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Kahook MY, Rapuano CJ, Messmer EM, Radcliffe NM, Galor A, Baudouin C. Preservatives and ocular surface disease: A review. Ocul Surf 2024; 34:213-224. [PMID: 39098762 DOI: 10.1016/j.jtos.2024.08.001] [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: 03/06/2024] [Revised: 06/15/2024] [Accepted: 08/01/2024] [Indexed: 08/06/2024]
Abstract
Ocular surface disease (OSD) is a complex condition that can cause a range of symptoms (e.g, dryness, irritation, and pain) and can significantly impact the quality of life of affected individuals. Iatrogenic OSD, a common finding in patients with glaucoma who receive chronic therapy with topical ocular antihypertensive drugs containing preservatives such as benzalkonium chloride (BAK), has been linked to damage to the ocular surface barrier, corneal epithelial cells, nerves, conjunctival goblet cells, and trabecular meshwork. Chronic BAK exposure activates inflammatory pathways and worsens symptoms, compromising the success of subsequent filtration surgery in an exposure-dependent manner. In eyes being treated for glaucoma, symptomatic treatment of OSD may provide some relief, but addressing the root cause of the OSD often necessitates reducing or, ideally, eliminating BAK toxicity. Strategies to decrease BAK exposure in patients with glaucoma encompass the use of preservative-free formulations or drugs with alternative and less toxic preservatives such as SofZia®, Polyquad, potassium sorbate, or Purite®. Though the benefits of these alternative preservatives are largely unproven, they might be considered when financial constraints prevent the use of preservative-free versions. For patients receiving multiple topical preserved drugs, the best practice is to switch to nonpreserved equivalents wherever feasible, regardless of OSD severity. Furthermore, nonpharmacological approaches, including laser or incisional procedures, should be considered. This review explores the effects of BAK on the ocular surface and reviews strategies for minimizing or eliminating BAK exposure in patients with glaucoma in order to significantly improve their quality of life and prevent complications associated with chronic exposure to BAK.
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Affiliation(s)
- Malik Y Kahook
- Department of Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO, United States.
| | | | - Elisabeth M Messmer
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Nathan M Radcliffe
- New York Eye and Ear Infirmary of Mount Sinai, New York, NY, United States; New York Eye Surgery Center, The Bronx, New York, United States
| | - Anat Galor
- Ophthalmology, VA Miami Healthcare System, Miami, FL, United States; Ophthalmology, University of Miami Health System Bascom Palmer Eye Institute, Miami, FL, United States
| | - Christophe Baudouin
- Paris-Saclay, Versailles Saint Quentin University, Paris, Île-de-France, France; Centre Hospitalier National D'Ophtalmologie des Quinze-Vingts, IHU ForeSight, Paris, Île-de-France, France
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Mentek M, Peyret B, Zouari S, Urbaniak S, Papillon JM, Crouzet E, Perrache C, Hodin S, Delavenne X, He Z, Gain P, Thuret G. Design and validation of a custom-made system to measure transepithelial electrical impedance in human corneas preserved in active storage machine. Int J Pharm X 2024; 7:100234. [PMID: 38374874 PMCID: PMC10875219 DOI: 10.1016/j.ijpx.2024.100234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/21/2024] Open
Abstract
Corneal epithelial barrier represents one of the major limitations to ocular drug delivery and can be explored non-invasively through the evaluation of its electrical properties. Human corneas stored in active storage machine (ASM) could represent an interesting physiological model to explore transcorneal drug penetration. We designed a new system adapted to human corneas preserved in ASM to explore corneal epithelial barrier function ex-vivo. A bipolar set-up including Ag/AgCl electrodes adaptors to fit the corneal ASM and a dedicated software was designed and tested on freshly excised porcine corneas (n = 59) and human corneas stored 14 days in ASM (n = 6). Porcine corneas presented significant and proportional decrease in corneal impedance in response to increasing-size epithelial ulcerations and acute exposure to benzalkonium chloride (BAC) 0.01 and 0.05%. Human corneas stored 14 days in ASM presented a significant increase in corneal impedance associated with the restoration of a multi-layer epithelium and an enhanced expression of tight junctions markers zonula occludens 1, claudin 1 and occludin. These results support the relevance of the developed approach to pursue the exploration and development of human corneas stored in ASM as a physiological pharmacological model.
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Affiliation(s)
- Marielle Mentek
- Laboratory of Biology, Engineering and Imaging for Ophthalmology (BiiO), EA2521, Faculté de Médecine, Université de Jean Monnet, 10 rue de la Marandière, 42270 Saint-Etienne, France
| | - Benjamin Peyret
- Laboratory of Biology, Engineering and Imaging for Ophthalmology (BiiO), EA2521, Faculté de Médecine, Université de Jean Monnet, 10 rue de la Marandière, 42270 Saint-Etienne, France
| | - Siwar Zouari
- Laboratory of Biology, Engineering and Imaging for Ophthalmology (BiiO), EA2521, Faculté de Médecine, Université de Jean Monnet, 10 rue de la Marandière, 42270 Saint-Etienne, France
| | - Sébastien Urbaniak
- Laboratory of Biology, Engineering and Imaging for Ophthalmology (BiiO), EA2521, Faculté de Médecine, Université de Jean Monnet, 10 rue de la Marandière, 42270 Saint-Etienne, France
| | - Jean-Marie Papillon
- Laboratory of Biology, Engineering and Imaging for Ophthalmology (BiiO), EA2521, Faculté de Médecine, Université de Jean Monnet, 10 rue de la Marandière, 42270 Saint-Etienne, France
- Papillon Engineering, Saint-Etienne, France
| | - Emmanuel Crouzet
- Laboratory of Biology, Engineering and Imaging for Ophthalmology (BiiO), EA2521, Faculté de Médecine, Université de Jean Monnet, 10 rue de la Marandière, 42270 Saint-Etienne, France
| | - Chantal Perrache
- Laboratory of Biology, Engineering and Imaging for Ophthalmology (BiiO), EA2521, Faculté de Médecine, Université de Jean Monnet, 10 rue de la Marandière, 42270 Saint-Etienne, France
| | - Sophie Hodin
- INSERM U1059, Dysfonction Vasculaire et Hémostase, Université Jean Monnet, 10 rue de la Marandière, Campus Santé Innovations, Saint-Priest-en-Jarez, Saint-Etienne, France
| | - Xavier Delavenne
- INSERM U1059, Dysfonction Vasculaire et Hémostase, Université Jean Monnet, 10 rue de la Marandière, Campus Santé Innovations, Saint-Priest-en-Jarez, Saint-Etienne, France
| | - Zhiguo He
- Laboratory of Biology, Engineering and Imaging for Ophthalmology (BiiO), EA2521, Faculté de Médecine, Université de Jean Monnet, 10 rue de la Marandière, 42270 Saint-Etienne, France
| | - Philippe Gain
- Laboratory of Biology, Engineering and Imaging for Ophthalmology (BiiO), EA2521, Faculté de Médecine, Université de Jean Monnet, 10 rue de la Marandière, 42270 Saint-Etienne, France
- Département d'Ophtalmologie, Centre Hospitalier Universitaire, Avenue Albert Raimond, 42055 Saint-Etienne Cedex 02, France
| | - Gilles Thuret
