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Messmer EM, Baudouin C, Benitez-Del-Castillo JM, Iester M, Anton A, Thygesen J, Topouzis F. Expert Consensus Recommendations for the Management of Ocular Surface Inflammation in Patients With Glaucoma. J Glaucoma 2024; 33:715-727. [PMID: 39018018 DOI: 10.1097/ijg.0000000000002465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 07/07/2024] [Indexed: 07/18/2024]
Abstract
PRCIS We have developed through a consensus process 24 clinical recommendations for the comprehensive management of ocular surface inflammation in glaucoma patients, including diagnostic criteria, prevention measures, and treatment strategies according to ocular surface disease severity. PURPOSE To obtain expert consensus on the diagnosis, prevention, and management of ocular surface inflammation (OSI) in patients with glaucoma. METHODS An international steering committee of glaucoma and/or ocular surface disease (OSD) experts and a wider faculty of members from the Educational Club of Ocular Surface and Glaucoma (ECOS-G) collaborated to develop clinical recommendations on best practice in the management of OSI in glaucoma patients using a nonanonymous interactive quasi-Delphi process. Clinical recommendations were formulated by the steering committee based on an analysis of the recent literature to determine unmet needs, together with a web-based interactive survey of faculty members' opinion in seven identified areas of OSI management in glaucoma. Topics included (1) diagnosis of OSD, (2) diagnosis of OSI, (3) causes of OSI, (4) impact of OSD/OSI, (5) prevention of OSI, (6) treatment of OSI, and (7) inflammation and the deep structures of the eye. Faculty members were invited to vote on the clinical recommendations, and the steering committee then determined whether consensus had been achieved. RESULTS Consensus was obtained on 24 clinical recommendations by 80%-100% of faculty members. There was consensus that OSI should be investigated in all glaucoma patients. The main prevention measure in glaucoma patients with pre-existing OSD was the elimination/minimisation of preserved medications, especially BAK-preserved eye drops. A subtractive treatment strategy rather than an additive strategy is recommended according to OSI/OSD severity to improve the ocular health and/or before glaucoma surgery. CONCLUSION These recommendations for the management of OSI in glaucoma should be useful to guide decision-making in clinical practice.
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Affiliation(s)
| | - Christophe Baudouin
- Quinze-Vingts National Ophthalmology Hospital, INSERM-DGOS CIC 1423, IHU Foresight
- Sorbonne Université, INSERM, CNRS, Institut de La Vision, Paris
- Department of Ophthalmology, Ambroise Paré Hospital, APHP, Université de Versailles Saint-Quentin-en-Yvelines, Boulogne-Billancourt, France
| | | | - Michele Iester
- Clinica Oculistica, Department Of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alfonso Anton
- Hospital de l'Esperança, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
- Institut Català de Retina, Barcelona, Spain
| | - John Thygesen
- Department of Ophthalmology, Glaucoma Services in Copenhagen, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Fotis Topouzis
- First Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Fineide F, Lagali N, Adil MY, Arita R, Kolko M, Vehof J, Utheim TP. Topical glaucoma medications – Clinical implications for the ocular surface. Ocul Surf 2022; 26:19-49. [DOI: 10.1016/j.jtos.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 11/25/2022]
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Fogagnolo P, Romano D, De Ruvo V, Sabella P, Rossetti L. Clinical Efficacy of an Eyedrop Containing Hyaluronic Acid and Ginkgo Biloba in the Management of Dry Eye Disease Induced by Cataract Surgery. J Ocul Pharmacol Ther 2022; 38:305-310. [PMID: 35442771 PMCID: PMC9125569 DOI: 10.1089/jop.2021.0123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: To evaluate the prevalence of dry eye disease (DED) after cataract surgery, and the impact of hyaluronic acid and ginkgo biloba eyedrops (HA-GB). Methods: Forty patients with no DED received Ocular Surface Disease Index (OSDI) questionnaire, assessment of conjunctival hyperemia and epithelial damage, fluorescein tear break-up time (TBUT) at baseline, day 1, week 1, and 4; adherence and tolerability were checked at weeks 1 and 4. At day 0 patients underwent cataract surgery and were randomized to standard postoperative care (control group) or standard postoperative care + HA-GB 3 times a day for 4 weeks (HA-GB group). Results: At baseline, TBUT was 9.6 ± 2.6 sec in controls and 9.0 ± 1.6 in HA-GB; thereafter it was higher in HA-GB group: 5.8 ± 2.3 versus 7.8 ± 3.2 (week 1, P = 0.03) and 6.4 ± 2.3 versus 8.5 ± 2.5 (week 4, P = 0.009). OSDI and conjunctival hyperemia were better in HA-GB group at week 4; respectively, 9.0 ± 5.7 versus 14.8 ± 7.3 (P = 0.004) and 5% versus 35% (P = 0.04). In the last 2 visits 50% of controls were symptomatic (OSDI of 13 or higher) compared with 16% on HA-GB group (P < 0.001). In addition, tolerability was higher in HA-GB group (week 1: 0.81 ± 0.20 versus 0.70 ± 0.24, P = 0.007; week 4: 0.93 ± 0.17 versus 0.80 ± 0.28, P = 0.001). Conclusion: Treatment with HA-GB is effective in reducing DED signs and symptoms in patients receiving cataract surgery, with high tolerability and safety profiles. clinicaltrials.gov (ID number NCT05002036).
