bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of topical and systemic immunosuppression in aqueous-deficient dry eye disease
Authors: Kate Anahita , Shanbhag Swapna S , Donthineni Pragnya R , Amescua Guillermo , Quinones Victor L Perez , Basu Sayan
Published: April 2023

Immunosuppression in aqueous-deficient dry eye disease (ADDE) is required not only to improve the symptoms and signs but also to prevent further progression of the disease and its sight-threatening sequelae. This immunomodulation can be achieved through topical and/or systemic medications, and the choice of one drug over the other is determined by the underlying systemic disease. These immunosuppressive agents require a minimum of 6–8 weeks to achieve their beneficial effect, and during this time, the patient is usually placed on topical corticosteroids. Antimetabolites such as methotrexate, azathioprine, and mycophenolate mofetil, along with calcineurin inhibitors, are commonly used as first-line medications. The latter have a pivotal role in immunomodulation since T cells contribute significantly to the pathogenesis of ocular surface inflammation in dry eye disease. Alkylating agents are largely limited to controlling acute exacerbations with pulse doses of cyclophosphamide. Biologic agents, such as rituximab, are particularly useful in patients with refractory disease. Each group of drugs has its own side-effect profiles and requires a stringent monitoring schedule that must be followed to prevent systemic morbidity. A customized combination of topical and systemic medications is usually required to achieve adequate control, and this review aims to help the clinician choose the most appropriate modality and monitoring regimen for a given case of ADDE.
Assessment of prevalence of dry eye among medical students using ocular surface disease index questionnaire – Is COVID-19 to be really blamed?
Authors: Aberame AR , Bhandary Sulatha V , Rao Lavanya G , Gupta Chandni
Published: April 2023

Purpose:

An undergraduate research conducted during the pre-covid times, to highlight the importance of screen time and its association with dry eye in medical students. The aim was to study the prevalence of dry eye among medical students using the ocular surface index (OSDI) questionnaire.

Methods:

This was a cross-sectional study. This study was conducted among medical students using an OSDI questionnaire in the pre-covid times. Based on the pilot study, the minimum sample size calculated was 245. A total of 310 medical students participated in the study. These medical students answered the OSDI questionnaire. The OSDI score was used to categorize students with dry eye as mild (13–22 points), moderate (23–32 points), and severe (33–100 points). In addition, the associations between the OSDI score and possible risk factors such as gender, contact lens/spectacle wear, laptop/mobile usage, and duration of exposure to air conditioners were also studied.

Results:

The analysis of the study revealed that out of 310 students, dry eye was seen in 143 (46.1%) and severe dry eyes were seen in 50 (16.1%). A high OSDI score (>13 points) was associated with the usage of a laptop/mobile for more than 6 h in 40 (52.6%) (P < 0.001).

Conclusion:

The prevalence of dry eye among medical students was 46.1% in the present study. Longer duration of usage of visual display units (laptop/mobile) was the only factor that showed a statistically significant association with dry eye in our study.
Tear film dysfunction after clear corneal phacoemulsification in diabetics and non-diabetics
Authors: Momin Aseera A , Nikose Archana S , Thakre Uttkarsha D
Published: April 2023

Purpose:

A prospective cohort study was conducted in a tertiary eye care centre to study the incidence of tear film dysfunction and its recovery in diabetics and non-diabetics after clear corneal phacoemulsification.

Methods:

A total of 50 diabetics and 50 non-diabetics underwent clear corneal phacoemuslfication. Schirmer’s I test (SIT), tear film break-up time (TBUT), corneal staining, tear meniscus height (TMH), and ocular surface disease index (OSDI) assessment were done preoperatively, postoperatively at 7 days, 1 month, and 3 months in both groups to assess tear film function.

Results:

Both groups showed decreased SIT and TBUT values on postoperative Day 7, after which they gradually improved. SIT and TBUT values in diabetics were significantly lower than that in non-diabetics postoperatively (P < 0.001). SIT in non-diabetics reached baseline levels at postoperative 3 months. OSDI scores reached peak levels in both groups on postoperative Day 7, but were higher in diabetics than non-diabetics (P < 0.001). OSDI scores gradually improved over 3 months but remained over baseline levels in both groups. Corneal staining was positive in 22% diabetics and 8% non-diabetics at postoperative Day 7. However, none of the patients had corneal staining at 3 months. Tear meniscus height (TMH) did not reveal any significant difference between the two groups at any time interval.

Conclusion:

We concluded that tear film dysfunction after clear corneal incision occurs in both groups, but is more severe and recovers more slowly in diabetics than non-diabetics.
Management of corneal perforations in dry eye disease: Preferred practice pattern guidelines
Authors: Kate Anahita , Deshmukh Rashmi , Donthineni Pragnya R , Sharma Namrata , Vajpayee Rasik B , Basu Sayan
Published: April 2023

