Seminars in Ophthalmology最新文献

Preservatives are commonly used in eye drops to maintain sterility, to prolong shelf life and to enhance penetration into the eye. Cell culture and animal studies have demonstrated that commonly used preservatives have severe toxic effects on meibomian gland epithelial cells, conjunctival epithelial cells and corneal epithelial cells. Some preservatives penetrate into deeper tissues and cause inflammatory damage to the eye. Clinical studies show that symptoms and signs of ocular surface disease are much more common in patients using preserved eye drops. The beneficial effect of switching patients from preserved to preservative free eye drops has also been demonstrated in many studies. Preservative free eye drops are not universally available, especially in multi-dose vials, and may be more expensive than preserved eye drops. Awareness amongst physicians and patients about the potentially severe adverse effects of preserved eye drops is lacking. This article summarizes the laboratory and clinical evidence on this topic, and lists the recommendations of an expert group for various stakeholders.

Purpose:  Various ocular surface inflammatory disorders (OSID) such as allergic eye disease, Sjogren's syndrome, cicatrizing conjunctivitis, and ocular graft versus host disease have a chronic course, leading to visual morbidity and significantly impacting quality of life. They have chronic ocular surface inflammation which needs topical anti-inflammatory therapy to break the vicious cycle of inflammation and prevent worsening of the ocular surface disease. Topical cyclosporine A (CsA) acts by inhibiting T-cell activation and inflammatory cytokine production, thereby reducing inflammation and maintain the health of the tear film and the surface epithelial cells. The aim of this review is to provide an overview of mechanism of action, indications, formulations, concentration and efficacy of topical cyclosporine available for the treatment of ocular surface diseases.

Methods:  After carrying out a literature search on "Cyclosporine A", "Ocular surface disease", "Dry eye", "Vernal keratoconjunctivitis", "Graft versus host disease", "Restasis", "Cequa", "Vevye", "Ikervis", a total of 101 articles were included for this review.

Results:  CsA has been found useful in cases of dry eye disease, vernal keratoconjunctivitis, graft versus host disease, SJS and high-risk corneal transplantation. Multiple clinical trials have demonstrated significant improvement in corneal fluorescein staining, Schirmer's test scores, and tear break-up time with CsA use in patients with dry eye. Topical CsA formulations such as Restasis (0.05%), Cequa (0.09%), and Vevye (0.1%) have been FDA-approved, showing long-term efficacy and safety. Advancements in drug delivery, including cationic emulsions (Ikervis), nanomicellar solutions (Cequa), and water-free technology (Vevye), have enhanced its bioavailability and patient compliance. However, challenges such as delayed onset of action, transient irritation, and high discontinuation rates remain.

Conclusions:  Topical CsA remains a cornerstone therapy in the management of OSID, providing long-term inflammation control, improved ocular surface integrity, and symptomatic relief. Continued research into optimized formulations, combination therapies, and alternative delivery systems may further refine its clinical utility and enhance patient adherence.

Purpose: The Ocular Surface Workshop (OSW) is a sub-specialty meeting focussed on the management of complex ocular surface disorders. This survey aimed to assess the impact of the workshop on the knowledge and practice of attendees over a decade.

Methods: An online survey was circulated to attendees of past editions of the OSW in February 2025. Survey results were compiled and presented using descriptive statistics, charts and tables.

Results: Sixty-seven responses were received within the survey period. Respondents had a median age of 42 years, and included a significant proportion of trainees and young clinicians. Most respondents (64%) attended the workshop multiple times. Attendees improved their knowledge about various complex ocular surface conditions, which positively impacted their practice. Respondents also reported improvements in the availability of good quality care for ocular surface disorders in their practice location.

Conclusions: Attendees of the OSW reported significant improvements in their knowledge and impact on their practice after attending the workshop. The workshop serves as a model than can be emulated by other sub-specialty meetings to enhance clinician knowledge and improve access to high quality care for patients.