- Laboratory of Biology, Engineering and Imaging for Ophthalmology (BiiO), EA2521, Faculté de Médecine, Université de Jean Monnet, 10 rue de la Marandière, 42270 Saint-Etienne, France
- Département d'Ophtalmologie, Centre Hospitalier Universitaire, Avenue Albert Raimond, 42055 Saint-Etienne Cedex 02, France
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Moshkovsky R, Golan N, Aviel Gadot E, Bar A, Achiron A, Fischer N, Spierer O. Pain control and subconjunctival haemorrhage after intravitreal injection using cooled anaesthetic eyedrops and antiseptics: A prospective, double-blind, randomized controlled trial. Acta Ophthalmol 2023. [PMID: 37853924 DOI: 10.1111/aos.15798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/21/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE To evaluate whether cooled anaesthetic eyedrops and antiseptics alleviate pain and minimise subconjunctival haemorrhage following intravitreal injection. METHODS A prospective, double-masked, randomised controlled trial of 100 participants receiving either cooled (n = 50) or room temperature (n = 50) topical anaesthetic eyedrops and antiseptics before receiving an injection of bevacizumab. Baseline tolerability was estimated using a self-reported pain sensitivity questionnaire. RESULTS Overall tolerability was comparable between the study group and the control group (0.75 ± 0.13 vs. 0.74 ± 0.14, respectively, p = 0.99). Subconjunctival haemorrhage incidence was similar in both groups (80% vs. 86%, respectively, p = 0.113), as was subconjunctival haemorrhage size (2.75 ± 5.51 mm2 vs. 5.53 ± 10.72 mm2 , respectively, p = 0.11). Sub-group analysis demonstrated that the participants taking daily ocular eyedrops who received cooled anaesthetic eyedrops and antiseptics reported less pain at 10 min and less burning sensation at 24 h compared with matched controls (0.67 ± 1.50 vs. 2.50 ± 3.03, respectively, p = 0.040 and 0.00 ± 0.00 vs. 1.44 ± 2.96, respectively, p = 0.045). Participants who received cooled eyedrops and did not use antithrombotic therapy had smaller-sized subconjunctival haemorrhages compared with matched controls (1.55 ± 1.87 mm2 vs. 8.29 ± 14.61 mm2 , respectively, p = 0.038). Participants with hypertension who received cooled eyedrops had smaller-sized subconjunctival haemorrhage compared with matched controls (2.33 ± 4.99 mm2 vs. 6.89 ± 12.41 mm2 , respectively, p = 0.045). CONCLUSION The benefit of using cooled anaesthetic eyedrops and antiseptics to alleviate pain and minimise subconjunctival haemorrhage following intravitreal injection was not proven in the general population. It may be beneficial in part for some patients, such as those who regularly use eyedrops, patients with hypertension or those not on antithrombotic therapy.
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Affiliation(s)
- Ran Moshkovsky
- Department of Ophthalmology, Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nili Golan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva, Israel
| | - Einat Aviel Gadot
- The Faculty of Exact Sciences, Bar Ilan University, Ramat Gan, Israel
| | - Asaf Bar
- Department of Ophthalmology, Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Achiron
- Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naomi Fischer
- Department of Ophthalmology, Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oriel Spierer
- Department of Ophthalmology, Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Bonneau N, Potey A, Vitoux MA, Magny R, Guerin C, Baudouin C, Peyrin JM, Brignole-Baudouin F, Réaux-Le Goazigo A. Corneal neuroepithelial compartmentalized microfluidic chip model for evaluation of toxicity-induced dry eye. Ocul Surf 2023; 30:307-319. [PMID: 37984561 DOI: 10.1016/j.jtos.2023.11.004] [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] [Received: 07/31/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 11/22/2023]
Abstract
Part of the lacrimal functional unit, the cornea protects the ocular surface from numerous environmental aggressions and xenobiotics. Toxicological evaluation of compounds remains a challenge due to complex interactions between corneal nerve endings and epithelial cells. To this day, models do not integrate the physiological specificity of corneal nerve endings and are insufficient for the detection of low toxic effects essential to anticipate Toxicity-Induced Dry Eye (TIDE). Using high-content imaging tool, we here characterize toxicity-induced cellular alterations using primary cultures of mouse trigeminal sensory neurons and corneal epithelial cells in a compartmentalized microfluidic chip. We validate this model through the analysis of benzalkonium chloride (BAC) toxicity, a well-known preservative in eyedrops, after a single (6h) or repeated (twice a day for 15 min over 5 days) topical 5.10-4% BAC applications on the corneal epithelial cells and nerve terminals. In combination with high-content image analysis, this advanced microfluidic protocol reveal specific and tiny changes in the epithelial cells and axonal network as well as in trigeminal cells, not directly exposed to BAC, with ATF3/6 stress markers and phospho-p44/42 cell activation marker. Altogether, this corneal neuroepithelial chip enables the evaluation of toxic effects of ocular xenobiotics, distinguishing the impact on corneal sensory innervation and epithelial cells. The combination of compartmentalized co-culture/high-content imaging/multiparameter analysis opens the way for the systematic analysis of toxicants but also neuroprotective compounds.
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Affiliation(s)
- Noémie Bonneau
- Sorbonne Université, INSERM, CNRS, IHU FOReSIGHT, Institut de la Vision, 17 rue Moreau, F-75012, Paris, France; HORUS PHARMA, F-06200 Nice, France
| | - Anaïs Potey
- Sorbonne Université, INSERM, CNRS, IHU FOReSIGHT, Institut de la Vision, 17 rue Moreau, F-75012, Paris, France
| | - Michael-Adrien Vitoux
- Sorbonne Université, INSERM, CNRS, IHU FOReSIGHT, Institut de la Vision, 17 rue Moreau, F-75012, Paris, France
| | - Romain Magny
- Sorbonne Université, INSERM, CNRS, IHU FOReSIGHT, Institut de la Vision, 17 rue Moreau, F-75012, Paris, France; UMR CNRS 8038 CiTCoM, Chimie Toxicologie Analytique et Cellulaire, Université de Paris, Faculté de Pharmacie, Paris, France
| | | | - Christophe Baudouin
- Sorbonne Université, INSERM, CNRS, IHU FOReSIGHT, Institut de la Vision, 17 rue Moreau, F-75012, Paris, France; Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, INSERM-DGOS CIC 1423, IHU FOReSIGHT, 28 rue de Charenton, F-75012, Paris, France; Université Versailles-Saint-Quentin-en-Yvelines, Hôpital Ambroise Paré, APHP, F-92100, Boulogne-Billancourt, France
| | - Jean-Michel Peyrin
- Neurosciences Paris Seine, UMR8246, Inserm U1130, IBPS, UPMC, Sorbonne Université, 4 Place Jussieu, F-75005, Paris, France.
| | - Françoise Brignole-Baudouin
- Sorbonne Université, INSERM, CNRS, IHU FOReSIGHT, Institut de la Vision, 17 rue Moreau, F-75012, Paris, France; Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, INSERM-DGOS CIC 1423, IHU FOReSIGHT, 28 rue de Charenton, F-75012, Paris, France; Université Paris Cité, Faculté de Pharmacie de Paris, F-75006, Paris, France.
| | - Annabelle Réaux-Le Goazigo
- Sorbonne Université, INSERM, CNRS, IHU FOReSIGHT, Institut de la Vision, 17 rue Moreau, F-75012, Paris, France.
