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Lebrun F, Marty PA, Quintyn JC, Thariat J, Bailleul H. [High energy proton therapy for extraocular tumors, neurotrophic keratitis and functional consequence: A series of 3 cases]. J Fr Ophtalmol 2023; 46:841-850. [PMID: 37625997 DOI: 10.1016/j.jfo.2023.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 08/27/2023]
Abstract
INTRODUCTION High energy proton therapy (HEP) is a form of radiation therapy using protons for extraocular tumors. Its ballistic properties are theoretically advantageous, but the real impact on the surrounding ocular tissues during cerebral and ENT irradiation is poorly documented. We describe three consecutive patients with corneal damage following such irradiation. MATERIALS/METHODS Post-proton therapy neurotrophic keratitis (NK) is defined as corneal hypo/anesthesia responsible for an alteration of corneal trophicity and graded according to the Mackie classification, in terms of a prospective ophthalmological follow-up protocol for all patients with extraocular tumors treated with HEP. RESULTS Among 193 patients treated with HEP between 2018 and 2021 for extraocular tumors, three patients developed severe neurotrophic keratitis, i.e. 1.6% of treated patients. According to the Mackie classification, the three patients showed grade 3 NK less than one year after the conclusion of their HEP. These three patients underwent amniotic membrane grafting. They were placed on autologous serum eye drops. Two of the three patients had to be eviscerated. The dose to the cornea was greater than 50 Gray (Gy)_Relative biological effectiveness (RBE) in the three cases. DISCUSSION The diagnosis and etiological origin of neurotrophic keratitis are often difficult to establish. In these cases, the imputability of radiation therapy, proton therapy in our cases, in the development of neurotrophic keratitis was plausible based on the dosimetry of the patients, all of whom had anterior tumors with a poor prognosis requiring high tumoricidal doses. CONCLUSION Further studies to establish the impact of proton therapy on corneal sensitivity are necessary. However, this feedback and the multidisciplinary management of tumors can help to limit the risk of some complications of radiation therapy. Early diagnosis allows for appropriate management and could possibly minimize the anatomical and functional ocular complications of neurotrophic keratitis.
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Affiliation(s)
- F Lebrun
- Centre hospitalier universitaire de Caen-Normandie, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France.
| | - P-A Marty
- Centre hospitalier universitaire de Caen-Normandie, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - J-C Quintyn
- Centre hospitalier universitaire de Caen-Normandie, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - J Thariat
- Laboratoire de Physique Corpusculaire/IN2P3-CNRS UMR 6534-ARCHADE, Unicaen-Université de Normandie, Centre François-Baclesse, 14000 Caen, France
| | - H Bailleul
- Hôpital privé de la Baie-d'Avranches, 50300 Avranches, France
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2
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Abstract
Neurotrophic keratopathy (NK), or neurotrophic keratitis, is a degenerative condition that results from decreased innervation to the cornea. The cornea is innervated by the ophthalmic branch of the trigeminal nerve. Neurotrophic keratopathy is most commonly caused by herpes keratitis however, any condition that disrupts the normal corneal innervation can cause NK. Neurotrophic keratopathy is a clinical diagnosis and is classified into three stages based on the disease severity. Stage 1 has mild epithelial defects, such as punctate keratopathy, stage 2 disease has persistent epithelial defects, and stage 3 is defined by the presence of ulcers. Current treatment modalities consist of medical and surgical options. Stage 1 is treated with lubrication through artificial tears, eyelid taping, and punctal plug/cautery. Stage 2 treatment can involve therapeutic contact lenses, topical autologous or allogenic serum, tarsorrhaphy, botulinum toxin injections, and possibly anti-inflammatory medications. Stage 3 disease may require human nerve growth factor, amniotic membrane transplantation, conjunctival flap, or corneal neurotization. New therapies, such as matrix regenerating therapy, plasma rich in growth factors, Thymosin β4, Substance P/Insulin like growth factor-1, and nicergoline represent exciting future options.KEY MESSAGESNeurotrophic keratopathy is a rare degenerative disease defined by decreased innervation to the cornea that is associated with significant morbidity.Treatment options range from lubrication alone to various medical and surgical treatments.Matrix regenerating therapy, plasma rich in growth factors, Thymosin β4, Substance P/Insulin like growth factor-1, and nicergoline are exciting novel therapies that will influence how neurotrophic keratopathy is treated in the future.
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Affiliation(s)
- Erin NaPier
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Matthew Camacho
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Timothy F McDevitt
- Section of Ophthalmology, Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Adam R Sweeney
- Section of Ophthalmology, Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
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3
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Mutual Jellification of Two Bactericidal Cationic Polymers: Synthesis and Physicochemical Characterization of a New Two-Component Hydrogel. Pharmaceutics 2022; 14:pharmaceutics14112444. [PMID: 36432635 PMCID: PMC9692830 DOI: 10.3390/pharmaceutics14112444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/29/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
Here, a new two-component hydrogel (CP1OP2-Hgel) was developed, simply by dispersing in water two cationic bactericidal polymers (CP1 and OP2) effective against several multidrug-resistant (MDR) clinical isolates of the most relevant Gram-positive and Gram-negative species. Interestingly, while OP2 acts only as an antibacterial ingredient when in gel, CP1 works as both an antibacterial and a gelling agent. To verify whether it would be worthwhile to use CP1 and OP2 as bioactive ingredients of a new hydrogel supposed for a future treatment of skin infections, dose-dependent cytotoxicity studies with CP1 and OP2 were performed on human fibroblasts for 24 h, before preparing the formulation. Although a significant cytotoxicity at concentrations > 2 µM was evidenced for both polymers, selectivity indices (SIs) over 12 (CP1) and up to six (OP2) were determined, due to the powerful antibacterial properties of the two polymers, thus supporting the rationale for their formulation as a hydrogel. The chemical structure and morphology of CP1OP2-Hgel were investigated by PCA-assisted attenuated total reflectance (ATR) Fourier-transform infrared (FTIR) analysis and scanning electron microscopy (SEM), while its rheological properties were assessed by determining its dynamic viscosity. The cumulative weight loss and swelling percentage curves, the porosity, and the maximum swelling capability of CP1OP2-Hgel were also determined and reported. Overall, due to the potent bactericidal effects of CP1 and OP2 and their favorable selectivity indices against several MDR pathogens, good rheological properties, high porosity, and strong swelling capability, CP1OP2-Hgel may, in the future, become a new weapon for treating severe nosocomial skin infections or infected chronic wounds. Further investigations in this sense are currently being carried out.
