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Protzko EE, Segal BA, Korenfeld MS, Krösser S, Vittitow JL. Long-Term Safety and Efficacy of Perfluorohexyloctane Ophthalmic Solution for the Treatment of Patients With Dry Eye Disease: The KALAHARI Study. Cornea 2024; 43:1100-1107. [PMID: 37921522 PMCID: PMC11296276 DOI: 10.1097/ico.0000000000003418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/22/2023] [Accepted: 09/23/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE The aim of this study was to assess the long-term safety and efficacy of perfluorohexyloctane (PFHO) ophthalmic drop (formerly NOV03) for treatment of dry eye disease (DED). METHODS KALAHARI was a phase 3, multicenter, single-arm, open-label extension study in patients aged 18 years or older with DED associated with Meibomian gland dysfunction who completed the randomized, double-masked, hypotonic saline-controlled GOBI study. Patients instilled 1 drop of PFHO (MIEBO, Bausch + Lomb) 4 times daily in both eyes for 52 weeks. Safety assessments included adverse events, best-corrected visual acuity, slit-lamp biomicroscopy, intraocular pressure, and dilated fundoscopy. Efficacy end points included change from GOBI study baseline in total corneal fluorescein staining and eye dryness score (0-100 visual analog scale). RESULTS Overall, 208 patients from GOBI (PFHO [n = 97]; saline [n = 111]) were rolled over into KALAHARI. Twenty-nine patients (13.9%) had ≥1 ocular adverse event, with most being mild or moderate in severity; the most common ocular adverse events were vitreous detachment (1.9%), allergic conjunctivitis (1.4%), blurred vision (1.4%), and increased lacrimation (1.4%). Other safety end points were unremarkable. For patients continuing PFHO from GOBI, improvements in total corneal fluorescein staining and visual analog scale dryness scores observed in GOBI were maintained throughout KALAHARI. Patients treated with saline in GOBI and switched to PFHO in KALAHARI showed improvements in total corneal fluorescein staining and visual analog scale scores by week 4 that were maintained for the rest of the study. CONCLUSIONS PFHO was safe and well tolerated and maintained efficacy for improving signs and symptoms of DED in this year-long study of patients with DED associated with Meibomian gland dysfunction.
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Sharma N, Venugopal R, Nagpal R, K P, Verma K, Verma KK, Biswas NR, Velpandian T, Sen S, Dwivedi SN, Tandon R, Titiyal JS, Vajpayee R. Evaluation of adjuvant role of topical cyclosporine 1% in acute Stevens-Johnson syndrome: a randomised control trial. Br J Ophthalmol 2024:bjo-2023-324901. [PMID: 38802169 DOI: 10.1136/bjo-2023-324901] [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: 11/24/2023] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE To evaluate the role of topical cyclosporine A 1% (CsA) as an adjuvant therapy in patients with acute Stevens-Johnson syndrome (SJS). METHODS This is a randomised controlled trial in which 44 patients (88 eyes) with acute SJS, presenting within 3 months from the onset of the disease, were enrolled and randomised. Group A (n=44 eyes) patients received treatment with topical CsA 1% along with standard therapy consisting of topical corticosteroids, antibiotics and lubricants. Group B (n=44 eyes) patients received topical saline drops in combination with standard therapy. Various ocular surface parameters were assessed at baseline and the 6-month follow-up. RESULTS The mean age of patients (years) was 23.9±15.1 in the CsA group and 26.0±18.7 in the control group (p=0.6840). The mean time from disease onset to presentation (days) was 17.0±14.0 and 12.9±11.3 in CsA and control groups, respectively (p=0.1568). At presentation, the mean grades of severity scores of various parameters were comparable. At 6 months, both groups showed a significant improvement in the mean severity grades of conjunctival hyperaemia (A, p=0.001; B, p=0.0001), mucocutaneous junction involvement (A, p=0.001; B, p=0.0001) and meibomian gland involvement (A, p=0.0471; B, p=0.006). Compared with baseline, the grades of corneal keratinisation (baseline, 0.48±0.7; 6 months, 1.02±0.8; p=0.0015) and neovascularisation (baseline, 1.07±1.2; 6 months, 1.57±1.0; p=0.0412) worsened after 6 months of CsA therapy. Intergroup comparison of grades of various parameters however did not reveal any significant difference at 6 months. CONCLUSIONS Adjuvant treatment with topical CsA is not superior to standard therapy, in cases of acute SJS.
