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Aragona P, Giannaccare G, Dammino E, D'Esposito F, Genovese P, Postorino EI, Civiale C, Mazzone MG, Gagliano C. Observational Clinical Investigation Evaluating an Ophthalmic Solution Containing Xanthan Gum and Low Concentration Desonide Phosphate in Dry Eye Disease Treatment. Ophthalmol Ther 2024; 13:2559-2573. [PMID: 39060700 PMCID: PMC11408441 DOI: 10.1007/s40123-024-01003-z] [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: 05/22/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION Patients with dry eye disease (DED) complain of a multitude of symptoms that affect their visual function and quality of life (QoL). This clinical investigation assessed the performance, tolerance, and safety of a novel preservative-free ophthalmic solution containing xanthan gum 0.2% and desonide sodium phosphate 0.025%. METHODS This was an observational, prospective, multicentric, and post-market clinical investigation to assess the effect of three times a day instillation of the study formulation in patients suffering from DED. The primary objective was to achieve a 50% reduction in conjunctival hyperemia index as assessed with the OCULUS Keratograph after 1 month of treatment compared to baseline values. The secondary objectives included patient-reported outcomes, clinical performance, and safety. RESULTS Thirty patients were enrolled (21 women, 9 men) with a mean age of 61.10 ± 14.53 years. The instillation of the study formulation was associated with a significant reduction in redness scores after 1 month of treatment compared to baseline (mean - 0.51 ± 0.51; p ≤ 0.0001). Although the primary endpoint was not completely met, a 50% reduction in the conjunctival hyperemia index was achieved in 23% of the participants, and 77% showed a reduction of 26% of the same index. In addition, the ophthalmic solution significantly increased tear film break-up time, and a significant reduction of corneal and conjunctival staining with fluorescein was achieved. It also reduced DED symptoms and had a very good safety profile. CONCLUSIONS the study formulation produced a significant improvement in the signs, symptoms, and QoL of patients with mild to moderate DED with a good safety profile after 1 month of treatment.
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Affiliation(s)
- Pasquale Aragona
- Unità Operativa Complessa (U.O.C.) di Oftalmologia, Ophthalmology Clinic, Department of Biomedical Sciences, Scuola di Specializzazione in Oftalmologia, University of Messina, Piazza Pugliatti, 1, 98122, Messina, Italy.
| | - Giuseppe Giannaccare
- Ophthalmology Residency Program Eye Clinic, University of Cagliari, Via Università, 40, 09124, Cagliari, Italy
| | - Edoardo Dammino
- Faculty of Medicine, University of Catania, Piazza Università, 95123, Catania, Italy
| | - Fabiana D'Esposito
- Imperial College Ophthalmic Research Group Unit, Imperial College, London, SW7 2AZ, UK
- Eye Clinic, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, 80100, Naples, Italy
- Genofta s.r.l., Sant'Agnello, 80065, Naples, Italy
| | - Paola Genovese
- Unità Operativa Complessa (U.O.C.) di Oftalmologia, Ophthalmology Clinic, Department of Biomedical Sciences, Scuola di Specializzazione in Oftalmologia, University of Messina, Piazza Pugliatti, 1, 98122, Messina, Italy
| | - Elisa Imelde Postorino
- Unità Operativa Complessa (U.O.C.) di Oftalmologia, Ophthalmology Clinic, Department of Biomedical Sciences, Scuola di Specializzazione in Oftalmologia, University of Messina, Piazza Pugliatti, 1, 98122, Messina, Italy
| | - Claudine Civiale
- SIFI S.p.A., Via Ercole Patti 36, Aci San Antonio, 95025, Catania, Italy.
