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Abstract
A man in his 30s, with a history of two operated penetrating keratoplasty (PK), primarily for viral keratitis, presented with pain, redness and diminution of vision in his left eye of 4 days duration. Postoperatively, he was prescribed oral antivirals, topical steroid eyedrops, lubricants and antiglaucoma medications. Eight months after transplantation, an epithelial defect with heaped up margins was noted on anterior segment evaluation on a routine follow-up visit. On checking his medications, it was found that the patient was unknowingly using bromfenac drops in place of brimonidine tartrate for the past month. A diagnosis of neurotrophic keratitis was made in the setting of PK performed for viral keratitis, incited by use of topical bromfenac. The patient was prescribed preservative-free lubricants with immediate discontinuation of bromfenac drops. Topical steroid drops were withheld till the epithelial defect healed. Complete healing of the defect was noted after 4 weeks of therapy.
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Affiliation(s)
- Nimmy Raj
- Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Arnav Panigrahi
- Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Mahboob Alam
- Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Noopur Gupta
- Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Moshirfar M, West WB, Milner DC, McCabe SE, Ronquillo YC, Hoopes PC. Delayed Epithelial Healing with Corneal Edema and Haze After Photorefractive Keratectomy Using Intraoperative Mitomycin C. Int Med Case Rep J 2022; 14:863-870. [PMID: 34992474 PMCID: PMC8714007 DOI: 10.2147/imcrj.s342774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/12/2021] [Indexed: 11/23/2022] Open
Abstract
We report an unusual presentation of presumed mitomycin C toxicity with possible subsequent hypersensitization to other medication toxicities. A 50-year-old female presented three months after photorefractive keratectomy with intraoperative mitomycin C for the management of persistent epithelial defects, corneal haze, and edema. She was found to have used an expansive and rapidly changing medical regimen which may have caused additional toxicity. These medications included besifloxacin, bromfenac, and ketotifen. Additives such as benzalkonium chloride and DuraSite® may have also contributed. Intraoperative mitomycin C can result in longstanding corneal haze, edema, and delayed epithelial healing in the setting of corneal refractive surgery. These may leave the cornea more susceptible to additional subsequent medication toxicities during the postoperative period. This report describes a case of mitomycin C exposure leading to a prolonged sensitivity to other medication toxicities, which has not been discussed elsewhere in the literature.
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Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT, 84020, USA.,John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA.,Utah Lions Eye Bank, Murray, UT, 84107, USA
| | - William B West
- University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
| | - Dallin C Milner
- University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Shannon E McCabe
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT, 84020, USA
| | | | - Phillip C Hoopes
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT, 84020, USA
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Nanavaty M, Ashena Z, Bardan A, Thaker R, Bascaran L. Prophylactic use of nonsteroidal anti-inflammatory drugs after cataract surgery and corneal melt. J Curr Ophthalmol 2021; 33:485-491. [PMID: 35128199 PMCID: PMC8772489 DOI: 10.4103/joco.joco_107_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose: To describe a case where prophylactic use of nonsteroidal anti-inflammatory drugs (NSAID) eye drops lead to recurrent corneal melt with loss of vision and a brief literature review. Methods: This is a case report of an 84-year-old diabetic female with chronic dry eye, operated by two different surgeons on each eye at different time intervals. She received topical NSAID prophylaxis after the second surgery only, which led to blindness due to recurrent corneal melt and chronic choroidal effusions. We also present a brief literature review. Results: This lady presented with corneal melt and perforation 5 days following the use of topical NSAIDs prophylaxis after a routine cataract surgery in the second eye. Unfortunately, all efforts to save her vision and eye were unsuccessful as she developed repeated complications in spite of corneal gluing, amniotic membrane, penetrating keratoplasty, and tarsorrhaphy. She also had chronic choroidal effusions. She ended up with an opaque cornea and a subtotal tarsorrhaphy, with no other option to improve her vision as she did not qualify for sedation or general anesthesia due to her poor systemic health. Conclusion: Although it is a common practice for diabetic patients to have topical NSAIDs prophylaxis in combination with steroid eye drops to reduce the risk of cystoid macular edema after cataract surgery, the elderly diabetic patients with concomitant dry eyes should be considered high risk for corneal melt and should be closely monitored. This case highlights the rare but serious complication of topical NSAIDs prophylaxis in the vulnerable cornea, which warrants careful consideration.
