Hoornvliesbeschadiging na cataractchirurgie: belang van het droge-ogensyndroom en topische NSAID’s en oppuntstelling van de behandeling

Author(s):  
A. POTVIN ◽  
D. ROELS

Dry eye disease and cataract surgery: identification of risk factors for corneal damage and optimisation of treatment Various factors in the perioperative cataract surgery period can synergistically initiate a vicious inflammatory cycle of dry eye disease (DED) and tissue damage, with dire consequences. A careful anamnesis and preoperative assessment of the ocular surface can reveal some of the risk factors and facilitate an appropriate perioperative approach. Attention should be paid to DED and associated conditions, such as Meibomian gland dysfunction, as these conditions are very common. In the postoperative period, it is wise to avoid preserved topical medication, as well as to use topical medication that may be toxic to the ocular surface, such as non-steroidal anti-inflammatory drugs (NSAIDs), with care in specific cases. The treatment of DED and its complications consists primarily of the careful use of lubricating, antibiotic and anti-inflammatory agents. In serious DED cases, autologous serum promotes tissue regeneration by promoting epithelialisation and stromal recovery, and can be a useful adjunct to the first-line treatment. In extreme and rare cases, DED can, in combination with the use of topical NSAIDs and other risk factors, lead to sight-threatening complications, such as corneal melting. A surgical treatment consisting of conjunctival flap transplantation, amniotic membrane transplantation, gluing of the cornea or tectonic keratoplasty may be necessary when perforation is imminent.

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e048479
Author(s):  
Passara Jongkhajornpong ◽  
Pawin Numthavaj ◽  
Thunyarat Anothaisintawee ◽  
Kaevalin Lekhanont ◽  
Gareth McKay ◽  
...  

IntroductionDry eye disease (DED) is a common eye problem. Although the disease is not fatal, it substantially reduces quality of life and creates a high economic burden, especially in patients with moderate-to-severe DED. Several biological tear substitutes (eg, autologous serum (AS), autologous platelet-rich plasma (APRP) and autologous platelet lysate) could effectively improve dry eyes. However, evidence on their comparative efficacy is controversial. This study aims to compare the efficacy of 100% APRP with 100% AS eye drops in patients with moderate-to-severe DED.Methods and analysisThe study is a single-centre, double-blinded randomised, parallel, non-inferiority trial. One hundred and thirty patients with moderate-to-severe DED, aged 18–70 years will be recruited from outpatient clinic, Department of Ophthalmology, Ramathibodi Hospital, Bangkok from February 2021 to January 2023. Patients will be randomised to receive either 100% APRP or 100% AS eye drops (1:1 ratio) for 4 weeks. The primary outcomes are ocular surface disease index (OSDI) and ocular surface staining (OSS) evaluated using the Oxford scale. Secondary outcomes are fluorescein break-up time, Schirmer’s I test, meibomian gland parameters and adverse events. Other measured outcomes include best-corrected visual acuity, intraocular pressure and compliance.Ethics and disseminationThe study protocol and any supplements used in conducting this trial have been approved by the Ethics Committee of Faculty of Medicine, Ramathibodi Hospital, Mahidol University (MURA2020/1930). Informed consent will be obtained from all patients before study entry. Results will be presented in peer-reviewed journals and international conferences.Trial registration numberNCT04683796.


2020 ◽  
Vol 30 (5) ◽  
pp. 840-855
Author(s):  
Khayam Naderi ◽  
Jack Gormley ◽  
David O’Brart

Aim To review published literature concerning cataract surgery and dry eye disease (DED). Methods A search was undertaken using the following: PubMed (all years), Web of Science (all years), Ovid MEDLINE(R) (1946 to 12 December 2019), Ovid MEDLINE(R) Daily Update 10 December 2019, MEDLINE and MEDLINE non-indexed items, Embase (1974–2019, week 49), Ovid MEDLINE (R) and Epub Ahead of Print, In-Process and Other Non-Indexed Citations and Daily (1946 to 12 December 2019), CENTRAL (including Cochrane Eyes and Vision Trials Register; Cochrane Library: Issue 12 of 12 December 2019), metaRegister of Controlled Trials (mRCT) ( www.controlled-trials.com ), ClinicalTrials.gov ( www.clinicaltrial.gov ) and WHO International Clinical Trials Registry Platform ( www.who.int/ictrp/search/en ). Search terms included ‘cataract surgery’, ‘phacoemulsification’ and ‘cataract extraction’, combined with ‘dry eyes’ and ‘ocular surface’. Relevant in-article references not returned in our searches were also considered. Results Publications identified included systematic reviews, meta-analysis, randomized controlled trials, cohort studies, case series and laboratory-based studies. Published data highlighting the burden of DED both prior and following cataract surgery were reviewed as well as studies highlighting the effects of cataract surgery on the ocular surface, intra-operative measures to reduce deleterious effects on the ocular surface and current evidence on the management options of post-operative DED. Conclusions DED is common and can be exacerbated by cataract surgery. Ophthalmologists need to assess for pre-existing DED and instigate treatment before surgery; be aware of reduced accuracy of measurements for surgical planning in the presence of DED; limit intra-operative surgical factors damaging to the ocular surface; and consider management to reduce DED post-operatively.


