Corneal transplantation and concomitant SARS-CoV-2 infection: a case report / Transplante de córnea e infecção concomitante por SARS-CoV-2: relato de caso

ABSTRACT This report was aimed at presenting a case of neurotrophic keratitis and concomitant SARS-CoV-2 infection in a patient who has recently undergone a corneal DALK transplant. One month after corneal transplantation with adequate corneal epithelialization, the patient presented neurotrophic keratitis with a torpid course of the corneal transplant coinciding with a SARS-CoV-2 infection, with an excessive host immune response. In addition, the patient presented a re-positivization of nasopharyngeal polymerase chain reaction of SARS-CoV-2 with past disease after starting treatment with autologous serum eye drops. The implications at the ophthalmological level of SARS-CoV-2 infection may be clarified as the time the illness progresses and we learn more about how it acts. In this case, the disparity of signs and symptoms, the antecedent of corneal surgery, and the possibility of a herpetic infection as a cause of the primary leukoma suggested neurotrophic keratitis. Nonetheless, the involvement of systemic SARS-CoV-2 infection in the process, triggering an excessive host immune response at the corneal level with an increase in inflammatory cytokines must be taken into account. No relationship was found between treatment with autologous serum and re-positivization of nasopharyngeal polymerase chain reaction, presenting the patient a favorable response to treatment.

RESUMO O objetivo deste relato foi apresentar um caso de ceratite neurotrófica e infecção concomitante por SARS-CoV-2 em paciente submetido recentemente a transplante de córnea DALK. Um mês após o transplante de córnea com adequada epitelização da córnea, o paciente apresentou ceratite neurotrófica com curso tórpido do transplante de córnea, coincidindo com infecção por SARS-CoV-2, com resposta imune excessiva do hospedeiro. Além disso, o paciente apresentou repositivização da reação em cadeia da polimerase nasofaríngeo de SARS-CoV-2, com doença pregressa após iniciar tratamento com colírio de soro autólogo. As implicações a nível oftalmológico da infecção por SARS-CoV-2, podem ser esclarecidas à medida que a doença progride e aprendemos mais sobre sua forma de atuação. Neste caso, a disparidade de sinais e sintomas, o antecedente de cirurgia de córnea e a possibilidade de infecção herpética como causa do leucoma primário sugeriram ceratite neurotrófica. No entanto, deve-se levar em consideração o envolvimento da infecção sistêmica por SARS-CoV-2 no processo, desencadeando uma resposta imune excessiva do hospedeiro no nível da córnea, com aumento de citocinas inflamatórias. Não foi encontrada relação entre o tratamento com soro autólogo e a repositivização da reação em cadeia da polimerase nasofaríngea, apresentando ao paciente uma resposta favorável ao tratamento.

20% Autologous serum vs. 0.05% cyclosporine and preservative-free artificial tears in the treatment of Sjögren related dry eye / Soro autólogo a 20% versus ciclosporina a 0,05 e lubrificantes oculares sem conservantes no tratamento da síndrome do olho seco relacionada à Sjögren

ABSTRACT Purpose: To compare the 3-month results of treatment with 20% autologous serum or combination treatment with preservative-free artificial tears and 0.05% cyclosporine in patients with dry eye disease due to primary Sjögren's syndrome. Methods: A total of 130 eyes of 65 patients with newly diagnosed dry eye disease due to primary Sjögren's syndrome were included in the study. The patients were divided into two treatment groups: 66 eyes of 33 patients were assigned to the autologous serum treatment group, and 64 eyes of 32 patients were assigned to the combination treatment group. Schirmer test, tear break-up time and Ocular Surface Disease Index (OSDI) scores were recorded at pretreatment and at 3 months of treatment. Results: At 3 months of treatment, the mean Schirmer value and the mean tear break-up time were significantly higher in the combination treatment group (p<0.0001 and p=0.034, respectively). The OSDI score at 3 months was significantly lower in the autologous serum Group (p=0.004). When the two groups were evaluated separately, the improvements in Schirmer, tear break-up time test, and OSDI scores from before to after treatment were statistically significant: p<0.0001, p<0.001, and p<0.0001, respectively, for the authologus serum Group, and p<0.0001, p<0.001, and p<0.0001, respectively, for the combination treatment group. Conclusions: In short-term treatment of dry eye disease due to primary Sjögren's syndrome, treatment with autologous serum was significantly superior to -combination treatment with preservative-free artificial tears and 0.05% cyclosporine in terms of improvement in OSDI scores. Improvements in Schirmer test and tear break-up time scores were significantly superior in the group treated with preservative-free artificial tears and 0.05% cyclosporine.

