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Bitoun S, Rousseau A, Gosset M, Belkhir R, Lazure T, Mariette X, Nocturne G. Immune Checkpoint Inhibitor-induced Sicca Syndrome. Rheum Dis Clin North Am 2024; 50:291-300. [PMID: 38670727 DOI: 10.1016/j.rdc.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
The development of sicca in patients treated with immune checkpoint inhibitors (ICIs) is undoubtedly an underestimated complication, but one whose functional consequences and impact on quality of life are significant for patients. This update aims to review the frequency of this complication and different clinical pictures. The authors also propose a diagnostic and therapeutic approach to guide clinicians in daily practice.
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Affiliation(s)
- Samuel Bitoun
- Department of Rheumatology, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Saclay, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, FHU CARE, INSERM UMR1184, 78, Avenue du General Leclerc, Le Kremlin Bicêtre 94270, France
| | - Antoine Rousseau
- Department of Ophthalmology, Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital Bicetre, 78 Avenue du General Leclerc, Le Kremlin Bicêtre, 94270, France
| | - Marjolaine Gosset
- Laboratoire Orofacial Pathologies, Imaging and Biotherapies, URP2496, Université de Paris, Montrouge, France; Department of Oral Medicine / Dentistry, AP-HP, Hôpital Charles-Foix, 7 Avenue de La République, Ivry-sur-Seine, 94205, France
| | - Rakiba Belkhir
- Department of Rheumatology, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Saclay, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, FHU CARE, INSERM UMR1184, 78, Avenue du General Leclerc, Le Kremlin Bicêtre 94270, France
| | - Thierry Lazure
- Department of Pathology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bicêtre, 78 Rue du Général Leclerc, Le Kremlin Bicêtre, 94270, France
| | - Xavier Mariette
- Department of Rheumatology, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Saclay, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, FHU CARE, INSERM UMR1184, 78, Avenue du General Leclerc, Le Kremlin Bicêtre 94270, France
| | - Gaetane Nocturne
- Department of Rheumatology, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Saclay, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, FHU CARE, INSERM UMR1184, 78, Avenue du General Leclerc, Le Kremlin Bicêtre 94270, France.
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Larsson JME, Boberg-Ans LC, Vangsted A, van Dijk EHC, Grauslund J, Hajari JN, Klefter ON, Schneider M, Subhi Y. Topical non-steroidal anti-inflammatory drugs for central serous chorioretinopathy: A systematic review and meta-analysis. Acta Ophthalmol 2024; 102:274-284. [PMID: 37551858 DOI: 10.1111/aos.15743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/07/2023] [Accepted: 07/27/2023] [Indexed: 08/09/2023]
Abstract
Central serous chorioretinopathy (CSC) is a prevalent exudative maculopathy and the ongoing verteporfin shortage restricts current treatment possibilities. Topical non-steroidal anti-inflammatory drugs (NSAID) have previously been proposed as a treatment for CSC, although its exact efficacy remains unclear. In this systematic review and meta-analysis, we outlined the efficacy of topical NSAIDs for the treatment of CSC. We searched 11 literature databases on 13 December 2022, for any study describing topical NSAID treatment for CSC. Thirteen eligible studies were included with a total of 1001 eyes of 994 patients with CSC. Six studies were case reports, two were cohort studies and five were non-randomized comparative studies. Where specified, topical NSAIDs used were bromfenac 0.09%, diclofenac 0.1%, ketorolac 0.4% and 0.5%, pranoprofen 0.1%, and nepafenac 0.1% and 0.3%. Studies were predominantly of cases with acute CSC and several case studies reported treatment outcomes simultaneously with discontinuation of corticosteroid use, which complicated treatment evaluation. Meta-analyses of comparative studies revealed a statistically significant but clinically irrelevant best-corrected visual acuity improvement of -0.04 logMAR (95% CI: -0.07 to -0.01 logMAR; p = 0.01) at 1-month follow-up, which became statistically insignificant at 3-month follow-up (-0.03 logMAR; 95% CI: -0.06 to 0.003 logMAR; p = 0.08). Further, we found no benefit in complete subretinal fluid resolution at 1-month follow-up (OR: 1.20; 95% CI: 0.81-1.76; p = 0.37) or 3-month follow-up (OR: 1.17; 95% CI: 0.86 to 1.59; p = 0.33). Taken together, available evidence does not support the use of topical NSAIDs for the treatment of CSC.
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Affiliation(s)
| | | | | | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jakob Grauslund
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Ophthalmology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Javad N Hajari
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Oliver N Klefter
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Miklos Schneider
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Moramarco A, di Geronimo N, Gardini L, Grendele A, Fontana L. Management of corneal melting after collagen cross-linking for keratoconus: a case report and a review of the literature. BMC Ophthalmol 2024; 24:131. [PMID: 38528481 DOI: 10.1186/s12886-024-03400-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/17/2024] [Indexed: 03/27/2024] Open
Abstract
PURPOSE We describe the management of a case of severe corneal melting after corneal cross-linking (CXL) treated with a staged approach using a conjunctival flap followed by deep anterior lamellar keratoplasty (DALK). METHODS A 12-year-old male developed severe corneal melting with pending perforation after an accelerated epithelium-off CXL protocol. We initially treated the patient with a conjunctival flap to prevent perforation. Three months later, we performed DALK to restore vision. RESULTS Conjunctival flap surgery allowed us to avoid corneal perforation and penetrating keratoplasty (PK) à chaud. Once the inflammation had resolved, we recessed the conjunctiva and performed DALK for optical purposes. Twelve months later, the graft was clear and the corrected visual acuity was 20/25 (Snellen). No complications occurred after surgery. CONCLUSIONS Although CXL is considered a safe procedure, in rare cases it can lead to serious complications, such as corneal haze, infectious and non-infectious keratitis, stromal melting and perforation. Corneal melting and perforation are usually managed by emergency PK. Herein we suggest a staged approach involving an emergency conjunctival flap followed by DALK at a later time that allowed us to avoid PK à chaud.
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Affiliation(s)
- Antonio Moramarco
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Via Palagi 9, Bologna, 40138, Italy.
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Natalie di Geronimo
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Via Palagi 9, Bologna, 40138, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lorenzo Gardini
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Via Palagi 9, Bologna, 40138, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Arianna Grendele
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Via Palagi 9, Bologna, 40138, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luigi Fontana
- Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Via Palagi 9, Bologna, 40138, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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4
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Kassumeh S, Brunner BS, Priglinger SG, Messmer EM. [New and future treatment approaches for allergic conjunctivitis]. DIE OPHTHALMOLOGIE 2024; 121:180-186. [PMID: 38363381 DOI: 10.1007/s00347-024-01996-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND In severe and recurrent ocular allergies conventional ophthalmic drugs can reach their limits, especially in chronic forms. The first novel immunomodulators and biologicals are already in clinical use and could provide relief. OBJECTIVE Based on the immunopathophysiological mechanisms of ocular allergies, possible targets for innovative treatment approaches are presented. An overview of promising new and future immunomodulators and biologicals and their modes of action is also given. MATERIAL AND METHODS Current reviews on ocular allergies and the treatment of systemic allergic diseases were screened. Case reports on the treatment of ocular allergy using immunomodulators and biologicals were analyzed. The clinical relevance and possible applications are presented. RESULTS In chronic forms of ocular allergies, complex ocular surface inflammatory responses mediated via immunoglobulin E (IgE), mast cells, CD4-positive type 2 T‑helper cells and eosinophilic granulocytes are predominant. Cyclosporine A 0.1% eyedrops have been approved in Europe since 2018 for children aged 4 years and older with severe vernal keratoconjunctivitis (VKC). In addition, case reports present promising data on the systemic off-label use of biologicals, such as dupilumab or omalizumab, in refractory VKC or atopic keratoconjunctivitis (AKC). CONCLUSION A profound understanding of the immunopathophysiology of ocular allergies is necessary to detect further targets for future immunomodulators and biologicals. Currently, immunomodulatory therapy remains limited to cyclosporine A eyedrops. Other immunomodulatory agents, such as tacrolimus and biologicals can only be used off-label. Further studies on the controlled clinical use of these substances in the treatment of VKC or AKC are underway.
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Affiliation(s)
- Stefan Kassumeh
- Augenklinik und Poliklinik, LMU Klinikum, LMU München, Mathildenstr. 8, 80336, München, Deutschland.
| | - Barbara S Brunner
- Augenklinik und Poliklinik, LMU Klinikum, LMU München, Mathildenstr. 8, 80336, München, Deutschland
| | - Siegfried G Priglinger
- Augenklinik und Poliklinik, LMU Klinikum, LMU München, Mathildenstr. 8, 80336, München, Deutschland
| | - Elisabeth M Messmer
- Augenklinik und Poliklinik, LMU Klinikum, LMU München, Mathildenstr. 8, 80336, München, Deutschland
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Awidi AA, Chang DF, Riaz KM, Li X, LaBorwit S, Zebardast N, Srikumaran D, Prescott CR, Daoud YJ, Woreta FA. Anti-inflammatory medication use after cataract surgery: online survey of practice patterns. J Cataract Refract Surg 2024; 50:224-229. [PMID: 38381616 PMCID: PMC10878440 DOI: 10.1097/j.jcrs.0000000000001341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 02/23/2024]
Abstract
PURPOSE To determine current prescribing patterns for topical or intraocular/periocular anti-inflammatory medications (AIMs) after routine cataract surgery. SETTING kera-net online members. DESIGN Cross-sectional survey. METHODS An online survey was distributed to subscribers of kera-net, a global online platform sponsored by the Cornea Society. Questions were asked regarding the use of topical or intraocular/periocular AIM after cataract surgery and types of medications prescribed. RESULTS Of 217 surgeon respondents (23% response rate), 171 (79%) practiced in the United States and 171 (79%) were cornea subspecialists. Most of the respondents (n = 196, 97%) prescribed topical corticosteroids after routine cataract surgery. The most frequently prescribed were prednisolone acetate (n = 162, 83%), followed by dexamethasone (n = 26, 13%), difluprednate (n = 24, 12%), and loteprednol etabonate (n = 13, 7%). Corticosteroids comprised (n = 40, 32%) of total intraocular/periocular injections, with triamcinolone acetonide 10 or 40 mg (n = 19, 47.5%) most commonly used. 23 surgeons (58%) who utilized intraocular/periocular corticosteroids also prescribed topical corticosteroids. Topical nonsteroidal anti-inflammatory drugs were prescribed postoperatively by 148 surgeons (73%). CONCLUSIONS Most surgeons prescribed topical AIM after routine cataract surgery. Many surgeons injected intraocular or periocular AIM while prescribing topical AIM. The diversity of practice patterns may reflect the lack of clear evidence-based guidelines.
