Topical treatment of diabetic retinopathy: a systematic review.

Diabetic retinopathy (DR) is the most common microvascular complication in diabetes and may cause severe visual impairment. Until late stages of DR, treatment options are limited. The aim of the present review was to investigate whether changes of DR might be influenced by topical treatment with eye drops. This systematic review included both randomized and non-randomized human clinical studies on the subject. A systematic search of PubMed Medline, Embase and Scopus databases yielded 710 studies. No inclusion criteria regarding classification of DR were defined. Reference lists as well as first authors were screened for the inclusion of additional studies. Potential bias of the randomized studies was assessed using the Cochrane Risk of Bias tool. Nineteen studies suitable for inclusion were identified. Seven studies were randomized trials. These examined 11 different pharmacological groups of drugs in DR. A favourable effect of corticosteroid eye drops in diabetic macular oedema (DMO) was reported in four studies, and another study reported a positive trend. Eye drops with non-steroidal anti-inflammatory drugs were also reported to have a favourable effect in DMO, but not in non-center involving DMO. Application of neuroprotective agents was found effective in patients with pre-existing neurodegeneration in three studies. The remaining studies of DMO and DR were heterogeneous in both designs and results. Studies on treatment of DR with topical eye drops vary with regards to patient population, interventional drugs, study design, and outcome measures. Treatment of DR with eye drops was found effective in the aforementioned cases, but there is still a need for further investigations of long-term, randomized controlled trials in any of the reported pharmacological group.

Enhancing the Antifungal Activity and Ophthalmic Transport of Fluconazole from PEGylated Polycaprolactone Loaded Nanoparticles.

Fungal eye infections are caused mainly by an eye injury and can result in serious eye damage. Fluconazole (FLZ), a broad-spectrum antifungal agent, is a poorly soluble drug with a risk of hepatotoxicity. This work aimed to investigate the antifungal activity, ocular irritation, and transport of FLZ-loaded poly (ε-caprolactone) nanoparticles using a rabbit eye model. Three formulation factors affecting the nanoparticle's size, zeta potential, and entrapment efficiency were optimized utilizing the Box-Behnken design. Morphological characteristics and antifungal activity of the optimized nanoparticles were studied. The optimized nanoparticles were loaded into thermosensitive in situ hydrogel and hydroxypropylmethylcellulose (HPMC) hydrogel ophthalmic formulations. The rheological behavior, in vitro release and in vivo corneal transport were investigated. Results revealed that the percentage of poly (ε-caprolactone) in the nanoparticle matrix, polymer addition rate, and mixing speed significantly affected the particle size, zeta potential, and entrapment efficiency. The optimized nanoparticles were spherical in shape and show an average size of 145 nm, a zeta potential of -28.23 mV, and a FLZ entrapment efficiency of 98.2%. The antifungal activity of FLZ-loaded nanoparticles was significantly higher than the pure drug. The developed ophthalmic formulations exhibited a pseudoplastic flow, prolonged the drug release and were found to be non-irritating to the cornea. The prepared FLZ pegylated nanoparticles were able to reach the posterior eye segment without eye irritation. As a result, the developed thermosensitive in situ hydrogel formulation loaded with FLZ polymeric nanoparticles is a promising drug delivery strategy for treating deep fungal eye infections.

The Proportion of Complementary and Alternative Medicine Utilization Among Saudi Population for Eye Care: Cross-Sectional Study.

Purpose To estimate the prevalence, determinants and perceived benefit of complementary and alternative medicine (CAM) use for ophthalmic purposes among the Saudi population. Methods A cross-sectional study was carried out in 2019 targeting visitors of King Khaled Eye Specialist Hospital (KKESH), Riyadh, Saudi Arabia. The survey had 18 questions in Arabic regarding the use of CAM for eye ailments. The magnitude was associated to the demographic and eye-related factors. Results We interviewed 999 participants. The prevalence of CAM usage was 21.9% (95% confidence interval 19.3; 24.5). Castor oil (49.3%), antimony (khohl alethmed) (40.6%), chamomile (19.6%), and green tea leaves (11.4%) were the most common medications used. Other traditional eye treatments included eye vitamins, faith healing (prayer, reciting Quran, Zamzam water), cautery, cupping, and acupuncture. Conclusions One in five Saudi eye patients used CAM. The factors governing this health behavior should be studied to change this practice pattern.

Úlceras corneales en pacientes atendidos en el Hospital General Docente "Dr. Agostinho Neto", Guantánamo 2014-2019 / Corneal ulcers in patients treated at the General Teaching Hospital "Dr. Agostinho Neto", Guantanamo 2014-2019 / Úlceras de córnea em pacientes atendidos no Hospital Geral de Ensino "Dr. Agostinho Neto ", Guantánamo 2014-2019