RESUMO Objetivo: Comparar os resultados de 3 meses de soro autólogo a 20% com um tratamento combinado, ou seja, lubrificantes oculares sem conservantes e ciclosporina a 0,05% em pacientes com síndrome do olho seco devida à síndrome de Sjögren primária. Métodos: Foram incluídos no estudo 130 olhos de 65 pacientes recentemente diagnosticados com síndrome do olho seco devida à síndrome de Sjögren primária. Os pacientes foram divididos em dois grupos de tratamento, 66 olhos de 33 pacientes foram incluídos no grupo de tratamento com soro autólogo e 64 olhos de 32 pacientes foram incluídos no grupo de tratamento combinado com lubrificantes oculares sem conservantes e ciclosporina. Os resultados do teste de Schirmer e do tempo de ruptura do filme lacrimal e os índices de doença da superfície ocular (OSDI) foram registrados antes e depois de três meses de tratamento. Resultados: Três meses após o tratamento, o valor médio do teste de Schirmer foi mais alto com significância estatística no grupo do tratamento combinado com lubrificantes oculares sem conservantes e ciclosporina (p<0,0001) e o tempo de ruptura do filme lacrimal também foi significativamente maior nesse grupo (p=0,034). Também aos três meses, a doença da superfície ocular foi menor com significância estatística no grupo de tratamento com soro autólogo (p=0,004). Quando os dois grupos foram avaliados separadamente, a melhora no teste de Schirmer, o tempo de ruptura e a doença da superfície ocular antes e depois do tratamento tiveram diferenças estatisticamente significativas tanto no grupo de soro autólogo (p<0,0001, p<0,001 e p<0,0001, respectivamente) quanto no grupo de tratamento combinado (p<0,0001, p<0,001 e p<0,0001, respectivamente). Conclusões: No tratamento de curto prazo da síndrome do olho seco devida à síndrome de Sjögren primária, o tratamento com soro autólogo foi significativamente superior ao tratamento com lubrificantes oculares sem conservantes combinados com ciclosporina, em termos de melhora no doença da superfície ocular. As melhoras no teste de Schirmer e no tempo de ruptura do filme lacrimal foram significativamente maiores no grupo de tratamento combinado com lubrificantes oculares sem conservantes e ciclosporina.

Feasibility and ethnic differences of 0.005% atropine eye drops combined with orthokeratology in controlling low myopia in adolescents / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To observe the effectiveness, safety and ethnic differences of 0.005% atropine eye drops combined with orthokeratology in controlling adolescents' low myopia between different ethnic groups.METHODS:A total of 246 Han and Hani patients(246 eyes)with low myopia treated in our hospital from January to October 2021 were selected, with 120 patients(120 eyes)treated with 0.005% atropine eye drops combined with orthokeratology in experimental group, and 126 patients(126 eyes)treated with orthokeratology in control group. The uncorrected visual acuity, spherical equivalent(SE), axial length(AL), intraocular pressure, tear film break-up time(BUT), corneal curvature and corneal thickness of the two groups before and 1 a after wearing lenses were observed, and the incidence of complications were recorded.RESULTS:At 1 a after wearing lenses, the changes of AL and SE in the experimental group(0.16±0.35 mm, -0.39±0.47 D)were lower than those in the control group(0.22±0.89 mm, -0.48±0.54 D), uncorrected visual acuity(LogMAR)was better than the control group(0.11±0.25 vs 0.14±0.19; P&#x0026;#x003C;0.05), there were differences in BUT, anterior chamber depth, corneal curvature and corneal thickness(P&#x0026;#x003C;0.05), but there were no differences in intraocular pressure of the two groups(P&#x0026;#x003E;0.05). In the Han and Hani groups, there were no differences in the changes of uncorrected visual acuity, AL and SE(P&#x0026;#x003E;0.05). During the follow-up period, no significant local or systemic adverse reactions occurred in the two groups, and there was no difference in the incidence of ocular complications between the two groups of patients(P&#x0026;#x003E;0.05).CONCLUSION: The 0.005% atropine eye drops combined with orthokeratology can effectively delay the progression of low myopia in adolescents without significant adverse reactions and ethnic differences.

Insulina tópica en el tratamiento del defecto epitelial persistente posúlcera corneal grave

El tratamiento del defecto epitelial refractario es un reto y está sujeto al desarrollo de estudios preclínicos y clínicos con el objetivo de obtener tratamientos eficaces, entre los que emerge la insulina tópica. El objetivo del presente artículo fue describir la respuesta cicatrizal del epitelio corneal bajo tratamiento con colirio de insulina. Se presentan dos pacientes con diagnóstico de defecto epitelial persistente posúlcera corneal. Se indicó insulina tópica una gota cada 6 horas, con evolución hacia la epitelización corneal total a los 10 días de iniciado el tratamiento. Se sugiere el mecanismo por el cual la insulina promueve la cicatrización corneal al lograr la restauración de los nervios corneales y favorecer la migración de células epiteliales. En ambos casos el colirio de insulina logró la promover la cicatrización epitelial total de la córnea por lo que se es útil en el tratamiento de defecto epitelial persistente.

