Tuesday, August 19, 2008

Abstract: SuperFlexPlug

Evaluation of Eagle Vision's SuperFlexPlug. Stays in longer, but leaves the punctum a bit larger when it comes out.

[Clinical investigation of the extrusion rate and other complications of the new Super Flex Plug punctal plug and other plugs]
[Article in Japanese]
Nippon Ganka Gakkai Zasshi. 2008 Jul;112(7):601-6.
Nasu N, Yokoi N, Nishii M, Komuro A, Inagaki K, Kinoshita S.

PURPOSE: Currently, there are only three punctum plugs available for use in Japan [EaglePlug (EP), Eagle Flex Plug (FP), and Punctal Plug (PP)]. This study investigated the effectiveness of the newly marketed Super Flex Plug (SFP).

SUBJECTS AND METHODS: This study involved 291 eyes of 224 severe dry eye patients treated at the dry eye clinic of Kyoto Prefectural University of Medicine, Kyoto, Japan. For the SFP, EP, FP, and PP, this study compared the extrusion rate of each plug and other complications, including enlargement of the size of the punctum after extrusion, granulation, and the accumulation of soft whitish material around the plugs.

RESULTS: During the evaluation periods, the elapsed times until extrusion were significantly longer for SFP than for EP and FP(p<0.001). In all cases, there was a significant enlargement of the size of the punctum (mm) after extrusion of the SFP [0.74 +/- 0.13 (mean +/- SD)] as compared to that before insertion [0.62 +/- 0.14 (p < 0.0001)]. Granulation formed in 1.7% of the SFP cases, but the frequency was lower than that in PP cases (19%). No soft whitish material around the plug was seen in SFP-inserted eyes.

CONCLUSION: The SFP was harder to extrude, and was found to cause granulation. After extrusion of the SFP, the punctum was likely to be enlarged.

Abstract: Dry eye and glaucoma

GLAUCOMA PATIENTS AND DOCS, here's yet another one to put you on your guard about what kind of meds you're using! Every additional drop of a drug containing the preservative BAK doubles the risk of dry eye according to this study.

Prevalence of ocular surface disease in glaucoma patients.J Glaucoma. 2008 Aug;17(5):350-5.
Leung EW, Medeiros FA, Weinreb RN.

PURPOSE: To examine the prevalence of ocular surface disease (OSD) in glaucoma patients.

METHODS: This was a cross-sectional study. One hundred and one patients, 18 years of age or older, with open-angle glaucoma or ocular hypertension were consecutively recruited for the study. Patients with a history of use of cyclosporine, steroids, topical ocular nonsteroidal anti-inflammatory drugs, or punctal plugs within the last 3 months were excluded. Each patient completed an Ocular Surface Disease Index questionnaire and underwent evaluation by Schirmer test, corneal and conjunctival lissamine green staining, and tear break-up time.

RESULTS: Using Ocular Surface Disease Index for measuring symptoms of dry eye, 60 (59%) patients reported symptoms in at least 1 eye. Severe symptoms were reported by 27 (27%) patients. Schirmer testing showed 62 (61%) patients with decrease in tear production in at least 1 eye. Severe tear deficiency was presented in 35 (35%) patients. Corneal and conjunctival lissamine green staining showed positive results in 22 (22%) patients. None had severe staining. Tear break-up time showed abnormal tear quality in 79 (78%) patients and severe decrease in tear quality was found in at least 1 eye in 66 (65%) patients. Multivariate logistic regression models were used to investigate the association between the number of benzalkonium chloride (BAK)-containing eyedrops and results on the clinical tests of OSD. After adjustment for age and sex, each additional BAK-containing eyedrop was associated with an approximately 2 times higher odds of showing abnormal results on the lissamine green staining test (odds ratio=2.03; 95% confidence interval: 1.06 to 3.89; P=0.034).

CONCLUSION: A large proportion of patients with open-angle glaucoma or ocular hypertension had signs and/or symptoms of OSD in at least 1 eye. The coexistence of OSD and the use of BAK-containing medications may impact vision-related quality of life in this patient population.