Estudio primario

No clasificado

Allergic conjunctivitis: the evolution of therapeutic options.

Año 2012
Autores Bielory L
Revista Allergy and asthma proceedings : the official journal of regional and state allergy societies
Enlaces DOI , Pubmed
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The eye has become the target of intense pharmacologic development because it represents one of the most active sites of allergic inflammation, due to it having no mechanical barrier to prevent the impact of allergens such as pollen on its surface. Over the past 20 years, we have witnessed an astonishing growth in therapeutic advances, ranging essentially from derivatives of simple aspirin to various newly developed biological immunomodulatory agents, using implantable drug delivery devices that exceed the safety and efficacy of those available for other organ systems and resorting to advanced surgical techniques for the correction of sight-threatening, disease-related complications. Overall, with the expanding knowledge base, the intricacy of ocular inflammation appears to be becoming ever more manageable and the clinical allergist/immunologist has an increasing role in the treatment outcomes of patients with anterior inflammatory disorders of the ocular surface primarily allergic conjunctivitis but also including dry eye syndromes.

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Estudio primario

No clasificado

Topical heparin in the treatment of ligneous conjunctivitis.

Año 1995
Revista Ophthalmology
Enlaces Pubmed
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BACKGROUND:

Ligneous conjunctivitis is a rare acute or subacute membranous conjunctivitis of unknown etiology for which no generally accepted form of treatment is available.

METHODS:

Between 1972 and 1993, 17 patients with ligneous conjunctivitis were treated with excision biopsy, meticulous hemostasis, and immediate, intensive topical treatment with heparin, steroids, and, in 12 patients, alpha-chymotrypsin until all signs of conjunctival inflammation had subsided.

RESULTS:

On histologic examination, the lesions consisted of subepithelial deposits of fibrin in all patients. Eight patients had no recurrence (mean follow-up, 33.1 months) and in four patients the conjunctivitis was controlled after one repeat excision and topical treatment (mean follow-up, 40.3 months). One patient had three recurrences before responding to treatment (follow-up, 24 months). In four patients, treatment was unsuccessful, although lesion-free intervals were longer than usually seen in this condition (mean, 7.8 months).

CONCLUSION:

These results suggest that intensive and early use of topical heparin may improve therapy results in ligneous conjunctivitis.

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Estudio primario

No clasificado

Causes of conjunctivitis and keratoconjunctivitis in Karachi, Pakistan.

Año 1992
Revista Transactions of the Royal Society of Tropical Medicine and Hygiene
Enlaces DOI , Pubmed
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The causes of conjunctivitis and keratoconjunctivitis in 388 patients who attended eye casualty departments in Karachi, Pakistan, during a 5 month period were investigated. Most of these infections were diagnosed as adenovirus (291, 75%) or bacterial (71, 18.3%). Of the remainder, 9 cases (2.3%) were caused by herpes simplex virus and 7 (1.8%) by Chalmydia trachomatis. There was no evidence of typical active trachoma in this urban population. Bacteria or Candida albicans were also grown from 44 of the adenovirus cases (15%). Many of the bacteria grown from eyes in this study were resistant to antibiotics, probably because of inadequate and/or inappropriate self-medication with antibiotics in this community.

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Revisión sistemática

No clasificado

Topical Olopatadine in the Treatment of Allergic Conjunctivitis: A Systematic Review and Meta-analysis.

Año 2017
Autores Kam KW , Chen LJ , Wat N , Young AL
Revista Ocular immunology and inflammation
Enlaces DOI , Pubmed
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PURPOSE:

To assess the safety and efficacy of topical olopatadine versus placebo and other topical anti-allergic medications in treating allergic conjunctivitis.

METHODS:

We systematically searched the literature for randomized-controlled trials that included patients with allergic conjunctivitis, compared olopatadine versus placebo or alternative anti-allergic medications, and examined itch, conjunctival hyperemia, composite symptom or sign scores, and/or occurrence of adverse events. We assessed the safety and efficacy of topical olopatadine when compared with placebo or alternative anti-allergic medications using meta-analysis.

RESULTS:

When compared with placebo, topical olopatadine is associated with a pooled-mean difference (MD) in ocular itch of -1.33 (p < 0.00001) and ocular hyperemia of -0.92 (p < 0.00001). When compared with other agents, olopatadine was inferior to alcaftadine on ocular itch (pooled-MD = 0.39; p < 0.00001) but comparable with epinastine and ketotifen.

CONCLUSIONS:

Topical olopatadine is a safe and effective treatment modality for allergic conjunctivitis, whereas alcaftadine appears to be superior to olopatadine in reducing ocular itch.

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Estudio primario

No clasificado

The RPS adeno detector for diagnosing adenoviral conjunctivitis.

Año 2006
Revista Ophthalmology
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PURPOSE:

To compare the sensitivity, specificity, and accuracy of the RPS Adeno Detector (Rapid Pathogen Screening Inc., South Williamsport, PA) against both viral cell culture with confirmatory immunofluorescence staining (CC-IFA) and the polymerase chain reaction (PCR) for diagnosing adenoviral conjunctivitis.