The treatment of refractory epithelial defect is a challenge and depends upon the development of preclinical or clinical studies aimed at obtaining effective treatments, among which topical insulin emerges. The objective of this article was to describe the healing response of the corneal epithelium under treatment with insulin eye drops. The cases are presented of two patients with a diagnosis of persistent post-corneal ulcer epithelial defect. Topical insulin was prescribed at one drop every six hours, with evolution towards total corneal epithelialization ten days after the treatment started. The mechanism is suggested by which insulin promotes corneal healing, thus restoring corneal nerves and favoring epithelial cell migration. In both cases, the insulin eye drops were able to promote total epithelial healing of the cornea, making it useful in the treatment of persistent epithelial defect.

Conocimientos básicos para la preparación y uso de fórmulas magistrales en oftalmología

Los colirios fortificados o reforzados son fórmulas magistrales que reciben ese nombre por la vigorización que se les realiza a los colirios industriales con principios activos de antibióticos, antivirales, citostáticos y antimicóticos, en dependencia de los requerimientos individuales de los pacientes. Por tanto, la utilización de la formulación magistral es, por su capacidad y flexibilidad, un potencial para concebir nuevas pautas terapéuticas y posibilitar la creación de nuevas formulaciones o bien la actualización de antiguas fórmulas con principios activos más modernos, con el fin de lograr una alternativa a los colirios industriales de manera potente, eficaz y segura. El objetivo de este trabajo es describir los fundamentos teóricos, las tendencias nacionales e internacionales de la preparación y el uso oftalmológico de los colirios fortificados. Se realizó una revisión bibliográfica y documental actualizada, se utilizaron fuentes primarias, secundarias y terciarias y experiencias nacionales. La utilización de los colirios fortificados es cada día más frecuente en la especialidad de oftalmología, lo que obliga al farmacéutico hospitalario y al oftalmólogo a estar actualizado en temas como elaboración segura, composición, indicación y uso correctos.

Fortified or reinforced eye drops are masterful formulas that receive such name due to the industrial eye drops' invigoration with antibiotic, antiviral, cytostatic and antifungal active ingredients, depending on the patients' individual requirements. Therefore, the use of a masterful formulation is, due to its capacity and flexibility, a potential for conceiving new therapeutic guidelines and also for making possible the creation of new formulations or the updating of old formulations with more modern active ingredients, in order to achieve an alternative to industrial eye drops in a potent, effective and safe way. The objective of this work is to describe the theoretical foundations, the national and international trends in the preparation of fortified eye drops, as well as their ophthalmologic use. An updated bibliographic and documentary review was carried out, using primary, secondary and tertiary sources, together with national experiences. The use of fortified eye drops is becoming increasingly frequent in the ophthalmology specialty, which obliges the hospital pharmacist or the ophthalmologist to be updated on issues such as safe preparation, composition, prescription and correct use.

Efectividad del tratamiento con atropina versus oclusiones en pacientes con ambliopía refractiva moderada unilateral

Objetivo: Comparar la efectividad del tratamiento de atropina versus oclusión ocular en pacientes con ambliopía refractiva moderada unilateral. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo de una serie de casos que acudieron a la consulta de Oftalmología Pediátrica del Instituto Cubano de Oftalmología Ramón Pando Ferrer durante el período comprendido de septiembre del 2019 a septiembre de 2021. La muestra quedó conformada por 44 pacientes, los cuales se dividieron de forma aleatoria en dos grupos de estudio, 22 casos al grupo de oclusiones e igual número al grupo de atropina, que cumplían los criterios de inclusión. Se analizaron las variables edad, sexo, defecto refractivo, agudeza visual mejor corregida, sensibilidad al contraste y estereopsis. Resultados: Predominó el astigmatismo hipermetrópico en ambos grupos de estudio. La media de la agudeza visual mejor corregida inicial en ambos grupos fue de 0,4 LogMAR y mejoró a 0,1 LogMAR al finalizar el tratamiento. La media de la sensibilidad al contraste inicial fue de 1,48 (±19,75) para el grupo de oclusiones y de 1,47 (±20,5) para el grupo atropina, al finalizar alcanzaron 1,59 (±10,1) y 1,57 (±10,0) por orden de mención. La estereopsis inicial fue subnormal en ambos grupos, al finalizar el tratamiento fue normal en el 77,3 % grupo oclusión y el 68,2 % grupo atropina. Conclusiones: La efectividad del tratamiento en pacientes con ambliopía refractiva moderada unilateral con atropina es similar a la que se alcanza con la aplicación de la oclusión ocular.

