ABSTRACT
Dry eye disease (DED) is pathogenetically based on inflammation of the ocular surface. A step-by-step approach to DED treatment involves early initiation of anti-inflammatory therapy, including instillation of cyclosporine A (CsA). However, recommendations for the use of topical CsA in clinical practice are limited. This article presents an expert consensus on practical recommendations for the management of patients with DED, including indications, time of initiation and duration of CsA therapy, comparison of CsA forms currently registered in the Russian Federation, as well as issues of patient education.
Subject(s)
Cyclosporine , Emulsions , Humans , Administration, Ophthalmic , Cyclosporine/administration & dosage , Dry Eye Syndromes/drug therapy , Dry Eye Syndromes/etiology , Immunosuppressive Agents/administration & dosage , Ophthalmic Solutions/administration & dosage , Treatment Outcome , Xerophthalmia/etiology , Xerophthalmia/drug therapy , Xerophthalmia/diagnosisABSTRACT
INTRODUCTION: The problems of controlling inflammatory and proliferative response of the retina and correcting tear production in the post-operative period after photorefractive keratectomy (PRK) have not been fully solved yet. Patients intolerable to local steroids require an alternative. One drug that covers those needs is Cyclosporine 0.05%. PURPOSE: To analyze clinical effectiveness of Restasis eye drops in solving inflammatory-degenerative response and tear production insufficiency (dry eye syndrome) for post-PRK patients with steroid eye drops intolerance accompanied with increasing intraocular pressure (IOP). PATIENTS AND METHODS: Retrospective analysis of 14 myopic patients (28 eyes) was conducted; mean patient age was 25.9±6 years; myopia was (-)5.65±1.5 Diopters of spherical equivalent (SE); corneal-compensated IOP was 16.98±3.68 mm Hg before the surgery. All patients underwent excimer laser correction (PRK or Trans-PRK) with Schwind Amaris (SCHWIND eye-tech-solutions). After epithelization, all patients were prescribed 0.1% Dexamethasone solution 4 times a day (with decreasing dosing frequency) for 2 months, as well as local lubricants. The article also describes a separate clinical case of subepithelial fibroplasia that occurred post-PRK and was successfully stopped. RESULTS: All patients had transitory IOP increase caused by local steroid therapy. Mean IOP at 1-month post-op was 20.5±7 mm Hg. At that point local steroids were replaced with 'Restasis' 0.05% (Cyclosporine) eye drops prescribed 2 times per day for 2 months. As the result, IOP values decreased to 16.2±3.21 mm Hg (without any additional therapy); at 6 months mean uncorrected visual acuity reached 0.98±0.05, best corrected visual acuity achieved 1.03±0.06 and SE was 0.04±0.12 Diopters. CONCLUSION: Local Cyclosporine ('Restasis') is the method of choice for regulation of inflammatory and degenerative response and tear production insufficiency (dry eye syndrome) for post-PRK patients with intolerance to steroid eye drops.
Subject(s)
Myopia , Photorefractive Keratectomy , Adult , Cornea , Humans , Lasers, Excimer , Refraction, Ocular , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
PURPOSE: To evaluate the influence of dry eye disease (DED) in cataract patients on refractive results of phacoemulsification with implantation of intraocular lenses (IOLs). MATERIAL AND METHODS: The study included 24 patients (24 eyes) with early cataract or phacosclerosis who planned to undergo phacoemulsification with implantation of multifocal IOL. Inclusion criteria was preoperative presence of DED. During the initial visit, all patients first had IOL power calculated, received comprehensive treatment to address DED, and then repeated the IOL power calculation. Accuracy of achieving target refraction was evaluated by the amount of residual spherical equivalent one months after the surgery. RESULTS: In patients with cataract and DED, the following statistically significant changes were noted after ocular surface normalization: reduction of the cylindrical component of refraction, reduction of corneal irregularity and its asymmetry, as well as normalization of eye surface. The average difference in the calculation of IOL power before and after DED treatment was 0.87±0.11 D, maximum error was 2.25 D. Control examination one month after the operation showed high visual functions in all operated patients. Deviation from the planned refraction was minimal (41.2% of cases were within in ±0.25 D of the planned refraction, 76.5% of cases in ±0.5 D, 100% of cases in ±1.0 D). CONCLUSION: Preoperative detection of DED and its correction in patients with cataract increases calculation precision of IOL power and improves clinical and functional results.