2021 ◽  
Vol 21 (1) ◽  
pp. 18-23
Author(s):  
E.B. Tatarnikova ◽  
◽  
O.I. Krivosheina ◽  

For many years, dry eye disease (DED) is a common ophthalmic condition associated with ocular surface damage and loss of homeostasis of the tear film. The key pathogenic factors of DED are tear film instability and tear hyperosmolarity, ocular surface inflammation and damage, and neurosensory alterations. Current treatment for DED consists of non-medical therapies, tear substitutes, anti-inflammatory agents, and surgical procedures. These treatments improve disease course and quality of life. However, these treatments are largely palliative as long-term (and even life-long) installation of eye drops is required. Modern and effective treatments for DED are needed. This paper reviews domestic and foreign published data on the important therapies for DED and novel tools to promote symptom relief. These data are required for the understanding of the pharmacological effects of various drug classes prescribed for DED and early treatment initiation. Keywords: dry eye disease, tear replacement therapy, anti-inflammatory treatment, surgery, hyaluronic acid, preservatives. For citation: Tatarnikova E.B., Krivosheina O.I. Current treatment modalities for dry eye disease. Russian Journal of Clinical Ophthalmology. 2021;21(1):18–23. DOI: 10.32364/2311-7729-2021-21-1-18-23.


2021 ◽  
Vol 11 (10) ◽  
pp. 4519
Author(s):  
Joon-Young Hyon ◽  
Sang-Beom Han

Dry eye disease (DED) is a common disease, and have an adverse effect the physical, functional, and psychological quality of life. It is a multifactorial disorder characterized by the loss of tear film homeostasis, in which self-perpetuating vicious cycle leads to deterioration of function and inflammation of the lacrimal functional unit. Hence, treatment strategies should be aimed at the interruption of the vicious inflammatory cycle and alleviation of ocular surface inflammation. Anti-inflammatory therapies have been shown to improve the signs and symptoms of the disease. Evidence indicates that polyunsaturated fatty acids (PUFAs) may contribute to reinforcement of innate anti-inflammatory mechanisms, and systemic and topical administration of PUFAs may help modulate ocular surface inflammation. In the present review, the authors will introduce the results of clinical and experimental studies to elucidate the mechanism, efficacy, and safety of systemic and topical supplementation with PUFAs as an alternative therapeutic strategy for DED. This review will also include discussion regarding current perspectives, including evidence-based recommendations and possible side effects of PUFAs supplementation. The review of the literature suggests that PUFAs supplementation can be a viable option for the treatment of DED, although further studies are needed for establishment of treatment guidelines.


2022 ◽  
Vol 8 ◽  
Author(s):  
Jiawei Ling ◽  
Ben Chung-Lap Chan ◽  
Miranda Sin-Man Tsang ◽  
Xun Gao ◽  
Ping Chung Leung ◽  
...  

Dry eye is currently one of the most common ocular surface disease. It can lead to ocular discomfort and even cause visual impairment, which greatly affects the work and quality of life of patients. With the increasing incidence of dry eye disease (DED) in recent years, the disease is receiving more and more attention, and has become one of the hot research fields in ophthalmology research. Recently, with the in-depth research on the etiology, pathogenesis and treatment of DED, it has been shown that defects in immune regulation is one of the main pathological mechanisms of DED. Since the non-specific and specific immune response of the ocular surface are jointly regulated, a variety of immune cells and inflammatory factors are involved in the development of DED. The conventional treatment of DED is the application of artificial tears for lubricating the ocular surface. However, for moderate-to-severe DED, treatment with anti-inflammatory drugs is necessary. In this review, the immunomodulatory mechanisms of DED and the latest research progress of its related treatments including Chinese medicine will be discussed.


2019 ◽  
Vol 11 ◽  
pp. 251584141986950 ◽  
Author(s):  
Darren Shu Jeng Ting ◽  
Saurabh Ghosh

Dry eye disease is a common ocular surface disease in patients who are undergoing cataract surgery. The significance of dry eye disease is often underestimated or overlooked during preoperative assessment of cataract. We report an 80-year-old patient, with a background of seropositive rheumatoid arthritis and diabetes, who presented with an acute corneal melt and perforation associated with undiagnosed dry eye disease and use of topical ketorolac 1 week following an uncomplicated cataract surgery. The patient underwent repeated corneal gluing for corneal perforation and was subsequently diagnosed and treated for bilateral moderate-severe dry eye disease. This case highlights the importance of meticulous preoperative assessment and management of the ocular surface, especially in patients with systemic diseases such as rheumatoid arthritis and diabetes prior to cataract surgery. The implication of the use of topical nonsteroidal anti-inflammatory drugs following cataract surgery – which might have contributed to the process of corneal melt in our case – is also discussed.


2020 ◽  
Vol 50 (3) ◽  
pp. 133-142 ◽  
Author(s):  
Pragati Garg ◽  
Aditi Gupta ◽  
Nishi Tandon ◽  
Priyanka Raj

2018 ◽  
Vol Volume 13 ◽  
pp. 53-62 ◽  
Author(s):  
Alejandro Rodriguez-Garcia ◽  
Denise Loya-Garcia ◽  
Everardo Hernandez-Quintela ◽  
Alejandro Navas

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