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Alviset G, Corvis Y, Hammad K, Lemut J, Maury M, Mignet N, Boudy V. New Preservative-Free Formulation for the Enhanced Ocular Bioavailability of Prostaglandin Analogues in Glaucoma. Pharmaceutics 2022; 14:pharmaceutics14020453. [PMID: 35214185 PMCID: PMC8877962 DOI: 10.3390/pharmaceutics14020453] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 02/04/2023] Open
Abstract
Glaucoma is a wide-spread eye disease caused by elevated intraocular pressure. Uncontrolled, this pressure may lead to damages to the optic nerve. Prostaglandin analogues, such as latanoprost and travoprost (which are water-insoluble active substances), are the most used class of active pharmaceutical ingredient. To administer them as eye drops, preservatives, such as benzalkonium chloride, are used as solubilizers. The latter is known to cause a local inflammation when used chronically and is not recommended for patients with ocular surface disorders. In this work, we sought to use polysorbate 80 (PS80) as a solubilizing agent simultaneously with sodium hyaluronate (NaHA) as a thickener and cytoprotective agent for the corneal surface. The first part of this study assessed the compatibility of the excipients with the active substance, using physicochemical methods such as spectra fluorescence and differential scanning calorimetry (DSC), as well as the solubilization mechanism of PS80 regarding prostaglandin analogues using nuclear magnetic resonance (NMR). The second part evaluated the stability of a formula candidate, its viscosity upon instillation, and its pharmacokinetic profile in rabbits as compared to the commercially approved medicine Travatan®. The results show that sodium hyaluronate is inert with respect to travoprost, while PS80 successfully solubilizes it, meaning that benzalkonium chloride is no longer required. Moreover, the pharmacokinetic profiles of the rabbits showed that the original formula described in the present study enhanced the ocular bioavailability of the drug, making it a promising product to control intraocular pressure with a potential reduced dosage of travoprost, therefore minimizing its related side effects.
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Affiliation(s)
- Gabriel Alviset
- Unither Développement Bordeaux, ZA Tech Espace, av. Toussaint Catros, 33185 Le Haillan, France;
- Faculté de Santé de Paris, CNRS, INSERM, UTCBS, 75006 Paris, France; (Y.C.); (N.M.)
- Assistance Publique Hôpitaux de Paris (AP-HP), Agence Générale des Équipements et Produits de Santé (AGEPS), Département de Recherche et Développement Pharmaceutique (DRDP), 7 rue du fer à Moulin, 75005 Paris, France
| | - Yohann Corvis
- Faculté de Santé de Paris, CNRS, INSERM, UTCBS, 75006 Paris, France; (Y.C.); (N.M.)
| | - Karim Hammad
- Faculté de Santé de Paris, CNRS, CiTCoM, 75006 Paris, France;
| | - Josiane Lemut
- CMC Expert, 84 rue Maurice Béjart, 34080 Montpellier, France;
- Unither Pharmaceuticals, 3-5 rue St-Georges, 75009 Paris, France;
| | - Marc Maury
- Unither Pharmaceuticals, 3-5 rue St-Georges, 75009 Paris, France;
| | - Nathalie Mignet
- Faculté de Santé de Paris, CNRS, INSERM, UTCBS, 75006 Paris, France; (Y.C.); (N.M.)
| | - Vincent Boudy
- Faculté de Santé de Paris, CNRS, INSERM, UTCBS, 75006 Paris, France; (Y.C.); (N.M.)
- Assistance Publique Hôpitaux de Paris (AP-HP), Agence Générale des Équipements et Produits de Santé (AGEPS), Département de Recherche et Développement Pharmaceutique (DRDP), 7 rue du fer à Moulin, 75005 Paris, France
- Correspondence: ; Tel.: +33-1-4669-1576
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Lajmi H, Hmaied W, Achour BB, Zahaf A. Risk Factors for Ocular Surface Disease in Tunisian Users of Preserved Antiglaucomatous Eye Drops. J Curr Ophthalmol 2021; 33:128-135. [PMID: 34409222 PMCID: PMC8365590 DOI: 10.4103/joco.joco_226_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 12/01/2020] [Accepted: 04/01/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To study the clinical and the functional findings in glaucomatous patients under preserved eye drops having ocular surface alterations and to analyze their risk factors. METHODS A cross-sectional study of 155 glaucomatous patients was conducted. All of them answered the "Ocular Surface Disease Index" (OSDI) questionnaire and had a complete and precise evaluation of the ocular surface state including a Schirmer I test, a tear break-up time evaluation, eyelid, conjunctival, and corneal examination with a Fluorescein and a Lissamin green test. We studied factors that could influence the OSDI score and each type of ocular surface alteration (age, sex, glaucoma treatment duration, number and type of the active principle, and Benzalkonium Chloride [BAK] use). RESULTS BAK was used in 80% of cases. The OSDI score was ≥13, in 61.3% of cases. The biomicroscopic signs of ocular surface disease were at least minimal in 87.1% of cases. The main predictors of OSDI score increase were the glaucoma treatment duration (P = 0.01, t = 2.618), the number of molecules used (P = 0.018, t = 2.391), and the use of BAK (P = 0.011, t = 2.58). The severity of the biomicroscopic signs correlated with these same risk factors. Fixed combination was statistically associated with a lower incidence of superficial punctate keratitis (SPK) and corneal and conjunctival staining in the Lissamine green test (P < 0.001). Beta-blockers were associated with a significantly higher risk of SPK and corneal or conjunctival staining in the Lissamine green test (P < 0.001). CONCLUSIONS Preserved antiglaucomatous eye drops alter the patients' ocular surface. The main risk factors were advanced age, duration of glaucoma treatment, multiple therapies, and the use of BAK.
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Affiliation(s)
- Houda Lajmi
- Department of Ophthalmology, Internal Security Forces Hospital, La Marsa, Tunis, Tunisia
| | - Wassim Hmaied
- Department of Ophthalmology, Internal Security Forces Hospital, La Marsa, Tunis, Tunisia
| | - Besma Ben Achour
- Department of Ophthalmology, Internal Security Forces Hospital, La Marsa, Tunis, Tunisia
| | - Amin Zahaf
- Department of Ophthalmology, Internal Security Forces Hospital, La Marsa, Tunis, Tunisia
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Assil KK, Greenwood MD, Gibson A, Vantipalli S, Metzinger JL, Goldstein MH. Dropless cataract surgery: modernizing perioperative medical therapy to improve outcomes and patient satisfaction. Curr Opin Ophthalmol 2021; 32 Suppl 1:S1-S12. [PMID: 33273209 DOI: 10.1097/icu.0000000000000708] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW Advances in pharmacology offer freedom from topical medical therapy without compromise of anti-inflammatory and antimicrobial coverage in the perioperative period. In this review, we describe the basis for dropless cataract surgery with the goal of improving outcomes and the patient experience. RECENT FINDINGS Phacoemulsification outcomes depend largely on surgeon skill but also on adherence to a complex multidrug regimen of perioperative anti-inflammatory and antimicrobial therapy to prevent sight-threatening complications such as cystoid macular edema or endophthalmitis. Successful administration of this regimen can be limited by noncompliance, difficulty administering eye drops, bioavailability, and side effects, among others. The recent development of sustained-release formulations of dexamethasone - one an intracanalicular insert and the other an intraocular suspension - can provide sustained tapering doses of dexamethasone while reducing or eliminating the need for anti-inflammatory eye drop therapy. Similarly, mounting evidence compellingly demonstrates that intracameral antibiotic use intraoperatively is at least as effective as topical antibiotics in preventing endophthalmitis. SUMMARY Sustained-release dexamethasone coupled with intracameral antibiotics at the time of phacoemulsification can provide antimicrobial and anti-inflammatory prophylaxis without the need for topical eye drop medications. This approach has the potential to improve compliance with therapy, visual acuity outcomes, and the overall patient experience.
