Ji Min Ahn

Analysis of Tear Cytokines and Clinical Correlations in Sjögren Syndrome Dry Eye Patients and Non–Sjögren Syndrome Dry Eye Patients

PURPOSE To compare concentrations of tear cytokines in 3 groups composed of Sjögren syndrome (SS) dry eye, non-Sjögren syndrome (non-SS) dry eye, and normal subjects. Correlations between ocular surface parameters and tear cytokines were also investigated. DESIGN Prospective cross-sectional study. METHODS SS dry eye patients (n = 24; 40 eyes) were diagnosed with primary SS according to the criteria set by the American-European Consensus Group. Non-SS dry eye patients (n = 25; 40 eyes) and normal subjects (n = 21; 35 eyes) were also enrolled. Tear concentrations of interleukin (IL)-17, IL-6, IL-10, IL-4, IL-2, interferon γ (IFN-γ), and tumor necrosis factor α (TNF-α) were measured by a multiplex immunobead assay. Ocular Surface Disease Index (OSDI), tear film breakup time (TBUT), Schirmer I test, and fluorescein staining scores were obtained from dry eye patients. RESULTS All cytokine levels except for IL-2 were highest in the SS group, followed by non-SS dry eye group and control subjects. Concentrations of IL-17, TNF-α, and IL-6 were significantly different among the 3 groups (IL-17: SS > control P < .001, non-SS > control P = .042, SS > non-SS P < .001; TNF-α: SS > control P = .006, non-SS > control P = .034, SS > non-SS P = .029; IL-6: SS > control P = .002, non-SS > control P = .032, SS > non-SS P = .002). IL-17 was significantly correlated with TBUT (R = -0.22, P = .012) and Schirmer I test (R = -0.36, P = .027) scores in the SS group. IL-6 was significantly correlated only with TBUT (R = -0.38, P = .02) in the non-SS group. CONCLUSIONS Differences in tear cytokine levels and correlation patterns between SS dry eye and non-SS dry eye patients suggest the involvement of different inflammatory processes as causes of dry eye syndrome.

Evaluation of Dry Eye and Meibomian Gland Dysfunction After Cataract Surgery

PURPOSE To evaluate dry eye and meibomian gland dysfunction after cataract surgery. DESIGN Prospective observational case series. METHODS We studied 58 eyes of 48 patients who underwent phacoemulsification and evaluated them preoperatively and at 1 month and 3 months postoperatively. Ocular symptom scores, lid margin abnormalities, superficial punctate keratopathies (SPKs), tear film break-up time (TBUT), Schirmer test, lower tear meniscus height, depth, and area using Fourier domain optical coherence tomography, meibum expressibility and images of the meibomian glands using meibography were measured. RESULTS The ocular symptom scores were worse at 1 month and 3 months postoperatively (P < 0.001 and P < 0.001, respectively). Lid margin abnormalities were significantly increased (P < 0.001 and P < 0.001, respectively) and TBUT decreased postoperatively (P < 0.001 and P < 0.001, respectively). Meibum expressibility decreased at 3 months postoperatively (P = 0.016); however, meibography score, SPK, lower tear meniscus height, depth and area and the Schirmer test did not change significantly postoperatively (all P values >0.05). CONCLUSION Meibomian gland function may be altered without accompanying structural changes after cataract surgery.

Prevalence of and Risk Factors Associated With Dry Eye: The Korea National Health and Nutrition Examination Survey 2010-2011

PURPOSE To investigate the prevalence of and risk factors associated with dry eye syndrome (DES) in South Korea. DESIGN Cross-sectional study. METHODS In 2010 and 2011, 11,666 subjects, ranging in age from 19 to 95, were randomly selected as nationally representative participants in the Korea National Health and Nutrition Examination Survey (KNHANES). Subjects were divided into 2 groups: 1 with clinically diagnosed DES and 1 with symptoms of dry eye. We determined the prevalence of and risk factors for dry eyes in a Korean population. Health-related quality of life (HRQoL), measured by the EuroQoL-5 dimension (EQ-5D), was evaluated in patients with dry eyes. RESULTS The mean age was 49.9 years. The overall prevalence of diagnosed DES was 8.0% (95% confidence interval [CI], 7.3% to 8.7%), and of dry eye symptoms the prevalence was 14.4% (95% CI, 13.1 to 15.7). Age (adjusted odds ratio [aOR] = 1.8, 1.6), female (aOR = 2.8, 1.9); history of eye surgery (aOR = 2.6, 2.2); stress (aOR = 1.7, 1.6); thyroid disease (aOR = 1.7, 1.5); and high education level (aOR = 1.6, 1.5) were common risk factors in the groups. Subjects who had undergone ptosis, cataract or refractive surgery were more likely to have dry eye than subjects with no history of eye surgery. Means of pain and anxiety dimensions in the EQ-5D and the Euro Quality of Life Visual Analog Scale (EQ-VAS) were significantly higher in the group with diagnosed DES than in the normal group. CONCLUSIONS The risk factors were mostly similar in both groups. It is thought there are more patients with DES who have not been diagnosed by doctors. Doctors should identify whether a patient has any risk factors for dry eye. Patients need to be educated about the modifiable factors of DES.

