Topical Anti-inflammatory Therapy Research Articles

Medical Therapy for Large Idiopathic Full-Thickness Macular Holes.

To describe the characteristics and outcomes of eyes with idiopathic full-thickness macular holes (FTMH) that underwent initial medical management. This retrospective study included eyes with FTMH that were initially managed with one month of topical therapy. Eligible subjects were treated with dorzolamide 2% three times a day, nepafenac 0.1% twice a day, and prednisolone acetate 1% four times a day. The primary endpoints was hole closure at one month and secondary endpoint was change in best-corrected visual acuity (BCVA). Ten subjects (mean age: 62.80 years; female: 50%) with unilateral FTMH were studied. The mean basal diameter of the entire cohort at baseline was 824.1 µm (median 828 µm). Four (40%) of the smaller holes (mean 698 µm; median 698.50 µm) closed after one month of topical therapy, whereas larger holes (mean 908.17µm; median 889.50 µm) did not close. In one eye, the hole reopened 4 months after stopping the medication, but closed again at one month after re-starting the topical treatment. Median BCVA improved from 0.35 logMAR at baseline to 0.05 logMAR in eyes that closed but remained at 0.70 logMAR at one month in eyes that did not close. Topical corticosteroid, non-steroidal anti-inflammatory, and carbonic anhydrase inhibitor therapy may promote closure of small FTMHs, but large holes are less likely to respond. One month of topical therapy might avoid subjecting some patients to complex vitreo-retinal surgery without compromising visual outcomes. Macular hole may re-open after stopping the topical therapy.

The effectiveness of topical anti-inflammatory hormonal therapy in irritant contact dermatitis management in toddlers

The effectiveness of topical anti-inflammatory hormonal therapy in irritant contact dermatitis management in toddlers

The Formulation, Development And Evaluation Of Ointment For Anti-Inflammatory Activity

The search for safer anti-inflammatory agents has led to exploration of natural sources such as curcumin and fenugreek. Curcumin, derived from Curcuma longa, and α-linolenic acid from Trigonella foenum-graecum, exhibit significant anti-inflammatory properties. This study focuses on formulating an ointment utilizing these extracts for topical application. Molecular docking techniques were employed to assess the binding affinities of curcumin and α-linolenic acid. The ointment was prepared using various bases and preservatives, and its physicochemical properties were evaluated. Stability studies revealed consistent properties under different temperature conditions. Characterization of the drug extracts and ointment formulations was conducted to ensure efficacy and safety. The ointment showed promising results in terms of stability and efficacy, particularly formulation F2, suggesting its potential as a topical anti-inflammatory therapy with improved patient compliance

Sterile granulomatous panuveitis in dogs in the United Kingdom: A review of 33 cases.

To describe the clinical and histopathological features of a sterile granulomatous panuveitis syndrome in 33 dogs that underwent enucleation and ocular histopathology. Retrospective review of the medical records and ocular histopathology reports of 33 cases. Inclusion criteria were enucleation in conjunction with characteristic clinical and histopathological features. Thirteen breeds were represented (including crossbreeds). Panuveitis was acute and fulminating, and secondary glaucoma was common (n = 27). Interval from initial presentation to enucleation was 99 days (median 33 days, range 5-605 days). The mean age at enucleation was 6.7 years. Ocular signs were initially unilateral (n = 18) or bilateral (n = 15). The disease became bilateral in 18/25 cases that initially underwent unilateral enucleation, resulting in enucleation or euthanasia in 9/18 (mean interval of 168 days). Seven out of 59 eyes had a good outcome following topical anti-inflammatory and systemic immunosuppressive therapy. None of the dogs had travel history nor relevant systemic signs from presentation to follow-up (mean 619 days, range 16-3012 days). Histopathology revealed histiocytic and lymphoplasmacytic panuveitis with pigment dispersion, and no infectious agents were identified on light microscopy. To the authors' knowledge, this is the first report of a sterile granulomatous panuveitis syndrome in dogs in the UK. The clinical signs are severe, with rapid progression, and can result in bilateral enucleation or euthanasia in affected dogs. There does not appear to be an age or breed predisposition, however further research is necessary in this regard. Early and aggressive intervention, with both topical and systemic immunosuppressive therapy, is recommended to reduce the risk of blindness, enucleation, and euthanasia.

