Effect of Sodium Hyaluronate and Cyclosporine A on Tear Film in Dry Eye Syndrome

In Boem Chang; Jung Hyun Park; Moo Sang Kim; Tai Jin Kim

doi:10.3341/jkos.2013.54.2.231

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Chang, Park, Kim, and Kim: Effect of Sodium Hyaluronate and Cyclosporine A on Tear Film in Dry Eye Syndrome

Original Article

J Korean Ophthalmol Soc 2007;54(2):231-236.

Published online: 24 August 2007

DOI: https://doi.org/10.3341/jkos.2013.54.2.231

Effect of Sodium Hyaluronate and Cyclosporine A on Tear Film in Dry Eye Syndrome

In Boem Chang, MD, Jung Hyun Park, MD, Moo Sang Kim, MD, Tai Jin Kim, MD

Department of Ophthalmology, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea

Address reprint requests to Tai Jin Kim, MD, Department of Ophthalmology, Inje University Seoul Paik Hospital, #9 Mareunnae-ro, Jung-gu, Seoul 100-032, Korea Tel: 82-2-2270-0082, Fax: 82-2-2266-6159, E-mail: lasiklove@hanmail.net

Received 30 January 201222 July 2012 Accepted 24 November 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the efficacy of topical 0.1% hyaluronate (HA) and 0.05% cyclosporine A on tear film parameters in dry eye syndrome patients.

Methods

Patients who were diagnosed with dry eye syndrome were treated with 0.1% HA only (Group 1, 46 eyes) or 0.1% HA combined with cyclosporine A (Group 2, 54 eyes). Ocular surface disease index (OSDI), tear film break-up time (BUT), Schirmer's test, and tear osmolarity were evaluated before treatment and at 1, 2, 3, and 6 months after treatment.

Results

OSDI was significantly improved at 2 months after treatment and Schirmer's test results significantly improved at 1 month after treatment in both groups. The BUT was significantly improved 3 months after treatment in Group 1 and at 1 month after treatment in Group 2. Tear osmolarity significantly improved at 1 month after treatment in both groups, but continuously improved up to 6 months after treatment only in Group 2. The BUT and Schirmer's test showed greater improvements in Group 2 than in Group 1.

Conclusions

Combined treatment of topical 0.1% HA and 0.05% cyclosporine A may be more effective for improving dry eye syndrome.

Keywords: Cyclosporine, Dry eye syndrome, Restasis, Tear osmolarity

References

1. Byun YS, Jeon EJ, Chung SK. Clinical effect of cyclosporine 0.05% eye drops in dry eye syndrome patients. J Korean Ophthalmol Soc. 2008; 49:1583–8.

2. Pflugfelder SC, Tseng SC, Sanabria O, et al. Evaluation of subjective assessments and objective diagnostic tests for diagnosing tear-film disorders known to cause ocular irritation. Cornea. 1998; 17:38–56.

3. Lemp MA, Baudouin C, Baum J, et al. The definition and classification of dry eye disease: report of the Definition and Classification. Subcommittee of the International Dry Eye Work Shop (2007). Ocul Surf. 2007; 5:75–92.

4. Pflugfelder SC, Solomon A, Stern ME. The diagnosis and management of dry eye: a twenty-five-year review. Cornea. 2000; 19:644–9.

5. Stern ME, Beuerman RW, Fox RI, et al. The pathology of dry eye: the interaction between the ocular surface and lacrimal glands. Cornea. 1998; 17:584–9.

6. Stern ME, Gao J, Siemasko KF, et al. The role of the lacrimal functional unit in the pathophysiology of dry eye. Exp Eye Res. 2004; 78:409–16.

7. Smith VA, Rishmawi H, Hussein H, Easty DL. Tear film MMP accumulation and corneal disease. Br J Ophthalmol. 2001; 85:147–53.

8. Solomon A, Dursun D, Liu Z, et al. Pro- and anti-inflammatory forms of interleukin-1 in the tear fluid and conjunctiva of patients with dry-eye disease. Invest Ophthalmol Vis Sci. 2001; 42:2283–92.

