Role of artificial tears with and without hyaluronic acid in controlling ocular discomfort following PRK: a randomized clinical trial

AIM:To compare outcomes of applying preservative free artificial tears(PFAT)with and without hyaluronic acid(HA)in early postoperative course following photorefractive keratectomy(PRK).METHODS:In this triple-blinded randomized clinical trial,PRK procedure was performed on both eyes of 230 patients.Following PRK,patients were divided into three groups:the HA^(+)group,44 patients PFAT containing HA;the HA-group,71 patients PFAT without HA were administered 5 times per day(every 4 h);the third group,115 patients received no PFAT before lens removal.On the 1st and 4th postoperative day,Visual Analogue Score(VAS)was utilized to evaluate patient’s level of pain.Participants were asked to complete a questionnaire about the severity of eye discomfort ranked from 0 to 10(0=no complaint;10=most severe complaint experienced).RESULTS:In eyes receiving PFAT with or without HA(Drop group),mean scores for epiphora,foreign body sensation,and blurred vision on the 1st postoperative day were statistically lower(P<0.05).Filamentous keratitis(FK)was detected in 11(4.7%)eyes,and recurrent corneal erosion(RCE)was observed in 5(2.1%)eyes.In the control group,FK was noted in 16(6.9%)eyes while 13(5.6%)eyes had RCE and 5(2.1%)eyes had corneal haze.The rate of complications was statistically lower in Drop group(P=0.009).However,the aforementioned scores were not statically different between HA^(+)and HA-group one and two(P=0.29).CONCLUSION:Following PRK,applying PFAT with and without HA yields faster visual recovery,decreases postoperative ocular discomfor t and haze formation;however there is no additive effect for HA.

Evaluation of artificial tears on cornea epithelium healing

AIM： To observe the efficacy of different artificial eye drops on corneal epithelium healing in rabbit. METHODS： Thirty-five rabbits with 6 mm diameter central corneal epithelium removed were randomly assigned to six groups： 0.9% normal saline（NS） group, 0.1% hyaluronate（HA） group, 0.3% HA group, Tears Naturale Free？（TNF） group, 0.4% polyethylene glycol（PEG） group, 0.5% carboxymethyl cellulose（CMC） group and blank control group. Treatments were administered topically four times daily. Corneal epithelium healing was evaluated by the percentage reduction in wound area at 24, 36, 48, 60, and 72 h after removal of the corneal epithelium. Cornea re-epithelialization was also assessed by histological analysis and electron microscopy. RESULTS： All corneal wounds completely re-epithelialized in less than 72 h. The average re-epithelialization time was 47.61±4.25 h in the 0.3% HA group and 49.72±1.05 h in the 0.9% NS group, followed by 0.1% HA, TNF, 0.4% PEG, 0.5% CMC, and lastly by the control group. Compared to the control group, there were significant differences among 0.3% HA, 0.9% NS, PEG, and TNF（P〈0.05） groups. At the first 24 h, re-epithelialization at the 0.3% HA, TNF, and 0.9% NS treatment groups were significantly faster than the other groups. At 48 h post-wounding, corneal epithelium is nearly completing re-epithelialization at 0.3% HA and 0.9% NS treatment groups. Electron microscopy revealed that there were a large number of vacuoles in the cells of the 0.9% NS group at 72 h. CONCLUSION： Artificial tears promote corneal reepithelium varied in the efficacy. Obviously, all artificial eye drops better than blank group. In the process of corneal healing, corneal epithelium cells suffered from hypoxia caused by NS.

Impact of 0.1% sodium hyaluronate and 0.2% sodium hyaluronate artificial tears on postoperative discomfort following cataract extraction surgery: a comparative study

Background:Recent artificial tear preparations have provided 0.2%concentration of sodium hyaluronate.However,no published data exist on their potential superiority against 0.1%in alleviating dry-eye-disease symptoms in cataract extraction surgery.Methods:A total of 180 patients that underwent cataract extraction surgery were randomly divided into 2 groups according to their postoperative regime:Study group(SG)received fixed combination of tobramycin and dexamethasone(FCTD)quid for 3 weeks,and additionally 0.2%sodium hyaluronate provided in the COMOD®device quid for 6 weeks.Control group(CG)received fixed combination of tobramycin and dexamethasone(FCTD)quid for 3 weeks,and additionally 0.1%sodium hyaluronate provided in the COMOD®device quid for 6 weeks.The following indexes were evaluated at 3 postoperative checkpoints:(1)Surface discomfort index(SDI)which was derived by four direct 10-scale Likert-type questions that were addressed to the patient and pertained to:(a)foreign body sensation(FBS),(b)blinking discomfort(BD),(c)stinging sensation(SS),(d)tearing sensation(TS),(2)Tear breakup time(TBUT),(3)Schirmer’s test,(4)Central corneal thickness(CCT),and (4)Central Corneal Sensitivity(CCS).Results:Both groups showed reduced CCS values at all postoperative examination points;however,SG participants had significantly better CCS(all p<0.05).SG had better TBUT than CG at the 3rd(p=0.03)and 6th examination points(p=0.04).Moreover,SG had better SDI scores at the 3rd(SDI=9.26±0.55)and 6th weeks(SDI=9.47±0.48)vs.CG participants(p=0.03 and p<0.01,respectively).Conclusion:The increased 0.2%sodium hyaluronate concentration in the artificial tears provided in the COMOD®device seems to address dry-eye-disease symptoms better in patients who underwent phacoemulsification surgery than the 0.1%concentration.Trial registration:ClinicalTrials.gov Identifier:NCT03705949 Oct 15,2018,retrospectively registered.

