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Sharma N, Martin E, Pearce EI, Hagan S. A Delphi approach to establishing consensus on best practice for the diagnosis and treatment of Demodex blepharitis. Cont Lens Anterior Eye 2024; 47:102080. [PMID: 37949731 DOI: 10.1016/j.clae.2023.102080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/19/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Abstract
Demodex blepharitis does not have agreed standardized guidelines. The aim of this study was to classify signs and symptoms and to develop appropriate management strategies for Demodex blepharitis from a consensus of expert advice. METHODS A total of 11 anterior segment experts (ophthalmologists, optometrists and a contact lens optician) working in the United Kingdom participated in a modified 2-round Delphi panel. A mixed-methods approach was adopted and a survey questionnaire for round 1 was formulated, constructed from information in the available literature. Based on panel responses from round 1, feedback was provided and a round 2 questionnaire was formulated. More than two-thirds majority (72%) was used for consensus building. RESULTS Based on the clinical presentation of signs and symptoms along with associated conditions and risk factors, a diagnostic algorithm was proposed for the clinical investigation of Demodex blepharitis. A treatment algorithm was also proposed with first-line and second-line treatment recommendations for Demodex blepharitis. CONCLUSION The recommendation from this study provides the first effort in formulating clinical diagnostic algorithm and management guidelines for Demodex blepharitis. The guidelines include appropriate magnification on the slit lamp, associated signs, symptoms, risk factors and suggested management options. These guidelines can be used in a routine eyecare setting to encourage eyecare practitioners in tailoring the investigation and management of Demodex blepharitis.
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Affiliation(s)
- Nikhil Sharma
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom.
| | - Eilidh Martin
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom.
| | - Edward Ian Pearce
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom.
| | - Suzanne Hagan
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom.
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Nattis AS, Rosenberg ED, Rasool F. Intracanalicular dexamethasone insert for post-corneal crosslinking inflammation and pain: the LINK study. J Cataract Refract Surg 2023; 49:1114-1119. [PMID: 37532250 DOI: 10.1097/j.jcrs.0000000000001279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/28/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE To compare the efficacy of an intracanalicular dexamethasone insert with tapered topical steroid over 28 days after corneal cross-linking (CXL). SETTING Single private practice, outpatient setting. DESIGN Prospective observational randomized study. METHODS This prospective randomized study investigated the efficacy of a dexamethasone intracanalicular insert on post-CXL pain and inflammation in progressive keratoconus patients. 20 patients (40 eyes) were enrolled; half were randomized to the dexamethasone intracanalicular insert group; half were prescribed a 28-day topical tapering steroid regimen. All patients were evaluated for pain scores, rate of re-epithelialization, ease of the post-CXL regimen, and need for rescue pain medication after standard bilateral epithelium-off CXL on postoperative day (POD) 1, POD3, and POD4 to 7, as well as postoperative week (POW) 1, POW2, POW3, and POW4. RESULTS 20 patients (40 eyes) underwent standard-of-care epithelium-off bilateral CXL for progressive keratoconus. 10 patients were randomized to receive prednisolone eyedrops on a tapering schedule after CXL; 10 patients received dexamethasone intracanalicular inserts at the time of CXL. Regardless of the postoperative steroid regimen, there was no significant difference in the rate of re-epithelialization or use of rescue pain medication between groups. There was a nominal, however, statistical difference in pain scores between groups, favoring prednisolone eyedrops. Both groups stated no difficulty in following postoperative regimens. There were no adverse events noted in relation to treatment or the CXL procedure. CONCLUSIONS Using a dexamethasone insert to alleviate pain and inflammation can be considered as a safe and efficacious part of a post-CXL regimen.
