences Department, University of Messina, Messina, Italy
| | - Pietro Perroni
- Department of Ophthalmology, Oftalmico Hospital, ASST-Fatebenefratelli-Sacco, Milano, Italy
| | | | - Pasquale Aragona
- Biomedical, Dental and Morphological and Functional Images Sciences Department, University of Messina, Messina, Italy
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Tanito M, Manabe K, Mochiji M, Takai Y, Matsuoka Y. Comparison of anterior chamber flare among different glaucoma surgeries. Clin Ophthalmol 2019; 13:1609-1612. [PMID: 31686774 PMCID: PMC6709819 DOI: 10.2147/opth.s219715] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/13/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose To compare postsurgical anterior chamber flare (ACF) among conventional (trabeculectomy, LEC) and novel (EX-PRESS Shunt, EXP) filtration surgeries and microhook ab interno trabeculotomy (μLOT), a novel minimally invasive glaucoma surgery (MIGS). Subjects and methods This retrospective study included 125 primary open angle glaucoma eyes (89 consecutive subjects) treated with μLOT (n=38), LEC (n=12), or EXP (n=75). The intraocular pressure (IOP), numbers of antiglaucoma medication, and ACF at preoperatively and 2 weeks; 1, 3, and 6 months postoperatively were compared among the surgical groups using a mixed-effects regression model. Results The postoperative IOP (p<0.0001) and medication use were significantly (p<0.0001) lower in the LEC and EXP groups than with μLOT for up to 6 months postoperatively. The ACF differed significantly (p=0.0004) among groups; the ACF was significantly higher (p=0.0097, post-hoc Student’s t-test) with μLOT (33.6±52.8 pc/msec) than the EXP (15.7±19.9 pc/msec) at 2 weeks and was significantly (p=0.0111, post-hoc t-test) lower with μLOT (7.9±2.0 pc/msec) than LEC (12.0±6.1 pc/msec) at 6 months. Conclusion Considering our observation, although its clinical significance is unclear, not all MIGS are minimally invasive regarding early postsurgical inflammation.
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Affiliation(s)
- Masaki Tanito
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, Japan.,Division of Ophthalmology, Matsue Red Cross Hospital, Matsue, Japan
| | - Kaoru Manabe
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Mihoko Mochiji
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Yasuyuki Takai
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Yotaro Matsuoka
- Division of Ophthalmology, Matsue Red Cross Hospital, Matsue, Japan
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Agrawal R, Keane PA, Singh J, Saihan Z, Kontos A, Pavesio CE. Classification of semi-automated flare readings using the Kowa FM 700 laser cell flare meter in patients with uveitis. Acta Ophthalmol 2016; 94:e135-41. [PMID: 26408205 DOI: 10.1111/aos.12833] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 07/22/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE To propose a classification system to grade semi-automated flare readings and assess its correlation with clinical flare grading and also to explore the utility of an additional step in clinical flare assessment between grades 0 and 1. METHODS Semi-automated flare readings from 103 eyes with uveitis were taken using the Kowa FM 700 laser flare meter and classified into two models (LFCM and LFCM_1), and introduction of a 0.5 step in flare grading was explored. RESULTS Good correlation was present between the conventional SUN clinical flare and the proposed clinical classification for flare (weighted kappa (WK) = 89.64%, p < 0.001). Semi-automated flare grading (LFCM and LFCM_1) had WK agreement of 82.52% and 79.85% (p < 0.001) with conventional SUN clinical flare grading. CONCLUSIONS The proposed classification system for semi-automated laser flare readings (LFCM) allows stratification of measurements into grades analogous to clinical flare grades and correlates well with conventional clinical flare grading.
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Affiliation(s)
- Rupesh Agrawal
- Moorfields Eye Hospital; NHS Foundation Trust; London UK
- Institute of Ophthalmology; University College London; London UK
- National Healthcare Group Eye Institute; Tan Tock Seng Hospital; Singapore
| | | | - Jasmin Singh
- Moorfields Eye Hospital; NHS Foundation Trust; London UK
| | - Zubin Saihan
- Moorfields Eye Hospital; NHS Foundation Trust; London UK
| | - Andreas Kontos
- Moorfields Eye Hospital; NHS Foundation Trust; London UK
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