Publications by authors named "Jong Suk Song"

111 Publications

The Dopaminergic Neuronal System Regulates the Inflammatory Status of Mouse Lacrimal Glands in Dry Eye Disease.

Invest Ophthalmol Vis Sci 2021 Apr;62(4):14

Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.

Purpose: Comparison of the parasympathetic and sympathetic neurons, including the dopaminergic neural system, in dry eye (DE)-induced pathophysiology has not been elucidated well. This study investigated the presence of dopamine receptors (DRs) and their functional roles in the lacrimal glands (LGs) of DE-induced mice.

Methods: After DE was induced in B6 mice for 2 weeks, the expression of tyrosine hydroxylase (TH), dopamine, and DRs (DR1, DR2, etc.) in the LGs and corneas were measured by quantitative RT-PCR, immunoblot, and ELISA. Using flow cytometry and ELISA, immune cell infiltration and inflammatory cytokine expression were determined in DE-induced LGs with or without DR blockers, SCH-23390 (DR1i), or melperone (DR2i). Corneal erosion scores were also investigated.

Results: The mRNA and protein levels of TH significantly increased in DE-induced LGs. The dopamine concentration of LGs was 9.51 pmol in DE (versus naive: 1.39 pmol; P < 0.001). Both DR1 and DR2 mRNA expression were significantly enhanced in desiccating stress compared with those in naive (3.7- and 2.1-fold, P < 0.001). Interestingly, DR1 and DR2 immunostaining patterns stained independently in DE-induced LGs. CD3+ and CD19+ cell infiltration was significantly increased by DR2i (P < 0.001) but not by DR1i. Furthermore, IFN-γ, IL-17, and TNF-α were significantly upregulated by DR2i compared with the blow-only condition. The severity of corneal erosion and inflammation was also aggravated by DR2i.

Conclusions: Upregulation of DR1 and DR2 was observed in DE-induced mouse LGs. As the inflammatory conditions are aggravated by the inhibition of DRs, especially DR2, their activity may be an important factor preserving ocular surface homeostasis.
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http://dx.doi.org/10.1167/iovs.62.4.14DOI Listing
April 2021

Risk Factors Influencing the Occurrence and Severity of Symptomatic Dry Eye Syndrome: A Cross-sectional Study.

Ophthalmic Epidemiol 2021 Jan 31:1-7. Epub 2021 Jan 31.

Department of Preventive Medicine, Yonsei University College of Medicine , Seoul, Republic of Korea.

: We aimed to investigate the prevalence and risk factors of dry eye syndrome (DES) among a population-based cohort study.: This cross-sectional study was conducted on 475 subjects (184 men and 291 women) enrolled in the Study Group for Environmental Eye Disease at July 2013. Using the ocular surface disease index (OSDI), we measured the DES severity and defined DES as OSDI score ≥13. Current symptoms of DES and possible risk factors such as body mass index, occupations, comorbidities, exercise, smoking and drinking status were assessed by multivariate logistic regression.: Prevalence of DES was significantly higher in women (52.6%) than in men (41.9%) ( < .001). Compared to white-collar workers, blue-collar workers and unemployed persons showed significantly higher DES prevalence and severity. Compared to those with low BMI (<23.0 kg/m), people with extremely high BMI (≥30.0 kg/m) had significantly higher odds ratio (OR) of having DES after fully adjusted for sex, age, hypertension, diabetes, menopausal status, hormone replacement therapy, occupation, and lifestyle factors (OR: 2.83, 95% confidence interval: 1.04-7.71).: We found some novel factors which have been unknown to the relationship with DES through the five years observation of the cohort. The positive associations of unemployment status, blue-collar work, alcohol habit, and obesity with DES suggests a person's comprehensive condition, not individual factors, contribute significantly in developing DES. Further studies will be helpful to understand the underlying mechanisms.
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http://dx.doi.org/10.1080/09286586.2021.1879172DOI Listing
January 2021

A multicenter cross-sectional survey of dry eye clinical characteristics and practice patterns in Korea: the DECS-K study.

Jpn J Ophthalmol 2021 Mar 19;65(2):261-270. Epub 2021 Jan 19.

Department of Ophthalmology, Korea University College of Medicine, Seoul, Republic of Korea.

Purpose: To compare the proportions of patients satisfying Korean dry eye guidelines and Asia Dry Eye Society (ADES) diagnostic criteria and to describe the clinical characteristics and practice patterns of dry eye patients in Korea.

Study Design: Prospective observational study.

Methods: This study enrolled 160 patients, with 158 patients analyzed. ADES guidelines were applied to dry eye patients satisfying the Korean dry eye guidelines. Risk factors for dry eye (e.g. visual display terminal [VDT] use) were evaluated. Dry eye subtypes were categorized as aqueous-deficient or evaporative. Objective signs (e.g. corneal and keratoconjunctival staining scores, tear break-up time [TBUT], and Schirmer test) and symptoms (Dry Eye-Related Quality of Life Score [DEQS] and Ocular Surface Disease Index [OSDI] questionnaire) were evaluated. Treatment patterns were also recorded.

Results: Patients (mean age 43.1 years) were mainly women (85.4%), with a high proportion (77.2%) of VDT users. Concordance between Korean and ADES guidelines was high (94.3%), with most patients (94.3%) having tear film instability (TBUT ≤ 5 s). Evaporative dry eye occurred in 60.1% and aqueous-deficient in 39.9% of cases. Objective signs were significantly better in evaporative than in aqueous-deficient dry eye. The DEQS bothersome ocular symptoms' score was significantly higher in VDT users than in non-users. OSDI symptom severity and DEQS were significantly correlated (p < 0.001). The most common treatments were hyaluronic acid (33.5%) and diquafosol (15.2%), the latter used mainly for mild and evaporative dry eye.

Conclusion: The study showed high concordance between Korean and ADES diagnostic guidelines, with most patients having tear film instability.
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http://dx.doi.org/10.1007/s10384-020-00803-7DOI Listing
March 2021

Multizonal Design Multifocal Intraocular Lens-Induced Astigmatism According to Orientation.

J Refract Surg 2020 Nov;36(11):740-748

Purpose: To evaluate the differences in intraocular lens (IOL)-induced astigmatism according to differences in orientation of a multizonal multifocal IOL, the Precizon Presbyopic NVA IOL (Ophtec BV).

Methods: The clinical study reviewed 80 eyes from 40 patients with cataracts who underwent Precizon Presbyopic IOL implantation. Residual astigmatism, as measured by autorefraction and manifest refraction, was investigated using vector analysis of eyes implanted with vertical (90 ± 30 degrees) and horizontal (180 ± 30 degrees) orientations of the first near segment of the IOL. In the ray-tracing simulation study, pseudophakic eyes with the Precizon Presbyopic IOL were modeled. The modulation transfer function (MTF) of each case was compared with respect to the amount of corneal astigmatism of the model eyes and the orientation of the first near segment.

