Eyeworld

18 May 2018 EW NEWS & OPINION by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer proparacaine hydrochloride; kera- toepitheliopathy score; and the tear clearance rate ((log2)-1). What happened? At baseline, the control group had a mean tear film breakup time of 10.08 ± 1.55 s compared to 7.05 ± 2.26 s obtained 1 month after the initiation of treatment, which re- verted to 9.86 ± 2.53 s in the course of the second and third months after surgery. The mean baseline Schirm- er's test in the control group was 10.76 ± 2.60 mm compared to 6.70 ± 3.19 mm 1 month after surgery, and roughly 10 mm in the second and third months after treatment initiation. Controls had a baseline keratoepitheliopathy score of 0.24 ± 0.43, which changed to roughly 0.19 at 1 month, and back to 0.24 ± 0.43 at the 2-month point. The tear clearance rate of 5.97 ± 1.14 ((log2)- 1) sunk to 3.51 ± 0.69 ((log2)-1) in the first month, rising back to 5.35 ± 1.42 ((log2)-1) in the second month of treatment, with similar values in the third postoperative month. The Ginkgo biloba group had a baseline mean tear film break- up time of 4.15 ± 0.88 s, a mean Schirmer's test score of 4.20 ± 0.89 mm, a keratoepitheliopathy score of 2.35 ± 1.31, and a mean tear clearance rate of 3.45 ± 0.69 ((log2)- 1). One month after surgery and the oral Ginkgo biloba/cyclosporine regimen, the mean tear film break- up was 4.25 ± 0.79 s, remaining steady at about 4.15 ± 0.75 s during the second and third postoperative months. The Schirmer's test was 4.05 ± 0.83 mm after 1 month, 4.10 ± 0.85 mm after 2 months, and 4.15 ± 0.88 mm after 3 months of treat- ment. Keratoepitheliopathy scores were 3.2 ± 1.82 at 1 month after treatment, which decreased to 1.80 ± 1.28 by 3 months after treatment. The tear clearance rate 1 month after treatment was 3.25 ± 0.79 ((log2)-1), 3.30 ± 0.66 ((log2)-1) at 2 months, and 3.40 ± 0.68 ((log2)-1) after 3 months of treatment. Dr. Kim explained that although there was no significant difference between the two groups in the objective evaluation index, symp- tomatic improvement was greater in the Ginkgo biloba group clini- cally. While a longer follow-up was Ji-Hyun Kim, MD, Seoul St. Mary's Hospital, Seoul, Korea. The investigation based its premise on Ginkgo biloba's anti- oxidant activity and inhibition of excitotoxicity of the ocular surface, combined with immunosuppressant cyclosporine eye drops, to achieve the desired effect. Ginkgo biloba is known to have an effect on blood flow and a soothing effect on over- wrought nerve receptor sites. Excito- toxicity is the pathological process by which nerve cells are damaged or killed by excessive stimulation by neurotransmitters, due to receptor overactivation. The study included 32 patients who underwent cataract surgery and were followed for 3 months thereaf- ter. Sixteen of the patients received therapy with oral Ginkgo biloba extract and topical cyclosporine 0.05%. A control group was com- prised of 16 patients who received topical cyclosporine 0.05% only. The outcome assessment in- volved: tear film breakup time with 2 µL of 1% fluorescein solution instilled; Schirmer II test using 0.5% ocular surface, meibomian glands, the main lacrimal gland, and the innervation between them, and has many features in common with autoimmune disease. Dry eye is trig- gered by stress to the ocular surface, such as environmental factors, in- fection, endogenous stress, antigens, and genetic factors, and perpetuated through the body's inflammatory response, causing a vicious cycle of damage to the ocular surface and inflammation. 1 Novel approach to dry eye According to a study that was pre- sented as an e-poster at the XXXV Congress of the ESCRS, oral Ginkgo biloba extract effectively achieved symptomatic relief of dry eye in the study group, suggesting a feasible, highly successful new approach to the problem. "We think that oral Ginkgo biloba extract combined with cyclosporine eye drops is the new approach to relieve dry eye symptoms through stabilizing the activated nervous system," ac- cording to the study's first author A novel oral drug combination marshals the effects of increased antioxidant activity and reduced excitotoxicity to effectively reduce dry eye P hysicians are still trying to solve the painful and frustrating problem of dry eye, despite approaching this disease from various angles. Current research targets the disease pathophysiology and is exploring novel therapies such as secretagogues, topical androgens, and new anti-inflammatory drugs. Dry eye is a common occurrence, linked to hyperosmolarity of the tear film and inflammation of the ocular surface and lacrimal glands. This multifactorial disease of the tears and the ocular surface results in discomfort, visual disturbance, and tear film instability that threat- ens to damage the ocular surface. It can affect any aspect of the func- tional unit that is comprised of the New drug regimen uses Ginkgo biloba extract to alleviate dry eye Presentation spotlight

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