Effectiveness of 0.15% hylan A eye drops in ameliorating symptoms of severe dry eye patients in Saudi Arabia

PURPOSE

The aim of the HYLAN A study was to investigate if symptoms and/or signs of patients suffering from severe dry eye disease (DED) in Saudi Arabia can be improved by substituting individually optimized artificial tear therapy by high molecular weight hyaluronan (HMWHA) eye drops.

METHODS

The HYLAN M study, a multicenter prospective randomized open-label study, was performed in 11 centers in eight countries. Patients suffering from severe DED were electronically randomized in two parallel arms. patients with symptoms of at least ocular surface disease index (OSDI) 33 and corneal fluorescein staining (CFS) of at least Oxford grade 3 were included . The patients in the control group continued with their individual optimized therapy as by the time of inclusion. The patients in the hylan A group replaced their individual lubricant eye drops by preservative-free eye drops containing 0.15% hylan A. The total OSDI scores as well as the OSDI subscores for pain and for visual disturbances of each patient at baseline, at 4 weeks, and at 8 weeks of treatment was used to analyse the improvement of symptoms. We focus and report the results obtained at the two study centers in Riyadh ,Saudi Arabia (King Khaled Eye Specialist Hospital and Riyadh Military Hospital).

RESULTS

A total of 13 patients were included in the study. The majority of the study participants were middle aged (40-65 years). Overall, female patients accounted for 76.9% of all study participants. At the initiation of the study, both hylan A and control groups had relatively similar total OSDI scores together with pain and vision subscores. At 4-week follow-up, both groups demonstrated a noticeable decrease in all study variables. Nevertheless, the OSDI scores improved significantly in the group of patients treated with hylan A eye drops at 8 weeks, whereas the scores increased in the control group.

CONCLUSION

Saudi Arabia has a very high prevalence of patients with severe dry eye disease. Ethnicity, climate, and a high incidence of diabetes mellitus may contribute to this situation. Lubricant eye drops frequently do not provide adequate relief from ocular pain and instable vision in severe chronic ocular surface disease. High molecular weight hyaluronan (HMWHA) eye drops provide superior relief of symptoms of patients suffering from severe DED. This includes ocular pain as well as unstable vision.

Ocular tropism of coronavirus (CoVs): a comparison of the interaction between the animal-to-human transmitted coronaviruses (SARS-CoV-1, SARS-CoV-2, MERS-CoV, CoV-229E, NL63, OC43, HKU1) and the eye

PURPOSE

Several studies have reported conflicting results on ocular manifestations and transmission of coronavirus disease 2019 (COVID-19) whose causative virus, SARS-CoV-2, belongs to the coronavirus family, the seventh recognized as a human pathogen and the third causing a severe clinical syndrome. COVID-19 primarily affects the lungs, similar to the other human coronaviruses. Comparing the relation between the animal-to-human transmitted coronaviruses (SARS-CoV-1, SARS-Cov-2, MERS-CoV, CoV-229E, NL63, OC43, HKU1) and the eye may contribute to determining their actual eye-tissue tropism and risk of ocular transmission.

METHODS

Literature review was conducted via Pubmed.gov, Google Scholar and medRixv using the following keywords: COVID-19, SARS-CoV-2, SARS-CoV-1, MERS-CoV, CoV-229E, NL63, OC43, HKU1, conjunctivitis, tear swab, ocular expression, ocular symptoms and human angiotensin converting enzyme-2 expression. Studies with lack in methodology were excluded.

RESULTS

Sixteen observational studies were selected. The range for detection of viral RNA in tears was 0-8% for SARS-CoV-1 and 0-5.3% for SARS-CoV-2, while no reports were found for other coronaviruses. Ocular manifestations have been reported for NL63 and SARS-CoV-2. Ocular symptoms in the form of conjunctivitis/conjunctival congestion predominantly were detected in 65 (3.17%) out of 2048 reported patients with COVID-19 (range of 0.8-32%). Eye symptoms were not reported for the other coronaviruses.