PLGA Nanoparticles Containing Natural Flavanones for Ocular Inflammation.

Flavanones are natural compounds that display anti-inflammatory activity. The aim of this work was to prepare PLGA nanoparticles (NPs) containing natural flavanones I ((2S)-5,7-dihydroxy-6-methyl-8-(3-methyl-2-buten-1-il)-2-phenyl-2,3-dihydro-4H-1-Benzopyran-4-one) and II (2S)-5,7-dihydroxy-2-(4'-methoxyphenyl)-6-methyl-8-(3-methyl-2-buten-1-yl)-2,3-dihydro-4H-1-Benzopyran-4-one) (NP I and NP II, respectively) so as to evaluate their potential for topical anti-inflammatory ocular therapy. An in silico study was carried out using the Molinspiration® and PASS Online web platforms before evaluating the in vitro release study and the ex vivo porcine cornea and sclera permeation. The HPLC analytical method was also established and validated. Finally, the in vitro anti-inflammatory efficacy of NPs was studied in the HCE-2 model. The flavanones I and II could be released following a kinetic hyperbolic model. Neither of the two NPs was able to permeate through the tissues. NP I and NP II were found to be respectful of any changes in the tissues' morphology, as evidenced by histological studies. In HCE-2 cells, NP I and NP II were not cytotoxic at concentrations up to 25 µM. NP I showed higher anti-inflammatory activity than NP II, being able to significantly reduce IL-8 production in LPS-treated HCE-2 cells. In summary, ocular treatment with NP I and NP II could be used as a promising therapy for the inhibition of ocular inflammation.

Ophthalmic manifestations and management considerations for emerging chemical threats.

Chemical agents have been utilized for centuries in warfare and pose a health threat to civilians and military personnel during armed conflict. Despite treaties and regulations against their use, chemical agent exposure remains a threat and measures to understand their effects and countermeasures for systemic and organ-specific health are needed. Many of these agents have ocular complications, both acute and chronic. This mini-review focuses on key chemical agents including vesicants (mustards, lewisite), nerve agents (sarin, VX), knockdown gasses (hydrogen cyanide), and caustics (hydrofluoric acid). Their ophthalmic manifestations and appropriate treatment are emphasized. Acute interventions include removal of the source and meticulous decontamination, as well as normalization of pH to 7.2-7.4 if alteration of the ocular pH is observed. Besides vigorous lavage, acute therapies may include topical corticosteroids and non-steroid anti-inflammatory therapies. Appropriate personal protective equipment (PPE) and strict donning and doffing protocols to avoid healthcare provider exposure are also paramount in the acute setting. For more severe disease, corneal transplantation, amniotic membrane graft, and limbal stem cell transplantation may be needed. Orbital surgery may be required in patients in whom cicatricial changes of the ocular surface have developed, leading to eyelid malposition. Multidisciplinary care teams are often required to handle the full spectrum of findings and consequences associated with emerging chemical threats.

Rho-kinase inhibitors in pseudophakic cystoid macular edema with secondary glaucoma

Pseudophakic cystoid macular edema (PCME) is predominantly a self-limiting entity that can occasionally result in long-term visual deterioration. Rho-kinase (ROCK) inhibitors are therapeutic agents that have been successfully used for intraocular pressure (IOP) control in glaucoma patients and in the management of diabetic macular edema. In this report, we describe a case of mild nonproliferative diabetic retinopathy with PCME and secondary glaucoma. The patient presented with persistent PCME following scleral-fixated intraocular lens insertion, which was unresponsive to anti-vascular endothelial growth factor (anti-VEGF) agents and topical nonsteroidal anti-inflammatory therapy. A successful resolution of PCME was noted on 1-month follow-up after starting the patient on Rho-kinase inhibitors for secondary glaucoma.

Evidence for a restoration of TLR2 response in epidermal dendritic cells in atopic dermatitis by topical anti-inflammatory therapy.

Evidence for a restoration of TLR2 response in epidermal dendritic cells in atopic dermatitis by topical anti-inflammatory therapy.

