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Lu PT, Lee CY, Sun CC. Sex Differences and Discordance Between Symptoms and Signs of Dry Eye Disease. Am J Ophthalmol 2024; 260:14-20. [PMID: 37844751 DOI: 10.1016/j.ajo.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/27/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE To examine the initial presenting symptoms in relation to sex and identify predictors of discordance between symptoms and signs of dry eye disease (DED) in Taiwan. DESIGN Retrospective cross-sectional study. METHODS This clinic-based cohort from a tertiary referral center in Taiwan included 1229 patients diagnosed with DED at Keelung Chang Gung Memorial Hospital in Taiwan between August 1, 2011, and July 31, 2018. Initial presenting symptoms were cross-sectionally and retrospectively collected. The composite score, indicating the discordance between symptoms and signs, was derived from the difference between the DED symptom severity score and the DED sign severity score. RESULTS Of 1229 patients, 975 (79.3%) were female, with a mean age of 56.7 ± 14.9 years. Initial presenting symptoms didn't show significant sex differences (all P > .05). In multivariate analysis, predictors of higher symptom severity score than sign severity score included being female (P = .011) and having a surgical history of cataract (P = .037), pterygium, or conjunctivochalasis (P = .014). Conversely, older age (P < .001) and artificial tear use (P < .001) were significant predictors of a lower symptom severity score than sign severity score. CONCLUSIONS Strong predictors of incongruity between DED symptoms and signs include age, gender, surgical history for cataract, pterygium or conjunctivochalasis, and artificial tear use. Ophthalmologists should prioritize symptoms for female patients and postsurgery cases. In addition, the absence of symptoms should not dismiss DED possibility in older adult patients and those using artificial tears. Notably, early recognition and enhancement of postoperative care can improve patient satisfaction and quality of life.
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Affiliation(s)
- Pei-Ting Lu
- From the Department of Ophthalmology (P-T.L., C-C.S.), Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chia-Yi Lee
- Institute of Medicine (C-Y.L.), Chung Shan Medical University, Taichung, Taiwan; Nobel Eye Institute (C-Y.L.), Taipei, Taiwan; Department of Ophthalmology (C-Y.L.), Jen-Ai Hospital Dali Branch, Taichung, Taiwan
| | - Chi-Chin Sun
- From the Department of Ophthalmology (P-T.L., C-C.S.), Chang Gung Memorial Hospital, Keelung, Taiwan; School of Medicine (C-C.S.), College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Medical Research and Development (C-C.S.), Chang Gung Memorial Hospital, Keelung, Taiwan.
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Jensen P, Nilsen C, Gundersen M, Gundersen KG, Potvin R, Gazerani P, Chen X, Utheim TP, Utheim ØA. A Preservative-Free Approach - Effects on Dry Eye Signs and Symptoms After Cataract Surgery. Clin Ophthalmol 2024; 18:591-604. [PMID: 38435373 PMCID: PMC10906276 DOI: 10.2147/opth.s446804] [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: 10/26/2023] [Accepted: 02/15/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose To compare the effect of treatment with preservative-free dexamethasone, NSAIDs and trehalose/hyaluronic acid eye drops with the preservative benzalkonium chloride containing dexamethasone and NSAIDs after cataract surgery in dry versus non-dry eyes. Patients and Methods In this prospective randomized intervention study, dry eye tests were performed before and 6 weeks after cataract surgery. Patients were considered as having dry eye, SDE (sign of dry eye), if at least one of the following dry eye tests were abnormal; corneal fluorescein staining (CFS), non-invasive keratograph breakup time (NIKBUT) or tear osmolarity. Patients with SDE were randomly assigned to one of two groups. Group 1 patients were treated with dexamethasone and bromfenac eye drops with the preservative benzalkonium chloride (BAC). Group 2 patients were treated with preservative-free dexamethasone and preservative-free diclofenac, as well as a preservative-free lubricant with trehalose and hyaluronic acid both before and after surgery. Patients with normal tear film status acted as the control group (group 3) and received same treatment as group 1. Results A total of 215 patients were enrolled six weeks after surgery, the number of patients with SDE decreased significantly in groups 1 and 2 (p <0.001). Subjective symptoms and objective measures including osmolarity, NIKBUT, CFS, and tear film thickness (TFT) improved after surgery, tear production remained unchanged, while corneal sensitivity and meibomian gland dysfunction (MGD) parameters worsened. In the control group with normal tear-film status, SDE increased significantly after the surgery (p <0.001). There were no statistically significant differences in tear film parameters between the three groups after surgery. Conclusion After cataract surgery, patients with mild to moderate dry eyes may experience improved tear film status and reduced symptoms. However, we found no additional beneficial effect on dry eye parameters with treatment with preservative-free dexamethasone, NSAIDs, and lubricants compared to preservative-containing eye drops.
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Affiliation(s)
| | | | | | | | | | - Parisa Gazerani
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Xiangjun Chen
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
- Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway
- Department of Ophthalmology, Vestre Viken Hospital Trust, Drammen, Norway
| | - Tor P Utheim
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
- Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway
- Department of Ophthalmology, Vestre Viken Hospital Trust, Drammen, Norway
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- The Norwegian Dry Eye Clinic, Oslo, Norway
| | - Øygunn A Utheim
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- The Norwegian Dry Eye Clinic, Oslo, Norway
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Giannaccare G, Barabino S, Di Zazzo A, Villani E. Preventing and Managing Iatrogenic Dry Eye Disease during the Entire Surgical Pathway: A Study Focusing on Patients Undergoing Cataract Surgery. J Clin Med 2024; 13:748. [PMID: 38337442 PMCID: PMC10856703 DOI: 10.3390/jcm13030748] [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: 01/04/2024] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
Patient expectations for cataract surgery are continuously increasing, and dry eye disease (DED) represents a major cause of patient dissatisfaction in eye surgery. The present opinion paper aims to provide useful insights to improve the entire pathway of a patient undergoing cataract surgery, from the preoperative setting to the postoperative one. The available evidence from main clinical trials published on this topic is presented in association with experience-based points of view by the authors. Ocular surface disease (OSD) is common in patients presenting for cataract surgery, and more than half of these patients have DED and meibomian gland dysfunction (MGD), even in the absence of symptoms. Therefore, there is a need to encourage preoperative assessments for the risk of DED development or worsening in all patients as a routine approach to cataract surgery. New all-in-one diagnostic machines allow for fast and noninvasive screening of the ocular surface status. Once a preoperative diagnosis of DED/OSD is reached, ocular surface optimization should be obtained before surgery. In the case of unresolved OSD, the decision to delay surgery should be considered. The surgical procedure can be optimized by avoiding large incisions, limiting microscope light intensity and exposure, and avoiding an aspirating speculum or preserved eye drops. Postoperatively, the continued avoidance of preserved agents is advisable, as well as a limited exposure to epitheliotoxic antibiotics and nonsteroidal anti-inflammatory drugs. Short-term, preservative-free, soft corticosteroids may be useful for patients with extensive or persistent inflammation.
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Affiliation(s)
- Giuseppe Giannaccare
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, Via Università 40, 09124 Cagliari, Italy
| | - Stefano Barabino
- Ocular Surface and Dry Eye Center, ASST Fatebenefratelli-Sacco, Ospedale L. Sacco-Università di Milano, Via Giovanni Battista Grassi 74, 20157 Milan, Italy;
| | - Antonio Di Zazzo
- Ophthalmology, Foundation Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy;
| | - Edoardo Villani
- Department of Clinical Science and Community Health, University of Milan, Eye Clinic San Giuseppe Hospital, IRCCS Multimedica, Via San Vittore 12, 20123 Milan, Italy;
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Srinivasan S, Williams R. Propylene Glycol and Hydroxypropyl Guar Nanoemulsion - Safe and Effective Lubricant Eye Drops in the Management of Dry Eye Disease. Clin Ophthalmol 2022; 16:3311-3326. [PMID: 36237486 PMCID: PMC9553314 DOI: 10.2147/opth.s377960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/15/2022] [Indexed: 02/05/2023] Open
Abstract
Dry eye disease (DED) is a chronic condition of the ocular surface characterized by a loss of the tear film homeostasis and accompanied by symptoms such as eye discomfort and visual disturbances. DED is classified as aqueous deficient dry eye (ADDE), evaporative dry eye (EDE), and mixed dry eye etiologies. The mainstay treatment in the management of DED is artificial tear drops or lubricant eye drops that replenish the aqueous and/or lipid layer of the tear film. These are available as both lipid-based and non-lipid-based formulations, with/without preservatives. Lipid-based lubricant eye drops can stabilize the tear film lipid layer, reduce tear evaporation, and improve signs of EDE. In this review, we present the formulation components, mechanism of action, and summary of preclinical and clinical evidence on a lipid-based formulation - propylene glycol-hydroxypropyl guar (PG-HPG) nanoemulsion lubricant eye drops (SystaneTM Complete). These eye drops consist of the demulcent (lubricant), PG (0.6%). HPG forms a soft, thin, cross-linked in situ gel matrix with borate ions, when exposed to the tear film, which prolongs lubricant retention and provides ocular surface protection. Dimyristoyl phosphatidyl glycerol, an anionic phospholipid, helps in replenishing the lipid layer of the tear film. Moreover, the nanoemulsion formulation serves as a depot for delivery of dimyristoyl phosphatidyl glycerol to enhance ocular surface coverage. Preclinical and clinical evidence demonstrate that PG-HPG nanoemulsion lubricant eye drops are safe and effective in providing temporary relief of symptoms of DED, regardless of its subtypes. Specifically, it provides sustained reduction in dry eye symptoms, improves tear film stability/lipid layer grade, and improves ocular surface characteristics.
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Affiliation(s)
- Sruthi Srinivasan
- Alcon Research LLC, Johns Creek, GA, 30097, USA,Correspondence: Sruthi Srinivasan, Alcon Research LLC, 11460 Johns Creek Parkway, Johns Creek, GA, 30097, USA, Tel +1 678 415 5315, Email
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Rossi GCM, Tinelli C, Milano G, Lanteri S, Ricciarelli G, Giannì L, Pasinetti GM, Scudeller L. Randomised, Single Blind, Controlled, Three-Month Clinical Trial on the Evaluation and Treatment of the Ocular Surface Damage Following Phacoemulsification. Vision (Basel) 2022; 6:vision6030042. [PMID: 35893759 PMCID: PMC9326562 DOI: 10.3390/vision6030042] [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: 04/30/2022] [Revised: 06/07/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background: To determine efficacy of two lacrimal substitutes on signs and symptoms of ocular surface disease after phacoemulsification; to determine impact of surgery on patients’ vision related quality of life. Monocentric, randomised, physician blinded, three parallel groups clinical trial. Design and Methods: Patients in the operative list for phacoemulsification have been screened for eligibility; they underwent (at time 0, 15, 45 and 90 days): slit lamp examination; tear film break-up time (BUT); corneal staining; tear volume; 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ); Ocular Surface Disease Index (OSDI). Treatments to be compared were: 1. standard of care-SOC (lomefloxacine and tobramicine/dexamethasone fixed combination 4 times a day for 2 weeks), 2. SOC + carboxymethylcellulose sodium 0.5% and glycerin 0.9%, 3. SOC + Sodium Hyaluronate 0.15%. Study treatment started at T15. Groups were compared with parametric or nonparametric tests, and with Pearson’s χ2 test. Correlation between continuous variables was assessed by means of Pearson’s or Spearman’s coefficient. Results: Fifty-three patients were enrolled. At 45 and at 90 days from surgery, the group receiving lacrimal substitutes presented better BUT and Schirmer I test (p = 0.009, <0.001, <0.001 and 0.001, respectively); dry eye presence showed significant difference by group at time 90 (p = 0.019). General vision, near activity and vision-specific dependency subscales improved after surgery (p = <0.001, 0.004 and 0.048, respectively). At 45 and 90 days from surgery, the OSDI score significantly changed (p < 0.001).Conclusions: Cataract surgery causes the onset or the worsening of dry eye. Use of artificial tears can significantly reduce symptoms and signs of dry eye in patients after phacoemulsification.
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Affiliation(s)
- Gemma Caterina Maria Rossi
- Department of Surgical Sciences, University Eye Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (G.M.); (S.L.); (G.R.); (L.G.)
