Ophthalmic Treatment Research Articles

Upper Eyelid Meibomian Gland Dysfunction is a Risk Factor for Dry Eye Symptoms Following Cataract Surgery in the Early Phase.

PurposeTo evaluate perioperative dry eye (DE) syndrome and meibomian gland (MG) dysfunction parameters associated with cataract surgery-induced DE symptoms.Patients and MethodsThis retrospective, single-centered, observational study included 82 eyes of 43 patients without previous subjective DE symptoms, treatment, ocular comorbidities, and previous use of ophthalmic treatment, except for anti-allergic eye drops, who underwent uncomplicated cataract surgery. MG dropout, lid margin abnormality, meibum quality, meibum expressibility, MG orifice obstruction, ocular surface disease index, non-invasive tear break-up time, tear meniscus height, and Schirmer test score were measured at baseline and 1 month postoperatively. Multivariable logistic regression with generalized estimating equation models was used to determine the risk factors for cataract surgery-induced DE symptoms.ResultsTwenty-one patients had subjective DE symptoms 1 month following the cataract surgery. Preoperative and postoperative parameters, preoperative upper eyelid MG loss, and female sex (odds ratio [OR] 6.72, P = 0.012; OR 4.20, P = 0.037, respectively) were identified as risk factors for cataract surgery-induced DE symptoms.ConclusionOcular parameters, including upper eyelid MG findings at baseline, were considered important in predicting persistent DE symptoms following cataract surgery.

Applications of electronic devices based‐on smartphones in ophthalmic diagnosis and treatment activities

Clinical & Experimental OphthalmologyVolume 50, Issue 3 p. 349-350 LETTER TO THE EDITOR Applications of electronic devices based-on smartphones in ophthalmic diagnosis and treatment activities Ruyue Li MD, Ruyue Li MD orcid.org/0000-0001-9219-5332 Beijing Institute of Ophthalmology; Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Key Laboratory of Ophthalmology and Vision Sciences, Beijing, ChinaSearch for more papers by this authorNingli Wang MD, PhD, Ningli Wang MD, PhD orcid.org/0000-0002-8933-4482 Beijing Institute of Ophthalmology; Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Key Laboratory of Ophthalmology and Vision Sciences, Beijing, ChinaSearch for more papers by this authorHanruo Liu MD, PhD, Corresponding Author Hanruo Liu MD, PhD [email protected] Beijing Institute of Ophthalmology; Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Key Laboratory of Ophthalmology and Vision Sciences, Beijing, China Correspondence Hanruo Liu, Beijing Institute of Ophthalmology; Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Key Laboratory of Ophthalmology and Vision Sciences, Beijing, China. Email: [email protected]Search for more papers by this author Ruyue Li MD, Ruyue Li MD orcid.org/0000-0001-9219-5332 Beijing Institute of Ophthalmology; Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Key Laboratory of Ophthalmology and Vision Sciences, Beijing, ChinaSearch for more papers by this authorNingli Wang MD, PhD, Ningli Wang MD, PhD orcid.org/0000-0002-8933-4482 Beijing Institute of Ophthalmology; Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Key Laboratory of Ophthalmology and Vision Sciences, Beijing, ChinaSearch for more papers by this authorHanruo Liu MD, PhD, Corresponding Author Hanruo Liu MD, PhD [email protected] Beijing Institute of Ophthalmology; Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Key Laboratory of Ophthalmology and Vision Sciences, Beijing, China Correspondence Hanruo Liu, Beijing Institute of Ophthalmology; Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Key Laboratory of Ophthalmology and Vision Sciences, Beijing, China. Email: [email protected]Search for more papers by this author First published: 28 January 2022 https://doi.org/10.1111/ceo.14032 Funding information National Natural Science Foundation of China, Grant/Award Number: 82171051 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume50, Issue3April 2022Pages 349-350 RelatedInformation

Impact of Diquafosol Ophthalmic Solution on Tear Film and Dry Eye Symptom in Type 2 Diabetic Dry Eye: A Pilot Study