Alteration of Meibum Lipidomics Profiling in Patients With Chronic Ocular Graft-Versus-Host Disease.

To investigate the characteristics of the lipid profiling in meibum of patients with chronic ocular graft-versus-host disease (coGVHD) and to detect the potential influence of anti-inflammatory therapy on these differential lipids. This cross-sectional study included 25 coGVHD patients and 13 non-coGVHD after allogeneic hematopoietic stem cell transplantation. Among those with coGVHD, 14 had prior topical treatment (coGVHD(T)), and 11 did not (coGVHD(WT)). All participants completed ocular surface disease index questionnaire and received slit lamp examination, Schirmer's test without anesthesia, ocular surface interferometer, and meibography. Binocular meibum was collected and pooled for lipidomic analysis by liquid chromatography-mass spectrometry. One hundred and twenty differential lipid species were found among the three groups (96 of coGVHD(WT) vs. non-coGVHD, 78 of coGVHD(WT) vs. coGVHD(T), and three of non-coGVHD vs. coGVHD(T)). Compared with non-coGVHD group, coGVHD(WT) group had a significant abnormality of meibum composition, showing a significant decrease in glycerolipids, and an increase in glycerophospholipids and sphingolipids. Similar changes were also observed when coGVHD(WT) versus coGVHD(T). CoGVHD severity was negatively associated with mono-unsaturated triglycerides (TG), (β = -214.7; 95% CI, -363.9 to -65.5; P = 0.006) and poly-unsaturated TG (β = -4019.9; 95% CI, -7758.1 to -281.6; P = 0.036). Intensity of immunosuppression was negatively associated with mono-unsaturated TG (β = -162.4; 95% CI, -268.6 to -56.2; P = 0.004) and positively associated with phosphatidylcholine (β = 332.0; 95% CI, 19.2-644.8; P = 0.038). Altered meibum in coGVHD is characterized by a decrease of glycerolipids and an increase of glycerophospholipids and may be significantly reversed by topical anti-inflammatory therapy.

Development of interface haze after femtosecond laser-assisted in situ keratomileusis with accelerated corneal crosslinking: a case series.

Femtosecond laser-assisted in situ keratomileusis (FS-LASIK) with accelerated corneal crosslinking (FS-LASIK Xtra) is a recent procedure to achieve safer corneal ablation in myopic patients with borderline corneal thickness. Despite its well-accepted effectiveness, the development of remarkable interface haze is a potential concern but has rarely been reported and discussed. We report for the first time a case series of 11 eyes of 7 patients who developed typical interface haze 1-3months after FS-LASIK Xtra for the correction of myopia with astigmatism, with intensity grades ranging from 0.5 + to 3 + at the time of onset. The preclinical spherical diopters of the 7 patients ranged from - 2.25 D to - 9.25 D and cylindrical diopters ranged from - 0.25 D to - 2.50 D. The haze tended to be self-limiting, and topical anti-inflammatory therapy was given to moderate and severe cases, who responded well to treatment. The development of clinically significant interface haze is a relatively rare complication after FS-LASIK Xtra but tends to have a higher incidence and intensity compared to conventional stromal surgery such as FS-LASIK. Timely treatment and close follow-up are essential to patients undertaking FS-LASIK Xtra.

Ocular surface involvement and histopathologic changes in the acute stage of Stevens-Johnson syndrome and toxic epidermal necrolysis: a cross-sectional study

BackgroundStevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare and extremely serious drug-induced dermatological disorders. The ocular surface condition at the early stage has been little studied and should contribute to novel perspectives in early and effective topical therapy of these diseases. The objectives of the study were to evaluate the acute phase of ocular surface involvement and histopathologic changes in patients with acute SJS/TEN.MethodsTen patients with acute phase of SJS/TEN onset and eleven age- and sex-matched healthy volunteers were recruited. Ocular surface symptoms and signs, conjunctival impression cytology, and tear multi-cytokine were assessed.ResultsOcular surface objective signs were normal at the acute stage of SJS/TEN, while most patients have abnormal ocular surface subjective symptoms and meibomian gland secretion. Conjunctival impression cytology showed a significant decrease in goblet cell density and severe ocular surface squamous metaplasia in acute SJS/TEN patients. Tear multi-cytokine analysis showed all 21 pro- and anti-inflammatory cytokines all sharply elevated. Goblet cell density was significantly negatively correlated with tear C-X3-C motif chemokine ligand 1 (CX3CL1) and interleukin 13.ConclusionsSevere pathologic squamous metaplasia and inflammation onset in the ocular surface at the acute stage of the SJS/TEN, even if the ocular surface condition seemed basically normal with adequate systemic immunosuppressant and general supportive treatment. Early topical anti-inflammatory therapy should be carried out actively.

