Irrational ophthalmic fixed-dose combinations for dry eye syndrome

Dry eye syndrome (DES) is a common disorder with rising incidence due to increased use of digital devices. While multiple treatment options are available, some are not efficacious or sometimes even safe for use in DES. This is particularly true for Fixed Dose Combinations (FDCs) that may contain ingredients having no rational for their use or may actually be harmful. Various committees appointed by the Government have reviewed several FDCs marketed in India and found some of them to be irrational and recommended for their removal. This paper discusses the contents of some of these FDCs marketed for DES with an aim to ensure that prescribers are mindful of their ingredients and whether there is adequate data about their efficacy and safety and prescribe them only if they consider them necessary for managing the patient.

Effects of low-concentration atropine eye drops on the optical quality of the eyes in myopic children

Purpose: The present study was performed to compare the optical quality of the eyes of myopic children before and after treatment with atropine eye drops of different concentrations. Methods: In the study population of 71 patients (131 eyes), 34 patients (63 eyes) were given 0.01% atropine eye drops and 37 patients (68 eyes) were given 0.05% atropine eye drops. The modulation transfer function (MTF) cutoff frequency, Strehl ratio, objective scattering index (OSI), and predicted visual acuities (PVAs 100%, 20%, and 9%) under different lighting conditions were measured before and after two weeks of atropine treatment. Results: After using 0.05% atropine eye drops for two weeks, the Strehl ratio decreased from 0.27 ± 0.07 to 0.23 ± 0.07 (P = 0.0026), PVA 20% decreased from 1.15 ± 0.32 to 1.03 ± 0.36 (P = 0.0344), and PVA 9% decreased from 0.74 ± 0.23 to 0.64 ± 0.23 (P = 0.0073). The OSI was significantly higher after using 0.05% than 0.01% atropine eye drops (P = 0.0396), while both the Strehl ratio and PVA 20% were lower after using 0.05% than 0.01% atropine eye drops (P = 0.0087 and P = 0.0492, respectively). Conclusion: The children’s optical quality did not change significantly after using 0.01% atropine eye drops, whereas it decreased after using 0.05% atropine eye drops.

Mass variability in drops of multidose eyedrops: a quality and reliability study / Variabilidade da massa das gotas dos colírios: um estudo de qualidade e confiabilidade

ABSTRACT Purpose: This quality and reliability study aimed to identify the mass variability of multidose eyedrops and to verify the existence of a reference pattern for the drop volume of eyedrops using standard lubricant eyedrops available on the Brazilian market. Methods: Five brands of lubricant eyedrops were evaluated. An ideal standard 20 µL drop of eyedrops from each manufacturer was captured using an adjustable micropipette. The eyedrop bottles were randomly selected, and five measurements of the samples' masses were collected using calibrated precision scales. Results: The mass of the 20 µL samples varied significantly (p<0.001) among the different manufacturers. However, among eyedrops of the same brand, mass variation was not statistically different. The global mean mass of all weighed drops was 18.24 mg, and non-uniformity was identified across all eyedrop brands. Conclusion: Significant variations in the drop masses of common lubricant eyedrops were identified using standard laboratory equipment. Heterogeneity in the drop volume of standard eyedrop medications suggest that potential dosage discrepancies exist, possibly altering treatment efficacy. A pre-established reference measure may lead to the production of more appropriately sized eyedrops for use in human eyes.

RESUMO Objetivo: Este estudo de qualidade e confiabilidade teve como objetivo identificar a variabilidade da massa do volume da gota de colírios multidose e verificar a existência de um padrão de referência para o volume da gota dos colírios usando lágrimas artificiais do mercado brasileiro. Métodos: Cinco marcas de colírios lubrificantes foram avaliadas quanto ao volume da gota. Uma gota padrão ideal de 20 µL de cada fabricante foi coletada usando uma micropipeta ajustável. Os frascos dos colírios foram selecionados aleatoriamente e cinco medidas das massas das amostras foram coletadas usando escalas de precisão calibradas. Resultados: A massa das amostras de 20 µL variou significativamente (p<0,001) entre os diferentes fabricantes. No entanto, entre os colírios da mesma marca, a variação da massa não foi estatisticamente diferente. A massa média global de todas as gotas pesadas foi de 18,24 mg e foi observada uma não-uniformidade entre todas as marcas de colírios. Conclusão: Identificou-se uma variação significativa nas massas do volume das gotas dos colírios lubrificantes, usando equipamento padrão de laboratório. A heterogeneidade no volume da gota dos colírios testados sugere a existência de discrepâncias potenciais em suas posologias, possivelmente alterando a eficácia do tratamento. Uma medida de referência pré-estabelecida pode levar à produção de colírios com gotas de tamanho mais apropriado para uso em olhos humanos.