CONCLUSIONS

Data aggregation for coronaviruses shows a relatively low eye-tissue tropism. Conjunctival congestion is an uncommon manifestation of COVID-19 similar to all human coronaviruses' infections. In a low percentage of patients, the virus can be excreted in ocular fluids at different stages of the infection, regardless of positive SARS-Cov-2 throat swab. Albeit high viral loads in ocular tissue seem to have relatively low prevalence, the eye should be regarded as a potential source of infection dissemination for COVID-19.

Ocular bleeding in an undiagnosed hemophiliac neonate causing irreversible loss of vision: A case report with review of the literature

INTRODUCTION

Suprachoroidal hemorrhage is an unexpected complication after penetrating keratoplasty during childhood. We report the case of delayed suprachoroidal hemorrhage after penetrating keratoplasty in a neonate as the first manifestation of hemophilia.

CASE REPORT

A 4-day-old neonate was referred to our hospital because of bilateral corneal opacities present since birth. A diagnosis of bilateral Peter's anomaly type 2 with right eye corneal perforation was made after examination. Appropriate treatment was commenced, and later, right eye therapeutic penetrating keratoplasty combined with lensectomy, and anterior vitrectomy was performed. This was complicated postoperatively with suprachoroidal hemorrhage and retinal detachment. Conservative management was advised due to poor visual prognosis. Three months later, the patient was found to have high intraocular pressure in the left eye and glaucoma surgery was recommended. Proper hematological investigations before glaucoma surgery in the left eye revealed a low level of factor VIII with normal levels of factor IX and von Willebrand's factor antigen. Therefore, a diagnosis of hemophilia type A was established.

CONCLUSION

This case serves as a reminder that the occurrence of suprachoroidal hemorrhage, especially in the absence of other predisposing risk factors, should warrant detailed systemic assessment to exclude underlying bleeding disorders.

Fat-removal orbital decompression for thyroid associated orbitopathy: The right procedure for the right patient

Orbital decompression is an effective and invaluable procedure for addressing some of the chronic manifestations of Graves’ Ophthalmopathy (GO) such as exophthalmos and orbital congestion. Fat–removal orbital decompression (FROD) started to gain popularity after its introduction in the late 20th century. Among the therapeutic armamentarium of techniques and approaches available for orbital decompression, FROD has proven its efficacy and safety in addition to its ability to reduce proptosis in a relatively predictable manner. In addition, postoperative complications occurring after FROD are generally considered to be less frequent and less serious compared to bone-removal orbital decompression (BROD). Nevertheless, despite of FROD’s high benefit-to-risk ratio, proper selection of patients based on meticulous preoperative assessment, including imaging, is of paramount importance to achieve optimal functional and aesthetic results. Although up till now there is still no consensus regarding the procedure of choice in GO patients, FROD is an important option to consider in this subset of patients.

Portal vein embolization effect on colorectal cancer liver metastasis progression: Lessons learned

Colorectal liver metastasis (CRLM) is the major cause of death in patients diagnosed with colorectal cancer. The gold standard treatment of CRLM is surgical resection. Yet, in the past, more than half of these patients were deemed unresectable due to the inadequate future liver remnant (FLR). The introduction of efficient portal vein embolization (PVE) preoperatively allowed more resections of metastasis in CRLM patients by stimulating adequate liver hypertrophy. However, several experimental and clinical studies reported tumor progression after PVE which critically influences the subsequent management of these patients. The underlying pathophysiological mechanism of tumor progression post-PVE is still not fully understood. In spite of the adverse effects of PVE, it remains a potentially curative procedure in patients who would remain otherwise unresectable because of the insufficient FLR. Currently, the challenge is to halt tumor proliferation following PVE in patients who require this technique. This could potentially be achieved by either attempting to suppress the underlying oncologic stimulus or by inhibiting tumor growth once observed after PVE, without jeopardizing liver regeneration. More research is still required to better identify patients at risk of experiencing tumor growth post-PVE.