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Purpose Severity of ocular surface damages in glaucoma patients was shown to be correlated to the number of instilled benzalkonium chloride (BAK) preserved (P) antiglaucoma eye drops. While preservative‐free (PF) eye drops reduce iatrogenic toxicity they do not restore the ocular surface. The effects of PF‐cationic emulsion of latanoprost (Catioprost®) and BAK‐free travoprost combined with P‐ or PF‐timolol formulations were compared to BAK‐preserved prostaglandin (PG)/timolol‐fixed combinations (FC) in an established rat model of ocular surface injury. Methods Seven PG/timolol combinations were assessed in a rat model of corneal scraping. The upper part of the corneal epithelium was scraped mechanically prior to a 5‐day treatment followed by clinical (in vivo confocal microscopy (IVCM), fluorescein staining) and histological evaluations. Conjunctival function was assessed by goblet cell count and MUC5AC immunostaining. Results Catioprost®/timolol combinations did not induce toxicity as evidenced by IVCM scoring, both reducing inflammatory cell infiltration greater than BAK‐free travoprost/P‐timolol combination. In contrast, BAK‐preserved PG/timolol‐FC presented elevated IVCM scores. MUC5AC staining and goblet cell count demonstrated that BAK‐free Catioprost®/PF‐timolol is the best tolerated combination. Conclusion BAK‐free Catioprost®/P‐timolol is very well tolerated, in contrast to BAK‐preserved PG/timolol‐FC. The findings suggest that Catioprost® associated with PF‐ or P‐timolol have the potential to benefit glaucoma patients with ocular surface disease. Commercial interest [ABSTRACT FROM AUTHOR]

Purpose The aim of the present study was to evaluate the safety and tolerance of cationic oil‐in‐water emulsion on debrided cornea, and to characterize its benefits on the corneal epithelium healing process. Methods A rat model of corneal scraping was used to characterize the effects of four commercially available artificial tears (Cationorm®, Vismed®, Optive® and Systane Balance®) on the recovery process of the debrided corneas. The upper part of the corneal epithelium was scraped mechanically prior to a 5‐day treatment with different artificial tears. At the end of the treatment, the ocular surface was evaluated clinically (corneal fluorescein staining, CFS) and by in vivo confocal microscopy (IVCM). Conjunctival function was assessed by goblet cell count and MUC5AC immunostaining. Results The four artificial tears were all well tolerated by the debrided cornea. By restoring an adequately hydrated ocular surface environment they promote corneal healing, as evidenced by CFS measurements of the scraped area. In contrast 0.02% BAK solution inhibits the healing process. IVCM analysis of the different layers of the cornea confirmed the benefits of the cationic emulsion (Cationorm®). Interestingly inflammatory cells infiltration in the stroma was at its lower following Cationorm® treatment, while 0.02% BAK treatment resulted in marked inflammation. The different treatments were all able to protect goblet cells function and MUC5AC expression. Conclusion BAK‐free cationic emulsion (Cationorm®) is well tolerated by debrided cornea and allow for a safe healing of the cornea. The findings suggest that Cationorm® have the potential to benefit patients with corneal epithelium disorder. Commercial interest [ABSTRACT FROM AUTHOR]

Purpose Ocular surface damage is a consequence of tear instability arising from numerous inciting events: preserved eye drops, contact lens wear, systemic medications, environment and age. While unpreserved eye drop reduce iatrogenic toxicity they do not restore the deficient tear film which leads to ocular surface injury. Cationic oil‐in‐water emulsions have been shown to restore and reduce evaporation of the tear film. We studied the effect of cationic emulsions (Cationorm® and Catioprost®) in established animal models of ocular surface injury. Methods Acute toxicity and local tolerance were evaluated in rabbits. Healing properties were assessed in a rat model of corneal scraping. Abrasions were treated for 5 days, and corneas were evaluated clinically and histologically. Conjunctival function was assessed by goblet cell (GC) count and MUC5 immunostaining. The kinetics of ocular surface healing was assessed in an in vitro scraping assay. Results Neither Cationorm® nor Catioprost® induced toxicity as evidenced by clinical and confocal microscopy scoring. Catioprost® was well tolerated, with a reduced (‐42%) occurrence of hyperemia when compared to Xalatan®. In rats, Catioprost® improved healing, protected GC and maintained normal MUC5 secretion. In vitro, the cationic emulsions improved cell migration and maintained MUC4 expression. Conclusion Cationic emulsions were well tolerated. In contrast to preserved and unpreserved ophthalmic drops, cationic emulsions promoted healing, restored function of injured ocular surface, and protected against ocular surface injury. The findings suggest that cationic emulsions by augmenting the tear film may benefit patients with ocular surface disease. Commercial interest [ABSTRACT FROM AUTHOR]

Purpose Ocular Surface Disease (OSD), recognized in 50% of glaucoma patients, can decrease anti‐glaucoma therapy compliance. Benzalkonium chloride (BAK) has been shown to induce OSD. Catioprost® is an unpreserved latanoprost 0.005% cationic emulsion. The design of a study comparing the efficacy and safety of Catioprost® versus a BAK‐free prostaglandin agonist, Travatan Z® (travoprost 0.004%) in patients with glaucoma and OSD is described. Methods Patients with elevated IOP at baseline requiring treatment with ocular anti‐hypertensive therapy were enrolled in this multicenter, phase II, investigator‐masked, randomized study. Following a washout period, patients demonstrating OSD symptoms and signs (corneal fluorescein staining, CFS, score≥1 on the modified Oxford scale and a tear film break up time, TFBUT, ≤10) in at least one eye at the baseline visit were randomized to either Catioprost® or Travatan Z® QD with follow‐up study evaluations at month 1 and 3. Results 105 patients were randomized. Change in diurnal IOP, a change in the global symptoms (ocular discomfort, burning, dryness, grittiness, stinging) and objective signs (CFS, TFBUT, conjunctival hyperemia) of OSD at month 1 and 3 will be presented. Safety outcomes will also be reported. Conclusion Preservative free prostaglandin agonists reduce the risk of ocular toxicity associated with BAK. However, their effect on restoring ocular surface damage is unclear. In this study, the efficacy and safety of an unpreserved latanoprost 0.005% cationic emulsion relative to BAK‐free travoprost 0.004% solution on reducing IOP and improving the signs and symptoms of OSD will be revealed. Commercial interest [ABSTRACT FROM AUTHOR]

First-line options for the treatment of dry eye disease (DED) rely on artificial tears (ATs), among which cationic emulsion (CE)-based ATs have been developed in order to mimic the healthy tear film for an improved restoration of the ocular surface homeostasis. In this review, we describe the outcomes reported in several studies, assessing the mode of action, ocular tolerance and clinical performance of a CE-based AT. Pilot studies have revealed that CE-based ATs can increase the volume and stability of the tear film while limiting its evaporation rate. Larger studies have demonstrated that CE-based ATs play a significant role in the improvement of both objective and subjective DED parameters, including superior efficacy on DED symptoms compared to several other available AT formulation types. Concomitantly, CE-based ATs have been shown to help patients to prevent or recover from corneal defects associated with refractive surgery. These positive outcomes on ocular surface epithelia are likely due to the combination of unique rheological behaviour and intrinsic anti-inflammatory properties. Based on all clinical findings, CE-based ATs represent a valuable treatment option for patients with various etiologies of DED including evaporative forms and would deserve evaluation of benefits in other surgical intervention types triggering DED., (© 2024 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)