Wednesday, July 18, 2012

Lipiflow in Australia

After years of hearing nothing but misery from dry eye patients down under who cannot locate any even remotely well equipped dry eye treatment, we're starting to see many more signs of hope that things are improving. One I was reminded of this week is Malcolm McKellar (see his comments on this blog post about use of allogeneic serum in NZ) and now a friend sent me a link to a dr's blog in Sydney where they're starting to use Lipiflow and in the process, it seems, are discovering a whole new world - what dry eye looks like for the severe and desperate cases:

On Tuesday this week we installed the first meibomian gland dysfunction treatment device called LipiFlow.  What was amazing was the first three patients that had booked in, had found us off the internet.  They all had been desperately seeking a solution to their constant discomfort.
Uh huh.

One patient was from New Zealand, one from Melbourne and one from Sydney.  This certainly surprised us - why would people travel so far to have an innovative procedure done, so early in the release of this new procedure?
Nothing surprising about it to you and me, for sure (sigh). 
Obviously because they perceived that their symptoms warranted more help.
To be suitable for the LipiFlow procedure involves a significant process....

Now we wait.  Most people that have been interviewed from overseas seems to suggest that significant improvement in symptoms occur after a week or two.  This is also a little confusing.  If the problem is immediately fixed and this can be seen immediately after the procedure is done. The meibomian glands definitely start to secrete more meibomian oil.  Then why does it take a few weeks to perceive less irritation?

We assume that the corneal surface as well as the eyelids are still inflamed and tender.  With the extra oil bathing the eyes, they are no longer being irritated hence will take time to settle down from their extra sensitive state.  Whether this is true is purely hypothetical at this stage....
As we start to see more and more people seeking LipiFlow treatment for their dry eyes we will keep you up to date on what are the obvious and not so obvious trends.  What is for sure is that this is a fascinating topic, especially now that we finally have a treatment for what has been a most frustrating problem for patient and practitioner alike.

Monday, July 16, 2012

Abstract: Autologous platelet-rich plasma

This study is specific to its use in corneal chemical injuries but I found it interesting anyway... enjoying seeing these therapies pick up some speed.

Evaluation of efficacy of autologous platelet-rich plasma eyedrops as an adjunct to standard medical treatment as compared with standard medical treatment with artificial tears in acute ocular chemical injury.
Twenty eyes with grade III to grade V chemical injury were randomly assigned to 2 groups. Group I (10 eyes) received autologous platelet-rich plasma eyedrops along with standard medical treatment, and group II (10 eyes) received standard medical treatment alone. Follow-up was on days 3, 7, 14, 21, 30, 60, and 90. Chi-square test for categorical variables and Mann-Whitney test for quantitative variables were applied for statistical analysis.
The mean time between exposure and presentation was 2.15 ± 0.93 days (group I, 2.2 ± 0.73 days; group II, 2.1 ± 0.98 days; P = 0.81). Complete epithelialization was achieved in all the eyes. The mean ± SD and median (range) time to complete epithelialization were 40 ± 31.57 days and 25.5 (7-90) days in group I and 47 ± 26.15 days and 30.0 (21-90) days in group II (P = 0.29). For grade III injuries, mean ± SD and median (range) time to complete epithelialization were 14 ± 7 days and 14 (7-21) days in group I and 28.5 ± 3.67 days and 28.5 (21-30) days in group II (P = 0.006) [Wilcoxon rank sum (Mann-Whitney) test]. At 3 months, corneal clarity showed significant improvement in grade I compared with grade II (P = 0.048). Similarly, the percentage improvement in best-corrected visual acuity was 63.64 ± 55.75 and 37.74 ± 9.66 for grades I and II, respectively (P = 0.082).
Topical autologous platelet-rich plasma therapy is safe and effective, and it promotes rapid reepithelialization of ocular surface and can be administered along with standard medical therapy.

Cornea. 2012 Jul 2. [Epub ahead of print]
Panda A, Jain M, Vanathi M, Velpandian T, Khokhar S, Dada T.
Departments of *Corneal and Ocular Surface Disorders †Ocular Pharmacology and Pharmac, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.