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Bisen AC, Dubey A, Agrawal S, Biswas A, Rawat KS, Srivastava S, Bhatta RS. Recent updates on ocular disease management with ophthalmic ointments. Ther Deliv 2024:1-8. [PMID: 38888757 DOI: 10.1080/20415990.2024.2346047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 04/18/2024] [Indexed: 06/20/2024] Open
Abstract
Ophthalmic diseases can result in permanent vision loss and blindness. Convenient topical and systemic treatments are preferred to address these sight-threatening conditions. However, the unique anatomy of the eye presents challenges for drug delivery. Various ophthalmic ointment formulations have been developed to enhance bioavailability in the eye to prolong residence time and improve corneal permeability. This article explores a wide range of ocular diseases affecting individuals globally and how ointments are used to manage them. From eye to ocular barriers, this review focuses on published scientific research and formulation strategies for severe ocular complications using conventional topical ointments. Additionally, it delves through patented technologies and marketed formulations supporting the use of ointments in ocular drug delivery.
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Affiliation(s)
- Amol Chhatrapati Bisen
- Pharmaceutics & Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow, 226031, Uttar Pradesh, India
- Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, 201002, Uttar Pradesh, India
- Sophisticated Analytical Instrument Facility and Research, CSIR-Central Drug Research Institute, Lucknow, 226031, Uttar Pradesh, India
| | - Ayush Dubey
- Pharmaceutics & Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow, 226031, Uttar Pradesh, India
- School of Pharmaceutical Sciences, CSJM University, Kanpur, 208024, Uttar Pradesh, India
| | - Sristi Agrawal
- Pharmaceutics & Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow, 226031, Uttar Pradesh, India
- Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, 201002, Uttar Pradesh, India
| | - Arpon Biswas
- Pharmaceutics & Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow, 226031, Uttar Pradesh, India
| | - Kundan Singh Rawat
- Prof. Rajendra Singh Nanoscience & Chemistry D.S.B. Campus, Kumaun University, Nainital, 263001, Uttarakhand, India
| | - Saurabh Srivastava
- Pharmaceutics & Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow, 226031, Uttar Pradesh, India
- School of Pharmaceutical Sciences, CSJM University, Kanpur, 208024, Uttar Pradesh, India
| | - Rabi Sankar Bhatta
- Pharmaceutics & Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow, 226031, Uttar Pradesh, India
- Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, 201002, Uttar Pradesh, India
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Ali W, Alam Khan S, Ullah Khan F, Khan S, Khan WA, Zafar R, Moqeet MA. Long-Term Clinical Outcome of Tacrolimus Skin Ointment (0.03%) for the Treatment of Vernal Keratoconjunctivitis: A Quasi-Experimental Study. Cureus 2023; 15:e50579. [PMID: 38226116 PMCID: PMC10788690 DOI: 10.7759/cureus.50579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/17/2024] Open
Abstract
Background Vernal keratoconjunctivitis (VKC) is an allergic conjunctival inflammation with severe ocular complications if left untreated. The current management regimen is plagued with adverse effects, long-term problems, and clinical relapses. Tacrolimus offers an alternative treatment option, and long-term studies are needed to determine its efficacy. Methods A two-year follow-up based study was conducted on moderate to severe VKC patients, who were prescribed tacrolimus skin ointment. The 5-5-5 exacerbation scale was used for the monitoring and grading severity of the disease. Analysis of variance (ANOVA) and intergroup comparisons were conducted on exacerbation scale scores among follow-ups. Results A significant reduction was observed in the total score of severity from baseline (203.17±102.05) to three months' follow-up (69.94±70.54), and it kept reducing for 18 months post therapy. Similar results with statistically significant reduction were observed for all grades of the scale. The relapse rate was 5.71% within a month after therapy cessation, and none of the other patients showed relapse afterward. No significant ocular and systemic complications were observed during the study. Conclusion Tacrolimus is effective in the long-term management of VKC without the complications of conventional steroid-based therapy.
