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

Figures & data

Figure 1 Reaction of gaseous ozone and double carbon-carbon bonds of unsaturated fatty acids to form ozonides.

Figure 2 Ozonated oil encapsulated in liposomes.

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 Ozone promotes cellular adaptation to oxidative stress activating antioxidant endogen mechanisms.

Abbreviation: SOD, superoxide dismutase.

Table 1 Preoperative Topical Ozonated Oil Reduces Bacterial Colonization in Conjunctival Sac and Periocular Skin

	Total Microbial Count
	T0	T1	p (%)
Liposomal ozone dispersion	90.0 (10.0–160.0)	10.0 (0.0–60.0)	0.004 (−89%)
Povidone iodine 5%	90.0 (10.0–120.0)	8.0 (0.0–80.0)	0.01 (−91%)
Ofloxacin	100 (100–100,000)	80 (0–1000)	0.12 (−20%)
Placebo	10,000 (20–100,000)	1,000 (20–10,000)	0.25

Notes: Results in CFU/mL; the p values refer to statistical difference between T0 and T1. Adapted from Exp Eye Res, 189, Marchegiani A, Magagnini M, Cerquetella M et al. Preoperative topical liposomal ozone dispersion to reduce bacterial colonization in conjunctival sac and periocular skin: Preliminary study in dogs. 107848, Copyright 2019; with permission from Elsevier.²⁵

Abbreviations: T0, before instillation; T1, last instillation.

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.¹⁰

Abbreviations: OZO, ozonated oil group; TS, control group.

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):1548–1555.²⁸

Marchegiani A, Magagnini M, Cerquetella M, et al. Preoperative topical liposomal ozone dispersion to reduce bacterial colonization in conjunctival sac and periocular skin: preliminary study in dogs. Exp Eye Res. 2019;189:107848. doi:10.1016/j.exer.2019.107848

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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. doi:10.1007/s10792-020-01503-4

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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. doi:10.1097/j.jcrs.0000000000000672

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