Corneal perforations in eyes with dry eye disease (DED) are difficult to manage due to the interplay of several factors such as the unstable tear film, surface inflammation, and the underlying systemic disease affecting the wound healing process, and the eventual outcome. A careful preoperative examination is required to identify the underlying pathology, and status of ocular surface and adnexa, rule out microbial keratitis, and order appropriate systemic workup in addition to assessing the perforation itself. Several surgical options are available, which include tissue adhesives, multilayered amniotic membrane grafting (AMT), tenon patch graft (TPG), corneal patch graft (CPG), and penetrating keratoplasty (PK). The choice of procedure depends upon the size, location, and configuration of the perforation. In eyes with smaller perforations, tissue adhesives are effective treatment modalities, whereas AMT, TPG, and CPG are viable options in moderate-sized perforations. AMT and TPG are also preferable in cases where the placement of a bandage contact lens may be a challenge. Large perforations require a PK, with additional procedures such as tarsorrhaphy to protect the eyes from the associated epithelial healing issues. Conjunctival flaps are considered in eyes with poor visual potential. The management of the acute condition is carried out in conjunction with measures to improve the tear volume bearing in mind the chances of delayed epithelialization and re-perforation in these cases. Administration of topical and systemic immunosuppression, when indicated, helps improve the outcome. This review aims to facilitate clinicians in instituting a synchronized multifaceted therapy for the successful management of corneal perforations in the setting of DED.
Evaluation of post-operative dry eye in upper and lower eyelid reconstruction: A cross-sectional study
Authors: Ganguly Purban , Bhunia Jit , Das Kalishankar , Ghosh Asim K , Chatterjee Sumana , Chatterjee Debadyuti , Bhutia Dichen W , Ray Angana S , Ayub Asif
Published: April 2023

Purpose:

In cases of eyelid malignancies requiring full thickness excisional biopsy followed by reconstruction of the created defect, the Meibomian glands are lost. Post-operative varying degrees of dry eye disease (DED) are expected in such patients. The aim was to evaluate the objective and subjective statuses of DED in cases of full thickness eyelid reconstruction following excisional biopsy because of malignancies.

Methods:

This was a cross-sectional pilot study. Objective and subjective dry eye parameters are assessed in cases of full thickness eyelid reconstruction following excisional biopsy because of malignancies in 37 eyes at 6 months post-operative follow-up. Analysis of variance and Chi square test were used for statistical analysis.

Results:

When compared with fellow eye, all the parameters were found to be statistically significant (P < 0.0). Subjective assessment of dry eye by ocular surface disease index (OSDI) scoring did not corroborate with the objective data (p 0.00). Lower eyelid reconstruction showed a minimum number of dry eye cases (P > 0.05).

Conclusion:

Prevalence of post-operative dry eye is more with increasing percentage of full thickness upper eyelid reconstruction. Disparity was found between objective and subjective parameters of dry eye in patients requiring varying percentages of upper eyelid reconstruction because of malignancies.
Study of tear function before and after laser-assisted in-situ keratomileusis
Authors: Singh Smita , Shukla Ajay K , Garkal Priyanka , Yadav Vinita
Published: April 2023

Purpose:

This work assesses the change in tear function after LASIK surgery.

Methods:

This prospective, observational study was conducted in the Refractive Clinic of a tertiary care rural hospital. Tear dysfunction symptoms and the tear function tests were assessed in 269 eyes of 134 patients, OSDI score was used to document the tear dysfunction symptoms. Tear function was assessed by tear meniscus height, tear film break-up time (TBUT), Lissamine green staining, corneal fluorescein staining, Schirmer test 1 without anesthesia before and at 4–6 weeks and 10–12 weeks after LASIK surgery.

Results:

Preoperatively OSDI score was 8.54 ± 7.71. It increased to 15.11 ± 9.18 postoperatively at 4–6 weeks after LASIK surgery and 13 ± 9.56 at 10–12 weeks after LASIK surgery Mean TBUT preoperatively was 7.82 ± 3.57 sec which decreased to 5.34 ± 2.56 sec at 4–6 weeks and to 4.53 ± 2.63 sec at 10–12 weeks postoperatively. The number of eyes with clear secretion decreased from 40.5% preoperatively to 23.4% at 4–6 weeks and to 22.3% at 10–12 weeks postoperatively, whereas the granular and cloudy secretions increased significantly in eyes after LASIK surgery. The prevalence of eyes with Lissamine green score >3 (dry eye) increased from 17.1% preoperatively to 27.9% at 4–6 weeks and to 30.5% at 10–12 weeks. Similarly, the number of eyes showing positive fluorescein corneal staining increased from 5.6% preoperatively to 19% postoperatively at 4–6 weeks. Mean Schirmer score was 28.83 ± 6.39 mm preoperatively, 22.47 ± 5.38 mm at 4–6 weeks, and 21.27 ± 4.99 mm at 10–12 weeks after LASIK surgery.

Conclusion:

The prevalence of dry eye increased after LASIK as was assessed by an increase in the tear dysfunction symptoms using OSDI score and the deranged values of various tear function tests after LASIK surgery.
A randomized controlled study evaluating outcomes of intense pulsed light and low-level light therapy for treating meibomian gland dysfunction and evaporative dry eye
Authors: D’Souza Sharon , James Edwin , Koul Ameeta , Modak Durgalaxmi , Kundu Gairik , Shetty Rohit
Published: April 2023

Purpose:

This randomized, controlled, blinded study evaluates the efficacy of intense pulsed light (IPL) therapy with low-level light therapy (LLLT) in the treatment of meibomian gland dysfunction (MGD) and evaporative dry eye (EDE) compared to a control group.

Methods:

Hundred patients with MGD and EDE were randomized into control (50 subjects, 100 eyes) and study group (50 subjects, 100 eyes). The study group underwent three sittings of IPL with LLLT 15 days apart and were followed up 1 month and 2 months after the last treatment sitting. The control group underwent sham treatment and was followed up at the same intervals. The patients were evaluated at baseline and 1 month and 3 months (post 1st treatment) for dry eye. Schirmer’s test and tear breakup time (TBUT), OSDI, meibomian gland expression, and meibography.

