Sodium Hyaluronate Eye Drops Research Articles

Influence of Sodium Hyaluronate Concentration on Corneal Aberrations in Soft Contact Lens Wearers.

PurposeThis study aimed to evaluate the influence of varying concentrations of sodium hyaluronate (SH) eye drops on corneal aberrations in normal individuals wearing silicone hydrogel contact lenses.MethodsNormal individuals wearing silicone hydrogel contact lenses were enrolled in this study. Subjects were classified into two groups depending on the concentration of the preservative-free SH used (group 1, 0.1% SH; group 2, 0.3% SH). All subjects were asked to blink five times after instillation of the SH eye drop and before the Galilei measurements. Corneal aberrations were measured over the contact lenses before and after SH eye drop instillation. Visual acuity (VA) over the contact lenses was also measured both before instillation of the SH eye drop and after the subjects completed the five blinks.ResultsThere was no change in VA after SH instillation in group 1; however, group 2's VA significantly deteriorated after SH instillation. Changes in VA after SH instillation compared to baseline were significantly higher in group 2 than in group 1. Similarly, the increase in corneal aberrations after SH instillation was significant in group 2 but not significant in group 1. Among the significantly increased corneal aberration parameters, defocus was the main type in group 2. Changes in corneal aberrations after SH instillation compared to baseline were significantly higher in group 2 than in group 1.ConclusionsA 0.3%-concentration of SH increases corneal aberration and decreases VA in soft contact lens wearers. Defocus is the main type of aberration that increased in the 0.3% SH instillation group.

Clinical analysis of diclofenac sodium eye drops combined with sodium hyaluronate eye drops for dry eye after ophthalmic surgery

Clinical analysis of diclofenac sodium eye drops combined with sodium hyaluronate eye drops for dry eye after ophthalmic surgery

Efficacy of Sodium Hyaluronate in Murine Diabetic Ocular Surface Diseases.

To evaluate the efficacy of sodium hyaluronate (HA) eye drops for the treatment of diabetic ocular surface diseases in mice. Male 6- to 8-week-old C57BL/6 mice underwent induction of type 1 diabetes with intraperitoneal injections of streptozotocin, with normal mice as the control. Topical 0.3% HA, 0.1% HA, 0.4% polyethylene glycol eye drops, and normal saline were administered to diabetic mice with an intact or debrided corneal epithelium. Normal saline was applied in the controls. Corneal epithelial wound healing rate, corneal sensation, nerve fiber density, conjunctival goblet cell number, and MUC-5AC content were measured and compared. Compared with the controls, topical 0.3% HA use in diabetic mice showed significant improvements in the corneal epithelial wound healing rate (48 hours: 91.5% ± 4.8% vs. 79.8% ± 6.1%; P < 0.05), corneal sensitivity (4.1 ± 0.3 cm vs. 3.5 ± 0.3 cm; P < 0.05), nerve fiber density (12.9% ± 2.3% vs. 6.6% ± 2.4%; P < 0.05), conjunctival goblet cell number (31.0 ± 8.4/100 μm vs. 19.6 ± 7.1/100 μm; P < 0.05), and MUC-5AC content (12.5 ± 1.4 ng/mg vs. 7.8 ± 1.5 ng/mg protein; P < 0.05). The beneficial effects of 0.3% HA were better than those of 0.1% HA and 0.4% polyethylene glycol. Topical 0.3% HA treatment promoted corneal epithelial regeneration, improved corneal sensation, and increased density of corneal nerve fibers and conjunctival goblet cells in mice with diabetic ocular surface diseases.

Analysis of treatment results in dry eye syndrome patients after phacoemulsification by preservative-free 0.3% sodium hyaluronate eye drops

