Response predictors of a topical corticosteroid-based regimen for dry eyes: A real-life study

Tor Paaske Utheim; Xiangjun Chen; Fredrik Fineide; Tore Steinkjer; Steffen Heegaard; Miriam Kolko; Darlene A Dartt; Ayyad Zartasht Khan

doi:10.1111/aos.16758

Response predictors of a topical corticosteroid-based regimen for dry eyes: A real-life study

Acta Ophthalmol. 2024 Sep 30. doi: 10.1111/aos.16758. Online ahead of print.

Authors

Tor Paaske Utheim^{1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18}, Xiangjun Chen^{1

2

4

6}, Fredrik Fineide^{1

2}, Tore Steinkjer^{2

9}, Steffen Heegaard¹⁹, Miriam Kolko¹⁹, Darlene A Dartt¹⁸, Ayyad Zartasht Khan^{1

2

3}

Affiliations

¹ Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.
² The Norwegian Dry Eye Clinic, Oslo, Norway.
³ Department of Ophthalmology, Østfold Hospital Trust, Moss, Norway.
⁴ Department of Ophthalmology, Drammen Hospital, Vestre Viken Trust, Drammen, Norway.
⁵ Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.
⁶ Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway.
⁷ Department of Ophthalmology, Stavanger University Hospital, Stavanger, Norway.
⁸ Department of Ophthalmology, Vestfold Hospital Trust, Tønsberg, Norway.
⁹ Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway.
¹⁰ Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.
¹¹ Department of Research and Development, Oslo Metropolitan University, Oslo, Norway.
¹² Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway.
¹³ Department of Quality and Health Technology, The Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
¹⁴ Department of Health and Nursing Science, The Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway.
¹⁵ National Centre for Optics, Vision and Eye Care, Department of Optometry, Radiography and Lighting Design, Faculty of Health Sciences, University of South-Eastern Norway, Kongsberg, Norway.
¹⁶ Department of Ophthalmology, Faculty of Life Course Sciences and Medicine, King's College London, London, UK.
¹⁷ Department of Computer Science, Oslo Metropolitan University, Oslo, Norway.
¹⁸ Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA.
¹⁹ Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.

PMID: 39344883
DOI: 10.1111/aos.16758

Abstract

Purpose: To examine the effectiveness and identify clinical response predictors of a short corticosteroid-based regimen consisting of topical preservative-free 0.1% dexamethasone (Monopex®, Théa Laboratories) in conjunction with artificial tears (AT) for dry eyes in a real-life clinical setting.

Methods: Patients were recruited from the Norwegian Dry Eye Clinic and were allowed to use ATs of their own choice in addition to the prescribed 14-day topical dexamethasone course. Ocular Surface Disease Index (OSDI), Dry Eye Questionnaire (DEQ-5), Schirmer test (ST), fluorescein tear film break-up time (FBUT), ocular surface staining (OSS), meibum expressibility (ME), meibum quality (MQ), number of expressible meibomian glands among the central eight glands in the lower lids (N_MG) and intraocular pressure (IOP) were measured at baseline and at 1-month follow-up. The average values of clinical parameters from both eyes were used for analyses. A paired t-test and a significance value of p < 0.05 were used for statistical analyses. Associations between sex, age, baseline values and the changes after the intervention (Δ) were explored using linear regression.

Results: A total of 167 patients (124 women, mean age 54 years ±17 (standard deviation)) were included. One month after initiation of intervention, OSDI and DEQ5 scores improved from 39.5 ± 22.1 to 31.4 ± 21.3 (p < 0.001) and from 12.6 ± 4.2 to 11.0 ± 4.6 (p < 0.001), respectively. OSS improved from 2.2 ± 1.4 to 1.8 ± 1.5 (p < 0.001), N_MG increased from 4.8 ± 2.2 to 5.1 ± 2.2 (p < 0.05), while IOP decreased from 12.9 ± 3.3 to 12.4 ± 3.5 mmHg (p < 0.05). Significant associations were found between the change in symptoms and objective measures of DED (Δ_OSDI, Δ_DEQ5, Δ_OSS, Δ_FBUT, ΔN_MG, Δ_MQ) and their respective baseline values (OSDI, DEQ5, OSS, FBUT, N_MG, MQ). The remaining tests did not show statistically significant changes.

Conclusion: Improvement in dry eye symptoms and signs were observed following a short course of topical, preservative-free 0.1% dexamethasone treatment in combination with AT. Individuals exhibiting more pronounced symptoms and signs witnessed the most profound improvements with the treatment regimen, suggesting that poor baseline parameters may serve as response predictors of the treatment regimen. While the real-life data presented herein are valuable, the conclusions are limited by the inherent biases of a non-controlled study.

Keywords: corticosteroids; dry eyes; real‐life study; response predictors; topical dexamethasone.