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Background: Despite advances in repair techniques, the failure rates of meniscal surgery are still high. The seven most common tear types—horizontal cleavage tears (HCTs), radial tears (RTs), meniscal ramp lesions (MRLs), meniscal root tears (MRTs), longitudinal tears (LTs), bucket-handle tears (BHMTs), and complex meniscal tears (CMTs)—were reviewed. The present retrospective observational study aimed to analyze their characteristics, incidence, treatment approach and failure rates of a consecutive cohort of patients undergoing meniscal arthroscopic repair. Methods: The database of a high-volume meniscal suture center was examined for lesions managed by all-inside, inside-out, outside-in, or transtibial pull-out techniques from January 2018 to September 2022. Demographic (gender, age at surgery, laterality of the affected knee) and intraoperative data (tear type/site, repair technique, and suture number/combination) were collected in order to calculate the failure rates of the cohort and of each tear type and suture technique. Results: Altogether, 636 procedures met our criteria of having at least a 2-year follow-up. The overall failure rate was 1.98%. The most frequent lesions were HCTs (41.98%), with most injuries being in the body/posterior horn (88.52%) of the right knee (56.92%). Treatment predominantly (92.50%) included all-inside sutures. All-inside repair had the highest failure rate (2.98%), followed by inside-out (1.56%) repair (p = 1.0), whereas outside-in and pull-out techniques never failed. Failure rates by lesion included BHMTs (7.27%), HCTs (2.25%), CMTs (1.49%), and LTs (1.25%); RMT, RML, and MRT repair were always successful. Conclusions: Findings at two years suggest that 1–3 all-inside sutures minimize MRL failure, whereas three or more all-inside sutures or combined techniques seem to be effective for HCTs, LTs, and RTs but not BHMTs. Pull-out repair worked best for complete tears/avulsion types of MRTs, whereas all-inside sutures effectively managed partial lesions. Results for CMTs were inconclusive.

Dry eye disease (DED) is the most common ocular surface disease, characterized by insufficient production and/or instability of the tear film. Tear substitutes are usually the first line of treatment for patients with DED. Despite the large variety of tear substitutes available on the market, few studies have been performed to compare their performance. There is a need to better understand the specific mechanical and pharmacological roles of each ingredient composing the different formulations. In this review, we describe the main categories of ingredients composing tear substitutes (e.g., viscosity-enhancing agents, electrolytes, osmo-protectants, antioxidants, lipids, surfactants and preservatives) as well as their effects on the ocular surface, and we provide insight into how certain components of tear substitutes may promote corneal wound healing, and/or counteract inflammation. Based on these considerations, we propose an approach to select the most appropriate tear substitute formulations according to the predominant etiological causes of DED.

Dry eye disease is characterized by tear film instability, often linked to a reduced blink rate during prolonged visual display use. Although blink suppression during virtual reality (VR) headset use has been reported, its effect on tear film stability remains unclear. Accordingly, we developed a system using an ultra-compact camera for the time-course, noninvasive observation of tear film dynamics. Fourteen healthy participants played a 30-min VR game while tear film kinetics were analyzed. As gameplay progressed, a significant increase in the interference grade of the tear film lipid layer was observed ( p < 0.05), along with elevated corneal and upper eyelid surface temperatures ( p < 0.05). The increased interference grade suggests thickening of the lipid layer, possibly attributable to a periocular temperature elevation which may result in facilitation of the incorporation of polar lipids into the nonpolar lipid layer. These findings suggest that VR headset use may increase lipid layer thickness, potentially improving tear film stability under these conditions.

Background—It is recognized that inflammation is an underlying cause of dry eye disease (DED), with cytokine release involved. We systematically reviewed literature with meta-analyses to quantitatively summarize the levels of tear cytokines in DED. Methods—The PubMed, Embase, Web of Science, Ovid, Cochrane, and Scopus databases were reviewed until September 2019, and original articles investigating tear cytokines in DED patients were included. Differences of cytokines levels of DED patients and controls were summarized by standardized mean differences (SMD) using a random effects model. Study quality was assessed by applying Newcastle-Ottawa-Scale and the GRADE quality score. Methods of analytical procedures were included as covariate. Results—Thirteen articles investigating 342 DED patients and 205 healthy controls were included in the meta-analysis. The overall methodological quality of these studies was moderate. Systematic review of the selected articles revealed that DED patients had higher tear levels of interleukin (IL)-1β, IL-6, chemokine IL-8, IL-10, interferon-γ, IFN-γ, and tumor necrosis factor-α, TNF-α as compared to controls. Evidence was less strong for IL-2 and IL-17A. Conclusions—Data show that levels of tear cytokines in DED and control display a great variability, and further studies of higher quality enrolling a higher number of subjects are needed, to define a cut-off value.

