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      Dry Eye Disease in Patients with Functioning Filtering Blebs after Trabeculectomy

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          Abstract

          Purpose

          The aim of this study was to analyze dry eye disease (DED) in patients with functioning filtering blebs and to explore the relationship between the morphology of filtering blebs and ocular surface instability.

          Methods

          This was a cross-sectional, case-comparison study. Seventy glaucomatous patients (70 eyes) with functioning blebs who had undergone trabeculectomy more than 6 months prior (study group) and 35 control subjects (35 eyes) (control group) were included. All subjects completed an ocular symptom questionnaire that referred to the Shihpai Eye Study. Evaluation of meibomian gland obstruction, a tear film break-up time test (TFBUT), fluorescein corneal staining and a Schirmer’s tear test were then performed. Filtering bleb morphology was analyzed using Wuerzburg bleb classification scoring criteria in the study group. The presence of DED was defined as the concomitant presence of TFBUT <10 seconds and the presence of superficial punctate keratitis.

          Results

          The patients with functioning blebs presented higher corneal staining scores ( P = 0.012) and lower TFBUT values ( P = 0.043) than the control group. DED was present in 28/70 patients in the study group and 6/35 patients in the control group ( P = 0.018). More patients in the study group complained of dryness ( P = 0.001), a gritty or sandy sensation ( P < 0.001) and redness ( P = 0.048). In the study group, the patients with DED were significantly different from the patients without DED in both TFBUT ( P < 0.001) and corneal staining ( P < 0.001). More patients in the DED group were likely to report dryness ( P = 0.013) and watery or teary eyes ( P = 0.012). The differences in meibomian gland obstruction scores between the study and the control group, the DED and the non-DED group were not significant ( P = 0.105 and P = 0.077, respectively). The values for microcysts and bleb heights were significantly higher in the DED group ( P = 0.040 and P = 0.011, respectively). A Spearman’s rank correlation showed that microcysts were positively correlated with corneal staining (r = 0.270, P = 0.024). Bleb height was negatively correlated with TFBUT (r = -0.299, P = 0.012) and positively correlated with corneal staining (r = 0.275, P = 0.021). The relationships between DED and microcysts and between DED and bleb height were significant (r = 0.247, P = 0.039 and r = 0.307, P = 0.010, respectively).

          Conclusion

          DED is relatively common in patients with functioning filtering blebs following trabeculectomy. In DED patients, dryness and watery are common symptoms. Microcysts and bleb height are related to ocular surface instability and DED.

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          Most cited references27

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          Methodologies to diagnose and monitor dry eye disease: report of the Diagnostic Methodology Subcommittee of the International Dry Eye WorkShop (2007).

          (2007)
          The role of the Diagnostic Methodology Subcommittee of the Dry Eye Workshop was 1) to identify tests used to screen, diagnose and monitor dry eye disease, 2) to establish criteria for test performance, and 3) to consider the utility of tests in a variety of clinical settings. The committee created a database of tests used to diagnose and monitor dry eye, each compiled by an expert in the field (rapporteur) and presented within a standard template. Development of the templates involved an iterative process between the Chairman of the subcommittee, the rapporteurs, and, at times, an additional group of expert reviewers. This process is ongoing. Each rapporteur was instructed on how to the complete a template, using a proforma template and an example of a completed template. Rapporteurs used the literature and other available sources as the basis for constructing their assigned template. The chairman of the subcommittee modifed the template to produce a standardized version and reviewed it with the rapporteur. The completed database will be searchable by an alphabetical list of test names, as well as by functional groupings, for instance, tests of aqueous dynamics, lipid functions, etc. The templates can be accessed on the website of the Tear Film and Ocular Surface Society (www.tearfilm.org). This report provides a general overview of the criteria applied in the development of tests for screening and diagnosis.
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            Prevalence of dry eye among an elderly Chinese population in Taiwan: the Shihpai Eye Study.

