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Copyright of Arquivos Brasileiros de Oftalmologia is the property of Arquivos Brasileiros de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

ABSTRACT This report was aimed at presenting a case of neurotrophic keratitis and concomitant SARS-CoV-2 infection in a patient who has recently undergone a corneal DALK transplant. One month after corneal transplantation with adequate corneal epithelialization, the patient presented neurotrophic keratitis with a torpid course of the corneal transplant coinciding with a SARS-CoV-2 infection, with an excessive host immune response. In addition, the patient presented a re-positivization of nasopharyngeal polymerase chain reaction of SARS-CoV-2 with past disease after starting treatment with autologous serum eye drops. The implications at the ophthalmological level of SARS-CoV-2 infection may be clarified as the time the illness progresses and we learn more about how it acts. In this case, the disparity of signs and symptoms, the antecedent of corneal surgery, and the possibility of a herpetic infection as a cause of the primary leukoma suggested neurotrophic keratitis. Nonetheless, the involvement of systemic SARS-CoV-2 infection in the process, triggering an excessive host immune response at the corneal level with an increase in inflammatory cytokines must be taken into account. No relationship was found between treatment with autologous serum and re-positivization of nasopharyngeal polymerase chain reaction, presenting the patient a favorable response to treatment.

This report was aimed at presenting a case of neurotrophic keratitis and concomitant SARS-CoV-2 infection in a patient who has recently undergone a corneal DALK transplant. One month after corneal transplantation with adequate corneal epithelialization, the patient presented neurotrophic keratitis with a torpid course of the corneal transplant coinciding with a SARS-CoV-2 infection, with an excessive host immune response. In addition, the patient presented a re-positivization of nasopharyngeal polymerase chain reaction of SARS-CoV-2 with past disease after starting treatment with autologous serum eye drops. The implications at the ophthalmological level of SARS-CoV-2 infection may be clarified as the time the illness progresses and we learn more about how it acts. In this case, the disparity of signs and symptoms, the antecedent of corneal surgery, and the possibility of a herpetic infection as a cause of the primary leukoma suggested neurotrophic keratitis. Nonetheless, the involvement of systemic SARSCoV-2 infection in the process, triggering an excessive host immune response at the corneal level with an increase in inflammatory cytokines must be taken into account. No relationship was found between treatment with autologous serum and re-positivization of nasopharyngeal polymerase chain reaction, presenting the patient a favorable response to treatment. [ABSTRACT FROM AUTHOR]

Dry Eye Disease (DED) is a pathology that can be caused by genetic and environmental factors. It is characterized by the loss of homeostasis of the tear film, triggering symptoms such as pain, burning, redness, blurred vision, tearing, and photophobia. It is emphasized that the treatments are aimed at restoring the ocular surface and reducing tear film instability. Hyaluronic acid (HA) has emerged as a promising treatment for this disease. The aim of this study was to seek rationale for this condition and to evaluate the efficacy of the use of HA in its treatment. The methodology used was a literature search based on the descriptor: "{(Hyaluronic Acid)} AND {(Dry Eye)}" in the PubMed and Science Direct databases. Of the 4652 articles selected, 38 that related DED and HA. In this perspective, there are several mechanisms that are part of the pathophysiology of DED, which run with the loss of tear film homeostasis. Thus, HA, with its various applicability, has become a therapeutic option due to its different modes of application and its very few side effects. However, the importance of the development of an updated protocol and the continuity of studies on this condition is still emphasized. [ABSTRACT FROM AUTHOR]

