Demodex blepharitis is a chronic inflammatory ocular condition caused by Demodex mite infestation of the eyelid that can negatively impact quality of life. Currently, lotilaner ophthalmic solution 0.25% is the only FDA-approved treatment for Demodex blepharitis. The Demodex Expert Panel on Treatment and Eyelid Health has established consensus that lotilaner ophthalmic solution 0.25% should be considered the preferred first-line treatment for Demodex blepharitis. We report a patient who presented with collarettes, the pathognomonic sign of Demodex blepharitis, meibomian gland dysfunction, and poor visual acuity. The patient also had a history of neovascular age-related macular degeneration. Consistent with the Demodex Expert Panel on Treatment and Eyelid Health consensus recommendations, the patient was treated with lotilaner ophthalmic solution 0.25%, lid scrubs, and warm compresses. At the 2-month follow-up, collarettes had resolved, and signs of meibomian gland dysfunction had improved. This case supports the Demodex Expert Panel on Treatment and Eyelid Health recommendation that lotilaner ophthalmic solution 0.25% should be considered the preferred first-line treatment for Demodex blepharitis.
Allogeneic ocular surface stem cell transplantation (OSST) is an established therapeutic approach for limbal stem cell deficiency, utilizing techniques such as keratolimbal allograft (KLAL), living-related conjunctival limbal allograft (lr-CLAL), allogeneic cultivated limbal epithelial transplantation (allo-CLET), and allogeneic simple limbal epithelial transplantation (allo-SLET). This review synthesizes evidence from 35 studies encompassing 1, 268 eyes with at least 24 months of follow-up to evaluate intermediate- and long-term outcomes. Overall, OSST is associated with improvement in visual acuity and restoration of ocular surface stability, although success rates vary widely by technique, ranging from 13% to 87%. Outcomes appear to be influenced by the intensity of systemic immunosuppression, with triple-agent regimens demonstrating higher rates of long-term success compared with single- or dual-agent approaches. Among techniques, lr-CLAL may offer advantages over KLAL due to lower rejection rates. Despite encouraging results, long-term data remain limited for newer approaches such as allo-CLET and allo-SLET. Careful postoperative monitoring and management of complications, including rejection, glaucoma, and microbial keratitis, remain essential to optimize outcomes.
Reactive aldehyde species (RASP) are proinflammatory molecules that have been implicated in ocular inflammatory diseases, including dry eye disease (DED). Reproxalap is a small molecule RASP inhibitor in development for the treatment of DED. The objective of this clinical trial was to evaluate the long-term safety of reproxalap 0.25
Purpose: The goal of our study was to highlight the results of a corticosteroid-sparing immunosuppressive regimen for patients with limbal stem cell deficiency (LSCD) undergoing ocular surface stem cell transplantation (OSST). Methods: This retrospective review studied patients with LSCD undergoing OSST from 2014 to 2023, evaluating the evolving corticosteroid-sparing systemic immunosuppression regimen over time. Inclusion criteria encompassed patients aged 18 to 69 with total/near-total LSCD that underwent OSST and were treated postoperatively with oral corticosteroids. Outcomes included ocular surface stability, visual acuity, and rates of rejection/failure. Corticosteroid dosage, taper length, and corticosteroid-related side effects were recorded. Results: There were 166 eyes that met the inclusion criteria. The mean starting dose of prednisone was 34.5 mg (range: 30–60), with a mean taper length of 13.3 weeks (range: 3–59 weeks). There were 66 eyes that underwent a keratolimbal allograft, 96 eyes that underwent a living-related conjunctival limbal allograft, and 28 eyes that underwent a conjunctival limbal autograft. At the last follow-up, 72.3% of eyes had a stable ocular surface and 60.2% had visual improvement of at least 2 lines. Approximately 19.9% of eyes developed rejection and 13.3% developed failure during the follow-up period. Conclusions: A modified corticosteroid-sparing immunosuppression protocol for OSST has shown significant efficacy in restoring the ocular surface of patients with LSCD. A corticosteroid-sparing immunosuppressive regimen mitigates the side effects related to oral corticosteroid usage, without compromising the stability of the stem cell graft.