| | | | - Caterina Gagliano
- Department of Medicine and Surgery, University of Enna "Kore", Piazza dell'Università, 94100, Enna, Italy
- San Marco Hospital, Viale Carlo Azeglio Ciampi, 95100, Catania, Italy
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Scarabosio A, Surico PL, Patanè L, Tambasco D, Kahale F, Zeppieri M, Parodi PC, Coassin M, Di Zazzo A. The Overlooked Floppy Eyelid Syndrome: From Diagnosis to Medical and Surgical Management. Diagnostics (Basel) 2024; 14:1828. [PMID: 39202316 PMCID: PMC11353443 DOI: 10.3390/diagnostics14161828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Revised: 08/13/2024] [Accepted: 08/20/2024] [Indexed: 09/03/2024] Open
Abstract
Floppy Eyelid Syndrome (FES) is an underdiagnosed ocular condition characterized by the abnormal laxity of the upper eyelids, often leading to chronic eye irritation and redness. This review provides an in-depth examination of FES, covering its pathophysiology, clinical presentation, and diagnostic and therapeutic approaches. We discuss the potential etiological factors, including genetic predispositions and associations with ocular and systemic conditions such as obesity, obstructive sleep apnea, keratoconus, and glaucoma. Diagnostic strategies are outlined, emphasizing the importance of thorough clinical examinations and specific tests for an efficacious grading and assessment of FES. Management of FES ranges from conservative medical treatments to surgical interventions for more severe cases and should be driven by a comprehensive and multidisciplinary approach. Herein, we illustrate the practical aspects of diagnosing and managing this condition. This comprehensive review aims to enhance the recognition and treatment of FES, ultimately improving the quality of life for affected patients.
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Affiliation(s)
- Anna Scarabosio
- Department of Plastic Surgery, Massachusetts General Hospital, Boston, MA 02114, USA;
- Department of Plastic Surgery, University Hospital of Udine, 33100 Udine, Italy;
| | - Pier Luigi Surico
- Department of Ophthalmology, Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, USA;
- Department of Ophthalmology, Campus Bio-Medico University Hospital, 00128 Rome, Italy; (M.C.); (A.D.Z.)
| | - Luca Patanè
- Department of Plastic Surgery, Sapienza University of Rome, 00185 Rome, Italy;
| | - Damiano Tambasco
- Department of Plastic Surgery, Hospital San Carlo di Nancy, 00165 Rome, Italy;
| | - Francesca Kahale
- Department of Ophthalmology, Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, USA;
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Pier Camillo Parodi
- Department of Plastic Surgery, University Hospital of Udine, 33100 Udine, Italy;
| | - Marco Coassin
- Department of Ophthalmology, Campus Bio-Medico University Hospital, 00128 Rome, Italy; (M.C.); (A.D.Z.)
| | - Antonio Di Zazzo
- Department of Ophthalmology, Campus Bio-Medico University Hospital, 00128 Rome, Italy; (M.C.); (A.D.Z.)
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Bardoloi P, Vanathi M, Velpandian T, Laxmi M, Gupta N, Lomi N, Tandon R. Tear Tacrolimus Levels and Clinical Response After Adjunct Therapy With Cutaneous Application of Tacrolimus 0.1% Over Upper Eyelid Skin in Chronic Vernal Keratoconjunctivitis. Cornea 2024; 43:820-827. [PMID: 37921523 DOI: 10.1097/ico.0000000000003404] [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: 06/08/2023] [Accepted: 09/11/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE The aim of this study was to evaluate the role of cutaneous application of 0.1% tacrolimus eye ointment over the skin of the upper eyelid in chronic vernal keratoconjunctivitis (VKC). METHODS A prospective, longitudinal, noncomparative, open-label clinical study of moderate-to-severe grade steroid-dependent VKC was performed. Study participants were initiated on adjunct therapy of cutaneous application of 0.1% tacrolimus ointment twice daily on the upper eyelid skin. Ocular surface evaluation parameters, meibomian gland imaging, intraocular pressure, visual acuity, and clinical disease severity scoring were performed to assess clinical response at baseline and month 3 of therapy. Tear levels of tacrolimus were measured at month 3 using high-performance liquid chromatography tandem mass spectrometry and correlated with the clinical score. RESULTS Palpebral form of VKC was observed in 85% of the cases, with positive family history in 5%, atopy in 7.5%, and keratoconus in 11.25%. Clinical assessment revealed improvement in 97.5% patients with discontinuation of concomitant topical steroids in 64% of patients. There were no changes in visual acuity, intraocular pressure, or ocular surface evaluation after therapy. Tacrolimus was detected in the tears of all our study patients after cutaneous application over the upper eyelid skin, proving its bioavailability with mean tear tacrolimus levels of 6.55 ± 21.43 ng/mL. Correlation analysis revealed a moderate negative correlation between the clinical score and tacrolimus concentration (Spearman correlation coefficient: -0.34, P = 0.002). CONCLUSIONS Cutaneous tacrolimus 0.1% ointment over the upper eyelid skin is an efficacious alternative method of application in treatment of VKC, with no resultant ocular irritation.
