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Catania F, Vinciguerra P, Di Maria A. Low Rate of Postoperative Pterygium Recurrence in Patients under Treatment with Low-Dose Oral Doxycycline for Chronic Blepharitis: A First Report. Diagnostics (Basel) 2024; 14:715. [PMID: 38611627 PMCID: PMC11012025 DOI: 10.3390/diagnostics14070715] [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: 12/27/2023] [Revised: 03/02/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
PURPOSE Low doses of systemic doxycycline (LD-SD) inhibit angiogenesis and the expression of matrix metalloproteases, which are determinants of pterygium progression. This study aimed to compare the recurrence rate and visual outcome of pterygium excision in patients undergoing chronic treatment with LD-SD for chronic refractory blepharitis and LD-SD-naive patients. METHODS A retrospective analysis of patients that underwent surgical excision and conjunctival graft apposition was conducted. Patients were divided in a TETRA group (under LD-SD treatment at the moment of surgery) and a control group. The main outcome was the rate of recurrence at 1 year postoperatively. Secondary outcomes were the comparisons of surface regularity, visual quality, and dry-eye symptoms at 6-week, 6-month, and 1-year follow-up in the two groups. RESULTS The TETRA group showed a significantly lower rate of 1-year recurrence both in primary (p = 0.034) and recurrent (p < 0.001) pterygia. The best corrected visual acuity (BCVA), astigmatic error, corneal total root mean square (RMS), and ocular surface disease index (OSDI) significantly reduced during the follow-up in both groups. The surface asymmetry index and high-order aberrations (HOAs) significantly reduced only in the TETRA group. The final BCVA was significantly higher, while the OSDI score and total RMS and HOAs were significantly lower in the TETRA group compared to the control. CONCLUSIONS Patients under treatment with LD-SD showed a lower rate of recurrence at 1-year follow-up compared to controls. These patients also experienced higher BCVA and surface regularity and less dry-eye symptoms.
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Affiliation(s)
- Fiammetta Catania
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy;
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Italy;
| | - Paolo Vinciguerra
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy;
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Italy;
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Oh JY, Chun YS, Kim KW. Dichotomous versus 5-scale grading system for the interpretation of the point-of-care immunoassay for tear matrix metalloproteinase-9 in dry eye. Sci Rep 2023; 13:6085. [PMID: 37055446 PMCID: PMC10102124 DOI: 10.1038/s41598-023-32928-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/04/2023] [Indexed: 04/15/2023] Open
Abstract
In this study, we compared the dichotomous and 5-scale grading systems for point-of-care immunoassay of tear matrix metalloproteinase (MMP)-9 in dry eye disease (DED) patients and identified the optimal dichotomous system to correlate with DED parameters. We included 167 DED patients without primary Sjogren's syndrome (pSS) (Non-SS DED) and 70 DED patients with pSS (SS DED). We graded MMP-9 expression in InflammaDry® (Quidel, San Diego, CA, USA) using a 5-scale grading system and dichotomous grading systems with four different cut-off grades (D1 to D4 systems). The only DED parameter that showed a significant correlation with the 5-scale grading method was tear osmolarity (Tosm). In both groups, subjects with positive MMP-9 had lower tear secretion and higher Tosm than those with negative MMP-9 according to the D2 dichotomous system. Tosm determined D2 positivity at cutoffs > 340.5 and > 317.5 mOsm/L in the Non-SS DED and SS DED groups, respectively. Tear secretion < 10.5 mm or tear break-up time < 5.5 s stratified D2 positivity in the Non-SS DED group. In conclusion, the dichotomous grading system of InflammaDry reflects ocular surface indices better than the 5-scale grading system and may be more practical in real clinical circumstances.
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Affiliation(s)
- Ja Young Oh
- Department of Ophthalmology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Yeoun Sook Chun
- Department of Ophthalmology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Kyoung Woo Kim
- Department of Ophthalmology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea.
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3
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Derrick T, Habtamu E, Tadesse Z, Callahan EK, Worku A, Gashaw B, Macleod D, Mabey DC, Holland MJ, Burton MJ. The conjunctival transcriptome in Ethiopians after trichiasis surgery: associations with the development of eyelid contour abnormalities and the effect of oral doxycycline treatment. Wellcome Open Res 2022; 4:130. [PMID: 37426632 PMCID: PMC10323279 DOI: 10.12688/wellcomeopenres.15419.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2022] [Indexed: 07/31/2023] Open
Abstract
Background: Surgery to correct trichiasis is a key component of the World Health Organisation trachoma control strategy, however unfavourable outcomes such as eyelid contour abnormalities (ECA) following surgery are relatively common. This study aimed to understand the transcriptional changes associated with the early development of ECA and the impact of doxycycline, which has anti-inflammatory and anti-fibrotic properties, upon these transcription patterns. Methods: One thousand Ethiopians undergoing trichiasis surgery were enrolled in a randomised controlled trial following informed consent. Equal groups of randomly assigned individuals were orally administered with 100mg/day of doxycycline (n=499) or placebo (n=501) for 28 days. Conjunctival swabs were collected immediately prior to surgery and at one- and six-months post-surgery. 3' mRNA sequencing was performed on paired baseline and one-month samples from 48 individuals; 12 in each treatment/outcome group (Placebo-Good outcome, Placebo-Poor outcome, Doxycycline-Good outcome, Doxycycline-Poor outcome). qPCR validation was then performed for 46 genes of interest in 145 individuals who developed ECA at one month and 145 matched controls, using samples from baseline, one and six months. Results: All treatment/outcome groups upregulated genes associated with wound healing pathways at one month relative to baseline, however no individual differences were detected between groups. The summed expression of a highly coexpressed cluster of pro-fibrotic genes was higher in patients that developed ECA in the placebo group relative to controls. qPCR validation revealed that all genes in this cluster and a number of other pro-inflammatory genes were strongly associated with ECA, however these associations were not modulated by trial arm. Conclusions: The development of post-operative ECA is associated with overexpression of pro-inflammatory and pro-fibrotic genes including growth factors, matrix metalloproteinases, collagens and extracellular matrix proteins. There was no evidence that doxycycline modulated the association between gene expression and ECA.
