1
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Hynnekleiv L, Magno M, Vernhardsdottir RR, Moschowits E, Tønseth KA, Dartt DA, Vehof J, Utheim TP. Hyaluronic acid in the treatment of dry eye disease. Acta Ophthalmol 2022; 100:844-860. [PMID: 35514082 DOI: 10.1111/aos.15159aos15159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/05/2022] [Accepted: 04/18/2022] [Indexed: 05/25/2023]
Abstract
Dry eye disease (DED) is a highly prevalent and debilitating condition affecting several hundred million people worldwide. Hyaluronic acid (HA) is a naturally occurring glycosaminoglycan commonly used in the treatment of DED. This review aims to critically evaluate the literature on the safety and efficacy of artificial tears containing HA used in DED treatment. Literature searches were conducted in PubMed, including MEDLINE, and in Embase via Ovid with the search term: "(hyaluronic acid OR hyaluronan OR hyaluronate) AND (dry eye OR sicca)". A total of 53 clinical trials are included in this review, including eight placebo-controlled trials. Hyaluronic acid concentrations ranged from 0.1% to 0.4%. Studies lasted up to 3 months. A broad spectrum of DED types and severities was represented in the reviewed literature. No major complications or adverse events were reported. Artificial tears containing 0.1% to 0.4% HA were effective at improving both signs and symptoms of DED. Two major gaps in the literature have been identified: 1. no study investigated the ideal drop frequency for HA-containing eyedrops, and 2. insufficient evidence was presented to recommend any specific HA formulation over another. Future investigations assessing the optimal drop frequency for different concentrations and molecular weights of HA, different drop formulations, including tonicity, and accounting for DED severity and aetiology are essential for an evidence-based, individualized approach to DED treatment.
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Affiliation(s)
- Leif Hynnekleiv
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
- Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway
- Department of Twin Research & Genetic Epidemiology, King's College London, St Thomas' Hospital, London, UK
| | - Morten Magno
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
- Department of Ophthalmology and Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Emily Moschowits
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Kim Alexander Tønseth
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Darlene A Dartt
- Schepens Eye Research Institute/Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jelle Vehof
- Department of Twin Research & Genetic Epidemiology, King's College London, St Thomas' Hospital, London, UK
- Department of Ophthalmology and Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Ophthalmology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Tor P Utheim
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
- Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway
- Department of Ophthalmology, Stavanger University Hospital, Oslo, Norway
- Department of Ophthalmology, Vestre Viken Hospital, Drammen, Norway
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2
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Hynnekleiv L, Magno M, Vernhardsdottir RR, Moschowits E, Tønseth KA, Dartt DA, Vehof J, Utheim TP. Hyaluronic acid in the treatment of dry eye disease. Acta Ophthalmol 2022; 100:844-860. [PMID: 35514082 PMCID: PMC9790727 DOI: 10.1111/aos.15159] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/05/2022] [Accepted: 04/18/2022] [Indexed: 12/31/2022]
Abstract
Dry eye disease (DED) is a highly prevalent and debilitating condition affecting several hundred million people worldwide. Hyaluronic acid (HA) is a naturally occurring glycosaminoglycan commonly used in the treatment of DED. This review aims to critically evaluate the literature on the safety and efficacy of artificial tears containing HA used in DED treatment. Literature searches were conducted in PubMed, including MEDLINE, and in Embase via Ovid with the search term: "(hyaluronic acid OR hyaluronan OR hyaluronate) AND (dry eye OR sicca)". A total of 53 clinical trials are included in this review, including eight placebo-controlled trials. Hyaluronic acid concentrations ranged from 0.1% to 0.4%. Studies lasted up to 3 months. A broad spectrum of DED types and severities was represented in the reviewed literature. No major complications or adverse events were reported. Artificial tears containing 0.1% to 0.4% HA were effective at improving both signs and symptoms of DED. Two major gaps in the literature have been identified: 1. no study investigated the ideal drop frequency for HA-containing eyedrops, and 2. insufficient evidence was presented to recommend any specific HA formulation over another. Future investigations assessing the optimal drop frequency for different concentrations and molecular weights of HA, different drop formulations, including tonicity, and accounting for DED severity and aetiology are essential for an evidence-based, individualized approach to DED treatment.
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Affiliation(s)
- Leif Hynnekleiv
- Department of Plastic and Reconstructive SurgeryOslo University HospitalOsloNorway,Department of OphthalmologyHaukeland University HospitalBergenNorway,Department of Twin Research & Genetic EpidemiologyKing's College LondonSt Thomas' HospitalLondonUK
| | - Morten Magno
- Department of Plastic and Reconstructive SurgeryOslo University HospitalOsloNorway,Department of Medical BiochemistryOslo University HospitalOsloNorway,Department of Ophthalmology and EpidemiologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands,Faculty of MedicineInstitute of Clinical MedicineUniversity of OsloOsloNorway
| | | | - Emily Moschowits
- Department of Medical BiochemistryOslo University HospitalOsloNorway
| | - Kim Alexander Tønseth
- Department of Plastic and Reconstructive SurgeryOslo University HospitalOsloNorway,Faculty of MedicineInstitute of Clinical MedicineUniversity of OsloOsloNorway
| | - Darlene A. Dartt
- Schepens Eye Research Institute/Massachusetts Eye and EarDepartment of OphthalmologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Jelle Vehof
- Department of Twin Research & Genetic EpidemiologyKing's College LondonSt Thomas' HospitalLondonUK,Department of Ophthalmology and EpidemiologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands,Department of OphthalmologyVestfold Hospital TrustTønsbergNorway
| | - Tor P. Utheim
- Department of Plastic and Reconstructive SurgeryOslo University HospitalOsloNorway,Department of Medical BiochemistryOslo University HospitalOsloNorway,Department of OphthalmologySørlandet Hospital ArendalArendalNorway,Department of OphthalmologyStavanger University HospitalOsloNorway,Department of OphthalmologyVestre Viken HospitalDrammenNorway
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3
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Eom Y, Song JS, Kim HM. Effectiveness of Topical Cyclosporin A 0.1%, Diquafosol Tetrasodium 3%, and Their Combination, in Dry Eye Disease. J Ocul Pharmacol Ther 2022; 38:682-694. [PMID: 36473191 DOI: 10.1089/jop.2022.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose: To compare the effectiveness of the topical use of cyclosporin A (CsA) 0.1%, diquafosol (DQS) tetrasodium 3% ophthalmic solution, and their combination in treating dry eye disease in a general health care setting. Methods: This prospective, nonrandomized, observational study analyzed 279 patients. Patients instilled topical CsA 0.1% (Ikervis®; Santen Pharmaceutical Co., Ltd., Japan) once daily and/or DQS tetrasodium 3% (Diquas-S®; Santen) six times a day for 12 weeks. Objective signs [tear break-up time (TBUT), National Eye Institute (NEI) corneal and conjunctival staining scores] and symptoms [Symptom Assessment in Dry Eye (SANDE) and Dry Eye-related Quality-of-Life Score (DEQS) questionnaires] were evaluated at baseline, week 4, and week 12. Results: Patients (n = 279) were mainly female (85.0%) with a mean (SD) age of 50.1 (14.8) years, and received CsA (n = 93), DQS (n = 99), or CsA/DQS (n = 87). Both monotherapies and CsA/DQS combination therapy significantly improved TBUT, NEI corneal and conjunctival staining scores, and SANDE and DEQS scores from baseline to week 12 (all P < 0.0001). The mean change in TBUT between baseline and week 12 was significantly higher in CsA/DQS combination therapy (2.13 ± 2.41 s) than in CsA monotherapy (1.07 ± 1.71 s; P = 0.0011). Conclusions: Monotherapy with CsA or DQS and CsA/DQS combination therapy all significantly improved the objective signs and symptoms of dry eyes during 12 weeks of treatment. CsA/DQS combination therapy provides an additional benefit in terms of TBUT compared with CsA alone; however, a randomized controlled trial still needs to be performed to confirm this result.
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Affiliation(s)
- Youngsub Eom
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, Korea University Ansan Hospital, Gyeonggi-do, South Korea
| | - Jong Suk Song
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, Korea University Guro Hospital, Seoul, South Korea
| | - Hyo Myung Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, Korea University Anam Hospital, Seoul, South Korea
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4
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Doctor MB, Basu S. Lacrimal Gland Insufficiency in Aqueous Deficiency Dry Eye Disease: Recent Advances in Pathogenesis, Diagnosis, and Treatment. Semin Ophthalmol 2022; 37:801-812. [PMID: 35587465 DOI: 10.1080/08820538.2022.2075706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Aqueous deficiency dry eye disease is a chronic and potentially sight-threatening condition, that occurs due to the dysfunction of the lacrimal glands. The aim of this review was to describe the various recent developments in the understanding, diagnosis and treatment of lacrimal gland insufficiency in aqueous deficiency dry eye disease. METHODS A MEDLINE database search using PubMed was performed using the keywords: "dry eye disease/syndrome", "aqueous deficient/deficiency dry eye disease", "lacrimal gland" and "Sjogren's syndrome". After scanning through 750 relevant abstracts, 73 eligible articles published in the English language from 2016 to 2021 were included in the review. RESULTS Histopathological and ultrastructural studies have revealed new insights into the pathogenesis of cicatrising conjunctivitis-induced aqueous deficiency, where the lacrimal gland acini remain uninvolved and retain their secretory property, while significant ultrastructural changes in the gland have been observed. Recent advances in diagnosis include the techniques of direct clinical assessment of the lacrimal gland morphology and secretion, tear film osmolarity, tear film lysozyme and lactoferrin levels, tear film interferometry and lacrimal gland confocal microscopy. Developments in the treatment of aqueous deficiency dry eye disease, apart from the nanoparticle-based tear substitutes, include secretagogues like diquafosol tetrasodium and rebamipide, anti-inflammatory topical agents like nanomicellar form of cyclosporine and lifitegrast, scleral contact lenses, neurostimulation, and acupuncture for increasing the amount of tear production, minor salivary gland transplantation, faecal microbial transplantation, lacrimal gland regeneration and mesenchymal stem cell therapy. CONCLUSIONS Significant advances in the understanding, diagnosis and management of lacrimal gland insufficiency and its role in aqueous deficiency dry eye disease have taken place within the second half of the last decade. Of which, translational breakthroughs in terms of newer drug formulations and regenerative medicine are most promising.