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Affiliation(s)
- Namrata Sharma
- Rajendra Prasad Centre for Ophthalmic Science, All India Institute of Medical Sciences, New Delhi, India
| | - Renu Venugopal
- Rajendra Prasad Centre for Ophthalmic Science, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Nagpal
- Rajendra Prasad Centre for Ophthalmic Science, All India Institute of Medical Sciences, New Delhi, India
| | - Priyadarshini K
- Rajendra Prasad Centre for Ophthalmic Science, All India Institute of Medical Sciences, New Delhi, India
| | - Kamna Verma
- Rajendra Prasad Centre for Ophthalmic Science, All India Institute of Medical Sciences, New Delhi, India
| | - Kaushal K Verma
- Department of Dermatology, All India institute of Medical Sciences, New Delhi, Delhi, India
| | - N R Biswas
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Seema Sen
- Ocular Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - S N Dwivedi
- Department of Biostatistics, All India institute of Medical Sciences, New Delhi, Delhi, India
| | - Radhika Tandon
- Rajendra Prasad Centre for Ophthalmic Science, All India Institute of Medical Sciences, New Delhi, India
| | - Jeewan S Titiyal
- Rajendra Prasad Centre for Ophthalmic Science, All India Institute of Medical Sciences, New Delhi, India
| | - Rasik Vajpayee
- University of Melbourne, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
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Ballesteros-Sánchez A, Borroni D, De-Hita-Cantalejo C, Sánchez-González MC, Sanchez-Gomez S, Rocha-de-Lossada C, Sánchez-González JM. Efficacy of bilateral OC-01 (varenicline solution) nasal spray in alleviating signs and symptoms of dry eye disease: A systematic review. Cont Lens Anterior Eye 2024; 47:102097. [PMID: 38065797 DOI: 10.1016/j.clae.2023.102097] [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: 10/15/2023] [Revised: 11/13/2023] [Accepted: 11/27/2023] [Indexed: 01/22/2024]
Abstract
PURPOSE To comprehensively review the efficacy and safety of OC-01 varenicline nasal spray versus vehicle nasal spray (VNS) in the treatment in dry eye disease (DED). METHODS A systematic review that included full-length randomized controlled studies (RCTs), as well as post hoc analyses of RCTs reporting new findings on OC-01 VNS treatment in three databases, PubMed, Scopus and Web of Science, was performed according to the PRISMA statement. The search period included studies published between December 2021 and September 2023. The Cochrane risk of bias tool was used to analyze the quality of the studies selected. RESULTS A total of 8 studies were included in this systematic review. OC-01 VNS treatment achieved higher improvement than vehicle in all reported variables. The mean differences between both groups were in favor of OC-01 VNS treatment and were as follow: eye dryness score base on a visual analogue scale (EDS-VAS) of -7.5 ± 2.2 points [-11.6 to -5.6], Schirmer test (ST) with anesthesia of 6.6 ± 2.3 mm [4.9 to 11.8] and total corneal fluorescein staining (tCFS) of -1.2 ± 0.01 points [-1.2 to -1.1]. Similar improvements were reported with OC-01 VNS 0.03 mg and 0.06 mg. Adverse events (AEs) were 15.5 ± 19.4 % [-13 to 80.5] higher in the OC-01 VNS group with an overall adherence > 93 %. CONCLUSIONS OC-01 VNS improves dry eye symptoms and signs with a satisfactory tolerability. Therefore, OC-01 VNS seems to be a safe and effective treatment that could be recommended in patients with DED. This new treatment could be particularly useful in those patients who have difficulties with the administration of traditional topical therapies.
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Affiliation(s)
- Antonio Ballesteros-Sánchez
- Department of Physics of Condensed Matter, Optics Area, University of Seville, Seville, Spain; Department of Ophthalmology, Clínica Novovisión, Murcia, Spain.
