Evaluation of Dry Eye Parameters in Patients with Unilateral Herpetic Keratitis

Yıl 2022, Cilt: 8 Sayı: 3, 204 - 207, 03.10.2022

Sevgi Subasi

https://doi.org/10.30934/kusbed.1137415

Öz

Objective: Our aim in this study was to examine the tear parameters between affected and unaffected eyes of unilateral herpes simplex virus (HSV) keratitis patients, especially the meibomian glands status.
Methods: The examinations and tear parameters including; tear film meniscus height (TMH) and area (TMA), non-invazive break up time (NIBUT), schirmer test, meibomian gland’s ekspressibility grade, drop out grade and microstructure of patients who were treated in our clinic with the diagnosis of unilateral herpetic endothelitis or herpetic stromal keratitis, and who had a quiescent period of about 3 months, were evaluated retrospectively.
Results: The median age of our patients was 58.0 (55.25-72.25) years. The median NIBUT was 6.85 (4.62-17.0) sec. in affected eye and 15.85 (10.47-17.15) sec. in unaffected eye. NIBUT values were observed to be remarkable lower in the affected eye, although the change between groups was not statistically significant. Schirmer test values, TMH and TMA were similar between affected and unaffected eyes. Meibomian gland evaluations of affected and unaffected eyes were shown similar distribution across meibomian expressibility and drop out grades.
Conclusion: We observed similar effects in both morphological and microstructural features of meibomian glands in both eyes. This condition makes us think that the developing dry eye disease in both eyes may be caused not only by neurosensorial anomalies but also by changes in the meibomian glands.

Anahtar Kelimeler

herpetic keratitis, meibomian gland, tear film meniscus, in vivo confocal misroscopy

Unilateral Herpetik Keratitli Hastalarda Kuru Göz Parametrelerinin Değerlendirilmesi

Öz

Amaç: Çalışmamızın amacı tek taraflı herpes simpleks virüs (HSV) keratiti olan hastalarda etkilenen ve etkilenmeyen gözler arasındaki gözyaşı parametrelerinin özellikle meibomian bezlerinin durumunun değerlendirilmesidir.
Yöntem: Kliniğimizde tek taraflı HSV endoteliti ve HSV stromal keratiti tanılarıyla tedavi uygulanmış ve 3 aydan uzun süredir sakin dönemde seyreden hastaların muayeneleri ve gözyaşı filmi menisküsü yüksekliği (GFMY), alanı (GFMA), non-invazif gözyaşı kırılma zamanı (NIGKZ), schirmer testi, meibomian bezleri ekspressibilite gradeleri, drop-out dereceleri ve mikroyapısının değerlendirilmesini içeren gözyaşı parametreleri retrospektif olarak değerlendirildi.
Bulgular: Hastalarımızın yaş ortalaması 58,0 (55,25-72,25) yıldı. Medyan NIGKZ etkilenen gözde 6,85 (4,62-17,0) sn. ve etkilenmemiş gözde 15,85 (10,47-17,15) sn. idi. Gruplar arasındaki değişim istatistiksel olarak anlamlı olmasa da, etkilenen gözde NIGKZ değerlerinin belirgin şekilde daha düşük olduğu gözlendi. Schirmer test değerleri, GFMY ve GFMA, etkilenen ve etkilenmeyen gözler arasında benzerdi. Etkilenen ve etkilenmeyen gözlerin meibomian bezi değerlendirmeleri, meibomian ekspresyonu ve bırakma dereceleri benzer dağılım gösterdi.
Sonuç: Her iki gözde meibom bezlerinin hem morfolojik hem de mikroyapısal özelliklerinde benzer etkiler gözlemledik. Bu durum bize her iki gözde gelişen kuru göz hastalığının sadece nörosensoriyel anomalilerden değil meibomian bezlerdeki değişikliklerden de kaynaklanabileceğini düşündürmektedir.

