Richard Yudi Hida

Clinical treatment of dry eye using 0.03% tacrolimus eye drops.

Purpose: To report the clinical outcome of the treatment of dry eyes using 0.03% tacrolimus eye drops (olive oil + tacrolimus 0.03%) (Ophthalmos, Sao Paulo, Brazil). Methods: Sixteen eyes of 8 patients with Sjögren syndrome dry eyes (age, 51.13 ± 9.45 years) were enrolled in this study (prospective noncontrolled interventional case series). Patients were instructed to use topical 0.03% tacrolimus eye drops twice a day (every 12 hours) in the lower conjunctival sac. Schirmer I test, break-up time, corneal fluorescein, and rose bengal staining score were performed in all patients 1 day before, and 14, 28, and 90 days after treatment with 0.03% tacrolimus eye drops. Results: The average fluorescein staining and rose bengal staining scores improved statistically significantly after 14 days of treatment and improved even more after 28 and 90 days. The average Schirmer I test did not improve statistically significantly after 28 days of treatment, although we did observe a significant improvement after 90 days of treatment with 0.03% tacrolimus eye drops. The average break-up time did not improve statistically after 14 days of treatment, although we observed a significant improvement after 28 and 90 days of treatment with 0.03% tacrolimus eye drops. Conclusions: Topical 0.03% tacrolimus eye drops successfully improved tear stability and ocular surface status in patients with dry eyes.

TFOS DEWS II Management and Therapy Report

The members of the Management and Therapy Subcommittee undertook an evidence-based review of current dry eye therapies and management options. Management options reviewed in detail included treatments for tear insufficiency and lid abnormalities, as well as anti-inflammatory medications, surgical approaches, dietary modifications, environmental considerations and complementary therapies. Following this extensive review it became clear that many of the treatments available for the management of dry eye disease lack the necessary Level 1 evidence to support their recommendation, often due to a lack of appropriate masking, randomization or controls and in some cases due to issues with selection bias or inadequate sample size. Reflecting on all available evidence, a staged management algorithm was derived that presents a step-wise approach to implementing the various management and therapeutic options according to disease severity. While this exercise indicated that differentiating between aqueous-deficient and evaporative dry eye disease was critical in selecting the most appropriate management strategy, it also highlighted challenges, based on the limited evidence currently available, in predicting relative benefits of specific management options, in managing the two dry eye disease subtypes. Further evidence is required to support the introduction, and continued use, of many of the treatment options currently available to manage dry eye disease, as well as to inform appropriate treatment starting points and understand treatment specificity in relation to dry eye disease subtype.

Oral azithromycin for treatment of posterior blepharitis.

Purpose: To evaluate the effects of oral azithromycin in patients with posterior blepharitis. Methods: Twenty-six eyes of 13 patients with posterior blepharitis diagnosed by a qualified ophthalmologist were enrolled in this study. Patients were instructed to use oral azithromycin 500 mg per day for 3 days in 3 cycles with 7-day intervals. Subjective clinical outcomes were graded and scored 1 day before and 30 days after the end of the treatment (53 days after initiating the treatment) based on severity scores of: (1) eyelid debris; (2) eyelid telangiectasia; (3) swelling of the eyelid margin; (4) redness of the eyelid margin; and (5) ocular mucus secretion. For the assessment of global efficacy, patients were asked by the investigator to rate the subjective symptoms (eyelid itching, ocular itching, eyelid hyperemia, ocular hyperemia, ocular mucus secretion, photophobia, foreign body sensation, and dry eye sensation) on a scale of 0 (no symptoms) to 5 (severe symptoms). Break-up time, Schirmer I test, corneal fluorescein staining score, and rose bengal staining score were also performed in all patients. Results: All clinical outcomes scoring showed statistically significant improvement after oral azithromycin, except for eyelid swelling. Average subjective symptom grading improved statistically after treatment with oral azithromycin, except for eyelid hyperemia, photophobia, and foreign body sensation. Average tear film break-up time values showed statistically significant improvement after the treatment with oral azithromycin. No statistically significant improvement was observed on average values of Schirmer I test, corneal fluorescein staining score, and rose bengal staining score. Conclusions: The combination of multiple clinical parameters shown in this study supports the clinical efficacy of pulsed oral azithromycin therapy for the management of posterior blepharitis.

Treatment of Sjögren's syndrome dry eye using 0.03% tacrolimus eye drop: Prospective double-blind randomized study.

