Preservative-free Eye Drops Research Articles

Oxygen-Carrying Capacity of Perfluorohexyloctane, a Novel Eye Drop for Dry Eye Disease.

One-hundred percent perfluorohexyloctane (PFHO) is a water-free, preservative-free eye drop approved by the Food and Drug Administration in the United States for the treatment of dry eye disease. PFHO has shown relief of dry eye signs and symptoms in clinical trials and has potent antievaporative action in vitro. The objective of this study was to measure the level of oxygen in PFHO. T1 relaxation times (time taken for proton spins to translate from a random alignment to an alignment with the main magnetic field) for fluorine-19 in perfluorohexyloctane were measured using fluorine-19 nuclear magnetic resonance spectroscopy. The level of oxygen was interpolated from published data. The hydrogen-1 and fluorine-19 nuclear magnetic resonance spectra of PFHO were well resolved and the resonance assignments and intensities were as expected. The T1 values calculated for the CF3 group resonance in the current study was 0.901 seconds and 1.12 seconds at 25°C and 37°C, respectively. The T1 values for the CF2 group resonances increased by 17% to 24% with an increase in temperature from 25°C to 37°C. The mean (SD) partial pressure of oxygen in PFHO was calculated to be 257 (36) mm Hg and 270 (38) mm Hg at 25°C and 37°C, respectively. The current study confirms that PFHO contains a significant amount of oxygen, more so than that calculated for tears in equilibrium with air. Once instilled on the eye, PFHO is not expected to be a barrier to the oxygen necessary for a healthy cornea and may in fact deliver nonreactive oxygen to the cornea to facilitate healing in patients with dry eye disease.

Evaluation of Drug Use with a Focus on Prostaglandin Analogues and Assessment of Medication Adherence and Quality of Life in Patients with Primary Open Angle Glaucoma: A Prospective Study at a Tertiary Care Eye Hospital.

Background: Glaucoma, a chronic, progressive and most often asymptomatic disease 2ndleadingcause of irreversible blindness. Objectives: To study the drug use pattern in patients of Glaucoma,to evaluate the safety aspect with preservative or preservative free drugs, to evaluate quality of lifeusing the National Eye Institute Visual Function Questionnaire (NEI-VFQ25) and to evaluatemedication adherence using Glaucoma Treatment Compliance Assessment Tool (GTCAT).Materials and Method: Prospective observational follow up study was carried out for 18 months.IEC permission and Written Informed Consent from the patients were taken before hand. Patientsabove 18 years of age and of either gender and diagnosed with POAG and were on medication forpast three months were included in the study. Results: In a total of 312 patients, POAG wasprevalent in age group of 51-60 years. A total of 102(32.7%) patients were on monotherapy whilerest 210(67.3%) were prescribed combination. Most commonly used preservative wasBenzalkonium chloride. Bimatoprost caused a significantly higher mean percent reduction in IOPthan Latanoprost and Travoprost, when compared to baseline values. The Bimatoprost had asignificantly higher percentage of adverse events compared to the Latanoprost, but no significantdifference found when compared to Travoprost. Conclusion:Travoprost was most frequentlyprescribed. Drugs containing preservative BAK were reported higher incidence of ocular sideeffects when compared to preservative free eye drops. Nearly half of the patients were adherent totheir antiglaucoma medications. Keywords: Adherence, Drug use pattern, Glaucoma Treatment Compliance Assessment Tool(GTCAT), NEI-VFQ-25, PG analogues, Quality of life

Ocular Biodistribution of Once-Daily 0.6% Bilastine Eye Drops Reveals Highest Levels in Conjunctiva Up to 24 h Postadministration.