DESIGN:

Prospective, nonrandomized, masked, multicenter clinical trial.

PARTICIPANTS:

One hundred eighty-six consecutive patients from 5 clinical centers seeking treatment within 1 week of developing a red eye and thought to have acute conjunctivitis.

METHODS:

The RPS Adeno Detector is a 10-minute in-office lateral flow immunoassay. Patients were tested with the RPS Adeno Detector, CC-IFA, and PCR to detect the presence of adenovirus.

MAIN OUTCOME MEASURES:

The sensitivity, specificity, and accuracy of the RPS Adeno Detector were assessed for identifying cases of adenoviral conjunctivitis.

RESULTS:

Compared with CC-IFA, the RPS Adeno Detector was 88% sensitive and 91% specific at detecting adenoviral conjunctivitis. Using PCR as a reference method, the sensitivity of the RPS Adeno Detector increased to 89% and the specificity increased to 94%. Compared with PCR, CC-IFA was found to be 91% as sensitive and 100% as specific.

CONCLUSIONS:

The RPS Adeno Detector demonstrated sufficient sensitivity and specificity to be used in the physician's office for the detection of adenoviral conjunctivitis.

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Estudio primario

No clasificado

Comparison of olopatadin and ketotifen in the treatment of allergic conjunctivitis

Año 2010
Revista Revista médica del Instituto Mexicano del Seguro Social
Enlaces Pubmed
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OBJECTIVE:

To compare the efficacy of olopatadine 0.1 % and ketotifen 0.025 % ophthalmic solutions in the treatment of allergic conjunctivitis.

METHODS:

Forty patients with allergic conjunctivitis were included in the study, they were randomized in two groups: G-I (n = 20) olopatadine 0.1 % and G-II (n = 20) ketotifen 0.025 %, both receiving one drop every 12 hours. We evaluated itching, burning, tearing, redness and chemosis previously and 30 minutes, one, two and four week after.

RESULTS:

Age G-I was 19.7 +/- 6.7 years; G-II, 21.05 +/- 8.3 years. When evaluating itching, olopatadine had a significant improvement at 30 minutes and after one week (p < 0.05). In the following weeks, the results were similar in both groups. Olopatadine showed significant improvement in burning at 30 minutes, one and two week (p < 0.05). Tearing significantly decreased at 30 minutes with olopatadine (p < 0.05). There was no difference in redness or chemosis improvement in both groups.

CONCLUSIONS:

In this study, olopatadine 0.1 % was more effective than topical ketotifen 0.025 % in improving itching, tearing and burning in allergic conjunctivitis patients.

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Estudio primario

No clasificado

Management of seasonal allergic conjunctivitis: guide to therapy.

Año 2012
Autores Bielory BP , O'Brien TP , Bielory L
Revista Acta ophthalmologica
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Seasonal allergic conjunctivitis (SAC) is an inflammatory response of the conjunctiva triggered by exposure to seasonal allergens. Treatment options for SAC include artificial tears, antihistamines, decongestants, mast cell stabilizers, nonsteroidal anti-inflammatory drugs, dual antihistamine/mast cell stabilizers, immunotherapy and corticosteroids. Topical, intranasal and systemic formulations of corticosteroids have traditionally provided the most effective relief of the inflammation and signs and symptoms associated with severe, acute exacerbations of SAC. However, steroid-induced ocular and systemic side-effects have limited the prescribing of these agents. This limitation of traditional corticosteroids led to the development of modified corticosteroids that retain the anti-inflammatory mechanism of action of traditional corticosteroids with a much-improved safety profile because of their rapid breakdown to inactive metabolites after exerting their activity. The development of one such novel corticosteroid, loteprednol etabonate (LE), led to the insertion of an ester (instead of a ketone) group at the carbon-20 (C-20) position of the basic corticosteroid structure. Clinical trials assessing this C-20 ester corticosteroid have demonstrated similar efficacy to C-20 ketone corticosteroids in the prevention or treatment of the signs and symptoms of SAC but with a greatly improved safety profile, as the C-20 ester corticosteroid is less likely to elevate intraocular pressure. In addition, the ketone at the C-20 position has been implicated in the formation of cataract, while nonketolic corticosteroids do not form Schiff base intermediates with lens proteins, which is a common first step in cataractogenesis. The clinical relevance of the C-20 ester corticosteroid class, as modelled by LE, is that they provide both effective and safe treatment of the inflammation associated with SAC and relief of its signs and symptoms. Loteprednol etabonate offers a well-tolerated treatment option for patients with debilitating acute exacerbations as well as chronic forms of the disease.

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Estudio primario

No clasificado

Treatment of acute bacterial conjunctivitis with topical netilmicin.

Año 2002
Revista Cornea
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PURPOSE:

This study compares the clinical and microbiologic value of topical netilmicin with that of gentamicin in the treatment of acute bacterial conjunctivitis.