Purpose: Diquafosol ophthalmic solution (DQS) stimulates P2Y2 receptors on the ocular surface, which enhances mucin secretion from goblet cells. Therefore, tear film stability and hydration of the ocular surface can be achieved independent from lacrimal gland function. Methods: This prospective, open-label pilot study included 60 eyes of 30 diabetic patients diagnosed with dry eye disease (DED) and were randomly assigned to either DQS (n = 30 eyes) or hyaluronate (HA) group (n = 30 eyes). Participants in the DQS group received 3% diquafosol ophthalmic solution, whereas HA group received 0.1% sodium HA preservative-free artificial tears. The dosage for both drugs was 1 drop, 6 times per day for 4 weeks. Tear film lipid layer (TFLL), noninvasive breakup time (NITBUT), corneoconjunctival staining (CS) score, meibomian gland (MG), conjunctival hyperemia [redness score (RS)], ocular surface disease index (OSDI) was assessed and compared at baseline, day 14, and day 28. Results: Comparing baseline and day 28 measurements revealed that both groups found significant improvements in NITBUT, CS, MG quality, MG expressibility, and OSDI scores significantly (P < 0.05), in addition TFLL improvements were only found in the DQS group. At day 28, the magnitude of change in mean NITBUT was 1.74 (DQS) versus 0.31 (HA), 1.16 (DQS) versus 0.37 (HA) point grade reduction in corneoconjunctival staining score and 9.80 (DQS) versus 4.80 (HA) point grade in mean OSDI score. Conclusion: Three percent diquafosol ophthalmic solution treatment demonstrated the ability to improve the tear film dry eye parameters and clinically reduced sign and symptoms of DED in diabetic dry eye patients. Clinical Trials.gov ID: NCT04980144.

Review of vision screening referrals in children

Background: Childhood vision screening is aimed at the detection of reduced vision due to amblyopia, thus enabling early diagnosis and timely intervention. The purpose of the study was to review the demographics and visual parameters of children referred to the ophthalmologist at Community Health Centre Ljubljana from Slovenian community-based vision screening program and define the visual outcome after treatment in children with amblyopia.&#x0D; Methods: Retrospective medical records review of children referred from community-based vision screening program for further assessment. Medical records were reviewed to determine findings from ophthalmic assessments, treatment received, and visual acuity at the final visit. The main outcome measures were the cause of visual impairment and the visual acuity at the final follow-up visit.&#x0D; Results: From 439 children (mean age 7.3 +/- 3.7 years) referred from community-based vision screening program, 75 children (17%; mean age 5.3 +/- 2.6 years) had amblyopia and received treatment. They had amblyogenic refractive error (3.67 +/- 2.44 diopters of sphere and 1.86 +/- 1.23 diopters of astigmatism) with uncorrected visual acuity on average 0.32 +/- 0.28 logMAR in the worse eye. Visual outcomes after treatment were good with a visual acuity of 0.04 +/- 0.07 logMAR in the worse eye, 60% of them had a visual acuity of 0.00 logMAR (40/40).&#x0D; Conclusion: Children with amblyopia in the presented clinical sample were mostly diagnosed and treated before the school-age. These children showed significant improvement in visual acuity in the amblyopic eye.

Pathogenic Mechanism of Dry Eye-Induced Chronic Ocular Pain and a Mechanism-Based Therapeutic Approach.

PurposeDry eye–induced chronic ocular pain is also called ocular neuropathic pain. However, details of the pathogenic mechanism remain unknown. The purpose of this study was to elucidate the pathogenic mechanism of dry eye–induced chronic pain in the anterior eye area and develop a pathophysiology-based therapeutic strategy.MethodsWe used a rat dry eye model with lacrimal gland excision (LGE) to elucidate the pathogenic mechanism of ocular neuropathic pain. Corneal epithelial damage, hypersensitivity, and hyperalgesia were evaluated on the LGE side and compared with the sham surgery side. We analyzed neuronal activity, microglial and astrocytic activity, α2δ–1 subunit expression, and inhibitory interneurons in the trigeminal nucleus. We also evaluated the therapeutic effects of ophthalmic treatment and chronic pregabalin administration on dry eye–induced ocular neuropathic pain.ResultsDry eye caused hypersensitivity and hyperalgesia on the LGE side. In the trigeminal nucleus of the LGE side, neuronal hyperactivation, transient activation of microglia, persistent activation of astrocytes, α2δ–1 subunit upregulation, and reduced numbers of inhibitory interneurons were observed. Ophthalmic treatment alone did not improve hyperalgesia. In contrast, continuous treatment with pregabalin effectively ameliorated hypersensitivity and hyperalgesia and normalized neural activity, α2δ–1 subunit upregulation, and astrocyte activation.ConclusionsThese results suggest that dry eye–induced hypersensitivity and hyperalgesia are caused by central sensitization in the trigeminal nucleus with upregulation of the α2δ–1 subunit. Here, we showed that pregabalin is effective for treating dry eye–induced ocular neuropathic pain even after chronic pain has been established.