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Zhou X, Zhang X, Zhou D, Zhao Y, Duan X. A Narrative Review of Ocular Surface Disease Related to Anti-Glaucomatous Medications. Ophthalmol Ther 2022; 11:1681-1704. [PMID: 35943668 PMCID: PMC9437175 DOI: 10.1007/s40123-022-00557-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/29/2022] [Indexed: 01/31/2023] Open
Abstract
Topical anti-glaucomatous medications are still the most important measure to lower intraocular pressure. Large number of studies have confirmed that long-term use of anti-glaucomatous eye drops, especially containing benzalkonium chloride, a preservative, can cause or aggravate ocular surface injury. Ocular surface diseases damage the ocular microenvironmental health status, reduce the patients’ compliance with the treatment, and finally affect the treatment result. Therefore, the ocular surface management of patients with glaucoma is very important. This includes the selection of drugs that are better tolerated according to individual conditions, preservative-free formulations, drugs that protect against ocular surface disease, or selecting surgery and laser treatment, to prevent the damage to the ocular surface by topical anti-glaucomatous drugs.
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Affiliation(s)
- Xiaoyu Zhou
- Changsha Aier Eye Hospital, Changsha, Hunan Province, China.,The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Xinyue Zhang
- Changsha Aier Eye Hospital, Changsha, Hunan Province, China.,The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Dengming Zhou
- The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Yang Zhao
- Changsha Aier Eye Hospital, Changsha, Hunan Province, China.,The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Xuanchu Duan
- Changsha Aier Eye Hospital, Changsha, Hunan Province, China. .,Aier School of Ophthalmology, Central South University, Changsha, Hunan Province, China.
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5
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Fineide F, Lagali N, Adil MY, Arita R, Kolko M, Vehof J, Utheim TP. Topical glaucoma medications – Clinical implications for the ocular surface. Ocul Surf 2022; 26:19-49. [DOI: 10.1016/j.jtos.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 11/25/2022]
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6
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Wang J, Zhao Y, Yu AY, Wu J, Zhu M, Jiang M, Li X, Zhu D, Zhang P, Zheng X, Bao F, Elsheikh A. Effect of travoprost, latanoprost and bimatoprost PGF2α treatments on the biomechanical properties of in-vivo rabbit cornea. Exp Eye Res 2022; 215:108920. [PMID: 35007519 DOI: 10.1016/j.exer.2022.108920] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 12/07/2021] [Accepted: 12/31/2021] [Indexed: 11/04/2022]
Abstract
Prostaglandin F2α analogues (PGF2α), one of the most commonly prescribed classes of hypotensive agents, could decrease collagen fibril density and remodel the extracellular matrix in cornea. We hypothesized that PGF2α's would induce corneal softening, reduce the accuracy of intraocular pressure (IOP) measurement and lead to uncertainty in the effectiveness of the therapy. We determined the stress-strain behavior of rabbit cornea after PGF2α usage and evaluated the effect of biomechanical changes associated with PGF2α treatment on IOP measurements by Goldmann Applanation Tonometry (GAT). The tangent modulus decreased after PGF2α treatment, while the stromal interfibrillar spacing increased. PGF2α was shown to also affect the lateral eye with lower effect, which did not undergo direct eyedrop treatment. Significant decreases in the numerical predictions of GAT-IOP were predicted in all treated groups relative to control groups. Different PGF2α's (travoprost, latanoprost and bimatoprost) were associated with different extents of reduction in tissue stiffness and changes in corneal microstructure. PGF2α-induced changes in corneal mechanical properties could reduce the accuracy of IOP measurement and may cause an overestimation of the effect of PGF2α in lowering IOP, possibly leading to uncertainties in glaucoma management.
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Affiliation(s)
- JunJie Wang
- Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China; The Institute of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, 325027, China
| | - YiPing Zhao
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200025, China
| | - AYong Yu
- Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Jie Wu
- Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - ManMan Zhu
- Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - MuChen Jiang
- Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Xuefei Li
- Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - DaTian Zhu
- Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - PeiPei Zhang
- Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - XiaoBo Zheng
- Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China; The Institute of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, 325027, China.
| | - FangJun Bao
- Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China; The Institute of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, 325027, China.
| | - Ahmed Elsheikh
- School of Engineering, University of Liverpool, Liverpool, L69 3GH, UK; National Institute for Health Research (NIHR) Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK; Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
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7
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Garofalo R, Kunnen C, Rangarajan R, Manoj V, Ketelson H. Relieving the symptoms of dry eye disease: update on lubricating eye drops containing hydroxypropyl-guar. Clin Exp Optom 2021; 104:826-834. [PMID: 34137675 DOI: 10.1080/08164622.2021.1925208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Hydroxypropyl-guar (HPG) is a thickening agent first added to lubricating eye drops in 2003. This agent, which enhances viscosity, has been used in the SYSTANE® family of lubricant eye drops (Alcon Laboratories, Inc., Fort Worth, TX, USA). HPG forms a partially linked gel with borate to prolong the retention of demulcents, such as polyethylene glycol and propylene glycol, on the eye. This helps to protect the ocular surface, thereby reducing the symptoms of dry eye disease (DED). The definition of DED has evolved with advances in research, leading to changes in HPG-containing eye care solutions. This article reviews current knowledge on the use of HPG-containing lubricating eye drops in the management of DED.
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Affiliation(s)
- Renee Garofalo
- Research & Development, Alcon Research, LLC, Fort Worth, TX, USA
| | - Carolina Kunnen
- Research & Development, Alcon Research, LLC, Fort Worth, TX, USA
| | | | | | - Howard Ketelson
- Research & Development, Alcon Vision, LLC, Fort Worth, TX, USA
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8
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Zhu R, Zheng X, Guo L, Zhao Y, Wang Y, Wu J, Yu AY, Wang J, Bao F, Elsheikh A. Biomechanical Effects of Two Forms of PGF2α on Ex-vivo Rabbit Cornea. Curr Eye Res 2020; 46:452-460. [PMID: 32795212 DOI: 10.1080/02713683.2020.1805771] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To investigate the biomechanical effects of two synthetic prostaglandin F2α analogues (PGF2α), namely Travoprost and Tafluprost, on the ex-vivo rabbit cornea. MATERIALS AND METHODS Ninety-six eyes of 48 Japanese white rabbits were divided into 3 equal groups randomly; the Travoprost treated group (Tra), the Tafluprost treated group (Taf) and the control group (Co). Eyes in Tra and Taf groups were preserved in storage medium for 10 days with 1:10 Travoprost and Tafluprost diluents, respectively; while the Co eyes were preserved in a similar but PGF2α-free medium. Twenty-four corneas of each group were tested under inflation conditions with up to 30 mmHg posterior pressure. The pressure-deformation data obtained experimentally were used in an inverse analysis process to derive the stress-strain behavior of the tissue, using which the tangent modulus, a direct measure of the tissue's material stiffness, was calculated. The remaining eight specimens of each group were analyzed using electron microscopy for fibril diameter and interfibrillar spacing. RESULTS Although the central corneal thickness increased significantly in the three groups after storage (p < .01), it was similar in all groups both before (p = .598) and after storage (p = .181). After treatment with Travoprost and Tafluprost, the corneas exhibited lower tangent modulus (by 29.2% and 29.8%, respectively, at 6 kPa stress) and larger stromal interfibril spacing (by 21.9% and 23.6%) compared with the control group. There was no significant change in fibril diameter with either Travoprost or Tafluprost treatment (p = .769). CONCLUSIONS The results demonstrated significant reductions in tangent modulus and increases in interfibrillar spacing, which were of similar magnitudes, with the application of two different forms of PGF2α.
