International Sicca Award

- Edition 2005 -

Research Projects Czech Republic

Krejzkova Т., ZakP.

District Hospital, Pardubice

Dry eye syndrome prevalence with patients after allege-neic marrow transplantation

Abstract
The primary ophthalmic objective with chronic rejection of the graft against the host is the tear gland and conjunction, their degeneration results in the dry eye syndrome development. The objective of the study was to analyse the frequency of dry eye syndrome symptoms with patients after allogeneic marrow transplantation, start treatment and control its effectiveness.
The dry eye syndrome was demonstrated with all the seven patients examined by us, half of them had the severe form. Long-term substitution with artificial tears, temporary application of local corticosteroids and local eye anabolic agents were priorities of the treatment. Next we used stimulation of tear film water constituent production and lacrimal punctum occlusion (temporary collagenous plugs, permanent occlusion with plugs and thermocoagulation). The overall treatment was based on cooperation of a haematologist and an ophthalmologist, according to requirements also of other specialists. It always depends on the course of the disease and the overall condition of a patient.

Nemec Pavel UVN, Praha

Comparison of reflex tear secretion, stability and function of the tear film with insulin-dependent diabetic patients and non-diabetic patients

Abstract
Infraction: Most of diabetic patients mention dry eye syndromes such as burning or foreign body sensation at repeated examinations. The prospective study compares a group of insulin-dependent diabetic (IDDM) patients and a check group of non-diabetic patients. The study analyses correlation between diabetes rnellitus (DM) and dysfunction of tear film or tear hyposecretion.
Methodology: Fifty six gradually examined IDDM patients with non-proliferative diabetic retinopathy (NPDR) of various levels are compared with 60 non-diabetic patients, and at the same time age and representation of both sexes are comparable. Schirmer's test (Schirmer I) was conducted, tear film break up time was measured and eventual defects of eye surface by staining with Rose-Bengal were examined with all the patients.
Results: In the group of IDDM patients we find significantly lower values of Schirmer's test and more freguent defects of cornea and conjunction epithelium while in the TFBUT category are no statistically significant differences.
Conclusion: Reflex lacrimation is significantly lowered with IDDM patients. At the same time we can find more frequent signs of the defect of integrity of cornea and conjunction surface. On the other hand TFBUT is the same in both the groups and differences in the composition of the tear film are not found.

Obstova Alena

Hrabuvka-field Eye surgery, Ostrava Dry eye in the practice of a field ophthalmologist -in my own words ...

Abstract
Why should someone write about it? Why is it right me, an outpatient ophthalmologist, who should write about it?
Facts seem clear, frequent and repeated. All of us were taught it the same way during our journeymanship. We should diagnose it in equally many cases. And yet there are so many different opinions. They always taught us that every condition has its cause. The real is one often concealed for a long time. We often hear that a patient has been treated for chronic infectious or allergic conjunctivitis without success while a lot of rare antibiotics and antiallergics were applied; he/she is persuaded that he/she is chronically ill and is a person bothering the doctor. The patient has the feeling that every following call on his/her doctor in the outpatients' department is useless as nothing has worked so far. We should better seek the cause and pay more attention to what the patient says. The patient knows himself/herself best. We should chart the shape of palpebral aperture, inclination of outer canthus, whether eyes close or not, presence of tear on eyelids. We should use all available and at the same time cheap methods to determine the true cause of eye troubles. It is often one of the dry eye types.
My article is to make my colleagues pay more attention when diagnosing it. Doctors at clinics do not have so many opportunities to come across its manifold forms so often.
Several times I brought the conclusions in this article ad absurdum in order to provoke discussion, research of further possible connections and also increased attention which this diagnosis deserves. Among others especially for the fact that by recognising and curing it we can allow a patient to relish the beautiful feeling of his/her own health and understanding of himself/herself owing to the possibility of curing himself/herself.

