PurposeTo evaluate the incidence and severity pattern of dry eye after phacoemulsification.SettingKing Chulalongkorn Memorial Hospital, Bangkok, Thailand.DesignProspective descriptive study.MethodsSamples were collected from ninety-two uncomplicated cataract patients who were 18 years old or older. Dry eye incidence and pattern were analyzed at days 0, 7, 30 and 90 after phacoemulsification using (1) Ocular Surface Disease Index (OSDI) questionnaire, (2) tear break up time (TBUT), (3) Oxford ocular surface staining system, and (4) Schirmer I test without anesthesia.ResultsSeven days after phacoemulsification, the incidence of dry eye was 9.8% (95% confidence interval; 3.6–16.0%). The severity of dry eye peaked seven days post-phacoemulsification and was measured by OSDI questionnaire and all three clinical tests. Within thirty days and 3 months post-surgery, both the symptoms and signs showed rapid and gradual improvements, respectively. However, dry eye post-phacoemulsification was not significantly associated with sex and systemic hypertension (P = 0.26, 0.17 and 0.73, respectively).ConclusionsThe incidence of dry eye after phacoemulsification was 9.8%. Symptoms and signs of dry eye occurred as early as seven days post-phacoemulsification and the severity pattern improved over time. We recommend that ophthalmologists should evaluate patients both before and after phacoemulsification to prevent further damage to the ocular surface and able to manage the patient promptly and effectively so the patient will not have a poor quality of life and vision due to dry eye syndrome.

Purpose: To study the efficacy and safety of intense pulsed light (IPL) in patients with meibomian gland dysfunction (MGD). Methods: This prospective randomized double-masked sham-controlled trial included 114 patients with MGD. Patients were randomized into the IPL or sham group. Either the IPL or sham procedure was performed on days 0, 15, and 45. Ocular Surface Disease Index (OSDI), visual analog scale, visual acuity, tear breakup time, meibum quality and expressibility, meibography grade, ocular surface staining, tear film lipid layer thickness, tear osmolarity, Schirmer test, tear interleukin-1 receptor agonist, and interleukin-6 levels were examined on days 0, 15, and 45 and at months 3 and 6. Subgroup analysis according to stage and the patient's compliance to conventional treatment were also analyzed. Any adverse events during the study were recorded. A multilevel mixed-effect linear regression model was used. P value less than 0.05 was considered statistically significant. Results: At 6 months, tear breakup time, meibum quality grades, expressibility grades, and OSDI were better in the IPL group (5.23 ± 2.91 vs. 3.11 ± 0.99 seconds, P < 0.001; 8.74 ± 4.74 vs. 13.19 ± 5.01, P < 0.001; 0.50 ± 0.67 vs. 1.12 ± 0.70, P < 0.001; 24.29 ± 16.92 vs. 32.71 ± 20.07, P < 0.05). OSDI, meibum quality, and expressibility in the IPL group began to improve at day 15 (P < 0.001), whereas the results in the sham group began to improve at day 45 (P < 0001). No adverse event occurred after IPL. Conclusions: IPL is effective and safe for MGD treatment in all stages regardless of compliance.

To evaluate the effect of topical ascorbic acid on oxygen free radical tissue damage and the inflammatory cell influx in the cornea after excimer laser keratectomy.Methods: Five New Zealand white rabbits underwent bilateral phototherapeutic keratectomy with the 193-nm argon fluoride excimer laser. Following treatment, the right eye of each rabbit was treated with 10% ascorbic acid every 3 hours for 24 hours. The left eyes served as controls. After 24 hours, all animals were killed and their corneas were trephined and processed. Sections were stained with fast blue B and with hematoxylin-eosin. Oxidative tissue damage in the form of lipid peroxidation was detected by fluorescent peroxidized carbonyl compounds using a confocal laser scanning microscope. The quantity of these compounds was determined using the National Institutes of Health digital image analysis system. Statistical comparisons of lipid peroxidation and polymorphonuclear cell count between the ascorbic acid groups and the controls were performed using the Student t test.Results: Lipid peroxidation and polymorphonuclear cell counts were significantly decreased in the superficial cornea of ascorbic acid-treated eyes compared with control eyes (P Ͻ.03 and Ͻ.02, respectively).Conclusions: Topical ascorbic acid application decreased oxygen radical tissue damage following excimer keratectomy; moreover, topical application of ascorbic acid was shown to reduce the acute inflammatory reaction efficiently. This suggests that topical ascorbic acid could be considered a complementary treatment in the pharmacological modulation after excimer laser corneal surgery.Clinical Relevance: Corneal opacity may complicate excimer keratectomy. The use of an antioxidant to reduce tissue damage could help minimize postoperative stromal opacification.