| | - Davide Borroni
- Department of Doctoral Studies, Riga Stradins University, LV-1007 Riga, Latvia; Advalia Vision, Cornea Research Unit, 20145 Milan, Italy
| | | | | | - Serafin Sanchez-Gomez
- Servicio de Otorrinolaringología, Hospital Universitario Virgen Macarena, 41009 Seville, Spain
| | - Carlos Rocha-de-Lossada
- Ophthalmology Department, VITHAS Malaga, 29016 Malaga, Spain; Regional University Hospital of Malaga, Hospital Civil Square, 29009 Malaga, Spain; Qvision, Ophthalmology Department, VITHAS Almeria Hospital, 04120 Almeria, Spain; Surgery Department, Ophthalmology Area, University of Seville, Doctor Fedriani, 41009 Seville, Spain
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Koh S. Galápagosization: Diquafosol for Dry Eyes. Eye Contact Lens 2024; 50:57-58. [PMID: 38284907 DOI: 10.1097/icl.0000000000001071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Affiliation(s)
- Shizuka Koh
- Department of Innovative Visual Science (S.K.), Osaka University Graduate School of Medicine, Osaka, Japan; and Department of Ophthalmology (S.K.), Osaka University Graduate School of Medicine, Osaka, Japan
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Zitko KL, Ladd L, Dougherty TS. Intranasal Varenicline: Review of a Novel Formulation for the Treatment of Dry Eye Disease. J Pharm Pract 2023; 36:1448-1453. [PMID: 35703427 DOI: 10.1177/08971900221108725] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective: To examine the literature pertaining to safety and efficacy of intranasal (IN) varenicline for the treatment of dry eye disease (DED). Data Sources: A literature search of PubMed was performed (1985 to January 2022) using the following search terms: varenicline, OC-01, intranasal, and dry eye. Additional data were acquired from references of identified articles, prescribing information, government databases, and manufacturer website. Study Selection/Data Extraction: All relevant English-language studies were included in this review. Data Synthesis: IN varenicline was FDA approved for the treatment of DED in 2021. IN varenicline has demonstrated a statistically significant improvement in outcomes related to basal tear film production as measured by a Schirmer test score (STS) in data from phase 2 and 3 clinical trials. Safety data from these trials have demonstrated that IN varenicline is generally well tolerated with minimal ocular side effects. The most common side effects reported in the trials were sneezing, coughing, along with throat and nasal irritation. Relevance to Patient care and Clinical Practice: Patients suffering from DED have been traditionally treated with ophthalmic preparations; however, many patients struggle with proper administration of ophthalmic products. IN varenicline stimulates nicotinic cholinergic receptors and basal tear film production through the trigeminal parasympathetic nerve pathway (TPP). There is no evidence to support the long-term remission of DED symptoms with IN varenicline as seen with anti-inflammatory modulators. Conclusions: IN varenicline offers an effective and novel approach to management of DED for patients who desire a non-ophthalmic preparation with a favorable side effect profile.
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Affiliation(s)
- Kimberly L Zitko
- Pharmacy Practice, South College School of Pharmacy, Knoxville, TN, USA
| | - Lauren Ladd
- Pharmacy Practice, South College School of Pharmacy, Knoxville, TN, USA
| | - Tyler S Dougherty
- Pharmacy Practice, South College School of Pharmacy, Knoxville, TN, USA
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Ballesteros-Sánchez A, Sánchez-González MC, De-Hita-Cantalejo C, Gutiérrez-Sánchez E, Rocha-de-Lossada C, Sánchez-González JM. The Efficacy and Safety of Rebamipide Ophthalmic Suspension (OPC-12759) in Patients with Dry Eye Disease: A Systematic Review of Randomized Controlled Trials. J Clin Med 2023; 12:7155. [PMID: 38002767 PMCID: PMC10672675 DOI: 10.3390/jcm12227155] [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: 08/25/2023] [Revised: 10/24/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
The aim of this paper is to evaluate the efficacy and safety of Rebamipide (REB) ophthalmic suspension in dry eye disease (DED). A systematic review that only included full-length randomized controlled studies (RCTs) reporting the effects of REB ophthalmic suspension in three databases, PubMed, Scopus and Web of Science, was performed according to the PRISMA statement. The Cochrane risk of bias tool was used to analyze the quality of the studies selected. A total of seven studies were included in this systematic review. Although the overall risk of bias was low, most studies were sponsored by the manufacturer. REB ophthalmic suspension treatment achieved higher improvement than the control group in all reported variables. The mean differences between both groups were in favor of the REB group and were as follows: dry eye-related quality of life score (DEQS) -3.5 ± 2.9 points, tear film break-up time (TBUT) of 0.7 ± 0.6 s, Schirmer test (ST) without anesthesia of 0.3 ± 0.6 mm and total corneal fluorescein staining (tCFS) of -1.2 ± 0.7 points. Adverse events (AEs) were 5.2 ± 7.6% superior in the REB group, with an overall compliance > 95%. Therefore, REB ophthalmic suspension is a safe and effective treatment that could be recommended in patients with DED.
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Affiliation(s)
- Antonio Ballesteros-Sánchez
- Department of Physics of Condensed Matter, Optics Area, University of Seville, 41004 Seville, Spain; (M.C.S.-G.); (C.D.-H.-C.); (J.-M.S.-G.)
- Department of Ophthalmology, Ophthalmologic Novovision Clinic, 30008 Murcia, Spain
| | - María Carmen Sánchez-González
- Department of Physics of Condensed Matter, Optics Area, University of Seville, 41004 Seville, Spain; (M.C.S.-G.); (C.D.-H.-C.); (J.-M.S.-G.)
| | - Concepción De-Hita-Cantalejo
- Department of Physics of Condensed Matter, Optics Area, University of Seville, 41004 Seville, Spain; (M.C.S.-G.); (C.D.-H.-C.); (J.-M.S.-G.)
| | | | - Carlos Rocha-de-Lossada
- Department of Surgery, Ophthalmology Area, University of Seville, 41009 Seville, Spain; (E.G.-S.); (C.R.-d.-L.)