Results: The mean IOL-induced astigmatism measured by autorefraction was 0.68 ± 0.58 diopters (D) at 1 degree in the vertical orientation of the first near segment (n = 52) and 1.05 ± 0.81 D at 96 degrees in the horizontal orientation (n = 28). However, the mean IOL-induced astigmatism measured by manifest refraction was 0.14 ± 0.44 D at 171 degrees and 0.46 ± 0.40 D at 95 degrees. The MTF analysis showed that the highest MTF values were measured in eyes without corneal astigmatism in both the vertically and horizontally implanted IOLs.

Conclusions: Autorefraction measurement indicates induction of with-the-rule astigmatism by the Precizon Presbyopic IOL when implanted vertically with respect to the first near segment, and against-the-rule astigmatism when implanted horizontally. However, this astigmatism is clinically insignificant according to manifest refraction and ray-tracing simulation. [J Refract Surg. 2020;36(11):740-748.].
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http://dx.doi.org/10.3928/1081597X-20200828-02DOI Listing
November 2020

Comparison of Nd:YAG Laser Capsulotomy Rates Between Refractive Segmented Multifocal and Multifocal Toric Intraocular Lenses.

Am J Ophthalmol 2021 02 8;222:359-367. Epub 2020 Oct 8.

Department of Ophthalmology, Korea University College of Medicine, Seoul, Republic of Korea.

Purpose: To investigate the early incidence of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy according to intraocular lens (IOL) type (nontoric vs toric) and surgical techniques (femtosecond laser-assisted cataract surgery vs conventional phacoemulsification) in eyes with refractive multifocal IOLs.

Design: Retrospective case-control study.

Methods: Nine hundred thirteen eyes from 483 patients implanted with Lentis Mplus LS-313 MF20 (767 eyes) or Lentis Mplus Toric LU-313 MF20T (146 eyes) IOLs (Oculentis GmbH, Berlin, Germany) were enrolled. We compared the incidence of Nd:YAG laser capsulotomy between the nontoric and toric groups. In addition, the incidence of Nd:YAG laser capsulotomy was also evaluated according to the surgical technique used.

Results: The overall incidence of Nd:YAG laser capsulotomy was 10.2% (93/913 eyes). The Nd:YAG laser capsulotomy rate was significantly higher in the toric group (24/146; 16.4%) than in the nontoric group (69/767; 9.0%; P = .007). Of the 913 enrolled eyes, 448 eyes (49.1%) underwent femtosecond laser-assisted cataract surgery and 465 eyes (50.9%) underwent conventional phacoemulsification cataract surgery. There was no significant difference in the incidence of Nd:YAG laser capsulotomy between eyes with femtosecond laser-assisted cataract surgery and eyes with conventional phacoemulsification cataract surgery.

Conclusion: Patients with refractive multifocal toric IOLs had higher early incidence rates of Nd:YAG laser capsulotomy when compared to those with refractive multifocal nontoric IOLs. Furthermore, femtosecond laser-assisted cataract surgery could not reduce the early incidence of Nd:YAG laser capsulotomy in this study.
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http://dx.doi.org/10.1016/j.ajo.2020.09.046DOI Listing
February 2021

Effect of natural extract eye drops in dry eye disease rats.

Int J Ophthalmol 2020 18;13(7):1023-1030. Epub 2020 Jul 18.

Department of Ophthalmology, Korea University College of Medicine, Seoul 02841, Republic of Korea.

Aim: To investigate the therapeutic effect of natural extract eye drops containing bee venom, musk, and deer antlers in dry eye disease (DED) animal models.

Methods: Scopolamine-injected DED rats and lacrimal gland-excised rats were allocated into control, saline, and natural extract groups respectively and a normal group (lacrimal gland excision was not performed) in lacrimal gland-excised rats. After eye drop instillation 4 times a day for 5d, corneal fluorescein staining (CFS) scores, tear MUC5AC levels, and tear lactic dehydrogenase (LDH) levels were measured.

Results: In scopolamine-injected rats, the natural extract-treated group had significantly lower CFS scores (1.7±0.5, 4.7±1.4, 3.8±1.9, =0.006) and tear LDH levels (0.10±0.01, 0.19±0.01, 0.16±0.08 OD, =0.014) but higher tear MUC5AC levels (12.9±3.7, 7.9±2.0, 9.7±3.6 ng/mL, =0.041) compared with the control and saline-treated groups. There were no significant differences between the control and saline-treated groups. In lacrimal gland-excised rats, the natural extract-treated group also had lower CFS scores (4.3±1.2, 11.5±2.3, 9.0±1.9, <0.001, =0.001) and tear LDH levels (0.30±0.08, 0.48±0.12, 0.39±0.05 OD, <0.05) but higher tear volume (4.3±0.9, 1.9±0.7, 2.8±1.1 mm, =0.005, =0.124) and tear MUC5AC levels (8.2±2.0, 2.9±1.2, 5.4±2.2 ng/mL, <0.001, =0.047) compared with the control and saline-treated groups. There were no significant differences in the CFS scores, tear MUC5AC level, and tear LDH level between the normal and natural extract-treated groups.

Conclusion: The natural extract consisting of bee venom, musk, and deer antlers may have effectiveness in DED treatment by restoring the damaged ocular surface, increasing tear volume, and recovering the tear mucin layer in DED rats.
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http://dx.doi.org/10.18240/ijo.2020.07.02DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7321946PMC
July 2020

Clinical efficacy of eyelid hygiene in blepharitis and meibomian gland dysfunction after cataract surgery: a randomized controlled pilot trial.

Sci Rep 2020 07 16;10(1):11796. Epub 2020 Jul 16.

Department of Ophthalmology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea.

The purpose of this randomized clinical trial is to evaluate the effect of eyelid hygiene on subjective symptoms, anterior blepharitis, and meibomian gland dysfunction (MGD) after cataract surgery. Subjects with obstructive MGD who underwent cataract surgery were randomly divided into two groups. In the eyelid hygiene group, eyelid hygiene was performed twice a day for 10 days from 3 days before to 1 week after cataract surgery. The control group did not perform eyelid hygiene. A subjective symptom questionnaire of SPEED, anterior blepharitis grade, and meibum quality and quantity was evaluated at baseline and at postoperative 1 and 4 weeks. The eyelid hygiene group (n = 36) showed decreased SPEED score after cataract surgery and the control group (n = 33) did not. Anterior blepharitis grade was worse 1 week after surgery in the control group but not in the eyelid hygiene group. The control group had significantly decreased meibum quality and quantity in both the upper and lower eyelids after cataract surgery, but the eyelid hygiene group did not. Eyelid hygiene before/after cataract surgery improved postoperative subjective symptoms and prevented postoperative exacerbation of anterior blepharitis and MGD. Thus, perioperative eyelid hygiene is recommended for patients with obstructive MGD who undergo cataract surgery.
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http://dx.doi.org/10.1038/s41598-020-67888-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7366917PMC
July 2020

Retraction Note: Comparison of 0.05% cyclosporine and 3% diquafosol solution for dry eye patients: a randomized, blinded, multicenter clinical trial.

