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S Barabbino, M Rolando, P Camicione, S Zanardi, M Cro, S Giuffrida, G Calabria; Efficacy of Systemic Linoleic and Gamma-linolenic Acid Therapy in Dry Eye Syndrome with Inflammatory Component . Invest. Ophthalmol. Vis. Sci. 2002;43(13):51.
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Purpose: To evaluate the efficacy and the anti-inflammatory activity of the systemic use of linoleic (LA) and gamma-linolenic acid (GLA), which have been demonstrated to decrease the chronic inflammatory state in rheumatoid arthritis, on the ocular surface of patients with keratoconjunctivitis sicca. Methods: In a randomized clinical trial twenty-six dry eye subjects, average age 49.5±9.2 years, with aqueous deficient keratoconjunctivitis sicca were consecutively selected from patients seeking consultation at the Anterior Surface Diseases Center of the Department of Neurological and Vision Sciences of the University of Genoa. The diagnosis was made on: dry eye symptom survey score≷14, Schirmer I values (without anesthesia)<5 mm/5 minutes, positive vital staining with lissamine green (graded 0 to 9 according to Van Bijsterveld score system)<3.5, fluorescein break up time (FBUT)<7 sec. All patients showed ocular surface inflammation studied by the expression of HLA DR, a Major Hystocompatibility Class II antigen, tested on epithelial bulbar conjunctiva samples. The subjects were randomly divided into two groups, with no statistical differences in age, symptoms, signs or ocular surface inflammation at baseline. The study group (n=13) was treated orally with tablets containing LA (28,5 mg) and GLA (15 mg) twice daily for 45 days, the control group was treated with a tear substitute alone with the same frequency than the study group. Results: A statistically significant change in symptoms (p<0.005), lissamine green staining (p<0.005) and ocular surface inflammation (p<0.05) was observed in the study group compared to the control group. The HLA DR expression varied from 58.5±14.1% positive conjunctival cells to 41.3±18.9% for the treated group and from 61.4±21.9% to 58.0±13.3% for the untreated group. No statistically significant difference between groups was recorded for FBUT and Schirmer I test. Conclusion: Systemic therapy with LA and GLA, additionally to tear substitutes, is able to reduce ocular surface inflammation and to improve symptoms in dry eye patients. But long-term studies are needed to confirm the role of this new therapy for keratoconjunctivitis sicca.
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