Analyze interleukin-1β,interleukin-6,and tumor necrosis factor-αlevels in dry eye and the therapeutic effect of cyclosporine A

BACKGROUND Dry eye is a common eye disease.Artificial tears supplements are widely used for the treatment of dry eyes.However,multiple adverse effects have been observed in patients receiving long-term treatment with artificial tears,which may affect the therapeutic effect.AIM To analyze the characteristics of interleukin-1β(IL-1β),interleukin-6(IL-6),and tumor necrosis factor-alpha(TNF-α)levels in patients with dry eye and the therapeutic effect of artificial tears combined with cyclosporine A.METHODS A total of 124 dry eye patients treated at The First People’s Hospital of Xining from April 2020 to April 2022 were selected as the observation group,while 20 healthy individuals served as the control group during the same period.Levels of inflammatory markers,including IL-1β,IL-6,and TNF-α,were analyzed.The observation group was further divided into a study group and a control group,each consisting of 62 patients.The control group received artificial tears,whereas the study group received a combination of artificial tears and cyclosporine A.Inflammatory markers,Schirmer’s test(SIT),tear break-up time(TBUT),corneal fluorescein staining(CFS),National Eye Institute Visual Function Questionnaire-25(NEI-VFQ-25)scores,and adverse events(AEs)were compared between the two groups.RESULTS The observation group exhibited significantly elevated serum levels of IL-1β,IL-6,and TNF-αin comparison to the healthy group.Following treatment,the study group demonstrated substantial reductions in IL-1β,IL-6,and TNF-αlevels relative to the control group.Moreover,after treatment,the study group experienced a marked decrease in CFS scores and significant increases in both SIT and BUT levels when compared to the control group.Additionally,significant improvements were observed in the primary symptom of dry eye and secondary symptoms such as photophobia,foreign body sensation,fatigue,red eye,and burning sensation within the study group.Furthermore,post-treatment NEI-VFQ-25 scores across all dimensions exhibited significant enhancements in the study group compared to the control group(P<0.05).It is noteworthy that significant AEs were reported in both groups throughout the treatment period.CONCLUSION Cyclosporine A combined with artificial tears is effective in treating dry eye,yielding enhanced outcomes by improving SIT and TBUT levels,reducing CFS scores,and ameliorating vision-related quality of life.

Medical treatment of inflammatory punctual stenosis monitored by anterior segment optical coherence tomography

AIM:To evaluate the role of medical treatment in the management of inflammatory punctum stenosis guided by spectral domain anterior segment optical coherence tomography(OCT).METHODS:This prospective study included 60 patients complaining of epiphora due to inflammatory punctual stenosis.They were divided into two groups:Group A(30 patients)treated with a combination of preservative free hydrocortisone sodium phosphate 3.35 mg/m L eye drops,and preservative free artificial tears based on sodium hyaluronate,polyethylene and propylene Glycol;Group B(30 patients)treated with the same preservative free artificial tears only.Thirty normal subjects were included for comparison of pre-treatment anatomical parameters.Before starting treatment,all patients underwent anterior segment assessment including slit lamp examination,measurement of intraocular pressure(IOP),fluorescein dye disappearance test,and measurement of the outer punctum diameter(OPD)by Spectral domain anterior segment OCT.All assessments were repeated at each follow up done at 1 and 3 mo later,together with subjective evaluation of patient’s satisfaction of the treatment outcome by simple rating questionnaire.RESULTS:Punctual diameter increased significantly with treatment in both groups(P<0.0001);although the widening was more in Group A as compared to group B(16.2%vs 8%of the original punctual size,mean difference of 28.933μm,P=0.0076).Subjective satisfaction with treatment outcome was also better in group A(70%vs 40%,Chi-square P=0.0397).CONCLUSION:A combination of preservative free steroid eye drops and artificial tears causes significant widening of inflammed stenotic punctae and improvement of the associated epiphora.