Postsurgical dry eye syndrome is found in a substantial proportion of patients after phacoemulsification. Its onset could be explained by surgical trauma and by use of preservative-containing eye drops. In some patients, it causes substantial discomfort that continues unabated after 3-4 weeks after surgery.&#x0D; Purpose. To investigate the results of 0.3% sodium hyaluronate instillation therapy used to treat dry eye syndrome after phacoemulsification.&#x0D; Materials and methods. Basal tear secretion (Schirmer II test) and tear breakup time (TBUT) test were investigated in 33 patients with symptoms characteristic of dry eye syndrome in 1 month after phacoemulsification. These patients received 0.3% preservative-free sodium hyaluronate instillations for 30 days, whereupon Schirmer II and TBUT tests were repeated. Symptom dynamics was estimated according to the OSDI questionnaire scale.&#x0D; Results. Mean values of basal tear secretion and TBUT tests were slightly below normal ones. In one month of treatment, the TBUT index associated with Gilan Ultra Comfort use became somewhat better: mean TBUT value appeared to be 9.8 2.5 sec. OSDI questionnaire patient symptom score evaluation also revealed in patients a mild degree of xerosis severity. Mean score before treatment was 19.6 10.0. Positive disease dynamics after Gilan Ultra Comfort use is confirmed by a significant decrease of OSDI score index up to 12.3 6.3.

Comparison of 0.3% Hypotonic and Isotonic Sodium Hyaluronate Eye Drops in the Treatment of Experimental Dry Eye

ABSTRACTPurpose: To compare the efficacy of 0.3% hypotonic and isotonic sodium hyaluronate (SH) eye drops in the treatment of experimental dry eye.Methods: Experimental dry eye was established in female C57BL/6 mice by subcutaneous scopolamine injection and an air draft. The mice were divided into three groups (n = 15): control, preservative-free 0.3% isotonic SH, and preservative-free 0.3% hypotonic SH. The tear volume, tear film break-up time, and corneal fluorescein staining scores were measured 5 and 10 days after treatment. After conjunctival tissues were excised at 10 days, the levels of interleukin (IL)-6, IL-17, interferon (IFN)-γ, and IFN-γ inducible protein-10 were determined using the multiplex immunobead assay. In addition, PAS staining and flow cytometry were performed to evaluate the counts of conjunctival goblet cells and CD4+ IFN-γ+ T cells.Results: Mice treated with 0.3% hypotonic SH showed a significant decrease in corneal staining scores (P = 0.04) and the levels of IL-6 (16.7 ± 1.4 pg/mL, P = 0.02) and IFN-γ (46.5 ± 11.5 pg/mL, P = 0.02) compared to mice treated with 0.3% isotonic SH (IL-6; 32.5 ± 8.8 pg/mL, IFN-γ; 92.0 ± 16.0 pg/mL) at day 10. Although no significant difference in CD4+ IFN-γ+ T cell numbers was observed, goblet cell counts were higher in the hyopotonic SH group than in the isotonic SH group (P = 0.02).Conclusions: When compared to 0.3% isotonic SH eye drops, 0.3% hypotonic SH eye drops can be more effective by improving corneal staining scores, decreasing inflammatory molecules, and increasing goblet cell counts for experimental dry eye. These data suggest that hypotonic artificial tears may be useful as an adjunctive treatment for inflammatory dry eye.

Research on the efficacy of different concentrations of sodium hyaluronate for the treatments of ocular surface acid burns

Objective To observe the efficacy of different concentrations of sodium hyaluronate for the treatments of ocular surface acid burns. Methods The records of 90 eyes of 82 patients, which suffered from Ⅰ-Ⅱ degree ocular acid burn were analyzed restrospectively.All cases treated with different concentrations of sodium hyaluronate eye drops and were divided into two groups randomly.The concentration of sodium hyaluronate was 0.1% in group A (49 eyes) and 0.3% in group B (41 eyes). And the tear film break up time and repair time of corneal epithelium were compared between two groups. Results The tear film break up time after surgery was (3.1±1.8)s in group A and (5.4±1.9)s in group B. The repair time of corneal epithelium in group A and group B were (4.0±1.6)d and(2.6±1.2)d respectively.The difference in the corneal epithelium repair time and tear film break up time were statistically significant(P=0.001). Conclusion High concentrations of sodium hyaluronate eye drops (0.3%) are better than the low concentration of the same eyedrop in promoting cornea and conjunctiva repair. Key words: Acid burn, ocular surface; Repair time, epithelium, cornea; Eye drops, sodium hyaluronate

