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Mortemousque B, Pisella PJ, Salaun N, Lemaire N, Chanel I. Homoeopathic eye drops in the treatment of mild-to-moderate dry eye disease: Randomised, prospective, multicentre, single-masked study. Eur J Ophthalmol 2024; 34:1119-1127. [PMID: 38062637 DOI: 10.1177/11206721231216129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
INTRODUCTION To compare the efficacy and safety of a homeopathic eye drop medicinal product (Homeoptic®) with 0.9% sodium hydrochloride eye drops (Larmabak®) in patients with mild-to-moderate dry eye disease (DED). METHODS Prospective, single-masked, observer-blinded, multicentre study on adult patients. Non-inferiority primary endpoint of the relative change between treatment groups in a composite Visual Analogue Scale (VAS) score covering five symptoms of DED, namely pain, itching, sensation of dry eye, impression of foreign body presence and burning, after 30 days of treatment. Details of all Adverse Events (AEs) were recorded and analysed. RESULTS Ninety three patients were randomised to each treatment arm. At Day 30, the mean VAS symptom score was 26.0 ± 18.8 in the Homeoptic® group and 32.8 ± 21.2 Larmabak® group. Homeoptic® was demonstrated to be non-inferior to Larmabak®: the mean treatment difference of -7 being below the 10 mm upper limit of the 95% CI ([-12.9; -1.0]) pre-set as significant. The superiority of Homeoptic® over Larmabak® was then established with detection of a significant difference between the two treatment groups (p = 0.022). Significant differences between the treatment groups in favour of Homeoptic® were also detected in isolated VAS scores for the symptoms dry eye sensation (p = 0.009) and burning (p = 0.004). Results of ocular surface staining tests to estimate corneal and conjunctival damage as well as patient satisfaction were also significantly in favour of Homeoptic®. No new safety concerns were identified. CONCLUSION Homeoptic® is more effective than Larmabak® at relieving the symptoms of DED and constitutes an effective treatment for mild-to-moderate DED.
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Affiliation(s)
| | - P J Pisella
- Ophthalmologist, University Hospital, Tours, France
| | - N Salaun
- Ophthalmologist, Private Practitioner, Jouy aux Arches, France
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Conticini E, Bardelli M, Vitale A, De Stefano R, Falsetti P, Selvi E, Bacarelli MR, D'Alessandro R, Cantarini L, Frediani B, Gentileschi S. Diagnostic role of minor salivary glands biopsy in Sjögren's syndrome: correlations between histology and autoimmunity in a large, monocentric cohort. Reumatologia 2023; 61:109-115. [PMID: 37223369 PMCID: PMC10201380 DOI: 10.5114/reum/163213] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/12/2023] [Indexed: 05/25/2023] Open
Abstract
Introduction Based on ACR/EULAR classification criteria, minor salivary glands biopsy (MSGB) is a useful diagnostic tool for the diagnosis of primary Sjögren's syndrome (SS). The main objective of our study was to evaluate the diagnostic role of MSGB, as well as to highlight correlations between histological findings and autoimmune profiles. Material and methods We retrospectively evaluated histological and autoimmunity data from patients who underwent MSGB in our department in cases of suspected SS, from March 2011 to December 2018. Salivary gland samples were evaluated using Chisholm and Mason (CM) grading and the focus score (FS). Results A total of 1,264 patients (108 males, 1,156 females) were included. The median age was 55.22 ±13.51 years (range: 15-87). In univariate binary logistic regression, CM ≥ 3 and FS ≥ 1 were significantly predicted by antinuclear antibodies (ANA), anti-extractable nuclear antigens (ENA) and anti-Ro/SSA titer as well as anti-La/SSB, anti-Ro/SSA, rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) positivity. In multivariate analysis, CM ≥ 3 and MSGB positivity were significantly associated with ANA titer; FS ≥ 1 was not associated with laboratory findings. A positive biopsy was associated with laboratory findings, as ANA and ENA titers, anti-Ro/SSA, anti-La/SSB, RF and ACPA positivity may discriminate patients with SS-related histological findings. Conclusions Minor salivary glands biopsy is a useful tool to diagnose SS in cases of highly suggestive clinical symptoms but in the absence of a specific autoimmunity.
