Artificial Tears Research Articles

Pharmacogenomic Analysis of Response to Topical Tumor Necrosis Factor α Antagonist Licaminlimab (OCS-02) in Dry Eye Disease [RETRACTED

The purpose of this study was to evaluate the pharmacogenomics of response to topical ocular tumor necrosis factor α (TNFα) inhibitor licaminlimab in patients with DED. Three single-nucleotide polymorphisms (SNPs) associated with Sjögren syndrome, 3 in the TNFα gene and 1 in the TNF receptor 1 (TNFR1) gene, were assessed for association with response to licaminlimab in participants from a randomized, vehicle-controlled, Phase 2 study in which adults with DED and severe ocular discomfort persisting despite treatment with artificial tears received licaminlimab or vehicle for 6 weeks. Response was assessed for change from baseline in Global Ocular Discomfort score at Day 29 of treatment. The pharmacogenomic analysis was a prospectively specified exploratory objective of the study. mRNA expression for TNFα, interleukin (IL) 1β, and IL8 in conjunctival epithelium cells was determined. The relationship between SNPs and response to licaminlimab was assessed using a mixed model repeated measures analysis. SNP rs1800693 in the TNFR1 gene showed a significant effect on response to licaminlimab ( P < 0.0001, initial association test); no effect was seen for any of the other SNPs tested. The CC genotype of rs1800693 was associated with much greater response to licaminlimab than the CT or TT genotypes: LS mean changes from baseline to Day 29 in Global Ocular Discomfort score were -29.5, -0.09, and -3.90, in patients with the CC, CT, and TT genotypes, respectively ( P < 0.0001). No significant effect was observed in vehicle-treated patients. Improvements from baseline were seen in 3/4 licaminlimab-treated participants with the CC genotype. Conjunctival epithelium cell levels of mRNA for TNFα, IL1β, and IL8 decreased from baseline in participants with the CC genotype, but not with the CT or TT genotypes. Between-genotype differences in mRNA levels were not observed in participants receiving vehicle. The CC genotype of rs1800693, relatively common in patients with DED, was strongly associated with response to licaminlimab and decreased inflammatory cytokine gene expression in ocular surface cells during treatment. This study is one of the first to our knowledge to investigate pharmacogenomics in the treatment of DED.

Topical Dorzolamide as Adjunctive Treatment With Intravitreal Bevacizumab in Bilateral Diabetic Macular Edema.

Intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents is accepted as the gold standard treatment for center-involving diabetic macular edema (CI-DME). Adjunctive administration of topical dorzolamide may enhance the therapeutic effects of anti-VEGF agents. In this study, we compared the efficacy of topical dorzolamide plus intravitreal injection of bevacizumab (IVB) versus IVB alone in patients with bilateral DME. This prospective, randomized contralateral eye study was carried out in a tertiary referral ophthalmology center, Al-Zahra Eye Hospital, Zahedan, Iran, between April 2021 and April 2022. Thisstudy included 50 eyes of 25 patients with bilateral DME. All eyes received three consecutive monthly injections of IVB. For each patient, one eye was randomized to instill dorzolamide eye drops three times a day as an intervention, and the other received artificial tear drops as a placebo. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were evaluated before starting treatment and then monthly for the first three months. Among 25 included patients, the average age was 56.64 ± 7.97 years, and 48% were female. BCVA did not improve significantly in any groups (P > 0.05). No significant difference was observed in terms of BCVA between the intervention and control groups (P > 0.05). The present study showed a decrease in CMT in both study groups (P < 0.05). At month 3, the decrease in mean CMT from baseline was significantly higher in eyes receiving topical dorzolamide compared to the control group (-88.92 ± 82.90 vs. -37.64 ± 86.16 µM, respectively; P = 0.037). IOP decreased significantly only in eyes receiving dorzolamide (P < 0.001). The results of the present study indicate that adjunctive administration of topical dorzolamide has a beneficial effect on CMT reduction from baseline, but it did not have an additive effect on BCVA improvement compared to IVB monotherapy.

Two-Year Progression of Dry Eye Disease in Dry Eye Assessment and Management Study.