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Affiliation(s)
- Rong Zhu
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - XiaoBo Zheng
- Eye Hospital, Wenzhou Medical University, Wenzhou, China.,The Institution of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, China
| | - LiLi Guo
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - YiPing Zhao
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yuan Wang
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Jie Wu
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - AYong Yu
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - JunJie Wang
- Eye Hospital, Wenzhou Medical University, Wenzhou, China.,The Institution of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, China
| | - FangJun Bao
- Eye Hospital, Wenzhou Medical University, Wenzhou, China.,The Institution of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, China
| | - Ahmed Elsheikh
- School of Engineering, University of Liverpool, Liverpool, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
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9
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Walsh K, Jones L. The use of preservatives in dry eye drops. Clin Ophthalmol 2019; 13:1409-1425. [PMID: 31447543 PMCID: PMC6682755 DOI: 10.2147/opth.s211611] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/03/2019] [Indexed: 12/14/2022] Open
Abstract
Topical ocular preparations are widely recommended by health care professionals, or chosen by patients, to help manage dry eye disease (DED). The chronic and progressive nature of DED may result in the administration of topical products several times a day, over a period of many years. Given DED is a condition that by definition affects the ocular surface, it is important to understand how the repeated use of eye drops may impact the ocular surface, influence clinical signs, affect symptoms, and impact the overall disease process of dry eye. The component in topical preparations with the greatest potential to adversely affect the ocular surface is the preservative. This paper reviews the literature in relation to the use of preservatives in formulations for dry eye. The ocular effects of benzalkonium chloride (BAK) are summarised and compared to the performance of alternative preservatives and preservative-free formulations. Use of preserved and preservative-free drops in relation to the management of varying stages of DED is discussed.
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Affiliation(s)
- Karen Walsh
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, N2L 3G1, Canada
| | - Lyndon Jones
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, N2L 3G1, Canada
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Zheng X, Wang Y, Zhao Y, Cao S, Zhu R, Huang W, Yu AY, Huang J, Wang Q, Wang J, Bao F, Elsheikh A. Experimental Evaluation of Travoprost-Induced Changes in Biomechanical Behavior of Ex-Vivo Rabbit Corneas. Curr Eye Res 2018; 44:19-24. [PMID: 30273056 DOI: 10.1080/02713683.2018.1516781] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- XiaoBo Zheng
- Eye Hospital, WenZhou Medical University, Wenzhou, China
- The institution of ocular biomechanics, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Yuan Wang
- Eye Hospital, WenZhou Medical University, Wenzhou, China
| | - YiPing Zhao
- Eye Hospital, WenZhou Medical University, Wenzhou, China
| | - Si Cao
- Eye Hospital, WenZhou Medical University, Wenzhou, China
| | - Rong Zhu
- Eye Hospital, WenZhou Medical University, Wenzhou, China
| | - Wei Huang
- Eye Hospital, WenZhou Medical University, Wenzhou, China
| | - AYong Yu
- Eye Hospital, WenZhou Medical University, Wenzhou, China
| | - JinHai Huang
- Eye Hospital, WenZhou Medical University, Wenzhou, China
| | - QinMei Wang
- Eye Hospital, WenZhou Medical University, Wenzhou, China
- The institution of ocular biomechanics, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - JunJie Wang
- Eye Hospital, WenZhou Medical University, Wenzhou, China
- The institution of ocular biomechanics, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - FangJun Bao
- Eye Hospital, WenZhou Medical University, Wenzhou, China
- The institution of ocular biomechanics, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Ahmed Elsheikh
- School of Engineering, University of Liverpool, Liverpool, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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Alio JL, Rodriguez AE, De Arriba P, Gisbert S, Abdelghany AA. Treatment with platelet-rich plasma of surgically related dormant corneal ulcers. Eur J Ophthalmol 2018; 28:515-520. [PMID: 29566537 DOI: 10.1177/1120672117747042] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To assess the effectiveness of autologous platelet-rich plasma for the treatment of dormant corneal ulcers secondary to corneal surgery and unresponsive to conventional treatment. SETTING VISSUM, Ophthalmology Institute of Alicante, Alicante, Spain. DESIGN Prospective nonrandomized, observational consecutive study. METHODS A total of 44 eyes of 28 patients with dormant corneal ulcers secondary to corneal surgery were included in a prospective study and treated with autologous platelet-rich plasma during 6 weeks. Wilcoxon signed-rank test was used to compare the effect of the treatment. RESULTS In all, 28 patients (65.1%) improved their visual acuity at least one line in Snellen chart, 26 (59.09%) had a decrease in the size of the ulcer or even a total closure, and 40 (90.9%) experienced an improvement in their symptoms. The results are also provided for the four groups of patients (keratoplasty, refractive surgery, cross-linking, and chronic postsurgical corneal edema). CONCLUSION Platelet-rich plasma eye drops shows to be a good option for the treatment of dormant corneal ulcers secondary to corneal surgery.