Objective: To compare the effectiveness of atropine treatment versus ocular occlusion in patients with unilateral moderate refractive amblyopia. Methods: A descriptive, longitudinal and prospective study of a series of cases that attended the Pediatric Ophthalmology office of the Ramón Pando Ferrer Cuban Institute of Ophthalmology during the period from September 2019 to September 2021 was carried out. The sample consisted of 44 patients, who were randomly divided into two study groups, 22 cases to the occlusion group and the same number to the atropine group, who met the inclusion criteria. The variables age, gender, refractive defect, best corrected visual acuity, contrast sensitivity and stereopsis were analyzed. Results: Hypermetropic astigmatism predominated in both study groups. Average initial best-corrected visual acuity in both groups was 0.4 LogMAR and improved to 0.1 LogMAR at the end of treatment. Average initial contrast sensitivity was 1.48 (±19.75) for the occlusion group and 1.47 (±20.5) for the atropine group, at completion reaching 1.59 (±10.1) and 1.57 (±10.0) in order of mention. Initial stereopsis was subnormal in both groups, at the end of treatment it was normal in 77.3 % occlusion group and 68.2 % atropine group. Conclusions: The effectiveness of treatment in patients with unilateral moderate refractive amblyopia with atropine is similar to that achieved with the application of ocular occlusion.

Safety and efficacy of topical diquafosol for the treatment of dry eye disease: An updated meta-analysis of randomized controlled trials

Dry eye disease (DED) is a common multi-factorial disease that is characterized by tear film instability. Diquafosol tetrasodium (DQS), an ophthalmic solution, has been shown to be beneficial in the treatment of DED. The goal of this study was to provide an update on the safety and efficacy of topical 3% DQS in treating DED patients. A thorough search for all the published randomized controlled trials (RCTs) up to March 31, 2022 in CENTRAL, PubMed, Scopus, and Google Scholar databases was performed. Data were reported as standardized mean difference (SMD) with 95% confidence interval (CI). Modified Jadad scale was used for sensitivity analysis. Funnel plot and Egger’s regression test assessed the publication bias. Fourteen RCTs evaluating the safety and efficacy of topical 3% DQS treatment in DED patients were included. Eight included RCTs reported data on the DED after cataract surgery. Overall findings suggest that 3% DQS treatment in DED patients was associated with significantly better improvement at 4 weeks in tear breakup time, Schirmer test, fluorescein staining scores, and Rose Bengal staining score as compared to patients treated with others eye drops including artificial tears or 01% sodium hyaluronate. However, no significant difference in ocular surface disease index was observed. Our findings suggest that 3% DQS treatment is safer and had a superior efficacy compared to artificial tears or sodium hyaluronate for treating DED in general and DED after cataract surgery.

Diquafossol sodium combined with Qingrun Yangmu oral liquid for the treatment of dry eye after cataract operation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the clinical efficacy of diquafosol sodium(DQS)eye drops combined with Qingrun Yangmu oral liquid in the treatment of dry eye after phacoemulsification and intraocular lens implantation.METHODS:A total of 57 patients(65 eyes)with dry eye after cataract surgery, who were admitted to the ophthalmology department of our hospital from September 2020 to January 2021, were selected as the research objects. They were divided into a control group(28 cases, 32 eyes, treated with 3% DQS eye drops)and an observation group(29 cases, 33 eyes, treated with 3% DQS eye drops combined with the Qingrun Yangmu oral liquid)based on a random number table method. Indicators, such as ocular surface disease index(OSDI), non-invasive tear film break-up time(NIBUT), Schirmer I test(SIt), corneal fluorescein sodium staining(CFS), and TCM symptom score, were compared and analyzed between the two groups 1d before, 1wk after(before treatment), and 1mo after(after treatment)surgery.RESULTS:The total effective rates of the observation group and the control group after treatment were 88% and 75%, respectively. The OSDI, NIBUT and SIt of the two groups after treatment showed significant improvement compared to those before treatment(P&#x003C;0.05). The NIBUT, SIt, CFS, and TCM symptom scores of the observation group after treatment were better than those of the control group(P&#x003C;0.05). No adverse reactions were observed in both groups.CONCLUSION:Combined use of DQS eye drops and the Qingrun Yangmu oral liquid can improve symptoms and clinical indicators of dry eye after cataract surgery, providing a new treatment method for ocular surface management of dry eye during the perioperative period of cataract surgery.