A Two-Week, Randomized, Double-masked Study to Evaluate Safety and Efficacy of Lubricin (150 μg/mL) Eye Drops Versus Sodium Hyaluronate (HA) 0.18% Eye Drops (Vismed®) in Patients with Moderate Dry Eye Disease

PurposeThe objective of this clinical trial (NCT02507934) was to assess the efficacy and safety of recombinant human lubricin as compared to a 0.18% sodium hyaluronate (HA) eye drop in subjects with moderate dry eye disease (DED). MethodsDEWS Grade 2-3 subjects were randomized to use lubricin (N=19, 51.9 ± 11.8 years) or HA (N=20, 61.8 ± 13.3 years). After a saline washout period, subjects administered BID therapy for 7 days, followed by instillation as needed (2–6 drops per eye) for 7 days. Visual analog scale (VAS) including foreign body sensation, burning/stinging, itching, pain, sticky feeling, blurred vision and photophobia were primary outcomes, with secondary endpoints of corneal fluorescein staining, Schirmer test, tear film breakup time (TFBUT), eyelid and conjunctival erythema and number of instillations compared at day 14. ResultsThe primary endpoint was met. Lubricin supplementation achieved greater than a 72% reduction from baseline in foreign body sensation (P<.013), burning/stinging, pain, sticky feeling (P<.0432), blurred vision (P<.0013), and photophobia (P<.011) in at least one eye. Lubricin also showed significant improvement in fluorescein staining (OD/OS: 43.8%/50.0%, vs. 26.5%/23.3%, P<.0398, P<.0232), TFBUT (P<.010), SANDE frequency (P<.0435), eyelid erythema (P<.004), conjunctival erythema (P<.0013), and instillations (P<.04) as compared to HA. No treatment-related adverse events occurred during the investigation. ConclusionsRecombinant human lubricin was shown to produce significant improvement in both signs and symptoms of dry eye disease as compared to HA.

Investigation on the effects of eye drops of 0.3% hyaluronate sodium on ocular surface of after pterygium surgery

Objective To evaluate the the effects of 0.3% hyaluronate sodium eye drops on ocular surface of pterygium patients after limbal conjunctival autograft transplantation. Methods Prospective, double-blind, randomized, controlled clinical trial. Sixty eyes of 60 patients diagnosed as primary pterygium were randomly divided into two groups with 30 eyes in each group. All received pterygium resection combined with limbal conjunctival autograft transplantation by the same doctor. After operation, patients in the control group were given 0.5% levofloxacin, 0.1% fluorometholone eye drops 4 times a day. For that in treatment group, 0.3% sodium hyaluronate eye drops were added 1 day postoperatively, four times a day for 1 month. The follow-up time was 1 month. The healing of epithelium, the scores of clinical symptoms, corneal sensation, non-invasive breakup time of tear film (BUT), non-invasive tear meniscus height (TMH), and confocal microscopy examination were done and recorded. Results The scores of clinical symptoms at the 2, 3, 7 days after the surgery were lower in the treatment group than that in the control group(P 0.05). At day 2, the eyes with intact epithelium in treatment group was 17(57%), compared with control group only 9(30%)(χ2=4.344, P=0.037). TMH & BUT: at 14 and 28 days postoperatively, the TMH in the treatment group were higher than that in the control group(P 0.05). Corneal sensation: at each time point, there was no statistically significant difference between two groups(P>0.05). Confocal microscopy: at 7 days postoperatively, the epithelia of the pterygium resection area were assembled tightly without edema or inflammation cells infiltration in the treatment group; however, in the control group, some of the epithelial cells were swollen with inflammation cells infiltration. The corneal epithelial cells density was higher in the treatment group compared with the control group(P<0.05). Conclusion 0.3% hyaluronate sodium eye drops promote the healing of corneal epithelium, and significantly reduce the perioperative pain. Continual using 0.3% hyaluronate sodium eye drops could increase the TMH. Key words: Pterygium; Excision; Eye drops, hyaluronate sodium; Wound healing

Sodium hyaluronate’s effect on xerophthalmia: a meta-analysis of randomized controlled trials