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Affiliation(s)
- Paolo Fogagnolo
- Eye Clinic, ASST Santi Paolo e Carlo, Università degli Studi, Milan, Italy
| | - Dario Romano
- Eye Clinic, ASST Santi Paolo e Carlo, Università degli Studi, Milan, Italy
| | - Valentino De Ruvo
- Eye Clinic, ASST Santi Paolo e Carlo, Università degli Studi, Milan, Italy
| | | | - Luca Rossetti
- Eye Clinic, ASST Santi Paolo e Carlo, Università degli Studi, Milan, Italy
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Tapply I, Broadway DC. Improving Adherence to Topical Medication in Patients with Glaucoma. Patient Prefer Adherence 2021; 15:1477-1489. [PMID: 34239297 PMCID: PMC8259615 DOI: 10.2147/ppa.s264926] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/02/2021] [Indexed: 12/11/2022] Open
Abstract
The glaucomas form a heterogenous group of conditions, which collectively account for one of the most common irreversible causes of blindness worldwide. The only treatment, for which there is evidence, to stop or slow glaucomatous disease progression is to lower intraocular pressure (IOP); this is most often initially achieved with topical medication. Adherence to anti-glaucoma therapy is known to be low even when compared with adherence to therapy for other chronic conditions. We performed a PubMed search to review evidence as to how adherence to and persistence with anti-glaucoma medications might be improved. Approaches to improving adherence include technological (such as using smart drop bottles or automated reminders) use of instillation aids, improving communication with patient education and improving tolerability of eye drop formulations. There is limited short-term evidence that automated reminders can be effective and, unfortunately, instillation aids have not proved to be efficacious with respect to improving adherence. A range of factors have been identified which affect adherence and persistence, although only a multi-faceted approach has proven evidence of efficacy, compared to improved patient education alone. There is now a wider range of available preservative-free eye drops, which have been shown to be non-inferior in achieving IOP control, with fewer side effects and improved short-term adherence. Further studies relating to adherence are warranted, particularly given the projected increase in glaucoma prevalence worldwide.
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Affiliation(s)
- Ian Tapply
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, NR4 7UY, UK
- Department of Ophthalmology, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK
- Correspondence: Ian Tapply Department of Ophthalmology, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0QQ, UKTel +44 7810 583319 Email
| | - David C Broadway
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, NR4 7UY, UK
- School of Pharmacy, University of East Anglia, Norwich, NR4 7TJ, UK
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Zhou T, Miao Y, Li Z, Lu P, Liang Z, Yang J, He J, Xia H, Zhang Z, Zhang J. A Comparative Ocular Pharmacokinetics Study of Preservative-Free Latanoprost Unit-Dose Eye Drops and a Benzalkonium Chloride-Preserved Branded Product Following Topical Application to Rabbits. J Ocul Pharmacol Ther 2020; 36:522-528. [PMID: 32310714 DOI: 10.1089/jop.2019.0102] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Tianyang Zhou
- Department of Pharmaceutic and Pharmacology, Henan Eye Institute, Henan Eye Hospital, Zhengzhou, China
| | - Yan Miao
- China Otsuka Pharmaceutical Co. Ltd., Tianjin, China
| | - Zhengyan Li
- China Otsuka Pharmaceutical Co. Ltd., Tianjin, China
| | - Ping Lu
- Department of Pharmaceutic and Pharmacology, Henan Eye Institute, Henan Eye Hospital, Zhengzhou, China
| | - Zhen Liang
- Department of Pharmaceutic and Pharmacology, Henan Eye Institute, Henan Eye Hospital, Zhengzhou, China
| | - Jingjing Yang
- Department of Pharmaceutic and Pharmacology, Henan Eye Institute, Henan Eye Hospital, Zhengzhou, China
| | - Jijun He
- Department of Pharmaceutic and Pharmacology, Henan Eye Institute, Henan Eye Hospital, Zhengzhou, China
| | - Huiyun Xia
- Department of Pharmaceutic and Pharmacology, Henan Eye Institute, Henan Eye Hospital, Zhengzhou, China
| | - Zhen Zhang
- Department of Pharmaceutic and Pharmacology, Henan Eye Institute, Henan Eye Hospital, Zhengzhou, China
| | - Junjie Zhang
