title: Effects of amino acids enriched tears substitutes on the cornea of patients with dysfunctional tear syndrome.
abstract: OBJECTIVE
  To evaluate the effect of aminoacid enriched artificial tears on the ocular surface of patients with dysfunctional tear syndrome (DTS).
  
  
  METHODS
  Forty patients were divided into two groups: group 1 treated for 90 days with sodium hyaluronate (SH) 0.15% 1 drop × 5 times/day; group 2 treated for 90 days with SH 0.15% + aminoacids mixture 1 drop × 5 times/day. Symptom score questionnaire, tear break-up time (TBUT), corneal fluorescein stain, Shirmer's I test and confocal microscopy were performed at baseline and after 30 and 90 days. Confocal images underwent morphometric analysis.
  
  
  RESULTS
  Both treatments improved symptoms after 1 month. Group 2 patients showed at 1 month an improvement of TBUT and corneal stain, maintained throughout the study. Also Shirmer's I test improved after 3 months. In group 1, an improvement of TBUT and corneal stain was observed after 3 months. The morphometric analysis of confocal images demonstrated at month 1 an improvement of nerve tortuosity in group 2; after 3 months both groups showed a significant improvement versus baseline. The epithelium showed, in both groups, a reduction in hyperreflective large cells starting from 1 month; the area of the cells was significantly reduced after 3 months, with a significant higher reduction in group 2. The perineural stromal opacity was significantly increased after 3 months, particularly in group 2.
  
  
  CONCLUSIONS
  This is the first study addressing corneal changes after amino acids administration in a DTS population. The treatment with amino acids enriched SH can be considered a useful tool in the treatment of DTS.
authors.affiliation: Department of Experimental Medical-Surgical Sciences, Ocular Surface Diseases Unit, University of Messina, Italy. paragona@unime.it
authors.forename: Pasquale
authors.initials: P
authors.lastname: Aragona
authors.forename: Laura
authors.initials: L
authors.lastname: Rania
authors.forename: Anna M
authors.initials: AM
authors.lastname: Roszkowska
authors.forename: Rosaria
authors.initials: R
authors.lastname: Spinella
authors.forename: Elisa
authors.initials: E
authors.lastname: Postorino
authors.forename: Domenico
authors.initials: D
authors.lastname: Puzzolo
authors.forename: Antonio
authors.initials: A
authors.lastname: Micali
mesh_terms: D000368:Aged; D000596:Amino Acids / Q000008:administration & dosage*; D003315:Cornea / Q000187:drug effects* / Q000294:innervation / Q000473:pathology; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D019793:Fluorescein; D005456:Fluorescent Dyes; D015590:Fluorophotometry; D005998:Glycine; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007930:Leucine; D008239:Lysine; D018613:Microscopy, Confocal; D008875:Middle Aged; D009882:Ophthalmic Nerve / Q000473:pathology; D009883:Ophthalmic Solutions / Q000008:administration & dosage*; D011392:Proline; D011446:Prospective Studies; D012859:Sjogren's Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism; D011795:Surveys and Questionnaires; D013666:Tears / Q000502:physiology
chemical_list: D000596:Amino Acids; D005456:Fluorescent Dyes; D009883:Ophthalmic Solutions; D006820:Hyaluronic Acid; D011392:Proline; D007930:Leucine; D008239:Lysine; D005998:Glycine; D019793:Fluorescein
keywords: amino acids; confocal microscopy; corneal epithelium; corneal morphometry; corneal nerves; corneal stroma