- ASST Bergamo Est, Ospedale Locatelli, 24020 Piario, Italy
- Correspondence:
| | - Carmine Tinelli
- Clinical Epidemiology and Biometric Unit, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (C.T.); (L.S.)
| | - Giovanni Milano
- Department of Surgical Sciences, University Eye Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (G.M.); (S.L.); (G.R.); (L.G.)
- Medicine and Surgery Faculty, University of Pavia, 27100 Pavia, Italy
| | - Sara Lanteri
- Department of Surgical Sciences, University Eye Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (G.M.); (S.L.); (G.R.); (L.G.)
| | - Gabriella Ricciarelli
- Department of Surgical Sciences, University Eye Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (G.M.); (S.L.); (G.R.); (L.G.)
| | - Laura Giannì
- Department of Surgical Sciences, University Eye Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (G.M.); (S.L.); (G.R.); (L.G.)
| | | | - Luigia Scudeller
- Clinical Epidemiology and Biometric Unit, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (C.T.); (L.S.)
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Hamed MA, Aldghaimy AH, Mohamed NS, Amer AA. The Incidence of Post Phacoemulsification Surgery Induced Dry Eye Disease in Upper Egypt. Clin Ophthalmol 2022; 16:705-713. [PMID: 35300035 PMCID: PMC8921793 DOI: 10.2147/opth.s358866] [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] [Received: 01/27/2022] [Accepted: 02/18/2022] [Indexed: 12/02/2022] Open
Abstract
Background Dry eye is described as a multifactorial disorder of the tear film that occurs due to excessive tear evaporation or tears insufficiency, and so leads to ocular discomfort sensation and ocular tissue damage with time. Objective To assess the incidence of dry eye disease after uncomplicated phacoemulsification surgery in patients with no pre-existed dry eye. Patients and Methods This hospital-based cross-sectional study was conducted to assess the incidence of dry eye at 100 eyes of 100 patients who underwent uncomplicated phacoemulsification surgery, with age more than 45 years old. It is measured by dry eye tests Schirmer 1 and tear break up time. Results This study showed that 22% of the patients who underwent uncomplicated phacoemulsification surgery suffered from dry eye with significant results at 1st week post-operative that improved over time. Conclusion There was a statistically significant drop in the results of the Schirmer test 1 and TBUT post phacoemulsification surgery, but with no clinical significance as they still at the normal range. The tear film assessment results at the 1st week post-operative were out of the normal range with TBUT and were borderline with ST1 in 22% of the patients. These results improved over time to return to the normal values within 12 weeks postoperatively.
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Affiliation(s)
- Mohamed Ateto Hamed
- Ophthalmology Department, Luxor University, Luxor, Egypt
- Correspondence: Mohamed Ateto Hamed, Email
| | | | | | - Ahmed Ali Amer
- Ophthalmology Department, South Valley University, Qena, Egypt
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Miura M, Inomata T, Nojiri S, Sung J, Nagao M, Shimazaki J, Midorikawa-Inomata A, Okumura Y, Fujio K, Akasaki Y, Kuwahara M, Huang T, Nakamura M, Iwagami M, Hirosawa K, Fujimoto K, Murakami A. Clinical efficacy of diquafosol sodium 3% versus hyaluronic acid 0.1% in patients with dry eye disease after cataract surgery: a protocol for a single-centre, randomised controlled trial. BMJ Open 2022; 12:e052488. [PMID: 35105626 PMCID: PMC8808423 DOI: 10.1136/bmjopen-2021-052488] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The number of cataract surgeries, the most common ophthalmic surgery, is expected to increase due to ageing populations. Dry eye disease (DED) is a frequent side effect of cataract surgery, contributing to lower postoperative patient satisfaction and suboptimal quality of vision. It is unclear which eye-drops commonly used in these patients should be recommended for postoperative DED treatment. This study aims to compare the efficacy of topical administration of diquafosol sodium 3% vs hyaluronic acid 0.1% eye-drops in patients with DED after cataract surgery. METHODS AND ANALYSIS The study is designed as a single-blind randomised controlled trial. The participants will be randomly (1:1) allocated to either the diquafosol sodium 3% topical administration group (n=21) or the hyaluronic acid 0.1% topical administration group (n=21). Each group will receive its assigned eye-drop intervention over a 12-week period. The primary outcome will be measured using the total score of the Japanese version of the Ocular Surface Disease Index during the visit 5 weeks postoperatively. Both groups will be followed up after their respective eye-drop application for 12 weeks according to the intervention regimens. Secondary outcome measures including meibomian gland function assessment, tear film break-up time, keratoconjunctival staining score, maximum blink interval and tear secretion volume using Schirmer's test I will be assessed at 1, 5, 9, 13 and 25 weeks postoperatively. ETHICS AND DISSEMINATION This study has been approved by the Juntendo Hospital Certified Review Board, Tokyo, Japan (Approved protocol V.7.0 dated 7 May 2021. Approval number: J20-018) and has been registered with the Japan Registry of Clinical Trials. Written informed consent will be collected from every patient prior to study participation. The results of this trial will be presented at local and international meetings and submitted to peer-reviewed journals for publication. TRIAL REGISTRATION NUMBER jRCT1031210018.
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Affiliation(s)
- Maria Miura
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Takenori Inomata
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Strategic Operating Room Management and Improvement, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Jaemyoung Sung
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Masashi Nagao
- Medical Technology Innovation Center, Juntendo University, Bunkyo-ku, Tokyo, Japan
- Department of Orthopedic Surgery, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Sports Science, Juntendo University Faculty of Health and Sports Science, Chiba, Japan
| | - Jun Shimazaki
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Chiba, Japan
| | - Akie Midorikawa-Inomata
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Yuichi Okumura
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Strategic Operating Room Management and Improvement, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Kenta Fujio
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Yasutsugu Akasaki
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Mizu Kuwahara
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Tianxiang Huang
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Masahiro Nakamura
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Precision Health, Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Masao Iwagami
- Department of Health Services Research, University of Tsukuba, Tsukuba, Japan
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Kunihiko Hirosawa
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Keiichi Fujimoto
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Akira Murakami
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
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Dry eye and inflammation of the ocular surface after cataract surgery: effectiveness of a tear film substitute based on trehalose/hyaluronic acid vs hyaluronic acid to resolve signs and symptoms. J Cataract Refract Surg 2021; 47:1430-1435. [PMID: 34675150 DOI: 10.1097/j.jcrs.0000000000000652] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/13/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE To compare the effect of trehalose 3%/hyaluronic acid 0.15% vs hyaluronic acid 0.15% eyedrops in reducing ocular surface inflammation after cataract surgery. SETTING Perugia, Italy. DESIGN Randomized, prospective study. METHODS Patients with healthy ocular surface were enrolled. Tear break-up time (TBUT), Schirmer test, corneal fluorescein staining (CFS), ocular surface disease index (OSDI) and in vivo confocal microscopy (IVCM) were performed preoperatively and at 1 months, 4 months, and 8 months postoperatively. Patients were randomly assigned to receive trehalose 3%/hyaluronic acid 0.15% eyedrops (Group A), hyaluronic acid 0.15% eyedrops (Group B), or no treatment (Group C). RESULTS 98 patients were randomized as follows: 33 in Group A, 33 in Group B, and 32 in Group C. Schirmer test increased at 1-month follow-up in Group A and unchanged in Groups B and C. TBUT and CFS increased at 1-month follow-up in Group A and after 8 months in Groups B and C. OSDI score decreased at 1-month follow-up in Group A and at in Groups B and C. IVCM showed a reduction in the number of nerve fibers of the subbasal nerve plexus at 1 month in all groups and progressively increased to preoperative levels at 4 months in Group A, and at 8 months in Groups B and C. Tortuosity and reflectivity of subbasal plexus progressively decreased to became significant at 4-month follow-up in Group A whereas increased at 1-month follow-up and become normal at 8-month follow-up in Groups B and C. Langerhans cells and activated stromal keratocytes were higher in Groups B and C throughout the follow-up with a significantly lower density of hyperreflective stromal cells in Group A. CONCLUSIONS Trehalose 3%/hyaluronic acid 0.15% eyedrops were effective in reducing inflammation and dry-eye symptoms.
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Garg P, Gupta A, Tandon N, Raj P. Dry Eye Disease after Cataract Surgery: Study of its Determinants and Risk Factors. Turk J Ophthalmol 2021; 50:133-142. [PMID: 32630999 PMCID: PMC7338747 DOI: 10.4274/tjo.galenos.2019.45538] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Objectives To study the incidence of dry eye and its determinants in patients undergoing cataract surgery. Materials and Methods One hundred twenty patients with senile cataract underwent Schirmer's test, tear break-up time (TBUT) test, lissamine green staining of the cornea and conjunctiva, and Ocular Surface Disease Index (OSDI) for evaluation of dry eye preoperatively and again at first and second follow-up examinations at 1 week and 1 month after cataract surgery. Results Mean age of the patients was 59.25+9.77 years and 73 (60.8%) were men. None of the patients had dry eye at the time of enrollment as per the criteria of our study. Postoperatively, Schirmer's test values ranged from 12-35 mm and 8-24 mm at first and second follow-ups, respectively. Mean TBUT was 13.16±2.45 and 9.64±2.20 seconds, while lissamine green staining score was 3 in 67 (55.8%) and 1 in 67 (55.8%) subjects at first and second follow-up, respectively. OSDI values ranged from 1-30 and 10-33 with a mean of 25.97±5.34 and 11.96±7.47 respectively at first and second follow-up. At first follow-up, 89.1% of the 56 patients who underwent phacoemulsification were found to have grade 2 dry eye (p<0.001), while 92.2% of the 64 patients who underwent small-incision cataract surgery (SICS) had grade 2 dry eye (p<0.001). At second follow-up, grade 0 dry eye was observed in 92.2% of the patients who underwent phacoemulsification and 82.1% of the patients who underwent SICS (p<0.001). Conclusion The incidence of dry eye after cataract surgery was high and mostly independent of demographic and anthropometric profile, type of surgical procedure, time of microscope exposure, and amount of energy used. This dryness was transient in nature and showed a declining trend, tending to achieve normalization by the end of 1 month.
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Affiliation(s)
- Pragati Garg
- Era's Lucknow Medical College and Hospital, Clinic of Ophthalmology, Lucknow, India
| | - Aditi Gupta
- Era's Lucknow Medical College and Hospital, Clinic of Ophthalmology, Lucknow, India
| | - Nishi Tandon
- Era's Lucknow Medical College and Hospital, Clinic of Pathology, Lucknow, India
| | - Priyanka Raj
- Era's Lucknow Medical College and Hospital, Clinic of Ophthalmology, Lucknow, India
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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).
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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
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11
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Garofalo R, Kunnen C, Rangarajan R, Manoj V, Ketelson H. Relieving the symptoms of dry eye disease: update on lubricating eye drops containing hydroxypropyl-guar. Clin Exp Optom 2021; 104:826-834. [PMID: 34137675 DOI: 10.1080/08164622.2021.1925208] [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] [Indexed: 10/21/2022] Open
Abstract
Hydroxypropyl-guar (HPG) is a thickening agent first added to lubricating eye drops in 2003. This agent, which enhances viscosity, has been used in the SYSTANE® family of lubricant eye drops (Alcon Laboratories, Inc., Fort Worth, TX, USA). HPG forms a partially linked gel with borate to prolong the retention of demulcents, such as polyethylene glycol and propylene glycol, on the eye. This helps to protect the ocular surface, thereby reducing the symptoms of dry eye disease (DED). The definition of DED has evolved with advances in research, leading to changes in HPG-containing eye care solutions. This article reviews current knowledge on the use of HPG-containing lubricating eye drops in the management of DED.