- Department of Pharmaceutic and Pharmacology, Henan Eye Institute, Henan Eye Hospital, Zhengzhou, China
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Abstract
Glaucoma is the leading cause of irreversible blindness worldwide. Although no definitive cure exists, lowering of the intraocular pressure decreases the rate of progression in the majority of patients with glaucoma. Antiglaucomatous treatment modalities consist predominantly of chronic use of eye drops. It has become increasingly evident that long-term exposure to eye drops has a significant impact on the ocular surface, and thereby on patient compliance and quality of life. Maintenance of the ocular surface is highly dependent on a stable tear film. Conjunctival goblet cells (GCs) of the ocular surface play an important role in providing the innermost mucin layer of the tear film and are essential for maintaining the ocular surface homeostasis. Recent studies have reported severe side effects of antiglaucomatous drops on GCs. In particular, a preservative containing antiglaucomatous drops have been shown to affect the viability and functions of the GCs. Furthermore, GC density has been suggested as a potential predictor of surgical outcome after filtration surgery. The present review provides an overview of the current literature on the impact of antiglaucomatous eye drops on GCs as well as the impact on the ocular surface. Moreover, the existing evidence of a possible association between GC density and glaucoma filtration surgery outcome is summarized. We conclude that prostaglandin analogs spare the conjunctival GCs more compared with other antiglaucomatous drops and that GCs may be a good predictor of surgical outcome after filtration surgery. Overall, given the multiple functions of GCs in the ocular surface homeostasis, dedicated strategies should be adopted to preserve this cell population during the course of glaucoma.
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Molina-Solana P, Domínguez-Serrano FDB, Garrido-Hermosilla AM, Montero-Iruzubieta J, Fernández-Palacín A, Rodríguez-de-la-Rúa-Franch E, Caro-Magdaleno M. Improved Tear Film Stability in Patients with Dry Eye After Hyaluronic Acid and Galactoxyloglucan Use. Clin Ophthalmol 2020; 14:1153-1159. [PMID: 32425501 PMCID: PMC7196196 DOI: 10.2147/opth.s248949] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 03/17/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Artificial tears only provide transient relief for dry eye. To the best of our knowledge, this is the first study to objectively compare treatment with artificial tears with Keratograph 5M, which allows accurate and objective investigation of dry eye and artificial tear treatment. We aimed to evaluate whether a preservative-free combination of 0.4% hyaluronic acid and 0.2% galactoxyloglucan can improve dry eye using the new topographer, Keratograph 5M. Patients and Methods This prospective longitudinal, single-arm interventional cohort study was performed at a tertiary referral center and involved 20 patients with dry eye (40 eyes). Preservative-free artificial tears were administered every 3 h. The participants underwent clinical and instrumental evaluations at baseline, 15, 30, 60, 90 and 120 min after instillation and 1 week and 1 month after treatment. Baseline values were considered as the controls. All patients were assessed with Keratograph 5M for non-invasive Keratograph first break-up time and non-invasive Keratograph average break-up time, conjunctival hyperemia, and tear meniscus height. Ocular surface staining with fluorescein was evaluated using the slit-lamp and fluorescein break-up time examinations, and the Ocular Surface Disease Index score was recorded for each patient. Results The signs and symptoms improved after 1 month of preservative-free 0.4% hyaluronic acid and 0.2% galactoxyloglucan treatment. There was a significant increase in the non-invasive Keratograph first break-up time and non-invasive Keratograph average break-up time at 15, 30, 60, and 90 min, and 1 week and 1 month (P < 0.05) and a decrease in hyperemia, corneal staining, and Ocular Surface Disease Index scores after 1 week and 1 month (P < 0.05). No treatment-related adverse event was observed. Conclusion A combination of 0.4% hyaluronic acid and 0.2% galactoxyloglucan artificial tears seems effective for treating dry eye. Keratograph 5M can objectively detect these changes during the follow-up period.