Gary Jerkins,1 Jack V Greiner,2,3 Louis Tong,4– 6 Jacqueline Tan,7 Joseph Tauber,8 Ali Mearza,9,10 Sruthi Srinivasan11 1Advancing Vision Research, LLC, Nashville, TN, USA; 2Clinical Eye Research of Boston, Boston, MA, USA; 3Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; 4Singapore National Eye Center, National University of Singapore, Singapore; 5Singapore Eye Research Institute, Singapore; 6Duke-National University of Singapore Medical School, Singapore; 7University of New South Wales, Sydney, NSW, Australia; 8Tauber Eye Center, Kansas City, MO, USA; 9Imperial College Healthcare NHS Trust, London, UK; 10Ophthalmic Consultants of London, London, UK; 11Alcon Research, LLC, Johns Creek, GA, USACorrespondence: Gary JerkinsAdvancing Vision Research, LLC, Nashville, TN 37205, USATel +1 615-502-2871Fax +1 615-915-1825Email drjeyeguy@garyjerkins.comPurpose: The aim of this study was to compare the efficacy of two lipid-based lubricant eye drops in patients with lipid-deficient dry eye.Methods: This Phase IV, multicenter, prospective, double-masked study enrolled adults (aged ≥ 18 years) who had a tear film breakup time (TFBUT) of ≤ 15 seconds(s), and unanesthetized Schirmer I test of ≥ 3 mm to ≤ 12 mm in at least one eye, at both screening and baseline visits. Eligible patients (n=231) were randomized (1:1) and received either Systane® Balance (SYSB; n=117) or Refresh® Optive Advanced (RFO-Ad, n=114), four-times a day, for 35 days. The primary endpoint was non-inferiority for change from baseline in TFBUT at Day 35 (non-inferiority was established if the lower limit of the 95% confidence interval (CI) for the difference between the treatment groups was > – 1.0 s); secondary endpoints (test of superiority) were change in TFBUT and global ocular discomfort visual analog scale (VAS) score at Day 35. Other endpoints included the impact of dry eye on everyday life (IDEEL) treatment satisfaction scores (inconvenience and effectiveness) and safety.Results: At Day 35, the mean change from baseline in TFBUT was 0.998 s in the SYSB and 0.868 s in the RFO-Ad groups with a treatment difference: 0.130 s; (95% CI − 0.34, 0.60; P< 0.0001) demonstrating non-inferiority of SYSB to RFO-Ad. The global ocular discomfort VAS scores improved in both groups, with a mean change from baseline of – 9.7 and – 8.8 in SYSB and RFO-Ad groups (treatment difference – 0.8; P=0.62), respectively. No meaningful difference was observed in IDEEL treatment effectiveness and treatment inconvenience scores between SYSB vs RFO-Ad (P> 0.05 for treatment difference). Both treatments were well tolerated.Conclusion: SYSB lubricant eye drops were non-inferior to RFO-Ad for improvement in TFBUT in patients with lipid-deficient dry eye. Both lubricant eye drops improved TFBUT and ocular discomfort scores in patients with lipid-deficient dry eye.Keywords: dry eye, lipid-deficient, evaporative dry eye, lubricant eye drops, non-inferiority

Objective: To compare the efficacy of sodium hyaluronate, hydroxypropyl methylcellulose/dextran and polypropylene/polyethylene glycol based commercial artificial tear products using the noninvasive tear film breakup time. Study Design: Quasi experimental Study. Place and Duration of Study: Study was conducted at the Eye department of Combined Military Hospital Malir Cantt Karachi, from Sep 2017 to Nov 2017. Methodology: Three different types of commercially available artificial tears were evaluated on 30 eyes of 30 patients, having all types of dry eyes diseases. The noninvasive tear film breakup time was measured before and then at 15, 30 and 45 mins after instillation of the artificial tear using keratometer. The active ingredients in these eye drops were sodium hyaluronate, polyethylene glycol/propylene glycol and hydroxypropyl methylcellulose/ dextran 70. Results: Among the three artificial tears only Sodium hyaluronate eye drops caused a statistically significant increase in noninvasive tear film break up time at 45 mins post instillation. Polyethylene glycol/propylene eye drops extended tear film breakup time upto 30 mins. Comparison of the difference in extension of the breakup time was statistically insignificant between sodium hyaluronate and polyethylene glycol/polypropylene at 15 and 30 mins post instillation. Conclusion: Sodium hyaluronate eye drops were effective in prolonging the noninvasive tear film breakup time upto 45 mins postinstillation while polypropylene/polyethylene glycol were effective upto 30 mins in all types of dry eye diseases.