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Affiliation(s)
- Mariya B Doctor
- Academy of Eye Care Education, L V Prasad Eye Institute, Hyderabad, India.,The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Sayan Basu
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India.,Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
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Mohamed HB, Abd El-Hamid BN, Fathalla D, Fouad EA. Current trends in pharmaceutical treatment of Dry Eye Disease: A review. Eur J Pharm Sci 2022; 175:106206. [PMID: 35568107 DOI: 10.1016/j.ejps.2022.106206] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 01/02/2023]
Abstract
Dry eye disease (DED), keratoconjunctivitis sicca or dysfunctional tear syndrome, is the most prevalent ophthalmic disease which affects a substantial segment of people worldwide with increasing frequency. It is considered a multifactorial disease of the ocular surface and tear film, characterized by a variation of signs and symptoms. The symptoms range from mild to severe itching, burning, irritation, eye fatigue, and ocular inflammation that may lead to potential damage to the cornea, conjunctiva and even vision loss. Correspondingly, depending on the different manifestations and pathophysiology, the treatment must be tailored specifically to each patient by targeting the specific mechanisms implicated in their disease. Currently, there are several medical products and techniques available or under investigation for the treatment of DED. The present article focused on the pathophysiology of DED, the new diagnostic approach and the recently developed drug delivery systems or devices reducing the progress of the disease and treating the causes.
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Affiliation(s)
- Hebatallah B Mohamed
- Department of Pharmaceutics, Faculty of Pharmacy, South Valley University, Qena, 83523, Egypt.
| | - Basma N Abd El-Hamid
- Department of Pharmaceutics Faculty of Pharmacy, Assiut University, Assiut, 71526, Egypt
| | - Dina Fathalla
- Department of Pharmaceutics Faculty of Pharmacy, Assiut University, Assiut, 71526, Egypt
| | - Ehab A Fouad
- Department of Pharmaceutics Faculty of Pharmacy, Assiut University, Assiut, 71526, Egypt
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6
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Eom Y, Kim HM. Clinical effectiveness of diquafosol ophthalmic solution 3% in Korean patients with dry eye disease: a multicenter prospective observational study. Int J Ophthalmol 2021; 14:1518-1526. [PMID: 34667727 DOI: 10.18240/ijo.2021.10.07] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 03/02/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the effectiveness of diquafosol ophthalmic solution 3% administered in Korean patients with dry eye disease in real-world clinical settings. METHODS Diquafosol was administered for 8wk to 3 patient groups who received diquafosol as add-on therapy to existing medication (Add group, n=150); received diquafosol only (Monotherapy group, n=196); or discontinued part of their existing medication in favor of diquafosol (Switch group, n=11). Tear break-up time (TBUT), cornea and conjunctival staining based on National Eye Institute/Industry scoring scheme, subjective symptoms using the Ocular Surface Disease Index (OSDI) questionnaire, and meibum quality and expressibility were evaluated at baseline, week 4, and week 8. RESULTS The mean TBUT increased (from 3.46, 3.92, and 5.84s, respectively, to 5.15, 5.53, and 8.59s, respectively) and corneal staining score decreased (from 2.23, 2.24, and 3.09, respectively, to 0.85, 0.97, and 1.64, respectively) in a time-dependent manner from baseline to week 8 in all three groups. Conjunctival staining score, OSDI questionnaire, and meibum quality and expressibility improved over time from baseline to week 8 in the Add and Monotherapy groups, but differences were not statistically significant in the Switch group. CONCLUSION Diquafosol improves subjective symptoms and objective signs in patients treated with existing medicines combined with diquafosol and treated solely with diquafosol. Diquafosol can be used as an effective therapeutic agent for dry eye disease or additionally applied in patients who have insufficient response to existing medicines.
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Affiliation(s)
- Youngsub Eom
- Department of Ophthalmology, Korea University College of Medicine, Seoul 02841, Republic of Korea.,Department of Ophthalmology, Korea University Ansan Hospital, Gyeonggi-do 15355, Republic of Korea
| | - Hyo Myung Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul 02841, Republic of Korea.,Department of Ophthalmology, Korea University Anam Hospital, Seoul 02841, Republic of Korea
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7
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Yu L, Bhattacharya D, Wang Z, Wang M. Topical administration of ambroxol eye drops augments tear secretion in rabbits. Graefes Arch Clin Exp Ophthalmol 2021; 259:1529-1538. [DOI: 10.1007/s00417-020-05043-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/29/2020] [Accepted: 12/04/2020] [Indexed: 11/30/2022] Open
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8
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Kojima T, Dogru M, Kawashima M, Nakamura S, Tsubota K. Advances in the diagnosis and treatment of dry eye. Prog Retin Eye Res 2020; 78:100842. [PMID: 32004729 DOI: 10.1016/j.preteyeres.2020.100842] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/19/2020] [Accepted: 01/24/2020] [Indexed: 02/07/2023]
Abstract
The core mechanism of dry eye is the tear film instability. Tear film-oriented diagnosis (TFOD) is a concept to clarify the cause of tear film instability by tear film, and tear film-oriented treatment (TFOT) is a concept to treat dry eye disease by replacing the lacking components of the tear film layer based on the TFOD. In TFOD, the fluorescein breakup pattern of the tear film is important, and the subtype of dry eye can be judged to some extent from the breakup patterns. Current noninvasive devices related to the dynamic analysis of the tear film and visual acuity enabled the diagnosis of dry eye, subtype analysis, and the extent of severity. In Asian countries, secretagogues represent the main treatment in TFOT. Since meibomian gland dysfunction is a factor that greatly affects the tear breakup time, its treatment is also essential in the dry eye treatment strategy. A newly discovered dry eye subtype is the short breakup time-type (BUT) of dry eye. The only abnormal finding in this disease is the short BUT, suggesting a relationship with ocular neuropathic pain and eye strain. Recently, data from many studies have accumulated which show that dry eye is a life-style disease. In addition to the treatment of dry eyes, it is becoming possible to prevent the onset by intervening with the daily habits, diet, exercise and sleep, etc. It has been pointed out that oxidative stress is also involved in the pathology of dry eye, and intervention is being carried out by improving diet and taking supplements. Future research will be needed to link clinical findings to the molecular biological findings in the tear film.
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Affiliation(s)
- Takashi Kojima
- Department of Ophthalmology, Keio University School of Medicine, Japan
| | - Murat Dogru
- Department of Ophthalmology, Keio University School of Medicine, Japan
| | - Motoko Kawashima
- Department of Ophthalmology, Keio University School of Medicine, Japan
| | - Shigeru Nakamura
- Department of Ophthalmology, Keio University School of Medicine, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Japan; Tsubota Laboratory, Inc., Tokyo, Japan.
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9
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Fukuoka S, Arita R. Tear film lipid layer increase after diquafosol instillation in dry eye patients with meibomian gland dysfunction: a randomized clinical study. Sci Rep 2019; 9:9091. [PMID: 31235821 PMCID: PMC6591396 DOI: 10.1038/s41598-019-45475-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 05/14/2019] [Indexed: 12/13/2022] Open
Abstract
Diquafosol promotes secretion of tear fluid and mucin at the ocular surface and is administered for treatment of dry eye (DE). Tear film lipid layer is secreted from meibomian glands and stabilizes the tear film. We recently showed that diquafosol administration increased lipid layer thickness (LLT) for up to 60 min in normal human eyes. We here evaluated tear film lipid layer in DE patients (n = 47) with meibomian gland dysfunction (MGD) before as well as 30, 60, and 90 min after diquafosol administration. One drop of artificial tears or one drop of diquafosol was applied randomly to the eyes of each patient. Diquafosol significantly increased LLT at 30 (P < 0.001) and 60 (P = 0.042) min and noninvasive tear film breakup time for at least 90 min (P < 0.001 at each assessment point). Artificial tears had no such effect. Diquafosol significantly improved the tear interferometric pattern compared with artificial tears (P < 0.001 at each assessment point). A single topical administration of diquafosol thus improved LLT and tear film stability in DE patients with MGD, suggesting that diquafosol is a potential treatment not only for aqueous-deficient DE but also for evaporative DE associated with MGD.
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Affiliation(s)
- Shima Fukuoka
- Omiya Hamada Eye Clinic, 1-169-1 Sakuragicho, Omiya-ku, Saitama, Saitama, 330-0854, Japan.,Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Lid and Meibomian Gland Working Group (LIME), 626-11 Minami-Nakano, Minuma-ku, Saitama, Saitama, 337-0042, Japan
| | - Reiko Arita
- Itoh Clinic, 626-11 Minami-Nakano, Minuma-ku, Saitama, Saitama, 337-0042, Japan. .,Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Lid and Meibomian Gland Working Group (LIME), 626-11 Minami-Nakano, Minuma-ku, Saitama, Saitama, 337-0042, Japan.
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Abstract
Mucins, which play important roles on the ocular surface in wettability, lubrication, and barrier function, are classified into two categories: secreted mucins and membrane-associated mucins. The most important secreted mucin on the ocular surface is MUC5AC, which is secreted by the conjunctival goblet cells. In the human conjunctiva, goblet cells are present in higher concentrations in the fornix, inferior nasal bulbar, and the lid wiper on the lid margin. The number of conjunctival goblet cells and MUC5AC expression/secretion are decreased in a patient with dry eye. In Japan, drugs that stimulate mucin secretion or increase the number of conjunctival goblet cells are commercially available. A P2Y2 receptor, diquafosol, stimulates tear fluid secretion from conjunctival epithelial cells and promotes mucin secretion from conjunctival goblet cells. Rebamipide was marketed originally as an oral therapeutic drug to treat gastritis in Japan. Topical rebamipide increases numbers of goblet cells in the bulbar conjunctiva and the lid wiper area of palpebral conjunctiva. Many researchers have reported decreases in the ocular surface mucin expression including MUC5AC secreted by goblet cells in patients with dry eye. However, it is unknown whether changes in mucin expression on the ocular surface cause or result from dry eye. Further study is needed to determine the true mechanism of dry eye disease.
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Affiliation(s)
- Yuichi Hori
- Department of Ophthalmology, Toho University Graduate School of Medicine, Tokyo, Japan
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11
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Watanabe H. Medical Treatment for Dry Eye in Japan. Invest Ophthalmol Vis Sci 2019; 59:DES116-DES120. [PMID: 30481815 DOI: 10.1167/iovs.18-24130] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The etiology of dry eye has not been clarified. In the United States, the inflammation theory is supported as the main cause of dry eye, whereas the Asia Dry Eye Society has identified tear instability as the main cause. Based on this tear instability concept, the P2Y2 antagonist Diquas and the mucin secretagogue Mucosta were developed and launched in Japan over the last 5 years, and they have been widely prescribed to patients with dry eye. Moreover, Diquas has also been launched in other Asian countries, such as Korea, Thailand, and Vietnam. This report summarizes the efficacy and characteristics of these two eye drops to improve our understanding of dry eye.