BMC Ophthalmol 2020 06 23;20(1):251. Epub 2020 Jun 23.

Department of Ophthalmology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, 63-ro, Yeongdeungpo-gu, Seoul, 07345, South Korea.

An amendment to this paper has been published and can be accessed via the original article.
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http://dx.doi.org/10.1186/s12886-020-01524-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7310420PMC
June 2020

Rainbow halos occur less following implantation of extended range of vision one-piece intraocular lenses diffractive bifocal intraocular lenses.

Int J Ophthalmol 2020 18;13(6):913-919. Epub 2020 Jun 18.

Department of Ophthalmology, Ansan Hospital, Korea University College of Medicine, Seoul 15355, Republic of Korea.

Aim: To evaluate clinical outcomes following implantation of an extended range of vision intraocular lens (IOL), the ZXR00, and a diffractive multifocal IOL with +2.75 diopters (D) add power, the ZKB00.

Methods: Totally 30 patients who underwent either bilateral implantation of the ZXR00 IOL with intended emmetropia (ZXR00 emmetropia group: 20 eyes) and intended micromonovision (ZXR00 monovision group: 20 eyes), or bilateral implantation of the ZKB00 IOL with intended emmetropia (ZKB00 group: 20 eyes) were included in this study. Visual acuity at 4 m, 80, and 40 cm; and the types of halos (misty, fine, and rainbow) were analyzed at one and three months after surgery.

Results: There were no significant differences in distance visual acuity among the three groups. The mean uncorrected intermediate visual acuity was better in the ZXR00 emmetropia and monovision groups (0.02 logMAR and 0.02 logMAR, respectively) than in the ZKB00 group (0.14 logMAR). The mean uncorrected near visual acuity was worse in the ZXR00 emmetropia group (0.26 logMAR) than in the ZXR00 monovision and ZKB00 groups (0.12 logMAR and 0.10 logMAR, respectively). There was an increased incidence of rainbow halos in the ZKB00 group in either ZXR00 group (=0.033).

Conclusion: Implantation of the ZXR00 IOL with intended micromonovision provide superior visual acuity than implantation of the ZXR00 IOL with intended emmetropia. The ZXR00 IOLs tend to show a lower incidence of rainbow halos than did the ZKB00 IOL.
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http://dx.doi.org/10.18240/ijo.2020.06.09DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270270PMC
June 2020

Factors for good near and distance visual outcomes of multifocal intraocular lens with inferior segmental near add.

Graefes Arch Clin Exp Ophthalmol 2020 Aug 29;258(8):1735-1743. Epub 2020 May 29.

Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea.

Purpose: This study was conducted to investigate factors related to postoperative good near and distance visual outcomes in the Lentis Mplus LS-313 MF20 (Oculentis Gmbh, Berlin, Germany) intraocular lens (IOL)-implanted eye.

Methods: A retrospective cross-sectional study analyzed a total of 198 eyes of 198 patients. Patients with 20/20-or-more uncorrected distance visual acuity (UDVA, 5 m) and J2-or-more uncorrected near visual acuity (UNVA, 40 cm) were distributed into the good visual outcome (GVO) group (n = 96), and the remaining patients were distributed into the moderate visual outcome (MVO) group (n = 102). Differences between the two groups were compared for patient age, preoperative measurements (kappa distance, kappa angle, and pupil size), and postoperative measurements (residual sphere, cylinder, and spherical equivalent) to explore factors related to good visual outcomes after IOL implantation.

Results: The average age of the GVO group (56.2 years) was significantly lower than that of the MVO group (58.6 years), and the average kappa distance of the former was significantly smaller than that of the latter. However, there were no significant differences between the two groups in kappa angle and pupil size. Notably, multivariate binary regression analysis revealed that multiple factors including age, residual cylinder, and spherical equivalent were associated with good visual outcomes. Based on the receiver operating characteristic curve, cutoff values regarded as good visual outcome following cataract surgery were calculated to be - 0.38 CD in residual cylinder and - 0.32 D in residual spherical equivalent.

Conclusions: Patients with implanted Lentis Mplus LS-313 MF20 IOL who are young, had small kappa distance, and had low levels of postoperative residual cylinder and spherical equivalent tended to exhibit good vision at both near and distance. These results imply that surgeons should minimize postoperative residual cylinder and spherical equivalent to provide good visual outcomes to patients with implanted Lentis Mplus LS-313 MF20 IOL.
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http://dx.doi.org/10.1007/s00417-020-04761-1DOI Listing
August 2020

The Protective Effect of an Eye Wash Solution on the Ocular Surface Damage Induced by Airborne Carbon Black Exposure.

Cornea 2020 Aug;39(8):1040-1047

Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea; and.

Purpose: To investigate the effects of an eye wash solution on the ocular surface damage induced by airborne carbon black (CB) exposure.

Methods: Sprague-Dawley rats were exposed to ambient CB for 5 days. During the 5 days, a commercial eye wash solution (Eyebon-W) was used for irrigation twice daily on CB-exposed rat eyes; normal saline was used as the vehicle control. Lactic dehydrogenase (LDH) activity and matrix metallopeptidase (MMP)-9, histamine, and lactoferrin levels were measured in tears. The expression of inflammatory cytokines in the anterior segment of the eyeball was measured by Western blot analysis.

Results: The ocular surface staining scores, tear LDH activity, tear MMP-9, histamine, and lactoferrin concentrations, and the expression of interleukin-4 and interferon-γ in the eye were significantly increased in the CB group versus the normal control group. When compared with CB group, the Eyebon-W eye wash treatment significantly reversed these elevations induced by CB, including ocular staining scores, tear LDH activity, histamine and MMP-9 concentrations in the tear fluid, and the expression of interleukin-4 in the eye. On the other hand, saline irrigation only reduced the concentrations of histamine and MMP-9 in tear fluid and the expression of interferon-γ in the eye.

Conclusions: Both Eyebon-W eye wash treatment and saline irrigation reversed CB-induced ocular surface injury, but the efficacy of Eyebon-W was more significant than that of the saline solution when compared with CB group. The use of an eye wash solution seems to play a protective role for the ocular surface when exposed to airborne particulate matter.
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http://dx.doi.org/10.1097/ICO.0000000000002304DOI Listing
August 2020

HIF1α-mediated TRAIL Expression Regulates Lacrimal Gland Inflammation in Dry Eye Disease.