Evaluation of Optical Quality Parameters and Ocular Aberrations in Multifocal Intraocular Lens Implanted Eyes

Purpose We investigated the correlations between optical quality parameters obtained from the double-pass system and ocular aberrations obtained from the ray-tracing aberrometer in multifocal intraocular lens (IOL) implanted eyes. Materials and Methods Twenty eyes from 20 patients were enrolled in this study. Modulation transfer function cutoff frequency, The Strehl ratio, objective scatter index, and objective pseudo-accommodation obtained from the double-pass system were compared with root mean square (RMS) total aberration, RMS higher-order aberration, and spherical aberration obtained from the ray-tracing aberrometer. Additionally, parameters of the double-pass system and ray-tracing aberrometer were compared with manifested refraction values and subjective visual acuity, respectively. Results There was no statistically significant correlation between optical quality parameters obtained from the double-pass system and ocular aberrations, except between the Strehl ratio and RMS total aberration (r=-0.566, p=0.018). No significant correlations were found between the parameters of both devices, and manifested refraction values or subjective visual acuity. Conclusion Optical quality parameters, especially the Strehl ratio, in multifocal IOL implanted eyes were affected by RMS total aberration. Further studies based on accurate measurements of ocular aberrations and additional optical quality parameters are needed to delineate relationships between optical quality parameters and ocular aberrations in multifocal IOL implanted eyes.

Double-pass system assessing the optical quality of pseudophakic eyes.

Purpose To compare the optical quality measurements obtained from the double-pass system and ocular aberrations, subjective visual acuity, and contrast sensitivity score in pseudophakic eyes. Methods Three months after cataract surgery, modulation transfer function (MTF) cutoff frequency, Strehl ratio, objective scatter index, and objective pseudoaccommodation obtained from the double-pass system were compared with total aberration, higher-order aberration, and spherical aberration obtained from ray-tracing aberrometer. In addition, parameters of the double-pass system were compared with subjective visual acuity and the contrast sensitivity score. Results Forty eyes of 40 patients were included. The MTF cutoff frequency and Strehl ratio were negatively correlated with total aberration (r = −0.503, p = 0.003; r = −0.509, p = 0.003, respectively) and subjective visual acuity (r = −0.453, p = 0.007; r = −0.354, p = 0.040, respectively). The objective scatter index was positively correlated with total aberration (r = 0.451, p = 0.024) and subjective visual acuity (r = 0.516, p = 0.008). The MTF cutoff frequency showed a correlation with contrast sensitivity score under photopic and mesopic conditions. Conclusions Optical quality parameters obtained from the double-pass system were correlated with ocular aberrations, subjective visual acuity, and contrast sensitivity score in pseudophakic eyes.

Surgical approach with high-frequency radiowave electrosurgery for superior limbic keratoconjunctivitis.

Purpose: The aim was to introduce the application of a simple technique using high-frequency radiowave electrosurgery in the management of superior limbic keratoconjunctivitis (SLK). Methods: This study is a prospective, noncomparative, interventional case series analysis. Seven patients (9 eyes) with SLK were recruited from the outpatient clinic of the Department of Ophthalmology, Severance Eye Hospital and Kangbuk Samsung Hospital, Seoul, Korea. On the superior bulbar conjunctiva, multiple ablations were performed using a high-frequency radiowave electrosurgical unit (Ellman Surgitron Dual Frequency RF; Ellman International, Inc, Hewlett, NY) with the lowest power setting of 1 (of 100) in the cutting mode. The operation was completed when the operator found no redundant portion on the superior bulbar conjunctiva. Results: After the surgery was performed, all the patients had mild to moderate superior conjunctival injection and swelling at the operating area. One month postoperatively, slit-lamp examinations revealed a smooth conjunctival surface without remarkable hyperemia. The symptoms were significantly improved in all eyes. Follow-up Fourier domain optical coherence tomography images showed a decrease of the space between subconjunctival tissue and sclera. No notable complications were observed. Conclusions: This study demonstrated that high-frequency radiowave electrosurgery is a simple, safe, and effective first-line surgical treatment modality for refractory SLK patients with conjunctivochalasis.

Comparison of the topographic ablation zone after photorefractive keratectomy for myopia using two different excimer lasers.

PurposeTo compare the topographic features of eyes treated with photorefractive keratectomy (PRK) for myopia using two different excimer lasers.MethodsA total of 65 eyes in 39 patients treated with PRK (6.0-mm optical zone) using Technolas 217C and VISX S4 excimer lasers were evaluated retrospectively to determine the size of the topographic ablation zone.ResultsThe zones ablated using the VISX S4 had shorter diameters in both axes (−0.89±0.73, −1.59±0.49 mm; both P=0.00), whereas those ablated using the Technolas 217C had a longer diameter in the major axis (0.96±0.63 mm; P=0.00) and a shorter diameter in the minor axis (−0.39±0.59 mm; P=0.00). The theoretical ablated zone was a circle with a diameter of 6.0 mm. The Technolas 217C group tended to have oval cuts in comparison with the VISX S4 group, and the difference between the programmed (6.0 mm) and topographic diameters was significant in both groups.ConclusionsThere was a difference between the programmed and postoperative topographic diameters of the ablation zone. The postoperative ablation zone differed in shape and size according to the type of excimer laser.