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Affiliation(s)
- Abdelhalim A. Awidi
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - David F. Chang
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Kamran M. Riaz
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Ximin Li
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Scott LaBorwit
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Nazlee Zebardast
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Divya Srikumaran
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Christina R. Prescott
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Yassine J. Daoud
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Fasika A. Woreta
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
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Przybek-Skrzypecka J, Skrzypecki J, Suh L, Szaflik JP. Corneal ring infiltrate- far more than Acanthamoeba keratitis: review of pathophysiology, morphology, differential diagnosis and management. J Ophthalmic Inflamm Infect 2023; 13:55. [PMID: 38112842 PMCID: PMC10730498 DOI: 10.1186/s12348-023-00379-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023] Open
Abstract
OBJECTIVE Ring infiltrates usually accompany numerous infectious and sterile ocular disorders. Nevertheless, systemic conditions, drugs toxicity and contact lens wear may present with corneal ring infiltrate in substantial part. Considering its detrimental effect on vision, detailed knowledge on etiology, pathophysiology, differential diagnosis, and management should be considered essential for every ophthalmologist. METHODS The PUBMED database was searched for "corneal ring infiltrate" and "ring infiltrate" phrases, "sterile corneal infiltrate" and "corneal infiltrate". We analyzed articles written in English on risk factors, pathophysiology, clinical manifestation, morphological features, ancillary tests (anterior-segment optical coherence tomography, corneal scraping, in vivo confocal microscopy), differential diagnosis and management of corneal ring infiltrate. RESULTS Available literature depicts multifactorial origin of corneal ring infiltrate. Dual immunological pathophysiology, involving both antibodies-dependent and -independent complement activation, is underlined. Furthermore, we found that the worldwide most prevalent among non-infectious and infectious ring infiltrates are ring infiltrates related to contact-lens wear and bacterial keratitis respectively. Despite low incidence of Acanthamoeba keratitis, it manifests with corneal ring infiltrate with the highest proportion of the affected patients (one third). However, similar ring infiltrate might appear as a first sign of general diseases manifestation and require targeted treatment. Every corneal ring infiltrate with compromised epithelium should be scraped and treat as an infectious infiltrate until not proven otherwise. Of note, microbiological ulcer might also lead to immunological ring and therefore require anti-inflammatory treatment. CONCLUSION Corneal ring infiltrate might be triggered not only by ocular infectious and non-infectious factors, but also by systemic conditions. Clinical assessment is crucial for empirical diagnosis. Furthermore, treatment is targeted towards the underlying condition but should begin with anti-infectious regimen until not proven otherwise.
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Affiliation(s)
- J Przybek-Skrzypecka
- Department of Ophthalmology, Medical University of Warsaw, Marszałkowska 24/26, 00-576, Warsaw, Poland.
- SPKSO Ophthalmic University Hospital, Warsaw, Poland.
| | - J Skrzypecki
- SPKSO Ophthalmic University Hospital, Warsaw, Poland
- Department of Experimental Physiology and Pathophysiology, Medical University of Warsaw, Warsaw, Poland
| | - L Suh
- Cornea & Refractive Surgery, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, USA
| | - J P Szaflik
- Department of Ophthalmology, Medical University of Warsaw, Marszałkowska 24/26, 00-576, Warsaw, Poland
- SPKSO Ophthalmic University Hospital, Warsaw, Poland
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7
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Ali A, Bielory L, Dotchin S, Hamel P, Strube YNJ, Koo EB. Management of vernal keratoconjunctivitis: Navigating a changing treatment landscape. Surv Ophthalmol 2023:S0039-6257(23)00138-8. [PMID: 37890678 DOI: 10.1016/j.survophthal.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/12/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023]
Abstract
Vernal keratoconjunctivitis (VKC) is a chronic, progressive, and potentially sight-threatening form of ocular inflammatory disease that primarily affects children and young adults. Prevalence varies by region, ranging from <2 per 10,000 in the United States to as high as 1,100 per 10,000 in parts of Africa. The rarity of VKC in developed countries can make differential diagnosis challenging, and treatment is often delayed until the disease is advanced, and symptoms are significantly impacting patients' quality of life. Although once viewed primarily as an immunoglobulin E-mediated condition, approximately 50% of patients with VKC do not exhibit allergic sensitization. It is now recognized that the immunopathology of VKC involves multiple inflammatory pathways that lead to the signs, symptoms, and conjunctival eosinophilic and fibroproliferative lesions that are a hallmark of the disease. We examine the evolution of our understanding of the immunopathology of VKC, the expanding VKC treatment armamentarium, the clinical implications of emerging treatment approaches, and future directions for VKC research and practice.
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Affiliation(s)
- Asim Ali
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Leonard Bielory
- Departments of Medicine, Allergy, Immunology and Ophthalmology, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Stephanie Dotchin
- Department of Surgery, Section of Ophthalmology, University of Calgary, Calgary, Alberta, Canada
| | - Patrick Hamel
- CHU Ste-Justine, Université de Montréal and McGill University Health Center, Montréal, Québec, Canada
| | - Yi Ning J Strube
- Department of Ophthalmology, Queen's University/Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Euna B Koo
- Stanford Byers Eye Institute, Palo Alto, California, USA
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Bonelli F, Demirsoy I, Lasagni Vitar RM, Fonteyne P, Ferrari G. Topical formulations of Aprepitant are safe and effective in relieving pain and inflammation, and drive neural regeneration. Ocul Surf 2023; 30:92-103. [PMID: 37690516 DOI: 10.1016/j.jtos.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE To test long-term ocular toxicity and analgesic/anti-inflammatory efficacy of two novel ocular formulations of neurokinin 1 receptor (NK1R) antagonist Aprepitant. METHODS for toxicity studies, two Aprepitant formulations (X and Y) were tested on C57BL/6 N mice. Gold standards were 0.4% Oxybuprocaine, 0.1% Diclofenac, or saline. For efficacy studies, C57BL/6 N mice underwent corneal alkali burn, and then received Aprepitant formulation X, Dexamethasone or saline. Eye-drops were applied 3 times/day for 90 days (toxicity) and 14 days (efficacy). Stromal opacity, corneal epithelial damage, nociception and sensitivity were assessed in vivo. The eye-wiping test and corneal sensitivity were assessed to evaluate analgesic efficacy and nerve function. At the end of the experiments mice were euthanized, and corneas were dissected for immunohistochemistry and RT-PCR analyses. RESULTS In normal mice, formulation X was not toxic when topically administered for 90 days. Formulation Y was associated with increased leukocyte infiltration in the cornea (p < 0.001). X1 and X2 formulations significantly reduced corneal pain, as Diclofenac and Oxybuprocaine, but did not reduce corneal sensitivity. Formulation Y, instead, was not analgesic at any time point. In the alkali burn model, X1 and X2 formulation enhanced epithelial damage recovery, and reduced inflammation both at day 7 and 14. Moreover, formulation X showed a stronger analgesic effect when compared to the saline and Dexamethasone groups (p < 0.01). Finally, formulation X1 and X2 restored corneal sensitivity by promoting corneal nerve regeneration. CONCLUSIONS Aprepitant X formulation is a promising candidate for the treatment of pain associated with inflammation of the ocular surface.
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Affiliation(s)
- Filippo Bonelli
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy; Fondazione Banca degli Occhi del Veneto, Venice, Italy
| | - Ibrahim Demirsoy
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Romina Mayra Lasagni Vitar
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Philippe Fonteyne
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulio Ferrari
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Shahzad A, Arshad S, Zubair F, Shahzad S, Batool F, Fu Q. Development and Validation of Facile RP-HPLC Method for Simultaneous Determination of Timolol Maleate, Moxifloxacin Hydrochloride, Diclofenac Sodium and Dexamethasone in Plasma, Aqueous Humor and Pharmaceutical Products. J Chromatogr Sci 2023; 61:678-687. [PMID: 35870199 DOI: 10.1093/chromsci/bmac057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 06/02/2022] [Accepted: 06/17/2022] [Indexed: 08/22/2023]
Abstract
The present study aimed to develop a validated RP-HPLC method for the simultaneous determination of timolol maleate (TM), moxifloxacin hydrochloride (MOXI), diclofenac sodium (DS) and dexamethasone (DEXA) in human plasma, bovine aqueous humor and pharmaceutical preparations. The chromatographic separation was studied using the C18 column. The chromatographic conditions, such as composition, pH, the flow rate of mobile phase, the temperature of column, wavelength of absorption and injection volume of the sample, were studied. The method was validated to confirm specificity, linearity and accuracy in accordance with an International Conference on Harmonization guidelines. The optimum conditions for separation included mobile phase 0.05 M monobasic phosphate buffer: acetonitrile (65:35 v/v), pH of buffer adjusted to 6.2 and the flow rate of 1 mL/minute. The optimum temperature of the column was found to be 35°C, absorption wavelength 265 nm and injection volume 50 μL. The baseline separation of all four drugs with good sensitivity, resolution, and a less than 15 min run time was achieved. The retention time of TM, MOXI, DS and DEXA were 4.3,5.7,9.9 and 13.5 minutes respectively. The limit of detection (LOD) values were 6.2, 4.8, 0.8 and 1.2 ng/mL for TM, MOXI, DS and DEXA, respectively, whereas their respective limit of quantification (LOQ) values was: were 42.6, 26.8, 5.6 and 6.2 ng/mL. The coefficient of variation for intra-day and inter-day were in the range of 0.32-1.57 and 1.29-3.07%, respectively. The method was found to be sensitive, precise and accurate in human plasma and bovine aqueous humor and can be applied for the quantification of these compounds in plasma, aqueous humor and pharmaceuticals.