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Affiliation(s)
- Priyadarshana Bardoloi
- Cornea and Ocular Surface, Cataract and Refractive Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; and
| | - Murugesan Vanathi
- Cornea and Ocular Surface, Cataract and Refractive Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; and
| | - Thirumurthy Velpandian
- Ocular Pharmacology Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Moksha Laxmi
- Ocular Pharmacology Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Noopur Gupta
- Cornea and Ocular Surface, Cataract and Refractive Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; and
| | - Neiwete Lomi
- Cornea and Ocular Surface, Cataract and Refractive Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; and
| | - Radhika Tandon
- Cornea and Ocular Surface, Cataract and Refractive Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; and
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Noyman DBE, Chan CC, Mimouni M, Safir M. The Efficacy and Safety of Standard versus Soft Topical Steroids after Cataract Surgery: A Systematic Review and Meta-analysis. Ophthalmology 2024; 131:595-610. [PMID: 38007198 DOI: 10.1016/j.ophtha.2023.11.022] [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: 07/02/2023] [Revised: 10/27/2023] [Accepted: 11/17/2023] [Indexed: 11/27/2023] Open
Abstract
TOPIC Review of the efficacy and safety of standard versus soft topical steroid application after cataract surgery. CLINICAL RELEVANCE The control of postoperative inflammation is the mainstay of treatment after cataract surgery. However, no consensus exists regarding the postoperative steroid of choice. Basing the choice of topical postoperative steroidal treatment on high-quality data regarding both risks and benefits of various drugs would be advantageous for both patients and clinicians. METHODS A systematic search of the PubMed, Scopus, and Embase electronic databases for all peer-reviewed published randomized control trials that included clinical outcomes of topical steroidal treatment after uneventful cataract surgery was performed. Individual study data were extracted and evaluated in a weighted pooled analysis including grading of total anterior chamber (AC) inflammation, AC cells, AC flare, postoperative visual acuity (VA), intraocular pressure (IOP), and rate of adverse events (AEs). RESULTS Overall, 508 studies were found, of which 7 were eligible for the systematic review and ultimately were included for analysis, reporting on 593 patients from 5 countries. Age of included patients, when available, ranged between 3.7 and 73.4 years. Follow-up data were available for analysis at 1, 7, and 28 days after surgery. Except for a significantly lower grade of AC flare in the standard steroid group at day 7 (standardized mean difference, 0.26; 95% confidence interval, 0.05-0.47; I2 = 0%), inflammatory activity measurements displayed insignificant differences at every other follow-up (days 1 and 28 after surgery). Pooled analysis of IOP at each follow-up demonstrated a higher IOP at the 7-day visit in the standard steroid group, whereas IOP at other time points was comparable among the groups. Qualitative analysis of ocular AEs showed similarities among the groups. DISCUSSION The findings of this study suggest that for the average patient, both groups produce a comparable effect on both AC inflammation and postoperative IOP and VA. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
| | - Clara C Chan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Michael Mimouni
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel; Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Margarita Safir
