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Tariq F. Allergic Conjunctivitis: Review of Current Types, Treatments, and Trends. Life (Basel) 2024; 14:650. [PMID: 38929634 PMCID: PMC11204416 DOI: 10.3390/life14060650] [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: 03/27/2024] [Revised: 05/14/2024] [Accepted: 05/17/2024] [Indexed: 06/28/2024] Open
Abstract
Allergic conjunctivitis is an allergen-induced immune response secondary to the binding of immunoglobulin-E (IgE) to sensitized mast cells. Approximately 40% of North Americans and 20% of the world's population are impacted by some form of allergy and it continues to increase in prevalence, especially among children. Specified IgE antibodies can be found in almost all cases of exposure to seasonal or perennial allergens. Activation and degranulation of mast cells lead to increased tear levels of histamine, tryptase, leukotrienes, cytokines, and prostaglandins. The release of these factors initiates the recruitment of inflammatory cells in the conjunctival mucosa, which causes the late-phase reaction. Signs and symptoms of ocular allergies include itching, tearing, chemosis, and hyperemia, which can lead to decreased productivity and poor quality of life. Many treatment options are available to improve symptoms, including, mast cell stabilizers, antihistamines, dual-acting agents, steroids, nonsteroidal anti-inflammatory drugs (NSAIDS), and other off-label treatment modalities. This review article provides an overview of different types of allergic conjunctivitis, its pathology and immunology, and recommended methods of treatment.
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Affiliation(s)
- Fiza Tariq
- Pennsylvania College of Optometry, Salus University, Elkins Park, PA 19027, USA
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2
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Novack GD, Robin AL. Ocular Pharmacology. J Clin Pharmacol 2024. [PMID: 38708561 DOI: 10.1002/jcph.2451] [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: 02/28/2024] [Accepted: 04/08/2024] [Indexed: 05/07/2024]
Abstract
Treatment of ocular diseases presents unique challenges and opportunities for the clinician and for the clinical pharmacologist. Ophthalmic pharmaceuticals, typically given as liquids, require consideration of solubility, physiological pH, and osmolarity, as well as sterility and stability, which in turn requires optimal pharmaceutics. Ocular tissue levels are challenging to obtain in humans, and the clinical pharmacokinetics is typically blood levels, which are primarily related to safety, rather than efficacy. The eye is a closed compartment with multiple physiological barriers with esterases and transporters, but relatively little cytochrome oxidases. Delivery routes include topical, intravitreal, and systemic. Patient dosing involves not only adherence issues common to all chronic diseases, but also performance requirements on eye drop instillation. Therapeutically, ocular diseases and their pharmacological treatments include both those analogous to systemic diseases (e.g., inflammation, infection, and neuronal degeneration) and those unique to the eye (e.g., cataract and myopia).
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Affiliation(s)
- Gary D Novack
- PharmaLogic Development, Inc., San Rafael, CA, USA
- Department of Ophthalmology and Vision Science, School of Medicine, University of California, Davis, CA, USA
| | - Alan L Robin
- Department of Ophthalmology, University of Michigan, Ann Arbor, MI, USA
- Department of Ophthalmology, School of Medicine Johns Hopkins University, Baltimore, MD, USA
- Department of International Health, Bloomberg School of International Health, Johns Hopkins University, Baltimore, MD, USA
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Mohanty A, Joseph J, Pasha AA, Bagga B. Cluster cases of severe microbial keratitis following unsupervised usage of corticosteroid-antibiotic combination for the recent conjunctivitis outbreak in India. Indian J Ophthalmol 2024; 72:609-611. [PMID: 38546479 PMCID: PMC11149522 DOI: 10.4103/ijo.ijo_2448_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Affiliation(s)
- Amrita Mohanty
- Cornea and Anterior Segment Service, Shantilal Shanghvi Cornea Institute, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
| | - Joveeta Joseph
- Jhaveri Microbiology Centre, Hyderabad, Telangana, India
| | - Ahmed A Pasha
- Electronic Medical Record, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
| | - Bhupesh Bagga
- Cornea and Anterior Segment Service, Shantilal Shanghvi Cornea Institute, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
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Racaniello GF, Balenzano G, Arduino I, Iacobazzi RM, Lopalco A, Lopedota AA, Sigurdsson HH, Denora N. Chitosan and Anionic Solubility Enhancer Sulfobutylether-β-Cyclodextrin-Based Nanoparticles as Dexamethasone Ophthalmic Delivery System for Anti-Inflammatory Therapy. Pharmaceutics 2024; 16:277. [PMID: 38399331 PMCID: PMC10893235 DOI: 10.3390/pharmaceutics16020277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
Cataract surgery interventions are constantly increasing, particularly among adult and elderly patients. This type of surgery can lead to inflammatory states of the ocular anterior segment (AS), usually healed via postoperative treatment with dexamethasone (DEX)-containing eye drops. The application of eye drops is challenging due to the high number of daily administrations. In this study, mucoadhesive nanoparticles (NPs) were formulated to improve the residence time of DEX on the corneal mucosa, enhancing the drug's solubility and bioavailability. The NPs were generated using an ionotropic gelation technique, exploiting the interaction between the cationic group of chitosan (CS) and the anionic group of sulfobutylether-β-cyclodextrin (SBE-β-CD). The formation of the inclusion complex and its stoichiometry were studied through phase solubility studies, Job's plot method, and Bi-directional transport studies on MDCKII-MDR1. The obtained NPs showed good chemical and physical characteristics suitable for drug loading and subsequent testing on animal mucosa. The DEX-loaded CS/SBE-β-CD NPs exhibited a prolonged residence time on animal mucosa and demonstrated enhanced drug permeability through the corneal membrane, showing a sustained release profile. The developed NPs posed no irritation or toxicity concerns upon local administration, making them an optimal and innovative drug delivery system for inflammatory AS diseases treatment.
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Affiliation(s)
- Giuseppe Francesco Racaniello
- Department of Pharmacy–Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (G.F.R.); (G.B.); (I.A.); (R.M.I.); (A.L.); (A.A.L.)
| | - Gennaro Balenzano
- Department of Pharmacy–Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (G.F.R.); (G.B.); (I.A.); (R.M.I.); (A.L.); (A.A.L.)
| | - Ilaria Arduino
- Department of Pharmacy–Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (G.F.R.); (G.B.); (I.A.); (R.M.I.); (A.L.); (A.A.L.)
| | - Rosa Maria Iacobazzi
- Department of Pharmacy–Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (G.F.R.); (G.B.); (I.A.); (R.M.I.); (A.L.); (A.A.L.)
| | - Antonio Lopalco
- Department of Pharmacy–Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (G.F.R.); (G.B.); (I.A.); (R.M.I.); (A.L.); (A.A.L.)
| | - Angela Assunta Lopedota
- Department of Pharmacy–Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (G.F.R.); (G.B.); (I.A.); (R.M.I.); (A.L.); (A.A.L.)
| | | | - Nunzio Denora
- Department of Pharmacy–Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (G.F.R.); (G.B.); (I.A.); (R.M.I.); (A.L.); (A.A.L.)