9. Argüeso P, Balaram M, Spurr-Michaud S, et al. Decreased levels of the goblet cell mucin MUC5AC in tears of patients with Sjögren syndrome. Invest Ophthalmol Vis Sci. 2002; 43:1004–11.

10. Kunert KS, Tisdale AS, Gipson IK. Goblet cell numbers and epithelial proliferation in the conjunctiva of patients with dry eye syndrome treated with cyclosporine. Arch Ophthalmol. 2002; 120:330–7.

11. Hom MM. Use of cyclosporine 0.05% ophthalmic emulsion for contact lens-intolerant patients. Eye Contact Lens. 2006; 32:109–11.

12. Liu H, Begley C, Chen M, et al. A link between tear instability and hyperosmolarity in dry eye. Invest Ophthalmol Vis Sci. 2009; 50:3671–9.

13. O'Brien PD, Collum LM. Dry eye: diagnosis and current treatment strategies. Curr Allergy Asthma Rep. 2004; 4:314–9.

14. Stern ME, Pflugfelder SC. Inflammation in dry eye. Ocul Surf. 2004; 2:124–30.

15. Pflugfelder SC, Jones D, Ji Z, et al. Altered cytokine balance in the tear fluid and conjunctiva of patients with Sjögren's syndrome keratoconjunctivitis sicca. Curr Eye Res. 1999; 19:201–11.

16. Stern ME, Gao J, Schwalb TA, et al. Conjunctival T-cell sub-populations in Sjögren's and non-Sjögren's patients with dry eye. Invest Ophthalmol Vis Sci. 2002; 43:2609–14.

17. Fei WL, Chen JQ, Du X, et al. [Dry eye in graft-versus-host disease]. Zhonghua Yan Ke Za Zhi. 2003; 39:686–90.

18. Ogawa Y, Kuwana M. Dry eye as a major complication associated with chronic graft-versus-host disease after hematopoietic stem cell transplantation. Cornea. 2003; 22:S19–27.

19. Ogawa Y, Okamoto S, Wakui M, et al. Dry eye after haematopoietic stem cell transplantation. Br J Ophthalmol. 1999; 83:1125–30.

20. Lee JS, Yoon TJ, Kim KH. Cinical effect of Restasis^® eye drops in mild dry eye syndrome. J Korean Ophthalmol Soc. 2009; 50:1489–94.

21. Borel JF, Baumann G, Chapman I, et al. In vivo pharmacological effects of ciclosporin and some analogues. Adv Pharmacol. 1996; 35:115–246.

22. Laibovitz RA, Solch S, Andriano K, et al. Pilot trial of cyclosporine 1% ophthalmic ointment in the treatment of keratoconjunctivitis sicca. Cornea. 1993; 12:315–23.

23. Power WJ, Mullaney P, Farrell M, Collum LM. Effect of topical cyclosporin A on conjunctival T cells in patients with secondary Sjöngren's syndrome. Cornea. 1993; 12:507–11.

24. Vanley GT, Leopold IH, Gregg TH. Interpretation of tear film breakup. Arch Ophthalmol. 1977; 95:445–8.

25. Nichols KK, Mitchell GL, Zadnik K. The repeatability of clinical measurements of dry eye. Cornea. 2004; 23:272–85.

26. Nelson JD, Wright JC. Tear film osmolality determination: an evaluation of potential errors in measurement. Curr Eye Res. 1986; 5:677–81.

27. White KM, Benjamin WJ, Hill RM. Human basic tear fluid osmolality. I. Importance of sample collection strategy. Acta Ophthalmol (Copenh). 1993; 71:524–9.

28. Gilbard JP, Farris RL, Santamaria J 2nd. Osmolarity of tear micro-volumes in keratoconjunctivitis sicca. Arch Ophthalmol. 1978; 96:677–81.

29. Tomlinson A, Khanal S, Ramaesh K, et al. Tear film osmolarity: determination of a referent for dry eye diagnosis. Invest Ophthalmol Vis Sci. 2006; 47:4309–15.

