1
|
Valencia-Nieto L, Pinto-Fraga J, Blanco-Vázquez M, Fernández I, López-Miguel A, García-Vázquez C, González-García MJ, Enríquez-de-Salamanca A, Calonge M. Short-Term Efficacy of Ophthalmic Cyclosporine: A 0.1% Cationic Emulsion in Dry Eye Patients Assessed Under Controlled Environment. Ophthalmol Ther 2024; 13:1197-1210. [PMID: 38446281 DOI: 10.1007/s40123-024-00906-1] [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: 01/11/2024] [Accepted: 02/05/2024] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION To evaluate the short-term efficacy of cyclosporine A (CsA)-0.1% cationic emulsion (CE) in patients with dry eye disease (DED) and mitigation of the inflammatory flares triggered by desiccating stress environments. METHODS A single-center non-randomized clinical trial was performed at a tertiary care setting. Twenty patients with DED treated with CsA 0.1% CE were exposed to a normal controlled environment (NCE) (23 °C, 50% relative humidity) and an adverse controlled environment (ACE) (23 °C, 10% relative humidity, 0.43 m/s localized airflow) during baseline and the 1- and 3-month visits. Patients underwent the following evaluations: conjunctival hyperemia and staining, corneal fluorescein staining (CFS) using the Oxford and Cornea and Contact Lens Research Unit (CCLRU) scale, meibomian gland (MG) secretion quality, Dry Eye Questionnaire-5, Symptom Assessment in Dry Eye (SANDE II), and Change in Dry Eye Symptoms Questionnaire. Multivariate models were adjusted for statistical analysis. RESULTS Nineteen women and one man (mean age, 58.9 ± 12.3 years) completed the study. All symptom questionnaires, CFS, conjunctival hyperemia and staining, and MG secretion quality improved (p ≤ 0.003) with 1 month of treatment; improvements were maintained after 3 months (p ≤ 0.02), except for SANDE II (p ≥ 0.07). The CFS worsening (total CCLRU) after baseline ACE exposure (from 8.6 to 10.1) was higher, although not significant (p = 0.64), compared with 1 month (from 5.4 to 5.8) and 3 months (from 5.0 to 5.9) after treatment. CONCLUSION Topical CsA-0.1% CE improved DED signs and symptoms after 1 month of treatment under controlled environmental conditions. Future studies should confirm the benefit of CsA-0.1% CE in desiccating stress environments. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT04492878.
Collapse
Affiliation(s)
- Laura Valencia-Nieto
- Instituto de Oftalmobiología Aplicada (IOBA), University of Valladolid, Campus Universitario Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain
| | - José Pinto-Fraga
- Instituto de Oftalmobiología Aplicada (IOBA), University of Valladolid, Campus Universitario Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain
| | - Marta Blanco-Vázquez
- Instituto de Oftalmobiología Aplicada (IOBA), University of Valladolid, Campus Universitario Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain
| | - Itziar Fernández
- Instituto de Oftalmobiología Aplicada (IOBA), University of Valladolid, Campus Universitario Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain
| | - Alberto López-Miguel
- Instituto de Oftalmobiología Aplicada (IOBA), University of Valladolid, Campus Universitario Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain.
| | - Carmen García-Vázquez
- Instituto de Oftalmobiología Aplicada (IOBA), University of Valladolid, Campus Universitario Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain
| | - María J González-García
- Instituto de Oftalmobiología Aplicada (IOBA), University of Valladolid, Campus Universitario Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain
| | - Amalia Enríquez-de-Salamanca
- Instituto de Oftalmobiología Aplicada (IOBA), University of Valladolid, Campus Universitario Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain
| | - Margarita Calonge
- Instituto de Oftalmobiología Aplicada (IOBA), University of Valladolid, Campus Universitario Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain
| |
Collapse
|
2
|
Hadipour Jahromy M, Qomi M, Fazelipour S, Sami N, Faali F, Karimi M, Adhami Moghadam F. Evaluation of curcumin-based ophthalmic nano-emulsion on atropine-induced dry eye in mice. Heliyon 2024; 10:e29009. [PMID: 38601632 PMCID: PMC11004198 DOI: 10.1016/j.heliyon.2024.e29009] [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: 11/14/2023] [Revised: 03/20/2024] [Accepted: 03/28/2024] [Indexed: 04/12/2024] Open
Abstract
Background One of the most efficient treatments for dry eye syndrome (DES) is to use nanocarriers as a potential delivery system. We aim to evaluate curcumin in a nano emulsion formulation. Methods A new formulation containing 5.5% curcuminoid was used. DLS, Zeta potential, TEM, and HPLC tests were performed to determine the size and morphology. First, 30 mice were selected as atropine-induced dry eye models. Next, 25 mice in 5 groups were treated with the nano emulsion at different doses, and corneal tissues were separated for evaluation. Results The DLS test results were indicative of the particles' stability. Nano curcumin appeared to be thoroughly effective in all groups, with the highest dose showing the most similarity to the healthy control group. Conclusions Curcumin-based nano emulsion eye drop is a promising candidate for DES management. However, further investigation is required to evaluate the possible risks in humans.
Collapse
Affiliation(s)
- Mahsa Hadipour Jahromy
- Herbal Pharmacology Research Center, School of Medicine, Dept of Pharmacology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Mahnaz Qomi
- Active Pharmaceutical Ingredients Research Center (APIRC), Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
- Department of Medicinal Chemistry, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Simin Fazelipour
- School of Medicine, Dept of Histology & Anatomy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Nafiseh Sami
- School of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Farzaneh Faali
- School of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Mehrnaz Karimi
- Department of Nanotechnology, School of Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Farhad Adhami Moghadam
- School of Medicine, Dept of Ophthalmology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| |
Collapse
|
3
|
Safir M, Twig G, Mimouni M. Dry eye disease management. BMJ 2024; 384:e077344. [PMID: 38527751 DOI: 10.1136/bmj-2023-077344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Affiliation(s)
- Margarita Safir
- Ophthalmology Department, Yitzhak Shamir Medical Center, Zerifin, Israel
- Faculty of Medicine, Tel Aviv University, Israel
| | - Gilad Twig
- Department of Epidemiology and Preventive Medicine, School of Public Health, Tel Aviv University, Israel
- The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Michael Mimouni
- Ophthalmology Department, Rambam Health Care Campus, Haifa, Israel
| |
Collapse
|
4
|
Lazreg S, Hosny M, Ahad MA, Sinjab MM, Messaoud R, Awwad ST, Rousseau A. Dry Eye Disease in the Middle East and Northern Africa: A Position Paper on the Current State and Unmet Needs. Clin Ophthalmol 2024; 18:679-698. [PMID: 38464499 PMCID: PMC10924846 DOI: 10.2147/opth.s436027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/24/2024] [Indexed: 03/12/2024] Open
Abstract
In the Middle East and Northern Africa (MENA), dry eye disease (DED) is often misdiagnosed or overlooked. This review summarizes a series of conversations with ophthalmologists in the region around a variety of climatic, lifestyle, and iatrogenic factors that contribute to specific features of DED in the MENA region. These considerations are further classified by patient lifestyle and surgical choices. All statements are based on discussions and formal voting to achieve consensus over three meetings. Overall, a deeper understanding of the disease characteristics of DED specific to MENA can better guide local eyecare practitioners on appropriate management and follow-up care. Additionally, population-based studies and patient and physician education on ocular surface diseases, together with the use of culturally appropriate and language-specific questionnaires can help ease the public health burden of DED in this region.
Collapse
Affiliation(s)
| | - Mohamed Hosny
- Refractive and Cornea Service, Cairo University Hospitals, Cairo, Egypt
| | - Muhammad A Ahad
- Department of Ophthalmology, Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Mazen M Sinjab
- Dr Sulaiman Al Habib Hospital, DHCC, Dubai, United Arab Emirates
| | - Riadh Messaoud
- Department of Ophthalmology, Tahar SFAR University Hospital, Mahdia, Tunisia
| | - Shady T Awwad
- Department of Ophthalmology, American University of Beirut - Medical Center, Beirut, Lebanon
| | - Antoine Rousseau
- Department of Ophthalmology, Bicêtre Hospital, Paris-Saclay University, Le Kremlin-Bicêtre, France
| |
Collapse
|
5
|
Feng J, Zhang Y. The potential benefits of polyphenols for corneal diseases. Biomed Pharmacother 2023; 169:115862. [PMID: 37979379 DOI: 10.1016/j.biopha.2023.115862] [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: 06/30/2023] [Revised: 10/30/2023] [Accepted: 11/05/2023] [Indexed: 11/20/2023] Open
Abstract
The cornea functions as the primary barrier of the ocular surface, regulating temperature and humidity while providing protection against oxidative stress, harmful stimuli and pathogenic microorganisms. Corneal diseases can affect the biomechanical and optical properties of the eye, resulting in visual impairment or even blindness. Due to their diverse origins and potent biological activities, plant secondary metabolites known as polyphenols offer potential advantages for treating corneal diseases owing to their anti-inflammatory, antioxidant, and antibacterial properties. Various polyphenols and their derivatives have demonstrated diverse mechanisms of action in vitro and in vivo, exhibiting efficacy against a range of corneal diseases including repair of tissue damage, treatment of keratitis, inhibition of neovascularization, alleviation of dry eye syndrome, among others. Therefore, this article presents a concise overview of corneal and related diseases, along with an update on the research progress of natural polyphenols in safeguarding corneal health. A more comprehensive understanding of natural polyphenols provides a novel perspective for secure treatment of corneal diseases.
Collapse
Affiliation(s)
- Jing Feng
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China
| | - Yangyang Zhang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China.
| |
Collapse
|
6
|
Bhujel B, Oh SH, Kim CM, Yoon YJ, Chung HS, Ye EA, Lee H, Kim JY. Current Advances in Regenerative Strategies for Dry Eye Diseases: A Comprehensive Review. Bioengineering (Basel) 2023; 11:39. [PMID: 38247916 PMCID: PMC10813666 DOI: 10.3390/bioengineering11010039] [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: 11/20/2023] [Revised: 12/17/2023] [Accepted: 12/26/2023] [Indexed: 01/23/2024] Open
Abstract
Dry eye disease (DED) is an emerging health issue affecting millions of individuals annually. Ocular surface disorders, such as DED, are characterized by inflammation triggered by various factors. This condition can lead to tear deficiencies, resulting in the desiccation of the ocular surface, corneal ulceration/perforation, increased susceptibility to infections, and a higher risk of severe visual impairment and blindness. Currently, the clinical management of DED primarily relies on supportive and palliative measures, including the frequent and lifelong use of different lubricating agents. While some advancements like punctal plugs, non-steroidal anti-inflammatory drugs, and salivary gland autografts have been attempted, they have shown limited effectiveness. Recently, there have been promising developments in the treatment of DED, including biomaterials such as nano-systems, hydrogels, and contact lenses for drug delivery, cell-based therapies, biological approaches, and tissue-based regenerative therapy. This article specifically explores the different strategies reported so far for treating DED. The aim is to discuss their potential as long-term cures for DED while also considering the factors that limit their feasibility and effectiveness. These advancements offer hope for more effective and sustainable treatment options in the future.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Jae-Yong Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea; (B.B.); (S.-H.O.); (C.-M.K.); (Y.-J.Y.); (H.-S.C.); (E.-A.Y.); (H.L.)
| |
Collapse
|
7
|
Treewipanon N, Kasetsuwan N, Reinprayoon U, Satitpitakul V, Uthaithammarat L, Tanpowpong T. Efficacy of Interleukin-1β Inhibitor on Dry Eye Disease in Patients with Degenerative Arthritis. Clin Ophthalmol 2023; 17:2967-2974. [PMID: 37841899 PMCID: PMC10573358 DOI: 10.2147/opth.s419310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/06/2023] [Indexed: 10/17/2023] Open
Abstract
Purpose To evaluate diacerein (interleukin-1β inhibitor) efficacy on ocular surface disease (OSD). Patients and Methods This prospective observational study included patients who received diacerein for osteoarthritis and had dry eye (DE). The primary outcome was corneal staining score. Secondary outcomes were ocular surface disease index (OSDI) score, tear breakup time (TBUT), tear osmolarity (Osm), Schirmer's test results, interleukin-1α (IL-1α), interleukin-1β (IL-1β), and interleukin-1 receptor antagonist (IL-1Ra) levels in tears. All measurements were done at baseline and 2-month follow-up visits. Linear mixed models were used to examine the effect of all parameters, and log-transformed models were used for IL-1α, IL-1β, and IL-1Ra analyses. Results Thirty-four patients (31 females and 3 males) were enrolled. The corneal staining score improved by 1.29 points (P=0.022, 95% confidence interval [95% CI] 0.19 to 2.40) after 2 months, and the OSDI score improved by 17.2 points (P<0.001, 95% CI 10.82 to 23.58) but TUBT decreased by 0.66 seconds (P=0.021, 95% CI 0.10 to 1.22). No significant differences were observed in the tear Osm and Schirmer's test. IL-1Ra demonstrated no statistical difference, IL-1α was significantly increased by 80% (P=0.260), and IL-1β was significantly decreased by 99.21% (P<0.001). Conclusion Diacerein can improve corneal staining and decrease IL-1β levels in tears, which reflects better DE symptoms. Diacerein may be a promising alternative treatment for patients with OSD and osteoarthritis.
Collapse
Affiliation(s)
- Nathapon Treewipanon
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Ngamjit Kasetsuwan
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Excellence Center for Cornea Transplantation, Department of Ophthalmology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Usanee Reinprayoon
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Excellence Center for Cornea Transplantation, Department of Ophthalmology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Vannarut Satitpitakul
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Excellence Center for Cornea Transplantation, Department of Ophthalmology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Lita Uthaithammarat
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Thanathep Tanpowpong
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| |
Collapse
|
8
|
Gao M, Zhao L, Liang R, Zhu Q, Zhao Q, Kong X. Evaluation of the Efficacy and Safety of Topical 0.05% Cyclosporine Eye Drops (II) in the Treatment of Dry Eye Associated with Primary Sjögren's Syndrome. Ocul Immunol Inflamm 2023; 31:1662-1668. [PMID: 35914303 DOI: 10.1080/09273948.2022.2094812] [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: 01/13/2022] [Accepted: 06/20/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of 0.05% cyclosporine eye drops (II) for the treatment of primary Sjögren's syndrome-associated dry eye (PSSDE). METHODS Sixty patients with PSSDE were randomly divided into three groups, received treatment with 0.05% cyclosporine (C group), artificial tears (S group) or their combination (CS group). The evaluation indicators were evaluated at baseline and at weeks 2, 4 and 12. RESULTS The symptoms of C and CS groups were reduced significantly. The signs [schirmer I test (F = 4.838, p = .011), ocular staining score (F = 7.961, p = .001) and tear break-up time (F = 9.283, p < .001)] were significantly different between S and C groups as well as S and CS groups. The tear meniscus height (F = 3.197, p = .048) was significantly different between S and CS groups. No serious adverse events occurred. CONCLUSION 0.05% cyclosporine is an effective and safe treatment for patients with PSSDE.