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Affiliation(s)
- Aqeel Shahzad
- Department of Pharmaceutical Analysis, School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China
- Department of Pharmaceutics, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Sohail Arshad
- Department of Pharmaceutics, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Faryal Zubair
- Department of Pharmaceutical Analysis, School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China
- Department of Pharmaceutics, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Shakeel Shahzad
- Institute of Microbiology, University of Agriculture Faisalabad, Punjab 38040, Pakistan
- Faculty of Medicine and Health, University of New South Wales Sydney, NSW 2052, Australia
| | - Farzana Batool
- Department of Pharmaceutics, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Qiang Fu
- Department of Pharmaceutical Analysis, School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China
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Steindor FA, Büchau TM, Borgardts KC, Borrelli M, Guthoff R, Geerling G, Spaniol K. Descemet Membrane Endothelial Keratoplasty and Triple Descemet Membrane Endothelial Keratoplasty in Eyes With Macular Comorbidity. Cornea 2023; 42:986-991. [PMID: 36542355 DOI: 10.1097/ico.0000000000003113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/24/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this study was to evaluate results after Descemet membrane endothelial keratoplasty (DMEK) and DMEK with cataract surgery (triple DMEK) in eyes with endothelial dysfunction and concomitant macular pathology. METHODS A monocentric, prospective clinical observational study of patients who underwent DMEK or triple DMEK surgery at the Department of Ophthalmology, University Hospital Düsseldorf, Germany, from June 2013 to February 2016 was conducted. Sex, age, best-corrected visual acuity (BCVA), central corneal thickness, endothelial cell density, and central retinal thickness in the 1 millimeter zone were analyzed. RESULTS A total of 209 eyes were included in the study. Forty-two eyes (20.1%) had vision-limiting concomitant maculopathies. These were age-related macular degeneration (n = 17, 8.1%), epiretinal gliosis (n = 13, 6.2%), chronic macular edema (n = 7, 3.3%), macular holes (n = 3, 1.4%), and macular scarring (n = 2, 1.0%). BCVA significantly increased in patients without maculopathy from 0.6 ± 0.33 logMAR to 0.1 ± 0.15 logMAR ( P < 0.001) and also in patients with maculopathy from 0.9 ± 0.38 logMAR to 0.27 ± 0.23 logMAR 12 months postoperatively ( P < 0.001). There was a significant central retinal thickness increase of 34.1 μm 6 weeks after triple DMEK in the central 1-mm zone ( P = 0.011). This increase was insignificant after DMEK. Postoperative macular edema occurred in 5.9% of cases after DMEK and 8.1% after triple DMEK, which was not significantly different. CONCLUSIONS DMEK and triple DMEK significantly increase BCVA in eyes with concomitant maculopathy. Postoperative macular edema is a common disorder after lamellar keratoplasty; therefore, prophylactic treatment with nonsteroidal antiinflammatory drugs should be considered. Maculopathies did not predispose the development of postoperative macular edema.
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11
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[Pseudophakic cystoid macular edema : Statement of the German Society of Ophthalmology, the German Retina Society and the German Professional Association of Ophthalmologists. Status 22 October 2022]. DIE OPHTHALMOLOGIE 2023; 120:276-284. [PMID: 36692849 DOI: 10.1007/s00347-022-01771-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 01/25/2023]
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12
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James-Jenks EM, Pinard CL. Topical Ocular Therapeutics in Small Animals. Vet Clin North Am Small Anim Pract 2023; 53:473-492. [PMID: 36813396 DOI: 10.1016/j.cvsm.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
This article reviews the administration of common topical ophthalmic medications, in relation to factors influencing absorption including composition of topical ophthalmic preparations, and potential systemic effects. Commonly prescribed, commercially available topical ophthalmic medications are discussed with respect to pharmacology, their indications for use, and adverse effects. Knowledge of topical ocular pharmacokinetics is essential for the management of veterinary ophthalmic disease.
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Affiliation(s)
- Elizabeth M James-Jenks
- Department of Clinical Studies, University of Guelph, Ontario Veterinary College, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada.
| | - Chantale L Pinard
- Department of Clinical Studies, University of Guelph, Ontario Veterinary College, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada
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13
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[Pseudophakic Cystoid Macular Edema - Statement of the German Society of Ophthalmology, the German Retina Society and the German Professional Association of Ophthalmologists. Status 22 October 2022]. Klin Monbl Augenheilkd 2023; 240:316-326. [PMID: 36977428 DOI: 10.1055/a-2019-9748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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14
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Pezeshki PS, Nowroozi A, Razi S, Rezaei N. Asthma and Allergy. Clin Immunol 2023. [DOI: 10.1016/b978-0-12-818006-8.00002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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15
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Jin H, Yang B, Jiang D, Ding Z, Xiong Y, Zeng X. Inhibitory effect of anti-Scg3 on corneal neovascularization: a preliminary study. BMC Ophthalmol 2022; 22:455. [PMID: 36443679 PMCID: PMC9703748 DOI: 10.1186/s12886-022-02690-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 11/16/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Corneal neovascularization (CNV) is an important disease that causes blindness. Secretogranin III (Scg3) has emerged as a new influencing factor of neovascularization. This study analyzed the Scg3 antibody's inhibitory effect on CNV and and explored its preliminary mechanism. METHODS Human umbilical vein endothelial cells (HUVECs) were treated with Scg3 and anti-Scg3. Cell proliferation, wound healing migration and tube formation assays were performed. Healthy adult New Zealand rabbits were randomly selected to be alkali burned and establish the corneal neovascularization (CNV) model. The rabbits were randomly divided into 3 groups (the high concentration group, low concentration group and control group). Different doses of anti-Scg3 and PBS were administered to the rabbits. Clinical examinations, immunostaining, quantitative real-time polymerase chain reaction (qPCR) and western blotting analyses were performed postoperatively. RESULTS In the in vitro study, the Scg3 antibody mixture inhibited Scg3-induced endothelial cell proliferation and angiogenesis. In the in vivo study, significant CNV was observed in the control group. Confocal microscopy also revealed considerable active neovascularization in the control group. There was no obvious CNV growth in the high concentration group. Additionally, CD31, LYVE1 and CD45 expression was significantly inhibited after treatment with a high concentration of Scg3 antibody. The qPCR and western blotting analyses revealed that the levels of ERK in the low concentration group and high concentration group were higher than those in the control group at 7 days and 14 days. The levels of VEGF in the control group were significantly increased compared with those in the high concentration group. In all three groups, the levels of Akt were not significantly different at any time point. CONCLUSION The expression of Scg3 could affect the growth of HUVECs in vitro. Treatment with a high concentration (0.5 µg/mL) of Scg3 antibody reduced the inflammatory response and inhibited the growth of corneal neovascularization after corneal alkali burn injury in rabbits. The MEK/ERK pathway might play an important role in the inhibitory effect of anti-Scg3.
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Affiliation(s)
- He Jin
- grid.443385.d0000 0004 1798 9548Affiliated Hospital of Guilin Medical University, Guilin Medical University, 541001 Guilin, China
| | - Binbin Yang
- grid.443385.d0000 0004 1798 9548Affiliated Hospital of Guilin Medical University, Guilin Medical University, 541001 Guilin, China
| | - Dongdong Jiang
- grid.443385.d0000 0004 1798 9548Affiliated Hospital of Guilin Medical University, Guilin Medical University, 541001 Guilin, China
| | - Zhixiang Ding
- grid.443385.d0000 0004 1798 9548Affiliated Hospital of Guilin Medical University, Guilin Medical University, 541001 Guilin, China
| | - Yu Xiong
- grid.443385.d0000 0004 1798 9548Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin Medical University, 541001 Guilin, China
| | - Xinsheng Zeng
- grid.443385.d0000 0004 1798 9548Affiliated Hospital of Guilin Medical University, Guilin Medical University, 541001 Guilin, China
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Stasi K, Alshare Q, Jain M, Wald M, Li Y. Topical Ocular TRPV1 Antagonist SAF312 (Libvatrep) Demonstrates Safety, Low Systemic Exposure, and No Anesthetic Effect in Healthy Participants. Transl Vis Sci Technol 2022; 11:15. [DOI: 10.1167/tvst.11.11.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Kalliopi Stasi
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Qusai Alshare
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Monish Jain
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Michael Wald
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Yifang Li
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
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Abstract
A man in his 30s, with a history of two operated penetrating keratoplasty (PK), primarily for viral keratitis, presented with pain, redness and diminution of vision in his left eye of 4 days duration. Postoperatively, he was prescribed oral antivirals, topical steroid eyedrops, lubricants and antiglaucoma medications. Eight months after transplantation, an epithelial defect with heaped up margins was noted on anterior segment evaluation on a routine follow-up visit. On checking his medications, it was found that the patient was unknowingly using bromfenac drops in place of brimonidine tartrate for the past month. A diagnosis of neurotrophic keratitis was made in the setting of PK performed for viral keratitis, incited by use of topical bromfenac. The patient was prescribed preservative-free lubricants with immediate discontinuation of bromfenac drops. Topical steroid drops were withheld till the epithelial defect healed. Complete healing of the defect was noted after 4 weeks of therapy.
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Affiliation(s)
- Nimmy Raj
- Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Arnav Panigrahi
- Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Mahboob Alam
- Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Noopur Gupta
- Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
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18
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Rasmussen MLR, Schou MG, Bach‐Holm D, Heegaard S, Jørgensen CAB, Kessel L, Wiencke AK, Subhi Y. Comparative efficacy of medical treatments for vernal keratoconjunctivitis in children and young adults: a systematic review with network meta-analyses. Acta Ophthalmol 2022; 100:35-44. [PMID: 33779061 DOI: 10.1111/aos.14858] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/12/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To systematically review the literature on the treatment of vernal keratoconjunctivitis (VKC) in children and young adults and conduct comparative efficacy analysis on clinical signs and symptoms using network meta-analyses. METHODS We systematically searched the databases PubMed/MEDLINE, EMBASE, Cochrane Central and Web of Science on 21 October 2019 for randomized controlled trials (RCT). Studies considered had patients with VKC < 20 years of age randomized into either intervention (any medical intervention) or comparator (active treatment, placebo treatment or non-treatment control), where pre-defined outcomes (data from ≥2 weeks and as close as possible to 2 months) of symptoms (itching, tearing, photophobia and foreign body sensation) and signs (hyperaemia, punctate keratitis, Horner-Trantas dots and macropapillae) were reported. Risk of bias within studies was evaluated using the Cochrane risk of bias tool. Comparisons were made using network meta-analyses. RESULTS We identified 39 studies with data on 2046 individuals. Twenty-three studies were eligible for quantitative analyses. None were systemic therapy. Temporal trend analysis showed that an initial focus on topical mast cell stabilizers turned to a focus on calcineurin inhibitors and a more diverse variety of pharmacological strategies. Studies varied in population, treatment duration and quality. The quantitative analysis revealed that efficacy of different therapies differed substantially across important clinical signs and symptoms, but there was a general trend of superior efficacy when using topical corticosteroids with stronger efficacy of the more potent corticosteroids. CONCLUSION We provide an overview of RCTs comparing the efficacy of treatments for VKC in children and young adults, which we find differs across symptoms and signs. Overall, we saw a general trend of superior efficacy with topical corticosteroids. However, our findings highlight the need for better studies, consensus on core outcomes and potential for individualized therapy.