- Department of Ophthalmology, Yitzhak Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Dahlmann-Noor AH, Roberts C, Muthusamy K, Calder V, Hingorani M. Topical cyclosporine A 1 mg/ml for atopic keratoconjunctivitis: Five-year case series of 99 children and young people. Acta Ophthalmol 2023; 101:e197-e204. [PMID: 36151755 DOI: 10.1111/aos.15251] [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: 03/18/2022] [Revised: 05/20/2022] [Accepted: 09/03/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To explore the effects of cyclosporine A (CsA) in the management of atopic keratoconjunctivitis (AKC). METHODS Open single-group interventional consecutive cohort study (case series) at a single eye care facility in the UK. We reviewed the electronic patient records of 99 children and young people (CYP) aged 3.4-18 years with AKC treated with topical CsA 1 mg/ml. Main outcome measures were number of prescriptions and hospital clinic visits over 12 months before and after the start of CsA and the proportion of CYP affected by adverse effects. RESULTS The median number of inflammatory episodes requiring treatment with topical corticosteroids (tCS) fell from 3 (interquartile range IQR 1-4) during the 12 months prior to CsA to 1 (IQR 0-3) during the 12 months after, excluding tCS prescriptions with the first CsA prescription (Wilcoxon signed ranks test, 2 tailed, p < 0.01). In the 12-month period following initiation of CsA 1 mg/ml with concomitant prescription of tCS (n = 66), daily dosage of steroids was reduced in 62 CYP (93.9%), and they were discontinued in 43 (65.2%). The median number of hospital visits fell from 4 (IQR 3-6) to 3 (IQR 2-5; Wilcoxon p < 0.01). Adverse events leading to discontinuation of CsA were stinging (instillation site pain; 9/99, 9%) and a transient skin rash (1/99, 1%). CONCLUSIONS Off-label use of commercial preparations of CsA 1 mg/ml significantly reduces the need for concomitant topical corticosteroids and hospital clinic visits in CYP with AKC. Stinging and skin rash can lead to discontinuation.
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Affiliation(s)
- Annegret H Dahlmann-Noor
- NIHR Moorfields Biomedical Research Centre, London, UK.,Children's Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Clare Roberts
- Children's Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | | | - Melanie Hingorani
- Children's Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Corneal Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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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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Dahlmann-Noor AH, Roberts C, Muthusamy K, Calder V, Hingorani M. Steroid-sparing effect of ciclosporin A 1 mg/mL: 5-year case series of 107 children and young people with vernal keratoconjunctivitis. BMJ Open Ophthalmol 2022; 7:e001040. [PMCID: PMC9756209 DOI: 10.1136/bmjophth-2022-001040] [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] [Indexed: 12/23/2022] Open
Abstract
Background/aims To explore the steroid-sparing and other therapeutic effects of ciclosporin A (CsA) 1 mg/mL in the management of vernal keratoconjunctivitis (VKC). Methods Open retrospective single-group interventional consecutive cohort study (case series) of 107 children and young people (CYP) age 4.4–18 years with severe and/or recurrent VKC who were prescribed CsA 1 mg/mL between November 2015 and May 2021 at one institution. Review of electronic patient records, noting clinical indication for prescribing CsA 1 mg/mL, dosage prescribed at initiation and follow-up, impact on steroid usage before and after commencing CsA as well as adverse events and indications for discontinuation of treatment. Results The median number of inflammatory episodes requiring treatment with topical corticosteroids fell from 3 (IQR 2–4) during the 12 months prior to CsA 1 mg/mL to 1 (IQR 0–3) during the 12 months after, excluding steroid prescriptions with the first CsA 1 mg/mL prescription (Wilcoxon signed ranks test, two tailed, p<0.01). In the 12-month period following initiation of CsA 1 mg/mL with concomitant prescription of topical corticosteroids (n=82), daily dosage of steroids was reduced in 79 (96.3%) and discontinued in 67 (81.7%). The median number of hospital clinic visits fell from 4 (IQR 3–5) to 3 (IQR 2–5) (Wilcoxon p<0.01). Adverse events leading to discontinuation of CsA 1 mg/mL within 12 months of starting included stinging (instillation site pain) (6/107, 5.6%) and skinrash (1/107, 0.9%). Conclusion Commercial preparations of CsA 1 mg/mL, licensed for severe VKC in CYP, significantly reduce the need for concomitant topical corticosteroids and hospital clinic visits. Adverse events which may lead to discontinuation are stinging and skin rash.