Invest Ophthalmol Vis Sci 2020 Jan;61(1)

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Purpose: The purpose of this study was to investigate the expression of death ligands in the lacrimal glands (LGs), identify upstream factors that regulate their expression, and determine the functional roles of these factors in the pathogenesis of dry eye disease (DED).

Methods: For DED experiment, ex vivo coculture system with LG and in vivo murine model using a controlled environment chamber were utilized. C57BL/6 mice and hypoxia-inducible factor (HIF)-1α conditional knockout (CKO) mice were used. Immunohistochemical staining, polymerase chain reaction, and immunoblotting were performed to determine levels of death ligands including tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) in DED-induced LGs. Additionally, acinar cell and CD45+ cell apoptosis was determined with neutralizing TRAIL treatment.

Results: Desiccating stress significantly increased HIF-1α expression in LG-acinar cells. Furthermore, HIF-1α deficiency significantly enhanced the infiltration of CD45+ inflammatory cells in LG and induced LG-acinar cell death. Meanwhile, only TRAIL expression was increased in DED-LG, but abrogated in HIF-1α CKO. Interestingly, the main source of TRAIL was the CD45- LG-acinar cells, but not CD45+ immune cells after DED induction. Using ex vivo coculture system, we confirmed LG-induced apoptosis of immune cells via HIF-1α-mediated TRAIL secretion following DED. Consistent with ex vivo, the insufficiency of HIF-1α and TRAIL enhanced recruitment of inflammatory cells to the LG and subsequently exacerbated ocular surface damage in DED mice.

Conclusions: Our findings offer novel insight into the regulatory function of acinar cell-derived TRAIL in limiting inflammatory damage and could be implicated in the development of potential therapeutic strategies for DED.
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http://dx.doi.org/10.1167/iovs.61.1.3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7205192PMC
January 2020

Eyelid squinting improves near vision in against-the-rule and distance vision in with-the-rule astigmatism in pseudophakic eyes: an eye model experimental study.

BMC Ophthalmol 2020 Jan 2;20(1). Epub 2020 Jan 2.

Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea.

Background: To elucidate whether eyelid squinting improves near and distance vision in against-the-rule (ATR) and with-the-rule (WTR) simple myopic astigmatism in pseudophakic eyes.

Methods: A refraction-model eye was mounted on a wavefront analyzer. The eyelid fissure was simulated using a slit placed horizontally in front of the model eye. Four different refractive statuses [- 1.50 diopters (D) and - 3.00 D of both WTR and ATR simple myopic astigmatism] were set using cylindrical lenses. For each refractive status (emmetropia, - 1.50 D WTR, - 1.50 D ATR, - 3.00 D WTR, and - 3.00 D ATR astigmatism), wavefront aberrations were measured, both with and without the slit, 40 times each.

Results: The 2 mm horizontal slit caused a hyperopic focus shift (+ 6.69 μm) in - 1.50 D WTR astigmatism, whereas, in - 1.50 D ATR astigmatism, it caused a myopic focus shift (- 2.01 μm). The astigmatism was decreased in the ATR astigmatism groups and increased in the emmetropia and WTR astigmatism groups, respectively. Total aberrations were decreased in the emmetropia and WTR astigmatism groups and increased in the ATR astigmatism groups. When the reference plane was set to the near plane, total aberrations were decreased in the ATR astigmatism groups.

Conclusion: As the horizontal slit was placed in front of the model eye, the focus moves nearer in ATR astigmatism and farther in WTR astigmatism. These effects of eyelid cause improvement of near vision of pseudophakic eyes with ATR astigmatism.
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http://dx.doi.org/10.1186/s12886-019-1297-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6941361PMC
January 2020

Changes in Human Tear Proteome Following Topical Treatment of Dry Eye Disease: Cyclosporine A Versus Diquafosol Tetrasodium.

Invest Ophthalmol Vis Sci 2019 12;60(15):5035-5044

Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.

Purpose: To compare the changes in human tear proteome and clinical effects following topical cyclosporine A (CsA) 0.05% or diquafosol tetrasodium (DQS) 3% treatment of dry eye disease (DED), and to identify biomarkers for determining disease severity and treatment effectiveness in DED.

Methods: A total of 18 patients were diagnosed with non-Sjögren DED. Nine patients in each group were treated with topical CsA 0.05% or DQS 3% for 4 weeks. Tear samples were collected after evaluation of tear breakup time, corneal and conjunctival erosion staining, and results of Schirmer's test 1 before and after treatment. Proteomes were characterized using liquid chromatography mass spectrometry, and proteins exhibiting a fold change >1.5 or <0.67 (P < 0.05) were considered differentially expressed (DEP).

Results: A total of 794 proteins were identified, with no significant difference observed between pretreatment and posttreatment conditions. Proteomic analysis identified 54 and 106 DEPs between treatment groups (CsA and DQS, respectively), with gene ontology analysis indicating that both treatments enhanced innate and adaptive immune responses and cellular detoxification. Protein-network analysis showed that inflammation associated with the immune response was primarily responsible for the therapeutic process in both groups.

Conclusions: These results provide insight into the broad scope of changes at the ocular surface in DED and indicated that although both drugs improved the clinical parameters, the activated tear-specific biomarkers differed significantly between treatments. Our findings suggest that the DEPs identified here and those correlated with the clinical parameters might represent candidate biomarkers for DED.
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http://dx.doi.org/10.1167/iovs.19-27872DOI Listing
December 2019

Association Between Dyslipidemia and Dry Eye Syndrome Among the Korean Middle-Aged Population.

Cornea 2020 Feb;39(2):161-167

Cardiovascular and Metabolic Diseases Etiology Research Center, Seoul, Republic of Korea.

Purpose: Dry eye syndrome (DES) is a common eye disease caused by tear deficiency or excessive tear evaporation. Because the tear film layers play a major role in the pathogenesis of the evaporative dry eye, some previous articles have suggested the possible mechanism of dyslipidemia and DES. However, the previous results were inconsistent and few studies were conducted to find the independent relationship between dyslipidemia and DES. Therefore, we investigated the association of dyslipidemia with DES in middle-aged Korean adults.

Methods: This study was conducted on 2272 participants (854 men and 1418 women) enrolled in the Study Group for Environmental Eye Disease (2013-2017) after excluding people who have taken lipid-lowering medication. Participants with total cholesterol ≥240 mg/dL or high-density lipoprotein cholesterol <40 mg/dL or low-density lipoprotein cholesterol ≥160 mg/dL or triglycerides ≥200 mg/dL are defined as having dyslipidemia. Using the ocular surface disease index, we measured the DES severity and defined DES as an ocular surface disease index score ≥13.