Collapse
Affiliation(s)
- Mingjun Gao
- Department of Ophthalmology, Dalian Medical University, Dalian, China
| | - Lin Zhao
- Department of Rheumatology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Ran Liang
- Department of Ophthalmology, Dalian Medical University, Dalian, China
| | - Qing Zhu
- Department of Ophthalmology, Dalian Medical University, Dalian, China
| | - Qi Zhao
- Department of Ophthalmology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Xiaodan Kong
- Department of Rheumatology, The Second Hospital of Dalian Medical University, Dalian, China
| |
Collapse
|
9
|
Oren B, Erboga Ç, Kocaay F, Öztürk Y, Bilak S, Kocabas DO, Balli H, Bilen A. Assessment of Tear Meniscus Dimensions Using Anterior Segment Optical Coherence Tomography in Vitamin D Deficiency in a Pediatric Population. Klin Monbl Augenheilkd 2023; 240:1143-1150. [PMID: 36452979 DOI: 10.1055/a-1990-8942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND To investigate of the effect of vitamin D (Vit-D) deficiency on the tear film in children and compare it with that of healthy subjects. METHODS This prospective and cross-sectional study comprised 75 eyes of children who had Vit-D deficiency (Group 1) and 85 eyes of age- and gender-matched healthy children (Group 2). The tear-film break-up time (TF-BUT) and Schirmer test values, as well as the Ocular Surface Disease Index (OSDI) scores, were recorded for the participants in all groups. Measurement of the tear meniscus area (TMA) and tear meniscus height (TMH) was performed 2 times in the same day via the use of anterior segment-optical coherence tomography (AS-OCT). RESULTS The mean age of the participants in Group 1 was 12.42 ± 3.40 years, while in Group 2, it was 12.59 ± 2.32 years (p = 0.758). Group 1 comprised 43 females and 32 males, while Group 2 comprised 44 females and 41 males (p = 0.250). The mean TMH, TMA, and Schirmer test values were found to be significantly lower in children with Vit-D deficiency (Group 1) than in healthy children (Group 2), with p < 0.05 for all the values. It was concluded that there was no significant difference in the values for the mean TF-BUT and OSDI scores (p = 0.029 and p = 0.596, respectively). CONCLUSION The children with Vit-D deficiency exhibited lower TMH, TMA, and Schirmer test values. The alterations that were observed in these parameters were more prominent in the participants who had lower Vit-D levels.
Collapse
Affiliation(s)
- Burak Oren
- Ophthalmology, Adiyaman University, Adiyaman, Turkey
| | - Çaglar Erboga
- Ophthalmology, Adiyaman University, Adiyaman, Turkey
| | - Funda Kocaay
- Public Health, Ankara Medipol University, Ankara, Turkey
| | - Yücel Öztürk
- Ophthalmology, Istanbul Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey
| | | | | | - Haci Balli
- Pediatrics, Adiyaman University, Adiyaman, Turkey
| | | |
Collapse
|
10
|
Gyenes A, Tapasztó Z, Quirce S, Luna C, Frutos-Rincón L, Gallar J, Acosta MC, Kovács I. Cyclosporine A Decreases Dryness-Induced Hyperexcitability of Corneal Cold-Sensitive Nerve Terminals. Int J Mol Sci 2023; 24:13025. [PMID: 37629206 PMCID: PMC10455570 DOI: 10.3390/ijms241613025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/09/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
Cyclosporine A (CsA) is used for the treatment of dry eye (DE) with good clinical results, improving tear secretion and decreasing subjective symptoms. These effects are attributed to the improved tear film dynamics, but there are no data on the effect of CsA on the abnormal sensory nerve activity characteristic in DE. Our purpose was to evaluate the CsA effect on the enhanced activity of corneal cold thermoreceptors in a tear-deficient DE animal model using in vitro extracellular recording of cold thermoreceptors nerve terminal impulses (NTIs) before and in the presence of CsA. NTI shape was also analyzed. Blinking frequency and tearing rate were also measured in awake animals before and after topical CsA. CsA increased the tearing and blinking of treated animals. CsA significantly decreased the peak response to cold of cold thermoreceptors. Neither their spontaneous NTIs discharge rate nor their cooling threshold were modified. CsA also seemed to reverse some of the changes in NTI shape induced by tear deficiency. These data suggest that, at least in part, the beneficial clinical effects of CsA in DE can be attributed to a direct effect on sensory nerve endings, although the precise mechanisms underlying this effect need further studies to be fully clarified.
Collapse
Affiliation(s)
- Andrea Gyenes
- Department of Ophthalmology, Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Zsófia Tapasztó
- Department of Ophthalmology, Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Susana Quirce
- Instituto de Neurociencias, Universidad Miguel Hernández—CSIC, 03550 San Juan de Alicante, Spain (C.L.); (L.F.-R.); (M.C.A.)
| | - Carolina Luna
- Instituto de Neurociencias, Universidad Miguel Hernández—CSIC, 03550 San Juan de Alicante, Spain (C.L.); (L.F.-R.); (M.C.A.)
| | - Laura Frutos-Rincón
- Instituto de Neurociencias, Universidad Miguel Hernández—CSIC, 03550 San Juan de Alicante, Spain (C.L.); (L.F.-R.); (M.C.A.)
- Instituto de Investigación Sanitaria y Biomédica de Alicante-ISABIAL, 03010 Alicante, Spain
| | - Juana Gallar
- Instituto de Neurociencias, Universidad Miguel Hernández—CSIC, 03550 San Juan de Alicante, Spain (C.L.); (L.F.-R.); (M.C.A.)
- Instituto de Investigación Sanitaria y Biomédica de Alicante-ISABIAL, 03010 Alicante, Spain
| | - M. Carmen Acosta
- Instituto de Neurociencias, Universidad Miguel Hernández—CSIC, 03550 San Juan de Alicante, Spain (C.L.); (L.F.-R.); (M.C.A.)
| | - Illés Kovács
- Department of Ophthalmology, Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY 10021, USA
- Department of Clinical Ophthalmology, Faculty of Health Sciences, Semmelweis University, 1088 Budapest, Hungary
| |
Collapse
|
11
|
Kim JG, An JH, Cho SY, Lee CE, Shim KY, Jun JH. Efficacy of Topical 0.05% Cyclosporine A for Ocular Surface Disease Related to Topical Anti-Glaucoma Medications. J Ocul Pharmacol Ther 2023. [PMID: 37267211 DOI: 10.1089/jop.2022.0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
Purpose: We aimed to determine the therapeutic efficacy of 0.05% topical cyclosporine A (CsA) for chronic ocular surface disease (OSD) in patients using benzalkonium chloride (BAK)-preserved antiglaucoma eye drops. Methods: A prospective, randomized, paired-eye, controlled clinical trial was conducted with participants who had been instilling at least one BAK-preserved topical antiglaucoma drug in both eyes for at least 6 months. Topical CsA was only applied in randomly selected unilateral eyes. Visual field (VF) indices, ocular surface parameters, tear meniscus height (TMH), and matrix metalloproteinase-9 (MMP-9) immunoassay were evaluated at baseline and at 2 and 4 months. Results: Seventy eyes from 35 participants were included in the study. The Schirmer I, tear breakup time, and TMH increased by 4.5 ± 8.6 mm (P < 0.01), 5.0 ± 5.3 s (P < 0.001), and 85.4 ± 159.0 μm (P < 0.01) in the treated eyes at 4 months from baseline, respectively. The ocular staining score and MMP-9 positivity in the treated eyes decreased by 2.2 ± 1.3 (P < 0.001) and 0.7 ± 0.9 points (P < 0.001), respectively, at 4 months. In untreated eyes, only TMH increased by 41.4 ± 92.1 μm (P = 0.016) from baseline to 4 months. In VF indices, the tracking failure frequency was 19.09% ± 21.62%, and the test duration was 336.0 ± 79.5 s in the treated eyes at 4 months, which were lower than 34.37% ± 23.13% (P < 0.001) and 375.9 ± 70.7 s (P < 0.05) in the nontreated eyes. Conclusion: Application of topical 0.05% CsA significantly improved the OSD parameters and the reliability indices of VF tests. This study was registered with the Clinical Research Information Service (CRIS) (number KCT0007124).
Collapse
Affiliation(s)
- Jae-Gon Kim
- Department of Ophthalmology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Republic of Korea
| | - Jae-Hong An
- Department of Ophthalmology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Republic of Korea
| | - Soon Young Cho
- Department of Ophthalmology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Republic of Korea
| | | | - Kyu Young Shim
- Department of Ophthalmology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Republic of Korea
| | - Jong Hwa Jun
- Department of Ophthalmology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Republic of Korea
| |
Collapse
|
12
|
Alkhaldi SA, Allam KH, Radwan MA, Sweeney LE, Alshammeri S. Estimates of dry eye disease in Saudi Arabia based on a short questionnaire of prevalence, symptoms, and risk factors: The Twaiq Mountain Eye Study I. Cont Lens Anterior Eye 2023; 46:101770. [PMID: 36210288 DOI: 10.1016/j.clae.2022.101770] [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: 06/10/2022] [Revised: 09/01/2022] [Accepted: 09/26/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE To estimate the prevalence and associated risk factors of dry eye disease (DED) among the citizens of Saudi Arabia. METHODS A cross-sectional prevalence survey was administered to 4066 healthy adults from the five main regions of Saudi Arabia. Initial estimates of the prevalence and associated risk factors of DED were calculated for the general population and then stratified by demographic characteristics such as age, sex, and location. DED was assessed by a short, validated dry-eye questionnaire. RESULTS The overall prevalence of DED was 49.5 % (n = 2016), including 33.1 % (n = 1347) of participants who reported a previous DED diagnosis and 16.4 % (n = 669) who reported severe symptoms; 14.7 % reported severe symptoms and a previous DED diagnosis (n = 598). The DED prevalence among men was 49.8 % (n = 1005) compared with 50.2 % (n = 1011) for women. The multivariate model analysis confirmed the increased prevalence of DED in women (OR 1.48; 95 % CI 1.30-1.88), those ≥60 years of age (OR 1.99; 95 % CI 1.60-2.81), those who had undergone refractive surgery (OR 1.79; 95 % CI 1.50-2.59), those having undergone acne treatment (OR 1.51; 95 % CI 1.34-1.97), contact lens wearers (OR 1.77; 95 % CI 1.40-2.48), those having taken antiallergy drugs (OR 2.23; 95 % CI 1.55-2.78) or antidepressants (OR 1.60; 95 % CI 1.14-2.44), and those who reported computer use of >6 h per day (OR 1.66; 95 % CI 1.41-2.52). CONCLUSION Dry eye is a common disease among the Saudi Arabian population. Prevalence is found to be high and vary significantly across the country. DED could be attributed to dry weather, low annual rainfall, low humidity, widespread use of air conditioners, air pollution, high temperature, and exposure to sunlight.
Collapse
Affiliation(s)
- Saleh A Alkhaldi
- Department of Ophthalmology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Khalid H Allam
- Department of Ophthalmology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Mohammed A Radwan
- Department of Ophthalmology, King Saud Medical City, Riyadh, Saudi Arabia; College of Medicine, Cairo University, Cairo, Egypt
| | - Laura E Sweeney
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Saleh Alshammeri
- Department of Optometry, College of Applied Medical Sciences, Qassim University, Saudi Arabia.
| |
Collapse
|
13
|
Thorel D, Ingen-Housz-Oro S, Benaïm D, Daien V, Gabison E, Saunier V, Béral L, Touboul D, Brémond-Gignac D, Robert M, Vasseur R, Royer G, Dereure O, Milpied B, Bernier C, Welfringer-Morin A, Bodemer C, Cordel N, Tauber M, Burillon C, Servant M, Couret C, Vabres B, Tétart F, Cassagne M, Kuoch MA, Muraine M, Delcampe A, Gueudry J. Ocular sequelae of epidermal necrolysis: French national audit of practices, literature review and proposed management. Orphanet J Rare Dis 2023; 18:51. [PMID: 36906580 PMCID: PMC10007779 DOI: 10.1186/s13023-023-02616-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 01/15/2023] [Indexed: 03/13/2023] Open
Abstract
Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are serious and rare diseases, most often drug-induced, and their incidence has been estimated at 6 cases/million/year in France. SJS and TEN belong to the same spectrum of disease known as epidermal necrolysis (EN). They are characterized by more or less extensive epidermal detachment, associated with mucous membrane involvement, and may be complicated during the acute phase by fatal multiorgan failure. SJS and TEN can lead to severe ophthalmologic sequelae. There are no recommendations for ocular management during the chronic phase. We conducted a national audit of current practice in the 11 sites of the French reference center for toxic bullous dermatoses and a review of the literature to establish therapeutic consensus guidelines. Ophthalmologists and dermatologists from the French reference center for epidermal necrolysis were asked to complete a questionnaire on management practices in the chronic phase of SJS/TEN. The survey focused on the presence of a referent ophthalmologist at the center, the use of local treatments (artificial tears, corticosteroid eye drops, antibiotic-corticosteroids, antiseptics, vitamin A ointment (VA), cyclosporine, tacrolimus), the management of trichiatic eyelashes, meibomian dysfunction, symblepharons, and corneal neovascularization, as well as the contactologic solutions implemented. Eleven ophthalmologists and 9 dermatologists from 9 of the 11 centers responded to the questionnaire. Based on questionnaire results, 10/11 ophthalmologists systematically prescribed preservative-free artificial tears, and 11/11 administered VA. Antiseptic or antibiotic eye drops or antibiotic-corticosteroid eye drops were recommended as needed by 8/11 and 7/11 ophthalmologists, respectively. In case of chronic inflammation, topical cyclosporine was consistently proposed by 11/11 ophthalmologists. The removal of trichiatic eyelashes was mainly performed by 10/11 ophthalmologists. Patients were referred to a reference center for fitting of scleral lenses (10/10,100%). Based on this practice audit and literature review, we propose an evaluation form to facilitate ophthalmic data collection in the chronic phase of EN and we also propose an algorithm for the ophthalmologic management of ocular sequelae.
Collapse
Affiliation(s)
- Dhyna Thorel
- Ophthalmology Department, CHU Charles Nicolle Rouen, Rouen, France.