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Affiliation(s)
| | - Marianne Guldager Schou
- Department of Ophthalmology Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Daniella Bach‐Holm
- Department of Ophthalmology Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Steffen Heegaard
- Department of Ophthalmology Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | | | - Line Kessel
- Department of Ophthalmology Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Anne Katrine Wiencke
- Department of Ophthalmology Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Yousif Subhi
- Department of Ophthalmology Rigshospitalet Copenhagen Denmark
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19
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Lasagni Vitar RM, Bonelli F, Rama P, Ferrari G. Immunity and pain in the eye: focus on the ocular surface. Clin Exp Immunol 2021; 207:149-163. [PMID: 35020868 PMCID: PMC8982975 DOI: 10.1093/cei/uxab032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/21/2021] [Accepted: 12/10/2021] [Indexed: 02/03/2023] Open
Abstract
Most ocular diseases are associated with pain. While pain has been generally considered a mere (deleterious) additional symptom, it is now emerging that it is a key modulator of innate/adaptive immunity. Because the cornea receives the highest nerve density of the entire body, it is an ideal site to demonstrate interactions between pain and the immune response. Indeed, most neuropeptides involved in pain generation are also potent regulators of innate and adaptive leukocyte physiology. On the other hand, most inflammatory cells can modulate the generation of ocular pain through release of specific mediators (cytokines, chemokines, growth factors, and lipid mediators). This review will discuss the reciprocal role(s) of ocular surface (and specifically: corneal) pain on the immune response of the eye. Finally, we will discuss the clinical implications of such reciprocal interactions in the context of highly prevalent corneal diseases.
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Affiliation(s)
- Romina Mayra Lasagni Vitar
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Filippo Bonelli
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Rama
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulio Ferrari
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy,Correspondence: Giulio Ferrari, Cornea and Ocular Surface Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy. E-mail:
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20
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Jost HE, Keenan AV, Keys DA, Myrna KE, Diehl KA. Effect of topical non-steroidal anti-inflammatory drugs on healing times and complications in dogs with spontaneous chronic corneal epithelial defects. Vet Rec 2021; 190:e1118. [PMID: 34802145 DOI: 10.1002/vetr.1118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/06/2021] [Accepted: 10/17/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Little is published regarding topical NSAID effect on corneal healing in dogs. This retrospective cohort study aimed to compare healing times and complications in dogs with spontaneous chronic corneal epithelial defects (SCCED) treated with and without topical non-steroidal anti-inflammatory drugs (NSAID). METHODS Medical records of 66 dogs (71 eyes) diagnosed with SCCED between 2008 and 2019 were included. Eyes were divided into: (1) those receiving topical NSAIDs (n = 33) versus (2) those not receiving topical NSAID (n = 38). Follow-up until healed, such as comfortable eye, negative fluorescein stain was required. Use of topical or systemic anti-inflammatories outside of NSAID or presence of ocular disorders or systemic endocrinopathies that may contribute to delayed healing resulted in study exclusion. RESULTS Healing times were significantly longer in eyes that received topical NSAID (p = 0.008), however, the use of more topical medications for treatment was also associated with longer healing times (p = 0.001). The majority of eyes in the NSAID group received multiple medications, compared to the non-NSAID group, so it was not possible to separate the effects of NSAID from a number of medications. Complications occurred in three eyes of three dogs within the NSAID group. CONCLUSIONS In these canine SCCED eyes, the use of more topical medications, including NSAID, was associated with significantly delayed healing time.
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Affiliation(s)
- Haley E Jost
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Alessandra V Keenan
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Deborah A Keys
- Kaleidoscope Statistics, LLC, Keys Veterinary Medical Statistical Consulting, Athens, Georgia, USA
| | - Kathern E Myrna
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Kathryn A Diehl
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
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21
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Luccarelli SV, Villani E, Lucentini S, Bonsignore F, Sacchi M, Martellucci CA, Nucci P. Sutureless "Contact Lens Sandwich" Technique for Amniotic Membrane Therapy of Central Corneal Ulcers. Eur J Ophthalmol 2021; 32:2141-2147. [PMID: 34633886 DOI: 10.1177/11206721211049093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe a new technique for sutureless and glue-free amniotic membrane transplantation (AMT) and to investigate its effectiveness to treat corneal persistent epithelial defects (PEDs), compared to bandage contact lens (BCL) application alone. METHODS We performed AMT with "contact lens sandwich technique" (CLS-AMT) in 8 consecutive patients with central/para-central (up to 4.00 mm from the geometrical centre) PED/ulceration and we retrospectively compared the results with 11 BCL procedures. RESULTS The procedures were performed successfully with no complications.CLS-AMT showed significantly shorter healing time than BCL (24.0 ± 19.1 vs 42.9 ± 14.6 days; P < 0.05, Mann-Whitney test). Recurrence rates were 12% and 27% for CLS-AMT and BCL, respectively. CONCLUSION CLS-AMT technique, based on the suction effect due to the superposition of a bandage contact lens on the AM-ring complex, represents a quick, low cost, easy to perform and nearly non-invasive AMT technique. This approach is able to provide adequate fixation of AM, and it seems to be a safe and effective treatment for patients with PEDs.
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Affiliation(s)
| | - Edoardo Villani
- 18608Eye Clinic San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy.,Department of Clinical Sciences and Community Health, 9304University of Milan, Italy
| | - Stefano Lucentini
- 18608Eye Clinic San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | | | - Matteo Sacchi
- 18608Eye Clinic San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | | | - Paolo Nucci
- 18608Eye Clinic San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy.,Department of Clinical Sciences and Community Health, 9304University of Milan, Italy
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22
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Lasagni Vitar RM, Barbariga M, Fonteyne P, Bignami F, Rama P, Ferrari G. Modulating Ocular Surface Pain Through Neurokinin-1 Receptor Blockade. Invest Ophthalmol Vis Sci 2021; 62:26. [PMID: 33729475 PMCID: PMC7980039 DOI: 10.1167/iovs.62.3.26] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose The purpose of this study was to test the role of substance P (SP) and its receptor neurokinin 1 (NK1R) on ocular surface pain. Methods Eight-week-old C57BL6/N (wild type [WT]) and B6.Cg-Tac1tm1Bbm/J (TAC1-KO) male mice were used. 5 M NaCl was topically applied on the cornea, followed by topical fosaprepitant 2, 10, and 50 mg/mL; 4 mg/mL oxybuprocaine chloride, or 0.1% diclofenac. Th eye wiping test was used to quantify ocular surface pain. SP content was quantified in the tear fluid and trigeminal ganglia (TG), and TAC1 mRNA was assessed in the cornea. Corneas were immunostained for β3-tubulin and NK1R, or CD45, to quantify leukocyte infiltration. Results TAC1-KO mice displayed a significant reduction of ocular pain (P < 0.001). Similarly, a single dose of 10 or 50 mg/mL fosaprepitant applied topically to WT mice reduced ocular pain as compared to vehicle (P < 0.001). Fosaprepitant 2 mg/mL, instead, induced corneal analgesia only when it was administered for 10 days, 6 times/day (P < 0.05). Diclofenac or oxybuprocaine reduced corneal nociception when compared to vehicle or fosaprepitant (P < 0.05). Fosaprepitant or oxybuprocaine groups showed lower SP content in tear secretions and TG (P < 0.05), and reduction in TAC1 mRNA (P < 0.05), and leukocyte infiltration (P < 0.05) in the cornea. Colocalization of NK1R and β3-tubulin was detected in mouse corneas. Conclusions Topical administration of the NK1R antagonist fosaprepitant effectively reduces ocular surface nociception by decreasing SP release in the tear fluid and TG, and corneal leukocyte infiltration. Fosaprepitant repurposing shows promise for the treatment of ocular pain.
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Affiliation(s)
- Romina Mayra Lasagni Vitar
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Barbariga
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Philippe Fonteyne
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Bignami
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Rama
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulio Ferrari
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Chigbu DI, Labib BA. Immunopharmacology in Vernal Keratoconjunctivitis: Current and Future Perspectives. Pharmaceuticals (Basel) 2021; 14:ph14070658. [PMID: 34358085 PMCID: PMC8308551 DOI: 10.3390/ph14070658] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/24/2021] [Accepted: 06/29/2021] [Indexed: 12/27/2022] Open
Abstract
Vernal keratoconjunctivitis (VKC) is a complex and chronic, multifactorial Th2 cell-mediated chronic ocular surface inflammatory condition that typically affects predominantly male children in hot or warm climates. The primary symptom is intense ocular pruritus, often significant enough to affect activities of daily living. Clinical features differ from simple forms of allergic conjunctivitis in that they are more-or-less confined to the superior tarsus and limbus. There is also a risk of corneal involvement, which leads to irreversible vision loss in approximately 6% of patients. Right now, there is no standardized treatment protocol, and many of the currently available options are not effective in severe and recurrent cases. As such, it is imperative to understand this complex allergic immune response in order to identify future therapeutic targets. This review will focus on potential drug targets in VKC, with particular emphasis on immunomodulators and immunobiologic agents.
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Tsvetanova A, Powell RM, Tsvetanov KA, Smith KM, Gould DJ. Melting corneal ulcers (keratomalacia) in dogs: A 5-year clinical and microbiological study (2014-2018). Vet Ophthalmol 2021; 24:265-278. [PMID: 33794048 DOI: 10.1111/vop.12885] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To identify bacterial microorganisms associated with canine keratomalacia, review their antimicrobial sensitivity, and evaluate clinical outcomes compared to results of microbial culture. METHODS Retrospective analysis of clinical records of dogs diagnosed with a melting corneal ulcer presented to a referral hospital in Hertfordshire, UK between 2014 and 2018. RESULTS One hundred and ten melting corneal ulcers were sampled in 106 dogs. The most common pure bacterial isolate was Pseudomonas aeruginosa (n = 26) followed by β-hemolytic Streptococcus (n = 12). Melting corneal ulcers that cultured coagulase-positive Staphylococcus, coliform bacteria, Pasteurella multocida, Enterococcus, and Streptococcus viridans presented in smaller numbers and were analyzed together (n = 16). Multiple cultures were identified in nine cases (n = 9). Forty-seven cultures yielded no bacterial growth (n = 47). The susceptibility to fluoroquinolones remained high with the exception of β-hemolytic Streptococci. There was no significant difference in the ulcer severity at presentation in regard to the cultured bacteria. Overall, 63 eyes (57%) received surgical grafting in addition to medical treatment. In 14 cases (13%), the progression of corneal melting despite medical ± surgical treatment resulted in enucleation. Fifty-seven percent (8/14) of the enucleated eyes cultured pure Pseudomonas aeruginosa isolates. In contrast, all β-hemolytic Streptococcus-associated ulcers healed. CONCLUSIONS The most common bacterial species associated with canine keratomalacia were Pseudomonas aeruginosa and β-hemolytic Streptococcus. Because of the variation in antibacterial sensitivity between these two species, bacterial culture and sensitivity testing should be performed in all dogs presenting with keratomalacia. Melting corneal ulcers associated with pure Pseudomonas infection were significantly more likely to result in globe loss than melting corneal ulcers associated with other cultures.
