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Balasubramaniam B, Chong YJ, Azzopardi M, Logeswaran A, Denniston AK. Topical Anti-Inflammatory Agents for Non-Infectious Uveitis: Current Treatment and Perspectives. J Inflamm Res 2022; 15:6439-6451. [PMID: 36467992 PMCID: PMC9717596 DOI: 10.2147/jir.s288294] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/12/2022] [Indexed: 10/07/2023] Open
Abstract
Non-infectious uveitis represents a heterogenous group of immune-mediated ocular diseases, which can be associated with underlying systemic disease. While the initial choice of treatment of non-infectious uveitis depends on a number of factors such as anatomical location and degree of inflammation, topical therapies often remain the initial choice of non-invasive therapy. In this narrative review, we aim to describe the literature on non-infectious uveitis, with specific focus on the current perspective on topical anti-inflammatory therapy.
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Affiliation(s)
- Balini Balasubramaniam
- Ophthalmology Department, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - Yu Jeat Chong
- Birmingham & Midland Eye Centre, Birmingham, B18 7QH, UK
| | - Matthew Azzopardi
- Ophthalmology Department, Royal London Hospital, Barts Health NHS Trust, London, E1 1BB, UK
| | | | - Alastair K Denniston
- Ophthalmology Department, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
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2
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Acute Foggy Corneal Epithelial Disease: Seeking Clinical Features and Risk Factors. J Clin Med 2022; 11:jcm11175092. [PMID: 36079023 PMCID: PMC9457359 DOI: 10.3390/jcm11175092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/17/2022] [Accepted: 08/21/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Purpose: Here, we describe the clinical characteristics and predisposing factors of acute foggy corneal epithelial disease, a rare disease newly found during COVID-19 pandemic; (2) Methods: In this single-arm, ambispective case series study, ten patients with acute foggy corneal epithelial disease admitted between May 2020 and March 2021 were enrolled. Their detailed medical history and clinical and ophthalmic findings were recorded and analyzed; (3) Results: All the patients were female (100%), aged from 28 to 61 years (mean age of 40.4 ± 9.3 years). Seven cases (70%) had excessive eye use, and six cases (60%) had stayed up late and were overworked. Ten subjects (100%) presented with acute onset and a self-healing tendency. There was a mild-to-moderate decrease in the corrected visual acuity (0.35 ± 0.21 (LogMAR)). Slit-lamp examination showed diffuse dust-like opacity and edema in the epithelial layer of the cornea. By in vivo confocal microscope, epithelial cells presented characteristically a “relief-like” appearance. Anterior segment optical coherence tomography examination revealed that the mean epithelial thickness was increased (69.25 ± 4.31 μm, p < 0.01); (4) Conclusions: Acute foggy corneal epithelial disease is a rare disease in clinic, which tends to occur in young and middle-aged females. The typical clinical symptom is sudden foggy vision, which occurs repeatedly and can be relieved without treatment. Sex, an abnormal menstrual cycle, overuse of the eyes, fatigue and pressure might be risk factors. Changes in lifestyle and eye use habit during the COVID-19 pandemic may have possibly contributed to this disease incidence.
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Do topical ocular antihypertensives affect Dacryocystorhinostomy outcomes: The Coventry experience. Eye (Lond) 2022; 36:135-139. [PMID: 33637965 PMCID: PMC8727558 DOI: 10.1038/s41433-021-01468-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/24/2021] [Accepted: 02/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND It has been suggested that ocular antihypertensives are associated with an increased risk of nasolacrimal duct obstruction. This study aims to assess the effect of topical antihypertensive treatment on surgical outcomes for patients undergoing Dacryocystorhinostomy (DCR) with intubation. METHODS Single centre, retrospective analysis of 170 operations carried out on 144 patients between January 2014 and January 2019. Statistical analysis of DCR failure rates comparing patients on topical ocular antihypertensive treatment and those not on any topical ocular antihypertensive treatment was carried out following medical case record analysis. RESULTS 6.9% of patients undergoing DCR surgery were on topical antihypertensive treatment. The overall failure rate for all DCR operations during this time period was 11.2%. There was a statistically significant higher rate of primary DCR failure in patients on antihypertensive treatment (p = 0.02), with the endonasal DCRs worse affected (p = 0.01). The most commonly used topical treatments were carbonic anhydrase inhibitors (CAI, 81.8%), followed by beta-blockers (72.7%). All patients who had failure of primary DCR were using topical beta-blockers and CAI at the time of surgery and post-operatively. There was no statistically significant association between failure rates and the use of preserved or unpreserved drops (p = 1.0) CONCLUSIONS: Topical ocular antihypertensive treatment may lead to a higher failure rate for DCR surgery due to the provocation of an inflammatory cicatricial response. Beta-blockers and CAIs appear to have the strongest association. Considering a primary external approach in this group as well as switching the class of topical antihypertensive treatment pre-operatively could perhaps improve DCR outcomes.
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4
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McLaughlin M, Gilea MA, Earle MJ, Seddon KR, Gilmore BF, Kelly SA. Characterization of ionic liquid cytotoxicity mechanisms in human keratinocytes compared with conventional biocides. CHEMOSPHERE 2021; 270:129432. [PMID: 33422997 DOI: 10.1016/j.chemosphere.2020.129432] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/15/2020] [Accepted: 12/21/2020] [Indexed: 06/12/2023]
Abstract
The ability to chemically modify ionic liquids (ILs) has led to an expansion in interest in their use in a diversity of applications, not least as antimicrobials and biocides. Relatively little is known about cytotoxicity mechanisms of ILs in comparison to other biocides currently in widespread use, as well as their practical significance for the ecological environment and human health. Using NCTC 2544 and HaCat human keratinocyte cells, this study aimed to characterize cytotoxicity rates and mechanisms of a range of ILs. Using both lactate dehydrogenase (LDH) and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) based cytotoxicity assays, it was confirmed that at biocide-relevant concentrations, ILs with longer alkyl chains exhibited greater biocidal activity than those with shorter alkyl chains, with comparable activity to the commonly used biocides chlorhexidine, benzalkonium chloride and cetylpyridinium chloride, at relevant in-use biocide concentrations. Mode of cell death, measured using fluorescence-activated cell sorting (FACS) and caspase 3/7 activity, determined necrosis to be the primary cytotoxic mechanism at higher concentrations of the biocides stated above, and with ILs [C14MIM]Cl and [C14quin]Br, with apoptosis observed at borderline necrotic concentrations. Perhaps most interestingly, modification of anion had a significant effect on cytotoxicity. The use of N[SO2CF3] as an anion to [C16MIM] attenuated cytotoxicity 10-fold in comparison to other anions, suggesting cytotoxicity may also be a tuneable property when using ILs as biocides.
