다중혈관 관상동맥 환자에서 y-문합을 이용하여 양쪽 내흉동맥만을 사용한 우회술의 조기 성적

https://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=1006&context=covid19

SARS-CoV-2

The goals of the TFOS DEWS II Definition and Classification Subcommittee were to create an evidence-based definition and a contemporary classification system for dry eye disease (DED). The new definition recognizes the multifactorial nature of dry eye as a disease where loss of homeostasis of the tear film is the central pathophysiological concept. Ocular symptoms, as a broader term that encompasses reports of discomfort or visual disturbance, feature in the definition and the key etiologies of tear film instability, hyperosmolarity, and ocular surface inflammation and damage were determined to be important for inclusion in the definition. In the light of new data, neurosensory abnormalities were also included in the definition for the first time. In the classification of DED, recent evidence supports a scheme based on the pathophysiology where aqueous deficient and evaporative dry eye exist as a continuum, such that elements of each are considered in diagnosis and management. Central to the scheme is a positive diagnosis of DED with signs and symptoms, and this is directed towards management to restore homeostasis. The scheme also allows consideration of various related manifestations, such as non-obvious disease involving ocular surface signs without related symptoms, including neurotrophic conditions where dysfunctional sensation exists, and cases where symptoms exist without demonstrable ocular surface signs, including neuropathic pain. This approach is not intended to override clinical assessment and judgment but should prove helpful in guiding clinical management and research.

TFOS DEWS II Definition and Classification Report

Nanoparticle interaction with plasma proteins as it relates to particle biodistribution, biocompatibility and therapeutic efficacy.

The subcommittee reviewed the prevalence, incidence, risk factors, natural history, morbidity and questionnaires reported in epidemiological studies of dry eye disease (DED). A meta-analysis of published prevalence data estimated the impact of age and sex. Global mapping of prevalence was undertaken. The prevalence of DED ranged from 5 to 50%. The prevalence of signs was higher and more variable than symptoms. There were limited prevalence studies in youth and in populations south of the equator. The meta-analysis confirmed that prevalence increases with age, however signs showed a greater increase per decade than symptoms. Women have a higher prevalence of DED than men, although differences become significant only with age. Risk factors were categorized as modifiable/non-modifiable, and as consistent, probable or inconclusive. Asian ethnicity was a mostly consistent risk factor. The economic burden and impact of DED on vision, quality of life, work productivity, psychological and physical impact of pain, are considerable, particularly costs due to reduced work productivity. Questionnaires used to evaluate DED vary in their utility. Future research should establish the prevalence of disease of varying severity, the incidence in different populations and potential risk factors such as youth and digital device usage. Geospatial mapping might elucidate the impact of climate, environment and socioeconomic factors. Given the limited study of the natural history of treated and untreated DED, this remains an important area for future research.

TFOS DEWS II Epidemiology Report.

(cl-166): 2:40 pm severity And Management Of Cl Related Complications With Continuous Wear Of High Dk Silicone Hydrogel Lenses. : 2:40 pm

Objective To characterize the location of fluorescently labeled lysozyme on commercial contact lenses (CLs) using an in vitro eye model that simulates tear volume, tear flow, air exposure, and mechanical wear. Methods One commercially available conventional hydrogel CL material (etafilcon A) and three silicone hydrogel CL materials (balafilcon A, lotrafilcon B, and senofilcon A) were evaluated in this study. The CLs were mounted on the in vitro eye model and exposed to artificial tear fluid containing fluorescein isothiocyanate (FITC)-labeled lysozyme for 2 and 10 hrs. After these short incubation periods, circular discs were punched from the CLs at the center and periphery and were prepared for confocal laser scanning microscopy (CLSM). The CLSM captured a series of consecutive images spaced 5 μm apart, and the resulting images were rendered into two dimensional cross-sectional views of the CL. The mean fluorescence at each 5 μm slice was used to generate a histogram depicting the penetration of FITC-lysozyme into CLs. Results For both incubation periods, the CLSM images and histogram of etafilcon A showed that FITC-lysozyme is more concentrated at the lens surface, with a moderate amount of deposition in the lens matrix. For balafilcon A, FITC-lysozyme was evenly distributed throughout the lens. For lotrafilcon B, there was a greater amount of FITC-lysozyme deposition on the surfaces of the lens versus the matrix. Senofilcon A had differential FITC-lysozyme distribution profiles depending on the location of the lens. At the lens periphery, FITC-lysozyme primarily deposited on the surface, whereas FITC-lysozyme was uniformly distributed at the center of the lens. Conclusions With the use of a sophisticated in vitro eye model, the study revealed a complex deposition pattern of FITC-labeled lysozyme on various CL materials after short periods of exposure. An understanding of the early deposition pattern of lysozyme on different CL material may elucidate new insights into the processes behind CL discomfort.

