Bacterial keratitis was the most important infectious corneal disease in the 1960s. After the 1970s, viral keratitis, fungal keratitis, and Acanthamoebic keratitis increased rapidly, but bacterial keratitis still It is the infectious keratopathy with the highest incidence and blindness rate.
The development trend of bacterial keratitis is the increasing number of opportunistic infections, mixed infections and drug-resistant bacterial infections, which bring certain difficulties to the diagnosis and treatment of the disease, and we must be highly vigilant and pay attention to it.
- Conventional treatment of bacterial keratitis
Local antibiotics, such as levofloxacin eye drops and tobramycin eye drops, are the main treatments for bacterial corneal ulcers. However, studies have shown that long-term and large amounts of topical use of antibiotics can cause various ocular surface and corneal damage, mainly manifested as corneal epithelial peeling, decreased tear film stability, decreased corneal sensitivity, corneal nerve damage, etc., which in turn affects patients The therapeutic effect.
Clinically, it is also common to have poor response to antibiotic treatment, long-lasting ulcers, and even cases of corneal perforation. Therefore, for the treatment of bacterial corneal ulcers, it is necessary to find safer and more effective treatment methods based on the use of conventional antibiotics, supplemented by comprehensive treatment to shorten the course of the disease and increase the cure rate.
- Hypochlorous acid eye drops to treat bacterial corneal ulcer
In 2019, Wang Fan from the Department of Ophthalmology, Affiliated Hospital of Xuzhou Medical University, and others conducted a “Clinical Analysis of 0.01% Hypochlorous Acid Local Eye Drops for the Treatment of Bacterial Corneal Ulcer”.
The researchers selected 60 cases of 60 eyes of bacterial corneal ulcer patients who were treated at the Ophthalmology Department of the Affiliated Hospital of Xuzhou Medical University on August 12, 2018, and were randomly divided into 2 groups. The conventional treatment group was given levofloxacin eye drops to treat 30 cases and 30 eyes, combined with medication On the basis of conventional treatment, the group was added with 0.01% hypochlorous acid aqueous solution for local eye drops to observe and compare the treatment effects of the two groups of patients.
Studies have shown that the healing time of ulcers in the combined medication group was significantly shorter than that in the conventional treatment group (P=0. 005), but there was no difference in the cure rate (P=0. 643) and best corrected visual acuity (P=0. 787) between the two groups. There was no difference in the incidence of iridocyclitis between the two groups (P=0.643). There were no complications such as corneal perforation and corneal neovascularization in the two groups. Patients in the combined medication group used 0.01% hypochlorous acid eye drops without obvious corneal irritation.
Comparison of 1 patient in the combined treatment group before and after treatment
A: Corneal confocal microscopy results before treatment, showing a large number of acute inflammatory cell infiltration, which is less than the hyphae and amoebic structure; B: OCT image of the anterior segment before treatment, indicating that the depth of corneal infiltration is about the middle stroma; C, D: Slit lamp photography before treatment, see corneal nasal side near pupil area round ulcer lesions, about 4mm in diameter, positive fluorescein staining; E, F: Slit lamp photography for 3 days of treatment, ulcer area reduced, corneal edema reduced; G, H: After 6 days of treatment, the ulcer was healed and the fluorescein staining was negative.
In summary, the treatment cycle of hypochlorous acid combination therapy is shorter, the corneal epithelium is healed faster, vision recovery is also faster, and there are no obvious complications. The patient has no obvious symptoms of eye irritation, and hypochlorous acid is in the corneal ulcer. The treatment has good application prospects.
- Stable hypochlorous acid in the treatment of Acanthamoebic keratitis
Acanthamoeba is a protozoan parasite that causes serious human diseases. Research on new therapeutic drugs is of great significance for the treatment of refractory parasites.
In recent years, studies on stable hypochlorous acid have shown that it has a rapid killing effect on different kinds of microorganisms and can be used as a therapeutic agent for Acanthamoeba infection.
- YILDIZ of Adnan Mendres University in Turkey studied the effect of stable hypochlorous acid on Acanthamoeba
Fig Effect of HOCl with different exposure time on Acanthamoeba
Studies have shown that: 200ppm of stable hypochlorous acid has a fatality rate of 96% and 84% for Acanthamoeba at 90 minutes (the dilution is 1/2 and 1/4, respectively). The lethal effect of stable hypochlorous acid on Acanthamoeba is dose- and time-dependent.
A: Control group, the presence of parasites; B: At 0 minutes, the effect of stable hypochlorous acid at 1/2 dilution on Acanthamoeba; the death form of parasites stained with trypan blue; C: the same The dying and surviving parasite form at the dilution rate
The stable hypochlorous acid solution has high safety and can be used for the treatment of eye infections. Due to its effective properties of 1/2 and 1/4 dilution within 0-10min, it may become a new medicine for the treatment of parasites and their infections.
- Other applications of hypochlorous acid in eye care
A foreign team has used hypochlorous acid to treat fungal infections after Boston 1 artificial cornea surgery, and achieved good results. Povidone-iodine conjunctival sac disinfection can significantly reduce post-cataract infection complications. Studies have shown that disinfection with hypochlorous acid aqueous solution can also effectively kill the conjunctival sac bacteria and reduce corneal epithelial damage and other povidone-iodine-related eyes Complications occur.
In terms of the safety of eye medication, animal experiments show that the use of a hypochlorous acid aqueous solution with a concentration of 0.01%, 0.03%, and 0.1% for local eye drops has no symptoms of eye irritation.
Since the outbreak, hypochlorous acid (HClO) has been widely used in disinfection of surfaces, fabrics, skin, sanitary hands, and air. Since February 2020, a total of 121 hypochlorous acid disinfectant products have been newly filed, and a total of 12 hypochlorous acid water generator products have been added. These data far exceed the number of hypochlorous acid-related products filed in the past few years.
However, with the increase of products, the homogeneity of products is serious. In the US market, the number of products with hypochlorous acid as the main component is increasing, and as an eye care solution is one of the important applications.
Hypochlorous acid (HClO) as an eye care solution has not yet seen a product in the domestic market. A large number of studies have shown that it can treat viral keratitis, fungal keratitis and Acanthamoebic keratitis, and can be used as Basic eyelid and eyelash cleansers, as well as effective relief of dry eye, stye, redness and itching of eyelids, have great application prospects in the field of eye care, and the new application market is worth looking forward to…
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