不同浓度氟米龙滴眼液治疗儿童重度混合型春季角结膜炎

目的：观察不同浓度氟米龙滴眼液治疗儿童重度混合型春季角结膜炎的临床效果。

方法：选取2022-03/09于我院门诊就诊的重度混合型春季角结膜炎儿童患者50例100眼,随机分为两组,A组患者25例50眼给予0.1%氟米龙滴眼液联合0.05%环孢素滴眼液(Ⅱ)治疗; B组患者25例50眼给予0.02%氟米龙滴眼液联合0.05%环孢素滴眼液(Ⅱ)治疗。治疗1mo,观察两组患者SPEED问卷评分及角膜荧光素染色(FL)评分、泪膜破裂时间(TBUT)、泪液分泌试验(SⅠt)、眼红分析、非侵入式泪河高度(NIKTMH)、角膜光密度等眼部参数,记录不良反应发生情况。

结果：治疗1mo,两组患者SPEED评分、FL评分及眼红分析结果均有显著差异(均P<0.05),TBUT、SⅠt及NIKTMH结果均无差异(均P>0.05),但角膜不同深度、不同直径范围角膜光密度具有差异性(均P<0.05)。治疗1mo,两组患者眼压无显著差异(16.21±2.90mmHg vs 16.05±2.75mmHg,P>0.05),且治疗过程中均未出现明显不良反应。

结论： 0.1%氟米龙滴眼液可有效治疗儿童重度混合型春季角结膜炎,效果优于0.02%氟米龙滴眼液。     

Treatment of vernal keratoconjunctivitis a double-masked study

Thirty-one children aged five to 14 years with severe vernal keratoconjunctivitis (VKC) were enrolled in a double-masked study evaluating the efficacy of three ophthalmic preparations: cromolyn sodium (Opticrom) 2%, artificial tears and fluorometholone 0.1% (FML). These drugs were coded respectively as A, B, C, and dispensed in similar bottles. Both eyes were treated, and drug assignment was made at random.

Objective assessment of the disease activity was done under slit lamp by two ophthalmologists according to a five-point scale. The results were tabulated and the chi-square test performed. Decoding of the drugs was done only after completion of the statistical analysis. FML was found effective with a statistically significant difference from the other two drugs, both after the first week on the initially assigned treatment (p = 0.05) and on completion of the treatment period according to protocol (p = 0.005). Although several patients improved under cromolyn sodium, there was no statistically significant difference between cromolyn sodium 2% and artificial tears. All the preparations were well tolerated. One patient developed bilateral allergic blepharitis when treated with FML during the study. Another patient who responded well to FML developed posterior subcapsular cataract while continuing treatment with corticosteroids a few months after completion of the study.     

Topical 2% cyclosporine A in preservative-free artificial tears for the treatment of vernal keratoconjunctivitis

BACKGROUND: A double-masked, placebo-controlled trial to evaluate the short-term efficacy and safety of topical 2% cyclosporine A in preservative-free artificial tears for patients with vernal keratoconjunctivitis. METHODS: Twenty patients with severe vernal keratoconjunctivitis were included in the study. All were treated with topical 2% cyclosporine A eye drops. One eye of each patient was administered 2% cyclosporine A in preservative-free artificial tears; the fellow eye received the placebo (vehicle) for the first 2 weeks, in a double-masked, placebo-controlled trial. Thereafter, the placebo eye received cyclosporine A (open trial). Symptoms and signs were scored on the day of enrollment and at the end of week 2, 4, and 14. RESULTS: At the end of week 2, no statistically significant decrease was noted from baseline in mean scores of either signs (p = 0.18) or symptoms (p = 0.50) in the eyes that received placebo. On the other hand, a statistically significant decrease was observed in both sign and symptom scores (p < 0.001, for both) of eyes that received cyclosporine A. Significant differences were also noted at 2 weeks in mean scores of both signs and symptoms (p < 0.001, for both) between the eyes that received cyclosporine A and those that received placebo. At week 4 and 14, statistically significant decreases in both sign scores and symptom scores were noted compared with baseline in the eyes that received cyclosporine A and in the eyes that had initially received placebo (p < 0.001, for all). INTERPRETATION: Topical 2% cyclosporine A in preservative-free artificial tears is effective in alleviating signs and symptoms of patients with severe vernal keratoconjunctivitis and had no observed side effects over the course of the study.     

