Taiwan Journal of Ophthalmology最新文献

[This corrects the article on p. 450 in vol. 15, PMID: 40995323.].

Intense pulsed light (IPL) therapy has emerged as a promising modality for the treatment of meibomian gland dysfunction (MGD), a leading cause of evaporative dry eye disease. However, its clinical application varies significantly across studies, with notable procedural heterogeneity in device selection, treatment intervals, anatomical coverage, and adjunctive strategies. This comprehensive review synthesizes 110 clinical studies to delineate prevailing procedural trends and identify evidence-based components of IPL protocols for MGD. Using structured data extraction, we examined key treatment variables including IPL device type, pulse energy, number and frequency of sessions, anatomical treatment regions, filter types, light guide configurations, and adjunctive interventions such as meibomian gland expression, low-level light therapy, and pharmacologic agents. While substantial variability exists, several consistent procedural patterns were identified that may inform clinical standardization. This review provides a practical framework for optimizing IPL therapy in MGD and underscores the need for further comparative investigations to refine protocol design.

This article is based on the 2025 ASCRS Binkhorst Lecture which I delivered in Los Angles in April 2025. It will focus on the basic but oft-neglected step in phacoemulsification: hydrodissection. Over a 40 year career, I have had a particular interest in the techniques of 'hydro' manoeuvres to achieve nuclear mobility. The introduction of intra-operative OCT in 2017 allowed 'live' imaging of hydrodissection and hydrodelamination helping in our understanding of cleavage planes. Complications of hydrodissection like the 'pupil snap sign' will be analysed and the relevance of hydrodissection in modern cataract surgery discussed.

Purpose: Liquiritigenin (LIQ), an active flavanone derived from Glycyrrhiza uralensis, is known to possess potent antioxidant and anti-inflammatory properties. This study aimed to evaluate the antioxidative and anti-inflammatory effects of LIQ on experimental dry eye disease (DED) models.

Materials and methods: In vitro effects of LIQ were assessed using a hyperosmotic stress model with assays including quantitative polymerase chain reaction, western blotting, enzyme-linked immunosorbent assay, and immunofluorescent staining. The antioxidative effect was compared with n-acetyl cysteine (NAC) and the anti-inflammatory effect with dexamethasone (DEX). In vivo, DED was induced by desiccation stress in a controlled environmental chamber mouse model. Tear production rate, corneal staining scores, pro-inflammatory cytokine expression, conjunctival goblet cell density, infiltration of T-helper (Th) 17 cells, and reactive oxygen species (ROS) levels in the lacrimal gland were evaluated.

Results: In vitro studies demonstrated that LIQ significantly reduced ROS levels, comparable to NAC, and exhibited anti-inflammatory effects similar to DEX. In the mouse model, LIQ treatment significantly increased tear production and reduced corneal staining scores compared to controls, decreased the expression of Interleukin (IL)-1β, IL-4, IL-6, IL-8, IL-13, tumor necrosis factor α, Interferon γ, restored conjunctival goblet cell density, reduced Th17 cell infiltration, and lowered ROS levels in the lacrimal gland Microarray analysis revealed LIQ regulated cytokine expression and ROS levels through the modulation of the aldo-keto reductase (AKR) superfamily in hyperosmotic stress conditions.

Conclusion: LIQ shows potential as a therapeutic agent for DED through its dual anti-inflammatory and antioxidative actions, primarily through modulation of the AKR superfamily.

[This corrects the article on p. 331 in vol. 11, PMID: 35070660.].

Mucins are essential components of the ocular surface, ensuring epithelial protection, tear film stability, and immune regulation. Mucin deficiency contributes to a spectrum of ocular surface disorders, including dry eye disease, allergic conjunctivitis, and cicatricial conditions such as Stevens-Johnson syndrome and ocular graft-versus-host disease. This review outlines current knowledge of mucin biology, regulatory mechanisms, and emerging therapeutic applications of mucin secretagogues in ocular surface disorders. Signaling cascades involving EGFR activation, MAPK phosphorylation, cholinergic and adrenergic stimulation, and cytokine-mediated modulation (e.g., interleukin-13, tumor necrosis factor-α) govern mucin transcription and goblet cell function. Clinically approved secretagogues such as diquafosol and rebamipide improve mucin expression and epithelial healing, while biologics, gene therapies, and nutraceutical compounds are actively being explored. Advancing these therapies may enable more targeted and durable restoration of ocular surface integrity across a range of mucin-deficient diseases. We searched for related research on PubMed using the terms "Mucin" and "Mucin secretagogues," along with keywords such as "dry eye," "goblet cell," and "ocular surface disorder." Articles related to mucin secretagogues published within the last 10 years were reviewed.