Results: Men with dyslipidemia had an odds ratio of 1.29 (95% confidence interval, 0.97-1.71) for DES in an unadjusted model compared with those without DES. After adjusting for age, body mass index, hypertension, diabetes, occupations, smoking and drinking status, exercise, contact lens use, computer use, study cohorts, and calendar year of examinations, the adjusted odds ratio for DES was 1.40 (1.03-1.90) in men. However, there was no significant association between dyslipidemia and DES in women, even after stratifying by menopausal status.

Conclusions: Our findings suggest that dyslipidemia may be associated with the prevalence of DES in Korean men, but not in women.
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http://dx.doi.org/10.1097/ICO.0000000000002133DOI Listing
February 2020

Efficacy of Topical Cyclosporine Nanoemulsion 0.05% Compared with Topical Cyclosporine Emulsion 0.05% and Diquafosol 3% in Dry Eye.

Korean J Ophthalmol 2019 Aug;33(4):343-352

Department of Ophthalmology, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.

Purpose: To evaluate the efficacy and safety of cyclosporine nanoemulsion 0.05% compared to cyclosporine emulsion 0.05% and diquafosol sodium 3%.

Methods: This was a multicenter, randomized, evaluator-masked, active control, parallel, phase IV study. A total of 227 patients were randomly allocated to instill cyclosporine nanoemulsion 0.05% (CN) twice daily, cyclosporine emulsion 0.05% (CE) twice daily, or diquafosol sodium 3% (DQ) six times daily. Non-inferiority of CN was analyzed by primary endpoint (cornea and conjunctival staining scores at week 12). The secondary endpoints were scores of corneal staining, conjunctival staining, tear break-up time, Schirmer test, and Ocular Surface Disease Index at weeks 4 and 12.

Results: Primary endpoints showed statistically significant improvements in all groups. Primary endpoints were -6.60 for the CN group, -5.28 for the CE group, and -6.63 for the DQ group (National Eye Institute scale from 0 to 33), verifying the non-inferiority of CN compared to CE (95% confidence interval, -0.15 to 2.80, Δ>-2.88). In intergroup comparison between CN and CE groups, the CN group had significantly more decreased conjunctival staining score at week 12. Intergroup comparison between CN and DQ groups showed consistent statistically significant improvements in TBUT and Schirmer test in the CN group. In the DQ group, TBUT showed late statistically significant improvement at week 12 and Schirmer test showed relatively short-term statistically significant improvement at week 4.

Conclusions: Cyclosporine nanoemulsion 0.05% was equivalently efficient compared to cyclosporine emulsion 0.05% and diquafosol sodium 3%. In addition, CN showed significant improvements in several parameters for treatment of dry eyes.
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http://dx.doi.org/10.3341/kjo.2018.0116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6685820PMC
August 2019

Changes in the Matrix Metalloproteinase 9 Point-of-Care Test Positivity According to MMP-9 Concentration and Loading Volume.

Cornea 2020 Feb;39(2):234-236

Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea.

Purpose: To measure changes in the matrix metalloproteinase 9 (MMP-9) point-of-care test, InflammaDry (Rapid Pathogen Screening, Inc, Sarasota, FL) positivity, based on ocular surface MMP-9 concentrations and loading volume.

Methods: Two different MMP-9 products, preform and active, were analyzed using the InflammaDry test, detecting MMP-9 levels of more than 40 ng/mL of both preform and active MMP-9. Preform MMP-9 (Natural human MMP-9 protein; Abcam, Cambridge, UK) was analyzed at different concentrations (50, 100, 500, 1000, and 1500 ng/mL) and loading volumes (5, 10, and 20 μL). Active MMP-9 (Human MMP-9 protein; Novus Biologicals, Littleton, CO) was also analyzed using the InflammaDry test at different concentrations (50 and 100 ng/mL) and loading volumes (10, 20, and 40 μL).

Results: Natural human MMP-9 protein (preform) of 50, 100, and 500 ng/mL exhibited negative results for every loading volume. At 1000 ng/mL, the 20 μL volume was positive, whereas the 5 and 10 μL volumes were negative. At 1500 ng/mL, all loading volumes were positive, but the density of positive bands varied depending on the loading volume; larger loading volumes had higher band density. Human MMP-9 protein (active) of 50 ng/mL was negative for every loading volume. In 100 ng/mL, the 20 and 40 μL volumes showed positive results with similar positive band densities.

Conclusions: The InflammaDry test had a different detection range depending on MMP-9 formulas; higher concentrations of preform MMP-9 protein were needed to yield positive results. In addition, InflammaDry positivity varied based on the loading volumes. Clinicians should be aware of the possibility of false negatives with low tear volumes despite elevated MMP-9 concentrations.
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http://dx.doi.org/10.1097/ICO.0000000000002096DOI Listing
February 2020

Comparison of 0.05% cyclosporine and 3% diquafosol solution for dry eye patients: a randomized, blinded, multicenter clinical trial.

BMC Ophthalmol 2019 Jun 17;19(1):131. Epub 2019 Jun 17.

Department of Ophthalmology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, 63-ro, Yeongdeungpo-gu, Seoul, 07345, Republic of Korea.

Background: This study is aim to compare the clinical effectiveness between the two most prominent dry eye disease (DED)-specific eye drops, 0.05% cyclosporine (CN) and 3% diquafosol (DQ).

Methods: This is a multi-centered, randomized, masked, prospective clinical study. A total of 153 DED patients were randomly allocated to use CN twice per day or DQ six times daily. Cornea and conjunctival staining scores (NEI scale), tear break-up time (TBUT), Schirmer test scores, and ocular surface disease index (OSDI) score were measured at baseline, 4 and 12 weeks after treatment.

Results: At 12 weeks after treatment, NEI scaled scores were significantly reduced from the baseline by - 6.60 for CN and - 6.63 for DQ group (all P < 0.0001, P = 0.9739 between groups). TBUT and Schirmer values for CN were significantly improved from the baseline at 4 and 12 weeks (P = 0.0034, P < 0.0001 for TBUT, P = 0.0418, P = 0.0031 for Schirmer test). However, for DQ, TBUT showed significant improvement at 12 weeks only (P = 0.0281). Mean OSDI score differences from the baseline to 12 weeks were improved by - 13.03 ± 19.63 for CN and - 16.11 ± 20.87 for DQ, respectively (all P < 0.0001, P = 0.854 between groups). Regarding drug compliance, the mean instillation frequency of CN was less than that of DQ (P < 0.001). There were no statistically significant intergroup differences in safety evaluation.

Conclusions: The level of improvement regarding NEI, TBUT, and OSDI scores were not significantly different between the two treatment groups. However, with regards to the early improvement of TBUT and patient compliance, patients using CN improved faster and with greater adherence to drug usage than did those treated with DQ.

