1
|
Abdel-Radi M, Eldaly Z, Alattar S, Goda I. Preservative-Free Topical Anesthetic Unit-Dose Eye Drops for the Management of Postoperative Pain Following Photorefractive Keratectomy. Ophthalmol Ther 2023; 12:3025-3038. [PMID: 37665497 PMCID: PMC10640409 DOI: 10.1007/s40123-023-00791-0] [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: 06/15/2023] [Accepted: 08/04/2023] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION Ocular pain is a common complication following photorefractive keratectomy (PRK). The level of patient satisfaction with current pain control strategies is not high. This study aims to assess the efficacy and safety of a novel regimen of preservative-free oxybuprocaine hydrochloride 0.4% unit-dose eye drops for post-PRK pain control. METHODS In a contralateral eye study, 144 eyes of 72 patients who underwent bilateral transepithelial PRK (TransPRK) were stratified into experimental and control groups. The experimental group received preservative-free oxybuprocaine hydrochloride 0.4% unit-dose eye drops five times daily postoperatively until complete epithelial healing, while the control group received sodium hyaluronate 0.2% instead. The main outcome measures were pain scores assessed by the verbal rating scale and visual analogue scale (VRS, VAS), the corneal epithelial defect (CED) area, epithelial healing duration evaluated by slit-lamp biomicroscopy and anterior segment optical coherence tomography (AS-OCT), and endothelial cell density (ECD) measured before and 1 month after surgery. RESULTS Pain scores assessed by VRS and VAS were significantly lower in the experimental group 8 h after surgery, and 1, 2, and 3 days postoperatively (P < 0.001). The mean CED area showed no significant differences between the two groups at different follow-ups (P value > 0.05). The corneal epithelial healing had a mean duration of 3.32 ± 0.47 days in both studied groups and was parallel in both eyes of each patient. In each group, 49 eyes (68%) and 72 eyes (100%) had a fully epithelialized surface on the third and fourth postoperative days, respectively. No significant changes were observed in the mean ECD 1 month following surgery in both groups (P value > 0.05). CONCLUSION Preservative-free oxybuprocaine hydrochloride 0.4% unit-dose eye drops are effective and safe in controlling early postoperative pain following TransPRK. The availability of the single-dose unit preparation can overcome the problem of topical anesthetic abuse. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05733741.
Collapse
Affiliation(s)
- Mahmoud Abdel-Radi
- Department of Ophthalmology, Assiut University Hospital, Assiut University, 6th Floor, Asyût , 71516, Egypt.
| | - Zeiad Eldaly
- Department of Ophthalmology, Assiut University Hospital, Assiut University, 6th Floor, Asyût , 71516, Egypt
| | - Sara Alattar
- Department of Ophthalmology, Assiut University Hospital, Assiut University, 6th Floor, Asyût , 71516, Egypt
| | - Islam Goda
- Department of Ophthalmology, Assiut University Hospital, Assiut University, 6th Floor, Asyût , 71516, Egypt
| |
Collapse
|
2
|
Zhang R, Gou W, Yi P, Qin Z, Zhu D, Jia J, Liu L, Jiang X, Feng J. Tetracaine hydrochloride induces macrophage pyroptosis through caspase‑1/11‑GSDMD signaling pathways. Exp Ther Med 2023; 26:428. [PMID: 37602302 PMCID: PMC10433433 DOI: 10.3892/etm.2023.12127] [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: 03/29/2023] [Accepted: 06/29/2023] [Indexed: 08/22/2023] Open
Abstract
Tetracaine hydrochloride (TTC) is a long-lasting local anesthetic commonly used for topical anesthesia. Inappropriate dosage or allergic reactions to TTC can lead to local anesthetic toxicity. TTC exerts cytotoxic effects on certain cell types by inducing apoptosis and necrosis; however, the effects of TTC on macrophages are currently unclear. In the present study, the RAW 264.7 and BV2 cell lines, and murine peritoneal macrophages, were used to evaluate the cytotoxicity of TTC. The present study demonstrated that TTC caused a decrease in cell viability according to a Cell Counting Kit-8 assay, increased lactate dehydrogenase and IL-1β secretion according to ELISA, and induced morphological changes characteristic of pyroptosis according to western blotting. Moreover, TTC-induced macrophage pyroptosis was mediated by gasdermin (GSDM)D, and the cleavage of GSDMD was modulated by both caspase-1 and caspase-11. These results were experimentally validated using caspase-1 and caspase-11 inhibitors. Furthermore, it was observed that TTC and lipopolysaccharide (LPS) exerted similar effects on macrophages. However, the mechanism of induction of pyroptosis by TTC was different from that of LPS. The present study demonstrated that TTC alone could induce macrophage pyroptosis mediated by canonical and non-canonical inflammatory caspases. Therapies targeting pyroptosis may potentially provide a promising future strategy for the prevention and treatment of local anesthetic toxicity induced by TTC.
