ABSTRACT.Purpose: To evaluate ocular surface characteristics and tear film function following modified Hughes flap for eyelid reconstruction. Methods: This is an institutional study including 18 patients (6 male, 12 female) who underwent a tarsoconjunctival flap for reconstructing the lower eyelid's posterior lamella in one eye between 2005 and 2010. The median age of the patients was 72 (49-93) years at the time of surgery and 77 (51-97) years at the time of evaluation. The median follow-up time was 34 (9-69) months. All patients had large malignant or semi-malignant lid tumours. Data for subjective symptoms (OSDI questionnaire), lid margin morphology, tear break-up time (BUT), vital staining, Schirmer test, impression cytology, tear film osmolarity, lipid layer interference patterns, meibography and the size of the tumour and flap were recorded and compared with the contralateral side. Results: Statistical analysis of the data revealed a significant difference between the surgically treated lid and the untreated side in meibomian gland loss, more lid margin abnormalities in the upper and lower eyelid (p < 0.001) and increased fluorescein staining of the cornea (p = 0.031). For the operated side, the median OSDI score was higher (17.2 versus 14.7), and the median BUT value was shorter (4.2 versus 5.6 seconds) compared with the median values of the contralateral side. Conclusion: Despite the favourable cosmetic and functional results of the Hughes tarsoconjunctival flap, our results indicate that this procedure does affect the ocular surface health in the treated eyes.

In eyes with open-angle glaucoma, increased deposits of extracellular matrix have been found in the trabecular meshwork. 1As the trabecular meshwork is rinsed by aqueous humour, it seems possible and plausible that alterations of the aqueous humour might influence the behaviour of the trabecular meshwork cells. The so-called 'deep-freezing crystallisation' procedure limits the influence of changes in temperature on the crystallisation process.Using this method it is possible to obtain a pattern of single crystals that can be compared with other samples. The method and the analysis of freeze-crystallisation patterns of human tear fluid and aqueous humour have been described before. [11][12][13] In order to find a difference in the crystallisation behaviour of the aqueous humour we investigated glaucomatous and non-glaucomatous eyes under a constant temperature of -20°C. Patients and MethodsWe investigated samples of aqueous humour from 20 patients Freeze-controlled Crystallisation of the Aqueous Humour in Glaucomatous and Non-glaucomatous Patients AbstractThe purpose of this study was to investigate the aqueous humour of glaucomatous and non-glaucomatous patients by freeze-controlled crystallisation qualitatively to detect a possible difference. Aqueous humour was taken from 20 patients with different kinds of glaucoma(11 primary open-angle glaucoma, eight pseudo-exfoliation glaucoma, one pigmentary glaucoma) and compared with samples from 40 patients with cataracts and to samples from seven patients with cataract and glaucoma; 1μl of each sample was applied to a microscope slide and put in a deep-freezer at a constant temperature of -20°C for 24 hours. During this time, the water evaporated and distinct crystal patterns developed. These patterns were examined stereo-microscopically, stored digitally and compared with each other. Many distinct crystals of different sizes and formations were obtained. No obvious differences in the crystal patterns could be found between the three groups (patients with glaucoma, cataract or cataract and glaucoma). As a multifactorial disease, open-angle glaucoma is characterised by specific changes to the trabecular meshwork cells with an accumulation of deposits of extracellular matrix. Since the trabeculum is rinsed consistently by aqueous humour, changes of the compounds might influence these cells. Alterations concerning this were published. In contrast to the ferning test, one of several methods of examining fluids with patterns that are highly dependent on temperature and humidity, our examinations with freeze-controlled crystallisation at a constant and controlled temperature of -20°C gave more valid results. In our study we could not find obvious differences in the crystal patterns of patients with cataract, glaucoma or cataract and glaucoma.