Purpose: Bilastine is a second-generation antihistamine that has been shown to be effective for treatment of allergic conjunctivitis. The objective of this study was to evaluate the pharmacokinetics (PKs) and biodistribution of 0.6% bilastine preservative-free eye drops. Methods: Bilastine was quantified in the conjunctiva, cornea, aqueous humor, vitreous humor, iris/ciliary body, retina/choroid, crystalline lens, and plasma, following a single topical administration to male Dutch-belted rabbits. Results: Concentrations of bilastine were highest in the conjunctiva [Cmax: 2,545.04 ng/g, at 6 h postadministration; area under the concentration-time curve (AUCt): 11,382.40 ng·h/g] and cornea (Cmax: 609.11 ng/g, at 1 h postadministration; AUCt: 1,993.88 ng·h/g), followed by the iris/ciliary body, retina/choroid, aqueous humor, plasma, vitreous humor, and crystalline lens. Quantifiable bilastine concentrations were observed up to 24 h after instillation in the conjunctiva (388.45 ng/g), cornea (28.68 ng/g), iris/ciliary body (12.42 ng/g), retina/choroid (1.91 ng/g), and crystalline lens (0.12 ng/g). In plasma, aqueous humor, and vitreous humor, bilastine was detected up to 12 h postadministration (0.18 ng/mL, 0.40 ng/mL, and 0.32 ng/g, respectively). Conclusions: PKs and biodistribution of 0.6% bilastine eye drops in rabbits revealed a marked preferential distribution in the conjunctiva (target tissue), with sustained levels up to 24 h. These findings are consistent with clinical efficacy trials supporting once-daily administration of topical bilastine for treatment of allergic conjunctivitis.

Lacrimal gland injection of platelet rich plasma for treatment of severe dry eye: a comparative clinical study

BackgroundWe aimed to assess the efficacy of the injections of platelet rich plasma (PRP) for the treatment of severe dry eye disease (DED).ResultsIn this retrospecitve interventional clinincal study, we included 28 eyes of 14 patients with severe DED who were diagnosed with Sjogren syndrome. Each patient received unilateral lacrimal gland injection of PRP at days 0, 30, 60 and 90 days while the other eye served as control group who received preservative free eye drops. We objectively assessed parameters at baseline, 1 month, 2 months and 3 months including ocular surface analyzer (OSA) namely; noninvasive tear breakup times (NIBUT), tear meniscus height (TMH), lipid layer thickness (LLT) in addition to the Schirmer test I, corneal fluorescein staining (CFS) and meiboscore. The mean age was 43.4 ± .7.85 years. Comparing different parameters, baseline data showed non-significant difference between injected eye group and control group. After 1 and 3 months of follow up, there were significant differences between both groups regarding NITBUT, TMH, LLT, CFS and Schirmer test, with p < 0.001 in favor of PRP group.ConclusionInjection of PRP in lacrimal gland is simple, safe, and effective technique in treatment of severe dry eye; proved by improvement of tear film parameters through subjective and objective assessment. Further studies are needed to standardize the technique and to confirm these results.

"A Review of the Containers Available for Multi-Dose Preservative-Free Eye Drops"

Allison Campolo, Monica Crary* and Paul Shannon Author Affiliations Alcon Research, LLC, Fort Worth, USA Received: April 18, 2022 | Published: July 05, 2022 Corresponding author: Monica Crary, Alcon Research, LLC, Fort Worth, Texas, 6201 South Freeway, Fort Worth, USA DOI: 10.26717/BJSTR.2022.45.007130

An Evaluation of the Physicochemical Properties of Preservative-Free 0.005% (w/v) Latanoprost Ophthalmic Solutions, and the Impact on In Vitro Human Conjunctival Goblet Cell Survival.

Purpose: To examine the physicochemical properties of five preservative-free (PF) 0.005% latanoprost ophthalmic products; Monoprost®, Latanest®, Gaap Ofteno®, Xalmono®, and Xaloptic® Free. Furthermore, the study investigated the mucin production and cell survival of primary cultured human conjunctival goblet cells when treated with PF eye drops. Method: The pH value, osmolality, and surface tension were examined. Cell survival was analyzed using lactate dehydrogenase and tetrazolium dye colorimetric assays. Mucin production was analyzed with immunohistochemical staining. Results: Monoprost® (pH value 6.84 ± 0.032) had a pH value closest to the pH value of tear fluid (pH value 7.4–7.6), whereas Gaap Ofteno® (pH value 6.34 ± 0.004) and Latanest® (pH value 6.33 ± 0.003) had the lowest pH values. Gaap Ofteno® (325.9 ± 2.9 mosmol/kg) showed iso-osmolar probabilities, whereas the other products were hypo-osmolar. Gaap Ofteno® (60.31 ± 0.35 mN/m) had a higher surface tension compared to the tear fluid (40 to 46 mN/m), as described in the literature. No significant differences in goblet cell survival or mucin release were observed between the treatments and control. Conclusion: Significant differences in pH value, osmolality, and surface tension were observed. However, this did not affect the viability of the goblet cells or the release of mucin. Clinical studies are required to evaluate the long-term effects of use on efficacy and safety.