The purpose of this study was to evaluate the progression of dry eye disease (DED) symptoms and signs over 2 years through a secondary analysis of data collected from the Dry Eye Assessment and Management study. Participants who were assigned to omega-3 fatty acid in the first year were rerandomized in the second year to either continue with omega-3 fatty acid or switch to placebo. At baseline, 3, 6, 12, 18, and 24 months, DED symptoms were evaluated by using the Ocular Surface Disease Index and the Brief Ocular Discomfort Index (BODI). DED signs were assessed using conjunctival staining, corneal staining, tear break-up time, Schirmer testing, and keratography measures. Medication usage was documented at each visit. Because the treatment and placebo groups displayed no statistical differences in both signs and symptoms, data from the 43 participants were combined to assess longitudinal changes in symptoms and signs. At 3 months after omega-3 fatty acid treatment, there were significant improvements from baseline in Ocular Surface Disease Index and Brief Ocular Discomfort Index scores (all P ≤ 0.002) and less use of artificial tears or gel ( P = 0.02), but between 3 and 24 months, no significant changes in symptoms and treatments were observed ( P ≥ 0.06). Except for a significant improvement in conjunctival staining score over 2 years ( P = 0.001), there were no significant sign changes in corneal staining ( P = 0.32), tear break-up time ( P = 0.43), Schirmer test ( P = 0.09), and additional measures (all P ≥ 0.07). We did not observe a progression of DED signs or symptoms over a 2-year period, except for a probable placebo response in symptoms in the first 3 months and an improvement in conjunctival staining score.

Ocular surface changes following computer use in post-LASIK patients.

To assess the impact of computer use on the ocular surface of individuals after laser insitu keratomileusis (LASIK). The dry eye symptoms and ocular surface of 18 post-LASIK young individuals and 18 controls were evaluated before and after performing a 30-min task on a computer without (Visit 1) and with (Visit 2) initial instillation of artificial tears. Symptoms were assessed using the Ocular Surface Disease Index (OSDI), Symptom Assessment in Dry Eye questionnaire version two (SANDE II) and Computer Vision Syndrome Questionnaire (CVS-Q). The ocular surface was assessed by measuring corneal higher order aberrations, tear meniscus height (TMH), conjunctival redness, blink rate and incomplete blinking, lipid layer thickness (LLT) and non-invasive keratograph break-up time (NIKBUT). SANDE II scores were >0 after the computer task in both groups (p ≤ 0.01). SANDE II and CVS-Q scores did not differ between LASIK and controls (p ≥ 0.43). Greater bulbar-temporal conjunctival redness, TMH and LLT and shorter NIKBUT were found after computer use in the LASIK group (p ≤ 0.04), whereas no changes were observed in the controls (p ≥ 0.20). Lower SANDE II and CVS-Q scores were reported at Visit 2 compared with Visit 1 in both groups (p ≤ 0.01). Likewise, no worsening of dry eye signs was observed at Visit 2 (p ≥ 0.11). Ocular symptoms reported during computer use were comparable between the groups. However, a worsening of dry eye signs was mostly observed in post-LASIK individuals. The instillation of artificial tears was effective in preventing the effects of computer use on the ocular surface in post-LASIK patients.

Looking beyond in Sleep Medicine Practice: Effect of OSA Management in Floppy Eyelid Syndrome – A Case Report

AbstractObstructive Sleep Apnea Syndrome (OSA) is a common sleep disorder characterized by recurrent episodes of partial or complete upper airway obstruction during sleep. Floppy Eye Syndrome (FES) is a condition in which the upper eyelids easily evert with upward traction due to underlying tarsal plate laxity and is associated with chronic, reactive papillary conjunctivitis; this causes the eye to be vulnerable to discomfort and visual symptoms. A 49-year-old man with an 8-year history of snoring, sleep fragmentation, and daytime sleepiness was admitted as an outpatient in our sleep clinic. The patient had complied ocular symptoms such as burning eyes, redness, and irritative ocular symptoms in the past five years, arising upon waking up. The symptoms did not regress with the use of artificial tears and proper ointment. The patient was diagnosed with OSA and began using continuous positive airway pressure (CPAP). CPAP therapy significantly corrected the symptoms of FES associated with OSA . This would help to sensibilize ocular findings in patients with OSA and identify hidden sleeping diseases needing a more appropriate investigation and possible treatment. We must look beyond our approach to sleep clinic patients and avoid being kept to the common symptoms patients represent.

