Clinical efficacy of 0.05%cyclosporine nano-emulsion in the treatment of dry eye syndrome associated with meibomian gland dysfunction

AIM:To evaluate the clinical efficacy of topical 0.05%cyclosporine nano-emulsion in the treatment of dry eye syndrome(DES)with meibomian gland dysfunction(MGD).METHODS:This prospective study included 64 patients with DES and MGD who were randomly assigned to three groups:Group 1(n=24,conventional cyclosporine),Group 2(n=21,nano-emulsion cyclosporine),and Group 3(n=19,control).Lid margin telangiectasia(LMT),meibomian gland secretion(MGS),conjunctival injection(CI),corneal staining(CS),tear break-up time(TBUT),Schirmer test I(STI),Ocular Surface Disease Index(OSDI),and lipid layer thickness(LLT)was evaluated at 4,8,and 12wk of treatment.RESULTS:In Group 3(control),LMT,CS,and CI improved after 8wk,MGS,TBUT after 12wk of treatment.In Group 1(conventional cyclosporine),LMT,MGS,and TBUT improved significantly after 4wk,whereas CS,CI,STI,and LLT improved significantly after 8wk,and OSDI at 12wk.In Group 2(nano-cyclosporine),LMT,MGS,CS,CI,TBUT,and OSDI significantly improved after 4wk,and STI after 8wk.Especially,LLT was significantly higher than other groups after 4wk.CONCLUSION:Cyclosporine and nano-cyclosporine shows significant improvement in DES with MGD than the control group.In contrast,the nano-cyclosporine group shows more statistically improved CI and CS at 4wk,especially LLT at 4,8,and 12wk compared to the conventional cyclosporine group.

Systematic Review on the Epidemiology and Management of the Dry Eye Disease in Sub-Saharan Francophone Africa

Introduction: Dry Eye Disease (DED) is a multifactorial affection of the tears and the ocular surface. Its prevalence in the world varies between 7% and 33%. To the best of our knowledge, the prevalence of DED in Subsaharan Francophone African countries is not yet known. The objectives of this systematic review were to determine the prevalence of DED, to identify the main risk factors for DED, and to determine the diagnostic and therapeutic management of DED in Subsaharan Francophone African countries. Methodology: This is a systematic review of articles, dealing with DED, published in English or French language from 2010 to 2020. The following key words (Prevalence OR Incidence OR Proportion OR Rate OR Frequency OR Epidemiology OR Distribution) AND (Risk Factors OR Influences) AND (Symptoms or Questionnaire) AND (Clinical Signs OR Clinical Tests) AND (Dry Eye Disease OR Dry Eye Syndrome) AND (Pharmacological Treatment OR Non-pharmacological Treatment OR Management) AND (Benin OR Burkina Faso OR Burundi OR Cameroon OR Cap-Green OR Central African Republic OR Congo OR Congo (Democratic Republic of) OR Ivory Coast OR Gabon OR Guinea OR Guinea-Bissau OR Equatorial Guinea OR Mali OR Madagascar OR Mauritius (island) OR Niger OR Rwanda OR Sao Tome and Principe OR Senegal OR Seychelles OR Chad OR Togo) in French and English were searched on Pubmed, Chocrane database, Google scholar and ICTRP. Articles in English and French were selected from 2010 to 2020. Results: We selected 05 articles on the epidemiology and management of DED in sub-Saharan francophone Africa. The prevalence of DED in sub-Saharan francophone Africa in the articles ranged from 7.5% to 90.4%. DED affects more women than men. The risk factors found were: age over 50 years, diabetes, meibomian gland dysfunction, prolonged use of computers, and glaucomatous anti-glaucoma drugs. The Test of Breack Up Time (TBUT) was commonly used for the clinical diagnosis of dry eye disease in Sub-Saharan Francophone Africa. The therapeutic strategy for DED was not mentioned in any article. Conclusion: DED, a multifactorial and blinding eye disease, is insufficiently explored by eye health professionals in sub-Saharan Francophone Africa. The implementation of a systematic screening program and strategies for the treatment of dry eye disease in at-risk individuals would be beneficial for sub-Saharan Francophone African countries.

The Long-Term Clinical Efficacy of Smart Plug in the Treatment of Aqueous Tear Deficiency Dry Eye: Results of a 5-Year Study

Background: Dry eye syndrome, which affects 10% to 20% of adults, is a disorder of the tear film and is associated with symptoms of ocular discomfort. Smart Plug is a mechanical treatment in which the tear drainage system is blocked in order to aid in the preservation of natural tears on the ocular surface. Purpose: To evaluate the long-term clinical efficacy of Smart Plug in the treatment of aqueous tear deficiency dry eye. Patients and Methods: Retrospective study. Three hundred and two patients with aqueous tear deficiency dry eye were enrolled and all the patients accepted the punctual plug of Smart plug from Jan. 2011 to Jan. 2016. The clinical symptoms, Schirmer’s I test, Fluorescein staining (FL), tear break up time (TBUT), and complications were observed and analyzed. Results: Three hundred and two patients (604 eyes) were treated with Smart Plug (22 cases accepted upper and lower punctual plug, 280 cases only lower punctual plug). There were 109 males (36.1%) and 193 females (63.9%) with a mean age of 44.54 years old (Range from 25 to 83 years). Ten cases required the upper Smart Plug after lower punctual plug insertion because of no significantly improved symptoms. Smart plug was removed in 3 patients (1%) due to tearing. Six patients had mild postoperative tearing and no special treatment was required. Lacrimal canaliculitis occurred postoperatively in 8 cases (2.6%) (6 lower and 2 upper), and the affected plug was removed and treated with topical antibiotic eye drops. The BUT, SIT and FL scores of all patients were significantly improved from (2.11 ± 1.01, 4.20 ± 1.07, 6.06 ± 1.97) to (4.34 ± 1.22, 9.01 ± 1.56, 2.33 ± 1.28) respectively after at least 36 months of follow-up (All P P Conclusion: During a mean follow-up of 4.3 years, Smart plug is an effective method for the treatment of aqueous tear deficiency dry eye in spite of its postoperative complications such as canaliculitis and tearing.