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Affiliation(s)
- Martin McLaughlin
- School of Pharmacy, Queens University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK; Institute for Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
| | - Manuela A Gilea
- The QUILL Research Centre, School of Chemistry, Queen's University of Belfast, Belfast, BT9 5AG, UK
| | - Martyn J Earle
- The QUILL Research Centre, School of Chemistry, Queen's University of Belfast, Belfast, BT9 5AG, UK
| | - Kenneth R Seddon
- The QUILL Research Centre, School of Chemistry, Queen's University of Belfast, Belfast, BT9 5AG, UK
| | - Brendan F Gilmore
- School of Pharmacy, Queens University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Stephen A Kelly
- School of Pharmacy, Queens University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK.
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5
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Naderi K, Gormley J, O’Brart D. Cataract surgery and dry eye disease: A review. Eur J Ophthalmol 2020; 30:840-855. [PMID: 32515220 PMCID: PMC7549290 DOI: 10.1177/1120672120929958] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/07/2020] [Indexed: 01/26/2023]
Abstract
AIM To review published literature concerning cataract surgery and dry eye disease (DED). METHODS A search was undertaken using the following: PubMed (all years), Web of Science (all years), Ovid MEDLINE(R) (1946 to 12 December 2019), Ovid MEDLINE(R) Daily Update 10 December 2019, MEDLINE and MEDLINE non-indexed items, Embase (1974-2019, week 49), Ovid MEDLINE (R) and Epub Ahead of Print, In-Process and Other Non-Indexed Citations and Daily (1946 to 12 December 2019), CENTRAL (including Cochrane Eyes and Vision Trials Register; Cochrane Library: Issue 12 of 12 December 2019), metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrial.gov) and WHO International Clinical Trials Registry Platform (www.who.int/ictrp/search/en). Search terms included 'cataract surgery', 'phacoemulsification' and 'cataract extraction', combined with 'dry eyes' and 'ocular surface'. Relevant in-article references not returned in our searches were also considered. RESULTS Publications identified included systematic reviews, meta-analysis, randomized controlled trials, cohort studies, case series and laboratory-based studies. Published data highlighting the burden of DED both prior and following cataract surgery were reviewed as well as studies highlighting the effects of cataract surgery on the ocular surface, intra-operative measures to reduce deleterious effects on the ocular surface and current evidence on the management options of post-operative DED. CONCLUSIONS DED is common and can be exacerbated by cataract surgery. Ophthalmologists need to assess for pre-existing DED and instigate treatment before surgery; be aware of reduced accuracy of measurements for surgical planning in the presence of DED; limit intra-operative surgical factors damaging to the ocular surface; and consider management to reduce DED post-operatively.
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Affiliation(s)
- Khayam Naderi
- Department of Ophthalmology, Guy’s and St Thomas’ NHS Foundation
Trust, London, UK
- King’s College London, London, UK
| | - Jack Gormley
- Department of Ophthalmology, Guy’s and St Thomas’ NHS Foundation
Trust, London, UK
| | - David O’Brart
- Department of Ophthalmology, Guy’s and St Thomas’ NHS Foundation
Trust, London, UK
- King’s College London, London, UK
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6
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Azari AA, Arabi A. Conjunctivitis: A Systematic Review. J Ophthalmic Vis Res 2020; 15:372-395. [PMID: 32864068 PMCID: PMC7431717 DOI: 10.18502/jovr.v15i3.7456] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/25/2020] [Indexed: 01/10/2023] Open
Abstract
Conjunctivitis is a commonly encountered condition in ophthalmology clinics throughout the world. In the management of suspected cases of conjunctivitis, alarming signs for more serious intraocular conditions, such as severe pain, decreased vision, and painful pupillary reaction, must be considered. Additionally, a thorough medical and ophthalmic history should be obtained and a thorough physical examination should be done in patients with atypical findings and chronic course. Concurrent physical exam findings with relevant history may reveal the presence of a systemic condition with involvement of the conjunctiva. Viral conjunctivitis remains to be the most common overall cause of conjunctivitis. Bacterial conjunctivitis is encountered less frequently and it is the second most common cause of infectious conjunctivitis. Allergic conjunctivitis is encountered in nearly half of the population and the findings include itching, mucoid discharge, chemosis, and eyelid edema. Long-term usage of eye drops with preservatives in a patient with conjunctival irritation and discharge points to the toxic conjunctivitis as the underlying etiology. Effective management of conjunctivitis includes timely diagnosis, appropriate differentiation of the various etiologies, and appropriate treatment.
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Affiliation(s)
- Amir A Azari
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Torfeh Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Arabi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Torfeh Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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7
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Kim J, Ji YS, Yoon KC. Bilateral Corneal Edema After Inhalation of Spray Paint. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.6.676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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8
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Georgoudis P, Sabatino F, Szentmary N, Palioura S, Fodor E, Hamada S, Scholl HPN, Gatzioufas Z. Ocular Mucous Membrane Pemphigoid: Current State of Pathophysiology, Diagnostics and Treatment. Ophthalmol Ther 2019; 8:5-17. [PMID: 30694513 PMCID: PMC6393250 DOI: 10.1007/s40123-019-0164-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Indexed: 12/11/2022] Open
Abstract
Mucous membrane pemphigoid (MMP) is a systemic cicatrizing autoimmune disease that primarily affects orificial mucous membranes, such as the conjunctiva, the nasal cavity, the oropharynx, and the genitalia. Ocular involvement occurs in about 70% of all MMP cases. Ocular MMP (OcMMP) also encompasses the conditions linear immunoglobulin A disease, mucosal dominated epidermolysis bullosa acquisita, and anti-laminin 332/anti-epiligrin/anti-laminin 5 pemphigoid. It is a complex clinical entity that may lead to ocular surface failure and result in inflammatory and infectious complications, as well as potentially devastating visual loss. Early diagnosis and appropriate treatment are of paramount importance and require a high level of expertise as this condition can be extremely challenging to diagnose and treat even for experienced clinicians. In this review we provide an up-to-date insight on the pathophysiology of OcMMP, with an emphasis on the current state of its diagnostics and therapeutics. Our the aim is to increase our understanding of OcMMP and highlight modern diagnostic and therapeutic options.