Anahtar Kelimeler

herpetik keratit, meibomian bezi, gözyaşı film menisküsü, in vivo konfokal mikroskobi

Kaynakça

• Liesegang TJ, Thomas J. Herpes simplex virus epidemiology and ocular importance. Cornea. 2001;20(1):1-13. doi:10.1097/00003226-200101000-00001.
• Nishida T, Yanai R. Advances in treatment for neurotrophic keratopathy. Curr Opin Ophthalmol. 2009;20:276-281. doi:10.1097/ICU.0b013e32832b758f.
• Keijser S, van Best JA, Van der Lelij A, Jager MJ. Reflex and steady state tears in patients with latent stromal herpetic keratitis. Invest Ophthalmol Vis Sci. 2002;43(1):87-91.
• Simard-Lebrun A, Boisjoly H, Al-Saadi A, et al. Association between unilateral quiescent stromal herpetic keratitis and bilateral dry eyes. Cornea. 2010;29:1291-1295. doi:10.1097/ICO.0b013e3181cbf9f5.
• M’Garrech M, Rousseau A, Kaswin G, et al. Impairment of lacrimal secretion in the unaffected fellow eye of patients with recurrent unilateral herpetic keratitis. Ophthalmology. 2013;120:1959-1967. doi:10.1016/j.ophtha.2013.02.037.
• Hamrah P, Cruzat A, Dastjerdi MH, et al. Corneal sensation and subbasal nerve alterations in patients with herpes simplex keratitis: an in vivo confocal microscopy study. Ophthalmology. 2010;117:1930-1936. doi:10.1016/j.ophtha.2010.07.010.
• Ma X, Lu Y. Bilateral tear film alterations in patients with unilateral quiescent herpes simplex keratitis. Acta Ophthalmol. 2017;95:629-633. doi:10.1111/aos.13329.
• Battat L, Macri A, Dursun D, et al. Effects of laser in situ keratomileusis on tear production, clearance, and the ocular surface. Ophthalmology. 2001;108:1230-1235. doi:10.1016/S0161-6420(01)00623-6.
• Gilbard JP, Rossi SR. Tear film and ocular surface changes in a rabbit model of neurotrophic keratitis. Ophthalmology. 1990;97:308-312. doi:10.1016/S0161-6420(90)32587-3.
• Ibrahim O, Dogru M, Takano Y, et al. Application of Visante optical coherence tomography tear meniscus height measurement in diagnosis of dry eye disease. Ophthalmology. 2010;117:1923-1929. doi:10.1016/j.ophtha.2010.01.057.
• Pult H, Riede-Pult B. Comparison of subjective grading and objective assessment in meibography. Cont Lens Anterior Eye. 2013;36:22-27. doi:10.1016/j.clae.2012.10.074.
• Shimazaki J, Goto E, Ono M, et al. Meibomian gland dysfunction in patients with Sjögren syndrome. Ophthalmology. 1998;105:1485-1488. doi:10.1016/S0161-6420(98)98033-2.
• Cheng SN, Jiang FG, Chen H, et al. Intense pulsed light therapy for patients with Meibomian gland dysfunction and ocular Demodex infestation. Curr Med Sci. 2019;39:800-809. doi:10.1007/s11596-019-2108-1.
• Cheng SN, Zhang MC, Chen H, et al. The correlation between the microstructure of meibomian glands and ocular Demodex infestation: a retrospective case-control study in a Chinese population. Medicine (Baltimore). 2019;98(19):e15595. doi:10.1097/MD.0000000000015595.
• Jabbarvand, M., Hashemian, H., Khodaparast, et al. Do unilateral herpetic stromal keratitis and neurotrophic ulcers cause bilateral dry eye? Cornea. 2015;34(7):768-772. doi:10.1097/ICO.0000000000000425.
• Liedtke W, Opalka B, Zimmermann CW, et al Age distribution of latent herpes simplex virus 1 and varicella-zoster virus genome in human nervous tissue. J Neurol Sci. 1993;116:6-11. doi:10.1016/0022-510X(93)90082-A.
• Yamaguchi T, Turhan A, Harris DL, et al. Bilateral nerve alterations in a unilateral experimental neurotrophic keratopathy model: a lateral conjunctival approach for trigeminal axotomy. PLoS One. 2013;8:e70908. doi:10.1371/journal.pone.0070908.