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Affiliation(s)
- Agata Tsvetanova
- Davies Veterinary Specialists, Manor Farm Business Park, Hertfordshire, UK
| | | | - Kamen A Tsvetanov
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Kerry M Smith
- Davies Veterinary Specialists, Manor Farm Business Park, Hertfordshire, UK
| | - David J Gould
- Davies Veterinary Specialists, Manor Farm Business Park, Hertfordshire, UK
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Samadi B, Lundstrom M, Zetterberg M, Nilsson I, Montan P, Behndig A, Kugelberg M. Anti-inflammatory treatment after cataract surgery in Sweden: changes in prescribing patterns from 2010 to 2017. BMJ Open Ophthalmol 2021; 6:e000635. [PMID: 33880412 PMCID: PMC7993195 DOI: 10.1136/bmjophth-2020-000635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/19/2021] [Accepted: 02/01/2021] [Indexed: 11/29/2022] Open
Abstract
Aims To investigate changes in the prescribing patterns of postoperative eye drops following cataract surgery in Sweden from 2010 to 2017. Methods Data from cataract procedures registered in the National Cataract Register during the month of March from 2010 to 2017 were record linked and sent to the Swedish Prescribed Drug Register, which allowed us to determine which eye drops the patients had obtained from 3 months presurgery to 2 weeks post surgery. Results During the 8-year study period, 54 889 surgeries were registered. Combination treatment with steroid and non-steroidal anti-inflammatory drug (NSAID) eye drops increased from 12% in 2010 to 60% in 2017 (p<0.001) while monotherapy with steroids decreased from 71% in 2010 to 26% in 2017 (p<0.001). Monotherapy with NSAIDs after surgery was fairly stable, at 17% in 2010 and 13% in 2017 (p<0.001). Combination treatment was more frequent in patients with diabetic retinopathy (p<0.001) or age-related macular degeneration (p<0.001), while monotherapy with steroids was more frequent in patients with glaucoma (p<0.001). The proportion of monotherapy or combination therapy varied widely between ophthalmic clinics. The prescription of antibiotic eye drops after surgery also varied greatly between clinics, from 0% to 63%, with a national average of 4.9%. Conclusion There is a change in the prescription pattern of anti-inflammatory eye drops after cataract surgery in Sweden, with less monotherapy and an increasing proportion of patients receiving a combination of steroid and NSAID eye drops.
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Affiliation(s)
- Behrad Samadi
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Mats Lundstrom
- Department of Clinical Sciences, Ophthalmology, Faculty of Medicine, Lund University, Karlskrona, Sweden
| | - Madeleine Zetterberg
- Department of Clinical Neuroscience, University of Gothenburg, Mölndal, Sweden.,Ophthalmology, Sahlgrenska University Hospital, Goteborg, Sweden
| | | | - Per Montan
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, St Erik Eye Hospital, Stockholm, Sweden
| | - Anders Behndig
- RC Syd, Blekinge Hospital Karlskrona, Karlskrona, Sweden
| | - Maria Kugelberg
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, St Erik Eye Hospital, Stockholm, Sweden
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Roszkowska AM, Oliverio GW, Aragona E, Inferrera L, Severo AA, Alessandrello F, Spinella R, Postorino EI, Aragona P. Ophthalmologic Manifestations of Primary Sjögren's Syndrome. Genes (Basel) 2021; 12:genes12030365. [PMID: 33806489 PMCID: PMC7998625 DOI: 10.3390/genes12030365] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 02/06/2023] Open
Abstract
Sjögren’s syndrome (SS) is a chronic, progressive, inflammatory, autoimmune disease, characterized by the lymphocyte infiltration of exocrine glands, especially the lacrimal and salivary, with their consequent destruction. The onset of primary SS (pSS) may remain misunderstood for several years. It usually presents with different types of severity, e.g., dry eye and dry mouth symptoms, due to early involvement of the lacrimal and salivary glands, which may be associated with parotid enlargement and dry eye; keratoconjunctivitis sicca (KCS) is its most common ocular manifestation. It is still doubtful if the extent ocular surface manifestations are secondary to lacrimal or meibomian gland involvement or to the targeting of corneal and conjunctival autoantigens. SS is the most representative cause of aqueous deficient dry eye, and the primary role of the inflammatory process was evidenced. Recent scientific progress in understanding the numerous factors involved in the pathogenesis of pSS was registered, but the exact mechanisms involved still need to be clarified. The unquestionable role of both the innate and adaptive immune system, participating actively in the induction and evolution of the disease, was recognized. The ocular surface inflammation is a central mechanism in pSS leading to the decrease of lacrimal secretion and keratoconjunctival alterations. However, there are controversies about whether the ocular surface involvement is a direct autoimmune target or secondary to the inflammatory process in the lacrimal gland. In this review, we aimed to present actual knowledge relative to the pathogenesis of the pSS, considering the role of innate immunity, adaptive immunity, and genetics.
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Affiliation(s)
- Anna Maria Roszkowska
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
- Correspondence:
| | - Giovanni William Oliverio
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
| | - Emanuela Aragona
- IRCCS San Raffaele Scientific Institute, Ophthalmology Clinic, Vita Salute San Raffaele University, 20132 Milan, Italy;
| | - Leandro Inferrera
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
| | - Alice Antonella Severo
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
| | - Federica Alessandrello
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
| | - Rosaria Spinella
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
| | - Elisa Imelde Postorino
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
| | - Pasquale Aragona
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
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Nanavaty M, Ashena Z, Bardan A, Thaker R, Bascaran L. Prophylactic use of nonsteroidal anti-inflammatory drugs after cataract surgery and corneal melt. J Curr Ophthalmol 2021; 33:485-491. [PMID: 35128199 PMCID: PMC8772489 DOI: 10.4103/joco.joco_107_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose: To describe a case where prophylactic use of nonsteroidal anti-inflammatory drugs (NSAID) eye drops lead to recurrent corneal melt with loss of vision and a brief literature review. Methods: This is a case report of an 84-year-old diabetic female with chronic dry eye, operated by two different surgeons on each eye at different time intervals. She received topical NSAID prophylaxis after the second surgery only, which led to blindness due to recurrent corneal melt and chronic choroidal effusions. We also present a brief literature review. Results: This lady presented with corneal melt and perforation 5 days following the use of topical NSAIDs prophylaxis after a routine cataract surgery in the second eye. Unfortunately, all efforts to save her vision and eye were unsuccessful as she developed repeated complications in spite of corneal gluing, amniotic membrane, penetrating keratoplasty, and tarsorrhaphy. She also had chronic choroidal effusions. She ended up with an opaque cornea and a subtotal tarsorrhaphy, with no other option to improve her vision as she did not qualify for sedation or general anesthesia due to her poor systemic health. Conclusion: Although it is a common practice for diabetic patients to have topical NSAIDs prophylaxis in combination with steroid eye drops to reduce the risk of cystoid macular edema after cataract surgery, the elderly diabetic patients with concomitant dry eyes should be considered high risk for corneal melt and should be closely monitored. This case highlights the rare but serious complication of topical NSAIDs prophylaxis in the vulnerable cornea, which warrants careful consideration.
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Yani EV, Golikova VA. [Features of anti-inflammatory therapy of bacterial corneal ulcers]. Vestn Oftalmol 2020; 136:207-212. [PMID: 33371651 DOI: 10.17116/oftalma2020136062207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose - to evaluate clinical effectiveness and safety of anti-inflammatory therapy for the treatment of bacterial corneal ulcers. MATERIAL AND METHODS The study included 49 patients treated for bacterial corneal ulcers. Main study patients were divided into two subgroups - the 1st group in addition to conventional treatment received parabulbar injections of 0.3 ml Dexamethasone (4 mg/ml) from the first day of treatment and during the entire period. Patients of the 2nd group, in addition to parabulbar injections of 0.3 ml Dexamethasone (4 mg/ml), received instillation of 0.09% bromfenac (Broxinac) once a day from the first day of therapy and for the entire treatment period. The control group consisted of 17 subjects who underwent standard treatment. The study used a scale for assessing the severity of corneal ulcers. Along with standard ophthalmological examination, all patients were assessed for the ulcer defect using optical coherence tomography (OCT) to measure the diameter of the corneal ulcer and the depth coefficient. RESULTS In the first and second groups, the therapy algorithm has reduced the duration of treatment and hospitalization, promoted rapid epithelization and a reduction in the depth of the ulcer, led to less rough scarring of the cornea reducing corneal neoangiogenesis, and helped achieve higher visual acuity as a result of treatment. CONCLUSION The use of a corticosteroid drug (Dexamethasone) for bacterial corneal ulcers reduces the duration of treatment and hospitalization and improves functional results of the treatment. Bromfenac 0.09% (Broxinac) was effective in the treatment of pain associated with bacterial corneal ulcer, but did not delay corneal epithelialization nor cause any corneal adverse events.
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Affiliation(s)
- E V Yani
- Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - V A Golikova
- Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
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Li H, Fan TJ, Zou P, Xu B. Diclofenac Sodium Triggers p53-Dependent Apoptosis in Human Corneal Epithelial Cells via ROS-Mediated Crosstalk. Chem Res Toxicol 2020; 34:70-79. [PMID: 33356180 DOI: 10.1021/acs.chemrestox.0c00319] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Diclofenac sodium (DFS), a nonsteroidal anti-inflammatory drug, is frequently used in ophthalmology, but it causes negative effects on corneas. The mechanisms underlying the toxicities to corneas remains unclear. The present study was designed to assess the cytotoxicity of DFS to human corneal epithelial (HCEP) cells in vitro and further investigate its related mechanisms. The HCEP cells were treated with DFS at different concentrations ranging from 0.003 125% to 0.1%. DFS showed a dose- and time-dependent cytotoxicity to HCEP cells including abnormal morphology and declined viability. The 0.05% DFS-treated HCEP cells presented cell cycle arrest at S phase, reactive oxygen species (ROS) overproduction, and positive staining of phosphorylated H2AX, suggesting that DFS caused ROS-mediated DNA damage. The upregulation of p53 expression, formation of apoptotic body, phosphatidylserine externalization, and DNA ladder demonstrated that the p53-dependent apoptosis pathway was involved in the cytotoxicity of DFS. Furthermore, DFS activated caspase-8, caspase-9, and caspase-3 altered the expression levels of Bcl-2 family proteins including tBid, Bax, and Bcl-2, as well as increased poly(ADP-ribose) polymerase (PARP) cleavage. DFS also induced ΔΨm disruption, resulting in the release of cytochrome c and apoptosis-inducing factor into the cytoplasm. Additionally, the DFS-induced apoptosis was alleviated by p53 inhibitor. Taken together, DFS triggered p53-dependent apoptosis in HCEP cells via ROS-mediated crosstalk between the extrinsic and intrinsic pathways.
