orabase and Keratitis

Sodium hyaluronate (SH) is used in patients with dry eye. We evaluated the efficacy and safety of SH and carboxymethylcellulose (CMC) in the treatment of dry eye syndrome with superficial keratitis.. A total of 22 patients with moderate dry eye and superficial keratitis were enrolled in a prospective, randomised, masked-observer, parallel-group, single-centre study. Patients were randomly assigned to a 0.18% SH or 1% CMC solution for a 2-month period. In addition to the commonly assessed parameters in patients with dry eye (among others symptoms and corneal staining with fluorescein), flow cytometry analysis of CD44, HLA DR expressions in impression cytology was investigated as a potential efficacy parameter.. Both treatments improved the symptoms and ocular surface and were well tolerated. SH significantly (p<0.05) decreased CD44 values compared with CMC. Comfort was significantly (P<0.05) better in the SH group than that in the CMC group throughout the study. Recovery in keratitis (type, extent and depth) and symptoms were faster in the SH group than in the CMC group. Blurred vision was reported by patients in the CMC group only.. SH was well tolerated and tended to show a faster efficacy than did the CMC-based formulation in patients with moderate dry eye and superficial keratitis. SH could therefore advantageously be prescribed from the early stages of dry eye disease. This study also showed that flow cytometry in impression cytology specimens is a reliable tool for exploring the ocular surface at the epithelial level and that CD44, in addition to HLA DR, could be an interesting endpoint for future trials in dry eye syndrome with products based on SH.

Topics: Aged; Carboxymethylcellulose Sodium; Conjunctiva; Cornea; Corneal Topography; Dose-Response Relationship, Drug; Dry Eye Syndromes; Female; Flow Cytometry; Fluorescein; Fluorescent Dyes; Follow-Up Studies; Humans; Hyaluronic Acid; Keratitis; Male; Middle Aged; Ophthalmic Solutions; Prospective Studies; Severity of Illness Index; Single-Blind Method; Treatment Outcome; Viscosupplements

This article reports on comparative in vitro characterization and in vivo evaluation of pre-formed cellulose-based gels, methylcellulose (MC) and carboxymethylcellulose sodium (CMC) and in situ gel-forming Pluronic F127 (PL) for ocular delivery of ciprofloxacin hydrochloride (Cipro) by using a bacterial keratitis model and histological corneal examination. Drug-polymer interactions were studied employing thermal analysis. Further, different concentrations (1-3% w/w or 10-30% w/w) of gels depending on the nature of the polymer used were prepared, characterized for clarity, pH, rheology and in vitro release. Selected gel formulations were evaluated for ocular delivery to Staphylococcus aureus-infected rabbit corneas; and ocular toxicity through histological examination of the cornea. The results demonstrated no Cipro-polymers physicochemical interactions and pseudoplastic flow for all gels used at 35 °C. Both polymer concentrations and drug solubility in the gels are dominantly the rate-determining factors for in vitro drug release. The corneal healing rate for all gel-based formulations was significantly faster (p < 0.05) than that for Cipro solution-treated rabbits. PL-based gel induced significant swelling/edema of the corneal stroma, compared with MC- and CMC-based gels. In conclusion, cellulose-based polymers have superior ocular tolerability/dramatically less irritant; and superior efficacy with more convenient administration compared with PL and Cipro solution, respectively.

Topics: Animals; Anti-Bacterial Agents; Carboxymethylcellulose Sodium; Ciprofloxacin; Cornea; Delayed-Action Preparations; Female; Gels; Keratitis; Male; Methylcellulose; Poloxamer; Rabbits; Rheology; Staphylococcal Infections; Staphylococcus aureus; Viscosity

To describe a series of 4 patients with inadequately controlled primary open angle glaucoma and ocular surface disease (OSD) in whom a combination approach was used to manage the OSD resulting in improved intraocular pressure (IOP) control.. A retrospective review of the clinical notes of 4 patients referred to a tertiary surgical glaucoma service was performed. At the initial visit, measures to control the OSD were employed in all patients; twice-daily lid hygiene measures, a 3-month course of 50 mg daily oral doxycycline, topical carmellose sodium (celluvisc) 0.5% 4 to 6 times daily, and preservative-free equivalents of topical antiglaucoma medications as deemed appropriate, depending on the perceived severity of the OSD.. Patients were reviewed for a maximum of 24 months after intervention. In all patients treatment resulted in a marked symptomatic and clinical improvement in the ocular surface with a reduction in hyperemia, meibomian gland dysfunction and superficial keratopathy. A reduction in the IOP also occurred in all patients, obviating the need for glaucoma drainage surgery during the study period.. Patients with severe OSD often have glaucoma that is refractive to medical therapy. Furthermore, the surgical success of glaucoma filtering surgery is compromised in patients with scarring and inflammation of the conjunctiva. The term we postulate is "OSD exacerbated glaucoma." This is the first study to suggest that the use of a combination approach comprising medical treatment to manage the OSD in patients with primary open angle glaucoma may lead to an improvement in the IOP control and the management of glaucoma.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Antihypertensive Agents; Carboxymethylcellulose Sodium; Conjunctivitis; Doxycycline; Drug Carriers; Dry Eye Syndromes; Eyelid Diseases; Female; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Keratitis; Male; Retrospective Studies