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Affiliation(s)
- Edoardo Conticini
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - Marco Bardelli
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - Antonio Vitale
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - Renato De Stefano
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - Paolo Falsetti
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - Enrico Selvi
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - Maria Romana Bacarelli
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - Roberto D'Alessandro
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - Luca Cantarini
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - Bruno Frediani
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - Stefano Gentileschi
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
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Gomes JAP, Azar DT, Baudouin C, Efron N, Hirayama M, Horwath-Winter J, Kim T, Mehta JS, Messmer EM, Pepose JS, Sangwan VS, Weiner AL, Wilson SE, Wolffsohn JS. TFOS DEWS II iatrogenic report. Ocul Surf 2017; 15:511-538. [PMID: 28736341 DOI: 10.1016/j.jtos.2017.05.004] [Citation(s) in RCA: 255] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 05/02/2017] [Indexed: 01/04/2023]
Abstract
Dry eye can be caused by a variety of iatrogenic interventions. The increasing number of patients looking for eye care or cosmetic procedures involving the eyes, together with a better understanding of the pathophysiological mechanisms of dry eye disease (DED), have led to the need for a specific report about iatrogenic dry eye within the TFOS DEWS II. Topical medications can cause DED due to their allergic, toxic and immuno-inflammatory effects on the ocular surface. Preservatives, such as benzalkonium chloride, may further aggravate DED. A variety of systemic drugs can also induce DED secondary to multiple mechanisms. Moreover, the use of contact lens induces or is associated with DED. However, one of the most emblematic situations is DED caused by surgical procedures such as corneal refractive surgery as in laser-assisted in situ keratomileusis (LASIK) and keratoplasty due to mechanisms intrinsic to the procedure (i.e. corneal nerve cutting) or even by the use of postoperative topical drugs. Cataract surgery, lid surgeries, botulinum toxin application and cosmetic procedures are also considered risk factors to iatrogenic DED, which can cause patient dissatisfaction, visual disturbance and poor surgical outcomes. This report also presents future directions to address iatrogenic DED, including the need for more in-depth epidemiological studies about the risk factors, development of less toxic medications and preservatives, as well as new techniques for less invasive eye surgeries. Novel research into detection of early dry eye prior to surgeries, efforts to establish appropriate therapeutics and a greater attempt to regulate and oversee medications, preservatives and procedures should be considered.
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Affiliation(s)
- José Alvaro P Gomes
- Dept. of Ophthalmology and Visual Sciences, Federal University of Sao Paulo/Paulista School of Medicine (UNIFESP/EPM), São Paulo, SP, Brazil.