Background and aims:Several studies in the past have attempted to demonstrate the efficacy of sodium hyaluronate in the treatment of xerophthalmia. However, results have been conflicting and a definite conclusion has not yet been reached. In order to provide integrated evidence for the effectiveness of sodium hyaluronate and to judge the methodological value of relevant randomized controlled trials (RCTs) in nearly thirty years, we conducted this meta-analysis.Methods:A range of electronic databases were searched: MEDLINE, the Cochrane Library Database, EMBASE, CINAHL, Web of Science and the Chinese Biomedical Database (CBM) without language restrictions. Two independent reviewers assessed trials for eligibility and quality, and meta-analysis was performed using the STATA 12.0 software. An integrated odds ratio (OR) with its corresponding 95% confidence interval (95% CI) was calculated.Results:Six RCTs were included with a total of 839 xerophthalmia patients. The meta-analysis results revealed that patients with xerophthalmia who received the intervention of sodium hyaluronate eye drops didn’t have significantly higher remission rate of dry eye symptoms than those in controlled groups (OR = 1.811, 95% CI = 0.741–4.429, p = 0.193). Sensitivity analysis suggested that the statistical results were robust. No publication bias was detected in this meta-analysis (p > 0.05).Conclusion:Although sodium hyaluronate can be used to help relieve the symptoms of dry eyes, present evidence cannot show in unequivocal terms that patients with xerophthalmia can benefit more from the clinical application of sodium hyaluronate than other eye drops or therapies.

Treatment with sodium hyaluronate eye drops in a patient who had early-onset bleb leakage after trabeculectomy with mitomycin C

We present the case of a 47-year-old man who had bilateral proliferative diabetic retinopathy and neovascular glaucoma. Schirmer I test revealed tear secretions of 5 mm and 3 mm in the right and left eyes, respectively. Tear breakup times in the right and left eyes were 7 and 8 seconds, respectively. The ocular surface staining in both eyes was scored as Grade 1 as per the Oxford scheme. Retinal photocoagulation was performed for correction of the proliferative diabetic retinopathy and rubeosis iridis, which resolved with treatment. However, the intraocular pressure in the left eye could not be adequately controlled. Therefore, trabeculectomy with mitomycin C using limbal-based conjunctival flap was performed. Three hours after the surgery, the patient developed a large and diffuse filtering bleb, but no leakage occurred from the conjunctival scar. However, on the first postoperative day, leakage was noted and the conjunctiva was at the leakage point. The leakage resolved transiently, but recurred the next day. Severe keratoconjunctival epithelial failure was detected, and the patient was administrated 0.1% sodium hyaluronate eye drops six times daily. The epithelial failure improved, and many microcysts were detected on the bleb surface where the epithelial failure improved. The leakage resolved 2 days after initiation of the sodium hyaluronate eye drops. The microcysts disappeared and the bleb surface became smooth 1 month later.

Clinical effect of pranoprofen eye drops for mild and moderate dry eye–a multicenter, randomized, controlled clinical trial