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Affiliation(s)
- Alanna S Nattis
- From the SightMD, Babylon, New York (Nattis, Rosenberg); NYIT-COM, Old Westbury, New York (Rasool)
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Torres-Luna C, Fan X, Domszy R, Hu N, Wang NS, Yang A. Hydrogel-based ocular drug delivery systems for hydrophobic drugs. Eur J Pharm Sci 2020; 154:105503. [DOI: 10.1016/j.ejps.2020.105503] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/18/2020] [Accepted: 07/31/2020] [Indexed: 01/07/2023]
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Alvarez-Lorenzo C, Anguiano-Igea S, Varela-García A, Vivero-Lopez M, Concheiro A. Bioinspired hydrogels for drug-eluting contact lenses. Acta Biomater 2019; 84:49-62. [PMID: 30448434 DOI: 10.1016/j.actbio.2018.11.020] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/29/2018] [Accepted: 11/14/2018] [Indexed: 12/14/2022]
Abstract
Efficient ocular drug delivery that can overcome the challenges of topical application has been largely pursued. Contact lenses (CLs) may act as light-transparent cornea/sclera bandages for prolonged drug release towards the post-lens tear fluid, if their composition and inner architecture are fitted to the features of the drug molecules. In this review, first the foundations and advantages of using CLs as ocular drug depots are revisited. Then, pros and cons of common strategies to prepare drug-loaded CLs are analyzed on the basis of recent examples, and finally the main section focuses on bioinspired strategies that can overcome some limitations of current designs. Most bioinspired strategies resemble a reverse engineering process to create artificial receptors for the drug inside the CL network by mimicking the human natural binding site of the drug. Related bioinspired strategies are being also tested for designing CLs that elute comfort ingredients mimicking the blinking-associated renewal of eye mucins. Other bioinspired approaches exploit the natural eye variables as stimuli to trigger drug release or take benefit of bio-glues to specifically bind active components to the CL surface. Overall, biomimicking approaches are being revealed as valuable tools to fit the amounts loaded and the release profiles to the therapeutic demands of each pathology. STATEMENT OF SIGNIFICANCE: Biomimetic and bioinspired strategies are remarkable tools for the optimization of drug delivery systems. Translation of the knowledge about how drugs interact with the natural pharmacological receptor and about components and dynamics of anterior eye segment may shed light on the design criteria for obtaining efficient drug-eluting CLs. Current strategies for endowing CLs with controlled drug release performance still require optimization regarding amount loaded, drug retained in the CL structure during storage, regulation of drug release once applied onto the eye, and maintenance of CL physical properties. All these limitations may be addressed through a variety of recently growing bioinspired approaches, which are expected to pave the way of medicated CLs towards the clinics.
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Affiliation(s)
- Carmen Alvarez-Lorenzo
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, R+D Pharma Group (GI-1645), Facultad de Farmacia and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain.
| | - Soledad Anguiano-Igea
- HGBeyond Materials Science S.L, Edificio Emprendia, Campus Vida s/n, 15782 Santiago de Compostela, Spain
| | - Angela Varela-García
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, R+D Pharma Group (GI-1645), Facultad de Farmacia and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain; HGBeyond Materials Science S.L, Edificio Emprendia, Campus Vida s/n, 15782 Santiago de Compostela, Spain
| | - María Vivero-Lopez
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, R+D Pharma Group (GI-1645), Facultad de Farmacia and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Angel Concheiro
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, R+D Pharma Group (GI-1645), Facultad de Farmacia and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain
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Larrañeta E, Domínguez-Robles J, Coogan M, Heaney E, Stewart SA, Thakur RRS, Donnelly RF. Poly(methyl vinyl ether-co-maleic acid) Hydrogels Containing Cyclodextrins and Tween 85 for Potential Application as Hydrophobic Drug Delivery Systems. Macromol Res 2019. [DOI: 10.1007/s13233-019-7074-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Licker M, Moldovan R, Hogea E, Muntean D, Horhat F, Baditoiu L, Rogobete AF, Tîrziu E, Zambori C. Microbial biofilm in human health - an updated theoretical and practical insight. REV ROMANA MED LAB 2017. [DOI: 10.1515/rrlm-2017-0001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
The term biofilm designates an aggregate of microorganisms belonging to one or more species which adhere to various surfaces but also to each another. These microbial communities are included and interconnected within an organic structure known as slime, composed of protein substances, polysaccharides, and DNA.
