Improving and Protecting the Ocular Surface «

Improving and Protecting the Ocular Surface

The abrasion healed within 3 days after removal of the amniotic ring. In the next 3 months, the patient’s vision improved significantly, to 20/70 OD and 20/100 OS, respectively.

The patient was continued on a regimen of gel artificial tears and preservative-free artificial tears. However, about 7 months after her first episode of corneal abrasion, a 2- x 2.5-mm central epithelial defect recurred in the left eye with reduced vision, leaving her 20/200 OD and 20/400 OS. After insertion of a bandage lens and then another amniotic ring, the epithelial defect healed in 2 weeks and the vision of the left eye improved to 20/70.

She then continued on the preservative-free artificial tear regimen and topical cyclosporine. After 5 months, she was still unable to read (she was 20/200 OD and 20/100 OS), and moderate to severe superficial punctuate keratopathy continued to exist in both eyes. By then she had begun to have problems putting drops in the eyes so often.

I suggested LACRISERT^® (hydroxypropyl cellulose ophthalmic insert) to the patient. Why do you think I suggested LACRISERT for this patient?

○	a. Once-daily dosing Yes, once-daily dosing contributed to my suggestion of LACRISERT^®. For most patients, once daily use of the ophthalmic insert is sufficient.¹ Some patients may require twice-daily dosing for optimal results. This is not the only factor I was considering regarding use of LACRISERT for this patient. Please select again. Lacrisert [package insert] Bridgewater, NJ: Valeant Pharmaceuticals International, Inc.; 2014.
○	b. Continuous lubrication and protection Yes, lubrication and protection of the corneal surface is important in improving symptoms and signs of this patient’s moderate to severe dry eye. Containing 5 mg of hydroxypropyl cellulose that is released in a sustained fashion over 14 to 18 hours, the LACRISERT^® insert acts to lubricate and protect the corneal epithelium with once-daily dosing.¹ Some patients may require twice-daily use for optimal results. This is not the only factor I was considering regarding use of LACRISERT for this patient. Please select again. Lacrisert [package insert] Bridgewater, NJ: Valeant Pharmaceuticals International, Inc.; 2014.
○	c. Free of preservatives Yes, discontinuation or avoidance of preservatives in topical medications, which may be detrimental to the ocular surface epithelium, can be an important treatment strategy in patients with neurotrophic keratitis.¹ What other benefits may LACRISERT^® have? Please select again. Baudouin C, Labbé A, Liang H, et al. Preservatives in eyedrops: the good, the bad and the ugly. Prog Retin Eye Res. 2010; 29(4):312-334.
○	d. All of the above Yes, LACRISERT^® makes an appropriate therapy for this patient in many ways. Unlike artificial tears, the insert can be dosed once daily; some patients may require twice-daily use for optimal results. The insert contains no preservatives or other ingredients than hydroxypropyl cellulose. Importantly, LACRISERT can provide lubrication and protection of the corneal surface — a key to achieving the treatment goal at this stage: preventing the recurrence of epithelial breakdown.

Indications and Usage

LACRISERT^® (hydroxypropyl cellulose ophthalmic insert) is indicated in patients with moderate to severe dry eye syndromes, including keratoconjunctivitis sicca. LACRISERT is indicated especially in patients who remain symptomatic after an adequate trial of therapy with artificial tear solutions. LACRISERT is also indicated for patients with exposure keratitis, decreased corneal sensitivity, and recurrent corneal erosions.

Important Safety Information

LACRISERT^® (hydroxypropyl cellulose ophthalmic insert) is contraindicated in patients who are hypersensitive to hydroxypropyl cellulose.
Instructions for inserting and removing LACRISERT should be carefully followed.
If improperly placed, LACRISERT may result in corneal abrasion. Because LACRISERT may cause transient blurred vision, patients should be instructed to exercise caution when driving or operating machinery.
The following adverse reactions have been reported, but were in most instances mild and temporary: transient blurring of vision, ocular discomfort or irritation, matting or stickiness of eyelashes, photophobia, hypersensitivity, eyelid edema, and hyperemia.

Please see full Prescribing Information for LACRISERT^® (hydroxypropyl cellulose ophthalmic insert).

Paul Karpecki, OD, FAAO, works in Corneal Services and is clinical research director at the Kofﬂer Vision Group in Lexington, KY. He is a consultant for Bausch + Lomb and Bio-Tissue Inc.

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