Complex treatment for dry eye disease in intermediate uveitis
DOI: 10.32364/2311-7729-2022-22-1-30-35
E.B. Tatarnikova, O.I. Krivosheina
Siberian State Medical University, Tomsk, Russian Federation
Aim: to study clinical presentations of dry eye disease (DED) in intermediate uveitis (pars planitis) and develop a complex treatment algorithm including tear substitutes, reparative, and anti-inflammatory therapies combined with laser photocoagulation.
Patients and Methods: the study enrolled 98 patients divided into the study group (n=78) and the comparison group (n=20). Study group patients received complex treatment, including tear substitutes, anti-inflammatory therapies, and laser photocoagulation. Comparison group patients received topical medications only. All patients underwent a complex examination including the OSDI questionnaire, visual acuity, IOP measurements, slit lamp examination, binocular dilated fundus examination with scleral indentation, and Schirmer’s test 1 at baseline, after baseline three and six months. Treatment efficacy was assessed based on the severity of intermediate uveitis presentations.
Results: intermediate uveitis exacerba tes DED. The more active chorioretinal inflammation near the ora serrata is, the more severe clinical, functional changes of the ocular surface are. Complex treatment significantly improved typical DED complaints by the OSDI score (by 34.8%), ocular surface by slit-lamp examination (lower occurrence of conjunctival fold overhang, by 51.8%), mild eyelid and conjunctival hyperemia, and conjunctival discharge. Six months after treatment, a 2-fold (vs. baseline) increase in total tear secretion and resorption of vitreous exudates and retinal edema were reported in the study group. Changes in all parameters in the study group were more significant than in the comparison group.
Conclusion: complex treatment algorithm (tear substitutes, reparative, and anti-inflammatory therapies combined with laser photocoagulation) provides a more rapid and stable reduction in chorioretinal inflammation near the ora serrata. It significantly improves subjective and objective DED signs compared to conventional pharmacotherapy.
Keywords: dry eye disease, intermediate uveitis, laser photocoagulation, ora serrata.
For citation: Tatarnikova E.B., Krivosheina O.I. Complex treatment for dry eye disease in intermediate uveitis. Russian Journal of Clinical Ophthalmology. 2022;22(1):30–35 (in Russ.). DOI: 10.32364/2311-7729-2022-22-1-30-35.
Acknowledgements
The technical edition is supported by Bausch Health LLC.
About the authors:
Elena B. Tatarnikova — distant postgraduate student of theDepartment of Ophthalmology; ORCID iD 0000-0003-3038-8117.
Olga I. Krivosheina — Dr. Sc. (Med.), Professor, Head of the Department of Ophthalmology; ORCID iD 0000-0001-7509-5858.
Siberian State Medical University. 2, Moskovskiy tract, Tomsk, 634050, Russian Federation.
Contact information: Elena B. Tatarnikova, e-mail: elenka.morozova.92@inbox.ru.
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interests.
Received 17.05.2021.
2. Jones L., Downie L.E., Korb D. et al. TFOS DEWS II Management and Therapy Report Ocul Surf. 2017;15(3):575–628. DOI: 10.1016/j.jtos.2017.05.006.
3. Akpek E.K., Amescua G., Farid M. et al. Dry Eye Syndrome Preferred Practice Pattern. Ophthalmology. 2019;126(1):286–334. DOI: 10.1016/j.ophtha.2018.10.023.
4. Matossian C., McDonald M., Donaldson K.E. et al. Dry Eye Disease: Consideration for Women’s Health. J Womens Health (Larchmt). 2019;28(4):502–514. DOI: 10.1089/jwh.2018.7041.
5. Farrand K.F., Fridman M., Stillman I.O., Schaumberg D.A. Prevalence of diagnosed dry eye disease in the United States among adults aged 18 years and older. Am J Ophthalmol. 2017;182:90–98. DOI: 10.1016/j.ajo.2017.06.033.
6. Егоров Е.А. Особенности терапии синдрома «сухого глаза». РМЖ «Клиническая офтальмология». 2018;3:146–149. DOI: 10.21689/2311-7729-2018-18-3-146-149. [Egorov E.A. Features of dry eye syndrome treatment. RMJ "Clinical ophthalmology". 2018;3:146–149 (in Russ.)]. DOI: 10.21689/2311-7729-2018-18-3-146-149.
7. Fallacara A., Baldini E., Manfredini S., Vertuani S. Hyaluronic Acid in the Third Millennium. Polymers (Basel). 2018;10(7):701. DOI: 10.3390/polym10070701.