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Control of Pain in Intravitreal Injections: Evaluation of Combination Topical Anesthetics and Non-steroidal Anti-inflammatory Drops: A Randomized, Placebo-Controlled Clinical Trial. Ophthalmol Retina 2020; 5:308-309. [PMID: 32858247 DOI: 10.1016/j.oret.2020.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 11/21/2022]
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Rigas B, Huang W, Honkanen R. NSAID-induced corneal melt: Clinical importance, pathogenesis, and risk mitigation. Surv Ophthalmol 2020; 65:1-11. [DOI: 10.1016/j.survophthal.2019.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 12/21/2022]
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Phosphosulindac is efficacious in an improved concanavalin A-based rabbit model of chronic dry eye disease. Transl Res 2018; 198:58-72. [PMID: 29702077 DOI: 10.1016/j.trsl.2018.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 04/03/2018] [Accepted: 04/03/2018] [Indexed: 12/17/2022]
Abstract
Dry eye disease (DED) currently has no satisfactory treatment partly because of the lack of informative animal models. We evaluated the anti-inflammatory phosphosulindac (PS) for the treatment of DED using a new rabbit model of DED based on the concanavalin A (Con A) acute DED model: we injected all lacrimal glands with Con A weekly under ultrasound guidance, which prolonged DED to >3 weeks, and thoroughly assessed efficacy with tear break-up time (TBUT), tear osmolarity, Schirmer test, and tear lactoferrin levels. Rabbits with DED (n = 8-10 eyes per group) were treated topically with PS or vehicle 3×/day for 21days. PS restored TBUT, tear osmolarity, and lactoferrin levels (P < 0.0001-0.04) to normal but did not significantly improve the results of the Schirmer test. PS showed no side effects and was much more efficacious than cyclosporine or lifitegrast. In the cornea, PS suppressed the activation of nuclear factor kappa-B, the levels of transforming growth factor beta, interleukin-1 beta, interleukin-6, and interleukin-8, and the levels of matrix metalloproteinase (MMP)-1 and MMP-9, and MMP activity. Levels of prostaglandin E2 (PGE2) in tears and cornea were preserved in PS-treated rabbits. Ketorolac and diclofenac, two ophthalmic NSAIDs causing corneal melt, nearly completely suppressed PGE2 levels but had no effect on MMPs. The effects of PS on PGE2 and MMPs likely account for its apparent ocular safety. Our results establish an animal model for acute and chronic DED suitable for drug efficacy studies and indicate that PS merits evaluation for DED.
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Kim BJ, Lee JH, Kim SW. Change of Corneal Epithelial and Stromal Thickness after Cataract Surgery through Scleral Tunnel Incision. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.11.1215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Bong Jun Kim
- Department of Ophthalmology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jong-Hyuck Lee
- Department of Ophthalmology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sun Woong Kim
- Department of Ophthalmology, Yonsei University Wonju College of Medicine, Wonju, Korea
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Lipid-Based Therapy for Ocular Surface Inflammation and Disease. Trends Mol Med 2015; 21:736-748. [PMID: 26596867 DOI: 10.1016/j.molmed.2015.10.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 10/06/2015] [Accepted: 10/07/2015] [Indexed: 12/27/2022]
Abstract
Ocular surface diseases such as dry eye, allergic keratoconjunctivitis, and infection are very prevalent conditions and involve ocular surface stress and inflammation. Recently, various lipid-based therapies have been advocated for the modulation of ocular surface inflammation. Here we review the latest developments and challenges of these strategies. These include administration of essential fatty acids, cyclooxygenase (COX) inhibitors and resolvin analogs. Lipids form part of the tear film and are crucial for tear film stability; loss of tear film stability can aggravate ocular surface inflammation. Strategies to replenish tear film lipids - namely, eyelid warming and eye drops containing natural or synthetic lipids - are evaluated. Recent advances in the use of lipids as ocular drug delivery vehicles, antioxidants, and diagnostic markers are discussed.