Effects of 0.05% cyclosporine eye drops(Ⅱ)on corneal nerves of patients with moderate to severe dry eye / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To investigate the efficacy of domestic cyclosporine A(CsA)in dry eye and its effect on sub-basal nerves(SBN)by observing quantitative and morphological changes in corneal SBN of patients with moderate to severe dry eye before and after the treatment with 0.05% CsA eye drops(Ⅱ).METHODS: In this prospective study, a total of 20 patients(20 eyes)with moderate to severe dry eye who admitted to the ophthalmology department of the Affiliated Eye Hospital of Nanchang University from December 2020 to January 2022 were selected. They were treated with domestic CsA and followed up for 3mo. Clinical evaluation was carried out at baseline and at 3mo after treatment. The changes in clinical symptoms, signs and morphology and quantity of SBN were observed.RESULTS: The ocular surface disease index(OSDI)score, the tear break-up time(TBUT), Schirmer Ⅰ, corneal fluorescein staining(CFS)score were significantly improved at 3mo after treatment. Confocal microscopy data analysis showed that SBN density increased from 13.49±5.43 mm/mm2 to 14.93±5.34 mm/mm2(P&#x0026;#x003C;0.001), nerve curvature scores decreased from 2.86±0.92 to 2.31±0.75(P&#x0026;#x003C;0.001), number of beaded structure decreased from 1.45±0.67/100μm to 1.07±0.45/100μm(P&#x0026;#x003C;0.001), and the number of dendritic cell(DC)decreased from 5.83±3.28 per frame to 3.67±2.24 per frame at 3mo after treatment(P&#x0026;#x003C;0.001). The number of DC was positively correlated with the number of branch nerves, the grade of nerve curvature and the number of nerve bead.(rs=0.27, P=0.045; rs=0.407, P&#x0026;#x003C;0.01; rs=0.486, P&#x0026;#x003C;0.01).CONCLUSIONS: Nerve injury was positively correlated with corneal inflammation caused by dry eye, and 0.05%CsA eye drops(II)could effectively inhibit inflammation and improve the morphology and quantity of corneal SBN. Observation of corneal SBN via in vivo confocal microscopy can be used as an effective method to evaluate the therapeutic effect of dry eye patients.

Clinical analysis of P2Y2 receptor agonist in the treatment of diabetic dry eye / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the clinical efficacy of P2Y2 agonist diquafosol sodium(DQS)eye drops in the treatment of diabetic dry eye.METHODS: A total of 80 patients(160 eyes)with diabetic dry eye who admitted to our hospital from January 2022 to March 2022 were selected. They were randomly divided into study group and control group. A total of 40 patients(80 eyes)in the study group were treated with 3% DQS eye drops and 40 patients(80 eyes)in the control group were treated with 0.3% sodium hyaluronate eye drops. The ocular surface disease index(OSDI)score, non-invasive tear meniscus height(NITMH), first non-invasive tear film break-up time(NIBUTf), average non-invasive tear film break-up time(NIBUTav), tarsal gland loss score, lipid layer thickness grade and bulbar redness analysis(including conjunctival grade and ciliary grade), were examined before treatment and at 1wk, 1 and 3mo after treatment, respectively. Furthermore, corneal fluorescence staining and conjunctival lissamine green staining were analyzed based on the ocular surface staining score(OSS), and the conjunctival impression cytology and confocal microscopy were evaluated before and 3mo after treatment, respectively.RESULTS: There were no differences in OSDI score, tarsal gland loss score, conjunctival grade score and ciliary grade score between the two groups before and after treatment(P&#x0026;#x003E;0.05). OSS scores in the study group were lower than those in the control group, while NITMH, NIBUTf and NIBUTav were higher than those in the control group at 1 and 3mo after treatment(P&#x0026;#x003C;0.05). After 3mo of treatment, the density of conjunctival goblet cells increased and corneal dendritic cells decreased in the study group compared with the baseline(all P&#x0026;#x003C;0.05), while there were no significant changes in the control group compared with the baseline(all P&#x0026;#x003E;0.05).CONCLUSION: 3% DQS eye drops were effective in treating diabetic dry eye without serious complications.