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Affiliation(s)
| | | | - Andrea Gibson
- Ocular Therapeutix, Inc., Bedford, Massachusetts, USA
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8
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Sanghi P, Malik M, Hossain IT, Manzouri B. Ocular Complications in the Prone Position in the Critical Care Setting: The COVID-19 Pandemic. J Intensive Care Med 2020; 36:361-372. [PMID: 32985317 DOI: 10.1177/0885066620959031] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE Ocular complications are common in the critical care setting but are frequently missed due to the focus on life-saving organ support. The SARS-CoV-2 (COVID-19) pandemic has led to a surge in critical care capacity and prone positioning practices which may increase the risk of ocular complications. This article aims to review all ocular complications associated with prone positioning, with a focus on challenges posed by COVID-19. MATERIALS AND METHODS A literature review using keywords of "intensive care", "critical care", "eye care", "ocular disorders", "ophthalmic complications," "coronavirus", "COVID-19," "prone" and "proning" was performed using the electronic databases of PUBMED, EMBASE and CINAHL. RESULTS The effects of prone positioning on improving respiratory outcomes in critically unwell patients are well established; however, there is a lack of literature regarding the effects of prone positioning on ocular complications in the critical care setting. Sight-threatening ophthalmic disorders potentiated by proning include ocular surface disease, acute angle closure, ischemic optic neuropathy, orbital compartment syndrome and vascular occlusions. CONCLUSIONS COVID-19 patients may be more susceptible to ocular complications with increased proning practices and increasing demand on critical care staff. This review outlines these ocular complications with a focus on preventative and treatment measures to avoid devastating visual outcomes for the patient.
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Affiliation(s)
- Priyanka Sanghi
- Department of Ophthalmology, Barking Havering and Redbridge University Hospitals NHS Trust, 156727Queens Hospital, Romford, UK
| | - Mohsan Malik
- Department of Ophthalmology, Barking Havering and Redbridge University Hospitals NHS Trust, 156727Queens Hospital, Romford, UK
| | - Ibtesham T Hossain
- Department of Ophthalmology, Barking Havering and Redbridge University Hospitals NHS Trust, 156727Queens Hospital, Romford, UK
| | - Bita Manzouri
- Department of Ophthalmology, Barking Havering and Redbridge University Hospitals NHS Trust, 156727Queens Hospital, Romford, UK
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9
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Lipidomic analysis of epithelial corneal cells following hyperosmolarity and benzalkonium chloride exposure: New insights in dry eye disease. Biochim Biophys Acta Mol Cell Biol Lipids 2020; 1865:158728. [DOI: 10.1016/j.bbalip.2020.158728] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/20/2020] [Accepted: 04/22/2020] [Indexed: 02/06/2023]
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10
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Doan S, Zagórski Z, Palmares J, Yağmur M, Kaercher T, Benítez-Del-Castillo JM, Van Dooren B, Jonckheere P, Jensen PK, Maychuk DY, Bezdetko P. Eyelid Disorders in Ophthalmology Practice: Results from a Large International Epidemiological Study in Eleven Countries. Ophthalmol Ther 2020; 9:597-608. [PMID: 32613590 PMCID: PMC7406605 DOI: 10.1007/s40123-020-00268-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose Anecdotal evidence suggests that eyelid disorders are common, although estimates of prevalence vary. The current study determines the prevalence of eyelid disorders, meibomian gland dysfunction (MGD) and related diseases (specifically ocular surface disease) in a population of patients presenting for routine ophthalmologic consultations. Methods This cross-sectional epidemiologic survey evaluated patients presenting for routine ophthalmic visits. During the consultation an ophthalmologist completed a questionnaire, and each patient underwent an ophthalmic examination and completed a quality of life questionnaire. Results Three hundred forty-nine ophthalmologists, recruited from 11 countries, provided data on 6525 patients. Patients were predominantly females (61.6%). The mean age of the study population was 57.0 ± 17.6 years. Eyelid disorders were diagnosed in 5109 (78.3%) patients and were statistically associated with: atopic dermatitis, seborrheic dermatitis, dry eye, age-related macular degeneration, diabetes, cataract, allergy and MGD (P < 0.05, all associations). Eyelid abnormalities were identified in 59.6% of patients; conjunctival or corneal abnormalities were observed in 64.9% and 28.1% of patients, respectively. MGD was diagnosed in 54.3% patients and was statistically significantly associated with the presence of eyelid disorders and eyelid margin abnormalities (P < 0.001, both comparisons). Dry eye was diagnosed in 61.8% of patients. Concurrent dry eye and MGD were present in 67.6% of patients. Most patients reported some degree of impaired vision and daily/work activities related to dry eye. Impact on contact lens usage, emotions and quality of sleep was also reported. The effects on daily life were associated with the presence of MGD. Conclusion In conclusion, eyelid disorders were highly prevalent in this ‘real-world’ population of patients from ophthalmology clinics. Routine ophthalmologic consultations provide an opportunity to improve patient quality of life and to modify topical therapy in patients who may be predisposed to eyelid disorders.
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Affiliation(s)
- Serge Doan
- Fondation A de Rothschild, Paris, France.
| | | | | | - Meltem Yağmur
- The Faculty of Medicine Balcalı Hospital, Cukurova University, Adana, Turkey
| | | | - José Manuel Benítez-Del-Castillo
- Unidad de Superficie e Inflamación Ocular, Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico Universitario San Carlos, Madrid, Spain
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11
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Dominguez JR, Gonzalez T, Cuerda-Correa EM, Muñoz-Peña MJ. Combating paraben pollution in surface waters with a variety of photocatalyzed systems: Looking for the most efficient technology. OPEN CHEM 2019. [DOI: 10.1515/chem-2019-0133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractThe constant presence of parabens in natural surface waters has raised a growing concern of the potential long-term toxic effects that parabens may have in wildlife, mainly as endocrine disruptors. The present report describes the results of a study in which different photocatalyzed systems, such as photo-Fenton, Fenton, UV-H2O2, UV-TiO2 and UV-TiO2-H2O2, were applied to the removal of these recalcitrant pollutants in some surface waters, including natural (e.g. rivers) and man-made (e.g. reservoirs and wastewater treatment plants). Degradation of four widely-used parabens (methyl-paraben, ethyl-paraben, propyl-paraben and butyl-paraben) was analyzed. Experimental results reveal that the most efficient method to combat these emerging pollutants was photo-Fenton. When this process was optimized, optimal removal efficiency was attained using doses of H2O2 and Fe(II) equal to 2.92·10−4 mol dm-3 and 1.85·10−5 mol dm-3, respectively. It is also worth noting that the removal rate of these contaminants is slower in natural waters. The results suggest that the photo-Fenton process is promising and maybe an adequate technology for the treatment of these persistent contaminants.