Microbial contamination of multiple-dose preservative-free hospital ophthalmic preparations in a tertiary care hospital

BackgroundIt is possible that preservative-free eye drops can be contaminated. The aim of this study was to assess the incidence of microbial contamination of preservative-free hospital-prepared anti-infective eye drops and investigate factors that contribute to contamination. This finding may help to raise awareness of this problem to medical healthcare staff and patients in order to prevent the transmission of microorganisms from eye drops to the patients through treatment of pre-existing eye diseases. MethodsTwo hundred and ninety-five eye drop bottles were collected from patients attending Rajavithi Hospital Ophthalmologic outpatient and inpatient department, including both those used by patients at home and those administered in the hospital by medical staff. Samples were taken from the tips of droppers and bottles, and the residual fluid inside the bottles was then cultivated onto different culture plates. The culture results were identified and analyzed according to various factors related to both individual users and the bottles. ResultsSeven different types of eye drops were collected and 71 (24.06%) of the 295 bottles were contaminated. Vancomycin eye drops were the most contaminated. Twenty-six different types of pathogens were identified, most frequently mold (42.98%), and the amount of contamination was higher in tips than in residual fluid inside the bottle. There was no statistically significant difference in contamination between patients used eye drops collected in outpatient units (32.14%) and medical staff used eye drops collected in inpatient settings (23.22%). The only factor that was statistically significant was the number of eye drops used per person. We found that samples from patients who used only up to 2 eye drops suffered contamination (42.8%) more than those from their counterparts who used at least 3 (22.18%), P ​= ​0.02. ConclusionsOf these preservative-free hospital preparations anti-infective eye drops, 24.06% were contaminated. The number of eye drops used per person was statistically significant in triggering contamination. There is a possibility of number of eyedrops use person may trigger contamination.

Effect of eyelid-warming device on meibomian gland dysfunction

Background Meibomian gland dysfunction (MGD) has a significant effect on patients’ quality of life. Despite the numerous treatment options, it is still difficult to obtain complete relief of signs and symptoms. Blephasteam is an eyelid-warming device that is easy to use and standardized for treatment of MGD. Objective This study aimed to evaluate of the effect of Blephasteam on MGD compared with the traditional warm compresses. Patients and methods This is a prospective comparative interventional study that included 40 eyes of 20 patients with MGD. Patients were subdivided into two groups: in group I, warm compresses were applied to the eyelids twice daily for 20–30 min for 2 weeks, whereas in group II, the patients used the Blephasteam device three sessions per week for 2 weeks. Both groups received treatment by systemic tetracycline, topical antibiotic and steroid, and preservative-free artificial tears eye drops for 2 weeks. The patients were assessed before treatment and after 2 weeks, 1 month, and 3 months using the Standard Patient Evaluation of dry Eye Disease questionnaire for dry eye, breakup time test (invasive and noninvasive; IBUT and NIBUT), and the shape of the lipid layer of the tear film by a tearscope. Results Both groups showed statistically significant improvement regarding the dry eye symptoms, IBUT and NIBUT, and the lipid layer interferometry. However, the follow-up visits showed statistically significant better results in group II than in group I for the Standard Patient Evaluation of dry Eye Disease questionnaire (P=0.044, 0.001, and 0.001, respectively). In addition, the IBUT was statistically significantly better in group II than in group I during the follow-up (P=0.014, 0.007, and 0.002, respectively) as well as the NIBUT (P=0.043, P<0.001, and P<0.001, respectively). There was no statistically significant difference in interferometry between the two groups during the follow-up. Conclusions Both traditional warm compress and Blephasteam were effective in MGD treatment, but Blephasteam was more effective.