Intense pulsed light combined with meibomian gland massage and diquafosol sodium eye drops in the treatment of lipid deficiency / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To explore the efficacy of intense pulsed light combined with meibomian gland massage and diquafosol eye drops in lipid deficiency dry eye disease and related cytokines.METHODS: A total of 511 patients(1 022 eyes)with lipid deficiency dry eye diagnosed in the ophthalmology clinic of our hospital from January to December 2021 were selected as the research objects. They were divided into two groups according to the patient's wishes: 294 cases(588 eyes)in the study group were treated with diquafosol sodium eye drops combined with intense pulsed light and meibomian gland massage, while 217 cases(434 eyes)in the control group were treated with artificial tears combined with intense pulsed light and meibomian gland massage. The levels of tear tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β)and lactoferrin(LF)before and after treatment were detected, the corneal fluorescein staining(CFS)score, tear film break-up time(BUT), and Schirmer Ⅰ(SⅠt)under no surface anesthesia, ocular surface disease index(OSDI)were compared, the correlation between TNF-α, IL-1β, LF levels and CFS, BUT, SⅠt, OSDI before treatment was analyzed, and the occurrence of adverse reactions was observed.RESULTS: There was no significant difference in preoperative OSDI, SⅠt, BUT, CFS and levels of TNF-α, IL-1β and LF between the two groups(P&#x003E;0.05). The SⅠt, BUT, CFS and levels of TNF-α, IL-1β and LF in the study group at 3, 6 and 9wk after treatment were better than those of control group(P&#x003C;0.05). There were no differences in OSDI score of both groups at 9wk after treatment(P&#x003E;0.05). The TNF-α and IL-1β were negatively correlated with SⅠt and BUT, while they were positively correlated with CFS and OSDI; LF and SⅠt were positively correlated with SⅠt and BUT, while they were negatively correlated with CFS and OSDI(all P&#x003C;0.01); The adverse reaction rate of the study group(5.78%)was significantly lower than that of the control group(11.52%; P&#x003C;0.05).CONCLUSION: Intense pulsed light combined with meibomian gland massage and diquafosol sodium eye drops is effective and well tolerated in the treatment of lipid deficiency dry eye.

Different concentrations of fluorometholone eye drops on the treatment of children with severe mixed vernal keratoconjunctivitis / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To observe the clinical effect of different concentration of fluorometholone eye drops on severe mixed vernal keratoconjunctivitis in children.METHODS: A total of 50 cases(100 eyes)of children with severe mixed vernal keratoconjunctivitis treated in the outpatient department of our hospital from March to September, 2022 were selected and randomly divided into two groups. Group A consisted of 25 cases(50 eyes)who were treated with 0.1% fluorometholone eye drops combined with 0.05% cyclosporine eye drops(Ⅱ), while 25 patients(50 eyes)in group B were treated with 0.02% fluorometholone eye drops combined with 0.05% cyclosporine eye drops(Ⅱ). After 1mo of treatment, SPEED questionnaire score, corneal fluorescein staining(FL)score, tear break-up time(TBUT), Schirmer I test(SⅠt), R-scan, non-invasive tear meniscus height(NIKTMH), corneal optical density and other ocular parameters of the two groups were observed, and the occurrence of adverse reactions were recorded.RESULTS: After 1mo of treatment, there were significant differences in SPEED score, FL score and R-scan results between the two groups(all P&#x003C;0.05), and no differences in TBUT, SⅠt and NIKTMH results(all P&#x003E;0.05). However, there were statistical significance in corneal optical density in different corneal depth and diameter ranges(all P&#x003C;0.05). After 1mo of treatment, there was no significant difference in intraocular pressure between the two groups(16.21±2.90mmHg vs. 16.05±2.75mmHg, P&#x003E;0.05), and no obvious adverse reactions occurred during treatment.CONCLUSION: The 0.1% fluorometholone eye drops can effectively treat severe mixed vernal keratoconjunctivitis in children, and its effect is better than 0.02% fluorometholone eye drops.

Analysis of clinical treatment outcomes of ocular lesions in 28 cases of severe ocular rosacea / 中华皮肤科杂志

Objective:To investigate clinical treatment regimens for ocular lesions in patients with severe ocular rosacea.Methods:A total of 28 patients (34 eyes) with severe rosacea complicated by blepharokeratoconjunctivitis were collected from outpatient department of the Affiliated Eye Hospital of Nanjing Medical University from December 1, 2019 to May 30, 2021. They were randomly divided into two groups: group A (13 cases, 16 eyes) topically treated with sodium hyaluronate 0.3% eye drops and levofloxacin 0.5% eye drops, and group B (15 cases, 18 eyes) topically treated with sodium hyaluronate 0.3% eye drops alone. Patients in both groups also received oral minocycline hydrochloride 100 mg every day for the first 2 weeks, and then 50 mg every day for the next 6 weeks. Meanwhile, all patients received same physical therapies such as meibomian gland massage, eyelid hot compresses and eyelid margin cleaning. LogMAR visual acuity, tear break-up time (BUT) , ocular surface disease index (OSDI) score, and meibomian gland function grading examination results in the two groups were recorded before and 8 weeks after treatment. Paired t test was used to compare within-group differences in the parameters before and after treatment, and two-independent-sample t test to compare intergroup differences after treatment. Results:After 8-week treatment, both group A and group B showed significantly increased LogMAR visual acuity ( t = 3.10, 2.15, P = 0.007, 0.046, respectively) , improved BUT ( t = 3.44, 2.85, P = 0.003, 0.011, respectively) , but significantly decreased OSDI scores ( t = 7.12, 9.33, respectively, both P < 0.001) and meibomian gland function scores ( t = 13.73, 16.82, respectively, both P < 0.001) compared with those before treatment. After treatment, no significant differences were observed in the LogMAR visual acuity ( P = 0.721) , BUT ( P = 0.189) , OSDI scores ( P = 0.808) and meibomian gland function scores ( P = 0.191) between the two groups. No adverse drug reactions occurred during the treatment. During the follow-up period (8 months or shorter) , no recurrence of ocular lesions was observed. Conclusion:Without topical antibiotics, oral minocycline hydrochloride combined with topical sodium hyaluronate eye drops is still effective for the treatment and prevention of recurrence of ocular lesions in patients with severe ocular rosacea.