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Affiliation(s)
- Renee Garofalo
- Research & Development, Alcon Research, LLC, Fort Worth, TX, USA
| | - Carolina Kunnen
- Research & Development, Alcon Research, LLC, Fort Worth, TX, USA
| | | | | | - Howard Ketelson
- Research & Development, Alcon Vision, LLC, Fort Worth, TX, USA
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12
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Shokoohi-Rad S, Javaheri SZH, Malekabad FZ, Khakshoor H, Daluee MK. Effects of preoperative doses of betamethasone acetate 0.1% on dry eye control after cataract surgery. Indian J Ophthalmol 2021; 68:450-454. [PMID: 32057000 PMCID: PMC7043147 DOI: 10.4103/0301-4738.278367] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose The aim of the present study was to compare the effects of the preoperative doses of betamethasone acetate 0.1% and placebo on controlling dry eye after cataract surgery. Methods This randomized triple-blind clinical trial was conducted on 62 patients. For the purpose of the study, the participants were assigned into two groups of betamethasone (n = 28) and placebo (n = 34). The groups were administered with drops A or B three days before the operation, four times a day. These drops contained either betamethasone 0.1% or normal saline (placebo). Postoperative follow-up was performed 1, 7, and 30 days after the surgery. Dry eye symptoms were evaluated by means of the ocular surface disease index (OSDI) using the meniscometry test. Repeated measures analysis was also used to study the effect of the interaction between betamethasone and time on meniscometry and OSDI variables. Results A total of 62 patients, including 51.6% female and 48.4% male, were investigated in this study with a mean age o 69.19 ± 12.80 years. The results of the analysis of variance of the repeated measures plot indicated that the OSDI and meniscometry dry eye variables were not affected by the interaction between time and betamethasone (P = 0.192 and P = 0.578, respectively). Conclusion As the findings indicated, the use of betamethasone acetate 0.1% prior to cataract surgery had no significant effect on postoperative dry eye indices.
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Affiliation(s)
- Saeed Shokoohi-Rad
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | | | - Hamid Khakshoor
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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13
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Naderi K, Gormley J, O’Brart D. Cataract surgery and dry eye disease: A review. Eur J Ophthalmol 2020; 30:840-855. [PMID: 32515220 PMCID: PMC7549290 DOI: 10.1177/1120672120929958] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/07/2020] [Indexed: 01/26/2023]
Abstract
AIM To review published literature concerning cataract surgery and dry eye disease (DED). METHODS A search was undertaken using the following: PubMed (all years), Web of Science (all years), Ovid MEDLINE(R) (1946 to 12 December 2019), Ovid MEDLINE(R) Daily Update 10 December 2019, MEDLINE and MEDLINE non-indexed items, Embase (1974-2019, week 49), Ovid MEDLINE (R) and Epub Ahead of Print, In-Process and Other Non-Indexed Citations and Daily (1946 to 12 December 2019), CENTRAL (including Cochrane Eyes and Vision Trials Register; Cochrane Library: Issue 12 of 12 December 2019), metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrial.gov) and WHO International Clinical Trials Registry Platform (www.who.int/ictrp/search/en). Search terms included 'cataract surgery', 'phacoemulsification' and 'cataract extraction', combined with 'dry eyes' and 'ocular surface'. Relevant in-article references not returned in our searches were also considered. RESULTS Publications identified included systematic reviews, meta-analysis, randomized controlled trials, cohort studies, case series and laboratory-based studies. Published data highlighting the burden of DED both prior and following cataract surgery were reviewed as well as studies highlighting the effects of cataract surgery on the ocular surface, intra-operative measures to reduce deleterious effects on the ocular surface and current evidence on the management options of post-operative DED. CONCLUSIONS DED is common and can be exacerbated by cataract surgery. Ophthalmologists need to assess for pre-existing DED and instigate treatment before surgery; be aware of reduced accuracy of measurements for surgical planning in the presence of DED; limit intra-operative surgical factors damaging to the ocular surface; and consider management to reduce DED post-operatively.
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Affiliation(s)
- Khayam Naderi
- Department of Ophthalmology, Guy’s and St Thomas’ NHS Foundation
Trust, London, UK
- King’s College London, London, UK
| | - Jack Gormley
- Department of Ophthalmology, Guy’s and St Thomas’ NHS Foundation
Trust, London, UK
| | - David O’Brart
- Department of Ophthalmology, Guy’s and St Thomas’ NHS Foundation
Trust, London, UK
- King’s College London, London, UK
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Favuzza E, Cennamo M, Vicchio L, Giansanti F, Mencucci R. Protecting the Ocular Surface in Cataract Surgery: The Efficacy of the Perioperative Use of a Hydroxypropyl Guar and Hyaluronic Acid Ophthalmic Solution. Clin Ophthalmol 2020; 14:1769-1775. [PMID: 32616996 PMCID: PMC7326168 DOI: 10.2147/opth.s259704] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/09/2020] [Indexed: 01/02/2023] Open
Abstract
Purpose To evaluate the effects of a hydroxypropyl guar (HPG) and hyaluronic acid (HA) ophthalmic solution in terms of post-cataract surgery dry-eye disease (DED) prevention. Patients and Methods In this retrospective study, the data of 419 patients not previously affected by DED, who had undergone unilateral cataract surgery in 17 Italian centers with different perioperative lubricating regimens, were retrospectively reviewed. Patients who had instilled HPG/HA solution 3 times/day in the preoperative week and for two postoperative months were included in group A; group B only instilled HPG/HA for two postoperative months; group C did not instill any perioperative artificial tears. All patients followed the same antibiotic and anti-inflammatory postoperative topical regimen. The scores of SPEED (Standard Patient Evaluation of Eye Dryness) questionnaire, tear break-up time (BUT) and corneal fluorescein staining (CFS, Oxford scale), performed at the preoperative visit and at one, four and eight postoperative weeks, were evaluated. Results In groups A and B, the SPEED scores were significantly lower than group C in the whole postoperative period. In group A, the SPEED scores were significantly lower than group B 1 and 4 weeks after surgery (p<0.001 and p=0.021). In group C, 25% of patients reported symptom scores corresponding to mild-moderate dry eye 4 and 8 weeks after surgery. The fluorescein tear BUT in groups A and B was significantly higher than group C in the whole postoperative period (p<0.001). In group A, BUT was significantly higher than group B 4 weeks after surgery (p=0.016). More patients showed no corneal fluorescein staining (CFS grade=0) in groups A and B than group C at all the postoperative visits. Conclusion The hydroxypropyl guar and hyaluronic acid ophthalmic solution was effective at reducing post-cataract surgery ocular discomfort and tear instability, particularly if also administered in the preoperative period.
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Affiliation(s)
- Eleonora Favuzza
- Department of Neuroscience, Psychology, Pharmacology and Child Health (NEUROFARBA), Eye Clinic, University of Florence, Florence, Italy
| | - Michela Cennamo
- Department of Neuroscience, Psychology, Pharmacology and Child Health (NEUROFARBA), Eye Clinic, University of Florence, Florence, Italy
| | - Lidia Vicchio
- Department of Neuroscience, Psychology, Pharmacology and Child Health (NEUROFARBA), Eye Clinic, University of Florence, Florence, Italy
| | - Fabrizio Giansanti
- Department of Neuroscience, Psychology, Pharmacology and Child Health (NEUROFARBA), Eye Clinic, University of Florence, Florence, Italy
| | - Rita Mencucci
- Department of Neuroscience, Psychology, Pharmacology and Child Health (NEUROFARBA), Eye Clinic, University of Florence, Florence, Italy
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15
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Shimabukuro M, Maeda N, Koh S, Abe K, Kobayashi R, Nishida K. Effects of cataract surgery on symptoms and findings of dry eye in subjects with and without preexisting dry eye. Jpn J Ophthalmol 2020; 64:429-436. [PMID: 32495157 DOI: 10.1007/s10384-020-00744-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/26/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare dry eye symptoms and findings in post cataract surgery eyes' with and without preexisting dry eye. STUDY DESIGN Prospective, observational case-control study. METHODS Sixty-seven eyes that had undergone cataract surgery were included; 48 were classified into group D (preexisting dry eye) and 19 into group N (no preexisting dry eye). No subjects received perioperative treatment for dry eye. We evaluated between-group differences in symptom scores, corrected distance visual acuity (CDVA), tear film breakup time (BUT), tear film breakup pattern (BUP), and ocular surface fluorescein staining scores, at 1 week, 1 month, and 3 months postoperatively. RESULTS Symptoms were unchanged in group N, but improved in group D (P < .001) postoperatively. CDVA was improved after surgery in both groups (P < .001). BUT was shorter preoperatively in group D than in group N although this difference was absent 1 month postoperatively. Fluorescein staining scores significantly increased at 1 month postoperatively in group N (P = .01), but did not change in group D. During the perioperative period, the predominant BUP was the random break pattern in both groups (≥ 85%). From 1 week to 3 months, dimple break patterns decreased in group D (P = .007), whereas spot break patterns increased (P = .01). CONCLUSIONS Cataract surgery has an influence on tear film stability and the ocular surface. There was either a transient improvement or worsening of ocular surface wettability in some patients without preexisting dry eye.
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Affiliation(s)
- Mikiko Shimabukuro
- Department of Ophthalmology, Kansai Medical Hospital, Toyonaka, Osaka, Japan
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Room E7, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan
| | - Naoyuki Maeda
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Room E7, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan.
| | - Shizuka Koh
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Room E7, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan
| | - Keiichi Abe
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Room E7, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan
| | - Reiko Kobayashi
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Room E7, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Room E7, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan
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16
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Fogagnolo P, Favuzza E, Marchina D, Cennamo M, Vignapiano R, Quisisana C, Rossetti L, Mencucci R. New Therapeutic Strategy and Innovative Lubricating Ophthalmic Solution in Minimizing Dry Eye Disease Associated with Cataract Surgery: A Randomized, Prospective Study. Adv Ther 2020; 37:1664-1674. [PMID: 32185729 PMCID: PMC7140734 DOI: 10.1007/s12325-020-01288-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION To evaluate the effects of a new lubricating, antioxidant solution (VisuEvo®) on dry eye disease (DED) in patients undergoing cataract surgery. METHODS Patients requiring cataract surgery with either healthy ocular surface or mild DED (tear break-up time, TBUT > 7, Schirmer I test > 15 mm/5 min) were enrolled in this multicenter, open-label, randomized, prospective study. Scheduled visits were 2 weeks before surgery (screening), day of surgery (V0), week 1 (V1), and 2 (V2) after surgery. VisuEvo® was self-administered three times daily for the whole study duration (group A); the control group (group B) had no tear substitute administration. The primary endpoint was the change in TBUT over time; the secondary endpoints were changes in Ocular Surface Disease Index (OSDI), ocular surface staining, the Schirmer I test, and osmometry. RESULTS A total of 45 patients were included (group A, 23; group B, 22; age 74 ± 8 years). At the screening, TBUT was similar between the groups (group A, 8.5 ± 1.8 s; group B, 7.8 ± 0.7, p = 0.11). At the scheduled visits, TBUT increase vs screening visit was significantly higher in group A: +1.2 s at V0, +1.4 s at V1, and +1.9 s at V2 (p < 0.01). Also, OSDI was significantly lower in group A at V0, V1, and V2 (p < 0.027). After surgery, corneal staining was absent in 65-78% of group A compared with 54-59% in group B. The two groups did not show any significant differences of osmometry and the Schirmer I test. CONCLUSIONS The ocular surface was more protected and quickly restored from surgery when VisuEvo® was used from 2 weeks preoperatively to 2 weeks postoperatively. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT03833908.
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Affiliation(s)
- Paolo Fogagnolo
- Eye Clinic, ASST Santi Paolo Carlo, San Paolo Hospital, Milan, Italy.
