Dry eye can be caused by a variety of iatrogenic interventions. The increasing number of patients looking for eye care or cosmetic procedures involving the eyes, together with a better understanding of the pathophysiological mechanisms of dry eye disease (DED), have led to the need for a specific report about iatrogenic dry eye within the TFOS DEWS II. Topical medications can cause DED due to their allergic, toxic and immuno-inflammatory effects on the ocular surface. Preservatives, such as benzalkonium chloride, may further aggravate DED. A variety of systemic drugs can also induce DED secondary to multiple mechanisms. Moreover, the use of contact lens induces or is associated with DED. However, one of the most emblematic situations is DED caused by surgical procedures such as corneal refractive surgery as in laser-assisted in situ keratomileusis (LASIK) and keratoplasty due to mechanisms intrinsic to the procedure (i.e. corneal nerve cutting) or even by the use of postoperative topical drugs. Cataract surgery, lid surgeries, botulinum toxin application and cosmetic procedures are also considered risk factors to iatrogenic DED, which can cause patient dissatisfaction, visual disturbance and poor surgical outcomes. This report also presents future directions to address iatrogenic DED, including the need for more in-depth epidemiological studies about the risk factors, development of less toxic medications and preservatives, as well as new techniques for less invasive eye surgeries. Novel research into detection of early dry eye prior to surgeries, efforts to establish appropriate therapeutics and a greater attempt to regulate and oversee medications, preservatives and procedures should be considered.

TFOS DEWS II iatrogenic report.

http://www.webaigo.it/download/Barkun%202013.pdf

Topical hemostatic agents: a systematic review with particular emphasis on endoscopic application in GI bleeding

Although aging is a conserved phenomenon across evolutionary distant species, aspects of the aging process have been found to differ between males and females of the same species. Indeed, observations across mammalian studies have revealed the existence of longevity and health disparities between sexes, including in humans (i.e. with a female or male advantage). However, the underlying mechanisms for these sex differences in health and lifespan remain poorly understood, and it is unclear which aspects of this dimorphism stem from hormonal differences (i.e. predominance of estrogens vs. androgens) or from karyotypic differences (i.e. XX vs. XY sex chromosome complement). In this review, we discuss the state of the knowledge in terms of sex dimorphism in various aspects of aging and in human age-related diseases. Where the interplay between sex differences and age-related differences has not been explored fully, we present the state of the field to highlight important future research directions. We also discuss various dietary, drug or genetic interventions that were shown to improve longevity in a sex-dimorphic fashion. Finally, emerging tools and models that can be leveraged to decipher the mechanisms underlying sex differences in aging are also briefly discussed.

Widespread sex dimorphism in aging and age-related diseases.

Human vascular endothelial growth factor protects axotomized retinal ganglion cells in vivo by activating ERK-1/2 and Akt pathways

Glaucoma is the principal cause of irreversible blindness in the world, the second leading cause of blindness in the United States, and it results in optic nerve head axonal degeneration and corresponding visual field deficits. Intraocular pressure (IOP) is the only known modifiable risk factor in glaucoma. Non-modifiable risk factors for glaucoma include age, ethnicity, central corneal thickness, and family history. While our understanding of the role of gender as a risk factor in glaucoma development and progression remains nascent, multiple observations have shown gender differences in the incidence and prevalence of glaucoma. Depending on the type of glaucoma, hormone therapy, oral contraceptive use and menopausal status have also been associated with glaucoma. In addition, pregnancy leads to changes in IOP, while the treatment of glaucoma must be tailored based on the systemic effects of topical therapeutics on the mother and fetus. This review will focus on the epidemiologic, anatomic and endocrinologic differences in male and female glaucoma patients. In addition, this review will discuss treatment modalities that may be more appropriate for one gender than the other, especially with respect to a woman's pregnancy status.

Gender Difference in the Pathophysiology and Treatment of Glaucoma

Objective To determine concurrent changes in corneal thickness, intraocular pressure (IOP), and corneal topography measurements during normal pregnancy. Design Prospective cohort study. Participants We studied 50 eyes from 25 healthy women whose ages ranged from 21 to 35 years and who were first seen during the 10th week of pregnancy. Methods Measurements included IOP (noncontact tonometry); corneal thickness (ultrasound pachymetry); and corneal topography (TMS 2N, TOMEY, Nagoya, Japan). Changes in IOP, central corneal thickness (CCT), and corneal power were calculated at 4 time periods: first trimester, second trimester, third trimester, and 3 months postpartum. Results The mean IOPs in the second and third trimesters of pregnancy were found to be lower than those in the first trimester and at 3 months postpartum ( p = 0.001). The mean CCT in the second and third trimester of pregnancy was measured to be higher than in the first trimester and at 3 months postpartum ( p Conclusions An increase in CCT was accompanied by a decrease in IOP in the second and third trimesters. Physiologic changes occurring in CCT and IOP should be considered in the management of glaucoma during pregnancy.