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Affiliation(s)
| | | | - Nora Szentmary
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | | | - Eszter Fodor
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Samer Hamada
- Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK
| | - Hendrik P N Scholl
- Department of Ophthalmology, Basel University Hospital, Basel, Switzerland
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
| | - Zisis Gatzioufas
- Department of Ophthalmology, Basel University Hospital, Basel, Switzerland.
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Abstract
PURPOSE OF REVIEW This review offers recommendations for monitoring disease status in ocular cicatricial pemphigoid as well therapeutic options including local and systemic therapies. RECENT FINDINGS A negative biopsy on direct immunofluorescence does not preclude a diagnosis of OCP. If a patient's cicatrization is active and/or progressive, systemic immunosuppression should be commenced. SUMMARY OCP is a chronic systemic autoimmune disease that requires systemic immunosuppression.
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10
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Rabiolo A, Sacconi R, Giuffrè C, Corbelli E, Carnevali A, Querques L, Sarraf D, Freund KB, Sadda S, Bandello F, Querques G. SELF-INFLICTED LASER HANDHELD LASER-INDUCED MACULOPATHY: A NOVEL OCULAR MANIFESTATION OF FACTITIOUS DISORDER. Retin Cases Brief Rep 2018; 12 Suppl 1:S46-S50. [PMID: 28937524 DOI: 10.1097/icb.0000000000000640] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To report a case of factitious self-inflicted handheld laser-induced maculopathy. METHODS A 29-year-old man presented to our clinic complaining of a step-wise progressive loss of vision that abruptly began in his left eye but then became bilateral. He underwent comprehensive ocular examination, including visual acuity testing, biomicroscopic, dilated funduscopic examination, structural optical coherence tomography, en face structural optical coherence tomography, optical coherence tomography angiography, fundus autofluorescence, fluorescein angiography, and indocyanine green angiography. RESULTS Visual acuity was 20/200 in both eyes. Although the multimodal imaging was highly consistent with handheld laser-induced maculopathy, the patient continued to deny this behavior. CONCLUSION Self-inflicted handheld laser-induced maculopathy may be a novel manifestation of factitious disorder. Clinical suspicion for this should remain high in the presence of the signature multimodal retinal findings despite denial by the patient. This category of patients could benefit from psychiatric referral, to prevent further ocular or extra-ocular self-injury.
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Affiliation(s)
- Alessandro Rabiolo
- Department of Ophthalmology, IRCCS San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Riccardo Sacconi
- Department of Neurological and Movement Sciences, Eye Clinic, University of Verona, Verona, Italy
| | - Chiara Giuffrè
- Department of Ophthalmology, IRCCS San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Eleonora Corbelli
- Department of Ophthalmology, IRCCS San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Adriano Carnevali
- Department of Ophthalmology, IRCCS San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Lea Querques
- Department of Ophthalmology, IRCCS San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - David Sarraf
- Stein Eye Institute, University of California Los Angeles, Los Angeles, California
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York
- Department of Ophthalmology, New York University School of Medicine, New York, New York
| | - SriniVas Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California
- Department of Ophthalmology, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, IRCCS San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
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11
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Dua HS, Said DG, Messmer EM, Rolando M, Benitez-del-Castillo JM, Hossain PN, Shortt AJ, Geerling G, Nubile M, Figueiredo FC, Rauz S, Mastropasqua L, Rama P, Baudouin C. Neurotrophic keratopathy. Prog Retin Eye Res 2018; 66:107-131. [DOI: 10.1016/j.preteyeres.2018.04.003] [Citation(s) in RCA: 179] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 01/09/2023]
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12
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Egorova GB, Averich VV. [Reducing cytotoxic action of the preservative employed in ophthalmic hypotensive medications with tear replacement therapy]. Vestn Oftalmol 2018; 134:48-56. [PMID: 29953082 DOI: 10.17116/oftalma2018134348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE to assess the possibilities of reducing the cytotoxic effect of benzalkonium chloride (a preservative used in ophthalmic hypotensive drugs) with the help of tear replacement therapy. MATERIAL AND METHODS The study included 28 patients (56 eyes) who had been using antiglaucomatous drugs containing benzalkonium chloride as a preservative for various periods (from 2 months to 17 years). The examination was performed in the setting of compensated IOP. In addition to hypotensive topical medication regimen, all patients were prescribed Stilavit eye drops. Subjects were examined prior to the prescription of artificial tears and after 1, 3 and 6 months of its usage. Effectiveness of the treatment was evaluated with biomicroscopy, Norn's test, Jones test, tearscopy, OCT-meniscometry, confocal microscopy, and impression cytology. RESULTS The use of 'Stilavit' artificial tears in combination with antiglaucoma drugs led to an improvement of the corneal epithelium condition in 85% of cases, a statistically significant increase in the mean values of precorneal tear film rupture time after 1, 3 and 6 months by 26%, 61.2% and 85.8% respectively. Maximum increase of main tear production level was achieved after 3 months of treatment (increased by 43.5%), and was accompanied by 18.6% rise of the lower tear meniscus height after 3 months; in 6 months it raised by 29.4%. A tendency for restoration of the lipid layer of the tear film was observed. According to confocal microscopy and impression cytology, positive dynamics in the condition of corneal epithelium and conjunctival epithelial layer were present. CONCLUSION The study results justify the use of tear replacement therapy, in particular the tear substitute Stilavit, as an additional protective agent for glaucoma treatment regimen.