| | - Dimitri T Azar
- University of Illinois College of Medicine, Chicago, IL, USA
| | | | - Nathan Efron
- School of Optometry and Vision Science, Queensland University of Technology, Queensland, Australia
| | - Masatoshi Hirayama
- Department of Ophthalmology, School of Medicine, Keio University, Tokyo, Japan
| | | | - Terry Kim
- Duke University School of Medicine, Durham, NC, USA; Duke University Eye Center, Durham, NC, USA
| | | | - Elisabeth M Messmer
- Department of Ophthalmology, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Jay S Pepose
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Steven E Wilson
- Cole Eye Institute, The Cleveland Clinic, Cleveland, OH, USA
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Cornec D, Saraux A, Jousse-Joulin S, Pers JO, Boisramé-Gastrin S, Renaudineau Y, Gauvin Y, Roguedas-Contios AM, Genestet S, Chastaing M, Cochener B, Devauchelle-Pensec V. The Differential Diagnosis of Dry Eyes, Dry Mouth, and Parotidomegaly: A Comprehensive Review. Clin Rev Allergy Immunol 2016; 49:278-87. [PMID: 24952023 DOI: 10.1007/s12016-014-8431-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Primary Sjögren's syndrome (pSS) is a frequent autoimmune systemic disease, clinically characterized by eyes and mouth dryness in all patients, salivary gland swelling or extraglandular systemic manifestations in half of the patients, and development of lymphoma in 5 to 10 % of the patients. However, patients presenting with sicca symptoms or salivary gland swelling may have a variety of conditions that may require very different investigations, treatments, or follow-up. Eye and/or mouth dryness is a frequent complaint in clinical setting, and its frequency increases with age. When evaluating a patient with suspected pSS, the first step is to rule out its differential diagnoses, before looking for positive arguments for the disease. Knowledge of normal and abnormal lachrymal and salivary gland physiology allows the clinician to prescribe the most adapted procedures for evaluating their function and structure. New tests have been developed in recent years for evaluating these patients, notably new ocular surface staining scores or salivary gland ultrasonography. We describe the different diagnoses performed in our monocentric cohort of 240 patients with suspected pSS. The most frequent diagnoses are pSS, other systemic autoimmune diseases, idiopathic sicca syndrome and drug-induced sicca syndrome. However, other diseases are important to rule out due to their specific management, such as sarcoidosis, granulomatosis with polyangeitis, IgG4-related disease, chronic hepatitis C virus or human immunodeficiency virus infections, graft-versus-host disease, and head and neck radiation therapy. At the light of these data, we propose a core of minimal investigations to be performed when evaluating a patient with suspected pSS.
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Affiliation(s)
- Divi Cornec
- Department of Rheumatology, Brest Teaching Hospital, Brest, France.,EA2216, INSERM ESPRI, ERI29, Université de Brest, Brest, France.,LabEx IGO, Brest, France
| | - Alain Saraux
- Department of Rheumatology, Brest Teaching Hospital, Brest, France.,EA2216, INSERM ESPRI, ERI29, Université de Brest, Brest, France.,LabEx IGO, Brest, France
| | - Sandrine Jousse-Joulin
- Department of Rheumatology, Brest Teaching Hospital, Brest, France.,EA2216, INSERM ESPRI, ERI29, Université de Brest, Brest, France.,LabEx IGO, Brest, France
| | - Jacques-Olivier Pers
- EA2216, INSERM ESPRI, ERI29, Université de Brest, Brest, France.,LabEx IGO, Brest, France.,Department of Odontology, Brest Teaching Hospital, Brest, France
| | | | - Yves Renaudineau
- EA2216, INSERM ESPRI, ERI29, Université de Brest, Brest, France.,LabEx IGO, Brest, France.,Department of Odontology, Brest Teaching Hospital, Brest, France.,Laboratory of Immunology, Brest Teaching Hospital, Brest, France
| | - Yves Gauvin
- Department of Ear, Nose, Throat, Brest Teaching Hospital, Brest, France
| | | | - Steeve Genestet
- Department of Neurological Functional Explorations, Brest Teaching Hospital, Brest, France
| | - Myriam Chastaing
- Department of Psychiatry, Brest Teaching Hospital, Brest, France
| | | | - Valérie Devauchelle-Pensec
- Department of Rheumatology, Brest Teaching Hospital, Brest, France. .,EA2216, INSERM ESPRI, ERI29, Université de Brest, Brest, France. .,LabEx IGO, Brest, France. .,Service de Rhumatologie, Hôpital de la Cavale Blanche, BP 824, 29609, Brest Cedex, France.