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Affiliation(s)
- Hitoshi Watanabe
- Eye Division, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.,Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
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12
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Nam K, Kim HJ, Yoo A. Efficacy and Safety of Topical 3% Diquafosol Ophthalmic Solution for the Treatment of Multifactorial Dry Eye Disease: Meta-Analysis of Randomized Clinical Trials. Ophthalmic Res 2019; 61:188-198. [PMID: 30654362 DOI: 10.1159/000492896] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 08/14/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE A meta-analysis was performed to evaluate the safety and efficacy of topical 3% diquafosol in treating patients with dry eye disease (DED). METHODS Nine qualified randomized controlled trials incorporating 1,467 patients were included. Two of the reviewers selected the studies and independently assessed the risk of bias. The outcome measures were Schirmer score, tear film break-up time (TFBUT), rose bengal staining score, and corneal fluorescein staining score. To confirm the effect of diquafosol on dryness after cataract surgery, we performed a subgroup analysis according to the presence or absence of surgery. RESULTS We observed statistically significant improvements in scores on the Schirmer test (weighted mean difference 0.74 mm at 4 weeks; 95% CI: 0.24-1.24; I2 = 0%), fluorescein stain, rose bengal stain, and TFBUT after treatment with diquafosol compared with the group using other eye drops. As a result of the subgroup analysis of DED after cataract surgery, diquafosol was found to be more effective than the other eye drops with regard to TFBUT and rose bengal staining. CONCLUSIONS Topical diquafosol could be an effective treatment for DED, and also for DED after cataract surgery. Further randomized controlled trials with larger sample sizes for the different clinical types of DED are warranted to determine the efficacy and limitations of diquafosol for these different clinical types of DED.
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Affiliation(s)
- Kiyeun Nam
- Department of Physical Medicine and Rehabilitation, Dongguk University College of Medicine, Goyang, Republic of Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Aeri Yoo
- Central Seoul Eye Center, Seoul, Republic of Korea,
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13
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Kim CH, Seong S, Kim JK, Choi JH, Choe CM, Choi TH, Kim S. Effect of 3% Diquafosol Tetrasodium on Tear Film Stability after Laser-assisted in situ Keratomileusis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.10.915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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14
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Hialid®/Hyalein® (sodium hyaluronate) ophthalmic solution in dry eye syndrome: a profile of its use. DRUGS & THERAPY PERSPECTIVES 2018. [DOI: 10.1007/s40267-018-0540-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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15
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Effects of Diquafosol Ophthalmic Solution on Quality of Life in Dry Eye Assessed Using the Dry Eye-Related Quality-of-Life Score Questionnaire: Effectiveness in Patients While Reading and Using Visual Display Terminals. Cornea 2018; 36:908-914. [PMID: 28542084 DOI: 10.1097/ico.0000000000001241] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Diquafosol ophthalmic solution improves objective findings in the ocular surface and subjective symptoms in patients with dry eye. The Dry Eye-Related Quality-of-Life Score (DEQS) questionnaire was developed to assess dry eye symptoms and their effects on quality of life. However, because little research using the DEQS has been reported, we evaluated the effects of diquafosol ophthalmic solution on ocular surface findings and quality of life using the DEQS in patients with dry eye. METHODS Sixty-three patients with dry eye were assigned to the control group (artificial tears) or diquafosol group. Both groups instilled 1 drop of the solution in both eyes 6 times daily and were evaluated after 2 weeks; the diquafosol group also was instructed to be examined at 1 and 3 months. We evaluated the subjective symptoms using the DEQS, fluorescein staining score, tear film breakup time (BUT), Schirmer testing, and lower tear meniscus height with anterior-segment optical coherence tomography. RESULTS In the diquafosol group, the fluorescein staining score, BUT, tear meniscus height, and DEQS scores improved significantly compared with before treatment in contrast to the control group. Furthermore, in the diquafosol group, the staining score and BUT improved significantly compared with the control group. Analysis of each DEQS item indicated that diquafosol ophthalmic solution relieved foreign body sensation and problems when reading and using visual display terminals compared with the control group. CONCLUSIONS Diquafosol ophthalmic solution was effective in patients with dry eye, especially those with foreign body sensation and problems when reading and using visual display terminals.
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Eaton JS, Miller PE, Bentley E, Thomasy SM, Murphy CJ. Slit Lamp-Based Ocular Scoring Systems in Toxicology and Drug Development: A Literature Survey. J Ocul Pharmacol Ther 2017; 33:707-717. [DOI: 10.1089/jop.2017.0021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Joshua Seth Eaton
- Ocular Services On Demand (OSOD), LLC, Madison, Wisconsin
- Department of Surgical & Radiological Sciences, School of Veterinary Medicine, University of California–Davis, Davis, California
| | - Paul E. Miller
- Ocular Services On Demand (OSOD), LLC, Madison, Wisconsin
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin–Madison, Madison, Wisconsin
| | - Ellison Bentley
- Ocular Services On Demand (OSOD), LLC, Madison, Wisconsin
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin–Madison, Madison, Wisconsin
| | - Sara M. Thomasy
- Ocular Services On Demand (OSOD), LLC, Madison, Wisconsin
- Department of Surgical & Radiological Sciences, School of Veterinary Medicine, University of California–Davis, Davis, California
| | - Christopher J. Murphy
- Ocular Services On Demand (OSOD), LLC, Madison, Wisconsin
- Department of Surgical & Radiological Sciences, School of Veterinary Medicine, University of California–Davis, Davis, California
- Department of Ophthalmology & Vision Science, School of Medicine, University of California–Davis, Sacramento, California
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Abstract
Dry eye disease was redefined by the dry eye workshop (DEWS II) in May 2017. According to the new definition "dry eye is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film and accompanied by ocular symptoms". The current definition encompasses etiological factors, such as instability and hyperosmolarity of the tear film, ocular surface inflammation and damage as well as a new aspect compared to the former definition, neurosensory abnormalities. Recent and future therapeutic options for dry eye focus on treatment of the aforementioned pathogenetic events. New tear substitutes, medications and devices to stimulate tear production, innovative anti-inflammatory treatment, medications to influence corneal innervation and new methods for treatment of Meibomian gland dysfunction are already available or will be available in the near future.
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Cui L, Li Y, Lee HS, Yang JM, Choi W, Yoon KC. Effect of diquafosol tetrasodium 3% on the conjunctival surface and clinical findings after cataract surgery in patients with dry eye. Int Ophthalmol 2017; 38:2021-2030. [PMID: 28822028 DOI: 10.1007/s10792-017-0693-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/11/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE To investigate the effects of diquafosol tetrasodium (DT) 3% on conjunctival impression cytologic findings in addition to clinical symptoms and signs after cataract surgery in patients with preexisting dry eye disease (DED). METHODS Ninety-four eyes of 94 patients with DED who underwent uneventful cataract surgery were included. In total, 50 patients were treated with DT 3% (group A), while 44 patients were treated with sodium hyaluronate 0.1% (group B) postoperatively, along with topical antibiotics and steroids. Conjunctival impression cytology was performed at baseline and at 4 and 12 weeks after surgery. Visual acuity, ocular surface disease index (OSDI), tear film breakup time (TBUT), keratoepitheliopathy score, Schirmer's test, and tear clearance rate were measured at baseline and at 1, 4, and 12 weeks, and corneal aberration was analyzed at baseline and at 4 and 12 weeks. RESULTS The grade of conjunctival squamous metaplasia was lower at 12 weeks, and goblet cell density was higher at 4 and 12 weeks in group A than in group B (P < 0.05). Compared with group B, group A showed significantly lower OSDI scores at 4 and 12 weeks, longer TBUT at 1, 4, and 12 weeks, lower keratoepitheliopathy scores at 1 and 12 weeks, and lower total root-mean-square score and spherical aberrations at 4 weeks after surgery (P < 0.05). CONCLUSIONS DT 3% eye drops application after cataract surgery was effective in improving conjunctival epithelial morphology and goblet cell density as well as clinical findings in patients with DED.
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Affiliation(s)
- Lian Cui
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, South Korea.,Department of Biomedical Sciences and Center for Creative Biomedical Scientists, Chonnam National University, Gwangju, South Korea
| | - Ying Li
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Hyo Seok Lee
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Jee Myung Yang
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Won Choi
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Kyung Chul Yoon
- Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, South Korea. .,Department of Biomedical Sciences and Center for Creative Biomedical Scientists, Chonnam National University, Gwangju, South Korea.
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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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Lee H, Kim SM, Choi S, Seo KY, Kim EK, Kim TI. Effect of diquafosol three per cent ophthalmic solution on tear film and corneal aberrations after cataract surgery. Clin Exp Optom 2017; 100:590-594. [PMID: 28222481 DOI: 10.1111/cxo.12521] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/28/2016] [Accepted: 12/01/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The aim was to evaluate the effect of diquafosol on tear film parameters and corneal aberrations after cataract surgery. METHODS This retrospective, comparative, observational case series included patients who underwent cataract surgery with or without peri-operative use of diquafosol three per cent ophthalmic solution. Patients in group I (31 eyes) were treated with diquafosol three per cent ophthalmic solution six times a day from one week before surgery to three months after surgery. Patients in group II (33 eyes) underwent cataract surgery without being administered diquafosol. Tear film break-up time (BUT), the ocular surface disease index (OSDI), the Oxford Scheme score, Schirmer's test I and corneal aberrations were determined before and at one and three months post-surgery. RESULTS In group I, the BUT, OSDI and Oxford Scheme score showed significant improvement at one and three months post-surgery (p = 0.002 for BUT at one month and three months, p = 0.023 and p = 0.049 for OSDI at one month and three months and p = 0.001 and p = 0.026 for Oxford Scheme at one month and three months), compared to baseline. In group II, the BUT, OSDI and Oxford Scheme score did not show any significant improvement during the follow-up period. In both groups, Schirmer's test I significantly decreased at three months post-surgery (p = 0.011 for group I and p = 0.034 for group II), compared to baseline. There were significant differences in the BUT and OSDI between the groups at three months post-surgery (p = 0.037 for BUT and p = 0.011 for OSDI). Regarding the corneal aberration, there were no significant differences between the groups at three months post-surgery. CONCLUSION Peri-operative application of diquafosol three per cent ophthalmic solution may prevent dry eye-related ocular surface changes accompanied by improvement of ocular symptom. No definite changes in corneal aberrations were noted.