Results:

The study group showed significant improvement in OSDI scores (P < 0.0001) compared to the control group and a significant improvement in TBUT (P < 0.005) compared to the control group. There was no change in schirmer’s test and an improvement in the meibomian gland expression but not significant.

Conclusion:

The results show that a combined therapy of IPL with LLT is effective in treating MGD with EDE compared to controls, and repeated treatment sessions have a cumulative effect on the disease outcomes.
Study of correlation between vitamin D3 levels and dry eye
Authors: Bhatt Rupal B , Patel Naitik H , Shah Abhishek T , Ranpara Kaushambi H
Published: April 2023

Purpose:

Dry eye is a prevalent disorder of tear film resulting from either decreased tear production or increased tear evaporation. It is becoming a serious issue due to its disturbing symptoms, which become progressively troublesome affecting the work efficiency of patients and increasing financial burden due to lifelong dependency on eye drops. If not detected early, it can lead to sight-threatening complications. This study aims to explore serum vitamin D3 deficiency as a causative factor of dry eye.

Methods:

The study was conducted in the outpatient department of a tertiary care hospital in India, for a period of two years from September 2018 to September 2020. About 40 patients who had dry eye and 20 controls were enrolled in this study. They were given an Ocular Surface Disease Index (OSDI) questionnaire, examined for signs of dry eye on slit lamp with Schirmer’s test and tear film break-up time. All 60 participants were subjected to serum vitamin D3 level laboratory test and its deficiency prevalence was correlated with dry eye and its severity.

Results:

Serum vitamin D3 deficiency was found to be more prevalent in patients with dry eye. There was no gender predilection or change in prevalence with increasing age. Vitamin D3 level was negatively correlated with OSDI and positively with Schirmer’s test 1 and 2 and tear film break-up time (TBUT) scores.

Conclusion:

The prevalence of vitamin D3 deficiency was not consistently found to be associated with the increasing severity of dry eye.
A brief account on ocular graft versus host disease
Authors: Chatterjee Debapriya
Published: April 2023

The incidence of ocular graft versus host disease (oGVHD) is rising due to the increasing numbers of bone marrow transplantations for various hematologic malignancies and non-malignant indications. The ophthalmic aspect of graft versus host disease (GVHD) still requires much understanding. We carried out a PubMed search of all articles using the terms “oGVHD,” “dry eye + hematopoietic stem cell transplantation (HSCT),” “acute GVHD,” and “Chronic GVHD.” The review mainly focuses on the existing lacunae in terms of diagnostic criteria. Diagnosis of ocular involvement in GVHD follows the criteria described by the National Institute of Health Consensus Conference (NIH CC) or International Chronic oGVHD (ICCGCHD) consensus group. The severity grading of oGVHD is by Jab’s or Robinson’s grading for conjunctival involvement. NIH CC and ICCGVHD remain the most commonly used scoring systems. Management of ocular involvement during acute GVHD remains challenging, whereas chronic oGVHD in its milder forms mainly manifests as dry eye disease and is treated accordingly. Multiple unanswered questions remain regarding this entity’s pathogenesis, diagnostic criteria, and clinical features. Large-scale prospective studies involving oncologists and ophthalmologists must answer questions and formulate guidelines.
Tear proteomics in dry eye disease
Authors: Kannan Ramaraj , Das Samayitree , Shetty Rohit , Zhou Lei , Ghosh Arkasubhra , Deshpande Vrushali
Published: April 2023

Dry eye disease (DED) is a multi-factorial ocular surface condition driven by compromised ocular lubrication and inflammation which leads to itching, dryness, and vision impairment. The available treatment modalities primarily target the acquired symptoms of DED including tear film supplements, anti-inflammatory drugs, mucin secretagogues, etc., However, the underlying etiology is still an area of active research, especially in regard to the diverse etiology and symptoms. Proteomics is a robust approach that has been playing major role in understanding the causative mechanism and biochemical changes in DED by identifying the changes in protein expression profile in tears. Tears are a complex fluid composed of several biomolecules such as proteins, peptides, lipids, mucins, and metabolites secreted from lacrimal gland, meibomian gland, cornea, and vascular sources. Over the past two decades, tears have emerged as a bona-fide source for biomarker identification in many ocular conditions because of the minimally invasive and simple sample collection procedure. However, the tear proteome can be altered by several factors, which increases the complexity of the approach. The recent advancements in untargeted mass spectrometry-based proteomics could overcome such shortcomings. Also, these technological advancements help to distinguish the DED profiles based on its association with other complications such as Sjogren’s syndrome, rheumatoid arthritis, diabetes, and meibomian gland dysfunction. This review summarizes the important molecular profiles found in proteomics studies to be altered in DED which have added to the understanding of its pathogenesis.
Effect of maqui-berry extract in dry eye disease – A clinical and molecular analysis
Authors: Kundu Gairik , Shetty Rohit , D’Souza Sharon , Gorimanipalli Bhavya , Koul Ameeta , Sethu Swaminathan
Published: April 2023

Purpose:

This study aims to investigate the effects of maqui-berry extract (MBE) in improving signs and symptoms of dry eye disease (DED) along with ocular surface inflammation in patients with DED.