- Qvision, Ophthalmology Department, VITHAS Almeria Hospital, 04120 Almeria, Spain
- Ophthalmology Department, VITHAS Malaga, 29016 Malaga, Spain
- Regional University Hospital of Malaga, Hospital Civil Square, 29009 Malaga, Spain
| | - José-María Sánchez-González
- Department of Physics of Condensed Matter, Optics Area, University of Seville, 41004 Seville, Spain; (M.C.S.-G.); (C.D.-H.-C.); (J.-M.S.-G.)
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Labetoulle M, Leonardi A, Pisella PJ, Baudouin C. Ciclosporin A Cationic Emulsion 0.1% for the Management of Dry Eye Disease: Facts That Matter for Eye-Care Providers. Ocul Immunol Inflamm 2023; 31:1707-1715. [PMID: 35766874 DOI: 10.1080/09273948.2022.2088566] [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: 03/24/2022] [Accepted: 06/06/2022] [Indexed: 10/17/2022]
Abstract
Dry eye disease (DED) is a chronic inflammatory disease of the ocular surface requiring long-term therapy. Severe forms of DED generally do not respond to tear substitutes alone or combined, and often require treatment with topical anti-inflammatory agents to break the vicious circle of inflammation. This review summarises data from randomised controlled trials and real-world evidence on the efficacy and safety of ciclosporin A 0.1% cationic emulsion (Ikervis®) for the management of DED. Improvements in clinical signs and symptoms were reported from as early as 4 weeks after treatment initiation, although it can take a few months to reach the full benefits. Treatment periods of up to 12 months provide sustained benefit to patients. In the most responsive patients, treatment discontinuation is possible with no further substantial relapse over 12 months in over 65% of patients. Transient local ocular effects are the most commonly reported adverse events.
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Affiliation(s)
- Marc Labetoulle
- Department of Ophthalmology, Paris-Sud University, Paris, France
| | - Andrea Leonardi
- Department of Neuroscience, Ophthalmology Unit, University of Padua, Padua, Italy
| | | | - Christophe Baudouin
- Department of Ophthalmology, Quinze-Vingts National Ophthalmology Hospital and Vision Institute, IHU FOReSIGHT, Paris, France
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Priani D, Muhiddin HS, Sirajuddin J, Eka HB, Bahar B, Bukhari A. Effectiveness of Topical Cyclosporin-A 0.1% Compared to Combined Topical Cyclosporin-A 0.1% with Topical Sodium Hyaluronate on Interleukin-6 Levels in the Tears of Patients with Dry Eye Disease. Vision (Basel) 2023; 7:vision7020031. [PMID: 37092464 PMCID: PMC10123752 DOI: 10.3390/vision7020031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/15/2023] [Accepted: 03/29/2023] [Indexed: 04/07/2023] Open
Abstract
Introduction: Pro-inflammatory cytokines are important contributors to dry eye disease (DED). The cytokine interleukin (IL)-6 has become a therapeutic target in several DED drug studies. This randomized controlled trial aimed to determine the effectiveness of topical cyclosporin-A 0.1% compared to the combination of topical cyclosporin-A 0.1% and sodium hyaluronate in reducing tear IL-6 levels in DED patients. Methods: The participants were 20 patients, each with two eyes, who had moderate-to-severe DED. Before and after treatment, the clinical degree of DED was examined in each group, using ocular surface disease index (OSDI) scores, tear break-up time (TBUT), fluorescent tests, and Schirmer I tests. In addition, tear samples were taken to examine IL-6 levels through the ELISA method. The results were analyzed using the t-test, Wilcoxon test, and Mann–Whitney test. The correlation between tear IL-6 levels and the severity of DED was analyzed using the Spearman correlation test. Results: The study showed a significantly lower tear IL-6 level, OSDI score, and degree of ocular staining after either topical cyclosporin-A 0.1% or a combination of topical cyclosporin-A 0.1% and sodium hyaluronate (all values p < 0.05). Conclusions: The combination therapy was superior in reducing tear IL-6 levels. In addition, a correlation existed between tear IL-6 levels and the severity of DED based on the TBUT, although it was weak and not statistically significant.
