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Ranjini Kottaiyan, Geunyoung Yoon, Holly Butler Hindman, james zavislan, Richard P Phipps, James V Aquavella, ; Evaluation of Ocular Surface Inflammatory Mediators and Surface Metrology after Topical Application of Corticosteroid in Sjögren’s Dry Eye Subjects. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4477.
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To objectively evaluate and compare ocular surface inflammatory mediators to alterations in ocular surface metrology in subjects receiving ophthalmic corticosteroid drop.
20 eyes of 10 Sjögren’s syndrome (SS) subjects (9 female, 1 male, age: 56.7± 4.92 years) were imaged using a wavefront sensor and thermal camera to capture visual quality (VQ) changes from root mean square (RMS) of wave front aberrations and ocular surface temperature (OST) changes, respectively. The data was collected before drop instillation (BL), 30 min after instillation of Loteprednol (Lotemax 0.5%) drop, 1 week and 2 weeks of drop use (4 times a day) and at stressed environment (high temperature, 80 F and low humidity 20%). Tear film was collected in 64 mm micro capillary tube and analyzed to measure cytokine levels at BL and weeks 1 and 2 of Lotemax use in both non-stimulated tears and after a 20µL saline wash from 12 eyes of 6 SS subjects.
Both VQ and OST changed with Loteprednol use. At 30 minutes, VQ worsened (BL=0.48 ± 0.04 µm, 30 min=0.54 ± 0.04 µm) with an increase in average OST (BL=33.95 ± 0.13 0C, 30 min=34.3 ± 0.13 0C). VQ returned to base levels in week 1 (0.49 ± 0.08 µm) and week 2 (0.48 ±0.04 µm). OST increased after 2 weeks of Lotemax use (34.6 ± 0.14 0C). At stressed conditions, VQ worsened (0.67 ± 0.09 µm) and OST increased significantly from baseline (0.72 0C, p=0.03). Tear Luminex analysis showed that natural tears had higher cytokine concentrations than washout tears. Although saline wash samples were also collected, those data were highly variable and did not show trends across the sampling time points. MMP-9, IL-1a, IL-1b, IL-6, IL-8, TNFa were elevated in SS subjects before Lotemax use. TNFa, IL-1a, IL-1b, and IL-8 showed decreases after Lotemax treatment for all subjects. One patient showed decrease in all cytokines with noticeable improvement in VQ with Lotemax use as evidenced by significant reduction in RMS from BL (0.76 µm) to week 1 (0.56 µm) and week 2 (0.22 µm). IL-17 concentrations were low and IFNg were in normal range for all subjects, and did not show clear patterns of change after treatment.
A low strength corticosteroid like Lotemax effects ocular surface inflammatory mediators in dry eye patients with Sjögren’s syndrome as evidenced by tear cytokines analysis and concurrent ocular metrology measurements.
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