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Affiliation(s)
- Warda Ali
- Cornea and Refractive Surgery, Al-Shifa Trust Eye Hospital, Rawalpindi, PAK
| | - Saad Alam Khan
- Cornea and Refractive Surgery, Al-Shifa Trust Eye Hospital, Rawalpindi, PAK
| | - Fahim Ullah Khan
- Cornea and Refractive Surgery, Al-Shifa Trust Eye Hospital, Rawalpindi, PAK
| | - Shama Khan
- Cornea and Refractive Surgery, Al-Shifa Trust Eye Hospital, Rawalpindi, PAK
| | - Wajid A Khan
- Cornea and Refractive Surgery, Al-Shifa Trust Eye Hospital, Rawalpindi, PAK
| | - Rabeeah Zafar
- Cornea and Refractive Surgery, Al-Shifa Trust Eye Hospital, Rawalpindi, PAK
| | - Muhammad A Moqeet
- Cornea and Refractive Surgery, Al-Shifa Trust Eye Hospital, Rawalpindi, PAK
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Bardoloi P, Vanathi M, Velpandian T, Laxmi M, Gupta N, Lomi N, Tandon R. Tear Tacrolimus Levels and Clinical Response After Adjunct Therapy With Cutaneous Application of Tacrolimus 0.1% Over Upper Eyelid Skin in Chronic Vernal Keratoconjunctivitis. Cornea 2023:00003226-990000000-00409. [PMID: 37921523 DOI: 10.1097/ico.0000000000003404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/11/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE The aim of this study was to evaluate the role of cutaneous application of 0.1% tacrolimus eye ointment over the skin of the upper eyelid in chronic vernal keratoconjunctivitis (VKC). METHODS A prospective, longitudinal, noncomparative, open-label clinical study of moderate-to-severe grade steroid-dependent VKC was performed. Study participants were initiated on adjunct therapy of cutaneous application of 0.1% tacrolimus ointment twice daily on the upper eyelid skin. Ocular surface evaluation parameters, meibomian gland imaging, intraocular pressure, visual acuity, and clinical disease severity scoring were performed to assess clinical response at baseline and month 3 of therapy. Tear levels of tacrolimus were measured at month 3 using high-performance liquid chromatography tandem mass spectrometry and correlated with the clinical score. RESULTS Palpebral form of VKC was observed in 85% of the cases, with positive family history in 5%, atopy in 7.5%, and keratoconus in 11.25%. Clinical assessment revealed improvement in 97.5% patients with discontinuation of concomitant topical steroids in 64% of patients. There were no changes in visual acuity, intraocular pressure, or ocular surface evaluation after therapy. Tacrolimus was detected in the tears of all our study patients after cutaneous application over the upper eyelid skin, proving its bioavailability with mean tear tacrolimus levels of 6.55 ± 21.43 ng/mL. Correlation analysis revealed a moderate negative correlation between the clinical score and tacrolimus concentration (Spearman correlation coefficient: -0.34, P = 0.002). CONCLUSIONS Cutaneous tacrolimus 0.1% ointment over the upper eyelid skin is an efficacious alternative method of application in treatment of VKC, with no resultant ocular irritation.
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Affiliation(s)
- Priyadarshana Bardoloi
- Cornea and Ocular Surface, Cataract and Refractive Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; and
| | - Murugesan Vanathi
- Cornea and Ocular Surface, Cataract and Refractive Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; and
| | - Thirumurthy Velpandian
- Ocular Pharmacology Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Moksha Laxmi
- Ocular Pharmacology Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Noopur Gupta
- Cornea and Ocular Surface, Cataract and Refractive Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; and
| | - Neiwete Lomi
- Cornea and Ocular Surface, Cataract and Refractive Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; and
| | - Radhika Tandon
- Cornea and Ocular Surface, Cataract and Refractive Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; and
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Bruschi G, Ghiglioni DG, Cozzi L, Osnaghi S, Viola F, Marchisio P. Vernal Keratoconjunctivitis: A Systematic Review. Clin Rev Allergy Immunol 2023; 65:277-329. [PMID: 37658939 PMCID: PMC10567967 DOI: 10.1007/s12016-023-08970-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 09/05/2023]
Abstract
Vernal keratoconjunctivitis (VKC) is a chronic, bilateral corneal and conjunctival problem which typically presents in young individuals. VKC is characterized by itching, photophobia, white mucous discharge, lacrimation, foreign body sensation, and pain due to corneal involvement of shield ulcers. Vernal keratoconjunctivitis is categorized within ocular diseases. The diagnosis is clinical, as no sure biomarkers pathognomonic of the disease have yet been identified. The VKC therapy relies on different types of drugs, from antihistamines and topical steroids to cyclosporine or tacrolimus eye drops. In extremely rare cases, there is also the need for surgical treatment for the debridement of ulcers, as well as for advanced glaucoma and cataracts, caused by excessive prolonged use of steroid eye drops. We performed a systematic review of the literature, according to PRISMA guideline recommendations. We searched the PubMed database from January 2016 to June 2023. Search terms were Vernal, Vernal keratoconjunctivitis, and VKC. We initially identified 211 articles. After the screening process, 168 studies were eligible according to our criteria and were included in the review. In this study, we performed a systematic literature review to provide a comprehensive overview of currently available diagnostic methods, management of VKC, and its treatments.