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Affiliation(s)
- Desti Priani
- Department of Ophthalmology, Faculty of Medicine, Hasanuddin University, Makassar 90245, Indonesia
- Hasanuddin University Hospital, Makassar 90245, Indonesia
| | - Habibah S. Muhiddin
- Department of Ophthalmology, Faculty of Medicine, Hasanuddin University, Makassar 90245, Indonesia
- Hasanuddin University Hospital, Makassar 90245, Indonesia
| | - Junaedi Sirajuddin
- Department of Ophthalmology, Faculty of Medicine, Hasanuddin University, Makassar 90245, Indonesia
- Hasanuddin University Hospital, Makassar 90245, Indonesia
| | - Hasnah B. Eka
- Department of Ophthalmology, Faculty of Medicine, Hasanuddin University, Makassar 90245, Indonesia
- Hasanuddin University Hospital, Makassar 90245, Indonesia
| | - Burhanuddin Bahar
- Department of Public Health Medicine, Faculty of Medicine, Hasanuddin University, Makassar 90245, Indonesia
| | - Agussalim Bukhari
- Department of Clinical Nutrition, Faculty of Medicine, Hasanuddin University, Makassar 90245, Indonesia
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Koh S, Soma T, Oie Y, Nishida K. First Diquafosol Treatment for Dry Eye: 10-Year Follow-Up. Asia Pac J Ophthalmol (Phila) 2023; 12:103-104. [PMID: 35342178 DOI: 10.1097/apo.0000000000000493] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/21/2021] [Indexed: 02/01/2023] Open
Affiliation(s)
- Shizuka Koh
- Department of Innovative Visual Science, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takeshi Soma
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshinori Oie
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
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Ghauri AJ, Biswas S, Manzouri B, Barua A, Sharma V, Hoole J, Dahlmann-Noor A. Management of Vernal Keratoconjunctivitis in Children in the United Kingdom: A Review of the Literature and Current Best Practice Across Six Large United Kingdom Centers. J Pediatr Ophthalmol Strabismus 2023; 60:6-17. [PMID: 35611818 DOI: 10.3928/01913913-20220328-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Vernal keratoconjunctivitis (VKC) is a form of ocular allergy primarily affecting children. Considered a rare disease in Europe, its prevalence varies by geographic region and is poorly studied in the United Kingdom. There is considerable national variation in the management of VKC within the United Kingdom, risking misdiagnosis and delays to treatment for some children. This can significantly impact their quality of life, with the potential for lasting negative consequences. Based on discussions between experienced clinicians from six large centers across the United Kingdom, this article describes best practice recommendations for United Kingdom settings, including principles for diagnosis, referral, initial and long-term management, and supportive care. Recommendations include guidance on referral timing, which should depend on VKC severity, and a stepwise approach to treatment. Joint management by primary care and secondary care is recommended and the importance of supportive care, including emotional support and outreach to schools, is highlighted. Because frequent flareups are common in VKC, it is essential that families have access to the information they need to manage the disease and routes to access rapid care if needed. A thorough understanding of the nature of VKC, its triggers, and how best to manage it, by both patients and their families, is critical to ensuring appropriate management and to improving patient outcomes. [J Pediatr Ophthalmol Strabismus. 2023;60(1):6-17.].
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Cui D, Mathews P, Li G, VanCourt S, Akpek E. Outcomes of Sjögren's versus non-Sjögren's related dry eye in a longitudinal, tertiary clinic-based sample. PLoS One 2021; 16:e0261241. [PMID: 34919587 PMCID: PMC8682907 DOI: 10.1371/journal.pone.0261241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/25/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To assess the long-term treatment outcomes of dry eye in patients with and without underlying primary Sjögren’s syndrome (SS). Design Retrospective longitudinal cohort. Methods SS and non-SS dry eye patients with clinic visits for a minimum of 5 consecutive years at a tertiary, dedicated dry eye clinic were included. Electronic health records were reviewed to collect data regarding demographics, objective dry eye parameters, treatments utilized at baseline and final visit, and corneal complications observed during follow-up. Results Two hundred and two patients (101 SS and 101 randomly selected non-SS), with a mean follow-up of 7.1 years were included. At baseline, mean conjunctival lissamine green staining score was 2.9 and mean corneal fluorescein staining score was 2.0. At last visit, notable improvement in staining score for cornea (–1.1, P < .001) and conjunctiva (–1.8, P < .001) was seen equally in both dry eye groups. Most patients (88.1%) had an escalation of treatment by the final visit, with similar rates in both groups (P = .51). Half (48.9%) of the patients had no conjunctival staining, and a third (34.4%) had no corneal staining at their last visit. Twenty (9.9%) patients experienced a vision-threatening corneal complication, including ulcers and melt, with no difference in occurrences between the groups (P = .64). Conclusions The majority of patients in this longitudinal, tertiary clinic-based sample demonstrated improvement in their ocular surface staining score by the final visit with escalation in treatment. Treatments used, improvement achieved, and corneal complication rates leading to loss of vision were similar in both SS and non-SS dry eye groups.
