Modulating Contact Lens Discomfort With Anti-Inflammatory Approaches: A Randomized Controlled Trial

作者：Downie Laura E^*; Gad Anne; Wong Chinn Yi; Gray John Henry V; Zeng Weiguang; Jackson David C; Vingrys Algis J

来源：Investigative Ophthalmology & Visual Science, 2018, 59(8): 3755-3766.

DOI：10.1167/iovs.18-24758

• inflammation
• tear film
• contact lens
• interleukin
• tear instability
• IL-17A
• contact lens discomfort
• omega-3
• corticosteroid
• fatty acid
• steroid
• anti-inflammatory

PURPOSE. To assess the efficacy of anti-inflammatory approaches, comprising a topical corticosteroid and omega-3 supplements, for modulating the inflammatory overlay associated with contact lens discomfort (CLD).
METHODS. This randomized controlled trial involved 72 adults with CLD, randomized (1: 1: 1: 1) to one of the following: placebo (oral olive oil), oral fish oil (900 mg/d eicosapentaenoic acid [EPA] + 600 mg/d docosohexaenoic acid [DHA]), oral combined fish+flaxseed oils (900 mg/d EPA + 600 mg/d DHA + 900 mg/d alpha-linolenic acid), or omega-3 eye-drops (0.025% EPA + 0.0025% DHA four times per day [qid]) for 12 weeks, with visits at baseline, weeks 4 and 12. At week 12, participants who received placebo were assigned a low-potency corticosteroid (fluorometholone [FML] 0.1%, drops, three times per day [tid]) for 2 weeks (week 14).
RESULTS. Sixty-five participants completed the primary endpoint. At week 12, contact lens dry-eye questionnaire (CLDEQ-8) score was reduced from baseline with oral fish oil (-7.3 +/- 0.8 units, n = 17, P < 0.05), compared with placebo (-3.5 +/- 0.9 units, n = 16). FML produced significant reductions in tear IL-17A (-71.1 +/- 14.3%, n = 12) and IL-6 (-47.6 +/- 17.5%, n = 12, P < 0.05) relative to its baseline (week 12). At week 12, tear IL-17A levels were reduced from baseline in the oral fish oil (-63.2 +/- 12.8%, n = 12, P < 0.05) and topical omega-3 (-76.2 +/- 10.8%, n = 10, P < 0.05) groups, compared with placebo (-3.8 +/- 12.7%, n = 12). Tear IL-6 was reduced with all omega-3 interventions, relative to placebo (P < 0.05) at week 12.
CONCLUSIONS. CLD was attenuated by oral long-chain omega-3 supplementation for 12 weeks. Acute (2 week) topical corticosteroids and longer-term (12 week) omega-3 supplementation reduced tear levels of the proinflammatory cytokines IL-17A and IL-6, demonstrating parallels in modulating ocular inflammation with these approaches.

• 出版日期2018-7