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Affiliation(s)
- Hui Li
- Laboratory for Corneal Tissue Engineering, College of Marine Life Sciences, Ocean University of China, Qingdao, Shandong 266100, China
| | - Ting-Jun Fan
- Laboratory for Corneal Tissue Engineering, College of Marine Life Sciences, Ocean University of China, Qingdao, Shandong 266100, China
| | - Ping Zou
- Marine Agriculture Research Center, Tobacco Research Institute of Chinese Academy of Agricultural Sciences, Qingdao, Shandong 266101, China
| | - Bin Xu
- Laboratory for Corneal Tissue Engineering, College of Marine Life Sciences, Ocean University of China, Qingdao, Shandong 266100, China
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Gomes JÁP, Milhomens Filho JAP. Iatrogenic corneal diseases or conditions. Exp Eye Res 2020; 203:108376. [PMID: 33279524 DOI: 10.1016/j.exer.2020.108376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 02/06/2023]
Abstract
Any prescribed or self-administered therapy carries inherent risks of secondary adverse events. While the volume of treatments being administered through healthcare systems has been increasing, scientific advancements in our understanding of the mechanisms of pharmaceutical side effects and complications from procedures now allow us to reduce the risk of non-intentional damage to ocular health. This review summarizes the most common and leading causes of iatrogenic visual impairment, corneal diseases, and conditions that present in a general ophthalmologic practice, including a comprehensive analysis of their pathophysiology and recommendations for management and prophylaxis.Iatrogenic corneal diseases and conditions can arise from topical drugs, contact lens use, eye surgeries and procedures, systemic drugs, non-ophthalmological events, and cosmetic procedures. Topical and systemic drugs may disturb tear film homeostasis or result in ocular surface deposits. The use of ill-fitted contact lenses can trigger eye discomfort and poor hygiene conditions that can predispose to severe infections. Procedures to the eye may result in a variety of anatomical and functional complications that ophthalmologists should be aware of how to avoid or at least be prepared to manage if they occur. Even non-ophthalmological events such as non-invasive ventilation, radiation therapies and, immune-based conditions, or cosmetic procedures such as eyelash growth and fillers, can result in unwanted damage to the ocular surface.
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Affiliation(s)
- José Álvaro Pereira Gomes
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine / Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | - José Arthur Pinto Milhomens Filho
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine / Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
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Mansoor H, Tan HC, Lin MTY, Mehta JS, Liu YC. Diabetic Corneal Neuropathy. J Clin Med 2020; 9:jcm9123956. [PMID: 33291308 PMCID: PMC7762152 DOI: 10.3390/jcm9123956] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/26/2020] [Accepted: 12/03/2020] [Indexed: 12/14/2022] Open
Abstract
Diabetic keratopathy (DK) is a common, but underdiagnosed, ocular complication of diabetes mellitus (DM) that has a significant economic burden. It is characterised by progressive damage of corneal nerves, due to DM-induced chronic hyperglycaemia and its associated metabolic changes. With advances in corneal nerve imaging and quantitative analytic tools, studies have shown that the severity of diabetic corneal neuropathy correlates with the status of diabetic peripheral neuropathy. The corneal nerve plexus is, therefore, considered as an important surrogate marker of diabetic peripheral neuropathy and helps in the evaluation of interventional efficacy in the management of DM. The clinical manifestations of DK depend on the disease severity and vary from decreased corneal sensitivity to sight-threatening corneal infections and neurotrophic ulcers. The severity of diabetic corneal neuropathy and resultant DK determines its management plan, and a step-wise approach is generally suggested. Future work would focus on the exploration of biomarkers for diabetic corneal neuropathy, the development of new treatment for corneal nerve protection, and the improvement in the clinical assessment, as well as current imaging technique and analysis, to help clinicians detect diabetic corneal neuropathy earlier and monitor the sub-clinical progression more reliably.
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Affiliation(s)
- Hassan Mansoor
- Al Shifa Trust Eye Hospital, Rawalpindi 44000, Pakistan;
| | - Hong Chang Tan
- Department of Endocrinology, Singapore General Hospital, Singapore 169608, Singapore;
| | - Molly Tzu-Yu Lin
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore 169856, Singapore; (M.T.-Y.L.); (J.S.M.)
| | - Jodhbir S. Mehta
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore 169856, Singapore; (M.T.-Y.L.); (J.S.M.)
- Cornea and External Eye Diseases, Singapore National Eye Centre, Singapore 168751, Singapore
- Eye-Academic Clinical Program, Duke-National University Singapore Graduate Medical School, Singapore 169857, Singapore
| | - Yu-Chi Liu
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore 169856, Singapore; (M.T.-Y.L.); (J.S.M.)
- Cornea and External Eye Diseases, Singapore National Eye Centre, Singapore 168751, Singapore
- Eye-Academic Clinical Program, Duke-National University Singapore Graduate Medical School, Singapore 169857, Singapore
- Correspondence: ; Tel.: +65-65-767-246; Fax: +65-62-277-290
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Trinh T, Santaella G, Mimouni M, Mednick Z, Cohen E, Sorkin N, Rootman DS, Slomovic AR, Chan CC. Assessment of response to multimodal management of neurotrophic corneal disease. Ocul Surf 2020; 19:330-335. [PMID: 33189904 DOI: 10.1016/j.jtos.2020.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/29/2020] [Accepted: 11/08/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To characterize patients with neurotrophic keratopathy (NK) and describe treatment outcomes. METHODS Setting: Two institutional tertiary cornea clinics. PATIENTS Medical record review of 37 consecutive patients (37 eyes) with NK. INTERVENTION Management of NK. MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA), epithelial defects (ED), re-epithelialization time, number of perforations, need for penetrating keratoplasty and tarsorrhaphy. RESULTS Average age was 64.4 ± 15.0 years, with 59.5% male patients. Average follow up time was 20.8 ± 32.6 months. Moderate to severe NK (Mackie Stage) was present in 62.1% of patients. Herpetic, neurosurgical and pars plana vitrectomy were the top three causes in each Mackie Stage. 72.9% used topical steroids to treat inflammatory ocular disease. Mean number of EDs was 1.6 per patient averaging 85 days to heal. Persistent EDs affected 56.7%. Corneal perforation (18.9%) was more likely with advanced age, herpetic cause and Stage 3 presentation. Tarsorrhaphy was performed in 35% of patients and were more likely with Stage 3 presentation. Referral for neurotization occurred in 10.8%. Evisceration was required in 2 eyes. BCVA of 20/40 or better was achieved in 21.6% of eyes at last follow up. CONCLUSIONS NK is chronic, frequently visually disabling with multiple contributing factors requiring different treatment modalities. Herpetic, pars plana vitrectomy and neurosurgical causes constitute a significant proportion of NK. Persistent epithelial defects should be rapidly managed as corneal perforation is a serious complication. Advanced age, herpetic cause and Mackie Stage 3 at diagnosis are significant risk factors for corneal perforation.
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Affiliation(s)
- Tanya Trinh
- The University of Toronto, Department of Ophthalmology and Vision Sciences, Toronto, Canada
| | - Gisella Santaella
- The University of Toronto, Department of Ophthalmology and Vision Sciences, Toronto, Canada
| | - Michael Mimouni
- The University of Toronto, Department of Ophthalmology and Vision Sciences, Toronto, Canada
| | - Zale Mednick
- The University of Toronto, Department of Ophthalmology and Vision Sciences, Toronto, Canada
| | - Eyal Cohen
- The University of Toronto, Department of Ophthalmology and Vision Sciences, Toronto, Canada
| | - Nir Sorkin
- The University of Toronto, Department of Ophthalmology and Vision Sciences, Toronto, Canada; Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David S Rootman
- The University of Toronto, Department of Ophthalmology and Vision Sciences, Toronto, Canada
| | - Allan R Slomovic
- The University of Toronto, Department of Ophthalmology and Vision Sciences, Toronto, Canada
| | - Clara C Chan
- The University of Toronto, Department of Ophthalmology and Vision Sciences, Toronto, Canada.
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Prevalence and Risk Factors Associated With Corneal Perforation in Chronic Ocular Graft-Versus-Host-Disease. Cornea 2020; 40:877-882. [PMID: 32947414 DOI: 10.1097/ico.0000000000002526] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine the prevalence and risk factors associated with corneal perforation in patients with chronic ocular graft-versus-host disease (oGVHD). METHODS We reviewed the case records of 405 patients diagnosed with chronic oGVHD over 8 years at a single academic center and assessed the prevalence of corneal perforation in the cohort. We reviewed patient demographics, indication for and type of hematopoietic stem cell transplantation (HSCT), time elapsed between HSCT and perforation, and clinical characteristics including oGVHD severity scores, ocular comorbidities, and topical medications at the time of perforation. Data were analyzed to determine the characteristics of patients with corneal perforation and establish the risk factors. RESULTS Of the 405 patients with chronic oGVHD, 15 (3.7%) developed a corneal perforation. The mean age of patients at the time of perforation was 64 ± 11 years and 10 (67%) were men. The median time to corneal perforation was 3.3 years post-HSCT. Although perforation occurred unilaterally in all cases, 44% had epithelial defects and 38% had stromal abnormalities in the contralateral eye. Of the patients with corneal perforation, 9 (60%) had a National Institute of Health oGVHD severity score of 2 and 6 (40%) had a score of 3. Patients with chronic oGVHD on antiglaucoma drops had a significantly higher risk of corneal perforation (P < 0.001). CONCLUSIONS Corneal perforation is a rare but vision-threatening complication of chronic oGVHD. Our study emphasizes the need for frequent and long-term follow-up of patients with oGVHD regardless of the severity of disease. In particular, patients with chronic oGVHD on topical antiglaucoma medications should be monitored closely due to a higher risk for corneal perforation.
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Inflammation in Dry Eye Syndrome: Identification and Targeting of Oxylipin-Mediated Mechanisms. Biomedicines 2020; 8:biomedicines8090344. [PMID: 32932827 PMCID: PMC7555241 DOI: 10.3390/biomedicines8090344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/05/2020] [Accepted: 09/08/2020] [Indexed: 12/18/2022] Open
Abstract
Dry eye syndrome (DES) is characterized by decreased tear production and stability, leading to desiccating stress, inflammation and corneal damage. DES treatment may involve targeting the contributing inflammatory pathways mediated by polyunsaturated fatty acids and their derivatives, oxylipins. Here, using an animal model of general anesthesia-induced DES, we addressed these pathways by characterizing inflammatory changes in tear lipidome, in correlation with pathophysiological and biochemical signs of the disease. The decline in tear production was associated with the infiltration of inflammatory cells in the corneal stroma, which manifested one to three days after anesthesia, accompanied by changes in tear antioxidants and cytokines, resulting in persistent damage to the corneal epithelium. The inflammatory response manifested in the tear fluid as a short-term increase in linoleic and alpha-linolenic acid-derived oxylipins, followed by elevation in arachidonic acid and its derivatives, leukotriene B4 (5-lipoxigenase product), 12-hydroxyeicosatetraenoic acid (12-lipoxigeanse product) and prostaglandins, D2, E2 and F2α (cyclooxygenase products) that was observed for up to 7 days. Given these data, DES was treated by a novel ophthalmic formulation containing a dimethyl sulfoxide-based solution of zileuton, an inhibitor of 5-lipoxigenase and arachidonic acid release. The therapy markedly improved the corneal state in DES by attenuating cytokine- and oxylipin-mediated inflammatory responses, without affecting tear production rates. Interestingly, the high efficacy of the proposed therapy resulted from the synergetic action of its components, namely, the general healing activity of dimethyl sulfoxide, suppressing prostaglandins and the more specific effect of zileuton, downregulating leukotriene B4 (inhibition of T-cell recruitment), as well as upregulating docosahexaenoic acid (activation of resolution pathways).
