Restasis retards nerve regeneration????????????????

[patientpatrick]

Okay I understand this was a study done on animals. But I'm realllllllly confused. I thought that the use of cyclosporine was supposed to help in the regeneration of nerves after refractive surgery?

Now it looks like it prevents the regeneration of nerves!!!

I'm so confused. Anyone wish to throw in their thoughts?

Cyclosporine immunomodulation retards regeneration of surgically transected corneal nerves.

PURPOSE:
To determine whether immunomodulation with cyclosporine (CsA) affects reinnervation after surgical transection of stromal nerves.

CONCLUSIONS:
Immunomodulation with CsA reduces the expression of cytokines (IL6) in the cornea and retards regenerative sprouting from transected corneal stromal nerve trunks. In addition, CsA has a direct growth inhibitory action on neurites as well.

Here's the link to the whole study: http://www.ncbi.nlm.nih.gov/pubmed/22205605

[Cristi]

Why would it be different on humans????? Remember what Tommyboy was saying about using serum tears would increase the pain? It means that in some cases regeneration determines some degree of pain....so maybe that's why restasis is ''working'' for some of lasik victims ...because it is inhabiting the regrowths of the nerves and therefore reduces the pain...anyway just a stupid thought

[bakunin]

I've never heard that Restasis helps nerve regeneration. Cyclosporine is an anti-immune substance, it acts against inflamation

[Tanner]

It can hurt nerves if taken orally.

[patientpatrick]

Okay, here's a study that contradicts the orginal study i posted.

http://www.ncbi.nlm.nih.gov/pubmed/18500081

PURPOSE:
To determine whether cyclosporine (0.05%) can safely and effectively accelerate corneal nerve regeneration after LASIK, thereby facilitating faster recovery of corneal sensitivity.

METHODS:
This prospective, randomized, single-center clinical study comprised 44 eyes of 22 patients scheduled to undergo bilateral LASIK. One eye was randomly assigned to receive cyclosporine drops twice daily for 3 months in addition to standard postoperative LASIK medication. Corneal sensitivity was measured using the Cochet-Bonnet esthesiometer in four areas outside and five areas inside the LASIK flap preoperatively and at 1 day, 1 week, 1 month, and 3 months postoperatively. Safety parameters of best spectacle-corrected visual acuity and the incidence of adverse events were also collected.

RESULTS:
For all four points outside the LASIK flap, normal corneal sensitivity was maintained throughout the study. In addition, no significant difference was found between the cyclosporine-treated eyes and the control eyes at these points. All points within the LASIK flap except the point closest to the hinge demonstrated profound corneal hypoesthesia at 1 day, 1 week, and 1 month postoperatively with no differences noted between the control and cyclosporine-treated eyes. These same points had statistically significantly greater corneal sensitivity in the cyclosporine group relative to the control group (P< or =.011) at 3 months postoperatively.

CONCLUSIONS:
Cyclosporine was shown to significantly improve corneal sensitivity at 3 months after LASIK, which suggests that topical cyclosporine promotes enhanced corneal nerve regeneration.


I've read about a lot of MDs who use Restasis pre-op and very soon post-op with refractive surgery. It would seem that would be a very bad idea if cyclosporine retards nerve generation. Also, why would Restasis be used at all with post refractive surgery patients if nerves haven't healed yet???


So weird.

[patientpatrick]

An eye doc I've been seeing discussed the how the use of Restasis retards nerve regeneration post lasik.

What I still don't understand is why a lot of MDs prescribe Restasis to be used for several months right after Lasik, which is the most crucial time for nerve regeneration. And with positive results.

Has anyone who is post lasik have your eye doc prescribe it to you so early after surgery? and got good results.

[DCRdryeye]

Cyclosporine lowers the immune system with the purpose of preventing invasion of white blood cell infiltration in the lacrimal glands. If it assists nerve regeneration, it may do so by preventing the immune cells from inhibiting the process.

Restasis is a ridiculous drug, it's useless in my opinion and it's done nothing for me despite being on it for over 6 months.

[LaDiva]

I quit taking Restasis three days ago, and had taken it for years. A couple of months ago my eyes became more and more inflamed after using it, especially in the evenings. I figured so much inflammation couldn't be a good thing. The first couple of days my eyes felt drier, but today, they feel OK. Also, I now don't have as much of a mucous problem. I had PRK, and think I kept using Restasis after the surgery, but really can't remember.