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Affiliation(s)
- Hun Lee
- Department of Ophthalmology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea.,The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Myung Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seonghee Choi
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyoung Yul Seo
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
| | - Eung Kweon Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea.,Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
| | - Tae-Im Kim
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
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Evaluation of Tear Meniscus Dynamics Using Anterior Segment Swept-Source Optical Coherence Tomography After Topical Solution Instillation for Dry Eye. Cornea 2016; 35:654-8. [PMID: 26989953 DOI: 10.1097/ico.0000000000000807] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To investigate tear meniscus dynamics using anterior segment swept-source optical coherence tomography (SS-OCT) after the instillation of topical solutions for dry eye. DESIGN Prospective, observational, cross-sectional study. METHODS Thirty-six healthy subjects (28 men and 8 women; mean age, 34.4 ± 6.7 years) were enrolled in this study. The lower tear meniscus height, tear meniscus area, and tear meniscus volume were assessed using anterior SS-OCT. After baseline measurements, 40 μL of 0.1% sodium hyaluronate, 0.3% sodium hyaluronate, 3% diquafosol ophthalmic solution, or 2% rebamipide ophthalmic solution was instilled in one eye of 10 subjects each, whereas 40 μL saline was instilled in the other eye. Tear meniscus measurements were obtained using SS-OCT at 30 seconds and 1, 3, 5, 10, 15, 20, and 30 minutes after instillation. RESULTS The tear meniscus measurements showed a significant increase until 1, 3, 10, 10, and 3 minutes after the instillation of saline, 0.1% sodium hyaluronate, 0.3% sodium hyaluronate, 3% diquafosol, and 2% rebamipide, respectively, compared with the baseline levels (P < 0.05). Compared with those after saline instillation, the tear meniscus measurements were significantly higher until 30 seconds and 3, 30, and 15 minutes after the instillation of 0.1% sodium hyaluronate, 0.3% sodium hyaluronate, 3% diquafosol, and 2% rebamipide, respectively (P < 0.05). CONCLUSIONS The instillation of ophthalmic solutions for the treatment of dry eye greatly increased tear meniscus measurements in healthy subjects. Thus, SS-OCT can be a practical tool for the quantitative evaluation of early-phase tear fluid dynamics.
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Choi KE, Song JS, Kang B, Eom Y, Kim HM. Immediate Effect of 3% Diquafosol Ophthalmic Solution on Tear MUC5AC Concentration and Corneal Wetting Ability in Normal and Experimental Keratoconjunctivitis Sicca Rat Models. Curr Eye Res 2016; 42:666-671. [PMID: 27791390 DOI: 10.1080/02713683.2016.1233986] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the immediate effect of 3% diquafosol ophthalmic solution on tear MUC5AC concentration, periodic acid-Schiff (PAS)-positive goblet cells, and tear film stability in normal and keratoconjunctivitis sicca (KCS) rat models. METHODS Rats were divided into normal and KCS groups. 3% of diquafosol solution was instilled into the right eye and normal saline into the left eye in both groups. To determine the peak time of tear MUC5AC concentration, tears were collected after 3% diquafosol instillation every 5 min up to 20 min. The tear film stability and the numbers of PAS-positive goblet cells were compared in both models. RESULTS After diquafosol instillation, tear MUC5AC concentration increased steadily for 15 min, at which point the MUC5AC concentration reached its peak. In both normal and KCS groups, the MUC5AC concentration at 15 min was higher after instillation of 3% diquafosol solution (17.77 ± 2.09 ng/ml in the normal group, 9.65 ± 3.51 ng/ml in the KCS group) than that after saline instillation (13.74 ± 2.87 ng/ml in the normal group, 8.19 ± 3.99 ng/ml in the KCS group) (p = 0.018 for both). The corneal wetting ability was significantly longer after instillation of 3% diquafosol solution compared with that after instillation of normal saline in the normal group (p = 0.018). The percentage of PAS-positive goblet cells after the instillation of 3% diquafosol solution was significantly lower than that after instillation of normal saline in both models (p = 0.018 for both). CONCLUSIONS Diquafosol ophthalmic solution was effective in stimulating mucin secretion in both normal and KCS rat models, and the peak time of tear MUC5AC concentration was 15 min after diquafosol instillation. The increased tear MUC5AC concentration was accompanied by improved tear film stability and a decreased percentage of PAS-positive goblet cells.
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Affiliation(s)
- Kwang-Eon Choi
- a Department of Ophthalmology, Guro Hospital , Korea University College of Medicine , Seoul , South Korea
| | - Jong-Suk Song
- a Department of Ophthalmology, Guro Hospital , Korea University College of Medicine , Seoul , South Korea
| | - Boram Kang
- a Department of Ophthalmology, Guro Hospital , Korea University College of Medicine , Seoul , South Korea
| | - Youngsub Eom
- b Department of Ophthalmology, Ansan Hospital , Korea University College of Medicine , Gyeonggi , South Korea
| | - Hyo-Myung Kim
- c Department of Ophthalmology , Anam Hospital, Korea University College of Medicine , Seoul , South Korea
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Carracedo G, Crooke A, Guzman-Aranguez A, Pérez de Lara MJ, Martin-Gil A, Pintor J. The role of dinucleoside polyphosphates on the ocular surface and other eye structures. Prog Retin Eye Res 2016; 55:182-205. [PMID: 27421962 DOI: 10.1016/j.preteyeres.2016.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 06/30/2016] [Accepted: 07/05/2016] [Indexed: 11/17/2022]
Abstract
Dinucleoside polyphosphates comprises a group of dinucleotides formed by two nucleosides linked by a variable number of phosphates, abbreviated NpnN (where n represents the number of phosphates). These compounds are naturally occurring substances present in tears, aqueous humour and in the retina. As the consequence of their presence, these dinucleotides contribute to many ocular physiological processes. On the ocular surface, dinucleoside polyphosphates can stimulate tear secretion, mucin release from goblet cells and they help epithelial wound healing by accelerating cell migration rate. These dinucleotides can also stimulate the presence of proteins known to protect the ocular surface against microorganisms, such as lysozyme and lactoferrin. One of the latest discoveries is the ability of some dinucleotides to facilitate the paracellular way on the cornea, therefore allowing the delivery of compounds, such as antiglaucomatous ones, more easily within the eye. The compound Ap4A has been described being abnormally elevated in patient's tears suffering of dry eye, Sjogren syndrome, congenital aniridia, or after refractive surgery, suggesting this molecule as biomarker for dry eye condition. At the intraocular level, some diadenosine polyphosphates are abnormally elevated in glaucoma patients, and this can be related to the stimulation of a P2Y2 receptor that increases the chloride efflux and water movement in the ciliary epithelium. In the retina, the dinucleotide dCp4U, has been proven to be useful to help in the recovery of retinal detachments. Altogether, dinucleoside polyphosphates are a group of compounds which present relevant physiological actions but which also can perform promising therapeutic benefits.
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Affiliation(s)
- Gonzalo Carracedo
- Department of Optics II (Optometry and Vision), Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Almudena Crooke
- Department of Biochemistry and Molecular Biology IV, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Ana Guzman-Aranguez
- Department of Biochemistry and Molecular Biology IV, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Maria J Pérez de Lara
- Department of Biochemistry and Molecular Biology IV, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Alba Martin-Gil
- Department of Biochemistry and Molecular Biology IV, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Jesús Pintor
- Department of Biochemistry and Molecular Biology IV, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain.
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Jeon HS, Hyon JY. The Efficacy of Diquafosol Ophthalmic Solution in Non-Sjögren and Sjögren Syndrome Dry Eye Patients Unresponsive to Artificial Tear. J Ocul Pharmacol Ther 2016; 32:463-8. [PMID: 27294831 DOI: 10.1089/jop.2015.0081] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This study evaluates the efficacy of 3% diquafosol tetrasodium ophthalmic solution in Sjögren's syndrome (SS) and non-SS dry eye patients unresponsive to conventional artificial tear. METHODS This retrospective study included 38 dry eye patients (11 with SS and 27 with non-SS) who were treated with 3% diquafosol due to lack of response to artificial tear treatment for more than 3 months. Signs such as tear film break-up time (TBUT), Schirmer-I test, and total ocular staining score (OSS), which consisted of corneal OSS and conjunctival OSS, were evaluated at baseline and the first visit after treatment. Symptoms were quantified using visual analog scale (VAS) and ocular surface disease index (OSDI) scores. Changes of parameters after treatment in all the patients and differences of changes in SS and non-SS were evaluated. RESULTS In total population, total OSS and corneal OSS improved average 6 weeks after diquafosol treatment (all P < 0.05, paired t-test), although conjunctival OSS had no improvement. TBUT increased after treatment (P = 0.036), while Schirmer-I test, OSDI, and VAS showed no improvement. With respect to comparisons, total and corneal OSS improved in non-SS patients and TBUT improved in SS patients (all P < 0.05). CONCLUSIONS Three percent diquafosol tetrasodium treatment could be considered as an additive or substitute treatment when artificial tear treatment is insufficient, as it improved OSS and TBUT. This study also demonstrated that diquafosol treatment is beneficial for TBUT improvement in SS, while it is beneficial for OSS improvement in non-SS dry eye patients.
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Affiliation(s)
- Hyun Sun Jeon
- 1 Department of Ophthalmology, Seoul National University Bundang Hospital , Seongnam, Republic of Korea
| | - Joon Young Hyon
- 1 Department of Ophthalmology, Seoul National University Bundang Hospital , Seongnam, Republic of Korea.,2 Department of Ophthalmology, Seoul National University College of Medicine , Seoul, Republic of Korea
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Prominent Decrease of Tear Meniscus Height With Contact Lens Wear and Efficacy of Eye Drop Instillation. Eye Contact Lens 2016; 41:318-22. [PMID: 25839348 DOI: 10.1097/icl.0000000000000134] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the change in tear meniscus height (TMH) before and after wearing soft contact lenses (CLs) of different water contents (WCs) and the influence of eye drop instillation on TMH during CL wear. METHODS Tear meniscus heights were measured using anterior segment optical coherence tomography in 20 normal subjects wearing a high-WC CL (WC, 69%) in 1 eye and a low-WC CL (WC, 24%) in the other. Tear meniscus height change after eye drop instillation with 3% diquafosol ophthalmic solution or saline with CL wear was evaluated at 5, 15, 30, and 60 min after instillation. RESULTS A significant decrease in TMH was observed after lens insertions of both CLs. Tear meniscus height was significantly decreased with high-WC CL wear compared with that with low-WC CL wear. With high-WC CL wear, TMH increased significantly (P<0.001) at 5 min after the instillation of 3% diquafosol ophthalmic solution compared with the baseline values and then returned to the pre-instillation level. No significant TMH changes were found with the instillation of either eye drop (diquafosol or saline) with low-WC CL wear. CONCLUSIONS Tear meniscus height decreased with CL wear, especially with high-WC CL wear. Significant increases in TMH were observed at 5 min after the instillation of diquafosol ophthalmic solution with high-WC CL wear. The increases in TMH after diquafosol instillation tended to be greater than those after saline instillation at least for 30 min with both high-WC and low-WC CLs.