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Affiliation(s)
- Jorge L Alio
- 1 Research, Development and Innovation Department, VISSUM, Alicante, Spain.,3 Faculty of Medicine, Miguel Hernandez University, Alicante, Spain
| | | | - Pablo De Arriba
- 1 Research, Development and Innovation Department, VISSUM, Alicante, Spain
| | - Sandra Gisbert
- 2 Department of Cornea and Refractive Surgery, VISSUM, Alicante, Spain
| | - Ahmed A Abdelghany
- 1 Research, Development and Innovation Department, VISSUM, Alicante, Spain.,4 Ophthalmology Department, Faculty of Medicine, Minia University, Minia, Egypt
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12
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Rönkkö S, Vellonen KS, Järvinen K, Toropainen E, Urtti A. Human corneal cell culture models for drug toxicity studies. Drug Deliv Transl Res 2017; 6:660-675. [PMID: 27613190 PMCID: PMC5097077 DOI: 10.1007/s13346-016-0330-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In vivo toxicity and absorption studies of topical ocular drugs are problematic, because these studies involve invasive tissue sampling and toxic effects in animal models. Therefore, different human corneal models ranging from simple monolayer cultures to three-dimensional models have been developed for toxicological prediction with in vitro models. Each system has its own set of advantages and disadvantages. Use of non-corneal cells, inadequate characterization of gene-expression profiles, and accumulation of genomic aberrations in human corneal models are typical drawbacks that decrease their reliability and predictive power. In the future, further improvements are needed for verifying comparable expression profiles and cellular properties of human corneal models with their in vivo counterparts. A rapidly expanding stem cell technology combined with tissue engineering may give future opportunities to develop new tools in drug toxicity studies. One approach may be the production of artificial miniature corneas. In addition, there is also a need to use large-scale profiling approaches such as genomics, transcriptomics, proteomics, and metabolomics for understanding of the ocular toxicity.
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Affiliation(s)
- Seppo Rönkkö
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, P.O.Box 1627, 70211, Kuopio, Finland
| | - Kati-Sisko Vellonen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, P.O.Box 1627, 70211, Kuopio, Finland
| | - Kristiina Järvinen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, P.O.Box 1627, 70211, Kuopio, Finland
| | - Elisa Toropainen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, P.O.Box 1627, 70211, Kuopio, Finland
| | - Arto Urtti
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, P.O.Box 1627, 70211, Kuopio, Finland. .,Centre for Drug Research, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, P.O. Box 56, 00014, Helsinki, Finland.
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The Effects of Latanoprost With Benzalkonium Chloride Versus Travoprost With SofZia on the Ocular Surface. Eye Contact Lens 2017; 44 Suppl 2:S93-S98. [PMID: 28617732 DOI: 10.1097/icl.0000000000000405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess ocular surface changes in participants using latanoprost with benzalkonium chloride (Xalatan) and travoprost with SofZia (Travatan Z). METHODS In this prospective, open-label, nonrandomized cohort study, participants were classified into two groups: group 1 (n=28) naive to glaucoma therapy, group 2 (n=27) on previous Xalatan monotherapy in both eyes. Both groups started (or continued) Xalatan in the right eye and Travatan Z in the left eye. Baseline, 1-, and 2-month measurements of tear breakup time (TBUT), corneal staining score, conjunctival staining score, conjunctival hyperemia score, tear production, and intraocular pressure were obtained. The Ocular Surface Disease Index questionnaire measured participants' comfort and dryness symptoms. Medication preference was recorded. RESULTS Data were collected from 55 participants. Tear breakup time at baseline and 1-month follow-up in group 1 was significantly longer than that of group 2 (P=0.005). At 2 months, there was no significant difference in TBUT between the two groups (P=0.779). Tear production in group 1 at all three time points was significantly higher than group 2 (P<0.05). Conjunctival staining score at 2 months in group 1 was significantly higher than group 2 (P=0.031). There was no significant difference in other parameters between the groups at any other time point. No significant difference in any parameter was found between Xalatan and Travatan Z (intragroup comparison). CONCLUSIONS Significant differences in ocular surface characteristics were detected between groups, but no significant difference was detected between participants treated with Xalatan and Travatan Z.
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14
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Hakkarainen JJ, Reinisalo M, Ragauskas S, Seppänen A, Kaja S, Kalesnykas G. Acute cytotoxic effects of marketed ophthalmic formulations on human corneal epithelial cells. Int J Pharm 2016; 511:73-78. [PMID: 27374205 DOI: 10.1016/j.ijpharm.2016.06.135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 06/28/2016] [Accepted: 06/29/2016] [Indexed: 01/03/2023]
Abstract
The purpose of the study was to devise a fast, reliable and sensitive cell viability assay for assessment of acute cytotoxicity on human corneal epithelial cells by using a clinically relevant exposure time. Acute cytotoxic effects of the pharmaceutical excipients benzalkonium chloride (BAC), macrogolglycerol hydroxystearate (MGHS40), polysorbate 80 (PS80) and marketed ophthalmic formulations (Lumigan(®), Monoprost(®), Taflotan(®), Travatan(®), Xalatan(®)) containing these excipients were tested. Human corneal epithelial cell (HCE-T) viability was assessed by measuring the reduction of resazurin to highly fluorescent resorufin. Expression of the tight junction proteins in HCE-T cells were characterized by immunofluorescence staining. Presence of tight junction proteins in HCE-T cells was demonstrated. BAC preserved ophthalmic formulations showed concentration-dependent and time-dependent cytotoxicity to human corneal epithelium. In contrast, no acute cytotoxicity of non-ionic stabilizing/solubilizing excipients (MGSH40 and PS80) or ophthalmic formulation containing these excipients was observed. Marketed ophthalmic formulations used for glaucoma medication show differential toxicity on human corneal epithelial cells. The present study revealed that BAC-preserved ophthalmic formulations were able to induce acute cytotoxic effects even during a clinically relevant exposure time, which was not observed with MGSH40 and PS80 excipients or ophthalmic formulations containing these excipients.
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Affiliation(s)
- Jenni J Hakkarainen
- R&D department, Experimentica Ltd., P.O. Box 1199, FI-70211 Kuopio, Finland.
