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Oh SE, Kim JH, Park CK, Park HYL. Effect of Bromfenac on Reducing Neuroinflammation in an Ischemia-Reperfusion Glaucoma Model. Cells 2024; 13:1046. [PMID: 38920673 PMCID: PMC11201518 DOI: 10.3390/cells13121046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/04/2024] [Accepted: 06/11/2024] [Indexed: 06/27/2024] Open
Abstract
In the context of glaucoma, intraocular pressure (IOP) and age are recognized as the primary factors contributing to its onset and progression. However, significant reductions in IOP fail to completely halt its advancement. An emerging body of literature highlights the role of neuroinflammation in glaucoma. This study aimed to explore Bromfenac's anti-inflammatory properties in mitigating neuroinflammation associated with glaucoma using an ischemia-reperfusion (IR) glaucoma model. Bromfenac's impact on microglia and astrocytes under pressure was assessed via Western blotting and an enzyme-linked immunosorbent assay. Immunohistochemical staining was used to evaluate glial activation and changes in inflammatory marker expression in the IR model. Bromfenac led to the downregulation of inflammatory markers, which were elevated in the conditions of elevated pressure, and necroptosis markers were downregulated in astrocytes. In the IR model, elevated levels of GFAP and Iba-1 indicated glial activation. Following Bromfenac administration, levels of iNOS, COX-2, and PGE2-R were reduced, suggesting a decrease in neuroinflammation. Furthermore, Bromfenac administration in the IR model resulted in the improved survival of retinal ganglion cells (RGCs) and preservation of retinal function, as demonstrated by immunohistochemical staining and electroretinography. In summary, Bromfenac proved effective in diminishing neuroinflammation and resulted in enhanced RGC survival.
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Affiliation(s)
- Si-Eun Oh
- Department of Ophthalmology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Jie-Hyun Kim
- Department of Ophthalmology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Chan-Kee Park
- Department of Ophthalmology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Hae-Young Lopilly Park
- Department of Ophthalmology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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Racaniello GF, Balenzano G, Arduino I, Iacobazzi RM, Lopalco A, Lopedota AA, Sigurdsson HH, Denora N. Chitosan and Anionic Solubility Enhancer Sulfobutylether-β-Cyclodextrin-Based Nanoparticles as Dexamethasone Ophthalmic Delivery System for Anti-Inflammatory Therapy. Pharmaceutics 2024; 16:277. [PMID: 38399331 PMCID: PMC10893235 DOI: 10.3390/pharmaceutics16020277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
Cataract surgery interventions are constantly increasing, particularly among adult and elderly patients. This type of surgery can lead to inflammatory states of the ocular anterior segment (AS), usually healed via postoperative treatment with dexamethasone (DEX)-containing eye drops. The application of eye drops is challenging due to the high number of daily administrations. In this study, mucoadhesive nanoparticles (NPs) were formulated to improve the residence time of DEX on the corneal mucosa, enhancing the drug's solubility and bioavailability. The NPs were generated using an ionotropic gelation technique, exploiting the interaction between the cationic group of chitosan (CS) and the anionic group of sulfobutylether-β-cyclodextrin (SBE-β-CD). The formation of the inclusion complex and its stoichiometry were studied through phase solubility studies, Job's plot method, and Bi-directional transport studies on MDCKII-MDR1. The obtained NPs showed good chemical and physical characteristics suitable for drug loading and subsequent testing on animal mucosa. The DEX-loaded CS/SBE-β-CD NPs exhibited a prolonged residence time on animal mucosa and demonstrated enhanced drug permeability through the corneal membrane, showing a sustained release profile. The developed NPs posed no irritation or toxicity concerns upon local administration, making them an optimal and innovative drug delivery system for inflammatory AS diseases treatment.
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Affiliation(s)
- Giuseppe Francesco Racaniello
- Department of Pharmacy–Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (G.F.R.); (G.B.); (I.A.); (R.M.I.); (A.L.); (A.A.L.)
| | - Gennaro Balenzano
- Department of Pharmacy–Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (G.F.R.); (G.B.); (I.A.); (R.M.I.); (A.L.); (A.A.L.)
| | - Ilaria Arduino
- Department of Pharmacy–Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (G.F.R.); (G.B.); (I.A.); (R.M.I.); (A.L.); (A.A.L.)
| | - Rosa Maria Iacobazzi
- Department of Pharmacy–Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (G.F.R.); (G.B.); (I.A.); (R.M.I.); (A.L.); (A.A.L.)
| | - Antonio Lopalco
- Department of Pharmacy–Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (G.F.R.); (G.B.); (I.A.); (R.M.I.); (A.L.); (A.A.L.)
| | - Angela Assunta Lopedota
- Department of Pharmacy–Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (G.F.R.); (G.B.); (I.A.); (R.M.I.); (A.L.); (A.A.L.)
| | | | - Nunzio Denora
- Department of Pharmacy–Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (G.F.R.); (G.B.); (I.A.); (R.M.I.); (A.L.); (A.A.L.)
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Hosseini K, Gollamudi S, Reiser H, Walters T, Lindstrom RL. 0.2% Betamethasone Sodium Phosphate: A Multicenter, Randomized, Double-Masked Study to Compare Its Ocular Safety, Tolerability, and Efficacy to Vehicle in Cataract Surgery Subjects. Clin Ophthalmol 2023; 17:2219-2230. [PMID: 37564159 PMCID: PMC10411451 DOI: 10.2147/opth.s419857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/25/2023] [Indexed: 08/12/2023] Open
Abstract
Purpose To compare the preservative-free corticosteroid 0.2% betamethasone sodium phosphate BID (SURF-201) to vehicle BID in patients undergoing routine cataract surgery. Methods Phase 2, multicenter, randomized (1:1 ratio), double-masked, vehicle-controlled, parallel-group study in patients scheduled for uncomplicated cataract surgery without the aid of a femtosecond laser. Subjects instilled topical medications for 16 days beginning the day before cataract surgery (Day -1), 1 dose administered at least 1 hour prior to cataract surgery (on Day 0) and 1 dose on the evening after cataract surgery, and then 2 doses administered each day through Day 15; patients were re-evaluated on Days 22 and 32 to ensure no rebound inflammation. Primary outcome was the difference in the proportion of subjects with anterior chamber cell (ACC) grade 0 between the two groups at Day 15. Secondary outcomes included pain scores and overall safety. Results There was a statistically significant difference (P=0.004) in the proportion of subjects in the SURF-201 treatment group with an ACC grade of 0 at Day 15 (n=22/39 [56.4%]) compared to subjects in the vehicle treatment group (n=9/43 [20.9%]). There was no statistically significant difference (P=0.528) in the proportion of subjects in the SURF-201 treatment group who had a visual analog scale pain score of 0 at Day 15 (n=35/38 [89.7%]) compared to subjects in the vehicle group (n=33/40 [82.5%]). A slightly higher incidence of adverse events occurred in subjects in the SURF-201 treatment group (n=27/40 [67.5%]) compared to the vehicle treatment group (n=23/43 [53.5%]). Conclusion SURF-201 is an effective topical, preservative-free corticosteroid when dosed BID for the treatment of postoperative inflammation and prevention of pain in a post-cataract population.
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Affiliation(s)
| | | | | | - Tom Walters
- Texan Eye, PA — Keystone Research, Austin, TX, USA
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Osman SK, Yassin TM, Mohammed AM, Alfayomy AM, Abdellatif AA, Mahdi WA, Alshehri S, Hamd MAE, Sarhan H, Ibrahim MA. A Novel Approach for the Availability and Ocular Delivery of Tenoxicam Potassium: Synthesis, Characterization, and In Vivo Application. AAPS PharmSciTech 2023; 24:44. [PMID: 36703092 DOI: 10.1208/s12249-022-02487-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/08/2022] [Indexed: 01/27/2023] Open
Abstract
Tenoxicam (TX) is a non-steroidal anti-inflammatory agent that can be used to control pain in various ophthalmic lesions like cataracts, refractive surgery, and corneal abrasion. TX has a very slightly aqueous solubility of 0.072 mg/mL resulting in difficulty to be formulated in ophthalmic solutions. This study aims to improve TX solubility by converting it into its potassium salt to achieve a target of 10 mg/mL (1%w/v) concentration of TX in the desired aqueous medium for the formulation of aqueous ophthalmic solutions. The synthesized TX salt was characterized by different evaluation parameters such as solubility studies, 1H NMR, IR, and elemental analyses. Different TX potassium solutions were formulated at concentrations of 0.5% and 1% w/v using different viscosity-imparting agents. The prepared solutions were characterized for their physicochemical properties including visual inspection, pH, rheological, in vitro release, and kinetic behavior. Also, the formulations were biologically evaluated in vivo using male albino rabbits. The obtained results showed the successful synthesis of TX salt, as indicated by IR and NMR, and elemental analysis. The solubility study showed that the solubility of TX was improved hugely to 18 mg/mL (250-fold). In addition, the results showed that the prepared formulations showed acceptable physicochemical properties. The highest release rate was obtained with formula F1, which contains no viscosity-imparting agents. While as, the lowest release rate was obtained in the case of formula F9, composed of Pluronic F127 (12% w/v). The in vivo results showed that TX optimized ophthalmic solutions F8 and F9 inhibited the redness and edema in an extended or sustained manner.
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Affiliation(s)
- Shaaban K Osman
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Al-Azhar University, Assiut, 71524, Egypt.
| | - Taher M Yassin
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Minofia University, Minofia, Egypt
| | - Ahmed M Mohammed
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Al-Azhar University, Assiut, 71524, Egypt
| | - Abdallah M Alfayomy
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Al-Azhar University, Assiut, 71524, Egypt
| | - Ahmed A Abdellatif
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Al-Azhar University, Assiut, 71524, Egypt.,Department of Pharmaceutics, College of Pharmacy, Qassim University, Qassim, 51452, Saudi Arabia
| | - Wael A Mahdi
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Sultan Alshehri
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Mohamed A El Hamd
- Department of Pharmaceutical Sciences, College of Pharmacy, Shaqra University, Shaqra, 11961, Saudi Arabia. .,Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, South Valley University, Qena, 83523, Egypt.
| | - Hatem Sarhan
- Department of Pharmaceutics, Faculty of Pharmacy, Minia University, Minia, Egypt
| | - Mohammed A Ibrahim
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Al-Azhar University, Assiut, 71524, Egypt
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Kim S, Ko BY, Koh JW, Kim EC, Kim HK, Shin YJ, Song JS, Lee DH, Lee JE, Lee HK, Chung SH, Kim HS. Comparison of a preservative-free nonsteroidal anti-inflammatory drug and preservative-free corticosteroid after uneventful cataract surgery: multicenter, randomized, evaluator-blinded clinical trial. J Cataract Refract Surg 2022; 48:710-716. [PMID: 34629379 PMCID: PMC9119399 DOI: 10.1097/j.jcrs.0000000000000841] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 10/05/2021] [Indexed: 12/05/2022]
Abstract
PURPOSE To compare the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) and steroidal eyedrops for inflammation management after cataract surgery using slitlamp indicators. SETTING 11 eye centers in South Korea. DESIGN Randomized prospective multicenter study with a blinded evaluator. METHOD In 125 (250 eyes) patients who underwent cataract surgery, bromfenac sodium hydrate 0.1% (NSAID group) was applied twice a day in 1 eye, whereas the other eye was treated with fluorometholone 0.1% (steroid group), 4 times a day for 4 weeks postoperatively. The primary efficacy outcome was the presence of anterior chamber cells and flare at 1 week postoperatively. Anterior chamber cells and flare at 4 to 8 weeks, corrected distance visual acuity, central corneal thickness, conjunctival hyperemia, dry eye parameters, foveal thickness, and ocular and visual discomfort were evaluated as secondary outcomes. RESULTS At week 1, residual anterior chamber inflammation was not statistically significantly different between the groups (-1.03 ± 1.27 vs -0.95 ± 1.24, P = .4850). However, the NSAID group recovered from conjunctival hyperemia more rapidly than the steroid group (0.30 ± 0.52 vs 0.44 ± 0.81, P = .0144 at week 1). The increase in central corneal thickness in the NSAID group was less than that in the steroid group 1 week postoperatively (7.87 ± 22.46 vs 29.47 ± 46.60 μm, P < .0001). The change in foveal thickness in the NSAID group was significantly less than that in the steroid group (18.11 ± 68.19 vs 22.25 ± 42.37 μm, P = .0002). Lower levels of postoperative ocular and visual discomfort were reported in the NSAID group than in the steroid group under treatment. CONCLUSIONS Preservative-free bromfenac was as effective as preservative-free fluorometholone eyedrops in anterior chamber inflammation control and showed better signs and symptoms after cataract surgery.