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Affiliation(s)
- Tamsyn Derrick
- London School of Hygiene and Tropical Medicine, London, UK
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Esmael Habtamu
- London School of Hygiene and Tropical Medicine, London, UK
- The Carter Center, Addis Ababa, Ethiopia
| | | | | | - Abebaw Worku
- Amhara Regional Health Bureau, Bahirdar, Ethiopia
| | | | - David Macleod
- London School of Hygiene and Tropical Medicine, London, UK
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Antibiotic treatment for dry eye disease related to meibomian gland dysfunction and blepharitis – A review. Ocul Surf 2022; 26:211-221. [DOI: 10.1016/j.jtos.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 08/18/2022] [Accepted: 08/30/2022] [Indexed: 11/19/2022]
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Armstrong SK, Blacklock B, Keen J, Peck FS. Successful management of a unilateral persistent epithelial defect secondary to meibomian gland dysfunction in an Irish Sports Horse using a multi‐modal treatment plan. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Susan K. Armstrong
- The Royal (Dick) School of Veterinary Studies and the Roslin Institute University of Edinburgh Edinburgh UK
| | - Ben Blacklock
- The Royal (Dick) School of Veterinary Studies and the Roslin Institute University of Edinburgh Edinburgh UK
| | - John Keen
- The Royal (Dick) School of Veterinary Studies and the Roslin Institute University of Edinburgh Edinburgh UK
| | - Fraser S. Peck
- Ophthalmology Kent, Surrey, and Sussex Health Education London UK
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Tong CM, He B, Iovieno A, Yeung SN. Diagnosis and management of limbal stem cell deficiency, challenges, and future prospects. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1933441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- C. Maya Tong
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Canada
| | - Bonnie He
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Alfonso Iovieno
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Sonia N. Yeung
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
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Balci O, Gulkilik G. Assessment of efficacy of topical azithromycin 1.5 per cent ophthalmic solution for the treatment of meibomian gland dysfunction. Clin Exp Optom 2021; 101:18-22. [DOI: 10.1111/cxo.12557] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/03/2017] [Accepted: 03/16/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ozlem Balci
- Department of Ophthalmology, Istanbul Medipol University School of Medicine, Istanbul, Turkey,
| | - Gokhan Gulkilik
- Department of Ophthalmology, Istanbul Medipol University School of Medicine, Istanbul, Turkey,
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Filippelli M, dell'Omo R, Amoruso A, Paiano I, Pane M, Napolitano P, Bartollino S, Costagliola C. Intestinal microbiome: a new target for chalaziosis treatment in children? Eur J Pediatr 2021; 180:1293-1298. [PMID: 33226501 DOI: 10.1007/s00431-020-03880-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 11/06/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022]
Abstract
Intestinal dysbiosis (changes in the gut commensal microbiome) is related to several ophthalmic diseases. The aim of this study was to verify whether oral specific probiotics can alter the clinical course of chalaziosis and its recurrence. A prospective comparative pilot study involving 26 children suffering from chalaziosis was conducted. Children were randomly divided into two groups. The first group received medical treatment (lid hygiene, warm compression and dexamethasone/tobramycin ointment for at least 20 days), and the second group received medical treatment plus a daily supplementation of oral probiotics (≥ 1 × 10^9 live cells of Streptococcus thermophilus ST10 (DSM 25246), ≥ 1 × 10^9 live cells of Lactococcus lactis LCC02 (DSM 29536) and ≥ 1 × 10^9 live cells of Lactobacillus delbrueckii subsp. bulgaricus (DSM 16606) with maltodextrin as the bulking agent (Probiotical S.p.A., Novara, Italy). All patients were evaluated at 2-week intervals for 3 months. If the lesion had not disappeared or decreased in size to 1 mm or less in diameter at the time of subsequent visits, the same procedure was repeated for another 3-month cycle. There was a significant difference in the time taken for complete resolution of the chalazion between the two groups in favour of the children receiving the probiotics. The treatment was not associated with any significant complications in either group. Trial registration: The trial was registered at clinical trials.gov under NCT04322500 on 25/03/2020 ("retrospectively registered").Conclusions: Modification of the intestinal microbiome with specific probiotics can alter the clinical course of chalaziosis in children by re-establishing intestinal and immune homeostasis. Probiotic supplementation can increase the effectiveness of traditional therapies by prompting the complete resolution of chalaziosis in a shorter amount of time, in an easy and feasible way. What is Known: • The intestinal microbiome plays a crucial role in several inflammatory diseases of the eye and is considered a therapeutic target. • Probiotics play a role in the prevention and treatment of different conditions in children. What is New: • In children probiotic supplementation is safe and effective. • Probiotic supplementation reduced the time required for complete resolution of the chalazion.
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Affiliation(s)
- Mariaelena Filippelli
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Molise, Italy.
| | - Roberto dell'Omo
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Molise, Italy
| | - Angela Amoruso
- R&D Department, PROBIOTICAL RESEARCH Srl, Novara, Piemonte, Italy
| | - Ilaria Paiano
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Molise, Italy
| | - Marco Pane
- R&D Department, PROBIOTICAL RESEARCH Srl, Novara, Piemonte, Italy
| | - Pasquale Napolitano
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Molise, Italy
| | - Silvia Bartollino
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Molise, Italy
| | - Ciro Costagliola
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Molise, Italy
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In vitro validation of the tear matrix metalloproteinase 9 in-situ immunoassay. Sci Rep 2020; 10:15126. [PMID: 32934302 PMCID: PMC7492475 DOI: 10.1038/s41598-020-71977-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 08/23/2020] [Indexed: 12/21/2022] Open
Abstract
We aimed to validate a tear MMP-9 in-situ immunoassay (InflammaDry) and to identify factors that could affect results or interpretation. Three factors were examined: sample concentration, volume, and time. Recombinant human (rh) MMP-9 (10 or 20 μl; 0, 12.5, 25, 50, 100, 200, 500, and 1,000 ng/ml) was applied to the kit and the detection limit and assay reproducibility were examined. At a rhMMP-9 volume of 10 μl (≥ 50 ng/ml), all positive results were identified by densitometry at 10 and 20 min; however, after 20 min, more than half of the nine ophthalmologists interpreted a positive result. At a rhMMP-9 volume of 20 μl (≥ 25 ng/ml), ophthalmologists and densitometry identified almost all test lines at 10 and 20 min. At 10 μl, densitometry showed a linear dose–response pattern. At 20 μl, densitometry showed a linear dose–response pattern at concentrations up to 500 ng/ml; however, full saturation was achieved at concentrations ≥ 500 ng/ml. When the same amount of rhMMP-9 was applied, the density result increased significantly upon doubling of the solvent volume (i.e., by adding the same volume of PBS to a sample). InflammaDry showed a high inter- and intra-assay coefficient of variation at 10 min (28.4% and 24.7%, respectively). The results of the MMP-9 in-situ immunoassay varied significantly depending on sample volume. Therefore, when interpreting the results, careful attention must be paid to tear volume.