Background Nonsteroidal anti-inflammatory drugs are widely used in the treatment of dry eye, but the related multicenter clinical study is lack. Objective This study aimed to evaluate the clinic efficacy of pranoprofen eye drops for dry eye. Methods This study protocol followed the Declaration of Helsinki, and oral informed consent was obtained from each patient prior to entering the cohort. A randomized, open, parallel, controlled, multi-center clinical trial was conducted. Total 1 023 patients with dry eye were enrolled based on the same diagnosis criteria in 58 eye institutes of China from July 2011 to July 2012. The patients was randomized into trial group and control group. The combination of 0. 1% pranoprofe dry drops (4 times per day) with 0. 1% sodium hyaluronate eye drops (4 times per day) was used in the trial group, and only 0. 1% sodium hyaluronate eye drops was used in the same way in the control group. The primary evaluated indexes included corneal fluorescence staining scores and break-up time of tear film (BUT), and secondary outcome measurements were the dry eye symptom scores and palpebral conjunctiva congestion and papilla scores as well as Shirmer Ⅰ test (SⅠt). The best corrected visual acuity (BCVA) and adverse response were compared between the two groups. Results The demography was matched between the two groups (both at P>0. 05). The corneal fluorescence staining scores were 0. 76±0. 66 and 0. 35±0. 54 in 14 days and 28 days after treatment in the trial group, which were lower than 1. 41±0. 58 before treatment (t=24. 439, 37. 236, both at P=0. 000); those in the control group were 0. 84±0. 65 and 0. 45±0. 60 in 14 and 28 days after treatment, with significant reduce in comparison with before treatment (1. 41±0. 62) (t=19. 702, 29. 517, both at P=0. 000). The corneal fluorescence staining score was significantly lower in the trial group compared with the control group in 28 days after treatment (t=8. 384, P=0. 004). The BUT was significantly delayed in 14 and 28 days after treatment compared with before treatment in the trial group (4. 88±2. 40)seconds and (6. 03±3. 25) seconds versus (3. 47±2. 10) seconds (t=-13. 358, -17. 734, both at P=0. 000), and so were the control group ([4. 62±2. 21] seconds and [5. 42±2. 70] seconds versus [3. 50±1. 52] seconds [t=-13. 984, t=-17. 879, both at P=0. 000]). The BUT was longer in the trial group compared with the control group in 28 days after treatment (t=10. 483, P=0. 001). In addition, the scores of dry eye symptom, palpebral conjunctiva congestion and papilla were significantly lower in the trial group than those in the control group in post-treated 14 and 28 days (all at P 0. 05). Conclusions Pranoprofen has a better anti-inflammatory effect on dry eye. The combination of 0. 1% pranoprofe dry drops with 0. 1% sodium hyaluronate eye drops can relieve dry eye symptoms and signs very well, especially in mild and moderate dry eye patients. Key words: Dry eye; Non-steroidal anti-inflammatory drugs; Pranoprofen; Inflammation

Observation and nursing strategy of side effects for children wearing Ortho-K contact lens

Objective To summarize the observation and nursing strategy of side effects for children wearing Ortho-K contact lens in order to improve the effects of treatment and reduce side effects. Methods A total of 1 066 myopic children wearing Ortho-K CL, who could recheck on time in Beijing Children′s Hospital from May 2013 to June 2014 were included. The reason of dyed cornea, dislocation, and discomfortable were analyzed, and corresponding nursing and healthy propaganda were performed. Results Among 1 066 children, 350 children (32.8%) wearing Ortho-K CL had epithelial dyed cornea after 6 months, and most of them appeared 1 month after wearing the lens. It would disappear after the treatment by levofloxacin eye drops, sodium hyaluronate eye drops and recombinant bovine basic fibroblast growth factor gel, stopping using the Ortho-K contact lens and providing healthy progaganda after 1 week. A total of 170 children (16%) wearing Ortho-K CL had dislocation, in which 2 children slipped into conjunctival sac and it was taken out under guidance of nurse by parents. A total of 128 children (12%) suffered from diplopia after wearing the lens, and 234 children(22%) wearing Ortho-K CL had discomfortable feeling. No children had irreversible impairment and ocular infection. Conclusions According to the reason of side effects, appropriate nursing strategy and healthy propaganda can improve the success rate of Ortho-K contact lens, prolong their service time, contribute treatment effectiveness, and reduce its side effects. Key words: Children; Ortho-K contact lens; Side effects; Nursing

A Case of Toxic Keratitis due to Chronic Use of Sodium Hyaluronate Eyedrops

Purpose: To report a case of toxic keratitis due to chronic use of sodium hyaluronate eyedrops. Case summary: A 74-year-old female visited our clinic with severe ocular pain and decreased vision in both eyes. She had received refractive surgeries in both eyes 10 years prior. She had been using sodium hyaluronate eyedrops for the treatment of dry eye symptoms for 10 years. Slit-lamp examination revealed inferior punctate erosions in the inferior part of the cornea in both eyes. With her history of chronic use of sodium hyaluronate and after ophthalmologic examination, we suspected keratitis medicamentosa due to sodium hyaluronate eyedrops. We discontinued the eyedrops she was using and prescribed autologous serum. One month later, ocular discomfort and decreased vision were improved and corneal erosions were decreased. Conclusions: In the present case, toxic keratitis was assumed to be associated with the use of sodium hyaluronate eyedrops and corneal erosions improved after the eyedrops were discontinued. We suggest sodium hyaluronate eyedrops are potentially hazardous and recommend a regular follow-up should be performed by a qualified ophthalmologist. J Korean Ophthalmol Soc 2015;56(2):291-295