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Affiliation(s)
| | | | | | - Jesús Montero-Iruzubieta
- Ophthalmology, Virgen Macarena Hospital Seville, Seville, Spain.,Surgery Department, University of Seville, Seville, Spain
| | - Ana Fernández-Palacín
- Preventive Medicine and Public Health Department, University of Seville, Seville, Spain
| | | | - Manuel Caro-Magdaleno
- Ophthalmology, Virgen Macarena Hospital Seville, Seville, Spain.,Surgery Department, University of Seville, Seville, Spain
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8
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Fogagnolo P, Favuzza E, Marchina D, Cennamo M, Vignapiano R, Quisisana C, Rossetti L, Mencucci R. New Therapeutic Strategy and Innovative Lubricating Ophthalmic Solution in Minimizing Dry Eye Disease Associated with Cataract Surgery: A Randomized, Prospective Study. Adv Ther 2020; 37:1664-1674. [PMID: 32185729 PMCID: PMC7140734 DOI: 10.1007/s12325-020-01288-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION To evaluate the effects of a new lubricating, antioxidant solution (VisuEvo®) on dry eye disease (DED) in patients undergoing cataract surgery. METHODS Patients requiring cataract surgery with either healthy ocular surface or mild DED (tear break-up time, TBUT > 7, Schirmer I test > 15 mm/5 min) were enrolled in this multicenter, open-label, randomized, prospective study. Scheduled visits were 2 weeks before surgery (screening), day of surgery (V0), week 1 (V1), and 2 (V2) after surgery. VisuEvo® was self-administered three times daily for the whole study duration (group A); the control group (group B) had no tear substitute administration. The primary endpoint was the change in TBUT over time; the secondary endpoints were changes in Ocular Surface Disease Index (OSDI), ocular surface staining, the Schirmer I test, and osmometry. RESULTS A total of 45 patients were included (group A, 23; group B, 22; age 74 ± 8 years). At the screening, TBUT was similar between the groups (group A, 8.5 ± 1.8 s; group B, 7.8 ± 0.7, p = 0.11). At the scheduled visits, TBUT increase vs screening visit was significantly higher in group A: +1.2 s at V0, +1.4 s at V1, and +1.9 s at V2 (p < 0.01). Also, OSDI was significantly lower in group A at V0, V1, and V2 (p < 0.027). After surgery, corneal staining was absent in 65-78% of group A compared with 54-59% in group B. The two groups did not show any significant differences of osmometry and the Schirmer I test. CONCLUSIONS The ocular surface was more protected and quickly restored from surgery when VisuEvo® was used from 2 weeks preoperatively to 2 weeks postoperatively. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT03833908.
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Affiliation(s)
- Paolo Fogagnolo
- Eye Clinic, ASST Santi Paolo Carlo, San Paolo Hospital, Milan, Italy.
- Department of Health Sciences, University of Milan, Milan, Italy.