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Affiliation(s)
- G B Egorova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - V V Averich
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
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13
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Chokrani H, Bengarai W, Tabet Aouel S, Abdallah E, Berraho A. Ocular Munchhausen's syndrome: Self-inflicted conjunctivitis. J Fr Ophtalmol 2018; 41:e285-e286. [DOI: 10.1016/j.jfo.2017.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/19/2017] [Accepted: 08/21/2017] [Indexed: 10/14/2022]
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14
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Sacchetti M, Lambiase A, Coassin M, Bonini S, Bonini S. Toxic corneal ulcer: a frequent and sight-threatening disease. Eur J Ophthalmol 2018; 19:916-22. [DOI: 10.1177/112067210901900604] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Marta Sacchetti
- Department of Ophthalmology, University of Roma Campus Bio-Medico, Roma
| | | | - Marco Coassin
- Department of Ophthalmology, University of Roma Campus Bio-Medico, Roma
| | - Sergio Bonini
- Internal Medicine, Second University of Naples, and Institute of Neurobiology and Molecular Medicine, Italian National Research Council, Roma - Italy
| | - Stefano Bonini
- Department of Ophthalmology, University of Roma Campus Bio-Medico, Roma
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15
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Sheppard JD, Foster CS, Toyos MM, Markwardt K, Da Vanzo R, Flynn TE, Kempen JH. Difluprednate 0.05% versus Prednisolone Acetate 1% for Endogenous Anterior Uveitis: Pooled Efficacy Analysis of Two Phase 3 Studies. Ocul Immunol Inflamm 2017; 27:484-496. [PMID: 29260952 DOI: 10.1080/09273948.2017.1407433] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Purpose: To analyse pooled data from 2 similar phase 3 noninferiority studies comparing difluprednate 0.05% versus prednisolone acetate 1% in patients with endogenous anterior uveitis. Methods: Patients received difluprednate alternating with vehicle or prednisolone acetate for 14 days (8 drops/day in both groups), followed by tapering from day 14 to 28. All patients were observed until day 42. Results: More patients on difluprednate than on prednisolone acetate were cleared of anterior chamber cells on day twenty one (71.3% vs 54.7%; p = 0.02); results were similar at the other time points. Treatment withdrawals were higher with prednisolone acetate than difluprednate (19.8% vs 7.4%; log-rank p = 0.02). Study discontinuation due to lack of efficacy was also higher with prednisolone acetate than difluprednate (14.0% vs 0%; p = 0.0002 [pre-specified exploratory analysis]). Conclusions: More difluprednate-treated eyes were quiet following 21 days of treatment, and difluprednate-treated patients were much less likely to be withdrawn from the study because of treatment failure.
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Affiliation(s)
- John D Sheppard
- a Eastern Virginia Medical School , Norfolk , Virginia , USA
| | - C Stephen Foster
- b Massachusetts Eye Research and Surgery Institution , The Ocular Immunology and Uveitis Foundation , Cambridge , Massachusetts , USA
| | | | | | | | - Thomas E Flynn
- f Ellsworth Uveitis and Retina Care , Ellsworth , Maine , USA.,g Edward S. Harkness Eye Institute , New York, New York , USA
| | - John H Kempen
- h Department of Ophthalmology, Harvard Medical School , Boston , Massachusetts , USA.,i The Discovery Eye Center, MyungSung Christian Medical Center and MyungSung Medical School , Addis Ababa , Ethiopia
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16
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Sanyal S, Law A, Law S. Chronic pesticide exposure and consequential keratectasia & corneal neovascularisation. Exp Eye Res 2017; 164:1-7. [DOI: 10.1016/j.exer.2017.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/21/2017] [Accepted: 08/02/2017] [Indexed: 11/29/2022]
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17
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Dart JK. The 2016 Bowman Lecture Conjunctival curses: scarring conjunctivitis 30 years on. Eye (Lond) 2017; 31:301-332. [PMID: 28106896 DOI: 10.1038/eye.2016.284] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 11/07/2016] [Indexed: 12/22/2022] Open
Abstract
This review is in two sections. The first section summarises 35 conditions, both common and infrequent, causing cicatrising conjunctivitis. Guidelines for making a diagnosis are given together with the use of diagnostic tests, including direct and indirect immunofluorescence, and their interpretation. The second section evaluates our knowledge of ocular mucous membrane pemphigoid, which is the commonest cause of cicatrizing conjunctivitis in most developed countries. The clinical characteristics, demographics, and clinical signs of the disease are described. This is followed by a review and re-evaluation of the pathogenesis of conjunctival inflammation in mucous membrane pemphigoid (MMP), resulting in a revised hypothesis of the autoimmune mechanisms causing inflammation in ocular MMP. The relationship between inflammation and scarring in MMP conjunctiva is described. Recent research, describing the role of aldehyde dehydrogenase (ALDH) and retinoic acid (RA) in both the initiation and perpetuation of profibrotic activity in MMP conjunctival fibroblasts is summarised and the potential for antifibrotic therapy, using ALDH inhibition, is discussed. The importance of the management of the ocular surface in MMP is briefly summarised. This is followed with the rationale for the use of systemic immunomodulatory therapy, currently the standard of care for patients with active ocular MMP. The evidence for the use of these drugs is summarised and guidelines given for their use. Finally, the areas for research and innovation in the next decade are reviewed including the need for better diagnostics, markers of disease activity, and the potential for biological and topical therapies for both inflammation and scarring.