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Demarinis G, Tatti F, Taloni A, Giugliano AV, Panthagani J, Myerscough J, Peiretti E, Giannaccare G. Treatments for Ocular Diseases in Pregnancy and Breastfeeding: A Narrative Review. Pharmaceuticals (Basel) 2023; 16:1433. [PMID: 37895903 PMCID: PMC10610321 DOI: 10.3390/ph16101433] [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: 07/30/2023] [Revised: 09/30/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
Pregnancy is a medical condition in which the physiological changes in the maternal body and the potential impact on the developing fetus require a cautious approach in terms of drug administration. Individual treatment, a thorough assessment of the extent of the disease, and a broad knowledge of the therapeutic options and different routes of administration of ophthalmic drugs are essential to ensure the best possible results while minimizing risks. Although there are currently several routes of administration of drugs for the treatment of eye diseases, even with topical administration, there is a certain amount of systemic absorption that must be taken into account. Despite continuous developments and advances in ophthalmic drugs, no updated data are available on their safety profile in these contexts. The purpose of this review is both to summarize the current information on the safety of ophthalmic treatments during pregnancy and lactation and to provide a practical guide to the ophthalmologist for the treatment of eye diseases while minimizing harm to the developing fetus and addressing maternal health needs.
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Affiliation(s)
- Giuseppe Demarinis
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Via Ospedale 48, 09124 Cagliari, Italy; (G.D.); (F.T.); (E.P.)
| | - Filippo Tatti
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Via Ospedale 48, 09124 Cagliari, Italy; (G.D.); (F.T.); (E.P.)
| | - Andrea Taloni
- Department of Ophthalmology, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy;
| | | | - Jesse Panthagani
- Department of Ophthalmology, Southend University Hospital, Southend-on-Sea SS0 0RY, UK; (J.P.); (J.M.)
| | - James Myerscough
- Department of Ophthalmology, Southend University Hospital, Southend-on-Sea SS0 0RY, UK; (J.P.); (J.M.)
| | - Enrico Peiretti
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Via Ospedale 48, 09124 Cagliari, Italy; (G.D.); (F.T.); (E.P.)
| | - Giuseppe Giannaccare
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Via Ospedale 48, 09124 Cagliari, Italy; (G.D.); (F.T.); (E.P.)
- Department of Ophthalmology, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy;
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Zhou N, Zheng D, You Q, Chen T, Jiang J, Shen W, Zhang D, Liu J, Chen D, Hu K. Therapeutic Potential of Biochanin A in Herpes Simplex Keratitis. Pharmaceuticals (Basel) 2023; 16:1240. [PMID: 37765049 PMCID: PMC10536220 DOI: 10.3390/ph16091240] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Herpes simplex keratitis (HSK) is a blinding eye disease that is initiated by the herpes simplex virus type 1 (HSV-1). Resistance to acyclovir (ACV) and the side effects of corticosteroid drugs have become concerning issues, so it is crucial to develop new antivirals for treating HSK. In this study, we report that biochanin A (BCA), a naturally occurring flavonoid compound, provides multifaceted protective effects with anti-viral, anti-inflammatory, anti-oxidative stress and anti-apoptotic activities to alleviate HSK. The results show that BCA significantly inhibited HSV-1 replication in vitro and further proved that BCA principally influenced the early stage of virus infection. We reveal that BCA downregulated the expression of pro-inflammatory factors triggered by HSV-1, including TNF-α, RANTES, IL-1β and IL-6. Furthermore, BCA treatment alleviated oxidative stress and apoptotic arising from HSV-1 infection. Lastly, we induced HSK in male C57BL/6 mice and treated them with either BCA or phosphate buffer solution (PBS) eye drops. We observed the ocular surface lesions; determined the virus load in the tear fluid, corneas as well as trigeminal ganglions (TGs); and detected the levels of inflammation and apoptosis in the corneas simultaneously. These results show that BCA inhibits HSV-1 and alleviates the corneal lesion degree. Our study illustrates that BCA is a promising therapeutic approach for application in treating HSK.
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Affiliation(s)
- Nan Zhou
- Department of Ophthalmology, The Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China; (N.Z.)
| | - Deyuan Zheng
- State Key Laboratory of Pharmaceutical Biotechnology, Chemistry and Biomedicine Innovation Center, Medical School of Nanjing University, Nanjing 210093, China
| | - Qiao You
- Center for Public Health Research, Medical School of Nanjing University, Nanjing 210093, China
| | - Taige Chen
- Department of Ophthalmology, The Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China; (N.Z.)
| | - Jiaxuan Jiang
- Department of Ophthalmology, The Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China; (N.Z.)
| | - Wenhao Shen
- Department of Ophthalmology, The Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China; (N.Z.)
| | - Di Zhang
- Department of Ophthalmology, The Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China; (N.Z.)
| | - Junpeng Liu
- Nanjing Drum Tower Hospital Clinical College, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Deyan Chen
- Center for Public Health Research, Medical School of Nanjing University, Nanjing 210093, China
| | - Kai Hu
- Department of Ophthalmology, The Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China; (N.Z.)
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Uner B, Ozdemir S, Tas C, Uner M, Ozsoy Y. Loteprednol-Loaded Nanoformulations for Corneal Delivery by Quality-by-Design Concepts: Optimization, Characterization, and Anti-inflammatory Activity. AAPS PharmSciTech 2023; 24:92. [PMID: 36977841 DOI: 10.1208/s12249-023-02551-6] [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: 12/12/2022] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
Loteprednol etabonate (LE) is a topical corticosteroid that uses inflammatory conditions of the eye. It has a low ocular bioavailability and side effects such as corneal disorder, eye discharge, and ocular discomfort. Therefore, it was decided to select the delivery systems, which are solid lipid nanoparticles (SLN), nanostructured lipid carriers (NLC), and nanoemulsion (NE). Design of experiments (DoE) of SLN, NLC, and NE formulations were formulated by using the quality by design (QbD) approach. Precirol® ATO 5 and oleic acid were used as solid and liquid lipids, respectively, in SLN, NLC, and NE formulations. Physiochemical characterization was performed on the formulations. The optimized formulations' inflammatory effects have been appraised on human corneal epithelial cells employing the ELISA test. Physicochemical characterization studies and inflammatory effects were appraised. The sizes of optimized formulations of SLN, NLC, and NE were 86.19 nm, 82.38 nm, and 126.35 nm, respectively, with minimum polydispersity. The release behavior of the formulations is composed of both diffusion and erosion. ELISA test results proved that the formulations significantly reduced IL-1 and IL-6 levels (p < 0.05). D-optimal mixture experimental design allowed us to develop the most precise formulations of SLN, NLC, and NE. Furthermore, the optimized formulations could be promising candidates for treating an inflammation-based corneal disease of the eye.
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Affiliation(s)
- Burcu Uner
- Institute of Graduate Studies in Health Sciences, Istanbul University, Istanbul, Turkey.
- Faculty of Pharmacy, Yeditepe University, Atasehir, 34755, Istanbul, Turkey.
- University of Health Science and Pharmacy in St. Louis, 1 Pharmacy Place, St. Louis, Missouri, 63110-1088, USA.
| | - Samet Ozdemir
- Faculty of Pharmacy, Istanbul Health and Technology University, Zeytinburnu, 34010, Istanbul, Turkey
| | - Cetin Tas
- Faculty of Pharmacy, Yeditepe University, Atasehir, 34755, Istanbul, Turkey
| | - Melike Uner
- Faculty of Pharmacy, Istanbul University, Beyazıt, 34116, Istanbul, Turkey
| | - Yildiz Ozsoy
- Faculty of Pharmacy, Istanbul University, Beyazıt, 34116, Istanbul, Turkey
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Gilmour KM, Ramaesh K. Case for conservative management of adenoviral pseudomembranous conjunctivitis. BMJ Case Rep 2023; 16:e253014. [PMID: 36810328 PMCID: PMC9945021 DOI: 10.1136/bcr-2022-253014] [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] [Indexed: 02/24/2023] Open
Abstract
The clinical course of adenoviral pseudomembranous conjunctivitis is mostly self-limiting and requires only supportive management measures; however, a minority of patients may develop severe inflammation in response to the virus, which can present as subepithelial infiltrates and pseudomembranes. In its most severe form, symblepharon can result from the inflammatory response resulting in longer-term clinical sequelae. The optimal management of adenoviral pseudomembranous conjunctivitis is poorly defined and while debridement is commonly recommended, there is limited evidence base to support this practice. In this paper, we present two cases of PCR-proven adenoviral pseudomembranous conjunctivitis managed conservatively with topical lubricants and corticosteroids rather than debridement to good effect.