Long-Term Effect of Preservative-Free Sodium Hyaluronate Eye Drop on Human Corneal Epithelial Cell

Purpose: To investigate the biological effects of preservative-free artificial tear drops on cultured human corneal epithelial cells in vitro. Methods: The effects of the preservative-free artificial tear drops (Kynex 0.1%, Kynex II 0.18% [Alcon, Seoul, Korea] and Hyaluni eye drops 0.15%, 0.3% [Taejun, Seoul, Korea]) on the human corneal epithelial cells were evaluated. An methyl thiazolyl tetrazolium (MTT)-based colorimetric assay was performed to assess the cellular metabolic activity and a lactate dehydrogenase (LDH) leakage assay was used to determine cellular toxicity. The eye drop ingredients were analyzed for electrolyte composition, pH, and osmolarity. We performed a scratch assay and cellular morphology test using electronic microscopy. Results: The metabolic activity of corneal epithelial cells was higher than controls at 24 hours after exposure and then decreased at 48 and 72 hours after exposure (p < 0.05). The LDH titers of the 4 eye drops were higher compared with controls (p < 0.05). Sodium hyaluronate 0.18% contained lower concentrations of Na or Cl and showed lower osmolarity values compared with the other eye drops. The cellular migration based on the scratch assay was more delayed and cellular damage such as loss of microvilli, rough endothelial reticulum (RER), and mitochondria dilatation was greater than controls based on electron microscopy. Conclusions: Long-term exposure to preservative-free sodium hyaluronate eye drops may induce decreased metabolic activity and cellular damage. Thus, preservative-free artificial tears should be used carefully to prevent cellular toxicity. J Korean Ophthalmol Soc 2015;56(12):1945-1952

Clinical efficacy of sodium hyaluronate and bFGF eye drops in dry eye and eyes after LASIK

Objective To observe the efficiency and safety of 0.1% sodium hyaluronate(SH)eye drops and basic fibroblast growth factor(bFGF) eye drops in simplex dry eye and dry eye after LASIK. Design Randomized controlled study. Participants 70 cases with simplex dry eye(group Ⅰ) and 40 post-LASIK cases(group Ⅱ) from January 2012 to August 2012. Method There were two subgroups in group Ⅰ and group Ⅱ respectively. 0.1% SH(A) and bFGF(B) eye drops were used randomly, four times a day for 14 days in group Ⅰ and 30 days in group Ⅱ. Changes of symptoms and signs were observed at different times. Dry eye symptoms including asthenopia, foreign body sensation, eye dry, burning sensation, swelling sensation, ophthalmodynia, conjunctiva congestion and photophobia were scored using questionnaire survey. Main Outcome Measures Score of dry eye symptoms, tear break-up time(BUT), Schirmer TestⅠ,corneal fluorescein staining(FL), symptoms changes of self-evaluation. Results Ocular symptoms and signs improved significantly after treatment in both subgroups of group Ⅰ(P0.05). 0.1% SH eye drops was better than bFGF eye drops in improving asthenopia(P=0.006) and ophthalmodynia(P=0.040) at 14 days after treatment(P0.05). SH was better to improve BUT(P=0.055) and Schirmer TestⅠ(P=0.573),and bFGF was better to reduce corneal fluorescein staining(P=0.375), but the different was not significant. Significant change of symptoms in patients using SH eye drops and bFGF eye drops were 94.3% and 78.6%, respectively. In group Ⅱ, there were symptoms in 1and 3 days after LASIK, and improved in 10 and 30 days post-operation. SH eye drops was better than bFGF eye drops in improving foreign body sensation(P=0.004), burning sensation(P0.001), swelling sensation(P=0.005) and conjunctiva congestion(P=0.007). BUT and Schirmer TestⅠ decreased in 10 days after LASIK, but increased in 30 days, than that of 10 days after operation(groupⅡA BUT:P=0.142, Schirmer TestⅠ: P=0.053; groupⅡB BUT: P=0.006, Schirmer TestⅠ: P=0.010). Corneal fluorescein staining aggravated in 10 day after LASIK, and improved in 30 days, with significant differences(groupⅡA P=0.005, groupⅡB P=0.079). There was no significant difference between groupⅡA and groupⅡB in changes of dry eye signs. No side-effect was found during observation. Conclusion SH and bFGF eye drops can facilitate corneal epithelial repair, improve tear film stability, and alleviate various symptoms in simplex dry eye and post-LASIK patients. SH eye drops is better than bFGF eye drops in improving certain symptoms including asthenopia, foreign body sensation, burning sensation, swelling sensation, conjunctiva congestion and ophthalmodynia.

