Efficacy of recombinant human epidermal growth factor plus sodium hyaluronate eye drops in diabetic dry eye post-cataract surgery

BACKGROUND Dry eye syndrome(DES)after diabetic cataract surgery can seriously affect the patient’s quality of life.Therefore,effective alleviation of symptoms in patients with this disease has important clinical significance.AIM To explore the clinical effect of recombinant human epidermal growth factor(rhEGF)plus sodium hyaluronate(SH)eye drops on DES after cataract surgery in patients with diabetes.METHODS We retrospectively evaluated 82 patients with diabetes who experienced DES after cataract surgery at Tianjin Beichen Hospital,Affiliated Hospital of Nankai University between April 2021 and April 2023.They were classified into an observation group(42 cases,rhEGF+SH eye drops)and a control group(40 cases,SH eye drops alone),depending on the different treatment schemes.The therapeutic efficacy,dry eye symptom score,tear film breakup time(TFBUT),basic tear secretion score[assessed using Schirmer I test(SIt)],corneal fluorescein staining(FL)score,tear inflammatory markers,adverse reactions during treat-ment,and treatment satisfaction were compared between the two groups.RESULTS Therapeutic efficacy was higher in the observation group compared with the control group.Both groups showed improved TFBUT and dry eye,as well as improved SIt and FL scores after treatment,with a more pronounced improvement in the observation group.Although no marked differences in adverse reactions were observed between the two groups,treatment satisfaction was higher in the observation group.CONCLUSION rhEGF+SH eye drops rendered clinical benefits to patients by effectively ameliorating dry eye and visual impairment with favorable efficacy,fewer adverse reactions,and high safety levels.Thus,this treatment should be promoted in clinical practice.

A combined treatment for patients with dry eye and associated laryngopharyngeal reflux:a real-life approach

AIM:To evaluate the efficacy and tolerability of administering a combined therapy in patients with dry eye syndrome(DES)and associated laryngopharyngeal reflux(LPR).METHODS:The study was retrospective,open,observational,and conducted in a real-life setting.Patients had pathological symptom assessment in dry eye(SANDE)and reflux symptom index(RSI)at baseline.Patients were re-assessed after 1mo and at the end of treatment.The treatment consisted of a three-month course based on the combined therapy:Gastroftal eye drops,one drop three times a day,and Gastroftal tablets,two tablets after lunch and two tablets after dinner.Tear break-up-time(TBUT)test,Schirmer test,RSI,and SANDE questionnaire were evaluated.RESULTS:The study included 253 patients.The mean age was 58±11.19y.TBUT test score and Schirmer’s test significantly increased(both P<0.001)after 1mo and at the end of treatment.The RSI score and SANDE scores significantly decreased(both P<0.001)after 1mo and at the end of treatment.CONCLUSION:The current,retrospective,and open study shows that combined therapy using Gastroftal eye drops and tablets could represent a valuable option in managing patients with DES associated with LPR.

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.

A randomized controlled trial of omega-3 fatty acids in dry eye syndrome

AIM:To evaluate the role of dietary supplementation of omega-3 fatty acids in dry eye syndrome.METHODS:A prospective,interventional,placebo controlled,double blind randomized trial was done at two referral eye centers.Two hundred and sixty-four eyes of patients with dry eye were randomized to receive one capsule(500mg)two times a day containing 325mg EPA and 175mg DHA for 3 months(omega-3 group).The omega-3 group was compared to a group of patients(n=254)who received a placebo(placebo group).There were 4 patient visits(at baseline,1 month,2 months and3 months).On each visit,recording of corrected distance visual acuity(CDVA),slit lamp examination and questionnaire based symptom evaluation and scoring was done.A symptomatic score of 0-6 was mild,6.1-12moderate and 12.1-18 severe dry eye.Response to intervention was monitored by routine tear function tests like Schirmer I test,tear film break-up time(TBUT),Rose Bengal staining and most notably,conjunctival impression cytology.RESULTS:Sixty-five percent of patients in the omega-3group and 33%of patients in placebo group had significant improvement in symptoms at 3 months(P=0.005).There was a significant change in both Schirmer’s test value and TBUT values in the omega-3group(P【0.001),both comparisons.However,there was a larger drift in TBUT values in omega-3 than the placebo group,in comparison to Schirmer’s test values.The mean TBUT score was 2.54±2.34 in the omega-3group and 0.13±0.16 in placebo group,respectively.The mean reduction in symptom score in omega-3 group was 2.02±0.96 as compared to 0.48±0.22 in placebogroup(P【0.001).Despite a slight increase mean score,the Schirmer scores did not correlate well with symptomatic improvement.CONCLUSION:Omega-3 fatty acids have a definite role for dry eye syndrome.The benefit seems to be more marked in conditions such as blepharitis and meibomian gland disease.The role of omega fatty acids in tear production and secretion needs further evaluation.