Collapse
Affiliation(s)
- Ran Zhang
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Department of Anesthesiology, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Wanrong Gou
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Department of Anesthesiology, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Peng Yi
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Department of Anesthesiology, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Zhengshan Qin
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Department of Anesthesiology, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Danli Zhu
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Department of Anesthesiology, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Jing Jia
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Department of Anesthesiology, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Li Liu
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Department of Anesthesiology, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Xian Jiang
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Department of Anesthesiology, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
- Department of Anesthesiology, Luzhou People's Hospital, Luzhou, Sichuan 646000, P.R. China
| | - Jianguo Feng
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Department of Anesthesiology, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| |
Collapse
|
3
|
Sharifi A, Naisiri N, Shams M, Sharifi M, Sharifi H. Adverse Reactions from Topical Ophthalmic Anesthetic Abuse. J Ophthalmic Vis Res 2022; 17:470-478. [PMID: 36620720 PMCID: PMC9806309 DOI: 10.18502/jovr.v17i4.12297] [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: 10/26/2021] [Accepted: 06/10/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose To assess the adverse drug reactions (ADR) of tetracaine among patients referred to an eye emergency department in the southeast of Iran. Methods In this case series study, we assessed 31 eyes of 24 patients who were referred due to adverse effects of ocular anesthetics during2017-2020. We collected the data, including age, sex, job, how the medicine was obtained, symptoms, examination results, and ADR. Results Of 24 patients, 22 (91.7%) were male. The mean (standard deviation) age of the patients was 32.6 (1.9) years. Twenty-two patients obtained the medicines without a prescription and a general practitioner prescribed the medicine to two patients. In the first interview, the most common symptoms were: photophobia, reduced vision, ocular pain, and redness. The main signs of persistent epithelial defect, patchy or diffuse corneal stromal infiltration, ring infiltration, and Descemet's folds were noticed in the examinations. Finally, 51.6% (n =16) of the eyes had decreased vision, 45.2% (n =14) had corneal opacity, 16.1% (n = 5) had elevated intraocular pressure that needed long-term anti-glaucoma therapy, and 6.5% (n = 2) had corneal pannus. Corneal perforation and phthisis bulbi were the final results in one eye. Conclusion ADR related to the use of ophthalmic topical anesthetics could cause sight-threatening severe morbidities. It seems that some general practitioners are not careful regarding the prescription of these kinds of medicine. Moreover, the over-the-counter availability of tetracaine eye drops should be managed.
Collapse
Affiliation(s)
- Ali Sharifi
- Department of Ophthalmology, Shafa Hospital, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Naser Naisiri
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Majid Shams
- Department of Ophthalmology, Shafa Hospital, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Meraj Sharifi
- Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| |
Collapse
|
4
|
Abstract
Background: To study the safety and efficacy provided by a minimal and localized anesthesia in cataract surgery. Methods: Randomized controlled trial. A total of 100 patients undergoing cataract surgery were randomly divided into two groups of 50, which respecitvely received conventional topical anesthesia consisting of preservative-free Oxibuprocaine hydrochloride 0.4% drops or minimal localized anesthesia, administered with a cotton bud soaked in preservative-free Oxibuprocaine hydrochloride 0.4% applied to clear cornea on the access sites for 10 s immediately before surgery. The mean outcome measures were intraoperative pain and the incidence of postoperative ocular discomfort. Results: All patients tolerated well the procedure, giving patin scores between 1–3. Fifteen patients (30%) of group 1 and ten of group 2 (25%) required supplemental anesthesia. No intraoperative complications were recorded. No eyes had epithelial defects at the end of the surgery or at postoperative check-ups. Conclusions: Minimal anesthesia in cataract surgery resulted quick, safe and non-invasive.
