Melis PALAMAR, Jale MENTEŞ, Ayşe YAĞCI, Özlem BARUT SELVER

Kontakt lens kullanımının oküler yüzey ve Meibomian bezleri üzerine etkileri

Amaç: Yumuşak kontakt lens (KL) kullanımının oküler yüzey ve Meibomian bezleri üzerine etkisini araştırmak Gereç ve Yöntem: Beş yılı aşkın süredir silikon hidrojel KL kullanım öyküsü bulunan 24 olgu (Grup 1) ve 26 sağlıklı gönüllünün (Grup 2) en iyi düzeltilmiş görme keskinlikleri, Schirmer 1 testi, gözyaşı kırılma zamanı, oküler yüzey boyanması (Oxford skalası), OSDI skoru ve meibomian bez özelliklerini içeren kayıtları retrospektif olarak değerlendirildi. Üst ve alt kapakların OCT meibografileri (Spectralis HRA+OCT; Heidelberg Engineering, Heidelberg, Germany) çekilerek bez kaybı açısından tek bir araştırmacı tarafından kör olarak değerlendirildi. Bulgular: Ortalama yaş Grup 1’de 30.00±6.22, Grup 2’de ise 28.70±4.95 idi (p=0.300). Erkek/kadın oranı Grup 1’de 4/20, Grup 2’de 9/17 idi. KL kullanım süresi 10.70±2.70 yıldı. Ortalama gözyaşı kırılma zamanı Grup 1’de 17.70±76.74, Grup 2’de 24.76±8.06 saniyeydi (p=0.002). Ortalama Schirmer 1 değeri Grup 1’de 29.04±7.67, Grup 2’de 25.50±8.48 mm idi (p=0.129). Oxford skalası puanı Grup 1’de 0.58±0.94, Grup 2’de 0.15±0.41 olup fark istatistiksel olarak anlamlıydı (p=0.040). OSDI skoru açısından gruplar arası istatistiksel anlamlı fark bulunmamaktaydı (Grup 1: 29.36±19.25, Grup 2: 23.63±21.99, p=0.334). Üst, alt kapak ve toplam meibomian bez skoru ortalaması Grup 1’de sırasıyla 0.95 ±0.87, 0.66±0.73 ve 1.60±1.40, Grup 2’de sırasıyla 0.67 ± 0.59, 0.67 ±0.70 ve 1.34±1.17 idi ve aralarındaki fark istatistiksel olarak anlamlı değildi. Sonuç: Uzun süreli KL kullanımının, oküler yüzeye birçok farklı etkisi mevcuttur. Meibomian bezler, oküler yüzeye önemli etkileri bulunan yapıladır. Meibobian bez skorlaması, Meibomian bez değerlendirmesi için etkili ve pratik bir yöntemdir.

Impact of contact lens wear on ocular surface and Meibomian glands

Aim: To determine the impact of contact lens (CL) wear on the ocular surface and Meibomian glands (MG). Materials and Methods: 24 silicone hydrogel CL wearers for a minimum of 5 years (Group 1) and 26 healthy volunteers (Group 2) were included in this retrospective study. Best corrected visual acuity, Oxford scoring, tear film break-up time (T-BUT), Schirmer 1 test, Ocular Surface Disease Index (OSDI) scoring and MG evaluation by infrared captures of optic coherence tomography (OCT) were performed. Loss of the MG was scored blindly by a single researcher. Results: The mean age was 30.00±6.22 in Group 1 and 28.70±4.95 in Group 2 (p=0.300). Male/female ratio was 4/20 in Group 1 and 9/17 in Group 2. The average duration of CL wear was 10.70±2.70 years. The mean T-BUT in Group 1 and 2 were 17.70±76.74 and 24.76±8.06 sec, respectively (p=0.002). The mean Schirmer 1 test in Group 1 and 2 were 29.04±7.67 and 25.50±8.48 mm, respectively (p=0.129). The mean Oxford scale staining in Group 1 and 2 were 0.58±0.94 and 0.15±0.41, respectively (p=0.040). The mean OSDI scores in Group 1 and 2 were 29.36±19.25 and 23.63±21.99, respectively (p=0.334). The average upper, lower eyelid, and total meiboscores in Group 1 and 2 were 0.95±0.87, 0.66±0.73, 1.60±1.40 and 0.67±0.59, 0.67±0.70 and 1.34±1.17, respectively. No statistical significance was detected in any of these scores. Conclusion: CL wear has a variety of effects on ocular surface. MG has a significant influence on ocular surface. Meiboscoring is an effective and practical way for evaluation of the MG.