Anti-inflammatory IL-8 Regulation via an Advanced Drug Delivery System at the Oral Mucosa.

Oral inflammatory diseases are highly prevalent in the worldwide population. Topical treatment of inflammation is challenging due to dilution effects of saliva and crevicular fluid. Thus, there is a great medical need to develop smart anti-inflammatory drug delivery systems for mucosa treatment. We compared two promising anti-inflammatory dendritic poly(glycerol-caprolactone) sulfate (dPGS-PCL) polymers for their applicability to the oral mucosa. Using an ex vivo porcine tissue model, cell monolayers, and full-thickness 3D oral mucosal organoids, the polymers were evaluated for muco-adhesion, penetration, and anti-inflammatory properties. The biodegradable dPGS-PCL97 polymers adhered to and penetrated the masticatory mucosa within seconds. No effects on metabolic activity and cell proliferation were found. dPGS-PCL97 revealed a significant downregulation of pro-inflammatory cytokines with a clear preference for IL-8 in cell monolayers and mucosal organoids. Thus, dPGS-PCL97 exhibits excellent properties for topical anti-inflammatory therapy, suggesting new therapeutic avenues in the treatment of oral inflammatory diseases.

Efficacy of topically applied rapamycin-loaded redox-sensitive nanocarriers in a human skin/T cell co-culture model.

Rapamycin, also known as Sirolimus, is a promising anti-proliferative drug, but its therapeutic use for the topical treatment of inflammatory, hyperproliferative skin disorders is limited by insufficient penetration rates due to its high molecular weight (MW of 914.172g/mol) and high lipophilicity. We have shown that core multi-shell (CMS) nanocarriers sensitive to oxidative environment can improve drug delivery to the skin. In this study, we investigated the mTOR inhibitory activity of these oxidation-sensitive CMS (osCMS) nanocarrier formulations in an inflammatory ex vivo human skin model. In this model, features of inflamed skin were introduced by treating the ex vivo tissue with low-dose serine protease (SP) and lipopolysaccharide (LPS), while phorbol 12-myristate 13-acetate and ionomycin were used to stimulate IL-17A production in the co-cultured SeAx cells. Furthermore, we tried to elucidate the effects of rapamycin on single cell populations isolated from skin (keratinocytes, fibroblast) as well as on SeAx cells. Further, we measured possible effects of the rapamycin formulations on dendritic cell (DC) migration and activation. The inflammatory skin model enabled the assessment of biological readouts at both the tissue and T cell level. All investigated formulations successfully delivered rapamycin across the skin as revealed by reduced IL-17A levels. Nevertheless, only the osCMS formulations reached higher anti-inflammatory effects in the skin compared to the control formulations with a significant downregulation of mTOR activity. These results indicate that osCMS formulations could help to establish rapamycin, or even other drugs with similar physico-chemical properties, in topical anti-inflammatory therapy.