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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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Baek J, Doh SH, Chung SK. The Effect of Topical Diquafosol Tetrasodium 3% on Dry Eye After Cataract Surgery. Curr Eye Res 2016; 41:1281-1285. [PMID: 27049809 DOI: 10.3109/02713683.2015.1122813] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the effectiveness of 3% diquafosol tetrasodium for treating dry eye after cataract surgery. METHODS Among patients who underwent bilateral cataract surgery, 34, who met the diagnostic criteria for dry eye syndrome 1 week postoperatively, were enrolled. Patients were randomly assigned to receive 3.0% diquafosol tetrasodium ophthalmic solution in one eye and 0.9% saline in the other eye four times daily for 8 weeks. Dry eye severity was measured at 1, 5, and 9 postoperative weeks using the Schirmer 1 test (SIT), tear film breakup time (TBUT), and fluorescein corneal staining. tear meniscus height (TMH), tear meniscus depth (TMD), and tear meniscus area (TMA) measured using Fourier-domain optical coherence tomography and symptom questionnaire scores. RESULTS TBUT and corneal staining significantly improved 8 weeks postoperatively in eyes treated with 3.0% diquafosol tetrasodium (p < 0.01, p < 0.01) and were better than normal saline-treated eyes (p < 0.01, p < 0.01). SIT did not improve (p = 0.26). TMH, TMD, and TMA did not improve at 4 and 8 weeks. All symptom questionnaire scores improved in eyes treated with 3.0% diquafosol tetrasodium (all p < 0.01). CONCLUSION The 3.0% diquafosol tetrasodium treatment improved tear film stability and subjective symptoms of dry eye after cataract surgery. Increased mucin production as a result of diquafosol treatment may have caused these results.
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Affiliation(s)
- Jiwon Baek
- a Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine , The Catholic University of Korea , Seoul , Korea
| | - Sang Hee Doh
- b Department of Ophthalmology and Visual Science, St. Paul's Hospital, College of Medicine , The Catholic University of Korea , Seoul , Korea
| | - Sung Kun Chung
- b Department of Ophthalmology and Visual Science, St. Paul's Hospital, College of Medicine , The Catholic University of Korea , Seoul , Korea
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Is the main lacrimal gland indispensable? Contributions of the corneal and conjunctival epithelia. Surv Ophthalmol 2016; 61:616-27. [PMID: 26968256 DOI: 10.1016/j.survophthal.2016.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/26/2016] [Indexed: 11/24/2022]
Abstract
The ocular surface system is responsible for ensuring that the precorneal tear film is sufficient in both quality and quantity to preserve optimal vision. Tear secretion is a complex, multifactorial process, and dysfunction of any component of the ocular surface system can result in tear film instability and hyperosmolarity with resultant dry eye disease. The tear film is primarily composed of lipids, aqueous, and mucins, with aqueous accounting for most of its thickness. The aqueous is produced by the main lacrimal gland, accessory lacrimal glands, and corneal and conjunctival epithelia. Although the main lacrimal gland has long been considered an indispensable source of the aqueous component of tears, there is evidence that adequate tear secretion can exist in the absence of the main lacrimal gland. We review and discuss the basics of tear secretion, the tear secretory capacity of the ocular surface, and emerging treatments for dry eye disease.
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Abstract
Diquafosol ophthalmic solution 3 % (Diquas(®)) is a P2Y2 receptor agonist that promotes tear fluid and mucin secretion and is currently approved in Japan and South Korea for the treatment of dry eye. In randomized, double-blind, multicentre trials in patients with dry eye, significantly greater improvements in fluorescein and rose bengal staining scores were seen with diquafosol ophthalmic solution 3 % than with placebo, and diquafosol ophthalmic solution 3 % was noninferior to sodium hyaluronate ophthalmic solution 0.1 % in terms of the improvement in the fluorescein staining score and more effective than sodium hyaluronate ophthalmic solution 0.1 % in terms of the improvement in the rose bengal staining score. The efficacy of diquafosol ophthalmic solution 3 % in the treatment of dry eye was maintained in the longer term, with improvements also seen in subjective dry eye symptoms, and was also shown in a real-world setting. Diquafosol ophthalmic solution 3 % also demonstrated efficacy in various specific dry eye disorders, including aqueous-deficient dry eye, short tear film break-up time dry eye, obstructive meibomian gland dysfunction, dry eye following laser in situ keratomileusis surgery and dry eye following cataract surgery, as well as in contact lens wearers and visual display terminal users. Diquafosol ophthalmic solution 3 % was generally well tolerated in patients with dry eye, with eye irritation the most commonly reported adverse event. In conclusion, diquafosol ophthalmic solution 3 % is a useful option for the treatment of dry eye.
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Affiliation(s)
- Gillian M Keating
- Springer, Private Bag 65901, Mairangi Bay 0754, Auckland, New Zealand,
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Lee SJ, Kim HY, Park YM, Lee JS. Comparison of Therapeutic Effects of 3% Diquafosol Tetrasodium with Aging in Dry Eye. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.5.734] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Seok Jae Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
| | - Ho Yun Kim
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
| | - Young Min Park
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
- Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jong Soo Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
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Comparison of Topical Cyclosporine and Diquafosol Treatment in Dry Eye. Optom Vis Sci 2015; 92:e296-302. [PMID: 26107023 DOI: 10.1097/opx.0000000000000657] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To compare the treatment effects of topical cyclosporine A (CsA) and diquafosol sodium (DQS) for the treatment of moderate to severe dry eye disease (DED). METHODS This prospective, nonrandomized, comparative study involved 60 eyes of 60 patients with moderate to severe DED who were treated with topical CsA 0.05% (group 1, 31 patients) or DQS 3% (group 2, 29 patients) in addition to artificial tears for 3 months. Before treatment, and at 1 and 3 months after treatment, the Ocular Surface Disease Index, tear breakup time, Schirmer score, tear clearance rate, and corneal and conjunctival staining scores were compared. RESULTS Significant improvements in Ocular Surface Disease Index score, tear clearance rate, and corneal staining score were observed 1 month after treatment in group 2 (p = 0.014, p = 0.002, and p < 0.001, respectively), when compared with group 1. However, no significant differences were observed between the two groups 3 months after treatment (p > 0.05). Tear breakup times were significantly higher in group 2 compared with group 1 for the duration of the study (p < 0.001). Three months after treatment, Schirmer score was significantly higher and conjunctival staining score was significantly lower in group 1 compared with group 2 (p < 0.001). CONCLUSIONS Both topical CsA 0.05% and DQS 3% are effective in patients with moderate to severe DED. However, the timing and degree of therapeutic effects on tear film and ocular surface parameters, as well as symptoms, can be different between the two treatments.
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Intraocular Scattering after Instillation of Diquafosol Ophthalmic Solution. Optom Vis Sci 2015; 92:e303-9. [PMID: 25551688 DOI: 10.1097/opx.0000000000000490] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess the changes in intraocular scattering before and after instillation of diquafosol ophthalmic solution in patients with short tear breakup time (TBUT) dry eye. METHODS We prospectively examined 20 eyes of 20 short TBUT dry eye patients (study group) and age-matched 20 eyes of 20 healthy subjects (control group). Intraocular scattering was measured as the objective scattering index (OSI) at 0.5-second intervals over 10 seconds without blinking. Patients were instructed to start topical administration of 3% diquafosol ophthalmic solution six times daily for 4 weeks. RESULTS The OSI significantly deteriorated after 7.0 seconds compared with the initial value of OSI after the blinking in the study group. The OSI was also significantly higher in the study group than in the control group at 4.5 to 10.0 seconds after the blinking (p < 0.05). We found significant improvements 2 weeks after treatment not only in TBUT (p < 0.001) but also in the mean OSI, the OSI change rate, and the slope of the linear regression line of the OSI within 10 seconds (p < 0.001, p = 0.003, and p = 0.002, respectively). We also found significant improvements 4 weeks after treatment in these variables. CONCLUSIONS Intraocular scattering deteriorates significantly with time in patients with short TBUT dry eye. Diquafosol ophthalmic solution exhibits an improvement not only in TBUT but also in intraocular scattering, indicating that diquafosol is also effective for improving the optical quality of the eye.
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Abstract
Dry eye (DE) is a prevalent ocular disease that primarily affects the elderly. Affecting up to 30% of adults aged 50 years and older, DE affects both visual function and quality of life. Symptoms of DE, including ocular pain (aching, burning), visual disturbances, and tearing, can be addressed with therapeutic agents that target dysfunction of the meibomian glands, lacrimal glands, goblet cells, ocular surface, and/or neural network. This review provides an overview of the efficacy, use, and limitations of current therapeutic interventions being used to treat DE.
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Sherstyuk YV, Abramova TV. How To Form a Phosphate Anhydride Linkage in Nucleotide Derivatives. Chembiochem 2015; 16:2562-70. [PMID: 26420042 DOI: 10.1002/cbic.201500406] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Indexed: 12/25/2022]
Abstract
The fundamental roles of nucleoside triphosphates and nucleotide cofactors such as NAD(+) in biochemistry are well known. In recent decades, continuing research has revealed the key role of 5'-capped RNA and 5',5'-dinucleoside polyphosphates in the regulation of vitally important physiological processes. Last but not least, the commercial potential of nucleoside triphosphate synthesis can hardly be overestimated. Nevertheless, despite decades of investigation and the obvious topicality of the research on the chemical synthesis of the nucleotide compounds containing phosphate anhydride linkages, none of the existing procedures can be considered an up-to-date "gold standard". However, there are a number of fruitful synthetic approaches to forming phosphate anhydride linkages in satisfactory yield. These are summarized in this concise review, organized by the type of active phosphorous intermediate and reagents used.