Trial Registration: KCT0002180 , retrospectively registered on 23 December 2016.
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http://dx.doi.org/10.1186/s12886-019-1136-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6580465PMC
June 2019

Distribution and Characteristics of Meibomian Gland Dysfunction Subtypes: A Multicenter Study in South Korea.

Korean J Ophthalmol 2019 Jun;33(3):205-213

Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Purpose: We sought to evaluate the distribution and characteristics of meibomian gland dysfunction (MGD) and the treatment patterns for symptomatic MGD patients in South Korea.

Methods: One hundred ninety-six right eyes of 196 MGD patients were enrolled. For each patient, meibum expressibility in the central eight glands in both the upper and lower eyelids was examined. Each upper and lower eyelid was separately classified into one of the following three subtypes: nonobvious obstructive (low-delivery without lid margin abnormality), obvious obstructive (low-delivery with lid margin abnormality), and hypersecretory (high-delivery with lid margin abnormality). All treatment plans were also recorded.

Results: The mean number of expressible glands of the central eight glands in the upper eyelids (3.9 ± 2.6) was significantly higher than that in the lower eyelids (2.2 ± 2.4, < 0.001). Obvious obstructive MGD was the most common subtype, followed by the hypersecretory and nonobvious obstructive subtypes in both the upper and lower eyelids. Of the 196 subjects, 38 (19.4%) had upper and lower eyelids that were assigned to different categories. Eyelid hygiene was the most prescribed treatment (74.5%), followed by lubricant eye drop usage (71.5%). Physicians tended to determine treatment plans based on the subtype of the upper eyelid rather than that of the lower eyelid.

Conclusions: The majority of subjects were classified as having the obvious obstructive subtype of MGD, and 19.4% had upper and lower eyelids that were different subtypes. Eyelid hygiene was the most prescribed treatment for MGD patients, and treatment patterns were mostly determined based on the subtype of the upper eyelids.
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http://dx.doi.org/10.3341/kjo.2018.0104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6557798PMC
June 2019

The Protective Effect of a Topical Mucin Secretagogue on Ocular Surface Damage Induced by Airborne Carbon Black Exposure.

Invest Ophthalmol Vis Sci 2019 01;60(1):255-264

Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea.

Purpose: Exposure to airborne particulate matter can induce ocular surface damage and inflammation. We evaluated the effects of a topical mucin secretagogue on the mitigation of ocular surface damage induced by exposure to airborne carbon black (CB).

Methods: Sprague-Dawley rats were exposed to ambient CB for 2 hours twice daily for 5 days. Corneal staining score and tear lactic dehydrogenase (LDH) activity were measured to evaluate ocular surface damage. Serum immunoglobulin (Ig) G and IgE levels and the sizes of cervical lymph nodes were also measured. The expressions of interleukin (IL)-4, IL-17, and interferon (IFN)-γ were measured by Western blot analysis. Diquafosol tetrasodium was instilled six times a day for 5 days, and the extent of ocular surface damage was evaluated.

Results: After exposure to airborne CB, the median corneal staining score and LDH activity were significantly increased. Serum IgG and IgE levels and the sizes of cervical lymph nodes were also significantly increased. Additionally, the expression of IL-4 and IFN-γ was elevated in the anterior segment of the eyeball. Furthermore, the expression of IL-4, IL-17, and IFN-γ was elevated in the cervical lymph nodes. When exposed to airborne black carbon, topical diquafosol tetrasodium significantly increased tear MUC5AC concentration and decreased tear LDH activity.

Conclusions: Exposure to airborne CB induced ocular surface damage and increased proinflammatory cytokines in the eyes and cervical lymph nodes. Topical mucin secretagogues seem to have a protective effect on the ocular surface against exposure to airborne particulate matters.
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http://dx.doi.org/10.1167/iovs.18-25964DOI Listing
January 2019

Downregulation of IL-7 and IL-7R Reduces Membrane-Type Matrix Metalloproteinase 14 in Granular Corneal Dystrophy Type 2 Keratocyte.

Invest Ophthalmol Vis Sci 2018 11;59(13):5693-5703

Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.

Purpose: Granular corneal dystrophy type 2 (GCD2) is caused by a point mutation (R124H) in the TGF-β-induced gene (TGFBI). However, the mechanisms underlying the accumulation of TGF-β-induced protein (TGFBIp) are poorly understood. Therefore, we evaluated the signaling cascade affecting the expression of TGFBIp using patient-derived cells.

Methods: Keratocyte primary cultures were prepared from corneas from the eye bank or from heterozygous or homozygous patients with GCD2 after penetrating or lamellar keratoplasty. GCD2 diagnoses were based on the results of a DNA analysis for the R124H TGFβI mutation. Keratocytes were treated with various cytokines and then analyzed using quantitative PCR (qPCR) array, qPCR, flow cytometry, ELISA, and Western blotting.

Results: TGFBI expression was counterregulated by IL-7 in corneal fibroblasts. IL-7 expression was significantly reduced in corneal fibroblasts from patients with GCD2. TGF-β and TGFBI expression were reduced on IL-7 treatment in corneal fibroblasts. Interestingly, the interplay between TGF-β and IL-7 was regulated by the RANKL/RANK signaling cascade. Also, IL-7 regulates the expression of a membrane-type matrix metalloproteinase (MT-MMP), which plays a crucial role in migration and neovascularization in the cornea.

Conclusions: These studies demonstrate that impaired IL-7 expression in patients with GCD2 affects disease pathogenesis via a failure to control TGF-β expression. The RANKL/RANK axis regulates TGF-β and TGFBI expression via IL-7-mediated MT-MMP regulation in corneal fibroblasts. These findings improve our understanding of the pathogenesis of GCD2.
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http://dx.doi.org/10.1167/iovs.18-25161DOI Listing
November 2018

Poleward migration of the destructive effects of tropical cyclones during the 20th century.

Proc Natl Acad Sci U S A 2018 11 22;115(45):11543-11548. Epub 2018 Oct 22.

Institute of Botany, Czech Academy of Sciences, 252 43 Pruhonice, Czech Republic.

Determination of long-term tropical cyclone (TC) variability is of enormous importance to society; however, changes in TC activity are poorly understood owing to discrepancies among various datasets and limited span of instrumental records. While the increasing intensity and frequency of TCs have been previously documented on a long-term scale using various proxy records, determination of their poleward migration has been based mostly on short-term instrumental data. Here we present a unique tree-ring-based approach for determination of long-term variability in TC activity via forest disturbance rates in northeast Asia (33-45°N). Our results indicate significant long-term changes in TC activity, with increased rates of disturbances in the northern latitudes over the past century. The disturbance frequency was stable over time in the southern latitudes, however. Our findings of increasing disturbance frequency in the areas formerly situated at the edge of TC activity provide evidence supporting the broad relevance of poleward migration of TCs. Our results significantly enhance our understanding of the effects of climate change on TCs and emphasize the need for determination of long-term variation of past TC activity to improve future TC projections.
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http://dx.doi.org/10.1073/pnas.1808979115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6233067PMC
November 2018

Comparison of Ocular Surface Mucin Expression After Topical Ophthalmic Drug Administration in Dry Eye-Induced Mouse Model.