The aim was to compare the outcomes acquired from the OSA-Vet ® device with conventional quantitative and qualitative tear tests and between groups within each test, in brachycephalic dogs both healthy and those diagnosed with keratoconjunctivitis sicca. The dogs were divided into four groups: healthy dogs (HD), with mild KCS (MIKCS); moderate KCS (MOKCS); severe KCS (SKCS). All patients underwent ocular surface diagnostic examination in the following order, with a 10-minute interval between tests: non-invasive tear film breakup time (TBUTNI - OSA-Vet ® ), tear meniscus height (TMH-OSA-Vet ® ), meniscometry (I-Tear ® test), Schirmer Tear Test-1 (STT-1), and tear film breakup time (TBUT). Kruskal-Wallis H tests were performed to establish the difference between the groups and Spearman´s correlation coefficient test to assess the correlation between tests. And an analysis of variance (ANOVA) followed by Tukey-Kramer post-hoc test was performed for TMH. Results with ( p  <.05) were considered statistically significant. The correlation of conventional tests in relation to those obtained by OSA-Vet ® proved to be low, except between TBUTNI (OSA-Vet ® ) and TBUT in MOKCS, with a strong correlation ( r  =.925). In the comparison between TBUTNI (OSA-Vet ® ) and TBUT in MIKCS the correlation was moderate ( r  =.547) as well as STT-1 and I-Tear ® test in MOKCS ( r  =.416). In the comparison between groups, the main result observed was a significant difference between all the KCS groups and HD, in the TBUT and TBUTNI (OSA-Vet ® ) test. The OSA-Vet ® and conventional tests are useful for evaluating the ocular surface of brachycephalic dogs. However, the OSA-Vet ® does not correlate well with conventional standardized tests.

Abnormalities in the tear film lipid layer, which plays a critical role in preventing water evaporation and protecting the corneal surface, lead to dry eye disease. The lipids in this layer include both meibum lipids (from the meibomian glands) and phospholipids of other origins. Meibum lipids include cholesteryl esters, wax monoesters, wax diesters (WdiEs), ( O -acyl)-ω-hydroxy fatty acids (OAHFAs), and cholesteryl OAHFAs. Nonetheless, the exact composition of these lipid classes remains largely unclear. Here, we analyze the composition of cholesteryl esters, wax monoesters, WdiEs, OAHFAs, cholesteryl OAHFAs, phosphatidylcholines, and sphingomyelins in human meibum and tears using multiple reaction monitoring mode liquid chromatography-tandem mass spectrometry, which is highly sensitive, selective, and quantitative. This revealed that the WdiEs in meibum and tears fall within the type 1ω and 2ω classes. Among the lipids examined, the type 1ω WdiEs in particular comprised diverse species. The lipid composition of most of the lipid classes, except for the phosphatidylcholines, was similar in meibum and tears. The findings of this comprehensive lipid analysis contribute to elucidating the overall composition of human meibum and tear lipids.