| | - Eleonora Favuzza
- Department of Oto-Neuro-Ophthalmological Surgical Sciences Eye Clinic, University of Florence, Florence, Italy
| | - Daniele Marchina
- Eye Clinic, ASST Santi Paolo Carlo, San Paolo Hospital, Milan, Italy
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Michela Cennamo
- Department of Oto-Neuro-Ophthalmological Surgical Sciences Eye Clinic, University of Florence, Florence, Italy
| | - Roberto Vignapiano
- Department of Oto-Neuro-Ophthalmological Surgical Sciences Eye Clinic, University of Florence, Florence, Italy
| | - Chiara Quisisana
- Eye Clinic, ASST Santi Paolo Carlo, San Paolo Hospital, Milan, Italy
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Luca Rossetti
- Eye Clinic, ASST Santi Paolo Carlo, San Paolo Hospital, Milan, Italy
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Rita Mencucci
- Department of Oto-Neuro-Ophthalmological Surgical Sciences Eye Clinic, University of Florence, Florence, Italy
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Doughty MJ. On the in vivo assessment of goblet cells of the human bulbar conjunctiva by confocal microscopy - A review. Cont Lens Anterior Eye 2020; 43:315-321. [PMID: 31954627 DOI: 10.1016/j.clae.2020.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 12/15/2019] [Accepted: 01/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND In vivo confocal microscopy (IVCM) has been used for over 10 years to assess the goblet cell density (GCD) within the human conjunctiva, but the reported values have been variable with no obvious indications as to why. METHODS From publications between 2008 and 2019, representative GCD values were extracted, as well as on the image sampling strategy used. RESULTS Average GCD values for any particular group of individuals ranged from 7 to 979 goblet cells / sq. mm, and with one notable outlier removed, an overall group-mean value for GCD (+/- SD) from single site locations was 207 +/- 143 goblet cells / sq. mm from 15 data sets for those usually designated as control subjects, with a value of 190 +/- 161 goblet cells / sq. mm calculated from 20 single site data sets from other (patient) groups. An overall analysis indicated that the reported average values for GCD from different groups of individuals increased according to the number of images assessed / individual (Spearman rho = 0.304), on the number of individuals evaluated to generate an averaged value for each group (rho = 0.367), and the total number of images assessed (rho = 0.346, multivariate analysis partial r = greater or = to 0.522). CONCLUSIONS In the use of confocal microscopy to assess the number of goblet cells in the human bulbar conjunctiva, the substantial differences reported appear to be linked to the protocols used for image selection, and some type of standardization needs to be developed.
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Affiliation(s)
- Michael J Doughty
- Department of Vision Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 OBA, United Kingdom.
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Fogagnolo P, Torregrossa G, Tranchina L, Ferreras A, De Cillá S, Labbé A, Figus M, Ottobelli L, Rossetti L. Tear Film Osmolarity, Ocular Surface Disease and Glaucoma: A Review. Curr Med Chem 2019; 26:4241-4252. [PMID: 31345142 DOI: 10.2174/0929867326666190725160621] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/23/2018] [Accepted: 01/10/2019] [Indexed: 12/16/2022]
Abstract
Glaucoma is the second leading cause of blindness in the world, affecting more than 60 million people globally. In order to reduce the progression of the disease, both medical and surgical treatments are used. Frequent side effects of both treatments include a range of modifications of the ocular surface grouped as the Ocular Surface Disease (OSD), which include Dry Eye Disease (DED). DED and other OSD negatively impact on the success of anti-glaucoma treatments and reduce the adherence to medical therapies. Tear film osmolarity (TFO) is a relatively novel test which has become a hallmark of DED. The aim of this paper was to review the association between OSD, DED and glaucoma in view of published TFO data, and to discuss future fields of research and treatments on the topic of glaucoma iatrogenic damage.
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Affiliation(s)
- Paolo Fogagnolo
- Eye Clinic, San Paolo Hospital, University of Milan, Milan, Italy
| | | | - Laura Tranchina
- Eye Clinic, San Paolo Hospital, University of Milan, Milan, Italy
| | - Antonio Ferreras
- Department of Ophthalmology, Miguel Servet University Hospital, University of Zaragoza, Zaragoza, Spain
| | - Stefano De Cillá
- Unit of Ophthalmology, Ospedale Maggiore della Carita, Novara, Italy
| | - Antoine Labbé
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, Vision Institute, Versailles Saint-Quentin en Yvelines University, 75012 Paris, France
| | - Michele Figus
- Ophthalmology, Department of Neurosciences, University of Pisa, Pisa, Italy
| | - Laura Ottobelli
- Eye Clinic, San Paolo Hospital, University of Milan, Milan, Italy
| | - Luca Rossetti
- Eye Clinic, San Paolo Hospital, University of Milan, Milan, Italy
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Posarelli C, Passani A, Del Re M, Fogli S, Toro MD, Ferreras A, Figus M. Cross-Linked Hyaluronic Acid as Tear Film Substitute. J Ocul Pharmacol Ther 2019; 35:381-387. [PMID: 31373862 DOI: 10.1089/jop.2018.0151] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose: The aim of this review is to clarify the role of cross-linked Hyaluronic acid (HA) molecule as a tear supplement and to define its possible applications in dry eye disease. Methods: Current Literature about HA and its cross-linked derivatives has been examined. Results: HA is superior in increasing the viscosity and stability of the tear film compared with other tear supplements such as polyvinyl alcohol, hydroxypropyl methylcellulose, carboximethyl cellulose and polyethylene glycol. Moreover, HA can be modified in different ways to improve its properties such as molecular weight, viscosity, and hydrophobicity to adapt the new artificial molecule to different aims. Conclusions: The current pharmacological trend is to improve the properties of HA by cross-linking parts of the molecule to achieve better bioavailability and resistence to degradation. In dry eye disease, cross-linked HA as tear supplement seems to provide better ocular comfort than linear HA and is therefore subjected to growing interest and diffusion.