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Affiliation(s)
- Joaquin R. Dominguez
- Dept. Chemical Engineering and Physical Chemistry. University of Extremadura, Avda. Elvas, 06006. Badajoz, Spain
| | - Teresa Gonzalez
- Dept. Chemical Engineering and Physical Chemistry. University of Extremadura, Avda. Elvas, 06006. Badajoz, Spain
| | - Eduardo M. Cuerda-Correa
- Dept. Organic and Inorganic Chemistry. University of Extremadura, Avda. Elvas, 06006Badajoz, Spain
| | - Maria J. Muñoz-Peña
- Dept. Chemical Engineering and Physical Chemistry. University of Extremadura, Avda. Elvas, 06006. Badajoz, Spain
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12
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Optimization of intraocular lens hydrogels for dual drug release: Experimentation and modelling. Eur J Pharm Biopharm 2019; 141:51-57. [DOI: 10.1016/j.ejpb.2019.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 02/06/2023]
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13
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Medical devices biocompatibility assessment on HCE: Evidences of delayed cytotoxicity of preserved compared to preservative free eye drops. Regul Toxicol Pharmacol 2019; 106:81-89. [DOI: 10.1016/j.yrtph.2019.04.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/16/2019] [Accepted: 04/26/2019] [Indexed: 11/21/2022]
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Abstract
Purpose: Effective glaucoma therapy relies to a great extent on the patients' ability to regularly self-administer eye drops. This study aimed to assess self-reported nonadherence and to identify potential barriers to adherence in glaucoma patients. Methods: Participants completed a 16-item questionnaire, designed to examine nonadherence rate and assess the therapy experience. Inclusion criteria stipulated treatment duration of at least 1 year. Nonadherence was defined as missing ≥5% of the prescribed pressure-lowering eye drops doses. Results: In total, 201 glaucoma patients aged 24-88 years were included. Mean treatment duration was 9.4 years. Nonadherence was reported by 30.3% of participants and 69.7% were reported to be adherent. Individuals who experienced side effects reported higher levels of nonadherence than those who did not (37.6% vs. 18.4%; P = 0.004). Eye drops with preservatives were used by 84.1% of participants, 11.9% were on combined preservative and preservative-free treatment, and 4.0% on preservative-free medication only. Self-reported nonadherence levels were 32.0%, 25.0%, and 12.5%, respectively, for each of these groups. Men reported higher rates of nonadherence than women (36.8% vs. 24.5%; P = 0.066). Age, social status, history of migration, severity of disease, and fear of blindness were not associated with significant differences in nonadherence levels. Conclusions: Nonadherence with glaucoma therapy is a significant barrier to therapeutic success for approximately one-third of patients. Nonadherence may be reduced if side effects are avoided. Preservative-free products may provide adherence benefits. The patient experience should be a key consideration when selecting appropriate treatments, to reduce nonadherence and optimize outcomes.
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Affiliation(s)
- Christian Wolfram
- 1 Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany.,2 Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Mainz, Germany
| | - Erik Stahlberg
- 1 Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany.,3 Department for Radiology and Nuclear Medicine, University Hospital of Schleswig Holstein, Campus Luebeck, Mainz, Germany
| | - Norbert Pfeiffer
- 1 Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
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Gautier E, Saillard J, Deshayes C, Vrignaud S, Lagarce F, Briot T. Stability of a 50 mg/mL Ceftazidime Eye-Drops Formulation. PHARMACEUTICAL TECHNOLOGY IN HOSPITAL PHARMACY 2018. [DOI: 10.1515/pthp-2018-0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Microbial keratitis are severe infectionsgenerally linked to risk factors. High-doses antibiotic eye-drops could be required to avoid severe complications. In such cases, hospital pharmacists are in charge of their production given the lack of such formulations on the market. The stability of these antibiotic eye-drops is generally limited to a couple of days and publications generally do not describe addition of microbial preservatives even though it is a European Pharmacopeia requirement. The aim of this study was to describe a new ceftazidime eye-drops formulation at 50 mg/mL with a antimicrobial additive, benzalkonium chloride at 0.04 mg/mL.
Methods
Physico-chemical studies of this new formulation were performed by a stability indicating HPLC-UV method validated according to ICH standards, osmolality measurements, pH monitoring and visual examinations. Antimicrobial preservative efficacy was evaluated according to the method from the European Pharmacopeia.
Results
After 75 days at −20 °C followed by 7 days at 4 °C, or after 7 days at 4 °C, the eye-drops were stable. A degradation trend was finally observed at day 14 at 4 °C.
Conclusions
A new ceftazidime eye-drops formulation is proposed with a stability of 7 days. Outpatients do not need to return to the hospital pharmacy for repeat dispensing, thus possibly improving treatment compliance.
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Affiliation(s)
- Eric Gautier
- Pharmacy , University Hospital of Angers , Angers , France
| | | | - Caroline Deshayes
- Laboratoire SiFCIR UPRES EA2647/USC INRA 1330, SFR 4207 QUASAV, UFR Sciences, Université Angers , Angers , France
| | - Sandy Vrignaud
- Pharmacy , University Hospital of Angers , Angers , France
| | - Frederic Lagarce
- Pharmacy , University Hospital of Angers , Angers , France
- Micro et Nanomedecines Translationnelles , INSERM 1066, CNRS6021 , University of Angers, Angers , France
| | - Thomas Briot
- Pharmacy , University Hospital of Angers , Angers , France
- Micro et Nanomedecines Translationnelles , INSERM 1066, CNRS6021 , University of Angers, Angers , France
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Mohammadi M, Patel K, Alaie SP, Shmueli RB, Besirli CG, Larson RG, Green JJ. Injectable drug depot engineered to release multiple ophthalmic therapeutic agents with precise time profiles for postoperative treatment following ocular surgery. Acta Biomater 2018; 73:90-102. [PMID: 29684622 PMCID: PMC6218335 DOI: 10.1016/j.actbio.2018.04.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 04/16/2018] [Accepted: 04/19/2018] [Indexed: 12/15/2022]
Abstract
A multi-drug delivery platform is developed to address current shortcomings of post-operative ocular drug delivery. The sustained biodegradable drug release system is composed of biodegradable polymeric microparticles (MPs) incorporated into a bulk biodegradable hydrogel made from triblock copolymers with poly(ethylene glycol) (PEG) center blocks and hydrophobic biodegradable polyester blocks such as poly(lactide-co-glycolide) (PLGA), Poly(lactic acid) (PLA), or Poly(lactide-co-caprolactone) (PLCL) blocks. This system is engineered to flow as a liquid solution at room temperature for facile injection into the eye and then quickly gel as it warms to physiological body temperatures (approximately 37 °C). The hydrogel acts as an ocular depot that can release three different drug molecules at programmed rates and times to provide optimal release of each species. In this manuscript, the hydrogel is configured to release a broad-spectrum antibiotic, a potent corticosteroid, and an ocular hypotensive, three ophthalmic therapeutic agents that are essential for post-operative management after ocular surgery, each drug released at its own timescale. The delivery platform is designed to mimic current topical application of postoperative ocular formulations, releasing the antibiotic for up to a week, and the corticosteroid and the ocular hypotensive agents for at least a month. Hydrophobic blocks, such as PLCL, were utilized to prolong the release duration of the biomolecules. This system also enables customization by being able to vary the initial drug loading to linearly tune the drug dose released, while maintaining a constant drug release profile over time. This minimally invasive biodegradable multi-drug delivery system is capable of replacing a complex ocular treatment regimen with a simple injection. Such a depot system has the potential to increase patient medication compliance and reduce both the immediate and late term complications following ophthalmic surgery. STATEMENT OF SIGNIFICANCE After ocular surgery, patients routinely receive multiple medications including antibiotics, steroids and ocular hypotensives to ensure optimal surgical outcomes. The current standard of care for postoperative treatment after ocular surgery involves using eye drops daily, which has limited effectiveness mainly due to poor patient adherence. To improve patient experience and outcomes, this article presents the first thermoresponsive hydrogel able to release multiple drug molecules for the application of post-operative treatment following ocular surgery. By varying the parameters such as hydrogel type and polymer hydrophobicity, the drug release profile, duration and dosage can finely be tuned. The approach presented in this article can readily be applied to other applications by simply changing the drug loaded in the drug delivery system.