| | - Mika Reinisalo
- R&D department, Experimentica Ltd., P.O. Box 1199, FI-70211 Kuopio, Finland; School of Pharmacy, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Symantas Ragauskas
- R&D department, Experimentica Ltd., P.O. Box 1199, FI-70211 Kuopio, Finland; State Research Institute for Innovative Medicine, Vilnius, Lithuania
| | - Aila Seppänen
- R&D department, Experimentica Ltd., P.O. Box 1199, FI-70211 Kuopio, Finland
| | - Simon Kaja
- R&D department, Experimentica Ltd., P.O. Box 1199, FI-70211 Kuopio, Finland; Department of Ophthalmology, Stritch School of Medicine, Loyola University Chicago, 2160 S. First Ave, Maywood, IL 60153, USA; K&P Scientific LLC, P.O. Box 1432, Hines, IL 60141, USA
| | - Giedrius Kalesnykas
- R&D department, Experimentica Ltd., P.O. Box 1199, FI-70211 Kuopio, Finland; Department of Ophthalmology, SILK, School of Medicine, University of Tampere, Biokatu 14, FI-33520 Tampere, Finland
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Lusthaus JA, Goldberg I. Emerging drugs to treat glaucoma: targeting prostaglandin F and E receptors. Expert Opin Emerg Drugs 2016; 21:117-28. [DOI: 10.1517/14728214.2016.1151001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Suzuki K, Teranishi S, Sagara T, Yoshino H, Nakayama M, Enoki M, Nuno Y, Hirano S, Wakuta M, Takahashi N, Tokuhisa K, Kondo Y, Shiraishi R, Ishida Y, Sonoda KH. Safety and Efficacy of Benzalkonium Chloride-optimized Tafluprost in Japanese Glaucoma Patients With Existing Superficial Punctate Keratitis. J Glaucoma 2015; 24:e145-50. [PMID: 24240881 DOI: 10.1097/ijg.0000000000000020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of benzalkonium chloride (BAK)-optimized tafluprost (with a BAK concentration reduced from 0.01% to 0.001%) in glaucoma patients with existing superficial punctate keratitis (SPK). PATIENTS AND METHODS A prospective, multicenter, open-label study was designed to compare BAK-optimized tafluprost administered over 12 weeks relative to other preserved prostaglandin analogs previously administered in Japanese glaucoma patients. Thirty patients with SPK graded at <6 points by area density (AD) scoring in 1 eye were recruited. The primary outcome measure was change in AD score at 12 weeks after the switch in treatment compared with that at baseline. Secondary outcome measures included changes in tear film breakup time (TBUT), hyperemia score, and intraocular pressure (IOP). Four patients were excluded from analysis because of treatment discontinuation. RESULTS Mean AD score±SD decreased significantly from 3.4±0.9 to 1.8±1.8 after the switch (P<0.0001). Mean TBUT increased significantly from 6.3±3.3 to 8.0±4.2 seconds (P<0.01). Mean hyperemia score remained unchanged, whereas mean IOP decreased significantly from 15.6±2.6 to 14.4±2.0 mm Hg (P<0.01). For patients previously treated with BAK-preserved latanoprost (n=17) or bimatoprost (n=2), mean AD score decreased significantly from 3.4±0.9 to 1.8±1.8 (P<0.01) and mean TBUT increased significantly from 6.4±3.6 to 8.2±4.3 seconds (P<0.01); no such changes were apparent for patients previously treated with sofZia-preserved travoprost (n=7). CONCLUSIONS BAK-optimized tafluprost is a treatment option to improve the condition of the ocular surface and to maintain IOP control in glaucoma patients with existing SPK who have been previously treated with other BAK-preserved prostaglandin analogs.
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Affiliation(s)
- Katsuyoshi Suzuki
- *Department of Ophthalmology, Graduate School of Medicine, Yamaguchi University **Ube Industires Ltd. Central Hospital, Ube †Sagara Eye Clinic, Hagi ‡Tokuyama Central Hospital, Shunan §Saiseikai Shimonoseki General Hospital ¶Shimonoseki Kousei Hospital ††Toyota Central Hospital, Shimonoseki ∥Ogori Daiichi General Hospital, Yamaguchi #Yamaguchi Grand Medical Center, Hofu, Yamaguchi, Japan
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17
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Mantelli F, Nardella C, Tiberi E, Sacchetti M, Bruscolini A, Lambiase A. Congenital Corneal Anesthesia and Neurotrophic Keratitis: Diagnosis and Management. BIOMED RESEARCH INTERNATIONAL 2015; 2015:805876. [PMID: 26451380 PMCID: PMC4588028 DOI: 10.1155/2015/805876] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 07/29/2015] [Indexed: 11/30/2022]
Abstract
Neurotrophic keratitis (NK) is a rare degenerative disease of the cornea caused by an impairment of corneal sensory innervation, characterized by decreased or absent corneal sensitivity resulting in epithelial keratopathy, ulceration, and perforation. The aetiopathogenesis of corneal sensory innervation impairment in children recognizes the same range of causes as adults, although they are much less frequent in the pediatric population. Some extremely rare congenital diseases could be considered in the aetiopathogenesis of NK in children. Congenital corneal anesthesia is an extremely rare condition that carries considerable diagnostic and therapeutic problems. Typically the onset is up to 3 years of age and the cornea may be affected in isolation or the sensory deficit may exist as a component of a congenital syndrome, or it may be associated with systemic somatic anomalies. Accurate diagnosis and recognition of risk factors is important for lessening long-term sequelae of this condition. Treatment should include frequent topical lubrication and bandage corneal or scleral contact lenses. Surgery may be needed in refractory cases. The purpose of this review is to summarize and update data available on congenital causes and treatment of corneal hypo/anesthesia and, in turn, on congenital NK.
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Affiliation(s)
- Flavio Mantelli
- Department of Biology, College of Science and Technology, Temple University, 1900 N. 12 Street, Philadelphia, PA 19122, USA
| | - Chiara Nardella
- Department of Sense Organs, Sapienza University, Viale del Policlinico 155, 00186 Rome, Italy
| | - Eloisa Tiberi
- Neonatology Unit, Università Cattolica del Sacro Cuore Roma-Gemelli, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Marta Sacchetti
- Cornea and Ocular Surface Unit, Ospedale San Raffaele IRCCS, Via Olgettina 60, 20132 Milan, Italy
| | - Alice Bruscolini
- Department of Sense Organs, Sapienza University, Viale del Policlinico 155, 00186 Rome, Italy
| | - Alessandro Lambiase
- Department of Sense Organs, Sapienza University, Viale del Policlinico 155, 00186 Rome, Italy
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Kimakura M, Usui T, Yokoo S, Nakagawa S, Yamagami S, Amano S. Toxicity of topical antifungal agents to stratified human cultivated corneal epithelial sheets. J Ocul Pharmacol Ther 2015; 30:810-4. [PMID: 25280055 DOI: 10.1089/jop.2014.0044] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Prolonged use of topical antifungal agents may compromise corneal epithelial integrity. Here, we used an in vitro model of human stratified corneal epithelium to compare the ocular toxicity profiles of 4 different antifungal eye drops. METHODS Human corneal epithelial cell sheets were cultured in a serum-free medium containing 0.1% micafungin, 1% voriconazole, 5% pimaricin, 0.1% amphotericin B, or controls (saline or 5% glucose). Cell viability and barrier function were measured by WST-1 assay and carboxyfluorescein permeability assay, respectively. Cell migration was measured on a wound healing assay. RESULTS WST-1 assay and carboxyfluorescein permeability assay revealed that amphotericin B was the most toxic drug, followed by pimaricin, micafungin, and voriconazole. Cell migration on a wound healing assay was decreased in the following order, amphotericin B, pimaricin, micafungin, and voriconazole. CONCLUSIONS Topical micafungin and voriconazole appeared to be the least toxic to the corneal epithelium. Drug prescription should consider not only fungal species and susceptibility but also ocular toxicity and stage of treatment.