Collapse
|
5
|
Choi W, Ryu H, Fuwad A, Goh S, Zhou C, Shim J, Takagi M, Kwon S, Kim SM, Jeon TJ. Quantitative Analysis of the Membrane Affinity of Local Anesthetics Using a Model Cell Membrane. MEMBRANES 2021; 11:membranes11080579. [PMID: 34436342 PMCID: PMC8401255 DOI: 10.3390/membranes11080579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/17/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022]
Abstract
Local anesthesia is a drug that penetrates the nerve cell membrane and binds to the voltage gate sodium channel, inhibiting the membrane potential and neurotransmission. It is mainly used in clinical uses to address the pain of surgical procedures in the local area. Local anesthetics (LAs), however, can be incorporated into the membrane, reducing the thermal stability of the membrane as well as altering membrane properties such as fluidity, permeability, and lipid packing order. The effects of LAs on the membrane are not yet fully understood, despite a number of previous studies. In particular, it is necessary to analyze which is the more dominant factor, the membrane affinity or the structural perturbation of the membrane. To analyze the effects of LAs on the cell membrane and compare the results with those from model membranes, morphological analysis and 50% inhibitory concentration (IC50) measurement of CCD-1064sk (fibroblast, human skin) membranes were carried out for lidocaine (LDC) and tetracaine (TTC), the most popular LAs in clinical use. Furthermore, the membrane affinity of the LAs was quantitatively analyzed using a colorimetric polydiacetylene assay, where the color shift represents their distribution in the membrane. Further, to confirm the membrane affinity and structural effects of the membranes, we performed an electrophysiological study using a model protein (gramicidin A, gA) and measured the channel lifetime of the model protein on the free-standing lipid bilayer according to the concentration of each LA. Our results show that when LAs interact with cell membranes, membrane affinity is a more dominant factor than steric or conformational effects of the membrane.
Collapse
Affiliation(s)
- Wanjae Choi
- Department of Biological Engineering, Inha University, Incheon 22212, Korea; (W.C.); (H.R.); (S.G.); (C.Z.); (S.K.)
| | - Hyunil Ryu
- Department of Biological Engineering, Inha University, Incheon 22212, Korea; (W.C.); (H.R.); (S.G.); (C.Z.); (S.K.)
| | - Ahmed Fuwad
- Department of Mechanical Engineering, Inha University, Incheon 22212, Korea;
| | - Seulmini Goh
- Department of Biological Engineering, Inha University, Incheon 22212, Korea; (W.C.); (H.R.); (S.G.); (C.Z.); (S.K.)
| | - Chaoge Zhou
- Department of Biological Engineering, Inha University, Incheon 22212, Korea; (W.C.); (H.R.); (S.G.); (C.Z.); (S.K.)
| | - Jiwook Shim
- Department of Biomedical Engineering, Rowan University, Glassboro, NJ 08028, USA;
| | - Masahiro Takagi
- School of Materials Science, Japan Advanced Institute of Science and Technology, 1-1 Asahidai, Nomi 923–1292, Ishikawa, Japan;
| | - Soonjo Kwon
- Department of Biological Engineering, Inha University, Incheon 22212, Korea; (W.C.); (H.R.); (S.G.); (C.Z.); (S.K.)
- Department of Biological Sciences and Bioengineering, Inha University, Incheon 22212, Korea
| | - Sun Min Kim
- Department of Mechanical Engineering, Inha University, Incheon 22212, Korea;
- Department of Biological Sciences and Bioengineering, Inha University, Incheon 22212, Korea
- Correspondence: (S.M.K.); (T.-J.J.); Tel.: +82-32-860-7328 (S.M.K.); +82-32-860-7511 (T.-J.J.)
| | - Tae-Joon Jeon
- Department of Biological Engineering, Inha University, Incheon 22212, Korea; (W.C.); (H.R.); (S.G.); (C.Z.); (S.K.)