OBJECTIVE To describe the clinical efficacy of the treatment of Sjögrens syndrome dry eye using 0.03% tacrolimus eye drop. DESIGN Prospective double-blind randomized study. SETTING Institutional outpatient clinic. PARTICIPANTS Forty-eight eyes of twenty-four patients with dry eye related to Sjögren syndrome were enrolled in this study. The patients were randomized in 2 groups: tacrolimus (n=14) and vehicle (n=10) group. INTERVENTION The tacrolimus group received a vial containing tacrolimus 0.03% (almond oil as vehicle) and the other group received the almond oil vehicle. All patients were instructed to use the eye drops every 12h in the lower conjunctival sac. MAIN OUTCOME MEASURES Schirmer I test, break-up-time (BUT), corneal fluorescein and Rose Bengal staining scores were evaluated in all patients one day before the treatment (baseline), 7, 14, 28 and 90 days after treatment with the eye drops. RESULTS The average fluorescein and Rose Bengal scores improved statistically after 7 days of treatment and even more after 90 days. The average Schirmer I and BUT values were unchanged after 7, 14 and 21 days but did show an improvement relative to baseline after 28 days of treatment. Schirmer I, BUT, fluorescein and Rose Bengal did not show any statistical significance in the vehicle group. CONCLUSION Topical 0.03% tacrolimus eye drop improved tear stability and ocular surface status in cases of inflammatory or SS-related dry eye. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01850979.

Two-Year Outcome of Partial Lacrimal Punctal Occlusion in the Management of Dry Eye Related to Sjögren Syndrome

Purpose: To analyze the influence of thermal partial punctal occlusion on the ocular surface of dry eye related to Sjögren syndrome. Material and Methods: Thirty-seven eyes of 19 patients (3 male and 16 female; 49.11 ± 14.33 years old) with keratoconjunctivitis sicca were enrolled in this study. Superior and inferior partial occlusion were performed in both eyes under topical anesthesia using thermal cautery with a sterile tip to obtain lacrimal punctum smaller than 0.5 mm. Schirmer I, break-up-time, diameter of lacrimal puncta, corneal fluorescein, and rose Bengal staining scores were analyzed before and after 24 weeks and after 24 months of the procedure. All measurements were performed under controlled climate. Results: The average lacrimal punctum diameter before the procedure was 0.65 ± 0.134 mm. All lacrimal puncta were successfully reduced to less than 0.5 mm after 4 weeks of the procedure. The average Schirmer I test values improved statistically after 24 weeks and maintained stable after 24 months. Average break-up-time, rose Bengal, and fluorescein staining score values improved statistically after 24 weeks and improved even more after 24 months. Average Schirmer I test, break-up-time, rose Bengal, and fluorescein staining scores showed significant improvement (p < 0.0001) after 24 months of partial thermal punctal occlusion. Conclusion: Our study showed that reducing the punctum diameter to 0.5 mm can improve vital staining scores, break-up-time, and Schirmer I test in dry eye related to Sjögren syndrome.

Ocular Surface Changes in Eyes with Glaucoma Filtering Blebs

Purpose: To analyse the ocular surface changes in eyes with functioning filtering blebs and to correlate with the size of the bleb. Materials and methods: Forty eyes of 40 glaucomatous patients with functioning blebs and 40 normal control subjects underwent double vital staining for ocular surface evaluation, tear film break-up-time (BUT) and Schirmer I-test in a standardized fashion. Mann–Whitney U-test and Spearman’s rank correlation were used to correlate bleb height and horizontal extent with BUT, Schirmer I-test, rose bengal and fluorescein staining scores. Results: Eyes with functioning blebs presented minimal, but significantly, higher rose bengal and fluorescein staining than controls (p < 0.000). The staining correlated poorly with the height and extent of the bleb. The Schirmer test in the study group showed greater measurements than controls, however, BUT showed shorter values in the study group as compared to controls (p < 0.05). Conclusion: Filtering blebs can interfere with the ocular surface stability causing few dry eyes like signs.

Estudo quantitativo da lágrima pelo teste de fenol vermelho na população brasileira

OBJETIVO: Determinar parâmetros normais do teste de fenol vermelho na populacao brasileira, e comparar entre diferentes racas, idade e sexo. METODOS: Foram avaliados, com o teste de fenol vermelho, 280 individuos (560 olhos) da raca branca e 280 individuos (560 olhos) da raca nao branca, que foram divididos de acordo com a idade e o sexo. Foram excluidos individuos com qualquer doenca ocular, usuarios de lente de contato e que usavam medicacao ocular. RESULTADOS: Dos 1.120 olhos avaliados, o resultado medio foi de 19,77±7,90 mm. CONCLUSAO: O resultado medio encontrado foi um valor intermediario entre as duas populacoes previamente estudadas (japonesa e norte-americana).