Efficacy of topical cyclosporin A 0.05% in conjunctival impression cytology specimens and clinical findings of severe vernal keratoconjunctivitis in children

Purpose  To evaluate the efficacy of topical cyclosporin A 0.05% in managing the symptoms of severe vernal keratoconjunctivitis (VKC). Methods  Fifty-four children with severe VKC were included in this study. All 54 patients were treated with topical cyclosporin A (CsA) 0.05% for 3 months. Ocular signs and symptoms were scored in all patients at entry and after 3 months. Conjunctival impression cytology specimens were examined on the day of enrollment and at the end of the treatment period. Results  The mean scores for severity of signs and symptoms significantly decreased after 3 months compared with those at entry (P < 0.001). The density of inflammatory cells in the conjunctival impression cytology specimens decreased significantly. No side effects of the treatment with CsA 0.05% eyedrops were observed. Conclusions  Topical CsA 0.05% eyedrops were found to be safe and effective in the treatment of patients with VKC. Consistent with these results, topical CsA may efficiently reduce conjunctival inflammation in severe VKC.     

对春季卡他性角结膜炎联合用药的治疗观察

目的：探讨组胺H1受体拮抗剂联合治疗春季卡他性角结膜炎的疗效.方法：口服仙特敏片,外滴10g/L苯海拉明眼液治疗患者30例,其中睑结膜型16例,混合型7例,角膜缘型6例,角膜溃疡1例.结果：2个疗程痊愈者18例,占60%,3～4个疗程者6例,占20%,4个疗程以上者4例,占13%.总治愈率93%.结论：联合用药治疗春季卡他性角结膜炎疗效较好,作用迅速,易接受.     

他克莫司治疗春季卡他性角结膜炎的疗效分析

目的：评价免疫抑制剂——他克莫司滴眼液治疗春季卡他性角结膜炎(vernal keratoconjunctivitis,VKC)的治疗效果。

方法：随机双盲试验,安慰剂对照。收集四川大学华西医院眼科16例门诊患者,将16例患者按就诊顺序随机分为治疗组与对照组。治疗组使用他克莫司滴眼液,对照组使用他克莫司滴眼液基础液,观察期为28d。对研究眼眼部体征和自觉症状分别进行单项评分,以治疗前后眼部体征总分变化量为主要疗效指标,主观症状为次要疗效指标。

结果：(1)组内比较：两组症状和体征在用药前后的差异具有统计学意义,治疗组用药后各个时期的自觉症状评分均低于用药前,且随着时间推移,症状评分逐渐降低,差异有统计学意义,对照组用药后不同时期之间的差异无统计学意义。(2)组间比较：两组患者的主观症状和体征在用药前和用药后第一次复查时差异无统计学意义,之后两次复查差异均具有统计学意义。评分变化量(用药前评分-用药后评分)在用药后第一次复查时差异无统计学意义,之后两次复查差异均具有统计学意义。

结论：他克莫司滴眼液能改善VKC患者的体征与症状,对于使用抗过敏滴眼液无明显改善的VKC,具有迅速、优良的改善效果,可应用于临床。     

Efficacy of olopatadine HCI 0.1%, ketotifen fumarate 0.025%, epinastine HCI 0.05%, emedastine 0.05% and fluorometholone acetate 0.1% ophthalmic solutions for seasonal allergic conjunctivitis: a placebo‐controlled environmental trial

Purpose: We aimed to compare the clinical efficacy and ocular surface variables of olopatadine, ketotifen fumarate, epinastine, emedastine and fluorometholone acetate ophthalmic solutions in preventing the signs and symptoms of seasonal allergic conjunctivitis (SAC). Methods: This was a prospective, randomized, double‐blinded and placebo‐controlled study. A total of 100 patients with SAC were randomly assigned to one of five groups, in which they were administered olopatadine, ketotifen fumarate, epinastine, emedastine or fluorometholone acetate, instilled twice daily for 2 weeks. One eye of each patient was treated with the study drug and the other was treated with a placebo. Signs and symptoms of allergic conjunctivitis (itching, redness, tearing, chemosis and eyelid swelling) were scored on a 4‐point scale. Each symptom was assessed at baseline and then again after 1 and 2 weeks of treatment. Ocular surface variables were assessed by conjunctival impression cytology. Results: At weeks 1 and 2, all antiallergic agents were significantly more effective than placebo in alleviating itching, redness, tearing, chemosis and eyelid swelling. Fluorometholone acetate was significantly less effective than the other agents in reducing itching and redness at all control visits. Ocular surface findings by impression cytology improved significantly after all treatments compared with placebo. Conclusions: In patients with SAC, olopatadine, ketotifen, epinastine and emedastine are more efficacious than fluorometholone acetate in preventing itching and redness. All the antiallergic agents gave similar results in terms of reducing tearing, chemosis and eyelid swelling. Our data showed that impression cytology parameters improved after treatment with antiallergic agents in patients with SAC.     