Study of Myopia Correction Using Nanoporous Polymer Gas Permeable Contact Lenses

Ophthalmic treatments using contact lenses are now used by more and more specialists around the world. Improving contact lens (CL) materials is a condition that is constantly evolving. Contact lens materials are usually composed of polymer hydrogel or silicone hydrogel. The materials used for night contact lenses are gas permeable and they gradual flatten the center of the cornea which decreases the progression of myopia or myopic astigmatism. The aim of this study is to identify, in correlation with the chemical interactions between structural components of contact lenses and their biocompatibility with the surface layer and microtopography of the cornea or sclera, different incidents that occur in patients who have used rigid gas permeable contact lenses. The study was performed on a group of 10 patients who had a follow-up period between 4 and 6 years, who presented regularly for eye examinations. The following clinical parameters were analyzed: ocular refraction before and after wearing night contact lenses, types of contact lens materials, appearance of corneal topography, biomicroscopic examination of the anterior segment of the eye, keratometry, ocular comfort, as well as other incidents regarding this type of lenses. Difficulties caused by wearing contact lenses at night arose due to poor hygiene and maintenance in two cases or due to interruption of lens wear in one case.

Eye Manifestations in Behcet’s Syndrome

Behcet’s syndrome is an inflammatory, chronic, recurrent, multisystemic disease, common in men 25-40 years of age, with immunological determinism (including autoimmune) in the presence of infectious (bacterial) triggering agents and genetic involvement through the presence of HLA-B51. Behcet’s syndrome is characterized by a symptomatic triad of: recurrent nongranulomatous uveitis with hypopyon, oral and genital ulcers, and skin changes. Iridocyclitis (anterior uveitis) with acute, recurrent hypopyon is the most common ocular manifestation in Behcet’s syndrome and progresses to unpredictable outbreaks with sequelae and severe complications that cause loss / loss of vision. Ocular manifestations in Behcet’s syndrome are also accompanied by posterior pole involvement with posterior uveitis, venous and arterial occlusive vasculitis, necrotizing retinitis, macular edema, cystoid macular edema, which accentuates the decrease / loss of vision.Treatment of Behcet’s syndrome should be adapted to the chronic course of the disease and should be aggressive from the outset through systemic drug combinations: corticosteroid / immunosuppressive / immunomodulatory therapy and appropriate ophthalmic treatment: cycloplegics, antiglaucoma eye drops, filter surgery, cataract surgery, cataract surgery under cortisone protection, endoocular surgery, laser photocoagulation. Ophthalmologist / internist interdisciplinary collaboration is required.

Development of Microchip Laser for Ophthalmic Therapy Application

We have recently developed a several milli-joule, sub-nanosecond laser source for ophthalmic therapy application which allows to lower a laser breakdown threshold, less than half, and more stably/effectively yield the breakdown phenomenon compared to that based on conventionally employed source, implying the developed source has a potential to realize more minimally invasive ophthalmic treatment for secondary cataract. For further laser performance, the use of a photonic crystal device as an output coupler of the laser source has been also demonstrated. With this system, pulse width shortening and polarization control of the laser output could be achieved simultaneously. This paper presents these recent ophthalmic laser developments.

