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Review
. 2022 Jun 14:16:1953-1962.
doi: 10.2147/OPTH.S360929. eCollection 2022.

Liposomal Ozonated Oil in Ocular Infections: A Review of Preclinical and Clinical Studies, Focusing on Its Antiseptic and Regenerative Properties

Juan J Pérez-Santonja  1 , José Luis Güell  2 , Oscar Gris  2 , Xose Manuel Vázquez Dorrego  3 , Esther Pellicer  4 , Jose Manuel Benítez-Del-Castillo  5   6   7
Affiliations
Review

Liposomal Ozonated Oil in Ocular Infections: A Review of Preclinical and Clinical Studies, Focusing on Its Antiseptic and Regenerative Properties

Juan J Pérez-Santonja et al. Clin Ophthalmol. .

Abstract

Ozonated oil has shown antimicrobial, anti-inflammatory and regenerative properties that make it useful in the prevention of infectious diseases and also as an adjuvant in wound-healing management. This review brings together most aspects of the use of liposomal ozonated oil for ocular infections and regeneration of the ocular surface. A search was performed in PubMed, Medline, Web of Science and Cochrane Library for studies published by June 2021. Search terms were combined to sort out papers on the properties and use of ozonated oil in ocular infections. A total of 25 publications were selected for this review on the composition, mechanism of action, restorative action, and preclinical and clinical studies of liposomal ozonated oil focused on ocular infections. In patients with complicated corneal pathology, liposomal ozonated oil has been found to restore corneal ulcers and improve keratitis. In patients with ocular pathologies involving inflammation and infections, liposomal ozonated oil has been found to improve and almost completely restore the signs of vernal, granulomatous and even adenoviral conjunctivitis. Liposomal ozonated oil has also been found to be effective in reducing ocular microbial flora. In conclusion, liposomal ozonated oil has an antiseptic and regenerative effect on corneoconjunctival tissues. It has demonstrated efficacy and safety profile for its use in ocular infections and can be considered as a suitable supportive strategy both alone and combined with other antimicrobial agents.

Keywords: antifungal; antimicrobial; antiviral; liposomal ozonated oil; restorative action.

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Conflict of interest statement

Dr Pérez-Santonja is a consultant for Esteve Pharmaceuticals. Dr Güell is a consultant for Opthec, Meditec, Zeiss, Alcon, Thea Laboratories, Kowa Pharmaceuticals and RxSight. Dr Vázquez is a consultant for Esteve Pharmaceuticals and Visufarma. Dr Benitez-Del-Castillo is a consultant for Allergan Angelini, Esteve Pharmaceuticals, GSK, Lumenis, Novartis, Santen, Sifi, Thea Laboratories and Visufarma. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Reaction of gaseous ozone and double carbon-carbon bonds of unsaturated fatty acids to form ozonides.
Figure 2
Figure 2
Ozonated oil encapsulated in liposomes.
Figure 3
Figure 3
Mechanism of action. Liposomes bind to the pathogen surface breaking it by ozonolysis and releasing the ozonides, which penetrate in the pathogen and become hydrolyzed forming oxygenated compounds such as lipid peroxides and reactive oxygen species (ROS), which in turn alter the pathogen structure leading to the destruction of the pathogen.
Figure 4
Figure 4
Ozone promotes cellular adaptation to oxidative stress activating antioxidant endogen mechanisms.
Figure 5
Figure 5
Adenoviral PCR results in patients treated with ozonated oil and control group. Adapted from Cagini C, Mariniello M, Messina M et al. The role of ozonized oil and a combination of tobramycin/dexamethasone eye drops in the treatment of viral conjunctivitis: a randomized clinical trial. Int Ophthalmol. 2020;40(12):3209–3215. Creative Commons license and disclaimer available from: http://creativecommons.org/licenses/by/4.0/legalcode.
Figure 6
Figure 6
Microbial load reduction with ozonated oil versus control group. Data from Spadea L, Zanotto E, Cavallo R et al. Effectiveness of Liposomal Ozonised Oil in Reducing Ocular Microbial Flora in Patients Undergoing Cataract Surgery. J Cataract Refract Surg. 2021; 47(12):1548–1555.
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