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Affiliation(s)
- Annegret Hella Dahlmann-Noor
- NIHR Moorfields Biomedical Research Centre, London, UK,Children's Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Clare Roberts
- Children's Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Kirithika Muthusamy
- Children's Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Melanie Hingorani
- Children's Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Magnier F, Dutheil F, Pereira B, Watson SL, Baker JS, Chiambaretta F, Navel V. Preventive treatment of allograft rejection after endothelial keratoplasty: A systematic review and meta-analysis. Acta Ophthalmol 2022; 100:e1061-e1073. [PMID: 35411680 DOI: 10.1111/aos.15154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 02/10/2022] [Accepted: 03/30/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the efficacy of preventive treatment against allograft rejection after endothelial keratoplasty (EK), we conducted a systematic review and meta-analysis. METHOD PubMed, Cochrane Library, Embase and ScienceDirect databases were searched until May 2021. We computed a random-effect meta-analysis on graft rejection rate stratified by the intervention (i.e. Descemet membrane EK (DMEK) and Descemet stripping (Automated) EK (DS(A)EK) or ultrathin (UT)-DSAEK), and postoperative treatment. Meta-regressions were performed to compare intervention, treatment and influence of putative confusion factors. RESULTS We included 49 studies and 12 893 EK (6867 DMEK and 6026 DS(A)EK/UT-DSAEK). Topical steroids were merged in two efficacy regimens: standard steroids (prednisolone acetate 1% or dexamethasone 0.1%) and soft steroids (fluorometholone 0.1% or loteprednol etabonate 0.5%). Globally, DMEK had a lower graft rejection rate than DS(A)EK/UT-DSAEK (coefficient - 3.3, 95 CI, -4.60 to -1.90; p < 0.001). No significant differences were observed between standard and soft steroids to prevent graft rejection after DMEK. After EK, the rate of ocular hypertension was 20% (95 CI, 14 to 26%) with the use of standard steroids and 7% (5 to 9%) with soft steroids. Comparisons of treatments were not feasible in DS(A)EK/UT-DSAEK due to a lack of studies. CONCLUSIONS Descemet membrane endothelial keratoplasty (DMEK) has less risk of graft rejection compared with DS(A)EK/UT-DSAEK. Furthermore, soft steroids seemed to be a valuable alternative to standard steroids to prevent graft rejection after DMEK, involving a safe profile against ocular hypertension. Further studies are needed to compare other drugs in the prevention of graft rejection after EK.
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Affiliation(s)
- Florent Magnier
- Ophthalmology, CHU Clermont‐Ferrand University Hospital of Clermont‐Ferrand Clermont‐Ferrand France
| | - Frédéric Dutheil
- CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont‐Ferrand, CHU Clermont‐Ferrand, Preventive and Occupational Medicine Université Clermont Auvergne Clermont‐Ferrand France
| | - Bruno Pereira
- Biostatistics, CHU Clermont‐Ferrand University Hospital of Clermont‐Ferrand (CHU) Clermont‐Ferrand France
| | - Stephanie L. Watson
- Discipline of Ophthalmology, Save Sight Institute, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Sydney Eye Hospital Sydney New South Wales Australia
| | - Julien S. Baker
- Department of Sport, Physical Education and Health, Center for Health and Exercise Science Research Hong Kong Baptist University Kowloon Tong Hong Kong
| | - Frédéric Chiambaretta
- Translational Approach to Epithelial Injury and Repair, CNRS, INSERM, GReD, University Hospital of Clermont‐Ferrand, CHU Clermont‐Ferrand, Ophthalmology Université Clermont Auvergne Clermont‐Ferrand France
| | - Valentin Navel
- Translational Approach to Epithelial Injury and Repair, CNRS, INSERM, GReD, University Hospital of Clermont‐Ferrand, CHU Clermont‐Ferrand, Ophthalmology Université Clermont Auvergne Clermont‐Ferrand France