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Affiliation(s)
| | - Kanna Ramaesh
- Ophthalmology, Tennent Institute of Ophthalmology, Glasgow, UK
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Valladales-Restrepo LF, Machado-Duque ME, Gaviria-Mendoza A, López-Caicedo DF, Ospina-Cano JA, Oyuela-Gutiérrez MC, Martínez-Pulgarín DF, Machado-Alba JE. Indication-prescription study for the management of conjunctivitis in a Colombian population. Int Ophthalmol 2023; 43:83-93. [PMID: 35776393 PMCID: PMC9247934 DOI: 10.1007/s10792-022-02390-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/14/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Conjunctivitis is one of the most common ocular pathologies. Its treatment depends on its etiology, but an excessive use of antibiotics and corticosteroids, which in many cases are contraindicated, has been described. The objective was to describe the prescription patterns of medications used to treat conjunctivitis in a Colombian population. METHODS This was a cross-sectional study on the pharmacological treatment of patients diagnosed with conjunctivitis between April 1, 2020, and March 31, 2021; based on a drug-dispensing database of approximately 8.5 million people affiliated with the Colombian Health System. Some sociodemographic and pharmacological variables and comorbidities were considered. A descriptive analysis was performed. RESULTS A total of 8708 patients were identified; they had a median age of 44.7 years, and 59.3% were women. The most common causes of conjunctivitis were unspecified (53.1%) and allergic (37.4%). The most commonly used drug was olopatadine (26.1%), followed by dexamethasone with neomycin and polymyxin B (25.0%). A total of 97.0% of the patients received ophthalmic prescriptions, while 12.8% received systemic medications. Glucocorticoids (40.3%), antibiotics (37.7%) and antihistamines (31.7%) were the most commonly used groups of ophthalmic drugs. Glucocorticoids and ophthalmic antibiotics were the medications most frequently prescribed by general practitioners for the treatment of viral or bacterial conjunctivitis. CONCLUSIONS Many patients with conjunctivitis are not being managed according to the recommendations of clinical practice guidelines, which highlights that the widespread use of antibiotics with ophthalmic glucocorticoids could be considered potentially inappropriate prescriptions in many cases.
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Affiliation(s)
- Luis Fernando Valladales-Restrepo
- grid.412256.60000 0001 2176 1069Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Calle 105 # 14-140, 660003 Pereira, Risaralda Colombia ,grid.441853.f0000 0004 0418 3510Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia ,grid.441853.f0000 0004 0418 3510Semillero de Investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda Colombia
| | - Manuel Enrique Machado-Duque
- grid.412256.60000 0001 2176 1069Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Calle 105 # 14-140, 660003 Pereira, Risaralda Colombia ,grid.441853.f0000 0004 0418 3510Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Andrés Gaviria-Mendoza
- grid.412256.60000 0001 2176 1069Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Calle 105 # 14-140, 660003 Pereira, Risaralda Colombia ,grid.441853.f0000 0004 0418 3510Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Diana Fiorella López-Caicedo
- grid.412256.60000 0001 2176 1069Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Calle 105 # 14-140, 660003 Pereira, Risaralda Colombia
| | - Juan Alberto Ospina-Cano
- grid.412256.60000 0001 2176 1069Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Calle 105 # 14-140, 660003 Pereira, Risaralda Colombia
| | - María Camila Oyuela-Gutiérrez
- grid.441853.f0000 0004 0418 3510Semillero de Investigación en Farmacología Geriátrica, Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda Colombia
| | - Dayron Fernando Martínez-Pulgarín
- grid.10689.360000 0001 0286 3748Grupo de Investigación en Oftalmología Básica y Clínica, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Jorge Enrique Machado-Alba
- grid.412256.60000 0001 2176 1069Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Calle 105 # 14-140, 660003 Pereira, Risaralda Colombia
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Increased Risk of Ocular Hypertension in Patients With Cushing's Disease. J Glaucoma 2022; 31:941-946. [PMID: 35980841 DOI: 10.1097/ijg.0000000000002113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 07/14/2022] [Indexed: 12/29/2022]
Abstract
PRCIS An increased risk of ocular hypertension was seen in Cushing's disease. INTRODUCTION Systemic steroid use is a significant risk factor for increased intraocular pressure (IOP). The incidence of ocular hypertension may rise to 30%-40% of the general population due to topical or systemic glucocorticoid usage. However, the incidence of ocular hypertension in endogenous hypercortisolemia, as well as the ophthalmological outcomes after endocrine remission due to surgical resection, remain unknown. MATERIALS AND METHODS The IOP, visual field, and peripapillary retinal nerve fiber layer thickness were documented in all patients with Cushing's disease (CD) admitted to a tertiary pituitary center for surgery from January to July 2019. Patients with acromegaly and patients with nonfunctioning pituitary adenoma (NFPA) during the same study period served as controls. We calculated the odds ratio (OR), identified the risk factors of developing ocular hypertension, and presented postoperative trends of the IOP. RESULTS A total of 52 patients (38.4±12.4 y old) with CD were included. The IOP was higher in patients with CD (left 19.4±5.4 mm Hg and right 20.0±7.1 mm Hg) than in patients with acromegaly (left 17.5±2.3 mm Hg and right 18.6±7.0 mm Hg, P =0.033) and patients with NFPA (left 17.8±2.6 mm Hg and right 17.4±2.4 mm Hg, P =0.005). A total of 21 eyes (20.2%) in patients with CD were diagnosed with ocular hypertension compared with 4 eyes (4.7%) in the acromegaly group and 4 eyes (4.5%) in the NFPA group. The OR of developing ocular hypertension in patients with CD was 5.1 [95% confidence interval (CI), 1.3-25.1, P =0.029] and 6.6 (95% CI, 1.8-30.3, P =0.007) when compared with the 2 control groups. Among patients with CD, those with a higher urine-free cortisol were more likely to develop ocular hypertension (OR=19.4, 95% CI, 1.7-72.6). The IOP decreased at 1 month after surgery in patients with CD, and the change was sustained for 3 months after surgery. CONCLUSIONS An increased risk of ocular hypertension was seen in CD and suggests that endogenous hypercortisolemia should be considered as part of the glaucoma assessment. This result warrants the discretion of both ophthalmologists and neuroendocrinologists.