Lacrimal duct probing combined with tobramycin eye drops in the treatment of congenital dacryocystitis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To explore the clinical efficacy of probing lacrimal passage combined with tobramycin eye drops in the treatment of congenital dacryocystitis. <p>METHODS: A total of 228 children(250 eyes)aged from 6mo-3a with congenital dacryocystitis treated in our hospital from January 2017 to June 2019 were included. They were assigned into three groups by age: 133 patients(149 eyes)aged from 6mo-1a(Group A), 62 patients(64 eyes)aged from 1-2a(Group B), and 33 patients(37 eyes)aged from 2-3a(Group C). All patients received lacrimal duct probing in surface anesthesia combined with postoperative tobramycin eye drops. <p>RESULTS: The probing cure rates of congenital dacryocystitis among there groups were 97.3%(Group A), 92.2%(Group B)and 83.8%(Group C), respectively. No adverse events reported. Through comparison of these three groups, the cure rate of children from 6mo-1a was the highest. The difference was statistically significant(<i>P</i>=0.009).<p>CONCLUSION: Lacrimal duct probing is effective in the treatment of congenital dacryocystitis, and it is safe and reliable to combine tobramycin eye drops(TOBREX)after surgery. The best time for treatment is 6mo-1a. The operation is simple, less complication, with high clinical value.

Pharmacoepidemiology of the antiglaucoma drugs in Brazil from 2012 to 2018 / Farmacoepidemiologia das drogas antiglaucomatosas no Brasil de 2012 a 2018

Abstract Purpose: To outline the epidemiological profile of clinical treatments for glaucoma provided by the Brazilian Unified Health System (SUS, acronym in Portuguese) between January 2012 and December 2018. Methods: A quantitative and descriptive study was conducted using available data based on the outpatient information system from SUS (SIA/SUS, acronym in Portuguese). The variables were monocular treatment with first, second, and third-line drugs; monocular treatment with combinations of two drugs and three drugs from different lines; binocular treatment with first, second, and third-line drugs; and binocular treatment with combinations of two drugs and three drugs from different lines. Results: During the analysis period, the prevalence of clinical therapies for glaucoma increased from 2012 to 2017 and decreased from 2017 to 2018. Of the clinically treated patients, 96% were carriers of binocular glaucoma. Among the regions of Brazil, the Northeast had the highest prevalence of binocular glaucoma (about 60% of the number of cases), and the most common therapy was combinations of two drugs from different lines. The Southeast region had the highest concentration of monocular glaucoma (53% of cases), and the predominant therapy was combinations of three drugs from different lines. The Midwest region had the lowest prevalence of monocular-treatments for glaucoma (less than 6%). Conclusion: In Brazil, the highest number of treatments offered by the public health system was in the Northeast and Southeast regions. There is a high national prevalence and potential for the morbidity of this disease. Therefore, it is necessary to strengthen programs aimed at early diagnosis and appropriate treatment to reduce adverse outcomes.

Resumo Objetivo: Traçar o perfil epidemiológico do tratamento clínico para o glaucoma no Brasil fornecido pelo Sistema Único de Saúde (SUS), no período de janeiro de 2012 a dezembro de 2018. Métodos: Estudo quantitativo e descritivo, utilizando a base de dados disponível no Sistema de Informações Ambulatoriais do SUS (SIA/SUS). As variáveis utilizadas foram: tratamento monocular com drogas de primeira, de segunda e de terceira linha; tratamento monocular com combinações de duas drogas e de três drogas de diferentes linhas; tratamento binocular com drogas de primeira, de segunda e de terceira linha; e tratamento binocular com combinações de duas drogas e de três drogas de diferentes linhas. Resultados: Durante o período analisado, a prevalência de terapias clínicas para o glaucoma aumentou entre 2012 e 2017 e diminuiu entre 2017 e 2018. Dos pacientes tratados clinicamente, 96% eram portadores de glaucoma binocular. Entre as regiões do Brasil, o Nordeste teve a maior prevalência de glaucoma binocular (cerca de 60% do número de casos), e a terapia mais comum foi a combinação de duas drogas de diferentes linhas. A região Sudeste teve a maior concentração de glaucoma monocular (53% dos casos), e a terapia predominante foi a combinação de três drogas de diferentes linhas. A região Centro-Oeste apresentou a menor prevalência de tratamentos monoculares para o glaucoma (menos de 6%). Conclusão: No Brasil, o maior número de tratamentos oferecidos pelo sistema público de saúde foi nas regiões Nordeste e Sudeste. Existe uma alta prevalência nacional e um alto potencial para morbidade desta doença. Portanto, é necessário fortalecer programas voltados para o diagnóstico precoce e para o tratamento adequado a fim de reduzir os resultados adversos.