Background The American Shoulder and Elbow Surgeons (ASES) questionnaire was developed to provide a standardized method for evaluating shoulder function. Previous studies have determined the clinical responsiveness of this outcome measure for heterogenous populations or patients with nonoperatively treated rotator cuff disease. Currently, to our knowledge, no studies exist that establish the clinically relevant change in the ASES score after shoulder arthroplasty. Questions/purposes We asked: (1) What are the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) for the ASES score after primary and reverse shoulder arthroplasties? (2) Are the MCID and SCB for the ASES score different between primary and reverse shoulder arthroplasties? (3) What patient-related factors are associated with achieving the MCID and SCB after total shoulder arthroplasty and reverse shoulder arthroplasty? Methods A longitudinally maintained institutional shoulder arthroplasty registry was retrospectively queried for patients who underwent primary shoulder arthroplasty, including anatomic or reverse total shoulder arthroplasty from 2007 to 2013, with a minimum 2-year followup. Seven hundred ninety-four patients were identified and eligible; 304 of these patients did not have 2 years of followup or complete datasets, resulting in a study cohort of 490 patients (62% of the 794 potentially eligible). The MCID and SCB of the ASES score for these patients was calculated using an anchor-based method, using four different anchors measuring satisfaction with work, activities, overall, and activity from the SF-36. The MCID (anchored to somewhat satisfied) and SCB (very satisfied) of the ASES score were calculated for the entire cohort and stratified by arthroplasty type. Multivariate logistic regression of patient-related factors that influence the MCID and SCB achievement was performed. Results The MCID for all patients combined ranged from 6.3 to 13.5; for the overall satisfaction anchor, the MCID was 13.5 ± 4.5 (95% CI, 4.8–22.3). The SCB for the overall cohort ranged from 12.0 to 36.6; for the overall satisfaction anchor, the SCB was 36.6 ± 3.8 (95% CI, 29.1–44.1). There were no differences in the MCID of the ASES score between anatomic and reverse shoulder arthroplasty for any of the anchors (p = 0.159–0.992) or the SCB for any of the anchors (p = 0.467–0.977). Combining anatomic and reverse shoulder arthroplasty in one group, higher preoperative ASES score (odds ratio [OR], 0.96; 95% CI, 0.94–0.98; p < 0.001), having a reverse shoulder arthroplasty (OR, 0.36; 95% CI, 0.16–0.85; p = 0.016), and having rheumatoid arthritis were independent predictors of not achieving an MCID for the ASES 2 years after surgery. Higher preoperative ASES score (OR, 0.91; 95% CI, 0.89–0.92; p < 0.001), a diagnosis of rotator cuff tear arthropathy (OR, 0.14; 95% CI, 0.07–0.30; p < 0.001), a diagnosis of back pain (OR, 0.42; 95% CI, 0.24–0.71); p = 0.002), and living alone (OR, 0.36; 95% CI, 0.19–0.69; p = 0.002) were all independent predictors of not achieving SCB after shoulder arthroplasty. Conclusions Patients with glenohumeral arthritis or rotator cuff tear arthropathy who undergo primary conventional total or reverse shoulder arthroplasty and have at least a nine-point improvement in their ASES score experience a clinically important change, whereas those who have at least a 23-point improvement in their ASES score experience a substantial clinical benefit. High preoperative function was associated with a decreased likelihood of achieving clinically important change after total shoulder arthroplasty. Level of Evidence Level III, therapeutic study.

Tear hyperosmolarity plays a crucial role in initiation of inflammatory response and damage to ocular surface epithelia. Accurate measurement of tear osmolarity is essential for dry eye. This prospective observational and experimental study was conducted in 182 eyes of 182 participants, including 115 subjects with dry eye (Sjögren syndrome aqueous-deficient dry eye [SS ADDE], non-SS ADDE, and evaporative DE [EDE]), 36 with conjunctivochalasis (CCh), and 31 normal controls (NC). The ocular surface disease index (OSDI), tear meniscus height (TMH), Schirmer I test, tear matrix metalloproteinase-9 (MMP-9), tear breakup time, and ocular staining score were assessed. Tear osmolarity was measured using the TearLab osmolarity system (Escondido, CA, USA) by applying 1.0 μl tears collected by micropipette to the TearLab test card or by direct contact between the test card and the temporal tear meniscus. For in vitro analyses, osmolarity of 271.25, 300, 347.5, and 395 mOsm/L solutions were measured at various volumes (0.2, 0.5, 1.0, 2.0, and 5.0 μl) with a TearLab osmometer. Tear osmolarity measured by direct contact was higher than that measured by micropipette (13.7 ± 10.5 mOsm/L, p  < 0.001). The difference of osmolarities was higher in the non-SS ADDE, SS ADDE, and CCh than in the NC and EDE ( p  < 0.001 for all). Osmolarity was negatively correlated with Schirmer score and TMH (r = − 0.346, p  < 0.001; r = − 0.447, p  < 0.001, respectively). The smaller the sample volume, the higher the measured osmolarity in the in vitro analysis at 300 and 347.5 mOsm/L (r = − 0.659, p  < 0.01; r = − 0.579, p  < 0.05, respectively). The TearLab osmometer tended to report higher tear osmolarity inversely proportional to sample volumes, possibly due to the evaporation effect. Therefore, care should be taken when interpreting tear osmolarity in patients with low tear volume or CCh.