METHODS:

A double-blind, randomized, prospective, controlled study was performed in 209 patients. One to two drop(s) of either antibiotic was applied to the affected eye(s) four times a day for up to 10 days. Patients were examined at the time of diagnosis and after 3, 5, and 10 days. Clinical efficacy was measured as the cumulative sum score (CSS) of the key signs and symptoms of acute bacterial ocular infection. Sensitivity/resistance was evaluated using the disk diffusion method.

RESULTS:

Drug efficacy assessment was restricted only to patients with positive baseline culture results (n = 121). Of the isolated organisms, 96.9% were sensitive to netilmicin, whereas only 75.0% were sensitive to gentamicin (p = 0.00001). Netilmicin provided a broad-spectrum coverage comparable with that of ciprofloxacin, ofloxacin, and norfloxacin. Netilmicin also was more effective than gentamicin in eradicating infections (p = 0.001 at day 5 and p = 0.037 at day 10) and in ameliorating the CSS (p = 0.037 at day 3, p = 0.001 at both day 5 and day 10). Only minor adverse events occurred in patients treated with either netilmicin or gentamicin.

CONCLUSIONS:

This study demonstrates that netilmicin is a safe and effective antibiotic that can be used as first-line therapy for the treatment of acute bacterial conjunctivitis.

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Revisión sistemática

No clasificado

Sublingual immunotherapy for allergic conjunctivitis: Cochrane systematic review and meta-analysis.

Año 2011
Revista Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology
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BACKGROUND:

Allergic conjunctivitis (AC) is a common manifestation and represents an important co-morbidity of allergic rhinitis (AR). Sublingual immunotherapy (SLIT) is an effective and safe treatment for nasal symptoms of AR; its effectiveness is however less well established for ocular symptoms.

OBJECTIVES:

To evaluate the effectiveness of SLIT in reducing ocular symptoms, the need for ocular treatments and the threshold exposure for conjunctival immediate allergen sensitivity (CIAS).

METHODS:

We searched eight databases up to January 2010. We included only randomized controlled trials (RCT), double-blind and placebo-controlled evaluating the efficacy of SLIT in patients with symptoms of allergic rhinoconjunctivitis (ARC) or AC. Primary outcome measures were total ocular symptom scores, individual ocular symptoms scores (itchy eyes, eye redness, watery eyes, swelling eyes), eye drops use and CIAS. Meta-analysis was undertaken using RevMan 5 software.

RESULTS:

From 811 abstracts that were screened, 109 studies were reviewed in their full text version. Forty two trials including 3958 participants (n=2011 SLIT and n=1947 placebo) had data suitable for inclusion in the meta-analysis. SLIT induced a significant reduction on both total ocular symptom scores (

SMD:

-0.41; 95%CI: -0.53 to -0.28; I(2) : 59%) and individual ocular symptoms scores [red (-0.33; -0.45 to -0.22), itchy (-0.31; -0.42 to -0.20) and watery eyes (-0.23; -0.34 to -0.11)] compared with placebo. Participants in the SLIT group showed an increase in the threshold dose for the CIAS (

SMD:

0.35; 0.00-0.69). No significant reduction was observed on eye drops use (

SMD:

-0.10; -0.22 to 0.03).

CONCLUSIONS AND CLINICAL RELEVANCE:

SLIT is effective in reducing total and individual ocular symptom scores in subjects with ARC or conjunctivitis. No significant reduction was observed in ocular eye drops use.

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Estudio primario

No clasificado

Azithromycin vs doxycycline in the treatment of inclusion conjunctivitis.

Año 2003
Revista American journal of ophthalmology
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PURPOSE:

The aim of the study was to compare the efficacy and safety of azithromycin and doxycycline in the treatment of chlamydial conjunctivitis in adults.

DESIGN:

An open, randomized clinical trial.

METHODS:

Seventy-eight adult patients with incluson conjunctivitis were enrolled in this multicenter clinical study. Patients with chlamydial conjunctivitis as indicated by a positive direct fluorescent antibody (DFA) test or cell culture were randomized to receive a single 1-g dose of azithromycin or doxycycline, 100 mg twice daily for 10 days. A conjuctival swab for cell culture was obtained from all patients immediately before the treatment for subsequent confirmation of the presence of chlamydial infection in the central laboratory. Control examinations were performed 10 to 12 days and 4 to 6 weeks after the treatment initiation. Clinical and bacteriological responses to the treatment were evaluated at the last visit. The occurrence and frequency of adverse events were analyzed as well.

RESULTS:

Of 78 patients enrolled, 51 completed the study and were evaluated for efficacy. The main reasons for withdrawal were lack of confirmation of the presence of chlamydial infection by the central laboratory and failure to attend the follow-up visit. Eradication of C. trachomatis was achieved in 23 of 25 (92%) patients treated with azithromycin and in 25 of 26 (96%) patients treated with doxycycline. Clinical cure was observed in 15 (60%) and 18 (69%) patients treated with azithromycin and doxycycline, respectively. Both drugs were equally well tolerated.

CONCLUSIONS:

A single 1-g azithromycin therapy was as effective as standard 10-day treatment with doxycycline (100 mg twice daily) in the treatment of adult inclusion conjunctivitis.

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