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PURPOSE To evaluate the clinical efficacy and safety of immediate manual meibomian gland expression (MGX) after LipiFlow thermal pulsation (TearScience Inc, Morrisville, NC) for obstructive meibomian gland dysfunction and to compare the LipiFlow only and MGX after LipiFlow. METHODS Patients who underwent immediate manual MGX after LipiFlow or who received only LipiFlow treatment were included. Thirty eyes from 15 patients were enrolled in each group. All patients underwent 3 treatments at monthly intervals. All patients were followed up for 6 months after treatment. All patients were examined before and at 3 and 6 months after treatment. Examinations included the Ocular Surface Disease Index score, noninvasive tear film breakup time (NIBUT), lipid layer thickness (LLT), corneal and conjunctival staining, and tear meniscus height. RESULTS The Ocular Surface Disease Index scores improved in both groups during the follow-up periods (P = 0.001 and P = 0.001). In the LipiFlow-only group, the NIBUT and LLT significantly improved at 3 months (P < 0.001 and P = 0.006) but deteriorated at 6 months. In the MGX after LipiFlow group, the NIBUT and LLT improved at 3 months (P < 0.001 and P < 0.001), and this improvement was maintained at 6 months. The improvement of NIBUT at 3 months was greater in the MGX after LipiFlow group (3.24 ± 1.16 to 9.25 ± 1.36 s) than in the LipiFlow-only group (3.78 ± 1.75 to 7.18 ± 2.70 s), and the improvements of the LLT at 6 months were greater in the MGX after LipiFlow group (30.27 ± 10.74 to 46.93 ± 20.81 μm) than in the LipiFlow-only group (34.70 ± 10.79 to 38.73 ± 14.70 μm). CONCLUSIONS Both LipiFlow only and MGX after LipiFlow were clinically effective for obstructive meibomian gland dysfunction. However, the efficacy and persistence of treatment were greater in patients who received MGX after LipiFlow.

Purpose To compare the protective effects of cyclosporine A emulsion (Restasis: 0.05% cyclosporine A) (CsAE) and cyclosporine A cationic emulsion (Ikervis: 0.1% cyclosporine A) (CsACE) on cellular inflammation, apoptosis, proliferation, and survival in an in vitro dry eye model. Methods The concentration of CsA in CsAE and CsACE was verified using a liquid chromatography tandem mass spectrometry system. Human corneal epithelial cells were subjected to desiccation stress. Human corneal epithelial cells were incubated with or without 3 groups of cyclosporine A medium (CsAE 1:50, CsACE 1:50, and CsACE 1:100). p-NF-κB p65, p-IκBα, Bax, Bcl-xL, p-Erk1/2, and p-Akt levels were determined using Western blots, and TNF-α levels were quantified using an enzyme-linked immunosorbent assay. Results The CsA concentration of CsACE 1:100 was nearly the same as that of CsAE 1:50. Compared with CsAE 1:50 (0.78 ± 0.19 fold), the p-NF-κB p65 level was further reduced in CsACE 1:50 (0.38 ± 1.20 fold) and 1:100 (0.29 ± 0.11 fold) as well as p-IκBα. Levels of TNF-α were also lower in CsACE 1:50 and 1:100 than in CsAE 1:50. Induction of the apoptotic protein Bax was significantly decreased in CsACE 1:50 and 1:100 compared with CsAE 1:50, whereas that of the antiapoptotic protein Bcl-xL was increased in CsACE 1:50 and 1:100. p-ERK1/2 and p-Akt levels were higher in CsACE 1:50 and 1:100 than in CsAE 1:50. Conclusions CsACE had more potent anti-inflammatory and antiapoptotic effects than CsAE in a transwell desiccation stress model. CsACE also enhanced proliferation and survival factors under desiccation stress compared with CsAE in this in vitro dry eye model.

PURPOSE The aim of this study was to investigate the effect of intracameral injection of bisulfite-containing phenylephrine on rabbit corneal endothelium cells in rabbits. METHODS Fifteen eyes of 15 New Zealand white rabbits were divided into 3 groups. Five eyes from each group were injected with 0.5% (0.5 mL, 0.05% bisulfite, group 1), 1.0% bisulfite-containing phenylephrine (0.5 mL, 0.1% bisulfite, group 2), or an equal volume of balanced salt solution as a control (group 3). Specular microscopy, corneal pachymetry, and a slit-lamp examination were used to evaluate corneal endothelial cell loss and other complications before injection, and at 1 hour and 1 week after injection. For morphological studies, corneal buttons were excised at 1 week and stained with alizarin red and trypan blue. Optical microscopy was used to examine 1 cornea from each of the 3 groups. RESULTS Within each group, there were no changes in specular microscopy and corneal pachymetry findings over the 1-week duration of the study. Although all groups showed the presence of several giant cells in the endothelium, the hexagonal shape of the corneal endothelium was morphologically preserved, and no abnormal endothelial cells were observed. CONCLUSIONS Intracameral injection of bisulfite-containing phenylephrine (up to 1.0%) does not affect endothelial cell viability or morphology of the rabbit cornea.

The aim of this study was to evaluate the efficacy and safety of combination treatment using surgical reduction technique and 532-nm Q-switched Nd:YAG laser treatment for the removal of oculodermal melanocytosis.We retrospectively reviewed the medical records of patients who underwent combination treatment using surgical reduction and 532-nm Q-switched Nd:YAG laser for the removal of ocular pigmentation in oculodermal melanocytosis at Asan Medical Center (Seoul, Korea) between January 2009 and January 2013. The safety and cosmetic efficacy of this new surgical strategy were assessed by both patients and observers.Fifty eyes of 47 patients with oculodermal melanocytosis were enrolled. Ocular pigmentation was successfully reduced in all patients, and all patients were satisfied with the cosmetic results at the last visit. Preoperative and postoperative corrected visual acuity, keratometry, and refractive errors did not significantly differ. Postoperative intraocular pressure was significantly reduced (mean change, 2.33 ± 3.54 mm Hg; P = 0.03) at 1 month after surgery. During the follow-up period, no serious adverse events developed other than conjunctival neovascularization and conjunctival inclusion cyst in 5 eyes, respectively.Combination treatment for oculodermal melanocytosis removal seems to be cosmetically satisfactory and safe. This study suggested that combination treatment using surgical technique and 532-nm Q-switched Nd:YAG laser may be helpful for the removal of oculodermal melanocytosis.