Impact of Hypotonizing Treatment in Patients with Glaucoma on the Ocular Surface: About 52 Patients

Ocular surface disease (OSD) and glaucoma are common comorbidities in the same patient. Thus, the long-term instillation of topical intraocular pressure lowering drops induces changes in the ocular surface. For this, we have realized a cross-sectional study of 52 patients, collected at the ophthalmology department of the Hassan II University Hospital Center at Fez, Morocco. We have included all patients with glaucoma or ocular hypertonia on hypotonizing treatment for at least 06 months. They have answered the Ocular Surface Disease Index (OSDI) after their consent. All patients have been then examined with a slit lamp by the same ophthalmologist to assess the severity of the OSD. A total of 101 eyes from 52 patients were analyzed. Thirty-six (69%) patients treated with hypotonizing eye drops required multitherapy. Only nine (17%) patients were on preservative-free eye drops. The average OSDI score was 32.4/100 (0—82.5). According to clinical classification, 27 (52%) patients had severe OSD. This study confirms the high frequency of the OSD in patients medically treated for glaucoma or ocular hypertonia. Damage on the ocular surface is responsible for disabling symptoms that can affect both the quality of life of patients and adherence to the treatment. Thus, any ophthalmologist should systematically include the evaluation of the ocular surface in glaucomatous patients.

Management of Post-LASIK Dry Eye with Intense Pulsed Light in Combination with 0.1% Sodium Hyaluronate and Heated Eye Mask.

IntroductionLaser in situ keratomelieusis (LASIK) is one of the most frequently performed refractive treatments. Dry eye (DE) is common in patients after LASIK and can be bothersome postoperatively. Therapies such as intense pulsed light (IPL), sodium hyaluronate (SH) and heated eye mask (HEM) have been reported to improve signs and symptoms of DE .AimThe purpose of this prospective study was to evaluate and compare the effects of IPL and 0.1% SH (IPL group, 50 eyes) and IPL in combination with 0.1% SH and HEM (IPL + group, 50 eyes) in participants with persistent post-LASIK DE.MethodsThe final analysis included 100 patients (100 eyes) who had LASIK for myopic correction and had been experiencing moderate to severe DE following LASIK for over a year. Participants were randomly assigned to either the IPL group (2 IPL sessions) or IPL + group (2 IPL sessions and daily HEM for 4 weeks), and both groups continued the use of daily 0.1% SH (HYLO-COMOD®) preservative-free eye drops. Non-invasive tear break-up time (NITBUT), tear film lipid layer (TFLL), lower tear meniscus height (LTMH), meibomian gland quality (MGQ), meibomian gland expressibility (MGEx), corneal fluorescein staining (CFS), ocular surface disease index (OSDI) and artificial tear usage (ATU) survey were assessed at baseline (BL) and follow-up at 2 (F1) and 4 weeks (F2).ResultsFollowing the treatment protocol, all dry eye (DE) parameters assessed in this study improved significantly (P < 0.05) in both groups at F2 compared with their respective BL measurements. Inter-group comparison at F2 found significant differences in their NITBUT (IPL: 6.06 ± 0.59 vs. IPL +: 6.67 ± 0.86, P < 0.001), TFLL (IPL: 1.90 ± 0.65 vs. IPL +: 1.60 ± 0.64, P = 0.021), LTMH (IPL: 0.186 ± 0.053 vs. 0.204 ± 0.034, P = 0.003), MGQ (IPL: 1.48 ± 0.54 vs. IPL +: 1.26 ± 0.56, P = 0.026), MGEx (IPL: 1.62 ± 0.53 vs. IPL +: 1.44 ± 0.50, P = 0.038) and OSDI (IPL: 32.54 ± 6.85 vs. IPL +: 29.76 ± 4.74, P = 0.001), while CFS score (IPL: 4.02 ± 0.65 vs. IPL +: 3.96 ± 0.73, P = 0.652) and ATU (IPL: 1.88 ± 0.63 vs. IPL +: 1.72 ± 0.50, P = 0.159) showed no significant difference.ConclusionPost-LASIK DE signs and symptoms can be improved by combining therapies such as IPL, HEM and 0.1% SH. Increased TFLL due to a combination of IPL, 0.1% SH and HEM had a greater positive impact on the subjective and objective DE measurements in participants with persistent post-LASIK DE.