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Management of Dry Eye in Sjögren’s Syndrome. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2015. [DOI: 10.1007/s40674-015-0026-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abelson MB, Shetty S, Korchak M, Butrus SI, Smith LM. Advances in pharmacotherapy for allergic conjunctivitis. Expert Opin Pharmacother 2015; 16:1219-31. [PMID: 25943976 DOI: 10.1517/14656566.2015.1040760] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Allergy is the fifth leading group of chronic diseases, affecting as much as 40% of the first-world population. Its pathophysiology has a genetic component, and is driven by the immune system's sensitized response to antigens and environmental factors. As research continues to uncover the mediators responsible for ocular allergy, the development of novel drugs should progress. AREAS COVERED A literature review of allergic conjunctivitis, ocular allergy and their treatment was performed using PubMed and Medline. Additional information is also included from clinicaltrials.gov and associated web sites for drugs currently in clinical trials. EXPERT OPINION The initial step of therapy remains identification and avoidance of allergic triggers. The mainstay of treatment is the new generation of dual-acting antihistamines. Drugs that improve the magnitude and duration of relief, with greater subject responder rates, are gradually making their way into the clinic. Allergic conjunctivitis is a relatively easy disease to study because of the availability of models such as the conjunctival allergen challenge. New classes of drugs that target inflammatory pathways or mediators involved in the early and late-phase allergic response are being screened in these models and we are making progress in identifying the next generation of anti-allergic therapy.
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Affiliation(s)
- Mark B Abelson
- Harvard University, Department of Ophthalmology, Ora, Inc. , 300 Brickstone Square, Andover MA 01810 , USA
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Troumani Y, Beral L, Glatre F, Finke E, David T. [One case of corneal melting after instillation of bromfenac 0.09%]. J Fr Ophtalmol 2014; 37:e125-7. [PMID: 24838029 DOI: 10.1016/j.jfo.2014.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 12/15/2013] [Accepted: 01/24/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Y Troumani
- Service d'ophtalmologie, UFR des sciences médicales, CHU de Pointe-à-Pitre, route de Chauvel, BP 465, 97159 Pointe-à-Pitre cedex, Guadeloupe.
| | - L Beral
- Service d'ophtalmologie, UFR des sciences médicales, CHU de Pointe-à-Pitre, route de Chauvel, BP 465, 97159 Pointe-à-Pitre cedex, Guadeloupe
| | - F Glatre
- Service d'ophtalmologie, UFR des sciences médicales, CHU de Pointe-à-Pitre, route de Chauvel, BP 465, 97159 Pointe-à-Pitre cedex, Guadeloupe
| | - E Finke
- Service d'ophtalmologie, UFR des sciences médicales, CHU de Pointe-à-Pitre, route de Chauvel, BP 465, 97159 Pointe-à-Pitre cedex, Guadeloupe; UFR des sciences médicales, faculté de médecine Antilles-Guyane Hyacinthe Bastaraud, campus de Fouillole, BP 145, 97154 Pointe-à-Pitre cedex, Guadeloupe
| | - T David
- Service d'ophtalmologie, UFR des sciences médicales, CHU de Pointe-à-Pitre, route de Chauvel, BP 465, 97159 Pointe-à-Pitre cedex, Guadeloupe; UFR des sciences médicales, faculté de médecine Antilles-Guyane Hyacinthe Bastaraud, campus de Fouillole, BP 145, 97154 Pointe-à-Pitre cedex, Guadeloupe
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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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Carreño E, Portero A, Galarreta DJ, Herreras JM. Update on twice-daily bromfenac sodium sesquihydrate to treat postoperative ocular inflammation following cataract extraction. Clin Ophthalmol 2012; 6:637-44. [PMID: 22570544 PMCID: PMC3346189 DOI: 10.2147/opth.s23381] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Ophthalmic bromfenac sodium sesquihydrate is a topically applied selective cyclooxygenase (COX)-2 inhibitor. It is similar to amfenac, except for a bromine atom at the C(4) of the benzoyl ring position, which markedly affects its in vitro and in vivo potency, extends the duration of anti-inflammatory activity, and enhances its inhibitory effect on COX-2 absorption across the cornea and penetration into ocular tissues. The United States Food and Drug Administration approved bromfenac in 2005 for the treatment of postoperative inflammation and the reduction of ocular pain in patients who have undergone cataract surgery. Nonsteroidal anti-inflammatory drugs (NSAIDs), and among them bromfenac, could be even more effective than steroids at reestablishing the blood-aqueous barrier, as revealed by flare on slit-lamp examination and as quantitatively measured using ocular fluorophotometry. Similar to other NSAIDs, it has a role in inhibiting intraoperative miosis during cataract surgery. However, bromfenac also seems to be useful in other situations, such as refractive surgery, allergic conjunctivitis (not useful in dry eye), choroidal neovascularization, and even ocular oncology. No reports of systemic toxicity have been published and bromfenac has good topical tolerance with a low incidence of adverse effects.
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Affiliation(s)
- Ester Carreño
- Ocular Immunology Unit-IOBA (Instituto Universitario de Oftalmobiología), University of Valladolid, Campus Miguel Delibes, Valladolid, Spain
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