New Possibilities for Hyposecretory Dry Eye Treatment

Purpose: to evaluate the effectiveness of a fixed combination of 0.24 % hyaluronic acid, carbomer, glycerol and a lipid component in the hyposecretory dry eye treatment. Patients and methods. We examined 35 hyposecretory moderate dry eye (DE) patients in conditions of lipidaquas-mucin deficiency and meibomian gland dysfunction (MGD). All patients included in the study received instillations of a fixed combination of 0.24 % hyaluronic acid (in the form of sodium hyaluronate), carbomer, glycerol and a lipid component (in the form of medium chain triglycerides) — Artelak Night (3 times a day, 2 months). The main criterion for the effectiveness of therapy was the tear film brake up time (TBUT, Norn’s test, s). In addition, the dynamics of the following indicators were taken into account: OSDI (scores), “lid-wiper’ symptom (LWS, scores), lower tear meniscus height (LTMH, μm; OCT, OptoVue), Bijsterveld`s xerosis index (XI, scores; lyssamine green stained). Control points: at inclusion in the study; examination after 1 and 2 months of therapy. Statistics: calculation of the mean and its standard deviation (M ± s); assessment of the reliability of differences in indicators characterizing the state of the ocular surface before and after therapy (Wilcoxon t-test). Results. The patients showed a statistically significant increase in TBUT at the second and third control points, which indicated the effectiveness of DE therapy. The increase in TBUT was accompanied by a significant decrease in the severity of DE subjective symptoms at the same control points (OSDI). On the background of therapy, a trend towards a decrease in LWS was recorded, which was statistically insignificant. Apparently, a significant increase in TBUT and a decrease in OSDI were associated with a significant increase in LTMH at the third control point (decrease in the severity of aqua-deficiency) and a significant decrease in XI at the second and third control points (decrease in the severity of mucose-deficiency). Conclusion. A fixed combination of 0.24 % hyaluronic acid, carbomer, glycerol and a lipid component proved to be effective in the treatment of hyposecretory moderate DE in conditions of lipid-water-mucin deficiency, which was accompanied by a significant increase in TBUT and LTMH, as well as a decrease in OSDI and XI.

1. Stapleton F, Optom MC, Alves M. TFOS DEWS II Epidemiology Report. The Ocular Surface. 2017:15: 334–365. doi: 10.1016/j.jtos.2017.05.003.

2. Berk TA, Schlenker MB, Campos-Moller X. Visual and refractive outcomes in manual versus femtosecond laser-assisted cataract surgery: a single-centre retrospective cohort analysis of 1838 eyes. Ophthalmology. 2018:125(8):1172–1180. doi: 10.1016/j.ophtha.2018.01.028.

3. Lu Q, Lu Y, Zhu X. Dry Eye and Phacoemulsification Cataract Surgery: A Systematic Review and Meta-Analysis. Front. Med. 2021:8.649030. doi: 10.3389/fmed.2021.649030.

4. Craig JP, Nelson JD, Azar DT. TFOS DEWS II Report Executive Summary. The Ocular Surface. 2017;XXX:1–11. doi: 10.1016/j.jtos.2017.08.003.

5. Sakhnov SN, Yanchenko SV, Malyshev AV. Dry eye epidemiology in patients before cataract surgery. Ophthalmology in Russia. 2020;17(2):281–289 (In Russ.). doi: 10/18008/1816-5095-2020-2-281-289.

6. Sakhnov SN, Yanchenko SV, Malyshev AV. Eyelid hygiene in correcting the ocular surface condition in dry eye patients before cataract phacoemulsification. The Russian Annals of Ophthalmology. 2023;139(1):46–54 (In Russ.). doi: 10.17116/oftalma202313901146.

7. Brzhesky VV, Egorova GB, Egorov EA. Dry eye and ocular surface diseases. Moscow: GEOTAR-Media. 2016. 448 p. (In Russ).

8. Jones L, Downie LE, Korb,D. TFOS DEWS II management and therapy report. Ocul. Surf. 2017:15:575–628. 9. In Cheon You, Ying Li, Rujun Jin. Comparison of 0.1 %, 0.18 %, and 0.3 % Hyaluronic Acid Eye Drops in the Treatment of Experimental Dry Eye. Journal of ocular pharmacology and therapeutics. 2018:34:557–564. doi: 10.1089/jop.2018.0032.

