Effect of 3% diquafosol ophthalmic solution on tear film lipid layer in dry eye with meibomian gland dysfunction

Abstract

Purpose : Diquafosol is a P2Y₂ purinergic receptor agonist. 3% diquafosol ophthalmic solution (DQS) increased meibomian gland area by repeated application for months in eyes with meibomian gland dysfunction (MGD) (Arita et al. 2013) and increased tear film lipid layer thickness (LLT) for up to 60 min after a single topical instillation in normal human eyes (Fukuoka et al. 2017). We performed a prospective, single-center, masked trial to learn about changes in tear film lipid layer after randomized application of DQS or artificial tears (AT) to respective eyes of dry eye (DE) with MGD.

Methods : Forty-seven patients (33 males, 14 females, mean age of 48.1 ± 13.0 years) of DE with MGD randomly received one drop of AT in one eye and one drop of DQS in the other. LLT by quantitative tear interferometry (LipiView), noninvasive tear break-up time (NIBUT) (DR-1α), and tear interferometric pattern using qualitative tear interferometry (DR-1α) was examined before and 30, 60, and 90 min after instillation.

Results : DQS significantly increased LLT at 30 and 60 min after instillation compared with pre LLT (LLT before and 30, 60, 90 min after instillation, 49.2 ± 16.2, 70.6 ± 28.2, 63.9 ± 30.0, and 62.0 ± 26.2 nm, respectively; p < 0.001, = 0.042, = 0.11, versus pre, respectively, Wilcoxon signed-rank test with Bonferroni correction for three comparisons). DQS significantly increased NIBUT at 30, 60, 90 min after instillation (NIBUT, 3.0 ± 1.8, 6.1 ± 2.9, 6.6 ± 2.7, 6.1 ± 2.8 sec; p < 0.001, < 0.001, < 0.001, respectively). DQS did not change TMH (p = 0.853, 1.00, 1.00, respectively). AT did not significantly increase LLT, NIBUT, or TMH. Significantly more improvements in interferometric fringe pattern in the eyes without interference fringes (evaporative DE type) before instillation were seen after DQS instillation (25, 32, 23 eyes of 40 eyes) compared with AT (5, 5, 2 eyes of 36 eyes) (p < 0.001, < 0.001, < 0.001, respectively).

Conclusions : A single topical instillation of DQS increased LLT for up to 60 min and improved tear film stability for up to 90 min in DE with MGD. Our results suggest that DQS stimulates the secretion of lipids not only from meibomian glands of healthy human subjects but also from those of DE with MGD.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.