The Tietz syndrome associated with cardiac malformation: a case report with literature review

BackgroundTietz syndrome is a very rare clinical entity characterized by the association of profound bilateral congenital sensorineural deafness and generalized hypopigmentation of skin, eyes, and integuments (snow white appearance). It is an autosomal dominant syndrome due to a mutation in the melanocyte inducing transcription factor (MITF) gene. The association of a heart malformation has never been reported in this syndrome.Case presentationWe report two cases of two cousins aged 5 years and 20 months respectively with a history of first degree consanguineous parents. Both girls presented with diffuse hypopigmentation of the skin, blond hair, blue eyes, and bilateral diffuse retinal hypopigmentation at ocular fundus exam. Bilateral profound sensorineural hearing loss was confirmed by auditory brainstem response in both cases. Echocardiography revealed a cardiac malformation such as interventricular communication in the older cousin and interatrial communication in the younger cousin. The family investigation did not reveal a similar case among ancestors. The diagnosis of Tietz syndrome was based on clinical criteria and pedigree. The older cousin underwent a total optical correction and a right unilateral cochlear implantation followed by speech therapy with a satisfactory result after a follow-up of two years. Unfortunately, the little cousin died following a head trauma.ConclusionsTietz syndrome is a rare autosomal dominant genetic disorder, characterized by generalized albinism with bilateral profound hearing loss. It results from a nontruncating mutation in the basic domain of in the MITF gene. Its management must include, in addition to hearing and ophthalmic rehabilitation, the research and treatment of cardiac malformations which may be life-threatening.

Development of Lactoferrin-Loaded Liposomes for the Management of Dry Eye Disease and Ocular Inflammation.

Dry eye disease (DED) is a high prevalent multifactorial disease characterized by a lack of homeostasis of the tear film which causes ocular surface inflammation, soreness, and visual disturbance. Conventional ophthalmic treatments present limitations such as low bioavailability and side effects. Lactoferrin (LF) constitutes a promising therapeutic tool, but its poor aqueous stability and high nasolacrimal duct drainage hinder its potential efficacy. In this study, we incorporate lactoferrin into hyaluronic acid coated liposomes by the lipid film method, followed by high pressure homogenization. Pharmacokinetic and pharmacodynamic profiles were evaluated in vitro and ex vivo. Cytotoxicity and ocular tolerance were assayed both in vitro and in vivo using New Zealand rabbits, as well as dry eye and anti-inflammatory treatments. LF loaded liposomes showed an average size of 90 nm, monomodal population, positive surface charge and a high molecular weight protein encapsulation of 53%. Biopharmaceutical behaviour was enhanced by the nanocarrier, and any cytotoxic effect was studied in human corneal epithelial cells. Developed liposomes revealed the ability to reverse dry eye symptoms and possess anti-inflammatory efficacy, without inducing ocular irritation. Hence, lactoferrin loaded liposomes could offer an innovative nanotechnological tool as suitable approach in the treatment of DED.

Development of topical eye-drops of lactoferrin-loaded biodegradable nanoparticles for the treatment of anterior segment inflammatory processes

Ocular inflammation is one of the most common comorbidities associated to ophthalmic surgeries and disorders. Since conventional topical ophthalmic treatments present disadvantages such as low bioavailability and relevant side effects, natural alternatives constitute an unmet medical need. In this sense, lactoferrin, a high molecular weight protein, is a promising alternative against inflammation. However, lactoferrin aqueous instability and high nasolacrimal duct drainage compromises its potential effectiveness. Moreover, nanotechnology has led to an improvement in the administration of active compounds with compromised biopharmaceutical profiles. Here, we incorporate lactoferrin into biodegradable polymeric nanoparticles and optimized the formulation using the design of experiments approach. A monodisperse nanoparticles population was obtained with an average size around 130 nm and positive surface charge. Pharmacokinetic and pharmacodynamic behaviour were improved by the nanoparticles showing a prolonged lactoferrin release profile. Lactoferrin nanoparticles were non-cytotoxic and non-irritant neither in vitro nor in vivo. Moreover, nanoparticles exhibited significantly increased anti-inflammatory efficacy in cell culture and preclinical assays. In conclusion, lactoferrin loaded nanoparticles constitute a safe and novel nanotechnological tool suitable for the treatment of ocular inflammation.

