Visual Functions’ Detailed Evaluating in Patients with Sjögren’s Syndrome before
and after Intracanalicular Implants’ (Smart Plug) Insertion – (First Results)
Hejcmanová D., Němcová I., 1Slezák R.
Oční klinika FN, Hradec Králové, přednosta prof. MUDr. Pavel Rozsíval, CSc. 1Stomatologická klinika FN, Hradec Králové, přednosta doc. MUDr. Věra Hubková, CSc. |
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Summary:
The aim of the study was to determine exact visual functions (log MAR
[minimal angle of resolution] and CS [contrast sensitivity]) and to evaluate
corneal topographic maps in patients with established (by means of laboratory
and biopsy examinations) Sjögren’s Syndrome, and to determine the difference
in subjective symptoms before and after insertion of the intracanalicular
implants as well.
Patients and methods: Twelve eyes (1 man, 6 women) with established Sjögren’s
syndrome were examined before and during two months after the insertion of
the plugs. The best-corrected visual acuity (BCVA) was assessed on Landolt C
rings optotypes. CS was measured on computer-controlled device
(Neuroscientific Corp., U.S.A.) in 6 space-frequencies (0.74–29.55 c/deg). The
corneal topographic changes (Keraton Opticon) were established by means of
comparing total aberrations values before and after the intracanalicular
implants’ (Smart Plugs type) insertion. The control group for visual functions
assessment consisted of 10 woman (20 eyes) of similar middle age.
Results: The BCVA on log MAR optotypes was 0.84 (0.69–0.95) before and 0.88
(0.52–1.23) after the insertion, on both occasions, it was lower than in the
control group. The CS was before the insertion in all of the spatial frequencies
lower, the largest differences were in the frequencies range 1.97–7.29 c/deg
(p < 0.01). After the treatment, the values grow but they don’t reach the values
of the control group.
Subjective complains of the patients decreased markedly; in 100 % they had
relief, in 3 cases they referred improvement up to 50 %; no patient observed
tearing. The frequency of drops’ application has decreased by 63 %. The
Schirmer test, in 100 % positive before the treatment, was after the insertion in
75 % negative; the height of the tear-meniscus was positive in 100 % before the
procedure, and after that, its measurement improved to 1 mm in 91 %; in 9 % it
was 1.5 mm. We also noticed changes of the ocular surface by means of
lissamine green staining; this test was before the procedure positive in 100 %,
the improvement after that was in 63 %.
The regularity of the corneal surface is the determining factor of visual
functions in “dry eyes”. The measurement of the corneal topography is useful
in differential diagnosis and helps to distinguish mild and more serious
conditions of dry eye. The improvement of BCVA and CS values after insertion
corresponds with patients’ subjective evaluating. The best value of the
treatment is improvement of the patients’ comfort; furthermore, after insertion
of the permanent plugs they feel pronounced subjective relief and lowering of
the frequency of drops application.
Key words:
Sjögren’s syndrome, contrast sensitivity, intracanalicular lacrimal
plugs
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