- Department of Health Sciences, University of Milan, Milan, Italy.
| | - Eleonora Favuzza
- Department of Oto-Neuro-Ophthalmological Surgical Sciences Eye Clinic, University of Florence, Florence, Italy
| | - Daniele Marchina
- Eye Clinic, ASST Santi Paolo Carlo, San Paolo Hospital, Milan, Italy
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Michela Cennamo
- Department of Oto-Neuro-Ophthalmological Surgical Sciences Eye Clinic, University of Florence, Florence, Italy
| | - Roberto Vignapiano
- Department of Oto-Neuro-Ophthalmological Surgical Sciences Eye Clinic, University of Florence, Florence, Italy
| | - Chiara Quisisana
- Eye Clinic, ASST Santi Paolo Carlo, San Paolo Hospital, Milan, Italy
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Luca Rossetti
- Eye Clinic, ASST Santi Paolo Carlo, San Paolo Hospital, Milan, Italy
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Rita Mencucci
- Department of Oto-Neuro-Ophthalmological Surgical Sciences Eye Clinic, University of Florence, Florence, Italy
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17
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Zamora MG, Caballero EF, Maldonado MJ. Short-term changes in ocular surface signs and symptoms after phacoemulsification. Eur J Ophthalmol 2020; 30:1301-1307. [PMID: 31902240 DOI: 10.1177/1120672119896427] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this study is to evaluate the incidence, natural course, and distribution pattern of superficial punctate keratopathy and describe the changes in signs and symptoms of dry eye after cataract surgery. SETTING The setting of this study is University Hospital Rio Hortega and Instituto Universitario de Oftalmobiología Aplicada, Valladolid, Spain. DESIGN This is a prospective interventional study. MATERIALS AND METHODS In total, 55 eyes of 55 different patients with no history of dry eye underwent standard phacoemulsification through a 2.75-mm-wide corneal incision. We measured tear break-up time, Schirmer test I, and tear meniscus height, and recorded the Ocular Surface Disease Index score, fluorescein staining patterns, and photo documentation of the ocular surface before and 1 day, 1 week, and 1 month postoperatively. Patients were divided into two groups (with and without superficial punctate keratopathy development, 1 day postoperatively). RESULTS Patients (mean age: 75.75 ± 7.27 years) showed an incidence of 76.3% of superficial punctate keratopathy at 24 h. Location predominated in the center of the cornea until a week (32.7%) and then began to prevail in the inferior quadrant (21.8%) at 1 month. All dry eye tests were significantly worse after surgery. Ocular Surface Disease Index increased from 10.98 ± 5.05 to 15.87 ± 6.57 at 24 h (p < .001), to 12.80 ± 5.77 at 7 days (p < .001), and to 11.09 ± 4.63 at 1 month (p = .90). Fluorescein staining patterns got worse 24 h postoperatively with a score of 2.12 using the National Eye Institute/Industry-recommended guidelines staining grid. Average break-up time values were significantly lower at 1 day (6.61 ± 2.68),1 week (6.98 ± 2.79), and 1 month (7.05 ± 2.86) postoperatively than preoperatively (8.78 ± 2.97) (p < .001). The mean postoperative first month Schirmer test I value (8.32 ± 3.58) was significantly lower than preoperative value (9.05 ± 3.63) (p < .001). CONCLUSION Phacoemulsification tends to induce short-term transitory ocular surface impairment manifesting as both signs and symptoms. Superficial punctate keratopathy distribution has a characteristic pattern evolution according to the postoperative time. Those patients with altered preoperative values are more likely to develop ocular surface disease and for longer time.
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Affiliation(s)
- María García Zamora
- Ophthalmology Department, Hospital Universitario Rio Hortega, Valladolid, Spain.,Ophthalmology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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Abstract
Surgical intervention is the most effective treatment for decreased vision resulting from cataracts. Although the current procedures for cataract surgery are safe and effective, it is well known that several complications can develop after surgery. Postoperative cystoid macular edema (CME) is a well-known complication, and prophylactic medications such as steroids and/or nonsteroidal antiinflammatory drugs are routinely used for its prevention. Ocular surface abnormalities, such as dry eye, have also been reported to develop after cataract surgery. However, the causative mechanisms for postoperative dry eye have not been definitively determined. At present, there are no prophylactic medications that are commonly used to prevent the development of postoperative dry eye. Although nonsteroidal antiinflammatory drugs are very effective in reducing the incidence and degree of postoperative CME, it is known that they can cause adverse side effects, including ocular surface abnormalities. Thus, perioperative medications must be carefully selected to improve surgical outcomes and patient satisfaction. Here, we summarize the results of recent studies on postoperative dry eye and CME that can develop after cataract surgery. We suggest appropriate combinations of medications that can be used to minimize these postsurgical complications.
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19
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Surgical Factors Affecting Changes in Ocular Surface Dynamics in the Early Postoperative Period After 25-Gauge Vitrectomy. Eye Contact Lens 2019; 45:254-259. [PMID: 30418296 DOI: 10.1097/icl.0000000000000562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Because vitrectomy-associated postoperative ocular surface changes are not well known, we evaluated such changes before and after vitrectomy in eyes with posterior segment diseases and investigated their associations with patients' characteristics and surgical procedures. METHODS Thirty-five eyes of 32 consecutive patients (16 women; average age 66.6±11.1 years) were included in this prospective, noncomparative case series from tertiary care university hospital. Contact lens wearers and patients with history of ocular surgery or regular use of topical eyedrops were excluded. Patients had undergone primary 25-gauge vitrectomy at Osaka University Hospital in Japan between July and December 2016. Tear break-up time (TBUT), corneal and conjunctival fluorescein staining score (FSS), and tear meniscus height (TMH) were evaluated before, 1 week after, and 1 month after vitrectomy. RESULTS Conjunctival FSS and TMH were significantly higher at 1 week after vitrectomy than preoperatively. However, they decreased significantly 1 month after. Changes in TBUT and corneal FSS showed a similar course at 1 week, but this was not statistically significant. Multiple linear regression analysis showed no significant correlation between significantly increased ocular parameters and patients' characteristics. By contrast, surgical time and combined cataract surgery significantly contributed to increased and decreased conjunctival FSS, respectively (P=0.011 and 0.033, respectively). Sclerotomy site suturing significantly contributed to increased TMH (P=0.025). CONCLUSIONS We showed associations between ocular surface changes and specific surgical procedures. Caution should be exercised to minimize the effect of surgical procedures on the ocular surface during vitrectomy.
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20
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Gomes JAP, Santo RM. The impact of dry eye disease treatment on patient satisfaction and quality of life: A review. Ocul Surf 2018; 17:9-19. [PMID: 30419303 DOI: 10.1016/j.jtos.2018.11.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 11/02/2018] [Accepted: 11/07/2018] [Indexed: 12/23/2022]
Abstract
Several aspects of the quality of life (QoL) and treatment satisfaction of patients with dry eye disease (DED) may be underestimated. Ocular symptoms, which are assessed by validated patient-reported questionnaires and may include stinging, burning, itchiness, grittiness, dryness and discomfort, reduce QoL by affecting daily activities and work productivity. Self-reported symptoms do not always correlate with post-treatment improvements in clinical measures such as tear film break-up time, inflammation and osmolarity. Thus, treatments may improve clinical ocular features without improving symptoms that affect daily life. This review explores 1500 abstracts from congress presentations and peer-reviewed journals for QoL and treatment satisfaction data on the use of active lubricants, osmoprotectants, secretagogues, and immunomodulators present in topical formulations for DED treatment, and validated symptom questionnaires. Patient-reported symptoms of DED are generally improved after treatment with topical formulations for tear replacement, tear stimulation or anti-inflammatory therapy compared with baseline or a control treatment. However, more data are required to compare the performance of active ingredients. It is fundamental to diagnose patients with DED accurately, recognising the major cause behind their dry eyes. Studies are also necessary to identify how patient satisfaction and QoL may be improved through long-term use of topical preparations. We conclude that careful and thorough consideration of patient-reported symptoms should be integrated into DED management to help tailor treatment to patient needs.
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Affiliation(s)
- José A P Gomes
- Department of Ophthalmology and Visual Sciences, Federal University of Sao Paulo (UNIFESP/EPM), Brazil.
| | - Ruth M Santo
- Department of Ophthalmology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
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21
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Aguilar A, Berra M, Trédicce J, Berra A. Efficacy of polyethylene glycol-propylene glycol-based lubricant eye drops in reducing squamous metaplasia in patients with dry eye disease. Clin Ophthalmol 2018; 12:1237-1243. [PMID: 30034217 PMCID: PMC6047859 DOI: 10.2147/opth.s164888] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Purpose Squamous metaplasia in dry eye disease (DED) manifesting as the loss of conjunctival goblet cells results in reduced mucin secretion and tear film instability. The objective of this study was to evaluate the efficacy of a polyethylene glycol–propylene glycol/hydroxypropyl-guar (PEG-PG/HP-guar) artificial tear formulation in reducing the squamous metaplasia in patients with DED using conjunctival impression cytology (CIC). Methods In this Phase IV, single-arm, open-label study, DED patients (aged ≥18 years) with a corneal staining sum score ≥3 and tear film break-up time (TFBUT) <7 s self-administered the PEG-PG/HP-guar artificial tears, 3 times a day for a period of 90 days. The primary end point was the change from baseline in goblet cell density (Nelson’s CIC grading score) over the treatment period. Other end points were change in the corneal and conjunctival staining scores, and TFBUT. Statistical evaluation was performed using a paired t-test. Results In total, 49 patients (n=98 eyes) completed the study. Compared with baseline, there was a significant reduction in the mean CIC scores (ie, improvement in goblet cell density) at Days 30, 60, and 90 (1.6±0.5 vs 1.2±0.5, 0.9±0.5, and 0.8±0.5; P<0.0001). At Day 90, 22% of eyes demonstrated squamous metaplasia Grade 0 (ie, normal epithelium). Similar improvements were observed in the corneal staining scores (5.7 vs 3.1, 1.1, and 0.5; P<0.0001), conjunctival staining scores (5.5 vs 3.6, 1.6, and 0.9; P<0.0001), and TFBUT (4.8 vs 5.8, 6.3, and 6.8 s; P<0.0001) at Days 30, 60, and 90, respectively. Conclusion In this study, treatment with PEG-PG/HP-guar artificial tears for 90 days decreased CIC score, reduced corneal and conjunctival staining, and increased TFBUT in patients with DED. These results suggest that PEG-PG/HP-guar artificial tears can improve the ocular surface health and reverse the changes induced by squamous metaplasia in DED.
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Affiliation(s)
- Alejandro Aguilar
- Department of Ophthalmology, Medical Group Las Lomas, Buenos Aires, Argentina, .,Department of Ophthalmology, University of Salvador, Buenos Aires, Argentina,
| | - Martin Berra
- Department of Ophthalmology, Lagleyze Hospital, Buenos Aires, Argentina
| | - Jorge Trédicce
- Department of Ophthalmology, Santa Lucia Hospital, Buenos Aires, Argentina
| | - Alejandro Berra
- Department of Pathology, University of Buenos Aires, Buenos Aires, Argentina
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Kohli P, Arya SK, Raj A, Handa U. Changes in ocular surface status after phacoemulsification in patients with senile cataract. Int Ophthalmol 2018; 39:1345-1353. [PMID: 29926365 DOI: 10.1007/s10792-018-0953-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 06/11/2018] [Indexed: 12/11/2022]
Abstract
AIM To evaluate the signs and symptoms of dry eye after phacoemulsification; effects on the status of ocular surface using impression cytology; and associated risk factors. METHODS Prospective study included 50 eyes (50 patients) with no dry eye signs or symptoms, who underwent clear corneal phacoemulsification for senile cataract. Dry eye indices used included Ocular Surface Disease Index scoring, Schirmer I test, tear break up time, tear meniscus height, corneal fluorescein staining, lissamine green staining and goblet cell density (GCD) with the help of impression cytology. Primary outcome measures included post-operative changes in the dry eye indices. Secondary outcome measures included correlation of the dry eye signs and symptoms with various risk factors. RESULTS Aggravation of both the signs and symptoms of dry eye were noted in immediate post-operative period. The sharp deterioration was followed by a recovering trend towards the end of sixth week. A decrease in GCD was also noted. Risk factors for deterioration include age, duration of exposure to microscope light and effective phacoemulsification time. Diabetic status, socio-economic status and site of incision did not have any effect on dry eye status. CONCLUSION There is a transient deterioration of "dry eye" status post-phacoemulsification. The patients should be carefully counselled about the evanescent nature of the disease. Incision can be given at the site of high corneal curvature to neutralize astigmatism without any fear of inducing dry eye. Minimum light exposure and ultrasound energy should be used during the surgery.
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Affiliation(s)
- Piyush Kohli
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India.
| | - Sudesh Kumar Arya
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Amit Raj
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Uma Handa
- Department of Pathology, Government Medical College and Hospital, Chandigarh, India
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Trattler WB, Majmudar PA, Donnenfeld ED, McDonald MB, Stonecipher KG, Goldberg DF. The Prospective Health Assessment of Cataract Patients' Ocular Surface (PHACO) study: the effect of dry eye. Clin Ophthalmol 2017; 11:1423-1430. [PMID: 28848324 PMCID: PMC5557104 DOI: 10.2147/opth.s120159] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose To determine the incidence and severity of dry eye as determined by the International Task Force (ITF) scale in patients being screened for cataract surgery. Patients and methods This was a prospective, multi-center, observational study of 136 patients, at least 55 years of age, who were scheduled to undergo cataract surgery. The primary outcome measure was the incidence of dry eye as evaluated by grade on the ITF scale and secondary outcome measures include tear break-up time (TBUT), ocular surface disease index score, corneal staining with fluorescein, conjunctival staining with lissamine green, and a patient questionnaire to evaluate symptoms of dry eye. Results Mean patient age was 70.7 years. A total of 73.5% of patients were Caucasian and 50% were female. Almost 60% had never complained of a foreign body sensation; only 13% complained of a foreign body sensation half or most of the time. The majority of patients (62.9%) had a TBUT ≤5 seconds, 77% of eyes had positive corneal staining and 50% of the eyes had positive central corneal staining. Eighteen percent had Schirmer’s score with anesthesia ≤5 mm. Conclusion The incidence of dry eye in patients scheduled to undergo cataract surgery in a real-world setting is higher than anticipated.
