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Every practicing ophthalmologist, regardless of the scope of their clinical and scientific interests, is faced with a dilemma — what treatment to prescribe to a patient who applied for a primary outpatient appointment with signs of red eye syndrome? Prescribing an adequate amount of pathogenetically substantiated therapy will reduce the potential risk of developing complications associated with drug therapy.Purpose: to study the effectiveness of the treatment the blepharoconjunctivitis, episcleritis and keratitis, the regimen of which included the non-steroidal anti-inflammatory drug Okofenac 0.09 % (Otisipharm, Russia), the main active component of which is bromfenac, showed that the average term for stopping the inflammatory process in in all groups of patients included in the study, was 7–14 days, which indicates a high level of effectiveness of the treatment. At the same time, the maximum amount of drug therapy — more than two groups of drugs was prescribed to patients with keratitis. The quality of life according to the SPEED questionnaire, which reflects the symptoms characteristic of dry eye syndrome, was significantly lower in patients in the keratitis group, which suggested a relationship between the amount of drug therapy and the onset of dry eye syndrome in the long-term period — 1 month. This assumption was confirmed by a correlation analysis, which revealed a direct correlation between the number of prescribed drugs at the beginning of treatment and the quality of life according to the SPEED questionnaire after 1 month in all three groups of patients included in the study. Since this study was aimed at studying the effectiveness of anti-inflammatory therapy in the treatment of different, not only in terms of pathogenesis, but also the localization of the process, it only revealed certain trends in the relationship between the number of prescribed drugs at the beginning of treatment and the development of dry eye signs in the long-term period. Therefore, further research is needed to study the above trend in detail.In addition, as the analysis of literature data has shown, there are currently no indications for prescribing one or another type of drug therapy in the complex treatment of inflammatory diseases related to the “red eye syndrome”. In order to form criteria that take into account the history data — somatic status, duration of the inflammatory process, complaints of patients characterizing the inflammatory process, as well as biomicroscopic signs of inflammation, to select one or another pharmaceutical group of drugs, a survey of expert ophthalmologists was conducted. Based on the data of the survey, an algorithm for rational therapy of one of the most common pathologies included in the group of diseases red eye syndrome — conjunctivitis was formed. The above algorithm will be presented in the second part of this article.
Every practicing ophthalmologist, regardless of the scope of their clinical and scientific interests, is faced with a dilemma — what treatment to prescribe to a patient who applied for a primary outpatient appointment with signs of red eye syndrome? Prescribing an adequate amount of pathogenetically substantiated therapy will reduce the potential risk of developing complications associated with drug therapy.Purpose: to study the effectiveness of the treatment the blepharoconjunctivitis, episcleritis and keratitis, the regimen of which included the non-steroidal anti-inflammatory drug Okofenac 0.09 % (Otisipharm, Russia), the main active component of which is bromfenac, showed that the average term for stopping the inflammatory process in in all groups of patients included in the study, was 7–14 days, which indicates a high level of effectiveness of the treatment. At the same time, the maximum amount of drug therapy — more than two groups of drugs was prescribed to patients with keratitis. The quality of life according to the SPEED questionnaire, which reflects the symptoms characteristic of dry eye syndrome, was significantly lower in patients in the keratitis group, which suggested a relationship between the amount of drug therapy and the onset of dry eye syndrome in the long-term period — 1 month. This assumption was confirmed by a correlation analysis, which revealed a direct correlation between the number of prescribed drugs at the beginning of treatment and the quality of life according to the SPEED questionnaire after 1 month in all three groups of patients included in the study. Since this study was aimed at studying the effectiveness of anti-inflammatory therapy in the treatment of different, not only in terms of pathogenesis, but also the localization of the process, it only revealed certain trends in the relationship between the number of prescribed drugs at the beginning of treatment and the development of dry eye signs in the long-term period. Therefore, further research is needed to study the above trend in detail.In addition, as the analysis of literature data has shown, there are currently no indications for prescribing one or another type of drug therapy in the complex treatment of inflammatory diseases related to the “red eye syndrome”. In order to form criteria that take into account the history data — somatic status, duration of the inflammatory process, complaints of patients characterizing the inflammatory process, as well as biomicroscopic signs of inflammation, to select one or another pharmaceutical group of drugs, a survey of expert ophthalmologists was conducted. Based on the data of the survey, an algorithm for rational therapy of one of the most common pathologies included in the group of diseases red eye syndrome — conjunctivitis was formed. The above algorithm will be presented in the second part of this article.