Systemic absortion and adverse effects of topical ocular use of ketorolac tromethamine and sodium diclofenac in New Zealand rabbits for 90 days / Absorção sistêmica e efeitos adversos do uso tópico ocular por 90 dias de cetorolaco de trometamina e diclofenacode sódio em coelhos da raça Nova Zelândia

The effect of the systemic absorption of 0.1% diclofenac sodium (DS) eyedrop was compared to that of 0.5% ketorolac tromethamine (KT) in female New Zealand white rabbits treated on both eyes three times a day for 90 days. The rabbits were divided in three groups of six animals (n= 18): KT group, DS group, and control (Co) group, in which saline (0.9% NaCl) solution was instilled. Water and food consumption were measured daily, clinical examination was performed weekly, and blood samples were collected every 30 days for laboratory examination. The plasma was analyzed for the presence of KT and DS by solid-phase extraction (SPE) associated with mass spectrometry (MS). Systemic absorption of these drugs was confirmed by SPE-MS, allowing their separation and identification in the plasma. At the end of the treatment, the animals were euthanized and necropsied, and no macroscopic or microscopic changes were found. This observation confirmed the laboratory results, which were within normal reference standards for the species. According to the results obtained, it can be concluded that treatment with eyedrops containing KT and DS for 90 days in healthy rabbits does not cause adverse systemic effects.(AU)

Comparou-se o efeito da absorção sistêmica do colírio de diclofenaco de sódio 0,1% (DS) em relação ao de cetorolaco de trometamina 0,5% (CT) em coelhas da raça Nova Zelândia, tratadas nos dois olhos, três vezes ao dia, por 90 dias. As coelhas foram separadas em três grupos de seis animais (n=18): grupo CT, grupo DS e grupo controle (Co), no qual foi instilada solução fisiológica (NaCl 0,9%). Os consumos de água e ração foram mensurados diariamente, os exames clínicos foram realizados semanalmente e o sangue foi coletado a cada 30 dias para realização de exames laboratoriais. O plasma foi analisado para detectar a presença de CT e DS por extração em fase sólida (SPE) associada à espectrometria de massas (MS). A absorção sistêmica desses fármacos foi confirmada por SPE-MS, permitindo sua separação e identificação no plasma. Ao final do tratamento, os animais foram eutanasiados e necropsiados, e não foram encontradas alterações macroscópicas ou microscópicas. Essa observação confirmou os resultados laboratoriais, que estavam dentro dos padrões de referência para a espécie. De acordo com os resultados obtidos, pode-se concluir que o tratamento com colírio contendo KT e DS, por 90 dias, em coelhos saudáveis, não causa efeitos adversos sistêmicos.(AU)

Comparative Study On The Efficacy Of Pushpavarti Eye Drops And Nayanasukhavarti Eye Drops In The Management Of Arma With Special Reference To Pterygium

Arma is the Shuklagata roga. Arma can be correlated to pterygium based on the character of growth. Pterygium is a common ocular- surface disorder capable of causing significant visual impairment & cosmetic deformity. At present surgical treatment is the only satisfactory approach, recurrence after surgical excision is common & recurred lesions grow more aggressively than the primary lesions. The ayurvedic approach of the disease mainly concentrates on preventing the progression of the disease. With this aim clinical study was undertaken. The objectives of the study are to evaluate the efficacy of Pushpavarti eye drops and the efficacy of Nayanasukhavarti eye drops in the management of Arma before and after treatment in the group and between the groups. In the present study 30 patients were randomly selected and divided into 2 groups, with 15 patients each. Group Apatients were treated with Pushpavarti eye drops for 45 th th th days. Group B were treated with Nayanasukhavarti eye drops for 45 days. Observations were made on 45 day and 2 follow ups on 15 and 30 day after treatment to observe the possible recurrences. In both the groups subjective and objective parameters were assessed and the results were statistically analysed.

Evaluation of used eye drop containers for microbial contamination in outpatient department of tertiary care teaching hospital

Background: Contaminated eyedrops are considered as serious risk factor for many iatrogenic ocular infections. Apart from the risk of infection, microbial contamination may alter the pH of the solution thereby reducing the efficacy of drugs. Presently many preservatives are added to these eye drops preparations to extend the duration of use. Hence authors aimed this study to find the contamination rates in such eye drop preparations.Methods: This was a prospective observational research conducted at Ophthalmology OPD, of tertiary care teaching hospital for the period of 2 months. Total fifty five used eyedrops were collected.Results: Authors found that 25.45% of the collected eye drops were contaminated with various organisms, viz. E. coli (10.90%), Staphylococcus aureus (9.09%), Pseudomonas aerugenosa (1.81%), Bacillus subtilis (1.81%) and Candida albicans (1.81%). Among various eyedrops, mydriatic (60%) eyedrops had the highest rate of contamination. We also found that, different preservatives in the eye drops were presents with different level of microbial contamination.Conclusions: The present study showed that there is a definite co-occurrence between eyedrop contamination and ocular infections irrespective of preservatives. This research raises a concern about questionable efficacy of preservatives.