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Abd Rashid N, Mohammed SNF, Syed Abd Halim SA, Ghafar NA, Abdul Jalil NA. Therapeutic Potential of Honey and Propolis on Ocular Disease. Pharmaceuticals (Basel) 2022; 15:1419. [PMID: 36422549 PMCID: PMC9696375 DOI: 10.3390/ph15111419] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 09/01/2023] Open
Abstract
Honey and propolis have recently become the key target of attention for treating certain diseases and promoting overall health and well-being. A high content of flavonoids and phenolic acids found in both honey and propolis contributes to the antioxidant properties to scavenge free radicals. Honey and propolis also exhibited antibacterial effects where they act in two ways, namely the production of hydrogen peroxide (H2O2) and gluconic acids following the enzymatic activities of glucose oxidase, which exerts oxidative damage on the bacteria. Additionally, the anti-inflammatory effects of honey and propolis are mainly by reducing proinflammatory factors such as interleukins and tumor necrosis factor alpha (TNF-α). Their effects on pain were discovered through modulation at a peripheral nociceptive neuron or binding to an opioid receptor in the higher center. The aforementioned properties of honey have been reported to possess potential therapeutic topical application on the exterior parts of the eyes, particularly in treating conjunctivitis, keratitis, blepharitis, and corneal injury. In contrast, most of the medicinal values of propolis are beneficial in the internal ocular area, such as the retina, optic nerve, and uvea. This review aims to update the current discoveries of honey and propolis in treating various ocular diseases, including their antioxidant, anti-inflammatory, antibacterial, and anti-nociceptive properties. In conclusion, research has shown that propolis and honey have considerable therapeutic promise for treating various eye illnesses, although the present study designs are primarily animal and in vitro studies. Therefore, there is an urgent need to translate this finding into a clinical setting.
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Affiliation(s)
- Norhashima Abd Rashid
- Department of Biomedical Science, Faculty of Applied Science, Lincoln University College, Petaling Jaya 47301, Malaysia
| | - Siti Nur Farhana Mohammed
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | | | - Norzana Abd Ghafar
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Nahdia Afiifah Abdul Jalil
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
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12
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More than Antibiotics: Latest Therapeutics in the Treatment and Prevention of Ocular Surface Infections. J Clin Med 2022; 11:jcm11144195. [PMID: 35887958 PMCID: PMC9323953 DOI: 10.3390/jcm11144195] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/18/2022] [Accepted: 07/18/2022] [Indexed: 12/10/2022] Open
Abstract
Ocular surface infections have been common issues for ophthalmologists for decades. Traditional strategies for infection include antibiotics, antiviral agents, and steroids. However, multiple drug-resistant bacteria have become more common with the prevalence of antibiotic use. Furthermore, an ideal treatment for an infectious disease should not only emphasize eliminating the microorganism but also maintaining clear and satisfying visual acuity. Immunogenetic inflammation, tissue fibrosis, and corneal scarring pose serious threats to vision, and they are not attenuated or prevented by traditional antimicrobial therapeutics. Herein, we collected information about current management techniques including stem-cell therapy, probiotics, and gene therapy as well as preventive strategies related to Toll-like receptors. Finally, we will introduce the latest research findings in ocular drug-delivery systems, which may enhance the bioavailability and efficiency of ocular therapeutics. The clinical application of improved delivery systems and novel therapeutics may support people suffering from ocular surface infections.
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Majewska A, Mlynarczyk-Bonikowska B. 40 Years after the Registration of Acyclovir: Do We Need New Anti-Herpetic Drugs? Int J Mol Sci 2022; 23:ijms23073431. [PMID: 35408788 PMCID: PMC8998721 DOI: 10.3390/ijms23073431] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/10/2022] [Accepted: 03/18/2022] [Indexed: 01/17/2023] Open
Abstract
Herpes simplex virus types 1 and 2 HSV1 and 2, namely varicella-zoster VZV and cytomegalovirus CMV, are among the most common pathogens worldwide. They remain in the host body for life. The course of infection with these viruses is often asymptomatic or mild and self-limiting, but in immunocompromised patients, such as solid organ or bone marrow transplant recipients, the course can be very severe or even life-threatening. Unfortunately, in the latter group, the highest percentage of infections with strains resistant to routinely used drugs is observed. On the other hand, frequent recurrences of genital herpes can be a problem even in people with normal immunity. Genital herpes also increases the risk of acquiring sexually transmitted diseases, including HIV infection and, if present in pregnant women, poses a risk to the fetus and newborn. Even more frequently than herpes simplex, congenital infections can be caused by cytomegalovirus. We present the most important anti-herpesviral agents, the mechanisms of resistance to these drugs, and the associated mutations in the viral genome. Special emphasis was placed on newly introduced drugs such as maribavir and brincidofovir. We also briefly discuss the most promising substances in preclinical testing as well as immunotherapy options and vaccines currently in use and under investigation.
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Affiliation(s)
- Anna Majewska
- Department of Medical Microbiology, Medical University of Warsaw, Chałubińskiego 5, 02-004 Warsaw, Poland;
| | - Beata Mlynarczyk-Bonikowska
- Department of Dermatology, Immunodermatology and Venereology, Medical University of Warsaw, Koszykowa 82a, 02-008 Warsaw, Poland
- Correspondence: ; Tel.: +48-225021313
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Kuchar E, Karlikowska-Skwarnik M, Wawrzuta D. Anti-Inflammatory Therapy of Infections. ENCYCLOPEDIA OF INFECTION AND IMMUNITY 2022. [PMCID: PMC8496905 DOI: 10.1016/b978-0-12-818731-9.00181-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Anti-inflammatory treatment of infections is challenging due to the heterogeneity of etiologic agents and complex immune interactions. Nevertheless, anti-inflammatory medications are commonly used in infections to reduce unpleasant symptoms and to modify host response. They may play a fundamental role in managing infection with over-inflammation by decreasing inflammatory organ damage, e.g., COVID-19. However, by its inherent inhibition of immune functions, they might also contribute to the development of serious bacterial infections. Moreover, reducing a patient's symptoms and signs may provide a false sense of security and delay diagnosing threatening infections.
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A One-Week Course of Levofloxacin/Dexamethasone Eye Drops: A Review on a New Approach in Managing Patients After Cataract Surgery. Ophthalmol Ther 2021; 11:101-111. [PMID: 34936061 PMCID: PMC8770779 DOI: 10.1007/s40123-021-00435-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/17/2021] [Indexed: 01/24/2023] Open
Abstract
A new fixed-dose combination of dexamethasone and levofloxacin eye drops has recently been approved for the prevention and treatment of inflammation, and the prevention of infection associated with cataract surgery in adults. This combination has been developed to respond to a series of unmet needs in the practical management of patients undergoing cataract surgery. Namely, despite updated guidelines, many ophthalmologists employ protocols mainly based on their personal experience. As a result, the choice of drugs, treatment duration, and drug association is not evidence-based medicine (EBM)-oriented. In addition, antibiotic resistance may occur since antibiotics are used for an extended length of time, even with tapering. Corticosteroids are also prescribed for prolonged periods, frequently without follow-up. Therefore, patient adherence to postsurgical self-care is low, and mainly affects older patients who are the majority undergoing cataract surgery. In both rabbit and human trials, it has been demonstrated that both active ingredients penetrate the ocular system without pharmacokinetic interaction between the two. The concentrations of both ingredients in aqueous humor after their ocular instillation are high enough at the site of action to carry out their expected potent anti-inflammatory and antibiotic activity. Tested in a pivotal study aimed at investigating efficacy and safety of the intended indication, the mixture/compound was non-inferior to a 2-week treatment with dexamethasone/tobramycin in preventing or reducing inflammation and in preventing infection when administered for 1 week, followed by the administration of dexamethasone alone for another week. The outcomes obtained by this study suggest that a 1-week course of levofloxacin/dexamethasone eye drops is sufficient to resolve inflammation and prevent infection in patients undergoing cataract surgery. In addition, this study underlines that a follow-up visit after 1 week allows for a decision about whether to stop or continue a treatment in patients still experiencing symptoms or inflammation. In conclusion, this new dose combination could represent a turning point in managing patients after cataract surgery, while mostly avoiding antibiotic resistance and improving treatment adherence.