Purpose: To evaluate the efficacy and safety of nonsteroid anti-inflammatory drugs (NSAIDs) in monotherapy and as part of combination therapy with glucocorticosteroids for the prevention of postoperative inflammation after cataract phacoemulsification.Material and methods. The study included 75 patients who underwent phacoemulsification with implantation of a posterior chamber intraocular lens. Patients were divided into groups depending on anti-inflammatory treatment: A1 — nepafenac (Nepafenac-Optic), A2 — bromfenac (Broxinac), A3 — dexamethasone (Dexamethasone), B1 — Nepafenac-Optic + dexamethasone, B2 — bromfenac + Dexamethasone. Postoperative inflammation was assessed by the severity of conjunctival hyperemia, pain, Tyndall effect and retinal thickness in the macular region.Results. The severity of the pain symptom was lower in the nepafenac group (A1) as compared to groups A2 and A3 by 49 and 74 %, respectively. A strong direct correlation with the Tyndall effect was revealed, which was more pronounced in group A3 and amounted to 0.73 points. An increase in the thickness of the retina in the macular region in the early stages after surgery was observed in groups A2 and A3, on average by 30 microns. In the groups of Nonpafenac Optic and combined therapy with GCS, the thickness of the retina remained stable. Cystic macular edema in the early postoperative period was observed in groups A2 and A3 and amounted to 2.6 and 1.3 %, respectively. There was a tendency to higher IOP rates in the GCS therapy groups.Conclusion. After surgical treatment of cataracts, the Nepafenac Optic significantly relieves the pain syndrome, as compared with monotherapy with bromfenac or dexamethasone. Nepafenac-Optic helps to reduce the severity of inflammation in the anterior and posterior segments of the eye, minimizes the changes in the retinal thickness of the macular region in the postoperative period. The severity of these effects is comparable to the combination therapy of NSAIDs + GCS. Nepafenac-Optic does not increase IOP, has a more favorable safety profile than in combinations with glucocorticosteroids, and reduces the risk of postoperative complications.
Conjunctivitis, according to various studies, is the most common reason for going to the initial outpatient appointment and can be caused by several factors at the same time. Treatment is carried out comprehensively, depending on the clinical picture, somatic status and anamnesis data. In accordance with the clinical guidelines developed by the Russian Association of Ophthalmologists, the following groups of drugs are recommended for use: antibacterial, antiseptic, antihistamine, nonsteroidal anti-inflammatory drugs.Purpose: to analyze the use of the above groups of drugs in the treatment of conjunctivitis in order to recommend a reasonable prescription of the necessary therapy.Materials and methods. The literature data on the study of the features of the action of the above pharmacological groups in the treatment of conjunctivitis, obtained on the resources of PubMed, eLibrary, Crossref Metadata, mainly over the past 20 years, are presented.Results. The presence of signs of an allergic reaction involves the appointment of antiallergic drugs with multiple pharmacological effects – blockade of histamine receptors, stabilization of mast cell membranes and suppression of eosinophil filtration. Given the different mechanisms of action within this group of drugs, it is necessary to select them individually. When prescribing tablet forms of antihistamines, it must be remembered that with prolonged use, they can cause patients to feel dry in their eyes. In cases where the above antiallergic drugs do not adequately control the allergic inflammatory process, anti-inflammatory drugs are used. Nonsteroidal and steroid anti-inflammatory drugs are used as anti-inflammatory drugs. Usually nonsteroidal anti-inflammatory drugs are recommended for use in chronic conjunctivitis and patients with a history of systemic diseases. Steroid drugs are indicated for severe forms of manifestation of the allergic process on the eyes, as well as the appointment of steroid anti-inflammatory drugs is recommended for use in short courses (up to 2 weeks), and with their longer use, control of intraocular pressure is necessary. Literature data indicate the lack of efficacy of antiviral drugs such as acyclovir and others from this group in the treatment of conjunctivitis of adenoviral etiology. Drugs with an immunomodulatory effect based on interferon or inducers of interferon synthesis are widely used. The prescription of antibiotics should be justified, since in recent years the level of resistance to them has significantly increased. Antiseptics that have a wide spectrum of action (bacteria, viruses, fungi and protozoa) are an alternative to antibiotics, but it must be remembered that this group of drugs often causes allergic reactions.Conclusion. The treatment of conjunctivitis must be approached carefully, taking into account not only the etiology of the disease, but also the somatic and immune status of the patient. To avoid the negative effects of the use of antibiotics, replace them with alternative drugs and do not use them in the treatment of conjunctivitis of a non-bacterial nature.
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