The Center for Disease prevention and control considers infections with bacteria in biofilms among the 7 most important challenges which must be overcome in order to improve the safety of health services. The risk of microbial biofilm development exists for a long list of medical devices and equipment, as well as in certain diseases such as cystic fibrosis. An aggravating aspect is represented by the almost 1,000 times higher antimicrobial resistance of bacteria growing and multiplying within biofilms. Thus, in case of biofilm-infected medical devices, the resistance to antimicrobial treatments requires the removal of the device which essentially means the failure of the exploratory or therapeutic intervention in question.
The role of microbial biofilms in medical pathology is a subject that raises interest for both researchers and clinicians in order to establish new methods for prevention and treatment of biofilms. This paper is intended as an overview in the management of microbial biofilms, presenting future insights, with technological progress in microscopy, molecular genetics, and genome analysis. Therefore the present paper will focus on describing the mechanisms involved in biofilm development, biofilm related infections, methods of detection and quantification of microbial communities and therapeutical approaches.
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Affiliation(s)
- Monica Licker
- „Victor Babeș” University of Medicine and Pharmacy Timișoara, Romania
- „Pius Branzeu” Emergency, Clinical, County Hospital Timișoara, Romania
| | - Roxana Moldovan
- „Victor Babeș” University of Medicine and Pharmacy Timișoara, Romania
| | - Elena Hogea
- „Victor Babeș” University of Medicine and Pharmacy Timișoara, Romania
- „Victor Babeș” Clinical Infectious Diseases Hospital Timișoara, Romania
| | - Delia Muntean
- Department of Microbiology, „Victor Babeș” University of Medicine and Pharmacy Timișoara, Romania
| | - Florin Horhat
- „Victor Babeș” University of Medicine and Pharmacy Timișoara, Romania
- „Pius Branzeu” Emergency, Clinical, County Hospital Timișoara, Romania
| | - Luminița Baditoiu
- „Victor Babeș” University of Medicine and Pharmacy Timișoara, Romania
- Regional Centre of Public Health Timișoara, Romania
| | | | - Emil Tîrziu
- Banat’s University of Agricultural Sciences and Veterinary Medicine, King Michael I of Romania, Timișoara, Romania
| | - Csilla Zambori
- „Victor Babeș” University of Medicine and Pharmacy Timișoara, Romania
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Abstract
For many years, blepharitis and dry eye disease have been thought to be two distinct diseases, and evaporative dry eye distinct from aqueous insufficiency. In this treatise, we propose a new way of looking at dry eye, both evaporative and insufficiency, as the natural sequelae of decades of chronic blepharitis. Dry eye is simply the late form and late manifestation of one disease, blepharitis. We suggest the use of a new term in describing this one chronic disease, namely dry eye blepharitis syndrome (DEBS). Bacteria colonize the lid margin within a structure known as a biofilm. The biofilm allows for population densities that initiate quorum-sensing gene activation. These newly activated gene products consist of inflammatory virulence factors, such as exotoxins, cytolytic toxins, and super-antigens, which are then present for the rest of the patient’s life. The biofilm never goes away; it only thickens with age, producing increasing quantities of bacterial virulence factors, and thus, increasing inflammation. These virulence factors are likely the culprits that first cause follicular inflammation, then meibomian gland dysfunction, aqueous insufficiency, and finally, after many decades, lid destruction. We suggest that there are four stages of DEBS which correlate with the clinical manifestations of folliculitis, meibomitis, lacrimalitis, and finally lid structure damage evidenced by entropion, ectropion, and floppy eyelid syndrome. When one fully understands the structure and location of the glands within the lid, it becomes easy to understand this staged disease process. The longer a gland can resist the relentless encroachment of the invading biofilm, the longer it can maintain normal function. The stages depend purely on anatomy and years of biofilm presence. Dry eye now becomes a very easy disease to understand. We feel that dry eye should be treated and prevented by early and routine biofilm removal through electromechanical lid margin debridement.
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Affiliation(s)
| | - Henry D Perry
- Department of Ophthalmology, Nassau University Medical Center, Hofstra University School of Medicine, East Meadow, NY, USA
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