A clinical study of the efficacy of topical corticosteroids on dry eye

Objective: To evaluate the effect of topical corticosteroid for treatment of moderate or severe dry eye. Methods: Sixty eyes of 30 patients with moderate or severe dry eye, who were not sensitive to artificial tears, were treated with 0.1% fluoro- metholone eye drops. Subjective symptom and objective tests were used to evaluate the efficacy of treatment before and after application of 0.1% fluorometholone eye drops for 1 week and 1 month. Side effects were also evaluated. Results: After 1 week of treatment, subjective symptoms were improved in all dry eye patients; objective tests were improved in all dry eye patients 1 month after treatment, and the difference was significant. Conclusion: Topical corticosteroid drops can rapidly and effectively relieve the symptoms and signs of moderate or severe dry eye.

Effect of mistletoe combined with carboxymethyl cellulose on dry eye in postmenopausal women

AIM： To investigate the protective effect of mistletoe combined with carboxymethyl cellulose eye drops on dry eye in postmenopausal women.METHODS： Sixty postmenopause female patients diagnosed of dry eye were assigned randomly to mistletoe combined with carboxymethyl cellulose eye drops treatment group（n=30） and control group treated with normal saline eye drops（n=30）. The subjective symptoms of ocular surface, Ocular Surface Disease Index（OSDI）, tear film function tests, tear protein and corneal morphology by confocal scanning microscopy were analyzed before treatment and at 1, 2, 4 and 8 wk after treatment respectively. To ensure the safety of the trial, all patients were examined with systolic pressure, diastolic pressure, glutamic-pyruvic transaminase, glutamic oxaloacetic transaminase, urine creatinine, and blood urea nitrogen at 8 wk after treatment.RESULTS： There were no obvious differences between two groups before the treatment（P〉0.05）. In two months after the treatment, the symptoms of ocular surface, OSDI, tear protein, and tear film function were only slightly changed in normal saline eye drops group. However, all indices were improved after the treatment of mistletoe combined with carboxymethyl cellulose eye drops group（P〈0.05）. In addition, the average amount of corneal epithelium basal cells and inflammatory cells of mistletoe treated group were 3174±379 and 38±25 cells/mm2, significantly decreased as compared to the control group with 4309±612 and 158± 61 cells/mm2, respectively. In the control group, althoughnerves still maintained straight under corneal epithelium, the number of nerves were significantly decreased, as compared with normal female. In the mistletoe treated group, the number of nerves was only slightly reduced, compared with normal female.CONCLUSION： Mistletoe combined with carboxymethyl cellulose eye drops can alleviate the symptoms and signs of dry eye symptoms.

Clinical efficacy of 0.1% pranoprofen in treatment of dry eye patients：a multicenter, randomized, controlled clinical trial

Background Dry eye is a multifactorial disease of the tears and the ocular surface.This study aimed to investigate the clinical efficacy of a non-steroidal anti-inflammatory drug,pranoprofen,in the treatment of dry eye.Methods It is a prospective,multi-center,randomized,controlled,parallel group study.One hundred and fifteen patients with mild to moderate dry eye disease （55-60 in each treatment group） participated in this multi-center study.Patients were randomly administered with eyedrops containing 0.1％ pranoprofen （PRA） plus 0.1％ sodium hyaluronate （SH） or SH only,three times daily for 28 days,followed by a 1-week after treatment observation.Dry eye symptom score （DESS）,fluorescein corneal staining （FLCS）,tear break-up time （TBUT）,and Shirmer 1 tear test （ST1,without anesthesia） were evaluated or conducted before treatment and at each study visit.Conjunctival impression cytology was taken from the patients treated with PRA plus SH before and after treatment and real-time polymerase chain reaction （RT-PCR） was performed to detect the changes of human leukocyte antigen DR （HLA-DR） and intercellular adhesion molecule 1 （ICAM-1）.Results Patients treated with PRA plus SH showed gradual improvements of DESS,FLCS,and TBUT.Between-group comparisons of FLCS and TBUT have statistically significant differences from day 14.Good tolerance with no severe adverse events was found in both groups.Patients treated with PRA plus SH had a reduced expression level of HLA-DR and were statistically different after 28 days of therapy.Conclusions The application of PRA at a dose of 0.1％ was well tolerated and benefited to the patients with mild to moderate dry eye disease.The underlying mechanism of its efficacy may be associated with the reduction of inflammatory factors of conjunctival epithelial cells.

不同施肥处理芳樟N、P、K元素的DRIS营养诊断

以芳樟1年生苗为对象,用N、P、K三元二次正交旋转组合设计试验,对芳樟不同器官的N、P、K元素含量进行测定,计算相应系数并用诊断施肥综合法（DRIS）、图解法和指数法对N、P、K需求关系进行分析。通过DRIS图解法得出：N、P、K三元素最佳比值范围P/N=0.141 4~0.094 8、K/N=0.174 4~0.153 0、P/K=0.836 7~0.597 9,在所有处理中处理19、20的养分处于平衡状态;通过DRIS指数法得出,处理15~20的各营养指数与0最为接近,表明这6个处理的养分比较平衡,与图解法的结果一致。图解法与指数法均说明芳樟对N的需求量相对较大,对P的需求次之,对K的需求相对较弱。