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De Loof H, De Win E, Moens N, Verhoeven V, Van Royen P, Kreps EO, Philips H. Overprescribing of Topical Ocular Corticosteroids and Antibiotics in Out-of-Hours Primary Care in Belgium. Drug Healthc Patient Saf 2021; 13:229-232. [PMID: 34849033 PMCID: PMC8627259 DOI: 10.2147/dhps.s339141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/03/2021] [Indexed: 11/23/2022] Open
Abstract
Prescribing patterns by primary care physicians concerning ophthalmic problems were studied using the iCAREdata, a database containing information from the out-of-hours care setting in the Flanders region of Belgium. A very high percentage of prescribed ophthalmic medication was topical antibiotics (89.4%) with tobramycin as the most prevalent substance and in clear conflict with the prevailing guidelines. In addition, a very substantial fraction of prescribed medication contained corticosteroids (30.4%). This is a potentially unsafe option within the technical infrastructure of this setting, which limits the diagnostic possibilities concerning viral infections or preexisting glaucoma risk. We conclude that more efforts are required to limit unnecessary and inappropriate prescribing behavior to further promote patient safety.
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Affiliation(s)
- Hans De Loof
- Laboratory of Physiopharmacology, Department of Pharmaceutical Sciences, University of Antwerp, Antwerp, Belgium
| | - Ellen De Win
- Laboratory of Physiopharmacology, Department of Pharmaceutical Sciences, University of Antwerp, Antwerp, Belgium
| | - Nathalie Moens
- Laboratory of Physiopharmacology, Department of Pharmaceutical Sciences, University of Antwerp, Antwerp, Belgium
| | - Veronique Verhoeven
- Research Group, Primary and Interdisciplinary Care (ELIZA), Department Family Medicine and Population Health (FAMPOP) University of Antwerp, Antwerp, Belgium
| | - Paul Van Royen
- Research Group, Primary and Interdisciplinary Care (ELIZA), Department Family Medicine and Population Health (FAMPOP) University of Antwerp, Antwerp, Belgium
| | - Elke O Kreps
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium
| | - Hilde Philips
- Research Group, Primary and Interdisciplinary Care (ELIZA), Department Family Medicine and Population Health (FAMPOP) University of Antwerp, Antwerp, Belgium
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17
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Cagini C, Muzi A, Castellucci G, Ragna G, Lupidi M, Alabed HBR, Pellegrino RM. Kinetics of hydrocortisone sodium phosphate penetration into the human aqueous humor after topical application. Int J Clin Pract 2021; 75:e14987. [PMID: 34672064 PMCID: PMC9286650 DOI: 10.1111/ijcp.14987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/27/2021] [Accepted: 10/19/2021] [Indexed: 11/30/2022] Open
Abstract
AIM OF THE STUDY Hydrocortisone is a soft steroid with low anti-inflammatory properties and a short duration of action, used to manage several ocular conditions. The clinical benefits and side effects associated with hydrocortisone are well documented, but its basic pharmacokinetic in the eye is yet to be fully elucidated. The purpose of this study is to investigate the anterior chamber penetration capabilities of hydrocortisone when used in different concentrations as eye drops treatment. MATERIALS AND METHODS This is a double-blind, single-centre, randomised clinical trial performed at the Department of Medicine and Surgery of the University of Perugia (Italy) on consecutive patients who undergone phacoemulsification with intraocular lens implantation. Patients were randomly assigned on the morning of surgery to receive a single instillation of 0.33% (group A) or 0.001% (group B) hydrocortisone sodium phosphate solution. Group of patients C did not receive any treatment and was used to measure the hydrocortisone endogenous levels. Before surgery, one aliquot of aqueous humor for each patient was aspirated. The time of collection for each sample was recorded. Hydrocortisone concentrations were then stratified into six interval classes of 30 minutes each. RESULTS The mean concentration of hydrocortisone was significantly higher in group A (25.2 ± 12.4 ng/mL) compared with group B (7.11 ± 1.51 ng/mL) and compared with the mean hydrocortisone endogenous levels (3.92 ± 1.18 ng/mL) (P < .0001). No statistically significant differences of hydrocortisone mean concentrations between group B and the mean endogenous levels were found. CONCLUSIONS Considering the frequent need for prolonged topical steroid therapies and the possible consequent undesirable side effects, ophthalmologists should consider the lowest clinically effective dose of hydrocortisone useful to obtain the desired therapeutic effect and in an adequate time, to minimise the amount of steroids into the anterior chamber and to avoid side effects like intra-ocular pressure increase or cataract development.
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Affiliation(s)
- Carlo Cagini
- Department of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
| | - Alessio Muzi
- Department of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
| | | | - Giulia Ragna
- Department of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
| | - Marco Lupidi
- Department of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
| | - Husam B. R. Alabed
- Department of Chemistry, Biology and BiotechnologyUniversity of PerugiaPerugiaItaly
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Mah FS, Karpecki PM. Review of Loteprednol Etabonate 0.5%/Tobramycin 0.3% in the Treatment of Blepharokeratoconjunctivitis. Ophthalmol Ther 2021; 10:859-875. [PMID: 34708391 PMCID: PMC8589901 DOI: 10.1007/s40123-021-00401-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/23/2021] [Indexed: 11/25/2022] Open
Abstract
Use of a combination corticosteroid and antibiotic in a single formulation is common in the treatment of ocular inflammatory conditions for which corticosteroid therapy is indicated and there exists a risk of superficial bacterial infection. Loteprednol etabonate (LE) is a corticosteroid engineered to maintain potent anti-inflammatory activity while minimizing the risk of undesirable class effects of corticosteroids, such as elevated intraocular pressure and cataract. Tobramycin is a broad-spectrum aminoglycoside antibiotic that is considered generally safe and well tolerated. An ophthalmic suspension combining LE 0.5% and tobramycin 0.3% (LE/T) is approved in the US and several other countries. Use of a combination therapy increases convenience, which may promote patient adherence. A systematic literature review was conducted to examine the efficacy and safety of LE/T for ocular inflammatory conditions within the scope of its labeled indications. Results of published studies indicate that LE/T is effective in the treatment of blepharokeratoconjunctivitis in adults, with similar efficacy as dexamethasone 0.1%/tobramycin 0.3%, but is associated with a lower risk of clinically significant increases in intraocular pressure as demonstrated in both efficacy and safety studies and studies with healthy volunteers. Furthermore, studies in children with blepharitis or blepharoconjunctivitis indicate LE/T was well tolerated in this population, although efficacy vs vehicle was not demonstrated, potentially due to improvements in all groups overall and/or limited sample size. Separately, tobramycin demonstrated potent in vitro activity against most bacterial species associated with blepharitis. In conclusion, published data demonstrate the utility of LE/T for the treatment of the various clinical manifestations of blepharokeratoconjunctivitis in adults.