MANIFESTASI KLINIS DAN TATALAKSANA OPERATIF DEGENERASI KORNEA NODULAR SALZMANN

Introduction : Salzmann nodular degeneration (SND) is an idiopathic and degenerative noninflammatory condition of the cornea. SND is characterized by a grayish-white or blue-white subepithelial nodule. Mild symptoms may improve with lubrication and topical anti-inflammatory therapy. Visual disturbances may occur and surgery may be required. Purpose: To explain clinical manifestations and operative management of corneal Salzmann nodular degeneration. Case Report: A 63-year-old woman came with the chief complaint of a nodule in her left eye since 4 months ago. Complaints accompanied by blurry vision, watery eyes and glare. Ophthalmological examination revealed a regression of visual, a nodule in the corneal stroma was grayish white. After examination, the patient was diagnosed with Salzmann OS nodular degeneration and ODS immature senile cataract. Debridement keratectomy and amniotic membrane transplantation (AMT) were performed as the management of this patient. Anatomical pathology results clinically support Salzmann's nodular degeneration. Discussion: Slow-progressive, yellowish-white nodules are characteristic of SND. SND can be asymptomatic, mild symptoms, or until there is a decrease in visual function. It depends on the location and depth of the nodule. Several treatment options can be done ranging from conservative with topical drugs to surgery. Surgical treatment options have the goal of reducing the worsening symptoms of nodule recurrence. Conclusions: A complete history, comprehensive ophthalmological examination can help establish the diagnosis of SND. The appearance of nodules causes complaints of foreign body sensation, decreased visual function and other accompanying symptoms. Treatment needs to be given according to the patient's condition and indications, especially the selection of surgical therapy.

Extreme intraocular pressure and steroid-dependent iritis.

A 50-year-old ophthalmic technician was referred by her retina specialist for urgent consultation due to markedly elevated intraocular pressure (IOP) unresponsive to medical therapy. Her history included chronic polyarticular juvenile rheumatoid arthritis and chronic uveitis requiring ongoing topical steroid therapy. She had a sub-Tenon injection of Kenalog (triamcinolone) 18 months prior to referral. Chronic topical anti-inflammatory therapy included nepafenac (Ilevro) and prednisolone acetate 2 times a day. Attempts to discontinue topical steroid resulted in worsening inflammation. The patient was referred when the IOP measured 44 mm Hg in the left eye despite aggressive medical therapy, including acetazolamide. The IOP improved slightly when loteprednol was substituted for prednisolone acetate. Current medications in the left eye include brimonidine 3 times a day, loteprednol 2 times a day, nepafenac 2 times a day, and fixed combination latanoprost + netarsudil at bedtime. Her only medication in the right eye was travoprost. She is intolerant to dorzolamide. She was also taking acetazolamide 500 mg 2 times a day. She was not taking any anticoagulants. Past surgical history included cataract surgery in each eye. She has not had laser trabeculoplasty in either eye. Examination revealed uncorrected visual acuity of J1+ in the right eye (near) and 20/30 in the left eye (mini-monovision). There was no afferent pupillary defect. There was mild band keratopathy in each eye while the central cornea was clear in both eyes without keratic precipitates. Here angles were open to gonioscopy without peripheral anterior synechia. There was mild to moderate flare in each eye with trace cells. The IOP was 17 mm Hg in the right eye and 31 mm Hg in the left. Central corneal thickness measured 560 μm and 559 μm in the right and left eye respectively. There was a well-positioned intraocular lens within each capsule with a patent posterior capsulotomy. There was mild vitreous syneresis but no vitreous cell. The cup to disc ratio was 0.5 in each eye with a symmetrical neural rim. The retina was flat without macular edema. Visual field was normal in both eyes (Figures 1 and 2). Optical coherence tomography of retinal nerve fiber layer (RNFL) is shown in Figure 3 and retinal ganglion cell layer is shown in Supplemental Figure 1 (http://links.lww.com/JRS/A756).JOURNAL/jcrs/04.03/02158034-202301000-00020/figure1/v/2022-12-26T045736Z/r/image-tiffJOURNAL/jcrs/04.03/02158034-202301000-00020/figure2/v/2022-12-26T045736Z/r/image-tiffJOURNAL/jcrs/04.03/02158034-202301000-00020/figure3/v/2022-12-26T045736Z/r/image-tiff Please comment on your management of this patient's left eye.

