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Annals of Medicine Dec 2023Dry eye disease (DED) is a multifactorial disorder characterized by loss of tear film homeostasis with an estimated worldwide prevalence of 5% to 50%. In DED,... (Review)
Review
Dry eye disease (DED) is a multifactorial disorder characterized by loss of tear film homeostasis with an estimated worldwide prevalence of 5% to 50%. In DED, dysfunction of the ocular structures that create and regulate the tear film components-including the lacrimal glands, meibomian glands, cornea, and conjunctiva-causes a qualitative and/or quantitative tear deficiency with resultant tear film instability and hyperosmolarity. This initiates a vicious cycle of ocular surface inflammation and damage that may ultimately impair the quality of life and vision of affected patients. Many factors can contribute to the development of DED, including ocular and systemic diseases, topical and systemic medications, and environmental conditions. Because DED is a chronic disorder, treatment is most often long term and may utilize both pharmacologic and nonpharmacologic interventions to address all etiologic components. The long-term management of DED can be challenging and most often should involve eye care specialist referral. However, primary care clinicians (PCCs) are often the first points of contact for patients with DED and importantly provide initial diagnosis and preliminary patient education about the disease process. Consideration of DED is also vital for the practice of various specialties due to the large number of comorbidities and medications that can contribute to DED pathogenesis and progression. Therefore, it is important that PCCs and clinical specialists be aware of the etiology of DED and its available therapeutic options. This manuscript provides an overview of DED pathophysiology and treatment and discusses specific considerations regarding DED management for PCCs and clinical specialists.Key messagesSuccessful management of dry eye disease often requires the use of various pharmacologic and/or nonpharmacologic therapies, as well as environmental and lifestyle modifications, to mitigate the underlying etiologies and restore tear film homeostasis.Primary care clinicians play an essential role in dry eye disease management by establishing a diagnosis, educating patients about the disorder, and providing referrals to eye care specialists for initiation of specialized treatment and long-term follow-up.Primary care clinicians and clinical specialists should consider prescribing medications with fewer ocular surface effects whenever possible in patients at risk for or with existing dry eye disease.
Topics: Humans; Quality of Life; Dry Eye Syndromes; Conjunctiva; Tears; Primary Health Care
PubMed: 36576348
DOI: 10.1080/07853890.2022.2157477 -
Indian Journal of Ophthalmology Aug 2023This article explains a technique of scleral fixation of intraocular lens (SFIOL) by using a 30-gauge (g) needle.
UNLABELLED
This article explains a technique of scleral fixation of intraocular lens (SFIOL) by using a 30-gauge (g) needle.
BACKGROUND
The X-nit needle by "Aurolab" uses a 26-g needle, while in this technique, a 30-g needle is used, thus reducing the incision size and relevant complications.
PURPOSE
In this technique, glue or end-gripping forceps are not used, thus making it hassle free and more economical. There is no dependency on assistant; because of using 30 g needle, bleeding is minimal and wound healing is faster.
SYNOPSIS
A 30-g needle is bent at 3/4-1/4 junction (from the tip) and a piece of 240 silicon band is inserted into the needle to be used as a stopper. After completing vitrectomy, a 1.5-mm marking is done perpendicular to the limbus at 3'o clock and 9'o clock positions. Another marking is done 1.5 mm away from the first mark parallel to the limbus. A 30-g needle is inserted into partial-thickness sclera from the second mark toward the first marking, thus making a tunnel. The needle is penetrated into the sclera to enter in the vitreous cavity. The needle is then progressed toward the anterior vitreous cavity and brought out through the lip of previously made scleral tunnel in the superior quadrant. The tip of leading haptic of three-piece intraocular lens (IOL) is fed into the tip of needle and gradually, the needle is withdrawn. As soon as the tip of needle is visualized, the piece of band is gradually slipped into the haptic and the needle freed from the haptic. In a similar fashion, the trailing haptic is withdrawn from the opposite side. The bands are removed and the haptics are adjusted by pulling or pushing to centralize the IOL in the pupillary axis. Haptics are trimmed and ends are cauterized to make them blunt. Tunnel and conjunctiva are sutured with one or two (8-0) absorbable Vicryl sutures. The 25-g ports are removed and no suturing of ports is done.
HIGHLIGHTS
It is a minimally invasive and glueless technique in which end-gripping forceps is not used. So, it is very economical with faster wound healing and minimal bleeding and no post-op hypotony. Since the temporal scleral flaps are not made and 30 g needle is used so minimal invasive. Astigmatiam induced by scleral tunnel is seen i;e about 0.75- 1.15 D of cylinder.
VIDEO LINK
https://youtu.be/1msuS5KySOk.
Topics: Humans; Lens Implantation, Intraocular; Lenses, Intraocular; Sclera; Vitrectomy; Conjunctiva; Suture Techniques
PubMed: 37530297
DOI: 10.4103/IJO.IJO_125_23