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Affiliation(s)
- Francis S Mah
- Refractive Surgery Service, Scripps Clinic, 10710 N. Torrey Pines Road, MS 214, La Jolla, CA, 92037, USA.
| | - Paul M Karpecki
- Kentucky Eye Institute, 601 Perimeter Dr, Suite 100, Lexington, KY, USA
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Liao K, Cui Z, Zeng Y, Liu J, Wang Y, Wang Z, Tang S, Chen J. Inhibition of enhancer of zeste homolog 2 prevents corneal myofibroblast transformation in vitro. Exp Eye Res 2021; 208:108611. [PMID: 33992624 DOI: 10.1016/j.exer.2021.108611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/25/2021] [Accepted: 04/29/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE Corneal fibroblast can be transformed into corneal myofibroblasts by TGF-β1. Enhancer of zeste homolog 2 (EZH2) upregulation has been observed in the occurrence of other fibrotic disorders. We investigated the role of EZH2 in the progression of corneal fibrosis and the antifibrotic effect of EZH2 inhibition in corneal fibroblasts (CFs). METHODS Primary CFs were isolated from corneal limbi and the CFs were treated with TGF-β1 to induce fibrosis. EPZ-6438 and EZH2 siRNA were used to inhibit EZH2 expression. Myofibroblast activation and extracellular matrix (ECM) protein synthesis was detected by quantitative real-time PCR, western blotting, and immunofluorescence staining assay. The functions of myofibroblast were evaluated by cell migration and collagen gel contraction assays. Molecular mechanisms involved in EZH2 inhibition were investigated by RNA sequencing. RESULTS TGF-β1 activated EZH2 expression in CFs. Treatment with EPZ-6438 (5 μM) and EZH2 siRNA considerably suppressed corneal myofibroblast activation and ECM protein synthesis in CFs induced by TGF-β1 when compared to the control group. EPZ-6438 (5 μM) suppressed cell migration and gel contraction in CFs. RNA sequencing results revealed that antifibrotic genes were activated after EZH2 inhibition to suppress corneal myofibroblast activation. CONCLUSION Inhibition of EZH2 suppresses corneal myofibroblast activation and ECM protein synthesis, and could serve as a novel therapeutic target for preventing corneal scarring.
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Affiliation(s)
- Kai Liao
- Aier School of Ophthalmology, Central South University, Changsha, Hunan, China; Aier Eye Institute, Changsha, Hunan Province, China
| | - Zekai Cui
- Aier Eye Institute, Changsha, Hunan Province, China
| | - Yong Zeng
- Department of Ophthalmology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Jian Liu
- Aier Eye Institute, Changsha, Hunan Province, China
| | - Yini Wang
- Aier Eye Institute, Changsha, Hunan Province, China
| | - Zhijie Wang
- Aier School of Ophthalmology, Central South University, Changsha, Hunan, China; Aier Eye Institute, Changsha, Hunan Province, China
| | - Shibo Tang
- Aier School of Ophthalmology, Central South University, Changsha, Hunan, China; Aier Eye Institute, Changsha, Hunan Province, China; CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China.
| | - Jiansu Chen
- Aier School of Ophthalmology, Central South University, Changsha, Hunan, China; Aier Eye Institute, Changsha, Hunan Province, China; Key Laboratory for Regenerative Medicine, Ministry of Education, Jinan University, Guangzhou, China.
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Toffoletto N, Chauhan A, Alvarez-Lorenzo C, Saramago B, Serro AP. Asymmetry in Drug Permeability through the Cornea. Pharmaceutics 2021; 13:694. [PMID: 34064834 PMCID: PMC8151369 DOI: 10.3390/pharmaceutics13050694] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 12/14/2022] Open
Abstract
The permeability through the cornea determines the ability of a drug or any topically applied compound to cross the tissue and reach the intraocular area. Most of the permeability values found in the literature are obtained considering topical drug formulations, and therefore, refer to the drug permeability inward the eye. However, due to the asymmetry of the corneal tissue, outward drug permeability constitutes a more meaningful parameter when dealing with intraocular drug-delivery systems (i.e., drug-loaded intraocular lenses, intraocular implants or injections). Herein, the permeability coefficients of two commonly administered anti-inflammatory drugs (i.e., bromfenac sodium and dexamethasone sodium) were determined ex vivo using Franz diffusion cells and porcine corneas in both inward and outward configurations. A significantly higher drug accumulation in the cornea was detected in the outward direction, which is consistent with the different characteristics of the corneal layers. Coherently, a higher permeability coefficient was obtained for bromfenac sodium in the outward direction, but no differences were detected for dexamethasone sodium in the two directions. Drug accumulation in the cornea can prolong the therapeutic effect of intraocular drug-release systems.
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Affiliation(s)
- Nadia Toffoletto
- Centro de Química Estrutural, Instituto Superior Técnico, University of Lisbon, Av. Rovisco Pais, 1049-001 Lisbon, Portugal; (B.S.); (A.P.S.)
- Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Quinta da Granja, Monte de Caparica, 2829-511 Caparica, Portugal
| | - Anuj Chauhan
- Department of Chemical Engineering, Colorado School of Mines, Golden, CO 80401, USA;
| | - Carmen Alvarez-Lorenzo
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma (GI-1645), Facultad de Farmacia and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain;
| | - Benilde Saramago
- Centro de Química Estrutural, Instituto Superior Técnico, University of Lisbon, Av. Rovisco Pais, 1049-001 Lisbon, Portugal; (B.S.); (A.P.S.)
| | - Ana Paula Serro
- Centro de Química Estrutural, Instituto Superior Técnico, University of Lisbon, Av. Rovisco Pais, 1049-001 Lisbon, Portugal; (B.S.); (A.P.S.)
- Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Quinta da Granja, Monte de Caparica, 2829-511 Caparica, Portugal
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Sabry HS, Al-Shohani ADH, Mahmood SZ. Formulation and Evaluation of Levofloxacin and Betamethasone Ophthalmic Emulgel. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2021; 13:205-211. [PMID: 34349481 PMCID: PMC8291107 DOI: 10.4103/jpbs.jpbs_338_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/05/2020] [Accepted: 09/27/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Drug delivery to ocular tissues is challenging due to rapid removal of instilled drug due to low resident time in ocular tissues. The aim of the study was to formulate an ophthalmic emulgel that delivers two drugs (betamethasone sodium phosphate [BSP] and levofloxacin). The new combination will allow the simultaneous administration and extended release of the two drugs which potentially improve resident time in ocular tissues, patient compliance, and adherence to treatment. MATERIALS AND METHODS Formulations containing different gelling agents at different concentrations were prepared to choose the optimum combination regarding physical properties and release. The emulgel formulations F1, F2, F3, and F4 were made using gelling agent 1% and 2% xanthan gum, 1% carbopole 934, and 2% methyl cellulose, respectively. F5 was formulated using 2% methyl cellulose with double the amount of poloxamer 188 as emulsifying agent. All the formulations were examined regarding their physical appearance, pH, viscosity, drug content, and in vitro drug release. The optimum formula was also examined for antibacterial activity. RESULTS The results demonstrated that F5 was the optimum formulation having a proper physical characteristics and release profile of both drugs, 96% and 90% for BSP and levofloxacin, respectively, compared to other formulations and commercial eye drops. CONCLUSION Simultaneous and extended release of the two drugs was achieved using one formulation of emulgel. The ability to deliver hydrophilic and hydrophobic drug through the same formulation without the need to use two drops will improve patient compliance and hence patient adherence to treatment.