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Affiliation(s)
- J K Dart
- Ocular Biology and Therapeutics, UCL Institute of Ophthalmology, London, UK.,National Institute of Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and The UCL Institute of Ophthalmology, London, UK.,Corneal and External Disease Service, Moorfields Eye Hospital, London, UK
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Pang X, Fan TJ. Cytotoxic effect and possible mechanisms of Tetracaine on human corneal epithelial cells in vitro. Int J Ophthalmol 2016; 9:497-504. [PMID: 27162719 DOI: 10.18240/ijo.2016.04.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/25/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To demonstrate the cytotoxic effect and possible mechanisms of Tetracaine on human corneal epithelial (HCEP) cells in vitro. METHODS In vitro cultured HCEP cell were treated with Tetracaine hydrochloride at different doses for different times, and their morphology, viability, and plasma membrane permeability were detected by light microscopy, methyl thiazolyl tetrazolium (MTT) assay, and acridine orange (AO)/ethidium bromide (EB) staining, respectively. Their cell cycle progression, phosphatidylserine orientation in plasma membrane, and mitochondrial membrane potential (MTP) were assessed by flow cytometry. DNA fragmentation, ultrastructure, caspase activation, and the cytoplasmic apoptosis inducing factor (AIF) and cytochrome c (Cyt. c) along with the expression of B-cell lymphoma-2 (Bcl-2) family proteins were examined by gel electrophoresis, transmission electron microscope, enzyme linked immunosorbent assay (ELISA), and Western blot, respectively. RESULTS After exposed to Tetracaine at doses from 10.0 to 0.3125 g/L, the HCEP cells showed dose- and time-dependent morphological abnormality and typical cytopathic effect, viability decline, and plasma membrane permeability elevation. Tetracaine induced phosphatidylserine externalization, DNA fragmentation, G1 phase arrest, and ultrastructural abnormality and apoptotic body formation. Furthermore, Tetracaine at a dose of 0.3125 g/L also induced caspase-3, -9 and -8 activation, MTP disruption, up-regulation of the cytoplasmic amount of Cyt. c and AIF, the expressions of Bax and Bad, and down-regulation of the expressions of Bcl-2 and Bcl-xL. CONCLUSION Tetracaine above 0.3125 g/L (1/32 of its clinical applied dosage) has a dose- and time-dependent cytotoxicity to HCEP cells in vitro, with inducing cell apoptosis via a death receptor-mediated mitochondrion-dependent pathway.
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Affiliation(s)
- Xin Pang
- Key Laboratory for Corneal Tissue Engineering, College of Marine Life Sciences, Ocean University of China, Qingdao 266003, Shandong Province, China
| | - Ting-Jun Fan
- Key Laboratory for Corneal Tissue Engineering, College of Marine Life Sciences, Ocean University of China, Qingdao 266003, Shandong Province, China
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Baydar T, Kemer OE, Kilicarslan B, Cardak A, Girgin G. Detection of neopterin in tear samples. Pteridines 2016. [DOI: 10.1515/pterid-2015-0020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The main goal of the present study was to detect neopterin concentrations in human tear samples and to evaluate its potential correlation with serum neopterin levels. For this purpose, 20 systemically healthy volunteers were recruited, and both tear and serum samples were synchronically collected from each individual. Enzyme-linked immunoassay (ELISA) was carried out to detect the quantity of neopterin in the samples. Mean human tear neopterin levels were observed as 3±0.56 nM while mean serum neopterin was 9±1.25 nM. Additionally, a significant positive correlation between tear neopterin and serum neopterin concentrations was observed. This is the first report to show neopterin concentration in human tears as a biological sample. Collecting tears from the individuals is a non-invasive sampling method, and as an analytical aspect detection of neopterin by ELISA in tear samples construct a valuable, practical and cheap procedure for the diagnosis and monitoring of intraocular inflammation and systemic immune-mediated diseases.
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Affiliation(s)
- Terken Baydar
- Faculty of Pharmacy, Department of Toxicology, Hacettepe University, 90-06100 Ankara, Turkey
| | - Ozlem Evren Kemer
- Ophthalmology Clinic, Numune Research and Education Hospital, Ankara, Turkey
| | - Bilge Kilicarslan
- Faculty of Pharmacy, Department of Toxicology, Hacettepe University, 90-06100 Ankara, Turkey
| | - Aziz Cardak
- Ophthalmology Clinic, Numune Research and Education Hospital, Ankara, Turkey
| | - Gözde Girgin
- Faculty of Pharmacy, Department of Toxicology, Hacettepe University, 90-06100 Ankara, Turkey
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Tzili N, El Orch H, Ahbeddou S, Ahmimech J, Charif Chefchaouni M, Abdallah EH, Berraho A. [Pathomimia in ophthalmology: We must acknowledge it!]. J Fr Ophtalmol 2016; 39:376-9. [PMID: 26847221 DOI: 10.1016/j.jfo.2015.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/05/2015] [Accepted: 08/28/2015] [Indexed: 10/22/2022]
Abstract
Pathomimia is an unconscious falsification of physical manifestations. The eyelids and ocular surface are almost always affected because of the easy accessibility to these structures for the purpose of attracting attention from one's entourage as well as the medical community. We report four cases of lid and conjunctival pathomimia. The diagnosis was made after a long follow-up and numerous ancillary tests.
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Affiliation(s)
- N Tzili
- Service d'ophtalmologie B, hôpital des spécialités, CHU de Rabat, quartier Souissi, 6220 Rabat, Maroc.