Effect of sodium hyaluronate eye drops combined with tobramycin, dexamethasone and pranoprofen eye drops in the treatment of dry eye after phacoemulsification

Purpose: To investigate the clinical effect of sodium hyaluronate eye drops combined with tobramycin, dexamethasone, and pranoprofen eye drops in the treatment of dry eye after phacoemulsification. Methods: Medical records of 188 patients with dry eye after phacoemulsification, treated in our hospital from August 2020 to August 2021, were included and divided into groups based on the type of dry eye treatment. Patients in the control group (n = 90) were treated with tobramycin, dexamethasone, and pranoprofen eye drops. Patients in the test group (n = 98) were treated with sodium hyaluronate, tobramycin, dexamethasone, and pranoprofen eye drops. The tear secretion test (TST), film rupture time (BUT), corneal fluorescence staining (FS) score, levels of interleukin (IL)?6, and tumor necrosis factor (TNF)?? before the treatment and at 1 month follow?up, the overall total effective rate and the number of completely cured cases were compared between the two groups. Multiple linear regression was used to calculate coefficients for predicting clinical variables. Ordinal logistic regression was used to compute coefficients and odds ratios for predicting effective scores. Results: The total effective rate in the observation group (99%) was significantly higher than that in the control group (80.00%). After the treatment, the TST and BUT indexes of the observation group were higher compared to the control group, and the FS score of the observation group was lower than that of the control group. TNF?? and IL?6 levels of the observation group were lower compared to the control group. Logistic regression analysis demonstrated that the differences in the effective rate and clinical variables between the two groups remained significant after adjusting for the effect of age. Conclusion: A combination of sodium hyaluronate, tobramycin, dexamethasone, and pranoprofen eye drops for the treatment of dry eye after phacoemulsification can improve the curative effect, reduce corneal fluorescein staining and inflammatory factor index levels compared to the treatment regimen lacking sodium hyaluronate eye drops.

Abuse of tropicamide eye drops: review of clinical data

Over the past 15 years, the increasing nonmedical use of tropicamide ophthalmic drops has been reported in Europe, coinciding with an increase in opioid addiction and drug-related mortality. Although tropicamide is generally known as a cheap alternative to heroin in Eastern Europe, it still appears to be a relatively new phenomenon that has arisen over the last decade. A narrative review was conducted of all the relevant sources published in more than five countries between January 1, 1975 and January 10, 2021. For bibliographic accuracy, the materials published in Russian and Italian were professionally translated to English. During the preparation of this report, we were able to interview five Russian-speaking patients who injected tropicamide in the past and we discuss another case of intravenous tropicamide use. This review was acknowledged by the institutional review board of the University of Missouri-Kansas City. All patients interviewed at the Unica Medical Center consented for their clinical information to be reported in a medical publication. We analyzed data from 50+ various sources and covered a variety of drug-related issues, including information on the extent, patterns, and trends in tropicamide use, its health consequences, and other clinical findings. The information provided in this article may help providers better detect tropicamide abuse and incorporate new rehabilitation strategies into the management of these patients.