Depth Profile Assessment of the Early Phase Deposition of Lysozyme on Soft Contact Lens Materials Using a Novel In Vitro Eye Model

Novel in vitro method to determine pre-lens tear break-up time of hydrogel and silicone hydrogel contact lenses.

SIGNIFICANCE In this study, assessments of conjunctival redness were performed to evaluate whether patients with or without dry eye disease (DED) could be discriminated based on this measure Our findings suggest that subjectively grading redness by quadrant, as opposed to automated en face measurements, may be more suitable for this purpose PURPOSE This study aimed to quantify bulbar redness using the validated bulbar redness (VBR) grading scale and an automated objective method (Oculus Keratograph 5M; K5M) in participants with DED and non-DED controls METHODS Participants with DED (Ocular Surface Disease Index score ≥20 and Oxford scale corneal staining ≥2) and controls (Ocular Surface Disease Index score ≤10 and corneal staining ≤1) attended two study visits In part 1A of visit 1, baseline bulbar redness was graded with the VBR scale in each conjunctival quadrant of both eyes, followed by automated measurements of temporal and nasal redness with the K5M This was immediately followed by part 1B, during which a topical vasoconstrictor was instilled into both eyes Redness assessments were repeated 5 and 30 minutes after instillation with both instruments Participants returned 14 days later for visit 2, where the same assessments as for visit 1A were repeated RESULTS Seventy-four participants (50 DED and 24 controls) completed the study There were statistically significant differences in redness between the DED and control groups when assessed with the VBR scale (14/16 comparisons; all, P < 05), whereas no significant differences in K5M-derived redness between the DED and non-DED groups were found at any location or time point Both subjective and objective instruments detected statistically significant reductions in redness 5 and 30 minutes after instillation of the vasoconstrictor (all, P < 01) CONCLUSIONS Although both subjective and objective instruments were sensitive to detecting changes in redness induced by vasoconstriction, statistically significant differences in redness between DED and control groups were only found using the VBR scale

Bulbar Redness and Dry Eye Disease: Comparison of a Validated Subjective Grading Scale and an Objective Automated Method.