Corneal sensitivity,ocular surface health and tear film stability after punctal plug therapy of aqueous deficient dry eye

AIM： To evaluate the effect of punctal occlusion using thermosensitive（smart plug） versus silicone plug for management of aqueous deficient dry eye on cornea sensitivity, ocular surface health and tear film stability.METHODS： A comparative prospective interventiona case study included 45 patients with bilateral severe form of aqueous deficient dry eye. In each patient, the smar plug was inserted in the lower punctum of the right eye which was considered as study group 1 and silicone plug was inserted in the lower punctum of the left eye o the same patient which was considered as study group2. All patients were subjected to careful history taking and questionnaire for subjective assessment of severity of symptoms. Corneal sensitivity, corneal fluorescein rose bengal staining, Schirmer＇s I test, tear film break up time and conjunctival impression cytology were performed pre and 1, 3 and 6mo post plug insertion.RESULTS： A statistically significant improvement in subjective and objective manifestations occurred following treatment with both types of plugs（P 〈0.01）The thermosensitive plug caused significant overal improvement, decrease in frequency of application o tear substitutes and improvement of conjunctiva impression cytology parameters in the inserted side（P 〈0.01）. Canaliculitis was reported in two eyes（4.4% following punctal occlusion using thermosensitive plug（study group 1）. Spontaneous plug loss occurred in 21eyes（46.6%） in the silicone plug group（study group 2）.CONCLUSION： Improvement of subjective and objective manifestations of aqueous deficient dry eye occurs following punctal plug occlusion. Thermosensitive plug has good patient＇s compliance with fewer complications and lower rates of loss compared to the silicone plug.

Alcohol consumption and dry eye syndrome: a Metaanalysis

AIM：To quantify the association between alcohol consumption and dry eye syndrome（DES） with Meta-analysis of published case-control and cross-sectional studies. METHODS： Three databases were screened for potentially eligible studies through Nov.30,2015,Pub Med,Web of Science,and the Cochrane Library.Odds ratios（ORs） were pooled with 95% confidence intervals（CIs） to evaluate the relationship between alcohol consumption and DES risk.Subgroup analyses were performed according to diagnostic criteria,publication year,sample size,alcohol intake and adjusted factors.RESULTS： A total of 10（9 case-control and 1 crosssectional） studies from 8 articles were included in this Meta-analysis.The pooled results showed that alcohol consumption would significantly increase the risk of DES（OR 1.15,95% CI： 1.02-1.30）,and the results were independent of smoking,hypertension,diabetes and thyroid disease history.And the results of subgroup analyses indicated an increased incidence of DES diagnosed by typical DES symptoms and positive objective tests together（OR 1.18,95% CI： 1.01-1.39）among drinkers,but not by typical DES symptoms alone（OR 1.11,95% CI： 0.94-1.32）.What＇s more,any drinkers were at higher risk of suffering from DES（OR 1.33,95%CI： 1.31-1.34）,while heavy drinkers not（OR 1.01,95% CI：0.86-1.18）.CONCLUSION： The present Meta-analysis suggests that alcohol consumption may be a significant risk factor for DES.Alcohol-induced peripheral neuropathymay falsely reduce the prevalence of DES among heavy drinkers.Future prospective studies of alcohol consumption and DES risk are needed to confirm our results.