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Affiliation(s)
- Seonjoo Kim
- From the Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (S.J. Kim, Chung, H.S. Kim); Department of Ophthalmology, Konyang University College of Medicine, Daejeon, South Korea (Ko); Department of Ophthalmology, Chosun University College of Medicine, Gwangju, South Korea (Koh); Department of Ophthalmology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, South Korea (E.C. Kim); Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, South Korea (H.K. Kim); Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea (Shin); Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea (Song); Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea (D.H. Lee); Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea (J.E. Lee); Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (H.K. Lee)
| | - Byung-Yi Ko
- From the Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (S.J. Kim, Chung, H.S. Kim); Department of Ophthalmology, Konyang University College of Medicine, Daejeon, South Korea (Ko); Department of Ophthalmology, Chosun University College of Medicine, Gwangju, South Korea (Koh); Department of Ophthalmology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, South Korea (E.C. Kim); Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, South Korea (H.K. Kim); Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea (Shin); Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea (Song); Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea (D.H. Lee); Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea (J.E. Lee); Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (H.K. Lee)
| | - Jae Woong Koh
- From the Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (S.J. Kim, Chung, H.S. Kim); Department of Ophthalmology, Konyang University College of Medicine, Daejeon, South Korea (Ko); Department of Ophthalmology, Chosun University College of Medicine, Gwangju, South Korea (Koh); Department of Ophthalmology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, South Korea (E.C. Kim); Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, South Korea (H.K. Kim); Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea (Shin); Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea (Song); Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea (D.H. Lee); Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea (J.E. Lee); Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (H.K. Lee)
| | - Eun Chul Kim
- From the Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (S.J. Kim, Chung, H.S. Kim); Department of Ophthalmology, Konyang University College of Medicine, Daejeon, South Korea (Ko); Department of Ophthalmology, Chosun University College of Medicine, Gwangju, South Korea (Koh); Department of Ophthalmology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, South Korea (E.C. Kim); Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, South Korea (H.K. Kim); Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea (Shin); Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea (Song); Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea (D.H. Lee); Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea (J.E. Lee); Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (H.K. Lee)
| | - Hong Kyun Kim
- From the Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (S.J. Kim, Chung, H.S. Kim); Department of Ophthalmology, Konyang University College of Medicine, Daejeon, South Korea (Ko); Department of Ophthalmology, Chosun University College of Medicine, Gwangju, South Korea (Koh); Department of Ophthalmology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, South Korea (E.C. Kim); Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, South Korea (H.K. Kim); Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea (Shin); Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea (Song); Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea (D.H. Lee); Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea (J.E. Lee); Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (H.K. Lee)
| | - Young Joo Shin
- From the Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (S.J. Kim, Chung, H.S. Kim); Department of Ophthalmology, Konyang University College of Medicine, Daejeon, South Korea (Ko); Department of Ophthalmology, Chosun University College of Medicine, Gwangju, South Korea (Koh); Department of Ophthalmology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, South Korea (E.C. Kim); Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, South Korea (H.K. Kim); Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea (Shin); Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea (Song); Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea (D.H. Lee); Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea (J.E. Lee); Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (H.K. Lee)
| | - Jong-Suk Song
- From the Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (S.J. Kim, Chung, H.S. Kim); Department of Ophthalmology, Konyang University College of Medicine, Daejeon, South Korea (Ko); Department of Ophthalmology, Chosun University College of Medicine, Gwangju, South Korea (Koh); Department of Ophthalmology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, South Korea (E.C. Kim); Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, South Korea (H.K. Kim); Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea (Shin); Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea (Song); Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea (D.H. Lee); Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea (J.E. Lee); Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (H.K. Lee)
| | - Do Hyung Lee
- From the Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (S.J. Kim, Chung, H.S. Kim); Department of Ophthalmology, Konyang University College of Medicine, Daejeon, South Korea (Ko); Department of Ophthalmology, Chosun University College of Medicine, Gwangju, South Korea (Koh); Department of Ophthalmology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, South Korea (E.C. Kim); Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, South Korea (H.K. Kim); Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea (Shin); Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea (Song); Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea (D.H. Lee); Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea (J.E. Lee); Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (H.K. Lee)
| | - Ji Eun Lee
- From the Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (S.J. Kim, Chung, H.S. Kim); Department of Ophthalmology, Konyang University College of Medicine, Daejeon, South Korea (Ko); Department of Ophthalmology, Chosun University College of Medicine, Gwangju, South Korea (Koh); Department of Ophthalmology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, South Korea (E.C. Kim); Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, South Korea (H.K. Kim); Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea (Shin); Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea (Song); Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea (D.H. Lee); Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea (J.E. Lee); Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (H.K. Lee)
| | - Hyung Keun Lee
- From the Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (S.J. Kim, Chung, H.S. Kim); Department of Ophthalmology, Konyang University College of Medicine, Daejeon, South Korea (Ko); Department of Ophthalmology, Chosun University College of Medicine, Gwangju, South Korea (Koh); Department of Ophthalmology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, South Korea (E.C. Kim); Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, South Korea (H.K. Kim); Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea (Shin); Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea (Song); Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea (D.H. Lee); Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea (J.E. Lee); Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (H.K. Lee)
| | - So-Hyang Chung
- From the Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (S.J. Kim, Chung, H.S. Kim); Department of Ophthalmology, Konyang University College of Medicine, Daejeon, South Korea (Ko); Department of Ophthalmology, Chosun University College of Medicine, Gwangju, South Korea (Koh); Department of Ophthalmology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, South Korea (E.C. Kim); Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, South Korea (H.K. Kim); Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea (Shin); Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea (Song); Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea (D.H. Lee); Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea (J.E. Lee); Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (H.K. Lee)
| | - Hyun Seung Kim
- From the Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (S.J. Kim, Chung, H.S. Kim); Department of Ophthalmology, Konyang University College of Medicine, Daejeon, South Korea (Ko); Department of Ophthalmology, Chosun University College of Medicine, Gwangju, South Korea (Koh); Department of Ophthalmology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, South Korea (E.C. Kim); Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, South Korea (H.K. Kim); Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea (Shin); Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea (Song); Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea (D.H. Lee); Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea (J.E. Lee); Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (H.K. Lee)
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Treatment of Non-Infectious Corneal Injury: Review of Diagnostic Agents, Therapeutic Medications, and Future Targets. Drugs 2022; 82:145-167. [PMID: 35025078 PMCID: PMC8843898 DOI: 10.1007/s40265-021-01660-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/03/2022]
Abstract
Corneal injuries can occur secondary to traumatic, chemical, inflammatory, metabolic, autoimmune, and iatrogenic causes. Ocular infection may frequently occur concurrent to corneal injury; however, antimicrobial agents are excluded from this present review. While practitioners may primarily rely on clinical examination techniques to assess these injuries, several pharmacological agents, such as fluorescein, lissamine green, and rose bengal, can be used to formulate a diagnosis and develop effective treatment strategies. Practitioners may choose from several analgesic medications to help with patient comfort without risking further injury or delaying ocular healing. Atropine, cyclopentolate, scopolamine, and homatropine are among the most frequently used medications for this purpose. Additional topical analgesic agents may be used judiciously to augment patient comfort to facilitate diagnosis. Steroidal anti-inflammatory agents are frequently used as part of the therapeutic regimen. A variety of commonly used agents, including prednisolone acetate, loteprednol, difluprednate, dexamethasone, fluorometholone, and methylprednisolone are discussed. While these medications are effective for controlling ocular inflammation, side effects, such as elevated intraocular pressure and cataract formation, must be monitored by clinicians. Non-steroidal medications, such as ketorolac, bromfenac, nepafenac, and diclofenac, are additionally used for their efficacy in controlling ocular inflammation without incurring side effects seen with steroids. However, these agents have their own respective side effects, warranting close monitoring by clinicians. Additionally, ophthalmologists routinely employ several agents in an off-label manner for supplementary control of inflammation and treatment of corneal injuries. Patients with corneal injuries not infrequently have significant ocular surface disease, either as a concurrent pathology or as an exacerbation of previously existing disease. Several agents used in the management of ocular surface disease have also been found to be useful as part of the therapeutic armamentarium for treatment of corneal injuries. For example, several antibiotics, such as doxycycline and macrolides, have been used for their anti-inflammatory effects on specific cytokines that are upregulated during acute injuries. There has been a recent wave of interest in amniotic membrane therapies (AMTs), including topical, cryopreserved and dehydrated variants. AMT is particularly effective in ocular injuries with violation of corneal surface integrity due to its ability to promote re-epithelialization of the corneal epithelium. Blood-based therapies, including autologous serum tears, plasma-enriched growth factor eyedrops and autologous blood drops, have additionally been explored in small case series for effectiveness in challenging and recalcitrant cases. Protection of the ocular surface is also a vital component in the treatment of corneal injuries. Temporary protective methods, such as bandage contact lenses and mechanical closure of the eyelids (tarsorrhaphy) can be particularly helpful in selective cases. Glue therapies, including biologic and non-biologic variants, can also be used in cases of severe injury and risk of corneal perforation. Finally, there are a variety of recently introduced and in-development agents that may be used as adjuvant therapies in challenging patient populations. Neurotrophic corneal disease may occur as a result of severe or chronic injury. In such cases, recombinant human nerve growth factor (cenegermin), topical insulin, and several other novel agents may be an alternate and effective option for clinicians to consider.
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Patel M, Saha N, Patel S, Ahlawat P, Dharamsi A, Patel A. Development of Bromfenac Sodium Loaded Pluronic Nanomicelles: Characterization and Corneal Permeation Study. RECENT ADVANCES IN DRUG DELIVERY AND FORMULATION 2022; 16:68-78. [PMID: 35088685 DOI: 10.2174/2667387816666220128123737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/28/2021] [Accepted: 11/05/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The Cataract is the leading cause of visual impairment and preventable blindness worldwide. Cataract removal surgery involves various post-operative complications like pain and inflammation. OBJECTIVES The objective of this study is to screen the polymer concentration as well as optimize the formulation components to develop the pluronic micelles with nanosized characterization and for enhanced corneal permeation study. METHODOLOGY For optimization, Central Composite design was employed to study the effect of independent variables, concentration of Pluronic F 127 (X1) and the concentration of Hyaluronic acid (X2) on chosen responses (Y 1 ) Micelle size, (Y 2 ) Entrapment Efficiency, (Y 3 ) Viscosity. The lyophilised powder was used for physical characterisation. RESULTS The formulation containing 5%w/v Pluronic F127 and 0.2%w/v Hyaluronic acid was the optimised composition with micelle size and zeta potential 38.74±4.12nm and -17.6±0.1 mV respectively. In-vitro drug release was found to be 91.72±1.2 percentage in 8 hours. Surface morphology revealed micelles were spherical in shape. Ocular irritancy study showed that formulation was safe and non-irritant. In vitro corneal permeation studies through excised rabbit cornea indicated 1.5 fold increase in ocular availability without corneal damage compared to an aqueous suspension containing the same amount of drug in nanomicelles. CONCLUSION In a nutshell, Pluronic Nanomicelles would be a platform for the delivery of Bromfenac Sodium.