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Yusufu M, Liu X, Zheng T, Fan F, Xu J, Luo Y. Hydroxypropyl methylcellulose 2% for dry eye prevention during phacoemulsification in senile and diabetic patients. Int Ophthalmol 2017; 38:1261-1273. [PMID: 28699061 DOI: 10.1007/s10792-017-0590-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 06/05/2017] [Indexed: 12/23/2022]
Abstract
PURPOSE To assess the effect of hydroxypropyl methylcellulose (HPMC) 2% to prevent dry eye during phacoemulsification in senile and diabetic patients. METHODS This prospective interventional case series comprised 60 eyes (44 patients) with age-related cataract scheduled for standardized phacoemulsification surgery. The patients were assigned to receive either balanced saline solution (BSS, 30 eyes) or HPMC 2% (30 eyes) during surgery. Preoperative and postoperative examinations (1, 3, 7 and 30 days) included measurements of automatic noninvasive tear film breakup time (NITBUT), fluorescein staining, Schirmer I test, tear meniscus height, depth and area and subjective symptoms. Intraoperative application frequency was also assessed. RESULTS The mean age of patients was 68.7 ± 2.3 years. The application frequency of BSS during surgery was significantly reduced in HPMC group (P = 0.001). The incidence of dry eye syndrome (DES) was significantly reduced in HPMC group in both senile and diabetic patients. Scores of subjective symptoms were significantly higher in the BSS group in 1 day (P = 0.003) and 3 days (P = 0.043) postoperatively. The first and average NITBUT were significantly higher in HPMC group in 1 day and 3 days after surgery, respectively (P = 0.012 and P = 0.024, respectively). NITBUT values did not significantly change postoperatively in the HPMC group (P > 0.05), while they were significantly lower postoperatively in the BSS group. CONCLUSIONS Application of HPMC 2% during phacoemulsification reduced the incidence of DES and improved patients' satisfaction in both senile and diabetic cataract patients. It was also effective in maintaining corneal hydration and was able to significantly reduce the application frequency intraoperatively.
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Affiliation(s)
- Maierhaba Yusufu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- Key Laboratory of Myopia of State Health Ministry, Shanghai, People's Republic of China
- People's Hospital of Xinjiang Uygur Autonomous Region, Ürümqi, People's Republic of China
| | - Xin Liu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- Key Laboratory of Myopia of State Health Ministry, Shanghai, People's Republic of China
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, People's Republic of China
| | - Tianyu Zheng
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- Key Laboratory of Myopia of State Health Ministry, Shanghai, People's Republic of China
| | - Fan Fan
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
| | - Jianjiang Xu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China
- Key Laboratory of Myopia of State Health Ministry, Shanghai, People's Republic of China
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, People's Republic of China
| | - Yi Luo
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, People's Republic of China.
- Key Laboratory of Myopia of State Health Ministry, Shanghai, People's Republic of China.
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, People's Republic of China.
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Jones L, Downie LE, Korb D, Benitez-del-Castillo JM, Dana R, Deng SX, Dong PN, Geerling G, Hida RY, Liu Y, Seo KY, Tauber J, Wakamatsu TH, Xu J, Wolffsohn JS, Craig JP. TFOS DEWS II Management and Therapy Report. Ocul Surf 2017; 15:575-628. [DOI: 10.1016/j.jtos.2017.05.006] [Citation(s) in RCA: 578] [Impact Index Per Article: 82.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/03/2017] [Indexed: 02/06/2023]
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TFOS DEWS II Diagnostic Methodology report. Ocul Surf 2017; 15:539-574. [DOI: 10.1016/j.jtos.2017.05.001] [Citation(s) in RCA: 836] [Impact Index Per Article: 119.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 05/01/2017] [Indexed: 01/09/2023]
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Perényi K, Dienes L, Kornafeld A, Kovács B, Kiss HJ, Szepessy Z, Nagy ZZ, Barsi Á, Acosta MC, Gallar J, Kovács I. The Effect of Tear Supplementation with 0.15% Preservative-Free Zinc-Hyaluronate on Ocular Surface Sensations in Patients with Dry Eye. J Ocul Pharmacol Ther 2017; 33:487-492. [DOI: 10.1089/jop.2016.0194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kristóf Perényi
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Lóránt Dienes
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Anna Kornafeld
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Balázs Kovács
- Department of Ophthalmology, Kaposi Mor Hospital, Kaposvár, Hungary
| | - Huba J. Kiss
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | | | - Zoltán Z. Nagy
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Árpád Barsi
- Department of Photogrammetry and Geoinformatics, Budapest University of Technology and Economics, Budapest, Hungary
| | - M. Carmen Acosta
- Instituto de Neurociencias, Universidad Miguel Hernandez-CSIC, San Juan de Alicante, Spain
| | - Juana Gallar
- Instituto de Neurociencias, Universidad Miguel Hernandez-CSIC, San Juan de Alicante, Spain
| | - Illés Kovács
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
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Nassiri N, Rodriguez Torres Y, Meyer Z, Beyer MA, Vellaichamy G, Dhaliwal AS, Chungfat N, Hwang FS. Current and emerging therapy of dry eye disease. Part A: pharmacological modalities. EXPERT REVIEW OF OPHTHALMOLOGY 2017. [DOI: 10.1080/17469899.2017.1327350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Nariman Nassiri
- Kresge Eye Institute - Department of Ophthalmology, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Yasaira Rodriguez Torres
- Kresge Eye Institute - Department of Ophthalmology, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Zachary Meyer
- Kresge Eye Institute - Department of Ophthalmology, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Michael A. Beyer
- Kresge Eye Institute - Department of Ophthalmology, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Gautham Vellaichamy
- Kresge Eye Institute - Department of Ophthalmology, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Amar S. Dhaliwal
- Kresge Eye Institute - Department of Ophthalmology, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Neil Chungfat
- Department of Ophthalmology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Frank S. Hwang
- Kresge Eye Institute - Department of Ophthalmology, School of Medicine, Wayne State University, Detroit, MI, USA
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Labiris G, Ntonti P, Sideroudi H, Kozobolis V. Impact of polyethylene glycol 400/propylene glycol/hydroxypropyl-guar and 0.1% sodium hyaluronate on postoperative discomfort following cataract extraction surgery: a comparative study. EYE AND VISION 2017; 4:13. [PMID: 28497070 PMCID: PMC5424421 DOI: 10.1186/s40662-017-0079-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 05/01/2017] [Indexed: 11/25/2022]
Abstract
Background Universal postoperative guidelines for cataract extraction surgery are yet to be introduced. Artificial tears are gaining popularity as an additional integral component of the postoperative regime. The primary objective of this study was to explore the impact of two prevalent artificial tear preparations on postoperative discomfort following cataract extraction surgery. Methods A total of 180 patients that underwent cataract extraction surgery were randomly divided into three groups according to their postoperative regime: a) Study group 1 (SG1) received a fixed combination of tobramycin and dexamethasone (FCTD) quid for 3 weeks and, additionally polyethylene glycol 400/propylene glycol/hydroxypropyl-guar quid, for 6 weeks, b) Study group 2 (SG2) received FCTD quid for 3 weeks and, additionally 0.1% sodium hyaluronate provided in the COMOD® device quid, for 6 weeks, and, c) Control Group (CG) received only FCTD quid for 3 weeks. The following indexes were evaluated at three postoperative checkpoints: 1) Subjective discomfort index (SDI) derived from four direct 10-scale Likert-type questions that were addressed to the patient and pertained to: a) foreign body sensation (FBS), b) blinking discomfort (BD), c) stinging sensation (SS), d) tearing sensation (TS), 2) Tear break-up time (TBUT), 3) Central corneal thickness (CCT) and, 4) Central Corneal Sensitivity (CCS). Results Both groups showed increased CCT values at the first examination point and reduced CCS values at all examination points. Furthermore, both SGs had better TBUT times at all examination points compared to CG (CG: 8.86 ± 1.08, SG1: 9.59 ± 1.45, CG2: 9.45 ± 1.33, p < 0.05). BD was significantly better in both SGs only at the 1st week of examination, while SDI values were better until the 3rd week and only borderline better at 6th week. Lastly, no significant differences were detected between SGs, regarding all parameters, at all examination points. Conclusion Polyethylene glycol 400/propylene glycol/hydroxypropyl-guar and 0.1% sodium hyaluronate provided in the COMOD® device seem to be equally efficient in alleviating OSD symptoms following cataract extraction surgery and any of them should be routinely added to the postoperative regime. Trial registration ClinicalTrials.gov Identifier: https://clinicaltrials.gov/ct2/show/NCT02558218NCT02558218 Electronic supplementary material The online version of this article (doi:10.1186/s40662-017-0079-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Georgios Labiris
- Department of Ophthalmology, University Hospital of Alexandroupolis, 68100 Dragana, Alexandroupolis, Greece.,Eye Institute of Thrace, Alexandroupolis, Greece
| | - Panagiota Ntonti
- Department of Ophthalmology, University Hospital of Alexandroupolis, 68100 Dragana, Alexandroupolis, Greece
| | | | - Vassilios Kozobolis
- Department of Ophthalmology, University Hospital of Alexandroupolis, 68100 Dragana, Alexandroupolis, Greece.,Eye Institute of Thrace, Alexandroupolis, Greece
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Pinazo-Durán MD, Zanón-Moreno V, Herrero Vanrell R, Sanz-González SM, García-Medina JJ, Benitez Del Castillo Sánchez J. Hypotensive eyedrops: The neverending story. Should we consider more than active principles? ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2017; 92:199-201. [PMID: 28215763 DOI: 10.1016/j.oftal.2016.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 12/27/2016] [Indexed: 06/06/2023]
Affiliation(s)
- M D Pinazo-Durán
- Unidad de Investigación Oftalmológica «Santiago Grisolía»-Fundación FISABIO, Hospital Universitario Doctor Peset, Valencia, España; Unidad de Oftalmobiología Celular y Molecular (UOCEM), Universidad de Valencia, Valencia, España; Red Temática de Investigación Cooperativa en Patología Ocular (OFTARED), España.