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10
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Tao T, Tao L. Systematic review and meta-analysis of treating meibomian gland dysfunction with azithromycin. Eye (Lond) 2020; 34:1797-1808. [PMID: 32346111 PMCID: PMC7608442 DOI: 10.1038/s41433-020-0876-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 01/27/2020] [Accepted: 03/04/2020] [Indexed: 11/18/2022] Open
Abstract
To systematically review studies of managing meibomian gland dysfunction (MGD) with azithromycin and pool clinical outcomes to show its effectiveness. Eligible studies were retrieved from five main electronic databases. Symptom score was the primary outcome, while clinical signs and objective measurements were secondary outcomes. Pooled rates for adverse events were also calculated. Improvements in each outcome after administering either oral azithromycin (OA) or topical azithromycin (TA) were pooled and measured by standard mean difference (SMD) to show the overall effectiveness. Then the effectiveness was sub-grouped by TA and OA. In addition, pooled outcomes after administering TA and oral doxycycline (OD) were compared with assess their effectiveness. Finally, 18 eligible studies were included. The overall pooled symptom scores were significantly reduced after administering both TA and OA [P < 0.0001; SMD = 1.54 (95% CI: 1.15–1.92)]. Similarly, the overall combined eyelid signs, plugging of the meibomian gland, meibum quality, and tear secretion were also distinctly improved. However, significant improvements for tear break-up time (TBUT) and corneal staining (CS) were achieved by TA (TBUT: P = 0.02; CS: P = 0.02) but not by OA (TBUT: P = 0.08; CS: P = 0.14). The pooled adverse event rates for TA and OA were 25% and 7%, respectively. Moreover, TA was comparable to OD to treat MGD regarding symptom score, TBUT and tear secretion. This study showed that MGD could be treated effectively with oral or topical azithromycin by improving symptoms, clinical signs, and stabilization of tear film. Topical azithromycin seemed to be superior over oral azithromycin or doxycycline in improving the quality of tear film in the short term.
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Affiliation(s)
- Tianchang Tao
- Department of Ophthalmology, Peking University People's Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases College of Optometry, Peking University Health Science Center, Beijing, China
| | - Liming Tao
- Department of Ophthalmology, The Second Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China.
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Derrick T, Habtamu E, Tadesse Z, Callahan EK, Worku A, Gashaw B, Macleod D, Mabey DC, Holland MJ, Burton MJ. The conjunctival transcriptome in Ethiopians after trichiasis surgery: associations with the development of eyelid contour abnormalities and the effect of oral doxycycline treatment. Wellcome Open Res 2019. [DOI: 10.12688/wellcomeopenres.15419.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Surgery to correct trichiasis is a key component of the World Health Organisation trachoma control strategy, however unfavourable outcomes such as eyelid contour abnormalities (ECA) following surgery are relatively common. This study aimed to understand the transcriptional changes associated with the early development of ECA and the impact of doxycycline, which has anti-inflammatory and anti-fibrotic properties, upon these transcription patterns. Methods: One thousand Ethiopians undergoing trichiasis surgery were enrolled in a randomised controlled trial following informed consent. Equal groups of randomly assigned individuals were orally administered with 100mg/day of doxycycline (n=499) or placebo (n=501) for 28 days. Conjunctival swabs were collected immediately prior to surgery and at one- and six-months post-surgery. 3’ mRNA sequencing was performed on paired baseline and one-month samples from 48 individuals; 12 in each treatment/ECA outcome group. qPCR validation was then performed for 46 genes of interest in 145 individuals who developed ECA at one month and 145 matched controls, using samples from baseline, one and six months. Results: All treatment/outcome groups upregulated genes associated with wound healing pathways at one month relative to baseline, however no individual differences were detected between groups. The summed expression of a highly coexpressed cluster of pro-fibrotic genes was higher in patients that developed ECA in the placebo group relative to controls. qPCR validation revealed that all genes in this cluster and a number of other pro-inflammatory genes were strongly associated with ECA, however these associations were not modulated by trial arm. Conclusions: The development of post-operative ECA is associated with overexpression of pro-inflammatory and pro-fibrotic genes including growth factors, matrix metalloproteinases, collagens and extracellular matrix proteins. There was no evidence that doxycycline modulated the association between gene expression and ECA.
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12
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De Benedetti G, Vaiano AS. Oral azithromycin and oral doxycycline for the treatment of Meibomian gland dysfunction: A 9-month comparative case series. Indian J Ophthalmol 2019; 67:464-471. [PMID: 30900575 PMCID: PMC6446637 DOI: 10.4103/ijo.ijo_1244_17] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose To compare the efficacy and safety profile of oral azithromycin with that of doxycycline over 9 months in patients experiencing failure with conservative and topical treatment for Meibomian gland dysfunction (MGD), to assess recurrence of MGD, and to determine the number of treatments required. Methods This is a randomized controlled trial with a cross-over design at a tertiary care center. In all, 115 consecutive patients underwent a complete ophthalmological examination before being randomly assigned to oral treatment with doxycline (4 g for 30 days) or azithromycin (1.25 g for 5 days). Patients were evaluated at 3, 6, and 9 months. Therapy was switched or conservative management maintained according to signs and symptoms. Results In the azithromycin group, 83.25% of the patients were stable after one treatment, 16.5% needed a further one or two treatments (some had previously been switched to doxycycline), and 5.77% did not improve despite treatment. In the doxycycline group, 33.79% of patients were stable after one treatment, 66.21% needed a further one or two treatments (some had previously switched to azithromycin), and 29.41% did not improve despite treatment (P < 0.05). Minimal gastrointestinal adverse effects (nausea, diarrhea, abdominal cramp, and decreased appetite) were reported, mostly unchanged at the follow-up visits. At the first visit, more adverse effects were reported in the doxycycline group (14/51, 24%) than in the azithromycin group (3/52, 6%; P < 0.005). Conclusion Both antibiotics were effective and safe for treating patients with persistent MGD, although azithromycin was superior when the reduced dose and the shorter course of therapy (5 days vs. 4 weeks) were taken into consideration. Given the chronic nature of the disease and the improvement in some signs with minimal adverse effects, a shorter therapy seems a safer and more logical alternative to longer regimens.