Supplementation of fexofenadine therapy with nedocromil sodium 2% ophthalmic solution to treat ocular symptoms of seasonal allergic conjunctivitis

Purpose: Ocular symptoms are often under‐treated in patients with allergic rhinoconjunctivitis. The efficacy of fexofenadine hydrochloride 60 mg capsules supplemented with nedocromil sodium 2% ophthalmic solution was evaluated to determine the optimal drug regimen for control of ocular allergic symptoms. Methods: In this 5‐week, open‐label, randomized, multicentre comparative study, 89 patients with documented ragweed pollen allergy received fexofenadine b.i.d. with nedocromil rescue, fexofenadine q.d. with nedocromil b.i.d., or fexofenadine rescue with nedocromil b.i.d. during the ragweed pollen season. Results: For all regimens, mean symptom severity scores for itching, burning, tearing, redness, grittiness, discharge, light sensitivity and swelling improved significantly (P < 0.003). Similarly, all groups experienced significant (P < 0.02) improvement in all clinical signs: erythema, oedema, discharge, conjunctival injection and conjunctivitis, as well as quality‐of‐life scores (P < 0.0001). All regimens reduced overall symptom severity scores after 5 min (P < 0.05) with relief persisting over 12 h (P < 0.03). Improvements in mean symptoms, signs and quality‐of‐life scores were similar among the treatment groups as were onset and duration of action even though patients in two of the three study arms were taking one‐half or less of the recommended fexofenadine dosage. Patients and physicians judged the regimens containing lower fexofenadine dosages (with nedocromil b.i.d.) to be more effective overall than the regimen containing the highest fexo­fenadine dosage (with nedocromil as rescue only). Conclusions: Supplementation of oral fexofenadine therapy with nedocromil sodium 2% ophthalmic solution relieves ocular symptoms of seasonal allergic rhinoconjunctivitis, allowing control of rhinal symptoms with half the recommended dosage of fexofenadine.     

Clinical,histological and immunohistochemistry characteristics of cornea in the sequelae stage of chronic vernal keratoconjunctivitis

Purpose:To report the clinical outcomes and histopathological and immunohistochemistry (IHC) features in eyes with the sequelae stage of vernal keratoconjunctivitis (VKC).Methods:Investigative study of corneal samples obtained following surgical intervention for vision restoration in four eyes of three patients with VKC. Patient 1 (an 11-year-old boy) had deep anterior lamellar keratoplasty in both eyes, Patient 2 (a 24-year-old male) underwent superficial keratectomy followed by penetrating keratoplasty, and Patient 3 (a 22-year-old male) underwent penetrating keratoplasty. The corneal samples retrieved after surgical intervention were assessed for histology features and immunohistochemistry (IHC) studies.Results:The grafts were clear till the follow-up of 2–18 months. Histopathology of all four corneal samples showed epithelial hyperplasia, absent Bowman layer, thick hyalinized stromal lamellae, vascularization, and chronic inflammatory cells such as lymphocytes and plasma cells. IHC showed strong expression of CK 3 in both eyes of Patient 1 and no expression in Patients 2 and 3. The marker for limbal stem cells, ABCG2, was absent in all four samples; however, p63α was expressed strongly in Patients 2 and 3, moderately in the right eye of Patient 1, and marginally expressed in the left eye of Patient 1.Conclusion:The eyes in the sequelae stage of VKC (having corneal scarring and 360° hypertrophied limbus) can be managed favorably with keratoplasty and amniotic membrane transplantation without allogenic/cadaveric stem cell transplantation. The expression of transient progenitor cells in the scarred corneas of VKC patients in the sequelae stage suggests that the limbal stem cell dysfunction is more likely partial and self-renewal of limbal stem cells is a plausibility in these eyes.     

结膜乳头磨削术治疗重度春季角结膜炎的临床研究

目的:观察并评估结膜乳头磨削术治疗重度春季角结膜炎巨大结膜乳头的安全性和有效性。方法:前瞻性、对照性临床病例研究。比较结膜乳头磨削术(8例12眼)与结膜乳头切除术(9例12眼)两种方法治疗巨大结膜乳头,手术前后的眼痒、流泪、畏光、异物感等症状和结膜乳头、角膜上皮等体征的变化情况。结果:两组病例术后1,2,4wk不适症状、体征明显改善,与术前相比统计学差异有显著性意义(P<0.01)。但术后1,2,4wk巨大结膜乳头体征、术后2wk角膜损伤修复情况等评分,磨削治疗组治疗效果优于手术切除组(P<0.05)。结论:结膜乳头磨削术能使粗糙的结膜创面快速变平,减轻不适症状,促进角结膜上皮修复,是治疗重度春季角结膜炎巨大结膜乳头的简单、安全、有效的治疗方式。     