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Affiliation(s)
- Maziar Mohammadi
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; Translational Tissue Engineering Center, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; BioInterfaces Institute, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kisha Patel
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; Translational Tissue Engineering Center, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Seyedeh P Alaie
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; Translational Tissue Engineering Center, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; Howard University College of Medicine, Washington, DC 20001, USA
| | - Ron B Shmueli
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; Translational Tissue Engineering Center, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Cagri G Besirli
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor MI 48105, USA
| | - Ronald G Larson
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; BioInterfaces Institute, University of Michigan, Ann Arbor, MI 48109, USA; Department of Chemical Engineering, University of Michigan, Ann Arbor MI 48109, USA.
| | - Jordan J Green
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; Translational Tissue Engineering Center, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; Departments of Ophthalmology, Oncology, Neurosurgery, Chemical & Biomolecular Engineering, and Materials Science & Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA.
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Barriers to Glaucoma Medication Compliance Among Veterans: Dry Eye Symptoms and Anxiety Disorders. Eye Contact Lens 2018; 44:50-54. [PMID: 28181960 DOI: 10.1097/icl.0000000000000301] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To identify barriers to compliance of medical treatment for glaucoma among veterans. METHODS Patients with glaucoma from the Miami Veterans Affairs Eye Clinic (n=74) filled out a 63-question survey regarding dry eye symptoms, concurrent systemic disease, and medications. The association between glaucoma medical compliance was defined as self-reported adherence to drop regimens greater than 75% of the time. RESULTS Eighty percent of veterans (n=59) reported compliance with glaucoma therapy. Dry eye symptoms (as defined by Dry Eye Questionnaire 5 score ≥6) were reported by 39% (n=29), and their presence was associated with decreased compliance (63% vs. 89%, P=0.007). Anxiety and posttraumatic stress syndrome (PTSD) were also associated with significant noncompliance (64% vs. 83%, P=0.05 and 58% vs. 84%, P=0.02, respectively). Other studied factors including demographics, depression (P=0.11), and glaucoma regimens did not play a significant role in glaucoma medication compliance. CONCLUSIONS Dry eye symptoms, PTSD, and anxiety were associated with decreased compliance to medical treatment of glaucoma. Identifying and treating underlying ocular surface disease and anxiety disorders may lead to increased adherence to glaucoma treatment.
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Comparison of Efficacy and Ocular Surface Disease Index Score between Bimatoprost, Latanoprost, Travoprost, and Tafluprost in Glaucoma Patients. J Ophthalmol 2018; 2018:1319628. [PMID: 29707390 PMCID: PMC5863284 DOI: 10.1155/2018/1319628] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 11/07/2017] [Accepted: 12/03/2017] [Indexed: 11/18/2022] Open
Abstract
Aim The purpose of this study is to evaluate and compare the efficacy of 4 prostaglandin analogues (PGAs) and to determine the incidence of ocular surface disease in newly diagnosed, primary open-angle glaucoma (POAG) patients started on one of those 4 PGAs: bimatoprost (benzalkonium chloride, BAK, 0.3 mg/mL), latanoprost (BAK 0.2 mg/mL), travoprost (polyquad), and tafluprost (BAK-free). Patients and Methods In this single-center, open-label trial, 32 patients newly diagnosed with POAG were randomly started on one of the four PGAs. All patients underwent a complete ophthalmological exam at presentation and at 1, 3, and 6 months of follow-up. Dry eye disease (DED) was assessed using the original Ocular Surface Disease Index (OSDI) questionnaire, in order to evaluate the impact of the drops on the quality of life of patients. Results The mean age was 60.06 years ± 11.76. All four drugs equally and significantly reduced the intraocular pressure (IOP) with respect to the baseline IOP. There was a trend for a slightly greater reduction of IOP with bimatoprost, but the difference was not found to be statistically significant when compared to other PGAs. OSDI scores were significantly superior for travoprost (10.68 ± 5.73) compared to the other three drugs (p < 0.05). Latanoprost caused the most significant eyelash growth and iris discoloration. Conjunctival hyperemia and superficial keratitis occurrence were similar in the four groups. Conclusion All prostaglandin analogues equally and significantly reduce the IOP in patients with POAG. According to the results of the OSDI score, latanoprost seems to be the least tolerated among the four drugs.
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Pillunat LE, Erb C, Ropo A, Kimmich F, Pfeiffer N. Preservative-free fixed combination of tafluprost 0.0015% and timolol 0.5% in patients with open-angle glaucoma and ocular hypertension: results of an open-label observational study. Clin Ophthalmol 2017; 11:1051-1064. [PMID: 28652689 PMCID: PMC5472425 DOI: 10.2147/opth.s128453] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Efficacy, tolerability and safety of the novel preservative-free fixed combination of tafluprost 0.0015%/timolol 0.5% (Taptiqom®) were investigated in an observational study in Germany. Objective To assess efficacy, tolerability and safety of the preservative-free fixed combination of tafluprost 0.0015%/timolol 0.5% in a real-life setting. Methods Intraocular pressure (IOP) was recorded for each eye at baseline (any previous therapy or untreated) and 4–16 weeks after changing medical treatment to or initiating treatment with the preservative-free fixed combination of tafluprost 0.0015%/timolol 0.5%. Change in IOP was evaluated over the study period for all patients and for specific pretreatment subgroups. Clinical signs such as conjunctival hyperemia and lid-parallel conjunctival folds (LIPCOF) were recorded using standardized comparative photographs. Corneal staining, subjective symptoms and local comfort were measured using a four-step scale. All adverse events were recorded. Results Among 1,157 patients enrolled, 1,075 patients were treated with the preservative-free fixed combination as the only medication at the final visit. Medical treatment was initiated in 741 patients because of an insufficient IOP-lowering effect of the prior medication. In 343 patients, medication was changed because of tolerability issues. The preservative-free fixed combination lowered IOP significantly in the subgroup of naïve patients, all subgroups with prior monotherapy and patients with prior fixed combinations: naïve patients: −8.9 mmHg, alpha- 2-agonists: −6.4 mmHg, beta-blockers: −5.7 mmHg, carbonic anhydrase inhibitors: −5.2 mmHg, prostaglandins: −4.7 mmHg, fixed-combination prostaglandins/timolol: −2.4 mmHg. At the final visit, clinical signs and subjective symptoms were improved in patients with prior medical therapy. Local comfort was rated as “very good” or “good” by 89.1% of patients at the final visit. Only few adverse events occurred during the treatment period. Conclusion The preservative-free fixed combination of tafluprost 0.0015%/timolol 0.5% was effective, well tolerated and showed a good safety profile.
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Affiliation(s)
- Lutz E Pillunat
- Department of Ophthalmology, University Hospital Carl Gustav Carus, Dresden
| | - Carl Erb
- Augenklinik am Wittenbergplatz, Berlin, Germany
| | | | | | - Norbert Pfeiffer
- Department of Ophthalmology, Mainz University Medical Center, Mainz, Germany
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Cuerda-Correa EM, Domínguez JR, Muñoz-Peña MJ, González T. Degradation of Parabens in Different Aqueous Matrices by Several O3-Derived Advanced Oxidation Processes. Ind Eng Chem Res 2016. [DOI: 10.1021/acs.iecr.6b00740] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Eduardo M. Cuerda-Correa
- Department
of Organic and Inorganic Chemistry, University of Extremadura, Avda. de Elvas, s/n.