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Affiliation(s)
- Chiara Posarelli
- Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
| | - Andrea Passani
- Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
| | - Marzia Del Re
- Department of Medical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Fogli
- Department of Medical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Antonio Ferreras
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain
| | - Michele Figus
- Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
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12
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Timolol 0.1% in Glaucomatous Patients: Efficacy, Tolerance, and Quality of Life. J Ophthalmol 2019; 2019:4146124. [PMID: 31191995 PMCID: PMC6525866 DOI: 10.1155/2019/4146124] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 02/24/2019] [Indexed: 01/30/2023] Open
Abstract
Glaucoma is a progressive, chronic optic neuropathy characterized by a typical visual field defects. Four main classes of topical medication are actually available on the market: beta-blockers, prostaglandins, alpha2-agonists, and topical carbonic anhydrase inhibitor to treat intraocular pressure (IOP). The aim of this review is to outline the efficacy of timolol and to evaluate the impact of this treatment on patients' quality of life. Among beta-blockers, timolol is most used at three different concentrations: 0.1%, 0.25%, and 0.5%. While the first one is a gel, the other two products are solution. Timolol has few topical side effects, while it has some important systemic side effects on the cardiac and respiratory systems. The balance between efficacy and safety is always the main aspect to care patients. Because of the less efficacy of timolol 0.1% solution, the possibility to use carbomers as vehicle in the gel drops helped timolol 0.1 to be used in clinics, extending the time contact between the active ingredient and the surface of the cornea. Using preservative-free timolol 0.1 for treatment, IOP was at the same level of the other beta-blockers at higher concentration, but it was better tolerated. Preservative-free treatment improved the quality of life reducing dry-eye like symptoms; furthermore, the presence of an artificial tear in the medication bottle could help adherence. The once daily dosing improves compliance.
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13
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Gomes JAP, Azar DT, Baudouin C, Efron N, Hirayama M, Horwath-Winter J, Kim T, Mehta JS, Messmer EM, Pepose JS, Sangwan VS, Weiner AL, Wilson SE, Wolffsohn JS. TFOS DEWS II iatrogenic report. Ocul Surf 2017; 15:511-538. [PMID: 28736341 DOI: 10.1016/j.jtos.2017.05.004] [Citation(s) in RCA: 258] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 05/02/2017] [Indexed: 01/04/2023]
Abstract
Dry eye can be caused by a variety of iatrogenic interventions. The increasing number of patients looking for eye care or cosmetic procedures involving the eyes, together with a better understanding of the pathophysiological mechanisms of dry eye disease (DED), have led to the need for a specific report about iatrogenic dry eye within the TFOS DEWS II. Topical medications can cause DED due to their allergic, toxic and immuno-inflammatory effects on the ocular surface. Preservatives, such as benzalkonium chloride, may further aggravate DED. A variety of systemic drugs can also induce DED secondary to multiple mechanisms. Moreover, the use of contact lens induces or is associated with DED. However, one of the most emblematic situations is DED caused by surgical procedures such as corneal refractive surgery as in laser-assisted in situ keratomileusis (LASIK) and keratoplasty due to mechanisms intrinsic to the procedure (i.e. corneal nerve cutting) or even by the use of postoperative topical drugs. Cataract surgery, lid surgeries, botulinum toxin application and cosmetic procedures are also considered risk factors to iatrogenic DED, which can cause patient dissatisfaction, visual disturbance and poor surgical outcomes. This report also presents future directions to address iatrogenic DED, including the need for more in-depth epidemiological studies about the risk factors, development of less toxic medications and preservatives, as well as new techniques for less invasive eye surgeries. Novel research into detection of early dry eye prior to surgeries, efforts to establish appropriate therapeutics and a greater attempt to regulate and oversee medications, preservatives and procedures should be considered.