Treatment for allergic conjunctivitis with olopatadine eye drops and other therapies: a Meta-analysis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To systemically evaluate the clinical efficacy and safety of treating allergic conjunctivitis with olopatadine eye drops and other therapies. <p>METHODS: We performed a comprehensive search for the randomized controlled trials(RCTs)about the olopatadine eye drops and other therapies <i>vs.</i> olopatadine eye drops monotherapy for treating allergic conjunctivitis published by April, 2016 from PubMed, EMbase, Cochrane Library, VIP Chinese periodical Database, CNKI and Wan Fang Chinese periodical Database. Studies obtained from eligible database were filtered according to the criteria, and data were retrieved from those studies for further analysis. Then we performed a Meta-analysis using RevMan 5.3 software. <p>RESULTS: A total of 28 RCTs were included. Among all 3568 patients involved in, 1 799 were in the treatment group, while the other 1 769 were in the control group. The results of Meta-analysis showed that the olopatadine eye drops and other therapies was superior to monotherapy for patients with allergic conjunctivitis in clinical effects \〖<i>OR</i>=3.54,95%<i>CI</i>(2.71,4.61),<i>P</i><0.001\〗. <p>CONCLUSION: The existing evidence supports that the prognosis of the olopatadine eye drops and other therapies is better than olopatadine eye drops monotherapy for treating allergic conjunctivitis. For the quality and quantity limitations of the included studies, more well-designed and double blind RCTs are required to further prove this conclusion.

Clinical analysis of diclofenac sodium eye drops combined with sodium hyaluronate eye drops for dry eye after ophthalmic surgery / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To study and analyze the clinical efficacy of diclofenac sodium eye drops combined with sodium hyaluronate eye drops in treating dry eyes after ophthalmic surgery.METHODS: Totally 94 eyes from 94 patients with dry eyes were slected, and they were randomly divided into orbervation group and control group.Fouty-seven patients in the control group using conventional treatment combined with sodium hyaluronate eye drops.Other 47 patients in orbervation group were treated with diclofenac sodium eye drops on the basis of control group.We compared symptoms, fluorescein station, tear film break time, Schirmer Ⅰ test between the two groups.RESULTS: Compared with before treatment, patients of both groups with sympotom, fluorescein station score, BUT, and Schirmer Ⅰ test were significantly improved(P<0.05).At the same time, sympotom, fluorescein station score, BUT and Schirmer Ⅰ test of control group were better than observation group(P<0.05).The cure rates of the orbervation group (98%) were more significant than control group (74%)(P<0.05).CONCLUSION: Diclofenac sodium eye drops combined with sodium hyaluronate eye drops have significant efficacy in treatment of dry eyes after ophthalmic surgery, which can effectively relieve clinical symptoms, improve BUT and Schirmer Ⅰ test.

The Effect of Anti-glaucoma Eyedrops and 0.1% Fluorometholone on Myopic Regression after LASIK or LASEK

PURPOSE: To evaluate the effect of combined medical treatment with anti-glaucoma eyedrops and 0.1% fluorometholone on visual acuity and refractive errors in patients complaining of blurred vision due to myopic regression after laser-assisted in-situ keratomileusis (LASIK) or laser-assisted sub-epithelial keratectomy (LASEK). METHODS: This study comprised 155 patients (155 eyes) who were diagnosed with myopic regression after LASIK or LASEK and received medical treatment from January 2015 to January 2016. The visual acuity and refractive errors were compared before and after medical treatment and evaluated to determine whether the results differ between LASIK and LASEK. RESULTS: The mean time of medical treatment was 64.1 ± 36.8 months after surgery. The responder group whose vision was improved and whose myopic error was decreased after medical treatment was comprised of 63 patients (41%). Their visual acuity in this group improved -0.21 ± 0.11 logMAR, and the amount of myopic error decreased 0.56 ± 0.32 diopters. The full responder group was 24 patients (15%), and the partial responder group was 39 patients (26%). The frequency of response to medical treatment was higher after LASIK than after LASEK, but the difference was not statistically significant. CONCLUSIONS: The combined medical treatment with anti-glaucoma eyedrops and 0.1% fluorometholone was effective in 41% of patients with regard to visual acuity improvement when used for post-LASIK or post-LASEK myopic regression. The medical treatment was effective after both LASIK and LASEK.

Efficacy of recombinant bovine basic fibroblast growth factor in treatment of dry eye following phacoemulsification with IOL implantation / 中华实验眼科杂志

