Abstract
BACKGROUND--Several studies in the past have attempted to demonstrate the efficacy of sodium hyaluronate in the treatment of dry eyes. However, results have been conflicting and a definite conclusion has not yet been reached. This study recruited a larger group of patients and has incorporated for the first time both fluorescein and rose bengal staining in the evaluation of the epithelium. METHODS--Eighteen albino rabbit corneas were used in a basic animal study to demonstrate the efficacy of sodium hyaluronate by comparing the effects on the rate of epithelial healing. The optimal concentration to be used in the clinical trial was determined from the results of the basic study. In the clinical study 104 patients with dry eye syndrome were enrolled in a double masked controlled clinical trial. Patients received sodium hyaluronate drops in one eye and control medication in the other eye for 4 weeks. Grading of subjective symptoms and clinical examinations were performed at 2 and 4 weeks. RESULTS--In the animal study sodium hyaluronate at concentrations of 0.1% and 0.5% significantly accelerated the recovery time of iodine vapour induced corneal erosions (p < 0.01). In the clinical study no statistical significance was observed in the improvement of subjective symptoms or rose bengal staining, while fluorescein scores significantly improved in eyes receiving sodium hyaluronate (p = 0.0001) at 4 weeks. CONCLUSION--Sodium hyaluronate drops applied in six daily doses could not be demonstrated to offer advantages over conventional tear supplies in the improvement of subjective symptoms, but may play a role in maintaining a healthy corneal epithelium.
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- DeLuise V. P., Peterson W. S. The use of topical Healon tears in the management of refractory dry-eye syndrome. Ann Ophthalmol. 1984 Sep;16(9):823–824. [PubMed] [Google Scholar]
- Feenstra R. P., Tseng S. C. Comparison of fluorescein and rose bengal staining. Ophthalmology. 1992 Apr;99(4):605–617. doi: 10.1016/s0161-6420(92)31947-5. [DOI] [PubMed] [Google Scholar]
- Fox R. I., Robinson C. A., Curd J. G., Kozin F., Howell F. V. Sjögren's syndrome. Proposed criteria for classification. Arthritis Rheum. 1986 May;29(5):577–585. doi: 10.1002/art.1780290501. [DOI] [PubMed] [Google Scholar]
- Inoue M., Katakami C. The effect of hyaluronic acid on corneal epithelial cell proliferation. Invest Ophthalmol Vis Sci. 1993 Jun;34(7):2313–2315. [PubMed] [Google Scholar]
- Limberg M. B., McCaa C., Kissling G. E., Kaufman H. E. Topical application of hyaluronic acid and chondroitin sulfate in the treatment of dry eyes. Am J Ophthalmol. 1987 Feb 15;103(2):194–197. doi: 10.1016/s0002-9394(14)74226-6. [DOI] [PubMed] [Google Scholar]
- Mengher L. S., Pandher K. S., Bron A. J., Davey C. C. Effect of sodium hyaluronate (0.1%) on break-up time (NIBUT) in patients with dry eyes. Br J Ophthalmol. 1986 Jun;70(6):442–447. doi: 10.1136/bjo.70.6.442. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Moses R. A., Parkison G., Schuchardt R. A standard large wound of the corneal epithelium in the rabbit. Invest Ophthalmol Vis Sci. 1979 Jan;18(1):103–106. [PubMed] [Google Scholar]
- Nelson J. D., Farris R. L. Sodium hyaluronate and polyvinyl alcohol artificial tear preparations. A comparison in patients with keratoconjunctivitis sicca. Arch Ophthalmol. 1988 Apr;106(4):484–487. doi: 10.1001/archopht.1988.01060130530029. [DOI] [PubMed] [Google Scholar]
- Nishida T., Nakagawa S., Awata T., Ohashi Y., Watanabe K., Manabe R. Fibronectin promotes epithelial migration of cultured rabbit cornea in situ. J Cell Biol. 1983 Nov;97(5 Pt 1):1653–1657. doi: 10.1083/jcb.97.5.1653. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Nishida T., Nakagawa S., Nishibayashi C., Tanaka H., Manabe R. Fibronectin enhancement of corneal epithelial wound healing of rabbits in vivo. Arch Ophthalmol. 1984 Mar;102(3):455–456. doi: 10.1001/archopht.1984.01040030369040. [DOI] [PubMed] [Google Scholar]
- Nishida T., Nakamura M., Mishima H., Otori T. Hyaluronan stimulates corneal epithelial migration. Exp Eye Res. 1991 Dec;53(6):753–758. doi: 10.1016/0014-4835(91)90110-z. [DOI] [PubMed] [Google Scholar]
- Pflugfelder S. C., Huang A. J., Feuer W., Chuchovski P. T., Pereira I. C., Tseng S. C. Conjunctival cytologic features of primary Sjögren's syndrome. Ophthalmology. 1990 Aug;97(8):985–991. doi: 10.1016/s0161-6420(90)32478-8. [DOI] [PubMed] [Google Scholar]
- Sand B. B., Marner K., Norn M. S. Sodium hyaluronate in the treatment of keratoconjunctivitis sicca. A double masked clinical trial. Acta Ophthalmol (Copenh) 1989 Apr;67(2):181–183. doi: 10.1111/j.1755-3768.1989.tb00750.x. [DOI] [PubMed] [Google Scholar]
- Snibson G. R., Greaves J. L., Soper N. D., Tiffany J. M., Wilson C. G., Bron A. J. Ocular surface residence times of artificial tear solutions. Cornea. 1992 Jul;11(4):288–293. doi: 10.1097/00003226-199207000-00003. [DOI] [PubMed] [Google Scholar]
- Toda I., Fujishima H., Tsubota K. Ocular fatigue is the major symptom of dry eye. Acta Ophthalmol (Copenh) 1993 Jun;71(3):347–352. doi: 10.1111/j.1755-3768.1993.tb07146.x. [DOI] [PubMed] [Google Scholar]
- Toda I., Tsubota K. Practical double vital staining for ocular surface evaluation. Cornea. 1993 Jul;12(4):366–367. doi: 10.1097/00003226-199307000-00015. [DOI] [PubMed] [Google Scholar]
- Tsubota K., Toda I., Yagi Y., Ogawa Y., Ono M., Yoshino K. Three different types of dry eye syndrome. Cornea. 1994 May;13(3):202–209. doi: 10.1097/00003226-199405000-00002. [DOI] [PubMed] [Google Scholar]
- Tsubota K., Yamada M. Tear evaporation from the ocular surface. Invest Ophthalmol Vis Sci. 1992 Sep;33(10):2942–2950. [PubMed] [Google Scholar]
- Watanabe K., Nakagawa S., Nishida T. Chemotactic and haptotactic activities of fibronectin for cultured rabbit corneal epithelial cells. Invest Ophthalmol Vis Sci. 1988 Apr;29(4):572–577. [PubMed] [Google Scholar]