| | - V Zanón-Moreno
- Unidad de Investigación Oftalmológica «Santiago Grisolía»-Fundación FISABIO, Hospital Universitario Doctor Peset, Valencia, España; Unidad de Oftalmobiología Celular y Molecular (UOCEM), Universidad de Valencia, Valencia, España; Red Temática de Investigación Cooperativa en Patología Ocular (OFTARED), España
| | - R Herrero Vanrell
- Red Temática de Investigación Cooperativa en Patología Ocular (OFTARED), España; Departamento de Farmacia y Tecnología Farmacéutica, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, España
| | - S M Sanz-González
- Unidad de Investigación Oftalmológica «Santiago Grisolía»-Fundación FISABIO, Hospital Universitario Doctor Peset, Valencia, España; Unidad de Oftalmobiología Celular y Molecular (UOCEM), Universidad de Valencia, Valencia, España; Red Temática de Investigación Cooperativa en Patología Ocular (OFTARED), España
| | - J J García-Medina
- Red Temática de Investigación Cooperativa en Patología Ocular (OFTARED), España; Servicio de Oftalmología, Hospital General Universitario Reina Sofía, Murcia, España; Departamento de Oftalmología, Facultad de Medicina, Universidad de Murcia, Murcia, España
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Roy NS, Wei Y, Kuklinski E, Asbell PA. The Growing Need for Validated Biomarkers and Endpoints for Dry Eye Clinical Research. Invest Ophthalmol Vis Sci 2017; 58:BIO1-BIO19. [PMID: 28475698 PMCID: PMC5455411 DOI: 10.1167/iovs.17-21709] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/04/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose Biomarkers with minimally invasive and reproducible objective metrics provide the key to future paradigm shifts in understanding of the underlying causes of dry eye disease (DED) and approaches to treatment of DED. We review biomarkers and their validity in providing objective metrics for DED clinical research and patient care. Methods The English-language literature in PubMed primarily over the last decade was surveyed for studies related to identification of biomarkers of DED: (1) inflammation, (2) point-of-care, (3) ocular imaging, and (4) genetics. Relevant studies in each group were individually evaluated for (1) methodological and analytical details, (2) data and concordance with other similar studies, and (3) potential to serve as validated biomarkers with objective metrics. Results Significant work has been done to identify biomarkers for DED clinical trials and for patient care. Interstudy variation among studies dealing with the same biomarker type was high. This could be attributed to biologic variations and/or differences in processing, and data analysis. Correlation with other signs and symptoms of DED was not always clear or present. Conclusions Many of the biomarkers reviewed show the potential to serve as validated and objective metrics for clinical research and patient care in DED. Interstudy variation for a given biomarker emphasizes the need for detailed reporting of study methodology, including information on subject characteristics, quality control, processing, and analysis methods to optimize development of nonsubjective metrics. Biomarker development offers a rich opportunity to significantly move forward clinical research and patient care in DED. Overview DED is an unmet medical need - a chronic pain syndrome associated with variable vision that affects quality of life, is common with advancing age, interferes with the comfortable use of contact lenses, and can diminish results of eye surgeries, such as cataract extraction, LASIK, and glaucoma procedures. It is a worldwide medical challenge with a prevalence rate ranging from 8% to 50%. Many clinicians and researchers across the globe are searching for better answers to understand the mechanisms related to the development and chronicity of DED. Though there have been many clinical trials for DED, few new treatments have emerged over the last decade. Biomarkers may provide the needed breakthrough to propel our understanding of DED to the next level and the potential to realize our goal of truly personalized medicine based on scientific evidence. Clinical trials and research on DED have suffered from the lack of validated biomarkers and less than objective and reproducible endpoints. Current work on biomarkers has provided the groundwork to move forward. This review highlights primarily ocular biomarkers that have been investigated for use in DED, discusses the methodologic outcomes in providing objective metrics for clinical research, and suggests recommendations for further work.
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Affiliation(s)
- Neeta S. Roy
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Yi Wei
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Eric Kuklinski
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Penny A. Asbell
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
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Understanding Symptoms and Quality of Life in Patients With Dry Eye Syndrome. Ocul Surf 2016; 14:365-76. [DOI: 10.1016/j.jtos.2016.04.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/23/2016] [Accepted: 04/01/2016] [Indexed: 11/21/2022]
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Kovács I, Dienes L, Perényi K, Quirce S, Luna C, Mizerska K, Acosta MC, Belmonte C, Gallar J. Lacosamide diminishes dryness-induced hyperexcitability of corneal cold sensitive nerve terminals. Eur J Pharmacol 2016; 787:2-8. [PMID: 27263827 DOI: 10.1016/j.ejphar.2016.05.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/26/2016] [Accepted: 05/31/2016] [Indexed: 10/21/2022]
Abstract
Lacosamide is an anti-epileptic drug that is also used for the treatment of painful diabetic neuropathy acting through voltage-gated sodium channels. The aim of this work was to evaluate the effects of acute application of lacosamide on the electrical activity of corneal cold nerve terminals in lacrimo-deficient guinea pigs. Four weeks after unilateral surgical removal of the main lachrimal gland in guinea pigs, corneas were excised and superfused in vitro at 34°C for extracellular electrophysiological recording of nerve terminal impulse activity of cold thermosensitive nerve terminals. The characteristics of the spontaneous and the stimulus-evoked (cooling ramps from 34°C to 15°C) activity before and in presence of lacosamide 100µM and lidocaine 100µM were compared. Cold nerve terminals (n=34) recorded from dry eye corneas showed significantly enhanced spontaneous activity (8.0±1.1 vs. 5.2±0.7imp/s; P<0.05) and cold response (21.2±1.7 vs. 16.8±1.3imp/s; P<0.05) as well as reduced cold threshold (1.5±0.1 vs. 2.8±0.2 Δ°C; P<0.05) to cooling ramps compared to terminals (n=58) from control animals. Both lacosamide and lidocaine decreased spontaneous activity and peak response to cooling ramps significantly (P<0.05). Temperature threshold was increased by the addition of lidocaine (P<0.05) but not lacosamide (P>0.05) to the irrigation fluid. In summary, the application of lacosamide results in a significant decrease of the augmented spontaneous activity and responsiveness to cold of corneal sensory nerves from tear-deficient animals. Based on these promising results we speculate that lacosamide might be used to reduce the hyperexcitability of corneal cold receptors caused by prolonged ocular surface dryness due to hyposecretory or evaporative dry eye disease.
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Affiliation(s)
- Illés Kovács
- Instituto de Neurociencias, Universidad Miguel Hernández - CSIC, San Juan de Alicante, Spain; Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Lóránt Dienes
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Kristóf Perényi
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Susana Quirce
- Instituto de Neurociencias, Universidad Miguel Hernández - CSIC, San Juan de Alicante, Spain
| | - Carolina Luna
- Instituto de Neurociencias, Universidad Miguel Hernández - CSIC, San Juan de Alicante, Spain
| | - Kamila Mizerska
- Instituto de Neurociencias, Universidad Miguel Hernández - CSIC, San Juan de Alicante, Spain
| | - M Carmen Acosta
- Instituto de Neurociencias, Universidad Miguel Hernández - CSIC, San Juan de Alicante, Spain
| | - Carlos Belmonte
- Instituto de Neurociencias, Universidad Miguel Hernández - CSIC, San Juan de Alicante, Spain
| | - Juana Gallar
- Instituto de Neurociencias, Universidad Miguel Hernández - CSIC, San Juan de Alicante, Spain.
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Abstract
PURPOSE OF REVIEW To provide a summary of the mechanisms that may cause dry eye after cataract surgery and discuss available and upcoming treatment modalities. RECENT FINDINGS Development or worsening of dry eye symptoms after cataract surgery is multifactorial with corneal nerve transection, inflammation, goblet cell loss, and meibomian gland dysfunction commonly cited as underlying disorders. With increasing awareness of the prevalence of dry eye disease, current surgical techniques are being analyzed for their contribution to the issue. Although many classic interventions, such as artificial tears and anti-inflammatory drops, remain first-line treatment options, they may not adequately address abnormalities of the tear film. The trend has been to create new drugs and technologies that target meibomian gland deficiencies and restore goblet cell numbers. SUMMARY Therapy for postoperative dry eye symptoms should be determined based on symptom severity and which underlying cause is most prominent at a given time. Patients with high-level risk factors for dry eye should be evaluated preoperatively to determine whether they have preexisting dry eye disease or if they are susceptible to developing disease after surgery.
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Chao W, Belmonte C, Benitez del Castillo JM, Bron AJ, Dua HS, Nichols KK, Novack GD, Schrader S, Willcox MD, Wolffsohn JS, Sullivan DA. Report of the Inaugural Meeting of the TFOS i2 = initiating innovation Series: Targeting the Unmet Need for Dry Eye Treatment. Ocul Surf 2016; 14:264-316. [DOI: 10.1016/j.jtos.2015.11.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 11/09/2015] [Accepted: 11/11/2015] [Indexed: 01/09/2023]
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Kwon JW, Chung YW, Choi JA, La TY, Jee DH, Cho YK. Comparison of postoperative corneal changes between dry eye and non-dry eye in a murine cataract surgery model. Int J Ophthalmol 2016; 9:218-24. [PMID: 26949638 DOI: 10.18240/ijo.2016.02.06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 07/10/2015] [Indexed: 01/17/2023] Open
Abstract
AIM To compare the effects of the surgical insult of cataract surgery on corneal inflammatory infiltration, neovascularization (NV) and lymphangiogenesis (LY) between the dry eye and non-dry eye in murine cataract surgery models. METHODS We established two groups of animals, one with normal eyes (non-dry eye) and the second with induced dry eyes. In both groups, we used surgical insults to mimic human cataract surgery, which consisted of lens extraction, corneal incision and suture. After harvesting of corneas on the 9(th) postoperative day and immunohistochemical staining, we compared NV, LY and CD11b+ cell infiltration in the corneas. RESULTS Dry eye group had significantly more inflammatory infiltration (21.75%±7.17% vs 3.65%±1.49%; P=0.049). The dry eye group showed significantly more NV (48.21%±4.02% vs 26.24%±6.01%; P=0.016) and greater levels of LY (9.27%±0.48% vs 4.84%±1.15%; P=0.007). In corneas on which no surgery was performed, there was no induction of NV in both the dry and non-dry group, but dry eye group demonstrated more CD11b+ cells infiltration than the non-dry eye group (0.360%±0.160% vs 0.023%±0.006%; P=0.068). Dry eye group showed more NV than non-dry eye group in both topical PBS application and subconjunctival PBS injection (P=0.020 and 0.000, respectively). CONCLUSION In a murine cataract surgery model, preexisting dry eye can induce more postoperative NV, LY, and inflammation in corneal tissue.
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Affiliation(s)
- Jin Woo Kwon
- Department of Ophthalmology, St.Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon 442723, Gyeonggi-Do, Korea
| | - Yeon Woong Chung
- Department of Ophthalmology, St.Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon 442723, Gyeonggi-Do, Korea
| | - Jin A Choi
- Department of Ophthalmology, St.Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon 442723, Gyeonggi-Do, Korea
| | - Tae Yoon La
- Department of Ophthalmology, St.Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon 442723, Gyeonggi-Do, Korea
| | - Dong Hyun Jee
- Department of Ophthalmology, St.Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon 442723, Gyeonggi-Do, Korea
| | - Yang Kyung Cho
- Department of Ophthalmology, St.Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon 442723, Gyeonggi-Do, Korea
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Dienes L, Kiss HJ, Perényi K, Szepessy Z, Nagy ZZ, Barsi Á, Acosta MC, Gallar J, Kovács I. The Effect of Tear Supplementation on Ocular Surface Sensations during the Interblink Interval in Patients with Dry Eye. PLoS One 2015; 10:e0135629. [PMID: 26302222 PMCID: PMC4547761 DOI: 10.1371/journal.pone.0135629] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 07/24/2015] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate the characteristics of ocular surface sensations and corneal sensitivity during the interblink interval before and after tear supplementation in dry eye patients. METHODS Twenty subjects (41.88±14.37 years) with dry eye symptoms were included in the dry eye group. Fourteen subjects (39.13±11.27 years) without any clinical signs and/or symptoms of dry eye were included in the control group. Tear film dynamics was assessed by non-invasive tear film breakup time (NI-BUT) in parallel with continuous recordings of ocular sensations during forced blinking. Corneal sensitivity to selective stimulation of corneal mechano-, cold and chemical receptors was assessed using a gas esthesiometer. All the measurements were made before and 5 min after saline and hydroxypropyl-guar (HP-guar) drops. RESULTS In dry eye patients the intensity of irritation increased rapidly after the last blink during forced blinking, while in controls there was no alteration in the intensity during the first 10 sec followed by an exponential increase. Irritation scores were significantly higher in dry eye patients throughout the entire interblink interval compared to controls (p<0.004). NI-BUT significantly increased after HP-guar (p = 0.003) but not after saline drops (p = 0.14). In both groups, either after saline or HP-guar the shape of symptom intensity curves remained the same with significantly lower irritation scores (p<0.004), however after HP-guar the decrease was significantly more pronounced (p<0.004). Corneal sensitivity to selective mechanical, cold and chemical stimulation decreased significantly in both groups after HP-guar (p<0.05), but not after saline drops (p>0.05). CONCLUSION Ocular surface irritation responses due to tear film drying are considerably increased in dry eye patients compared to normal subjects. Although tear supplementation improves the protective tear film layer, and thus reduce unpleasant sensory responses, the rapid rise in discomfort is still maintained and might be responsible for the remaining complaints of dry eye patients despite the treatment.