Faculty of Sciences, 06006 Badajoz, Spain
| | - Joaquín R. Domínguez
- Department
of Chemical Engineering and Physical Chemistry, University of Extremadura, Avda. de
Elvas, s/n. Faculty of Sciences, 06071 Badajoz, Spain
| | - María J. Muñoz-Peña
- Department
of Chemical Engineering and Physical Chemistry, University of Extremadura, Avda. de
Elvas, s/n. Faculty of Sciences, 06071 Badajoz, Spain
| | - Teresa González
- Department
of Chemical Engineering and Physical Chemistry, University of Extremadura, Avda. de
Elvas, s/n. Faculty of Sciences, 06071 Badajoz, Spain
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Chan Hew Wai A, Becasse P, Tworski S, Pradeau D, Planas V. Optimising concentrations of antimicrobial agents in pharmaceutical preparations: Case of an oral solution of glycerol and an ophthalmic solution containing cysteamine. ANNALES PHARMACEUTIQUES FRANÇAISES 2014; 72:415-21. [DOI: 10.1016/j.pharma.2014.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/29/2014] [Accepted: 06/04/2014] [Indexed: 11/25/2022]
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Nebbioso M, Evangelista M, Librando A, Plateroti AM, Pescosolido N. Iatrogenic dry eye disease: An eledoisin/carnitine and osmolyte drops study. Biomed Pharmacother 2013; 67:659-63. [DOI: 10.1016/j.biopha.2013.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Revised: 08/26/2012] [Accepted: 07/03/2013] [Indexed: 10/26/2022] Open
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Lanzl I, Hamacher T, Rosbach K, Ramez MO, Rothe R, Růžičková E, Karhanová M, Kimmich F. Preservative-free tafluprost in the treatment of naive patients with glaucoma and ocular hypertension. Clin Ophthalmol 2013; 7:901-10. [PMID: 23717036 PMCID: PMC3663435 DOI: 10.2147/opth.s41640] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The study reported here investigated the efficacy, tolerability, and safety of the preservative-free prostaglandin analog tafluprost 0.0015% in treatment-naive patients. PATIENTS AND METHODS Data were collected in two non-interventional, prospective, multicenter, observational, open-label studies of identical design that were conducted in Germany and the Czech Republic. All subjects received preservative-free tafluprost 0.0015% once daily. Intraocular pressure (IOP) levels were recorded for each eye at untreated baseline and 3 months after initiation of medical treatment. The primary outcome was change in mean IOP from baseline to month 3. In the primary open-angle glaucoma (POAG) and ocular hypertension (OH) patient subgroups, analyses were stratified by the level of baseline IOP: ≥20 to 23 mmHg versus ≥24 mmHg. In addition, responder rates and the achievement of pre-specified IOP levels at month 3 were evaluated. Local tolerance of preservative-free tafluprost was evaluated by the patients at final visit. Overall satisfaction with the medical treatment was evaluated by both patients and physicians. All adverse events were recorded. RESULTS A total of 579 treatment-naive patients with POAG (n = 349), OH (n = 105), normal tension glaucoma (n = 71), exfoliative glaucoma (n = 27), or other glaucomas (n = 27) were included in this observational study. Mean IOP level at baseline for all patients was 23.6 ± 4.0 mmHg. Mean IOP at month 3 was 16.8 ± 2.9 mmHg (-28.8% vs baseline). At month 3, significant reductions in mean IOP (P < 0.001) were seen in all patients and all subgroups. Preservative-free tafluprost lowered mean IOP significantly in patients with POAG and OH with IOP levels ≥ 20 to 23 mmHg from 21.9 ± 1.1 mmHg at baseline to 16.5 ± 2.2 mmHg, and in the subgroup with IOP levels ≥ 24 mmHg from 26.2 ± 2.4 mmHg to 17.9 ± 2.4 mmHg. In the subgroups of patients with POAG and OH, an IOP response ≥20%, ≥30%, and ≥40% was achieved by 83.4%, 44.1%, and 12.8%, respectively. Overall, patients with higher baseline IOP values showed a better response than patients with lower baseline IOP levels. Preservative-free tafluprost was well tolerated and safe. After 3 months, 97.9% of all patients remained on therapy. CONCLUSION In this real-world observational study, treatment with once-daily preservative-free tafluprost proved efficacious, well tolerated, and safe in treatment-naive patients.
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Safety and Efficacy of 0.1% Clobetasone Butyrate Eyedrops in the Treatment of Dry Eye in Sjögren Syndrome. Eur J Ophthalmol 2012; 23:368-76. [DOI: 10.5301/ejo.5000229] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2012] [Indexed: 11/20/2022]
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Allaire C, Siou-Mermet R, Bassols A. Efficacité et tolérance d’une nouvelle formulation oculaire de lévocabastine sans conservateur (Levofree®) évaluées lors d’un test de provocation conjonctivale. J Fr Ophtalmol 2012; 35:491-8. [DOI: 10.1016/j.jfo.2011.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 08/13/2011] [Accepted: 08/23/2011] [Indexed: 10/28/2022]
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Nebbioso M, Evangelista M, Librando A, Di Blasio D, Pescosolido N. Fixed topical combinations in glaucomatous patients and ocular discomfort. Expert Opin Pharmacother 2012; 13:1829-35. [PMID: 22770575 DOI: 10.1517/14656566.2012.705830] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The purpose of this study was to verify the ocular comfort of a fixed topical combination of brinzolamide 1% plus timolol 0.5% suspension vs. dorzolamide 2% plus timolol 0.5% solution, both preserved with benzalkonium chloride (BAK), in patients with primary open-angle glaucoma (POAG) through subjective and objective methods. BAK is the most commonly used preservative in topical glaucoma medications. METHODS 62 subjects were examined and included in the analysis. Each patient was asked to complete a questionnaire on symptoms (Ocular Surface Disease Index) and then underwent a series of examinations. The Ocular Protection Index evaluated the risk of damage to the ocular surface, and was expressed as the ratio between fluorescein breakup time and blinking interval. These and other analyses were repeated 30 days after instillation of the new eye drop treatment. RESULTS The results demonstrated that patients enrolled with the preserved fixed combination of dorzolamide or brinzolamide represented a subgroup of patients in which the discomfort symptoms were supposedly justified by the presence of BAK used chronically in antihypertensive drops. Ocular discomfort scores were significantly higher with dorzolamide/timolol than brinzolamide/timolol (p < 0.0001). CONCLUSIONS This work shows the better tolerability of brinzolamide 1% plus timolol 0.5% suspension, compared with dorzolamide 2% plus timolol 0.5% solution. Fortunately, some of the adverse reactions induced by preserved eye drop glaucoma medication are reversible after removing the preservatives. Both the potential for added benefit and patient compliance should be considered when selecting ocular hypotensive therapy.
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Affiliation(s)
- Marcella Nebbioso
- Sapienza University of Rome, Centre of Ocular Electrophysiology, Department of Sense Organs, viale del policlinico 155, 00161 Rome, Italy.
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Schrage N, Frentz M, Spoeler F. The Ex Vivo Eye Irritation Test (EVEIT) in evaluation of artificial tears: Purite-preserved versus unpreserved eye drops. Graefes Arch Clin Exp Ophthalmol 2012; 250:1333-40. [PMID: 22580989 DOI: 10.1007/s00417-012-1999-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 03/04/2012] [Accepted: 03/06/2012] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Preservatives in artificial tears cause controversy. New developments such as the Purite system have been introduced into the market, with the promise of little damage to the corneal surface. We wanted to give insight into the differences in the effect of preserved and unpreserved artifical tears on rabbit corneas cultured with the Ex Vivo Eye Irritation Test (EVEIT) system. MATERIALS We compared the two artifical tears products Hylo Comod and Optive being dropped for 72 hours each hour one drop onto the corneal surface. METHODS Each cornea was mechanically wounded with four epithelial defects on each cornea with a size of 3 to 4.5 mm(2). With n = 4 corneas in the Hylo-Comod and n = 4 corneas in the Optive group, we exposed the corneal surfaces to repeated doses of these artificial tears for 3 days. We observed healing of corneal erosions and surface epithelial integrity with sodium-fluoresceine staining under cobalt blue light illumination. RESULTS We found nearly complete healing of epithelial defects with both artificial tears. The Hylo-Comod group healed significantly faster. After 72 hours, the vast majority of epithelial defects were closed. All corneas exposed to Purite showed superficial stippling, whereas the HyloComod group did not show any stippling of the cornea; this difference was significant. DISCUSSION Epithelial healing and recovery in the EVEIT system is observed in both groups, confirming the concept of artificial tears as a supporting factor of corneal health and healing. The superficial stippling of the corneal epithelium was observed only in the Optive group. This effect is considered as a marker of dry eye syndrome, and should be prevented by the application of artificial tears. Preservative-free eye drops such as HyloComod improve healing, and prevent symptoms of dry eye syndrome in the EVEITsystem. Compared to EVEIT results of former experiments with benzalconium chloride-preserved eye drops, Optive promoted healing of corneal erosions.
