Transcript Efficacy of Ivermectin for the treatment of chronic

Efficacy of Ivermectin for the treatment
of chronic blepharitis in patients with
positive microbiological exam for
Demodex ( spp )
Pedro Antonio Nogueira Filho, MD,
Rossen Mihaylov Hazarbassanov, MD,
Ana Beatriz Diniz Grisolia, MD,
Henrique Baltar Pazos, MD,
Igor Kaiserman MD,
José Álvaro Pereira Gomes, MD
Autors have no financial interest
Instituto de Suel Abujamra, Sao Paulo, SP
Departamento de Oftalmologia, UNIFESP, São Paulo, SP
Purpose
• To evaluate the efficacy of oral Ivermectin
for the treatment of chronic blepharitis with a
positive microbiological exam for Demodex
spp.
Introduction
• Chronic blepharitis is one of the most
common disorders seen in clinical
practice, but sometimes it is a challenging
diagnose. (1)
• The most prevalent microbiologic agents
are: bacteria Sthaphylococcus aureus, S.
epidermidis, Corynebacterium sp; fungus
Candida albicans, Pitysporum ovale;
parasites Demodex folliculorum ,
Demodex brevis.
Introduction
• For a long time, parasites role has been
discussed, raising questions regarding their
pathogenic or commensal influence. (2,3)
• Li et al., reported correlation between
Demodex mites and their symbiotic B
oleronius in facial rosacea and blephatitis. (4)
• Other studies described a strong correlation
between
number of Demodex counting
and severity of ocular discomfort (5,6)
Methods and Patients
• Prospective, longitudinal study.
• Carried out at the Cornea Service,“Instituto Suel
Abujamra”, Sao Paulo, SP, Brazil.
• 20 patients previously diagnosed with chronic blepharitis
with prolonged treatment, resistant to tetracyclines, were
included:
– Complete ophthalmologic exam (OSDI, Break-up time).
– Microbiological exam of the eyelashes for Demodex
spp mites; three lashes from each eyelid were
collected.
– Liver function screened by Alanine aminotransferase
(ALT), Aspartate aminotransferase (AST) and total,
direct and indirect bilirubin.
Methods and Patients
• The microbiological investigation of the
eyelashes was performed under optical
microscope (Nikon Instruments Inc, Japan )
(7) with magnification of 40x. The slides
were counterstained with fluorescein.
• For patients with positive exam of their
lashes, oral Ivermectin 6mg (Revectina®–
Solvay Farma Ltda., Ivermec®- UCI-Farma)
was prescribed bid for one day and the
treatment was repeated after 15 days.
Photos
1. Before the treatment;
4. The aspect of the eyelashes with
Demodex spp.;
2. After the treatment;
5. A group of Demodex spp. In the base
of the eyelashes;
3. A- Demodex spp.; B- (a) The image
shown the Demodex spp. in the base
of the eyelashes;
6. Demodex spp.;
Results
• 19 patients were evaluated
– Mean age: 65.75±16.96
– Gender: 6 males (31.58%) and 14 females (69,02%)
– 4 (21.05%) patients were with blepharitis, additionally
12 (63.16%) patients were with blepharitis and
Staphylococcus; and 3 (15.79%) patients were with
blepharitis and Rosacea.
• Treated patients improved their symptoms (itching and
eye redness) between 60 to 90 days post treatment
– Itching was still reported in only 3 patients (15.79%)
– None of them showed redness of the eyes.
Results
• Reduction on the number of mites within 60
days after initial treatment was statistically
significant (ϰ2 test, p<0.0001).
• There was not significant difference for
OSDI (one way ANOVA, p=0.132) and BUT
(ϰ2 test, p=0.7452) in all periods compared
to pre-treatment.
- Liver function screened by ALT, AST and
Total, direct and indirect bilirubin were
normal before and after the treatment.
Results
Pre
% (n=19)
30d pos Tx
% (n=17)
60d pos Tx
% (n=14)
90 D Pos Tx
% (n=14)
ϰ2 - test
P=
0 mites
0% (0/19)
35.29%(6/17)
92.86%
(13/14)
100%(14/14)
<0.0001
1-3 mites
68.21%
(13/19)
58.82%
(10/17)
7.14% (1/14)
0%(0/14)
<0.0001
3-5 mites
21.05 %
(4/19)
5.88% (1/17)
0% (0/14)
0%(0/14)
0.0692
>5 mites
10.53 %
(2/19)
0% (0/17)
0% (1/14)
0%(0/14)
0.1801
Conclusions
• Treatment with oral Ivermectin decreases the
number of mites in patients who present
Demodex spp in the eyelashes .
• It might improve the symptoms and signs of
chronic blepharitis and it can be considered as
an alternative/adjunct treatment in these cases.
References
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1. SMITH, R.E.; FLOWERS Jr, C.W.; Cronic blepharitis: a review.
CLAO J. jul, 1995; 21(3): 200-7.
2. ENGLISH, F.P.; ZHANG, G.W.; McMANUS, D.P.; CAMPBELL,P.;
Electron microscopic evidence os acarine infestation of the eyelid
margin; Am J Oph, 109 (2), Feb 1990; 239-240.
3. CORREDOR-OSORIO R., NAVA CASATAÑEDA A., CANALLES
J.L.T., POMAR J.L.T., SALAS S.M. Blefaritis por Demodex
folliculorum. Revista de la faculdad de medicina vol 43, n4 jul-ago
2000.
4. Li J,O'Reilly N,Sheha H,Katz R,Raju VK,Kavanagh K,Tseng SC.
Correlation between Ocular Demodex Infestation and Serum
Immunoreactivity to Bacillus Proteins in Patients with Facial
Rosacea. Ophthalmology (Ophthalmology).
5. Lee SH,Chun YS,Kim JH,Kim ES,Kim JC. The Relationship
Between Demodex and Ocular Discomfort. Invest Ophthalmol Vis Sci
(Investigative ophthalmology & visual science).
6. MASCARÓS E.M. Parasitación por Demodex folliculorum. Em
http://www.seimc.org/control/revi_Para/demodex.htm
7. FRAUNFELDER,FT ; ROY FH. Current ocular therapy.
Philadelphia:WB. Saunders company,2000.