[Topical cyclosporine for the treatment of ocular surface changes in contact lens wearers].

OBJECTIVE: To assess opportunities for the use of cyclosporine emulsion 0.05% for the treatment of dry eye syndrome in long-term contact lens wearers. MATERIAL AND METHODS: A total of 25 long-term contact lens wearers (50 eyes) with signs of dry eye syndrome and corneal epitheliopathy of different degree, unresponsive to conventional artificial tears therapy, were observed. All of them were prescribed cyclosporine emulsion 0.05% twice daily at 12-hour intervals 10 min before inserting contact lenses or after removing. Biomicroscopy with fluorescein eye stain test, determination of the tear film break-up time (Norn's test), optical coherence tomography of tear meniscus (OCT-meniscometry), Jones test, impression cytology, and corneal confocal microscopy (Confoscan-4, "Nidek", Japan) were used to evaluate the treatment effect. RESULTS: The treatment resulted in better contact lens tolerance, significantly increased mean values of tear film break-up time (by 13.2% at 1 month, 62% at 3 months, and 37.3% at 6 months as compared with the baseline) and basal tear secretion (by 29%, 32%, and 82.4% at 1, 3, and 6 months correspondingly). Confocal microscopy revealed restitution of corneal superficial epithelial structure and cell density. Goblet cells were present in impression cytology specimens. CONCLUSION: Topical use of cyclosporine emulsion 0.05% has a positive effect on morphofunctional parameters of ocular surface and promotes basal tear secretion and precorneal tear film stability.

[Corneal protection in contact lens users].

PURPOSE: To evaluate the efficacy of corneoprotective agents (Corneregel and Solcoseryl) in contact lens users. MATERIAL AND METHODS: A total of 66 long-term contact lens wearers with dry eye symptoms and varying degrees of corneal epitheliopathy were monitored. All patients used artificial tears, which, however, were not effective enough to suppress manifestations of corneal epitheliopathy and to release the associated discomfort. The therapy was supplemented with Corneregel. The following examination methods were applied: biomicroscopy with fluorescent staining, Norn test, Schirmer's test, advanced tearscopy with digital image analysis of the precorneal tear film lipid layer, corneal confocal microscopy. In all cases the assessment was performed prior to starting Corneregel and repeated in 7 days, 14 days and 1 month. RESULTS: Complete corneal re-epithelization and restoration of the most superficial layer of the epithelium were achieved within 7-14 days. In case of severe initial epitheliopathy the effect of Corneregel was not sufficient and epithelium defects remained. These patients additionally received Solcoseryl Eye Gel. After the treatment course the condition of corneal epithelium ameliorated and contact lens wearing comfort increased. A longer precorneal tear film break-up time indicated an increase of tear film stability. The total tear production did not change significantly. The moistening effect of Corneregel and low-viscosity artificial tears together with intensive regeneration of corneal epithelium enables structural recovery of the epithelial membrane and considerable improvement of the anterior corneal stroma. CONCLUSION: At the first stage of corneoprotective treatment it is appropriate to use preservative-free artificial tears of low and high viscosity. If the effect of tear substitutive therapy is unsatisfactory it is recommended to prescribe Corneregel and Solcoseryl. The regimen is to be adjusted individually.