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Yakin M, Kumar A, Kodati S, Jones L, Sen HN. Risk of Elevated Intraocular Pressure With Difluprednate in Patients With Non-Infectious Uveitis. Am J Ophthalmol 2022; 240:232-238. [PMID: 35381204 PMCID: PMC9308646 DOI: 10.1016/j.ajo.2022.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 02/10/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the risk factors associated with clinically important intraocular pressure (IOP) elevation with topical difluprednate treatment in patients with non-infectious uveitis. DESIGN Retrospective cohort study. METHODS Fifty-four eyes of 54 patients with non-infectious uveitis treated with topical difluprednate at the current institution were included. Demographics and clinical characteristics of uveitis patients were collected. The main outcome measure was development of clinically important IOP elevation defined as IOP ≥21 mmHg and an increase of ≥10 mmHg from baseline. RESULTS A clinically important IOP elevation was observed in 17 patients (31.5%). The mean time to clinically important IOP elevation was 7.4±4.8 weeks (range 3-19). Statistically significant risk factors for incident clinically important IOP elevation were being a child (adjusted hazard ratio [aHR] 7.85 [95% CI 1.48-41.56], P = .02) and concurrent use of systemic steroids (aHR 5.31 [95% CI 1.18-24.00], P = .03). Patients with concurrent systemic corticosteroids developed clinically important IOP elevation earlier than those without systemic corticosteroid (mean 5.7±3.4 [range 3-14] vs 10.4±5.7 [range 4-19] weeks, P = .05). Incident IOP ≥30 mmHg occurred in 7 patients (13.0%). All patients responded well to the cessation of difluprednate and/or use of topical antiglaucomatous agents and no eyes required glaucoma surgery. CONCLUSIONS This study demonstrated that clinically important IOP elevation is common in uveitis patients with topical difluprednate treatment. Children and patients with concurrent systemic corticosteroids are at substantial risk of developing clinically important IOP elevation.
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Affiliation(s)
- Mehmet Yakin
- From the National Eye Institute, National Institutes of Health, Bethesda, MD, USA (M.Y, A.K, S.K, H.N.S); University of Health Sciences, Ankara Training and Research Hospital, Ophthalmology Department, Ankara, Turkey (M.Y)
| | - Aman Kumar
- From the National Eye Institute, National Institutes of Health, Bethesda, MD, USA (M.Y, A.K, S.K, H.N.S); Albany Medical College, Albany, NY (A.K)
| | - Shilpa Kodati
- From the National Eye Institute, National Institutes of Health, Bethesda, MD, USA (M.Y, A.K, S.K, H.N.S)
| | - Leslie Jones
- Howard University College of Medicine, Ophthalmology Department, Washington DC, USA (L.J)
| | - H Nida Sen
- From the National Eye Institute, National Institutes of Health, Bethesda, MD, USA (M.Y, A.K, S.K, H.N.S).
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Iomdina EN, Kushnarevich NY. Possibilities of monitoring intraocular pressure in children using EASYTON transpalpebral tonometer. Int Ophthalmol 2022; 42:1631-1638. [PMID: 35088357 PMCID: PMC9122879 DOI: 10.1007/s10792-021-02158-5] [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: 03/19/2021] [Accepted: 12/18/2021] [Indexed: 12/03/2022]
Abstract
Purpose To compare the effectiveness of transpalpebral scleral tonometry (TPST) and corneal pneumotonometry in children, and assess the discomfort level when measuring intraocular pressure (IOP) by these methods. Methods TPST using EASYTON tonometer (Russia) and pneumotonometry using Reichert 7 Non-contact AutoTonometer (USA) have been sequentially performed on 84 eyes (42 children aged 5–14, ave. 9.3 ± 2.7), including 64 myopic eyes (-0.5 to 6.75D), 18 hyperopic eyes (+ 0.75 to + 3.75D), and 2 emmetropic eyes. We assessed tolerance to the procedure on a five-point scale using a questionnaire which listed several criteria: discomfort, presence of pain, fear or anxiety during the procedure, the child's resistance to measurement. Results EASYTON tonometry demonstrated repeatability of IOP indicators when measuring the same eye three times sequentially and almost the same IOP level in paired eyes of isometropic children. Pneumotonometry reveals a greater individual data variability and a more pronounced asymmetry of the paired eyes’ indicators. IOP measured using the TPST was 18.3 ± 2.3 mmHg across the whole group, 18.2 ± 2.3 mmHg in myopic, and 18.5 ± 2.3 mmHg in hyperopic children. With pneumotonometry, the corresponding indicators were 17.1 ± 3.9 mmHg, 16.9 ± 3.8 mmHg, and 18.2 ± 4.0 mmHg. The average score for the TPST (4.64 ± 0.60 points) was significantly higher than that for pneumotonometry (3.85 ± 0.90 points) (p < 0.05). Conclusions TPST provides broader possibilities for IOP control in pediatric practice, yielding more reliable and accurate results than pneumotonometry, eliminating the influence of corneal thickness and irregularity on the measurement result, and ensuring a calmer behavior and more comfort of children during the procedure.