Background The study on eye surface damage following phacoemulsification with intraocular lens (IOL) implantation is increasingly concerned,and these symptoms were associated with dry eye and often treated by polyethylene glycol eyedrops to remit the discomfortableness.Recombinant bovine basic fibroblast growth factor (rb-bFGF) eyedrops contains neurotrophic factors, but its effect on eye surface damage is worth researching.Objective This study was to evaluate the repair effects of rb-bFGF on ocular surface injury after phacoemulsification with IOL implantation.Methods A randomized controlled trail was designed.Ninety eyes of 72 consecutive patients with age-related cataract were enrolled in Fenyang Hospital of Shanxi Province from September 2010 to August 2013 under the informed consent.Phacoemulsification with IOL implantation was performed on all the eyes, and tobramycin and dexamethasone eye drops was used for 15 days as basis therapy.According to the treatment sequence,the operative eyes were assigned to rb-bFGF eyedrops group, polyethylene glycol eyedrops group and basis therapy group.rb-bFGF drops and polyethylene glycol drops were topically administered 4 times per day since the first day after surgery for consecutive 30 days in corresponding group,and only basis therapy was maintained in the basis therapy grouply.Corneal fluorescence (FL) staining scores,breakup time of tear film (BUT) and Schirmer Ⅰ test (S Ⅰ t) without topical anesthesia were examined in 1 day before operation and 1 day,7 days, 15 days and 30 days after operation.The efficacy was intergrouply compared.Results No significant differences were seen in the demography and the relevant surface examinational outcomes among the rb-bFGF group, polyethylene glycol drops group and the basis therapy group before surgery (age : F =1.50;gender :x2 =0.336, both at ＞ 0.05;FL : F =0.31;BUT:F =0.65;S Ⅰ t: F =0.57;all at P ＞ 0.05).Compared with the before operation, FL scores were obviously increased,and BUT values were reduced and S Ⅰ t values were elavated in all the eyes early stage of surgey and then gradually improved with the lapse of postoperative time, showing significant differences (Ftime =7.83,7.32,7.17, all at P＜0.01).The FL scores,BUT and S Ⅰ t in 15 days after surgery in the rb-bFGF drops group and 30 days after surgery in the polyethylene glycol drops group was closed to those of before surgery (all at P＞0.05).However,there were still significant differences between the before and after operation in the basis were closed to those of before surgery therapy group (all at P＜0.05).In addition, significant differences were found in corneal FL scores, BUT and S Ⅰ t among these three groups (Fgroup =5.08,4.15,4.61, all at P＜0.05).In postoperative 15 days and 30 days, the S Ⅰ t values were (12.32±1.18) and (11.32±1.98) mm/5 rmin,which were significantly lower than (14.36±1.77) and (13.36±2.32) mm/5 min in the polyethylene glycol drops group and (17.25 ±2.24) and (13.25 ±2.53) mm/5 min in the basis therapy group (all at P ＜ 0.05).Conclusions The topical application of rb-bFGF combined with tobramycin and dexamethasone eyedrops can improve the dry eye-related symptoms and promote the repair of the ocular surface injury after phacoemulsification with IOL implantation,and the clinical efficacy of rb-bFGF eyedrops is better than that of polyethylene glycol eyedrops or only tobramycin and dexamethasone eyedrops.

Effect of a Preservative-free Dorzolamide/Timolol Fixed Combination on Elevated Intraocular Pressure after Vitrectomy

PURPOSE: To verify the effect of preservative-free Dorzolamide/Timolol fixed combination (PFDTC) on intraocular pressure (IOP) elevation after vitrectomy. METHODS: We retrospectively reviewed medical records of 33 patients who used PFDTC after pars plana vitrectomy. All patients' visual acuity and IOP was measured and symptoms of conjunctival irritation were investigated through survey and slit lamp examination. RESULTS: Before vitrectomy, the mean IOP was 13.6 ± 4.4 mm Hg which was elevated to 31.7 ± 5.4 mm Hg after vitrectomy (p < 0.001) and applying eyedrop lowered the mean IOP to 17.2 ± 7.0 mm Hg (p < 0.001). Regardless of tamponade material type, all elevated IOP decreased (p < 0.001) and the IOP of all 33 eyes did not rise to over 30 mm Hg again. No additional surgery for IOP control was needed during two-month follow-up period. Of the 33 patients using PFDTC, patients who felt discomfort were five (15.2%) and no patients showed side effects severe enough to stop use of eyedrop. CONCLUSIONS: PFDTC is an anti-glaucomatic agent which can reduce the IOP by inhibiting aqueous humor production. Without need for additional surgery, the eyedrop can effectively lower elevated post-vitrectomy IOP, with expectation of good patient compliance due to low risk of conjunctival irritation.

Volume da gota dos colírios lubrificantes: estudo farmacoeconômico / Drop volume of artificial tear solutions: pharmacoeconomic study

