title: Effect of rebamipide ophthalmic suspension on signs and symptoms of keratoconjunctivitis sicca in Sjögren syndrome patients with or without punctal occlusions.
abstract: OBJECTIVE
  The aim of this study was to investigate the efficacy of 2% rebamipide suspension in treatment of keratoconjunctivitis sicca (KCS) in patients with Sjögren syndrome (SS) with or without punctal occlusions.
  
  
  METHODS
  Thirty patients with SS, diagnosed based on the presence of autoantibodies and/or focus score >1 on lip biopsies, with corneal fluorescein staining scores (FSS) >3, and conjunctival lissamine green-staining scores (LSS) >3, were treated 4 times daily for 4 weeks with 2% rebamipide ocular suspension. Ocular examinations were performed before treatment and 2 and 4 weeks after treatment to evaluate FSS (0-9), LSS (0-6), and tear film break-up time (BUT). Hyaluronate and/or artificial tears were not discontinued. The patients were interviewed regarding the 5 major KCS symptoms, foreign body sensation, dry eye sensation, photophobia, ocular pain, and blurred vision, with each graded from none (0) to very severe (4).
  
  
  RESULTS
  Of the 30 patients, 3 failed to attend all sessions, leaving 27 (25 females, 2 males, mean age 62.5 ± 10.8 years) to be studied. FSS and LSS showed improvement at week 2, but BUT showed improvement later, at week 4. All 5 symptoms improved significantly. When the patients were divided into 3 groups according to the presence of punctal occlusions, FSS and LSS were found to improve in all groups, but BUT improved only in patients with both puncta occluded at week 4.
  
  
  CONCLUSIONS
  Rebamipide ophthalmic suspension was effective in treating KCS of patients with SS, probably by increasing mucins and suppressing inflammatory cytokines. Punctal occlusions resulted in sufficient retention of tear fluid to enhance the activities of rebamipide and improve BUT.
authors: Department of Ophthalmology, Kanazawa Medical University, Ishikawa, Japan.
authors: Atsushi
authors: A
authors: Arimoto
authors: Kazuko
authors: K
authors: Kitagawa
authors: Norihiro
authors: N
authors: Mita
authors: Yoriko
authors: Y
authors: Takahashi
authors: Eri
authors: E
authors: Shibuya
authors: Hiroshi
authors: H
authors: Sasaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000409:Alanine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000974:Antibodies, Antinuclear / Q000276:immunology; D000975:Antioxidants / Q000008:administration & dosage / Q000627:therapeutic use*; D001323:Autoantibodies / Q000097:blood; D005143:Eyelids / Q000601:surgery; D005260:Female; D015590:Fluorophotometry; D006801:Humans; D007638:Keratoconjunctivitis Sicca / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009077:Mucins / Q000378:metabolism; D009301:Nasolacrimal Duct / Q000601:surgery; D009883:Ophthalmic Solutions; D058912:Purinergic P2Y Receptor Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D015363:Quinolones / Q000008:administration & dosage / Q000627:therapeutic use*; D012859:Sjogren's Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism; D013535:Suspensions; D013666:Tears / Q000502:physiology*
chemical_list: D000974:Antibodies, Antinuclear; D000975:Antioxidants; D001323:Autoantibodies; D009077:Mucins; D009883:Ophthalmic Solutions; D058912:Purinergic P2Y Receptor Agonists; D015363:Quinolones; C035356:SS-A antibodies; C035357:SS-B antibodies; D013535:Suspensions; C052785:rebamipide; D000409:Alanine