Horackova M., Hejcmanova M.
FN Bohunice, Brno

Diagnosis and therapy of Dry Eye after LASIK

Abstract
Surgery in ophthalmology is one of possible causes of dry eye syndrome incidence. With LASIK the cause is incision of afferent sensitive cornea innervation in cornea lamella formation. Microscopic manifestations of the dry eye syndrome in the cornea lamella zone are called LASIK- inducted neurotropic epitheliopathy. Clinical manifestations of the dry eye syndrome are discomfort, changed visual acuity, biomicroscopic finding and changed lacrimation tests. The biomicroscopic examination shows significant punctiform epithelium erosions in the flap area - keratitis epithelialis punctata and defects stained with 1 % Rose-Bengal. The monitored set included 57 myopic eyes of 31 patients, who underwent LASIK from January to April 2004 at ophthalmic hospital Brno-Bohunice. Average age was 29.5 ± 6.3 and input refraction -5.71D ± 2.6. Time of monitoring was from 4 to 8 months (on average 5.05 months ± 1.6). We evaluated history of changes as regards quantity and quality of tear film, biomicroscopic finding in the flap area after fluorescein staining on the gap lamp, subjective complaints of the client and therapy success.
The highest representation of dry eye syndrome manifestations was recorded on the 1st postoperative day -with 94.7 % of clients (54/57). Values of Schirmer's test (0 20.9 mm + 4.98 preoperatively) slightly grew on the 1st postoperative day (0 22.2 mm ± 4.94). Then values declined on the 10th day (0 18.8 mm ± 4.7) and the 1st month (0 19.7 mm + 4.9) postoperatively. 3 months later the values reached the preoperative value. These changes in the total tear production were not statistically significant (P> 0.5). BUT values (0 12.9 s ± 4.1) were significantly lower on the 1st day (0 3.5 ± 0.7; P = 0.001), the 10th day (0 6.9 s ± 3.6; P = 0.004), 1 st month (0 8.3 s + 2.8; P = 0.01) and the 3rd month (0 9.5 s ± 2.3; P % 0.05). Stabilisation occurred after 6 months (0 12.3 s ± 2.4; P = 0.5). Findings of keratitis epithelialis punctata in the flap area on the gap lamp after fluorescein stai-
ning were manifested most of all on the 1 st and 10th postoperative day. Subjective complaints of the client (burning, dry eye sensation, lacrimation, discomfort, soreness) manifested themselves maximally also on the 1st and 10th postoperative day (85.9 % and 61.4 %). Within the therapy the client was always informed of suitable adaptation of working and home environment. This adaptation with conservative therapy by means of artificial tears was a success with 92.9 % of eyes. With two eyes we used temporary bandage with hydrophilic therapeutic contact lens. With two eyes we used temporary lacri-mal punctum occlusion with collagenous plugs in local anaesthesia.

Zavorkova M., Prochazkova L.
Masaryk hospital, Usti nad Labern

Dry eye syndrome after pars ріала vitrectomy

Abstract
Objective: To evaluate dry eye syndrome incidence with patients after pars plana vitrectomy (PPV).
Set and methodology: The set included patients after PPV who are regularly examined at our ward, altogether 23 patients, 24 eyes. The average monitoring time was 4.7 ± 4.54 months. PPV was carried out 11 times in connection with retina rhegmatogenous amoc, 7 times in connection with haemophthalmus (of them 2 times after venous occlusion and 5 times in connection with proliferative diabetic retinopathy (RDP)), 3 times in connection with haemophthalmus with traction amoc in RDP,
2 times in connection with endoftalmitis after trauma with the presence of a foreign intra-ocular body and 1 time in connection with haemophthalmus with traction amoc after a serious perforation injury. With all the patients we measured the Break-Up Time (BUT) - time necessary to break the precorneal tear film, carried out vital staining of cornea and Schirmer's test 1. We followed the difference between an operated eye and the not-operated eye, and the result of the not-operated eye of every patient was considered the normal condition. Next in the group of operated eyes we compared eyes after peroperation epithelium abrasion and eyes without abrasion.
Results: Average BUT of eyes after PPV was 4.8 ± 1.98 second. Average BUT of not-operated eyes was 7.9 ± 4.35 second. An average BUT difference between the operated eye and the not operated eye of every patient was 3.0 ± 4.07 second. In the group of eyes after PPV and after epithelium abrasion the average BUT was 4.86 ± 2.61 second. In the group after PPV without epithelium abrasion it was 4.84 ± 1.22 second. In the group of eyes after PPV average Schirmer's test 1 was 8.65 mm ± 8.58 mm. In the group of not-operated eyes the average result of Schirmer's test 1 was 10.23 ± 8.68 mm. The average difference between the operated eye and the not-operated eye of every patient was 2.0 ± 5.17 mm. In the ser of eyes after PPV and after epithelium abrasion average Schirmer's test I was 13.7 ± 10.72 mm. The minimum secretion was 2 m and maximum secretion was 30 mm. In the set after PPV without abrasion the average secretion was 6.1 ± 6.19 mm. As regards the vital fluorescein staining there was no staining in the group after PPV with 8 eyes, less than 10 spots were stained on the cornea with 10 eyes and fluorescein distribution was homogenous, more than 10 spots were stained with 6 eyes and of them with one eye a filament was found on the cornea. In the group without PPV 16 eyes were not stained, less than 10 spots were stained on 5 corneas and more than 10 spots were stained on 1 cornea.
BUT test had the most conclusive values which was considerably lower with eyes after PPV in comparison with not-operated eyes. Results of Schirmer's test 1 were not conclusive, secretion is influenced by water component amount and especially by reflex lacrimation which is increased with eyes after operation. Nevertheless we found a difference with lower secretion within the operated eye with most of the patients. The vital fluorescein cornea staining is a test with which we follow the course of cornea epithelisation.
Conclusion: We have proved that with patients after pars plana vitrectomy that the dry eye syndrome incidence is more frequent in our original expectation and that it occurs also on not-operated eyes of the patients who did not complain about serious troubles. Of the three used tests the most conclusive results were achieved with the BUT test. The BUT test will therefore be included in the routine examination plan with all the patients after PPV as well as after other operations as it was confirmed that BUT is one of the best screening tests for the dry eye diagnosis.

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