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Affiliation(s)
| | - Daniele Giovanni Ghiglioni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Via della Commenda 9, 20122, Milan, Italy.
| | - Laura Cozzi
- Università degli Studi di Milano, Milan, Italy
| | - Silvia Osnaghi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Via della Commenda 9, 20122, Milan, Italy
| | - Francesco Viola
- Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Via della Commenda 9, 20122, Milan, Italy
| | - Paola Marchisio
- Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Via della Commenda 9, 20122, Milan, Italy
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Ghauri AJ, Biswas S, Manzouri B, Barua A, Sharma V, Hoole J, Dahlmann-Noor A. Management of Vernal Keratoconjunctivitis in Children in the United Kingdom: A Review of the Literature and Current Best Practice Across Six Large United Kingdom Centers. J Pediatr Ophthalmol Strabismus 2023; 60:6-17. [PMID: 35611818 DOI: 10.3928/01913913-20220328-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Vernal keratoconjunctivitis (VKC) is a form of ocular allergy primarily affecting children. Considered a rare disease in Europe, its prevalence varies by geographic region and is poorly studied in the United Kingdom. There is considerable national variation in the management of VKC within the United Kingdom, risking misdiagnosis and delays to treatment for some children. This can significantly impact their quality of life, with the potential for lasting negative consequences. Based on discussions between experienced clinicians from six large centers across the United Kingdom, this article describes best practice recommendations for United Kingdom settings, including principles for diagnosis, referral, initial and long-term management, and supportive care. Recommendations include guidance on referral timing, which should depend on VKC severity, and a stepwise approach to treatment. Joint management by primary care and secondary care is recommended and the importance of supportive care, including emotional support and outreach to schools, is highlighted. Because frequent flareups are common in VKC, it is essential that families have access to the information they need to manage the disease and routes to access rapid care if needed. A thorough understanding of the nature of VKC, its triggers, and how best to manage it, by both patients and their families, is critical to ensuring appropriate management and to improving patient outcomes. [J Pediatr Ophthalmol Strabismus. 2023;60(1):6-17.].
