Comparison of the clinical efficacy of preserved and preservative-free hydroxypropyl methylcellulose-dextran-containing eyedrops / Comparación de la eficacia clínica de los colirios con conservantes y los colirios con contenido de hidroxipropil metilcelulosa-dextran sin conservantes

Purpose: This study aimed to compare the efficacy of two sustained-release formulation of artificial tear drops. Patients and methods: This is a randomized patient-masked clinical trial, a total 88 patients into two group A (n=41; with single dose of artificial tear, containing dextran 70, 1mg/ml and hypromellose, 3mg/ml hydroxypropyl methylcellulose (HPMC) and group B (n=47; with multidose of artificial tear, containing 0.3g HPMC and 0.1g of dextran 70, with 0.01% benzalkonium chloride (BAK) as preservative) were completed the study. The ocular surface disease index (OSDI) questionnaire, tear break up time (TBUT), corneal and conjunctival staining and Schirmer test, were performed. Repeated measures ANOVA was used to assess the differences among the two products. A p-value less than 0.05 was considered significant. Results: The mean of age of the participants in the Group A and B was 44.08±6.29 (range, 33-58 years) years and 45.83 ± 8.42 (31-60 years), respectively. In comparing two groups before the intervention, the OSDI scores, the TBUT scores, the conjunctival and corneal staining scores and the Schirmer scores did not show statistically significant differences (p=0.339, p=0.640, p=0.334, p=0.807 and p=0.676, respectively). After 4 weeks, the OSDI scores, conjunctival and corneal staining scores showed improvement in compare to those before the intervention (p<0.001). But, the differences for the Schirmer test score and TBUT score was not significant (p=0.115, p=0.013, respectively). Conclusion: Our outcomes indicated that improvement occurred with use of both products but there was no statistically significant difference between them (AU)

Objetivo: El objetivo de este estudio fue comparar la eficacia de dos fórmulas de lágrimas artificiales de liberación sostenida. Pacientes y Métodos: Ensayo clínico aleatorizado y enmascarado para el paciente, se incluyó a un total de 88 pacientes distribuidos en dos grupos: el grupo A (n=41; con una dosis única de lágrima artificial con contenido de Dextran 70,1mg/ml e hipromelosa, 3mg/ml hidroxipropil metilcelulosa (HPMC), y el grupo B (n=47; con multidosis de lágrima artificial, con contenido de 0,3g HPMC y 0,1g de Dextran 70, y 0,01% de cloruro de benzalconio (BAK) como conservante). Se realizaron las siguientes pruebas: cuestionario del índice de enfermedad de la superficie ocular (OSDI), tear break-up time (TBUT), tinción corneal y conjuntival y prueba de Schirmer. Para el análisis estadístico se utilizó ANOVA para mediciones repetidas, a fin de evaluar las diferencias entre los dos productos. Se consideró significativo un valor p inferior a 0,05. Resultados: La media de edad de los participantes de los grupos A y B fue de 44,08±6,29 (rango de 33 a 58 años) y 45,83 ± 8,42 (de 31 a 60 años), respectivamente. Al comparar los dos grupos antes de la intervención, las puntuaciones OSDI, TBUT, las de tinción conjuntival y corneal, y las de la prueba de Schirmer no reflejaron diferencias estadísticamente significativas (p=0,339, p=0,640, p=0,334, p=0,807 y p=0,676, respectivamente). Transcurridas cuatro semanas, las puntuaciones OSDI y las de tinción conjuntival y corneal reflejaron una mejora en comparación a las puntuaciones anteriores a la intervención (p<0,001). Pero las diferencias en cuanto a las puntuaciones de la prueba de Schirmer y TBUT no fueron significativas (p=0,115, p=0,013, respectivamente). Conclusión: Nuestros resultados indican que se produjo una mejora con el uso de ambos productos, pero que no se produjo una diferencia estadísticamente significativa entre ambos (AU)

[General substance classification and pharmacology of glaucoma]. / Allgemeine Substanzklassen und Pharmakologie bei Glaukom.

The pharmaceutical therapy of glaucoma dates back to 1875 when Weber introduced pilocarpine into the medicinal treatment of glaucoma. Since then there has been a continuous development of topical antiglaucoma therapy whereby the main developments date back to the 1980s and 1990s. All forms of medicinal therapy aim at lowering the intraocular pressure and achieve this either by inhibiting aqueous humor secretion into the ciliary body or by enhancing physiological drainage routes along Schlemm's canal. This article gives an overview over the most important classes of antiglaucoma drugs, the indications and contraindications as well as pharmacological characteristics. The focus lies on the market of combination and generic drug preparations that is currently rapidly developing and therefore needs to be discussed in detail.

