For Dr. Glasser, gentle treatment of the ocular surface for MGD patients in the periop period is paramount. That should include short surgical times and aggressive intraop lubrication. Additionally, a viscoelastic placed on the ocular surface during surgery can help. I eliminate topical NSAIDs entirely for those patients with significant dry eye disease and no risk factors for cystoid macular edema. Davidson has financial interests with Shire.
Ocular Surface Disease - Mark J Mannis, Edward J Holland - Bok () | Bokus
Glasser has no financial interests related to his comments. Contact information Glasser : dbg comcast.
Skip to main content. All Years Sort by Post date Article Name. Order Asc Desc. August July June May The median interval before onset of dry eye symptoms after surgery was Mean tear breakup time TBUT was 5. Possible major risk factors for OSD in the cases include limbal stem cell deficiency occurring from exposure to antimetabolites, chronic use of antiglaucoma medications prior to surgery, and the preoperative status of the ocular surface prior to disease onset. Conclusion: OSD is a clinical problem often overlooked in patients who undergo antimetabolite-augmented filtration surgery.
Recognition of the condition and appropriate treatment can improve patient symptoms and reduce health-care burdens on the economy. Keywords: cornea, glaucoma, ocular surface, trabeculectomy. Dry eye disease, or ocular surface disease OSD , as defined by the International Dry Eye Workshop , 1 is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability, with potential damage to the ocular surface. It is associated with an increase in tear osmolarity and inflammation of the ocular surface.
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Trabeculectomy is the surgical treatment of choice to lower the intraocular pressure in eyes that are suboptimally controlled with topical antiglaucoma medications alone. Although the success rate of trabeculectomy has significantly improved with the standard use of mitomycin C MMC and other adjunctive antimetabolite treatment, 2 complications such as OSD may compromise visual function postoperatively.
These concerns are important because, together, glaucoma and OSD may greatly increase the health-care burdens of the economy. There have been several reports on the development of OSD after refractive surgery, specifically photorefractive keratectomy. In this study, we report a case series of OSD following trabeculectomy in 12 patients at our institution.
Twelve glaucoma patients were referred to the Dry Eye Clinic from the Glaucoma Service after developing persistent symptoms and signs of dry eye disease. An eye was considered to have OSD if patients experienced ocular discomfort such as gritty sensation, burning or transient blurring of vision, and an associated abnormal TBUT value or Schirmer score without anesthesia.
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Each patient was reviewed by the attending ophthalmologist with a special interest in dry eye disorders. The patients were queried about their symptoms and examined accordingly. Examination of the eyes was performed, with particular attention directed toward identifying signs of OSD, which included the presence of conjunctival injection, fluorescein staining of the cornea, and presence of meibomian gland dysfunction MGD. The demographic data included sex, age, and ethnicity. Further information regarding the type of glaucoma, the different types of antiglaucoma medications each patient received before surgery, and the time of onset of OSD following trabeculectomy was also recorded.
The average age was There were 10 Chinese patients Of the 15 eyes that underwent trabeculectomy surgery, 14 had MMC and one had 5-fluorouracil.
Topical eyedrops used to treat glaucoma in these patients prior to surgery varied Figure 1. Timolol maleate, a beta-adrenergic blocker, was the most common intraocular pressure-lowering topical eyedrop used in these patients, with 11 out of 12 patients previously or currently on this medication. Prostaglandin analogs followed, with seven patients Figure 1 Distribution of IOP-lowering eyedrops used to treat glaucoma.
Notes: Timolol maleate, a beta-adrenergic blocker, was the commonest IOP-lowering topical eyedrop used in these patients, followed by prostaglandin analogs and alpha-adrenergic blockers. In comparison, combination therapy and carbonic anhydrase inhibitors were used much less frequently in these patients. For the 14 eyes that underwent trabeculectomy surgery with adjunctive MMC, a sponge soaked with MMC was applied at a concentration of 0.
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The eyes were then thoroughly irrigated with 50 mL of balanced salt solution. The median interval before onset of dry eye symptoms following trabeculectomy was Primary symptoms at presentation were, as reported by patients, severe feeling of dryness On slit-lamp examination, all eyes had punctate epithelial erosions when stained with fluorescein Figure 2.
As defined earlier, TBUT value and Schirmer I score were also used to measure the degree of dry eye disease in these patients at the time of diagnosis. TBUT ranged from 2 seconds to 13 seconds, with a mean of 5. Figure 2 Corneal epitheliopathy in OSD. Notes: Corneal epitheliopathy in these patients ranged from punctate epithelial erosions to epithelial defects, as seen in three different patients with eyes stained with fluorescein.
Abbreviation: OSD, ocular surface disease. At the time of presentation to the Dry Eye Clinic, all patients were treated with lubricants, and depending on disease progression and severity of dry eye disease, treatment was stepped up accordingly. Five of the 12 patients After treatment, improvement in BCVA at least one-line improvement from presentation to the Dry Eye Clinic until the final visit was observed in seven eyes Median duration of follow-up was 15 months. Click here to sign up.
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