8. Cejka C., Kubinova S., Cejkova J. Trehalose in ophthalmology. Histol Histopathol. 2019;34(6):611–618. DOI: 10.14670/HH-18-082.
9. Aggarwal S., Galor A. What’s new in dry eye disease diagnosis? Current advances and challenges. F1000Res. 2018;19;7:F1000 Faculty Rev-1952. DOI: 10.12688/f1000research.16468.1.
10. Weatherby T.J.M., Raman V.R.V., Agius M. Depression and dry eye disease: a need for an interdisciplinary approach? Psychiatr Danub. 2019;31(Suppl 3):619–621. PMID: 31488802.
11. Ayaki M., Tsubota K., Kawashima M. et al. Sleep Disorders are a Prevalent and Serious Comorbidity in Dry Eye. Invest Ophthalmol Vis Sci. 2018;1;59(14):DES143-DES150. DOI: 10.1167/iovs.17-23467.
12. McDonald M., Patel D.A., Keith M. et al. Economic and Humanistic Burden of Dry Eye Disease in Europe, North America, and Asia: A Systematic Literature Review. Ocul Surf. 2016;14(2):144–167. DOI: 10.1016/j.jtos.2015.11.002.
13. The management of dry eye. Drug Ther Bull. 2016;54(1):9–12. DOI: 10.1136/dtb.2016.1.0378.
14. Иванова Е.В., Дениско М.С., Хороших Ю.И. Диагностика хронического периферического увеита. Современные технологии в офтальмологии. 2017;4:99–101. [Ivanova E.V., Denisko M.S., Khoroshikh Yu.I. Diagnosis of chronic peripheral uveitis. Modern technologies in ophthalmology. 2017;4:99–101 (in Russ.)].
15. Berker N., Sen E., Elgin U. et al. Analysis of clinical features and visual outcomes of pars planitis. Int Ophthalmol. 2018;38(2):727–736. DOI: 10.1007/s10792-017-0526-2.
16. Ozdal P.C., Berker N., Tugal-Tutkun I. Pars Planitis: Epidemiology, Clinical Characteristics, Management and Visual Prognosis. J Ophthalmic Vis Res. 2015;10(4):469–480. DOI: 10.4103/2008-322X.176897.
17. Хороших Ю.И., Иванова Е.В., Кривошеина О.И. Клинико-функциональные результаты лечения хронического периферического увеита, осложненного макулярным отеком, с помощью лазерного циркляжа. Современные технологии в офтальмологии. 2017;1;322–324. [Khoroshikh Yu.I., Ivanova E.V.,Krivosheina O.I., Clinical and functional results of treatment of chronic peripheral uveitis complicated by macular edema using laser circlage. Modern technologies in ophthalmology. 2017;1:322–324 (in Russ.)].
18. Navarrete A., Koriat A., Amer R. Implications of pars planitis-associated cystoid macular edema on visual outcome and management in children. Graefes Arch Clin Exp Ophthalmol. 2020;258(8):1803–1811. DOI: 10.1007/s00417-020-04696-7.
19. Grzybowski A., Kanclerz P., Pleyer U. Challenges with cataract surgery in pars planitis patients. Graefes Arch Clin Exp Ophthalmol. 2017;255(8):1483–1484. DOI: 10.1007/s00417-017-3698-6.
20. Albavera-Giles T., Serna-Ojeda J.C., Jimenez-Corona A. et al. Outcomes of cataract surgery with/without vitrectomy in patients with pars planitis and immunosuppressive therapy. Graefes Arch Clin Exp Ophthalmol. 2017;255(6):1213–1219. DOI: 10.1007/s00417-017-3658-1.
21. Murray P.I., Rauz S. The Eye and Inflammatory Rheumatic Diseases: The Eye and Rheumatoid Arthritis, Ankylosing Spondylitis, Psoriatic Arthritis. Best Pract Res Clin Rheumatol. 2016;30(5):802–825. DOI: 10.1016/j.berh.2016.10.007.
22. Yuan J., Deng Y.Q. Emphasizing the diagnosis and treatment of diabetes related dry eye. Zhonghua Yan KeZaZhi. 2017;53(9):645–647. DOI: 10.3760/cma.j.issn.0412-4081.2017.09.002.
23. Karaman Erdur S., Kulac Karadeniz D., Kocabora M.S. et al. Ocular surface and tear parameters in patients with chronic hepatitis C at initial stages of hepatic fibrosis. Eye Contact Lens. 2015;41(2):117–120. DOI: 10.1097/ICL.0000000000000079.
24. Gonzales J.A., Jap A., Chee S.P. Pars Planitis and Other Intermediate Uveitis. Ophthalmology. 2019;7:21:777–779.
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