Methods:

Twenty patients were randomly assigned to a MBE or a placebo group (PLC). DED parameters including Schirmer’s test 1 (ST1), tear film break-up time (TBUT), ocular surface disease index (OSDI), and corneal staining were assessed before treatment and 2 months post-treatment. Tear fluid samples before and after treatment from a subset of these patients were collected from the study subjects using sterile Schirmer’s strips, and the levels of interleukin (IL)-1β, IL-10, IL-6, IL-17A, tumor necrosis factor-α (TNFα), matrix metalloproteinase-9 (MMP9), soluble intercellular adhesion molecule-1 (sICAM1), and vascular endothelial growth factor-A (VEGF-A) were measured using a microfluidic cartridge-based multiplex ELISA.

Results:

The MBE group demonstrated a significant (p < 0.05) decrease in OSDI scores along with a significant increase in Schirmer’s test 1 compared to the PLC group. No significant change in TBUT and corneal staining was observed between the study groups. Levels of proinflammatory factors such as IL-1β, IL-6, IL-17A, TNFα, and MMP9 were observed to be significantly reduced, along with a significant increase in IL-10 levels following treatment in the MBE group compared with the PLC group.

Conclusion:

Consumption of MBE resulted in the resolution of DED signs and symptoms, along with a reduction in ocular surface inflammation.
Automatic segmentation and quantified analysis of meibomian glands from infrared images
Authors: Vunnava Krishna Poojita , Shetty Rohit , Prabhu Sahana M , Tiwari Piyush , Kummelil Mathew Kurian
Published: April 2023

Purpose:

An algorithm for automated segmentation of meibomian glands from infrared images obtained using a novel prototype infrared hand-held imager has been proposed in this study. Meibomian gland dysfunction (MGD) is quantified in terms of five clinically relevant metrics. A comparison of these metrics in patients with MGD has been presented against a sample of the normative healthy population.

Methods:

This is a prospective cross-sectional observational study. Patients presenting to the clinics were enrolled after written informed consent. The everted eyelids of 200 eyes of patients (of which 100 were healthy and 100 were diagnosed with MGD) were imaged using a prototype hand-held camera. The proposed algorithm was used to process the images using enhancement techniques and the glands were automatically segmented. A comparison of glands of normal eyes versus MGD-affected eyes is performed using five metrics presented in this study: (i) drop-out, (ii) length, (iii) width, (iv) the number of glands, and (v) the number of tortuous glands.

Results:

The 95% confidence interval for the metrics did not show any overlap between the two groups. In MGD patients, the drop-out ratio was higher than normal. The length and number of glands were significantly lesser than normal. A number of tortuous glands were more in the MGD group. The metrics for MGD versus healthy and cut-off ranges were computed in the results.

Conclusion:

The prototype infrared hand-held meibographer and the proposed automatic algorithm for gland segmentation and quantification are effective aids in MGD diagnosis. We present a set of five metrics, which are clinically relevant for guiding clinicians in the diagnosis of MGD.
Tear biomarkers in dry eye disease: Progress in the last decade
Authors: Kumar Nimisha R , Praveen Machiraju , Narasimhan Raghav , Khamar Pooja , D’Souza Sharon , Sinha-Roy Abhijit , Sethu Swaminathan , Shetty* Rohit , Ghosh* Arkasubhra
Published: April 2023

Dry eye disease (DED) is a commonly occurring, multifactorial disease characterized by reduced tear film stability and hyperosmolarity at the ocular surface, leading to discomfort and visual compromise. DED is driven by chronic inflammation and its pathogenesis involves multiple ocular surface structures such as the cornea, conjunctiva, lacrimal glands, and meibomian glands. The tear film secretion and its composition are regulated by the ocular surface in orchestration with the environment and bodily cues. Thus, any dysregulation in ocular surface homeostasis causes an increase in tear break-up time (TBUT), osmolarity changes, and reduction in tear film volume, all of which are indicators of DED. Tear film abnormalities are perpetuated by underlying inflammatory signaling and secretion of inflammatory factors, leading to the recruitment of immune cells and clinical pathology. Tear-soluble factors such as cytokines and chemokines are the best surrogate markers of disease severity and can also drive the altered profile of ocular surface cells contributing to the disease. Soluble factors can thus help in disease classification and planning treatment strategies. Our analysis suggests increased levels of cytokines namely interleukin-1β (IL-1β), IL-2, IL-4, IL-6, IL-9, IL-12, IL-17A, interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α); chemokines (CCL2, CCL3, CCL4, CXCL8); MMP-9, FGF, VEGF-A; soluble receptors (sICAM-1, sTNFR1), neurotrophic factors (NGF, substance P, serotonin) and IL1RA and reduced levels of IL-7, IL-17F, CXCL1, CXCL10, EGF and lactoferrin in DED. Due to the non-invasive sample collection and ease of quantitively measuring soluble factors, tears are one of the best-studied biological samples to molecularly stratify DED patients and monitor their response to therapy. In this review, we evaluate and summarize the soluble factors profiles in DED patients from the studies conducted over the past decade and across various patient groups and etiologies. The use of biomarker testing in clinical settings will aid in the advancement of personalized medicine and represents the next step in managing DED.
Preferred practice patterns and review on rosacea
Authors: Patel Nikunj V , Gupta Nidhi , Shetty Rohit
Published: April 2023

