EGF supplement therapy with a controlled release device in patients with keratoconjunctivitis sicca seems to improve dry eye symptoms

Abstract

Abstract: : Purpose: Epidermal growth factor (EGF) seems to be important for ocular surface homeostasis. In patients with keratoconjunctivitis sicca (KCS) a reduced EGF concentration was found in tear fluid samples, furthermore reduced levels of EGFmRNA were found in corneal epithelial cells of KCS patients. As a pilot study with application of the device 2x 48h were promising, we performed another pilot study for medium term EGF supplement therapy. Methods: Inclusion criteria were: dry eye symptoms with regular use of tear substitute, basal tear secretion of 10 mm or less or break–up time (BUT) of 10 sec or less. Patients with more than mild blepharitis, ocular comorbidity and those taking special medications (e.g. oral b–blocker, neuroleptics) were excluded. A 5x3 mm oval alginate platelet loaded with 0,8 µg EGF was placed in the conjunctival sac of both eyes in 10 patients for 24 h once a week over 8 weeks with then further follow up. Subjective criteria (e.g. dry eye symptoms by questionnaire, smily score) were checked every week until week 12, objective parameters (e.g. BUT, lissamingreen and fluorescein score) every 2 weeks until week 12 and than once more at week 22 after begin of the study. Results: The platelet handling and tolerance was relatively good. All symptoms exept "sticky eyelids" improved from week 2 and 3 onwards (especially burning, sensation of dryness, light sensitivity and tearing) and returned to the preexisting level within the next 1 to 8 weeks after the end of EGF supplement therapy. Overall assessment as well as the smily score improved in a similar way. The frequency of tear substitute application was reduced from 5x to 0,5x (week 8) and 2x (week 10) and then increased back to 4x per day (mean values) at week 22. BUT and staining scores changed only slightly. No complications were observed. Conclusions: Medium term EGF supplement therapy seems to be able to alleviate dry eye symptoms and the effect seems to be sustained for one to several weeks after the end of platelet application. A randomised study will follow.

Keywords: cornea: tears/tear film/dry eye • cornea: clinical science • growth factors/growth factor receptors