Comparative study of 0.1% hyaluronic acid versus 0.5% carboxymethylcellulose in patients with dry eye associated with moderate keratitis or keratoconjunctivitis

Abstract

BackgroundEye drops containing 0.1% hyaluronic acid (HA) and 0.5% carboxymethylcellulose (CMC) applied one drop three times a day per affected eye were compared in patients with moderate keratitis or keratoconjunctivitis related to dry eye disease (DED).Patients and methodsThis was a prospective, randomized, multicenter, Phase IIIB noninferiority study, with a single-masked phase in parallel mode with two groups over 84 days. The primary efficacy outcome was change in ocular surface (OS) staining between day 0 (D0) and day 35 (D35). The conjunctiva and cornea were stained with lissamine green and fluorescein. Secondary efficacy measures at day 84 (D84) were OS-staining score (SS), ocular comfort index, tear-film breakup time and how patients and investigators rated treatment efficacy and safety.ResultsAt D35, 0.1% HA achieved a 46.6% reduction in OS-SS (−2.03±1.35 points, n=39 patients) and 0.5% CMC treatment, followed by a 34.9% reduction (−1.61±1.69 points, n=38 patients) compared to D0. At D84, the SS difference to D0 improved by −2.58±1.45 points (−59.2%) for 0.1% HA and −2.59±2.27 points (−54.4%) for 0.5% CMC. Ocular comfort-index scores improved, with significantly lower (better) values for stinging and itching on D84 for 0.1% HA. Patients assessed treatment with 0.1% HA as significantly better than 0.5% CMC (Likert scale, 4.82 vs 3.97; P=0.018). Four adverse events (AEs) occurred in four of 41 patients (9.8%) treated with 0.1% HA, and three AEs in two of 39 patients (5.1%) treated with 0.5% CMC. No serious AEs were noted.ConclusionDED signs and symptoms of DED significantly improved with both eye drops. OS staining improved >54% at D84. Treatment was well tolerated, with only minor AEs <10%. 0.1% HA and 0.5% CMC were equally safe and effective. Significant and nonsignificant results were constantly in favor of 0.1% HA.

A Meta-Analysis of the Efficacy of Hyaluronic Acid Eye Drops for the Treatment of Dry Eye Syndrome

“…The 17 studies finally included were published between 1988 and 2018. Of these, 13 were conducted in Europe [ 11 , 12 , 16 , 18 , 19 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 34 ], 2 in Asia [ 20 , 33 ], 1 in the United States [ 35 ], and 1 in the Canada [ 32 ] ( Table 1 ). Based on the type of study, 12 studies were parallel, and 5 studies were crossover.…”

“…Because 15 of 17 studies were investigator-/assessor-blinded [ 11 , 12 , 16 , 19 , 20 , 25 , 26 , 27 , 29 , 30 , 31 , 33 , 34 , 35 ], the detection bias was low. In addition, the blinding of participants was performed in 11 studies [ 11 , 12 , 19 , 25 , 26 , 27 , 28 , 31 , 34 , 35 ]. All studies were assessed as having low risks of attrition bias and reporting bias.…”

Ophthalmic complaints in face-mask wearing: prevalence, treatment, and prevention with a potential protective effect against SARS-CoV-2

“…Osmolarity balanced artificial tears are used to increase tear volume in patients with DTS. Products containing sodium hyaluronate, and carboxymethylcellulose alone or combined with glycerin are effective in treating dry eye symptoms and for their prevention, but sodium hyaluronate has faster efficacy [67][68][69][70][71]. Seawater sprays are reported to decrease the level of pro-inflammatory IL-1-beta IL-6 and could be safely and effectively used for the treatment of dry eye symptoms [72].…”

“…The usage of artificial tears could be recommended to patients with DTS and to the general population to increase tear volume and drainage and thus decrease potential viral load. Preservative-free formulations show safety and efficacy and could be applied as frequently as needed [70,73].…”

Functionalized Hyaluronic Acid for “In Situ” Matrix Metalloproteinase Inhibition: A Bioactive Material to Treat the Dry Eye Sydrome

“…Hyaluronic acid (HA), a naturally occurring polysaccharide consisting of the repetition of a disaccharide composed of d -glucuronic acid (GLCA) and N -acetyl d -glucosamine (GlcNAc), plays a role in numerous molecular functions that contribute to the structure and physiology of the tissues, modulating cell behavior during morphogenesis, tissue remodeling, and inflammation. , HA is found naturally in physiological tear fluid and possesses excellent moisturizing and mucus-layer-adhesive properties. The inherent biocompatibility together with the susceptibility to chemical modifications have made HA particularly attractive for the development of viscoelastic tools with a broad clinical potential, including ophthalmology. , HA has been studied extensively for its applications for the treatment of DES. Dry eye is the disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability .…”