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Affiliation(s)
- N Schrage
- ACTO e.V. An-Institut der medizinischen Fakultät RWTH Aachen, Karlsburgweg 9, 52070 Aachen, Germany.
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Current World Literature. Curr Opin Ophthalmol 2012; 23:155-9. [DOI: 10.1097/icu.0b013e3283511bcf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Current world literature. Curr Opin Allergy Clin Immunol 2011; 11:497-502. [PMID: 21878753 DOI: 10.1097/aci.0b013e32834bbdcd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Erb C, Lanzl I, Seidova SF, Kimmich F. Preservative-free tafluprost 0.0015% in the treatment of patients with glaucoma and ocular hypertension. Adv Ther 2011; 28:575-85. [PMID: 21725844 DOI: 10.1007/s12325-011-0038-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The objective of this study was to evaluate efficacy, local tolerability, and safety of this first-in-class preservative-free prostaglandin preparation in patients with ocular hypertension and glaucoma. METHODS Patients with glaucoma or ocular hypertension who required a change of medication or were naïve to treatment were included in this noninterventional and observational study. Noninterventional means that no influence was made upon the decision of the physicians to include specific patients and upon the treatment algorithm used. German law for observational studies does not allow any influence on the choice of drugs used, patient selection, masking, and comparator treatment regimens. The main aim of this observational study was to collect "real-life data" on the efficacy and safety of a new medical treatment after approval in a large patient population. Participating ophthalmologists were asked to provide anonymous patient data collected during regular visits by filling a simple data entry form. Intraocular pressure (IOP) readings were recorded at baseline (previous therapy or untreated) and 6-12 weeks after changing medical treatment to or initiating treatment with preservative-free tafluprost once daily. Changes in the IOP were evaluated over the study period for all patients as well as for specific pretreatment subgroups. Local comfort was determined using a five-point scale (very good, good, satisfactory, less satisfactory, not acceptable) before and after the change of medical treatment. All adverse events were recorded. RESULTS Data from 2123 patients with glaucoma or ocular hypertension were considered for the final evaluation. Medication was changed in 41.1% of patients due to tolerability issues and in 25.6% of patients due to insufficient efficacy with prior medication. In all patients preservative-free tafluprost 0.0015% lowered IOP from 19.5 ± 4.4 mmHg (baseline) to 16.4 ± 2.9 mmHg after 6-12 weeks. Preservativefree tafluprost also significantly lowered the IOP in all monotherapy subgroups: treatment-naïve patients (n=440): 22.6 ± 3.9 mmHg (baseline) to 16.7 ± 2.7 mmHg (week 6-12); beta blockers (n=307): 20.3 ± 3.5 mmHg (baseline) to 16.7 ± 2.6 mmHg (week 6-12); carbonic anhydrase inhibitors (n=158): 19.0 ± 3.6 mmHg (baseline) to 16.0 ± 2.6 mmHg (week 6-12); prostaglandin analogs (PGAs; n=447): 16.8 ± 2.9 mmHg (baseline) to 15.8 ± 2.6 mmHg (week 6-12). Local comfort was rated as "very good" or "good" by 85.6% of patients at the final visit (P<0.001). Only few adverse events occurred during the treatment period: 18 patients (0.8%) discontinued medical treatment with preservative-free tafluprost due to local intolerance; six patients (0.3%) due to efficacy issues; four patients complained about systemic side effects (0.2%); and two patients preferred to use a multidose treatment regimen (0.2%). CONCLUSION Although this study was limited by its observational design the results demonstrate that preservative-free tafluprost 0.0015% was effective, generally well tolerated, and safe in a broad and heterogeneous patient population.
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Affiliation(s)
- Carl Erb
- Klinik am Wittenbergplatz, Kleiststr. 23-26, D-10787, Berlin, Germany
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Hommer A, Kimmich F. Switching patients from preserved prostaglandin-analog monotherapy to preservative-free tafluprost. Clin Ophthalmol 2011; 5:623-31. [PMID: 21629567 PMCID: PMC3104790 DOI: 10.2147/opth.s17876] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Indexed: 11/23/2022] Open
Abstract
Purpose: Efficacy, tolerability and safety of the novel preservative-free prostaglandin tafluprost 0.0015% were investigated for the treatment of patients with glaucoma or ocular hypertension in a clinical setting. Patients and methods: Data were collected in a non-interventional, prospective, multi-center, observational, open label study. 118 patients were treated with a prostaglandin analog (PGA) monotherapy (preserved formulations of latanoprost, travoprost or bimatoprost) prior to baseline. Intraocular pressure (IOP) readings were recorded for each eye at baseline (previous therapy), 4–6 weeks, and 12 weeks after changing medical treatment to preservative-free tafluprost once-daily. We analyzed the change in IOP over the study period for all patients as well as for a subgroup of patients with prior PGA monotherapy. Subjective symptoms and objective ocular signs were determined. Comfort was measured using a 4 step scale. All adverse events were recorded. Paired t-tests were conducted to compare IOP values at baseline to IOP values after treatment with tafluprost 0.0015%. Bowker’s test of symmetry was used for statistical evaluation of changes of clinical signs (hyperemia). Results: In total 118 patients were eligible for evaluation. In these patients with prior PGA monotherapy (n = 118) IOP decreased significantly from 16.2 ± 4.3 mm Hg (95% CI: 0.55) at treated baseline to 14.8 ± 3.2 mm Hg (95% CI: 0.43; P < 0.001) at final visit on tafluprost. In a subset of patients with prior latanoprost monotherapy (n = 68) mean IOP at baseline (±SD) was reduced from 16.2 ± 4.6 mm Hg (95% CI: 0.77) 14.8 ± 3.1 mm Hg at final visit (95% CI: 0.54, P < 0.001), in patients with prior travoprost monotherapy (n = 32) from 16.2 ± 4.3 mm Hg (95% CI: 1.05) to 14.9 ± 3.3 mm Hg (95% CI: 0.91; P < 0.05) and in patients with prior bimatoprost monotherapy (n = 18) from 16.4 ± 3.5 mm Hg (95% CI: 1.14) to 15.0 ± 3.3 mm Hg (95% CI: 1.14; P = 0.252). Both, objective clinical signs and subjective symptoms improved after changing medication to preservative-free tafluprost until final visit. The number of patients with moderate and severe hyperemia decreased from 51 (43.2%) at baseline to 2 (1.9%) at final visit. Conclusion: Preservative-free tafluprost 0.0015% was effective, well tolerated and safe. IOP was controlled effectively and ocular symptoms and clinical signs were improved after changing medication to a monotherapy with preservative-free tafluprost in patients previously treated with a preserved latanoprost, travoprost or bimatoprost monotherapy.
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