Standardised antibacterial Manuka honey in the management of persistent post‐operative corneal oedema: a case series

Abstract

Background: Corneal oedema is a common post-operative problem that delays or prevents visual recovery from ocular surgery. Honey is a supersaturated solution of sugars with an acidic pH, high osmolarity and low water content. These characteristics inhibit the growth of microorganisms, reduce oedema and promote epithelialisation. This clinical case series describes the use of a regulatory approved Leptospermum species honey ophthalmic product, in the management of post-operative corneal oedema and bullous keratopathy. Methods: A retrospective review of 18 consecutive cases (30 eyes) with corneal oedema persisting beyond one month after single or multiple ocular surgical procedures (phacoemulsification cataract surgery and additional procedures) treated with Optimel Antibacterial Manuka Eye Drops twice to three times daily as an adjunctive therapy to conventional topical management with corticosteroid, aqueous suppressants, hypertonic sodium chloride five per cent, eyelid hygiene and artificial tears. Visual acuity and central corneal thickness were measured before and at the conclusion of Optimel treatment. Results: A temporary reduction in corneal epithelial oedema lasting up to several hours was observed after the initial Optimel instillation and was associated with a reduction in central corneal thickness, resolution of epithelial microcysts, collapse of epithelial bullae, improved corneal clarity, improved visualisation of the intraocular structures and improved visual acuity. Additionally, with chronic use, reduction in punctate epitheliopathy, reduction in central corneal thickness and improvement in visual acuity were achieved. Temporary stinging after Optimel instillation was experienced. No adverse infectious or inflammatory events occurred during treatment with Optimel. Conclusions: Optimel was a safe and effective adjunctive therapeutic strategy in the management of persistent post-operative corneal oedema and warrants further investigation in clinical trials.

Randomised controlled trial of topical antibacterial Manuka (Leptospermum species) honey for evaporative dry eye due to meibomian gland dysfunction

“…Prior to recruitment, an instillation trial of each Optimel treatment product was performed to assess for a hypersensitive reaction (right eye received Optimel 16 per cent drops and left eye received 98 per cent gel). It was expected that the topical ocular use of honey would produce transient stinging and conjunctival inflammation . If protracted inflammation and/or stinging (more than five minutes after instillation) was experienced or any late stage reactions were reported, the participant was excluded from further participation.…”

“…Honey is a supersaturated solution of sugars with an acidic pH, high osmolarity and low water content and can inhibit the growth of microorganisms, reduce oedema and promote epithelialisation . Honey from a variety of floral sources and geographic locations and in a range of concentrations, has been used in the chronic management of ocular surface diseases, including post‐operative corneal oedema and bullous keratopathy, Sjögren's and non‐Sjögren's aqueous deficient dry eye, evaporative dry eye due to MGD, neurotrophic keratitis, vernal keratoconjunctivitis, contact lens‐related microbial keratitis and as antimicrobial prophylaxis for eye surgery …”

“…These medically regulated Leptospermum spp. antibacterial honey products have numerous practical advantages in the chronic care of dry eye and MGD: low cost, over‐the‐counter, sterile, non‐preserved (gel product) and non‐benzalkonium chloride preserved (eye drop product), non‐cytotoxic with frequent dosing and long‐term dosing, multidose, broad spectrum, unaffected by standard room temperature (being most active at 25°C) and unaffected by UV and extended shelf life . Leptospermum spp.…”

“…Leptospermum spp. honeys can also be used concurrently with topical lubricant, antimicrobial, anti‐glaucoma and anti‐inflammatory therapies …”

Honey: A Natural Remedy for Eye Diseases

“…Recently, Albietz and Lenton [44] demonstrated the effects of standardized Manuka honey eye drops on post-operative corneal edema persisting beyond 1 month after surgery. A temporary reduction in corneal epithelial edema lasting for up to several hours was observed after the initial Manuka honey eye drop instillation in 18 cases (30 eyes) and was associated with a reduction in central corneal thickness, the resolution of epithelial microcysts, the collapse of epithelial bullae, improved corneal clarity, improved visualization of the intraocular structures, and improved visual acuity.…”