Randomized controlled trial on the efficacy and safety of autologous serum eye drops in dry eye syndrome

BACKGROUND Autologous serum eye drops(ASEDs),a novel treatment derived from blood serum,have emerged as a groundbreaking solution for managing dry eye syndrome(DES).These drops have shown significant promise in relieving the distressing symptoms of DES.This study aimed to evaluate the safety and effectiveness of ASEDs compared to traditional treatments,which often prove inadequate or result in unwanted side effects,particularly in individuals with moderate-to-severe DES.AIM To evaluate whether ASEDs are safer and more effective than conventional artificial tears in the treatment of moderate-to-severe DES.METHODS This multi-centered randomized controlled trial included 240 patients with moderate-to-severe DES from three ophthalmology clinics in China.They were randomly assigned to receive either ASEDs or artificial tears for 12 wk.The primary outcome was the change in the ocular surface disease index(OSDI)score,with secondary outcomes including tear break-up time(TBUT),Schirmer I test,corneal fluorescein staining(CFS),and conjunctival impression cytology(CIC).Statistics analysis was performed using an analysis of covariance with adjustments made for baseline values.RESULTS Our findings revealed that both ASEDs and artificial tears significantly improved the OSDI score,TBUT,Schirmer I test,CFS,and CIC from baseline to week 12.The ASEDs group showed significantly greater improvement in all these measures than the artificial tears group(all P values<0.05).The average difference in the OSDI score between the two cohorts was-10.3(95%confidence interval:-13.6 to-7.0),indicating a substantial improvement in the ASEDs group.The occurrence of adverse events was comparable between cohorts,with no reports of severe adverse events.CONCLUSION ASEDs are more effective and safer than artificial tears for mitigating symptoms of moderate-to-severe DES.ASEDs could be an alternative/supplementary therapy for patients with DES less responsive to traditional treatments.

Impact of polyethylene glycol 400/propylene glycol/hydroxypropyl-guar and 0.1%sodium hyaluronate on postoperative discomfort following cataract extraction surgery:a comparative study

Background:Universal postoperative guidelines for cataract extraction surgery are yet to be introduced.Artificial tears are gaining popularity as an additional integral component of the postoperative regime.The primary objective of this study was to explore the impact of two prevalent artificial tear preparations on postoperative discomfort following cataract extraction surgery.Methods:A total of 180 patients that underwent cataract extraction surgery were randomly divided into three groups according to their postoperative regime:a)Study group 1(SG1)received a fixed combination of tobramycin and dexamethasone(FCTD)quid for 3 weeks and,additionally polyethylene glycol 400/propylene glycol/hydroxypropyl-guar quid,for 6 weeks,b)Study group 2(SG2)received FCTD quid for 3 weeks and,additionally 0.1%sodium hyaluronate provided in the COMOD^(®)device quid,for 6 weeks,and,c)Control Group(CG)received only FCTD quid for 3 weeks.The following indexes were evaluated at three postoperative checkpoints:1)Subjective discomfort index(SDI)derived from four direct 10-scale Likert-type questions that were addressed to the patient and pertained to:a)foreign body sensation(FBS),b)blinking discomfort(BD),c)stinging sensation(SS),d)tearing sensation(TS),2)Tear break-up time(TBUT),3)Central corneal thickness(CCT)and,4)Central Corneal Sensitivity(CCS).Results:Both groups showed increased CCT values at the first examination point and reduced CCS values at all examination points.Furthermore,both SGs had better TBUT times at all examination points compared to CG(CG:8.86±1.08,SG1:9.59±1.45,CG2:9.45±1.33,p<0.05).BD was significantly better in both SGs only at the 1^(st) week of examination,while SDI values were better until the 3^(rd) week and only borderline better at 6^(th) week.Lastly,no significant differences were detected between SGs,regarding all parameters,at all examination points.Conclusion:Polyethylene glycol 400/propylene glycol/hydroxypropyl-guar and 0.1%sodium hyaluronate provided in the COMOD^(®)device seem to be equally efficient in alleviating OSD symptoms following cataract extraction surgery and any of them should be routinely added to the postoperative regime.

Effects of auricular point sticking on dry eye in myopia patients after SMILE surgery:a prospective randomized controlled clinical trial

Objective:To observe the intervention effect of auricular point sticking on dry eye in myopia patients after small-incision lenticule extraction(SMILE)surgery.Methods:This was a prospective randomized controlled study conducted among the myopia patients who received SMILE surgery at Eye and ENT Hospital of Fudan University.The post-SMILE operation patients who screened by the inclusion and exclusion criteria were randomized into a control group and a treatment group.Patients in the control group were given 0.1%fluorometholone and 0.5%carboxymethylcellulose sodium eye drops,while the treatment group was given additional unilateral auricular point sticking for 1 month.The patients were estimated using ocular surface disease index(OSDI),Schirmer tear test-1(STT-1),tear film break-up time(TF-BUT),corneal fluorescein staining(CFS)score,corneal sensitivity(CS)and visual quality(VQ)at 1 d,1 week and 1 month after surgery;the changes in anxiety and depression were also observed in the patients.Results:Compared with the first day after operation,CS in the nasal region was improved in the treatment group,and the VQ score increased in the control group patients at 1 week after operation(both P<0.05);at 1 month after operation,the TF-BUT increased,CFS score decreased,CS in the central and nasal regions increased(all P<0.05),and VQ score increased(P<0.01)in the treatment group,and the CS in the central,upper,lower and nasal regions were improved(all P<0.05),and VQ score increased(P<0.01)in the control group.The between-group comparison showed that the differences in the change of TF-BUT were statistically significant at 1 week and 1 month after surgery,respectively(both P<0.05).Conclusion:Auricular point sticking therapy can increase the TF-BUT and accelerate the repair of ocular surface function in post-SMILE patients.