30. Wilson SE, Perry HD. Long-term resolution of chronic dry eye symptoms and signs after topical cyclosporine treatment. Ophthalmology. 2007; 114:76–9.

31. Barber LD, Pflugfelder SC, Tauber J, Foulks GN. Phase III safety evaluation of cyclosporine 0.1% ophthalmic emulsion administered twice daily to dry eye disease patients for up to 3 years. Ophthalmology. 2005; 112:1790–4.

Figure 1.

Changes and differences of tear osmolarity in 2 groups during follow up (mOsm/L). Mean tear osmolarity at baseline and after treatment with topical 0.1% sodium hyaluronate alone (group 1) versus after treatment with topical 0.1% sodium hyaluronate and 0.05% cyclosporine A (group 2). The decrease from baseline in tear osmolarity was statistically significant only at 1 month in group 1, then at 1, 2, 3 and 6 months in group 2. Differences of tear osmolarity in both groups were statistically significant at 3 and 6 months. ∗ p < 0.05 difference between 2 groups.

Table 1.

Changes in tear film and ocular surface parameters before and after treatment with topical 0.1% sodium hyaluronate alone (Group 1)

	Baseline	1 month after treatment	2 months after treatment	3 months after treatment	6 months after treatment
OSDI	38.47 ± 5.85	37.61 ± 5.12	32.57 ± 5.63^∗	30.06 ± 4.97^∗	29.82 ± 4.88^∗
Tear film break-up time (sec)	5.07 ± 1.48	4.83 ± 1.12	5.00 ± 1.23	6.13 ± 1.24^∗	6.26 ± 1.30^∗
Schirmer's test (mm)	6.91 ± 3.97	7.78 ± 3.56^∗	8.13 ± 3.56^∗	8.71 ± 3.93^∗	8.26 ± 3.99^∗
Tear osmolarity (mOsm/L)	318.98 ± 17.59	315.93 ± 14.67^∗	314.15 ± 15.39^∗	313.28 ± 15.66^∗	313.76 ± 15.11^∗

Values are presented as mean ± SD. OSDI = ocular surface disease index.

^∗ p < 0.05 compared with baseline.

Table 2.

Changes in tear film and ocular surface parameters before and after treatment with topical 0.1% sodium hyaluronate and 0.05% cyclosporine A (Group 2)

	Baseline	1 month after treatment	2 months after treatment	3 months after treatment	6 months after treatment
OSDI	39.21 ± 5.13	38.41 ± 5.67	28.12 ± 5.24^∗	25.34 ± 4.69^∗	23.93 ± 4.45^∗
Tear film break-up time (sec)	4.44 ± 1.40	5.35 ± 1.50	6.06 ± 1.88^∗	7.00 ± 1.81^∗	7.67 ± 2.11^∗
Schirmer's test (mm)	8.07 ± 4.84	8.92 ± 4.60^∗	9.69 ± 4.82^∗	11.76 ± 6.36^∗	13.07 ± 6.95^∗
Tear osmolarity (mOsm/L)	318.24 ± 19.75	314.94 ± 16.56^∗	310.13 ± 16.29^∗	301.19 ± 13.42^∗	300.50 ± 13.66^∗

Values are presented as mean ± SD.

OSDI = ocular surface disease index.

^∗ p < 0.05 compared with baseline.

Table 3.

Comparisons in tear film break up time, Schirmer's test, and tear osmolarity from baseline measured at final follow up (t-test) in both groups

	Group 1 (Mean ± SD)	Group 2 (Mean ± SD)	p-value (Group 2 - Group 1)
Tear film break-up time (sec)	1.19 ± 1.13	3.24 ± 1.82	0.03
Schirmer's test (mm)	1.35 ± 1.48	5.03 ± 5.83	0.02
Tear osmolarity (mOsm/L)	5.35 ± 5.06	17.63 ± 16.44	<0.01

Values are presented as mean ± SD.

SD = standard deviation.

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