Purpose: To evaluate the epidemiological and clinical profile and economic impact of the acute conjunctivitis outbreak in the period of 2017-2018 in Recife-PE. Methods: Cross-sectional study based on the analysis of medical records of patients diagnosed with conjunctivitis at the emergency room of the Altino Ventura Foundation (FAV) between December 2017 and March 2018. The collected data included ocular manifestations at examination, subsequent complications, management, and days of sick leave. Results: Out of 12,712 patients assisted at FAV from December 2017 to March 2018, 6,359 (50.0%) were diagnosed with conjunctivitis. The mean age of patients was 29.5 ± 14.1 years (range, 01-85 years), with similar distribution between sex (2,288 [50.1%] male; 2,282 [49.9%] female). The most common diagnosis was non-pseudomembranous conjunctivitis (5,645 cases [88.8%]). Conjunctival hyperemia (6,278 cases [98.7%]) and follicular reaction (6,255 cases [98.4%]) were the most frequent ocular findings. The most common complication was pseudomembrane in 1,062 cases (16.7%). Lubricants (4,308 [67.7%]) and antibiotic associated to corticosteroid eyedrops (2,033 [32.0%]) were the most prescribed medications. The average days of sick leave per patient was 4.8 ± 2.9 days (range, 1-47 days) and the productivity loss estimated in R$1.159.329,14. Conclusion: The conjunctivitis outbreak in Pernambuco, Brazil was responsible for half of the consultations in an ophthalmic emergency room. Conjunctivitis outbreaks may cause an economic impact as it mostly affects young adults in their productive ages and take in average a 5-day sick leave. The clinical characteristics observed suggest an outbreak of conjunctivitis of viral etiology. [ABSTRACT FROM AUTHOR]

Purpose: To assess the safety and efficacy of multi‐ingredient sacha inchi microemulsion (SIME) eye drops designed to target (1) tear film instability, (2) tear hyperosmolarity, and (3) ocular surface damage and inflammation in moderate or severe dry eye. Methods: This randomized, quadruple‐masked, active‐controlled parallel study in 64 adult patients comprised three parts. Part 1 (n = 3): one eye was treated with SIME for one day. Part 2 (n = 9): randomized eyes were treated with SIME and 0.2% hyaluronic acid (HA) control eye drops 3 times a day for 10 days. Part 3 (n = 26 + 26): randomized treatment was applied on both eyes 3 times a day for 30 days. OSDI change was tested for superiority of SIME over HA. Ocular assessments were performed at baseline and after the last dose. Results: Both treatments were well tolerated without adverse device effects. Tear film break‐up time (p = 0.0025) and ocular protection index (p = 0.0026; change vs. HA, p = 0.047) increased significantly with SIME after 30 days. Tear osmolarity decreased more in SIME than in the HA group and significantly with both eye drops in hyperosmolar subgroups. Corneal (p = 0.014) and nasal conjunctival staining (p = 0.043) were reduced with SIME in per‐protocol patients (n = 24). Conjunctival (p = 0.001) and lid redness (p = 0.012) decreased with SIME in all patients (n = 26). Symptoms decreased by about 25 OSDI units with both treatments (p < 0.0001) and with nonsignificant difference between treatments. Conclusions: Sacha inchi microemulsion (SIME) proved safe and efficacious in improving each aetiologic factor for dry eye as revealed through objective tests. Hyperosmolar stress dominating blink cycles must be disrupted by biophysical protection of the ocular surface to facilitate resolution of cellular damage and inflammation, and relief of ocular symptoms. [ABSTRACT FROM AUTHOR]

Aim of this blinded, prospective, randomized clinical study was to compare three different lubricant eye drops (LED) in healthy adult dogs undergoing general anaesthesia (GA) for non-ophthalmic surgery. Tear production rate was monitored by means of Schirmer tear test-1 (STT-1), and incidence of post-operative corneal abrasions/ulcerations was detected by corneal staining. A complete ophthalmic examination was performed before premedication, at extubation time and 24 h after GA in twenty-five non-brachycephalic dogs (fifty eyes) undergoing elective orthopaedic or spinal surgery procedures. Dogs were randomly allocated to one of three groups receiving as prophylactic LED either carmellose sodium (GC), or 1% hyaluronic acid (GH), or 0.25% hyaluronic acid (GL). In each eye STT-1 was repeated every hour during GA, before instilling one drop of the assigned LED. In all groups STT-1 values drastically decreased during GA, while 24 h later nine eyes (18%) had STT-1 values lower than 15 mm/minute. All of the three formulations tested were fully effective in preventing corneal ulceration (0% in all groups), while 10% of eyes reported superficial de-epithelialization. Fluorescein staining demonstrated that hourly prophylactic LED application prevented exposure keratopathy during general anesthesia in 90% of the eyes in non-brachycephalic dogs. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of sodium hyaluronate, hydroxypropyl methylcellulose/dextran and polypropylene/polyethylene glycol based commercial artificial tear products using the noninvasive tear film breakup time. Study Design: Quasi experimental Study. Place and Duration of Study: Study was conducted at the Eye department of Combined Military Hospital Malir Cantt Karachi, from Sep 2017 to Nov 2017. Methodology: Three different types of commercially available artificial tears were evaluated on 30 eyes of 30 patients, having all types of dry eyes diseases. The noninvasive tear film breakup time was measured before and then at 15, 30 and 45 mins after instillation of the artificial tear using keratometer. The active ingredients in these eye drops were sodium hyaluronate, polyethylene glycol/propylene glycol and hydroxypropyl methylcellulose/ dextran 70. Results: Among the three artificial tears only Sodium hyaluronate eye drops caused a statistically significant increase in noninvasive tear film break up time at 45 mins post instillation. Polyethylene glycol/propylene eye drops extended tear film breakup time upto 30 mins. Comparison of the difference in extension of the breakup time was statistically insignificant between sodium hyaluronate and polyethylene glycol/polypropylene at 15 and 30 mins post instillation. Conclusion: Sodium hyaluronate eye drops were effective in prolonging the noninvasive tear film breakup time upto 45 mins postinstillation while polypropylene/polyethylene glycol were effective upto 30 mins in all types of dry eye diseases. [ABSTRACT FROM AUTHOR]