| | - H El Orch
- Service d'ophtalmologie B, hôpital des spécialités, CHU de Rabat, quartier Souissi, 6220 Rabat, Maroc
| | - S Ahbeddou
- Service d'ophtalmologie B, hôpital des spécialités, CHU de Rabat, quartier Souissi, 6220 Rabat, Maroc
| | - J Ahmimech
- Service d'ophtalmologie B, hôpital des spécialités, CHU de Rabat, quartier Souissi, 6220 Rabat, Maroc
| | - M Charif Chefchaouni
- Service d'ophtalmologie B, hôpital des spécialités, CHU de Rabat, quartier Souissi, 6220 Rabat, Maroc
| | - E H Abdallah
- Service d'ophtalmologie B, hôpital des spécialités, CHU de Rabat, quartier Souissi, 6220 Rabat, Maroc
| | - A Berraho
- Service d'ophtalmologie B, hôpital des spécialités, CHU de Rabat, quartier Souissi, 6220 Rabat, Maroc
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Kurata M, Atsumi I, Yamagiwa Y, Sakaki H. Ocular instillation toxicity study: current status and points to consider on study design and evaluation. ACTA ACUST UNITED AC 2016. [DOI: 10.2131/fts.3.217] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Masaaki Kurata
- Pharmacokinetics & Toxicology Research Laboratories, Senju Pharmaceutical Co., Ltd
| | - Ikuyo Atsumi
- Pharmacokinetics & Toxicology Research Laboratories, Senju Pharmaceutical Co., Ltd
| | - Yoshinori Yamagiwa
- Pharmacokinetics & Toxicology Research Laboratories, Senju Pharmaceutical Co., Ltd
| | - Hideyuki Sakaki
- Pharmacokinetics & Toxicology Research Laboratories, Senju Pharmaceutical Co., Ltd
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Asahi MG, Bobarnac Dogaru GL, Onishi SM, Gallemore RP. Strong topical steroid, NSAID, and carbonic anhydrase inhibitor cocktail for treatment of cystoid macular edema. Int Med Case Rep J 2015; 8:305-12. [PMID: 26664246 PMCID: PMC4671768 DOI: 10.2147/imcrj.s92794] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Purpose To report the combination cocktail of strong steroid, non-steroidal anti-inflammatory drug (NSAID), and carbonic anhydrase inhibitor drops for treatment of cystoid macular edema. Methods This is a retrospective case series of patients with cystoid macular edema managed with a topical combination of strong steroid (difluprednate), NSAID, and carbonic anhydrase inhibitor drops. The patients were followed with optical coherence tomography and fluorescein angiography. Results In our six cases, resolution of the cystic edema with improvement in visual acuity was achieved with the use of a combination cocktail of drops. Leakage on fluorescein angiography and cystic edema on optical coherence tomography both responded to treatment with the topical cocktail of drops. Conclusion A topical cocktail of strong steroid, NSAID, and carbonic anhydrase inhibitor drops are effective for managing cystoid macular edema. Further studies comparing this combination with more invasive treatments should be undertaken to determine the efficacy of this cocktail over other treatment options.
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Hamada S, Moore TCB, Moore JE, Al-Dreihi MG, Anbari A, Shah S. Assessment of the effect of cyclosporine-A 0.05% emulsion on the ocular surface and corneal sensation following cataract surgery. Cont Lens Anterior Eye 2015; 39:15-9. [PMID: 26275686 DOI: 10.1016/j.clae.2015.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 07/13/2015] [Accepted: 07/14/2015] [Indexed: 11/28/2022]
Abstract
AIM To assess the effect of cyclosporine-A (CsA) 0.05% ophthalmic emulsion on corneal sensation and ocular surface problems following cataract surgery. DESIGN Prospective, randomized, double masked clinical trial. METHODS Consecutive case series of patients attending for bilateral cataract surgery. Subject's eyes were randomized to receive either topical CsA or carboxymethylcellulose 0.5% (CMC) eye drops twice daily for one month following routine cataract surgery. Subjective and objective assessments were performed pre-operatively, one week, and one month after surgery. Primary safety parameters included best spectacle-corrected visual acuity and incidence of adverse events. Objective assessments included tests of tear film (osmolarity, tear break-up time, and Schirmer's type-I test), ocular surface staining, corneal sensitivity and a subjective assessment: ocular surface disease index (OSDI) questionnaire. RESULTS 30 subjects (60 eyes) were recruited. At one month following cataract surgery, osmolarity, ocular surface staining, TBUT, Schirmer's results showed a greater improvement after CsA drops compared to CMC and this was statistically significant for all measures (p<0.05). All corneal sensation measurements were reduced after one week and one month. Eyes receiving CsA had higher recovery of corneal sensation at both time points post operatively and this was statistically significant at one month. OSDI questionnaire results did not show a statistically significant difference between the two eyes. CONCLUSIONS CsA is effective and safe in the management of ocular surface problems after cataract surgery and allows faster recovery of corneal sensation. This recovery of sensation may be relevant to the improvement in ocular surface problems in all patients.
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Affiliation(s)
- Samer Hamada
- School of Biomedical Sciences, University of Ulster, Coleraine, NI, UK; Birmingham and Midland Eye Centre, Birmingham, UK; Corneo Plastic Unit and Eye Bank, Queen Victoria Hospital, East Grinstead, UK
| | - Tara C B Moore
- School of Biomedical Sciences, University of Ulster, Coleraine, NI, UK
| | - Jonathan E Moore
- School of Biomedical Sciences, University of Ulster, Coleraine, NI, UK; Cathedral Eye Clinic, Belfast, NI, UK
| | | | - Anas Anbari
- Corneo Plastic Unit and Eye Bank, Queen Victoria Hospital, East Grinstead, UK; Manar International Hospital, Damascus, Syria
| | - Sunil Shah
- School of Biomedical Sciences, University of Ulster, Coleraine, NI, UK; Birmingham and Midland Eye Centre, Birmingham, UK; Midland Eye, Solihull, UK.
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Watson SL, Geerling G, Dart JKG. Clinical study of therapeutic ocular surface medium for persistent epithelial defect. Ophthalmic Res 2013; 51:82-7. [PMID: 24335180 DOI: 10.1159/000355065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 07/20/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate therapeutic ocular surface medium (TOSM), a potential physiological tear replacement therapy, for persistent epithelial defect (PED). METHODS 11 eyes of 10 patients with PED for ≥ 2 weeks without improvement despite conventional treatment were enrolled in a prospective pilot study of TOSM over 1 month. RESULTS Healing of the PED occurred in 3 out of the 11 eyes at 1, 2 and 4 weeks, respectively. At week 4, 2 eyes were almost healed (PED area ≤ 0.5 mm(2)). In 4 of the remaining 6 eyes, the PED area was reduced. Failure occurred in 1 case with end-stage ocular cicatricial pemphigoid and severe dry eye, and 1 patient withdrew due to a mild allergic reaction. There were no serious or irreversible side effects with TOSM. CONCLUSIONS TOSM is a potential novel physiological therapy for PED that, unlike autologous serum, has the potential to be easily manufactured and widely available.