Purpose: The purpose of the study was to evaluate the clinical characteristics and therapeutic response in patients with meibomitis-related keratoconjunctivitis (MRKC) who were treated with oral cefcapene pivoxil hydrochloride hydrate, and to determine factors associated with favorable outcomes.

Materials and methods: A retrospective analysis was conducted on 62 patients with MRKC, including 31 patients who received a 14-day course of oral cefcapene (100 mg three times daily) in combination with standard warm compression and lid hygiene. These patients were 1:1 propensity score-matched with 31 controls who underwent warm compression and lid hygiene, based on age, sex, meibomian gland expressibility, and meibum quality. Baseline characteristics and posttreatment outcomes - including corneal staining score (CSS) and ocular surface disease index (OSDI) - were compared between the groups.

Results: One month after treatment, mean CSS was significantly lower in the cefcapene group (0.55 ± 0.65) compared with controls (0.86 ± 0.44, P = 0.032*). The cefcapene group also showed higher rates of complete corneal staining resolution (CSS = 0) and greater OSDI improvement, although these outcomes did not reach statistical significance.

Conclusion: Adjunctive use of short-term oral cefcapene therapy alongside standard eyelid hygiene measures resulted in a significant reduction in CSSs in patients with MRKC. However, this reduction was not accompanied by a statistically significant improvement in subjective symptoms.

Dry eye is a multifactorial condition characterized by tear film instability, leading to visual disturbances and discomfort. In Asia, clinical management often follows a tear film-oriented approach that emphasizes restoring specific tear components, particularly through the use of secretagogues such as diquafosol and rebamipide. These agents promote aqueous and/or mucin secretion and have been widely adopted in Japan and other Asian countries as frontline therapies for various tear film deficiencies. This review outlines the clinical rationale for secretagogue use and summarizes real-world applications across different settings, including general outpatient care, perioperative management for cataract surgery, and contact lens-related ocular surface disorders. Tear Film-Oriented Diagnosis - a framework for classifying dry eye subtypes based on tear breakup patterns and identifying deficiencies in aqueous, lipid, or mucin components - is presented as a practical guide for treatment selection. Evidence from clinical trials and long-term observational studies supports the safety and efficacy of diquafosol and rebamipide in improving tear stability, reducing epithelial damage, and enhancing patient satisfaction. By highlighting regional practice patterns and accumulated clinical experience, this article offers perspectives on effectively integrating secretagogues into dry eye management. These insights may contribute to a broader understanding of individualized, mechanism-based treatment strategies beyond inflammation suppression.

Meibomian gland dysfunction (MGD) is a leading cause of evaporative dry eye, significantly impairing the quality of life. Bacterial proliferation and inflammation play central roles in the pathogenesis of MGD, creating a vicious cycle of gland obstruction and ocular surface instability. Antibiotics, particularly tetracyclines (e.g. doxycycline and minocycline), and macrolides (e.g. azithromycin and erythromycin), are widely used as adjunctive therapy for moderate-to-severe or refractory MGD. This review conducted a comprehensive literature search of PubMed, focusing on original peer-reviewed articles published in English that reported on the efficacy and/or safety of oral or topical antibiotics for MGD or blepharitis. Eligible studies were identified using the specific search terms, screened by title and abstract, and selected based on predefined inclusion and exclusion criteria. Relevant data were extracted and synthesized, with an emphasis on randomized controlled trials and comparative studies. The review indicates that both oral and topical antibiotics improve subjective symptoms, tear film stability, ocular surface staining, meibum quality, and lid margin abnormalities in the short term. Oral azithromycin may be at least as effective as doxycycline, with a shorter treatment course and fewer adverse events, while topical azithromycin offers similar or superior efficacy to systemic regimens with reduced systemic exposure. However, benefits are usually limited to active treatment periods, and optimal dosing and duration remain uncertain. Long-term efficacy, safety, risk of resistance, and effects on the ocular microbiome require further investigation. Antibiotics should be used judiciously as part of a comprehensive, individualized management strategy for MGD.