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Affiliation(s)
- Yuliya V Sherstyuk
- Laboratory of Organic Synthesis, Institute of Chemical Biology and Fundamental Medicine, SB RAS, Lavrent'ev Avenue, 8, Novosibirsk, 630090, Russia
| | - Tatyana V Abramova
- Laboratory of Organic Synthesis, Institute of Chemical Biology and Fundamental Medicine, SB RAS, Lavrent'ev Avenue, 8, Novosibirsk, 630090, Russia.
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Byun YS, Yoo YS, Kwon JY, Joo JS, Lim SA, Whang WJ, Mok JW, Choi JS, Joo CK. Diquafosol promotes corneal epithelial healing via intracellular calcium-mediated ERK activation. Exp Eye Res 2015; 143:89-97. [PMID: 26505315 DOI: 10.1016/j.exer.2015.10.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 10/15/2015] [Accepted: 10/16/2015] [Indexed: 12/27/2022]
Abstract
Diquafosol is known as a purinergic P2Y2 receptor (P2Y2R) agonist that stimulates water and mucin secretion from conjunctival epithelial cells and goblet cells, leading to tear film stability in dry eye. However, its effect on corneal epithelial healing has not yet been elucidated. The aim of the present study was to evaluate the effect of diquafosol on corneal epithelial healing in vivo and on P2Y2R-related downstream signaling pathways in vitro. We administered 3% diquafosol ophthalmic solution on 3 mm-diameter epithelial defects made in rat corneas and assessed the wound closure over time. Corneal epithelial healing was significantly accelerated in diquafosol-treated eyes compared to control eyes at 12 and 24 h. During wound healing, P2Y2R staining appeared stronger in the re-epithelized margin near the wound defect. To evaluate whether diquafosol stimulates epidermal growth factor receptor/extracellular-signal-regulated kinase (EGFR/ERK)-related cell proliferation and migration, simian virus 40-transfected human corneal epithelial (THCE) cells were used for in vitro experiments. Cell proliferation was accelerated by diquafosol at concentrations from 20 to 200 μM during 48 h, but inhibited at concentrations over 2000 μM. The intracellular calcium ([Ca(2+)]i) elevation was measured in diquafosol (100 μM)-stimulated cells using Fluo-4/AM ([Ca(2+)]i indicator). [Ca(2+)]i elevation was observed in diquafosol-stimulated cells regardless of the presence of calcium in media, and suramin pretreatment inhibited the calcium response. The effect of diquafosol on phosphorylation of EGFR, ERK and Akt, and cell migration was determined by western blotting and in vitro cell migration assay. Diquafosol induced phosphorylation of EGFR at 2 min post-stimulation, and phosphorylation of ERK at 5 min post-stimulation. Phosphorylation of ERK was attenuated in cells pretreated with suramin or BAPTA/AM ([Ca(2+)]i chelator), and partially with AG1478 (EGFR inhibitor). Likewise, diquafosol-treated cells showed acceleration of gap closure in cell migration assay, which was inhibited by suramin, BAPTA/AM, AG1478, and U0126 (MEK inhibitor). These studies demonstrate that diquafosol is effective in promoting corneal epithelial wound healing and that this effect may result from ERK-stimulated cell proliferation and migration via P2Y2R-mediated [Ca(2+)]i elevation.
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Affiliation(s)
- Yong-Soo Byun
- Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea; Catholic Institute of Visual Science, Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Sik Yoo
- Catholic Institute of Visual Science, Catholic University of Korea, Seoul, Republic of Korea
| | - Ji-Young Kwon
- Catholic Institute of Visual Science, Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-Soo Joo
- Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-A Lim
- Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Woong-Joo Whang
- Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jee-Won Mok
- Catholic Institute of Visual Science, Catholic University of Korea, Seoul, Republic of Korea
| | - Jun-Sub Choi
- Catholic Institute of Visual Science, Catholic University of Korea, Seoul, Republic of Korea
| | - Choun-Ki Joo
- Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea; Catholic Institute of Visual Science, Catholic University of Korea, Seoul, Republic of Korea.
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Efficacy and safety of topical diquafosol ophthalmic solution for treatment of dry eye: a systematic review of randomized clinical trials. Cornea 2015; 34:644-50. [PMID: 25909234 DOI: 10.1097/ico.0000000000000429] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of topical diquafosol ophthalmic solution for treatment of dry eye. METHODS Randomized clinical trials (RCTs) from MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were identified to evaluate the efficacy and safety of topical administration of diquafosol to patients with dry eyes. Data evaluation was based on endpoints including Schirmer test, tear film break-up time, ocular surface staining score, subjective symptom score, and adverse events. RESULTS A total of 8 RCTs involving 1516 patients were selected based on the prespecified criteria. Significant improvement of Schirmer test values and tear film break-up time were reported in 40% (2 of 5) and 80% (4 of 5) studies, respectively. Ocular surface staining scores significantly decreased in 100% (fluorescein corneal staining, 6 of 6; Rose Bengal corneal and conjunctival staining, 4 of 4) RCTs. Symptoms significantly improved in 75% (6 of 8) RCTs in patients with dry eyes. No severe adverse events were reported with the concentration of diquafosol from 0.5% to 5%. Heterogeneity in study design prevented meta-analysis from statistical integration and summarization. CONCLUSIONS Topical diquafosol seems to be a safe therapeutic option for the treatment of dry eye. The high variability of the selected RCTs compromised the strength of evidence and limits the determination of efficacy. However, the topical administration of diquafosol seems to be beneficial in improving the integrity of the epithelial cell layer of the ocular surface and mucin secretion in patients with dry eyes. This review indicates a need for standardized criteria and methods for evaluation to assess the efficacy of diquafosol in the future clinical trials.
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Sy A, O'Brien KS, Liu MP, Cuddapah PA, Acharya NR, Lietman TM, Rose-Nussbaumer J. Expert opinion in the management of aqueous Deficient Dry Eye Disease (DED). BMC Ophthalmol 2015; 15:133. [PMID: 26462481 PMCID: PMC4604775 DOI: 10.1186/s12886-015-0122-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 09/30/2015] [Indexed: 01/05/2023] Open
Abstract
Background Dry eye disease (DED) affects millions of people worldwide. There are a variety of new treatments beyond traditional therapies such as preservative free artificial tears. Here, we conduct a survey to identify the most common treatments used among specialists and assess their interest in newer therapies. Methods An international survey was distributed to dry eye researchers and expert practitioners via an internet survey. The survey data collected were analyzed with descriptive statistics. Results One hundred and fifteen respondents completed the survey; of these, 66 % were cornea specialists. The most commonly prescribed topical treatments included cyclosporine A (CSA) 0.05 % (71/104, 68 %), fluorometholone (FML) 0.1 % (59/99, 60 %), loteprednol etabonate 0.5 % (50/99, 51 %), and autologous serum eye drops (ASD; 48/97, 49 %). The most commonly prescribed non-topical medications included essential fatty acid supplements (72/104, 69 %), low-dose doxycycline (oral; 61/100, 61 %), and flaxseed supplements (32/96, 33 %) as well as punctal plugs (76/102, 75 %). Respondents reported treatment with topical corticosteroids for 2 to 8 weeks (46/86, 53 %), followed by less than 2 weeks (24/86, 28 %) and with topical CSA between 2 to 8 weeks (45/85, 53 %) followed by 2 to 6 months (24/85, 28 %). The top three signs and symptoms reported to indicate treatment response were, in order, fluorescein staining of the cornea, reduction in foreign body sensation, and reduction in burning sensation. Conclusion This survey offers insight into current expert opinion in the treatment of DED. The results of this survey are hypothesis generating and will aid in the design of future clinical studies.
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Affiliation(s)
- Aileen Sy
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA. .,F.I. Proctor Foundation, University of California, Room S309, 513 Parnassus Ave, UCSF, San Francisco, CA, 94143-0412, USA.
| | - Kieran S O'Brien
- F.I. Proctor Foundation, University of California, Room S309, 513 Parnassus Ave, UCSF, San Francisco, CA, 94143-0412, USA.
| | - Margaret P Liu
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA.
| | - Puja A Cuddapah
- F.I. Proctor Foundation, University of California, Room S309, 513 Parnassus Ave, UCSF, San Francisco, CA, 94143-0412, USA.
| | - Nisha R Acharya
- F.I. Proctor Foundation, University of California, Room S309, 513 Parnassus Ave, UCSF, San Francisco, CA, 94143-0412, USA. .,Department of Ophthalmology, University of California, San Francisco, CA, USA.
| | - Thomas M Lietman
- F.I. Proctor Foundation, University of California, Room S309, 513 Parnassus Ave, UCSF, San Francisco, CA, 94143-0412, USA. .,Department of Ophthalmology, University of California, San Francisco, CA, USA.
| | - Jennifer Rose-Nussbaumer
- F.I. Proctor Foundation, University of California, Room S309, 513 Parnassus Ave, UCSF, San Francisco, CA, 94143-0412, USA. .,Department of Ophthalmology, University of California, San Francisco, CA, USA.
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Effect of Rebamipide Ophthalmic Suspension on Intraocular Light Scattering for Dry Eye After Corneal Refractive Surgery. Cornea 2015; 34:895-900. [DOI: 10.1097/ico.0000000000000456] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Diquafosol is a drug used for dry eye treatment with a novel mechanism of action. It stimulates the secretion of tear fluid and mucin on the ocular surface, thus enabling us to selectively treat the tear film layer, playing an important role in the establishment of the concept of "Tear Film Oriented Therapy (TFOT)", an effective therapeutic approach to dry eye in Japan. The 3% diquafosol ophthalmic solution has been widely used for the treatment of dry eye in clinical practice, and it is currently available in Japan and South Korea. This review provides an overview of the clinical utility of 3% diquafosol ophthalmic solution, focusing on the results of clinical studies on various types of dry eye, including aqueous-deficient dry eye, short tear film breakup time-type dry eye, and post dry eye after laser in situ keratomileusis. It also introduces the additive effect of diquafosol on sodium hyaluronate monotherapy for dry eye, and the effect of 3% diquafosol ophthalmic solution for dry eye-related conditions. Additionally, it summarizes the ocular effects of diquafosol in healthy human eyes. Lastly, the importance of improving tear film stability in dry eye treatment, as well as general advances in dry eye treatments, are described.