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Khan SA, Lee CS. Recent progress and strategies to develop antimicrobial contact lenses and lens cases for different types of microbial keratitis. Acta Biomater 2020; 113:101-118. [PMID: 32622052 DOI: 10.1016/j.actbio.2020.06.039] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 12/16/2022]
Abstract
Although contact lenses are widely used for vision correction, they are also the primary cause of a number of ocular diseases such as microbial keratitis (MK), etc. and inflammatory events such as infiltrative keratitis (IK), contact lens acute red eye (CLARE), contact lens-induced peripheral ulcer (CLPU), etc. These diseases and infiltrative events often result from microbial contamination of lens care solutions and lens cases that can be exacerbated by unsanitary lens care and extended lens wear. The treatment of microbial biofilms (MBs) on lens cases and contact lenses are complicated and challenging due to their resistance to conventional antimicrobial lens care solutions. More importantly, MK caused by MBs can lead to acute visual damage or even vision impairment. Therefore, the development of lens cases, lens care solutions, and contact lenses with effective antimicrobial performance against MK will contribute to the safe use of contact lenses. This review article summarizes and discusses different chemical approaches for the development of antimicrobial contact lenses and lens cases employing passive surface modifications, antimicrobial peptides, free-radical fabricating agents, quorum sensing quenchers, antibiotics, antifungal drugs and various metals and coatings with antimicrobial nanomaterials. The benefits and shortcomings of these approaches are assessed, and alternative solutions for future developments are discussed.
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Affiliation(s)
- Shakeel Ahmad Khan
- Center of Super-Diamond and Advanced Films (COSDAF), Department of Chemistry, City University of Hong Kong, 83 Tat Chee Avenue, Kowloon, Hong Kong
| | - Chun-Sing Lee
- Center of Super-Diamond and Advanced Films (COSDAF), Department of Chemistry, City University of Hong Kong, 83 Tat Chee Avenue, Kowloon, Hong Kong.
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Recurrence of Infection in Corneal Grafts After Therapeutic Penetrating Keratoplasty for Microbial Keratitis. Cornea 2020; 39:39-44. [PMID: 31259861 DOI: 10.1097/ico.0000000000002044] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the factors responsible for the recurrence of infection after therapeutic penetrating keratoplasty (TPK) in severe microbial keratitis. METHODS This is a retrospective interventional case series that reviewed the medical records of 229 consecutive patients (2005-2017) who underwent TPK for microbial keratitis at a tertiary eye care center in Central India. The primary outcome was recurrence of the primary infection. The factors responsible for recurrence were identified by univariate and multivariate regression analysis. RESULTS The overall outcomes were clear graft in 50 (21.8%) eyes, failed graft in 139 (60.7%) eyes, evisceration in 19 (8.3%) eyes, phthisis bulbi in 14 (6.1%) eyes, repeat TPK in 2 (0.9%) eyes, and anterior staphyloma in 1 (0.4%) eye. Recurrence occurred in 63 (27.5%) eyes within 16.2 ± 13.8 (range: 2-66) days. Univariate analysis identified fungal etiology (P = 0.001), ulcer size > 60 mm (P = 0.001), limbal involvement (P = 0.001), endothelial exudates (P = 0.024), retro-iris exudates (P = 0.001), corneal perforation (P = 0.005), coexisting endophthalmitis (P < 0.001), and graft size ≥ 10 mm (P < 0.001) as significant risk factors. Multiple logistic regression identified fungal etiology (P = 0.013), retro-iris exudates (P = 0.011), coexisting endophthalmitis (P = 0.004), and graft size ≥ 10 mm (P = 0.058) as independent risk factors for recurrence. Presenting visual acuity of 20/200 or better was seen in 49 (21.4%) and 39 (17%) eyes, and no light perception in 11 (4.8%) and 26 (11.4%) eyes at postoperative months 1 and 3, respectively. CONCLUSIONS Fungal etiology, retro-iris exudates, coexisting endophthalmitis, and larger grafts were susceptible to recurrence. Early surgery may mitigate most of these factors. Despite the risk of recurrence, TPK remains an effective treatment in severe nonresponsive keratitis.
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Radeck V, Märker D, Prahs P, Helbig H, Krause L. Pseudophakes zystoides Makulaödem. Ophthalmologe 2020; 117:579-590. [DOI: 10.1007/s00347-020-01122-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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38
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Dupuis P, Prokopich CL, Hynes A, Kim H. A contemporary look at allergic conjunctivitis. Allergy Asthma Clin Immunol 2020; 16:5. [PMID: 31993069 PMCID: PMC6975089 DOI: 10.1186/s13223-020-0403-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/09/2020] [Indexed: 01/16/2023] Open
Abstract
Allergic eye disease is common, yet often overlooked in North America. In the U.S., up to 40% of the population is deemed to be affected and this number is growing. Symptoms and signs of ocular allergy can lead to decreased productivity and negatively impact quality of life (QoL). Various treatment options exist to achieve symptom control. For allergic conjunctivitis, ophthalmic agents include antihistamines, mast cell stabilizers, dual-activity agents, nonsteroidal anti-inflammatory drugs (NSAIDs), steroids and some off-label treatments. Immunotherapy is recommended as a therapeutic option. This review provides a summary of the forms of ocular allergies, with a focus on symptoms and signs, impact on QoL, physical examination, diagnosis and therapeutic options of allergic conjunctivitis. Through multidisciplinary collaborations, a simplified algorithm for the treatment of allergic conjunctivitis is proposed for Canadian clinical practice.
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Affiliation(s)
- Pascale Dupuis
- 1Division of Clinical Immunology and Allergy, Department of Medicine, St. Joseph's Hospital, Western University, Room B3-102, 268 Grosvenor Street, London, ON N6A 4V2 Canada
| | - C Lisa Prokopich
- 2School of Optometry & Vision Science, University of Waterloo, 200 Columbia St W., Waterloo, ON N2L 3G1 Canada
| | | | - Harold Kim
- 1Division of Clinical Immunology and Allergy, Department of Medicine, St. Joseph's Hospital, Western University, Room B3-102, 268 Grosvenor Street, London, ON N6A 4V2 Canada.,4Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University Health Sciences Centre, 1280 Main St. W., Hamilton, ON L8S 4K1 Canada
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Rigas B, Huang W, Honkanen R. NSAID-induced corneal melt: Clinical importance, pathogenesis, and risk mitigation. Surv Ophthalmol 2020; 65:1-11. [DOI: 10.1016/j.survophthal.2019.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 12/21/2022]
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Abstract
Surgical intervention is the most effective treatment for decreased vision resulting from cataracts. Although the current procedures for cataract surgery are safe and effective, it is well known that several complications can develop after surgery. Postoperative cystoid macular edema (CME) is a well-known complication, and prophylactic medications such as steroids and/or nonsteroidal antiinflammatory drugs are routinely used for its prevention. Ocular surface abnormalities, such as dry eye, have also been reported to develop after cataract surgery. However, the causative mechanisms for postoperative dry eye have not been definitively determined. At present, there are no prophylactic medications that are commonly used to prevent the development of postoperative dry eye. Although nonsteroidal antiinflammatory drugs are very effective in reducing the incidence and degree of postoperative CME, it is known that they can cause adverse side effects, including ocular surface abnormalities. Thus, perioperative medications must be carefully selected to improve surgical outcomes and patient satisfaction. Here, we summarize the results of recent studies on postoperative dry eye and CME that can develop after cataract surgery. We suggest appropriate combinations of medications that can be used to minimize these postsurgical complications.
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Insights into mechanisms of pranoprofen-induced apoptosis and necroptosis in human corneal stromal cells. Toxicol Lett 2019; 320:9-18. [PMID: 31765691 DOI: 10.1016/j.toxlet.2019.11.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 11/15/2019] [Accepted: 11/18/2019] [Indexed: 12/13/2022]
Abstract
Pranoprofen (PPF) is a wildly used anti-inflammatory ophthalmic drug. It was reported that PPF could decrease early epithelialization of scrape wounds in rabbit cornea and could reduce cell activities of cultured human corneal endothelial cells. However, effects of PPF on corneal stromal cells playing important roles in corneal wound healing remain unknown. In this study,in vitro model of cultured human corneal stomal (HCS) cells and in vivo model of rabbit corneas were used to investigate the effects and underlying mechanisms of PPF. Our findings showed that high concentrations of PPF treatment (0.1 % to 0.0125 %) caused limited chromatin condensation and quickly decreased cell viability that was proved to initiate necroptosis in HCS cells through activating receptor interacting protein kinase (RIPK) and mixed lineage kinase domain-like (MLKL). While low concentrations of PPF treatment (0.00625 %) induced DNA fragmentation, apoptotic body formation, ROS generation, activation of caspases and increase in cytoplasmic content of Bad, Bax and cytoplasmic cytochrome c that suggested apoptosis happened through ROS-mediated caspase-dependent and caspase-independent pathways. Studies of rabbit corneas treated with 0.1 % PPF (the clinical concentration) showed that PPF could induce apoptosis of rabbit corneal stromal cells. This work would be helpful for better understanding cytotoxic effects PPF on human corneal cells.
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Tu PN, Hou YC. Bilateral corneal melting associated with topical diclofenac 0.1% after cataract surgery in a patient with Sjögren's syndrome. Taiwan J Ophthalmol 2019; 9:202-205. [PMID: 31572659 PMCID: PMC6759556 DOI: 10.4103/tjo.tjo_3_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/02/2019] [Indexed: 11/30/2022] Open
Abstract
A 79-year-old female with Sjögren's syndrome (SS) underwent phacoemulsification and lens implantation in both eyes within 2 days. Postoperatively, topical diclofenac 0.1% and tobramycin 0.3% were applied. She presented 10 days later with photophobia, large central corneal melting, and visual acuity of counting finger in both eyes. Diclofenac was discontinued, and systemic doxycycline and steroids were administered. Amniotic membrane transplantation was performed in the left eye with topical steroid and autologous serum 20%. Corneal melting gradually healed in 3 weeks, but the centers of both corneas became thin and opaque. Hyperopic shift and irregular corneal surface were more significant in the right eye than in the left eye. Vision recovered to 0.05 and 0.1 in the right and left eyes, respectively. Topical nonsteroidal anti-inflammatory drugs should be used with caution in cataract surgery in patients with SS.