A Protocol for Managing Watery Eyes in Patients with Punctal Stenosis

Purpose • To elucidate all factors resulting in watery eyes in patients with punctal stenosis. • To treat these factors pre-operatively and post-operatively following a horizontal 3-snip punctoplasty to achieve surgical success. Methods: 77 consecutive cases presenting to a tertiary care oculoplastics centre with watery eyes due to punctal stenosis/ occlusion were included. The clinical type of stenois/occlusion was identified. Co-existing factors causing lacrimation and epiphora, besides punctal stenosis, were identified and treated preoperatively. All cases had a rectangular 3-snip punctoplasty followed by repeated punctal dilatation in clinic, weekly for one month, and then 2 monthly for 6 months. The anti-inflammatory therapy was continued post-operatively for 2-4 months. Results: All cases had severe watery eyes (Munk grade 4-5). 69 cases (89.6 %) cases were on steroid-antibiotic topical therapy for recurrent blepharitis, while 12 cases (15.7%) were on anti-glaucoma therapy. 58 cases (75.3%) had previously failed punctoplasty. Ocular surface inflammatory disease (OSD) was present in all 77 cases (100%) causing lacrimation. It was notably severe in cases with pinpoint punctae. Membranous punctal occlusion was more common in the elderly patients with less severe OSD. Repeated punctal dilatation was necessary to maintain punctal patency post-operatively, achieving success rate of 97.4%, and 100% patient satisfaction. Conclusion: Disturbed balance between tear production and its drainage exists in patients with watery eyes. A protocol is suggested to restore that balance in patients with punctal stenosis: • Thorough clinical assessment, identifying factors causing lacrimation and treating them pre-operatively. • Identifying lower lid margin pathology that may be contributing to epiphora besides punctal stenosis and correcting it simultaneously with punctoplasty. • Rectangular 3-snip punctoplasty should be the preferred surgical procedure as it maintains the structure and function of the punctum. • Repeated punctal dilatation post-operatively and continued topical anti-inflammatory therapy to avoid punctal re-stenosis. • Patient education regarding recurrent nature of OSD and its early treatment to prevent punctal re-stenosis

Topical Anti-Inflammatory Agents for Non-Infectious Uveitis: Current Treatment and Perspectives

Non-infectious uveitis represents a heterogenous group of immune-mediated ocular diseases, which can be associated with underlying systemic disease. While the initial choice of treatment of non-infectious uveitis depends on a number of factors such as anatomical location and degree of inflammation, topical therapies often remain the initial choice of non-invasive therapy. In this narrative review, we aim to describe the literature on non-infectious uveitis, with specific focus on the current perspective on topical anti-inflammatory therapy.

Biological therapy for young children with atopic dermatitis

Atopic dermatitis is a common inflammatory skin disease that might lead to severe and persistent disease during infancy. Atopic dermatitis is associated with poor school performance, psychiatric disease, and allergic comorbidities.1–3 If atopic dermatitis is inadequately controlled with emollient use and topical anti-inflammatory therapies, systemic medications including ciclosporin, azathioprine, and methotrexate can be used to treat children with moderate-to-severe disease. However, systemic therapies are rarely used in children because the natural disease course often leads to spontaneous improvement, and because their use requires continuous blood monitoring and is associated with tolerance issues and modest efficacy.

Inflammatory Bowel Disease: An Overview

Crohn's disease and ulcerative colitis are the most common chronic inflammatory bowel diseases. The diagnosis is based on clinical presentation and endoscopic findings completed by histopathology. The therapeutic options range from topical antiinflammatory therapies to classical immunosuppression and biological agents, i. e. anti-TNF-antibodies. This manuscript gives an overview on the state of the art in diagnostics and therapy ofboth, Crohn's disease and ulcerative colitis. Therapeutic algorithms are based on the statements of the German consensus conferences.

Management of atopic dermatitis: a narrative review.

Atopic dermatitis (atopic eczema) is the most common inflammatory skin disease and has a significant burden on the quality of life of patients, families and caregivers. Its pathogenesis is a complex interplay between genetics and environment, involving impaired skin barrier function, immune dysregulation primarily involving the Th2 inflammatory pathway, itch, and skin microbiome. Restoration of skin barrier integrity with regular emollients and prompt topical anti-inflammatory therapies are mainstays of treatment. Systemic therapy is considered for moderate to severe disease. New understanding of inflammatory pathways and developments in targeted systemic immunotherapies have significantly advanced atopic dermatitis management. Dupilumab is a safe and effective treatment that is now available in Australia. Other promising agents for atopic dermatitis include Janus kinase, interleukin (IL)-13 and IL-31 inhibitors.