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Tsui M, Chiang B, Wang I. Successful treatment and prevention of the recurrence of refractory vernal keratoconjunctivitis with dupilumab. Clin Exp Ophthalmol 2022; 50:1100-1103. [DOI: 10.1111/ceo.14142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/16/2022] [Accepted: 07/23/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Mei‐Chi Tsui
- Department of Ophthalmology National Taiwan University Hospital Taipei Taiwan
- Department of Ophthalmology An Nan Hospital, China Medical University Tainan Taiwan
| | - Bor‐Luen Chiang
- Department of Pediatrics National Taiwan University Hospital Taipei Taiwan
- Graduate Institute of Clinical Medicine College of Medicine, National Taiwan University Taipei Taiwan
| | - I‐Jong Wang
- Department of Ophthalmology National Taiwan University Hospital Taipei Taiwan
- Department of Ophthalmology College of Medicine, National Taiwan University Taipei Taiwan
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Mehta JS, Chen WL, Cheng ACK, Cung LX, Dualan IJ, Kekunnaya R, Khaliddin N, Kim TI, Lam DK, Leo SW, Manurung F, Tesavibul N, Bremond-Gignac D. Diagnosis, Management, and Treatment of Vernal Keratoconjunctivitis in Asia: Recommendations From the Management of Vernal Keratoconjunctivitis in Asia Expert Working Group. Front Med (Lausanne) 2022; 9:882240. [PMID: 35979210 PMCID: PMC9376221 DOI: 10.3389/fmed.2022.882240] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Vernal keratoconjunctivitis (VKC) is an underdiagnosed and underrecognized ocular surface disease with limited epidemiological data in Asia. It is more prevalent in warm, dry, and windy climates, and often has a substantial impact on a patient’s quality of life. In rare cases, VKC can be associated with vision loss, either through corticosteroid overuse or inadequate treatment of persistent inflammation. As a potentially severe and complex disease, there is variability with how VKC is managed across Asia and among the various allergic eye diseases. Diagnosis and treatment of patients with VKC is a challenge for many ophthalmologists, since no precise diagnostic criteria have been established, the pathogenesis of the disease is unclear, and anti-allergic treatments are often ineffective in patients with moderate or severe disease. In addition, the choice of treatment and management strategies used for patients varies greatly from country to country and physician to physician. This may be because of a lack of well-defined, standardized guidelines. In response, the Management of Vernal Keratoconjunctivitis in Asia (MOVIA) Expert Working Group (13 experts) completed a consensus program to evaluate, review, and develop best-practice recommendations for the assessment, diagnosis, and management of VKC in Asia. The expert-led recommendations are summarized in this article and based on the currently available evidence alongside the clinical expertise of ophthalmologists from across Asia with specialism and interest in the ocular surface, VKC, and pediatric ophthalmology.
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Affiliation(s)
- Jodhbir S. Mehta
- Corneal & External Eye Disease Department, Singapore National Eye Centre, Singapore, Singapore
- *Correspondence: Jodhbir S. Mehta,
| | - Wei-Li Chen
- Department of Ophthalmology and Advanced Ocular Surface and Corneal Nerve Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Arthur C. K. Cheng
- Department of Ophthalmology, Hong Kong Sanatorium & Hospital, Hong Kong, Hong Kong SAR, China
| | | | - Ivo J. Dualan
- Department of Ophthalmology and Visual Sciences, University of the Philippines, Quezon City, Philippines
| | - Ramesh Kekunnaya
- Child Sight Institute, Jasti V Ramanamma Children’s Eye Care Center, LV Prasad Eye Institute, Hyderabad, India
| | - Nurliza Khaliddin
- Department of Ophthalmology, University Malaya Eye Research Center, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Tae-Im Kim
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Douglas K. Lam
- The Hong Kong Ophthalmic Associates, Hong Kong, Hong Kong SAR, China
| | - Seo Wei Leo
- Dr Leo Adult & Paediatric Eye Specialist Pte Ltd; Mount Elizabeth Hospital, Singapore, Singapore
| | | | - Nattaporn Tesavibul
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Dominique Bremond-Gignac
- Department of Ophthalmology, University Hospital Necker-Enfants Malades, APHP, OPHTARA, Paris, France; INSERM Unit UMRS1138, Team 17, Paris University, Paris, France
- Dominique Bremond-Gignac,
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Bernales A, Berger O, Hamada S. Topical tacrolimus for the treatment of external eye inflammation in children. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2039628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Osvaldo Berger