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France.
| | - Saskia Ingen-Housz-Oro
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Dermatology Department, AP-HP, Henri Mondor Hospital, Univ Paris Est Créteil EpidermE, Créteil, France
| | - Daniel Benaïm
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Vincent Daien
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmology Department CHU Montpellier, Montpellier, France
| | - Eric Gabison
- 6Ophthalmology Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Valentine Saunier
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmology Department, CHU Bordeaux, Bordeaux, France
| | - Laurence Béral
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmology Department, CHU Pointe À Pitre, Pointe À Pitre, Guadeloupe, France
| | - David Touboul
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmology Department, CHU Bordeaux, Bordeaux, France
| | - Dominique Brémond-Gignac
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmology Department, Hôpital Universitaire Necker Enfants-Malades, APHP, Paris, France
| | - Matthieu Robert
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmology Department, Hôpital Universitaire Necker Enfants-Malades, APHP, Paris, France
| | - Robin Vasseur
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmology Department, CHU de Nantes, Nantes, France
| | - Gérard Royer
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Olivier Dereure
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Dermatology Department, CHU Montpellier, Montpellier, France
| | - Brigitte Milpied
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Dermatology Department, CHU Bordeaux, Bordeaux, France
| | - Claire Bernier
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Dermatology Department, CHU Nantes, Nantes, France
| | - Anne Welfringer-Morin
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Dermatology Department, AP-HP, Hôpital Universitaire Necker Enfants-Malades, APHP, Paris, France
| | - Christine Bodemer
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Dermatology Department, AP-HP, Hôpital Universitaire Necker Enfants-Malades, APHP, Paris, France
| | - Nadège Cordel
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Dermatology and Clinical Immunology Department, CHU Guadeloupe, Pointe À Pitre, , Guadeloupe, France
| | - Marie Tauber
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Dermatology Department, CHU de Toulouse, Toulouse, France
| | - Carole Burillon
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmolgy Department, CHU Lyon, Lyon, France
| | - Marion Servant
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmology Department, CHU de Nantes, Nantes, France
| | - Chloe Couret
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmology Department, CHU de Nantes, Nantes, France
| | - Bertrand Vabres
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmology Department, CHU de Nantes, Nantes, France
| | - Florence Tétart
- Ophthalmology Department, CHU Charles Nicolle Rouen, Rouen, France
- Dermatology Department, CHU Charles Nicolle Rouen, Rouen, France
| | - Myriam Cassagne
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmology Department, CHU de Toulouse, Toulouse, France
| | - Marie-Ange Kuoch
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Marc Muraine
- Ophthalmology Department, CHU Charles Nicolle Rouen, Rouen, France
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
| | - Agnès Delcampe
- Ophthalmology Department, CHU Charles Nicolle Rouen, Rouen, France
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
| | - Julie Gueudry
- Ophthalmology Department, CHU Charles Nicolle Rouen, Rouen, France
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
| |
Collapse
|
14
|
Ingen-Housz-Oro S, Schmidt V, Ameri MM, Abe R, Brassard A, Mostaghimi A, Paller AS, Romano A, Didona B, Kaffenberger BH, Ben Said B, Thong BYH, Ramsay B, Brezinova E, Milpied B, Mortz CG, Chu CY, Sotozono C, Gueudry J, Fortune DG, Dridi SM, Tartar D, Do-Pham G, Gabison E, Phillips EJ, Lewis F, Salavastru C, Horvath B, Dart J, Setterfield J, Newman J, Schulz JT, Delcampe A, Brockow K, Seminario-Vidal L, Jörg L, Watson MP, Gonçalo M, Lucas M, Torres M, Noe MH, Hama N, Shear NH, O’Reilly P, Wolkenstein P, Romanelli P, Dodiuk-Gad RP, Micheletti RG, Tiplica GS, Sheridan R, Rauz S, Ahmad S, Chua SL, Flynn TH, Pichler W, Le ST, Maverakis E, Walsh S, French LE, Brüggen MC. Post-acute phase and sequelae management of epidermal necrolysis: an international, multidisciplinary DELPHI-based consensus. Orphanet J Rare Dis 2023; 18:33. [PMID: 36814255 PMCID: PMC9945700 DOI: 10.1186/s13023-023-02631-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Long-term sequelae are frequent and often disabling after epidermal necrolysis (Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)). However, consensus on the modalities of management of these sequelae is lacking. OBJECTIVES We conducted an international multicentric DELPHI exercise to establish a multidisciplinary expert consensus to standardize recommendations regarding management of SJS/TEN sequelae. METHODS Participants were sent a survey via the online tool "Survey Monkey" consisting of 54 statements organized into 8 topics: general recommendations, professionals involved, skin, oral mucosa and teeth, eyes, genital area, mental health, and allergy workup. Participants evaluated the level of appropriateness of each statement on a scale of 1 (extremely inappropriate) to 9 (extremely appropriate). Results were analyzed according to the RAND/UCLA Appropriateness Method. RESULTS Fifty-two healthcare professionals participated. After the first round, a consensus was obtained for 100% of 54 initially proposed statements (disagreement index < 1). Among them, 50 statements were agreed upon as 'appropriate'; four statements were considered 'uncertain', and ultimately finally discarded. CONCLUSIONS Our DELPHI-based expert consensus should help guide physicians in conducting a prolonged multidisciplinary follow-up of sequelae in SJS-TEN.
Collapse
Affiliation(s)
- S. Ingen-Housz-Oro
- grid.412116.10000 0004 1799 3934Department of Dermatology, AP-HP, Henri Mondor Hospital, 1 Rue Gustave Eiffel, 94000 Créteil, France ,ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France ,grid.410511.00000 0001 2149 7878EpiDermE, Université Paris Est Créteil, Créteil, France
| | - V. Schmidt
- grid.410567.1University Hospital Basel, Basel, Switzerland ,grid.7400.30000 0004 1937 0650Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - M. M. Ameri
- grid.7400.30000 0004 1937 0650Faculty of Medicine, University of Zurich, Zurich, Switzerland ,grid.412004.30000 0004 0478 9977Department of Dermatology, University Hospital Zurich, Zurich, Switzerland ,grid.507894.70000 0004 4700 6354Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - R. Abe
- grid.260975.f0000 0001 0671 5144Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - A. Brassard
- grid.413079.80000 0000 9752 8549Department of Dermatology, UC Davis Medical Center, Sacramento, CA USA
| | - A. Mostaghimi
- grid.62560.370000 0004 0378 8294Department of Dermatology, Brigham and Women’s Hospital, Boston, MA USA
| | - A. S. Paller
- grid.16753.360000 0001 2299 3507Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - A. Romano
- grid.419843.30000 0001 1250 7659Oasi Research Institute-IRCCS, Troina, Italy
| | - B. Didona
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.419457.a0000 0004 1758 0179Rare Disease Unit, I Dermatology Division, Istituto Dermopatico Dell’Immacolata, IRCCS, Rome, Italy
| | - B. H. Kaffenberger
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.412332.50000 0001 1545 0811The Ohio State University Wexner Medical Center Division of Dermatology, Upper Arlington, OH USA
| | - B. Ben Said
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France ,Department of Dermatology, CHU Edouard Herriot, Lyon, France
| | - B. Y. H. Thong
- grid.240988.f0000 0001 0298 8161Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - B. Ramsay
- grid.415522.50000 0004 0617 6840Department of Dermatology, University Hospital Limerick, Limerick, Ireland
| | - E. Brezinova
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.10267.320000 0001 2194 0956First Department of Dermatovenereology, Masaryk University Faculty of Medicine, St. Ann’s Faculty Hospital in Brno, Brno, Czech Republic
| | - B. Milpied
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France ,grid.412041.20000 0001 2106 639XDepartment of Adult and Pediatric Dermatology, Bordeaux University Hospitals, Bordeaux, France
| | - C. G. Mortz
- grid.7143.10000 0004 0512 5013Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
| | - C. Y. Chu
- grid.19188.390000 0004 0546 0241Department of Dermatology, National Taiwan University Hospital, National Taiwan University College of Medicine, No. 7, Chung-Shan South Road, Taipei, 10002 Taiwan
| | - C. Sotozono
- grid.272458.e0000 0001 0667 4960Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Hirokoji-Agaru, Kawaramach-Dori, Kamigyo-Ku, Kyoto, 602-0841 Japan
| | - J. Gueudry
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France ,grid.417615.0Department of Ophthalmology, CHU Charles-Nicolle, Rouen, France
| | - D. G. Fortune
- grid.10049.3c0000 0004 1936 9692Department of Psychology, University of Limerick, Limerick, Ireland
| | - S. M. Dridi
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France ,grid.416670.2MICORALIS Laboratory, Department of Periodontology, Faculty of Dentistry, Côte d’Azur University, Saint Roch Hospital, Nice, France
| | - D. Tartar
- grid.27860.3b0000 0004 1936 9684Department of Dermatology, University of California Davis, Sacramento, CA USA
| | - G. Do-Pham
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France ,grid.414145.10000 0004 1765 2136Department of Internal Medicine, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - E. Gabison
- grid.417888.a0000 0001 2177 525XFondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - E. J. Phillips
- grid.1025.60000 0004 0436 6763Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, WA Australia ,grid.412807.80000 0004 1936 9916Department of Medicine, Vanderbilt University Medical Center, Nashville, TN USA
| | - F. Lewis
- grid.425213.3St John’s Institute of Dermatology, Guy’s and St Thomas’ Hospital, London, UK
| | - C. Salavastru
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,Department of Paediatric Dermatology, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - B. Horvath
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.4830.f0000 0004 0407 1981Department of Dermatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - J. Dart
- grid.83440.3b0000000121901201Moorfields Eye Hospital NHS Foundation Trust, The UCL Institute of Ophthalmology, London, UK
| | - J. Setterfield
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.420545.20000 0004 0489 3985Department of Oral Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - J. Newman
- grid.429705.d0000 0004 0489 4320Department of Dermatology, King’s College Hospital NHS Foundation Trust, London, UK
| | - J. T. Schulz
- grid.32224.350000 0004 0386 9924Division of Burns, Massachusetts General Hospital, Boston, 02114 USA
| | - A. Delcampe
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France ,grid.417615.0Department of Ophthalmology, CHU Charles-Nicolle, Rouen, France ,grid.417888.a0000 0001 2177 525XFondation Ophtalmologique Adolphe de Rothschild, Paris, France ,grid.411119.d0000 0000 8588 831XDepartment of Ophthalmology, CHU Bichat-Claude Bernard, Paris, France
| | - K. Brockow
- grid.6936.a0000000123222966Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | - L. Seminario-Vidal
- grid.170693.a0000 0001 2353 285XDepartment of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, FL USA
| | - L. Jörg
- grid.412004.30000 0004 0478 9977Department of Dermatology, University Hospital Zurich, Zurich, Switzerland ,grid.5734.50000 0001 0726 5157Division of Allergology and Clinical Immunology, Department of Pneumology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - M. P. Watson
- grid.439257.e0000 0000 8726 5837Cornea and External Eye Disease Service, Moorfields Eye Hospital, London, UK
| | - M. Gonçalo
- grid.28911.330000000106861985Department of Dermatology, Coimbra University Hospital Center, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - M. Lucas
- grid.1012.20000 0004 1936 7910Medical School, University of Western Australia, Perth, WA 6009 Australia ,grid.3521.50000 0004 0437 5942Department of Immunology, Sir Charles Gairdner Hospital, Pathwest Laboratory Medicine, Perth, WA 6009 Australia
| | - M. Torres
- grid.452525.1Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | - M. H. Noe
- grid.62560.370000 0004 0378 8294Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - N. Hama
- grid.260975.f0000 0001 0671 5144Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - N. H. Shear
- grid.17063.330000 0001 2157 2938Department of Dermatology, University of Toronto, Toronto, ON Canada ,grid.413104.30000 0000 9743 1587Sunnybrook Health Sciences Centre, Toronto, ON Canada
| | - P. O’Reilly
- grid.10049.3c0000 0004 1936 9692Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - P. Wolkenstein
- grid.412116.10000 0004 1799 3934Department of Dermatology, AP-HP, Henri Mondor Hospital, 1 Rue Gustave Eiffel, 94000 Créteil, France ,ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
| | - P. Romanelli
- grid.26790.3a0000 0004 1936 8606Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, FL USA
| | - R. P. Dodiuk-Gad
- grid.6451.60000000121102151Dermatology Department, Emek Medical Center, Bruce Rappaport Faculty of Medicine, Technion - Institute of Technology, Haifa, Israel ,grid.17063.330000 0001 2157 2938Department of Medicine, University of Toronto, Toronto, Canada
| | - R. G. Micheletti
- grid.25879.310000 0004 1936 8972Department of Dermatology and Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - G. S. Tiplica
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,2Nd Department of Dermatology, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - R. Sheridan
- grid.415829.30000 0004 0449 5362Burn Service, Boston Shriners Hospital for Children, Boston, MA USA ,grid.32224.350000 0004 0386 9924Division of Burns, Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Surgery, Harvard Medical School, Boston, MA USA
| | - S. Rauz
- grid.6572.60000 0004 1936 7486Academic Unit of Ophthalmology, Birmingham and Midland Eye Centre, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - S. Ahmad
- grid.83440.3b0000000121901201Moorfields Eye Hospital NHS Foundation Trust, The UCL Institute of Ophthalmology, London, UK
| | - S. L. Chua
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.412563.70000 0004 0376 6589Department of Dermatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - T. H. Flynn
- grid.460892.10000 0004 0389 5639Ophthalmology, Bon Secours Hospital, Cork, Ireland
| | - W. Pichler
- grid.482939.dADR-AC GmbH, Bern, Switzerland
| | - S. T. Le
- grid.413079.80000 0000 9752 8549Department of Dermatology, UC Davis Medical Center, Sacramento, CA USA
| | - E. Maverakis
- grid.413079.80000 0000 9752 8549Department of Dermatology, UC Davis Medical Center, Sacramento, CA USA
| | - S. Walsh
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.429705.d0000 0004 0489 4320Department of Dermatology, King’s College Hospital NHS Foundation Trust, London, UK
| | - L. E. French
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.411095.80000 0004 0477 2585Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany ,grid.26790.3a0000 0004 1936 8606Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL USA
| | - M. C. Brüggen
- ToxiTEN Group, European Reference Network for Rare Skin Diseases, Paris, France ,grid.7400.30000 0004 1937 0650Faculty of Medicine, University of Zurich, Zurich, Switzerland ,grid.412004.30000 0004 0478 9977Department of Dermatology, University Hospital Zurich, Zurich, Switzerland ,grid.507894.70000 0004 4700 6354Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| |
Collapse
|
15
|
Thacker M, Singh V, Basu S, Singh S. Biomaterials for dry eye disease treatment: Current overview and future perspectives. Exp Eye Res 2023; 226:109339. [PMID: 36470431 DOI: 10.1016/j.exer.2022.109339] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/04/2022] [Accepted: 11/27/2022] [Indexed: 12/09/2022]
Abstract
Dry eye disease (DED) is an emerging health problem affecting millions of individuals every year. The current treatments for DED include lubricating eye drops and anti-inflammatory agents. These agents have to be used frequently and contain preservatives, which can damage the ocular surface. A substantially long-acting treatment with better bioavailability on the ocular surface might reduce the frequency of drug use and its side effects. This review summarizes the current state of different biomaterials-nanosystems, hydrogels, and contact lenses used as drug delivery systems in DED. The explored drugs in biomaterial formulation are cyclosporin, ocular lubricants, and topical steroids. Most of the data is from animal models where increased drug delivery and desired therapeutic effects could be obtained; however, trials involving human participants are yet to happen. There is no published study comparing the different types of biomaterials for DED use. Long-term studies evaluating their ocular toxicity and biocompatibility would enhance their transition to human use. Overall they look promising for DED treatment, but they are still in the stage of technological advancement and clinical studies.
