The Efficacy of 2% Topical Rebamipide on Conjunctival Squamous Metaplasia and Goblet Cell Density in Dry Eye Disease

Abstract

Purpose: To clarify the pharmacological effects of 2% rebamipide eye drops on mucosal membrane functions of the ocular surface epithelium, we investigated keratoconjunctival alterations at the cellular level in this study. Methods: Fifteen patients with definite dry eye disease were recruited from outpatient clinics of the Department of Ophthalmology, Ichikawa General Hospital. The patients received treatment with 2% rebamipide eye drops q.i.d for 12 weeks. Symptom score assessment, tear film breakup time, fluorescein and lissamine green ocular surface vital staining, grading of lid wiper epitheliopathy, Cochet-Bonnet corneal sensitivity, assessment of squamous metaplasia grades, and goblet cell density calculations from conjunctival impression cytology samples, as well as evaluation of nucleocytoplasmic ratios and corneal epithelial cells from in vivo confocal microscopy images before and 3 months after treatment were performed. Results: The mean symptom scores, tear film breakup time values, ocular surface fluorescein and lissamine green vital staining scores, and lid wiper scores showed a significant improvement after treatment (P < 0.01). The mean squamous metaplasia grade also showed a significant improvement (1.2-0.1 / 0.3-0.1) 3 months after treatment (P = 0.004). There were similar significant improvements in the mean corneal epithelial cell density (660.1-62.6 / 1015.5-43.5 cells/mm 2) (P = 0.002) and nucleocytoplasmic ratios (0.1-0.0 / 0.2-0.0) (P = 0.0042) after treatment. Conclusions: Topical use of 2% rebamipide for 3 months was associated with improvements in ocular surface differentiation due to changes of mucosal functions at the cellular level. These alterations may explain objective and subjective improvements in dry eye disease.

Imaging assessment of conjunctival goblet cells in dry eye disease

“…Furthermore, the assessment of CGCs status can significantly contribute to the diagnosis, classification, severity evaluation, and treatment of DED. 62,63 Notably, the use of evaluation methods for assessing CGCs can yield widely varying results, apart from factors such as age, sex, and disease characteristics. Given the significance of CGCs in DED, we covered imaging methodological developments in the visual assessment of CGCs below.…”

Reflections on the Ocular Surface: Summary of the Presentations at the 4th Coronis Foundation Ophthalmic Symposium Debate: “A Multifactorial Approach to Ocular Surface Disorders” (August 31 2021)

“…Compromised epithelial barrier function is also related to aging and hence, strengthening the epithelial barrier is not only essential in allergic keratoconjunctivitis, but also in all forms of DED. Significantly, the anti-oxidative activity of 2% Rebamipide has been shown to stabilize the corneal epithelial barrier [85,86].…”

The Efficacy and Safety of Rebamipide Ophthalmic Suspension (OPC-12759) in Patients with Dry Eye Disease: A Systematic Review of Randomized Controlled Trials

“…There are many studies that show its effectiveness in the treatment of DED. REB ophthalmic suspension (1% and 2%) has shown significant improvements in corneal and conjunctival staining, as well as tear film break-up time (TBUT) [20][21][22][23][24]. Igarashi et al [25] reported an improvement in DED symptoms and signs among contact lens (CL) wearers.…”