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Wladis EJ, Lau KW, Adam AP. Nuclear Factor Kappa-B Is Enriched in Eyelid Specimens of Rosacea: Implications for Pathogenesis and Therapy. Am J Ophthalmol 2019; 201:72-81. [PMID: 30703356 DOI: 10.1016/j.ajo.2019.01.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 01/16/2019] [Accepted: 01/19/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess the role of nuclear factor kappa-B (NFKB) in cutaneous specimens of rosacea and unaffected tissue. METHODS Immunohistochemical staining was performed for the activated, phosphorylated variant of NFKB (pNFKB) in eyelid specimens of rosacea (n = 12) and normal, healthy tissue (n = 12). The numbers of positively staining cells/40× microscopic field were counted across 5 consecutive fields. Additionally, quantitative Western blotting was carried out for pNFKB and NFKB in specimens of rosacea (n = 15) and normal controls (n = 14). Statistical comparisons were performed via a dedicated software package. RESULTS The mean number of cells/40× microscopic field that stained positively for pNFKB was 18.4 (standard deviation = 15.3) for control patients and 39.3 (standard deviation = 16.9) for rosacea patients, and the difference between the 2 groups was statistically significant (P = .0024). On Western blotting, the mean ratios of pNFKB:NFKB for control and rosacea patients measured 0.58 (standard deviation = 0.81) and 3.11 (standard deviation = 3.53), respectively. The 2 groups were statistically significantly different (P = .0002). CONCLUSIONS The activated form of NFKB is enriched in rosacea, indicating a role for this pathway in the pathogenesis of this disease. Interference with NFKB signaling may represent a novel therapy for rosacea as clinical agents become available. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Di Zazzo A, Micera A, De Piano M, Cortes M, Bonini S. Tears and ocular surface disorders: Usefulness of biomarkers. J Cell Physiol 2018; 234:9982-9993. [PMID: 30515814 DOI: 10.1002/jcp.27895] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 11/12/2018] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Corroborating data suggest that the analysis of tear fluid might represent an additional tool in the ophthalmological practice. AREAS COVERED The purpose of this review was to sum up the tear protein profiles in healthy and diseased ocular surface and to highlight biomarker usefulness in the early diagnosis as well as at follow-up. This analysis encompasses a deep examination of the protein profile expression under physiological and pathological conditions. Tear protein profile analysis will allow in the near future discriminating between different grades of inflammation, from acute trauma toward immune-, endocrine-, and nervous-related disorders of the ocular surface. CONCLUDING REMARKS The review provides an overview of old and recent findings about inflammatory mediators identified at the ocular surface, under physiological and pathological conditions. To date, the analysis of tear fluid represents a new additional approach for diagnosis and management of ocular surface diseases. Understanding the pathophysiological mechanism could also offer significant advantages to develop strategies addressed to better clarify some complex ocular surface disorders. To sum up, the possibility to provide selective biomarkers as a future target of specific diseases should be considered for supporting diagnosis and management of ocular surface diseases.
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Affiliation(s)
- Antonio Di Zazzo
- Research Laboratories in Ophthalmology, IRCCS Fondazione Bietti, Rome, Italy.,Ophthalmology Operative Complex Unit, University Campus Bio-Medico of Rome, Rome, Italy
| | - Alessandra Micera
- Research Laboratories in Ophthalmology, IRCCS Fondazione Bietti, Rome, Italy
| | - Maria De Piano
- Research Laboratories in Ophthalmology, IRCCS Fondazione Bietti, Rome, Italy
| | - Magdalena Cortes
- Research Laboratories in Ophthalmology, IRCCS Fondazione Bietti, Rome, Italy
| | - Stefano Bonini
- Ophthalmology Operative Complex Unit, University Campus Bio-Medico of Rome, Rome, Italy
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Lam-Franco L, Perfecto-Avalos Y, Patiño-Ramírez B, Rodríguez García A. IL-1α and MMP-9 Tear Levels of Patients with Active Ocular Rosacea before and after Treatment with Systemic Azithromycin or Doxycycline. Ophthalmic Res 2018; 60:109-114. [DOI: 10.1159/000489092] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 04/09/2018] [Indexed: 11/19/2022]
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16
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Treatment of ocular rosacea. Surv Ophthalmol 2018; 63:340-346. [DOI: 10.1016/j.survophthal.2017.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 07/30/2017] [Accepted: 07/31/2017] [Indexed: 02/06/2023]
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Habtamu E, Wondie T, Aweke S, Tadesse Z, Zerihun M, Gashaw B, Roberts CH, Kello AB, Mabey DCW, Rajak SN, Callahan EK, Macleod D, Weiss HA, Burton MJ. Oral doxycycline for the prevention of postoperative trachomatous trichiasis in Ethiopia: a randomised, double-blind, placebo-controlled trial. Lancet Glob Health 2018; 6:e579-e592. [PMID: 29653629 PMCID: PMC5912946 DOI: 10.1016/s2214-109x(18)30111-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/11/2018] [Accepted: 02/22/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Trachomatous trichiasis is treated surgically to prevent sight loss. Unfavourable surgical outcomes remain a major challenge. We investigated the hypothesis that doxycycline might reduce the risk of postoperative trichiasis following surgery in patients with trachomatous trichiasis through anti-matrix metalloproteinase and anti-inflammatory activity. METHODS In this randomised, double-blind, placebo-controlled trial, adults (aged >18 years) with upper lid trachomatous trichiasis in association with tarsal conjunctive scarring were recruited through community-based screening and surgical outreach campaigns in Ethiopia. Individuals who had previously had eyelid surgery were excluded. Participants were randomly assigned (1:1), with random block sizes of four or six, to receive oral doxycycline (100 mg once a day) or placebo for 28 days immediately after trichiasis surgery. Randomisation was stratified by surgeon. Patients, investigators, surgeons, and all other study team members were masked to study group allocation and treatment. Participants were examined at 10 days, and 1, 6, and 12 months after surgery. The primary outcome was the cumulative proportion of individuals who developed postoperative trichiasis by 12 months. Primary analyses were done in all participants who attended at least one of the four follow-up assessments. Safety analyses were done in all participants who attended either the 10 day or 1 month follow-up assessments. This trial is registered with the Pan African Clinical Trials Registry, number PACTR201512001370307. FINDINGS Between Dec 21, 2015, and April 6, 2016, 1000 patients with trichiasis were enrolled and randomly assigned to treatment (499 patients to doxycycline, 501 patients to placebo). All but one participant attended at least one follow-up assessment. Thus, 999 participants were assessed for the primary outcome: 498 in the doxycycline group and 501 in the placebo group. By month 12, 58 (12%) of 498 patients in the doxycycline group and 62 (12%) of 501 patients in the placebo group had developed postoperative trichiasis (adjusted odds ratio 0·91, 95% CI 0·61 to 1·34, p=0·63), with a risk difference of -0·5% (-4·5% to 3·5%). Significantly more patients in the doxycycline group had an adverse event than in the placebo group (18 [4%] of 498 vs six [1%] of 501; odds ratio 3·09, 95% CI 1·21-7·84; p=0·02). The most frequent adverse events in the doxycycline group were gastritis symptoms (n=9), constipation (n=4), and diarrhoea (n=4). INTERPRETATION Doxycycline did not reduce the risk of postoperative trichiasis and is therefore not indicated for the improvement of outcomes following trachomatous trichiasis surgery. Surgical programmes should continue to make efforts to strengthen surgical training and supervision to improve outcomes. FUNDING The Wellcome Trust.