[Cytotoxic effects of three kinds of eye drops for Chinese herbal medicines on various cell lines in vitro].

OBJECTIVE: To study the cytotoxic effects of three kinds of eye drops on human cancer cells and normal cells. METHODS: Cytotoxic effects of Yuxingcao Eye Drop (YXC), Gegensu Eye Drop (GGS) and Shuanghuanglian Eye Drop (SHL) on 6 cell lines (CNE2, Glc-82, HRPE, Fibro, 3T3 and ECV-304) were assayed using MTF method. And cytotoxic efficacy was evaluated using fifty percent of inhibitory concentration (IC50). RESULTS: IC50 of YXC to human cancer cells CNE2 and Glc-82 were (11.5 +/- 0.25) microl/ml and (24.0 +/- 0.8) microl/ml; to normal cells HRPE, Fibro, 3T3 and ECV-304 were (18.0 +/- 3.5) microl/ml, (52.0 +/- 14.0) microl/ml, (17.5 +/- 3.5) microl/ml and (17.5 +/- 1.3) microl/ml, respectively. IC50 of GGS to CNE2, Glc-82, ECV-304 cells were (9.8 +/- 2.3) microl/ml, (17.0 +/- 5.0) microl/ml and (10.5 +/- 0.95) microl/ml, respectively. Under the concentration of 100 microl/ml, the average survival rates of HRPE, Fibro and 3T3 cells were 60.0%, 87.8% and 58.2%, respectively. IC50 of SHL to CNE2, Glc-82 and HRPE cells were (18.9 +/- 5.0) microl/ ml, (23.9 +/- 0.6) micorl/ml and (113.9 +/- 25.6) microl/ml. At the concentration of 100 microl/ml, the average survival rates of Fibro, 3T3 and ECV-304 Cells were 89.6%, 77.2% and 74.7%. CONCLUSION: YXC has evident cytotoxicities to human cancer cells and normal cells. While, GGS and SHL has not obvious cytotoxic effects to normal cells.

New classification of ophthalmic viscosurgical devices--2005.

PURPOSE: To revise the generally accepted classification of ophthalmic viscosurgical devices (OVDs) to include cohesion data and the new class of viscous dispersive OVDs. SETTING: York Finch Eye Associates, Toronto, Ontario, Canada, and Alcon Research Limited, Fort Worth, Texas, USA. METHODS: Pseudoplasticity and cohesion-dispersion (CDI) data of DisCoVisc (hyaluronic acid 1.6%-chondroitin sulfate 4%), a new viscous dispersive OVD, were determined and compared with existing OVDs. The existing classification of OVDs was unable to accommodate its properties, so the classification was modified to include a new class and other potential new classes which currently remain unoccupied. RESULTS: Current OVD classification, although based on the clinically significant rheologic parameters of zero-shear viscosity and cohesion, only uses zero-shear viscosity because of the high correlation of these 2 parameters in existing OVDs. The appearance of DisCoVisc forces modification of the existing scheme because it does not fit into a preexisting category. The new proposed broadened classification is changed from a 1-dimensional list into a 2-dimensional table and considers CDI independently from viscosity for all OVDs. Expansion of the classification of OVDs in this manner predicts further possible new innovative OVDs for surgical use. CONCLUSION: The surgical behavior of OVDs can be predicted by their position in a classification of OVDs based upon zero-shear viscosity and cohesion.

Patient and ophthalmologist attitudes concerning compliance and dosing in glaucoma treatment.

AIM: The aim of this study was to identify research avenues that might improve patient compliance with glaucoma therapy. METHODS: 500 patients and physicians were interviewed by telephone in 5 European countries, and the results were compiled and evaluated by 2 independent physicians. RESULTS: Most physicians believed that pressure reduction is useful (UK (96%), France (94%), Spain (80%), Italy (72%), and Germany (70%), p < 0.0001). The majority of physicians believed that noncompliance exists in 0%-25% of patients, whereas 34% of patients admitted to noncompliance. Physicians believed patients would prefer once-daily dosing (92%) and that it would help compliance, whereas 60% of patients preferred once-daily dosing, and 20% of patients believed it would help compliance. Physicians (94%) believed that noncompliance could lead to visual loss and, while this information concerned most physicians, this was less likely in Germany (52%) (p < 0.0001). Most patients received information concerning dosing of their medicines (79%), and, accordingly, waited an average of 10 minutes between doses; but only half of the patients had been told to wait at least 5 minutes between instilling preparations. Approximately 2 of 3 patients knew that missing medicines could cause visual loss. CONCLUSIONS: Once-daily dosing to increase patient satisfaction and/or dosing convenience and providing patient education are potential clinical techniques that could be further evaluated as a means to increase compliance.