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Affiliation(s)
- Mikiko Kimakura
- Department of Ophthalmology, University of Tokyo School of Medicine , Tokyo, Japan
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Daull P, Lallemand F, Garrigue JS. Benefits of cetalkonium chloride cationic oil-in-water nanoemulsions for topical ophthalmic drug delivery. ACTA ACUST UNITED AC 2014; 66:531-41. [PMID: 24001405 PMCID: PMC4283994 DOI: 10.1111/jphp.12075] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 04/07/2013] [Indexed: 02/06/2023]
Abstract
Objectives Topical ocular administration is the most convenient route of administration of drugs for the treatment of eye diseases. However, the bioavailability of drugs following eye instillations of eye drops is very low. Over the past 20 years, extensive efforts have been put into research to improve drug bioavailability without compromising treatment compliance and patients' quality of life. Key findings One of the most efficient ways to improve drug bioavailability is to increase the precorneal residence time of the eye drop formulations. As a result, new eye drops, with bioadhesive properties, have been developed based on the cationic oil-in-water (o/w) nanoemulsion technology. These low viscosity eye drop nanoemulsions have improved precorneal residence time through the electrostatic interactions between the positively charged oil nanodroplets and the negatively charged ocular surface epithelium. Summary This review is the first to present the benefits of this new strategy used to improve ocular drug bioavailability. The roles of the cationic agent in the stabilization of a safe cationic o/w nanoemulsion have been discussed, as well as the unexpected benefits of the cationic o/w nanoemulsion for the protection and restoration of a healthy tear film and corneal epithelium.
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20
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Craven ER, Alzuhairy SA. Bimatoprost: a unique compound that in its nonhydrolyzed form is a prostamide and hydrolyzed form has prostaglandin receptor activity, for glaucoma and cosmetic indications. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/17469899.2014.917959] [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: 11/08/2022]
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21
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Campbell JH, Schwartz GF, LaBounty B, Kowalski JW, Patel VD. Patient adherence and persistence with topical ocular hypotensive therapy in real-world practice: a comparison of bimatoprost 0.01% and travoprost Z 0.004% ophthalmic solutions. Clin Ophthalmol 2014; 8:927-35. [PMID: 24868144 PMCID: PMC4027934 DOI: 10.2147/opth.s49467] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Effective control of intraocular pressure is predicated upon patient compliance with pharmacotherapy. We compared patient adherence and persistence with two new ocular hypotensive formulations, using real-world utilization data. METHODS This observational cohort study employed pharmacy claims data from the Source(®) Lx (Wolters Kluwer Pharma Solutions) database. Patients with an initial (index) prescription for topical bimatoprost 0.01% or travoprost Z (April to June 2011) and no claim for ophthalmic prostaglandin or prostamide analogs within the previous 18 months were identified. Treatment adherence was expressed as proportion of days covered with study medication during the first 365 days after the index prescription. Treatment persistence with study medication was assessed over the first 12 months using Kaplan-Meier survival analyses, allowing a maximum 30-day gap for prescription refill. Treatment status was determined monthly over this period. RESULTS A total of 12,985 patients were assessed for treatment adherence, and 10,470 for treatment persistence. Adherence was better with bimatoprost 0.01% than with travoprost Z (mean proportion of days covered 0.540 versus [vs] 0.486, P<0.001), and more patients showed high adherence (proportion of days covered >0.80) with bimatoprost 0.01% than travoprost Z (29.1% vs 22.3%, P<0.001). Continuous 12-month persistence was higher with bimatoprost 0.01% than with travoprost Z (29.5% vs 24.2%, P<0.001). At month 12, more patients were on treatment with bimatoprost 0.01% than travoprost Z (48.8% vs 45.7%, P<0.01). Similar findings were demonstrated in cohorts of ocular hypotensive treatment-naïve patients, branded latanoprost switchers, and older patients (age ≥65 years), and after inclusion of patient characteristics as covariates. CONCLUSION For patients with glaucoma or ocular hypertension, bimatoprost 0.01% offers compliance advantages over travoprost Z.
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Affiliation(s)
| | - Gail F Schwartz
- Greater Baltimore Medical Center and Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
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Niwano Y, Iwasawa A, Ayaki M. Ocular surface cytotoxicity and safety evaluation of tafluprost, a recently developed anti-glaucoma prostaglandin analog. OPHTHALMOLOGY AND EYE DISEASES 2014; 6:5-12. [PMID: 24558301 PMCID: PMC3928056 DOI: 10.4137/oed.s12445] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 12/11/2013] [Accepted: 12/12/2013] [Indexed: 11/05/2022]
Abstract
In vitro cytotoxicity of tafluprost, which is the most recently developed anti-glaucoma prostaglandin (PG) analog, in ocular surface cells is addressed in comparison with other PG analogs. Irrespective of cell lines and models, the cytotoxicity of anti-glaucoma PG eyedrops was primarily related to the concentration of benzalkonium chloride (BAK) contained in the eyedrops as a preservative. Accordingly, preservative-free tafluprost was apparently less cytotoxic than BAK-preserved PG analogs. Furthermore, our study for cytotoxicity assays on ocular cells, conducted by comprehensive investigations covering a variety of concentrations and treatment times, which is termed the cell viability score (CVS) system, demonstrated that 0.001% BAK-preserved tafluprost was not cytotoxic, and suggested that tafluprost may even reduce the cytotoxic effect of BAK. It has been reported that adverse reactions associated with tafluprost in healthy human volunteers and patients with glaucoma include conjunctival hyperemia, eyelid pigmentation, eyelash bristles, and deepening of upper eyelid sulcus. Nonetheless, most clinical studies have demonstrated that not only preservative-free tafluprost but also BAK-preserved tafluprost is well tolerated and safe in patients with glaucoma and ocular hypertension.