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Affiliation(s)
- Miral Patel
- Department of Pharmaceutics, Parul Institute of Pharmacy, Parul University, Vadodara, Gujarat, 391760, India
| | - Nithun Saha
- Department of Pharmaceutics, Parul Institute of Pharmacy, Parul University, Vadodara, Gujarat, 391760, India
| | - Shruti Patel
- Department of Pharmaceutics, Parul Institute of Pharmacy, Parul University, Vadodara, Gujarat, 391760, India
| | - Priyanka Ahlawat
- Department of Pharmaceutics, Parul Institute of Pharmacy, Parul University, Vadodara, Gujarat, 391760, India
| | - Abhay Dharamsi
- Department of Pharmaceutics, Parul Institute of Pharmacy, Parul University, Vadodara, Gujarat, 391760, India
| | - Asha Patel
- Department of Pharmaceutics, Parul Institute of Pharmacy, Parul University, Vadodara, Gujarat, 391760, India
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Comparison of VEGF level in tears post phacoemulsification between non-proliferative diabetic retinopathy and non-diabetic patients. J Diabetes Metab Disord 2021; 20:2073-2079. [PMID: 34900842 DOI: 10.1007/s40200-021-00875-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/08/2021] [Indexed: 12/14/2022]
Abstract
Background Progression of diabetic retinopathy post cataract surgery is related to the increased level of vascular endothelial growth factor (VEGF) in ocular fluid post operatively. The aim of this study was to compare the VEGF level in tears post phacoemulsification between non-proliferative diabetic retinopathy (NPDR) and non-diabetic patients. Methods This was a prospective cohort study and was conducted from June 2017 to May 2019. Patients with underlying NPDR who were planned for phacoemulsification were recruited in this study. Non-diabetic patients who were planned for phacoemulsification were included as control group. Tears samples were collected using Schirmer strip two weeks prior to operation, at day (D) 7 and D30 post phacoemulsification. Tears samples were analyzed for VEGF level. Results A total of 65 patients were recruited in this study (NPDR: 32 and control: 33). There was significant increase of VEGF levels in tears from pre operation to D7 post phacoemulsification in NPDR (p < 0.001) and control (p < 0.001). There was also significant reduction of tear VEGF level from D7 to D30 post phacoemulsification in both groups (p < 0.001 in NPDR and p = 0.027 in control). The tear VEGF level was significantly higher in NPDR group compared to control at D7 post phacoemulsification (149.4 SD 55.2 pg/mL vs 109.7 SD 48.7 pg/mL, p = 0.003). Conclusion VEGF level in tears showed significant elevation post early cataract surgery in NPDR compared to non-diabetic patient. Therefore, tears VEGF level may provide as a non-invasive method to predict progression of diabetic retinopathy post operation among diabetic patients.
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Razumova IY, Godzenko AA. [Nonsteroidal anti-inflammatory drugs in the treatment of anterior uveitis associated with spondyloarthritis]. Vestn Oftalmol 2020; 136:70-77. [PMID: 33084282 DOI: 10.17116/oftalma202013606170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anterior uveitis (AU) is one of the common extraskeletal manifestations of spondyloarthritis (SpA). The course of AU in patients with SpA is characterized by frequent relapses. The article considers the question of local and systemic use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment and prevention of SpA-associated uveitis exacerbations.
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Affiliation(s)
| | - A A Godzenko
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
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10
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Corticosteroids in ophthalmology: drug delivery innovations, pharmacology, clinical applications, and future perspectives. Drug Deliv Transl Res 2020; 11:866-893. [PMID: 32901367 DOI: 10.1007/s13346-020-00843-z] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Corticosteroids remain the mainstay of the treatment for various ocular conditions affecting the ocular surface, anterior and posterior segments of the eye due to their anti-inflammatory, anti-oedematous, and anti-neovascularization properties. Prednisolone, prednisolone acetate, dexamethasone, triamcinolone acetonide, fluocinolone acetonide, and loteprednol etabonate are amongst the most widely used ophthalmic corticosteroids. Corticosteroids differ in their activity and potency in the eye due to their inherent pharmacological and pharmaceutical differences. Different routes and regimens are available for ocular administration of corticosteroids. Conventional topical application to the eye is the route of choice when targeting diseases affecting the ocular surface and anterior segment, while periocular, intravitreal, and suprachoroidal injections can be potentially effective for posterior segment diseases. Corticosteroid-induced intraocular pressure elevation and cataract formation remain the most significant local risks following topical as well as systemic corticosteroid administration. Invasive drug administration via intracameral, subconjunctival, and intravitreal injection can enhance ocular bioavailability and minimize dose and dosing frequency of administration, yet may exacerbate ocular side effects of corticosteroids. This review provides a critical appraisal of the ophthalmic uses of corticosteroid, routes of administration, drug delivery fundamentals and novel ocular implantable steroid delivery systems, factors influencing side effects, and future perspectives for ocular corticosteroid therapy.
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Fondi K, Miháltz K, Vécsei-Marlovits PV. Keratokonjunktivitis sicca und Katarakt-Chirurgie – eine Übersicht der Problematik. SPEKTRUM DER AUGENHEILKUNDE 2020. [DOI: 10.1007/s00717-020-00463-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Hanyuda A, Negishi K, Tsubota K, Ayaki M. Persistently Worsened Tear Break-up Time and Keratitis in Unilateral Pseudophakic Eyes after a Long Postoperative Period. Biomedicines 2020; 8:biomedicines8040077. [PMID: 32260530 PMCID: PMC7235885 DOI: 10.3390/biomedicines8040077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/16/2020] [Accepted: 04/03/2020] [Indexed: 11/16/2022] Open
Abstract
Dry eye disease may develop and persist after cataract surgery; however, unilateral cases have not been fully documented. This cross-sectional, observational study was conducted in five eye clinics in Japan. A total of 1023 outpatients were initially enrolled, and 89 unilateral pseudophakic subjects with 1+ year of follow-up after uncomplicated cataract surgery were included. The tear break-up times (TBUTs) and keratoconjunctival staining results were compared between phakic and pseudophakic eyes. The mean age of the patients was 69.3 ± 10.4 years (32 men, 36.0%), and the mean postoperative period was 4.6 ± 4.4 (1–20) years. For the ophthalmic parameters, the TBUTs were 4.4 ± 1.9 and 3.8 ± 1.9 s (p < 0.001), the keratoconjunctival staining scores were 0.11 ± 0.38 and 0.22 ± 0.56 (p = 0.02), the spherical equivalents were −1.27 ± 2.51 and −0.99 ± 1.45 D (p = 0.21), the astigmatic errors were 0.79 ± 0.66 and 0.78 ± 0.58 D (p = 0.80), and the intraocular pressures were 13.6 ± 2.9 and 13.5 ± 2.6 mmHg (p = 0.62) for the phakic and pseudophakic eyes, respectively. The corneal status was significantly worse in the pseudophakic eyes than in the contralateral phakic eyes, even after more than one year after implant surgery. The present results suggested that long-term ocular surface problems should be examined further since they may not originate only from surgery or postoperative ocular surface diseases.
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Affiliation(s)
- Akiko Hanyuda
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (A.H.); (K.N.); (K.T.)
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo 104-0045, Japan
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA 02215, USA
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (A.H.); (K.N.); (K.T.)
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (A.H.); (K.N.); (K.T.)
| | - Masahiko Ayaki
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (A.H.); (K.N.); (K.T.)
- Otake Clinic Moon View Eye Center, Kanagawa 242-0001, Japan
- Correspondence:
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Song SH, Baek SK, Lee MW, Lee YH. Effect of 0.1% Bromfenac for Preventing Macular Edema after Cataract Surgery in Patients with Diabetes. KOREAN JOURNAL OF OPHTHALMOLOGY 2020; 34:46-55. [PMID: 32037749 PMCID: PMC7010466 DOI: 10.3341/kjo.2019.0044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 09/30/2019] [Accepted: 10/08/2019] [Indexed: 12/03/2022] Open
Abstract
Purpose To investigate the effect of 0.1% bromfenac sodium hydrate ophthalmic solution for prevention of macular edema after cataract surgery in patients with diabetes. Methods A retrospective analysis of 75 patients with diabetes who underwent cataract surgery was performed. Thirty-eight patients (52 eyes) were instilled with 0.1% bromfenac solution (bromfenac group) and 37 patients (46 eyes) were not (control group). Results There were no significant preoperative between-group differences. Compared to the control group, at 1 month after surgery, the bromfenac group showed slightly better best-corrected visual acuity (0.12 ± 0.12 vs. 0.32 ± 0.42, p = 0.142), lower central macular thickness (265.58 ± 31.28 vs. 314.15 ± 76.11 µm, p < 0.001), and lower macular volume (8.46 ± 0.60 vs. 9.14 ± 1.53 mm3, p = 0.022). There were no significant differences between the two groups at 4 and 6 months postoperatively (p > 0.05). Mean changes in central macular thickness showed significant differences at 1 and 4 months postoperatively (−1.44 ± 11.72 and 10.44 ± 22.48 µm in bromfenac group vs. 47.19 ± 70.24 and 31.69 ± 48.04 µm in control group, p < 0.001 and p = 0.016) and mean changes in macular volume showed a significant difference at 1 month postoperatively (−0.08 ± 0.47 mm3 in bromfenac group vs. 0.58 ± 1.28 mm3 in control group, p < 0.001). There were no significant differences thereafter (p > 0.05). Conclusions Treatment with 0.1% bromfenac sodium hydrate ophthalmic solution showed good efficacy for preventing cystoid macular edema early after cataract surgery in patients with diabetes.
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Affiliation(s)
- Seok Hyeon Song
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea
| | - Seung Kook Baek
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea
| | - Min Woo Lee
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea
| | - Young Hoon Lee
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea.
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Doga AV, Maychuk NV, Mushkova IA, Shamsetdinova LT. [Causes, prevention and correction of refractive errors after phacoemulsification with intraocular lens implantation]. Vestn Oftalmol 2020; 135:83-90. [PMID: 32015312 DOI: 10.17116/oftalma201913506183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the influence of dry eye disease (DED) in cataract patients on refractive results of phacoemulsification with implantation of intraocular lenses (IOLs). MATERIAL AND METHODS The study included 24 patients (24 eyes) with early cataract or phacosclerosis who planned to undergo phacoemulsification with implantation of multifocal IOL. Inclusion criteria was preoperative presence of DED. During the initial visit, all patients first had IOL power calculated, received comprehensive treatment to address DED, and then repeated the IOL power calculation. Accuracy of achieving target refraction was evaluated by the amount of residual spherical equivalent one months after the surgery. RESULTS In patients with cataract and DED, the following statistically significant changes were noted after ocular surface normalization: reduction of the cylindrical component of refraction, reduction of corneal irregularity and its asymmetry, as well as normalization of eye surface. The average difference in the calculation of IOL power before and after DED treatment was 0.87±0.11 D, maximum error was 2.25 D. Control examination one month after the operation showed high visual functions in all operated patients. Deviation from the planned refraction was minimal (41.2% of cases were within in ±0.25 D of the planned refraction, 76.5% of cases in ±0.5 D, 100% of cases in ±1.0 D). CONCLUSION Preoperative detection of DED and its correction in patients with cataract increases calculation precision of IOL power and improves clinical and functional results.