- Corneoplastic department. Queen Victoria Hospital. East Grinstead. United Kingdom
| | - Samer Hamada
- Corneoplastic department. Queen Victoria Hospital. East Grinstead. United Kingdom
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Shih EJ, Lin JC, Peng KL, Chen JL. Treating refractory corneal hydrops in a male patient with vernal keratoconjunctivitis and mental retardation: a case report. BMC Ophthalmol 2022; 22:36. [PMID: 35073856 PMCID: PMC8785578 DOI: 10.1186/s12886-021-02241-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 12/30/2021] [Indexed: 11/15/2022] Open
Abstract
Background Keratoconus is the most common noninflammatory bilateral corneal ectasia. Vernal keratoconjunctivitis (VKC) and eye rubbing may be associated with keratoconus in children and young adults. Timely management of advanced keratoconus is important to improve visual quality. In addition, it is challenging to carry out VKC treatment with an intent to avoid the occurrence of punctate epithelial keratitis, ulceration, or corneal neovascularization on corneal grafts. Case presentation We report the case of an 18-year-old male patient with a long-term history of mental retardation due to megalencephaly presenting with acute onset of corneal hydrops with prominent bulging and refractory steroid-induced glaucoma of the right eye. The topography of the right eye was unavailable due to advanced ectasia, and that of the left eye revealed central steepening with inferior-superior dioptric asymmetry. According to the clinical findings, the patient was diagnosed with keratoconus. Because of progressive corneal opacity and neovascularization, the patient underwent penetrating keratoplasty (PK) with combination of interrupted and intrastromal running suturing after receiving a preoperative subconjunctival injection of bevacizumab in his right eye, followed by lower eyelid correction. After surgery, the patient was treated with 0.1% tacrolimus dermatological ointment, 0.1% cyclosporine eye drops, artificial tears, and 0.5% loteprednol for keratoplasty and VKC. Repeated education on avoiding eye rubbing was offered to the patient. Two years after PK treatment, his best-corrected visual acuity of the right eye successfully improved from hand motion at 10 cm preoperatively to 6/20 postoperatively. Conclusions Large-diameter PK with intrastromal suturing technique for advanced keratoconus could achieve better visual outcomes and avoid suture-related complications. In addition, tacrolimus dermatological ointment rather than tacrolimus topical eye drops or ointment showed satisfactory efficacy when combined with topical cyclosporine and steroid that no significant VKC reactivation were noted after PK.
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Chen M, Wei A, Ke B, Zou J, Gong L, Wang Y, Zhang C, Xu J, Yin J, Hong J. Combination of 0.05% Azelastine and 0.1% Tacrolimus Eye Drops in Children With Vernal Keratoconjunctivitis: A Prospective Study. Front Med (Lausanne) 2021; 8:650083. [PMID: 34604246 PMCID: PMC8484704 DOI: 10.3389/fmed.2021.650083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 08/18/2021] [Indexed: 11/29/2022] Open
Abstract
Aims: To compare the efficacy of the combination of 0. 05% azelastine and 0.1% tacrolimus eye drops with 0.1% tacrolimus monotherapy in pediatric patients with vernal keratoconjunctivitis (VKC). Methods: Prospective study. Seventy-six patients with VKC were randomized 1:1 into monotherapy group with 0.1% tacrolimus or combination therapy group with 0.1% tacrolimus and 0.05% azelastine. The Ocular Surface Disease Index (OSDI) scores and the signs of conjunctival hyperemia, corneal involvement, and palpebral conjunctiva papillae were assessed at baseline and at 1, 2, and 6 weeks after treatment. Results: Two groups were comparable in age, sex, duration of VKC, OSDI, and clinical signs of VKC at baseline. Significant improvements in OSDI score and clinical signs were observed in both groups at all follow-up visits (all p < 0.001), compared with baseline. The combination therapy group showed a larger decrease in OSDI score from baseline (10.30 ± 0.9) compared with monotherapy group (7.30 ± 0.7, p =0.0085) at 1 week. Greater improvements in conjunctival hyperemia and conjunctival papillae were identified in the combination therapy group, compared with in the monotherapy group, at all follow-up visits (all p < 0.05). The corneal involvement scores in the combination group is significantly lower than the monotherapy group at 2 weeks after the treatment (p = 0.0488). No severe adverse effect was found in either group during the study. Conclusions: Compared with a monotherapy of 0.1% tacrolimus, the combination of 0.05% azelastine and 0.1% tacrolimus eye drops lead to faster and greater improvements in clinical signs and symptoms of vernal keratoconjunctivitis in pediatric patients.