Collapse
Affiliation(s)
- Minal Thacker
- Brien Holden Center for Eye Research (BHERC), L V Prasad Eye Institute, Hyderabad, 500034, Telangana, India; Centre for Ocular Regeneration, L V Prasad Eye Institute, Hyderabad, 500034, Telangana, India
| | - Vivek Singh
- Brien Holden Center for Eye Research (BHERC), L V Prasad Eye Institute, Hyderabad, 500034, Telangana, India; Centre for Ocular Regeneration, L V Prasad Eye Institute, Hyderabad, 500034, Telangana, India
| | - Sayan Basu
- Brien Holden Center for Eye Research (BHERC), L V Prasad Eye Institute, Hyderabad, 500034, Telangana, India; The Cornea Institute, L V Prasad Eye Institute, Hyderabad, 500034, Telangana, India
| | - Swati Singh
- Centre for Ocular Regeneration, L V Prasad Eye Institute, Hyderabad, 500034, Telangana, India; Ophthalmic Plastic Surgery Services, L V Prasad Eye Institute, Hyderabad, 500034, Telangana, India.
| |
Collapse
|
16
|
[Ocular Graft-Versus-Host Disease : Guidelines of the German Society of Ophthalmology (DOG) and the German Professional Association of Ophthalmologists (BVA)]. DIE OPHTHALMOLOGIE 2023; 120:50-58. [PMID: 36525047 DOI: 10.1007/s00347-022-01781-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 12/23/2022]
|
17
|
Messmer EM, Ahmad S, Benitez del Castillo JM, Mrukwa-Kominek E, Rolando M, Vitovska O, Baudouin C. Management of inflammation in dry eye disease: Recommendations from a European panel of experts. Eur J Ophthalmol 2022; 33:1294-1307. [PMID: 36471573 PMCID: PMC10152565 DOI: 10.1177/11206721221141481] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction Early initiation of anti-inflammatory therapies is recommended for dry eye disease (DED) to break the vicious cycle of pathophysiology. However, there is limited guidance on how to implement topical ciclosporin (CsA) and corticosteroid treatment into clinical practice. This expert-led consensus provides practical guidance on the management of DED, including when and how to use topical CsA. Methods A steering committee (SC) of seven European DED experts developed a questionnaire to gain information on the unmet needs and management of DED in clinical practice. Consensus statements on four key areas (disease severity and progression; patient management; efficacy, safety and tolerability of CsA; and patient education) were generated based on the responses. The SC and an expanded expert panel of 22 members used a nine-point scale (1 = strongly disagree; 9 = strongly agree) to rate statements; a consensus was reached if ≥75% of experts scored a statement ≥7. Results A stepwise approach to DED management is required in patients presenting with moderate corneal staining. Early topical CsA initiation, alone or with corticosteroids, should be considered in patients with clinical risk factors for severe DED. Patient education is required before and during treatment to manage expectations regarding efficacy and tolerability in order to optimise adherence. Follow-up visits are required, ideally at Month 1 and every 3 months thereafter. Topical CsA may be continued indefinitely, especially when surgery is required. Conclusion This consensus fills some of the knowledge gaps in previous recommendations regarding the use of topical corticosteroids and CsA in patients with DED.
Collapse
Affiliation(s)
| | - Sajjad Ahmad
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Ewa Mrukwa-Kominek
- Department of Ophthalmology, Medical University of Silesia, Katowice, Poland
| | | | | | - Christophe Baudouin
- Department of Ophthalmology, Quinze-Vingts National Ophthalmology Hospital and Vision Institute, Paris, France
| | | |
Collapse
|
18
|
Zeng W, Zhou X, Yu S, Liu R, Quek CWN, Yu H, Tay RYK, Lin X, Feng Y. The Future of Targeted Treatment of Primary Sjögren's Syndrome: A Focus on Extra-Glandular Pathology. Int J Mol Sci 2022; 23:ijms232214135. [PMID: 36430611 PMCID: PMC9694487 DOI: 10.3390/ijms232214135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/11/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022] Open
Abstract
Primary Sjögren's syndrome (pSS) is a chronic, systemic autoimmune disease defined by exocrine gland hypofunction resulting in dry eyes and dry mouth. Despite increasing interest in biological therapies for pSS, achieving FDA-approval has been challenging due to numerous complications in the trials. The current literature lacks insight into a molecular-target-based approach to the development of biological therapies. This review focuses on novel research in newly defined drug targets and the latest clinical trials for pSS treatment. A literature search was conducted on ClinicalTrials.gov using the search term "Primary Sjögren's syndrome". Articles published in English between 2000 and 2021 were included. Our findings revealed potential targets for pSS treatment in clinical trials and the most recent advances in understanding the molecular mechanisms underlying the pathogenesis of pSS. A prominent gap in current trials is in overlooking the treatment of extraglandular symptoms such as fatigue, depression, and anxiety, which are present in most patients with pSS. Based on dryness and these symptom-directed therapies, emerging biological agents targeting inflammatory cytokines, signal pathways, and immune reaction have been studied and their efficacy and safety have been proven. Novel therapies may complement existing non-pharmacological methods of alleviating symptoms of pSS. Better grading systems that add extraglandular symptoms to gauge disease activity and severity should be created. The future of pSS therapies may lie in gene, stem-cell, and tissue-engineering therapies.
Collapse
Affiliation(s)
- Weizhen Zeng
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
| | - Xinyao Zhou
- Department of Rheumatology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijng 100053, China
| | - Sulan Yu
- School of Chinese Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ruihua Liu
- Department of Rheumatology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijng 100053, China
| | - Chrystie Wan Ning Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Haozhe Yu
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
| | - Ryan Yong Kiat Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Xiang Lin
- School of Chinese Medicine, The University of Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong SAR, China
- Correspondence: (X.L.); (Y.F.)
| | - Yun Feng
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
- Correspondence: (X.L.); (Y.F.)
| |
Collapse
|
19
|
Gao D, Da Z, Yang K, Shi Y. Comparison of seven cyclosporine A formulations for dry eye disease: A systematic review and network meta-analysis. Front Pharmacol 2022; 13:882803. [PMID: 36419623 PMCID: PMC9676501 DOI: 10.3389/fphar.2022.882803] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 10/20/2022] [Indexed: 08/27/2023] Open
Abstract
Background: Dry eye disease is a common ocular surface disease affecting tens of millions of people worldwide. It is characterized by an unstable tear film and increasing prevalence. Different commercial formulations of cyclosporine A for dry eye have been approved, however, it is still unclear whether the differences in formulations of these products will make a difference in clinical efficacy and safety. Methods: Randomized controlled trials of commercial cyclosporine A formulation for dry eye disease were searched in Pubmed, EMBASE, Scopus, and Cochrane controlled trials registries and Web of Science from inception till 1 December 2021. Independent literature screening, data extraction, quality evaluation, and the study in line with quality standards were analyzed by using Stata16.0 software. The study is registered with PROSPERO under the number CRD42022301423. Code and data for this study is publicly available (https://github.com/DongYangGao/Dongyang.github.io.git). Results: 21 randomized clinical trials with a total of 4,107 participants were included in this study. Restasis® (OR-4.82, 95% CI-6.18 to 3.45, SUCRA 77.2%) was the most effective commercial formulation for reducing OSDI, Zirun® (SUCRA 73.9%) performed better in improving Schirmer's test. TJ Cyporin® (SUCRA 65.3%) ranked first in terms of improving tear film break-up time. For treatment-emergent adverse events incidence, Clacier® was close to placebo. The risk of reporting bias is considered low. Conclusion: In the comparison of outcomes included in this study, the optimal order of various commercial cyclosporine A formulations is different, so it is difficult to select the optimal formula. Appropriate commercial formulations should be selected according to patients' conditions in clinical practice.
Collapse
Affiliation(s)
- Dongyang Gao
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Zhuoli Da
- Department of Ophthalmology, The First People’s Hospital of Lanzhou City, Lanzhou, China
| | - Kan Yang
- Department of Ophthalmology, The First People’s Hospital of Lanzhou City, Lanzhou, China
| | - Yuanyuan Shi
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
- Shenzhen Research Institute, Beijing University of Chinese Medicine, Shenzhen, China
| |
Collapse
|
20
|
Atzeni F, Gozza F, Cafaro G, Perricone C, Bartoloni E. Cardiovascular Involvement in Sjögren’s Syndrome. Front Immunol 2022; 13:879516. [PMID: 35634284 PMCID: PMC9134348 DOI: 10.3389/fimmu.2022.879516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/22/2022] [Indexed: 12/26/2022] Open
Abstract
Sjögren Syndrome (SS) seems to be associated with a greater “overall risk” of cardiovascular (CV) and cerebrovascular events. Although not conventionally considered a feature of the disease, CV events represent a major burden in SS patients. CV risk is the consequence of a complex combination of multiple factors, including traditional risk factors and disease-related mechanisms. A complex relationships between disease-related features, endothelial dysfunction and traditional risk factor has been suggested. Several drugs are available for treating the systemic manifestations of SS, however they have shown positive effects on different outcomes of the disease, but until today the data on the role of these drugs on CV events are scarse. Given these data, the aim of this review was to evaluate the risk of CV risk in primary SS and the effect of the drugs on this manifestation.
Collapse
Affiliation(s)
- Fabiola Atzeni
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- *Correspondence: Fabiola Atzeni,
| | - Francesco Gozza
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giacomo Cafaro
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Carlo Perricone
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| |
Collapse
|
21
|
Shin D, Sang Min J. Comparison of treatment effects between 4.9% N-acetyl-aspartyl glutamic acid and 0.05% cyclosporine A eye drops in dry eye patients. Graefes Arch Clin Exp Ophthalmol 2022; 260:3285-3291. [PMID: 35486175 DOI: 10.1007/s00417-022-05682-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/30/2022] [Accepted: 04/15/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE We aimed to investigate the difference in the treatment effects of 4.9% N-acetyl-aspartyl glutamic acid (NAAGA) and 0.05% cyclosporine A (CsA) eye drops in dry eye patients. METHODS We retrospectively reviewed the medical records of 86 patients (86 eyes) who were diagnosed with dry eye and treated with NAAGA or CsA eye drops. Patients treated with NAAGA or CsA eye drops were designated as group A or B, respectively. We also calculated Ocular Surface Disease Index (OSDI), dry eye, and meibomian gland dysfunction (MGD) parameters before treatment and at 1 and 3 months after treatment. Eye drop discomfort was assessed by calculating visual analog scale (VAS) scores at 1 month and 3 months after treatment. RESULTS There were no significant differences in patients' demographics and OSDI, dry eye, and MGD parameters between the two groups. OSDI, dry eye, and MGD parameters at 1 month and 3 months after treatment were found to be improved in both groups. However, at 1 month after treatment, the dry eye and MGD parameters of group A, except for corneal fluorescein staining, showed more improvement than those of group B. Additionally, at 3 months after treatment, the lid margin abnormality score, corneal staining score, tear break-up time, and OSDI of group A were significantly lower than those of group B. VAS scores of group A at 1 and 3 months after treatment were significantly lower than those of group B. CONCLUSION Treatment with NAAGA eye drops was effective in dry eye patients and demonstrated faster treatment response and less discomfort during application than CsA eye drops.
Collapse
Affiliation(s)
- Daeun Shin
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, 1, 34 Gil, Yeongshinro, Youngdeungpo-gu, Seoul, 07301, Republic of Korea
| | - Ji Sang Min
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, 1, 34 Gil, Yeongshinro, Youngdeungpo-gu, Seoul, 07301, Republic of Korea.
| |
Collapse
|
22
|
Bustamante-Arias A, Ruiz Lozano RE, Rodriguez-Garcia A. Dry eye disease, a prominent manifestation of systemic autoimmune disorders. Eur J Ophthalmol 2022; 32:3142-3162. [PMID: 35300528 DOI: 10.1177/11206721221088259] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Dry eye disease (DED) is arguably the most frequent ocular disease encountered in ophthalmic clinical practice. DED is frequently an underestimated condition causing a significant impact on visual function and quality of life. Many systemic autoimmune diseases (SAIDs) are related to moderate to severe DED. The main objective of this review is to enhance the awareness among ophthalmologists of the potential association of an underlying SAID in a high-risk patient with DED. METHODS An exhaustive literature search was performed in the National Library of Medicine's Pubmed, Scopus, Web of Science, and Google Scholar databases for all English language articles published until November 2021. The main keywords included "dry eye disease" associated with autoimmune, connective tissue, endocrine, gastrointestinal, hematopoietic, vascular, and pulmonary diseases. Case reports, series, letters to the editor, reviews, and original articles were included. RESULTS Although DED is frequently associated with SAIDs, its diagnosis is commonly delayed or missed, producing significant complications, including corneal ulceration, melting, scleritis, uveitis, and optic neuritis resulting in severe complications detrimental to visual function and quality of life. SAID should be suspected in a woman, 30 to 60 years old with a family history of autoimmunity, presenting with DED symptoms and extraocular manifestations including arthralgias, dry mouth, unexplained weight and hair loss, chronic fatigue, heat or cold intolerance, insomnia, and mood disorders. CONCLUSIONS Establishing the correct diagnosis and treatment of DED associated with SAIDs is crucial to avoid its significant burden and severe ocular complications.
Collapse
Affiliation(s)
- Andres Bustamante-Arias
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences. Monterrey, Mexico
| | - Raul E Ruiz Lozano
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences. Monterrey, Mexico
| | - Alejandro Rodriguez-Garcia
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences. Monterrey, Mexico
| |
Collapse
|
23
|
Bayat AH, Aydemir E, Aydemir GA, Gencer H. Assessment of Tear Film Anomalies in Childhood Obesity. Klin Monbl Augenheilkd 2021; 239:331-337. [PMID: 34911123 DOI: 10.1055/a-1668-0276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine if childhood obesity has an effect on the ocular surface and tear film of children who are afflicted. METHODS Patients who had childhood obesity, 85 eyes, and patients who were healthy, 75 eyes, were enrolled in this prospective and comparative study. The tear film breakup time (TF-BUT), tear meniscus area and height (TMA and TMH) values, Schirmer test scores, and ocular surface disease index (OSDI) scores were obtained for all participants. RESULTS The TMH, TMA, TF-BUT, and Schirmer test results were statistically significantly lower in the obesity group (p < 0.001 for all). The children with obesity and insulin resistance had lower TMH, TMA, TF-BUT, and Schirmer test results when compared to the children without insulin resistance (p < 0.05 for all). The body mass index was found to be correlated with the TMH, TMA, TF-BUT, and Schirmer test results (p < 0.001 for all). CONCLUSION Children with obesity had lower TMA, TMH, TF-BUT, and Schirmer test results than healthy subjects. When insulin resistance was added to obesity, these values were even lower.