Rosacea is a chronic, inflammatory facial dermatosis commonly found in fair skin tone population. Recent studies have shown the increasing prevalence in the dark skin tone population as well. Ocular involvement is very common and can occur without cutaneous features. Common ocular features are chronic blepharoconjunctivitis with eyelid margin inflammation and meibomian gland dysfunction. Corneal complications include corneal vascularization, ulceration, scarring, and rarely, perforation. Diagnosis is largely based on clinical signs, although it is often delayed in the absence of cutaneous changes, particularly in children. The management ranges from local therapy to systemic treatment, depending on the severity of the disease. There is a positive association between demodicosis and rosacea; however, causality is always argued. In this review, we describe the epidemiology, clinical features, and treatment of rosacea and ocular rosacea.
Rasch development and validation of the “Medellín Dry Eye Inventory” (ME·Dry), an instrument to measure multidimensional quality of life compromise in patients with dry eye disease
Authors: Balparda Kepa , Herrera-Chalarca Tatiana , Cardozo-Dávila Ximena , Pacheco Maria A , Godin Fernando , Nicholls-Molina María A
Published: April 2023

Purpose:

Dry eye disease (DED) is a common condition that affects the quality of life. There is a great need for better-developed scales that comply with Rasch model requirements.

Methods:

Prospective study including patients with DED. A series of focus groups were performed to determine the best items to be included. A Rasch modeling methodology was used to validate the Medellín Dry Eye Inventory (ME·Dry). After iterative analysis and scale modification, a final version of the scale was attained which complied with the Rasch analysis expectations. Correlation between the different subscales of the ME·Dry and the Ocular Surface Disease Index (OSDI) was evaluated through Spearman correlation.

Results:

A total of 166 patients with DED were included. Rasch modeling demonstrated an excellent behavior for the ME·Dry, including four subscales: Symptoms, Triggers, Activity Limitation, and Emotional Compromise. Infit and Outfit parameters were all between 0.50 and 1.50, with excellent category utilization. Person and item separation and reliability were excellent for all subscales. There was a need for a category collapsing for the Emotional Compromise subscale. There was a strong correlation between the different subscales of the ME·Dry except for the Emotional Compromise subscale, which seems to be independent.

Conclusion:

The ME·Dry is a reliable scale, complying with the Rasch model expectations, that allows for a reliable measurement of quality of life compromise in patients with DED. Emotional compromise secondary to DED does not seem to correlate with disease severity as assessed by the other quality-of-life subscales.
Ion channels in dry eye disease
Authors: Ashok Nikhil , Khamar Pooja , D’Souza Sharon , Gijs Marlies , Ghosh Arkasubhra , Sethu Swaminathan , Shetty Rohit
Published: April 2023

Dry eye disease (DED) which affects millions of people worldwide is an ocular surface disease that is strongly associated with pain, discomfort, and visual disturbances. Altered tear film dynamics, hyperosmolarity, ocular surface inflammation, and neurosensory abnormalities are the key contributors to DED pathogenesis. The presence of discordance between signs and symptoms of DED in patients and refractoriness to current therapies in some patients underpin the need for studying additional contributors that can be modulated. The presence of electrolytes or ions including sodium, potassium, chloride, bicarbonate, calcium, and magnesium in the tear fluid and ocular surface cells contribute to ocular surface homeostasis. Ionic or electrolyte imbalance and osmotic imbalance have been observed in DED and feed-forward interaction between ionic imbalances and inflammation alter cellular processes in the ocular surface resulting in DED. Ionic balances in various cellular and intercellular compartments are maintained by dynamic transport via ion channel proteins present in cell membranes. Hence, alterations in the expression and/or activity of about 33 types of ion channels that belong to voltage-gated channels, ligand-gated channels, mechanosensitive ion channel, aquaporins, chloride ion channel, sodium–potassium–chloride pumps or cotransporters have been investigated in the context of ocular surface health and DED in animal and/or human subjects. An increase in the expression or activity of TRPA1, TRPV1, Nav1.8, KCNJ6, ASIC1, ASIC3, P2X, P2Y, and NMDA receptor have been implicated in DED pathogenesis, whereas an increase in the expression or activity of TRPM8, GABAA receptor, CFTR, and NKA have been associated with resolution of DED.
Dry eye parameters measured with an ocular surface analyzer in eyes after vitrectomy for vitreomacular interface disorders
Authors: Nawrocka Zofia A , Dulczewska-Cichecka Karolina , Nawrocka Zofia , Nawrocki Jerzy
Published: April 2023

Purpose:

Dry eye disease (DED) might be caused by multiple ocular surgical interventions. The aim of the study was to estimate the extent of DED in patients undergoing core vitrectomy for vitreoretinal interface disorders.

Methods:

In this prospective observational study, we included patients with 12 months of follow-up after vitrectomy. The following data were collected as controls: age, sex, best-corrected visual acuity before and after surgery, and phakic status. In OSA (ocular surface analysis), the following parameters were evaluated: NIBUT (non-invasive tear break-up time), sltDear (thickness of the lipid layer), Meibomian gland (MGD) loss, and the height of tear meniscus. Shapiro–Wilk test, Wilcoxon rank-sum test, and Mann–Whitney U tests were used for statistical analysis.

Results:

We evaluated 48 eyes of 24 patients (10 men, 14 women; 64.63 ± 14.10 years) 1 year after vitrectomy. From the analyzed ocular surface parameters, NIBUT was significantly lower in operated versus non-operated eyes (P = 0.048). The higher the level of difference in MGD loss between both eyes, the higher the level of difference in NIBUT between both eyes (rs = 0.47, P = 0.032).