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Affiliation(s)
- Elena N Iomdina
- Department of Refractive Pathology, Binocular Vision and Ophthalmoergonomics, Helmholtz National Medical Research Center of Eye Diseases, 14/19 Sadovaya-Chernogryazskaya St, Moscow, Russia, 105062.
| | - Nina Yu Kushnarevich
- Department of Refractive Pathology, Binocular Vision and Ophthalmoergonomics, Helmholtz National Medical Research Center of Eye Diseases, 14/19 Sadovaya-Chernogryazskaya St, Moscow, Russia, 105062
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11
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Olusanya B, Ugalahi M, Ibukun F, Baiyeroju A. Intraocular pressure elevation following the use of topical dexamethasone ointment after squint surgery. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2022; 12:70-75. [PMID: 36203922 PMCID: PMC9531743 DOI: 10.4103/jwas.jwas_26_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/22/2022] [Indexed: 11/21/2022]
Abstract
Purpose: To describe the pattern of intraocular pressure (IOP) changes after squint surgery in eyes of black Africans at the University College Hospital, Ibadan, Nigeria. Materials and Methods: This was a retrospective review of the clinical records of patients who underwent squint surgery between 2010 and 2019. Data on demographic characteristics, preoperative and postoperative intraocular pressure values, co-existing ocular pathology, type of strabismus, surgery performed, frequency and duration of postoperative topical steroid use and treatment received for elevated intraocular pressure were collected and descriptively summarised. Results: Thirty-six (39.1%) out of 92 patients who had squint surgery during the study period met study inclusion criteria. Mean age was 20.5 ± 13.6 years. All patients were administered Maxitrol® ointment postoperatively. Baseline, peak and net change in IOP were 12.9 ± 2.6 mmHg, 21.3 ± 6.8 mmHg and 8.39 ± 7.2 mmHg respectively. Thirty-one (86.1%) patients had elevation in IOP from baseline; 21 (67.7%) of these had significant IOP elevation. Topical steroid therapy was tailed off rapidly for all patients with significant IOP elevation. Twelve patients were commenced on topical IOP lowering medications, with normalization of intraocular pressure in majority of them by three months after surgery. Conclusion: Elevated intraocular pressure with the use of topical dexamethasone ointment after squint surgery was common in this study and majority of the patients had significant elevation in intraocular pressure. Close monitoring of the intraocular pressure of black patients, especially children, on topical steroid medication after squint surgery is strongly recommended.