A snake venom ophthalmia: A case – report

Introduction : Snake venom ophthalmia is caused by venoms of spitting snakes. Delayed treatment may result in corneal ulcer, corneal perforation and blindness. We aim to report a fortunate snake venom ophthalmia case.&#x0D; Case Illustration : A-54-year-old male complained of burning eye pain, watery, and redness of the right eye (RE) after being spat by a snake 3 hours before admission. The snake was identified as a cobra-snake, spitted at a distance of 1 meter without body bite. He rinsed his eyes with tap water and irrigated at a nearby hospital before referred. During the admission, the pH of both eyes (BE) was 8. The patient was irrigated with normal-saline. The visual acuity (VA) of the right eye was 6/12 and left eye 6/6. There was RE conjunctival and ciliary injection. Other examinations were unremarkable. The patient was discharged and treated with levofloxacin eye-drop, sulfas-atropine 1%, EDTA 1%, artificial tears, and vitamin C. He did self-eye irrigation. Two days later, he presented with VA of 6/6 for BE with normal ocular examinations and pH of 7 for BE.&#x0D; Discussion : The general principle is prompt and copious irrigation of the eyes in chemical contact. The snake venom mixture of chemicals was washed out, which local necrosis can be prevented. Managing snake venom as a chemical splash injury with considerable irrigation, lubricants, and topical antibiotics, resulted a good outcome and prevented sequelae in this patient.&#x0D; Conclusion : Urgent irrigation of the affected eyes and other mucous membranes is the key in treating snake venom ophthalmia

Topical Treatment for Dry Eye Disease Related to Sjögren's Syndrome: A Systematic Review

Abstract&#x0D; Introduction &amp; Objectives : Sjögren’s syndrome (SS) is a systemic autoimmune disorder characterized by dry eyes and dry mouth caused by inflammation in exocrine glands. Dry eye with SS is often more severe than non-SS dry eye and can greatly affect patients’ quality of life, thus treatment modalities must be selected carefully. This study aims to evaluate the recent studies on topical treatment for dry eye disease related to SS and provide evidence based recommendation for clinical practice.&#x0D; Methods : Electronic literature search was performed through the PubMed and Cochrane database from the last 10 years. We only included studies with prospective clinical trial design, a follow-up period of at least 4 weeks, and had outcome parameters among the following: Ocular Surface Disease Index, Schirmer test, tear break up time, tear meniscus height, and corneal fluorescein staining.&#x0D; Results : Fifteen studies were selected from 125 articles retrieved. We identified clinical trials using tacrolimus, cyclosporine, cortisol phosphate, diquafosol, rebamipide, fluorometholone, hydrocortisone, clobetasone butyrate, autologous serum, autologous platelet lysate, artificial tear, and various type of vehicles including hyaluronic acid, sodium hyaluronate, almond oil, ceftazidime,or saline solution.&#x0D; Conclusion : Cyclosporine has comparably equal efficacy to corticosteroid eye drops in improving signs and symptoms of dry eye in SS, but with a better safety for long-term use. Autologous serum is also an effective therapy with the best concentration being 100% serum (no dilution). Diquafosol is a promising therapy but more research is needed to confirm its efficacy and safety.

Efficacy of 0.1 % Sodium Hyaluronate versus 0,5 % Carboxymethylcellulose in Dry Eye Disease : A Meta-Analysis

Introduction &amp; Objectives : Dry eye is a disorder that involves either insufficient tear production or excessive tear evaporation. Artificial tears are the main treatment for dry eye disease. Sodium Hyaluronate (AH) and Carboxymethylcellulose (CMC) are the two most frequently prescribed and used. To analyze the efficacy of 0,1% sodium hyaluronate compared with 0,5% carboxymethylcellulose toward the symptom score, tear break up time, corneal stain fluorescein in dry eye through a meta-analysis.&#x0D; Methods : A systematic search was performed using Medline and Cochrane database up to December 2022. Review was performed according to the PRISMA Statement. The eligible studies were RCTs which comparing Sodium hyaluronate with Carboxymethylcellulose.&#x0D; Results : From 88 retrieved articles, 6 trials involving total 373 patients were included. The median follow-up period of the studies was 6 weeks. Sodium hyaluronate significantly increases tear break up time compared to Carboxymethylcellulose (Mean Difference (MD): 0.46, 95%CI [0.09-0.84], p=0.01, I2=76%), and significantly decrease corneal stain fluorescein (MD: -0.54, 95%CI [-0.86-(-0.23)], p=0.0008, I2=88%). The analysis shows insignificantly decrease in subjective symptom scores (MD: -0.08, 95%CI [-0.40-0.23], p&lt;0.60, I2= 79 %).&#x0D; Conclusion : In dry eye disease, 0,1% sodium hyaluronate significantly improves tear break up time and significantly decreasing corneal stain fluorescein, while insignificantly decrease subjective symptom scores.

