'Remend' eye drops

RE: 'Remend' eye drops

Sara Ramsey — Sat, 11 Nov 2017 13:50:45 GMT

Thanks for the replies, I think I'm happy with what we advise our clients now

RE: 'Remend' eye drops

Martin Atkinson — Fri, 10 Nov 2017 17:22:06 GMT

[quote user="Robert Lowe"]

You will know on Monday if it was critical! Might be worth posting a prescription for ILube (acetylcysteine 5%) so it can be picked up from a chemist tomorrow and started then.

[/quote]I've compromised, I've emailed a PDF of a prescription to her with the acetylcysteine and atropine drops. If the pharmacy won't accept it she can drive the 15 miles to collect the hard copy.

Thanks again for your help.

Martin

RE: 'Remend' eye drops

Robert Lowe — Fri, 10 Nov 2017 16:31:29 GMT

You will know on Monday if it was critical! Might be worth posting a prescription for ILube (acetylcysteine 5%) so it can be picked up from a chemist tomorrow and started then.

RE: 'Remend' eye drops

Martin Atkinson — Fri, 10 Nov 2017 16:11:00 GMT

Thanks again sorry for the delay in replying I had to go an pick up my daughter's new car. It is going to be difficult to get the owner back until Monday how critical do you think serum drops are? - I know you can't say without seeing it and I don't have a photograph anyway!

RE: 'Remend' eye drops

Robert Lowe — Fri, 10 Nov 2017 15:46:42 GMT

Serum is fine enough. Its marginal the difference between it and others. Doxycycline has anti-collagenase properties hence its recommendation. I had quietly resigned myself internally to the lack of swab when writing the previous reply!

RE: 'Remend' eye drops

Martin Atkinson — Fri, 10 Nov 2017 14:38:23 GMT

Thanks for that. So with relation to your previous posts on this, would you suggest acetylcysteine drops as the anticollaginase? I don't have any in stock nor atropine drops and as its Friday can't get them until Monday. Doxycycline is on the shelf but is there a real advantage to that over pot. amox. given the client has gone home and lives quite a distance a way and I haven't taken a swab!

RE: 'Remend' eye drops

Robert Lowe — Fri, 10 Nov 2017 13:07:00 GMT

I would be treating with an anticollagenase and consider oral doxycycline in addition to the Ciloxan you are already using. Hypopyon suggests infectious keratitis. A drop of atropine to reduce the iritis would be great and then further treatment can be tailored to the culture and sensitivity.

Rob

RE: 'Remend' eye drops

Martin Atkinson — Fri, 10 Nov 2017 12:27:48 GMT

Hi Rob

Don't know if we still have your attention but I'm treating a Shih tzu with a history of spontaneous corneal ulcers last one had to have a conjunctival graft. This time it presented with a superficial scrape/longtitudinal ulcer presumed secondary to a claw from another dog in a fight. I started with treating it as a standard corneal ulcer with Chloramphenical drops and ahem...Remend with carprodyl for some analgesia. It re-presented today 4 days later with a horribly inflammed eye with uveitis and hypopyon. There does not seem to be a penetrating wound, the ulcer is not deep enough to warrant a graft and I'm reluctant to perform a nictitans flap. I've sent it home with Ciloxan (1-2 drops q 15 mins then every 6 hours) and Acular drops bid with parenteral pot amox. tablets started with an injection. Any thoughts on advancement of treatment at this stage?

RE: 'Remend' eye drops

Robert Lowe — Fri, 10 Nov 2017 11:52:15 GMT

Hi Glen

1. Some data out there to suggest that serum is not as good as EDTA or other anti-collagenases in vitro.

2. Anecdotally some cases really react to topical serum.

3. ILube (acetylcysteine 5%) is in a bottle ready to go off the shelf

4. Serum needs to be harvested from the patient. Raising jugular pressure is not always advisable with fragile eyes as increases intraocular pressure. If not autologous then need to consider cross infection.

Hope this helps

Rob

RE: 'Remend' eye drops

Glen McIntosh — Fri, 10 Nov 2017 10:54:18 GMT

Hello Rob,

You use acetylcysteine drops (ilube) in preference to serum drops for anticollagenase purposes.

What is your reasoning for this?

Thanks

Glen

RE: 'Remend' eye drops

Robert Lowe — Fri, 10 Nov 2017 09:32:07 GMT

Lubricants come in all sorts of formulations. Personal preference when I had facial palsy is a hyaluronic based drop. There are countless versions of these of which one is Remend but others are just as good for lubrication and may be much cheaper.

Carbomer gel (Lubrithal) also quite good and paraffin based ones good for overnight etc.

NONE of these lubricants have any active ingredients that improve corneal healing they JUST lubricate - no more no less.

If your new grad is from Cambridge then they may need significant additional guidance on evidence based medicine and its application in clinical veterinary medicine

RE: 'Remend' eye drops

Martin Atkinson — Thu, 09 Nov 2017 10:37:54 GMT

[quote user="SER"]So my question is: which active substances are better? or which should be used in what situation?[/quote]That Remend is useless for the purpose it was first launched - to treat corneal ulcers is well recognised. I do still use it in that situation in the vain hope it may help but for long term lubrication especially in the early stages after an ulcer has healed I use Lubrithal. Indeed I dispensed a tube today for a cat with entropian the owners of which are procrastinating over surgery. For what it costs, I find Remend no advantage over Lubrithal as a lubricant. I haven't used Lacrilube in years its too thick and gooey.

RE: 'Remend' eye drops

Sara Ramsey — Wed, 08 Nov 2017 23:10:49 GMT

Hi, apologies for resurrecting an old thread but I couldn't quite find the answer I wasn't looking for.