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Affiliation(s)
- S L Watson
- Corneal and External Disease Service, Moorfields Eye Hospital, London, UK
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Trocme S, Hwang LJ, Bean GW, Sultan MB. The Role of Benzalkonium Chloride in the Occurrence of Punctate Keratitis: A Meta-Analysis of Randomized, Controlled Clinical Trials. Ann Pharmacother 2010; 44:1914-21. [DOI: 10.1345/aph.1p268] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Benzalkonium chloride (BAK), the most commonly used preservative in topical ophthalmic solutions, has undergone considerable criticism in recent years, principally based on in vitro and in vivo studies. Relevance to the clinical setting has not been confirmed. Objective: To determine whether administration of twice the amount of BAK was associated with an increased incidence of punctate keratitis in long-term, double-masked trials comparing latanoprost ophthalmic solution and vehicle with timolol ophthalmic solution in patients with glaucoma or ocular hypertension. Methods: A meta-analysis of the double-masked phases of 7 prospective, controlled clinical trials compared the incidence of punctate keratitis among patients assigned to treatment with latanoprost or timolol. In all studies, the amount of BAK administered daily in the latanoprost arms was approximately twice the amount used in the timolol arms. All reports of punctate keratitis either as a finding or an adverse event were included. A fixed-effect model was used because the heterogeneity was small and not statistically significant. Sensitivity analyses were conducted. Funnel plots were provided to address potential publication bias. Results: Of the 1694 patients enrolled in the double-masked portion of the trials (latanoprost, n = 892; timolol, n = 802), the overall incidence of punctate keratitis was 6.3% (106/1694). The incidence in latanoprost-treated patients was 6.5% and in timolol-treated patients was 6.0%. The risk difference for punctate keratitis of latanoprost versus timolol was 0.005 (95% CI –0.011 to 0.020; p = 0.574), and the risk ratio of latanoprost versus timolol was 1.084 (95% CI 0.739 to 1.589; p = 0.680). Conclusions: These results indicate that BAK does not produce significant corneal toxicity in the vast majority of patients with glaucoma or ocular hypertension at the concentrations used in these studies.
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Affiliation(s)
- Stefan Trocme
- Refractive Surgery, Department of Ophthalmology and Visual Sciences, Case Western Reserve University and University Hospitals Eye Institute, Cleveland, OH
| | | | | | - Maria B Sultan
- Global Clinical Lead, Pfizer Ophthalmics, Global Medical Organization, New York, NY
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Corneal deposit of ciprofloxacin after laser assisted subepithelial keratomileusis procedure: a case report. J Ophthalmol 2010; 2010:296034. [PMID: 20634934 PMCID: PMC2903952 DOI: 10.1155/2010/296034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Accepted: 05/12/2010] [Indexed: 11/18/2022] Open
Abstract
Purpose. To report one case of corneal antibiotic deposition after ciprofloxacin administration in Laser Assisted Subepithelial Keratomileusis (LASEK). Methods. One case of post-LASEK treatment resulted in corneal precipitates and poor wound healing. Debris was analyzed with dark field microscopy and placed on a blood-agar plate seeded with a susceptible stain of Staphylococcus aureus (ATCC 29213). Results. The alterations resolved with discontinuation of ciprofloxacin treatment, although some residual deposits persisted subepithelially for 6 months. Analysis of precipitates revealed polydisperse crystalline needles of 183 μm average length (SD = 54 μm) and the excised precipitate demonstrated a zone of inhibition. Conclusions. Fluoroquinolone antibiotic drops have been used extensively in postsurgical treatment of refractive surgery. Corneal precipitates have been previously reported in the literature, but up to now nothing has been documented after LASEK. Polypharmacy during refractive surgery may impair epithelialisation, and clinical management should reduce toxic environment and promote ocular surface stability when performing surface ablations.
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Rubino P, Orsoni JG, Rampini A, Mora P. Over-Treated Corneal Abscess May Be Toxic Keratopathy. Case Rep Ophthalmol 2010; 1:20-23. [PMID: 20737055 PMCID: PMC2914444 DOI: 10.1159/000315397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background/Aims Keratitis, especially when long-standing and unresponsive to common antimicrobial treatment, leads to a suspicion of fungal aetiology. Methods Photographically documented case report. Results A 65-year-old man with diabetes was referred for corneal abscess unresponsive to antibiotic and antifungal treatment lasting 6 weeks. Corneal biopsy was performed following a 72-hour washout for identification of bacteria and fungi. Previously administered drops were withdrawn and only preservative-free artificial tears were maintained. Neither bacteria nor fungi were cultured. After 2 weeks, the clinical situation had conspicuously improved. Conclusion Over-treatment of corneal affections fearing mycosis may lead to toxic keratopathy.
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Affiliation(s)
- P Rubino
- Institute of Ophthalmology, University of Parma, Parma, Italy
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Erdem U, Hurmeric V, Muftuoglu O, Kerimoglu H. Linear Corneal Epithelial Keratitis with a Horseshoe Pattern. Ocul Immunol Inflamm 2009; 15:131-4. [PMID: 17558840 DOI: 10.1080/09273940701244210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To report the treatment and follow-up of a linear epithelial keratitis with a horseshoe pattern. METHODS A 21-year-old Turkish soldier, who presented with epithelial keratitis with a horseshoe pattern that did not respond to immunosuppressive and multiple anti-microbial treatment, was studied clinically. RESULTS No microorganism was identified with different stains, cultures, and herpes simplex virus-polymerase chain reaction. The impression cytology revealed prominent polymorphonuclear leukocyte infiltration at the keratitis line. The keratitis did not respond to different antimicrobial treatment or local and systemic corticosteroids. After a fourth scraping was perfomed deeply with a disc-knife, the lesion healed and did not recur in six months. CONCLUSION Linear epitheliitis of cornea with a horseshoe pattern was not found to be associated with any microorganism or systemic disease.
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Affiliation(s)
- Uzeyir Erdem
- Gülhane Military Medical School, Department of Ophthalmology, Ankara, Turkey
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Abstract
Cicatricial pemphigoid is the most common of the immunobullous disorders causing conjunctival cicatrization and is an autoimmune disease in which the ocular component of the immunopathology is directed at the conjunctival basement membrane. The disease is usually bilateral and more common in females, with most cases occurring between 30-90 years, and most often in the seventh decade. The disease occasionally occurs in children. Tear deficiency is a major cause of symptoms, although loss of vision is usually due to surface failure before the onset of aqueous tear deficiency, which occurs late in the progression of the disease. Management of the dry eye must be integrated with the management of the other components of both the ocular surface disease and inflammation. Management requires plastic surgery for the lid and lash malposition, tetracyclines and lid hygiene for the accompanying blepharitis. For the dry eye, the use of lubricants without preservatives is important, to avoid toxicity, and lubricant ointment is helpful for the relief of symptoms in terminally dry eyes without the capacity for surface wetting. Contact lenses, either large limbal diameter rigid gas permeable or gas permeable scleral lenses, are useful for treating dry eye and improving vision in some patients. Control of the conjunctival inflammation is mandatory to prevent disease progression and usually requires systemic immunosuppressive therapy.