Real time IOP can be measured during keratomileusis. The results demonstrated a significant increase in IOP during the procedure. Suction ring pressure setting is an important variable in determining consistent corneal flap thickness during the keratomileusis procedure.

Both tetracaine and proparacaine had toxic effects on stromal keratocytes related not only to drug concentrations but also to time exposure. These findings underscore the widespread concern that anesthetic drugs may affect corneal stromal wound healing after PRK.

Purpose: To evaluate the efficacy of additional thermal pulsatile system compared to standard lid hygiene alone in meibomian gland dysfunction (MGD) patients who are using long-term anti-glaucoma medications. Patients and Methods: Well-controlled glaucoma patients who used anti-glaucoma medications for at least 1 year and had MGD were enrolled and randomized between a study group who received thermal pulsatile system (Lipiflow ®) treatment and standard lid hygiene, and a control group who received standard lid hygiene alone. The primary outcome was meibomian gland expression score, and the secondary outcomes were the Ocular Surface Disease Index (OSDI) score, Schirmer test score, tear break-up time (TBUT), corneal staining score, lipid layer thickness (LLT), and meibography score. All the outcomes were re-evaluated at 1 week, then at 1, 3, and 6 months after treatment. Results: Of 60 participants who underwent randomization, 48 completed the study. At the 6-month mark, this study could not demonstrate any significant difference between groups in both primary and secondary outcomes. However, there was significant improvement from baseline in both groups of the following outcomes: meibomian gland expression score, OSDI score, LLT, and meibography score. No serious adverse event was found in this study. Conclusion: An additional single thermal pulsatile system treatment with standard lid hygiene significantly improved meibomian gland assessment score and subjective symptoms at 6 months. Any difference between additional thermal pulsatile system treatment and lid hygiene alone was not found in this study. The results may suggest more chronic MGD and more damaged meibomian gland induced by long-term anti-glaucoma medications.

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Aim: To assess the short-term efficacy of hypotonic 0.18% sodium hyaluronate in patients with evaporative tear-sufficient dry eye due to lipid tear deficiency (LTD). Methods: This was a randomised, double-blind, controlled, exploratory study. A total of 10 patients with dry eye due to LTD were treated as follows: one drop of hypotonic 0.18% sodium hyaluronate in one eye and one drop of isotonic 0.3% hydroxypropyl-methylcellulose (HPMC)/0.1% dextran in the other eye. Non-invasive tear film break-up time (NIBUT) evaluated by using a tear scope with grid pattern and subjective ocular symptoms of dry eye were assessed at 15, 30, 60 and 90 min after instillation. Results: Both sodium hyaluronate and HPMC/dextran caused a significant (p,0.05) improvement in NIBUT and symptoms. Mean (SD) NIBUT in the sodium hyaluronate group was 3.2 (1.0), 6.4 (2.8), 5.5 (1.9), 5.3 (1.3) and 3.9 (1.7) s at 0, 15, 30, 60 and 90 min, respectively, compared with 3.6 (1.9), 5.5 (3.2), 5.0 (1.5), 4.4 (2.2) and 3.5 (1.2) s in the HPMC/dextran group. However, increase in NIBUT was significantly (p,0.05) greater and longer in the sodium hyaluronate group than in the HPMC/dextran group. Conclusion: Treatment with sodium hyaluronate and HPMC/dextran eye drops is useful for treating patients with dry eye due to LTD. However, sodium hyaluronate caused a significantly (p,0.05) greater increase in NIBUT values than HPMC/dextran in such patients. C auses of dry eye have been classified into two groupsnamely, aqueous tear-deficient dry eye (ATD) and tearsufficient evaporative dry eye.1 Artificial tears are widely used to treat ATD. In most severe cases, treatment with nonpreserved eye drops is mandatory to avoid the toxicity of preservative when using the eye drops at frequent intervals. The efficacy of non-preserved artificial tears is well recognised in this case.2 Sodium hyaluronate as a tear-replacement eye drop is widely used in the treatment of ATD, as indicated in several wellcontrolled studies.3-5 However, little is known on the efficacy profile of sodium hyaluronate in evaporative dry eye due to lipid tear deficiency (LTD). LTD is one of the important causes of tear film instability. It is caused by meibomian gland abnormality, which results in lack of or abnormal lipid tear layer, instability of the tear film and shortening of tear breakup time (TBUT). As a consequence, the purpose of this study was to assess the performance profile of hypotonic 0.18% sodium hyaluronate eye drops after a single instillation in patients with dry eye due to LTD. Hydroxypropyl-methylcellulose (HPMC)/dextran eye drops were used as the reference product. MATERIALS AND METHODS Study designThis was a randomised, double-blind, controlled, exploratory study. Before initiation of the study, the informed consent form and protocol were approved by the committee for the protection of human participants in research at the Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. The study was conducted in accordance with good clinical practice guidelin...