RESUMEN Introducción: Las úlceras corneales no se han caracterizado en el Hospital General Docente "Dr. Agostinho Neto" de Guantánamo. Objetivo: Caracterizar la úlcera corneal en pacientes atendidos en el Servicio de Oftalmología de este hospital en el período de enero 2014 a julio 2019. Método: Se realizó un estudio descriptivo, retrospectivo y longitudinal con 40 pacientes. Se estudiaron las variables: sexo, edad, procedencia, ocupación, factores de riesgo, etiología, tratamiento y complicaciones de este tipo de úlcera y las modificaciones de la agudeza visual de acuerdo al tratamiento que se les aplicó. Resultados: El 75,0 % de los pacientes fue del sexo masculino que tenían 65 o más años de edad (47,5 %), procedían de áreas rurales (72,5 %) y realizaban actividades agrícolas (45,0 %). El trauma corneal fue el factor de riesgo más usual (25,0 %). En el 47,5 % la úlcera fue de etiología micótica. El 100 % recibió tratamiento farmacológico, sobre todo con colirio antibiótico fortificado (25,0 %). Se le aplicó tratamiento quirúrgico al 27,5 %, la técnica más común fue el recubrimiento conjuntival (15,0 %). La agudeza visual mejoró en el 75,0 % de los pacientes luego del tratamiento. Conclusiones: En el Hospital General Docente "Dr. Agostinho Neto" la úlcera corneal no es un problema de salud, pero sí determina la agudeza visual de los pacientes afectados, en los que es más común la etiología micótica y la necesidad del uso de colirios fortificados.

ABSTRACT Introduction: Corneal ulcers have not been characterized in the General Teaching Hospital "Dr. Agostinho Neto" from Guantanamo. Objective: To characterize the corneal ulcer in patients treated in the Ophthalmology Service of this hospital in the period from January 2014 to July 2019. Method: A descriptive, retrospective and longitudinal study was carried out with 40 patients. The variables were studied: sex, age, origin, occupation, risk factors, etiology, treatment and complications of this type of ulcer and the modifications of visual acuity according to the treatment applied to them. Results: 75.0% of the patients were male who were 65 years of age or older (47.5%), came from rural areas (72.5%) and carried out agricultural activities (45.0%). Corneal trauma was the most usual risk factor (25.0%). In 47.5% the ulcer was of fungal etiology. 100% received drug treatment, especially with fortified antibiotic eye drops (25.0%). Surgical treatment was applied to 27.5%, the most common technique was the conjunctival lining (15.0%). Visual acuity improved in 75.0% of patients after treatment. Conclusions: In the General Teaching Hospital "Dr. Agostinho Neto" corneal ulcer is not a health problem, but it does determine the visual acuity of affected patients, in which the fungal etiology and the need for the use of fortified eye drops are more common.

RESUMO Introdução: As úlceras de córnea não foram caracterizadas no Hospital Geral de Ensino "Dr. Agostinho Neto "de Guantánamo. Objetivo: Caracterizar a úlcera de córnea nos pacientes atendidos no Serviço de Oftalmologia deste hospital no período de janeiro de 2014 a julho de 2019. Método: Estudo descritivo, retrospectivo e longitudinal, realizado com 40 pacientes. As variáveis estudadas foram: sexo, idade, procedência, ocupação, fatores de risco, etiologia, tratamento e complicações desse tipo de úlcera e as modificações da acuidade visual de acordo com o tratamento a elas aplicado. Resultados: 75,0% dos pacientes eram homens com 65 anos ou mais (47,5%), procedentes de áreas rurais (72,5%) e realizando atividades agrícolas (45,0%). O trauma corneano foi o fator de risco mais comum (25,0%). Em 47,5%, a úlcera era de etiologia fúngica. 100% receberam tratamento medicamentoso, especialmente com colírios antibióticos fortificados (25,0%). O tratamento cirúrgico foi aplicado em 27,5%, a técnica mais comum foi o revestimento conjuntival (15,0%). A acuidade visual melhorou em 75,0% dos pacientes após o tratamento. Conclusões: No Hospital Geral de Ensino "Dr. A úlcera de córnea de Agostinho Neto não é um problema de saúde, mas determina a acuidade visual dos pacientes afetados, nos quais a etiologia fúngica e a necessidade do uso de colírios fortificados são mais comuns.

Ophthalmic Start-Up Chief Executive Officers' Perceptions of Development Hurdles.

PURPOSE: To identify current challenges facing ophthalmic pharmaceutical start-ups in developing new products. METHODS: Surveys were distributed to the chief executive officer (CEO) or president of ophthalmic start-ups. RESULTS: The survey attracted 24 responses from 78 surveys distributed (31%). The CEOs stated that a lack of financial capital (n = 18, 75%), FDA regulations (n = 6, 25%), and failure to meet clinical endpoints (n = 6, 25%) were their greatest development hurdles. Risk aversion to medicines in early development (n = 18, 75%), mergers and acquisitions reducing corporate choice for licensing agreements (n = 7, 29%), the emergence of large pharmaceutical-based venture capital funding groups (n = 12, 50%), and the failure of many large pharmaceutical companies to develop their own medicines (n = 10, 42%) were noted as recent prominent trends affecting fundraising. CONCLUSION: The study suggests that development funding, regulatory burden, and meeting clinical endpoints are the greatest development challenges faced by ophthalmic start-up CEOs.

The effect of intravitreal injections on dry eye, and proposed management strategies.

Intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents has become a commonly used treatment method for a number of ophthalmic conditions, including age-related macular degeneration. Although anti-VEGF therapy has shown promising results for many patients, there are several aspects of its application that have not been thoroughly investigated. One of these is the development and/or escalation of concurrent dry eye syndrome. Many patients undergoing treatment are already predisposed to dry eye disease due to their age and overall ocular health. As dry eye can have a substantial impact on quality of life, it has become increasingly apparent that the clinical signs and symptoms should be closely monitored and aggressively managed. This will allow for the optimization of patient comfort and visual potential. Here, we discuss the reasons why dry eye may develop during the course of repeated ocular anti-VEGF therapy, highlighting the key concerns about current practices and proposing possible solutions to improve the outcome for the patients.