            To describe the epidemiology of dry eye in an elderly Chinese population in Taipei, Taiwan. A population-based cross-sectional study. The Shihpai Eye Study was a population-based survey of eye diseases in the elderly (> or =65 years) in Shihpai, Taipei, Taiwan. Noninstitutionalized residents, as of July 1999, were identified by using the official household registration database. A total of 2045 subjects were selected, and 1361 (66.6%) people participated in the study. Among them, 822 (60.4%) were men. Trained interviewers administered a standardized questionnaire pertaining to dry-eye symptoms. Objective examinations of dry eye included tear film breakup time, Schirmer test, fluorescein stain of the cornea, and anatomic assessment of the meibomian glands via slit-lamp biomicroscopy. Frequency of dry-eye symptoms and positive dry-eye tests. In this population, 33.7% (459/1361) were symptomatic, defined as reporting 1 or more dry-eye symptoms often or all of the time. Women were more likely to report frequent symptoms of dry eye (odds ratio, 1.49; 95% confidence interval, 1.19-1.87). Among those who were symptomatic, 78.9% (362/459) had a low tear film breakup time (< or =10 seconds), 62.5% (287/459) had a low Schirmer test result (< or =5 mm), and 61.7% (283/459) had abnormal anatomic features of the meibomian glands. Furthermore, 85.4% (392/459) were symptomatic and had either a low Schirmer score or an abnormal meibomian gland assessment. Of those symptomatic, 49.9% (229/459) indicated that they had visited an eye doctor, 5.4% (25/459) responded that they had been diagnosed with dry eye, and 47.5% (218/459) reported current use of eyedrops. This is the first report of population-based data of dry eye that includes symptoms and signs in elderly Asians. The prevalence of dry eye, although varied according to definition, is relatively higher in this study than that reported for whites. Further studies are needed to determine whether this is due to racial or environmental factors.
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              Prevalence of dry eye among adult Chinese in the Beijing Eye Study.

              To study the prevalence and associations of dry eye symptoms in adult Chinese. The Beijing Eye Study is a population-based study in northern China, which included 4439 of 5324 subjects invited to participate with an age of 40+ years (response rate: 83.4%). For the present study, a random sample was taken consisting of 1957(44.1%) subjects (1112 women; 56.9%). Dry eye symptoms were evaluated with (1) an interviewer-assisted questionnaire; (2) measurement of the tear-film break-up time; (3) assessment of the fluorescein staining of the cornea; (4) slit-lamp-based examination of a meibomian gland dysfunction; and (5) Schirmer's test. Symptoms of a dry eye felt 'often' or 'at all times' were present in 411 subjects (21.0%). In a multivariate analysis, dry eye symptoms were significantly associated with age (P<0.001), female gender (P<0.001; odds ratio (OR): 1.56; 95% confidence intervals (CI): 1.23, 1.98), urban region (P<0.001;OR: 1.89; 95% CI: 1.46, 2.48), low degree of nuclear cataract (P=0.02), and undercorrection of refractive error (P=0.005; OR: 1.42; 95% CI: 1.11, 1.82). All tests for dry eye did not vary significantly between the dry eye group and the normal group. The dry eye symptoms as evaluated subjectively in a questionnaire occurred in about 21% of the adult population in China, with associations to age, female gender, urban region, and undercorrection of a refractive error. Measurement of the tear-film break-up time, assessment of the corneal fluorescein staining, slit-lamp-based examination of a meibomian gland dysfunction, and Schirmer's test were not significantly associated with dry eye symptoms.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                31 March 2016
                2016
                : 11
                : 3
                : e0152696
                Affiliations
                [001]State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
                Save Sight Institute, AUSTRALIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: HJ YHZ. Performed the experiments: HJ YTZ YYZ ZHL. Analyzed the data: HJ YTZ YHZ. Contributed reagents/materials/analysis tools: HJ YTZ YHZ. Wrote the paper: HJ YTZ JG YHZ.

                Article
                PONE-D-15-38011
                10.1371/journal.pone.0152696
                4816306
                27032098
                d5e09008-7eed-4a57-8f58-2ef7aaf66e7a
                © 2016 Ji et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 20 September 2015
                : 17 March 2016
                Page count
                Figures: 0, Tables: 8, Pages: 12
                Funding
                This work was supported by Guangdong Province National Natural Science Foundation (2014A030308016). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Ophthalmology
                Eye Diseases
                Glaucoma
                Biology and Life Sciences
                Anatomy
                Ocular System
                Ocular Anatomy
                Cornea
                Medicine and Health Sciences
                Anatomy
                Ocular System
                Ocular Anatomy
                Cornea
                Biology and Life Sciences
                Anatomy
                Head
                Eyes
                Medicine and Health Sciences
                Anatomy
                Head
                Eyes
                Biology and Life Sciences
                Anatomy
                Ocular System
                Eyes
                Medicine and Health Sciences
                Anatomy
                Ocular System
                Eyes
                Medicine and Health Sciences
                Ophthalmology
                Eye Diseases
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Musculoskeletal System Procedures
                Trabeculectomy
                Biology and Life Sciences
                Neuroscience
                Sensory Perception
                Biology and Life Sciences
                Psychology
                Sensory Perception
                Social Sciences
                Psychology
                Sensory Perception
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Ophthalmic Procedures
                Cataract Surgery
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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