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Affiliation(s)
- Yoshimi Niwano
- Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Atsuo Iwasawa
- Department of Bioengineering, Tokyo Institute of Technology, Yokohama, Japan
| | - Masahiko Ayaki
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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Semeraro F, Forbice E, Romano V, Angi M, Romano MR, Filippelli ME, Di Iorio R, Costagliola C. Neurotrophic keratitis. ACTA ACUST UNITED AC 2013; 231:191-7. [PMID: 24107451 DOI: 10.1159/000354380] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 07/10/2013] [Indexed: 11/19/2022]
Abstract
Neurotrophic keratitis (NK) is a rare degenerative corneal disease that occurs as a result of partial or total impairment of trigeminal innervations, leading to a reduction (hypoesthesia) in or loss (anaesthesia) of corneal sensitivity. The impairment of sensory innervation causes a reduction in the lacrimation reflex and the vitality, metabolism and mitosis of epithelial cells, with subsequent deficiency in epithelial repair, stromal and intracellular oedema, loss of microvilli, and abnormal development of the basal lamina. Several recent studies have proposed different therapies based on different aetiopathogenetic theories. The aim of the therapy is to treat aetiopathogenesis and, at the same time, promote corneal healing. In this paper, we report the aetiology, diagnosis, management, and medical and surgical treatment of NK, also indicating future treatments based on the most recent studies.
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Affiliation(s)
- F Semeraro
- Eye Clinic, Department of Ophthalmology, University of Brescia, Brescia, Italy
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Aihara M, Oshima H, Araie M. Effects of SofZia-preserved travoprost and benzalkonium chloride-preserved latanoprost on the ocular surface -- a multicentre randomized single-masked study. Acta Ophthalmol 2013; 91:e7-e14. [PMID: 23241328 DOI: 10.1111/j.1755-3768.2012.02565.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the effect of SofZia-preserved travoprost on ocular surface conditions in comparison with benzalkonium chloride (BAK)-preserved latanoprost. METHODS A prospective randomized multicentre single-masked comparative study. Patients with open-angle glaucoma or ocular hypertension who had been treated with BAK-preserved latanoprost 0.005% (Xalatan(®) ) monotherapy for at least 3 months. Patients were enrolled at 23 facilities. Patients were randomly divided into the X-X group, continuous use of Xalatan(®) , or the X-T group, switching from Xalatan(®) to SofZia-preserved travoprost 0.004% (TravatanZ(®) ), and followed for 3 months. The superficial punctate keratopathy (SPK), conjunctival epitheliopathy, hyperaemia, tear break-up time (TBUT) and intraocular pressure (IOP) were examined for each patient in a masked manner. Changes in the frequency of keratoconjunctival epitheliopathy were evaluated 3 months after study initiation. Intra- and intergroup comparisons of changes in SPK, conjunctival epitheliopathy, hyperaemia, TBUT and IOP were also carried out. RESULTS Two hundred twenty patients participated and 215 completed the 3-month study. The frequency of keratoconjunctival epitheliopathy significantly decreased in the X-T group (p = 0.036) and the intergroup difference was also significant (p = 0.001). SPK scores and TBUT were significantly improved in the X-T group (p = 0.034, 0.049), also with significant intergroup differences in the cornea excluding the inferior area and TBUT. There were no significant intergroup differences in changes of the hyperaemia scores and the IOP reduction. CONCLUSION Switching to SofZia-preserved travoprost after BAK-preserved latanoprost resulted in a lower incidence of keratoconjunctival epitheliopathy, especially in the cornea, with no clinically relevant changes in hyperaemia and IOP.
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Affiliation(s)
- Makoto Aihara
- Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Liu Y, Mao W. Tafluprost once daily for treatment of elevated intraocular pressure in patients with open-angle glaucoma. Clin Ophthalmol 2012; 7:7-14. [PMID: 23293509 PMCID: PMC3533683 DOI: 10.2147/opth.s30951] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Glaucoma is a leading cause of visual loss worldwide. Current antiglaucoma therapy focuses on lowering intraocular pressure to a safe level. In recent years, prostaglandin analogs have become the first-line agents for treating open angle glaucoma. Tafluprost, which was first reported in 2003, is a novel prostaglandin analog, and has been shown to be a potent ocular hypotensive agent in a number of preclinical and clinical studies. Also, its unique preservative-free formulation helps to decrease preservative-associated ocular disorders and improve patient compliance. In this review, studies from 2003 to 2012 focusing on the structure, metabolism, efficacy, and safety of tafluprost are summarized. These studies suggested that application of tafluprost once daily is a safe and effective treatment for patients with open angle glaucoma.
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Affiliation(s)
- Yang Liu
- Department of Cell Biology and Anatomy, North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX
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In Vitro and In Vivo Evaluation of a Preservative-Free Cationic Emulsion of Latanoprost in Corneal Wound Healing Models. Cornea 2012; 31:1319-29. [DOI: 10.1097/ico.0b013e318255a7f8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Seibold LK, Ammar DA, Kahook MY. Acute effects of glaucoma medications and benzalkonium chloride on pre-adipocyte proliferation and adipocyte cytotoxicity in vitro. Curr Eye Res 2012; 38:70-4. [PMID: 23078159 DOI: 10.3109/02713683.2012.733055] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine and compare the short-term, in vitro effect of prostaglandin analogues (PGAs), timolol, and benzalkonium chloride (BAK) on pre-adipocyte proliferation and adipocyte cytotoxicity. METHODS For the proliferation assay, human primary subcutaneous pre-adipocytes were incubated in the presence of either bimatoprost (0.015%, 0.03%, 0.06%) travoprost (0.002%, 0.004%, 0.008%), latanoprost (0.0025%, 0.005%, 0.010%), tafluprost (0.00075%, 0.0015%, 0.003%), timolol maleate (0.25%, 0.5%, 1.0%), BAK (0.005%, 0.010%, 0.015%, 0.020%, 0.040%), or control of BAK vehicle. After 72 h in culture, cell numbers were determined by fluorescent assay with CellTiter-Blue(®) reagent. For the cytotoxity assay, mature human adipocytes were cultured for 72 h with the same test compounds and controls. Cell numbers were again determined in the same manner through fluorescence. RESULTS In the proliferation assay, all four PGA medications failed to show a statistically significant difference from BAK vehicle alone (p = 0.065-0.751). Both timolol and BAK alone demonstrated near complete inhibition of pre-adipocyte proliferation at all concentrations tested (p < 0.01 for all). In the cytotoxicity assay, all four PGAs again exerted no significant effect when compared to control (p = 0.211-0.901). Timolol and BAK again displayed near complete toxicity of adipocytes at all concentrations (p < 0.01 for all). CONCLUSIONS All four PGAs had similar and negligible short-term effects on pre-adipocyte proliferation and adipocyte toxicity in vitro. Timolol and BAK had profound cytotoxic effects on mature adipocytes and antiproliferative effects on pre-adipocytes in vitro. Further testing is needed to determine whether similar effects are present in vivo.
