Wednesday, June 20, 2012

Abstract: Autologous serum drops versus artificial tears

Autologous serum drops are being used more and more. There have been a great many more sophisticated studies of what it does - this is just a simple one showing how serum drops relieve symptoms better than artificial tears.

To determine symptoms improvement in dry eye patients with short-term autologous serum (AS) eyedrops treatment using the standardized Ocular Surface Disease Index (OSDI) survey.
Materials and methods:
A double-blind randomized crossover clinical trial was conducted, comparing short-term (2 weeks) topical treatment with AS eyedrops diluted at 20% versus conventional artificial tears treatment in adult severe dry eye syndrome (DES) patients. The main outcome measure was assessment of symptoms with OSDI survey. Secondary outcomes were corneal and conjunctival fluorescein staining score of OXFORD and tear break up time (TBUT). The protocol was registered in, ID number: NCT00779987.
Twelve severe DES patients were included. Autologous serum treatment showed a statistically significant (p = 0.002) higher OSDI decrease (50%) versus conventional treatment (22%). There were no significant changes in objectives parameters (OXFORD and TBUT).
Severe DES patients treated with AS achieve better symptoms improvement compared to artificial tears in a short-term treatment.

Curr Eye Res. 2012 Jun 6. [Epub ahead of print]
Department of Ophthalmology, University of Chile Clinic Hospital , Santiago , Chile.

Abstract: InflammaDry in detecting MMP-9

PURPOSE:To evaluate the importance and practicality of testing for matrix metalloproteinase 9 (MMP-9) in dry eye and ocular surface disease. This enzyme, which can cause tissue damage, seems also to be the most reliable diagnostic indicator of ocular surface disease.
METHODS:Enzyme-linked immunosorbent assay, polymerase chain reaction, diffusion, and InflammaDry, a new rapid immunoassay by RPS (Rapid Pathogen Screening Inc).
RESULTS:MMP-9 measurement is sensitive and accurate for diagnosing dry eye and ocular surface disease and compares favorably in both sensitivity and specificity against the existing methods of dry eye diagnosis. Abnormal elevations of MMP-9 may predict post-laser in situ keratomileusis complications and refractive complications such as epithelial ingrowth and corneal ulceration. The presence of elevated MMP-9 on the ocular surface will identify those patients who should receive antiinflammatory therapy, such as cyclosporine, and may predict those patients who will respond to this therapy.
CONCLUSIONS:A rapid in-office test that is sensitive for identifying inflammatory dry eye and ocular surface disease may facilitate better preoperative management of the ocular surface. Optimization of the ocular surface perioperatively would be expected to reduce complications from laser in situ keratomileusis and other surgeries that often make the underlying disease worse. This test may also indicate the need for antiinflammatory therapies, such as cyclosporine or steroids, and also may predict those patients who are more likely to respond.

Cornea. 2012 Jun 5. [Epub ahead of print]
Louisiana State University Medical School, Department of Ophthalmology, Louisiana State University Eye Center, New Orleans, LA.

Abstract: Azasite and Doxy - comparing what they do (or don't) for MGs

PURPOSE:Meibomian gland dysfunction (MGD) is a common clinical problem that is often associated with evaporative dry eye disease. Alterations of the lipids of the meibomian glands have been identified in several studies of MGD. This prospective, observational, open-label clinical trial documents the improvement in both clinical signs and symptoms of disease as well as spectroscopic characteristics of the meibomian gland lipids after therapy with topical azithromycin ophthalmic solution and oral doxycycline treatment.
METHODS:Subjects with symptomatic MGD were recruited. Signs of MGD were evaluated with a slit lamp. Symptoms of MGD were measured by the response of subjects to a questionnaire. Meibum lipid-lipid interaction strength, conformation, and phase transition parameters, and meibum protein content were measured using Fourier transform infrared spectroscopy and principal component analysis. Terpenoids, short-chain CH3 moieties, lipid oxidation, wax, cholesterylesters and glycerides were measured with a proton nuclear magnetic resonance (H-NMR) spectrometer.
RESULTS:Topical therapy with azithromycin and oral therapy with doxycycline relieved signs and symptoms and restored the lipid properties of the meibomian gland secretion toward normal. Compared with 4 weeks of azithromycin treatment reported in our previous study, oral doxycycline treatment was slightly less effective in improving foreign body sensation and the signs of plugging and secretion. In subjects with clinical evidence of MGD, changes in ordering of the lipids and phase transition temperature were brought closer to normal with azithromycin treatment than doxycycline treatment. Treatment with doxycycline but not azithromycin restored the Fourier transform infrared spectroscopy-principal component analysis scores and relative area of the H-NMR resonance at 1.26 ppm. Both doxycycline and azithromycin treatment restored the levels of the relative areas of the H-NMR resonance at 5.2 and 7.9 ppm to normal levels. The levels of meibum protein and meibum lipid oxidation were not influenced by azithromycin or doxycycline treatment.
CONCLUSIONS:The mechanism of action of doxycycline may be different from that of azithromycin in therapy of MGD. It is notable that when carotenoids in meibum are low, as in MGD, the tear film is unstable and patients have the signs and symptoms of dry eyes. When carotenoids are restored with azithromycin and doxycycline treatment, tear film stability is restored and patients no longer have the signs and symptoms of dry eyes.
Cornea. 2012 Jun 4. [Epub ahead of print]
*Department of Surgery, Robley Rex Veterans Affairs Medical Center, Louisville, KY †Department of Ophthalmology and Vision Science ‡Department of Chemistry §Department of Physiology, University of Louisville, Louisville, KY.

Abstract: Anti-inflammatory effects of ALA on epithelial cells

Systemic polyunsaturated fatty acids (PUFAs) were shown to improve the symptoms of dry eye syndrome due to their anti-inflammatory effects. This study evaluated the in-vitro anti-inflammatory effects of PUFAs on human corneal epithelial (HCE) cells.
HCE cells were incubated for 2 hours with different concentrations of PUFAs: Alpha-linolenic acid (ALA), Gamma-linolenic acid (GLA) and Linolenic acid (LA). Oleic acid (OA) and dexamethasone (DM) served as negative and positive controls, respectively. Cells were stimulated with either polyinosinic:polycytidylic acid (poly I:C) or lipopolysaccharide (LPS) complex. The protein contents and mRNA expression levels of Interleukin (IL)-6, IL-8, IL-1β, and Tumor necrosis factor-α (TNF-α) were evaluated with multiplex fluorescent bead immunoassay and real time-PCR, respectively. The expression of inhibitory factor-κBα (I-κBα) was evaluated with real time-PCR.
The protein and mRNA levels of IL-6, IL-8, IL-1β and TNF-α were significantly increased after stimulation with LPS or poly I:C. Following treatment with ALA, a significant decrease was demonstrated in the protein content of TNF-α to 23.81% (P<0.001), IL-6 to 46.71% (P<0.001), IL-1β to 20.86% (P<0.05) and IL-8 to 52.21% (P<0.001). Similar results were demonstrated at the mRNA level. The anti-inflammatory effects of ALA were similar to those of DM for all of the pro-inflammatory cytokines. The ALA inhibition of the pro-inflammatory cytokines was associated with a significant reduction of I-κBα.
ALA may serve as a potent anti-inflammatory agent in ocular surface inflammation. The anti-inflammatory effects of ALA are comparable to those of corticosteroids, and are mediated through NF-κB signal transduction.

Invest Ophthalmol Vis Sci. 2012 Jun 5. [Epub ahead of print]
Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.