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Affiliation(s)
- Hiba Sabah Sabry
- Department of Pharmaceutics, College of Pharmacy, Mustansiriyah University, Baghdad, Iraq
| | | | - Sura Zuhair Mahmood
- Department of Pharmaceutics, College of Pharmacy, Mustansiriyah University, Baghdad, Iraq
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Webber AL, Sharwood P. Practical use and prescription of ocular medications in children and infants. Clin Exp Optom 2021; 104:385-395. [PMID: 33689620 DOI: 10.1080/08164622.2021.1877533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Optometrists in Australia employ ophthalmic medicines in their paediatric practice to assist clinical diagnosis and to treat ocular conditions. Prior to employing ocular medicines or initiating treatment, it is important to consider the risks versus benefits of ophthalmic medicines and determine the minimum dose required to safely achieve a diagnostic or therapeutic benefit. Instilling drops in infants and young children may require techniques that do not depend on full cooperation, particularly to maintain appropriate dosing and limit the rate of elimination from the eye. Diagnostic cycloplegic agents are highly recommended for the accurate determination of refractive error in infants and young children. Topical atropine is commonly prescribed in paediatric optometry practice in highly variable concentrations. 1% atropine eye drops are used for pharmacological penalisation in management of amblyopia, and, increasingly, low concentration (< 0.1%) atropine is used to manage the progression of childhood myopia. Doses of topical ocular medicines to treat inflammation, infection or glaucoma are generally identical to those use in adults; however, there is potential for increased ocular and systemic side effects with certain medications. It is, therefore, timely to present, summarise and comment on the use of ophthalmic diagnostic and therapeutic agents in children and reference where practitioners can look for more detailed information. The perspective is set in the Australian context of a collaborative approach between paediatric optometry and ophthalmology eye care practitioners for delivery of best practice care in infants and young children. Inclusion of the more complex spectrum of paediatric eye disease in a tertiary ophthalmological setting is provided to build practitioner knowledge of treatment regimens their patients may be using, even though management of these conditions lies outside their scope of practice.
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Affiliation(s)
- Ann L Webber
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia.,Department of Ophthalmology, Queensland Children's Hospital, Brisbane, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Phillipa Sharwood
- Department of Ophthalmology, Queensland Children's Hospital, Brisbane, Australia
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A Drug Safety Surveillance Study of a Ciprofloxacin/Dexamethasone Ophthalmic Fixed Combination in Peruvian Population. PHARMACY 2021; 9:pharmacy9010015. [PMID: 33435238 PMCID: PMC7838768 DOI: 10.3390/pharmacy9010015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/28/2020] [Accepted: 01/06/2021] [Indexed: 02/06/2023] Open
Abstract
(1) Background: drugs provide a significant benefit for patients who require medical treatment; however, their use implies an intrinsic potential danger, with the possibility of causing unwanted effects. These effects are known as adverse drug reactions (ADRs). Post-marketing drug safety surveillance detects unknown risks that have not been identified in clinical trials, and it is necessary to monitor marketed medications under real-life practice. Due to the scarce information about fixed combination of ciprofloxacin 0.3%/dexamethasone 0.1% (SDO), we performed a drug safety surveillance study. (2) Methods: A prospective non-controlled drug safety surveillance study was conducted in Peruvian population. A total of 236 patients prescribed SDO were included derived from 12 sites. Patients' standardized information was collected through two phone calls, including demographics, medical history, prescribing patterns of SDO, concomitant medication, and ADRs in detail. The ADRs were classified by causality and severity, followed by outcome measures to identify new risk. (3) Results: 236 patients prescribed with SDO participated in the study and 220 were included. A total of 82 ADRs/220 patients were reported after the use of SDO, presenting a ratio 0.37 ADR/patient. The most frequent ADR with SDO administration was eye irritation (30%). All ADRs were classified as non-serious, and 97.5% (n = 80) were classified as mild while 2.5% as moderate (n = 2). No cases under the severe category were identified. (4) Conclusion: No new risks were found in the population where this study was conducted.
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Hashimoto Y, Michihata N, Yamana H, Shigemi D, Morita K, Matsui H, Yasunaga H, Aihara M. Ophthalmic Corticosteroids in Pregnant Women with Allergic Conjunctivitis and Adverse Neonatal Outcomes: Propensity Score Analyses. Am J Ophthalmol 2020; 220:91-101. [PMID: 32681904 DOI: 10.1016/j.ajo.2020.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/03/2020] [Accepted: 07/08/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE The risks of topical ophthalmic corticosteroids during pregnancy remain unclear. This study investigated the association between exposure to topical ophthalmic corticosteroids during pregnancy and adverse neonatal outcomes. DESIGN Retrospective, cohort, database study. METHODS Pregnant women with allergic conjunctivitis in the JMDC claims database (JMDC, Tokyo, Japan) between 2005 and 2018 were included. Adverse neonatal outcomes (congenital anomalies [CA], preterm birth [PB], low birthweight [LB], and the composite of these 3 outcomes) were compared between mothers who did and did not receive topical ophthalmic corticosteroids during the first trimester. Controls were women who were not prescribed topical ophthalmic corticosteroids during the first trimester. First, propensity scores were calculated with known confounders, including disorders during pregnancy, other chronic comorbidities, and use of antihistamines. Logistic regression was then conducted with propensity score adjustment. RESULTS A total of 6,847 eligible women were identified of whom 898 (13%) had received topical ophthalmic corticosteroids. CA occurred in 5.5% and 4.9%, respectively; PB in 3.4% and 3.9%, respectively; LB in 5.9% and 7.0%, respectively; and the composite outcome in 11.7% and 11.7% of unexposed and exposed mothers, respectively. Corticosteroid eye drops were not significantly associated with an increase in CA (adjusted odds ratio [aOR], 0.78; 95% confidence interval [CI], 0.54-1.14; P = .20); PB (aOR, 1.23; 95% CI, 0.80-1.88; P = .35); LB (aOR, 1.17; 95% CI, 0.84-1.61; P = .35), or composite outcome (aOR, 0.95; 95% CI, 0.73-1.22; P = .68). CONCLUSIONS The use of topical ophthalmic corticosteroids in pregnant women with allergic conjunctivitis was not associated with any increase in CA, PB, or LB.
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Corticosteroids Versus Cyclosporine for Subepithelial Infiltrates Secondary to Epidemic Keratoconjunctivitis: A Prospective Randomized Double-Blind Study. Cornea 2020; 40:726-732. [PMID: 33201059 DOI: 10.1097/ico.0000000000002589] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 09/11/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare efficiency and tolerance between topical 0.5% cyclosporine A (CSA) and fluorometholone (FML) for subepithelial infiltrates (SEI) complicating epidemic keratoconjunctivitis. METHODS We conducted a prospective double-blind randomized study involving 72 eyes with SEI. Thirty-eight eyes were treated with topical FML (FML group) and 34 eyes with CSA 0.5% eye drops (CSA group). Treatment was considered successful in case of SEI reduction and visual acuity improvement. Tolerance was evaluated by Schirmer test value, burning on eye drops instillation, and conjunctival injection. RESULTS Baseline characteristics of both groups were similar (P > 0.05). After 3 months of the regimen, resolution of SEI was 3 times more observed in the FML group than that in the CSA group (P = 0.026). After 6 months, resolution of SEI was observed in 70% of the FML group and in 47% of the CSA group (P = 0.068). The recurrence of SEI was almost twice higher in the FML group than that in the CSA group (16% vs. 9%). FML was better tolerated during the first 3 months: a higher Schirmer test value (P = 0.0003), less burning on instillation (P = 0.242), and less conjunctival injection (P = 0.003). For the rest of the follow-up period, the 2 groups were comparable in tolerance. No ocular hypertension was noted. CONCLUSIONS Epidemic keratoconjunctivitis can evolve favorably under both FML and CSA. The effect of FML is faster and CSA is more durable with fewer recurrences. Both are safe therapeutic options for long-term control of SEI.