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Affiliation(s)
- Leonard K Seibold
- University of Colorado Eye Center, Department of Ophthalmology, University of Colorado at Denver, Aurora, Colorado, USA
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Rolando M, Crider JY, Kahook MY. Ophthalmic preservatives: focus on polyquaternium-1. Expert Opin Drug Deliv 2011; 8:1425-38. [PMID: 21905766 DOI: 10.1517/17425247.2011.617736] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Ophthalmic preservatives, such as polyquaternium-1 (PQ-1), are critical for the inhibition of growth of microbial contaminants in multi-dose bottles of topical medications. These antimicrobial agents must have a high efficacy against pathogenic organisms, while maintaining a favorable tolerability and safety profile. AREAS COVERED This review focuses on the ophthalmic preservative PQ-1. For comparison purposes, the most commonly used preservative, benzalkonium chloride (BAK), is also discussed. This survey focuses primarily on data collected during the past 10 years. EXPERT OPINION Effective drug delivery requires more than just an active ingredient that achieves its desired biological effect on end-target tissues. In addition, drugs must be stable in the containers that they are stored in, and must possess minimal undesired local and systemic side effects that can cause patients to decrease their adherence. In addressing these concerns, specifically in topical ophthalmic drops, one must take into account the active ingredients, vehicle components and preservatives. Medications with fewer adverse effects may lead to enhanced adherence to therapy; therefore, the induction of such adverse outcomes must be considered by physicians when treating patients with chronic ocular disease. Although BAK will continue to be used in ophthalmic medications, due to its familiarity and compatibility with a broad range of topical ocular formulations, PQ-1 is certainly a viable alternative in the preservative formulary armamentarium.
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Fain JM, Kotak S, Mardekian J, Bacharach J, Edward DP, Rauchman S, Brevetti T, Fox JL, Lovelace C. A multicenter, retrospective chart review study comparing index therapy change rates in open-angle glaucoma or ocular hypertension patients newly treated with latanoprost or travoprost-Z monotherapy. BMC Ophthalmol 2011; 11:13. [PMID: 21668980 PMCID: PMC3136403 DOI: 10.1186/1471-2415-11-13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 06/13/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Because latanoprost and the original formulation of travoprost that included benzalkonium chloride (BAK) have been shown to be similar with regard to tolerability, we compared initial topical intraocular pressure (IOP)-lowering medication change rates in patients newly treated with latanoprost or travoprost-Z monotherapy. METHODS At 14 clinical practice sites, medical records were abstracted for patients with a diagnosis of open-angle glaucoma or ocular hypertension and who were ≥40 years of age, had a baseline and at least one follow-up visit, and had no prior history of ocular prostaglandin use. Data regarding demographics, ocular/systemic medical histories, clinical variables, therapy initiations and reasons for changes, adverse events, and resource utilization were recorded from randomly chosen eligible charts. Primary outcomes were rates of and reasons for changing from the initial therapy within six months and across the full study period (1000 days). RESULTS Data from 900 medical charts (latanoprost, 632; travoprost-Z, 268) were included. For both cohorts, average follow-up was >1 year. Cohorts were similar with regard to age (median ~67 years), gender distribution (>50% female), and diagnosis (~80% with open-angle glaucoma). Within six months, rates of index therapy change for latanoprost versus travoprost-Z were 21.2% (134/632) and 28.7% (77/268), respectively (p = 0.0148); across the full study period, rates were 34.5% (218/632) and 45.2% (121/268), respectively (p = 0.0026). Among those who changed their index therapy, insufficient IOP control was the most commonly reported reason followed by adverse events; hyperemia was the most commonly reported adverse event at index therapy change. CONCLUSIONS In this "real world" study of changes in therapy in patients prescribed initial monotherapy with latanoprost with BAK or travoprost-Z with SofZia, medication changes were common in both treatment groups but statistically significantly more frequent with travoprost-Z.
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Katz G, Springs CL, Craven ER, Montecchi-Palmer M. Ocular surface disease in patients with glaucoma or ocular hypertension treated with either BAK-preserved latanoprost or BAK-free travoprost. Clin Ophthalmol 2010; 4:1253-61. [PMID: 21151330 PMCID: PMC2993125 DOI: 10.2147/opth.s14113] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose The preservative benzalkonium chloride (BAK) may adversely affect ocular surface health. This study evaluated symptoms of ocular surface disease (OSD) in patients previously treated with a BAK-preserved therapy to lower their intraocular pressure, who either continued that therapy or switched to a BAK-free therapy. Methods Eligible adult patients with ocular hypertension or open-angle glaucoma that had been controlled with BAK-preserved latanoprost 0.005% monotherapy (Xalatan®) for at least one month and had a score of ≥ 13 (0 = none, 100 = most severe) on the Ocular Surface Disease Index (OSDI) questionnaire were entered into this prospective, double-masked, randomized, active-controlled, multicenter trial. By random assignment, patients either continued with BAK-preserved latanoprost 0.005% or transitioned to BAK-free travoprost 0.004% (Travatan Z® ophthalmic solution). OSDI scores were assessed again after six and 12 weeks. Results For the 678 evaluable patients, mean change in OSDI score from baseline to week 12 favored the travoprost 0.004% BAK-free group, but was not statistically different between groups (P = 0.10). When patients with mild OSD at baseline were assessed after 12 weeks, the mean OSDI score was significantly lower (P = 0.04) in the BAK-free travoprost 0.004% group (score = 11.6 ± 10.8 units) than in the BAK-preserved latanoprost 0.005% group (score = 14.4 ± 11.9 units), and a significantly larger percentage (P < 0.01) improved to normal OSDI scores in the BAK-free travoprost 0.004% group (62.9% of group) than in the BAK-preserved latanoprost 0.005% group (47.0% of group). Patients pretreated with BAK-preserved latanoprost 0.005% for >24 months were significantly more likely (P = 0.03) to improve to a normal OSDI score after 12 weeks if they were switched to BAK-free travoprost 0.004% (47.9% of group) than if they remained on BAK-preserved latanoprost 0.005% (33.9% of group). Conclusions Switching from BAK-preserved latanoprost 0.005% to BAK-free travoprost 0.004% yielded significant improvements in symptoms of OSD in patients with glaucoma or ocular hypertension.
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