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Affiliation(s)
- Esmael Habtamu
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK.
| | | | | | | | | | | | - Chrissy H Roberts
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | | | - David C W Mabey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Saul N Rajak
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - David Macleod
- Medical Research Council Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen A Weiss
- Medical Research Council Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
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Baudouin C, Irkeç M, Messmer EM, Benítez-del-Castillo JM, Bonini S, Figueiredo FC, Geerling G, Labetoulle M, Lemp M, Rolando M, Van Setten G, Aragona P. Clinical impact of inflammation in dry eye disease: proceedings of the ODISSEY group meeting. Acta Ophthalmol 2018; 96:111-119. [PMID: 28390092 PMCID: PMC5836968 DOI: 10.1111/aos.13436] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 02/05/2017] [Indexed: 12/30/2022]
Abstract
Dry eye disease (DED) is a common, multifactorial ocular condition with major impact on vision and quality of life. It is now well recognized that the pathophysiology of chronic DED can include a cycle of inflammation involving both innate and adaptive immune responses. Recently, in vitro/in vivo models have been used to obtain a better understanding of DED‐related inflammatory processes at molecular/cellular levels although they do not truly reproduce the complex and chronic hallmarks of human DED. In clinical DED research, advanced techniques such as impression cytology, conjunctival biopsy, in vivo confocal microscopy and multiplex tear analyses have allowed an improved assessment of inflammation in DED patients. This was supported by the identification of reliable inflammatory markers including matrix metalloproteinase‐9, human leucocyte antigen‐DR or intercellular adhesion molecule‐1 in tears and impression cytology samples. One of the current therapeutic strategies focuses on breaking the inflammatory cycle perpetuating the ocular surface disease, and preclinical/clinical research has led to the development of promising anti‐inflammatory compounds. For instance, cyclosporine, already approved in the United States, has recently been authorized in Europe to treat DED associated with severe keratitis. In addition, other agents such as corticosteroids, doxycycline and essential fatty acids, through their anti‐inflammatory properties, show encouraging results. We now have a clearer understanding of the inflammatory processes involved in DED, and there is hope that the still emerging preclinical/clinical findings will be translated into new and highly effective therapies for patients in the near future.
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Affiliation(s)
- Christophe Baudouin
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts; INSERM-DHOS CIC 503; Paris France
- UPMC Université Paris 06; UMR-S968; Institut de la Vision; Paris France
- CNRS; UMR-7210; Paris France
- Ambroise Paré Hospital, APHP; Dept Ophthalmology; F-92100 Boulogne France
- University of Versailles Saint Quentin en Yvelines; 78000, Versailles France
| | - Murat Irkeç
- Hacettepe University School of Medicine; Ankara Turkey
| | | | | | | | - Francisco C. Figueiredo
- Department of Ophthalmology; Royal Victoria Infirmary and Newcastle University; Newcastle upon Tyne UK
| | - Gerd Geerling
- Department of Ophthalmology; Heinrich Heine University; Düsseldorf Germany
| | | | - Michael Lemp
- Department of Ophthalmology; Georgetown University; Washington USA
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Hagen KB, Bedi R, Blackie CA, Christenson-Akagi KJ. Comparison of a single-dose vectored thermal pulsation procedure with a 3-month course of daily oral doxycycline for moderate-to-severe meibomian gland dysfunction. Clin Ophthalmol 2018; 12:161-168. [PMID: 29398903 PMCID: PMC5775735 DOI: 10.2147/opth.s150433] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose The aim of this study was to compare the efficacy of a single bilateral 12-minute vectored thermal pulsation (VTP) procedure versus daily oral doxycycline for 3 months for moderate-to-severe meibomian gland dysfunction (MGD). Methods This prospective, randomized, parallel-group, single-masked study included 28 subjects who received either a single-dose VTP or 3 months of doxycycline treatment. At baseline and 3 months post treatment, all subjects were evaluated for the following: dry eye symptoms with a standard dry eye questionnaire (the Standard Patient Evaluation for Eye Dryness [SPEED]), meibomian gland (MG) function by counting the number of glands yielding liquid secretion with the MG evaluator (MGE), tear breakup time (TBUT) and corneal and conjunctival staining. Results In the VTP group, at 3 months, there was a significant improvement in MG function (4.00±1.47 to 7.73±5.53), SPEED score (11.00±3.30 to 5.42±2.15), TBUT (6.26±2.01 to 8.44±1.81), corneal staining (0.38±0.50 to 0.12±0.33) and conjunctival staining (1.69±1.93 to 0.62±0.85). In the doxycycline group, there was a significant improvement in MG function (4.63±1.41 to 10.63±5.91), SPEED score (13.42±4.17 to 9.42±5.47) and conjunctival staining (2.38±1.88 to 1.13±1.51), but the improvement in TBUT (6.90±2.56 to 7.59±2.03) and corneal staining (0.21±0.41 to 0.13±0.34) was not statistically significant (p=0.262 and p=0.414, respectively). At 3 months, SPEED score was significantly better in the VTP group (p<0.05); other parameters were comparable between the two groups. Conclusion A single 12-minute bilateral VTP procedure was significantly more effective than the 3-month daily course of oral doxycycline at improving the dry eye symptoms secondary to MGD. A single 12-minute VTP treatment was at least as effective as a dose of doxycycline for 3 months, in improving MG function and all measured signs of MGD. Given the minimal risk profile of the single VTP procedure over long-term doxycycline use, a single VTP presents a favorable alternative to long-term antibiotic use.
