MAY 15, 2005 A l l t h e C l i n i c a l N e w s i n S i g h t Punctal plugs plus topical agent maximize dry eye relief Combination offers improvement with less reliance on artificial tears By Cheryl Guttman
scores in the three groups ranged from 2 to 2.3 at
Dual approach
baseline (possible score range, 0 to 4). All groups
“Management of dry eye has received increased at-
showed a modest benefit after 1 month (mean
Fort Lauderdale, FL—A dual treatment approach
tention recently, and with the introduction of sev-
change range, –0.2 to –0.3), and there was no fur-
combining punctal plugs with use of topical cy-
eral new therapeutic modalities, including new ar-
ther improvement throughout the course of the
closporine ophthalmic emulsion 0.05% (Restasis,
tificial tear products, topical cyclosporine, and new
study in the patients using punctal plugs. How-
Allergan) affords dry eye sufferers greater improve-
punctal plugs, the question arises what is the best
ever, patients using cyclosporine alone or in com-
ment in their signs and symptoms than monother-
first-line intervention for patient care,” Dr. Roberts
bination with punctal plugs achieved greater re-
apy with either modality alone, said Calvin W.
said.“While topical cyclosporine is being used more
ductions in conjunctival staining after 3 months
and more for the treatment of moderate dry eye,
and further benefit by study conclusion when mean
Dr. Roberts, clinical professor of ophthalmol-
our study results indicate clinicians should not aban-
changes from baseline were –0.9 and –1, respec-
ogy, Weill Medical College of Cornell University,
don punctal plugs nor consider punctal plugs and
New York, reported the results of a parallel com-
cyclosporine as mutually exclusive. Those modali-
Mean frequency of artificial tear instillation at
parison study in which 30 consecutive patients
ties are complementary, work by different mecha-
baseline ranged from 5.5 to 6.0 times daily across
with bilateral dry eye symptoms and 2+ conjunc-
nisms of action, and act synergistically to maximize
the three treatment groups. By 1 month, patients
tival staining with lissamine green were randomly
relief of the signs and symptoms of dry eye.”
who had punctal plugs placed reduced their usage
assigned to receive topical cyclosporine twice a day,
At baseline, mean Schirmer scores ranged from
by about two instillations a day whether or not
punctal plugs to the lower lids only, or combina-
2.5 to 2.7 mm across the three groups. At the 1-
they also were using cyclosporine whereas patients
tion treatment. Responses were evaluated after 1,
using cyclosporine monotherapy had minimal
3, and 6 months by assessing Schirmer test results
(5 minutes with anesthesia), conjunctival staining
However, the group receiving the punctal plugs
‘Our study
scores, and frequency of use of artificial tears for
alone achieved no additional reduction in artifi-
symptom relief. He presented the results at the As-
results indicate
cial tear use over the next several months while
sociation for Research in Vision and Ophthalmol-
those using cyclosporine had progressively greater
clinicians
ogy annual meeting here earlier this month.
benefit. After 6 months, mean reductions in the
After just 1 month, punctal plugs were associ-
should not
frequency of artificial tear instillation were –3.2 in
ated with marked improvement in Schirmer scores
the cyclosporine group and –3.8 in the combina-
abandon punctal plugs nor
and decreased frequency of artificial tear use, but
that intervention had little effect on conjunctival
consider punctal plugs and
Dr. Roberts chose the Parasol Punctal Occluder
staining. Onset to efficacy took longer with cy-
(Odyssey Medical) for punctal plug placement in cyclosporine mutually exclusive.’
closporine monotherapy, but all three measures
this study based on his positive experience with
of efficacy eventually improved with its use. How-
that product in clinical practice. The Parasol Punc-
Calvin W. Roberts, MD
ever, patients in the combination group enjoyed
tal Occluder was easy to fit in all patients and well-
the benefits of both modalities with improvements
tolerated throughout the study. OT
that occurred early and that were equal or supe-
month visit, mean Schirmer scores had increased
rior to those associated with either of the
to 7 mm in the punctal plug group and 7.1 mm
among patients receiving combination therapy, buthad decreased to 1.2 mm in the cyclosporine group.
At study conclusion, however, mean Schirmer scores
Take-Home Message
were comparable in the punctal plug and combi-
Calvin W. Roberts, MD
nation groups (6.3 and 6.5 mm, respectively) and
Results of a prospective, parallel comparison study
were slightly inferior in patients using cyclosporine
support combined treatment with punctal plugs
Dr. Roberts received no industry financial support for this
plus topical cyclosporine (Restasis, Allergan) for
Mean lissamine green conjunctival staining
study. He is a consultant to Allergan, and has no financial
management of moderately severe dry eye.
Reprinted from OPHTHALMOLOGY TIMES, May 15, 2005
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Journal of Antimicrobial Chemotherapy (2001) 48 , 141–156 Correspondence Emergence of TetM-mediated tetracycline ductive Health is situated in the rural district of Hlabisa in resistance in rural South Africa KwaZuluNatal. A direct spinoff of this centre has been theestablishment of an STD clinic for the area. During STD J Antimicrob Chemother 2001; 48: 142–143 prevalence an
1. DÉNOMINATION DU MÉDICAMENT TRIVASTAL® 50 mg LP, comprimé enrobé à libération prolongée. 2. COMPOSITION QUALITATIVE ET QUANTITATIVE Piribédil . 50,00 mg Pour un comprimé enrobé à libération prolongée. Pour la liste complète des excipients, voir rubrique 6.1. 3. FORME PHARMACEUTIQUE Comprimé enrobé à libération prolongée. 4. DONNÉES CLINIQUES 4.1