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Affiliation(s)
- David Cui
- Ocular Surface Disease and Dry Eye Clinic, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Priya Mathews
- Ocular Surface Disease and Dry Eye Clinic, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Gavin Li
- Ocular Surface Disease and Dry Eye Clinic, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Shanna VanCourt
- Ocular Surface Disease and Dry Eye Clinic, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Esen Akpek
- Ocular Surface Disease and Dry Eye Clinic, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
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A phase II randomized trial to evaluate the long-term (12-week) efficacy and safety of OC-01 (varenicline solution) nasal spray for dry eye disease: The MYSTIC study. Ocul Surf 2021; 24:15-21. [PMID: 34920097 DOI: 10.1016/j.jtos.2021.12.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/06/2021] [Accepted: 12/13/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE Dry eye disease is characterized by loss of tear film stability. OC-01 (varenicline solution) is a small-molecule nicotinic acetylcholine receptor agonist administered as a nasal spray that stimulates tear production. METHODS In MYSTIC (NCT03873246) patients aged ≥22 years with dry eye disease were randomized 1:1:1 to OC-01 0.03 mg, OC-01 0.06 mg, or vehicle (n = 41 per group), administered twice daily via intranasal spray, for 12 weeks (84 days). Primary efficacy endpoint was mean change from baseline in anesthetized Schirmer's test score (STS) in study eye at day (D) 84. RESULTS Patients receiving OC-01 0.03 and 0.06 mg had statistically significantly increased tear production at D84 versus vehicle; least squares mean changes from baseline in STS were 10.8 mm and 11.0 mm for OC-01 0.03 and 0.06 mg, respectively. A trend toward a higher proportion of patients experiencing ≥10-mm improvement in STS from baseline was observed with OC-01 0.03 mg (36.6%; p > 0.05), and was significant for OC-01 0.06 mg (48.8%; p = 0.024), versus vehicle (24.4%). Non-ocular treatment-emergent adverse events (TEAEs) were reported by 21 patients; the most common was sneezing (OC-01 0.03 mg, 2 [4.9%]; OC-01 0.06 mg, 3 [7.3%]), with similar frequencies between treatment groups. No severe or serious TEAEs were reported. CONCLUSIONS OC-01 (varenicline solution) nasal spray improved tear production in patients with dry eye disease over a long-term (12-week) period, and represents a receptor neuro-activator with a nasal route of administration that spares the ocular surface to stimulate tear production.
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Therapie des Trockenen Auges. SPEKTRUM DER AUGENHEILKUNDE 2021. [DOI: 10.1007/s00717-021-00497-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ZusammenfassungDie Therapie des Trockenen Auges stellt eine schwierige Aufgabe für den behandelnden Augenarzt dar. Fortschritte in unserem Verständnis der Risikofaktoren, der Ätiologie und Pathophysiologie des Trockenen Auges haben zu einer Weiterentwicklung der Behandlungsstrategien geführt. Vor Beginn der Therapie ist die korrekte Zuordnung in eine wässrig-muzinöse Tränenfilmdysfunktion (Mindersekretion), in eine lipidbedingte Tränenfilmdysfunktion (hyperevaporative Form durch eine abnormen Meibom-Drüsen-Physiologie) oder in eine variable Kombination wichtig. Unter Berücksichtigung aktueller Empfehlungen der DOG, des BVA und des TFOS DEWS II Unterausschusses wurde ein Behandlungsalgorithmus abgeleitet, der ein schrittweises Vorgehen je nach Schweregrad der Erkrankung darstellt.
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Tavassoli S, Wong N, Chan E. Ocular manifestations of rosacea: A clinical review. Clin Exp Ophthalmol 2021; 49:104-117. [PMID: 33403718 DOI: 10.1111/ceo.13900] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 12/07/2020] [Accepted: 12/18/2020] [Indexed: 12/13/2022]
Abstract
Ocular rosacea is a chronic inflammatory condition that can occur in the absence of cutaneous features. The most common ocular features are chronic blepharoconjunctivitis with eyelid margin inflammation and meibomian gland dysfunction. Corneal complications include corneal vascularization, ulceration, scarring and, rarely, perforation. Diagnosis is largely based on clinical signs, although it is often delayed in the absence of cutaneous changes, particularly in children. It can also be associated with systemic disorders such as cardiovascular disease. Management ranges from local therapy to systemic treatment, depending on the severity of the disease. In this review, we describe the epidemiology, pathophysiology, clinical features and treatment of rosacea and ocular rosacea.