PDF

___

1. Knop N, Knop E. Meibomian glands. Part I. Anatomy, embryology and histology of the Meibomian glands. Ophthalmologe 2009;106(10):872-83.
2. Nagyova B, Tiffany JM. Components responsible for the surface tension of human tears. Curr Eye Res 1999;19(1):4-11.
3. Craig JP, Tomlinson A. Importance of the lipid layer in human tear film stability and evaporation. Optom Vis Sci 1997;74(1):8-13.
4. Nelson JD, Shimazaki J, Benitez-del-Castillo JM, et al. The international workshop on meibomian gland dysfunction: Report of the definition and classification subcommittee. Invest Ophthalmol Vis Sci 2011;52(4):1930-7.
5. Arita R, Itoh K, Inoue K, Amano S. Noncontact infrared meibography to document age-related changes of the meibomian glands in a normal population. Ophthalmology 2008;115(5):911-5.
6. Pult H, Riede-Pult BH. Non-contact meibography: Keep it simple but effective. Cont Lens Anterior Eye 2012;35(2):77-80.
7. Srinivasan S, Sorbara L, Jones L, Sickenberger W. Imaging the structure of the meibomian glands. Contact Lens Spectrum 2011;7(1):52-3
8. Nichols JJ, Sinnott LT. Tear film, contact lens, and patient- related factors associated with contact lens-related dry eye. Invest Ophthalmol Vis Sci 2006;47(4):1319-28.
9. Pisella PJ, Malet F, Lejeune S, et al. Ocular surface changes induced by contact lens wear. Cornea 2001;20(8):820-5.
10. Hatfield RO, Jordan DR, Bennett ES, Henry VA, Marohn JW, Morgan BW. Initial comfort and surface wettability: A comparison between different contact lens materials. J Am Optom Assoc 1993;64(4):271-3.
11. Nichols JJ, Mitchell GL, Nichols KK, Chalmers R, Begley C. The performance of the contact lens dry eye questionnaire as a screening survey for contact lens-related dry eye. Cornea 2002;21(5):469-75.
12. Begley CG, Caffery B, Nichols KK, Chalmers R. Responses of contact lens wearers to a dry eye survey. Optom Vis Sci 2000;77(1):40-6.
13. Arita R, Itoh K, Inoue K, Kuchiba A, Yamaguchi T, Amano S. Contact lens wear is associated with decrease of meibomian glands. Ophthalmology 2009;116(3):379-84.
14. Ngo W, Srinivasan S, Jones L. Historical overview of imaging the meibomian glands. Journal of Optometry 2013;6(1):1-8.
15. Nichols JJ, Berntsen DA, Mitchell GL, Nichols KK. An assessment of grading scales for meibography images. Cornea 2005;24(4):382-8.
16. Shimazaki J, Goto E, Ono M, Shimmura S, Tsubota K. Meibomian gland dysfunction in patients with Sjögren syndrome. Ophthalmology 1998;105(8):1485-8.
17. Goto E, Monden Y, Takano Y, et al. Treatment of noninflamed obstructive meibomian gland dysfunction by an infrared warm compression device. Br J Ophthalmol 2002;86(11):1403-7.
18. McCann LC, Tomlinson A, Pearce EI, Diaper C. Tear and meibomian gland function in blepharitis and normals. Eye Contact Lens 2009;35(4):203-8.
19. McCulley JP, Shine WE, Aronowicz J, Oral D, Vargas J. Presumed hyposecretory/hyperevaporative KCS: Tear characteristics. Trans Am Ophthalmol Soc 2003;101(3):141-52.
20. Aronowicz JD, Shine WE, Oral D, Vargas JM, McCulley JP. Short term oral minocycline treatment of meibomianitis. Br J Ophthalmol 2006;90(7):856-60.
21. Jester JV, Rife L, Nii D, Luttrull JK, Wilson L, Smith RE. In vivo biomicroscopy and photography of meibomian glands in a rabbit model of meibomian gland dysfunction. Invest Ophthalmol Vis Sci 1982;22(5):660-7.
22. Den S, Shimizu K, Ikeda T, Tsubota K, Shimmura S, Shimazaki J. Association between meibomian gland changes and aging, sex, or tear function. Cornea 2006;25(6):651-5.
23. Arita R, Itoh K, Inoue K, Amano S. Noncontact infrared meibography to document age-related changes of the meibomian glands in a normal population. Ophthalmology 2008;115(5):911-5.
24. Srinivasan S, Menzies K, Sorbara L, Jones L. Infra-red imaging of meibomian gland structure using a novel keratograph. OptomVis Sci 2012;89(5):788-94.
25. Henriquez AS, Korb DR. Meibomian glands and contact lens wear. Br J Ophthalmol 1981;65(2):108-11.
26. Ong BL. Relation between contact lens wear and meibomian gland dysfunction. Optom Vis Sci 1996;73(3):208-10.
27. Efron N, Jones L, Bron AJ, et al. The TFOS International Workshop on Contact Lens Discomfort: Report of the contact lens interactions with the ocular surface and adnexa subcommittee. Invest Ophthalmol Vis Sci 2013;54(11):98-122.