RESUMO Objetivo: Determinar o volume médio das gotas produzidas pelos colírios lubrificantes em diferentes ângulos de inclinação e determinar o custo médio do tratamento. Métodos: Determinação do volume da gota de 3 frascos originais dos colírios lubrificantes Artelac®, Hylo Comod®, Lacrima® Plus, Systane® UL, Lacrifilm®, Hyabak®, Lacribell®, Ecofilm®, Mirugell®, Plenigell®, Fresh Tears®, Optive® e Endura® à inclinação de 90º e 45º. Determinou-se o número médio de gotas em cada frasco e foi feita avaliação farmacoeconômica dos colírios. Resultados: O volume das gotas variou de 32,2 a 64,0 µL a 45o e de 29,1 a 65,1 µL a 90o. A diferença entre as gotas em cada inclinação foi de 2 a 24% e o custo anual dos colírios de acordo com a inclinação variou de R$2,73 a R$130,73. A Duração Máxima de Tratamento (DMT) foi de 29,3 a 51,4 dias na inclinação de 45o, e de 28,8 a 48,4 dias a 90º, sendo que a diferença na DMT foi de 0,5 até 8 dias a mais ou a menos, de acordo com a marca. Conclusão: Nenhum dos colírios estudados apresentou gotas ideais para o olho humano, levando a um desperdício do produto e maior custo para o fabricante e para o consumidor. Percebemos que existe uma variação significativa no volume da gota de acordo com a inclinação do frasco, e que uma variação maior do que 10% traria impactos financeiros para o paciente.

ABSTRACT Objective: To determine the mean drop volume produced by artificial tear solutions in different inclination angles and to determine the mean cost of the treatment. Methods: The drop volume of 3 original bottles of the artificial tear solutions Artelac®, Hylo Comod®, Lacrima® Plus, Systane® UL, Lacrifilm®, Hyabak®, Lacribell®, Ecofilm®, Mirugell®, Plenigell®, Fresh Tears®, Optive® and Endura® were determined at the inclination of 90º and 45º. The mean number of drops in each bottle was determined and a pharmacoeconomic evaluation of the drops was made. Results: The drop volume ranged from 32.2 to 64.0 µL at 45º and from 29.1 to 65.1 µL at 90º. The difference between drops in each inclination varied from 2 to 24%. The annual cost was from R$2,73 to R$130,73 according to the inclination of the bottle. The Maximum Duration of Treatment (MDT) was from 29.3 to 51.4 days at 45o and from 28.8 to 48.4 days at 90º, being the difference in MDT from 0.5 to 8 more or less days depending on each brand. Conclusion: None of the collyria studied presented ideal drops for human eyes, leading to a waste of the product and higher cost for the manufacturer and the consumer. We noted that there is a significant variation in the drop volume according to the inclination of the bottle, and that a variation of over 10% would bring financial impact for the patient.

Clinical study of adverse effects induced by Travoprost eyedrops on ocular surface / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the effects induced by topical antiglaucomatous drugs, Travoprost eyedrops on tear film. METHODS: Eighteen patients ( 32 eyes ) with primary open-angle glaucoma or ocular hypertension were all treated with Travoprost eyedrops once every night. The symptom score, Schirmer's test ( S Ⅰ t ) , corneal fluorescein staining ( FL ) , tear film break - up time (BUT), were observed before the treatment and 1, 2 and 3mo after the treatment. RESULTS: The average symptom score, FL of all patients were 1. 34 ± 1. 56 and 0. 44 ± 0. 73 before the treatment, and 2. 75±1. 63, 1. 08±0. 84; 5. 10±1. 68, 1. 53±0-67;6. 33±1. 40, 1. 98±0. 50 respectively after 1, 2 and 3mo of the treatment. There was significant increase in symptom score and FL after the treatment for 1, 2 and 3mo (P=0. 00). The average BUT, SⅠt of all patients were (7. 76±0. 92s), (8. 47±2. 73mm/5min) before the treatment, and (7. 08±1. 15s), (7. 73±3. 44mm/5min);(5-59±1. 33s), (6. 82±3. 05mm/5min); (4. 29±1. 87s), (6-04±3. 15mm/5min) respectively after 1, 2 and 3mo of the treatment. There was significant decrease in BUT and ST after the treatment for 1, 2 and 3mo (P=0. 00). CONCLUSION: Travoprost eyedrops can obviously aggravate patients’ corneal irritation after treatment. Our results show abnormal decreased tear secretion and stability of tear film induced by Travoprost eyedrops over the short term.

Preservatives in eyedrops: the advantages, the disadvantages and the countermeasure of use / 中华实验眼科杂志

Preservative is added to multidose eyedrops to ensure that the eyedrops do not become heavily contaminated during patient use,if the active component in the eyedrops do not have a potent antimicrobial effect.There is a large body of evidence from experimental and clinical studies showing that the long-term use of eyedrops with preservative may induce ocular surface damage.It is a system engineering to control the microbial contamination of eyedrops and to relieve ocular surface damage of preservatives.It is the responsibility of drug regulatory departments,the duty of the medicine workers,and the innovativeness studys of the scientific researcher.Then,the best benefit is acquired by the extensive patient with eye disorders.