Conclusion:

NIBUT levels were still decreased 12 months after vitrectomy. Patients with more pronounced MGD loss or decreased NIBUT levels in the fellow eye were more likely to experience such disorders. The tear meniscus height was lower in patients undergoing surgery for retinal detachment than in those with vitreoretinal disorders. This might allow the suggestion to include artificial tears in pre- and post-operative care in vitrectomized eyes.
Resveratrol for dry eye disease – Hope or Hype?
Authors: Shetty Rohit , Joshi Parth D , Mahendran Krithikaa , Jayadev Chaitra , Das Debashish
Published: April 2023

Dry eye disease (DED) is a multifactorial and common ophthalmic disease that has a tremendous effect on the quality of life. It is now becoming a public health concern because of our changing lifestyle and environment. The current treatment modalities, artificial tear substitutes, and anti-inflammatory therapy are directed at dry eye symptoms. One of the major drivers for DED is oxidative stress, and the polyphenol group of natural compounds has the potential to reduce the same. Resveratrol, widely found in the skin of grapes and nuts, has antioxidative and anti-inflammatory properties. It has been shown to have beneficial effects in glaucoma, age-related macular degeneration, retinopathy of prematurity, uveitis, and diabetic retinopathy. Studies have also explored the beneficial effects of resveratrol in DED, making it as a promising therapeutic molecule. Resveratrol has not yet reached clinical application because of difficulty in deliverability and low bioavailability. In this review, we explore the potential of resveratrol in DED treatment based on various in vitro and in vivo studies.
Neuroparalytic keratopathy in Stüve-Wiedemann syndrome treated with tarsoconjunctival flap
Authors: Hernández-García Silvia , Valdivia Hugo González , Bartomeu Joan Prat , Molina Jorge Sánchez
Published: April 2023

Stüve–Wiedemann syndrome is a rare bone dysplasia with dysautonomic manifestations. Most patients die in the neonatal period or during infancy because of the multiple complications they present. The main ophthalmological complications reported are reduced corneal reflex, corneal anesthesia, hypolacrimation, and severely reduced blinking. We are going to present the first tarsoconjunctival flap in a Stüve–Wiedemann patient, the surgery, and the results in a 13-year-old patient that came to our hospital because of severe corneal ulceration.
Assessing clinical and molecular outcomes of prophylactic thermal pulsation therapy on ocular surface health following refractive surgery
Authors: Shetty Rohit , Khamar Pooja , Nair Archana Padmanabhan , Pandian Packiya Raj , Vaidya Tanuja Arun , Trivedi Divya , Sethu Swaminathan , Roy Subhasita , Mahajan Sanjay , Shirodkar Sailie
Published: April 2023

Purpose:

To study ocular surface signs, symptoms, and tear film composition following prophylactic thermal pulsation therapy (TPT) prior to refractive surgery, and to compare these outcomes with those who underwent TPT after refractive surgery.

Methods:

Patients with mild-to-moderate evaporative dry eye disease (DED) and/or meibomian gland dysfunction (MGD) undergoing refractive surgery were included. Group 1 patients received TPT (LipiFlow) prior to laser-assisted in situ keratomileusis (LASIK; n = 32, 64 eyes), and Group 2 patients received TPT three months after LASIK (n = 27, 52 eyes). Ocular Surface Disease Index (OSDI) score, Schirmer’s test (ST1, ST2), Tear Breakup Time (TBUT), meibography, and tear fluid were obtained preoperatively and at three months postoperatively in Groups 1 and 2. Additional postoperative evaluation was performed three months after TPT in Group 2. Tear soluble factor profile was measured by multiplex enzyme-linked immunosorbent assay (ELISA) using flow cytometry.

Results:

Postoperative OSDI score was significantly lower and TBUT was significantly higher when compared with matched preoperative values of Group 1 participants. On the other hand, the postoperative OSDI score was significantly higher and TBUT significantly lower when compared with matched preoperative values of Group 2 participants. TPT significantly reduced the postoperative elevation in OSDI and significantly reduced the postoperative reduction in TBUT in Group 2 participants. Tear Matrix metalloproteinase-9/ Tissue inhibitor matrix metalloproteinase 1 (MMP-9/TIMP1) ratio was significantly higher, postoperatively, when compared with matched preoperative levels in Group 2. However, MMP9/TIMP1 ratio remained unaltered in Group 1 participants.

Conclusion:

TPT prior to refractive surgery improved postsurgical ocular surface signs and symptoms and reduced tear inflammatory factors, thereby suggesting the plausibility of reduced post-refractive surgery DED in patients.
Nexus of ocular motility and dry eye
Authors: Gorimanipalli Bhavya , Muthu Sumitha , Shetty Rohit , Ranade Reshma Raghunath , Khamar Pooja
Published: April 2023

Purpose:

To evaluate the effectiveness of vision therapy (VT) in patients with chronic presumed refractory dry eye disease (DED) and concurrent nonstrabismic binocular vision anomalies (NSBVAs). To propose an algorithmic approach to manage patients with refractory DED.

Methods:

Thirty-two patients with chronic (>1 year) presumed refractory DED and NSBVA were prospectively evaluated. The baseline dry eye evaluation and comprehensive orthoptic evaluation were done. VT was administered by a trained orthoptist for 2 weeks. The binocular vision (BV) parameters and percentage subjective improvement were assessed after the VT.