Metabolic syndrome risk factors and dry eye syndrome:a Meta-analysis

AIM：To explore the relationship between metabolic risk factors and dry eye syndrome（DES）.METHODS：Retrieved studies on the association of metabolic syndrome risk factors（hypertension,hyperglycemia,obesity,and hyperlipidemia） and DES were collected from PubMed,Web of Science,and the Cochrane Library in December 2015.Odds ratio（OR） with 95% confidence interval（Cl） were pooled to evaluate the final relationship.Subgroup analyses were conducted according to diagnostic criteria of DES.RESULTS：Nine cross-sectional studies and three case-control studies were included in this Meta-analysis.The pooled results showed that people with hypertension,hyperglycemia,and hyperlipidemia had a higher risk of suffering from DES（P〈0.05）,especially the typical DES symptoms.On the other hand,obesity did not increase the risk of DES.CONCLUSION：The present Meta-analysis suggests that all metabolic risk factors except obesity were risk factors for DES.

Preventive effect of Angelica gigas Nakai extract oral administration on dry eye syndrome

Objective:To identify the preventive effect of Angelica gigas Nakai(A.gigas Nakai)extract in a benzalkonium chloride-induced dry eye model.Methods:A total of 28 mice were divided into 4 groups:1)Normal group:mice received only saline;2)positive control group:mice received an oral solution without A.gigas Nakai extract at 10:00 a.m.and 0.2%benzalkonium chloride eye drops at 2:00 p.m.;3)A.gigas Nakai extract(5 mg);4)A.gigas Nakai extract(10 mg).Both group 3)and group 4)received an oral solution with A.gigas Nakai extract(either 5 mg/kg or 10 mg/kg)at 10:00 a.m.and 0.2%benzalkonium chloride eye drops at2:00 p.m.After 14 d of follow-up,tear volume measurement and fluorescein staining were evaluated for the recovery effects on ocular surface.Histologic analysis was conducted by hematoxylin and eosin staining.Apoptosis on ocular epithelium layer was examined using terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling staining.Expression of TNF-a was also measured using western blot analysis.Results:An increase in both the tear volume and the sustained fluorescein staining scores was observed,demonstrating the preventive effects of A.gigas Nakai extract.Structure changes such as irregularity of the epithelial layer and corneal epithelial cell death were inhibited in the A.gigas Nakai extract groups.Expression of TNF-αmoderately declined;however,its expression level was still higher,compared to the normal group.Conclusions:Results from the current study show the significant preventive effect of A.gigas Nakai extract in a mouse model of benzalkonium chloride-induced dry eye syndrome.Thus,A.gigas Nakai extract could be considered as an oral preventive agent for dry eye syndrome in the future.

Ocular surface and tear film changes after eyelid surgery

Eyelid surgery is widely and extensively used in facial plastic and reconstructive surgeries.There are many categories of eyelid surgeries,the most common of which include blepharoplasty,ptosis surgery,and eyelid reconstruction.In many cases,these procedures are combined,and there are many different techniques for each type of operation.Upper eyelid blepharoplasty usually includes the excision of skin,preseptal orbicularis oculi muscle,and orbital fat.Common methods of lower eyelid blepharoplasty are the skin-muscle flap,the skin flap,and the transconjunctival.Ptosis surgery is mainly divided into three types:transcutaneous,transconjunctival,and sling surgery.Surgeons often used the Hughes or Cutler-Beard Bridge Flaps in eyelid reconstruction.Different types and methods of surgery have their own advantages and disadvantages,and postoperative complications may occur.Therefore,postoperative complications of eyelid surgeries,such as dry eye symptoms,should be taken into serious consideration.Relevant literature involving these complaints can be found in PubMed by searching the terms“dry eye”,“eyelid”,“surgery”,and other related keywords.Moreover,various ocular surface and tear film alterations may be detected using the Ocular Surface Disease Index(OSDI),tear film breakup time,Schirmer test,fluorescein staining,and lissamine green staining after various eyelid surgeries.As dry eye disease is prevalent in the general population,it is more urgent to figure out what we can learn from these complaints.Further exploration in this field may help surgeons to choose a better surgical method and give an accurate evaluation of the postoperative effect.