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Affiliation(s)
- A V Doga
- S.N. Fyodorov National Medical Research Center 'MNTK 'Eye Microsurgery', 59A Beskudnikovsky Blvd., Moscow, Russian Federation, 127486
| | - N V Maychuk
- S.N. Fyodorov National Medical Research Center 'MNTK 'Eye Microsurgery', 59A Beskudnikovsky Blvd., Moscow, Russian Federation, 127486
| | - I A Mushkova
- S.N. Fyodorov National Medical Research Center 'MNTK 'Eye Microsurgery', 59A Beskudnikovsky Blvd., Moscow, Russian Federation, 127486
| | - L T Shamsetdinova
- 'K+31' Clinic, 42/4 Lobachevskogo St., Moscow, Russian Federation, 119415
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Donnenfeld ED, Shojaei RD. Effect Of Intracameral Phenylephrine And Ketorolac 1.0%/0.3% On Intraoperative Pain And Opioid Use During Cataract Surgery. Clin Ophthalmol 2019; 13:2143-2150. [PMID: 31806927 PMCID: PMC6839573 DOI: 10.2147/opth.s229515] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/23/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose To compare the effect of Omidria (phenylephrine and ketorolac 1.0%/0.3%) vs epinephrine on pain reduction and opioid usage during cataract surgery. Patients and methods Sixty patients at a single center underwent femtosecond laser (FLACS) or conventional phacoemulsification under topical lidocaine gel anesthesia and intracameral preservative-free lidocaine 1%. Eligible participants were prospectively assigned to receive either intracameral phenylephrine and ketorolac 1.0%/0.3% or intracameral epinephrine. All patients received standardized pre- and post-operative topical therapy. Intravenous (IV) fentanyl was administered for ocular discomfort in patients who complained of intraoperative pain. Outcome measures included both pain (measured by mean visual analog scale (VAS) pain scores from 0 (no pain) to 10 (extreme pain)) and the use of IV fentanyl during surgery. A composite endpoint identified “responders” as being patients who: (1) did not require fentanyl and (2) experienced no to minimal pain (VAS score ≤ 3). Results Forty-one patients were in the phenylephrine and ketorolac 1.0%/0.3% (study) group and 19 were in the epinephrine (control) group. Mean VAS pain scores were significantly (48.9%) lower in the study group than the control group (2.3 vs 4.5; P < 0.0001). The proportion of patients with VAS scores ≤ 3 was significantly greater in the study group (85.0%) than the control group (31.6%) (P < 0.0001). A smaller proportion of patients required intraoperative fentanyl in the study group compared to the control group (9.8% vs 42.1%; P = 0.006). For the composite endpoint, patients receiving phenylephrine and ketorolac 1.0%/0.3% were 94% less likely to require fentanyl or to have moderate-to-severe pain (pain VAS ≥ 4; OR, 0.06; 95% CI 0.02–0.24) than patients receiving epinephrine. Conclusion Our results suggest that the routine use of intracameral phenylephrine and ketorolac 1.0%/0.3% during cataract surgery can significantly reduce patient pain as well as the need for opioids.
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Affiliation(s)
| | - Ryan D Shojaei
- Ophthalmic Consultants of Long Island, Westbury, NY, USA
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Abstract
Aim. The study of free radical oxidation processes in an experiment on model systems using the anti-inflammatory drug bromfenac (nakwan) widely used in ophthalmology for the treatment of infectious and inflammatory diseases of the anterior chamber of the eye.
Methods. The antioxidant capacity of the drug was evaluated by chemiluminescence registration and analysis of model systems that generate reactive oxygen species and reproduce lipid peroxidation processes using the chemiluminomer CL-003. The following parameters of spontaneous and induced chemiluminescence were determined: light sum and maximum luminescence amplitude, duration of latent period, amplitude of fast and slow flash.
Results. When tested in vitro in two different model systems, a high antioxidant activity of the studied drug was established, up to complete suppression of chemiluminescence when 90 μg of bromfenac was added to the incubation medium, which characterizes the inhibition of the generation of reactive oxygen species. A significant increase in total antioxidant activity with bromfenac was also demonstrated, which is reflected by the integral parameter of chemiluminescence — light sum which decreased with the introduction of 10 μg of the drug by 1.2 times, and with 90 μg by 1.5 times. A comparative analysis of the antioxidant properties of various nonsteroidal anti-inflammatory drugs used in ophthalmic practice demonstrated a more pronounced efficacy of bromfenac compared to ketorolac, the use of which was not accompanied by statistically significant changes in chemiluminescence. A very important mechanism of the positive effect of bromfenac is the direct dependence of the action on its quantity in the reaction medium, which opens up prospects for the controlled correction of free radical phenomena and the excessive activation of lipid peroxidation in the imbalance of the pro- and antioxidant processes in biological systems.
Conclusion. It is suggested that the protective effects of the drug in various infectious-inflammatory lesions of the eye can be determined, along with previously known properties, its antioxidant activity, restriction of increased production of reactive oxygen species and oxidative stress phenomena.
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Morgan-Warren PJ. Ophthalmic medicine regulatory approvals through the European Centralised Procedure, 1999-2017: Clinical efficacy considerations. Eur J Ophthalmol 2019; 30:321-349. [PMID: 30832499 DOI: 10.1177/1120672119830932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Regulatory approval of new medicines requires a thorough assessment of the potential clinical benefits and risks. Study end-points are expected to demonstrate a clinically relevant treatment effect that will translate into direct patient benefits. This study sought to review the ophthalmic medicines with European Union-wide approval granted via the Centralised Procedure and characterise the key efficacy end-points underpinning the demonstration of clinical benefit. METHODS This study was a retrospective review of published data pertaining to the European regulatory authorisation of centrally approved ophthalmic products between 1999 and 2017, inclusive. All sources and data consulted are in the public domain. European Public Assessment Reports published by the European Medicines Agency were consulted for data concerning the pivotal clinical efficacy studies supporting the applications. Data analyses were descriptive. RESULTS The European Medicines Agency have authorised 30 products via the Centralised Procedure between 1999 and 2017. For these products, a total of 24 additional approvals for line extensions or additional therapeutic indications were granted. Four products have been approved for orphan indications, including one approval 'under exceptional circumstances' and one 'Conditional Marketing Authorisation'. Approvals for products in retina (36%) and glaucoma (28%) indications together accounted for the majority of authorisations, with trial end-points predominantly based on visual acuity and intraocular pressure parameters, respectively. Products were also approved for indications in ocular surface disease, inflammation, optic neuropathy and surgical adjuncts, with a range of functional and anatomical end-points. CONCLUSION Approvals for ophthalmic medicines have been granted for a range of clinical indications, representing a considerable portion of available major therapeutics for practitioners. Benefit-risk assessments rely on clinical trial data demonstrating a clearly relevant patient benefit.
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Hovanesian J, Holland E. Tolerability and toxicity of topically applied nepafenac 0.3% compared with generic ketorolac 0.5%. J Cataract Refract Surg 2019; 45:174-180. [DOI: 10.1016/j.jcrs.2018.08.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/16/2018] [Accepted: 08/21/2018] [Indexed: 11/16/2022]
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Hombrebueno JR, Ali IHA, Ma JX, Chen M, Xu H. Antagonising Wnt/β-catenin signalling ameliorates lens-capsulotomy-induced retinal degeneration in a mouse model of diabetes. Diabetologia 2018; 61:2433-2446. [PMID: 30019207 PMCID: PMC6182657 DOI: 10.1007/s00125-018-4682-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/22/2018] [Indexed: 12/15/2022]
Abstract
AIMS/HYPOTHESIS Cataract surgery in diabetic individuals worsens pre-existing retinopathy and triggers the development of diabetic ocular complications, although the underlying cellular and molecular pathophysiology remains elusive. We hypothesise that lens surgery may exaggerate pre-existing retinal inflammation in diabetes, which may accelerate neurovascular degeneration in diabetic eyes. METHODS Male heterozygous Ins2Akita mice (3 months of age) and C57BL/6 J age-matched siblings received either lens capsulotomy (to mimic human cataract surgery) or corneal incision (sham surgery) in the right eye. At different days post surgery, inflammation in anterior/posterior ocular tissues was assessed by immunohistochemistry and proinflammatory gene expression in the retina by quantitative PCR (qPCR). Degenerative changes in the retina were evaluated by electroretinography, in vivo examination of retinal thickness (using spectral domain optical coherence tomography [SD-OCT]) and morphometric analysis of retinal neurons. The therapeutic benefit of neutralising Wnt/β-catenin signalling following lens capsulotomy was evaluated by intravitreal administration of monoclonal antibody against the co-receptor low-density lipoprotein receptor-related protein 6 (LRP6) (Mab2F1; 5 μg/μl in each eye). RESULTS Lens capsulotomy triggered the early onset of retinal neurodegeneration in Ins2Akita mice, evidenced by abnormal scotopic a- and b-wave responses, reduced retinal thickness and degeneration of outer/inner retinal neurons. Diabetic Ins2Akita mice also had a higher number of infiltrating ionised calcium-binding adapter molecule 1 (IBA1)/CD68+ cells in the anterior/posterior ocular tissues and increased retinal expression of inflammatory mediators (chemokine [C-C motif] ligand 2 [CCL2] and IL-1β). The expression of β-catenin was significantly increased in the inner nuclear layer, ganglion cells and infiltrating immune cells in Ins2Akita mice receiving capsulotomy. Neutralisation of Wnt/β-catenin signalling by Mab2F1 ameliorated ocular inflammation and prevented capsulotomy-induced retinal degeneration in the Ins2Akita mouse model of diabetes. CONCLUSIONS/INTERPRETATION Targeting the canonical Wnt/β-catenin signalling pathway may provide a novel approach for the postoperative management of diabetic individuals needing cataract surgery.
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Affiliation(s)
- Jose R Hombrebueno
- Centre for Experimental Medicine, Wellcome-Wolfson Institute of Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK.
| | - Imran H A Ali
- Centre for Experimental Medicine, Wellcome-Wolfson Institute of Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Jian-Xing Ma
- Department of Physiology, Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Mei Chen
- Centre for Experimental Medicine, Wellcome-Wolfson Institute of Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK.
| | - Heping Xu
- Centre for Experimental Medicine, Wellcome-Wolfson Institute of Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK.
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Hoffman RS, Braga-Mele R, Donaldson K, Emerick G, Henderson B, Kahook M, Mamalis N, Miller KM, Realini T, Shorstein NH, Stiverson RK, Wirostko B. Cataract surgery and nonsteroidal antiinflammatory drugs. J Cataract Refract Surg 2018; 42:1368-1379. [PMID: 27697257 DOI: 10.1016/j.jcrs.2016.06.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 04/04/2016] [Accepted: 04/11/2016] [Indexed: 10/20/2022]
Abstract
Nonsteroidal antiinflammatory drugs (NSAIDs) have become an important adjunctive tool for surgeons performing routine and complicated cataract surgery. These medications have been found to reduce pain, prevent intraoperative miosis, modulate postoperative inflammation, and reduce the incidence of cystoid macular edema (CME). Whether used alone, synergistically with steroids, or for specific high-risk eyes prone to the development of CME, the effectiveness of these medications is compelling. This review describes the potential preoperative, intraoperative, and postoperative uses of NSAIDs, including the potency, indications and treatment paradigms and adverse effects and contraindications. A thorough understanding of these issues will help surgeons maximize the therapeutic benefits of these agents and improve surgical outcomes. FINANCIAL DISCLOSURE Proprietary or commercial disclosures are listed after the references.