J Ocul Pharmacol Ther 2018 11 16;34(9):612-620. Epub 2018 Oct 16.

1 Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine , Seoul, Korea.

Purpose: To determine the mucinogenic effect of dry eye (DE) treatment drugs currently in use, we compared the levels of mucin production and inflammatory cytokine expression on the ocular surfaces using a DE-induced mice model.

Methods: C57BL/6 mice were separated into 6 groups: a control group, DE-induced mice with the vehicle and treated with cyclosporine A (CsA), rebamipide (Reb), diquafosol tetrasodium (DQS), or prednisolone (Pred). The mRNA expression of MUC 1, 4, 16, 5AC, and proinflammatory cytokines on the corneal epithelia were determined by quantitative real-time polymerase chain reaction. Expression of each MUC was evaluated using flow cytometry and immunohistostaining. Conjunctival goblet cells were analyzed through periodic acid-Schiff (PAS) staining.

Results: Desiccating stress significantly decreased both mRNA and protein levels of all MUCs in the cornea. CsA mainly enhanced MUC5AC, with an increase in PAS-positive cells, whereas DQS chiefly increased membrane-associated mucins (MM). However, Reb only minimally increased expression of MUC5AC and Pred only increased MUC4. MUC16 did not show any significant change in any group. On the contrary, the mRNA levels of interleukin (IL)-1β, -6, tumor necrosis factor (TNF)-α, and interferon (IFN)-γ were increased in the DE corneas of the control mice and were reduced by all treatments; in particular, IL-6 was significantly suppressed.

Conclusion: Topical DQS and CsA not only ameliorated ocular surface inflammation under desiccating stress but also upregulated both MM and secretory mucins (SM) and contributed to conjunctival goblet cell recovery, compared to Reb and Pred. Both anti-inflammatory and secretory factors should be considered simultaneously when measuring the treatment effect of DE drugs.
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http://dx.doi.org/10.1089/jop.2018.0005DOI Listing
November 2018

Five Misconceptions Related to Punctal Plugs in Dry Eye Management.

Cornea 2018 Nov;37 Suppl 1:S58-S61

Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea.

Punctal plugs are an effective treatment option for patients with aqueous-deficient dry eye refractory to topical medications. However, punctal plugs are not commonly used in clinical practice mainly because of various misconceptions, rather than clinical complications. We analyzed previous studies and present 5 misconceptions related to punctal plugs. The first and most important misconception is that ocular surface inflammation should be sufficiently controlled before punctal plug insertion. However, it is unclear how ocular surface inflammation can be sufficiently controlled in patients refractory to conventional topical medications. The second misconception is that silicone punctal plugs are made of nonabsorbable materials and, therefore, permanent. In fact, silicone plugs are reversible and can be easily removed if necessary. Therefore, depending on the specific type, nonabsorbable plugs may be classified as reversible or permanent. The third misconception is that punctal plugs disrupt normal tear drainage. However, punctal plugs maintain natural tears on the ocular surface for extended periods and reduce the frequency of artificial tear use. The fourth is that all punctal and canalicular plugs have similar effects. The efficacy and complication rates differ depending on plug types. The fifth misconception about punctal plugs is that they are effective only in aqueous-deficient dry eye disease. Many studies have reported that plugs are effective in a variety of ocular diseases and conditions. Understanding these 5 misconceptions may provide an opportunity to rethink the use of silicone punctal plugs in clinical practice.
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http://dx.doi.org/10.1097/ICO.0000000000001734DOI Listing
November 2018

Standardization of the proceedings for preparing clinical trials of corneal xenotransplantation in South Korea.

Xenotransplantation 2019 01 4;26(1):e12448. Epub 2018 Aug 4.

Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.

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http://dx.doi.org/10.1111/xen.12448DOI Listing
January 2019

Protocol for the first clinical trial to investigate safety and efficacy of corneal xenotransplantation in patients with corneal opacity, corneal perforation, or impending corneal perforation.

Xenotransplantation 2019 01 31;26(1):e12446. Epub 2018 Jul 31.

Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.

Background: Xenotransplantation using fresh porcine corneas has been suggested as a feasible alternative to overcome the shortage of human donor corneas. Successful long-term survival of grafts without evidence of xenozoonosis in clinically applicable pig-to-non-human primate corneal transplantation model has brought researchers close to human clinical trials. Accordingly, we aimed to prepare a clinical trial protocol to conduct the first corneal xenotransplantation.

Methods: We developed the clinical trial protocol based on international consensus statement on conditions for undertaking clinical trials of corneal xenotransplantation developed by the International Xenotransplantation Society. Detailed contents of the protocol have been modified with reference to comments provided by ophthalmologists and multidisciplinary experts, including an infectionist, an organ transplantation specialist, a clinical pharmacologist, a neuropsychiatrist, a laboratory medicine doctor, and a microbiologist.

Results: Two patients with bilateral legal corneal blindness (best-corrected visual acuity ≤20/200 in the better eye and ≤20/1000 in the candidate eye) or with (impending) corneal perforation will be enrolled. During the screening period, participants and their family members will have two separate deep consideration periods before signing informed consent forms. Each patient will undergo corneal xenotransplantation using fresh corneas from Seoul National University miniature pigs. Commercially available immunosuppressants will be administered and systemic infection prophylaxis will be performed according to the program schedule. After transplantation, each patient will be monitored at a specialized clinic to investigate safety up to 2 years and efficacy up to 1 year.

Conclusions: A detailed clinical trial protocol for the first corneal xenotransplantation reflecting the global guidelines is provided.
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http://dx.doi.org/10.1111/xen.12446DOI Listing
January 2019

Effects of Topical Mucolytic Agents on the Tears and Ocular Surface: A Plausible Animal Model of Mucin-Deficient Dry Eye.

Invest Ophthalmol Vis Sci 2018 06;59(7):3104-3114

Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea.

Purpose: A topical mucolytic agent, N-acetylcysteine (NAC), has been used to create an animal model without the intestinal mucus layer. In this study, we investigated the effects of topical NAC on the tears and ocular surface.

Methods: NAC-treated models were established by topically administering 10% NAC four times daily for 5 days in male Sprague-Dawley rats. Clinical parameters and the expression of mucin proteins and genes were evaluated. Alterations in the conjunctival epithelium and goblet cells were observed.