Ocular Toxicity of Commercially Available Belantamab Mafodotin in Patients with Advanced Multiple Myeloma

Ocular Toxicity of Commercially Available Belantamab Mafodotin in Patients with Advanced Multiple Myeloma

Комплексное лечение синдрома сухого глаза у пациентов с синдромом Шегрена путем применения препарата бесконсервантных капель, содержащих гиалуронат натрия 0,4 % и комплекса нутрицевтиков

The aim. To increase the effectiveness of treatment of dry eye syndrome in patients with Sjogren’s syndrome with preservative-free drops which contain 0.4 % sodium hyaluronate and nutraceutical complexes nutraceuticals. Materials and methods. The study was conducted on the basis of the Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine. The study included 64 patients aged 34 to 58 years (128 eyes) with dry eye syndrome accompanied by Sjogren’s syndrome. Examination of patients included: assessment of complaints, visometry, refractometry, bacterial culture of the conjunctiva and nasopharynx, biomicroscopy, ophthalmoscopy, Schirmer and Norn tests, assessment of "comfort of application of drops" on the questionnaire. This study is an extension of the study previously conducted at the premises of the Filatov Institute of Eye Diseases and Tissue Therapy of The National Academy of Medical Sciences of Ukraine on the effectiveness of preservative-free eye drops containing 0.4 % hyaluronic acid in the treatment of Sjogren’s syndrome. Results. Prior to the appointment of comprehensive treatment with instillations, the Norn test showed 6.55 s (SD 1.57) with a minimum of 3 s, a maximum of 9 s, and a median of 6.5 s. After 3 months of treatment the Norn test score in the 1st group averaged 14.66 (SD 1.07) vs. 13.86 (SD 1.07) in the 2nd group, but the difference was not statistically significant (p=1.0). The mean number of required instillations per day was 4.1 (SD 1.04) in the 1st group and 5.27 (SD 1.11) in the 2nd group. Conclusion. Instillations of preservative-free drops containing sodium hyaluronate 0.4 % (in a bottle with an innovative ophthalmic squeeze dispenser (OSD)) in combination with a nutraceutical complex in the treatment of dry eye syndrome in patients with Sjogren’s syndrome is effective and allows achieving a stable and long-term effect. Keywords: Sjogren’s syndrome, hyaluronic acid, nutraceuticals, artificial tear, Schirmer test, Norn test, dry eye syndrome, tear film.

Improving Adherence to Topical Medication in Patients with Glaucoma.

The glaucomas form a heterogenous group of conditions, which collectively account for one of the most common irreversible causes of blindness worldwide. The only treatment, for which there is evidence, to stop or slow glaucomatous disease progression is to lower intraocular pressure (IOP); this is most often initially achieved with topical medication. Adherence to anti-glaucoma therapy is known to be low even when compared with adherence to therapy for other chronic conditions. We performed a PubMed search to review evidence as to how adherence to and persistence with anti-glaucoma medications might be improved. Approaches to improving adherence include technological (such as using smart drop bottles or automated reminders) use of instillation aids, improving communication with patient education and improving tolerability of eye drop formulations. There is limited short-term evidence that automated reminders can be effective and, unfortunately, instillation aids have not proved to be efficacious with respect to improving adherence. A range of factors have been identified which affect adherence and persistence, although only a multi-faceted approach has proven evidence of efficacy, compared to improved patient education alone. There is now a wider range of available preservative-free eye drops, which have been shown to be non-inferior in achieving IOP control, with fewer side effects and improved short-term adherence. Further studies relating to adherence are warranted, particularly given the projected increase in glaucoma prevalence worldwide.

A multicentric study of pharmacological treatment for presbyopia.

To evaluate the safety, efficacy, and patient satisfaction with a pharmacological treatment of presbyopia performed with the Benozzi's method. A non-randomized multicentric case-series retrospective study was developed. Were included patients from 5 centers of Argentina, from January 2010 to June 2019, aged at baseline between 40 and 60 years old, with binocular uncorrected distance visual acuity (UDVA) of 25/20 or better, and with uncorrected near visual acuity (UNVA) at least Jaeger (J) 2 or worse. The treatment was performed with a patented formulation (pilocarpine and diclofenac preservative-free eye drops). The main outcome was binocular UNVA and UDVA. Differences were evaluated by paired t-test. The presence of side effects and patient's satisfaction were also evaluated. Data was analyzed in separated groups according to their follow-up time, from 2 to 10 years. A total of 148 patients were included. At baseline, the UNVA for the different groups were between J3 and J8 which was improved to J1 to J2. The mean baseline UDVA has been ranged between 0.02 and 0.04 logMAR. The mean baseline UDVA has been ranged between 0.02 to 0.04 logMAR, after treatment were between 0.01 to 0.03, without a statisticallysignificant improvement. Side effects were spontaneously resolved, and subjective evaluation shows that patients were satisfied. This first multicentric shows that Benozzi's method for presbyopia treatment was safety and improves the UNVA without affecting the UDVA, maintaining their efficacy even after 10 years, in a population aged between 40 and 60 years old, from different ophthalmic centers in Argentina.