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Affiliation(s)
| | - Raman Bedi
- Iris Advanced Eye Centre, Chandigarh, India
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Blepharochalasis: A rare cause of eye swelling. Ann Allergy Asthma Immunol 2017; 119:402-407. [PMID: 29150067 DOI: 10.1016/j.anai.2017.07.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/24/2017] [Accepted: 07/28/2017] [Indexed: 11/23/2022]
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Abstract
PURPOSE To describe a rare case of blepharochalasis that progressed from unilateral to bilateral involvement at five years after disease onset. CASE REPORT A previously healthy five-year-old white boy presented to our hospital for a screening visual examination. He was found to have a 2-mm right eyelid ptosis with crepe-like skin and subcutaneous telangiectatic vessels. His mother noted that since the age of three, the child has been having two to seven day-long episodes of right upper eyelid swelling and edema with tenderness. The episodes eventually progressed to involving the left eyelid as well. Oral steroid taper was found to effectively resolve these exacerbations, and a diagnosis of blepharochalasis was made. CONCLUSION Blepharochalasis should be in the differential diagnosis for young children presenting with unilateral or bilateral ptosis with periorbital skin abnormalities.
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Affiliation(s)
- Douglas P Dworak
- Department of Surgery, John H. Stroger, Jr. Hospital of Cook County Division of Ophthalmology, Chicago, IL, USA
| | - Shyam A Patel
- Department of Surgery, John H. Stroger, Jr. Hospital of Cook County Division of Ophthalmology, Chicago, IL, USA
| | - Lisa S Thompson
- Department of Surgery, John H. Stroger, Jr. Hospital of Cook County Division of Ophthalmology, Chicago, IL, USA.,Department of Surgery, Medical Eye Services, IL, USA
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Browning RJ, Sanchez AT, Mullins S, Sheehan DJ, Davis LS. Blepharochalasis: something to cry about. J Cutan Pathol 2016; 44:279-282. [DOI: 10.1111/cup.12841] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 01/28/2016] [Accepted: 05/17/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Richard J. Browning
- Department of Dermatology; Medical College of Georgia at Georgia Regents University; Augusta GA USA
| | - April T. Sanchez
- Department of Dermatology; Medical College of Georgia at Georgia Regents University; Augusta GA USA
| | | | - Daniel J. Sheehan
- Department of Dermatology; Medical College of Georgia at Georgia Regents University; Augusta GA USA
| | - Loretta S. Davis
- Department of Dermatology; Medical College of Georgia at Georgia Regents University; Augusta GA USA
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Zandian M, Rahimian N, Soheilifar S. Comparison of therapeutic effects of topical azithromycin solution and systemic doxycycline on posterior blepharitis. Int J Ophthalmol 2016; 9:1016-9. [PMID: 27500111 DOI: 10.18240/ijo.2016.07.14] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 07/20/2015] [Indexed: 12/15/2022] Open
Abstract
AIM To compare the effect of azithromycin drop and doxycycline capsule on treatment of posterior blepharitis. METHODS Fifty patients (100 eyes) with moderate posterior blepharitis, randomly divided into two therapeutic groups; all the patients got warm eyelid compress and massage three times a day for 3wk. In addition the first group got azithromycin 1% drop, twice daily for 1wk and then one drop daily for 2wk. The second group got oral doxycycline 100 mg daily for 3wk. At the end of the research, patients' signs and symptoms were compared together. ANOVA, Chi-square and Mann-Whitney tests were used for statistical analysis. RESULTS Topical therapy with azithromycin and oral therapy with doxycycline relieved signs and symptoms after 3wk. There were no significant differences between symptoms healing rate and foreign body sensation healing in these two groups (P>0.05). However, azithromycin drop was more effective in reduction of eye redness and doxycycline was more effective in meibomian glands plugging healing and reducing the corneal staining. CONCLUSION Topical azithromycin could have similar effects as oral doxycycline on posterior blepharitis in improving subjective symptoms. However, doxycycline can reduce objective signs such as ocular surface staining and meibomian gland plugging more than azithromycin.
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Affiliation(s)
- Mehdi Zandian
- Department of Ophthalmology, Faculty of Medicine, Hamadan University of Medical sciences, Hamadan 6516836595, Iran
| | - Neda Rahimian
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran 193954763, Iran
| | - Sanaz Soheilifar
- Department of Orthodontics, Faculty of Dentistry, Hamadan University of Medical Sciences, Hamadan 6516836595, Iran
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López-Valverde G, Garcia-Martin E, Larrosa-Povés JM, Polo-Llorens V, Pablo-Júlvez LE. Therapeutical Management for Ocular Rosacea. Case Rep Ophthalmol 2016; 7:237-42. [PMID: 27462249 PMCID: PMC4943766 DOI: 10.1159/000446104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 04/12/2016] [Indexed: 01/20/2023] Open
Abstract
Purpose The purpose of this study is to describe a case of ocular rosacea with a very complex evolution. Rosacea is a chronic dermatological disease that may affect the ocular structures up to 6-72% of all cases. This form is often misdiagnosed, which may lead to long inflammatory processes with important visual consequences for affected patients. Therefore, an early diagnosis and an adequate treatment are important. Methods We report the case of a 43-year-old patient who had several relapses of what seemed an episode of acute bacterial conjunctivitis. Two weeks later, he developed a corneal ulcer with a torpid evolution including abundant intrastromal infiltrators and calcium deposits. He was diagnosed with ocular rosacea and treated with systemic doxycycline and topical protopic. Results A coating with amniotic membrane was placed in order to heal the ulcer, but a deep anterior lamellar keratoplasty to restore the patient's vision because of the corneal transparency loss was necessary. Conclusions Ocular rosacea includes multiple ophthalmic manifestations ranging from inflammation of the eyelid margin and blepharitis to serious corneal affectations. A delayed diagnosis can result in chronic inflammatory conditions including keratinization and loss of corneal transparency, which lead to important visual sequelae for affected patients.