Results:

On evaluation, 12 patients (37.5%) had both DED and NSBVA, and 20 patients (62.5%) had only NSBVA. Twenty-nine patients (90.62%) showed significant improvement in BV parameters following VT. Binocular near point of accommodation (median, range) improved from 17 (8–40) to 12 (5–26) mm (P value < 0.0001), and near point of convergence (median, range) improved from 6 (3–33) to 6 (5–14) (P value 0.004) with VT. Thirty-one patients (96.87%) reported symptomatic improvement after VT, and 62.5% of these showed more than 50% improvement in symptoms.

Conclusion:

The present study confirms the beneficial role of VT in the treatment of patients with DED with concurrent NSBVA. It is essential to diagnose and treat NSBVA in patients with DED to ensure complete relief of symptoms and patient satisfaction. As there is a significant overlap between symptoms of dry eye disease and that of NSBVA, a complete orthoptic evaluation is recommended in all patients presenting with refractory dry eye disease related symptoms.
Cataract surgery in ocular surface disease
Authors: Priyadarshini K , Sharma Namrata , Kaur Manpreet , Titiyal Jeewan S
Published: April 2023

Cataract surgery, which is the most widely performed ophthalmic procedure, is usually done in the elderly population, who are also prone to ocular surface disorders. Ocular surface diseases are multifactorial in nature and associated with symptoms and signs such as foreign body sensation, burning, fatigue, photophobia, red or watery eyes, or reduced visual acuity. These include a spectrum of conditions that may be immune or non-immune in nature. Cataract surgery in itself is known to alter the normal ocular surface milieu and cause tear film disturbances which can last up to 6 months post-operatively. These symptoms can be exaggerated in patients with ocular surface diseases. The planning and execution of cataract surgery can also be difficult in patients with associated ocular surface diseases. In this review, we discuss the various aspects of planning and intraoperative modifications to optimize the outcomes of cataract surgery in patients with ocular surface diseases.
Refractive surgery and dry eye - An update
Authors: Nair Sridevi , Kaur Manpreet , Sharma Namrata , Titiyal Jeewan S
Published: April 2023

Dry eye disease is the most common complication and a frequent cause of patient dissatisfaction after corneal laser refractive surgery, which includes laser-assisted in situ keratomileusis (LASIK), small-incision lenticule extraction (SMILE), and photorefractive keratectomy (PRK). It has a complex, multifactorial etiology and is characterized by a highly variable clinical presentation. A detailed preoperative screening and optimization of the ocular surface prior to refractive surgery are the key to minimizing the incidence and severity of postoperative dry eye. Diagnosis of postrefractive surgery dry eye remains a challenge as no single symptom or clinical parameter is confirmative of the condition, and the symptoms and signs may not correlate well in many cases. A thorough understanding of the pathomechanism of the disease and its manifestations is essential to facilitate a treatment approach that is individualized for each patient. This article reviews various aspects of postrefractive surgery dry eye including its epidemiology, etiopathogenesis, risk factors, diagnosis, and management.
Somatoform Disorders and Expressed Emotions in the Family: Results from a Cross-Sectional Observational Study to Evaluate a Novel Relationship
Authors: Gupta Manushree , Saluja Jasdeep , Dhiman Rupam , Singh Shagun , Kumar Kuldip
Published: April 2023

Background:

Expressed emotions (EEs) in the family affect the presentation and course of psychiatric disorders. Somatoform disorders with their psychosocial origins may be caused or perpetuated by family dynamics like EEs.

Aims:

The study aimed to assess the prevalence, type, and levels of EEs in the families of patients with somatoform disorders.

Methods:

One hundred and six adult patients with somatoform disorders (F45; ICD-10) and their family member were recruited for the study. Patients with any comorbid medical or psychiatric disorder and substance use disorders (except tobacco dependence) or subjects living alone were excluded from the study. The study participants were assessed for somatoform disorders and EEs using a sociodemographic proforma, Mini-International Neuropsychiatric Interview structured interview, Patient Health Questionnaire-15 (PHQ-15), Family Emotional Involvement and Criticism Scale, and perceived criticism measure (PCM). Final analysis was done using statistical tests including Chi-square test, Fisher’s exact test, Student’s t-test, Pearson’s correlation coefficient, and univariate and multiple regression analysis. P ≤ 0.05 was considered to denote statistical significance.

Results:

The most common somatoform disorder in the sample was somatization disorder (33%) followed by persistent somatoform pain disorder (18.87%) and undifferentiated somatoform disorder (15.09%). Age (P = 0.007), married status (c2 = 6.752, P = 0.034), and a diagnosis of hypochondriacal disorder and somatization disorder (c2 = 14.613, P = 0.023) were significantly associated with perceived criticism (P < 0.05), while emotional overinvolvement (EOI) was high in subjects with somatoform autonomic dysfunction disorder (21.75) (P < 0.05). Significant positive correlation was seen between PCM and PHQ15 (severity measure) scores (r = 0.209; P = 0.032).

Conclusions:

Moderate level of EEs were found in the families of patients with somatoform disorders with the association being significant for criticism in hypochondriacal and somatization disorders and for EOI in somatoform autonomic dysfunction disorders. The hypothesis needs further study with follow-up and stronger statistical models to establish causation.
Eye Tracking as a Tool for Assessing Social Cognition: A Case-Control Study Comparing Patients with Psychosis and Healthy Controls
Authors: Tom Ashlyn , Narnoli Shubham , Verma Rohit
Published: April 2023

Background:

Eye movement dysfunction is a common abnormality in Schizophrenia and other psychotic disorders. Various eye movement paradigms can be used to measure predefined parameters using eye trackers. The current study intends to understand the eye movement characteristics in individuals suffering from psychosis using newer eye-tracking instruments with better precision.