Collapse
Affiliation(s)
| | - Emre Aydemir
- Ophthalmology, Adiyaman Universitesi Egitim ve Arastirma Hastanesi, Adiyaman, Turkey
| | - Gozde Aksoy Aydemir
- Ophthalmology, Adiyaman Universitesi Egitim ve Arastirma Hastanesi, Adiyaman, Turkey
| | - Hasim Gencer
- Pediatrics, Istanbul Medipol University, Istanbul, Turkey
| |
Collapse
|
24
|
Mullick R, Annavajjhala S, Thakur P, Mohapatra A, Shetty R, D'Souza S. Efficacy of topical cyclosporine 0.05% and osmoprotective lubricating eye drops in treating dry eye disease and inflammation. Indian J Ophthalmol 2021; 69:3473-3477. [PMID: 34826977 PMCID: PMC8837309 DOI: 10.4103/ijo.ijo_3822_20] [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] [Indexed: 11/04/2022] Open
Abstract
Purpose To evaluate the effect of topical cyclosporine 0.05% and osmoprotective lubricating eye drops on patients with dry eye disease (DED) with inflammation as measured by raised tear matrix metalloproteinases (MMP-9). Methods This prospective study included 106 eyes of 53 patients diagnosed with DED based on any of the following DED criteria (Ocular Surface Disease Index [OSDI] score >12, tear film breakup time [TBUT] <10 s, Schirmer's I test result <10 mm/5 min, ocular surface staining). Ocular surface inflammation was assessed by assessing MMP-9 positivity from tears of the patients in the study (Inflammadry kit Quidel corporation). Patients were prescribed osmoprotective lubricating eye drops (Osmodrops, Cipla Ltd) four times a day and cyclosporine A 0.05% eye drops (Imudrops, Cipla Ltd) twice a day for 6 months. Efficacy of the formulations was evaluated by OSDI scores, Schirmer's test, TBUT change, reduction in ocular surface staining, and reduction in MMP-9 levels after 6 months of usage. Check P value and add from results. Results After 6 months of topical therapy, improvement was observed in OSDI scores (mean pretreatment: 25.7 ± 12.8, and mean posttreatment: 15.2 ± 8.4), P < 0.001. There was also reduction number of patients who were MMP-9 positive. Out of 75 eyes that tested MMP-9 positive, 70.66% showed reduction in MMP-9 levels P < 0.0001). Ocular surface staining also improved. Conclusion Topical osmoprotective lubricating eye drops and cyclosporine A 0.05% reduce inflammation in cases of DED, which correlates with improvement in OSDI scores, ocular surface staining, and reduction in inflammation as measured by levels of tear MMP-9.
Collapse
Affiliation(s)
- Ritika Mullick
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Sriram Annavajjhala
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Prashansa Thakur
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Ayushi Mohapatra
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| |
Collapse
|
25
|
Abokyi S, Mensah SN, Otchere H, Akoto YO, Ntodie M. Differential effect of maximal incremental treadmill exercise on tear secretion and tear film stability in athletes and non-athletes. Exp Eye Res 2021; 214:108865. [PMID: 34848214 DOI: 10.1016/j.exer.2021.108865] [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: 05/21/2021] [Revised: 11/13/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022]
Abstract
The study investigated the differential response to a single bout of maximal incremental treadmill exercise between athletes and non-athletes without dry eyes regarding tear secretion, tear film stability, visual acuity (VA), and stereoacuity. Additionally, the study examined the effect of gender and the duration of exercise on exercise-induced changes. Study participants included young university students aged 18-25 years who were athletes (male/female: 13/13) or non-athletes (male/female: 17/9). Participants underwent an aerobic exercise session using a treadmill and following the laid down Bruce treadmill test protocol till exhaustion. Measurements were taken in the order of distance VA, stereopsis, non-invasive tear break-up time (TBUT), and phenol red thread test, at baseline and after the exercise regimen. Within- and between-subject analyses using multiple t-tests with correction for multiple comparisons were performed to determine differences before and after exercise in athletes and non-athletes. Subsequently, ANCOVA was used to assess the influence of gender and the duration of exercise. The mean age (SD) of the athletes and the non-athletes was 22.4 ± 2.1 years and 21.8 ± 2.1 years, respectively (p = 0.357). Before exercise, the athletes had higher TBUT than non-athletes (14.6 ± 2.9 s vs. 11.9 ± 3.8 s; p = 0.021), but no difference was observed in any other ocular measurements. After exercise, the athletes showed significant improvement in tear secretion with the basal tear secretion increasing from 22.3 ± 2.5 mm to 25.8 ± 1.7 mm (p < 0.001). The non-athletes on the other hand had a borderline increase in tear secretion from 21.42 ± 2.85 mm to 23.73 ± 2.68 mm (p = 0.08). Also, the TBUT was much improved in the athletes after exercise compared to the non-athletes (17.7 ± 2.7 s vs. 14.8 ± 2.9 s, p = 0.004). Additionally, exercise improved the VA indifferently between the groups, while stereoacuity was unchanged after exercise in either group. Gender had no influence on the differences in the tear function measures between athletes and non-athletes after exercise. The duration of exercise, however, showed a borderline effect on the tear film stability (p = 0.068) after exercise. Our findings support the differential effect of maximal incremental treadmill exercise on tear secretion and tear film stability between athletes and non-athletes. Thus, increased physical fitness and the duration of exercise might be crucial in the improvement of tear function through aerobic exercise.
Collapse
Affiliation(s)
- Samuel Abokyi
- Department of Optometry and Vision Science, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana; School of Optometry, The Hong Kong Polytechnic University, Hong Kong, Hong Kong.
| | - Sekyere Nyamaah Mensah
- Department of Optometry and Vision Science, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Heinz Otchere
- School of Optometry and Vision Science, University of Waterloo, Ontario, Canada
| | - Yaw Osei Akoto
- Our Lady of Grace Hospital, Breman Asikuma, Central Region, Ghana
| | - Michael Ntodie
- Department of Optometry and Vision Science, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| |
Collapse
|
26
|
Chennakesavalu M, Somala SRR, Dommaraju SR, Peesapati MP, Guo K, Rosenblatt MI, Chang JH, Azar DT. Corneal lymphangiogenesis as a potential target in dry eye disease - a systematic review. Surv Ophthalmol 2021; 66:960-976. [PMID: 33811911 PMCID: PMC9991079 DOI: 10.1016/j.survophthal.2021.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 02/03/2023]
Abstract
Dry eye disease (DED) is a common ocular surface condition causing symptoms of significant discomfort, visual disturbance, and pain. With recent advancements, DED has become recognized as a chronic self-perpetuating inflammatory condition triggered by various internal and environmental factors. DED has been shown to arise from the activation of both the innate and adaptive immune systems, leading to corneal epithelium and lacrimal gland dysfunction. While the cornea is normally avascular and thus imbued with angiogenic and lymphangiogenic privilege, various DED models have revealed activated corneal antigen-presenting cells in regional lymph nodes, suggesting the formation of new corneal lymphatic vessels in DED. The recent availability of reliable lymphatic cell surface markers such as LYVE-1 has made it possible to study lymphangiogenesis. Accordingly, numerous studies have been published within the last decade discussing the role of lymphangiogenesis in DED pathology. We systematically review the literature to identify and evaluate studies presenting data on corneal lymphangiogenesis in DED. There is considerable evidence supporting corneal lymphangiogenesis as a central mediator of DED pathogenesis. These findings suggest that anti-lymphangiogenic therapeutic strategies may be a viable option for the treatment of DED, a conclusion supported by the limited number of reported clinical trials examining anti-lymphangiogenic modalities in DED.
Collapse
Affiliation(s)
- Mohansrinivas Chennakesavalu
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Sri Raghurama R Somala
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Sunil R Dommaraju
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Meghna Priyanka Peesapati
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Kai Guo
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Mark I Rosenblatt
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Jin-Hong Chang
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, IL.
| | - Dimitri T Azar
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, IL
| |
Collapse
|
27
|
Yu L, Yu C, Dong H, Mu Y, Zhang R, Zhang Q, Liang W, Li W, Wang X, Zhang L. Recent Developments About the Pathogenesis of Dry Eye Disease: Based on Immune Inflammatory Mechanisms. Front Pharmacol 2021; 12:732887. [PMID: 34421626 PMCID: PMC8375318 DOI: 10.3389/fphar.2021.732887] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/26/2021] [Indexed: 01/18/2023] Open
Abstract
Dry eye disease is a common and frequently occurring ophthalmology with complex and diverse causes, and its incidence is on the upward trend. The pathogenesis of DED is still completely clear. However, the immune response based on inflammation has been recognized as the core basis of this disease. In this review, we will systematically review the previous research on the treatment of DED in immune inflammation, analyze the latest views and research hotspots, and provide reference for the prevention and treatment of DED.
Collapse
Affiliation(s)
- Lifei Yu
- Department of Ophthalmology, The Third People's Hospital of Dalian, Non-Directly Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Chunjing Yu
- Department of Ophthalmology, The Third People's Hospital of Dalian, Non-Directly Affiliated Hospital of Dalian Medical University, Dalian, China
| | - He Dong
- Department of Ophthalmology, The Third People's Hospital of Dalian, Non-Directly Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yanan Mu
- Department of Ophthalmology, The Third People's Hospital of Dalian, Non-Directly Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Rui Zhang
- Department of Ophthalmology, The Third People's Hospital of Dalian, Non-Directly Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qiaosi Zhang
- Department of Ophthalmology, The Third People's Hospital of Dalian, Non-Directly Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Wei Liang
- Department of Ophthalmology, The Third People's Hospital of Dalian, Non-Directly Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Wenjia Li
- Department of Ophthalmology, The Third People's Hospital of Dalian, Non-Directly Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xun Wang
- Department of Neurosurgery, The Third People's Hospital of Dalian, Non-Directly Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lijun Zhang
- Department of Ophthalmology, The Third People's Hospital of Dalian, Non-Directly Affiliated Hospital of Dalian Medical University, Dalian, China
| |
Collapse
|
28
|
Shokoohi S, Iovieno A, Yeung SN. Effect of Bevacizumab on the Viability and Metabolism of Human Corneal Epithelial and Endothelial Cells: An In Vitro Study. Transl Vis Sci Technol 2021; 10:32. [PMID: 34323952 PMCID: PMC8322713 DOI: 10.1167/tvst.10.8.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To examine the cytotoxic effects of bevacizumab on the viability and metabolism of human corneal epithelial cells (HCEpCs) and human corneal endothelial cells (HCEnCs), as well as human retinal pigment epithelial (ARPE-19) cells for comparison. Methods Immortalized cell lines of HCEpCs, HCEnCs, and ARPE-19 cells were exposed to clinically relevant concentrations of bevacizumab (0.313-5.00 mg/mL). The ApoTox-Glo Triplex Assay was used to assess cell viability, cytotoxicity, and apoptosis, and the Mitochondrial ToxGlo Assay was used to assess cell membrane integrity and adenosine triphosphate (ATP) levels after a 24-hour treatment period. Results Across all three cell types, we observed similar results of a decrease in cell viability at 5.00 mg/mL (P < 0.05) and an increase in cytotoxicity at 5.00 mg/mL (P < 0.05), whereas apoptotic activity remained unchanged (P > 0.05), which is a profile consistent with cells undergoing primary necrosis at high concentrations. Additionally, cell membrane integrity was compromised at 5.00 mg/mL (P < 0.05), whereas no decrease in ATP levels were observed (P > 0.05). Thus, no interference with mitochondrial oxidative phosphorylation in ATP production was seen, and the cells were able to maintain normal metabolic levels at high concentrations of bevacizumab. Conclusions HCEpCs, HCEnCs, and ARPE-19 cells experience a decrease in viability and undergo primary necrosis when exposed to bevacizumab at a concentration of 5.00 mg/mL; however, they are able to maintain normal metabolism and mitochondrial function at the high concentrations used for the treatment of corneal neovascularization. Translational Relevance This study provides safety data on the concentrations of bevacizumab injected intravitreally and complements clinical data showing toxicity of topical bevacizumab on corneal epithelial and endothelial cells.
Collapse
Affiliation(s)
- Shayan Shokoohi
- Department of Ophthalmology and Visual Sciences, University of British Columbia Eye Care Centre, Vancouver, BC, Canada
| | - Alfonso Iovieno
- Department of Ophthalmology and Visual Sciences, University of British Columbia Eye Care Centre, Vancouver, BC, Canada
| | - Sonia N Yeung
- Department of Ophthalmology and Visual Sciences, University of British Columbia Eye Care Centre, Vancouver, BC, Canada
| |
Collapse
|
29
|
Giacomazzi S, Urits I, Hoyt B, Hubble A, Cornett EM, Gress K, Charipova K, Berger AA, Kassem H, Kaye AD, Viswanath O. Comprehensive Review and Update of Burning Eye Syndrome. J Patient Cent Res Rev 2021; 8:255-260. [PMID: 34322578 DOI: 10.17294/2330-0698.1813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Keratoconjunctivitis sicca ("dry eye") is a common (14%-30% of adults over age 48) though difficult to treat condition that causes both discomfort and disability with associated dryness, pain, and visual disturbances. Etiology is not clearly understood but is likely varied, with a subset of patients suffering from chronic neuropathic pain referred to as "burning eye syndrome." This review of existing literature summarizes the clinical presentation, natural history, pathophysiology, and treatment modalities of burning eye syndrome. Chronicity of burning eye syndrome is likely secondary to increased nociception from the cornea, decrease in inhibitory signals, and nerve growth factor expression alterations. Treatment centers around symptomatic alleviation and reduction of inflammation. Conservative treatments focus on well-being and perception and include exercise, acupuncture, and cognitive behavioral therapy. Topical treatment consists of the anti-adhesion T-cell antagonist lifitegrast, corticosteroids, and cyclosporine; all have moderate efficacy and good safety. Autologous serum eye drops are a second-line topical that may promote corneal and neural healing on top of symptomatic relief. When these treatments fail, patients may trial neuromodulation with transcranial magnetic stimulation. Despite general treatment safety, more research is needed to develop novel approaches to this condition, possibly focusing more directly on the neurological component.
Collapse
Affiliation(s)
| | - Ivan Urits
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA
| | - Briggs Hoyt
- Creighton University School of Medicine, Omaha, NE
| | | | - Elyse M Cornett
- Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Kyle Gress
- Georgetown University School of Medicine, Washington, DC
| | | | - Amnon A Berger
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA
| | - Hisham Kassem
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach, FL
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA
| | - Omar Viswanath
- Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ.,Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ.,Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE
| |
Collapse
|
30
|
Lu Q, Lu Y, Zhu X. Dry Eye and Phacoemulsification Cataract Surgery: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:649030. [PMID: 34307395 PMCID: PMC8295542 DOI: 10.3389/fmed.2021.649030] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 06/17/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To evaluate whether dry eye deteriorates after phacoemulsification cataract surgery, and to explore the influential factors. Methods: Studies published before February 2020 indexed on PubMed and the Cochrane Central Register of Controlled Trials were retrieved. A meta-analysis, including meta-regression, a sensitivity analysis, and a subgroup analysis, were performed. Results: Twenty studies with 2,247 eyes were included in the meta-analysis, dry eye-related parameters were investigated preoperatively and 1 month postoperatively. Patients with pre-existing meibomian gland dysfunction (MGD) had worsened subjective symptoms of dry eye (1.31, 95% confidence interval (CI) [0.66, 1.95], P < 0.0001), a reduced tear break-up time (BUT) (−2.27, 95% CI [−2.66, −1.88], P < 0.0001), and a worse corneal fluorescein staining (CFS) score (0.75, 95% CI [0.5, 1.0], P < 0.0001) after phacoemulsification cataract surgery, whereas in the general population, the subjective symptoms score and CFS remained unchanged and BUT decreased slightly after surgery. Patients without diabetes showed significantly reduced total tear secretion after phacoemulsification cataract surgery (−1.25, 95% CI [−1.62, −0.88], P < 0.0001). Conclusion: Dry eye generally remained unchanged 1 month after phacoemulsification cataract surgery. Notably, worsened symptoms and signs of dry eye were observed more frequently in patients with pre-existing MGD. Patients without diabetes were more susceptible to reduced tearing postoperatively. Clinical Trial Registration: Identifier: PERSPERO (2020: CRD42020203316).