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Affiliation(s)
- Gloria López-Valverde
- Hospital Royo Villanova, Zaragoza, Spain; Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Elena Garcia-Martin
- Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragon), Zaragoza, Spain
| | - José Manuel Larrosa-Povés
- Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragon), Zaragoza, Spain
| | - Vicente Polo-Llorens
- Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragon), Zaragoza, Spain
| | - Luis E Pablo-Júlvez
- Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragon), Zaragoza, Spain
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Doughty MJ. On the prescribing of oral doxycycline or minocycline by UK optometrists as part of management of chronic Meibomian Gland Dysfunction (MGD). Cont Lens Anterior Eye 2016; 39:2-8. [DOI: 10.1016/j.clae.2015.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 07/30/2015] [Accepted: 08/08/2015] [Indexed: 12/17/2022]
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Wladis EJ, Bradley EA, Bilyk JR, Yen MT, Mawn LA. Oral Antibiotics for Meibomian Gland-Related Ocular Surface Disease: A Report by the American Academy of Ophthalmology. Ophthalmology 2015; 123:492-6. [PMID: 26707417 DOI: 10.1016/j.ophtha.2015.10.062] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 10/28/2015] [Accepted: 10/28/2015] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To review the existing medical literature on the role of oral antibiotics in the management of ocular surface disease (OSD) that arises from disorders of the meibomian glands and to assess the efficacy of oral antibiotics in the management of this common ocular disease. METHODS A literature search was last conducted on August 12, 2015, in the PubMed and Cochrane databases for English-language original research investigations that evaluated the role of doxycycline, minocycline, and azithromycin in OSD among adult patients. The searches identified 87 articles, and 8 studies ultimately met the criteria outlined for this assessment. RESULTS The 8 studies identified in the search documented an improvement in meibomian gland-related OSD after treatment with these agents, although side effects were common. This search identified only 1 randomized, controlled trial to assess the efficacy of these medications. CONCLUSIONS Although oral antibiotics are used commonly in the management of OSD, there is no level I evidence to support their use. There are only a few studies that have assessed the efficacy of oral antibiotics in clinically meaningful ways in the management of OSD that arises from disorders of the meibomian glands. The current level of evidence is insufficient to conclude that antibiotics are useful in managing OSD arising from disorders of the meibomian glands. The few existing studies on the topic indicate that oral antibiotics may be an effective treatment for OSD that results from meibomian gland disease.
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Affiliation(s)
- Edward J Wladis
- Ophthalmic Plastic Surgery, Department of Ophthalmology, Albany Medical Center, Albany (Slingerlands), New York
| | | | | | - Michael T Yen
- Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
| | - Louise A Mawn
- Vanderbilt Eye Institute, Vanderbilt University, Nashville, Tennessee
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Arman A, Demirseren DD, Takmaz T. Treatment of ocular rosacea: comparative study of topical cyclosporine and oral doxycycline. Int J Ophthalmol 2015; 8:544-9. [PMID: 26086005 DOI: 10.3980/j.issn.2222-3959.2015.03.19] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 10/09/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To compare the effectiveness of topical cyclosporine A emulsion with that of oral doxycycline for rosacea associated ocular changes and dry eye complaints. METHODS One hundred and ten patients with rosacea were screened. Thirty-eight patients having rosacea associated eyelid and ocular surface changes and dry eye complaints were included in the study. Patients were randomly divided into two groups: nineteen patients were given topical cyclosporine twice daily and nineteen patients were given oral doxycycline 100 mg twice daily for the first month and once daily for the following two months. Symptom and sign scores, ocular surface disease index questionnarie and tear function tests were evaluated at baseline and monthly for 3mo. Three months after results were compared with that of baseline. RESULTS Mean values of symptom, eyelid sign and corneal/conjunctival sign scores of each treatment group at baseline and 3mo after treatments were compared and both drugs were found to be effective on rosacea associated ocular changes (P<0.001). Cyclosporine was more effective in symptomatic relief and in the treatment of eyelid signs (P=0.01). There was statistically significant increase in the mean Schirmer score with anesthesia and tear break up time scores in the cyclosporine treatment group compared to the doxycycline treatment group (P<0.05). CONCLUSION Cyclosporine as a topical drug can be used in the treatment of rosacea associated ocular complications because it is more effective than doxycycline. In addition ocular rosacea as a chronic disease requires long term treatment and doxycycline has various side effects limiting its long term usage.
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Affiliation(s)
- Aysegul Arman
- Ophthalmology Clinic, Ankara Ataturk Training and Research Hospital, Ankara 06800, Turkey
| | | | - Tamer Takmaz
- Ophthalmology Clinic, Ankara Ataturk Training and Research Hospital, Ankara 06800, Turkey
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Motegi SI, Uchiyama A, Yamada K, Ogino S, Takeuchi Y, Ishikawa O. Blepharochalasis: Possibly associated with matrix metalloproteinases. J Dermatol 2014; 41:536-8. [DOI: 10.1111/1346-8138.12503] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 03/29/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Sei-ichiro Motegi
- Department of Dermatology; Gunma University Graduate School of Medicine; Maebashi Gunma Japan
| | - Akihiko Uchiyama
- Department of Dermatology; Gunma University Graduate School of Medicine; Maebashi Gunma Japan
| | - Kazuya Yamada
- Department of Dermatology; Gunma University Graduate School of Medicine; Maebashi Gunma Japan
| | - Sachiko Ogino
- Department of Dermatology; Gunma University Graduate School of Medicine; Maebashi Gunma Japan
| | - Yuko Takeuchi
- Department of Dermatology; Gunma University Graduate School of Medicine; Maebashi Gunma Japan
| | - Osamu Ishikawa
- Department of Dermatology; Gunma University Graduate School of Medicine; Maebashi Gunma Japan
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The Practical Detection of MMP-9 Diagnoses Ocular Surface Disease and May Help Prevent Its Complications. Cornea 2013; 32:211-6. [DOI: 10.1097/ico.0b013e3182541e9a] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Narayanan S, Redfern RL, Miller WL, Nichols KK, McDermott AM. Dry eye disease and microbial keratitis: is there a connection? Ocul Surf 2013; 11:75-92. [PMID: 23583043 DOI: 10.1016/j.jtos.2012.12.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 12/14/2012] [Accepted: 12/16/2012] [Indexed: 02/07/2023]
Abstract
Dry eye is a common ocular surface disease of multifactorial etiology characterized by elevated tear osmolality and inflammation leading to a disrupted ocular surface. The latter is a risk factor for ocular surface infection, yet overt infection is not commonly seen clinically in the typical dry eye patient. This suggests that important innate mechanisms operate to protect the dry eye from invading pathogens. This article reviews the current literature on epidemiology of ocular surface infection in dry eye patients and laboratory-based studies on innate immune mechanisms operating at the ocular surface and their alterations in human dry eye and animal models. The review highlights current understanding of innate immunity in dry eye and identifies gaps in our knowledge to help direct future studies to further unravel the complexities of dry eye disease and its sequelae.
