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P. Aragona, F. Ferreri, M. Mobrici, V. Amico, M.G. Cro, S. Giuffrida; Effects of Treatment with NSAIDs on Corneal Sensitivity and Ocular Surface of Sjögren's Syndrome Patients . Invest. Ophthalmol. Vis. Sci. 2003;44(13):692.
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Purpose:The treatment of ocular surface inflammation with NSAIDs can be helpful to improve symptoms of ocular discomfort in patients with Sjögren's syndrome. Many reports show that NSAIDs have an influence on corneal sensitivity and this might interfere with corneal epithelium healing in patients with epithelial suffering. Aim of this study is to evaluate the effects of two NSAIDs on corneal sensitivity and corneal epithelium in Sjögren's syndrome patients. Methods: Twenty patients affected by Sjögren's syndrome with epithelial corneal suffering score of at least 2+, were randomly divided into two groups: Group 1, ten patients (10 F, age 35-63 years), treated with 0.1% indomethacin, one drop three times a day; group 2, ten patients (9F, 1 M, age 38-65 years) treated with 0.1% diclofenac, at the same regimen. No systemic NSAIDs were used for all the study period. Use of the same tear substitute was allowed. Ocular discomfort symptoms (graded from 0=absent to 3=intense), BUT (sec), corneal fluorescein vital staining (0-15) (Lemp M, 1995) and corneal sensitivity by Cochet-Bonnet method were evaluated before treatment and after 15, 30 days of treatment and after 7 days of NSAID discontinuation, in both eyes. For statistical analysis only the right eye values were considered. The Student's t-test and Mann-Whitney U-test were used. Results: At baseline the BUT was 2.2±0.9 in group 1 and 2.1±0.7 in group 2; symptoms score was 7.5±3 in group 1 and 6.7±1.7 in group 2; corneal fluorescein score was 3.5±1.8 in group 1 and 3.6±1.7 in group 2; the corneal sensitivity was 5.7±0.4 in group 1 and 5.5±0.9 in group 2. After 15 days the symptoms score was lower in both groups (4.8±1 in group 1 and 5.4±0.8 in group 2, p=0.01 and p=0.004 versus baseline respectively), lasting so up to the end of the study. At day 30 a reduction in corneal sensitivity was observed in both groups; values were 5.4±0.6 in group 1 and 4.3±0.8 (p<0.01) in group 2. Seven days after discontinuation of NSAIDs a recovery of the corneal sensitivity was observed (5.5±0.5 in group 1, and 4.8±0.7 in group 2). Conclusions: Our findings show that topical NSAIDs are useful in dry eye patients. A one month treatment with both 0.1% diclofenac and 0.1% indomethacin brought to a reduction of ocular discomfort symptoms in Sjögren's syndrome patients although diclofenac determined a greater impairment of corneal sensitivity. Moreover, no significant deterioration of corneal epithelium was observed in both groups.
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