Nintedanib suppresses expression of extracellular matrix proteins in TGF-β1-stimulated primary human fibroblasts of the Tenon

Abstract The development of strategies for fibrosis prevention is a perpetual cutting the edge challenge, especially in ophthalmologic fistulating surgery. Stenosis of liquid draining implants but also fibrotic activation of implant-associated tissues are major clinical examples for fibrosis induced implant failure. Implant coating or incorporation of antifibrotic agents offer a promising approach to minimise failure rates. Nintendanib is a drug that has been successfully used for the treatment of ideopathic pulmonary fibrosis since 2015. In this study, we evaluated the suitability of Nintedanib for ophthalmic therapeutic treatment. Therefore, the antifibrotic potential of the active substance was tested with a fibrotic cell culture model on primary fibroblasts of the Tenon (hTF) in vitro. The concentration of 10μM Nintedanib demonstrated a marginal effect on cell viability but coincidently diminished cell proliferation remarkably. Both, immunocytochemical and Western blot analyses revealed a significant inhibitory effect of Nintedanib on the TGF-β1 induced expression of the extracellular matrix (ECM) components fibronectin and collagen. Moreover it supressed the expression and formation of stress fibres of the fibrotic marker protein alpha smooth muscle actin (α-SMA).

Exposure of Ophthalmologists to Patients' Exhaled Droplets in Clinical Practice: A Numerical Simulation of SARS-CoV-2 Exposure Risk.

Background: Lack of quantification of direct and indirect exposure of ophthalmologists during ophthalmic diagnostic process makes it hard to estimate the infectious risk of aerosol pathogen faced by ophthalmologists at working environment.Methods: Accurate numerical models of thermal manikins and computational fluid dynamics simulations were used to investigate direct (droplet inhalation and mucosal deposition) and indirect exposure (droplets on working equipment) within a half-minute procedure. Three ophthalmic examination or treatment scenarios (direct ophthalmoscopic examination, slit-lamp microscopic examination, and ophthalmic operation) were selected as typical exposure distance, two breathing modes (normal breathing and coughing), three levels of ambient RH (40, 70, and 95%) and three initial droplet sizes (50, 70, and 100 μm) were considered as common working environmental condition.Results: The exposure of an ophthalmologist to a patient's expiratory droplets during a direct ophthalmoscopic examination was found to be 95 times that of a person during normal interpersonal interaction at a distance of 1 m and 12.1, 8.8, and 9.7 times that of an ophthalmologist during a slit-lamp microscopic examination, a surgeon during an ophthalmic operation and an assistant during an ophthalmic operation, respectively. The ophthalmologist's direct exposure to droplets when the patient cough-exhaled was ~7.6 times that when the patient breath-exhaled. Compared with high indoor RH, direct droplet exposure was higher and indirect droplet exposure was lower when the indoor RH was 40%.Conclusion: During the course of performing ophthalmic examinations or treatment, ophthalmologists typically face a high risk of SARS-CoV-2 infection by droplet transmission.

Cost-effectiveness of Inpatient Tympanostomy Prophylaxis.

Tympanostomy is the most common pediatric ambulatory surgery. Post-tympanostomy otorrhea is a prevalent complication leading to high costs to patients for treatment. The cost-effectiveness of intraoperative prophylaxis for both patient and institution has not been examined. An analytical observational study of data collected from the literature and purchasing records. A break-even analysis was performed to determine the required absolute risk reduction (ARR) and final infection rate in post-tympanostomy otorrhea to make intraoperative prophylaxis using ofloxacin and ciprofloxacin dexamethasone otic version cost effective with the following outpatient treatments: ofloxacin, ciprofloxacin-dexamethasone ophthalmic version, and ciprofloxacin-dexamethasone otic version. Absolute risk reduction is a statistic used to express the difference in risk between a treatment and control. The conservative initial infection rate used was 10%. Ofloxacin intraoperative prophylaxis was not cost effective when prescribing ofloxacin outpatient treatment with an ARR of 0.20. Ofloxacin intraoperative prophylaxis was cost-effective with an ARR of 0.08 for ciprofloxacin-dexamethasone ophthalmic version outpatient treatment. Ofloxacin intraoperative prophylaxis was cost-effective for ciprofloxacin-dexamethasone otic version outpatient treatment with an ARR of 0.01.Ciprofloxacin-dexamethasone intraoperative prophylaxis was not cost-effective when prescribing ofloxacin outpatient treatment with an ARR of 1.52. Ciprofloxacin-dexamethasone intraoperative prophylaxis was not cost-effective when prescribing ciprofloxacin-dexamethasone ophthalmic version outpatient treatment with an ARR of 0.60. Ciprofloxacin-dexamethasone intraoperative prophylaxis was cost effective when prescribing ciprofloxacin-dexamethasone otic version outpatient treatment with an ARR of 0.09. Intraoperative prophylaxis can be cost effective for preventing post-tympanostomy otorrhea. Physicians can use this economic model to determine the cost-effectiveness of these interventions for their patients and institutions.