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Zhang G, Liu S, Yang L, Li Y. The role of Dexamethasone in clinical pharmaceutical treatment for patients with cataract surgery. Exp Ther Med 2017; 15:2177-2181. [PMID: 29434822 DOI: 10.3892/etm.2017.5639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/24/2017] [Indexed: 12/16/2022] Open
Abstract
The aim of the present study is to determine the efficacy of dexamethasone (DEX) vs. indomethacin (IND) and ciprofloxacin (CIP) in modulating immediate inflammation following cataract surgery. A total of 644 patients with cataract were recruited and inflammation was investigated during the perioperative period. The management protocol was similar in both groups. Each drug was given four times a day for 30 days starting 7 days prior to surgery. The primary efficacy criteria for evaluation were the reduction in anterior chamber (AC) flare and AC inflammation score, in addition, a different secondary efficacy and safety evaluation criteria were maintained. The results demonstrated that the average inflammation score was 1.2±0.8 in the DEX group, which was significantly lower compared with the IND (1.9±0.7) and CIP (1.8±0.6) groups. Intra-ocular pressure was decreased following treatment with DEX, while intra-ocular pressure was slightly increased in the IND (1.9±0.7) and CIP (1.8±0.6) groups. The final visual outcomes for patients postcataract surgery were clinically superior in the DEX group compared with that of the IND and CIP groups (P=0.034 and P=0.042, respectively), but there was no significant difference between the ND and CIP groups (P=0.78). Outcomes indicated that AC inflammation, conjunctival hyperaemia, corneal and lid oedema, ocular infection, pain, photophobia, and tearing were significantly improved in each group. No significant poor local tolerance or adverse reaction was observed in the DEX, IND and CIP groups. In conclusion, the outcomes of the present study suggest that DEX serves an important role in the clinical pharmaceutical treatment of patients with cataract surgery.
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Affiliation(s)
- Gaokun Zhang
- Department of Nursing, Mudanjiang Medical University of Affiliated HongQi Hospital, Mudanjiang, Heilongjiang 157000, P.R. China
| | - Shuang Liu
- Emergency Internal Medicine, Mudanjiang Medical University of Affiliated HongQi Hospital, Mudanjiang, Heilongjiang 157000, P.R. China
| | - Lieying Yang
- Department of Ophthalmology, Mudanjiang Medical University of Affiliated HongQi Hospital, Mudanjiang, Heilongjiang 157000, P.R. China
| | - Yanqing Li
- Department of Ophthalmology, Mudanjiang Medical University of Affiliated HongQi Hospital, Mudanjiang, Heilongjiang 157000, P.R. China
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Twice-Daily vs. Once-Daily Dosing with 0.075% Bromfenac in DuraSite: Outcomes from a 14-Day Phase 2 Study. Ophthalmol Ther 2017; 6:277-284. [PMID: 28819932 PMCID: PMC5693819 DOI: 10.1007/s40123-017-0102-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Bromfenac is a well-known topical ophthalmic nonsteroidal anti-inflammatory drug (NSAID) that is commercialized in the USA and other regions of the world. A new formulation, 0.075% bromfenac in DuraSite®, was developed to treat postoperative inflammation and reduce pain in patients who have undergone cataract surgery. We hypothesized that efficacy and safety would be enhanced with twice-daily (BID) dosing compared to once-daily (QD) dosing. METHODS This was a multicenter, double-masked, comparative study in which 40 and 45 subjects were randomized to groups receiving BID dosing and QD dosing, respectively. Subjects self-instilled the study drug for 14 days postoperative and were followed for an additional 2-week evaluation phase. The primary efficacy endpoint was the proportion of subjects with an anterior chamber cell (ACC) grade of 0 at day 15. RESULTS A total of 45 subjects had cleared ACC (grade "0") at day 15, of whom 21 were in the BID group (52.5%) and 24 were in the QD group (53.5%). A secondary analysis found 7/40 (17.5%) subjects in the BID group and 10/45 (22.2%) subjects in the QD group achieved an ACC grade of 0 at day 8. There were more adverse events in the QD group (n = 16) than in the BID group (n = 12). CONCLUSION Similar outcomes were observed for subjects using Bromfenac 0.075% in DuraSite® in the BID and QD dosing regimens for the treatment of post-cataract surgery inflammation. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT01190878. FUNDING InSite Vision (now a division of Sun Pharma).
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Tomilova EV, Nemsitsveridze MN, Panova IE. [Effect of medicinal treatment on epithelial wound healing after phacoemulsification]. Vestn Oftalmol 2017; 133:44-50. [PMID: 28745656 DOI: 10.17116/oftalma2017133344-50] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AIM to compare the dynamics of epithelial wound healing under two different post-op treatments in patients after uncomplicated phacoemulsification. MATERIAL AND METHODS This prospective randomized clinical trial included 40 eyes of 40 patients aged 66.4±8.2 years who underwent uncomplicated phacoemulsification with flexible intraocular lens implantation through a 2.2-mm corneal incision. Patients were randomized to receive either dexamethasone 0.1% and diclofenac 0.1% (n=20 eyes, Group I), or bromfenac 0.09% (n=20 eyes, Group II). Also, all patients instilled levofloxacin 0.5%. The dynamics of epithelial wound healing was assessed with the RTVue-100 spectral domain optical coherence tomograph with CAM-L corneal module in the 3D CORNEA mode 2 hours after surgery and on days 1, 3, 5, and 10. RESULTS The postoperative period was uneventful in all cases. Two hours after surgery, epithelial defects were found in all eyes and their length did not differ statistically p=0.47. On the first day after surgery, complete epithelization was observed in 30% of cases from Group I and 60% of cases from Group II. The average length of epithelial defects was reliably smaller in Group II than in Group I (p=0.04 respectively). On postoperative day 3, 20% eyes from Group I still had epithelial defects with the average length of 0.45±0.13 mm, while there was only one eye with a 0.2-mm epithelial defect in Group II. Finally, on postoperative day 5, there was a single 0.3-mm epithelial defect in one eye from Group I. On day 10, none of the patients had epithelial defects in either group. CONCLUSION Epithelial wound healing at the site of corneal incision after non-complicated phacoemulsification was found to be faster in patients instilled with bromfenac twice daily than in patients receiving dexamethasone and diclofenac four times daily as anti-inflammatory therapy and given topical fluoroquinolones for antibacterial purpose.
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Affiliation(s)
- E V Tomilova
- Saint Petersburg branch of S. Fyodorov Eye Microsurgery Federal State Institution, 21 Yaroslava Gasheka St., Saint Petersburg, Russia, 192283
| | - M N Nemsitsveridze
- Saint Petersburg branch of S. Fyodorov Eye Microsurgery Federal State Institution, 21 Yaroslava Gasheka St., Saint Petersburg, Russia, 192283
| | - I E Panova
- Saint Petersburg branch of S. Fyodorov Eye Microsurgery Federal State Institution, 21 Yaroslava Gasheka St., Saint Petersburg, Russia, 192283
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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: 250] [Impact Index Per Article: 35.7] [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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Hosseini K, Walters T, DaVanzo R, Lindstrom RL. A randomized double-masked study to compare the ocular safety, tolerability, and efficacy of bromfenac 0.075% compared with vehicle in cataract surgery subjects. Clin Ophthalmol 2016; 10:2311-2317. [PMID: 27920490 PMCID: PMC5123663 DOI: 10.2147/opth.s120428] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose The aim of this study was to evaluate the safety, tolerability, and efficacy of a low-dose version of bromfenac 0.075% in DuraSite® (bromfenac 0.075%) compared with DuraSite® vehicle (vehicle) alone for the treatment of postoperative inflammation and ocular pain after cataract surgery. Methods A multicenter, double-masked, vehicle-controlled, parallel-group clinical trial of 240 subjects randomized in a 2:1 ratio to bromfenac 0.075% or vehicle was conducted. Subjects were dosed BID beginning 1 day before the cataract surgery, the day of surgery, and 14 days after surgery. A slit lamp biomicroscopy examination was performed to evaluate the signs of inflammation, including anterior chamber cells (ACC) and anterior chamber flare (ACF). The primary efficacy variable was the proportion of subjects with an ACC grade of 0 at Day 15. Secondary efficacy endpoints included the proportion of subjects who achieved a pain score of 0 at each postsurgical visual analog scale (VAS) assessment and the proportion of subjects with an ACF grade of 0 at Day 15. Results At Day 15, proportionally more subjects in the bromfenac 0.075% group than in the vehicle group had an ACC grade of 0 (57.1% vs 18.8%, respectively; P<0.001). At each of the postsurgical time points (Days 1, 8, 15, and 29), proportionally more bromfenac 0.075%-treated subjects (76.8%, 90.5%, 92.9%, and 85.1%, respectively) had no pain (a VAS score of 0) compared with the vehicle-treated subjects (48.2%, 38.8%, 42.4%, and 47.1%, respectively), and at each time point, these differences in proportions were statistically significant (P<0.001). More subjects in the bromfenac 0.075% group had complete ACF resolution (151/167; 90.4%) compared to those in the vehicle group (54/85; 63.5%). There were no new safety signals reported. Conclusion Bromfenac 0.075% in DuraSite is safe, well tolerated, and effective at reducing inflammation and preventing pain associated with cataract surgery.
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Chen PQ, Han XM, Zhu YN, Xu J. Comparison of the anti-inflammatory effects of fluorometholone 0.1% combined with levofloxacin 0.5% and tobramycin/dexamethasone eye drops after cataract surgery. Int J Ophthalmol 2016; 9:1619-1623. [PMID: 27990365 DOI: 10.18240/ijo.2016.11.13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 04/28/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the combination of fluorometholone 0.1% and levofloxacin 0.5% to tobramycin/dexamethasone eye drops in controlling inflammation and preventing infection after phacoemulsification with an intraocular lens implantation. METHODS Sixty eyes from 60 patients undergoing cataract phacoemulsification were randomized into two groups; half of the patients were treated with fluorometholone (6 times/d) combined with levofloxacin (4 times/d), while the other half were treated with tobramycin/dexamethasone (4 times/d) eye drops for one week. Preoperative and postoperative intraocular pressure, aqueous flare, corneal thickness, and signs and symptoms were recorded before the operation and 1wk following treatments. RESULTS There were no statistically significant differences between the two groups in corneal thickness (P≥0.629), aqueous flare (P≥0.398), and signs and symptoms scores (P≥0.350) at each time point. Ocular hypertension was only observed in two eyes in the tobramycin/dexamethasone group. CONCLUSION Fluorometholone combined with levofloxacin treatment shows comparable efficacy but without the tendency to increase intraocular pressure; thus, it might be a better regimen for postoperative use.