Devastating Mooren Ulcer Halt by Timely Aggressive Treatment - A Case Report

Introduction : Mooren ulcer is a progressive and painful peripheral ulcerative keratitis of unknown cause. Study aims to show effective aggressive treatment for Mooren ulcer.&#x0D; Case Illustration : A 43-year-old man was admitted with a marked clinical worsening of the white tissue covering the cornea, accompanied by pain, redness, and blurry vision of the left eye. Initial examination showed visual acuity of 6/21cc. Peripheral corneal ulcer was found from 6 to 2 clock hours with superficial vascularization and epithelial defect. Patient underwent ancillary examinations with unremarkable findings. Patient was diagnosed with Mooren Ulcer and treated with artificial tears and steroid topical. Patient had no significant improvement; therefore conjunctival resection with immunosuppressive therapy were performed. At follow up, no pain was reported, vision improved to 6/15cc, and the ocular surface inflammation resolved.&#x0D; Discussion : Mooren ulcer is usually misdiagnosed since the clinical signs are similar to other differential diagnoses. The examination must be performed carefully to rule out autoimmune and corneal infection. Treatment goals are to halt the destructive process and promote reepithelization. The stepwise aggressive approach of Mooren Ulcer treatments is crucial. It starts directly with topical steroid to control the progression of inflammation. However, when used alone, topical steroid usually cannot prevent the rapid progression so conjunctival resection is needed to remove the source of collagenase production by cutting the perilimbal blood vessels’ access to the area of the ulcer. Combination with an immunosuppressant will effectively maintain a stable condition.&#x0D; Conclusion : Early diagnosis and aggressive treatment for Mooren ulcer are needed to prevent the rapid progression.

Corneal and conjunctival foreign bodies caused by a firecracker at RSUD Panembahan Senopati Bantul

Introduction : The majority of firecracker ocular injuries occur under the age of 20 years. The most common injuries were lid injuries, corneal abrasions, and superficial foreign bodies.&#x0D; Case Illustration : An 11-year-old patient came to the Emergency Room with redness, pain, and decreased vision in both eyes. The patient was hit by a firecracker an hour before. The visual acuity in the right and left eyes were 0.2 and 0.8. There were several red spots on his face, body and multiple foreign bodies on the superficial cornea and conjunctiva of both eyes. Irrigation with Ringer Lactate solution was done immediately followed by extraction of multiple foreign bodies under local anesthesia on the next day. Medical therapy consists of topical antibiotics, Atropine Sulphate and artificial tears were given.&#x0D; Discussion : Firecracker ocular injury has many symptoms, such as redness (100%), pain (97%), watering (86%), reduced vision (77%), and foreign body sensation (12%). In this case, we found all the clinical signs. The management of ocular foreign bodies caused by firecrackers could be conservative. This includes irrigation, topical antibiotics, and removal of ocular foreign bodies which should be done within 24 hours after the injury. In this case, we did all the treatment. Due to an incooperative patient, removal of corneal and conjunctival foreign bodies was done in 24 hours for the right eye and 48 hours for the left eye.&#x0D; Conclusion : Firecracker ocular injury can have serious consequences for ocular morbidity and visual acuity. Prompt diagnosis and meticulous management can prevent devastating sequelae.

OSDI Score Comparison between Sodium Hyaluronate, Carboxymethylcellulose and Polyvinylpirrolidone for Dry Eye in Medical Student during Online Learning