An Automated Detection and Classification of Cataract and Glaucoma Using RCNN

one of the human’s deterioration is visual impairment. Cataract and Glaucoma are the most prevailing cause blindness in the world. Early detection and treatment is the best way to prevent the blindness. Currently grading is done by human graders, it is found to be time taking and grading is usually subjective. Computer aided analysis can help human graders. An automated cataract and glaucoma detection and classification approach is proposed in this paper, to grade more objectively. Region based convolution neural network (RCNN) is used to classification process. The percentage of accuracy of classification obtained for cataract and glaucoma is 98.9% and 97.8% respectively. The method is especially suitable for cataract and glaucoma screening in the underdeveloped areas or areas which are in shortage of ophthalmic resources. It can also improve the accessibility of ophthalmic medical treatment.

Ophthalmic Outpatient and Inpatient Care Under Pandemic Conditions: Hygiene, Triage and New Challenges.

The progression of the COVID-19 pandemic has caused significant changes in the environment for outpatient and inpatient care in ophthalmology, with limitations on access to medical care but also new observations and challenges. We now describe major developments in recent months and provide an outlook on the expected consequences. PubMed literature search, clinical survey. To date, the course of the COVID-19 pandemic has been characterised by several new but overall rare ocular manifestations, the ophthalmological shared management of COVID-19 patients on intensive care units, and a significant decrease in case numbers, associated with an increase in case severity and relative proportion of emergencies, as a result of delayed presentation of patients and reduced treatment adherence. With the introduction of hygiene measures and infection control procedures, ophthalmic patient care was maintained - including emergencies and urgent treatments. Due to the extensive postponement of elective surgeries, scarce therapeutic and health care professional resources, and the prioritisation of critically ill patients from other specialties, there is a reasonable likelihood that urgent treatments will be delayed as infection rates rise. Outpatient and inpatient care in ophthalmology during the COVID-19 pandemic is primarily accompanied by additional organisational or medical challenges and a decline in case volume. Although to date emergency and urgent ophthalmic treatments have been maintained, long-term persistence of pandemic conditions will require additional strategies to provide continuation of ophthalmic care at the required level.

Topical ophthalmic atropine in horses, pharmacokinetics and effect on intestinal motility

BackgroundTopical ophthalmic atropine sulfate is an important part of the treatment protocol in equine uveitis. Frequent administration of topical atropine may cause decreased intestinal motility and colic in horses due to systemic exposure. Atropine pharmacokinetics are unknown in horses and this knowledge gap could impede the use of atropine because of the presumed risk of unwanted effects. Additional information could therefore increase safety in atropine treatment.ResultsAtropine sulfate (1 mg) was administered in two experiments: In part I, atropine sulfate was administered intravenously and topically (manually as eye drops and through a subpalpebral lavage system) to six horses to document atropine disposition. Blood-samples were collected regularly and plasma was analyzed for atropine using UHPLC-MS/MS. Atropine plasma concentration was below lower limit of quantification (0.05 μg/L) within five hours, after both topical and IV administration. Atropine data were analyzed by means of population compartmental modeling and pharmacokinetic parameters estimated. The typical value was 1.7 L/kg for the steady-state volume of distribution. Total plasma clearance was 1.9 L/h‧kg. The bioavailability after administration of an ophthalmic preparation as an eye drop or topical infusion were 69 and 68%, respectively. The terminal half-life was short (0.8 h). In part II, topical ophthalmic atropine sulfate and control treatment was administered to four horses in two dosing regimens to assess the effect on gastro-intestinal motility. Borborygmi-frequency monitored by auscultation was used for estimation of gut motility. A statistically significant decrease in intestinal motility was observed after administration of 1 mg topical ophthalmic atropine sulfate every three hours compared to control, but not after administration every six hours. Clinical signs of colic were not observed under any of the treatment protocols.ConclusionsTaking the plasma exposure after topical administration into consideration, data and simulations indicate that eye drops administrated at a one and three hour interval will lead to atropine accumulation in plasma over 24 h but that a six hour interval allows total washout of atropine between two topical administrations. If constant corneal and conjunctival atropine exposure is required, a topical constant rate infusion at 5 μg/kg/24 h offers a safe alternative.