Dry eye disease due to meibomian gland dysfunction treated with Pinggan Yuyin Qingre formula(平肝育阴清热方):a stratified randomized controlled trial

OBJECTIVE:To observe the clinical efficacy on improving the quality of meibum in patients suffer from dry eye disease(DED)due to meibomian gland dysfunction(MGD)with hyperactivity of Yang due to Yin deficiency pattern after being treated with Pinggan Yuyin Qingre formula(平肝育阴清热方,PGYYQR).METHODS:Totally 120 patients who met the inclusion criteria were included and stratified into three levels according to the level of MGD(1-3),and patients in each level was randomly allocated into the treatment group and control group according to a 1∶1 ratio.Both groups were treated with sodium hyaluronate eye drops,and the treatment group was also given PGYYQR granules.Both groups were treated continuously for eight weeks.The score of the properties of meibomian gland(MG)secretion,the score of the palpebral margins,the average noninvasive tear breakup time(NITBUTav),lipid layer thickness(LLT),and Traditional Chinese Medicine(TCM)syndrome efficacy were compared between the two groups after treatment.RESULTS:A total of 116 cases were included in the statistical analysis.The differences were statistically significant in the score of the properties of MG secretion,the score of the palpebral margins,and NITBUTav between the two groups after treatment,the treatment group was superior to the control group;there was no evidence of a difference in LLT.In terms of TCM syndrome efficacy,the total effective rate was 84.7%in the treatment group and 50.9%in the control group,with the statistically significant difference.None of the included cases had adverse reactions.CONCLUSIONS:PGYYQR is effective in improving the quality of meibum,and the tear film stability which thereby relieving the ocular symptoms in MGD-related DED patients with hyperactivity of Yang due to Yin deficiency pattern.

Electrical Stimulation of Auricular Acupressure for Dry Eye:A Randomized Controlled-Clinical Trial

Objective： To evaluate the clinical efficacy of electrical stimulation（ES） of auricular acupressure on reducing the ocular symptoms and signs before and after treatment for dry eye. Methods： The inclusion criteria were the tear film break-up time（TFBUT） below 5 s and a Schirmer test-Ⅰ below 5 mm in dry eyes with ocular symptoms for at least 6 months. Subjects were randomized into a treatment group（50 cases） with continuous low frequency ES under auricular acupressure at acupoints and a no ES under auricular acupressure（no-ES, control group, 50 cases） on the same acupoints. Auricular acupressure were stimulated with ES at 4 master points of both ears, which were performed twice a week for 4 weeks at each point for 30 s. The ocular symptoms, the TFBUT, and Schirmer test-Ⅰ were evaluated before and after this procedure. Results： There were significantly better scores in TFBUT（P=0.032）, the Schirmer test-Ⅰ（P=0.044） and ocular symptoms（P=0.029） at 3 months post-treatment in the treatment group than in the control group. The total effective rate in the treatment group was accomplished in 41（82%） of the 50 cases of dry eye. Conclusions： Auricular acupressure with ES at auricular acupoint improves ocular symptoms and signs of dry eye for a period of at least 3 months.

Ocular surface changes in Graves’ophthalmopathy

Many patients with Graves’ophthalmopathy(GO)suffer from dry eye syndrome(DES),and this is one of the most common reasons of eye discomfort in patients with GO.The prevalence of DES in patients with GO is significantly higher than normal subjects.The ocular surface changes involving changes in tears,cornea,conjunctiva and glands occur in GO patients.However,the mechanism of how DES occurs in GO still remains unclear.In this review,the ocular surface changes were illustrated and analyzed the reasons for high prevalence of DES in GO patients.