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Affiliation(s)
- Lóránt Dienes
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Huba J Kiss
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Kristóf Perényi
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | | | - Zoltán Z Nagy
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Árpád Barsi
- Department of Photogrammetry and Geoinformatics, Budapest University of Technology and Economics, Budapest, Hungary
| | - M Carmen Acosta
- Instituto de Neurociencias, Universidad Miguel Hernandez-CSIC, San Juan de Alicante, Spain
| | - Juana Gallar
- Instituto de Neurociencias, Universidad Miguel Hernandez-CSIC, San Juan de Alicante, Spain
| | - Illés Kovács
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
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Cetinkaya S, Mestan E, Acir NO, Cetinkaya YF, Dadaci Z, Yener HI. The course of dry eye after phacoemulsification surgery. BMC Ophthalmol 2015; 15:68. [PMID: 26122323 PMCID: PMC4485332 DOI: 10.1186/s12886-015-0058-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 06/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this retrospective study was to evaluate the course of dry eye syndrome after phacoemulsification surgery. METHODS One hundred and ninety-two eyes of 96 patients (30 males, 66 females) with chronic dry eye syndrome and cataract, who had undergone phacoemulsification surgery were enrolled in this study. RESULTS Their mean age was 68.46 ± 8.14 standard deviation (SD) (range 56-83) years . Thirty of them (31 %) were males and 66 (69 %) were females. Ocular Surface Disease Index (OSDI) questionnaire scores increased postoperatively, but arrived preoperative levels at the end of 3rd month following the surgery. Fluorescein staining patterns according to Oxford Schema got worse postoperatively, however after postoperative 3rd month they got better and resembled preoperative patterns. The mean postoperative 1st day, 1st week and 1st month Break-up Time (BUT) values were significantly lower than preoperative BUT value (P < 0.001, P < 0.001, P < 0.001), however 3rd month, 6th month, 1st year and 2nd year values were not significantly different from preoperative value (P = 0.441, P = 0.078, P = 0.145, P = 0.125). The mean postoperative 1st day, 1st week and 1st month Schirmer Test 1 (ST1) values were significantly lower than preoperative ST1 value (P < 0.001, P < 0.001, P < 0.001), however 3rd month, 6th month, 1st year and 2nd year values were not significantly different from preoperative value (P = 0.748, P = 0.439, P = 0.091, P = 0.214). CONCLUSION Phacoemulsification surgery may aggravate the signs and symptoms of dry eye and affect dry eye test values in chronic dry eye patients in short-term. However, in long-term, signs and symptoms of dry eye decrease and dry eye test values return to preoperative values.
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Affiliation(s)
- Servet Cetinkaya
- Ophthalmology Clinics, Turkish Red Crescent Hospital, Konya, Turkey. .,Turkish Red Crescent Hospital (Kizilay Hastanesi), Ophthalmology Clinics, Sukran Mah. Taskapu Medrese Sok. No:15, Meram, 42200, Konya, Turkey.
| | - Emine Mestan
- Department of Neurology, Dumlupinar University, Faculty of Medicine, Kutahya, Turkey.
| | - Nursen Oncel Acir
- Department of Ophthalmology, Faculty of Medicine, Mevlana University, Konya, Turkey.
| | | | - Zeynep Dadaci
- Department of Ophthalmology, Faculty of Medicine, Mevlana University, Konya, Turkey.
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Fernandez KB, Epstein SP, Raynor GS, Sheyman AT, Massingale ML, Dentone PG, Landegger LD, Asbell PA. Modulation of HLA-DR in dry eye patients following 30 days of treatment with a lubricant eyedrop solution. Clin Ophthalmol 2015; 9:1137-45. [PMID: 26170605 PMCID: PMC4485852 DOI: 10.2147/opth.s81355] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose To determine the changes in dry eye disease (DED) severity and the percentage of cells expressing HLA-DR on the ocular surface following treatment with lubricant eyedrops containing polyethylene glycol and propylene glycol (PEG/PG) and the gelling agent hydroxypropyl guar (HP-Guar). Patients and methods Nineteen patients with DED used PEG/PG + HP-Guar eyedrops four times per day for 30 days. Assessments included DED severity (Ocular Surface Disease Index [OSDI], corneal staining, conjunctival staining, tear film break-up time [TFBUT], and Schirmer testing) and impression cytology of the conjunctiva with masked flow cytometry at baseline and at 30 days. Results There was a significant decrease in corneal staining (P<0.01), OSDI (P=0.02), and TFBUT (P<0.01) following treatment with PEG/PG + HP-Guar. Results from flow cytometry revealed a significant decrease in cells expressing HLA-DR (P=0.02). Conclusion Treatment with PEG/PG + HP-Guar eyedrops showed improvement in dry eye severity and reduction in surface inflammation as indicated by a reduction in HLA-DR expression.
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Affiliation(s)
- Karen B Fernandez
- Department of Ophthalmology, Mount Sinai School of Medicine, New York, NY, USA
| | - Seth P Epstein
- Department of Ophthalmology, Mount Sinai School of Medicine, New York, NY, USA
| | - Geoffrey S Raynor
- Department of Ophthalmology, Mount Sinai School of Medicine, New York, NY, USA
| | - Alan T Sheyman
- Department of Ophthalmology, Mount Sinai School of Medicine, New York, NY, USA
| | - Morgan L Massingale
- Department of Ophthalmology, Mount Sinai School of Medicine, New York, NY, USA
| | - Peter G Dentone
- Department of Ophthalmology, Mount Sinai School of Medicine, New York, NY, USA
| | - Lukas D Landegger
- Department of Ophthalmology, Mount Sinai School of Medicine, New York, NY, USA
| | - Penny A Asbell
- Department of Ophthalmology, Mount Sinai School of Medicine, New York, NY, USA
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Yao K, Bao Y, Ye J, Lu Y, Bi H, Tang X, Zhao Y, Zhang J, Yang J. Efficacy of 1% carboxymethylcellulose sodium for treating dry eye after phacoemulsification: results from a multicenter, open-label, randomized, controlled study. BMC Ophthalmol 2015; 15:28. [PMID: 25880685 PMCID: PMC4407782 DOI: 10.1186/s12886-015-0005-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 02/13/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For patients who experience dry eye after phacoemulsification, vision and quality of life can significantly deteriorate. In this study, the efficacy and safety of carboxymethylcellulose sodium (CMC) 1% ophthalmic solution combined with conventional therapy in treating dry eye signs and symptoms after phacoemulsification were evaluated. METHODS In this prospective, multicenter, open-label, controlled study, 180 patients with age-related cataract were randomized to treatment with conventional therapy plus CMC 1% (n = 90) or to conventional therapy only (control group, n = 90) after phacoemulsification and intraocular lens implantation. Tear breakup time (TBUT), the Schirmer test with anesthesia, and fluorescein and lissamine green staining were performed. The Ocular Surface Disease Index (OSDI) questionnaire and a patient subjective symptom evaluation were administered preoperatively (baseline) and postoperatively at 7 and 30 days. RESULTS TBUT was significantly longer in the treatment group compared with the control group at day 7 (8.5 ± 5.5 versus 6.6 ± 3.8 s; P = 0.0475) and day 30 (9.0 ± 5.9 versus 6.7 ± 4.8 s; P = 0.0258) after surgery. Compared with baseline, TBUT significantly increased in patients in the treatment group (P < 0.001 at both day 7 and day 30) with a presurgical diagnosis of dry eye, but significantly decreased in patients in the control group (P < 0.02 at both day 7 and day 30) with no prior diagnosis of dry eye. Fluorescein and lissamine staining, OSDI questionnaire and subjective symptom scores all improved from baseline, with no significant differences between the two groups. No significant differences in tolerability and safety were observed between the group receiving CMC and conventional therapy, and those receiving conventional therapy only. CONCLUSION Treatment with CMC 1% can provide significant improvement in tear film stability after phacoemulsification for age-related cataract. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02028754 (Date of registration: Jan. 6, 2014).
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Affiliation(s)
- Ke Yao
- Eye Center, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Yongzhen Bao
- Peking University People's Hospital, Beijing, China.
| | - Jian Ye
- Daping Hospital, Third Military Medical University, Chongqing, China.
| | - Yi Lu
- Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China.
| | | | - Xin Tang
- Tianjin Eye Hospital, Tianjin, China.
| | - Yune Zhao
- The Affiliated Eye Hospital of Wenzhou Medical College, Wenzhou, China.
| | - Jinsong Zhang
- The Fourth Affiliated Hospital of China Medical University, Shenyang, China.
| | - Jinling Yang
- Allergan Information Consulting (Shanghai) Co, Ltd, Shanghai, China.
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Gemensky-Metzler AJ, Sheahan JE, Rajala-Schultz PJ, Wilkie DA, Harrington J. Retrospective study of the prevalence of keratoconjunctivitis sicca in diabetic and nondiabetic dogs after phacoemulsification. Vet Ophthalmol 2014; 18:472-80. [DOI: 10.1111/vop.12238] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Anne J. Gemensky-Metzler
- The Ohio State University College of Veterinary Medicine; 601 Vernon L. Tharp St. Columbus OH 43210 USA
| | | | - Paivi J. Rajala-Schultz
- The Ohio State University College of Veterinary Medicine; 601 Vernon L. Tharp St. Columbus OH 43210 USA
| | - David A. Wilkie
- The Ohio State University College of Veterinary Medicine; 601 Vernon L. Tharp St. Columbus OH 43210 USA
| | - Jay Harrington
- Veterinary Emergency and Referral Group; 318 Warren St. Brooklyn NY 27320 USA
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Rodríguez Uña I, Martínez-de-la-Casa JM, Pablo Júlvez L, Martínez Compadre JA, García Feijoo J, Belda Sanchís JI, Canut Jordana MI, Hernández-Barahona Palma J, Muñoz Negrete FJ, Urcelay Segura JL. Perioperative pharmacological management in patients with glaucoma. ACTA ACUST UNITED AC 2014; 90:274-84. [PMID: 25443206 DOI: 10.1016/j.oftal.2014.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 06/03/2014] [Accepted: 06/25/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED REVIEẂS AIM: When a phacoemulsification, a filtration surgery or a combined surgery are necessary, questions about the convenience of continuing certain antiglaucomatous drugs could appear. The aim of this review article is to unify criteria that will guide daily clinical practice and including the developing algorithms of action in the preoperative and postoperative periods of filtration surgery and/or cataract surgery. PROPOSED PROTOCOLS In the preoperative period of cataract surgery, the use of non-steroidal anti-inflammatory drugs is at the discretion of the surgeon, with the monodose presentation being recommended. The suspension of prostaglandines a fewdays before the surgery should be considered. Preservative-free drugs ensure a better recovery of the ocular surface (OS) after cataract surgery. Once all modifying factors of the intraocular pressure (IOP) have been removed, baseline IOP should be evaluated again, choosing preservative-free antiglaucomatous drugs when needed. The use of preservative-free ocular antihypertensive drugs and steroids in the preoperative period of glaucoma surgery reduces the risk of surgical failure. The interruption of prostaglandines is recommended. In the postoperative period of glaucoma surgery, steroids are the anti-inflammatory treatment of choice, the preservative-free ones being preferred. When reintroducing antiglaucomatous treatment, preservatives should be avoided to prevent scarring. The appropriate perioperative management of patients with glaucoma is essential to obtain a correct control of IOP, improve the situation of the OS, prevent complications and improve the result of the filtration surgery and cataract surgery. CONCLUSIONS this protocol aims to unify the different lines of action in order to decrease the incidence of adverse events and maximize the surgical outcome.