Influence of topical Iotemax on intraocular pressure following excimer laser corneal refractive surgery / 中华实验眼科杂志

Background Excimer laser corneal refractive surgery is widely used because it reduces the dependency of refractive error eye to glasses.However,the adverse effects of anti-inflammatory drugs is a problem after operation.Lotemax eyedrops is a kind of steroidal anti-inflammatory drug,with a good effect on the operative eye.But its influence on intraocular pressure(IOP) after long-term topical administration is less studied.Objective This study was to investigate the influence of lotemax eyedrops on IOP after long-term topical administration in myopic eyes received excimer laser corneal refractive surgery.Methods An one-month retrospective case serial study was adopted.The case history data of 1552 eyes from 1552 Patients who received excimer laser corneal refractive surgery were collected in Tangshan Eye Hospital from 2011 January to 2012 January,including 321 eyes with laser in situ keratomileusis(LASIK),608 eyes with sub-Bowman keratomileusis (SBK) and 623 eyes with femtosecond laser for flap excimer laser in situ keratomileusis(FS-LASIK).Lotemax eyedrops was topically administered after operation 4 times per day initial and then decreased 1 time weekly for 1 month.IOP was measured in before,1 week,2 weeks,3 weeks,4 weeks after operation with non-contact tonometer.The increasing range of IOP was divided into ＜5 mmHg,5-15 mmHg and ＞ 15 mmHg after operation.Optical head parameters were measured by Heidelberg retina tomography when IOP increasing after operation.Results Within 1 month,elevated IOP was found in 47 of 1552 eyes after administration of lotemax eyedrops,including 3.12％ (10/321) in the LASIK group,3.29％ (20/608) in the SBK group and 2.73％ (17/623) in the FS-LASIK group,without significant difference among them(x2 =1.95,P＞0.05).The IOP elevated 1 week after operation and remained normal after that till drug withdrawal in all eyes.There were no significant differences in the disk area (1.65 ±0.44) mm2 vs.(1.66 ±0.44) mm2,disk volume (0.40 ±0.09)mm3 vs.(0.39±0.08) mm3 and mean nerve fiber layer thickness (0.28 ± 0.08) mm vs.(0.29 ± 0.07) mm in IOP elevation duration compared with 1 month after IOP recovery(t =0.34,0.81,0.48,P＞0.05).Conclusions Topical administration of 0.5％ lotemax eyedrops after excimer laser corneal refractive surgery leads to reversible high IOP.It is very important to monitor the IOP during use of the drug.

Spontaneous Eyeball Rupture in a 94-Year-Old Patient

PURPOSE: To report a case of spontaneous eye ball rupture without trauma in a 94-year-old patient. CASE SUMMARY: A 94-year-old female patient diagnosed with cataract in both eyes 20 years was referred to this ophthalmologic department for treatment consultation of a painful left eye with spontaneous bleeding. She has used anti-cataract eye drops and artificial tears three times a day for several years without consulting a doctor. Fifteen days prior to presentation, the patient suffered severe left eyeball pain and headache and was diagnosed with acute angle-closure glaucoma secondary to hypermature cataract. She underwnet eviceration after ocular examination and systemic evaluation. Surgical findings included a thin cornea at the inferior limbus and protruding intraocular tissues. Additionally, the eyeball was filled with a blood clot from a choroidal hemorrhage. Morganella morganii were grown in a bacterial swap culture, and a corneal biopsy revealed suppurative inflammation. CONCLUSIONS: In old age, a thin corneal limbus due to infection and complicated acute angle-closure glaucoma can cause massive suprachoroidal hemorrhage with spontaneous eyeball rupture.

Desarrollo tecnológico de una formulación de cloruro de sodio al 5 por ciento para el tratamiento del edema corneal en Cuba / Technological development of a 5 percent sodium chloride formula for treatment of corneal edema in Cuba

Se desarrolló una formulación para uso oftálmico, que contenía cloruro de sodio al 5 por ciento, estable desde el punto de vista físico, químico y microbiológico. Se realizaron los estudios de formulación correspondientes, seleccionándose la composición y procedimiento tecnológico más adecuados. Además, se estudió la efectividad antimicrobiana de los preservativos antimicrobianos empleados según se establece en la Farmacopea de los Estados Unidos 30 y se comprobó la seguridad del uso de este medicamento a través de los resultados del ensayo de irritabilidad oftálmica. Se elaboraron 3 lotes del medicamento y se envasaron en frascos plásticos de polietileno de baja densidad con tapa de polipropileno de alta densidad y se almacenaron a temperatura ambiente durante 24 meses; se estudió su estabilidad física y química por el método acelerado y de vida de estante. Se comprobó su estabilidad microbiológica a cada uno de los lotes elaborados, al inicio y final del estudio, según se establece en la Farmacopea de los Estados Unidos 30, y se obtuvieron resultados satisfactorios. Todos los resultados cumplieron con los límites de calidad establecidos en la literatura oficial para este tipo de forma farmacéutica, por lo que se concluyó que el medicamento desarrollado está correctamente formulado desde el punto de vista galénico con un tiempo de vida útil de 24 meses almacenado bajo las condiciones estudiadas, demostrado según el otorgamiento del certificado de registro por el organismo regulador (Centro Estatal para el Control de Medicamentos, CECMED). Finalmente el medicamento fue introducido al nivel industrial sin que se presentaran problemas tecnológicos