Comparison of the anti-inflammatory effects of fluorometholone 0.1% combined with levofloxacin 0.5% and tobramycin/dexamethasone eye drops after cataract surgery

AIM: To compare the combination of fluorometholone 0.1% and levofloxacin 0.5% to tobramycin/dexamethasone eye drops in controlling inflammation and preventing infection after phacoemulsification with an intraocular lens implantation. METHODS: Sixty eyes from 60 patients undergoing cataract phacoemulsification were randomized into two groups; half of the patients were treated with fluorometholone (6 times/d) combined with levofloxacin (4 times/d), while the other half were treated with tobramycin/dexamethasone (4 times/d) eye drops for one week. Preoperative and postoperative intraocular pressure, aqueous flare, corneal thickness, and signs and symptoms were recorded before the operation and 1wk following treatments. RESULTS: There were no statistically significant differences between the two groups in corneal thickness (P≥0.629), aqueous flare (P≥0.398), and signs and symptoms scores (P≥0.350) at each time point. Ocular hypertension was only observed in two eyes in the tobramycin/dexamethasone group. CONCLUSION: Fluorometholone combined with levofloxacin treatment shows comparable efficacy but without the tendency to increase intraocular pressure; thus, it might be a better regimen for postoperative use.     

Effectiveness of a modified therapeutic protocol for the management of vernal keratoconjunctivitis based on Bonini’s graded clinical severity

Purpose:To evaluate the effectiveness of a modified therapeutic protocol used for vernal keratoconjunctivitis (VKC) based on severity as per Bonini grading system.Methods: This was a prospective observational clinical study conducted with 123 eyes of 63 patients. A meticulous clinical examination was performed, and data was documented in all the cases. Patients on known systemic atopy and antiallergic therapy were excluded from the study. Eyes with a clinical diagnosis of VKC were segregated based on Bonnini’s grading system. A treatment protocol was created depending on the grade of VKC. Therapeutic responses were documented at 3 weeks, 3 months, 6 months, 12 months, and 24 months. Grading of the eyes was performed in each visit.Results: The mean age of the patients was 8.85 years with a standard deviation of 4.48 years. Males were predominant, and 95.24% had bilateral manifestation. The palpebral component was the most common form of manifestation. Itching was the most common manifestation, followed by congestion, discharge, and papillae in a decreasing order. Also, 68% of patients were in grade 2, 14% in grade 3, 12% in grade 1, and the rest were in grade 4. Following the treatment protocol, 70% showed signs of significant improvement in grade by the end of 6 weeks, reaching 90% at the end of 6 months (P = 0.074) and 92% at the end of 12 months (P = 0.002). Also, 52.4% versus 77.8% of patients had no recurrence in the pre- versus posttreatment protocol and it was statistically significant (P = 0.001).Conclusion: Grading of VKC gives a clear evaluation of the severity and progression of the condition. Besides, significant improvement in the grades was observed with fewer incidences of recurrences following execution of the therapeutic protocol. Hence, it is essential to maintain a treatment protocol in our clinical practice to provide grade-based therapy and monitor accurate changes in the clinical condition.     

亚洲春季角结膜炎的诊疗规范：2022年亚洲专家共识解读

春季角结膜炎(VKC)是一种反复发作的眼部过敏性疾病,其特征表现为双侧眼表慢性炎症,若不及时干预,可导致眼表不可逆性损伤甚至失明。《亚洲春季角结膜炎的诊断、管理和治疗：亚洲春季角结膜炎管理专家工作组的建议》详细介绍了VKC的最新管理方法。本文就该共识进行全面解读,旨在进一步提高广大医务工作者诊断和治疗VKC的水平,以便更好地服务于广大眼病患者。     

A randomised,double masked,multicentre clinical trial comparing bimatoprost and timolol for the treatment of glaucoma and ocular hypertension