9. Aragona P, Papa V, Micali A. Long term treatment with sodium hyaluronatecontaining artificial tears reduces ocular surface damage in patients with dry eye. Br. J. Ophthalmol. 2002:86:181–184.

10. Duan ZH, Tang YF. The clinical effects of sodium hyaluronate, polyethylene glycol, and dextran-70 eye drops in relieving dry eye after phacoemulsification. Medicine. 2021:100:25(e26358). 12. Yang YJ, Lee WY, Kim Y. A Meta-Analysis of the Efficacy of Hyaluronic Acid Eye Drops for the Treatment of Dry Eye Syndrome. Int. J. Environ. Res. Public Health. 2021:18:2383. doi: 10.3390/ijerph18052383.

11. Hynnekleiv L, Magno M, Vernhardsdottir RR. Hyaluronic acid in the treatment of dry eye disease. Acta Ophthalmol. 2022:100:844–860. doi: 10.1111/aos.15159.

12. Tsung-Jen Wang , I-Jong Wang, Jau-Der Ho. Comparison of the clinical effects of carbomer-based lipid-containing gel and hydroxypropyl-guar gel artificial tear formulations in patients with dry eye syndrome: a 4-week, prospective, open-label, randomized, parallel-group, noninferiority study. Clin Ther. 2010:32(1):44–52. doi: 10.1016/j.clinthera.2010.01.024.

13. So-Hyang Chung , Sung A Lim, Hungwon Tchach Efficacy and Safety of Carbomer- Based Lipid-Containing Artificial Tear Formulations in Patients With Dry Eye Syndrome. Cornea. 2016:35(2):181–186. doi: 10.1097/ICO.0000000000000660.

14. Yung Hui Kim, Yeon Soo Kang, Hyo Seok Lee. Effectiveness of Combined Tear Film Therapy in Patients with Evaporative Dry Eye with Short Tear Film Breakup Time. J Ocul Pharmacol Ther. 2017:33(8):635–643. doi: 10.1089/jop.2017.0019.

15. Garrigue J-S, Amrane M, Faure M-O. Relevance of Lipid-Based Products in the Management of Dry Eye Disease. J Ocul Pharmacol Ther. 2017:33(9):647661. doi. 10.1089/jop.2017.0052.

16. Korb DR. The tear film — its role today and in future. In The Tear Film, structure, function and examination. Butterworth — Heimann. 2002. 254 p.

17. Korb DR, Herman JP, Greiner JV. Lid wiper epitheliopathy and dry eye symptoms. Eye Contact Lens. 2005:31:2–8. 20. Nichols KN, Foulks GN, Bron AJ, Glasgow BJ, Dogru M, Tsubota K, Lemp MA, Sullivan DA. The International Workshop on Meibomian Gland Dysfunction: Executive Summary IOVS, Special Issue. 2011:52(4):1923–1929. doi: 10.1167/iovs.10-6997a.

18. Bijesterveld OP. Diagnostic tests in the sicca syndrome. Arch. Ophthalmol. 1969:82:10–14.

19. Yokoi N, Georgiev GA. Classification of fluorescein breakup patterns: A novel method of differential diagnosis for dry eye. Am. J. Ophthalmol. 2017:180:72–85

20. Yokoi N, Georgiev GA. Tear-film-oriented diagnosis for dry eye. Jpn. J. Ophthalmol. 2019:63:127–136.

21. Shpak AA. Issues of the statistical analysis in the Russian ophthalmic journals. The Fyodorov Journal of Ophthalmic Surgery. 2016;1:73–77 (In Russ.). doi: 10.25276/0235-41602016-1-73-77.

22. Yanchenko SV, Malyshev AV, Sakhnov SN, Fedotova NV, Orehova OYu. Eye lid hygiene in chronic allergic blepharoconjunctivitis patients before laser refractive surgery. The Russian Annals of Ophthalmology. 2016;5:83–88 (In Russ.). doi: 10.17116/oftalma202313901146

23. Guillon M, Maissa C, Wong S. Symptomatic relief associated with eyelid hygiene in anterior blepharitis and MGD. Eye and contact lens. 2012:38(5):306–312.

24. Peral A, Alonso J, Garsia-Garsia C, Nino-Rueda C, Calvo del Bosque P. Importance of lid hygiene before ocular surgery: qualitative and quantitative analysis of eyelid and conjunctiva microbiota. Eye and contact lens. 2016:42(6):366–370.