- Department of Biological Sciences and Bioengineering, Inha University, Incheon 22212, Korea
- Correspondence: (S.M.K.); (T.-J.J.); Tel.: +82-32-860-7328 (S.M.K.); +82-32-860-7511 (T.-J.J.)
| |
Collapse
|
6
|
Torres-Luna C, Hu N, Domszy R, Fan X, Yang J, Briber RM, Wang NS, Yang A. Effect of Carbon Chain Length, Ionic Strength, and pH on the In Vitro Release Kinetics of Cationic Drugs from Fatty-Acid-Loaded Contact Lenses. Pharmaceutics 2021; 13:pharmaceutics13071060. [PMID: 34371751 PMCID: PMC8309118 DOI: 10.3390/pharmaceutics13071060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 11/17/2022] Open
Abstract
This paper explores the use of fatty acids in silicone hydrogel contact lenses for extending the release duration of cationic drugs. Drug release kinetics was dependent on the carbon chain length of the fatty acid loaded in the lens, with 12-, 14- and 18-carbon chain length fatty acids increasing the uptake and the release duration of ketotifen fumarate (KTF) and tetracaine hydrochloride (THCL). Drug release kinetics from oleic acid-loaded lenses was evaluated in phosphate buffer saline (PBS) at different ionic strengths (I = 167, 500, 1665 mM); the release duration of KTF and THCL was decreased with increasing ionic strength of the release medium. Furthermore, the release of KTF and THCL in deionized water did not show a burst and was significantly slower compared to that in PBS. The release kinetics of KTF and THCL was significantly faster when the pH of the release medium was decreased from 7.4 towards 5.5 because of the decrease in the relative amounts of oleate anions in the lens mostly populated at the polymer–pore interfaces. The use of boundary charges at the polymer–pore interfaces of a contact lens to enhance drug partition and extend its release is further confirmed by loading cationic phytosphingosine in contact lenses to attract an anionic drug.
Collapse
Affiliation(s)
- Cesar Torres-Luna
- Department of Chemical & Biomolecular Engineering, University of Maryland, College Park, MD 20740, USA;
- Lynthera Corporation, 1200 Corporate Blvd., STE 10C, Lancaster, PA 17601, USA; (N.H.); (R.D.); (J.Y.)
| | - Naiping Hu
- Lynthera Corporation, 1200 Corporate Blvd., STE 10C, Lancaster, PA 17601, USA; (N.H.); (R.D.); (J.Y.)
| | - Roman Domszy
- Lynthera Corporation, 1200 Corporate Blvd., STE 10C, Lancaster, PA 17601, USA; (N.H.); (R.D.); (J.Y.)
| | - Xin Fan
- Department of Chemical Engineering, Auburn University, Auburn, AL 36849, USA;
| | - Jeff Yang
- Lynthera Corporation, 1200 Corporate Blvd., STE 10C, Lancaster, PA 17601, USA; (N.H.); (R.D.); (J.Y.)
| | - Robert M. Briber
- Department of Materials Science & Engineering, University of Maryland, College Park, MD 20740, USA;
| | - Nam Sun Wang
- Department of Chemical & Biomolecular Engineering, University of Maryland, College Park, MD 20740, USA;
- Correspondence: (N.S.W.); (A.Y.); Tel.: +1-(301)-405-1910 (N.S.W.); +1-(717)-522-1739 (A.Y.)
| | - Arthur Yang
- Lynthera Corporation, 1200 Corporate Blvd., STE 10C, Lancaster, PA 17601, USA; (N.H.); (R.D.); (J.Y.)
- Correspondence: (N.S.W.); (A.Y.); Tel.: +1-(301)-405-1910 (N.S.W.); +1-(717)-522-1739 (A.Y.)
| |
Collapse
|