The course of corneal and intraocular pressure changes during pregnancy.

Background Systemic absorption of eye drops is known to occur via the nasal mucosa, cornea, and conjunctiva. Diffusion of eye drops through the skin is previously unrecognized. Here, two cases are presented in which we observed skin pallor around the eyes after instillation of phenylephrine 2.5% drops. Case 1 A 32-week gestational age premature infant had mydriatic eye drops instilled as part of retinopathy of prematurity screening. Case 2 A term newborn dysmorphic infant underwent fundus examination to rule out ocular pathology. In both cases, discoloration of periorbital skin was observed 45 min following administration of drops. Conclusion The risks of percutaneous toxicity must always be considered in children, especially in premature neonates, in whom the epidermal permeability barrier is frequently incompetent. Application of smaller drop size or wiping of overflowed drop from the skin may be useful to decrease the risk of systemic side effects.

The local vasoconstriction of infant's skin following instillation of mydriatic eye drops.

Purpose Intellectual disability (ID) is a major public health issue, affecting more than 1% of children worldwide. Pediatric vision screening using standard eye charts may be challenging for children with ID, who may benefit from a quick noninvasive vision screening tool. This study evaluated the accuracy of plusoptiX S04 (Plusoptix Gmbh, Nuremberg, Germany) in detecting amblyopia risk factors in children with ID. Methods Children diagnosed with ID according to age-appropriate psychological tests were examined consecutively. Vision screening was performed using the plusoptiX S04 prior to complete ophthalmological examination, including cycloplegic refraction. Pass/refer screening results was compared with findings of ophthalmological examination. Amblyogenic risk factors were defined according to American Association for Pediatric Ophthalmology and Strabismus referral criteria. Results A total of 182 infants and children were examined. Only 3% of children were uncooperative for screening. Ophthalmological examination detected amblyogenic risk factors in 32% of patients. The sensitivity of plusoptiX S04 was 95% (95% CI, 85.6%-98.9%), and specificity was 50% (95% CI, 40.8%-59.1%). The positive predictive value was 47% (95% CI, 37.7%-56.4%) and the negative predictive value was 95.4% (95% CI, 87.1%-99.1%). Conclusions High sensitivity and negative predictive values suggest that the plusoptiX S04 will detect most children with ID who have amblyogenic risk factors, but one-half of all children referred will have no risk factors.

Validation of plusoptiX S04 photoscreener as a vision screening tool in children with intellectual disability.

Muller muscle-conjunctival resection (MCR) is a surgical technique to correct mild and moderate ptosis. In this study, tear function tests and ocular surface are evaluated in patients who underwent unilateral surgery. Sixteen patients with normal preoperative tear function who underwent unilateral MCR were evaluated prospectively. The fellow eyes of the patients were taken as the control group. A dry eye assessment questionnaire, Schirmer testing, tear film break-up time, fluorescein stain, Rose-Bengal stain, and conjunctival impression cytology were used to assess the tear film functions and ocular surface changes in the operated and non-operated eyes. There was no statistically significant difference in the tear function tests and goblet cell densities between the operated and non-operated eyes. The results indicate that an MCR procedure has no apparent effect on tear function tests and goblet cell density in patients with normal preoperative tear function.

Tear function and ocular surface after muller muscle- conjunctival resection

Purpose: To evaluate the effect of a single dose of intravitreal dexamethasone (DEX) implant on retinal nerve fiber layer (RNFL) thickness in patients with branch retinal vein occlusion (BRVO) in a 6-month period.Materials and methods: This retrospective observational study included the patients with BRVO who received intravitreal DEX implant and whose assessment included the baseline RNFL thickness measurements. The data of 26 eyes of 24 patients were retrospectively analyzed. Spectral domain optic coherence tomography was used to measure peripapillary RNFL thickness in six regional subfields. Intraocular pressure (IOP) values at each visit were recorded. The data of single dose DEX implant during 6 months were assessed.Results: The mean preoperative and postoperative 6th month nasal RNFL values were 85.4 ± 23.0 μm and 82.1 ± 17.6 μm, respectively, and the difference between the measurements was not statistically significant (p = 0.372). There was a slight decrease in the mean RNFL values postope...

Silay Canturk Ugurbas

Papers

The course of corneal and intraocular pressure changes during pregnancy.

The local vasoconstriction of infant's skin following instillation of mydriatic eye drops.

Validation of plusoptiX S04 photoscreener as a vision screening tool in children with intellectual disability.

Tear function and ocular surface after muller muscle- conjunctival resection

The Effect of Dexamethasone Intravitreal Implant on Retinal Nerve Fiber Layer in Patients Diagnosed with Branch Retinal Vein Occlusion.