To assess Pseudomonas aeruginosa growth in Refresh Plus(®), a unit-dose preservative-free ophthalmic solution indicated for the treatment of dry eye and after laser-assisted in situ keratomileusis (LASIK) surgery, which contains carboxymethylcellulose 0.5% as its active ingredient.. Multiple test tubes of Refresh Plus were inoculated with 3 clinical ocular isolates of P. aeruginosa to achieve a target concentration of ∼100 colony-forming units (CFU)/mL. The tubes were incubated at 25°C and samples were aseptically removed at 6, 12, and 24 h. The samples were cultured to enumerate the population at each time point.. After 6 h incubation, the number of CFU/mL was 3,200 for isolate 1, 2,000 for isolate 2, and 6,480 CFU/mL for isolate 3. For all 3 organisms tested, the number of CFU/mL after 12 and 24 h incubation was >10(6) CFU/mL.. Under the conditions of this experiment, Refresh Plus appears to support P. aeruginosa growth, suggesting that if the solution in a unit-dose vial of Refresh Plus were contaminated with P. aeruginosa during use, the organism would survive and replicate in the solution over time. Noncompliance with the manufacturer's recommendations (i.e., reuse of an open vial) may result in contamination of the solution with P. aeruginosa, which may cause severe keratitis.

Topics: Carboxymethylcellulose Sodium; Drug Contamination; Drug Delivery Systems; Dry Eye Syndromes; Humans; Keratitis; Keratomileusis, Laser In Situ; Ophthalmic Solutions; Preservatives, Pharmaceutical; Pseudomonas aeruginosa

To investigate the association between the use of carboxymethylcellulose sodium 1% (Celluvisc) (Allergan, Inc.) during laser in situ keratomileusis (LASIK) and the development of diffuse lamellar keratitis (DLK).. Outpatient surgery center, Detroit, Michigan, USA.. In this retrospective case series, the postoperative clinical course and surgical outcomes in 30 eyes of 15 consecutive patients who had LASIK with the use of Celluvisc were reviewed. All patients had primary LASIK, and the incidence and severity of DLK were analyzed.. Diffuse lamellar keratitis developed in 24 of the 30 eyes (80.0%) in which Celluvisc was used before the keratectomy (P = <.0001, Fischer exact test). Sixteen eyes (66.7%) had stage 1, and 8 (33.3%) had stage 2. Diffuse lamellar keratitis was diagnosed in most cases (91.6%) on postoperative day 1. All inflammation resolved after treatment with intense topical corticosteroids.. Celluvisc used immediately before the keratectomy in LASIK was highly associated with the development of DLK.

Topics: Adult; Carboxymethylcellulose Sodium; Humans; Keratitis; Keratomileusis, Laser In Situ; Middle Aged; Prednisolone; Preoperative Care; Retrospective Studies

To evaluate the incidence of epithelial defects that occur with laser in situ keratomileusis (LASIK) using nonpreserved carboxymethylcellulose sodium 0.5% solution (Refresh Plus(R)) intraoperatively.. Community-based refractive center.. This retrospective study comprised 105 patients (210 eyes) who had primary bilateral LASIK by 1 of 2 surgeons between October 1 and December 1, 2000. The 114 eyes treated subsequent to November 1, 2000, received Refresh Plus intraoperatively, and the 96 eyes treated before this date did not. The incidence of epithelial defects and diffuse lamellar keratitis (DLK) in both groups was recorded. The preoperative keratometry measurements of all cases were also recorded.. There was a statistically significant decrease in the incidence of epithelial defects in the group that received Refresh Plus intraoperatively (P =.02). No statistically significant between-group difference in the incidence of DLK was detected. Analysis of the keratometry measurements revealed no statistically significant association between the amount or axis of astigmatism and the incidence of epithelial defects or DLK.. The intraoperative use of nonpreserved Refresh Plus significantly decreased the rate of epithelial defects that occurred during LASIK.

Topics: Carboxymethylcellulose Sodium; Corneal Diseases; Epithelium, Corneal; Humans; Incidence; Intraoperative Care; Keratitis; Keratomileusis, Laser In Situ; Ophthalmic Solutions; Retrospective Studies