Expert opinion in the management of aqueous Deficient Dry Eye Disease (DED).

BACKGROUND: Dry eye disease (DED) affects millions of people worldwide. There are a variety of new treatments beyond traditional therapies such as preservative free artificial tears. Here, we conduct a survey to identify the most common treatments used among specialists and assess their interest in newer therapies. METHODS: An international survey was distributed to dry eye researchers and expert practitioners via an internet survey. The survey data collected were analyzed with descriptive statistics. RESULTS: One hundred and fifteen respondents completed the survey; of these, 66 % were cornea specialists. The most commonly prescribed topical treatments included cyclosporine A (CSA) 0.05 % (71/104, 68 %), fluorometholone (FML) 0.1 % (59/99, 60 %), loteprednol etabonate 0.5 % (50/99, 51 %), and autologous serum eye drops (ASD; 48/97, 49 %). The most commonly prescribed non-topical medications included essential fatty acid supplements (72/104, 69 %), low-dose doxycycline (oral; 61/100, 61 %), and flaxseed supplements (32/96, 33 %) as well as punctal plugs (76/102, 75 %). Respondents reported treatment with topical corticosteroids for 2 to 8 weeks (46/86, 53 %), followed by less than 2 weeks (24/86, 28 %) and with topical CSA between 2 to 8 weeks (45/85, 53 %) followed by 2 to 6 months (24/85, 28 %). The top three signs and symptoms reported to indicate treatment response were, in order, fluorescein staining of the cornea, reduction in foreign body sensation, and reduction in burning sensation. CONCLUSION: This survey offers insight into current expert opinion in the treatment of DED. The results of this survey are hypothesis generating and will aid in the design of future clinical studies.

Inhibition effect of tetrandrine on haze formation after Epi-LASIK surgery in rabbits.

PURPOSE: To observe the inhibitory effect of tetrandrine on haze formation after Epi-LASIK surgery in rabbits. MATERIALS AND METHODS: Twenty-seven healthy New Zealand rabbits were selected and underwent Epi-LASIK surgery. According to a self comparison principle, these rabbits were randomly divided into three groups. The first group was treated with tetrandrine eye drops (Tet), the second (negative control, NC) group was treated with pure solvent, and the third group was treated with fluorometholone (FML) solvent. Haze grades of each group were respectively observed by slit lamp exam at half-month, one month, and two months after surgery. After corneal tissues were extracted, optical microscopy, Sirius Red staining, immunohistochemistry, and semi-quantitative RT-PCR tests were conducted, in order to test collagen formation of operated eyes after surgery and expression of transformation growth factor beta 2 (TGF-ß(2)) in corneal stroma. RESULTS: At a half month and one month after surgery, haze grades and type III collagen expression in Tet and FML groups were significantly lower than that in NC groups (P < 0.01). No statistical difference was observed between Tet and FML groups. Immunohistochemistry showed that, at each time point after surgery, expressions of TGF-ß(2) protein in Tet and FML groups were significantly lower than that in the NC group (P < 0.01), whereas there was no statistical difference between Tet and FML groups. The expression level of TGF-ß(2) protein increased, reaching its peak one month after surgery. RT-PCR also showed that, at each point after surgery, the TGF-ß(2) mRNA expression in Tet and FML groups was lower than that in the NC group (P < 0.01), nevertheless no statistical difference was observed between Tet and FML groups. CONCLUSIONS: Like FML, Tet could inhibit haze formation in rabbits after Epi-LASIK surgery, possible through TGF-ß(2)-collagen-III pathway.

[Fluorometholon/tetryzoline in the treatment of conjunctival irritation]. / Fluorometholon/Tetryzolin zur Behandlung konjunktivaler Reizzustände.

The clinical efficacy of Efemoline eyedrops [fluourometholone (0.1%) + tetryzoline (0.25%)] and of fluorometholone 0.1% was investigated in a double-blind controlled clinical trial in 35 patients (63 eyes) in treatment of the upper bulbus area and postoperatively after surgery for cataract, glaucoma and strabismus. Both drugs were effective inflammation inhibitors. The superiority of fluorometholone + tetryzoline over fluorometholone was evident: subjective symptoms improved much more quickly. No tendency toward elevation of intraocular pressure was found. The combined preparation was compatible and produced no side-effects.

Clinical studies with a new steroid--fluorometholone.

Thirty-four cases of uveitis, 26 anterior and 8 posterior, showed elevated intraocular pressure in 25 cases during treatment with local steroids as well as systemic steroids. The patients were treated with drugs to reduce the IOP, but this was not accomplished until the local steroids were stopped. Then a good anti-inflammatory response was obtained with fluorometholone, without further increase of the IOP during the whole treatment. Two cases of episcleritis and one case of allergic conjunctivitis that responded very well to local steroids but showed an increase of the intraocular pressure were treated with fluorometholone. The same anti-inflammatory response was obtained without any increase of the IOP. In our small series, a new steroid has been reviewed. No double-blind studies were done, and the series was not well controlled. But this preliminary result shows that fluorometholone can control inflammation in cases of uveitis, episcleritis, and allergic conjunctivitis as well as other steroids, but without increase of the IOP.