Preservative-free versus preserved latanoprost eye drops for reducing intraocular pressure: a non-inferiority phase III randomized, multi-center, single-blind, parallel-group controlled trial

Background: The aim of this study was to test the non-inferiority of preservative-free (PF) latanoprost 50 μg/mL multi-dose ophthalmic solution versus the marketed benzalkonium chloride (BAK)-preserved latanoprost 50 μg/mL ophthalmic solution in patients with open-angle glaucoma and patients with ocular hypertension.&#x0D; Methods: This was a prospective, national, randomized, multi-center, observer-blind, parallel-group controlled clinical trial. Patients were randomized to receive either PF or BAK-preserved latanoprost once daily for 12 weeks. The primary endpoint was the change in intraocular pressure (IOP) at 8:00 AM in the affected eye between the end of the treatment (week 12) and the baseline (week 0). Secondary measurements were taken at weeks 2 and 6, with IOP being recorded at 8:00 AM, 12:00 PM, and 4:00 PM.&#x0D; Results: A total of 158 patients were included in the per protocol (PP) population (77 in the PF latanoprost treatment arm and 81 patients in the BAK-preserved latanoprost treatment arm). PF latanoprost was non-inferior to BAK-preserved latanoprost in reducing IOP at 8:00 AM in the study eye from the baseline (week 0) to the end of the treatment (week 12). The point estimate of the between-treatment difference was 0.1 mmHg (95% confidence interval: -0.646, 0.847). Mean between-group differences in IOP reduction from the baseline to each of the secondary measurements were also similar between the two treatment arms. The two treatments were well tolerated and had comparable adverse event profiles.&#x0D; Conclusions: PF latanoprost was non-inferior to BAK-preserved latanoprost in reducing IOP in patients with open-angle glaucoma or ocular hypertension. Both treatments were well tolerated.

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.

Autologous serum eye drops versus lacrimal gland injection of platelet-rich plasma for severe dry eye

Aim The aim of this study was to evaluate the use of autologous serum (AS) eye drops versus lacrimal gland injection of platelet-rich plasma (PRP) in the treatment of severe dry-eye disease (DED).Setting and design This is a prospective comparative interventional study that was carried out at Eye Tech Centre, Alexandria, Egypt.Patients and methods The study included 40 eyes of 20 patients with severe DED. They were randomized into two groups: group A received lacrimal gland injection of PRP transcutaneously into the external one-third of the orbital rim at a depth of 4 mm to the superior area on days 0, 30, 60, and 90, while group B received AS eye drops five times daily for the duration of the study. Both groups received preservative-free artificial tears eye drops (hyaluronic acid) —three to five times daily for the study duration. The patients were followed up for 12 weeks after the first injection or the initiation of AS eye drops for the subjective changes in symptoms and in ocular surface parameters.Results The patients’ age ranged from 46 to 71 years (mean=56.0±8.2 years). Both groups showed a significant improvement of dry-eye symptoms (P<0.05) using the Ocular Surface Disease Index scoring with group B having more significant improvement of symptoms compared with group A patients after 3 months of follow-up (P<0.05). Schirmer’s test I showed a statistically significant improvement in both groups over the follow-up period (P<0.05), with no statistically significant difference between the two groups after 3 months (P>0.05). The other ocular surface parameters, using the ocular surface analyzer, including the noninvasive tear breakup time, tear-meniscus height, and lipid-layer thickness, showed significant improvement in both groups (P<0.001), while the meibomian gland loss area showed no statistically significant change throughout the follow-up period, with no statistically significant difference between the two groups after 3 months (P>0.05).Conclusions Both AS and lacrimal gland injection of PRP proved the safety and efficacy in the treatment of severe DED and were comparable. More studies are needed to confirm these results.

Presbyopia Treatment With Eye Drops: An Eight Year Retrospective Study.

