title: Long-term rebamipide and diquafosol in two cases of immune-mediated dry eye.
abstract: OBJECTIVE
  Two new drugs with mucin-inducing and secretion-promotive effects, rebamipide and diquafosol, were recently approved as topical dry-eye treatments. We report two cases in which the long-term use of mucin-inducing eye drops improved chronic ocular graft-versus-host disease (cGVHD)-related dry eye and ocular cicatricial pemphigoid (OCP)-like disease.
  
  
  METHODS
  Case 1. A 61-year-old woman had cGVHD-related dry eye that resisted traditional medications. Next, we use topical diquafosol in addition to conventional treatments. The patient used diquafosol for 6 months without experiencing any side effects. The symptoms, including dry-eye sensation, ocular pain, foreign body sensation, and photophobia, as well as ocular surface findings including fluorescein and rose bengal scores and tear break-up time (TBUT), partly improved. To further improve the clinical signs and symptoms and decrease chronic inflammation, rebamipide was added to diquafosol. The symptoms, TBUT, and fluorescein and rose bengal scores markedly improved after long-term dual treatment without any side effects for 6 months. Case 2. A 77-year-old woman had OCP-like disease with dry eye. The patient did not improve using the currently available conventional treatments. Next, we use topical rebamipide in addition to conventional treatments. Symptoms including asthenopia, dry-eye sensation, ocular pain, and dull sensation, as well as fluorescein and rose bengal scores and TBUT, partly improved. Specifically, functional visual acuity was markedly improved after commencement of rebamipide. To further improve the clinical signs and symptoms and increase tear film stability and tear film volume, diquafosol was added to rebamipide. The combination of diquafosol and rebamipide worked for the patient. Improvements were seen in several symptoms, fluorescein and rose bengal scores, Schirmer test value, and TBUT without any side effects for 12 months.
  
  
  CONCLUSIONS
  Long-term treatment with topical rebamipide and diquafosol can improve dry eye in patients with cGVHD or OCP-like disease.
authors.affiliation: *MD †PhD Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan (all authors).
authors.forename: Mio
authors.initials: M
authors.lastname: Yamane
authors.forename: Yoko
authors.initials: Y
authors.lastname: Ogawa
authors.forename: Masaki
authors.initials: M
authors.lastname: Fukui
authors.forename: Mizuka
authors.initials: M
authors.lastname: Kamoi
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Saijo-Ban
authors.forename: Saori
authors.initials: S
authors.lastname: Yaguchi
authors.forename: Shin
authors.initials: S
authors.lastname: Mukai
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kawakita
authors.forename: Shigeto
authors.initials: S
authors.lastname: Simmura
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tsubota
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000409:Alanine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D015352:Dry Eye Syndromes / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D019793:Fluorescein; D005456:Fluorescent Dyes; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008875:Middle Aged; D009883:Ophthalmic Solutions; D010390:Pemphigoid, Benign Mucous Membrane / Q000150:complications* / Q000188:drug therapy; D011122:Polyphosphates / Q000627:therapeutic use*; D058912:Purinergic P2Y Receptor Agonists / Q000627:therapeutic use*; D015363:Quinolones / Q000627:therapeutic use*; D016896:Treatment Outcome; D014500:Uracil Nucleotides / Q000627:therapeutic use*; D014792:Visual Acuity
chemical_list: D004791:Enzyme Inhibitors; D005456:Fluorescent Dyes; D009883:Ophthalmic Solutions; D011122:Polyphosphates; D058912:Purinergic P2Y Receptor Agonists; D015363:Quinolones; D014500:Uracil Nucleotides; C403315:diquafosol; C052785:rebamipide; D000409:Alanine; D019793:Fluorescein