Comparative efficacy of the ophthalmic gel containing metronidazole, hyaluronic acid, Aloe vera extract, and sulfur preparations in the treatment of patients with chronic blepharitis on the background of meibomian gland dysfunction
- Authors: Prozornaya L.P.1, Prozorny A.A.1, Mashenkova T.A.1
-
Affiliations:
- Saint-Petersburg State Pediatric Medical University
- Issue: Vol 30, No 6 (2024)
- Pages: 680-589
- Section: Original Research Articles
- URL: https://journals.rcsi.science/0869-2106/article/view/292635
- DOI: https://doi.org/10.17816/medjrf631624
- ID: 292635
Cite item
Abstract
BACKGROUND: Meibomian gland dysfunction (MGD) and chronic blepharitis remain significant challenges in ophthalmology. Standard therapy comprises phytoblepharohygiene and eyelid massage, with anti-inflammatory and tear substitutes. However, the efficacy of the sequential use of phytoblepharohygiene and the ophthalmic gel containing metronidazole, hyaluronic acid, Aloe vera extract and sulfur preparations (Blepharogel Forte®; Geltek-Medica, Russia) for chronic blepharitis and MGD, remains underexplored.
AIM: To evaluate the therapeutic effect of a sequential regimen comprising a line of phytoblepharohygiene products, including the ophthalmic gel containing metronidazole, hyaluronic acid, Aloe vera extract and sulfur preparations (in patients with prolonged chronic blepharitis and MGD).
MATERIALS AND METHODS: The study involved 42 patients (84 eyes) aged 16–73 years, including 30 men (60 eyes, 71.4%) and 12 women (24 eyes, 28.6%), diagnosed with chronic blepharitis, MGD, and dry eye syndrome. Depending on the treatment method, two groups were formed. Patients of control group I (20 subjects, 40 eyes, 47.6%) received eyelid massage and phytoblepharohygiene with the ophthalmic gel containing hyaluronic acid and Aloe vera extract (agent 1) or the ophthalmic gel containing hyaluronic acid, Aloe vera extract, and sulphur preparations (agent 2) (in case of confirmed demodicosis). The comparison group II (22 subjects, 44 eyes, 52.4%) underwent eyelid massage and phytoblepharohygiene, which was completed by applying the ophthalmic gel containing metronidazole, hyaluronic acid, Aloe vera extract, and sulfur preparations (agent 3) (irrespective of a positive or negative test for demodicosis).
RESULTS: From the first week onwards, the indices characterizing hyposecretion of meibomian glands in groups I and II were already 1.9±0.2 and 1.1±0.3 points lower than the initial values of 2.6±0.2 and 2.4±0.3 points, respectively (p <0.05). Furthermore, the dynamics of hypersecretion indices exhibited a comparable trend, with values of 1.6±0.2 and 1.5±0.2 points recorded after a week in comparison with the initial values of 2.3±0.3 and 2.2±0.2 points, respectively (p <0.05). The index characterizing eyelid edema at this stage of the study exhibited a statistically significant decrease only in group II of patients who received the ophthalmic gel containing metronidazole, hyaluronic acid, Aloe vera extract and sulfur preparations (1.4±0.2 points after a week in comparison with the initial 2.3±0.2 points) (p <0.05). In group I, only the initial results were maintained, whereas in group II, a stable increase was observed.
CONCLUSION: The ophthalmic gel containing metronidazole, hyaluronic acid, Aloe vera extract and sulfur preparations can be effective in the treatment of patients with blepharitis and MGD due to its superior therapeutic effectiveness compared with the standard blepharohygiene and phytoblepharohygiene regimens.
Full Text
##article.viewOnOriginalSite##About the authors
Lyudmila P. Prozornaya
Saint-Petersburg State Pediatric Medical University
Email: prozornaya@mail.com
ORCID iD: 0000-0001-7436-1915
SPIN-code: 3762-0548
MD, Cand. Sci. (Medicine)
Russian Federation, Saint PetersburgAlexander A. Prozorny
Saint-Petersburg State Pediatric Medical University
Author for correspondence.
Email: alexprozornyy@gmail.com
ORCID iD: 0009-0005-5263-8852
SPIN-code: 6356-1791
Russian Federation, Saint Petersburg
Tatyana A. Mashenkova
Saint-Petersburg State Pediatric Medical University
Email: m.t.mashenkova@gmail.com
ORCID iD: 0009-0004-0860-2708
SPIN-code: 2438-7679
Russian Federation, Saint Petersburg
References
- Maychuk YF. Blepharitis: modern drug therapy. A brief manual for doctors. Moscow: Biocodex; 2013. (In Russ.)
- Prozornaya LP, Brzeskii VV. General meibomian index as a criterion for diagnostics of meibomian gland dysfunction. In: Proceedings of the scientific conference of ophthalmologists “Nevsky horizons — 2012”. Vol. 1. Saint Petersburg: Politehnikaservis; 2012. P. 406–412. (In Russ.)
