Levels of prostaglandin E2 and leukotriene B4 in tears of vernal conjunctivitis patients during a therapeutic trial with indomethacin

Abstract

A therapeutic trial of 1% indomethacin (Indoptic) eye drops was carried out in 21 children. Looking for possible mediators of inflammation in vernal conjunctivitis, prostaglandin E2 (PGE2) and leukotriene B4 (LTB4 levels in the tears of 9 patients were measured and the effect of the treatment on them examined. A control group of 10 unaffected children was added. Out of 42 eyes in which indomethacin treatment was instilled, only 17 remained in treatment through a 6-week follow-up period. In a few of them a moderate improvement was obtained. The mean level of PGE2 in the patients before treatment was found to be slightly lower than that in the control group, and it dropped even lower during treatment. The average LTB4 level found in patients before treatment was significantly higher than the control group; it decreased somewhat following treatment, but not significantly. This is the first report of elevated LTB4 levels in vernal conjunctivitis, previously not recorded in the literature, it points to the possible role of LTB4 in the pathogenesis of the disease. A constant relationship was observed between low PGE2 levels and high LTB4 content in the patients' tears during highly inflamed states of the eye. We conclude that: (a) indomethacin did not prove to be a highly effective topical treatment for vernal conjunctivitis; (b) PGE2 does not seem to be a dominant mediator of inflammation in this disease; and (c) LTB4, on the other hand, apparently has a role in the mechanism of inflammation of the disease, thus raising hopes for future addition to therapy.

Topical Bromfenac Sodium for Long-Term Management of Vernal Keratoconjunctivitis

“…However, it has been reported that systemic bromfenac treatment significantly reduces not only PGE 2 and PGF 2 α levels in the follicular fluid, but also LTB 4 levels compared with those after placebo treatment in humans [25]. The LTB 4 level in tears of patients with VKC is reported to be elevated [26]. We have recently reported that the tear LTB 4 level in AD patients with ocular complications showed a significant elevation compared with that in AD patients without ocular complications and controls [4].…”

Vernal keratoconjunctivitis

“…[32][33][34][35][36] It has been demonstrated that leukotrienes are also produced in the conjunctiva 37 and are detectable in tear fluids of patients affected by allergic conjunctivitis including VKC. [38][39][40] Indeed LT concentration in tears increases in allergic subjects following allergen challenge. 41,42 In addition, conjunctival administration of LTB4, as well as LTC4 and LTD4, induces vessel vasodilatation, oedema, hyperaemia, and leucocyte and eosinophilic infiltration of the conjunctiva.…”

Preservative-free diclofenac sodium 0.1% for vernal keratoconjunctivitis

“…These mediators may contribute to the pathogenesis of VKC through several mechanisms. The oedema observed in VKC is related to the activity of LTs and PGs in inducing a conjunctival microvascular permeability increase that remains virtually constant over time even in very small doses [3,17,19,20].…”