Abstract&#x0D; Introduction &amp; Objectives : Online learning during COVID pandemic increase medical students’ screen time. Prolonged screen time is known as a risk factor for dry eye. Health problems during online learning such as those induced by dry eye could affect students’ academic performance. This study aim to find the best solution for dry eye in medical student during online learning by comparing three artificial tears eye drops, namely sodium hyaluronate, carboxymethylcellulose and polyvinylpirrolidone.&#x0D; Methods : This is an experimental study with 48 respondents divided into three treatment groups : sodium hyaluronate (SH), carboxymethylcellulose (CMC) and polyvinylpirrolidone (PVP). Each group consists of 16 respondents. Each respondents use their eyedrops six times daily in both eyes for two weeks. This study use Ocular Surface Disease Index questionnaire to evaluate dry eye. Data were analyzed using SPSS software, with p&lt;0,05 is considered significant.&#x0D; Results : In SH group, mean OSDI score before treatment were 37,52 and after treatment 13,84 (p=0,001). In CMC group, mean OSDI score before treatment were 35,28 and after treatment 12,54 (p=0,000). In PVP group mean OSDI score before treatment were 38,17 and after treatment 13,15 (p=0,000). No significant differences of OSDI score was found between groups before treatment and after treatment (p=0,237).&#x0D; Conclusion : Sodium hyaluronate, carboxymethylcellulose and polyvinylpirrolidone eye drops could similiary improve dry eye symptoms significantly as measured by OSDI score in medical students during online learning.

MILLER FISHER SYNDROME: A RARE BENIGN VARIANT OF GUILLAIN- BARRE SYNDROME

Abstract&#x0D; Introduction : Guillain-Barré Syndrome (GBS) is a broad category of syndromes that includes several types of acute immune-mediated polyneuropathy. Miller Fisher Syndrome (MFS) is a scarce variant of GBS (1-2:1,000,000) that presents at least 2 of ataxia, areflexia, and ophthalmoplegia.&#x0D; Case Illustration : A 32 years-old-man came to JEC-Candi with ophthalmic discomfort and exhibited a week onset of total ophthalmoplegia, ptosis, diplopia, and lagophthalmos. Two weeks backward, the patient had a respiratory infection then emerged symmetrical sensory abnormalities (glove-and-stocking-type pinprick sensations in distal extremities). Neurological examinations were performed, and the patient got multiple cranial nerve weaknesses (oculomotor, trochlear, abducens, trigeminal, and facial) both in motoric and sensory, ataxia (positive Romberg sign, stepping test, gait, shallow-knee- bend), and negative pathologic reflexes. Hematology showed leukocytosis, MRI and CT-Scan were normal. Pulse therapy was given (Methylprednisolone 1g/day) for three days, neuroprotector and artificial tears added. Ataxia and diplopia improved, then the patient was referred to Kariadi Hospital for five-times plasmapheresis that involved neurologist and internist. Ophthalmoplegia improved slowly, and lagophthalmos disappeared one month after hospital admission.&#x0D; Discussion : GBS subvariant could overlap; this case presents bifacial weakness with paresthesia and MFS. Viral infection precedes neurological symptoms in most cases, with an average of 10 days of the incubation period. Ataxia, diplopia, and ophthalmoplegia may confuse the physician and presume an upper motor neuron sign or central cause. Steroid and plasmapheresis evince meaningful upturn.&#x0D; Conclusion : This rare disease requires a multidisciplinary approach to cure and diagnose. Nonetheless, MFS has a good prognosis. Appropriate treatment selection will enhance patients' quality of life.

Recurrent Candida Parapsilopsis Corneal Ulcer cum Hypopion: A Case Report

Introduction : Candida is common in tropical and subtropical climes estimated for 20-60% of all culture-positive corneal infection. Over the past two-decades, candida parapsilosis has become a common opportunistic fungal pathogen.&#x0D; Case Illustration : A-60-years-old-man, came with redness and pain in the left eye since one month ago after working at field. In the left eye, visual acuity was hand movement, palpebra was spasm and oedema, conjunctiva was hyperaemia, hazy, feathery edge and fluorescein test were positive in paracentral corneal 6x7 mm and hypopyon in anterior chamber. KOH staining revealed yeast, corneal scrapping revealed candida parapsilopsis, and antifungal sensitive to fluconazole. Fluconazole intravenous 200mg 2-times-a-day, moxifloxacin eyedrop loading dose, fluconazole eyedrop fortified every-one- hour, atropine 1% eyedrop 2-times-a-day, artificial tears eyedrop every-one-hour was administered.In the fifth-day, hypopyon was improved, and patient was discharged. Tenth-days after, patient felt pain and hypopyon raised 4mm. Debridement in the ulcer, and therapy was continued. Two weeks later, hypopyon was less than 1 mm, and pain was relieved.&#x0D; Discussion : There was clinically improvement using antifungal therapy. Recurrent hypopyon was happen, and mechanical debridement in the ulcer was administered. In four-times within two-weeks, hypopyon was improved. Although, initial treatment was antibiotics until microbiological confirmation, antifungal therapy, combined with mechanical eradication of fungal filaments could be administered for fungal corneal ulcer.&#x0D; Conclusion : In this case, combination of antifungal therapy with mechanical debridement could be the right choice to treat candida parapsilopsis corneal ulcer. Better outcomes can be achieved and complications can be avoided with appropriate diagnosis and efficient therapy.