Methodology:

In this study, we included 29 individuals meeting the diagnostic criteria for schizophrenia spectrum and other psychotic disorders based on the clinical assessment as per Diagnostic and Statistical Manual of Mental Disorders, 5th Edition along with 29 age- and gender-matched healthy controls and measured various eye tracking parameters using a Tobii Pro Spectrum. We compared the eye-tracking parameters between both groups.

Results:

There were significant differences between the groups in the free-viewing task. The average duration of fixations was higher, whereas the number of fixations and total amplitude of saccades was found to be reduced in the patient group. The peak velocity of the first saccade was also seen to be reduced in the patient group. However, there were no abnormalities in the anti-saccade, predictive saccade, memory saccade, and smooth pursuit tasks. Eye movement parameters were also found to be significantly correlated with the cognitive task measurements.

Conclusion:

These findings confirm the presence of eye movement abnormalities in psychosis spectrum disorders and their role in cognitive deficits in psychosis. Altered free viewing may be linked to deficits in social cognition found in patients with schizophrenia.
Hemolacria as a Rare Presentation of Dissociative Disorder
Authors: Sachdeva Diksha , Shah Ruchita , Singla Himanshu
Published: April 2023

Hemolacria is a rare manifestation of dissociative disorder. Aim of index report was to present clinical findings in a 13-year old female and explore the socio-cultural meaning associated with this phenomenon. Eclectic psychotherapeutic approach was implemented to address the symptoms. To conclude, physical symptoms presenting in dissociative disorder may be conceptualized in socio-cultural context.
Assessment of Suitability of Indian Disability Evaluation Scale (IDEAS) to Assess Disability among Persons with Alcohol use Disorders
Authors: Singh Shalini , Modak Tamonud , Sarkar Siddharth , Balhara Yatan Pal Singh
Published: April 2023

Background:

Alcohol use disorders (AUD) contribute substantially to the global disease and disability burden. The Indian Disability Evaluation and Assessment Scale (IDEAS) has seldom been used to measure disability in those with AUDs.

Objectives:

To assess the validity of IDEAS to quantify disability among persons with AUDs by measuring the level of agreement between IDEAS and World Health Organization Disability Assessment Schedule version 2.0 (WHODAS 2.0).

Materials and Methods:

A cross-sectional measurement of disability and quality of life (QoL) measures was carried out among those seeking treatment for AUDs. Correlational analyses and Bland–Altman plot analysis were done to measure the level of agreement between IDEAS and WHODAS2.0.

Results:

The scores on the WHODAS and IDEAS show statistically significant positive correlation (Rho: 0.435, P = 0.0001) indicating convergent validity. There was a significant level of agreement of disability scores using both tools. The IDEAS score had significant negative correlation with the brief version (WHOQoL BREF-Hindi) measures (Rho: –0.301, P = 0.003) indicating divergent validity. Those with greater severity of AUD had higher IDEAS scores (b = 1.9, P = 0.046).

Conclusions:

IDEAS scores correlate with disability scores measured with WHODAS 2.0 and QoL assessment using WHOQOL-BREF Hindi in those with AUDs. This instrument can be used to quantify disability and provide socioeconomic compensations to these individuals.
Effect of Age of Gravida on Post-Cesarean Section Pain: An Observational Study
Authors: Kasim Mohammad , Malviya Deepak , Nath Soumya Sankar , Misra Shilpi , Kumar Suraj , Parashar Samiksha , Singh Neetu
Published: April 2023

Objective:

Preoperative identification of women at greater risk of post-cesarean pain might allow more intensive analgesic interventions. This study aimed to assess the effect of age of a parturient on post-cesarean section (CS) pain.

Methods:

100 pregnant females were enrolled and divided into 4 groups: group A (age 18–24 years), group B (25–30 years), group C (31–35 years), and group D (≥36 years). Patient-controlled epidural analgesia was started postoperatively in all patients. Pain on a 0- to 10-point visual analog scale (VAS), a number of attempts tried for patient-activated dose delivery of ropivacaine, and successful delivery of patient-activated dose of ropivacaine were recorded for 72 hours. Breastfeeding was initiated as early as possible. The effect of breastfeeding on post-CS pain was observed for 72 hours in terms of increase, decrease, or no change in VAS scores with breastfeeding.

Results:

The peak VAS scores over 72 hours were 4.10 ± 0.60, 4.00 ± 0.67, 3.75 ± 0.45, and 3.42 ± 0.67, respectively, in groups A, B, C, and D, showing a significant declining trend (P = 0.007). The mean VAS scores decreased from 4.08 to 1.69 (group A, P < 0.0001), from 4.00 to 1.64 (group B, P < 0.0001), from 3.67 to 1.25 (group C, P < 0.0001), and from 3.33 to 1.50 (group D, P < 0.0001) over 72 hours. A statistically significant decline in patient-activated rescue drug delivery attempts, the number of times the rescue analgesic was delivered, and 24-h cumulative ropivacaine dose requirement was seen.

Conclusions:

In this study, it was found that post-cesarean pain decreases significantly with increasing age, as evidenced by reduced pain scores, reduced attempts at rescue drug delivery, and reduced rescue analgesic requirements.