Two-year follow-up of latanoprost 0.005% monotherapy after changing from previous glaucoma therapies.

AIM: The aim of this study was to evaluate the long-term follow-up of patients who were changed to latanoprost from previous glaucoma therapies. METHODS: Primary open-angle, exfoliative or chronic angle-closure glaucoma, or ocular hypertensive patients who switched to latanoprost therapy with a 2-year follow-up, were evaluated for efficacy, safety, and continuance of therapy. RESULTS: In 1,571 patients, the intraocular pressure (IOP) across all treatment groups of 21.3 +/- 4.1 was reduced to 17.6 +/- 3.2 mm Hg after switching to latanoprost. Latanoprost reduced the IOP from previous monotherapies, including nonselective beta-adrenergic blockers, topical carbonic anhydrase inhibitors, alpha-adrenergic agonists and pilocarpine (p < 0.0001) and adjunctive therapies, including the fixed combinations of dorzolamide and timolol, pilocarpine and timolol, and pilocarpine and metipranolol, and the unfixed combination of dorzolamide and timolol and dorzolamide and clonidine (p < 0.0028). Latanoprost further reduced the IOP across all diagnostic groups (p < 0.0001). The most common ocular adverse event was ocular irritation (n = 25; 1.6%), which was also the most common reason given for patients who discontinued latanoprost because of an adverse event (n = 20; 1.3%). CONCLUSIONS: The mean IOP was maintained at an acceptable level throughout the 2-year follow-up period on latanoprost. Latanoprost generally provides further reduction of IOP when switched from previous mono- and adjunctive therapies, with a low rate of side effects and discontinuations.

[Classification of visco-elastic substances for ophthalmologic surgery]. / Einteilung der viskoelastischen Substanzen für die Ophthalmochirurgie.

UNLABELLED: Individual properties of a viscoelastic substance for ophthalmologic applications are intimately tied to its chemical and rheologic characteristics. Independent comparative data for vicoelastic substances are not readily available or interpretable. MATERIAL AND METHODS: Twenty-six different commercially available viscoelastic substances were investigated using the Advanced Rheometric Expansion System and the Rheometric Scientific 800 device to analyze elastic and viscous modulus, complex viscosity (dynamic frequency dependance) and viscosity at the zero shear rate by extrapolation using the Ellis fit. RESULTS: Viscosity (cps) at zero shear rate (s-1, mean of six different samples): Sodium hyaluronate products: Amivisc Plus: 128; AMO Vitrax: 41; Biolon: 243; Dispasan: 130; Dispasan Plus: 782; Healon: 243; Healon GV: 2451; Healon 5: 5525; Microvisc (Morcher Oil): 1162; Microvisc Plus: 3663; Morcher Oil: 1253; Provisc: 207; Rayvisc: 78; Viscoat: 58; Viscorneal (Allervisc): 733; Viscorneal Plus (Allervisc Plus): 1176; Visko: 206; Visko Plus: 1683. Hydroxypropylmethylcellulose (HPMC) products: Acrivisc: 7; Adatocel: 8; Coatel: 6; HPMC Ophthal H: 94; HPMC Ophthal L: 7; Ocucoat: 6; PeHa-Visko: 5; Visco Shield: 60. CONCLUSION: Sodium hyaluronate as well as HPMC viscoelastic substances demonstrated remarkable differences in rheological properties from each other. In some cases, the results of this independent investigation differed from the values provided by the companies. A new division of commercially available viscoelastic substances into subgroups is presented, which provides a scientific base for various practical viscosurgical aspects. These real rheologic properties of each substance allow the ophthalmic surgeon to choose the viscoelastic substance that is most suitable for the surgical situation.

Topical ophthalmic drug administration: a practical guide.

Of the various routes used to administer drugs to the eye, the topical route is the most commonly used. The safe and effective administration of topical eye medication is often the responsibility of the nurse. The procedure for the administration of topical eye medication involves a sequence of simple steps and an understanding of the drug action.

Ophthalmic drug use in the OR.

Categories of ophthalmic drugs used in the operating room (OR), their generic and trade names, indications for use, actions, contraindications, usual dosages, adverse reactions, and nursing concerns are presented to give the ophthalmic nurse a comprehensive knowledge of the most commonly used ocular pharmaceuticals.