PurposeThe purpose of this study was to evaluate the safety and efficacy across time, of patients topically treated with Benozzi's method for presbyopia.MethodsA nonrandomized case series retrospective study was developed, including patients with emmetropia with binocular uncorrected distance visual acuity (UDVA) of 25/20 or better, and with uncorrected near visual acuity (UNVA) at least Jaeger 2 or worse. The study was set in Buenos Aires, Argentina, from January 2011 to June 2018, with at least 1-year follow-up. Patients were treated with pilocarpine and diclofenac preservative-free eye drops (Benozzi Method; US 8.524.758 B2, EP1.938.839 B1), and the main outcome measured was binocular UNVA at different follow-up times. Other parameters, as the UDVA and presence of side effects, were evaluated.ResultsA total of 910 patients were included with a mean age at baseline of 48.67 ± 3.72 years old (range, 40–59 years). The baseline UNVA was 4.74 ± 1.53 and at 8 years of follow-up was decreased to 1.36 ± 0.48 (Jaeger scale). The mean binocular UDVA at baseline was 0.00 ± 0.01 logarithm of the minimum angle of resolution (logMAR) and after 8 years of follow-up was 0.03 ± 0.04 logMAR. All side effects reported (decrease of light perception, headaches, symptoms of ocular surface dryness, and dizziness) were spontaneously resolved in patients who continued with the treatment.ConclusionsThe efficacy of the pharmacological treatment of presbyopia to improve the UNVA without affecting the UDVA is shown. Side effects were well tolerated and resolved before 1 year of treatment.Translational RelevanceThis is a nonsurgical option for patients with emmetropic presbyopia who do not wish to wear glasses, which is a pharmacological treatment with eye drops.

Preoperative management of subconjunctival/sub-Tenon's glaucoma surgery with special consideration of the gel implant (XEN®)

When using subconjunctival/sub-Tenon's ab interno glaucoma surgical procedures, patient selection and preoperative management are essential to reduce postoperative scarring of the bleb. The aim of this study was to compile alist of risk factors that may have an unfavorable effect on the scarring process. A literature search was carried out in PubMed with respect to the scarring process of the gel implant XEN®. Ophthalmological risk factors for conjunctivoscleral/Tenon's wound healing process include dry eye, allergies, use of eye drops containing preservatives and previous eye surgery. The preoperative administration of artificial tear substitutes, corticosteroids and the fundamental change to preservative-free eye drops can support the normalization of achronic inflammatory altered conjunctiva and thus positively influence the wound healing process after surgery.

Corneal damage and its recovery after instillation of preservative-free versus preserved latanoprost eye drops

Purpose: Latanoprost ophthalmic solution is highly effective as a therapeutic agent for glaucoma and is applied worldwide. However, harmful effects on the corneal surface have been reported regarding the commercially available latanoprost ophthalmic solution. Corneal surface toxicity may be caused by the added preservative of the ophthalmic solution. In order to ascertain whether latanoprost itself can damage the cornea or if this is solely due to the added preservatives, this study attempted to determine the corneal changes that occur at different time periods following usage of preservative-free versus preserved latanoprost eye drops.Materials and methods: Preservative-free latanoprost eye drops (Monoprost®) or preserved latanoprost eye drops (Xalatan®) containing 0.02% benzalkonium chloride (BAC) were instilled in the corneas of rabbits. For each of the two different eye drop solutions, the rabbits used in this experiment were divided into three exposure groups: 1 minute, 24 hour, and 1 week groups. Corneal transepithelial electrical resistance (TER) and scanning electron microscopy (SEM) were examined immediately (1 minute) after instillation, at 24 hours after instillation, and at 24 hours after 1 week of daily instillations of latanoprost. Hank’s balanced salt solution was used in the control group.Results: The mean corneal TER of the control group was 933.8 ± 279.0 Ω cm2. In preservative-free latanoprost instilled corneas, there was no significant decrease in the TER or morphological changes at any of the time points, with the relative TER values of 117 ± 38%, 100 ± 34%, and 93 ± 21% for 1 minute, 1 day, and 1 week time points, respectively. In preserved latanoprost instilled corneas, SEM showed that only the immediate group exhibited superficial cell damage and a significant decrease in the corneal TER compared to the controls and other time points and to the immediate preservative-free latanoprost corneas. In the preserved latanoprost groups, the relative TER values were 18 ± 5%, 110 ± 28%, and 92 ± 10%, for the three respective observation time points.Conclusions: Preservative-free latanoprost can be safely instilled to the corneal epithelium. Latanoprost with 0.02% BAC has an immediate deleterious impact on the corneal epithelium; however, it disappears within 24 hours after instillation.