Results: The NAC group showed significant decreases in tear secretion, corneal wetting ability, tear MUC5AC concentration, and conjunctival goblet cell numbers as compared with the control group (all P < 0.01). In addition, significant increases in corneal fluorescein score and rose bengal scores were observed in the NAC group versus in the control group (P < 0.05 and P < 0.01, respectively). Hematoxylin and eosin (H&E) staining and scanning electron microscopy clearly showed damage in the epithelial cell layer and microvilli of the NAC group. Although there was no significant difference in MUC16 gene expression, the MUC16 concentration of the tear film and ocular surface tissue was significantly increased in the NAC group versus in the control group (P < 0.01 and P < 0.05, respectively). Five-day treatment with 3% diquafosol had minimal therapeutic effect in NAC-treated rat eyes.

Conclusions: Topical administration of 10% NAC induced ocular surface damage and tear film instability by prompting MUC16 disruption and release from the ocular surface. This animal model could be used to study dry eye disease, especially the mucin-deficiency subtype.
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http://dx.doi.org/10.1167/iovs.18-23860DOI Listing
June 2018

Comparative evaluation of refractive outcomes after implantation of two types of intraocular lenses with different diopter intervals (0.25 diopter versus 0.50 diopter).

BMC Ophthalmol 2018 Jul 18;18(1):176. Epub 2018 Jul 18.

Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea.

Background: Intraocular lenses (IOLs) with different diopter (D) intervals may have different tolerance, and may provide different accuracy of refractive outcome after cataract surgery. The aim of the study is to compare the accuracy of refractive outcome after implantation of IOLs with different D intervals after cataract surgery.

Methods: A total of 80 eyes from 40 patients who underwent phacoemulsification with implantation of a 0.50 D interval Akreos AO IOL in one eye and a 0.25 D interval Softec HD™ IOL in the other eye were enrolled. The percentages of eyes with refractive prediction error within ±0.50 D at one month after surgery were compared. To evaluate the effect of the dioptric errors of the IOL itself on refractive prediction error, the percentage of eyes with refractive prediction error within ±0.25 D of the IOL with a standard deviation (SD) of ±0.40 D was compared with that of the IOL with a SD of ±0.11 D through Monte Carlo simulations.

Results: In this clinical study, the percentage of eyes with refractive prediction error within ±0.50 D by the Haigis formula in the Softec HD™ group (85.0%) was significantly greater than that in the Akreos AO group (57.5%; P = 0.027). In Monte Carlo simulations, all percentages of eyes with refractive prediction error within ±0.25 D by the Haigis and SRK/T formulas in the Softec HD™ group were significantly greater than those in the Akreos AO group.

Conclusions: The IOL with a 0.25 D interval was more accurate than the IOL with a 0.50 D interval in predicting refractive outcome after cataract surgery.

Trial Registration: Current Controlled Trials KCT0002192 , Retrospectively registered (Date of registration: 6 January 2017).
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http://dx.doi.org/10.1186/s12886-018-0840-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6052586PMC
July 2018

Comparison of Anterior, Posterior, and Total Corneal Astigmatism Measured Using a Single Scheimpflug Camera in Healthy and Keratoconus Eyes.

Korean J Ophthalmol 2018 06 15;32(3):163-171. Epub 2018 May 15.

Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea.

Purpose: To compare the effect of posterior corneal astigmatism on the estimation of total corneal astigmatism using anterior corneal measurements (simulated keratometry [K]) between eyes with keratoconus and healthy eyes.

Methods: Thirty-three eyes of 33 patients with keratoconus of grade I or II and 33 eyes of 33 age- and sex-matched healthy control subjects were enrolled. Anterior, posterior, and total corneal cylinder powers and flat meridians measured by a single Scheimpflug camera were analyzed. The difference in corneal astigmatism between the simulated K and total cornea was evaluated.

Results: The mean anterior, posterior, and total corneal cylinder powers of the keratoconus group (4.37 ± 1.73, 0.95 ± 0.39, and 4.36 ± 1.74 cylinder diopters [CD], respectively) were significantly greater than those of the control group (1.10 ± 0.68, 0.39 ± 0.18, and 0.97 ± 0.63 CD, respectively). The cylinder power difference between the simulated K and total cornea was positively correlated with the posterior corneal cylinder power and negatively correlated with the absolute flat meridian difference between the simulated K and total cornea in both groups. The mean magnitude of the vector difference between the astigmatism of the simulated K and total cornea of the keratoconus group (0.67 ± 0.67 CD) was significantly larger than that of the control group (0.28 ± 0.12 CD).

Conclusions: Eyes with keratoconus had greater estimation errors of total corneal astigmatism based on anterior corneal measurement than did healthy eyes. Posterior corneal surface measurement should be more emphasized to determine the total corneal astigmatism in eyes with keratoconus.
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http://dx.doi.org/10.3341/kjo.2017.0075DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5990638PMC
June 2018

Effect of Cataract Grade according to Wide-Field Fundus Images on Measurement of Macular Thickness in Cataract Patients.

Korean J Ophthalmol 2018 06 15;32(3):172-181. Epub 2018 May 15.

Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea.

Purpose: To investigate the effects of cataract grade based on wide-field fundus imaging on macular thickness measured by spectral domain optical coherence tomography (SD-OCT) and its signal-to-noise ratio (SNR).

Methods: Two hundred cataract patients (200 eyes) with preoperative measurements by wide-field fundus imaging and macular SD-OCT were enrolled. Cataract severity was graded from 1 to 4 according to the degree of macular obscuring by cataract artifact in fundus photo images. Cataract grade based on wide-field fundus image, the Lens Opacity Classification System III, macular thickness, and SD-OCT SNR were compared. All SD-OCT B-scan images were evaluated to detect errors in retinal layer segmentation.

Results: Cataract grade based on wide-field fundus imaging was positively correlated with grade of posterior subcapsular cataracts (rho = 0.486, p < 0.001), but not with nuclear opalescence or cortical cataract using the Lens Opacity Classification System III. Cataract grade was negatively correlated with total macular thickness (rho = -0.509, p < 0.001) and SD-OCT SNR (rho = -0.568, p < 0.001). SD-OCT SNR was positively correlated with total macular thickness (rho = 0.571, p < 0.001). Of 200 eyes, 97 (48.5%) had segmentation errors on SD-OCT. As cataract grade increased and SD-OCT SNR decreased, the percentage of eyes with segmentation errors on SD-OCT increased. All measurements of macular thickness in eyes without segmentation errors were significantly greater than those of eyes with segmentation errors.

Conclusions: Posterior subcapsular cataracts had profound effects on cataract grade based on wide-field fundus imaging. As cataract grade based on wide-field fundus image increased, macular thickness tended to be underestimated due to segmentation errors in SD-OCT images. Segmentation errors in SD-OCT should be considered when evaluating macular thickness in eyes with cataracts.
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http://dx.doi.org/10.3341/kjo.2017.0067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5990639PMC
June 2018