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12
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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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13
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Lee JH, Chung HS, Moon SY, Yoon J, Lee K, Lee H, Kim JY, Lim HT, Tchah H. Effect of preoperative eyedrops on cytokine concentrations in aqueous humor of patients undergoing femtosecond laser-assisted cataract surgery. Graefes Arch Clin Exp Ophthalmol 2021; 260:885-891. [PMID: 34625847 DOI: 10.1007/s00417-021-05428-1] [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: 02/04/2021] [Revised: 09/09/2021] [Accepted: 09/23/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To compare the anti-inflammatory activity of preoperatively applied eyedrops, as determined by cytokine concentrations in aqueous humor collected during surgery in patients undergoing femtosecond laser-assisted cataract surgery. METHODS A total of 120 patients undergoing femtosecond laser-assisted cataract surgery were randomly assigned to four groups of 30 patients each. Groups were administered 0.1% fluorometholone eyedrops, 0.45% ketorolac tromethamine eyedrops, both 0.1% fluorometholone and 0.45% ketorolac tromethamine eyedrops, or no eyedrops. Eyedrops were instilled 1 h, 20 min, and just before surgery. After anterior capsulotomy and nuclear fragmentation using a femtosecond laser, 0.1 cc aqueous humor was obtained using a needle and syringe. Cytokine and prostaglandin E2 (PGE2) concentrations were quantitatively determined. RESULTS The 120 patients included 59 men and 61 women, of mean age 65.02 years. The mean interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) concentrations after treatment did not differ significantly in the four groups. The average interleukin-8 (IL-8) concentrations were significantly lower in the fluorometholone (4.80 pg/mL), ketorolac tromethamine (4.84 pg/mL), and fluorometholone + ketorolac tromethamine (4.68 pg/mL) groups than in the control group (6.83 pg/mL). Furthermore, the average PGE2 concentrations were significantly lower in the ketorolac tromethamine (270.04 pg/mL) and fluorometholone + ketorolac tromethamine (239.00 pg/mL) groups, but not in the fluorometholone (393.16 pg/mL) group, than in the control group (472.36 pg/mL). CONCLUSION Preoperative fluorometholone instillation reduced IL-8, and ketorolac tromethamine instillation reduced IL-8 and PGE2, in aqueous humor of patients undergoing femtosecond laser surgery, with the combination of both eyedrops being more effective than either alone. TRIAL REGISTRATION KCT0005717.
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Affiliation(s)
- Jae Hyuck Lee
- Department of Ophthalmology, HanGil Eye Hospital, Incheon, Republic of Korea.,Department of Ophthalmology, Catholic Kwandong University College of Medicine, Gangneung, Republic of Korea
| | - Ho Seok Chung
- Department of Ophthalmology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Su Young Moon
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Jooyoung Yoon
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Koeun Lee
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Hun Lee
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Jae Yong Kim
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Hyun Taek Lim
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Hungwon Tchah
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea.
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14
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Koduri VA, Reddy AK, Patnaik JL, Palestine AG, Lynch AM, Pantcheva MB. Endoscopic Cyclophotocoagulation Combined with Phacoemulsification Increases Risk of Persistent Anterior Uveitis Compared to Phacoemulsification Surgery Alone. Clin Ophthalmol 2021; 15:437-443. [PMID: 33574652 PMCID: PMC7873618 DOI: 10.2147/opth.s294791] [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: 12/09/2020] [Accepted: 01/19/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To evaluate if the addition of endoscopic cyclophotocoagulation (ECP) to uncomplicated phacoemulsification cataract extraction increases the risk of persistent anterior uveitis (PAU) compared to phacoemulsification alone. PATIENTS AND METHODS Retrospective analysis of patients who had either phacoemulsification alone or combined with endoscopic cyclophotocoagulation from January 1, 2014 to December 31, 2017. Visual acuity, intraocular pressure, presence of anterior chamber cells, and steroid usage were analyzed pre- and post-operatively. Patient eyes with a history of uveitis, autoimmune disease, complicated cataract surgery, combined surgery other than ECP, and less than 3 months of follow-up were excluded. RESULTS This study consisted of 4423 eyes from 2903 patients, meeting the inclusion criteria (phacoemulsification only group n=4242 and phacoemulsification/ECP group n=181 eyes). PAU developed in 14.9% in the phacoemulsification with ECP group compared to 1.7% who had phacoemulsification alone. White patients had a 17.9 (95% CI: 7.8-41.1, p<0.0001) increased odds of developing persistent anterior uveitis with a combined procedure compared to phacoemulsification only, while Non-white patients had a 5.8 (95% CI: 2.8-12.1, p<0.0001) increased odds. Despite the higher odds ratio in White patients, this group had a significantly lower rate of PAU compared to Non-white patients after phacoemulsification/ECP. CONCLUSION The addition of endoscopic cyclophotocoagulation to phacoemulsification significantly increases the risk of developing PAU in the post-operative period compared to phacoemulsification alone.
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Affiliation(s)
- Vivek A Koduri
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Amit K Reddy
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jennifer L Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Alan G Palestine
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Anne M Lynch
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Mina B Pantcheva
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
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