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Affiliation(s)
- Srihari Narayanan
- University of the Incarnate Word, Rosenberg School of Optometry, San Antonio, TX, USA
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Dinc M, Bilgen MS, Kucukalp A, Bilgen OF. An assessment of the chondroprotective effects of intra-articular application of statin and tetracycline on early-stage experimental osteoarthritis. ISRN ORTHOPEDICS 2012; 2012:182097. [PMID: 24977073 PMCID: PMC4063183 DOI: 10.5402/2012/182097] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 03/28/2012] [Indexed: 11/23/2022]
Abstract
Objectives. To compare the effects of intra-articular application of statin and tetracyclines on cartilage and synovial tissue on experimental osteoarthritis.
Methods. Osteoarthritis was created in 30 rabbits of 3 groups. The control group received saline intra-articularly, statin group, atorvastatin and the tetracycline group, doxycycline once a week for 3 weeks. Chondral and synovial tissues were evaluated macroscopically and histopathologically.
Results. Macroscopic evaluation determined mean values of control group 3.0, statin group 0.56, and tetracycline group 2.5. Histopathological evaluations determined mean values; femoral medial condyle cartilage tissue, control group, 14.60 ± 1.00, statin group 2.20 ± 1.30, tetracycline group 12.7 ± 5.39: tibia medial plateau, control group, 14.33 ± 8.68, statin group 2.89 ± 1.96, tetracycline group, 15.90 ± 7.03: synovial tissue, control group 12.22 ± 3.63, statin group 4.33 ± 2.69, tetracycline group 10.70 ± 2.62. Average values of synovial tissue cell layer thickness were control group 14.46 ± 2.35 μm, statin group 10.56 ± 1.01 μm, tetracycline group 12.80 ± 0.79 μm. All measurements showed statistically significant differences between statin and control groups (P < 0.05) but not between tetracycline and control groups (P > 0.05).
Conclusions. Tetracycline has little effect due to chemical modification requirement, and the effect is dose dependent. Statins have chondroprotective effects, so may become a novel therapeutic agent in osteoarthritis management after chemical processing.
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Affiliation(s)
- Mustafa Dinc
- Department of Orthopaedics and Traumatology, Nizip State Hospital, Gaziantep, Turkey
| | - Muhammed Sadik Bilgen
- Ortopedi ve Travmatoloji Bölümü, Tıp Fakültesi, Uludağ Üniversitesi, 16059, Görükle Kampüsü, Bursa, Turkey
| | - Abdullah Kucukalp
- Ortopedi ve Travmatoloji Bölümü, Tıp Fakültesi, Uludağ Üniversitesi, 16059, Görükle Kampüsü, Bursa, Turkey
| | - Omer Faruk Bilgen
- Ortopedi ve Travmatoloji Bölümü, Tıp Fakültesi, Uludağ Üniversitesi, 16059, Görükle Kampüsü, Bursa, Turkey
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Doxycycline for Treatment of Blepharochalasis via Inhibition of Matrix Metalloproteinases. Ophthalmic Plast Reconstr Surg 2012; 28:e76-8. [DOI: 10.1097/iop.0b013e31822ddf6e] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pflugfelder SC. Tear dysfunction and the cornea: LXVIII Edward Jackson Memorial Lecture. Am J Ophthalmol 2011; 152:900-909.e1. [PMID: 22019306 DOI: 10.1016/j.ajo.2011.08.023] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 08/22/2011] [Accepted: 08/23/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe the cause and consequence of tear dysfunction-related corneal disease. DESIGN Perspective on effects of tear dysfunction on the cornea. METHODS Evidence is presented on the effects of tear dysfunction on corneal morphology, function, and health, as well as efficacy of therapies for tear dysfunction-related corneal disease. RESULTS Tear dysfunction is a prevalent eye disease and the most frequent cause for superficial corneal epithelial disease that results in corneal barrier disruption, an irregular optical surface, light scattering, optical aberrations, and exposure and sensitization of pain-sensing nerve endings (nociceptors). Tear dysfunction-related corneal disease causes irritation and visual symptoms such as photophobia and blurred and fluctuating vision that may decrease quality of life. Dysfunction of 1 or more components of the lacrimal functional unit results in changes in tear composition, including elevated osmolarity and increased concentrations of matrix metalloproteinases, inflammatory cytokines, and chemokines. These tear compositional changes promote disruption of tight junctions, alter differentiation, and accelerate death of corneal epithelial cells. CONCLUSIONS Corneal epithelial disease resulting from tear dysfunction causes eye irritation and decreases visual function. Clinical and basic research has improved understanding of the pathogenesis of tear dysfunction-related corneal epithelial disease, as well as treatment outcomes.
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Affiliation(s)
- Stephen C Pflugfelder
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA.
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Pfeffer I, Borelli C, Zierhut M, Schaller M. Treatment of ocular rosacea with 40 mg doxycycline in a slow release form. J Dtsch Dermatol Ges 2011; 9:904-7. [DOI: 10.1111/j.1610-0387.2011.07723.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Geerling G, Tauber J, Baudouin C, Goto E, Matsumoto Y, O'Brien T, Rolando M, Tsubota K, Nichols KK. The international workshop on meibomian gland dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction. Invest Ophthalmol Vis Sci 2011; 52:2050-64. [PMID: 21450919 DOI: 10.1167/iovs.10-6997g] [Citation(s) in RCA: 400] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Gerd Geerling
- Department of Ophthalmology, Heinrich-Heine University, Düsseldorf, Germany
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Abstract
Practical relevance Corneal ulcers in cats (ulcerative keratitis) are a common presenting complaint, and are a frequent sequela to feline herpesvirus (FHV-1) infection. In fact, it is fair to assume an FHV-1 aetiology until proven otherwise. In practice, therefore, many cases of corneal ulceration can be treated medically, but treatment can frequently be challenging, with the need to tailor therapy carefully to the type of ulcer, the individual cat and its temperament. Patient group All age groups and breeds can suffer with ulcerative keratitis although some breeds are over-represented for some types of corneal ulceration. Evidence base The scientific literature on feline ulcerative keratitis is extensive, particularly that related to FHV-1 infection. This article reviews the medical treatment options for corneal ulceration in cats with reference to the current evidence base.
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