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Affiliation(s)
- Minjie Chen
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, Shanghai, China.,Key myopia Laboratory of NHC, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Science, Shanghai, China
| | - Anji Wei
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, Shanghai, China.,Key myopia Laboratory of NHC, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Science, Shanghai, China
| | - Bilian Ke
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jun Zou
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lan Gong
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, Shanghai, China.,Key myopia Laboratory of NHC, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Science, Shanghai, China
| | - Yan Wang
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, Shanghai, China.,Key myopia Laboratory of NHC, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Science, Shanghai, China
| | - Chaoran Zhang
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, Shanghai, China.,Key myopia Laboratory of NHC, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Science, Shanghai, China
| | - Jianjiang Xu
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, Shanghai, China.,Key myopia Laboratory of NHC, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Science, Shanghai, China
| | - Jia Yin
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
| | - Jiaxu Hong
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, Shanghai, China.,Key myopia Laboratory of NHC, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Science, Shanghai, China.,Department of Ophthalmology, The Affiliated Hospital of Guizhou Medical University, Guizhou, China
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11
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Modi D, Mohammad, Warsi MH, Garg V, Bhatia M, Kesharwani P, Jain GK. Formulation development, optimization, and in vitro assessment of thermoresponsive ophthalmic pluronic F127-chitosan in situ tacrolimus gel. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2021; 32:1678-1702. [PMID: 34013840 DOI: 10.1080/09205063.2021.1932359] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
To overcome problems associated with topical delivery of tacrolimus (TCS), a thermoresponsive in situ gel system containing pluronic F127 (PL), and chitosan (CS) was developed, to enhance the precorneal retention, and to sustain the release of the drug. The PL-CS in situ gel was optimized using a 2-factor-3-level central composite experimental design by selecting the concentration of PL and CS as independent variables while gelation time, gelation temperature, and spreadability as dependent variables. The optimized formulation was developed using 22.5 g PL and 0.3 g CS, gels at 33.6 °C, in 22.93 s, and showed the spreadability of 6.2 cm. In vitro studies conducted for the optimized gel revealed the sustained release of TCS (81.73% in 4 h) and improved corneal permeation (74.13% in 4 h), compared with TCS solution. The mechanism of release of TCS followed the Higuchi model with Fickian diffusion transport. Further, histopathology and HET-CAM studies revealed that the developed gel was non-irritating and safe for ocular administration.
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Affiliation(s)
- Deepika Modi
- Department of Pharmaceutical Sciences, Guru Jambheshwar University of Science and Technology, Hisar, Haryana, India
| | - Mohammad
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, Delhi, India
| | - Musarrat H Warsi
- Department of Pharmaceutics and Industrial Pharmacy, College of Pharmacy, Taif University, Taif-Al-Haweiah, Saudi Arabia
| | - Vaidehi Garg
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, Delhi, India
| | - Meenakshi Bhatia
- Department of Pharmaceutical Sciences, Guru Jambheshwar University of Science and Technology, Hisar, Haryana, India
| | - Prashant Kesharwani
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, Delhi, India
| | - Gaurav K Jain
- Department of Pharmaceutics, Delhi Pharmaceutical Science and Research University, New Delhi, Delhi, India
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Abstract
PURPOSE OF REVIEW The purpose of this article is to provide an update on the advances made through recent clinical trials regarding the treatment of the signs and symptoms of allergic conjunctivitis and its associated conditions. RECENT FINDINGS Recent studies have demonstrated significant advancement in the various forms of immunotherapy treatments. Nutritional interventions such as probiotics have surfaced as a viable complementary treatment option. Novel delivery methods such as contact lenses have been further studied along with a new tacrolimus formulation to improve ocular levels of the drug. SUMMARY Currently, the primary advances in treatment for allergic conjunctivitis has shifted from new ophthalmic agents to immunotherapy and improvement of drug delivery. This includes the classic subcutaneous and sublingual and the novel epicutaneous and intralymphatic immunotherapy delivery systems as well as an edible rice vaccine. New targets for treatment have spurred research into new antagonist drugs such as (OC000459), a prostaglandin D2 antagonist. The Marinosolv formulation using tacrolimus shows promise and may be considered for other ophthalmic agents in the future. Other nonpharmacological treatments such as stenting and mechanical barrier gel have demonstrated their usefulness in treating ocular symptoms.
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