Intensive topical interferon therapy in uveitic macular edema

Purpose: To evaluate the efficacy of intensive topical interferon alfa-2b (IFN) therapy in uveitic macular edema (UME). Methods: This is a prospective, interventional case study of eyes with UME. Commercially available injection IFN for subcutaneous use was reconstituted to form eye drops and a dose of 6 times/day for 2 weeks, 5 times/day for next 2 weeks, followed by 4, 3, 2, 1 taper per month was prescribed. Optical coherence tomography (OCT) and clinical examination was done at 0, 2, 4, 8 weeks, and further as required. Results: Nine eyes of 9 patients with UME were studied. Mean central macular thickness (CMT) at presentation was 522.2 ?m (range: 408–803 ?m). At 2-week, 1-month, and 2-month follow-up, mean CMT decreased to 451.6 ?m (range: 322–524 ?m), 375.8 ?m (range: 287–480 ?m), and 360.3 ?m (range: 260–485 ?m), respectively. Four eyes which showed inadequate response to previous topical IFN therapy (4 times/day) showed significant improvement with intensive therapy at 1 month follow-up. In 4 eyes, UME resolved completely with mean CMT 285.5 ?m (range: 260–312 ?m) at 7.5 weeks (range: 4–12 weeks). Study exit was seen in 2 cases due to inadequate response and relapse of uveitis. Mean follow up was 3.38 months (range: 1–5 months). Conclusion: Intensive topical IFN therapy can be an alternative therapeutic option in the treatment of UME. Study of intraocular penetration, combination with other drugs, and the efficacy of IFN separately for different uveitic entities may explore new avenues in treatment of UME.

The effectiveness of a three-step sterilization method for Goldmann tonometer prism: A cross-sectional study

Purpose: To propose a three?step sterilization method for Goldmann tonometer prism (GTP) and to analyze the sterilization effects of each step. Methods: 120 patients (240 eyes) who underwent Goldmann applanation tonometer (GAT) IOP measurement were enrolled in this study. GTPs were used individually for each patient and wiped by swabs soaked with 75% ethyl alcohol, ofloxacin eye drops, and 75% ethyl alcohol for at least 5 s. GTPs were directly pressed onto the surface of agar plates before (W0) and after three?step sterilization (W1, W2, and W3). All the agars were sent to the laboratory in 2 h and incubated at 37°C for 48 h. Subsequently, the growth of microbial species was assessed through visual inspection of the colonies at the inoculation points on the agar surface. Results: Staphylococcus. epidermidis was the most frequently isolated bacterium and was observed in 23.33% of all prisms. Most of the bacteria were eliminated at W3 except Staphylococcus. epidermidis and Kocuria roseus in one case. The isolation rates of Staphylococcus genus and Staphylococcus. epidermidis were significantly decreased (both with P < 0.001). The number of bacteria types isolated from prisms at time point W2 and W3 had a statistically significant difference compared with W1 and W (both with P < 0.05), while W2 and W3 exhibited no significant difference. Conclusion: This three?step sterilization method for GTP proved to be effective and safe for repeated use. We recommend using ofloxacin to prevent the transmission of pathogens based on ethyl alcohol, which could also bring some economic benefits.

Meta-analysis of the efficacy and safety of Gatifloxacin and Levofloxacin in the acute bacterial conjunctivitis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the clinical efficacy and safety of gatifloxacin eye drops and levofloxacin eye drops in the treatment of acute bacterial conjunctivitis using Meta-analysis.<p>METHODS: According to the Cochrane systematic evaluation method, “gatifloxacin” “levofloxacin” and “acute bacterial conjunctivitis” were used as keywords for literature search in Embase, Cochrane library, Pubmed, Medline, CNKI, Wanfang, VIP and CBMdisc from the establishment of the database to March 1, 2021. Randomized controlled trials(RCTs)gatifloxacin eye drops and levofloxacin eye drops in the treatment of acute bacterial conjunctivitis were included. Cochrane bias risk assessment tool was used to evaluate the quality of the included studies. RevMan5.3 software was used for combined analysis. Egger's test in Stata12 was used to assess publication bias, and the level of evidence was evaluated according to the GRADE system.<p>RESULTS: A total of 10 RCTs were included in this study with 1 149 patients. The control group was treated with levofloxacin and the experimental group was treated with gatifloxacin. The results of Meta-analysis showed that the clinical effective rate of acute bacterial conjunctivitis in gatifloxacin group was higher than that in levofloxacin group(<i>OR</i>=3.75, 95%<i>CI</i>: 2.52-5.58, <i>P</i><0.00001). Egger's test suggested there was publication bias among studies. And GRADE rating results indicated, the level of evidence was VERY LOW. The incidence of adverse drug reactions in the gatifloxacin group was lower than that in levofloxacin group(<i>OR</i>=0.37, 95%<i>CI</i>: 0.19-0.71, <i>P</i>=0.003). No publication bias was observed in Egger's test and GRADE showed the level of evidence was LOW.<p>CONCLUSION: Gatifloxacin eye drops is more effective than levofloxacin eye drops in the treatment of acute bacterial conjunctivitis, and has lower adverse effect rates. And due to the low levels of evidence included, more multicenter, randomized double-blind clinical trials are needed to improve the strength of evidence for the clinical efficacy of gatifloxacin eye drops in the treatment of acute bacterial conjunctivitis.