Copyright of Acta Médica Peruana is the property of Colegio Medico del Peru and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim of this blinded, prospective, randomized clinical study was to compare three different lubricant eye drops (LED) in healthy adult dogs undergoing general anaesthesia (GA) for non-ophthalmic surgery. Tear production rate was monitored by means of Schirmer tear test-1 (STT-1), and incidence of post-operative corneal abrasions/ulcerations was detected by corneal staining. A complete ophthalmic examination was performed before premedication, at extubation time and 24 h after GA in twenty-five non-brachycephalic dogs (fifty eyes) undergoing elective orthopaedic or spinal surgery procedures. Dogs were randomly allocated to one of three groups receiving as prophylactic LED either carmellose sodium (GC), or 1% hyaluronic acid (GH), or 0.25% hyaluronic acid (GL). In each eye STT-1 was repeated every hour during GA, before instilling one drop of the assigned LED. In all groups STT-1 values drastically decreased during GA, while 24 h later nine eyes (18%) had STT-1 values lower than 15 mm/minute. All of the three formulations tested were fully effective in preventing corneal ulceration (0% in all groups), while 10% of eyes reported superficial de-epithelialization. Fluorescein staining demonstrated that hourly prophylactic LED application prevented exposure keratopathy during general anesthesia in 90% of the eyes in non-brachycephalic dogs.

Copyright of Arquivos Brasileiros de Oftalmologia is the property of Arquivos Brasileiros de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Ingredients of lubricant eye drops are potentially harmful to the ocular surface. The products Optive, Optive Fusion, Neopt were tested regarding corneal irritability versus Vismed Multi and 0.01% benzalkonium chloride as negative and positive control, respectively. Formulas (30–40 μl per hour) were applied hourly in-vitro for six days on rabbit corneas (n = 5, per product) cultured in artificial anterior chambers (EVEIT system). Initially, four corneal abrasions (2.4–4.6 mm 2 ) were induced. All defects were monitored during drop application by fluorescein stains and photographs. To ensure corneal vitality, glucose and lactate concentrations in artificial anterior chamber fluids were determined photometrically. All products showed a complete corneal healing on day 2. Thereafter, all five Optive-treated corneas developed progressive fluorescein-positive epithelial lesions until day six (24.96 μm, ±21.45 μm, p < 0.01). For Optive Fusion three corneas showed corneal erosions on day six (23.11 μm, ±37.02 μm, p > 0.5) while Vismed Multi did not adversely affect the corneal integrity. Glucose/lactate concentrations remained unchanged while lubricants were applied. Histology revealed epithelial loss and severe alterations of the superficial stroma for Optive. Optive Fusion displayed a comparable pathology. Neopt did not significantly affect the corneal healing and integrity. This study suggested a cumulative corneal toxicity of Optive and, to a lesser extent, Optive Fusion most likely caused by its oxidative preservative, SOC. Clinical data are needed to clarify the application frequency at which corneal toxicity might occur. Neopt and Vismed Multi did not affect the corneal integrity. [ABSTRACT FROM AUTHOR]