Maurizio Rolando

The International Workshop on Meibomian Gland Dysfunction: Report of the Subcommittee on Management and Treatment of Meibomian Gland Dysfunction

The goals of the subcommittee were to review the current practice and published evidence of medical and surgical treatment options for meibomian gland dysfunction (MGD) and to identify areas with conflicting, or lack of, evidence, observations, concepts, or even mechanisms where further research is required. To achieve these goals, a comprehensive review of clinical textbooks and the scientific literature was performed and the quality of published evidence graded according to an agreed on standard, using objective criteria for clinical and basic research studies adapted from the American Academy of Ophthalmology Practice Guidelines1 (Table 1). It should be noted that, in many of the clinical textbooks and previous reports, terminology is often interchanged and the management of anterior and posterior blepharitis and/or meibomitis is often considered concurrently. Thus, a broad scope of documents was reviewed in this process. Consistency in terminology and global adoption of the term “meibomian gland dysfunction” would significantly aid clinical research and clinical care in MGD going forward. Table 1. Grading Level of Evidence of Clinical and Basic Research Studies1

The ocular surface and tear film and their dysfunction in dry eye disease.

The ocular surface, tear film, lacrimal glands, and eyelids act as a functional unit to preserve the quality of the refractive surface of the eye and to resist injury and protect the eye against changing bodily and environmental conditions. Events that disturb the homeostasis of this functional unit can result in a vicious cycle of ocular surface disease. The tear film is the most dynamic structure of the functional unit, and its production and turnover is essential to maintaining the health of the ocular surface. Classically, the tear film is reported to be composed of three layers: the mucin, aqueous, and lipid layers. The boundaries and real thickness of such layers is still under discussion. A dysfunction of any of these layers can result in dry eye disease.

Topical Non-Preserved Diclofenac Therapy for Keratoconjunctivitis Sicca

Keratoconjunctivitis sicca, regardless of origin, is associated with variable levels of inflammation of the ocular surface. Chronic inflammation induces and maintains the metaplastic changes that typically develop in the conjunctival epithelium of patients with this disease. Although inflammatory phenomena associated with KCS can be immunomediated and/or induced by local prostaglandin secretion, it is unknown which of the two mechanisms has the prevailing role in the genesis of injury. Nevertheless, it is reasonable to assume that inflammatory prostaglandins are liberated as a result of epithelial damage. In support of this hypothesis, a recent study demonstrated the efficacy of a therapy consisting of cycles of topically administered steroids in the treatment of KCS(4). However, the study also reported notable risks to other aspects of ocular structural health from the well known side effects of corticosteroids, e.g., intraocular hypertension and cataracts. A therapy with non-steroidal and non-preserved anti-inflammatory agents in association with tear substitutes could be an effective therapy for the reduction of inflammation of the ocular surface and its associated symptoms.

The effect of pneumatic trabeculoplasty on intraocular pressure : The results of a 6-month, open-label, multicenter study

Purpose To evaluate the effects of pneumatic trabeculoplasty (PNT) in ocular hypertension and glaucoma subjects. Methods A total of 63 consecutive subjects, either treated (79%) or untreated (21%), with intraocular pressure (IOP) between 20 and 25 mmHg were enrolled; the eye with higher IOP (or, in case of identical IOP, worse visual field) was treated with PNT, with the fellow eye used as control. Subjects underwent a baseline evaluation the day before treatment, two PNT treatments at day 0 and 7, visits at day 1, 8, 14, and at each month until the end of the study, which lasted 6 months. Safety was addressed at all visits; an IOP curve (at 8 and 10 AM, 2 and 4 PM) was obtained at baseline and during monthly visits. Results In PNT eyes, baseline IOP was 22.2±1.6 mmHg. Following PNT a statistically significant reduction of IOP occurred at all visits (p<0.0001), with a mean decrease ranging from −2.7±2.5 (-11.9±10.8%) to −3.6±2.6 mmHg (-16.0±11.6%); mean reduction was 12.8±11.5%. Although IOP diminished also in the control eyes after baseline (p<0.05), the change in IOP was significantly higher in PNT group at each visit (p<0.05). Mild side effects were experienced by 76% of subjects and they all resolved without sequelae. Conclusions The results suggest the effect of this procedure in reducing IOP in glaucoma and ocular hypertensive subjects.