Jeewan S Titiyal1, Manpreet Kaur1, Ruchita Falera1, Ashima Bharghava1, Ramkishor Sah1, Seema Sen2. 1. Cornea, Cataract & Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institutes of Medical Sciences, New Delhi, India. 2. Department of Ocular Pathology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institutes of Medical Sciences, New Delhi, India.
Abstract
Purpose: To evaluate the role of topical chloroquine (CHQ) as an adjunct to topical lubricants in the management of mild-moderate dry eye disease (DED) Methods: Prospective comparative pilot study allocated 150 patients with symptoms of mild to moderate DED to receivetopical CMC 0.5% three times a day (group I, n = 75) or topical CHQ 0.03% twice a day with carboxymethylcellulose (CMC) 0.5% three times a day (group II, n = 75), for three months. Primary outcome measures were ocular surface disease index (OSDI) score and conjunctival impression cytology at 3 months. Secondary outcome measures were TBUT, Schirmer's test, ocular surface staining and any adverse effects at 3 months. Follow up was performed at 1 and 3 months. Results: At three months, the OSDI score was significantly better in the CHQ group as compared with the CMC group (CMC-18.36 ± 4.03 (SD), CHQ group- 15.9 ± 5.18 (SD); p = .002). Nelson's score was 0.92 ± 0.69 (SD) in the CHQ group as compared with 1.60 ± 0.77 (SD) in the CMC group (p < .001). Abnormal impression cytology was observed in 20% cases in the CHQ group as compared with 61.3% cases in CMC group (p < .001). A significant correlation was observed between Nelson's score and OSDI (Spearman's rho correlation coefficient 0.414, p < .001). TBUT, Schirmer test and ocular surface staining were significantly better in the CHQ group (p < .001). No adverse effects were observed in any group. Conclusion:Topical chloroquine is a useful adjunct to topical lubricants in the management of DED as it decreases the underlying chronic inflammation and helps maintain ocular surface stability.
RCT Entities:
Purpose: To evaluate the role of topical chloroquine (CHQ) as an adjunct to topical lubricants in the management of mild-moderate dry eye disease (DED) Methods: Prospective comparative pilot study allocated 150 patients with symptoms of mild to moderate DED to receive topical CMC 0.5% three times a day (group I, n = 75) or topical CHQ 0.03% twice a day with carboxymethylcellulose (CMC) 0.5% three times a day (group II, n = 75), for three months. Primary outcome measures were ocular surface disease index (OSDI) score and conjunctival impression cytology at 3 months. Secondary outcome measures were TBUT, Schirmer's test, ocular surface staining and any adverse effects at 3 months. Follow up was performed at 1 and 3 months. Results: At three months, the OSDI score was significantly better in the CHQ group as compared with the CMC group (CMC-18.36 ± 4.03 (SD), CHQ group- 15.9 ± 5.18 (SD); p = .002). Nelson's score was 0.92 ± 0.69 (SD) in the CHQ group as compared with 1.60 ± 0.77 (SD) in the CMC group (p < .001). Abnormal impression cytology was observed in 20% cases in the CHQ group as compared with 61.3% cases in CMC group (p < .001). A significant correlation was observed between Nelson's score and OSDI (Spearman's rho correlation coefficient 0.414, p < .001). TBUT, Schirmer test and ocular surface staining were significantly better in the CHQ group (p < .001). No adverse effects were observed in any group. Conclusion: Topical chloroquine is a useful adjunct to topical lubricants in the management of DED as it decreases the underlying chronic inflammation and helps maintain ocular surface stability.