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Affiliation(s)
- Pei-Qing Chen
- Eye Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Xue-Mei Han
- Zhejiang Hospital of Traditional Chinese Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Ya-Nan Zhu
- Eye Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Jia Xu
- Eye Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
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Achiron A, Karmona L, Mimouni M, Gershoni A, Dzhanov Y, Gur Z, Burgansky Z. Comparison of the Tolerability of Diclofenac and Nepafenac. J Ocul Pharmacol Ther 2016; 32:601-605. [DOI: 10.1089/jop.2016.0057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Asaf Achiron
- Department of Ophthalmology, The Edith Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lily Karmona
- Department of Ophthalmology, The Edith Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Mimouni
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
| | - Assaf Gershoni
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
| | - Yana Dzhanov
- Department of Ophthalmology, The Edith Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zvi Gur
- Department of Ophthalmology, Soroka University Medical Center, Ben-Gurion University, Beer-Sheva, Israel
| | - Zvia Burgansky
- Department of Ophthalmology, The Edith Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Palacio C, Fernández De Ortega L, Bustos FR, Chávez E, Oregon-Miranda AA, Mercado-Sesma AR. Bromfenac 0.09% bioavailability in aqueous humor, prophylactic effect on cystoid macular edema, and clinical signs of ocular inflammation after phacoemulsification in a Mexican population. Clin Ophthalmol 2016; 10:233-7. [PMID: 26869758 PMCID: PMC4734805 DOI: 10.2147/opth.s93530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the aqueous humor bioavailability and clinical efficacy of bromfenac 0.09% vs nepafenac on the presence of cystoid macular edema (CME) after phacoemulsification. MATERIAL AND METHODS A Phase II, double-blind, masked, active-controlled, multicenter, clinical trial of 139 subjects, randomized to either a bromfenac 0.09% ophthalmic solution (n=69) or nepafenac 0.1% (n=70). Subjects instilled a drop three times a day for a period of 30 days. Follow-up visits were on days 2, 7, 15, 30, and 60. Biomicroscopy, clinical ocular signs, and assessment of posterior segment were performed. The primary efficacy endpoints included the presence of CME evaluated by optical coherence tomography. Safety evaluation included intraocular pressure, transaminase enzymes, lissamine green, and fluorescein stain. RESULTS The demographic and efficacy variables were similar between groups at baseline. The presence of pain, photophobia, conjunctival hyperemia, chemosis, cellularity, and corneal edema disappeared by day 30 in both groups. The central retinal thickness did not show significant changes after treatment when compared to baseline as follows: in the bromfenac group (247.2±32.9 vs 252.0±24.9 μm; P=0.958) and in nepafenac group (250.8±34 vs 264.0±34.1 μm; P=0.137), respectively. A statistically significant difference was observed between bromfenac and nepafenac group: (252.0±24.9 vs 264.0±34.1 μm; P=0.022), at day 30, respectively; even though there was no clinical relevance in the presentation of CME. There were no significant alterations in intraocular pressure, either lissamine green or fluorescein stains. The adverse events were not related to the interventions. CONCLUSION Bromfenac 0.09% ophthalmic solution showed similar clinical efficacy to reduce the presentation of CME after phacoemulsification compared to nepafenac 0.01%.
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Affiliation(s)
- Claudia Palacio
- Anterior Segment Department, Fundación Hospital Nuestra Señora de la Luz, México City, México
| | - Lourdes Fernández De Ortega
- Anterior Segment Department, Asociación Para Evitar la Ceguera en México, Hospital Dr Luis Sánchez Bulnes, México
| | - Francisco R Bustos
- Anterior Segment Department, Antiguo Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, México
| | - Eduardo Chávez
- Anterior Segment Department, Instituto de Oftalmología, Fundación de Asistencia Privada Conde de Valenciana, IAP, México
| | - Aldo A Oregon-Miranda
- Clinical Research Department, Laboratorios Sophia, SA de CV, Zapopan, Jalisco, México
| | - Arieh R Mercado-Sesma
- Clinical Research Department, Laboratorios Sophia, SA de CV, Zapopan, Jalisco, México
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Jung JW, Chung BH, Kim EK, Seo KY, Kim TI. The Effects of Two Non-Steroidal Anti-Inflammatory Drugs, Bromfenac 0.1% and Ketorolac 0.45%, on Cataract Surgery. Yonsei Med J 2015; 56:1671-7. [PMID: 26446653 PMCID: PMC4630059 DOI: 10.3349/ymj.2015.56.6.1671] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 12/21/2014] [Accepted: 12/23/2014] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To compare the additive effects of two types of non-steroidal anti-inflammatory drugs (NSAIDs), bromfenac 0.1% or ketorolac 0.45%, relative to topical steroid alone in cataract surgery. MATERIALS AND METHODS A total 91 subjects scheduled to undergo cataract operation were randomized into three groups: Group 1, pre/postoperative bromfenac 0.1%; Group 2, pre/postoperative preservative-free ketorolac 0.45%; and Group 3, postoperative steroid only, as a control. Outcome measures included intraoperative change in pupil size, postoperative anterior chamber inflammation control, change in macular thickness and volume, and ocular surface status after operation. RESULTS Both NSAID groups had smaller intraoperative pupil diameter changes compared to the control group (p<0.05). There was significantly less ocular inflammation 1 week and 1 month postoperatively in both NSAID groups than the control group. The changes in central foveal subfield thickness measured before the operation and at postoperative 1 month were 4.30±4.25, 4.87±6.03, and 12.47±12.24 μm in groups 1 to 3, respectively. In the control group, macular thickness and volume increased more in patients with diabetes mellitus (DM), compared to those without DM. In contrast, in both NSAID groups, NSAIDs significantly reduced macular changes in subgroups of patients with or without DM. Although three ocular surface parameters were worse in group 1 than in group 2, these differences were not significant. CONCLUSION Adding preoperative and postoperative bromfenac 0.1% or ketorolac 0.45% to topical steroid can reduce intraoperative miosis, postoperative inflammation, and macular changes more effectively than postoperative steroid alone.
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Affiliation(s)
- Ji Won Jung
- Department of Ophthalmology, Severance Hospital, Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Ophthalmology and Inha Vision Science Laboratory, Inha University School of Medicine, Incheon, Korea
| | - Byung Hoon Chung
- Department of Ophthalmology, Severance Hospital, Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Eung Kweon Kim
- Department of Ophthalmology, Severance Hospital, Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Institute of Vision Research, Severance Biomedical Science Institute, Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoung Yul Seo
- Department of Ophthalmology, Severance Hospital, Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-im Kim
- Department of Ophthalmology, Severance Hospital, Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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Rodríguez Uña I, Martínez-de-la-Casa JM, Pablo Júlvez L, Martínez Compadre JA, García Feijoo J, Belda Sanchís JI, Canut Jordana MI, Hernández-Barahona Palma J, Muñoz Negrete FJ, Urcelay Segura JL. Perioperative pharmacological management in patients with glaucoma. ACTA ACUST UNITED AC 2014; 90:274-84. [PMID: 25443206 DOI: 10.1016/j.oftal.2014.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 06/03/2014] [Accepted: 06/25/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED REVIEẂS AIM: When a phacoemulsification, a filtration surgery or a combined surgery are necessary, questions about the convenience of continuing certain antiglaucomatous drugs could appear. The aim of this review article is to unify criteria that will guide daily clinical practice and including the developing algorithms of action in the preoperative and postoperative periods of filtration surgery and/or cataract surgery. PROPOSED PROTOCOLS In the preoperative period of cataract surgery, the use of non-steroidal anti-inflammatory drugs is at the discretion of the surgeon, with the monodose presentation being recommended. The suspension of prostaglandines a fewdays before the surgery should be considered. Preservative-free drugs ensure a better recovery of the ocular surface (OS) after cataract surgery. Once all modifying factors of the intraocular pressure (IOP) have been removed, baseline IOP should be evaluated again, choosing preservative-free antiglaucomatous drugs when needed. The use of preservative-free ocular antihypertensive drugs and steroids in the preoperative period of glaucoma surgery reduces the risk of surgical failure. The interruption of prostaglandines is recommended. In the postoperative period of glaucoma surgery, steroids are the anti-inflammatory treatment of choice, the preservative-free ones being preferred. When reintroducing antiglaucomatous treatment, preservatives should be avoided to prevent scarring. The appropriate perioperative management of patients with glaucoma is essential to obtain a correct control of IOP, improve the situation of the OS, prevent complications and improve the result of the filtration surgery and cataract surgery. CONCLUSIONS this protocol aims to unify the different lines of action in order to decrease the incidence of adverse events and maximize the surgical outcome.
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Affiliation(s)
| | - J M Martínez-de-la-Casa
- Hospital Clínico San Carlos, IdISSC, Madrid, España; Red Temática de Investigación Cooperativa en Oftalmología (RETICS), Instituto de Salud Carlos III, Madrid, España.
| | - L Pablo Júlvez
- Red Temática de Investigación Cooperativa en Oftalmología (RETICS), Instituto de Salud Carlos III, Madrid, España; Hospital Universitario Miguel Servet, Zaragoza, España
| | | | - J García Feijoo
- Hospital Clínico San Carlos, IdISSC, Madrid, España; Red Temática de Investigación Cooperativa en Oftalmología (RETICS), Instituto de Salud Carlos III, Madrid, España
| | | | | | | | - F J Muñoz Negrete
- Red Temática de Investigación Cooperativa en Oftalmología (RETICS), Instituto de Salud Carlos III, Madrid, España; Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España
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Beydoun T, Deloche C, Perino J, Kirwan BA, Combette JM, Behar-Cohen F. Subconjunctival injection of XG-102, a JNK inhibitor peptide, in patients with intraocular inflammation: a safety and tolerability study. J Ocul Pharmacol Ther 2014; 31:93-9. [PMID: 25347151 DOI: 10.1089/jop.2013.0247] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE We aimed to investigate the safety, tolerability, and systemic diffusion of a single escalating dose of XG-102 (a 31-D-amino-acid peptide inhibiting JNK pathway activation), administered subconjunctivally in the treatment of post-surgery or post-trauma intraocular inflammation. METHODS This is a dose-escalating, tolerance Phase Ib study. Twenty patients with post-surgery or post-traumatic intraocular inflammation were assigned to 1 of the 4 dose escalating (45, 90, 450, or 900 μg XG-102) groups of 5 patients each. Patients were evaluated at 24, 48 h, 8, and 28 days following the administration of XG-102, including laboratory tests, standard eye examinations, vital signs, and occurrence of adverse events. A single plasma quantification of XG-102 was performed 30 min after administration, according to previous pharmacokinetics studies performed on volunteers. RESULTS A total of 17 non-serious adverse events, considered unrelated to the study treatment, were reported for 10 patients. The adverse event incidence was not related to the drug dose. All patients experienced a decrease in intraocular inflammation as of 24 h post-administration and this decrease was sustained up to 28 days thereafter. No patient required local injection or systemic administration of corticoids following the administration of XG-102. XG-102 was undetectable in the first 3 dose groups. In the fourth-dose group (900 μg) the XG-102 plasma levels were above the limit of detection for 3 patients and above the limit of quantification for 1 patient. CONCLUSIONS In this first clinical trial using XG-102, administered as a single subconjunctival injection as adjunct therapy, in patients with recent post-surgery or post-trauma intraocular inflammation is safe and well tolerated. Further studies are required to evaluate its efficacy.
