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DNase drops show promise in reducing dry eye symptoms
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Recombinant deoxyribonuclease eye drops show potential in reducing both the signs and severity of dry eye in patients with severe tear-deficient dry eye disease, according to a study published in Translational Vision Science & Technology.
“This is the first clinical trial in humans using deoxyribonuclease (DNase) eye drops for treating ocular diseases,” the authors wrote. “Since there are no data regarding the use of DNase application to the human eye (other than a published case report), we performed this ‘investigator initiated’ clinical trial to assess the safety and the therapeutic potential of DNase in treating dry eye disease.”
This placebo-controlled clinical trial studied the efficacy and safety of DNase eye drops four times per day for 8 weeks in patients with severe tear-deficient dry eye disease.
Outcomes for safety, tolerability and proportion of adverse events were compared with efficacy outcomes that included Ocular Surface Disease Index (OSDI) scores as well as corneal and conjunctival staining, between baseline and 8 weeks.
Researchers found that both tolerability and adverse events were similar among placebo and DNase groups.
In the DNase group, corneal staining revealed a significant reduction at 8 weeks as compared to baseline. Additionally, the OSDI scores showed a significant median reduction of 27.3.
“Our data also showed that mucoid debris/strands are reduced significantly with DNase eye drops,” the authors wrote. “Therefore, mucoid debris/strands may represent repositories of inflammatory materials over the eye surface. By degrading and clearing them, DNase eye drops may lower this inflammatory material load over the ocular surface.”
Researchers concluded that while the median reduction in OSDI scores in the placebo group was less than that of the DNase group, the difference was borderline significant. However, the study did reveal the potential therapeutic effects of DNase for the treatment of dry eye disease due to the drop’s degradation of neutrophil extracellular traps from the ocular surface. – by Scott Buzby
Disclosure: Mun reported no relevant financial disclosures. Please see full study for all other authors’ disclosures.
Perspective
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Ellen Shorter, OD, FAAO
With limited options available for the treatment of dry eye disease, a cystic fibrosis medication, Pulmozyme (dornase alfa, Genentech), may provide a new therapeutic option for patients in the future. This pilot study is the first evaluation of DNase eye drops for ocular disease and evaluates the safety and efficacy of 0.1% DNase vs. placebo dosed four times a day for 8 weeks.
Mun and colleagues propose this new therapeutic option may act by decreasing the excess of extracellular DNA webs or neutrophil extracellular traps (NETs) by selectively cleaving DNA. NETs are part of the innate immune defense in normal physiological conditions, but in tear-deficient dry eye disease, they accumulate on the ocular surface and play a role in chronic inflammation.
In this study, the treatment group had a statistically significant decrease in corneal staining, and OSDI scores showed a clinically meaningful improvement at 8 weeks compared to placebo treatment. The preservative-free DNase eye drop treatment was reported to be safe and well tolerated.
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