Collapse
Affiliation(s)
- Qiang Lu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impariment and Restoration, Shanghai, China
| | - Yi Lu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impariment and Restoration, Shanghai, China
| | - Xiangjia Zhu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impariment and Restoration, Shanghai, China
| |
Collapse
|
31
|
Huang W, Wen Z, Saglam MS, Huang L, Honkanen RA, Rigas B. Phospho-Sulindac (OXT-328) Inhibits Dry Eye Disease in Rabbits: A Dose-, Formulation- and Structure-Dependent Effect. J Ocul Pharmacol Ther 2021; 37:321-330. [PMID: 34152861 DOI: 10.1089/jop.2019.0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose: Inflammation of the ocular surface is central to dry eye disease (DED). The anti-inflammatory agent phospho-sulindac (PS) at a high dose was efficacious against DED in a rabbit model. We assessed the dose, formulation and structure dependence of PS's effect. Methods: In rabbits with concanavalin A-induced DED we evaluated a range of PS concentrations (0.05%-1.6%) and dosing frequencies, assessed the duration of its effect with PS in 2 solution formulations and one emulsion formulation, and compared the efficacy of PS to that of sulindac, and of the structurally similar phospho-ibuprofen amide. We determined tear breakup time (TBUT) (tear stability), Schirmer's tear test (tear production), and by esthesiometry corneal sensitivity (symptoms). We also determined the biodistribution in the eye of topically applied PS. Results: PS in a solution formulation, given as eye drops q.i.d. was efficacious starting at a dose of 0.1%. The effect was apparent after 2 days of treatment and lasted at least 8 days after the last dose. Both signs (evidenced by TBUT and Schirmer's test) and symptoms (measured by corneal sensitivity) improved significantly. The best formulation was the solution formulation; a cyclodextrin-based formulation was also successful but the emulsion formulation was not. PS and its metabolites were essentially restricted to the anterior chamber of the eye. Sulindac and phospho-ibuprofen amide had no efficacy on DED. Conclusions: PS is efficacious against DED. Its effect, encompassing signs, and symptoms, are dose, formulation, and structure dependent. PS has therapeutic promise and merits further development.
Collapse
Affiliation(s)
- Wei Huang
- Department of Ophthalmology, Stony Brook University, Stony Brook, New York, USA.,Department of Medicine, Stony Brook University, Stony Brook, New York, USA.,Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ziyi Wen
- Department of Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Muhammet S Saglam
- Department of Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Liqun Huang
- Department of Medicine, Stony Brook University, Stony Brook, New York, USA.,Medicon Pharmaceuticals, Setauket, New York, USA
| | - Robert A Honkanen
- Department of Ophthalmology, Stony Brook University, Stony Brook, New York, USA
| | - Basil Rigas
- Department of Preventive Medicine, Stony Brook University, Stony Brook, New York, USA
| |
Collapse
|
32
|
[Ocular involvement in Stevens-Johnson syndrome and toxic epidermal necrolysis]. Ophthalmologe 2021; 118:519-532. [PMID: 33725172 DOI: 10.1007/s00347-021-01351-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 10/21/2022]
Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare severe and often life-threatening reactions of the skin and mucous membranes. They are considered as a single disease entity with different expressions of severity and are summarized under the term epidermal necrolysis (EN). There is a high risk of ocular involvement, which can lead to long-lasting eye problems and even blindness without immediate ophthalmological treatment. The acute occurrence, the unpredictable course and extreme variation in the manifestation of complications require an interdisciplinary approach. A rapid diagnosis of eye involvement and initiation of an intensive lubricating and anti-inflammatory surface treatment is of utmost importance for the long-term outcome. This article should help ophthalmologists to have a better understanding of this condition and therefore lead to substantial improvement in visual outcome and the quality of life of patients.
Collapse
|
33
|
Moawad P, Shamma R, Hassanein D, Ragab G, El Zawahry O. Evaluation of the effect of topical tacrolimus 0.03% versus cyclosporine 0.05% in the treatment of dry eye secondary to Sjogren syndrome. Eur J Ophthalmol 2021; 32:673-679. [PMID: 33530719 DOI: 10.1177/1120672121992680] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare the effect of topical application of tacrolimus 0.03% eyedrops versus cyclosporine 0.05% in Sjogren syndrome subjects with severe dry eyes. DESIGN A prospective single-blinded simply randomized controlled study. METHODOLOGY 60 Sjogren patients were randomized intoGroup A: 30 patients were instructed to put tacrolimus 0.03% eyedrops in one eye for 6 months and placebo eyedrops in the other eye, (N = 30, 44.9 ± 12.58 years).Group B: 30 patients were instructed to put cyclosporine 0.05% eyedrops in one eye for 6 months and placebo eyedrops in the other eye (N = 30, 49.4 ± 12.92 years).Main outcome measures: Patients were evaluated at day 0, 90, and 180 for Ocular Surface Disease Index Questionnaire (OSDI), frequency of use of artificial tears, average fluorescein tear break up time (TBUT), ocular surface staining scores, Schirmer I test, meibum quality, and expressibility scores. RESULTS Upon comparing both eyedrops, the mean value of OSDI decrease was 38.25 ± 18.29% versus 31.69 ± 18.57% (p-value 0.09), SICCA score decrease was 2.97 ± 1.92 versus 2.27 ± 2.02 (p-value 0.124) the decrease in artificial tear substitute use was 3.90 ± 2.22 versus 3.63 ± 1.92 (p-value 0.616), increase in Schirmer I values were 4.10 ± 4.21 and 4.26 ± 2.00 (p-value 0.590) in eyes treated with tacrolimus and cyclosporine respectively. Neither of them affected meibum quality or expressibility scores. CONCLUSION Both tacrolimus and cyclosporine significantly improved patient symptoms, frequency of artificial tears use and ocular surface staining compared to placebo-controlled eyes. However, no significant difference regarding the efficacy of both eyedrops at the end of 6 months treatment of severe dry eyes of Sjögren syndrome patients. TRIAL REGISTRATION ClinicalTrials.gov. Identifier: NCT03865888.
Collapse
Affiliation(s)
- Pavly Moawad
- Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Rehab Shamma
- Cairo University Faculty of Pharmacy, Cairo, Egypt
| | - Dina Hassanein
- Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Gaafar Ragab
- Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Omar El Zawahry
- Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| |
Collapse
|
34
|
Topical cyclosporine a (0.05%) treatment in dry eye patients: a comparison study of Sjogren's syndrome versus non-Sjogren's syndrome. Int Ophthalmol 2021; 41:1479-1485. [PMID: 33484384 DOI: 10.1007/s10792-021-01708-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/09/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the clinical effect of topical cyclosporine A (CsA) (0.05%) on dry eye patients with Sjogren's syndrome (SS) and non-Sjogren's syndrome (NSS). METHOD This retrospective comparative study includes the dry eye (DE) patients who were treated with topical CsA. DE patients were divided into two groups as follows: DE with Sjogren's syndrome (DE-SS) and DE with Non-Sjogren's syndrome (DE-NSS). Dry eye parameters were recorded at baseline and each visit. RESULTS Schirmer's test 1 scores were 2.7 ± 0.5 mm at baseline and 3.5 ± 0.7 mm at 12th month in DE-SS, 2.9 ± 0.7 mm at baseline and 9.5 ± 0.7 mm in DE-NSS groups at 12th month. Mean ST score was higher in DE-NSS group than DE-SS group at sixth and 12th months of the treatment (both p = 0.001). Tear break-up time score showed a significant improvement in DE-NSS group, and it was lower in DE-NSS group than DE-SS group group at sixth and 12th months of the treatment (p = 0.044 and 0.027, respectively). Mean OSDI score was lower in DE-NSS group than DE-SS group at sixth and 12th months of the treatment (p = 0.030 and 0.032, respectively). CONCLUSION Topical CsA seems to be more effective in the treatment of the DE-NSS.
Collapse
|
35
|
Shin J, Rho CR, Hyon JY, Chung TY, Yoon KC, Joo CK. A Randomized, Placebo-Controlled Phase II Clinical Trial of 0.01% or 0.02% Cyclosporin A with 3% Trehalose in Patients with Dry Eye Disease. J Ocul Pharmacol Ther 2021; 37:4-11. [PMID: 33449860 DOI: 10.1089/jop.2020.0104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose: To compare the efficacy and safety of HU00701 (0.01% cyclosporin A + 3% trehalose), HU007 (0.02% cyclosporin A + 3% trehalose) (all w/v), and placebo in patients with moderate to severe dry eye disease (DED). Methods: This was a multicenter, randomized, double-masked, parallel, placebo-controlled phase II study. In total, 114 patients were randomly assigned to the HU00701, HU007, placebo, or reference group. There was a 2-week run-in period before the 12-week intervention. Efficacy and safety were evaluated every 4 weeks. Results: The primary endpoint, change in corneal staining score from baseline to week 12, did not differ significantly among the control, HU00701, and HU007 groups in the full analysis. Of the secondary endpoints, only the tear film breakup time differed significantly at week 12 between the placebo and HU00701 groups. Twenty adverse events were reported by 15 patients, but the rate did not differ significantly among the 4 groups. The laboratory test, vital signs, and physical examination data showed no significant changes during the study. Conclusions: HU00701 and HU007 are safe, and HU007 effectively reduces the corneal staining score in patients with moderate-to-severe DED (NCT02917512).
Collapse
Affiliation(s)
- Jeongah Shin
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Seoul, Republic of Korea
| | - Chang Rae Rho
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Seoul, Republic of Korea
| | - Joon Young Hyon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae-Young Chung
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Chul Yoon
- Department of Ophthalmology, Chonnam National University, Chonnam National University Hospital, Gwangju, Korea
| | | |
Collapse
|
36
|
Pigment epithelium-derived factor (PEDF) plays anti-inflammatory roles in the pathogenesis of dry eye disease. Ocul Surf 2021; 20:70-85. [PMID: 33412338 DOI: 10.1016/j.jtos.2020.12.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 12/28/2020] [Accepted: 12/28/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To investigate the expression of pigment epithelium-derived factor (PEDF) in ocular surface in dry eye disease (DED) and its anti-inflammatory roles and mechanisms, clinically and by experiments in vivo and in vitro. METHODS A cross-sectional study was conducted to detect the expression of PEDF in tears of dry eye patients by enzyme-linked immunosorbent assay (ELISA). Using dry eye mouse model and human corneal epithelial cells (hCECs) stimulated by hyperosmolarity or inflammatory cytokines, expression of PEDF in corneal epithelial cells, stroma and conjunctiva was quantified by real-time polymerase chain reaction, ELISA and Western blot. Next, either dry eye mice or hyperosmotic hCECs were treated with recombinant PEDF or neutralizing antibodies, and the expressions of inflammatory cytokines and immune cells were detected. Finally, Western blot was performed on MAPK and NF-κB to investigate the signaling pathways by which PEDF played its roles. RESULTS Concentrations of PEDF were increased in tears of dry eye patients. Increased PEDF was observed in corneal epithelial cells (CECs) rather than corneal stroma or conjunctiva in dry eye mice. Furthermore, hCECs exposed to hyperosmolarity showed upregulation of PEDF. In vivo and in vitro studies showed that PEDF suppressed the expression of inflammatory cytokines including IL-1β, IL-6, TNF-α and IL-17A, as well as the percentage of Th17 cells in DED. Further investigation showed that PEDF inhibited the phosphorylation of MAPK p38 and JNK in hyperosmotic hCECs. CONCLUSIONS CECs derived PEDF is increased in DED. PEDF plays anti-inflammatory and immunoregulatory roles in the pathogenesis of DED.
Collapse
|
37
|
Lin X, Wu Y, Tang L, Ouyang W, Yang Y, Liu Z, Wu J, Zheng X, Huang C, Zhou Y, Zhang X, Chen Y, Li W, Hu J, Liu Z. Comparison of Treatment Effect and Tolerance of the Topical Application of Mizoribine and Cyclosporine A in a Mouse Dry Eye Model. Transl Vis Sci Technol 2020; 9:22. [PMID: 33364077 PMCID: PMC7745621 DOI: 10.1167/tvst.9.13.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 09/06/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose To compare the treatment effects and tolerability of a topical application of mizoribine (MZR) and cyclosporine A (CsA) eye drops (Restasis; Allergan, Inc., Irvine, CA, USA) in a mouse dry eye model. Methods C57BL/6 mice subjected to desiccating stress (DS) were treated with 0.05% MZR in phosphate-buffered saline (PBS) or Restasis eye drops four times a day for 5 days. Untreated mice served as control. Tear secretion, Oregon green dextran staining, and the conjunctival goblet cell quantity were evaluated. The apoptosis and matrix metalloproteinase 9 (MMP-9) in the ocular surface, conjunctival CD4, and T helper–related cytokines were verified. The ocular tolerance of these two drugs was evaluated by observing the mice's behavioral changes. Results Topical administrations of MZR or Restasis both increased tear production, maintained goblet cell density, and improved corneal barrier function. Both MZR and Restasis suppressed the expression of MMP-9 and apoptosis in the ocular surface. Meanwhile, both MZR and Restasis decreased the infiltration of CD4+ T cells, reversed the production of interferon-γ, interleukin (IL)–17A, and IL-13 in conjunctiva under DS. The abovementioned efficacies between these two eye drops were not statistically significant. However, the number of scratching and wiping behaviors in the MZR-treated group was significantly less than in the Restasis-treated group. Conclusions MZR (0.05% in PBS) could be a good competitive product for Restasis because of the comparable treatment effect in dry eye diseases and better ocular tolerability in ocular itch and pain. Translational Relevance This study provided an immunosuppressive agent comparable to Restasis for the treatment of dry eye disease.