Clinical study on high concentrations of sodium hyaluronate eye drops for moderate to severe dry eye

Clinical study on high concentrations of sodium hyaluronate eye drops for moderate to severe dry eye

Effect of hypotonic 0.18% sodium hyaluronate eyedrops on inflammation of the ocular surface in experimental dry eye.

To investigate the efficacy of hypotonic 0.18% sodium hyaluronate (SH) eyedrops in a mouse model of experimental dry eye (EDE). EDE was induced in C57BL/6 mice by a subcutaneous scopolamine injection and an air draft. The mice were divided into 4 groups according to topical treatment regimens: EDE control, isotonic 0.5% carboxymethycellulose (CMC), isotonic 0.1% SH, and hypotonic 0.18% SH. Tear volume, corneal smoothness, and corneal staining scores were measured at 5 and 10 days of EDE. Multiplex immunobead assay, immunohistochemistry, and flow cytometry for proinflammatory cytokines, chemokines, and inflammatory molecules were performed at 10 days of EDE. The 0.18% SH group had a significantly lower corneal smoothness and staining scores than the 0.5% CMC and 0.1% SH groups at 10 days of EDE (P<0.05). The 0.18% SH group showed significantly low levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, monokine induced by interferon-γ, and interferon-γ-inducible protein 10 compared with the other groups (P<0.05). The mean percentages of CD4(+)CXCR3(+), CD40(+), and CD44(+) cells in the conjunctiva were significantly lower in the 0.18% SH group than in the other groups (P<0.05). In addition, the 0.1% SH group showed lower levels of TNF-α and IL-1β and percentages of CD40(+) and CD44(+) cells than the EDE and 0.5% CMC groups. Hypotonic 0.18% SH eyedrops are more effective in improving ocular surface irregularity and staining and decreasing inflammatory cytokines, chemokines, and cells on the ocular surface compared with isotonic 0.5% CMC or 0.1% SH eyedrops in the treatment of EDE.

Effects of Sodium Hyaluronate on Wavefront Aberrations in Dry Eye Patients

To investigate the effects of a single instillation of hypotonic 0.18% sodium hyaluronate artificial tears on wavefront aberrations in dry eye patients. Fifty patients with dry eye were recruited into this single-center, prospective, double-masked, randomized controlled trial. Patients were randomly assigned to receive one drop of preservative-free, hypotonic 0.18% sodium hyaluronate (treatment) in one eye and one drop of sterile 0.9% sodium chloride solution (control) in the other eye. Ocular aberrations evaluated by a Hartmann-Shack aberrometer and severity of dry eye symptoms graded by a questionnaire (at baseline, 1, 10, 30, 60, and 120 minutes after instillation) were the main outcome measures. After a single instillation of one drop of the allocated eye drops, there were no statistically significant differences between the treatment and control groups in total higher-order aberrations, coma, and spherical aberrations during the study period (p = 0.40, 0.57, and 0.16, respectively). Although a statistically significant (p = 0.04) decrease from baseline in spherical aberrations was noted in the treatment group at 1 minute following instillation, it gradually increased back to baseline values at later time points. A statistically significant diminishment of dry eye symptoms compared with the placebo was reported at all time points by the treatment group (p < 0.001). A single instillation of hypotonic 0.18% sodium hyaluronate eye drops is safe and effective in alleviating subjective dry eye symptoms; however, it does not appear to affect higher-order aberrations in moderate to severe dry eye patients.

