Journal List > J Korean Ophthalmol Soc > v.51(8) > 1008610

Joo, Chun, and Kim: Clinical Effects of Combination Therapy Using Heparin and Phospholipid in Severe Dry Eye Syndrome

Abstract

Purpose

To evaluate the therapeutic effects of topical heparin (Hylo-Parin®, Ursapharm Saarbr cken, Germany) and spray type phospholipids (Tears Again®, Optima Pharmazeutische GmbH. Freising, Germany) in severe dry eye syndrome resistant to conventional therapy.

Methods

Twenty eyes of ten patients with refractory severe dry eye were treated with Hylo-Parin® (two times a day) and Tears Again® (three times a day) for three months. Before and one and three months after treatment, a symptom questionnaire was administered to the patients. The ocular surface disease index (OSDI), tear film breakup time, Schirmer test, conjunctival fluorescein staining examinations and filamentary keratitis were evaluated.

Results

After using Tears Again® and Hylo-Parin®, the OSDI score improved from 64.13 ± 15.12 to 43.80 ± 15.87 (p<0.01). Tear film breakup time significantly increased from 1.0 ± 0.65 to 2.3 ± 0.73 seconds (p<0.01) and conjunctival staining score (Oxford scale) significantly decreased from 3.85 ± 0.75 to 3.25 ± 0.97 (p<0.01). Filamentary keratitis in the slit-lamp examination showed significant improvement (p<0.01).

Conclusions

Tears Again® and Hylo-Parin® are considered as new treatment modalities for severe dry eye syndrome and filamentary keratitis in patients with chronic ocular surface disease resistant to conventional therapy. These treatments require additional research.

References

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Figure 1.
Changes in ocular surface disease index score (A), Tear breakup time (B), Schirmer test (C) and Oxford grading (D) before and 1, 3 months after treatment with Hylo-Parin® and Tears Again®.
jkos-51-1047f1.tif
Figure 2.
Amounts of BUT change in BUT 20 eyes. After treatment for 3 months, BUT increased by 2 seconds in 9 eyes and 1 second in 6 eyes. There was no interval change in BUT in 5 eyes.
jkos-51-1047f2.tif
Figure 3.
Patient with keratoconjunctivitis sicca and filamentary keratitis were treated with Tears Again® and Hylo-Parin®. The right eye shows severe corneal erosions (A). After 3-months treatment, corneal erosions are healed (B). Left eye shows severe corneal erosions and filaments (C). After 3-months treatment, corneal erosions and filaments are improved (D).
jkos-51-1047f3.tif
Figure 4.
In patient with a history of recurrent herpetic epithelial keratitis, corneal erosion, plaque, and filaments are observed (A). Three months after treatment with Tears Again® and Hylo-Parin®, multiple filaments and corneal erosions disappeared completely (B).
jkos-51-1047f4.tif
Table 1.
Constituents of Tears Again® and Hylo-Parin® (1 ml contains)
Tears again® constituents 1 ml contains Hylo-Parin® constituents 1 ml contains
Soy lecithin 10 mg Heparin 1,300 IU
Sodium chloride 8 mg Sodium Hyaluronate 1 mg
Ethanol 8 mg Glycerol <0.1
Phenoxyethanol 5 mg Water 1
Vitamin A palmitate 0.25 mg Preservatives
Vitamin E 0.02 mg    
Water 1    
Preservatives    
Total volume 10 ml Total volume 10 ml
Table 2.
Demographic data
No Sex /Age Systemic disease Disease activity Prior treatment Eye BUT. Oxford grade Filament (grade)
1 F/27 SJS Stable Serum, CsA, Punc Right 1 4 3
          Left 1 4 3
2 F/66 SS Stable Serum, steroid, Punc, BCL Right 0 5 3
          Left 0 5 0
3 M/61 Chemical burn Stable Serum, steroid, AMT Right 2 3 0
          Left 2 3 2
4 M/45 GVHD Stable Serum, steroid, BCL Right 2 4 2
          Left 2 4 1
5 F/57 SJS Stable Serum, steroid, AMT Right 1 4 0
          Left 1 4 1
6 M/67 HSK Stable Steroid, Punc, BCL Right 1 5 0
          Left 1 5 1
7 F/70 Chemical burn Stable Serum, steroid, AMT Right 1 3 1
          Left 1 3 1
8 F/79 None Serum, steroid, Punc Right 1 3 0
          Left 0 3 0
9 F/63 SS Stable Serum, CsA, Steroid, Punc Right 0 4 1
          Left 1 4 2
10 F/71 SS Stable Serum, steroid, Punc, BCL Right 1 4 1
          Left 1 3 0
The patients used artificial tears, gel, topical steroids, bandage contact lens and punctual occlusion. SJS=Stevens-Johnson syndrome; Serum =autologous serum; CsA=cyclosporine A; Punc=punctual occlusion; SS=Sjögren's syndrome; BCL=bandage contact lens; HSK=herpes simplex keratitis; Steroid=topical steroids; AMT=amniotic membrane transplantation.
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