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Aragona P, Postorino EI, Aragona E. Post-surgical management of cataract: Light and dark in the 2020s. Eur J Ophthalmol 2020; 31:287-290. [PMID: 33081522 DOI: 10.1177/1120672120963458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Cataract surgery is the most frequently performed elective surgery worldwide. Although considered a safe procedure, potentially sight-threatening adverse events are possible. Among these, post-surgical inflammation and infections are the most relevant. Anti-inflammatory drugs, such as corticosteroids, and topical antibiotics are the pillars for the treatment of inflammation and for the prevention of infections. However, uncertainties remain regarding the duration of both topical antibiotic prophylaxis and corticosteroid treatment. LEADER7, a recent international clinical study conducted with the new fixed combination of levofloxacin and dexamethasone eye drops in patients undergoing uncomplicated cataract surgery, found that 1-week topical antibiotic prophylaxis is just as effective as the 2-week course commonly used in clinical practice. The study also showed that treatment for 1 week with dexamethasone results in complete resolution of inflammatory signs and symptoms in over 85% of patients, for whom further prolongation of corticosteroid treatment is, therefore, not necessary. This new treatment strategy can represent a significant step forward to reduce the unjustified use of prophylactic antibiotics after cataract surgery, limiting the emergence of bacterial resistance, as well as representing an opportunity to optimize the use and safety of the corticosteroid treatment.
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Affiliation(s)
- Pasquale Aragona
- Department of Biomedical Sciences, Ophthalmology Clinic, University of Messina, Messina, Italy
| | - Elisa Imelde Postorino
- Department of Biomedical Sciences, Ophthalmology Clinic, University of Messina, Messina, Italy
| | - Emanuela Aragona
- Department of Ophthalmology, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Cagini C, Mariniello M, Messina M, Muzi A, Balducci C, Moretti A, Levorato L, Mencacci A. The role of ozonized oil and a combination of tobramycin/dexamethasone eye drops in the treatment of viral conjunctivitis: a randomized clinical trial. Int Ophthalmol 2020; 40:3209-3215. [PMID: 32696102 PMCID: PMC7669761 DOI: 10.1007/s10792-020-01503-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/30/2020] [Indexed: 02/07/2023]
Abstract
Purpose To determine whether topical tobramycin 0.3%/dexamethasone 0.1% plus ozonized oil eye drops reduces clinical signs and infectious viral titers of presumed viral conjunctivitis more than tobramycin/dexamethasone eye drops alone. Methods Prospective, single-blind, randomized, parallel-groups trial. Eighty patients with a clinical diagnosis of presumed viral conjunctivitis were randomizedly divided into two treatment groups: a study group and a control group, 40 for each group. Patients in the study group received topical tobramycin 0.3%/dexamethasone 0.1% eye drops, plus ozonized oil eye drops, both four times daily; patients in the control group received only topical tobramycin 0.3%/dexamethasone eye drops four times daily. The treatment was for seven days in both groups. Swabs were taken from the conjunctival fornix for adenovirus PCR analysis on the day of recruitment and at seven days follow-up. Clinical signs were also recorded on the day of recruitment and at follow-up examination: the main outcomes were conjunctival injection and conjunctival chemosis, graded on a 4-point clinical scale, presence or absence of superficial punctate keratitis and subepithelial corneal infiltrates. Results No statistically significant difference was reached in adenoviral infection negativization between the two groups, although the study group showed a higher number of PCR negative results at seven days follow-up. PCR real time detected adenoviral infection in 17 of 24 patients on the day of recruitment and it was positive in 4 patients on the seventh day (viral positivity reduction of 76%). In the control group PCR was positive for adenovirus in 18 of 24 patients on the day of recruitment and in 7 patients at seven days follow-up (reduction of 61%). There was statistically significant difference on conjunctival clinical signs between the study and control groups. Significant difference was also found on superficial punctate keratitis resolution between the study and the control group. In the former superficial punctate keratitis was detected in 14 eyes on the first day and in 5 eyes after seven days while in the latter superficial punctate keratitis was found in 124 eyes on the first day and in 6 eyes on the seventh day. No difference was found in subepithelial corneal infiltrates appearance between the two groups. Conclusions The use of ozonized-oil containing eye drops in combination with topical tobramycin 0.3%/dexamethasone 0.1% eye drops four times daily seems to reduce the signs of conjunctivitis, and the duration of viral infection, although it does not affect the subepithelial corneal infiltrates appearance.
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Affiliation(s)
- C Cagini
- Division of Ophthalmology, Department of Surgical and Biomedical Sciences, University of Perugia, Ospedale S. Maria della Misericordia, S. Andrea Delle Fratte, 06156, Perugia, Italy.
| | - M Mariniello
- Division of Ophthalmology, Department of Surgical and Biomedical Sciences, University of Perugia, Ospedale S. Maria della Misericordia, S. Andrea Delle Fratte, 06156, Perugia, Italy
| | - M Messina
- Division of Ophthalmology, Department of Surgical and Biomedical Sciences, University of Perugia, Ospedale S. Maria della Misericordia, S. Andrea Delle Fratte, 06156, Perugia, Italy
| | - A Muzi
- Division of Ophthalmology, Department of Surgical and Biomedical Sciences, University of Perugia, Ospedale S. Maria della Misericordia, S. Andrea Delle Fratte, 06156, Perugia, Italy
| | - C Balducci
- Division of Ophthalmology, Department of Surgical and Biomedical Sciences, University of Perugia, Ospedale S. Maria della Misericordia, S. Andrea Delle Fratte, 06156, Perugia, Italy
| | - A Moretti
- Microbiology Unit, Department of Medicine, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - L Levorato
- Microbiology Unit, Department of Medicine, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - A Mencacci
- Microbiology Unit, Department of Medicine, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
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Ta CN, Raizman MB, Gross RD, Joshi S, Mallick S, Wang Y, Segal B. A Prospective, Randomized Trial of Povidone-Iodine 0.6% and Dexamethasone 0.1% Ophthalmic Suspension for Acute Bacterial Conjunctivitis. Am J Ophthalmol 2020; 215:56-65. [PMID: 32222367 DOI: 10.1016/j.ajo.2020.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of a topical ophthalmic suspension combination of povidone-iodine 0.6% (PVP-I) and dexamethasone 0.1% (DEX) for infectious and inflammatory components of bacterial conjunctivitis. DESIGN Randomized, double-masked, multicenter, phase 3 clinical trial. METHODS Subjects of all ages (those <3 months had to be full-term) with a diagnosis of bacterial conjunctivitis were randomized 3:1:3 to either PVP-I/DEX, PVP-I alone, or placebo. The primary endpoint was clinical resolution in the study eye, and the key secondary efficacy endpoint was bacterial eradication, both at the day 5 visit. Adverse events (AEs) were documented at all visits. RESULTS Overall, 753 subjects were randomized (intent-to-treat [ITT] population; PVP-I/DEX [n = 324]; PVP-I [n = 108]; placebo [n = 321]); mean and standard deviation (SD) age was 44.3 (22.9) years, and most were female (61.2%) and white (78.1%). In all treatment groups, mean treatment compliance was >98%. The modified ITT population for the efficacy analysis comprised 526 subjects. In the study eye at the day 5 visit, clinical resolution was achieved by 50.5% (111/220) subjects in the PVP-I/DEX group vs 42.8% (95/222) in the placebo group (P = .127), and bacterial eradication was achieved by 43.3% (94/217) and 46.8% (102/218), respectively (P = .500). Treatment-emergent AEs were experienced by 32.8% (106/323), 39.8% (43/108), and 19.0% (61/321) of subjects in the safety population treated with PVP-I/DEX, PVP-I, and placebo, respectively (most mild in severity). CONCLUSION In this study, PVP-I/DEX did not demonstrate additional benefit in clinical efficacy compared with placebo in subjects with bacterial conjunctivitis.
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