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Affiliation(s)
- José Alvaro P Gomes
- Dept. of Ophthalmology and Visual Sciences, Federal University of Sao Paulo/Paulista School of Medicine (UNIFESP/EPM), São Paulo, SP, Brazil.
| | - Dimitri T Azar
- University of Illinois College of Medicine, Chicago, IL, USA
| | | | - Nathan Efron
- School of Optometry and Vision Science, Queensland University of Technology, Queensland, Australia
| | - Masatoshi Hirayama
- Department of Ophthalmology, School of Medicine, Keio University, Tokyo, Japan
| | | | - Terry Kim
- Duke University School of Medicine, Durham, NC, USA; Duke University Eye Center, Durham, NC, USA
| | | | - Elisabeth M Messmer
- Department of Ophthalmology, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Jay S Pepose
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Steven E Wilson
- Cole Eye Institute, The Cleveland Clinic, Cleveland, OH, USA
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Advances in Confocal Microscopy of the Eye. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1794240. [PMID: 27298821 PMCID: PMC4889803 DOI: 10.1155/2016/1794240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 04/06/2016] [Indexed: 11/17/2022]
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15
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Vagge A, Bonino M, Rolando M, Macrì A, Traverso CE, Iester M. The utility of an artificial substitute to improve corneal sensitivity in glaucomatous patients on chronic therapy with prostaglandin analogs. J Ocul Pharmacol Ther 2015; 31:286-90. [PMID: 25974240 DOI: 10.1089/jop.2014.0131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate whether a tear substitute can improve corneal subepithelial nerve plexus and corneal sensitivity in glaucomatous patients. METHODS This study was prospective, longitudinal, and single arm. Twenty glaucomatous patients were recruited. All the patients were treated with a prostaglandin analog with preservative for at least 1 year. Preservative-free artificial tears (0.5% tamarind seed polysaccharide 0.5(®) eye drops single-dose preservative free [Oftagen]) were prescribed thrice per day. The participants were subjected to clinical and instrumental evaluation at baseline (T0), after 1 month (T1) and after 3 months (T3) of treatment. All patients were examined with a digital corneal confocal laser-scanning microscope (HRT II Rostock Cornea Module; Heidelberg Engineering GmbH) and Cochet-Bonnet corneal esthesiometer. RESULTS After the artificial substitute, corneal and conjunctival sensitivity significantly (P < 0.001) improved at T1 and T3 compared to the baseline. A significant correlation was found between break-up time and both central corneal sensitivity and the number of fibers. CONCLUSION The use of a preservative-free artificial substitute in association with a topical therapy with chronic preservative could increase the compliance of patients.
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Affiliation(s)
- Aldo Vagge
- 1Clinica Oculistica, DiNOGMI, University of Genoa, Genoa, Italy
| | - Michele Bonino
- 1Clinica Oculistica, DiNOGMI, University of Genoa, Genoa, Italy
| | | | - Angelo Macrì
- 2Azienda Ospedaliera Universitaria San Martino IST, Genova, Italy
| | | | - Michele Iester
- 1Clinica Oculistica, DiNOGMI, University of Genoa, Genoa, Italy
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Age-related changes of the ocular surface: a hospital setting-based retrospective study. J Ophthalmol 2014; 2014:532378. [PMID: 25180084 PMCID: PMC4144156 DOI: 10.1155/2014/532378] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 07/26/2014] [Accepted: 07/27/2014] [Indexed: 11/17/2022] Open
Abstract
Purpose. To investigate the effects of age on the prevalence of ocular surface diseases (OSD), adherence to treatment, and recovery rates. Patients and Methods. Retrospective analysis of 3000 clinical records from a first-level general ophthalmology clinic. Patients with OSD were prospectively submitted a questionnaire to assess compliance and recovery rates. Results. OSD prevalence was 10.3%. Patients with OSD were significantly older than patients without it: 67.5 ± 20.3 versus 57.0 ± 22.0 years (P = 0.036). No significant difference in season distribution was shown. Dry eye disease (DED) represented 58% of OSD; its prevalence increased with age until 80 years old and suddenly decreased thereafter. Asymptomatic DED was 37%. Adherence to treatment in OSD was very high (94%); recovery rates were lower in patients aged 21-40 and 61-80 (resp., 65.5% and 77.8%) and this was associated with higher OSDI scores. Tear substitutes represented 50% of all prescribed medications; their use increased with age. Discussion. In a "real-life" low-tech setting, OSD showed a prevalence of 10.3%. DED was the most prevalent disease, and it was asymptomatic in more than 1/3 of cases.
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