Study Of Clinical Features Of Severe Dry Eye And The Efficacy Of A New Elastic Silicon Punctal Plugs

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The impact on corneal endothelial cell density and morphology in dry eyes[Purpose]To evaluate the impact of dry eye on corneal endothelial cell density and morphology,and explore the influence factors of it.[Method]156 patients were collected from the ophthalmology department of our hospital during June 2017 to Janury 2018,and were divided into two groups(dry eye group and control group)by their history and examination results.Examinations included uncorrected visual acuity,silt lamp examination,non-contact intraocular pressure,tear break-up time(BUT),Schirmer I test(SIt,without anesthesia),corneal fluoresce staining(FS)and noncontact specular microscope for corneal erndothelia.Meanwhile,patients,onset time of dry eye symptoms and Ocular Surface Disease Index(OSDI)were also collected.P value less than 0.05 was considered statistically different,and less than 0.01 was considered significantly statistically different.[Results]Compared with control group,the endothelial cell density(ECD)was statistically less(t=-4.72,P<0.01),and the average cell area(ACA)was statistically bigger(t=3.51,P<0.01).Age,duration of dry eye symptoms and OSDI were negatively correlated with ECD(r=-0.24,-0.33,-0.22,P<0.01,0.01,0.05),and were positively correlated with ACA(r=0.24,0.33,0.22,P<0.01,0.01,0.05).Age and OSDI was positively correlated with coefficient of variation(r=0.22,0.20,P<0.01,0.05).Moreover,the hexagonality of corneal endothelial cells in female was statistically lower than in male(r=0.19,P<0.05).[Conclusions]Compared with the control group,the density and morphology of corneal endothelial cells were damaged in dry eye patients.Part ? The short-term efficacy and psycological influence of elastic silicon punctal plugs on severe dry eye[Purpose]To evaluate the short-term efficacy and psycological influence of elastic silicon punctual plugs on severe dry eye patients.[Methods]Prospective case series study.28 severe dry eye patients(56 eyes)from the ophthalmology department of our hospital were treated with elastic silicon punctal plugs(Snug PlugsTM,FCI Ophthalmics,France)during January to September 2017.All the examination results were collected at baseline and 3 months after insertion.Uncorrected visual acuity(UCVA),silt lamp examination,conjunctiva grading(CG),lower tear meniscus height(TMS),tear break-up time(TBUT),Schirmer I test(Sit,without anesthesia),corneal fluoresce staining(FS)were recorded to evaluate the efficacy of the plugs.Meanwhile,Ocular Surface Disease Index(OSDI),Self-Rating Anxiety Scale(SAS)and Center for Epidemiological Survey-Depression Scale(CES-D)were collected to assess the changes of patients' symptoms and psychological status.[Results]Compared with baseline,the OSDI score,UCVA,TMS,CG,TBUT,FS,Sit and SAS score were significantly different 3months after insertion(t=6.11,-6.31,8.91,-8.97,-3.83,5.06,-6.14,3.04,P<0.01);CES-D score were statistically different(t=2.38,P<0.05).The number and the severity of patients with anxiety or depression was reduced after insertion.OSDI score was negatively correlated with UCVA,TMH and Sit(r=-0.42,-0.61,-0.31,P<0.01,0.01,0.05),and was positively correlated with FS,SAS and CES-D score(r=0.36,0.31,0.28,P<0.05).The main complication in this study was spontaneous loss of the punctal plugs(3eyes,8.82%).[Conclusions]Short term elastic silicon punctal plugs are effective in treating severe dry eye,and can partly alleviate anxiety and depression.Still,more attentions to the psychological status of dry eye patients should be paid.Part ? The short-term effect of elastic silicon punctal plugs on tear cytokines of severe dry eye[Purpose]To evaluate the efficacy of elastic silicon punctal plugs in severe dry eye patients with the level of dry-eye related tear cytokines(IFN-y,IL-2,IL-6,IL-17A,IL-21 and TNF-a),and explore the correlations between clinical signs and tear cytokines.[Methods]Prospective case series study.28 moderate to severe dry eye patients(56 eyes)from the ophthalmology department of our hospital were treated with elastic silicon punctal plugs(Snug PlugsTM,FCI Ophthalmics,France)during January to September 2017.All the examination results were collected at baseline and 3 months after insertion.Silt lamp examination,conjunctiva grading(CG),lower tear meniscus height(TMS),tear break-up time(TBUT),Schirmer I test(SIt,without anesthesia),corneal fluoresce staining(FS)were recorded to evaluate the efficacy of the plugs.Meanwhile,tears were collected by polymer polyvinyl alcohol swab.[Results]There were 24 patients included at last,because other 4 patients were failed in tear collection.Compared with baseline,the level of IL-2,IL-6 and IL-21 significantly decline 3months after insertion(z=2.78,3.54,3.62,P<0.01),and the level of IFN-y,IL-17A and TNF-a also statistically declined(z=2.51,2.20,2.64,P<0.05).Sex was correlated with every tear cytokine except IL-2(P<0.05),with cytokine levels of female were higher than that of male.All tear cytokines were positively correlated with CG and FS(P<0.01),and was negatively correlated with TMH and SIt(P<0.01).IL-2,IL-6,IL-17A and TNF-a was negatively correlated with BUT(P<0.05).No correlation was found between age and tear cytokines.[Conclusions]Elastic silicon punctal plugs are effective in lowerring the tear cytokine levels of severe dry eye.There are connections between tear cytokines and clinical signs.