Rapid Electrochemical Quantification for In Vitro Release Trait of Ophthalmic Drug Loaded within Mucoadhesive Metal Organic Framework (MOF)

AbstractLimited residence time of drugs in the ocular surface, poor bioavailability and side effects are the major challenges in ophthalmic treatment. From the last decade, the pharmaceutical industry is in search of a reliable ophthalmic drug delivery system. In the present study, we demonstrate amine‐functionalized mucoadhesive MIL88B(FeMOF) as a drug delivery cargo to encapsulate ophthalmic drug Timolol (TM) at a rate of 195 μg/mg. Invitro release of TM (only upto 63 %) from loaded FeMOF (TM@FeMOF) within 10 h without burst effect was a noticeable feature that anticipates enhanced preocular retention by the sustained release of TM through extensive H‐bonding of the amine group of MOFs with mucin. A novel and facile approach using Differential Pulse Voltammetry (DPV) were harnessed for rapid quantification of TM during in‐vitro release studies, further validated by HPLC measurement(&lt;10 % deviation). The encouraging results from in‐vitro studies forecast the success story of TM@FeMOF as a biocompatible, biodegradable, and sustainable ophthalmic drug delivery system.

Ocular side effects of novel anti-cancer biological therapies

To examine the ocular side effects of selected biological anti-cancer therapies and the ocular and systemic prognosis of patients receiving them. We retrospectively reviewed all medical records of patients who received biological anti-cancer treatment from 1/2012 to 12/2017 and who were treated at our ocular oncology service. The following data was retrieved: primary malignancy, metastasis, type of biological therapy, ocular side effects, ophthalmic treatment, non-ocular side effects, and ocular and systemic disease prognoses. Twenty-two patients received biological therapies and reported ocular side effects. Eighteen patients (81.8%) had bilateral ocular side effects, including uveitis (40.9%), dry eye (22.7%), and central serous retinopathy (22.7%). One patient (4.5%) had central retinal artery occlusion (CRAO), and one patient (4.5%) had branch retinal vein occlusion (BRVO). At the end of follow-up, 6 patients (27.27%) had resolution of the ocular disease, 13 patients (59.09%) had stable ocular disease, and 3 patients (13.64%) had progression of the ocular disease. Visual acuity improved significantly at the end of follow-up compared to initial values. Eighteen patients (81.8%) were alive at study closure. Biological therapies can cause a wide range of ocular side effects ranging from dry eye symptoms to severe pathologies that may cause ocular morbidity and vision loss, such as uveitis, CRAO and BRVO. All patients receiving biological treatments should be screened by ophthalmologists before treatment, re-screened every 4–6 months during treatment, and again at the end of treatment. Patients on biological treatment who have ocular complaints should be urgently referred to ocular consultation for early identification and early intervention.

Current Situation and Prospect of Teleophthalmology

With the development of technology, doctors can diagnose and treat many diseases through telemedicine. At present, teleophthalmology is mainly used in screening and diagnosing some ocular diseases, monitoring chronic ocular diseases, as well as teleconsultation. With the increasing demand and application of teleophthalmology, some problems will gradually become prominent, such as insufficient equipment and staff, medical risks, patient acceptance and satisfaction, network security, privacy, and covering of medical insurance. The global pandemic of COViD-19 has unexpectedly brought telemedicine to the forefront of ophthalmic services, and may continue to change the way of ophthalmic diagnosis and treatment. With the development of artificial intelligence technology, the expansion of 5G communication network coverage, the standardized training of primary medical staff, and the introduction of relevant laws and regulations, teleophthalmology will become more improved, universal, and widely applied, so as to provide patients with sustainable medical services of higher quality. © 2021, Peking Union Medical College Hospital. All rights reserved.