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There are approximately 125 million CL wearers in the
world. It is estimated that in India there are around 1 million contact lens wearers. Approximately 30% to 50% of contact lens (CL) wearers report dry eye symptoms . Meibomian gland dysfunction has been recognized as a possible cause of CL related dry eye. CL use induces various complications , including infection, allergic conjunctivitis, corneal disorders, and dry eye . Dry eye is particularly troubling because 30-50%of CL wearers report dry eye for which causative mechanisms have been proposed including inflammation , increased evaporation and osmolarity of the tear film, and dewetting of the CL surface.
PURPOSE : This study investigated the influence of
CL wear on the meibomian glands using a newly developed meibographic technique.
Design: Cross-sectional observational case series .
66 women. mean age = 31.8 years) and healthy volunteers(n=137. The entry criteria for control group included volunteers who had not worn CL and had no ocular diseases.4 years).METHODS AND MATERIALS PARTICIPANTS :Contact lens wearers(n=121.71 men . . The entry criteria for CL wearers included volunteers who had been wearing contact lenses for atleast one year and had no evidence of ocular diseases other than those associated with CL related changes. mean age =31. 47 men . 74 women .
.The following tests were performed : slit lamp examination of the eyelids . corneal and conjunctival stain using fluorescein measurement of the tear film break up time . evaluation of the meibomian glands using noncontact meibography and measurement of the tear production using the Schirmer І test.
The SPK staining was graded as 0(no staining). plugging of the meibomian gland orifices . .3(severe staining with confluent stains and occupying half or more of the cornea) The tear film break up time was measured 3 consecutive times after the instillation of fluorescein.1( mild staining with a few disseminated stains and limited to less than 1/3rd of the cornea). and shift of the mucocutaneous junction.2(moderate staining with severity between 1 and 3).vascular engorgement . Upper and lower eyelids were turned over and the meibomian glands were observed with the novel noncontact infrared meibographic method . Lid margin abnormalities were scored from 0 to 4 based on the presence of 4 criteria : irregular lid margin .
Meiboscores for upper and lower eyelids were summed for each eye. Partial or complete loss of the meibomian glands was scored using the following grades (meiboscores)for each eyelid: Grade 0(no loss of meibomian glands ) Grade 1 ( the affected area was less than 33% of the area occupied by the meibomian glands ) Grade 2( affected area was between 33% and 66% of the area occupied by meibomian glands) Grade 3 (affected area was more than 66% of the area occupied by meibomian glands). .
the average TBUT. The average score for SPK and lid margin abnormality . and Schirmer value in CL wearers and non wearers were compared using Mann-Whitney U test . .
respectively. The mean scores for the lid margin abnormalities in CL wearers and non-wearers were 0. respectively. .Observations & Results The mean SPK scores in CL wearers and non-wearers were 0.13. The mean Schirmers values in CL wearers and nonwearers were 20. The mean TBUT in CL wearers and non-wearers were 4.24.7 seconds.2 .58 and 0.40 and 0.4 and 20.respectively.8 and 6. respectively.
(representative of RGP group) In a 23-year-old man who had used rigid gas-permeable CLs for 8 years. The shortening of the meibomian glands began not from the orifice side but from the distal side. . The areas in which meibomian glands were absent are encircled with dotted white lines. most meibomian glands in both the upper and lower eyelids were shortened.Figure A.
Figure B. (representative of hydrogel CLs group) In a 28 year old woman who had used hydrogel CLs for 12 years . . shortening and dropout of meibomian glands were observed in both the upper and lower eyelids. The areas where meibomian glands were absent are encircled with dotted white lines.
Shortening or dropout of meibomian glands was not observed. .Figure C (representative of control group) A 29-year-old nonwearer.
The average upper eyelid. There was no significant difference in the average meiboscores from RGP lens wearers and hydrogel lens wearers . The shortening of these glands occurred not at the side with orifices . The duration of CL wear was the only variable that was significantly associated with the meiboscores.respectively.25.54 and 0. The average differences between the meiboscores of CL wearers and non wearers in the upper and lower eyelids were 0. This suggests that wearing of CL produces different effects on the upper and lower eyelids ( upper>> lower). CL wearers showed shortened clusters of meibomian glands . and total meiboscores in CL wearers were significantly higher than those in non wearers.but instead was observed on the distal side . . lower eyelid.
A significant positive correlation was observed between the duration of CL wear and the meiboscore. The average meiboscore of CL wearers was similar to that of a 60-69 year old age group from the normal population. .The meiboscore was significantly higher in CL wearers than in the control group.