We have a new grad who questioned why we stocked Lubrithal (a carbomer) rather than using Remend (hyaluronic acid) drops as they "worked so much better". My initial reaction was that they were all pretty similar, some cheaper than others and the Remend is good but not miraculous.....however I am conscious not to dismiss the information our younger employees bring.

Do they work better? I understand stand that products like lacrilube have soft paraffin in them and hence might be better for over night or when the owner can't apply regularly. I tend to use Lubrithal mainly for our many pugs/frenchies and just say use several times a day. I do remember also using hypromellose drops too... methyl cellulose polymer

So my question is: which active substances are better? or which should be used in what situation?

Thank you

Re: 'Remend' eye drops

Robert Lowe — Mon, 07 Jul 2014 11:57:53 GMT

[quote user="Linda Filshie"]If you get a bit of extra blood from a donor dog during a blood transfusion can you freeze the serum for future use for eye drops or does it have to be fresh?[/quote]

Yes it can be used from frozen but I have no idea on lifespan as a frozen product.

Re: 'Remend' eye drops

Virginia Campbell — Sat, 05 Jul 2014 13:56:29 GMT

[quote user="Robert Lowe"]Serum from another animal (doesn't have to be same species). Would recommend this anyway as restraining a pug for venupuncture might cause further issues with a fragile cornea.[/quote]

Oh good, this was always my worry so that's good to know

Re: 'Remend' eye drops

Charlotte Marshall — Fri, 04 Jul 2014 21:19:40 GMT

I always just put sterile water into the edta tube to the line and use that as an eyedrop. I have seen it apparently make a difference in some ulcers which were not healing properly.

Re: 'Remend' eye drops

Martin Atkinson — Fri, 04 Jul 2014 14:09:46 GMT

[quote user="Kishor Mahind"]Just bit off topic, but what else can you use for anti-collagenase activity other than autologous serum? I have read about EDTA but any tips how to prepare it.[/quote] Well out of desperation I took blood into an EDTA tube spun it and used the serum so it was serum + EDTA then added a couple of drops from some liquid EDTA I had. Seemed to work but maybe despite rather than because of the treatment.

Re: 'Remend' eye drops

Linda Filshie — Fri, 04 Jul 2014 11:42:50 GMT

[quote user="Robert Lowe"]

2. Serum from another animal (doesn't have to be same species). Would recommend this anyway as restraining a pug for venupuncture might cause further issues with a fragile cornea.

[/quote]

If you get a bit of extra blood from a donor dog during a blood transfusion can you freeze the serum for future use for eye drops or does it have to be fresh?

Re: 'Remend' eye drops

Robert Lowe — Fri, 04 Jul 2014 09:56:40 GMT

[quote user="Kishor Mahind"]

Just bit off topic, but what else can you use for anti-collagenase activity other than autologous serum? I have read about EDTA but any tips how to prepare it.

[/quote]

We use acetylcysteine (confusingly caused Ilube but we don't use it for its lubricant properties). It is available in a 10ml vial as an eye drop so ready to use off the shelf.

Other options

1. EDTA but I couldn't tell you the composition off the top of my head

2. Serum from another animal (doesn't have to be same species). Would recommend this anyway as restraining a pug for venupuncture might cause further issues with a fragile cornea.

3. Oral doxycycline at the standard BSAVA formulary dose

Re: 'Remend' eye drops

Gareth C. — Fri, 04 Jul 2014 09:52:20 GMT

if I think I have a melting ulcer I would use serum, doesn't have to be the same dog. let the blood clot (this activates the anitcollagenases) and pipette off the serum. keep it in the fridge. use cytology to looks for excessive neutrophils, rods etc

edta is in some drops (tiacil I think) or you can use it from edta blood tubes . I put a few mls in one and pipette it across 5 tubes then use tha resultant solution, but open to any more accurate suggestions Rob..?

Re: 'Remend' eye drops

Robert Lowe — Fri, 04 Jul 2014 09:52:07 GMT

[quote user="Gareth C."]

If a pug is producing normal amount of tears you still need to consider exposure keratopathy, I would always lubricate a brachycephalic corneal ulcer. IMHO!

[/quote]

Yes I agree you need to treat the underlying causes, but I would have lubrication as much less important that antibiotic and anticollagenases in the face of active ulceration if the owner couldn't give all of the drops that you want them to.

Re: 'Remend' eye drops

Gareth C. — Fri, 04 Jul 2014 01:04:24 GMT

If a pug is producing normal amount of tears you still need to consider exposure keratopathy, I would always lubricate a brachycephalic corneal ulcer. IMHO!

Re: 'Remend' eye drops

Virginia Campbell — Fri, 04 Jul 2014 00:31:46 GMT

[quote user="Kishor Mahind"]what else can you use for anti-collagenase activity other than autologous serum? I have read about EDTA but any tips how to prepare it.[/quote]

I want to know this too!

Re: 'Remend' eye drops

Kishor Mahind — Thu, 03 Jul 2014 12:56:38 GMT

[quote user="Robert Lowe"]

Hi Virginia

As a general approach to the pug eye my priority would be antibiotic and anti-collagenase topically

[/quote]

Hi Robert,

Just bit off topic, but what else can you use for anti-collagenase activity other than autologous serum? I have read about EDTA but any tips how to prepare it.

Re: 'Remend' eye drops

Malcolm Ness — Thu, 03 Jul 2014 12:17:54 GMT

[quote user="Robert Lowe"]No it doesn't. There is NO published data to indicate that it has any effect in dogs, cats and horses.[/quote]

They could add chondroitin and glucosamine and call it Remend Plus then it would be ineffective against arthritis as well.