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Abstract
Purpose
The present study was performed to evaluate the changes in tear film and ocular surface parameters after using sodium hyaluronate (SH) 0.1% alone or in combination with cyclosporine A (CsA) 0.05% in patients with thyroid-associated ophthalmopathy accompanied by dry eye.
Methods
A total of 72 eyes from 36 patients were divided into two groups; 36 eyes of 18 patients were treated with 0.1% SH alone (group 1), and 36 eyes of 18 patients were treated with SH 0.1% and CsA 0.05% (group 2). Tear breakup time (BUT), basal tear secretion test (BST), tear clearance rate (TCR), fluorescein staining (FS) and corneal sensitivity test (CST) were evaluated at pre-treatment and one, three and six months post-treatment. Conjunctival impression cytology was performed and tear CXCL11 (Chemokine (C-X-C motif) ligand) levels were measured pre-treatment and three months post-treatment.
Results
BUT, BST, TCR, KEP and CST were significantly improved at six months in group 1 (p < 0.05) and at three months in group 2 (p < 0.05). The degree of conjunctival squamous cell metaplasia, goblet cell density and tear CXCL11 levels were significantly changed at three months in group 2 (p < 0.05). However, there were no significant changes in group 1 after 3 months.
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Figure 1.
Impression cytologic findings (PAS, ×400) (A,B). Specimen before (A) and 3 months after (B) treatment of topical 0.1% sodium hyaluronate. (A) Loss of goblet cell and large, polygonal epithelial cells with a nucleocytoplasmic ratio of 1:4 or 1:5 (squamous metaplasia grade 2) is visible. (B) Goblet cell density and microscopic findings did not changed after 3 months of treatment. (C, D) Specimen before (C) and 3 months after (D) treatment of topical 0.1% sodium hyaluronate and 0.05% cyclosporine A. (C) Loss of goblet cell and large, polygonal epithelial cells with a nucleocytoplasmic ratio of 1:4 or 1:5 (squamous metaplasia grade 2) were visible. (D) Increased periodic acid-Schiff positive goblet cells and round epithelial cells with a nucleocytoplasmic ratio of 1:3 (squamous metaplasia grade 1) are shown after 3 months of treatment.
Figure 2.
Comparison of tear CXCL11 levels between before and 3 months after treatment with topical 0.1% sodium hyaluronate alone (Group 1) or topical 0.1% sodium hyaluronate and 0.05% cyclosporine A (Group 2).
Table 1.
Changes in tear film and ocular surface parameters before and after treatment with topical 0.1% sodium hyaluronate alone (Group 1) or topical 0.1% sodium hyaluronate and 0.05% cyclosporine A (Group 2)
| | | Baseline | 1 month after treatment | 3 months after treatment | 6 months after treatment |
|---|---|---|---|---|---|
| Tear break up time (sec) | Group 1 | 3.94 ± 1.24 | 3.81 ± 1.19 | 3.78 ± 1.17 | 6.17 ± 2.91* |
| Group 2 | 4.19 ± 1.26 | 4.19 ± 1.28 | 5.89 ± 2.88*† | 7.58 ± 2.60*† | |
| Basal tear secretion (mm) | Group 1 | 4.61 ± 2.09 | 5.03 ± 2.44 | 4.28 ± 2.24 | 8.14 ± 2.59* |
| Group 2 | 4.83 ± 2.30 | 4.47 ± 1.93 | 7.78 ± 2.50*† | 9.28 ± 2.08*† | |
| Tear clearance rate ((log2)-1) | Group 1 | 2.75 ± 0.73 | 2.56 ± 0.69 | 2.39 ± 0.49 | 5.78 ± 0.93* |
| Group 2 | 2.83 ± 2.44 | 2.78 ± 0.72 | 5.28 ± 1.16*† | 5.44 ± 0.84* | |
| Fluorescein staining score | Group 1 | 2.75 ± 0.73 | 2.72 ± 0.74 | 2.75 ± 0.73 | 1.56 ± 0.69* |
| Group 2 | 2.44 ± 1.16 | 2.44 ± 1.18 | 1.39 ± 0.93*† | 1.33 ± 0.86* | |
| Corneal sensitivity (mm) | Group 1 | 54.36 ± 4.13 | 55.56 ± 4.30 | 55.75 ± 3.05 | 58.33 ± 2.39* |
| Group 2 | 54.86 ± 4.22 | 55.28 ± 4.30 | 57.92 ± 2.50*† | 58.06 ± 2.47* |
Table 2.
Changes in impression cytologic findings before and 3 months after treatment in the both groups
| | | Baseline | 3 months after teatment |
|---|---|---|---|
| Group 1 | Conjunctival squamous cell metaplasia (grade) | 2.22 ± 0.88 | 2.00 ± 0.84 |
| Goblet cell density (cell/mm2) | 132.89 ± 60.00 | 127.39 ± 51.91 | |
| Group 2 | Conjunctival squamous cell metaplasia (grade) | 2.33 ± 0.84 | 0.89 ± 0.76*† |
| Goblet cell density (cell/mm2) | 134.56 ± 57.19 | 199.06 ± 39.68*† |
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