I t is estimated that there are approximately 39 million contact lens wearers in the United States and the global value of the contact lens market may be as high as $7.6 billion annually. Currently, contact lenses are almost exclusively used to correct ametropia and provide clear vision. However, the recent availability of new materials and new technologies has resulted in some revolutionary proposals for contact lenses. This OVS Feature Issue highlights the potential future opportunities for the prescribing of contact lenses that extend far beyond their traditional uses. In our opening manuscript, Lyndon Jones sits down with four world renowned experts to highlight recent developments in the use of contacts to deliver topical ocular and systemic drugs, assist with ocular surface disease management, and limit the progression of myopia. Particular attention is paid to the barriers to the commercialization of such innovative products, and the article provides a fascinating insight for the clinician into the likelihood of such revolutionary contact lenses being available in a clinical setting. The progression of myopia and its impact on disease in the long term has been a topic of much debate and concern recently, with the prevalence of myopia in some Asian countries being over 90%. In light of the known association between ocular disease and high myopia, attempts to slow the progression of myopia have grown in importance and contact lens options for this purpose are of growing interest to eye care practitioners. Paul and Kate Gifford provide a timely overview of the current state of knowledge regarding the use of contact lenses to slow myopia progression. This review is followed by two prospective clinical studies describing the use of soft lenses for this very purpose. In a 12-month study, Aller and colleagues enrolled 86 myopic subjects and fitted them with a commercially available center distance soft multifocal lens or single vision soft lens in the same material. The multifocal lens resulted in reduced myopia progression and reduced axial elongation in comparison, and opens up the discussion around whether clinicians can consider using commercially available products off-label before the launch of a product with a specific indication for reduction in myopia progression. Cheng and co-workers investigated the impact of a novel soft lens design incorporating positive spherical aberration on myopia progression and were also able to show a reduction in axial progression. Interestingly, upon cessation of wear of the test lens, no rebound effect was noted, unlike that previously noted upon cessation of atropine treatment for myopia control. Taken together, these three manuscripts suggest a bright future for contact lenses in the management of myopia control, especially as new designs, with the appropriate approvals, come onto the market. Contact lenses have been discussed as potential reservoirs to deliver drugs to the eye since the publication of the first soft contact lens patent in the 1960s. Hui and Willcox eloquently summarize the data thus far from in vivo animal and human studies that have investigated novel materials and approaches to delivering topical pharmaceutical agents to the eye. They conclude that while currently available lenses provide limited benefits, materials that are modified specifically for this purpose may prove to be attractive in terms of dosing kinetics. However, the number of in-eye studies remains small at this point in time and more work is required to confirm if the promised benefits are tangible. Many methods exist to modify materials to control the delivery of drugs, and among these, molecular imprinting has received considerable attention, particularly for contact lens delivery. In an in vitro study, Byrne and colleagues developed silicone hydrogel materials and used the concept of molecular imprinting to release a cocktail of agents that may assist in mediating contact lens comfort. The results demonstrated that with careful design, a high level of control can occur and that multiple molecules of interest can be released over time periods from days to weeks in physiologically relevant conditions. Many in vitro studies use small volumes to look at drug release, in which the materials of interest release their drugs into a 2 to 10 mL volume of fluid in a static, immobile system. These systems, although simple, do not mimic the in vivo system, in which there is a small volume of tear fluid that is constantly being replenished and in which blinking and air exposure occurs. This marked difference in test environments may help to explain the apparent mismatch that often occurs between in vitro and in vivo results with drug delivery systems. As an illustration of this phenomenon, Phan et al. describe the release of an antifungal agent (fluconazole) from commercially available daily disposable soft lenses into both a traditional vial-based environment and a system that mimics air exposure, blinking, and physiological tear flow. The markedly extended release kinetics shown in the latter setup indicate how important it is to make physiologically relevant measurements in this field. Some drugs that are of interest to treat ocular disease are photounstable, and extending their release profile is of little value unless they can be protected from light during storage or wear. One method of addressing this issue involves incorporating vitamin E into the hydrogel polymer matrix, and Hsu and Chauhan investigate the impact of both vitamin E and UV-blocking contact lens materials on the photodegradation of dexamethasone. In 1040-5488/16/9304-0325/0 VOL. 93, NO. 4, PP. 325Y327 OPTOMETRY AND VISION SCIENCE Copyright * 2016 American Academy of Optometry

Lyndon Jones

Papers

(cl-166): 2:40 pm severity And Management Of Cl Related Complications With Continuous Wear Of High Dk Silicone Hydrogel Lenses. : 2:40 pm

Depth Profile Assessment of the Early Phase Deposition of Lysozyme on Soft Contact Lens Materials Using a Novel In Vitro Eye Model

Novel in vitro method to determine pre-lens tear break-up time of hydrogel and silicone hydrogel contact lenses.

Bulbar Redness and Dry Eye Disease: Comparison of a Validated Subjective Grading Scale and an Objective Automated Method.

Revolutionary Future Uses of Contact Lenses.