What is the dosage and treatment duration for MURO 128 (sodium chloride 5% ophthalmic solution) for corneal edema?

MURO 128 (Sodium Chloride 5% Ophthalmic Solution) for Corneal Edema

For corneal edema, MURO 128 (sodium chloride 5% ophthalmic solution) should be instilled as 1-2 drops in the affected eye(s) as needed, typically 4 times daily, with treatment continued until the edema resolves. 1, 2

Mechanism of Action and Indication

• Sodium chloride 5% ophthalmic solution works through a hyperosmotic effect that draws fluid from the edematous cornea, temporarily reducing corneal thickness and improving visual acuity 2
• MURO 128 is specifically indicated for temporary relief of corneal edema 1

Dosage Recommendations

• Standard dosing: Instill 1-2 drops in the affected eye(s) 4 times daily 1, 3
• Frequency can be adjusted based on severity of edema - more frequent administration (up to 6 times daily) may be required for severe cases 4, 5
• Treatment should continue until resolution of symptoms and clinical improvement in corneal thickness 3

Clinical Efficacy

• Clinical studies demonstrate significant improvement in visual acuity after just one week of treatment with sodium chloride 5% solution 3
• Measurable reduction in central corneal thickness occurs within hours of application 4
• In a randomized crossover trial, sodium chloride 5% drops showed significant reduction in corneal thickness from baseline, with effects beginning as early as 2 hours after application 4

Monitoring and Treatment Duration

• Treatment effectiveness should be monitored through:
  • Improvement in visual acuity 3, 6
  • Reduction in central corneal thickness (measurable by pachymetry or optical coherence tomography) 4, 5
  • Resolution of symptoms (reduced glare, improved clarity, decreased foggy vision) 5
• Duration of treatment varies based on underlying cause of edema, with chronic conditions like Fuchs endothelial dystrophy requiring ongoing therapy 5, 6

Comparative Efficacy

• While sodium chloride 6% ointment may provide slightly greater reduction in corneal thickness (37.5 μm vs 23 μm at 6 hours), the 5% solution is better tolerated by patients 4
• The 5% solution causes fewer side effects such as stinging, blurring, and foreign body sensation compared to the ointment formulation 4

Potential Side Effects

• Most patients tolerate sodium chloride 5% solution well 3, 6
• Temporary stinging or burning sensation may occur upon instillation 4
• Transient blurring of vision may occur immediately after application 4

Special Considerations

• For patients with severe or persistent corneal edema, combination therapy with a therapeutic contact lens may provide additional benefit 5
• The hyperosmolar solution (1955 mOsm/L) is significantly higher than physiological tear osmolarity (289 mOsm/L), which enables its therapeutic effect 7
• For overnight symptom control, sodium chloride ointment may be considered as an adjunct to the solution 4

Treatment Algorithm

1. Begin with sodium chloride 5% solution at 4 times daily dosing 3
2. If inadequate response after 1 week, increase frequency to 6 times daily 4, 5
3. For persistent symptoms, consider adding sodium chloride ointment at bedtime 4
4. Continue treatment until resolution of edema or stabilization of chronic condition 3, 6
5. For chronic conditions requiring long-term management, maintain at lowest effective frequency 6