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Affiliation(s)
- John Dart
- Moorfields Eye Hospital, London, United Kingdom.
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Jamal KN, Callanan DG. The role of difluprednate ophthalmic emulsion in clinical practice. Clin Ophthalmol 2009; 3:381-90. [PMID: 19668594 PMCID: PMC2709030 DOI: 10.2147/opth.s4460] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Indexed: 11/23/2022] Open
Abstract
The mainstay in the treatment of ocular inflammation, either post-surgical or endogenous, is the use of steroids. While these agents effectively address inflammation, they are not without their risks, including ocular hypertension and acceleration of cataract formation. The most notorious culprits are the strong steroids, such as prednisolone acetate and betamethasone. This review aims to cover the biochemistry and drug development of difluprednate, a novel synthetic strong steroid emulsion. In vivo pharmacokinetics as well as ocular distribution and metabolism are discussed, followed by a comprehensive summary of phase I, II, and III clinical trials evaluating safety and efficacy in patients suffering from postoperative inflammation or anterior uveitis. The objective is to provide an increased familiarity with this newly approved medication as a welcome addition to the ophthalmologist’s armamentarium.
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Korenfeld MS, Silverstein SM, Cooke DL, Vogel R, Crockett RS. Difluprednate ophthalmic emulsion 0.05% for postoperative inflammation and pain. J Cataract Refract Surg 2009; 35:26-34. [DOI: 10.1016/j.jcrs.2008.09.024] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Revised: 09/04/2008] [Accepted: 09/05/2008] [Indexed: 11/25/2022]
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De Rojas MV, Dart JKG, Saw VPJ. The natural history of Stevens Johnson syndrome: patterns of chronic ocular disease and the role of systemic immunosuppressive therapy. Br J Ophthalmol 2007; 91:1048-53. [PMID: 17314145 PMCID: PMC1954786 DOI: 10.1136/bjo.2006.109124] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To characterize patterns of chronic ocular disease in patients with Stevens-Johnson syndrome (SJS) and its variant toxic epidermal necrolysis (TEN), and to describe their response to treatment. METHODS Retrospective case series. A review of hospital records of 30 patients (60 eyes) with ocular manifestations of SJS or TEN was carried out. The principal outcome measure was to identify and classify the patterns of chronic ocular disease in SJS and TEN. The secondary outcome measure was the response to treatment. RESULTS Patterns of chronic ocular disease observed after the acute episode included: mild/moderate SJS, severe SJS, ocular surface failure (SJS-OSF), recurrent episodic inflammation (SJS-RI), scleritis (SJS-S) and progressive conjunctival cicatrisation resembling mucous membrane pemphigoid (SJS-MMP). The median follow-up was 5 years (range 0-29). 19 patients (29 eyes (48%)) developed SJS-OSF, SJS-RI, SJS-S or SJS-MMP during follow-up. SJS-OSF was present in 12 patients (18 eyes (30%)). In 5 patients (eight eyes) this developed 1 year after the acute illness, without any further inflammatory episodes; it was associated with SJS-RI in 1 patient (2 eyes), with SJS-RI and SJS-S in 1 patient (1 eye), with SJS-S in 1 patient (1 eye) and with SJS-MMP in 4 patients (6 eyes). Episodes of SJS-RI occurred in 4 patients (7 eyes (12%)). The median time from acute disease to the first episode of SJS-RI was 8.5 years (range 5-63). SJS-S developed in 2 patients (4 eyes (7%)), of which 2 eyes subsequently developed SJS-OSF. SJS-MMP developed in 5 patients (10 eyes (16.6%)). The median duration from the acute stage to the diagnosis of SJS-MMP was 2 years (range 1-14). Immunosuppressive therapy successfully controlled inflammation in 10/10 patients with SJS-MMP, SJS-RI or SJS-S. CONCLUSION Ocular disease in SJS/TEN is not limited solely to the sequelae of the acute phase illness. Patients and physicians need to know that ocular disease progression, due to surface failure and/or acute inflammatory conditions, may occur at variable periods following the acute disease episode. Recognition of this, and prompt access to specialist services, may optimise management of these uncommon patterns of disease in SJS.
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Mitra A, Tsesmetzoglou E, McElvanney A. Corneal deposits and topical ofloxacin—the effect of polypharmacy in the management of microbial keratitis. Eye (Lond) 2006; 21:410-2. [PMID: 16543928 DOI: 10.1038/sj.eye.6702303] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To report six cases of corneal deposits after administration of topical ofloxacin in the treatment of bacterial keratitis. METHOD/RESULT Six cases of microbial keratitis treated with multiple topical medications, including topical ofloxacin, resulted in corneal precipitates and poor wound healing. In five cases, the precipitates resolved with discontinuation of ofloxacin treatment. However, in one patient, some residual deposits persisted following discontinuation of ofloxacin. The cornea epithelialised, but deposits were identified subepithelially. DISCUSSION Fluoroquinolone antibiotic drops have been extensively used in bacterial keratitis because of their ease of availability, broad spectrum of activity, and lack of toxicity. While corneal precipitates have been reported with cases of topical ciprofloxacin and norfloxacin, little has been documented on corneal deposits and topical ofloxacin in the treatment of bacterial keratitis. The predisposing factors resulting in corneal deposits and the role of polypharmacy are important features that may impair epithelialisation. Clinical management should be aimed at reducing the toxic environment and promoting ocular surface stability.
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Affiliation(s)
- A Mitra
- Department of Ophthalmology, Epsom and St Helier University Hospitals NHS Trust, Sutton Hospital, Sutton, UK.
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