Aim: To evaluate the safety and efficacy of bimatoprost 0.03% once daily or twice daily compared with timolol 0.5% twice daily in patients with glaucoma or ocular hypertension. METHODS: Multicentre, double masked, randomised, parallel group, 3 month trial comparing bimatoprost once daily (n=240), bimatoprost twice daily (n=240), and timolol twice daily (n=122). The primary efficacy end point was diurnal intraocular pressure (IOP) (8 am, 10 am, 4 pm). Safety measures included adverse events, ocular parameters, and systemic variables. RESULTS: Bimatoprost once daily provided significantly lower mean IOP than timolol twice daily at all times and follow up visits (p<0.001). At month 3, mean IOP reductions from baseline at 10 am (peak timolol effect) were bimatoprost once daily, 8.0 mm Hg (32.4%); bimatoprost twice daily, 6.3 mm Hg (25.2%); timolol, 5.5 mm Hg (22.7%). Bimatoprost twice daily was also more effective than timolol, but was not as effective as bimatoprost once daily. A higher percentage of patients achieved low target pressures with bimatoprost once daily than with timolol. The most frequent side effects with bimatoprost were eyelash growth and mild conjunctival hyperaemia. Systemic safety parameters were not affected by bimatoprost. CONCLUSIONS: Bimatoprost 0.03% once daily demonstrated superior efficacy compared with timolol 0.5% twice daily in patients with elevated IOP. Bimatoprost once daily was more effective than twice daily dosing.     

Randomised double masked trial comparing the efficacy and tolerance of 0.05% mequitazine eye drops versus 0.05% levocabastine and placebo in allergic conjunctivitis induced by a conjunctival provocation test with Dermatophagoides pteronyssinus

AIM: A double masked randomised trial comparing 0.05% mequitazine eye drops with 0.05% levocabastine and placebo was carried out in otherwise healthy volunteers allergic to house dust mites (Dermatophagoides pteronyssinus). METHOD: Double masked, randomised, single centre study, comparing three parallel treatment groups. 60 healthy adults with a confirmed history of allergic conjunctivitis to house dust mites for at least 2 years were included and completed the trial. Conjunctival provocation tests (CPT) were done at screening, at visit 2 (V2) (1 week later), and at visit 3 (V3) (2 weeks after V2). Treatment was instilled in the same eye, 5 minutes after the CPT at V2, and twice daily until V3. CPT were scored 5, 10, 15, and 60 minutes after instillation of the dose of Dermatophagoides pteronyssinus antigen determined at inclusion (V2, curative test) or resulting in positivity (V3, preventive test) RESULTS: In the V2 (curative) test the difference between the active treatments and placebo on the redness+itching scores was not significant. At the V3 (preventive) CPT there was a lower number of reactions at the threshold dose with mequitazine (20%) compared to placebo (60%, p = 0.01) or levocabastine (45%, p = 0.10). CONCLUSION: This trial failed to clearly demonstrate curative superiority of topical antihistamines with placebo, when a single dose of treatment was instilled following CPT. However mequitazine 0.05% eye drops were superior to placebo in preventing a reaction to CPT, after 2 weeks of treatment.     

Contact lens induced keratopathy: a severe complication extending the spectrum of keratoconjunctivitis in contact lens wearers

A 21-year-old woman developed bilateral keratoconjunctivitis from contact lens wear, which progressed to diffuse corneal scarring and vascularization after the patient refused to discontinue wearing contact lenses. The visual disturbance became so severe that a penetrating keratoplasty had to be performed in one eye for visual rehabilitation. Examination of the penetrating keratoplasty specimen disclosed destruction of Bowman's membrane throughout the superior half of the cornea, which was replaced by a fibrous scar that was only midly chronically inflamed. Deep vascularization occurred within the stroma. This case represents an extreme expression of a recently characterized syndrome consisting of conjunctival and corneal changes in patients who may be allergic to contact lenses or the solutions used in conjunction with their care. In the milder end of the spectrum, there is superior epibulbar conjunctival injection with associated tarsal injection, and a mild superficial punctate keratopathy without filaments. Some earlier workers have termed this syndrome a variant of superior limbic keratoconjunctivitis in association with contact lens wear, but this leads to confusion with Theodore's classical superior limbic keratoconjunctivitis, to which the present entity bears no etiologic relationship; it also fails to show many of the findings of Theodore's disease. In mild cases, we would recommend the term contact lens-induced keratoconjunctivitis, and in the more severe cases, such as demonstrated by our patient, we would suggest the term contact lens-induced keratopathy.     

Metipranolol 0.1% and pilocarpine 2% as a fixed combination compared to each substance alone in the treatment of glaucoma. A controlled, randomized clinical study comparing the intraindividual effects and tolerance

A fixed combination of pilocarpine 2% and metipranolol 0.1% was found to have a better pressure-lowering effect than pilocarpine 2% alone or metipranolol 0.1% alone, as well as being tolerated well, both subjectively and objectively. In many cases only the fixed combination was successful in lowering intraocular pressure to tolerable values.