Collapse
Affiliation(s)
- Xiang Lin
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yang Wu
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Liying Tang
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Weijie Ouyang
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yiran Yang
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Zhaolin Liu
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Jieli Wu
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Xiaoxiang Zheng
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Caihong Huang
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yueping Zhou
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Xiaobo Zhang
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yongxiong Chen
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Wei Li
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China.,Xiamen University affiliated Xiamen Eye Center, Xiamen, Fujian, China
| | - Jiaoyue Hu
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China.,Xiamen University affiliated Xiamen Eye Center, Xiamen, Fujian, China
| | - Zuguo Liu
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China.,Xiamen University affiliated Xiamen Eye Center, Xiamen, Fujian, China
| |
Collapse
|
38
|
Liu J, Dong Y, Wang Y. Vitamin D deficiency is associated with dry eye syndrome: a systematic review and meta-analysis. Acta Ophthalmol 2020; 98:749-754. [PMID: 32421222 DOI: 10.1111/aos.14470] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/21/2020] [Indexed: 12/15/2022]
Abstract
A systematic review and meta-analysis was conducted to determine the association between the serum vitamin D level and dry eye. A systematic literature search was performed using the PubMed, Embase, Web of Science and Cochrane Library databases to identify clinical studies evaluating the association between vitamin D levels and dry eye. The random-effect model was used to combine the results. Possible sources of heterogeneity across studies were determined by meta-regression and sensitivity analysis. Overall, 10 studies (n = 18 919) were included. Patients with dry eye had a mean serum vitamin D level that was lower than that in healthy controls by 3.99 ng/ml (95% CI -6.57, -1.40; p = 0.002). The mean Ocular Surface Disease Index score was higher (mean difference 10.70, 95% CI 1.55-19.86; p = 0.02) and Schirmer's test without anaesthesia result was lower (mean difference 6.38 mm/5 min, 95% CI -10.48, -2.28; p = 0.002) in patients with vitamin D deficiency than in controls. Tear break-up time was comparable in the vitamin D deficiency and control groups (p = 0.15). Sensitivity analyses indicated that the results obtained were robust. This meta-analysis suggested that vitamin D deficiency is associated with worse subjective symptoms and less tear production in patients with dry eye. Vitamin D deficiency may be a risk factor for dry eye syndrome. Prospective cohort and intervention studies are warranted to determine if vitamin D has a protective role in the development of dry eye.
Collapse
Affiliation(s)
- Jing Liu
- Clinical College of Ophthalmology Tianjin Medical University Tianjin China
| | - Yi Dong
- Clinical College of Ophthalmology Tianjin Medical University Tianjin China
- Tianjin Key Laboratory of Ophthalmology and Visual Science Tianjin Eye Hospital Tianjin Eye Institute Clinical College of Ophthalmology Nankai UniversityTianjin Medical University Tianjin China
| | - Yan Wang
- Clinical College of Ophthalmology Tianjin Medical University Tianjin China
- Tianjin Key Laboratory of Ophthalmology and Visual Science Tianjin Eye Hospital Tianjin Eye Institute Clinical College of Ophthalmology Nankai UniversityTianjin Medical University Tianjin China
| |
Collapse
|
39
|
Efficacy of topical bevacizumab 0.05% eye drops in dry eye disease: A double-masked, randomized trial. PLoS One 2020; 15:e0234186. [PMID: 32502179 PMCID: PMC7274382 DOI: 10.1371/journal.pone.0234186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 05/19/2020] [Indexed: 12/27/2022] Open
Abstract
The objective of this double-masked, placebo-controlled, randomized trial was to assess the efficacy and safety of bevacizumab 0.05% eye drops in dry eye patients. This study included Dry Eye Workshop Study (DEWS) Grade 3–4 dry eye participants (n = 31) whose tear break-up time (TBUT) was ≤5 seconds(s). Participants were randomized to undergo treatment with either bevacizumab 0.05% eye drops (n = 19) or placebo (n = 12). The primary outcome was TBUT, and the proportion of responders (increase of ≥3s in TBUT at week 12), ocular surface disease index (OSDI) score, Schirmer test, and Oxford scheme grade were secondary outcomes. All outcomes were measured at 1-, 4- and 12 weeks. TBUT in bevacizumab group differed significantly from TBUT in placebo group within 12 weeks (P = 0.001). Moreover, the improvement of TBUT in bevacizumab group versus placebo group at 4- and 12 weeks differed significantly from that difference at baseline (P = 0.002 and P = 0.003, respectively). The proportion of participants achieving increase of 3 seconds or more of TBUT at week 12 in the bevacizumab group was significantly greater than that in the placebo group (P = 0.02). Oxford scheme grade at 1-, 4- and 12 weeks differed significantly from the values at baseline in bevacizumab group (P = 0.001, P = 0.01, and P = 0.03, respectively). OSDI scores at 1-, 4- and 12-week follow-ups were significantly lower than that at baseline in bevacizumab group (P<0.001 at each follow-up). Schirmer test were not significantly different within or between groups (the lowest P = 0.92). No adverse events occurred in this study. Patients treated with bevacizumab 0.05% eye drops showed significant improvement in tear film stability, corneal staining and symptoms.
Collapse
|
40
|
Li L, Jin R, Li Y, Nho JH, Choi W, Ji YS, Yoon HJ, Yoon KC. Effects of Eurya japonica extracts on human corneal epithelial cells and experimental dry eye. Exp Ther Med 2020; 20:1607-1615. [PMID: 32742392 PMCID: PMC7388282 DOI: 10.3892/etm.2020.8830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/28/2020] [Indexed: 01/22/2023] Open
Abstract
Eurya japonica (EJ) leaves have been indicated to exert anti-oxidative and anti-inflammatory effects. Dry eye disease (DED) is a chronic inflammatory disease and oxidative stress is closely associated with DED. The aim of the present study was to analyze the therapeutic efficacy of EJ in DED using human corneal epithelial (HCE) cells and a mouse model of experimental dry eye (EDE). EJ extracts (0.001, 0.01 and 0.1%) were used to treat HCE cells. Cell viability and mitochondrial function were detected using a EZ-Cytox cell viability assay kit and mitochondrial membrane potential assays. Dichlorofluorescein diacetate (DCF-DA) assay was used to measure cellular reactive oxygen species (ROS) levels. Subsequently, eye drops consisting of BSS or 0.001%, 0.01 and 0.1% EJ extracts were applied for treatment of EDE. At 7 days, conjunctival ROS production was measured using a DCF-DA assay. Tumor necrosis factor (TNF)-α, interleukin (IL)-1β, 10 kDa interferon gamma-induced protein 10 (IP-10) and monokine induced by interferon-γ (MIG) levels in the conjunctiva were analyzed using a multiplex immunobead assay. Tear film and ocular surface parameters were measured. Treatment with EJ extracts in HCE cells effectively improved cell viability, ROS levels and mitochondrial function. Mice treated with 0.01 and 0.1% EJ extracts indicated a significant decrease in ROS, TNF-α, IL-1β, IP-10 and MIG levels compared with the EDE or BSS groups. Furthermore, a significant improvement in all clinical parameters was observed in the 0.01 and 0.1% EJ extract groups. EJ extracts could decrease cytotoxicity and ROS production in HCE cells. Additionally, topical EJ extracts reduced oxidative damage and inflammation and improved clinical signs of EDE, suggesting that EJ extracts may be used as an adjunctive therapy for DED.
Collapse
Affiliation(s)
- Lan Li
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju 61469, Republic of Korea.,Biomedical Sciences and Center for Creative Biomedical Scientists, Chonnam National University Medical School and Hospital, Gwangju 61469, Republic of Korea
| | - Rujun Jin
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju 61469, Republic of Korea
| | - Ying Li
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju 61469, Republic of Korea
| | - Jong Hyun Nho
- Department of Korean Medicine Preclinical Trial Center, National Development Institute of Korean Medicine, Jangheung-gun 59319, Republic of Korea
| | - Won Choi
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju 61469, Republic of Korea
| | - Yong Sok Ji
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju 61469, Republic of Korea
| | - Hyeon Jeong Yoon
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju 61469, Republic of Korea
| | - Kyung Chul Yoon
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju 61469, Republic of Korea
| |
Collapse
|
41
|
Saldanha IJ, Lindsley KB, Lum F, Dickersin K, Li T. Reliability of the Evidence Addressing Treatment of Corneal Diseases: A Summary of Systematic Reviews. JAMA Ophthalmol 2020; 137:775-785. [PMID: 31070698 DOI: 10.1001/jamaophthalmol.2019.1063] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Patient care should be informed by clinical practice guidelines, which in turn should be informed by evidence from reliable systematic reviews. The American Academy of Ophthalmology is updating its Preferred Practice Patterns (PPPs) for the management of the following 6 corneal diseases: bacterial keratitis, blepharitis, conjunctivitis, corneal ectasia, corneal edema and opacification, and dry eye syndrome. Objective To summarize the reliability of the existing systematic reviews addressing interventions for corneal diseases. Data Source The Cochrane Eyes and Vision US Satellite database. Study Selection In this study of published systematic reviews from 1997 to 2017 (median, 2014), the Cochrane Eyes and Vision US Satellite database was searched for systematic reviews evaluating interventions for the management of any corneal disease, combining eyes and vision keywords and controlled vocabulary terms with a validated search filter. Data Extraction and Synthesis The study classified systematic reviews as reliable when each of the following 5 criteria were met: the systematic review specified eligibility criteria for inclusion of studies, conducted a comprehensive literature search for studies, assessed risk of bias of the individual included studies, used appropriate methods for quantitative syntheses (meta-analysis) (only assessed if meta-analysis was performed), and had conclusions that were supported by the results of the systematic review. They were classified as unreliable if at least 1 criterion was not met. Main Outcomes and Measures The proportion of systematic reviews that were reliable and the reasons for unreliability. Results This study identified 98 systematic reviews that addressed interventions for 15 corneal diseases. Thirty-three of 98 systematic reviews (34%) were classified as unreliable. The most frequent reasons for unreliability were that the systematic review did not conduct a comprehensive literature search for studies (22 of 33 [67%]), did not assess risk of bias of the individual included studies (13 of 33 [39%]), and did not use appropriate methods for quantitative syntheses (meta-analysis) (12 of 17 systematic reviews that conducted a quantitative synthesis [71%]). Sixty-five of 98 systematic reviews (66%) were classified as reliable. Forty-two of the 65 reliable systematic reviews (65%) addressed corneal diseases relevant to the 2018 American Academy of Ophthalmology PPPs; 33 of these 42 systematic reviews (79%) are cited in the 2018 PPPs. Conclusions and Relevance One in 3 systematic reviews addressing interventions for corneal diseases are unreliable and thus were not used to inform PPP recommendations. Careful adherence by systematic reviewers and journal editors to well-established best practices regarding systematic review conduct and reporting might help make future systematic reviews in eyes and vision more reliable.
Collapse
Affiliation(s)
- Ian J Saldanha
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Kristina B Lindsley
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California
| | - Kay Dickersin
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Tianjing Li
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
42
|
McMonnies CW. Aqueous deficiency is a contributor to evaporation-related dry eye disease. EYE AND VISION (LONDON, ENGLAND) 2020; 7:6. [PMID: 32021877 PMCID: PMC6995051 DOI: 10.1186/s40662-019-0172-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/30/2019] [Indexed: 11/10/2022]
Abstract
Dry eye disease aetiologies can be classified dichotomously into aqueous deficient and evaporative types although many cases involve combinations of both. Differential diagnosis can be confounded by some features of dry eye disease being common to both aetiologies. For example, short tear break-up times are prime diagnostic findings of tear instability due to lipid and/or mucin deficiencies, but thin tear layers in aqueous deficient eyes also shorten tear break-up times, even at normal range rates of evaporation in eyes without lipid and/or mucin deficiencies. Because tear instability and short tear film break-up times due to thin tear layers can be independent of lipid and/or mucin deficiency, aqueous deficiency can be another form of evaporation-related dry eye. Conversely, tear layers which are thickened by punctal occlusion can be less susceptible to tear break-up. An inflamed lacrimal gland producing reduced quantities of warmer tears can be a basis for thin tear layers and tear instability demonstrated by shorter tear break-up times. Commonly used clinical tests for aqueous deficiency can be unreliable and less sensitive. Consequently, failure to detect or confirm aqueous deficiency as a contributor to short tear break-up times could result in too much weight being given to a diagnosis of meibomian gland deficiency. Less successful treatment outcomes may be a consequence of failing to detect aqueous deficiency. Refining disease classification by considering aqueous deficiency as a contributor to, or even a form of evaporation-related dry eye, could be the basis for more comprehensive and appropriate treatment strategies. For example, some treatment methods for evaporation-related dry eye might be appropriate for aqueous and mucin-deficient as well as lipid-deficient dry eyes. Anti-inflammatory treatment for the lacrimal gland as well as the conjunctiva, may result in increased aqueous production, reduced tear temperature, tear instability and evaporation rates as well as lower osmolarity.
Collapse
Affiliation(s)
- Charles W McMonnies
- Honorary Professor, School of Optometry and Vision Science, University of New South Wales, 77 Cliff Avenue, Northbridge, Sydney, Kensington, New South Wales 2052 Australia
| |
Collapse
|
43
|
Tuan HI, Chi SC, Kang YN. An Updated Systematic Review With Meta-Analysis Of Randomized Trials On Topical Cyclosporin A For Dry-Eye Disease. DRUG DESIGN DEVELOPMENT AND THERAPY 2020; 14:265-274. [PMID: 32021110 PMCID: PMC6974131 DOI: 10.2147/dddt.s207743] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 09/27/2019] [Indexed: 12/23/2022]
Abstract
Background/Aims To evaluate the effects of topical cyclosporin A (CsA) and artificial tears (ATs) for treating patients with dry-eye disease (DED). Methods On January 25, 2019, five electronic databases and reference lists were searched for randomized clinical trials (RCTs) comparing CsA with ATs among patients with DED. The search strategy had no restriction on language or time. Two authors extracted surgery, mean age, anesthesia for Schirmer’s test, tear-breakup time, Schirmer’s test score, fluorescein-staining score, ocular surface–disease index, and adverse events. Mean differences (MDs) were calculated for continuous outcomes and Peto ORs for dichotomous data with zero cells. Results were analyzed with 95% CIs in a random-effect model. Results Eleven RCTs recruiting 1,085 cases with DED were included. Pooled results showed that CsA had better tear-breakup time (MD 0.94, 95% CI 0.08–1.80), fluorescein-staining score (standardized MD −0.72, 95% CI −1.28 to −0.16), and ocular surface–disease index (MD −4.75, 95% CI −6.31 to −3.18) when compared to ATs. Although CsA had more adverse events than ATs (Peto OR 7.70, 95% CI 3.17–18.68), no serious adverse events were reported. Conclusion Overall, CsA is an effective option for treating patients with DED, yet our evidence indicated decreasing effects when CsA was combined with ATs. CsA may be worth suggesting to relatively older patients with DED. We anticipate further RCTs to explore the effects of treatment duration, optimal dosage, and efficacy of CsA in different DED etiology. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/lX9_2xdnXqc
Collapse
Affiliation(s)
- Hsin-I Tuan
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sheng-Chu Chi
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Education, Linkou Chang Gung Memorial Hospital, New Taipei City, Taiwan
| | - Yi-No Kang
- Center for Evidence-Based Medicine, Department of Education, Taipei Medical University Hospital, Taipei, Taiwan.,Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
44
|
Wang L, Cao K, Wei Z, Baudouin C, Labbé A, Liang Q. Autologous Serum Eye Drops versus Artificial Tear Drops for Dry Eye Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Ophthalmic Res 2019; 63:443-451. [PMID: 31884498 DOI: 10.1159/000505630] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/20/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the efficacy of autologous serum (AS) eye drops and artificial tears (AT) in dry eye disease (DED). METHODS Five databases (PubMed, Science Direct, the Cochrane Library, the Chinese National Knowledge Infrastructure, and the Wanfang Database) were searched for randomized controlled trials (RCTs). Efficacy was evaluated in terms of the Ocular Surface Disease Index (OSDI), Schirmer I test, tear break-up time (TBUT), and fluorescein and rose bengal staining of ocular surface. The estimated effects of AS or AT were expressed as a proportion with the 95% confidence interval and plotted on a forest plot. RESULTS Seven RCTs with 267 subjects were included in the meta-analysis. For most of the studies, subjects' age was around 50 years old, and the mostly treatment duration was within 8 weeks. The follow-up results showed that the OSDI after AS treatment was lower than that after the AT treatment: the mean difference (MD) was -10.75 (95% CI, -18.12; -3.39) points. There was no difference on the Schirmer I test after treatment between the two groups: the MD was 1.68 (95% CI, -0.65; 4.00) mm. The TBUT of the AS group was longer than that of the AT group, with an MD of 4.53 (95% CI, 2.02; 7.05) s. There was no statistically significant difference on fluorescein staining score of the ocular surface between the AS group and the AT group, the MD was -2.53 (95% CI, -6.08; 1.03) points. The rose bengal staining score of the AS group was slightly lower than that of the AT group after treatment: the MD was -0.78 (95% CI, -1.34; -0.22) points. CONCLUSION AS could be an effective treatment for DED, improving OSDI, TBUT, and rose bengal staining score. Further RCTs with large samples and long-term follow-up are still needed to determine the exact role of AS in the management of DED.