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Affiliation(s)
- Shizuka Koh
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Ye J, Xu YF, Lou LX, Jin K, Miao Q, Ye X, Xi Y. Anti-inflammatory effects of hinokitiol on human corneal epithelial cells: an in vitro study. Eye (Lond) 2015; 29:964-71. [PMID: 25952949 DOI: 10.1038/eye.2015.62] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/08/2015] [Indexed: 12/29/2022] Open
Abstract
PURPOSE This study assessed the anti-inflammatory effect and mechanism of action of hinokitiol in human corneal epithelial (HCE) cells. METHODS HCE cells were incubated with different concentrations of hinokitiol or dimethylsulfoxide (DMSO), which served as a vehicle control. Cell viability was evaluated using Cell Counting Kit-8 (CCK-8) assay. After polyriboinosinic:polyribocytidylic acid (poly(I:C)) stimulus, cells with or without hinokitiol were evaluated for the mRNA and protein levels of interleukin-8 (IL-8), interleukin-6 (IL-6), and interleukin-1β (IL-1β) using real-time PCR analysis and an enzyme-linked immunosorbent assay (ELISA), respectively. Nuclear and cytoplasmic levels of nuclear factor kappa B (NF-κB) p65 protein and an inhibitor of NF-κB α (IκBα) were evaluated using western blotting. RESULTS There were no significant differences among the treatment concentrations of hinokitiol compared with cells incubated in medium only. Incubating with 100 μM hinokitiol significantly decreased the mRNA levels of IL-8 to 58.77±10.41% (P<0.01), IL-6 to 64.64±12.71% (P<0.01), and IL-1β to 54.19±8.10% (P<0.01) compared with cells stimulated with poly(I:C) alone. The protein levels of IL-8, IL-6, and IL-1β had similar trend. Further analysis revealed that hinokitiol maintained the levels of IκBα and significantly reduced NF-κB p65 subunit translocation to the nucleus which significantly inhibiting the activation of the NF-κB signal pathway. CONCLUSION Hinokitiol showed a significant protective effect against ocular surface inflammation through inhibiting the NF-κB pathway, which may indicate the possibility to relieve the ocular surface inflammation of dry eye syndrome (DES).
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Affiliation(s)
- J Ye
- Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - Y-F Xu
- Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - L-X Lou
- Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - K Jin
- Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - Q Miao
- Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - X Ye
- Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - Y Xi
- Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
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Additive Effect of preservative-free sodium hyaluronate 0.1% in treatment of dry eye syndrome with diquafosol 3% eye drops. Cornea 2015; 33:935-41. [PMID: 25055152 DOI: 10.1097/ico.0000000000000213] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to evaluate the treatment effect of diquafosol 3% with preservative-free sodium hyaluronate 0.1% eye drops in dry eye syndrome. METHODS In total, 150 patients with dry eye syndrome were divided randomly into 3 groups. Group 1 (50 patients) was treated 4 times daily with preserved sodium hyaluronate 0.1%, group 2 (50 patients) was treated 4 times daily with diquafosol 3%, and group 3 (50 patients) was treated 4 times daily with diquafosol 3% and preservative-free sodium hyaluronate 0.1% eye drops for 3 months. Ocular surface disease index (OSDI) score, tear film break-up time, Schirmer I test, corneal fluorescein staining, and impression cytology were evaluated. RESULTS There were significant improvements in the OSDI score, tear film break-up time, Schirmer I score, fluorescein and Rose Bengal staining, goblet cell density, and impression cytological findings in groups 2 and 3 compared with those for group 1 in patients with dry eye syndrome at 1, 2, and 3 months (P < 0.05). There were statistically significant improvements in the OSDI score (-8.48 ± 0.97, -5.69 ± 0.78; P = 0.02), fluorescein (-1.43 ± 0.21, -1.02 ± 0.18; P = 0.03), and Rose Bengal staining (-1.12 ± 0.26, -0.75 ± 0.12; P = 0.03), goblet cell density (89.65 ± 14.39, 70.36 ± 16.75; P = 0.03), and impression cytological findings (-0.53 ± 0.12, -0.34 ± 0.90; P = 0.01) in group 3 compared with those in group 2 at 3 months. CONCLUSIONS Treatment with diquafosol 3% with preservative-free sodium hyaluronate 0.1% was more effective than diquafosol 3% monotherapy or treatment with preserved sodium hyaluronate 0.1% in dry eye syndrome. Preservative-free sodium hyaluronate 0.1% eye drops can increase the effect of diquafosol 3% in dry eye syndrome.
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Gong L, Sun X, Ma Z, Wang Q, Xu X, Chen X, Shao Y, Yao K, Tang L, Gu Y, Yuan H, Chua WH, Chuan JCY, Tong L. A randomised, parallel-group comparison study of diquafosol ophthalmic solution in patients with dry eye in China and Singapore. Br J Ophthalmol 2015; 99:903-8. [PMID: 25631485 DOI: 10.1136/bjophthalmol-2014-306084] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 12/27/2014] [Indexed: 02/05/2023]
Abstract
AIMS To compare the efficacy and safety of 3% diquafosol ophthalmic solution with those of 0.1% sodium hyaluronate ophthalmic solution in patients with dry eye in China and Singapore. METHODS A total of 497 patients with dry eye (Schirmer's test, 5 mm; fluorescein and RB score, 3 points) from China and Singapore were randomised to receive either diquafosol ophthalmic solution (diquafosol) or sodium hyaluronate ophthalmic solution (HA) at 1:1 ratio. The fluorescein staining scores and rose bengal (RB) subjective symptom scores and tear film breakup time were evaluated before treatment and 2 and 4 weeks after start of treatment. RESULTS In the diquafosol group, changes in fluorescein and RB scores compared with baseline at week 4 or at the time of discontinuation were -2.1±1.5 and -2.5±2.0, respectively. Compared with the HA group, changes in fluorescein score were non-inferior and changes in RB score were superior (p=0.019). In addition, diquafosol and HA improved tear film breakup time by 1.046±1.797 and 0.832±1.775 s, respectively (no significant intergroup difference). Adverse event onset rates were 16.3% (40 of 246 subjects) and 10.0% (25 of 251 subjects) in the diquafosol group and HA group, respectively, with borderline significant intergroup differences (p=0.046), while adverse drug reaction incidence rates were 12.2% (30 of 246 subjects) and 6.0% (15 of 251 subjects), respectively (p=0.019). Only mild adverse drug reactions (>2%) in the form of eye discharge, itching or irritation were observed. CONCLUSIONS Diquafosol improved fluorescein staining score in a manner similar to HA, and significantly improved RB score compared with HA. TRIAL REGISTRATION NUMBER NCT01101984.
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Affiliation(s)
- Lan Gong
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Xinghuai Sun
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Zhizhong Ma
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Qinmei Wang
- The School of Ophthalmology and Optometry Affiliated with Wenzhou Medical College, Wenzhou, Zhejiang, China
| | - Xun Xu
- Department of Ophthalmology, Shanghai First People's Hospital, Shanghai, China
| | - Xiaoming Chen
- Department of Ophthalmology, West China Medical School, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Shao
- Department of Ophthalmology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ke Yao
- Department of Ophthalmology, Second Affiliated Hospital Zhejiang University College of Medicine, Hangzhou, China
| | - Luosheng Tang
- Department of Ophthalmology, Second Xiangya Hospital, Central South University, Changsha, China
| | - Yangshun Gu
- Department of Ophthalmology, First Affiliated Hospital Zhejiang University College of Medicine, Hangzhou, China
| | - Huiping Yuan
- Department of Ophthalmology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wei Han Chua
- Parkway Eye Centre, Mount Elizabeth Hospital, Singapore, Singapore
| | | | - Louis Tong
- Singapore Eye Research Institute, Singapore National Eye Center, Duke-NUS Graduate Medical School, Singapore, Singapore
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Effect of diquafosol tetrasodium eye drop for persistent dry eye after laser in situ keratomileusis. Cornea 2015; 33:659-62. [PMID: 24858017 DOI: 10.1097/ico.0000000000000136] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the effect of diquafosol tetrasodium (DQS) for the treatment of persistent dry eye after laser in situ keratomileusis (LASIK). SETTING Miyata Eye Hospital, Miyazaki, Japan. DESIGN Noncomparative case series. METHODS This prospective study included 30 eyes of 15 patients in whom dry eye had persisted for over 12 months after LASIK, and the symptoms had not improved with artificial tears and sodium hyaluronate treatment. In addition, treatment with DQS 3% eye drops, 6 times a day, was performed for 12 weeks. Best-corrected visual acuity, tear secretion with the Schirmer test, tear break-up time, and fluorescein and lissamine green staining scores on the cornea and conjunctiva were examined before and at 1, 4, and 12 weeks after the addition. A subjective questionnaire of 14 symptoms was also assessed before and 12 weeks after treatment. RESULTS The fluorescein and lissamine green staining scores significantly improved over 12 weeks; however, the best-corrected visual acuity and tear secretion did not change. The symptoms of fatigue, dryness, grittiness, discomfort, difficulty in reading, and discomfort within the area of dryness improved after the additional DQS treatment. CONCLUSIONS The DQS treatment improved the subjective and objective symptoms of persistent dry eye after LASIK. Increased mucin production because of the addition of DQS probably improved the tear film stability and reduced the symptoms of dry eye in patients who had persistent dry eye after LASIK.
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Jung HH, Kang YS, Sung MS, Yoon KC. Clinical Efficacy of Topical 3% Diquafosol Tetrasodium in Short Tear Film Break-Up Time Dry Eye. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.3.339] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hyun Ho Jung
- Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea
| | - Yeon Soo Kang
- Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea
| | - Mi Sun Sung
- Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung Chul Yoon
- Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea
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Koh S, Maeda N, Ikeda C, Oie Y, Soma T, Tsujikawa M, Watanabe H, Nishida K. Effect of diquafosol ophthalmic solution on the optical quality of the eyes in patients with aqueous-deficient dry eye. Acta Ophthalmol 2014; 92:e671-5. [PMID: 24863298 DOI: 10.1111/aos.12443] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 04/16/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the short- and long-term effects of diquafosol ophthalmic solution on the optical quality of the eyes in patients with aqueous-deficient dry eye. METHODS Sixteen eyes in 16 patients with mild or moderate aqueous-deficient dry eye were treated with 3% diquafosol ophthalmic solution. Ocular higher-order aberrations (HOAs) were measured with a wavefront sensor before and at 15 min after diquafosol instillation at the baseline visit and at 4 weeks after treatment initiation. Dry eye symptoms, tear break-up time (BUT), corneal/conjunctival fluorescein staining and Schirmer's test were also evaluated before and after treatment with diquafosol. RESULTS Treatment with diquafosol ophthalmic solution significantly improved dry eye symptoms, corneal staining and BUT. Compared with mean total HOAs at baseline (0.180 ± 0.06 μm), those at 4 weeks after treatment significantly decreased (0.148 ± 0.039 μm; p = 0.035), whereas those 15 min after diquafosol instillation at the baseline visit did not change significantly (0.170 ± 0.049 μm; p = 0.279). CONCLUSIONS Although no significant change in HOAs was observed as a short-term effect of a single-drop instillation of diquafosol, long-term use of diquafosol to treat aqueous-deficient dry eye reduced HOAs as well as improved corneal epithelial damage and tear film stability.