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Affiliation(s)
| | - Nathan Wong
- Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Elsie Chan
- Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
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Topical cyclosporine a (0.05%) treatment in dry eye patients: a comparison study of Sjogren's syndrome versus non-Sjogren's syndrome. Int Ophthalmol 2021; 41:1479-1485. [PMID: 33484384 DOI: 10.1007/s10792-021-01708-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/09/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the clinical effect of topical cyclosporine A (CsA) (0.05%) on dry eye patients with Sjogren's syndrome (SS) and non-Sjogren's syndrome (NSS). METHOD This retrospective comparative study includes the dry eye (DE) patients who were treated with topical CsA. DE patients were divided into two groups as follows: DE with Sjogren's syndrome (DE-SS) and DE with Non-Sjogren's syndrome (DE-NSS). Dry eye parameters were recorded at baseline and each visit. RESULTS Schirmer's test 1 scores were 2.7 ± 0.5 mm at baseline and 3.5 ± 0.7 mm at 12th month in DE-SS, 2.9 ± 0.7 mm at baseline and 9.5 ± 0.7 mm in DE-NSS groups at 12th month. Mean ST score was higher in DE-NSS group than DE-SS group at sixth and 12th months of the treatment (both p = 0.001). Tear break-up time score showed a significant improvement in DE-NSS group, and it was lower in DE-NSS group than DE-SS group group at sixth and 12th months of the treatment (p = 0.044 and 0.027, respectively). Mean OSDI score was lower in DE-NSS group than DE-SS group at sixth and 12th months of the treatment (p = 0.030 and 0.032, respectively). CONCLUSION Topical CsA seems to be more effective in the treatment of the DE-NSS.
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Kuo YK, Lin IC, Chien LN, Lin TY, How YT, Chen KH, Dusting GJ, Tseng CL. Dry Eye Disease: A Review of Epidemiology in Taiwan, and its Clinical Treatment and Merits. J Clin Med 2019; 8:E1227. [PMID: 31443274 PMCID: PMC6722537 DOI: 10.3390/jcm8081227] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/06/2019] [Accepted: 08/08/2019] [Indexed: 12/11/2022] Open
Abstract
Dry eye disease (DED) has become common on a global scale in recent years. There is a wide prevalence of DED in different countries based on various ethnicities and environment. DED is a multifactorial ocular disorder. In addition to advanced age and gender, such factors as living at high altitude, smoking, pterygium, prolonged use of consumer electronics or overingesting of caffeine or multivitamins are considered to be the major risk factors of DED. We report the DED epidemiology in Taiwan firstly in this article. According to the pathophysiological factors and changes inthe composition of the tear film in DED, it can be categorized into several subtypes, including lipid anomaly dry eye, aqueous tear deficiency, allergic and toxic dry eye among others. Each subtype has its own cause and disease management; therefore, it is important for ophthalmologists to identify the type through literature review and investigation. The management of DED, relies not only on traditional medications such as artificial tears, gels and ointments, but also newer treatment options such as acupuncture, SYL1001, and nanomedicine therapy. We also conducted a comprehensive literature review including common subtypes and treatment of DED. Clearly, more clinical trials are needed to assess the efficacy and safety of the various treatments and common subtypes of DED.
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Affiliation(s)
- Yu-Kai Kuo
- School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - I-Chan Lin
- Department of Ophthalmology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Li-Nien Chien
- School of Health Care Administration, College of Management, , Taipei Medical University, Taipei 11031, Taiwan
- Health and Clinical Data Research Center, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan
| | - Tzu-Yu Lin
- Department of Ophthalmology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Ying-Ting How
- Graduate Institute of Biomedical Materials & Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan
| | - Ko-Hua Chen
- Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Gregory J Dusting
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC 3002, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, East Melbourne, VIC 3002, Australia
| | - Ching-Li Tseng
- Graduate Institute of Biomedical Materials & Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan.
- Institute of International PhD Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan.
- Research Center of Biomedical Device, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan.
- International PhD Program in Cell Therapy and Regenerative Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
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Kang MJ, Kim YH, Chou M, Hwang J, Cheon EJ, Lee HJ, Chung SH. Evaluation of the Efficacy and Safety of A Novel 0.05% Cyclosporin A Topical Nanoemulsion in Primary Sjögren's Syndrome Dry Eye. Ocul Immunol Inflamm 2019; 28:370-378. [PMID: 30986119 DOI: 10.1080/09273948.2019.1587470] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose: To evaluate the efficacy and safety of a novel topical cyclosporin A 0.05% nanoemulsion in comparison with a conventional emulsion in primary Sjögren's syndrome dry eyes.Methods: Prospective, randomized, double-blinded study was conducted.Results: Corneal and conjunctival staining score was improved in both groups, with a faster change noted in the nanoemulsion group at 12 weeks (p < 0.05). Tear film break-up time was significantly improved in the nanoemulsion group at 12 weeks (p < 0.05), while ocular surface disease index score was improved in both groups without a difference at 12 weeks. Schirmer I value and goblet cell grade did not change in both groups. IL-6 and MMP-9 were significantly decreased in both groups at 12 weeks.Conclusions: Both nanoemulsion and conventional cyclosporin A improved ocular signs, symptoms, and conjunctival inflammation. However, the novel cyclosporin A nanoemulsion showed faster improvement of ocular surface staining scores than the conventional emulsion.
