Combination of Hyaluronic Acid, Carmellose, and Osmoprotectants for the Treatment of Dry Eye Disease

Overview

Journal Clin Ophthalmol

Publisher Dove Medical Press

Specialty Ophthalmology

Date 2018 Mar 23

PMID 29563769

Citations 13

Authors

Antonio Jose Mateo Orobia

Jorge Saa

Alberto Ollero Lorenzo

Jose Maria Herreras

Affiliations

Soon will be listed here.

Abstract

Background: Dry Eye Disease (DED) is a multifactorial disease, with a high prevalence, that can have a great impact on the quality of life of patients. The first step of treatment includes the use of lacrimal substitutes composed of polymers, possible to associate osmoprotectant agents to the lacrimal substitutes. The aim of this article is to analyze the properties of the combination of hyaluronic acid (HA), carmellose, and osmoprotectors (Optava Fusion; Allergan, Inc., Irvine, CA, USA) on DED. General considerations on the use of artificial tears are also proposed.

Methods: A group of ophthalmologists, experts in the management of the ocular surface, analyzed different aspects related to DED; among them, the use of artificial tears in general and the properties of the combination of HA, carmellose, and osmoprotectors, in particular, were discussed. A review of the literature was carried out, which included different articles published in Spanish, English, and French until April 2017.

Conclusions: DED is a common chronic pathology that usually requires sustained treatment. In addition, the combination of HA, carmellose, and osmoprotectors has proven to be effective in the treatment of symptoms and signs of dry eye by the synergistic action of all its components. This review provides key elements to help ophthalmologists who begin in the management of DED.

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References

Calonge M, Enriquez-de-Salamanca A, Diebold Y, Gonzalez-Garcia M, Reinoso R, Herreras J . Dry eye disease as an inflammatory disorder. Ocul Immunol Inflamm. 2010; 18(4):244-53. DOI: 10.3109/09273941003721926. View

Pauloin T, Dutot M, Joly F, Warnet J, Rat P . High molecular weight hyaluronan decreases UVB-induced apoptosis and inflammation in human epithelial corneal cells. Mol Vis. 2009; 15:577-83. PMC: 2660376. View

Widner B, Behr R, Von Dollen S, Tang M, Heu T, Sloma A . Hyaluronic acid production in Bacillus subtilis. Appl Environ Microbiol. 2005; 71(7):3747-52. PMC: 1168996. DOI: 10.1128/AEM.71.7.3747-3752.2005. View

Yao K, Bao Y, Ye J, Lu Y, Bi H, Tang X . Efficacy of 1% carboxymethylcellulose sodium for treating dry eye after phacoemulsification: results from a multicenter, open-label, randomized, controlled study. BMC Ophthalmol. 2015; 15:28. PMC: 4407782. DOI: 10.1186/s12886-015-0005-3. View

Behrens A, Doyle J, Stern L, Chuck R, McDonnell P, Azar D . Dysfunctional tear syndrome: a Delphi approach to treatment recommendations. Cornea. 2006; 25(8):900-7. DOI: 10.1097/01.ico.0000214802.40313.fa. View

Stridh S, Palm F, Hansell P . Renal interstitial hyaluronan: functional aspects during normal and pathological conditions. Am J Physiol Regul Integr Comp Physiol. 2012; 302(11):R1235-49. DOI: 10.1152/ajpregu.00332.2011. View

Hua X, Su Z, Deng R, Lin J, Li D, Pflugfelder S . Effects of L-carnitine, erythritol and betaine on pro-inflammatory markers in primary human corneal epithelial cells exposed to hyperosmotic stress. Curr Eye Res. 2014; 40(7):657-67. PMC: 4793974. DOI: 10.3109/02713683.2014.957776. View

Deng R, Su Z, Hua X, Zhang Z, Li D, Pflugfelder S . Osmoprotectants suppress the production and activity of matrix metalloproteinases induced by hyperosmolarity in primary human corneal epithelial cells. Mol Vis. 2014; 20:1243-52. PMC: 4165325. View

Jin P, Kang Z, Yuan P, Du G, Chen J . Production of specific-molecular-weight hyaluronan by metabolically engineered Bacillus subtilis 168. Metab Eng. 2016; 35:21-30. DOI: 10.1016/j.ymben.2016.01.008. View

10.

Reitmeir P, Linkohr B, Heier M, Molnos S, Strobl R, Schulz H . Common eye diseases in older adults of southern Germany: results from the KORA-Age study. Age Ageing. 2016; 46(3):481-486. PMC: 5405752. DOI: 10.1093/ageing/afw234. View

11.

Li M, Gong L, Sun X, Chapin W . Anxiety and depression in patients with dry eye syndrome. Curr Eye Res. 2010; 36(1):1-7. DOI: 10.3109/02713683.2010.519850. View

12.

Goa K, Benfield P . Hyaluronic acid. A review of its pharmacology and use as a surgical aid in ophthalmology, and its therapeutic potential in joint disease and wound healing. Drugs. 1994; 47(3):536-66. DOI: 10.2165/00003495-199447030-00009. View

13.

Gouveia S, Tiffany J . Human tear viscosity: an interactive role for proteins and lipids. Biochim Biophys Acta. 2005; 1753(2):155-63. DOI: 10.1016/j.bbapap.2005.08.023. View

14.

Ubels J, Williams K, Lopez Bernal D, Edelhauser H . Evaluation of effects of a physiologic artificial tear on the corneal epithelial barrier: electrical resistance and carboxyfluorescein permeability. Adv Exp Med Biol. 1994; 350:441-52. DOI: 10.1007/978-1-4615-2417-5_77. View

15.

Versura P, Cellini M, Torreggiani A, Profazio V, Bernabini B, Caramazza R . Dryness symptoms, diagnostic protocol and therapeutic management: a report on 1,200 patients. Ophthalmic Res. 2001; 33(4):221-7. DOI: 10.1159/000055674. View

16.

Bjerrum K . Keratoconjunctivitis sicca and primary Sjögren's syndrome in a Danish population aged 30-60 years. Acta Ophthalmol Scand. 1997; 75(3):281-6. DOI: 10.1111/j.1600-0420.1997.tb00774.x. View

17.

Corrales R, Luo L, Chang E, Pflugfelder S . Effects of osmoprotectants on hyperosmolar stress in cultured human corneal epithelial cells. Cornea. 2008; 27(5):574-9. DOI: 10.1097/ICO.0b013e318165b19e. View

18.

Schaumberg D, Sullivan D, Buring J, Dana M . Prevalence of dry eye syndrome among US women. Am J Ophthalmol. 2003; 136(2):318-26. DOI: 10.1016/s0002-9394(03)00218-6. View

19.

Girish K, Kemparaju K . The magic glue hyaluronan and its eraser hyaluronidase: a biological overview. Life Sci. 2007; 80(21):1921-43. DOI: 10.1016/j.lfs.2007.02.037. View

20.

Wu H, Zhang H, Wang C, Wu Y, Xie J, Jin X . Genoprotective effect of hyaluronic acid against benzalkonium chloride-induced DNA damage in human corneal epithelial cells. Mol Vis. 2012; 17:3364-70. PMC: 3247171. View