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Affiliation(s)
- Shizuka Koh
- Department of Ophthalmology; Osaka University Graduate School of Medicine; Osaka Japan
| | - Naoyuki Maeda
- Department of Ophthalmology; Osaka University Graduate School of Medicine; Osaka Japan
| | - Chikako Ikeda
- Department of Ophthalmology; Osaka University Graduate School of Medicine; Osaka Japan
- Research & Development Division; Rohto; Kyoto Japan
| | - Yoshinori Oie
- Department of Ophthalmology; Osaka University Graduate School of Medicine; Osaka Japan
| | - Takeshi Soma
- Department of Ophthalmology; Osaka University Graduate School of Medicine; Osaka Japan
| | - Motokazu Tsujikawa
- Department of Ophthalmology; Osaka University Graduate School of Medicine; Osaka Japan
| | - Hitoshi Watanabe
- Department of Ophthalmology; Osaka University Graduate School of Medicine; Osaka Japan
| | - Kohji Nishida
- Department of Ophthalmology; Osaka University Graduate School of Medicine; Osaka Japan
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Current options and emerging therapies for anterior ocular inflammatory disease. Curr Opin Allergy Clin Immunol 2014; 14:485-9. [DOI: 10.1097/aci.0000000000000097] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Expression of the P2Y₂ receptor on the rat ocular surface during a 1-year rearing period. Jpn J Ophthalmol 2014; 58:515-21. [PMID: 25179431 DOI: 10.1007/s10384-014-0342-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 07/15/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE P2Y2 receptors are expressed on ocular surface tissues. Diquafosol ophthalmic solution (DIQUAS(®) ophthalmic solution 3 %; Santen Pharmaceutical Co., Ltd.) acts on these receptors and promotes the secretion of water and mucin. It has been shown to be an efficient dry eye treatment. If P2Y2 receptor expression on the ocular surface decreases with age, the effect of diquafosol may be reduced in elderly persons. In this study, we investigated the changes in P2Y2 receptor expression on the rat ocular surface over an extended period of time. METHODS P2Y2 receptor expression in the conjunctiva, cornea, meibomian gland and lacrimal glands of male and female Sprague-Dawley rats was examined from 5 weeks until 53 weeks of age using immunostaining and quantitative-PCR. RESULTS In the immunohistological examinations, P2Y2 receptor expression was observed in the conjunctival epithelium containing goblet cells, corneal epithelium, meibomian gland ductal epithelium and lacrimal gland ductal epithelium. However, its expression was not significantly different between each age group or between sexes. Regarding P2Y2 receptor mRNA expression, there was an age-related increase in the bulbar conjunctiva. In particular, a significant increase was observed in the 53-week-old age group as compared to the 5-week-old female age group. However, age-related changes in expression were not observed in the cornea or meibomian gland in males or females. CONCLUSIONS We observed no significant age-related decrease was observed for P2Y2 receptor protein and mRNA expression on rat ocular surface tissues.
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Terakado K, Yogo T, Kohara Y, Soeta S, Nezu Y, Harada Y, Hara Y, Amasaki H, Tagawa M. Conjunctival expression of the P2Y2 receptor and the effects of 3% diquafosol ophthalmic solution in dogs. Vet J 2014; 202:48-52. [PMID: 25178686 DOI: 10.1016/j.tvjl.2014.05.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 04/30/2014] [Accepted: 05/19/2014] [Indexed: 11/17/2022]
Abstract
Conjunctival epithelial and goblet cell P2Y2 nucleotide receptors regulate ion transport and secretory function. Diquafosol is a P2Y2 purinergic receptor agonist that stimulates secretion of aqueous tear components from conjunctival epithelial cells and secretion of mucin from conjunctival goblet cells. In humans suffering from keratoconjunctivitis sicca (dry eye), topical administration of diquafosol improves corneal epithelial integrity and stabilises the tear film. The aim of the present study was to investigate P2Y2 receptor expression and to determine the effect of topical administration of diquafosol on mucin and aqueous tear production in dogs. Canine conjunctival P2Y2 receptor expression was evaluated by Western blotting and immunohistochemical analysis. The effect of diquafosol on mucin secretion was evaluated by examining mucin-5 subtype AC (MUC5AC) concentration in tears. The effect of diquafosol on aqueous secretions was evaluated by performing the Schirmer tear test (STT) and phenol red thread test. Expression of the P2Y2 receptor was confirmed in canine bulbar and palpebral conjunctivae and receptors were identified at the conjunctival epithelial and goblet cell surface. Tear MUC5AC concentration significantly increased after administration of 3% diquafosol ophthalmic solution, although neither STT nor phenol red thread test values showed any significant change after diquafosol instillation. Topical ocular administration of 3% diquafosol might improve corneal epithelial disorders in dogs through stabilisation of the tear film, by virtue of an increase in MUC5AC secretion.
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Affiliation(s)
- Kunihiko Terakado
- Department of Veterinary Surgery, Nippon Veterinary and Life Science University, 1-7-1 Kyonancho, Musashino, Tokyo 180-8602, Japan.
| | - Takuya Yogo
- Department of Veterinary Surgery, Nippon Veterinary and Life Science University, 1-7-1 Kyonancho, Musashino, Tokyo 180-8602, Japan
| | - Yukihiro Kohara
- Department of Veterinary Anatomy, Nippon Veterinary and Life Science University, 1-7-1 Kyonancho, Musashino, Tokyo 180-8602, Japan
| | - Satoshi Soeta
- Department of Veterinary Anatomy, Nippon Veterinary and Life Science University, 1-7-1 Kyonancho, Musashino, Tokyo 180-8602, Japan
| | - Yoshinori Nezu
- Department of Veterinary Surgery, Nippon Veterinary and Life Science University, 1-7-1 Kyonancho, Musashino, Tokyo 180-8602, Japan
| | - Yasuji Harada
- Department of Veterinary Surgery, Nippon Veterinary and Life Science University, 1-7-1 Kyonancho, Musashino, Tokyo 180-8602, Japan
| | - Yasushi Hara
- Department of Veterinary Surgery, Nippon Veterinary and Life Science University, 1-7-1 Kyonancho, Musashino, Tokyo 180-8602, Japan
| | - Hajime Amasaki
- Department of Veterinary Anatomy, Nippon Veterinary and Life Science University, 1-7-1 Kyonancho, Musashino, Tokyo 180-8602, Japan
| | - Masahiro Tagawa
- Department of Veterinary Surgery, Nippon Veterinary and Life Science University, 1-7-1 Kyonancho, Musashino, Tokyo 180-8602, Japan
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Bremond-Gignac D, Gicquel JJ, Chiambaretta F. Pharmacokinetic evaluation of diquafosol tetrasodium for the treatment of Sjögren's syndrome. Expert Opin Drug Metab Toxicol 2014; 10:905-13. [PMID: 24797483 DOI: 10.1517/17425255.2014.915026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Dry eye is a multifactorial disease of the ocular surface causing ocular discomfort and visual impairment for the patient. A variety of topical and systemic drugs are available to treat dry eye. Conventional treatments are limited to tear supplementation or improvement of ocular surface inflammation by the use of corticosteroids or cyclosporine A. Treatment of severe dry eye associated with Sjögren's syndrome (SS) is even more challenging and is designed to improve the quality and quantity of tear fluid. Diquafosol tetrasodium , a P2Y2 purinergic receptor agonist, acts via a novel mechanism by activating P2Y2 receptors of the ocular surface. AREAS COVERED The aim of this review is to summarize the pharmacokinetics, and pharmacological and clinical data of 3% diquafosol tetrasodium ophthalmic solution in patients with dry eye, particularly SS. The mechanisms of impaired ocular surface due to severe dry eye, as defined by the International Dry Eye Workshop, are analyzed. EXPERT OPINION Diquafosol tetrasodium provides a novel mode of action in dry eye syndrome, including SS, by stimulating the quantity and quality of tear fluid secretion via various mechanisms. In clinical trials, 3% Diquafosol tetrasodium ophthalmic solution demonstrated a good safety profile and exhibited efficacy with clinical improvement of the ocular surface in dry eye including SS.
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Affiliation(s)
- Dominique Bremond-Gignac
- University Hospital, St Victor Center, Department of Ophthalmology , 354 Boulevard de Beauvillé, UPJV, Amiens , France +33 3 22 82 41 08 ; +33 3 22 82 40 61 ;
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Colligris B, Crooke A, Huete-Toral F, Pintor J. An update on dry eye disease molecular treatment: advances in drug pipelines. Expert Opin Pharmacother 2014; 15:1371-90. [PMID: 24773445 DOI: 10.1517/14656566.2014.914492] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Dry eye disease is a common disorder provoking changes in tear film and ocular surface. Untreated dry eye could cause ocular infections, corneal ulcer and blindness. Only a few drugs are authorized so far for the treatment of dry eye disease and the possibilities of evolution in this sector are immense. Consequently, a significant number of new potential solutions are under development or placed in the pharmaceutical pipeline, promising better results and lesser side effects. AREAS COVERED In this article, the corresponding literature and recent Phase III clinical trial data and the corresponding literature, for dry eye disease treatment are reviewed, revealing the new strategic movements in drug pipelines. EXPERT OPINION From the clinical trial results, the advancement in tear substitutes and secretagogues in addressing specific deficiencies of tear components even though not resolving the underlying conditions of the disease is evident. The vast majority of new compounds under development are anti-inflammatories, steroids, non-steroids and antibiotics; however, there are also some novel lubricating drops and mucin-tear secretagogues. A future aggressive therapy for dry eye, depending on the severity of the symptoms, would include combinations of soft steroids, anti-inflammatories, such as cyclosporine A, with the addition of the new polyvalent mucin and tear secretagogues.
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Affiliation(s)
- Basilio Colligris
- Universidad Complutense de Madrid, Departamento de Bioquimica y Biologia Molecular IV, Facultad de Optica y Optometria , C/Arcos de Jalon 118, 28037 Madrid , Spain +34 91 3946859 ; +34 91 3946885 ;
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