Corneal ulcer development due to sintilimab-anlotinib combination therapy-induced dry eye: a case report.

Background: Programmed cell death-1 (PD-1) inhibitors and anti-angiogenic drugs have become a hotspot in research of anti-tumor programs; however, they can also cause some rare drug-related adverse reactions. Immune checkpoint inhibitors (ICIs) cause adverse reactions in the body, collectively known as immune-related adverse events (irAEs). Ocular side effects can occur in both targeted and immunotherapy patients, including dry eye, blurred vision, uveitis, conjunctivitis, retinopathy, or thyroid eye disease. To our knowledge, this is the first case report describing corneal ulcers secondary to dry eye in a patient treated with the combination of PD-1 inhibitor sintilimab and multi-targeted receptor tyrosine kinase inhibitor (TKI) anlotinib. Case Description: A 65-year-old woman with non-small cell lung cancer (NSCLC) and bone metastases, without pre-existing ocular conditions, experienced mild dry eye symptoms 1 month following treatment with sintilimab (200 mg q3w) in combination with anlotinib (12 mg q3w). Unrelieved dry eye symptoms occurred after the third cycle of chemotherapy, and she was diagnosed with dry eye syndrome. Subsequently, she received corneal protective lens, sodium hyaluronate eye drops, and prednisone treatment. Her corneal epithelial damage did not improve significantly, and within the following 2 months, her vision decreased in both eyes and progressed to bilateral corneal ulcers. Oral administration of sintilimab and anlotinib was interrupted, and treatments such as corticosteroids, anti-inflammatory drugs, and corneal repair were administered; however, both eyes presented with corneal subepithelial defect and corneal scarring. Due to a shortage of donors, no corneal transplantation surgery could be performed. Conclusions: The development of corneal epithelial disorders in patients receiving target therapy and immunotherapy may not be reversed by reducing its dose. Although the condition is controlled with the use of glucocorticoids, some eye side effects cannot be cured. The timely detection and intervention of adverse effects of anti-tumor drugs by oncologists and ophthalmologists is critical for rational prescription. Ophthalmologists should be aware of eye side effects in patients using immunotherapy to ensure appropriate treatment and minimize potential eye complications such as dry eye, conjunctivitis, etc.

Qihuang Granule protects the retinal pigment epithelium from oxidative stress via regulation of the alternative complement pathway.

BACKGROUND: Age-related macular degeneration (AMD) is a leading cause of vision loss in elderly people, and dry AMD is the most common type of AMD. Oxidative stress and alternative complement pathway activation may play essential roles in the pathogenesis of dry AMD. There are no available drugs for dry AMD. Qihuang Granule (QHG) is an herbal formula for the treatment of dry AMD, and it achieves a good clinical effect in our hospital. However, its potential mechanism is unclear. Our study investigated the effects of QHG on oxidative stress-associated retinal damage to reveal its underlying mechanism. METHODS: Oxidative stress models were established using H2O2 and NaIO3 in ARPE-19 cells and C57BL/6 mice. Cell apoptosis and viability were assessed using phase contrast microscopy and flow cytometry, respectively. Alterations in the mouse retinal structure were evaluated using Masson staining and transmission electron microscopy (TEM). The expression of complement factor H (CFH), complement component 3a (C3a) and complement component 5a (C5a) in retinal pigment epithelium (RPE) cells and mice was measured using RT‒PCR, Western blot analysis and ELISA. RESULTS: Pretreatment with QHG significantly prevented cell apoptosis and disorder of the RPE and inner segment/outer segment (IS/OS) in H2O2-treated RPE cells and NaIO3-injected mice. QHG alleviated mitochondrial damage in mouse RPE cells, as shown by TEM. QHG also promoted CFH expression and inhibited the expression of C3a and C5a. CONCLUSIONS: The results suggest that QHG protects the retinal pigment epithelium from oxidative stress, likely by regulating the alternative complement pathway.

The upper eyelid levator weakening procedure for the correction of severe cicatricial entropion caused by trachoma.

BACKGROUND: Trachoma-induced upper eyelid cicatricial entropion (UCE) is a common and challenging eyelid disease. Surgeons have developed various surgical techniques to address UCE in the world. However, there are few reports about surgery for Chinese patients. Our study aims to evaluate the esthetic and functional outcomes of correction of trachoma-induced UCE using upper eyelid levator weakening combined with tarsotomy and an anterior lamella recession procedure in China. METHODS: A retrospective non-comparative study was performed in the Ophthalmology Department of Second Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2017 to December 2019. Thirty-six patients (56 eyelids) with severe UCE caused by trachoma, defined as shortening and retraction of the posterior lamella, were collected. Upper eyelid levator weakening combined with tarsotomy and an anterior lamella recession procedure was done on all patients. The mean follow-up time was 11.6±2.71 months (range, 6-24 months). RESULTS: Among the patients, 48 eyelids (85.7%) achieved complete success. Recurrence was observed in 4 eyelids (7.1%). No other severe complications occurred. CONCLUSIONS: This case series showed that upper eyelid levator weakening combined with tarsotomy and an anterior lamella recession procedure is a safe and effective treatment for severe trachoma-induced UCE in Chinese patients.

[Simultaneous determination of amino acids in food by capillary electrophoresis with indirect ultraviolet detection].

The characteristic of capillary electrophoresis (CE) with indirect ultraviolet (UV) detection of L-ornithine (Orn), L-proline (Pro) and L-glutamine (Gln) was investigated. A suitable electrolyte consists of 5 mmol/L sodium p-aminobenzene sulfonic acid-10 mmol/L KH2PO4 (pH 11.5) with UV detection at 254 nm. The applied voltage was set at 12 kV. The three amino acids were completely separated and detected by the method in 11 min. The relative standard deviations (RSD) of the method were better than 0.72% for migration time and 2.0% for peak height. The detection limits of Orn, Pro and Gln were 6.78, 8.71 and 7.86 mg/L, respectively. The proposed method was successfully applied to the determination of amino acids in foods (Haitian soybean sauce, Tsingtao beer and amino acids tonic) and the recoveries were in the range of 96.8% - 104%.