Collapse
Affiliation(s)
- Leying Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Zhenyu Wei
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Christophe Baudouin
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China.,IHU FOReSIGHT, Paris and Versailles Saint-Quentin-en-Yvelines University, Versailles, France.,Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France
| | - Antoine Labbé
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China.,IHU FOReSIGHT, Paris and Versailles Saint-Quentin-en-Yvelines University, Versailles, France.,Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France
| | - Qingfeng Liang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China,
| |
Collapse
|
45
|
Bang SP, Yeon CY, Adhikari N, Neupane S, Kim H, Lee DC, Son MJ, Lee HG, Kim JY, Jun JH. Cyclosporine A eyedrops with self-nanoemulsifying drug delivery systems have improved physicochemical properties and efficacy against dry eye disease in a murine dry eye model. PLoS One 2019; 14:e0224805. [PMID: 31738791 PMCID: PMC6860930 DOI: 10.1371/journal.pone.0224805] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/22/2019] [Indexed: 11/18/2022] Open
Abstract
PURPOSE We aimed to compare the physicochemical properties and in vivo efficacy of commercially available nanoemulsion cyclosporine A (CsA) eyedrops in benzalkonium chloride (BAC)-induced dry eye disease (DED). METHODS Particle size analysis was performed on conventional 0.05% CsA (Restasis, C-CsA) and two new types of 0.05% CsA eyedrops based on a self-nanoemulsifying drug delivery system (SNEDDS, SNEDDS-N and -T). Turbidometry, pH measurements and instability indices of each CsA solution were measured. DED was induced with BAC, and animals were treated with vehicle or CsA preparations. Tear volume and fluorescein staining scores were evaluated on days 7 and 14. Eyes were enucleated and subjected to IHC, TUNEL staining, periodic acid-Schiff (PAS) staining, real-time PCR and western blotting. RESULTS Both SNEDDSs had lower and more uniform particle size distribution than C-CsA, and a similar optical density to phosphate-buffered saline and stable pH, in contrast to the high turbidity and unstable pH of C-CsA. Aqueous tear volume and fluorescein staining scores were improved in C-CsA- and SNEDDS-treated mice. Numbers of PAS-positive goblet cells and levels of inflammatory mediators were decreased by both C-CsA and SNEDDS, although SNEDDS resolved inflammation more effectively than C-CsA. CONCLUSIONS Cyclosporine A eyedrops with SNEDDS have improved physicochemical properties and treatment efficacy in BAC-induced DED.
Collapse
Affiliation(s)
- Seung Pil Bang
- Department of Ophthalmology, Keimyung University School of Medicine, Dongsan Medical Centre, Daegu, Republic of Korea
- Department of Biomedical Engineering, University of Rochester, Rochester, New York, United States of America
| | - Chang Yeor Yeon
- Department of Biochemistry, School of Dentistry, IHBR, Kyungpook National University, Daegu, Republic of Korea
| | - Nirpesh Adhikari
- Department of Biochemistry, School of Dentistry, IHBR, Kyungpook National University, Daegu, Republic of Korea
| | - Sanjiv Neupane
- Department of Biochemistry, School of Dentistry, IHBR, Kyungpook National University, Daegu, Republic of Korea
| | - Harim Kim
- Department of Ophthalmology, Keimyung University School of Medicine, Dongsan Medical Centre, Daegu, Republic of Korea
| | - Dong Cheol Lee
- Department of Ophthalmology, Keimyung University School of Medicine, Dongsan Medical Centre, Daegu, Republic of Korea
| | - Myeong Jin Son
- Department of Ophthalmology, Keimyung University School of Medicine, Dongsan Medical Centre, Daegu, Republic of Korea
| | - Hyun Gyo Lee
- Department of Ophthalmology, Keimyung University School of Medicine, Dongsan Medical Centre, Daegu, Republic of Korea
| | - Jae-Young Kim
- Department of Biochemistry, School of Dentistry, IHBR, Kyungpook National University, Daegu, Republic of Korea
| | - Jong Hwa Jun
- Department of Ophthalmology, Keimyung University School of Medicine, Dongsan Medical Centre, Daegu, Republic of Korea
- * E-mail:
| |
Collapse
|
46
|
Chen D, Zhang S, Bian A, Hong J, Deng Y, Zhang M, Chen W, Shao Y, Zhao J. Efficacy and safety of 0.05% cyclosporine ophthalmic emulsion in treatment of Chinese patients with moderate to severe dry eye disease: A 12-week, multicenter, randomized, double-masked, placebo-controlled phase III clinical study. Medicine (Baltimore) 2019; 98:e16710. [PMID: 31374063 PMCID: PMC6709181 DOI: 10.1097/md.0000000000016710] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Dry eye disease (DED) is a chronic ocular surface disease that affects hundreds of millions of people worldwide. Although 0.05% cyclosporine ophthalmic emulsion (CsA OE) has long been prescribed in the U.S. for the treatment of DED, it is not commercially available in China. Our study aims to compare the efficacy and safety profile of 0.05% CsA OE versus vehicle in Chinese patients with moderate to severe DED. METHODS This was a multicenter, randomized, double-masked, 2-parallel-arm, 3-month phase III study. Patients with moderate to severe DED were randomized to receive twice-daily 0.05% CsA OE or its vehicle, along with unpreserved hypromellose eye drops 3 times per day. Patients were followed up at day 7, 28, 56, and 84, as well as 2 weeks after the medications were discontinued for safety assessment. RESULTS A total of 240 patients were randomized. The overall effective rate (OER) and efficacy index were significantly better in the CsA OE than vehicle group at all follow up times (all P < .05), and the OER of CsA OE and vehicle group at month 3 was 70.6% and 27.8%, respectively (P < .001) (primary endpoint). The patients in CsA OE group displayed a significant improvement in dry eye symptoms from day 28 and ocular surface test results from day 7 (all P < .05). The ocular surface disease index scores of 0.05% CsA OE treated patients were significantly better than those treated with vehicle control at day 56 and 84 (P = .0061 and <.001, respectively). Drug related adverse events (AEs) were recorded in 6(5%) and 3(2.5%) patients in the CsA OE and vehicle groups respectively (P = .4061) with ocular pain as the most frequently reported AEs, and it was mostly mild to moderate. There were no detrimental effects on visual acuity, intraocular pressure, or vital signs. CONCLUSIONS Twice-daily instillation of 0.05% CsA OE was effective and well tolerated for the treatment of moderate to severe DED in Chinese population during the 3 months of the study.
Collapse
Affiliation(s)
- Di Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
| | - Shunhua Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
| | - Ailing Bian
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
| | - Jing Hong
- Department of Ophthalmology, Peking University Third Hospital, Beijing
| | - Yingping Deng
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu
| | - Mingchang Zhang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Wei Chen
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Zhejiang
| | - Yan Shao
- Department of Ophthalmology, Second Affiliated Hospital of Dalian Medical College, Dalian, China
| | - Jialiang Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College
| |
Collapse
|
47
|
de Oliveira RC, Wilson SE. Practical guidance for the use of cyclosporine ophthalmic solutions in the management of dry eye disease. Clin Ophthalmol 2019; 13:1115-1122. [PMID: 31308620 PMCID: PMC6612764 DOI: 10.2147/opth.s184412] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/07/2019] [Indexed: 01/02/2023] Open
Abstract
Dry eye disease (DED) is a multifactorial disease of ocular surface and tear film, and is a common disorder treated by eye care providers. It is well established that ocular surface inflammation has an important role in the pathophysiology of DED and that anti-inflammatory cyclosporine A (CsA) improves the treatment outcomes of most patients with DED. The purpose of this review is to provide guidance for practitioners in the use of topical CsA for the management of DED to improve patient satisfaction and the quality of life.
Collapse
|
48
|
Napoli PE, Braghiroli M, Iovino C, Demarinis G, Fossarello M. A study of refractory cases of persistent epithelial defects associated with dry eye syndrome and recurrent corneal erosions successfully treated with cyclosporine A 0.05% eye drops. DRUG DESIGN DEVELOPMENT AND THERAPY 2019; 13:2001-2008. [PMID: 31354245 PMCID: PMC6590396 DOI: 10.2147/dddt.s207453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 05/22/2019] [Indexed: 11/23/2022]
Abstract
Background: Effective and tolerable therapeutic strategies for patients with refractory persistent epithelial defects (PEDs) are limited and generally provide poor outcomes. This retrospective case review describes four refractory cases of PEDs associated with recurrent corneal erosions (RCEs) and dry eye disease (DED), which were successfully treated with cyclosporine eye drops. Methods: Patients were treated with cyclosporine A 0.05% eye drops twice a day for at least 12 months. At enrolling time, each patient was asked to suspend topical steroids or other eye drops used for ocular surface abnormalities with the exception of lubricants and eye washing. A complete evaluation of ocular surface symptoms was performed including the McMonnies Dry Eye Questionnaire, Ocular Surface Disease Index, slit-lamp biomicroscopy, fluorescein break-up time, the fluorescein staining of the cornea and conjunctiva (according to the Oxford grading system), the Schirmer I test, and the meibomian secretion after digital pressure application on the lids. This set of exams was carried out at baseline and repeated at all follow-up assessments. Results: All participants that did not benefit from previous therapies, including corticosteroids tapering schedule, showed an important improvement in the clinical picture after two months with topical cyclosporine medication. Moreover, after 12 months of continuous therapy, all patients showed a clinical improvement in DED signs and symptoms, related to the absence of new RCE episodes. The treatment was well tolerated, and no adverse effects were reported. Conclusion: Although a small number of cases were available of our analysis, the treatment with cyclosporine eye drops represents a promising approach in the management of refractory PEDs with associated ocular comorbidities, since it may reduce the RCE episodes and improve the tear film stability, in absence of systemic or local side effects.
Collapse
Affiliation(s)
| | - Mirco Braghiroli
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Claudio Iovino
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Giuseppe Demarinis
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Maurizio Fossarello
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy.,Clinica Oculistica, San Giovanni di Dio Hospital, Azienda Ospedaliera Universitaria di Cagliari, Cagliari, Italy
| |
Collapse
|
49
|
Yokoi N, Georgiev GA. Tear Film-Oriented Diagnosis and Tear Film-Oriented Therapy for Dry Eye Based on Tear Film Dynamics. Invest Ophthalmol Vis Sci 2019; 59:DES13-DES22. [PMID: 30481801 DOI: 10.1167/iovs.17-23700] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In December 2010 and January 2012, 3% diquafosol sodium ophthalmic solution and 2% rebamipide ophthalmic suspension, respectively, appeared first in Japan as prescription drugs for the treatment of dry eye (DE). Since then, not only the diagnosis and treatment but also the understanding of the pathophysiology of DE have greatly advanced, and a new concept of layer-by-layer diagnosis and treatment for DE, respectively termed "tear-film-oriented diagnosis" (TFOD) and "tear-film-oriented therapy" (TFOT) was born. This new concept is currently in the process of expanding from Japan to other Asian countries. TFOD is the method used for the differential diagnosis of DE, which includes aqueous-deficiency DE (ADDE), decreased wettability DE (DWDE), and increased evaporation DE (IEDE), through the dynamics of tear film (TF) and breakup patterns (BUPs) after the eye is opened. BUPs and/or each diagnosed DE subtype are/is able to distinguish the insufficient components of the ocular surface that are responsible for each BUP in a layer-by-layer fashion. Aqueous fluid, membrane-associated mucins (especially MUC16), and the lipid layer and/or secretory mucins must be insufficient in ADDE, DWDE, and IEDE, respectively, and this allows for a layer-by-layer treatment to be proposed for each BUP via the supplementation of the insufficient components, using the topical therapy currently available. In Japan, TF breakup is regarded as a visible core mechanism for DE, and an abnormal breakup time (i.e., ≤5 seconds) and symptoms are currently used for the diagnosis of DE. Therefore, TFOD and TFOT could be an ideal and practical pathway for clinicians to manage DE.
Collapse
Affiliation(s)
- Norihiko Yokoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Georgi As Georgiev
- Department of Optics and Spectroscopy, Faculty of Physics, St. Kliment Ohridski University of Sofia, Sofia, Bulgaria
| |
Collapse
|
50
|
Effects of Polyunsaturated Fatty Acids on Nonspecific Typical Dry Eye Disease: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Nutrients 2019; 11:nu11050942. [PMID: 31027357 PMCID: PMC6566338 DOI: 10.3390/nu11050942] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/21/2019] [Accepted: 04/24/2019] [Indexed: 12/13/2022] Open
Abstract
To investigate the effects of polyunsaturated fatty acids (PUFAs) in patients with dry eye disease (DED), a multifactorial inflammatory disorder, we searched Cochrane Library, EMBASE, PubMed, and Web of Science for randomized clinical trials (RCTs) investigating the effect of PUFAs in patients with DED before March 2019. Two reviewers independently abstracted data of tear breakup time (TBUT), Schirmer’s test, osmolarity, and ocular surface disease index (OSDI). We conducted pairwise meta-analysis using means and standard deviations (SDs) in a random-effects model for continuous outcomes. Thirteen eligible RCTs with 1782 patients with nonspecific typical DED were included. Patients who received PUFA treatment without other eye medications exhibited greater improvements in TBUT (MD = 1.80; p = 0.001), Schirmer test scores (MD = 0.50; p < 0.001), osmolarity (MD = −15.95; p < 0.001), and OSDI scores (MD = −10.19; p < 0.001) than those who received placebo treatment. However, the effects of PUFAs on TBUT (p < 0.001) and OSDI scores (p = 0.03) weakened with treatment duration. PUFAs are effective in treating nonspecific typical DED, particularly as a short-term treatment, with relatively few adverse events. Therefore, in real-world clinical practice, PUFA supplements are worth being suggested to patients with nonspecific typical DED who are not concurrently using other topical or systematic eye medications.
Collapse
|