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Affiliation(s)
| | - J M Martínez-de-la-Casa
- Hospital Clínico San Carlos, IdISSC, Madrid, España; Red Temática de Investigación Cooperativa en Oftalmología (RETICS), Instituto de Salud Carlos III, Madrid, España.
| | - L Pablo Júlvez
- Red Temática de Investigación Cooperativa en Oftalmología (RETICS), Instituto de Salud Carlos III, Madrid, España; Hospital Universitario Miguel Servet, Zaragoza, España
| | | | - J García Feijoo
- Hospital Clínico San Carlos, IdISSC, Madrid, España; Red Temática de Investigación Cooperativa en Oftalmología (RETICS), Instituto de Salud Carlos III, Madrid, España
| | | | | | | | - F J Muñoz Negrete
- Red Temática de Investigación Cooperativa en Oftalmología (RETICS), Instituto de Salud Carlos III, Madrid, España; Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España
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Moshirfar M, Pierson K, Hanamaikai K, Santiago-Caban L, Muthappan V, Passi SF. Artificial tears potpourri: a literature review. Clin Ophthalmol 2014; 8:1419-33. [PMID: 25114502 PMCID: PMC4124072 DOI: 10.2147/opth.s65263] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Numerous brands and types of artificial tears are available on the market for the treatment of dysfunctional tear syndrome. Past literature has focused on comparing the components of these products on patient’s clinical improvement. The wide array of products on the market presents challenges to both clinicians and patients when trying to choose between available tear replacement therapies. Different formulations affect patients based on etiology and severity of disease. In order to provide an unbiased comparison between available tear replacement therapies, we conducted a literature review of existing studies and National Institutes of Health clinical trials on commercially available, brand name artificial tears. Outcomes evaluated in each study, as well as the percent of patients showing clinical and symptomatic improvement, were analyzed. Fifty-one studies evaluating different brands of artificial tears, and their efficacy were identified. Out of the 51 studies, 18 were comparison studies testing brand name artificial tears directly against each other. Nearly all formulations of artificial tears provided significant benefit to patients with dysfunctional tear syndrome, but some proved superior to others. From the study data, a recommended treatment flowchart was derived.
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Affiliation(s)
- Majid Moshirfar
- Department of Ophthalmology, John A Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Kasey Pierson
- University of Arizona College of Medicine, Phoenix, Phoenix, AZ, USA
| | - Kamalani Hanamaikai
- A T Still University, School of Osteopathic Medicine in Arizona, Mesa, AZ, USA
| | - Luis Santiago-Caban
- Department of Ophthalmology, John A Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Valliammai Muthappan
- Department of Ophthalmology, John A Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Samuel F Passi
- Department of Ophthalmology, John A Moran Eye Center, University of Utah, Salt Lake City, UT, USA
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Afsharkhamseh N, Movahedan A, Motahari H, Djalilian AR. Cataract surgery in patients with ocular surface disease: An update in clinical diagnosis and treatment. Saudi J Ophthalmol 2014; 28:164-7. [PMID: 25278791 DOI: 10.1016/j.sjopt.2014.06.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 06/30/2014] [Indexed: 11/25/2022] Open
Abstract
In this article we review essentials of diagnosis and management of ocular surface disease in patients who undergo cataract surgery. It is clearly shown that dry eye disease worsens following the cataract surgery in patients with prior history of ocular surface disease, Also new cases of dry eye might appear. Current strategies for the timely diagnosis and proper management of dry eye syndrome in the face of cataract surgery patients are mainly emphasized. To achieve the best outcome in cataract surgery, a healthy ocular surface is crucial. While ocular surface preparation is indispensable in patients with established ocular surface disease, it is also helpful in those with minimal signs or symptoms of surface disease. The current approach begins with early diagnosis and drastic management of ocular surface disease before cataract surgery using a stepwise regimen customized to each patient and disease severity. These measures are continued throughout and after the surgery.
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Affiliation(s)
- Neda Afsharkhamseh
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, 1855 W Taylor Street, Chicago, IL, 60612, United States
| | - Asadolah Movahedan
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, 1855 W Taylor Street, Chicago, IL, 60612, United States
| | - Hooman Motahari
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, 1855 W Taylor Street, Chicago, IL, 60612, United States
| | - Ali R Djalilian
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, 1855 W Taylor Street, Chicago, IL, 60612, United States
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Han KE, Yoon SC, Ahn JM, Nam SM, Stulting RD, Kim EK, Seo KY. Evaluation of dry eye and meibomian gland dysfunction after cataract surgery. Am J Ophthalmol 2014; 157:1144-1150.e1. [PMID: 24561172 DOI: 10.1016/j.ajo.2014.02.036] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 02/11/2014] [Accepted: 02/11/2014] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate dry eye and meibomian gland dysfunction after cataract surgery. DESIGN Prospective observational case series. METHODS We studied 58 eyes of 48 patients who underwent phacoemulsification and evaluated them preoperatively and at 1 month and 3 months postoperatively. Ocular symptom scores, lid margin abnormalities, superficial punctate keratopathies (SPKs), tear film break-up time (TBUT), Schirmer test, lower tear meniscus height, depth, and area using Fourier domain optical coherence tomography, meibum expressibility and images of the meibomian glands using meibography were measured. RESULTS The ocular symptom scores were worse at 1 month and 3 months postoperatively (P < 0.001 and P < 0.001, respectively). Lid margin abnormalities were significantly increased (P < 0.001 and P < 0.001, respectively) and TBUT decreased postoperatively (P < 0.001 and P < 0.001, respectively). Meibum expressibility decreased at 3 months postoperatively (P = 0.016); however, meibography score, SPK, lower tear meniscus height, depth and area and the Schirmer test did not change significantly postoperatively (all P values >0.05). CONCLUSION Meibomian gland function may be altered without accompanying structural changes after cataract surgery.
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Affiliation(s)
- Kyung Eun Han
- Department of Ophthalmology, Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, South Korea
| | - Sang Chul Yoon
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Sang Min Nam
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University College of Medicine, Sungnam, South Korea
| | - R Doyle Stulting
- Stulting Research Center, Woolfson Eye Institute, Atlanta, Georgia, USA
| | - Eung Kweon Kim
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyoung Yul Seo
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea.
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Jiang Y, Ye H, Xu J, Lu Y. Noninvasive Keratograph assessment of tear film break-up time and location in patients with age-related cataracts and dry eye syndrome. J Int Med Res 2014; 42:494-502. [PMID: 24445695 DOI: 10.1177/0300060513504701] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate tear-film break-up time and spatial distribution via noninvasive Keratograph 4 in patients with cataracts and dry eye syndrome (DES). METHODS Noninvasive first break-up time (NIKf-BUT) and average break-up time (NIKav-BUT) were evaluated via Keratograph 4 in patients with age-related cataracts and DES. The location and size of tear break regions were recorded and the distribution of first break-up areas was summarized. Patients also underwent conventional break-up time assessments (TBUT test and Schirmer's test). RESULTS A total of 43 left and 43 right eyes were examined. There was no significant difference between TBUT and NIKav-BUT. NIKf-BUT was significantly shorter than TBUT. Both NIKf-BUT and NIKav-BUT correlated positively with TBUT. In both the left and right eye, the most common first break-up areas were the peripheral domain of the inferior precorneal surface and the central domain of the superior portion. CONCLUSIONS The Keratograph 4 appears to provide an effective noninvasive method for assessing tear film, enabling effective preoperative evaluation of tear film break-up regularity, informing the location of the incision and reducing the probability of postoperative DES.
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Affiliation(s)
- Yongxiang Jiang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
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Ansari H, Weinberg L, Spencer N. Toxic epitheliopathy from a single application of preservative free oxybuprocaine (0.4%) in a patient with Sjogren's syndrome. BMJ Case Rep 2013; 2013:bcr2013010487. [PMID: 24038291 PMCID: PMC3794119 DOI: 10.1136/bcr-2013-010487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Topical ocular anaesthetic agents are frequently used for ophthalmic diagnosis and surgery. While corneal complications following long-term use or misuse of local anaesthetic solutions have been described, toxic epitheliopathy after a single application of six drops of preservative free oxybuprocaine is rare. In order to increase the awareness of this ocular complication, we report such a case in a patient with Sjogren's syndrome who presented for elective cataract surgery. We outline the mechanisms proposed to explain the ocular toxic effects of oxybuprocaine and discuss the management principles in preventing this complication in the context of Sjogren's syndrome.
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Affiliation(s)
- Humaira Ansari
- Department of Medicine, The Northern Hospital, Epping, Victoria, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
| | - Narelle Spencer
- Department of Ophthalmology, Austin Hospital, Heidelberg, Victoria, Australia
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Epstein SP, Gadaria-Rathod N, Wei Y, Maguire MG, Asbell PA. HLA-DR expression as a biomarker of inflammation for multicenter clinical trials of ocular surface disease. Exp Eye Res 2013; 111:95-104. [PMID: 23567204 PMCID: PMC4086244 DOI: 10.1016/j.exer.2013.03.018] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 03/21/2013] [Accepted: 03/25/2013] [Indexed: 11/20/2022]
Abstract
There are currently no validated minimally invasive objective metrics for the classification and evaluation of ocular surface diseases and/or for evaluating treatment efficacy. We thus sought to establish a standardized methodology for determining the relative amount of the inflammatory biomarker HLA-DR on the ocular surface and to evaluate the precision, reliability and repeatability of its use for large multicenter clinical trials and translational research studies of ocular surface disease. Multiple studies were conducted to establish a Standard Operating Procedure (SOP) for utilizing HLA-DR expression as a minimally invasive, objective, ocular surface inflammatory biomarker. The established SOPs provide specific guidelines for HLA-DR collection and analysis, in order to incorporate it reliably into multicenter clinical trials and/or translational research. Duplicate cell samples from impression cytology (IC) samples of both normal and dry eye individuals were collected and split to assess repeatability (between the splits and between the duplicate samples). To determine storage capability, one duplicate was stained immediately and the other after 30 days cold storage. To demonstrate the feasibility of the use of the SOP for a multicenter clinical trial, clinicians out-of-state were trained to collect IC samples, and the samples shipped to our Biomarker Laboratory, logged, processed and analyzed. Demonstration of the ability to incorporate of IC into a randomized double masked clinical trial of dry eye disease (DED) was performed. In all cases, processing and analyses were performed by a masked independent observer. The validity/viability of the SOPs was established by demonstrating that: 1) sufficient numbers of cells can be collected via IC; 2) the precision/repeatability of the relative biomarker expression quantified in samples; 3) personnel at distant sites can be taught to collect, store and ship samples successfully; 4) samples can be stored for up to 30 days (refrigeration) before processing without affecting results; 5) IC can be incorporated into a double blind randomized clinical trial (RCT) of DED; and 6) the Biomarker Laboratory can track a large number of masked samples reliably. In conclusion, our standard operating procedure for impression cytology analysis of HLA-DR expression appears to be repeatable and reproducible for use in multicenter clinical trials, providing a minimally invasive objective biomarker of inflammation of the ocular surface.
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Affiliation(s)
- Seth P Epstein
- Department of Ophthalmology, Mount Sinai Medical Center, New York, NY, USA.
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The effect of topical pranoprofen 0.1% on the clinical evaluation and conjunctival HLA-DR expression in dry eyes. Cornea 2013; 31:1235-9. [PMID: 22677643 DOI: 10.1097/ico.0b013e31824988e5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the effect of topical pranoprofen 0.1% on the clinical evaluation and conjunctival human leukocyte antigen II (HLA-DR) expression in dry eyes. METHODS Sixty patients with dry eyes were randomized to 2 groups. Patients in group 1 received topical pranoprofen 0.1% plus topical sodium hyaluronate 0.1%; and patients in group 2 received sodium hyaluronate without pranoprofen. Ocular surface disease index (OSDI), tear film break-up time (TBUT), Schirmer I test, ocular surface staining (OSS), and conjunctival HLA-DR expression were evaluated before treatment and at 15 and 30 days after treatment. RESULTS On day 15, patients in group 1 had significantly lower OSDI, OSS, and HLA-DR-positive cells compared with patients in group 2 (P < 0.01), and the TBUT was significantly longer in patients in group 1 than that of patients in group 2 (P < 0.01). On day 30, the difference between the 2 groups in OSS lost significance; however, there continued to be significant differences in the OSDI, TBUT, and HLA-DR expression between the 2 groups (P < 0.01). On days 15 and 30, the values in group 1 patients had significant improvement compared with their baseline values in terms of the above-mentioned parameters. The comparisons within group 2 did not reveal any significant differences. There was no significant effect in the Schirmer I test value in eyes of patients in group 1 or group 2 at days 15 or 30 (P > 0.05). CONCLUSIONS Topical pranoprofen 0.1% has a beneficial effect in reducing the ocular signs and symptoms of dry eyes and decreasing the inflammatory markers of conjunctival epithelial cells.
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Jacobi C, Kruse FE, Cursiefen C. Prospective, Randomized, Controlled Comparison of SYSTANE UD Eye Drops Versus VISINE INTENSIV 1% EDO Eye Drops for the Treatment of Moderate Dry Eye. J Ocul Pharmacol Ther 2012; 28:598-603. [DOI: 10.1089/jop.2012.0066] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Christina Jacobi
- Department of Ophthalmology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Friedrich E. Kruse
- Department of Ophthalmology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, University of Cologne, Cologne, Germany
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