Thursday, October 25, 2012

Abstract: Why are my eyes always watering?

To describe the aetiology and management of the symptom epiphora presenting to a specialist ophthalmic service.
A retrospective case series and patient postal questionnaire of all new referrals seen in a specialist unit with primary symptoms of epiphora between January 2007 and December 2008. The study was begun in 2010 to allow a 2-year follow-up for this cohort.
237 patients were identified, of which 192 met the inclusion criteria. There were 57 male, 135 female, with a mean age of 60.7 (range 0-95) years.
Patients were identified using a key word search of clinic letters and a search of primary care coding.
Duration of symptoms, referral source, aetiology and subjective improvement of symptoms post treatment.
At consultation, patients had experienced epiphora for a mean of 41.1 (range 0.066-360) months. A diagnosis of partial or complete nasolacrimal duct obstruction (31.8%), dry eye with secondary reflex tearing (29.2%), eyelid malposition (10.4%) and multi-factorial epiphora (28.7%) was made after follow up and treatment. A postal questionnaire follow up showed that 25% of patients no longer had any epiphora, with 67% reporting an improvement in their symptoms. Final follow-up was 30-54 months.
This study highlights the protean aetiology of the symptom and sign, epiphora. Sparse data exists on the audited success in managing this common symptom and sign. This study helps introduce an example of a benchmark for evaluating the effectiveness of epiphora. The majority of patients were referred, usually by ophthalmologists for lacrimal surgery.

Clin Experiment Ophthalmol. 2012 Sep 7. doi: 10.1111/j.1442-9071.2012.02866.x.
Sibley D, Norris JH, Malhotra R.
Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK.

Abstract: Storing serum drops for 6 months

: Serum eye drops are used for the treatment of ocular surface disease (eg, Sicca syndrome). The objective of this experimental study was to investigate whether they maintain their wound-healing potency after a prolonged storage of 6 months at -20°C and to find a parameter that can serve as a quality and stability indicator.
: After obtaining whole blood from 10 volunteers and preparing 100% (AS100), 50% (AS50), and 20% (AS20) serum eye drops, epitheliotrophic factors including EGF, fibronectin, vitamins A and E, albumin, and immunoglobulin A were quantified before and after storage for 7 days at 6°C or 3 and 6 months at -20°C. Human corneal epithelial (HCE) cell lines were used to investigate proliferation, migration, and overall wound healing potency of the cells in response to different serum preparations. The proliferation, migration, and wound healing of HCE cells were measured after incubation with different serum eye drop concentrations and after different storage conditions.
: The concentration of epidermal growth factor, fibronectin, vitamins A and E, immunoglobulin A, and albumin showed no significant reduction over the test period. Proliferation, migration, and wound healing of HCE cells was significantly better after incubation with undiluted serum in comparison with diluted serum. No significant loss of cytokine concentration, wound healing, and proliferation effect in HCE culture of AS100, AS50, and AS20 could be detected over the 6 months of storage.
: The concentration of a spectrum of cytokines involved in corneal epithelial wound healing and the epitheliothrophic effect of serum are not significantly changed after a prolonged storage of 6 months at -20°C. Hence, it seems justifiable to provide patients with appropriate freezer capacity with a 6-month supply of autologous serum eye drops. Albumin-which is known to be relevant for ocular surface health-could serve as a cost-effective parameter for stability controls.

Cornea. 2012 Nov;31(11):1313-8. doi: 10.1097/ICO.0b013e3182542085.
Fischer KR, Opitz A, Böeck M, Geerling G.
*Department of Periodontology, University of Wuerzburg, Wuerzburg, Germany †Department of Clinical Transfusion Medicine and Hemotherapy, University of Wuerzburg, Wuerzburg, Germany ‡Department of Ophthalmology, University of Duesseldorf, Duesseldorf, Germany.

Abstract: Cord blood serum eye drops

We standardized quality-controlled cord blood serum (CBS)-based eye drops and evaluated the efficacy of 1-month CBS treatment in the healing of diseased corneal epithelium in severe dry eye (DE) patients.
Seventeen graft-versus-host disease (GVHD) and 13 Sjogren syndrome patients with severe persistent corneal defects were enrolled in the framework of a registered clinical trial ( NCT01234623). Sterile CBS eye drops were prepared to supply 0.15 ng per eye per day epithelial growth factor and administered for 1 month in a 1-day dose dispensing. The extent of epithelial defect was evaluated in square millimeters area, and subjective symptom score (Ocular Surface Disease Index score), Schirmer test I, break-up time, tear osmolarity, corneal esthesiometry (Cochet-Bonnet esthesiometer), conjunctival scraping, and imprint cytology with goblet cell count were performed at baseline (V0) and after 15 (V1) and 30 (V2, endpoint) days of treatment. Satisfaction and tolerability questionnaires were evaluated at V1 and V2.
A significant reduction was shown at the endpoint versus baseline in corneal epithelial damage (mean ± SD, 16.1 ± 13.7 vs. 40.9 ± 30 mm/area, respectively), discomfort symptoms (Ocular Surface Disease Index score, 22.3 ± 10.3 vs. 39.3 ± 16.9), scraping cytology score (3.8 ± 1.2 vs. 6.6 ± 2.1), and tear osmolarity (312.5 ± 7 vs. 322 ± 9.1 mOsm/L), whereas a significant improvement was shown in corneal esthesiometry (48.2 ± 2.1 vs. 49.7 ± 2.1 nylon/mm/length, P < 0.05). All patients reported a high degree of satisfaction upon drop instillation.
Heterologous CBS-based eye drops represent a promising therapeutic approach in the healing of severely injured corneal epithelium and in subjective symptom relief. These drops can be obtained as readily available and quality-controlled blood derivative from cord blood banks on a routine basis.

Cornea. 2012 Sep 4. [Epub ahead of print]
Versura P, Profazio V, Buzzi M, Stancari A, Arpinati M, Malavolta N, Campos EC.
*Ophthalmology Unit †Cord Blood Bank Transfusion Service ‡Pharmacy Service §Hematology Unit ¶Reumatology Service, University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy.

Abstract: Cyclosporin nanosphere - another improvement on Restasis?

Cyclosporin A (CsA) is a widely used anti-inflammatory agent for the management of dry eye disease, and is available commercially as ophthalmic emulsion formulation (RESTASIS(®)). For increasing efficacy, and for reducing local toxicity including irritation to eyes, CsA nanosphere (CsA-NS) formulation was prepared and evaluated, in this work. CsA-NS formulation was prepared in a pre-concentrate form, which is a homogeneous solution of a CsA in a mixture of surfactants, lipids and solvents and provides nanosphere dispersion when added to aqueous medium. CsA-NS formulation was characterized and adjusted for particle size, pH, and osmolarity, suitable for ophthalmic administration. Thereafter, CsA-NS formulation was evaluated for parameters like irritation to eyes and penetrability of CsA in the rabbit eyes. Results obtained demonstrated that proposed CsA-NS formulation causes less irritation in rabbit eyes, with nearly same CsA penetration in the rabbit eyes in comparison to marketed emulsion formulation.

Int J Pharm. 2012 Nov 1;437(1-2):275-6. doi: 10.1016/j.ijpharm.2012.08.016. Epub 2012 Aug 19.
Institute of Drug Research, School of Pharmacy-Faculty of Medicine, Center for Nanoscience and Nanotechnology and The Alex Grass Center for Drug Design and Synthesis, The Hebrew University of Jerusalem, Jerusalem 91120, Israel.