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Ceylan E, Ozer MD, Yilmaz YC, Kartal B, Yildiz Ekinci D, Çinici E, Aksu Ceylan N. The ocular surface side effects of an anti-psychotic drug, clozapine. Cutan Ocul Toxicol 2015; 35:62-6. [PMID: 25853177 DOI: 10.3109/15569527.2015.1018387] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this study is to investigate the effects of long-term clozapine usage on tear film stability and corneal topographic parameters. MATERIAL AND METHODS The study was conducted between March 2014 and November 2014. Thirty patients who were diagnosed of schizophrenia and have been under clozapine treatment for 2.73 ± 0.73 years (range 2-4 years) were involved in this study (group 1). Thirty healthy subjects (group 2) who have statistically similar demographic features compared with the group 1, were involved as a control group. Full ophthalmologic examination with biomicroscopy and indirect ophthalmoscopy was applied. Corneal topographic parameters were measured using the Pentacam HR and Schirmer test was done. Statistical analysis of the subjects was evaluated by using SPSS (for Windows version 16.0; SPSS Inc., Chicago, IL) program. RESULTS K1 value was measured as 43.39 ± 0.17 D (43-43.50 D) and K2 value was measured as 43.39 ± 0.06 D (43.30-43.50 D) in groups 1 and 2, respectively. In groups 1 and 2, K2 values were noted as 43.86 ± 0.27 D (43.50-44.50 D) and 43.72 ± 0.18 D (43.50-44.00 D), respectively. Central corneal thickness was found to be 523.93 ± 15.66 µm (495-554 µm) and 550.13 ± 1.03 µm (520-580 µm) in groups 1 and 2, respectively. Corneal apex thickness was 525.86 ± 15.75 µm (497-556 µm) in group 1 and 551.60 ± 14.99 µm (521-581 µm) in group 2. The corneal thickness of thinnest location was 520.93 ± 15.60 µm (492-551 µm) and 548.06 ± 15.17 µm (518-578 µm) in groups 1 and 2, respectively. Corneal volume was determined as 58.13 ± 3.46 mm(3) (52-64 mm(3)) in group 1 and 60.73 ± 3.76 mm(3) (54-66 mm(3)) in group 2. The Schirmer test showed thickness of 3.33 ± 0.72 mm (2-4 mm) and 13.60 ± 1.59 mm (11-16 mm) in groups 1 and 2, respectively. The mean fluorescein break-up time was 5.40 ± 1.50 s (3-8 s) and 12.46 ± 1.40 s (10-14 s) in groups 1 and 2, respectively. There was a statistically significant difference in the Schirmer test, fluorescein break-up time, central corneal thickness, corneal apex, and the thinnest corneal location thickness between the two groups. CONCLUSION Clozapine may induce dry eye syndrome and thus may lead to morphological alterations in corneal parameters through its anticholinergic and antidopaminergic activities. Because of these corneal alterations, one should be aware of evaluating patients having diseases like glaucoma or preoperative selection of corneal refractive surgery candidates.
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Affiliation(s)
- Erdinç Ceylan
- a Department of Ophthalmology , Erzurum Regional Training and Research Hospital , Erzurum , Turkey and
| | - Muhammet Derda Ozer
- b Department of Ophthalmology , Istanbul Faculty of Medicine , Istanbul , Turkey
| | - Yusuf Cem Yilmaz
- b Department of Ophthalmology , Istanbul Faculty of Medicine , Istanbul , Turkey
| | - Baki Kartal
- a Department of Ophthalmology , Erzurum Regional Training and Research Hospital , Erzurum , Turkey and
| | | | - Emine Çinici
- a Department of Ophthalmology , Erzurum Regional Training and Research Hospital , Erzurum , Turkey and
| | - Nihan Aksu Ceylan
- b Department of Ophthalmology , Istanbul Faculty of Medicine , Istanbul , Turkey
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Creuzot-Garcher C, Baudouin C, Labetoulle M, Pisella PJ, Mouriaux F, Meddeb-Ouertani A, El Matri L, Khairallah M, Brignole-Baudouin F. Évaluation de l’efficacité du Nutrilarm®, complément nutritionnel à base d’acides gras essentiels polyinsaturés oméga 3 et oméga 6, versus placebo chez des patients atteints de sécheresse oculaire bilatérale modérée et traitée. J Fr Ophtalmol 2011; 34:448-55. [DOI: 10.1016/j.jfo.2011.01.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 01/24/2011] [Indexed: 11/17/2022]
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