A formula for ophthalmic use was developed containing 5 percent sodium chloride stable from the physical, chemical and microbiological point of view. Studies of corresponding formulae were conducted selecting the more suitable composition and technological procedure. Also, the antimicrobial effectiveness of animicrobials preservatives used according to United States Pharmacopeia was studied demonstrating the safe use of this drug by the results of the ophthalmic irritability trial. Three batchs of this drug were elaborated packing in low density polyethylene plastic flasks with a high density polypropylene top stored at room temperature during 24 monhts and its physical and cchemical stability was studied y accelerated method and of shield-life. At onset and the end of study microbiological stability was demonstrate in each of batches made (30), according to USP with satisfactory results. All results fulfill with the established quality limits in official literature for this type of pharmaceutical way concluding that this developeddrug is appropriately formulated fro the doctoral point of view with a useful life time of 24 months stored under study conditions, demonstrated according to award of registry certificate by regulator institution (State Center for Drugs' Control, CECMED). Finally, the drug was introduced at industrial level without technological problems

Noncompliance with drug therapy of glaucoma: a review about intervening factors / Abandono do tratamento medicamentoso do glaucoma: uma revisão sobre os fatores intervenientes

Glaucoma is defined as an optic neuropathy, characterized for loss of visual field and injury of the optic nerve, being considered as the second cause of blindness in the world, which could be prevented by the use of antiglaucoma eyedrops. The lack of adhesion of the patient to the drug treatment can culminate with loss of the vision. The objective was to revise possible literature data regarding intervening factors for noncompliance and explain estimated rates of noncompliance. A systematic review about the subject was carried out in the period of January to June of 2006. Articles had been searched in two data bases, in the National Library of Medicine (PUBMED) and in the Literature Latin American and Caribbean Health Sciences (LILACS) using the following keywords: glaucoma, compliance of the patient, noncompliance of the patient, treatment and eyedrops. In PUBMED, 199 articles were collected, written in English and French languages. No article was found in LILACS. Considering the inclusion and exclusion criteria, 27 articles were selected, with 25 originals and two reviews. Twelve possible intervening factors for noncompliance were raised, as well as estimates for rates of noncompliance. The noncompliance rates varied from 4.6 percent up to 59 percent. Two factors, forgetfulness and inadequate between-doses interval, had been associated to noncompliance of the drug therapy. The factors race, adverse effects, treatment cost, number of instilled doses, coexisting illnesses and number of eyedrops used, had resulted contradictory, being impossible to affirm that they have contributed for noncompliance. Age, sex, educational level and loss of visual field, had not been associated with noncompliance. The glaucoma patients tended to disregard the drug treatment. The wide variation in noncompliance rates could be an influence from the authors' difficulty to define the noncompliance and the variety of methodologies used to estimate it. More...

O glaucoma é definido como uma neuropatia óptica, caracterizada por perda de campo visual e lesão do nervo óptico, sendo considerado como a segunda causa de cegueira no mundo, podendo ser evitada pelo uso de colírios antiglaucomatosos. A falta de adesão ao tratamento medicamentoso pode culminar com perda da visão. O objetivo do trabalho foi revisar dados da literatura a respeito de possíveis fatores intervenientes para a não adesão à terapêutica medicamentosa e relatar taxas de não adesão estimadas. Foi realizada uma revisão sistematizada sobre o assunto, abrangendo o período de janeiro a junho de 2006. Foram pesquisados artigos em dois bancos de dados, o da National Library of Medicine (PUBMED) e o de Literatura Latino Americana e do Caribe em Ciências da Saúde (LILACS), utilizando-se as seguintes palavras-chave: glaucoma, adesão do paciente, não adesão do paciente, tratamento e colírios. Foram levantados 199 artigos no PUBMED, nas línguas inglesa e francesa. Não foram encontrados artigos no LILACS. A partir dos critérios de inclusão e exclusão, foram selecionados 27 artigos, sendo 25 originais e duas revisões. Foram averiguados 12 possíveis fatores intervenientes para não adesão, bem como estimativas de taxas de não cooperação ao tratamento. As taxas de não adesão variaram de 4,6 por cento a 59 por cento. Dois fatores, 'esquecimento' e 'intervalo inadequado entre as doses', foram associados ao não-cumprimento da terapêutica medicamentosa. Raça, custo do tratamento, efeitos adversos, número de doses instiladas, doenças coexistentes e número de colírios utilizados tiveram resultados contraditórios, não podendo afirmar-se que os mesmos contribuíram para a não adesão. Idade, sexo, nível de escolaridade e perda de campo visual não foram associados à não adesão. Os pacientes glaucomatosos tenderam a descumprir o tratamento medicamentoso. A ampla variação nas taxas de não adesão pode ter sido influenciada pela dificuldade dos autores em definir...