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Real-life results of switching from preserved to preservative-free artificial tears containing hyaluronate in patients with dry eye disease

Authors Nasser L, Rozycka M, Gomez Rendon G, Navas A

Received 16 December 2017

Accepted for publication 29 June 2018

Published 23 August 2018 Volume 2018:12 Pages 1519—1525


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Dr Scott Fraser

Linda Nasser,1 Malgorzata Rozycka,2 Gabriela Gomez Rendon,3 Alejandro Navas4

1Institute for Prevention of Blindness in Nuevo Leon, Monterrey, Mexico; 2Théa Laboratories, Mexico City, Mexico; 3Private practice; 4Cornea department, Institute of Ophthalmology, Conde de Valenciana, Mexico City, Mexico

Background: Dry eye disease (DED) is a chronic, multifactorial disease of the ocular surface leading to discomfort, visual disturbance, and tear film instability, with potential damage to the ocular surface.
Aim: The aim of this study was to assess the clinical benefit of a switch from preserved to preservative-free artificial tears (ATs) containing hyaluronate in patients with DED.
Materials and methods: This is a nationwide, multicenter, noninterventional, and transversal observational survey.
Results: The mean age was 51.0±15.4 years, ranging from 6 to 96 years. The majority (61.4%) was female. The mean Ocular Surface Disease Index (OSDI) before the switch was surprisingly high at 56.0±23.5, and 73.0% of the patients had superficial punctate keratitis (SPK). The mean duration of use of preserved ATs before the switch was 15.8±12.1 months. OSDI scores and the presence of SPK correlated with the patients’ ages but were independent of the duration of treatment with the preserved AT. The patients using ATs containing “soft” or “vanishing” preservatives presented exactly the same clinical pattern (level of OSDI and frequency of SPK) as those using ATs containing classical preservatives such as benzalkonium chloride (BAK). After switching to preservative-free AT containing hyaluronate (Hyabak®), the OSDI of 97.0% of the patients improved, decreasing from an average of 56.0 to an average of 28.2, with 23% of patients reporting a normal value of OSDI. The SPK frequency as well improved dramatically, with a frequency of positive fluorescein staining dropping from 73% to 46.1% of patients. A total of 94.0% of the patients considered that they preferred being treated with the preservative-free AT.
Conclusion: In patients suffering from DED and treated with a preserved AT, switching to a preservative-free AT provides clinical benefit by decreasing the severity of DED and reducing the prevalence of SPK, even after only 3 weeks of daily use of the preservative-free AT.

Keywords: dry eye syndrome, ocular surface diseases, preservative-free artificial tears, benzalkonium chloride free

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