Extensively Drug-Resistant Pseudomonas aeruginosa Outbreak Associated With Artificial Tears.

Carbapenemase-producing, carbapenem-resistant Pseudomonas aeruginosa (CP-CRPA) are extensively drug-resistant bacteria. We investigated the source of a multistate CP-CRPA outbreak. Cases were defined as a US patient's first isolation of P. aeruginosa sequence type 1203 with carbapenemase gene blaVIM-80 and cephalosporinase gene blaGES-9 from any specimen source collected and reported to the Centers for Disease Control and Prevention during 1 January 2022-15 May 2023. We conducted a 1:1 matched case-control study at the post-acute care facility with the most cases, assessed exposures associated with case status for all case-patients, and tested products for bacterial contamination. We identified 81 case-patients from 18 states, 27 of whom were identified through surveillance cultures. Four (7%) of 54 case-patients with clinical cultures died within 30 days of culture collection, and 4 (22%) of 18 with eye infections underwent enucleation. In the case-control study, case-patients had increased odds of receiving artificial tears versus controls (crude matched OR, 5.0; 95% CI, 1.1-22.8). Overall, artificial tears use was reported by 61 (87%) of 70 case-patients with information; 43 (77%) of 56 case-patients with brand information reported use of Brand A, an imported, preservative-free, over-the-counter (OTC) product. Bacteria isolated from opened and unopened bottles of Brand A were genetically related to patient isolates. Food and Drug Administration inspection of the manufacturing plant identified likely sources of contamination. A manufactured medical product serving as the vehicle for carbapenemase-producing organisms is unprecedented in the United States. The clinical impacts from this outbreak underscore the need for improved requirements for US OTC product importers.

In Vitro Evaluation of Soft Contact Lens Wettability With a Nonmodified Commercial Videokeratoscope.

To evaluate a new in vitro technique for measuring soft contact lens wettability using a nonmodified commercial videokeratoscope, the Medmont E300. To this end, the capability of different artificial tears containing hyaluronic acid (HA) to improve soft contact lens wettability in vitro was investigated. An experimental in vitro study was conducted to assess the wetting properties of three artificial tears containing different concentrations of HA (0.1%, 0.2%, and 0.3%) on soft contact lenses. A saline solution was used as the control. For each solution, 15 hydrogel (Ocufilcon D) contact lenses and 15 silicone-hydrogel (Somofilcon A) contact lenses were evaluated. The in vitro wettability of the lenses was measured using the Medmont E300 with a self-developed technique, which involved measuring the tear film surface quality (TFSQ) mean, TFSQ area, TFSQ central, and TFSQ inferior. Compared with the saline solution, all the concentration of HA (0.1%, 0.2%, and 0.3%) improved the in vitro wettability of both soft contact lenses by decreasing their TFSQ mean and TFSQ area ( P <0.05). Regression models revealed an exponential relationship between contact lens wettability and the concentration of HA for both soft contact lenses ( R >0.5, P <0.05). Furthermore, the hydrogel contact lens presented a wetter surface than the silicone-hydrogel contact lens ( P <0.05). The measurement of in vitro wettability of soft contact lenses with a nonmodified Medmont E300 seems to be a useful technique to evaluate the wetting properties of contact lens products.

Estimated prevalence, incidence and healthcare costs of Sjögren’s syndrome in France: a national claims-based study

ObjectivesTo estimate prevalence, incidence and mortality rates, and annual healthcare costs of primary Sjögren’s syndrome (pSS) and SS associated with other autoimmune disorders (SS+AID) in France.MethodsFrench national healthcare claims-based study...

Topical Medroxyprogesterone Acetate and Corneal Epithelium Healing after Photorefractive Keratectomy: A Randomized, Double-masked Contralateral Eye Study.