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Affiliation(s)
- Min-Ji Kang
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Youn-Hee Kim
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Miyoung Chou
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jehyung Hwang
- Department of Ophthalmology, Sanggye Paik Hospital, Seoul, Korea
| | - Eun-Jeong Cheon
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun-Jung Lee
- Department of Biochemical Engineering, Seoil University, Seoul, Republic of Korea
| | - So-Hyang Chung
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Dry Eye Syndrome Preferred Practice Pattern®. Ophthalmology 2019; 126:P286-P334. [DOI: 10.1016/j.ophtha.2018.10.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 01/04/2023] Open
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Pisella PJ, Labetoulle M, Doan S, Cochener-Lamard B, Amrane M, Ismail D, Creuzot-Garcher C, Baudouin C. Topical ocular 0.1% cyclosporine A cationic emulsion in dry eye disease patients with severe keratitis: experience through the French early-access program. Clin Ophthalmol 2018; 12:289-299. [PMID: 29440872 PMCID: PMC5804729 DOI: 10.2147/opth.s150957] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Purpose The objective of this study was to report the evaluation of efficacy and safety of cyclosporine A cationic emulsion (CsA CE) 0.1% for the treatment of severe keratitis in adults with dry eye disease (DED) in a French early-access program. Methods Patients with DED and severe keratitis (corneal fluorescein staining [CFS] score of 3-5 on the Oxford scale and/or the presence of corneal lesions [filaments or ulcers]) were enrolled in a compassionate use program (Authorization for Temporary Use [ATU]) for once-daily CsA CE, which was approved by French health authorities prior to its registration. Efficacy and safety at 1, 3, 6, and 12-month follow-up visits were evaluated. Results The ATU cohort (n=1,212; mean age =60.5 years; 79.5% female; 98.1% with severe keratitis; 74.5% with corneal lesions) consisted of 601 CsA-naïve patients and 611 patients treated previously with other CsA formulations. The primary DED etiology was Sjögren's syndrome (48.7%). Clinical benefit could be discerned among 548 evaluable patients from months 1 to 12: keratitis improvement, 44.8% at month 1 and 42.1% at month 12; keratitis stabilization, 47.2% and 45.7%, respectively; symptom improvement, 47.2% and 48.6%; and symptom stabilization, 44.8% and 45.0%. Corneal clearing (CFS score =0) increased from 4.8% (month 1) to 11.4% (month 12). No unexpected safety concerns were identified; instillation site pain (10.2%) and eye irritation (7.8%) were the most common adverse events. Conclusion The French ATU cohort provides supportive data on the clinical benefit of CsA CE in improving/stabilizing symptoms and corneal damage in DED patients with severe keratitis in real-world clinical practice.
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Affiliation(s)
- Pierre-Jean Pisella
- Department of Ophthalmology, Tours University Hospital, University François Rabelais, Bretonneau Hospital, Tours
| | - Marc Labetoulle
- Department of Ophthalmology, Bicêtre Hospital, APHP, Paris-Sud University, Le Kremlin-Bicêtre
| | - Serge Doan
- Department of Ophthalmology, Bichat Hospital and Fondation A de Rothschild, Paris
| | | | | | | | - Catherine Creuzot-Garcher
- Department of Ophthalmology, University Hospital.,Department of Ophthalmology III, Eye and Nutrition Research Group, Burgundy, Dijon
| | - Christophe Baudouin
- Research Team S12, Quinze-Vingts National Ophthalmology Hospital.,Department of Ophthalmology, Ambroise-Paré Hospital, APHP, UPMC University, Paris 6, Vision Institute, INSERM UMRS968, CNRS UMR7210, Paris.,University of Versailles Saint-Quentin en Yvelines, Versailles, France
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Abstract
Dry eye disease was redefined by the dry eye workshop (DEWS II) in May 2017. According to the new definition "dry eye is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film and accompanied by ocular symptoms". The current definition encompasses etiological factors, such as instability and hyperosmolarity of the tear film, ocular surface inflammation and damage as well as a new aspect compared to the former definition, neurosensory abnormalities. Recent and future therapeutic options for dry eye focus on treatment of the aforementioned pathogenetic events. New tear substitutes, medications and devices to stimulate tear production, innovative anti-inflammatory treatment, medications to influence corneal innervation and new methods for treatment of Meibomian gland dysfunction are already available or will be available in the near future.
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