- Goto E, Endo K, Suzuki A, et al. Tear evaporation dynamics in normal subjects and subjects with obstructive meibomian gland dysfunction. Invest Ophthalmol Vis Sci. 2003;44(2):533–539. doi: 10.1167/iovs.02-0170
- Brzeskii VV, Popov VYu, Kalinina NM, Brzeskaya IV. Prevention and treatment of degenerative changes in ocular surface epithelium in patients with dry eye syndrome. Russian Annals of Ophthalmology. 2018;134(5):126–134. EDN: YNPYDR doi: 10.17116/oftalma2018134051126
- Prozornaya LP. Diagnostics and treatment of “dry eye” syndrome in patients with chronic blepharitis [dissertation abstract]. Saint Petersburg; 2014. EDN: ZPGPXZ
- Elistratova LL, Potaturkina-Nesterova NI, Nesterov AS. Clinical features of rosacea in combination with demodicosis. Kazan Medical Journal. 2012;93(6):899–902. EDN: PJBVDP
- Maychuk DYu, Loshkareva AO, Tsvetkova TV. The complex treatment algorithm for dry eye syndrome with meibomian gland dysfunction. Combination of intense pulsed light (IPL) with eyelid hygiene and artificial tears. Ophthalmology. 2020;17(3):640–647. EDN: GOSVNR doi: 10.18008/1816-5095-2020-3s-640-647
- Pustovaya KN, Pyavchenko GA, Arisov MV, Nozdrin VI. In vitro study of the acaricidal drug action on Demodex Folliculorum (in Russian only). Russian Journal of Clinical Dermatology and Venereology. 2019;18(2):160–164. EDN: VALTCE doi: 10.17116/klinderma201918021160
- Siuch NI. Demodecosis: etiology, pathogenesis, clinic, laboratory diagnosis. Consilium medicum. 2004;6(3):191–194. (In Russ.) EDN: TKKKKF
- Kubanova AA, Fedorov SM, Timoshin GG. Spregal in the therapy of patients with acne rosacea and demodicosis. In: Scientific and practical conference "New in diagnostics and treatment of sexually transmitted diseases". Moscow; 1997. T. 22. P. 23. (In Russ.)
- Akhmetov SN, Butov YS. Practical dermatocosmetology. Moscow: Medicina; 2003. (In Russ.) EDN: QLEVNT
- Sokolova TV, Golitsyna MV, Malyarchuk AP, Lopatina YV. Dermatological propaedeutics as the basis of demodicosis classification: a new approach to the old problem. Russian Journal of Clinical Dermatology and Venereology. 2023;22(4):454–462. EDN: JJVKEI doi: 10.17116/klinderma202322041454
- Sokolova TV, Golitsyna MV, Malyarchuk AP, Lopatina YV. Diagnostics of demodecosis: pro and con. Russian Journal of Clinical Dermatology and Venereology. 2022;21(3):383–389. EDN: MAKCKI doi: 10.17116/klinderma202221031383
- Forton F, Seys B. Density of Demodex folliculorum in rosacea: a case-control study using standardized skin-surface biopsy. Br J Dermatol. 1993;128(6):650–659. doi: 10.1111/j.1365-2133.1993.tb00261.x
- Prozornaya LP, Prozorny AA, Baranov AYu. Possibilities of using eyelid care products in the treatment of patients with meibomian gland dysfunction and “dry eye” syndrome. Saint Petersburg: FGBOU VO SPbGPMU Minzdrava Rossii; 2021. (In Russ.)
- Trubilin VN, Polunina EG, Alieva AE, et al. A novel method of complex evaluation of meibomian glands morphological and functional state. Ophthalmology. 2014;11(2):39–46. EDN: SFOWPZ
- Polunin GS, Polunina YeG, Zabegailo AO, Gutova VP. Clinical features of the blepharoconjunctivitis type of the dry eye in demodicosis. Russian Annals of Ophthalmology. 2008;124(2):35–39. EDN: ISIDNT
- Polunin GS, Kasparova EA, Polunina EG. Clinical efficacy of blepharogels in the prevention and treatment of blepharitis. New in Ophthalmology. 2004;(1):44–47. (In Russ.) EDN: QCNXEV
- Clark IM, Rowan AD. Cawston TE. Matrix metalloproteinase inhibitors in the treatment of arthritis. Current Opinion in Anti-inflammatory and Immunomodulatory Investigational Drugs. 2000;2(1):16–25.
- Nagase H, Woessner JF. Matrix metalloproteinases. J Biol Chem. 1999;274(31):21491–21494. doi: 10.1074/jbc.274.31.21491
- Vu TN, Werb Z. Matrix metalloproteinases: effectors of development and normal physiology. Genes Dev. 2000;14(17):2123–2133. doi: 10.1101/gad.815400
- Sirmais NS, Ustinov MV, Kiseleva LF. Comparative clinical efficacy of up-to-date therapeutic modalities for low-grade forms of rosacea. Russian Journal of Clinical Dermatology and Venereology. 2012;10(3):78–82. EDN: PEJZER
- Rotondo JC, Borghi A, Selvatici R, et al. Association of retinoic acid receptor β gene with onset and progression of lichen sclerosus-associated vulvar squamous cell carcinoma. JAMA Dermatol. 2018;154(7):819–823. doi: 10.1001/jamadermatol.2018.1373
Supplementary files