This study also shows that lens material do not play a significant role in CL relate dry eye. Both aging and CL wear produce similar effects on meibomain glands . These results suggest that CL wear accelerates agerelated changes in the meibomain glands.DISCUSSION: Aging increased the severity of meibomain gland changes in normal individuals. .
Ong and Larke suggested that mechanical trauma from the CLs causes duct blockage in the meibomian glands. Henriquez and Korb suggested that meibomian gland dysfunction is a result of the aggregation of desquamated epithelial cells at the orifice of the glands.Two hypothesis have been proposed for the causative mechanism for meibomian gland loss in CL wearers: 1. . 2.
The decrease in these glands were greater in the upper eyelids . These results suggest that chronic irritation of these glands by CLs through conjunctiva is major causative mechanism for these gland changes in CLs wearers. The shortening of the meibomian glands in CL wearers began from the distal side. . These results show that dry eye resulting from increased evaporation of the tear film is more prevalent in CL wearers than in non wearers .as it experiences more irritation because it makes larger movements during blinking.
CONCLUSION: CL wear is associated with a decrease in the number of functional meibomian glands . This decrease is proportional to the duration of CL wear and contribute to dry eye in CL wearers. .
.Published in American Academy Of Ophthalmology(January-April).2009 .
. Endophthalmitis is a rare but serious postoperative complication of cataract surgery. resulting in outcome ascertainment difficulties . Many studies have estimated rates and identified risk factors for the condition but these studies are often limited by a small number of cases or by data collected over many years .
.AIM: The objective of study was to identify risk factors for suspected acute endophthalmitis after cataract surgery.
from April 1. to March 31 .000 consecutive cataract surgeries in Ontario. Canada. 2006.40.2002. .Methods & Materials: Design: Population based retrospective cohort study Participants: Administrative data from more than 4.
Acute endophthalmitis was defined using surrogate markers for intra-ocular infections. including vitrectomy. Anterior vitrectomy was used as a surrogate marker for capsular rupture. . performed 1 to 14 days after cataract surgery .Methods: Consecutive physicians billing claims for cataract surgery and specific intra-operative and postoperative procedures related to complications of cataract surgery were identified . vitreous injection or aspiration procedures not in combanation with air or fluid exchange or dislocated lens extraction .
year. season. socioeconomic status. .and association with capsular rupture. Anterior vitrectomy on the same day as the cataract surgery was used as a surrogate marker for capsular rupture. The procedure of air or fluid exchange was used as a surrogate marker for retinal detachment. surgical facility. They thus calculated overall rates of endophthalmitis and rates grouped by patient demographics (age. and residence).and the procedure of dislocated lens extraction was used as a surrogate marker for lost lens / lens fragments.sex.
Men had higher rates than women with an adjusted odds ratio of 1.Results: There were 617 suspected acute endophthalmitis cases of 4. The overall unadjusted and adjusted rates of suspected acute endophthalmitis were both 1. The oldest age group (≥85 years)had the highest rate and the youngest group(20-64)had the second highest rate. . The endophthalmitis rates for these age groups were significantly different from those in 65-84 years age group . The endophthalmitis rates were approximately 10 fold higher in those with capsular rupture compared with those without.42.000 cataract surgeries over the 4 years .40.4 per 1000 cataract surgeries.
Figure 1. .and sex-specific rates of acure suspected endophthalmitis. Age.
.Figure 2 .and sex-adjusted rates of acute suspected endophthalmitis. Annual age.
. Age.Figure 3.and sex-adjusted rates of acute suspected endophthalmitis by season.
16 per 1000 .Discussion: Overall rate of suspected acute endophthalmitis was found to be 1. Surgical facility rates ranged from 0 to 4.5 per 1000 cataract surgeries. This new finding requires further investigations as previous studies showed no difference in rates between men and women . between seasons. .this could be a result of differences in populations.there was no trend in patient socioeconomic status.4 per 1000.or between rural or non-rural communities . Rate was higher in men and there was no trend from young to old. This study found a 40% higher odds of developing endophthalmitis in men compared with women. There were no more than 4 endophthalmitis cases within any 4 week period at any facility over the study period. More than 75% facilities had a rate lower than 2. age distributions. No difference was found in annual rates .
Summary of Endophthalmitis Rates from Recent Large Studies .Table 1.
Our population-based analysis can be used as a benchmark for quality-improvement initiatives and can assist clinicians in educating their patients regarding the risks associated with cataract surgery. and yhe oldest patients undergoing cataract surgery. Future work is required to address the higher rate of endophthalmitis in men. .CONCLUSIONS: The overall rates of suspected acute endophthalmitis are low but significantly higher in certain patient groups. those with capsular rupture.