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Affiliation(s)
- Pei-Ning Tu
- Department of Ophthalmology, Cathay General Hospital, Taipei, Taiwan
| | - Yu-Chih Hou
- Department of Ophthalmology, Cathay General Hospital, Taipei, Taiwan.,Department of Ophthalmology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Ophthalmology, College of Medicine, Fu Jen Catholic University, 510, New Taipei City, Taiwan
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Ting DSJ, Ghosh S. Acute corneal perforation 1 week following uncomplicated cataract surgery: the implication of undiagnosed dry eye disease and topical NSAIDs. Ther Adv Ophthalmol 2019; 11:2515841419869508. [PMID: 31448362 PMCID: PMC6691664 DOI: 10.1177/2515841419869508] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/22/2019] [Indexed: 11/17/2022] Open
Abstract
Dry eye disease is a common ocular surface disease in patients who are undergoing cataract surgery. The significance of dry eye disease is often underestimated or overlooked during preoperative assessment of cataract. We report an 80-year-old patient, with a background of seropositive rheumatoid arthritis and diabetes, who presented with an acute corneal melt and perforation associated with undiagnosed dry eye disease and use of topical ketorolac 1 week following an uncomplicated cataract surgery. The patient underwent repeated corneal gluing for corneal perforation and was subsequently diagnosed and treated for bilateral moderate-severe dry eye disease. This case highlights the importance of meticulous preoperative assessment and management of the ocular surface, especially in patients with systemic diseases such as rheumatoid arthritis and diabetes prior to cataract surgery. The implication of the use of topical nonsteroidal anti-inflammatory drugs following cataract surgery - which might have contributed to the process of corneal melt in our case - is also discussed.
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Affiliation(s)
- Darren Shu Jeng Ting
- Sunderland Eye Infirmary, Sunderland, UK; Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
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Singhal D, Sahay P, Maharana PK, Raj N, Sharma N, Titiyal JS. Vernal Keratoconjunctivitis. Surv Ophthalmol 2019; 64:289-311. [DOI: 10.1016/j.survophthal.2018.12.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 11/28/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
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Mukwaya A, Jensen L, Peebo B, Lagali N. MicroRNAs in the cornea: Role and implications for treatment of corneal neovascularization. Ocul Surf 2019; 17:400-411. [PMID: 30959113 DOI: 10.1016/j.jtos.2019.04.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/25/2019] [Accepted: 04/01/2019] [Indexed: 12/18/2022]
Abstract
With no safe and efficient approved therapy available for treating corneal neovascularization, the search for alternative and effective treatments is of great importance. Since the discovery of miRNAs as key regulators of gene expression, knowledge of their function in the eye has expanded continuously, facilitated by high throughput genomic tools such as microarrays and RNA sequencing. Recently, reports have emerged implicating miRNAs in pathological and developmental angiogenesis. This has led to the idea of targeting these regulatory molecules as a therapeutic approach for treating corneal neovascularization. With the growing volume of data generated from high throughput tools applied to study corneal neovascularization, we provide here a focused review of the known miRNAs related to corneal neovascularization, while presenting new experimental data and insights for future research and therapy development.
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Affiliation(s)
- Anthony Mukwaya
- Department of Ophthalmology, Institute for Clinical and Experimental Medicine, Faculty of Health Sciences, Linkoping University, Linköping, Sweden
| | - Lasse Jensen
- Department of Medical and Health Sciences, Division of Cardiovascular Medicine, Linköping University, Linköping, Sweden
| | - Beatrice Peebo
- Department of Ophthalmology, Institute for Clinical and Experimental Medicine, Faculty of Health Sciences, Linkoping University, Linköping, Sweden
| | - Neil Lagali
- Department of Ophthalmology, Institute for Clinical and Experimental Medicine, Faculty of Health Sciences, Linkoping University, Linköping, Sweden; Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway.
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de Linde Henriksen M, Lim C, Sharp JL. Treatment of canine postoperative ocular hypertension with combined latanoprost 0.005% and atropine 1% ophthalmic solutions. Vet Ophthalmol 2019; 22:448-461. [PMID: 30716184 DOI: 10.1111/vop.12613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 07/24/2018] [Accepted: 08/02/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare the effects of topical 0.005% latanoprost (L) vs combined 0.005% latanoprost and 1% atropine (LA) on control of postoperative ocular hypertension (POH), development of posterior synechiae formation, pupil size, and blindness after phacoemulsification surgery in dogs. ANIMAL STUDIED Dogs with postoperative ocular hypertension were included in the study: L-group, latanoprost (eight dogs, 14 eyes) and LA-group, latanoprost and atropine (nine dogs, 15 eyes). PROCEDURES Complete ophthalmic examinations including tonometry were performed at 1, 7, and 21 days following phacoemulsification. RESULTS No significant differences were found between the measured intraocular pressure (IOP) at days 1 and 7 postphacoemulsification surgery in the L-group and the LA-group (P = 0.26 [14.12 ± 1.76 mmHg vs 16.96 ± 1.68 mmHg] and P = 0.71 [15.45 ± 1.43 mmHg vs 16.20 ± 1.36 mmHg], respectively). No significant differences were found between pupil sizes at day 7 for the two groups (P = 0.25 [13.83% vs 24.77%]). No significant differences were found between odds of posterior synechiae formation at day 21 (P = 0.92) with a probability ± SE for L-group vs LA-group at 0.27 ± 0.14 vs 0.25 ± 0.13. No significant differences were found in odds of postoperative blindness between groups (P = 0.58) with a probability ± SE of 0.21 ± 0.11 vs 0.13 ± 0.09, respectively for L and LA. CONCLUSIONS Combined topical latanoprost and atropine in dogs maintains normal postoperative IOPs but does not seem to cause increased mydriasis compared to latanoprost alone.
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Affiliation(s)
- Michala de Linde Henriksen
- Comparative Ophthalmology, Department of Clinical Sciences, College of Veterinary Medicine, Colorado State University, Fort Collins, Colorado
| | | | - Julia L Sharp
- Department of Statistics, College of Natural Sciences, Colorado State University, Fort Collins, Colorado
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Understanding the Role of Pro-resolving Lipid Mediators in Infectious Keratitis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1161:3-12. [PMID: 31562617 DOI: 10.1007/978-3-030-21735-8_2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Keratitis is a sight-threatening inflammatory condition of the cornea that can be caused by both infectious and non-infectious agents. Physical or chemical trauma are typically related to non-infectious keratitis, which may then become secondarily infected or remain non-infected. Etiology of infectious keratitis is most often associated with bacteria; but viruses, fungi, and parasites are common causative pathogens as well. As a global concern, common risk factors include: systemic immunosuppression (secondary to malnutrition, alcoholism, diabetes, steroid use), previous corneal surgery (refractive corneal surgery, penetrating keratoplasty), extended wear contact lens use, pre-existing ocular surface diseases (dry eye, epithelial defect) and ocular trauma (agriculture- or farm-related) [1-8]. Annual rates of incidence include nearly one million clinical visits due to keratitis in the United States, while it has been reported that roughly two million people develop corneal ulcers in India. Clinically, patients may show signs of eye pain (ranging from mild to severe), blurred vision, photophobia, chemosis and redness. Pathogenesis is generally characterized by rapid progression, focal white infiltrates with underlying stromal inflammation, corneal thinning, stromal edema, mucopurulent discharge and hypopyon, which can lead to corneal scarring, endophthalmitis, and perforation. In fact, corneal opacity is not only a complication of keratitis, but among the leading causes of legal blindness worldwide. Despite that empirical treatment effectively controls most of the pathogens implicated in infectious keratitis, improved clinical outcomes are not guaranteed. Further, if treatment is not initiated in a timely manner, good visual outcome is reduced to approximately 50% of keratitis patients [9]. Moreover, resultant structural alterations, loss of tissue and an unresolved host response remain unaddressed through current clinical management of this condition.
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Hirakata T, Lee HC, Ohba M, Saeki K, Okuno T, Murakami A, Matsuda A, Yokomizo T. Dietary ω-3 fatty acids alter the lipid mediator profile and alleviate allergic conjunctivitis without modulating T h2 immune responses. FASEB J 2018; 33:3392-3403. [PMID: 30383446 PMCID: PMC6404575 DOI: 10.1096/fj.201801805r] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Allergic conjunctivitis (AC) is one of the most common ocular surface diseases in the world. In AC, T helper type 2 (Th2) immune responses play central roles in orchestrating inflammatory responses. However, the roles of lipid mediators in the onset and progression of AC remain to be fully explored. Although previous reports have shown the beneficial effects of supplementation of ω-3 fatty acids in asthma or atopic dermatitis, the underlying molecular mechanisms are poorly understood. In this study, a diet rich in ω-3 fatty acids alleviated AC symptoms in both early and late phases without affecting Th2 immune responses, but rather by altering the lipid mediator profiles. The ω-3 fatty acids completely suppressed scratching behavior toward the eyes, an allergic reaction provoked by itch. Although total serum IgE levels and the expression levels of Th2 cytokines and chemokines in the conjunctiva were not altered by ω-3 fatty acids, eosinophil infiltration into the conjunctiva was dramatically suppressed. The levels of ω-6–derived proinflammatory lipid mediators, including those with chemoattractant properties for eosinophils, were markedly reduced in the conjunctivae of ω-3 diet–fed mice. Dietary ω-3 fatty acids can alleviate a variety of symptoms of AC by altering the lipid mediator profile.—Hirakata, T., Lee, H.-C., Ohba, M., Saeki, K., Okuno, T., Murakami, A., Matsuda, A., Yokomizo, T. Dietary ω-3 fatty acids alter the lipid mediator profile and alleviate allergic conjunctivitis without modulating Th2 immune responses.
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Affiliation(s)
- Toshiaki Hirakata
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Biochemistry, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hyeon-Cheol Lee
- Department of Biochemistry, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Mai Ohba
- Department of Biochemistry, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuko Saeki
- Department of Biochemistry, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshiaki Okuno
- Department of Biochemistry, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akira Murakami
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akira Matsuda
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takehiko Yokomizo
- Department of Biochemistry, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Abstract
Toxic keratoconjunctivitis (TK) is an underrecognized complication of ophthalmic drug use and various environmental or occupational exposures. A detailed history and clinical examination are important to identify the offending agent(s). Common drug-related causes of TK include preservatives in ophthalmic medications, topical antimicrobials, and topical anesthetics. Alternatives to benzalkonium chloride as well as preservative-free formulations should be considered in patients requiring long-term topical medication. More advanced cases of TK may require preservative-free topical steroids and/or antibiotics, and occasionally surgical intervention. Early recognition and appropriate management of TK may help prevent permanent ocular and visual damage.
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