Tracoma: estudo epidemiológico de escolares em Alagoas - Brasil

OBJETIVOS: Definir a taxa de deteccao de tracoma em escolares do Estado de Alagoas - Brasil. METODOS: A amostra foi constituida de 6.424 criancas e adolescentes. A avaliacao clinica dos escolares foi realizada por graduandos da Faculdade de Medicina sob supervisao de professores do Departamento de Oftalmologia, seguindo os criterios da Organizacao Mundial de Saude. A avaliacao clinica foi caracterizada por exame dos cilios, das palpebras, da conjuntiva e da cornea de ambos os olhos. Os estudantes foram catalogados, anotando-se nome, sexo, idade, diagnostico da forma clinica e municipio. Quanto a idade, os escolares foram divididos em tres grupos: grupo A ( 14 anos). RESULTADOS: A taxa de deteccao de tracoma foi de 4,5%. Dos 3.280 estudantes do sexo masculino, 161 (4,9%) casos foram considerados confirmados, e dos 3.144 estudantes do sexo feminino, 131 (4,2%) casos foram considerados confirmados. Do total de escolares do grupo A, B e C, respectivamente 175 (5,3%), 113 (8,0%) e 4 (1,6%), foram considerados casos confirmados. CONCLUSAO: Nesta regiao, o tracoma parece nao ter sido erradicado e, portanto, deve permanecer como diagnostico diferencial de conjuntivite folicular cronica em criancas e adolescentes advindos dela.ABSTRACT Purpose: To define the detection rate of trachoma in scholarsfrom Alagoas - Brazil. Methods: The sample included 6,424children and adolescents. Scholar’s clinical evaluation wasperformed by medical students under the supervision of pro-fessors of the Department of Ophthalmology, according to theWorld Health Organization guidelines. The clinical evaluationwas characterized by eyelashes, eyelids, conjunctiva and cor-nea examination in both eyes. The scholars were cataloged anddata of name, sex, age, clinical forms diagnosis and city wererecorded. Regarding the age, the students were divided intothree groups: group A ( 14 years old). Results: The detection rate oftrachoma was 4.5%. From 3,280 male scholars, 161 (4.9%) caseswere confirmed; from 3,144 female scholars, 131 (4.2%) caseswere considered confirmed. From the total scholars in group A,B and C; respectively 175 (5.3%), 113 (8.0%) and 4 (1.6%) wereconsidered confirmed cases.

Avaliação da ação antimicrobiana de soluções multiuso para desinfecção de lentes de contato hidrofílicas, in vitro

PURPOSE To evaluate the efficacy of disinfecting solutions in hydrophilic contact lenses (CL). METHODS Two multi-use solutions denominated solution A (0.001% polyquaternium-1 and 0.0005% myristamidopropyl dimethylamine) and solution B (0.0001% polyaminopropyl biguanide) were used. The solutions were tested in hydrophilic contact lenses infected with Pseudomonas aeruginosa (ATCC27583), Staphylococcus epidermidis (ATCC1226), Klebsiella pneumoniae (ATCC13883), Staphylococcus aureus (ATCC25923) and Candida albicans (ATCC 10231) and the decrease in microorganisms growth after the hydrophilic contact lenses were cleaned with the respective solutions was verified. The manufactures instructions were followed. RESULTS A decrease of 90% of Pseudomonas aeruginosa, Staphylococcus epidermidis, Staphylococcus aureus, Candida albicans and a decrease 100% of Klebsiella pneumoniae was observed. CONCLUSION The solutions decreased the amount of microorganisms tested.OBJETIVO: Avaliar a influencia da acao antimicrobiana das solucoes multiuso para desinfeccao de lentes de contato hidrofilicas. METODOS: Duas solucoes multiuso denominadas solucao A (poliquaternario-1 a 0,001% e miristamidopropil dimetilamina a 0,0005%) e solucao B (poliaminopropil biguanida a 0,0001%) foram testadas em lentes de contato hidrofilicas contaminadas com Pseudomonas aeruginosa (ATCC27583), Staphylococcus epidermidis (ATCC1226), Klebsiella pneumoniae (ATCC13883), Staphylococcus aureus (ATCC25923) e Candida albicans (ATCC 10231) para verificar a quantidade de reducao do crescimento dos microrganismos apos o enxague com as solucoes. Foram seguidas as instrucoes preconizadas pelos fabricantes. RESULTADOS: Houve reducao de 90% do crescimento de Pseudomonas aeruginosa, Staphylococcus epidermidis, Staphylococcus aureus e Candida albicans. Nao houve crescimento de Klebsiella pneumoniae. CONCLUSAO: As solucoes testadas neste trabalho mostraram reducao do numero de microrganismos testados.

Comparação entre dois meios de coleta e transporte para estudo da microbiota conjuntival de indivíduos normais

PURPOSE: To compare the microbiological profile of normal microbiota of healthy people obtained from conjunctival smear using dry swab in Stuarts transport medium and wet swab transported in test tube sealed with cotton. METHODS: A prospective study with random samples, performed at the Departments of Ophthalmology and Pathology of Santa Casa Misericordia de Sao Paulo, in August of 2006. Eighty normal eyes of 40 healthy individuals were analyzed. Samples were collected in the right eye with a dry swab and stored in Stuarts medium, where all microbiological material is kept immersed in the medium and the tube is hermetically sealed. In the left eye, the conjunctival material was collected using a swab embedded in saline solution 0.9%, and stored in dry and sterile test tubes sealed with cotton. The samples were analyzed within 2 hours at most after collection. RESULTS: Out of 40 samples collected with wet swab and transported in dry tube, bacteria were observed in 10 (25%), whereas of 40 samples collected with dry swab and transported in Stuarts medium, 12 (30%) had bacteria. CONCLUSION: The results of the microbiological profile of normal conjunctival microbiota using dry swab in Stuarts medium were statistically similar (p=0.85) to those obtained in wet swab in dry tube for spreading performed within 2 hours after collection of conjunctival specimen.