[DCRdryeye]

Restasis makes my eyelids burn, but subsides in about 30 minutes.

[littlemermaid]

http://www.youtube.com/watch?v=7khkIFsxDmQ
Reza Dana lecture 'Translational research applications in ocular surface inflammatory disorders' 14th annual visual sciences research symposium, June 1012, Case Western Reserve University - describes autoimmune dry eye mechanism and starting to trace chronic pathways through lymphatic system as well as blood vessels (beware pics).

Talks not about severed nerves and regrowth but about the search for control of cornea inflammation. And how when there is normal successful healing of epithelium there is regression of blood vessel overgrowth, in contrast with inflamed dry eye where there are blood vessels infiltrating.

Dry eye section starts at 26:20 'what are the immune mechanisms of dry eye disease'. In chronic dry eye disease unlike many other inflammatory phenomenon eg chemical burn:
'- the cornea is characterised almost exclusively by the motivation of antigen-presenting cells rather than large numbers of T-cells
- there is a selective ingrowth of corneal lymphatic vessels into the cornea carrying antigen-presenting cells'

So even if the eye surface is well maintained by lubrication, there is still a 'secondary response autoimmune autoinflammatory T-cell mediated component which has been set up' in chronic dry eye (at 37).

At 53:30, he thinks Restasis has a 'very modest effect in dry eye disease... nobody really knows where topical cyclosporine really works and... it primarily hits the IL2-mediated mechanism'. Hey, whatever works. But it would be nice to know how.

Eg what this means for us is that we have not been able to maintain the eye surface even in remission of chronic paediatric rosacea mgd without a minimum steroid drop, at the moment an unbelievable one drop of a preservative-free steroid every 10 days.

And we cannot decide whether and how to use cyclosporine because as Dr Dana says, no one understands the action yet, although we think it has to be in addition to rather than instead of the steroid, and only to help reduce the need for more steroid so I'm wondering why instill Restasis/cyclosporine generic drop into the eye 2/day when we have control with steroid just 1 in 10 days.

Obviously we don't want to set up cataracts in the long term by years of steroid use, which we are doing, but some of the flareups deteriorate the eye surface badly and leave scarring so it's been unavoidable. I'm just saying this is what we've had to do with chronic dry eye inflammation to prevent the cornea deteriorating and stop blood vessels continuing to grow into it, not recommending anything.

Sorry this is a garbled note on the good doc's talk, and what I'm thinking about Restasis. Wish he'd talked about nerves as well as blood vessels and lymphatic system. But I'm with LaDiva - it's about working out what makes things better or worse for us personally. Obviously I'm as desperate for input on Restasis as anyone.

[LaDiva]

Wow. I don't pretent to understand everything in Dr. Dana's video, but what is scary is that it sounds like whatever is going on with my eyes is also going on in the rest of my body. I just do not feel all of those antibiotics can be a good thing. What is interesting is that if they ever get the immunology aspect of dry eye figured out, it sounds like they will have other immune issues moving down a similar road. Wow. Still off Restasis, with no notable difference one way or the other. I wonder what people with dry eyes did hundreds of years ago, and wonder if the incidence was as high as it is today.

[littlemermaid]

Me neither, I don't understand the immunology they are starting to explore for us. I liked the video because the doc reaction on Restasis, questionning doc and Dr Dana, gives us a vibe on the uncertainties we deal with as patients and docs and researchers on whether/which anti-inflammatories and remedies are helping different eyes.

Pinky put this IOVS paper up in another thread http://www.iovs.org/content/53/13/8264.full which summarises where they are on this. I just looked in PubMed to see if there's anything new and Dr Dana found that where there is neovascularisation (new veins growing into the cornea), there is less nerve regeneration, although who knows what that means in immunology.

At least they are investigating the mechanisms although again, it's whatever anti-inflammatories work for us individually, I think. And reducing triggers and stresses generally.

I wonder that too, LaDiva. Maybe there's a similar increase with our lifestyles like allergy. Many countries don't have access to eye docs still though and 'blepharitis' damages corneas, here's a list of common causes http://telemedicine.orbis.org