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Affiliation(s)
- Talal Beydoun
- 1 Department of Ophthalmology, AP-HP Hôtel-Dieu, Paris, France
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Duong HVQ, Westfield KC, Singleton IC. Treatment Paradigm After Uncomplicated Cataract Surgery: A Prospective Evaluation. Asia Pac J Ophthalmol (Phila) 2014; 3:220-5. [PMID: 26107761 DOI: 10.1097/apo.0000000000000014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To compare 3 clinical variables, namely, visual recovery, anterior chamber inflammation, and macular edema, between 2 different regimens after uncomplicated cataract surgery. DESIGN Prospective, randomized, single-blind study at a single center, private, teaching practice in Las Vegas, NV. METHODS Patients randomized to group I (nonsteroidal anti-inflammatory drugs, n = 113) received besifloxacin ophthalmic suspension 0.6% and bromfenac 0.09%, whereas those randomized to group II (steroid, n = 109) received besifloxacin ophthalmic suspension 0.6% and prednisolone acetate 1%.Preoperative evaluation included a baseline macular optical coherence tomography. Postoperative data collected included visual acuity, direct visual anterior segment cell and flare counts, and macular optical coherence tomographies. Foveal thickness and total macular volume were used to assess the presence of cystoid macular edema. RESULTS Visual recovery was statistically insignificant with P values at 0.7, 0.10, 0.2, and 0.7 at 1 day, 1 week, 1 month, and 2 months, respectively.The degree of anterior segment inflammation was not statistically significant (P = 0.8) between the studied populations.The foveal thickness (1 week, P = 0.8; 1 month, P = 0.2; 2 months, P = 0.2) and total macular volume (1 week, P = 0.7; 1 month, P = 0.1; 2 months, P = 0.2) were not statistically significant between the groups, and the observed power were 0.902 and 0.666, respectively. CONCLUSIONS This study demonstrated that bromfenac was equally efficacious when compared with a potent topical steroid in restoring visual function, decreasing and resolving anterior chamber inflammation, and preventing the development of macular edema.
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Affiliation(s)
- Hon-Vu Q Duong
- From the *Westfield Eye Center, Las Vegas; and †Nevada State College, Henderson, NV
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Silverstein SM, Jackson MA, Goldberg DF, Muñoz M. The efficacy of bromfenac ophthalmic solution 0.07% dosed once daily in achieving zero-to-trace anterior chamber cell severity following cataract surgery. Clin Ophthalmol 2014; 8:965-72. [PMID: 24876763 PMCID: PMC4037304 DOI: 10.2147/opth.s60292] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose To evaluate the efficacy of bromfenac ophthalmic solution 0.07% dosed once daily in achieving zero-to-trace (0–5 cells) anterior chamber cells, following cataract surgery with posterior chamber intraocular lens implantation. Methods The study designed employed two Phase III, double-masked, placebo-controlled, multicenter clinical trials of 440 subjects, randomized to either bromfenac ophthalmic solution 0.07% (n=222) or placebo (n=218). Subjects self-dosed once daily, beginning 1 day before undergoing cataract surgery with intraocular lens implantation (day –1) and again on the day of surgery (day 0) and for 14 days postoperatively. Follow-up was on days 1, 3, 8, and 15. The outcome measures included the percentage of subjects with zero-to-trace anterior chamber cells at each visit, as determined by the percentage of subjects with ≤5 anterior chamber cells, overall anterior chamber cell grades, and summed ocular inflammation score (SOIS) (combined anterior chamber cell and flare scores). Results The proportion of subjects with zero-to-trace anterior chamber cells was significantly higher in the bromfenac 0.07% group compared with the placebo group as early as day 3 (P=0.0007), continued at day 8 (P<0.0001), and through day 15 (P<0.0001). At day 15, 80.2% of subjects in the bromfenac 0.07% group achieved zero-to-trace anterior chamber cells compared with 47.2% of subjects who did so in the placebo group. The overall anterior chamber cell scores were significantly lower in the bromfenac 0.07% group compared with the placebo group at days 3, 8, and 15 (P<0.0001 at each visit). The SOIS were also significantly lower in the bromfenac group compared with the placebo group at days 3, 8, and 15 (P<0.0001 at each visit). Conclusion Bromfenac ophthalmic solution 0.07%, dosed once daily was clinically effective in achieving zero-to-trace anterior chamber cell severity after cataract surgery and was superior to placebo in all anterior chamber cell severity and inflammation outcome measures.
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Kida T, Kozai S, Takahashi H, Isaka M, Tokushige H, Sakamoto T. Pharmacokinetics and efficacy of topically applied nonsteroidal anti-inflammatory drugs in retinochoroidal tissues in rabbits. PLoS One 2014; 9:e96481. [PMID: 24796327 PMCID: PMC4010472 DOI: 10.1371/journal.pone.0096481] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 04/09/2014] [Indexed: 11/26/2022] Open
Abstract
Purpose To evaluate the pharmacokinetics and efficacy of topically applied nonsteroidal anti-inflammatory drugs (NSAIDs) in the retinochoroidal tissues of rabbits. Methods The cyclooxygenase (COX) inhibitory activity of diclofenac, bromfenac, and amfenac, an active metabolite of nepafenac, were determined using human-derived COX-1 and COX-2. Each of the three NSAIDs was applied topically to rabbits, and after 0.5 to 8 hrs, the concentration of each drug in the aqueous humor and the retinochoroidal tissues was measured by liquid chromatography-tandem mass spectrometry. The pharmacokinetics of the drugs in the tissues after repeated doses as is done on patients was calculated by a simulation software. The inhibitory effect of each NSAID on the breakdown of the blood-retinal barrier was assessed by the vitreous protein concentration on concanavalin A-induced retinochoroidal inflammation in rabbits. Results The half-maximal inhibitory concentration (IC50) of diclofenac, bromfenac, and amfenac was 55.5, 5.56, and 15.3 nM for human COX-1, and 30.7, 7.45, and 20.4 nM for human COX-2, respectively. The three NSAIDs were detected in the aqueous humor and the retinochoroidal tissue at all-time points. Simulated pharmacokinetics showed that the levels of the three NSAIDs were continuously higher than the IC50 of COX-2, as an index of efficacy, in the aqueous humor, whereas only the bromfenac concentration was continuously higher than the IC50 at its trough level in the retinochoroidal tissues. The intravitreous concentration of proteins was significantly reduced in rabbits that received topical bromfenac (P = 0.026) but not the other two NSAIDs. Conclusions Topical bromfenac can penetrate into the retinochoroidal tissues in high enough concentrations to inhibit COX-2 and exerts its inhibitory effect on the blood-retinal barrier breakdown in an experimental retinochoroidal inflammation in rabbits. Topical bromfenac may have a better therapeutic benefit than diclofenac and nepafenac for retinochoroidal inflammatory diseases.
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Affiliation(s)
- Tetsuo Kida
- Research Laboratories for Drug Development, Senju Pharmaceutical Co., Ltd., Kobe, Japan
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Seiko Kozai
- Research Laboratories for Drug Development, Senju Pharmaceutical Co., Ltd., Kobe, Japan
| | - Hiroaki Takahashi
- Research Laboratories for Drug Development, Senju Pharmaceutical Co., Ltd., Kobe, Japan
| | - Mitsuyoshi Isaka
- Research Laboratories for Drug Development, Senju Pharmaceutical Co., Ltd., Kobe, Japan
| | - Hideki Tokushige
- Research Laboratories for Drug Development, Senju Pharmaceutical Co., Ltd., Kobe, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
- * E-mail:
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Abstract
Uveitis is a challenging disease to treat. Corticosteroids have been used in the treatment of uveitis for many years. Immunosuppressives are gaining momentum in recent years in the treatment of uveitis. In this article we present an overview of current treatment of uveitis and the major breakthroughs and advances in drugs and ocular drug delivery systems in the treatment of uveitis.
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Affiliation(s)
- Kalpana Babu
- Department of Uvea and Ocular Inflammation, Vittala International Institute of Ophthalmology, Bangalore, Karnataka, India
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Rajpal RK, Ross B, Rajpal SD, Hoang K. Bromfenac ophthalmic solution for the treatment of postoperative ocular pain and inflammation: safety, efficacy, and patient adherence. Patient Prefer Adherence 2014; 8:925-31. [PMID: 25028541 PMCID: PMC4077855 DOI: 10.2147/ppa.s46667] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Ophthalmic nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used by clinicians to manage ocular inflammation and pain following cataract surgery. Over the past decade, the US Food and Drug Administration has approved multiple topical NSAIDs for these purposes, including several reformulated products. One of these medications, bromfenac ophthalmic solution, has a long and extensive history, with proven efficacy and safety in patients following cataract surgery. The evolution of bromfenac ophthalmic solution over the years has involved either lowering the concentration of the active ingredient or extending the dosing interval to improve patient adherence/compliance. This review will focus on the history and progression of bromfenac ophthalmic solution and report the available patient preference and adherence data regarding this ocular NSAID throughout its evolution.
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Affiliation(s)
- Rajesh K Rajpal
- See Clearly Vision Group, McLean, VA, USA
- Correspondence: Rajesh Rajpal, See Clearly Vision Group, 8138 Watson St, McLean, VA 22102, USA, Email
| | - Bryan Ross
- See Clearly Vision Group, McLean, VA, USA
| | | | - Khoa Hoang
- See Clearly Vision Group, McLean, VA, USA
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Walters TR, Goldberg DF, Peace JH, Gow JA. Bromfenac Ophthalmic Solution 0.07% Dosed Once Daily for Cataract Surgery. Ophthalmology 2014; 121:25-33. [DOI: 10.1016/j.ophtha.2013.07.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 07/02/2013] [Accepted: 07/09/2013] [Indexed: 12/20/2022] Open
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Wang QW, Yao K, Xu W, Chen PQ, Shentu XC, Xie X, Weng Y, Zhang L, Jin CF, Wu W, Zhu YN, Yu YH. Bromfenac Sodium 0.1%, Fluorometholone 0.1% and Dexamethasone 0.1% for Control of Ocular Inflammation and Prevention of Cystoid Macular Edema after Phacoemulsification. Ophthalmologica 2013; 229:187-94. [PMID: 23429038 DOI: 10.1159/000346847] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 12/12/2012] [Indexed: 11/19/2022]
Affiliation(s)
- Qi-wei Wang
- Eye Center, 2nd Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
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Carreño E, Portero A, Galarreta DJ, Herreras JM. Update on twice-daily bromfenac sodium sesquihydrate to treat postoperative ocular inflammation following cataract extraction. Clin Ophthalmol 2012; 6:637-44. [PMID: 22570544 PMCID: PMC3346189 DOI: 10.2147/opth.s23381] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Ophthalmic bromfenac sodium sesquihydrate is a topically applied selective cyclooxygenase (COX)-2 inhibitor. It is similar to amfenac, except for a bromine atom at the C(4) of the benzoyl ring position, which markedly affects its in vitro and in vivo potency, extends the duration of anti-inflammatory activity, and enhances its inhibitory effect on COX-2 absorption across the cornea and penetration into ocular tissues. The United States Food and Drug Administration approved bromfenac in 2005 for the treatment of postoperative inflammation and the reduction of ocular pain in patients who have undergone cataract surgery. Nonsteroidal anti-inflammatory drugs (NSAIDs), and among them bromfenac, could be even more effective than steroids at reestablishing the blood-aqueous barrier, as revealed by flare on slit-lamp examination and as quantitatively measured using ocular fluorophotometry. Similar to other NSAIDs, it has a role in inhibiting intraoperative miosis during cataract surgery. However, bromfenac also seems to be useful in other situations, such as refractive surgery, allergic conjunctivitis (not useful in dry eye), choroidal neovascularization, and even ocular oncology. No reports of systemic toxicity have been published and bromfenac has good topical tolerance with a low incidence of adverse effects.