Protection effect of sodium hyaluronate on ocular surface toxicity induced by Benzalkonium chloride-preserved brimonidine in rabbits

To investigate the protective effects of sodium hyaluronate on ocular surface toxicity induced by a prolonged use of benzalkonium chloride-preserved Brimonidine eye drops. Experimental study. Thirty adult female New Zealand rabbits were divided into three groups with randomized numbers design. Ten rabbits were treated with 0.2% Brimonidine eye drops and PBS (PBS group), the other ten rabbits with 0.2% Brimonidine combined with sodium hyaluronate eye drops (SH group), and control group received no treatment for 60 days. Schirmer test, fluorescein (FL) and Rose Bengal (RB) staining, conjunctival impression cytology specimens collecting were performed on day 0, 31, and 61. Apoptosis of conjunctival epithelium was detected by in situ terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay on day 61. Conjunctival inflammation was observed by hematoxylin eosin staining. Histomorphological changes of cornea and conjunctiva were observed by light microscopy, and scanning and transmission electron microscopy at day 61. Fluorescein and Rose Bengal scores were analysed by Kruskal-Wallis test. Schirmer scores, goblet cell density and inflammatory cells infiltration were analysed by repeated measures analysis of variance. There were significant differences in fluorescein and Rose bengal (H = 22.031, 15.303, P < 0.01) staining among the groups on day 61. Compared with the control group (FL: 0, 0-1, RB: 0, 0-1), fluorescein and Rose Bengal scores were significantly (P < 0.001) increased in PBS group (FL: 1.5, 1-2, RB: 1, 1-2), whereas was significantly (P < 0.001) decreased in SH group (FL:0, 0-1 RB:1, 0-1) when compared to PBS group. There were significant differences in aqueous tear production and goblet cell density (F = 7.980, 14.545, both P < 0.01) among the groups on day 61. Compared with the control group [(9.43 ± 0.57) mm, (87.73 ± 2.34/HP)], Schirmer scores and goblet cell density were significantly (P < 0.01) reduced in PBS-treated group [(6.61 ± 0.38) mm, (68.06 ± 3.61)/HP], but significantly (P < 0.05) increased in SH-treated group [(8.75 ± 0.57) mm, (82.31 ± 1.64)/HP] compared with PBS-treated group. The number of inflammatory cells was significant difference (F = 56.306, P < 0.001) among the groups on day 61. Compared with the control group [(39.89 ± 2.03)/HP], inflammatory cells infiltration was significantly (P < 0.01) increased in both PBS [(73.18 ± 2.17)/HP] and SH groups [(48.79 ± 2.64)/HP], however, SH-treated group was significantly lowered when compared with PBS-treated group. In addition, decrease in apoptosis, complete microvilli and cell organelles were found in the corneal and conjunctival epithelial cells in SH-treated group. Our results demonstrate that topical application of SH reduces the ocular toxicity and protect the ocular surface in the long term anti-glaucomatous medical therapies and may be considered as a vehicles or neutralizing material for future ocular application.

Investigation of Protective Effects of Sodium Hyaluronate Eyedrop Against Corneal Epithelial Disorders Using an Electrophysiological Method

The purpose of this study was to investigate the protective effects of sodium hyaluronate eyedrop against corneal epithelial disorders caused by antiglaucomatous eyedrops using an electrophysiological method. Three kinds of antiglaucomatous eyedrops, including benzalkonium chloride (BAC) as an ophthalmic preservative, a BAC-free antiglaucomatous eyedrop, and a sodium hyaluronate eyedrop, were used in this study. Eyedrops were applied to excised rabbit corneas, and the electrophysiological property of the cornea was monitored using an Ussing chamber with a turnover system that mimics human tear turnover. With this system, changes in transepithelial electrical resistance (TER) in the corneal surface were recorded. The corneal TER after applying antiglaucomatous eyedrops tended to decrease concomitantly with increasing the concentration of the BAC included as a preservative. On the other hand, there was no significant change in the corneal TER for the initial 60 min after applying sodium hyaluronate eyedrop compared with those of the control. Moreover, the pretreatment with a sodium hyaluronate eyedrop reduced the extent of decrease in the corneal TER observed after application of antiglaucomatous eyedrops alone. Those results indicate that a sodium hyaluronate eyedrop has the potential to protect the corneal surface from antiglaucomatous eyedrops, including BAC as an ophthalmic preservative.