The objective of the study was to evaluate the efficacy and safety of topical 1% medroxyprogesterone in corneal epithelial healing after photorefractive keratectomy (PRK). In this placebo-controlled double-masked randomized contralateral eye study, 66 eyes of 33 patients with myopia and myopia-astigmatism were assigned into two groups to receive either 1% topical medroxyprogesterone (intervention) or artificial tear (placebo) at the end of PRK surgery. The patients were followed up daily for 5 days until epithelial healing was achieved. The time taken for epithelial healing was the main outcome measure. The mean age of the subjects was 32.97 ± 7.6 years and 46 individuals were female (69.7%). All baseline refractive characteristics were comparable between the groups. There was no significant difference between the two groups in terms of epithelial defect size on Day 1 (P: 0.67). Both groups exhibited a consistent pattern of decreasing epithelial defect size from Day 1 to Day 5, with the control group having slightly worse initial values. There were no significant differences between the groups in the following days. Both groups showed substantial reductions in the epithelial defect size, but the intervention group showed a more prominent decrease on Day 2. The intervention did not show a significant statistical difference compared to the control group, and both groups ended up with a similar outcome. These findings suggest that the topical 1% medroxyprogesterone does not significantly affect the healing of corneal epithelium after PRK.

Prevention and Treatment of Persistent Epithelial Defects After Common Refractive Surgery Procedures.

To discuss the prevention and treatment of persistent epithelial defects after the most common refractive surgeries-photorefractive keratectomy, laser in situ keratomileusis, or small incision lenticule extraction. PubMed was used to search the medical literature. Persistent epithelial defects are infrequent after photorefractive keratectomy, laser in situ keratomileusis, or small incision lenticule extraction. In the authors' opinion, any persistent epithelial defect present at 1 week or beyond after surgery should be treated aggressively with a properly fit bandage contact lens, lubrication with non-preserved artificial tears, and treatment of any eyelid abnormalities, including nocturnal lagophthalmos. Consideration should be given for presumptive treatment for herpes simplex virus or varicella zoster virus infection. If the persistent epithelial defect does not close within 2 weeks, then other measures should be considered, such as autologous serum drops, topical losartan, amniotic membranes, and topical human recombinant nerve growth factor to limit corneal scarring fibrosis and microbial infection. Persistent epithelial defects are among the most feared complications of refractive surgery. Timely and aggressive treatment should be instituted to close the epithelium prior to the development of scarring fibrosis and/or microbial corneal infection. [J Refract Surg. 2024;40(2):e117-e124.].

Review of clinical outcomes of a cationic emulsion tear substitute in patients with dry eye disease.

First-line options for the treatment of dry eye disease (DED) rely on artificial tears (ATs), among which cationic emulsion (CE)-based ATs have been developed in order to mimic the healthy tear film for an improved restoration of the ocular surface homeostasis. In this review, we describe the outcomes reported in several studies, assessing the mode of action, ocular tolerance and clinical performance of a CE-based AT. Pilot studies have revealed that CE-based ATs can increase the volume and stability of the tear film while limiting its evaporation rate. Larger studies have demonstrated that CE-based ATs play a significant role in the improvement of both objective and subjective DED parameters, including superior efficacy on DED symptoms compared to several other available AT formulation types. Concomitantly, CE-based ATs have been shown to help patients to prevent or recover from corneal defects associated with refractive surgery. These positive outcomes on ocular surface epithelia are likely due to the combination of unique rheological behaviour and intrinsic anti-inflammatory properties. Based on all clinical findings, CE-based ATs represent a valuable treatment option for patients with various etiologies of DED including evaporative forms and would deserve evaluation of benefits in other surgical intervention types triggering DED.

Laporan Kasus : Oklusi Arteri Retina Sentra

AbstractCentral retinal artery occlusion is an occlusion that occurs suddenly in the central retinal artery, which causes hypoperfusion of the retina, progressive cellular damage, and loss of visual acuity. Risk factors are similar to other thromboembolic diseases and include hypertension, smoking, hyperlipidemia, diabetes, hypercoagulability, and male gender. All therapy for central retinal artery occlusion aims to restore perfusion or oxygenation of the retina. Management for acute central retinal artery occlusion can only be effective if performed less than 6 hours after symptoms.41-year-old woman, came to the Retina Eye Polyclinic, Surabaya Community Eye Hospital with complaints of sudden blurring of the right eye since 3 days ago. On examination of the anterior segment of the right eye, relative afferent pupillary defect was found and on the posterior segment of the right eye, pale retina and cherry red spot was found. Timolol, artificial tears, and eye supplement was given but did not give good results