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Affiliation(s)
- Ester Carreño
- Ocular Immunology Unit-IOBA (Instituto Universitario de Oftalmobiología), University of Valladolid, Campus Miguel Delibes, Valladolid, Spain
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Wang XJ, Wong SH, Givergis R, Chynn EW. Evaluation of analgesic efficacy of bromfenac sodium ophthalmic solution 0.09% versus ketorolac tromethamine ophthalmic solution 0.5% following LASEK or Epi-LASIK. Clin Ophthalmol 2011; 5:1451-7. [PMID: 22034570 PMCID: PMC3198424 DOI: 10.2147/opth.s24656] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background To evaluate the analgesic efficacy of bromfenac sodium ophthalmic solution 0.09% compared with ketorolac tromethamine ophthalmic solution 0.5% in laser epithelial keratomileusis (LASEK) or epithelial keratomileusis (epi-LASEK), sometimes referred to as epi-LASIK. Methods Eighty eyes (from 40 patients, 18 men and 22 women) undergoing bilateral simultaneous LASEK or epi-LASEK were randomized to receive ketorolac in one eye and bromfenac in the other. Mean age was 33.13 ± 9.34 years. One drop of bromfenac or ketorolac was instilled in each eye 15 minutes and one minute prior to surgery, and two and four hours following surgery. Patients were instructed to instill the medications on-label each day through postoperative day 4. The subjects completed pain and visual blurriness assessments from day of surgery to postoperative day 4. Uncorrected visual acuity was tested on postoperative days 1 and 6. Results For each of the five days, pain scores for bromfenac-treated eyes were significantly less than that for ketorolac-treated eyes (P < 0.01). Of the 40 patients, 32 (80%) said bromfenac provided better postoperative analgesia than ketorolac. There was no statistically significant difference in visual blurriness scores between the two groups (P > 0.1). Uncorrected visual acuity did not vary significantly between the treatment groups (P > 0.1). No serious adverse events were noted. Conclusion Bromfenac is subjectively superior to ketorolac in reducing postoperative pain following LASEK or epi-LASEK. The subjects tolerated the drugs well with no serious adverse outcomes and no difference in uncorrected visual acuity.
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Silverstein SM, Cable MG, Sadri E, Peace JH, Fong R, Chandler SP, Gow JA, Klier SM, McNamara TR. Once daily dosing of bromfenac ophthalmic solution 0.09% for postoperative ocular inflammation and pain. Curr Med Res Opin 2011; 27:1693-703. [PMID: 21751945 DOI: 10.1185/03007995.2011.597663] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the efficacy and ocular safety of bromfenac ophthalmic solution 0.09% dosed once daily for the treatment of ocular inflammation and pain following cataract extraction with posterior chamber intraocular lens implantation. METHODS A total of 455 subjects (455 study eyes: 230 bromfenac, 225 placebo) were enrolled in two randomized double-masked, placebo-controlled, clinical trials at 64 ophthalmology clinics in the United States. Subjects were randomized to receive either bromfenac 0.09% or placebo dosed once daily. Dosing began 1 day before cataract surgery (Day -1), continued on day of surgery (Day 0), and for 14 days following surgery. Evaluations were completed on Days 1, 3, 8, 15 and 22. The primary efficacy endpoint was cleared summed ocular inflammation score (SOIS) by Day 15. The secondary efficacy endpoint was the number of subjects who were pain-free at Day 1. RESULTS The bromfenac 0.09% group was significantly higher compared to the placebo group in the primary endpoint of the proportion of subjects who had cleared ocular inflammation by Day 15 (P < 0.0001). The mean SOIS for the bromfenac 0.09% group was lower than the placebo group at Days 3, 8, 15, and 22 (P < 0.0001). More bromfenac 0.09% subjects were pain free at Days 1, 3, 8, and 15 (P < 0.0001). Fewer subjects in the bromfenac 0.09% group withdrew from the clinical trials due to lack of efficacy at Day 15 (P < 0.0001). Fewer adverse events were reported in the bromfenac 0.09% group than the placebo group. Limitations included advanced age, female predominance, and surgical nuances among cataract surgeons, making cross-trial comparisons difficult. CONCLUSIONS Bromfenac ophthalmic solution 0.09% dosed once daily is clinically safe and effective for the treatment of ocular inflammation and the reduction of ocular pain associated with cataract surgery.
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Henderson BA, Gayton JL, Chandler SP, Gow JA, Klier SM, McNamara TR. Safety and efficacy of bromfenac ophthalmic solution (Bromday) dosed once daily for postoperative ocular inflammation and pain. Ophthalmology 2011; 118:2120-7. [PMID: 21762992 DOI: 10.1016/j.ophtha.2011.04.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Revised: 04/22/2011] [Accepted: 04/27/2011] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To evaluate the efficacy and ocular safety of bromfenac ophthalmic solution (bromfenac) 0.09% dosed once daily for the treatment of ocular inflammation and pain after cataract surgery with posterior chamber intraocular lens implantation. DESIGN Randomized, double-masked, vehicle-controlled or active-controlled, multicenter, clinical trials. PARTICIPANTS AND CONTROLS A total of 872 subjects (872 study eyes: bromfenac in 584, placebo in 288). METHODS Four randomized, double-masked, vehicle or active-controlled, clinical trials were conducted at 134 ophthalmology clinics in the United States. Subjects aged ≥ 18 years were randomized to receive either bromfenac 0.09% or placebo dosed once daily beginning 1 day before cataract surgery (day -1), continuing on the day of surgery (day 0), and continuing for an additional postoperative 14 days. Subjects were evaluated for efficacy and safety on days 1, 3, 8, 15, and 22. The primary efficacy end point was cleared ocular inflammation, measured by the summed ocular inflammation score (SOIS; anterior chamber cells and flare) by day 15. The secondary efficacy end point was the number of subjects who were pain-free at day 1. The data from the 4 trials were pooled for analyses. MAIN OUTCOME MEASURES The SOIS and ocular pain. RESULTS The proportion of subjects who had cleared ocular inflammation by day 15 was significantly higher in the bromfenac 0.09% group than in the placebo group (P < 0.0001). The mean SOIS in the bromfenac 0.09% group was significantly lower than in the placebo group at days 3, 8, 15, and 22 (P < 0.0001). The proportion of subjects who were pain-free at days 1, 3, 8, and 15 was significantly higher in the bromfenac 0.09% group than in the placebo group (P < 0.0001). The incidence of adverse events reported in the bromfenac 0.09% group was significantly lower than in the placebo group (P < 0.0001). On day 15, 84.0% of the bromfenac subjects had ≥ 1-line improvement in visual acuity compared with 66.1% of placebo subjects (P < 0.0001). CONCLUSIONS Bromfenac 0.09% dosed once daily was clinically safe and effective for reducing and treating ocular inflammation and pain associated with cataract surgery. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Campos M, Muccioli C, Malta JB, Gerade RA, LA Salame A, Belfort R. Efficacy and tolerability of a combined gatifloxacin plus prednisolone formulation for topical prophylaxis after LASIK. Clin Ophthalmol 2011; 5:209-14. [PMID: 21386913 PMCID: PMC3046990 DOI: 10.2147/opth.s17059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Indexed: 11/23/2022] Open
Abstract
Purpose: To compare the efficacy and tolerability of a fixed-dose combination of 0.3% gatifloxacin and 1% prednisolone formulation versus the same agents administered separately for prophylaxis in a laser-assisted in situ keratomileusis (LASIK) population. Methods: In a prospective, randomized, double-masked, parallel-group study, 97 patients were evaluated for signs and symptoms of ocular infection or inflammation after bilateral LASIK. Group 1 (50 patients, 100 eyes) received a combined formulation of 0.3% gatifloxacin + 1% prednisolone acetate (Zypred®) plus placebo. Group 2 (47 patients, 94 eyes) received conventional treatment with the same agents from separate vials. The cohorts were similar in age, sex, race, and refractive error. Baseline and postoperative assessments were made on surgery days −2, 1, 3, and 15 and consisted of visual acuity; intraocular pressure; severity of inflammation of eyelids, conjunctiva, and cornea; tearing; ocular discomfort (foreign-body sensation, itching, or photophobia); and ocular pain. The posterior segment was evaluated at the screening and exit visits. Results: No ocular infection or persistent inflammation was detected in either group at any time. All objective and subjective criteria of efficacy were similar regardless of treatment, with no significant differences between the groups. More patients who were dosed with the combined agent complained of mild ocular discomfort on day 3, but this difference had disappeared by day 15. Conclusion: Post-LASIK topical prophylaxis with combined gatifloxacin + prednisolone eye drops (Zypred®) was well tolerated. This formulation appears to be therapeutically equivalent to conventional dosing with gatifloxacin and prednisolone from individual bottles for topical prophylaxis after laser refractive surgery.
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Affiliation(s)
- Mauro Campos
- Department of Ophthalmology, Hospital São Paulo, Universidade Federal de São Paulo, Brazil
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Topical application of analgesics: a clinical option in day case anaesthesia? Curr Opin Anaesthesiol 2010; 23:704-7. [DOI: 10.1097/aco.0b013e328338469b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yadav UCS, Srivastava SK, Ramana KV. Understanding the role of aldose reductase in ocular inflammation. Curr Mol Med 2010; 10:540-9. [PMID: 20642441 PMCID: PMC2912437 DOI: 10.2174/1566524011009060540] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 01/05/2010] [Indexed: 12/24/2022]
Abstract
Aldose reductase, although identified initially as a glucose-reducing enzyme via polyol pathway, is believed to be an important component of antioxidant defense system as well as a key mediator of oxidative stress-induced molecular signaling. The dual role played by AR has made it a very important enzyme for the regulation of not only the cellular redox state by detoxifying the reactive lipid-aldehydes generated by lipid peroxidation which is crucial in the cellular homeostasis, but also in the regulation of molecular signaling cascade that may regulate oxidative stress-induced cytotoxic events. Search for the new molecular targets to restrain the oxidative stress-induced inflammation has resulted in the identification of AR as an unanticipated mediator of oxidative stress-induced signaling. Although, in last one decade or so AR has been implicated in various inflammation-related diseases conditions ranging from diabetes, sepsis, cancer, cardiovascular and ocular inflammation, however, a critical evaluation of the clinical efficacy of AR inhibitors awaits a better understanding of the role of AR in regulating inflammation, especially in ocular inflammation.
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Affiliation(s)
- U C S Yadav
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, Texas 77555, USA.
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Comstock TL, Holland EJ. Loteprednol and tobramycin in combination: a review of their impact on current treatment regimens. Expert Opin Pharmacother 2010; 11:843-52. [PMID: 20210687 DOI: 10.1517/14656561003667532] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD The treatment of ocular inflammation continues to be a challenge. Topical corticosteroids are effective in reducing ocular inflammation but are limited by adverse events including elevation of intraocular pressure, development of cataracts, glaucoma and inhibition of wound healing with associated risk of infection. Loteprednol etabonate (LE) is a unique C-20 ester corticosteroid designed to produce a predictable therapeutic effect with a low incidence of side effects. Zylet (LE/T) a combination of LE and tobramycin (T) is indicated for the treatment of steroid-responsive ocular inflammatory conditions in which there exists either superficial bacterial ocular infection or a potential risk of bacterial infection. AREAS COVERED IN THIS REVIEW The current review of the literature (Medline and the Cochrane Library, 1996 - 2009) examines the safety and efficacy of LE/T in the treatment of ocular inflammation. WHAT THE READER WILL GAIN Studies with either LE or LE/T indicate that LE has a lower risk of IOP elevation compared with C-20 ketone corticosteroids owing to its rapid de-esterification to inactive metabolites. LE also lacks the ability to form Schiff base intermediates with lens proteins, a common first step in cataractogenesis. LE/T was noninferior to dexamethasone 0.1%/tobramycin 0.3% in the treatment of blepharokeratoconjunctivitis. TAKE HOME MESSAGE LE/T may be a safer treatment option for ocular inflammation in which there is risk of superficial bacterial infections.
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Affiliation(s)
- Timothy L Comstock
- Bausch & Lomb Incorporated, Rochester, 1400 North Goodman Street, Rochester, NY 1460, USA.
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