The Efficacy of 2.5% Phenylephrine and Flurbiprofen Combined in Inducing and Maintaining Pupillary Dilatation during Cataract Surgery

Purpose

To evaluate the effectiveness of phenylephrine 2.5% and flurbiprofen 0.03% combined in inducing and maintaining mydriasis during extracapsular cataract extraction (ECCE).

Methods

One hundred patients undergoing ECCE + intraocular lens (IOL) implantation were randomly divided into four groups. The first group was given phenylphrine 10%, the second group phenylephrine 10% + flurbiprofen, the third group phenylephrine 2.5% and fourth group phenylephrine 2.5% + flurbiprofen. Cyclopentolate 1% was used in all patients. Phenylephrine and cyclopentolate were instilled preoperatively four times during 1 hour and flurbiprofen was given four times the day before surgery and twice with an hour's interval before operation. Pre-operative and post-cortex aspiration horizontal pupil diameters were measured with callipers viewed through the operating microscope.

Results

Pupil diameters in pre-operative and post-cortex aspiration were no different in the 2.5% and 10% phenylephrine groups (p>0.05). Both diameters were larger and pupillary constriction was smaller in the flurbiprofen groups (p<0.05).

Conclusions

2.5% phenylephrine was as effective as 10% phenylephrine, with and without flurbiprofen, in inducing and maintaining pupil dilatation during ECCE surgery.

Prevention of posterior capsule opacification by retinoic acid and mitomycin

BACKGROUND

Our aim was to evaluate the effect of an intraoperative single dose of retinoic acid (RA) or mitomycin C (MMC) in preventing posterior capsule opacification (PCO).

METHODS

Twenty-seven rabbits were divided randomly into three groups. RA (250 microg/ml) and MMC (0.04 mg/ml) were given 0.1 ml by hydrosection and 0.9 ml into the capsular bag after phacoemulsification. The third group served as a control group. Three months after intervention PCO was graded clinically. Furthermore, proliferation of lens epithelial cells was evaluated histologically.

RESULTS

Two eyes developed corneal edema in the MMC group. On clinical assessment, RA and MMC were significantly effective in preventing PCO compared with controls (P<0.005). On histological analysis, there was significantly reduced proliferative activity on posterior capsules in the treatment groups, in contrast to multilayer cells in the control group.

CONCLUSION

Intraoperative single-dose administration of RA and MMC significantly prevented the development of PCO in rabbit eyes. The optimal biocompatible dosage must be carefully determined by further investigation.

Prevention of posterior capsule opacification by intraoperative single-dose pharmacologic agents

PURPOSE

To determine whether an intraoperative single dose of dexamethasone, diclofenac, ethylenediaminetetraacetic acid (EDTA), a combination of EDTA and RGD peptide (arginine-glycin-aspartic acid sequence), or mitomycin-C (MMC) is a pharmacological means of preventing or reducing the development of posterior capsule opacification (PCO).

SETTING

Department of Ophthalmology, Celal Bayar University, School of Medicine, Manisa, and Department of Pathology, Dokur Eylül University, School of Medicine, Izmir, Turkey.

METHODS

Fifty-four rabbits were randomly divided into 6 groups. Dexamethasone (4 mg/cc), diclofenac (2.5 mg/cc), EDTA (8 mg/cc), a combination of EDTA and RGD peptide (2.5 mg/cc), or MMC (0.04 mg/cc) was given, 0.1 cc by hydrodissection and 0.9 cc into the capsular bag after phacoemulsification. The sixth group served as a control group. After 3 months, the PCO was graded clinically and the proliferation of lens epithelial cells (LECs) was evaluated histologically.

RESULTS

The drugs were significantly effective in preventing PCO compared with the control (P <.005). Dexamethasone had a weaker effect than the other drugs. In histological analysis, although monolayer LECs in the dexamethasone and diclofenac groups were observed, there was no proliferative activity on the posterior capsules in the EDTA, EDTA+RGD, and MMC groups in contrast to the multilayer cells in the control.

CONCLUSIONS

Intraoperative single-dose application of EDTA, EDTA+RGD peptide combination, and MMC significantly prevented the development of PCO in rabbit eyes. Diclofenac was less effective but also reduced PCO. Although dexamethasone did not prevent the proliferation of LECs, it decreased PCO clinically.

Penetration of topical and oral ofloxacin into the aqueous and vitreous humor of inflamed rabbit eyes

PURPOSE

This study aimed to investigate the penetration of topical and oral ofloxacin into aqueous humor and vitreous humor in post-traumatic endophthalmitis model in rabbits.

METHODS

A standardized intraocular infection after penetrating injury was made in the right eyes of 16 rabbits. Intraocular infection was induced by intravitreal injection of a suspension of Staphylococcus aureus. The intact left eyes were maintained as controls. The animals were divided randomly into two groups. (1) In the topical group, two drops of ofloxacin 0.3% eyedrops were instilled to both eyes every 30 min for 4 h. (2) In the topical-oral group, two doses of 25 mg/kg of ofloxacin at 12-h intervals were given orally, then the protocol of the first group was applied. Aqueous and vitreous humor samples were taken 30 min after the last drop. Ofloxacin concentrations were measured by using HPLC.

RESULTS

Mean aqueous levels of ofloxacin in control eyes were: 3.25 +/- 2.55 microg/ml in topical group. 4.58 +/- 5.39 microg/ml in topical-oral group. Mean aqueous levels in inflamed eyes were: 5.21 +/- 4.55 microg/ml in topical group, 10.34 +/- 8.88 microg/ml in topical-oral group. Mean vitreous levels of ofloxacin in control eyes were: 0.17 +/- 0.07 microg/ml in topical group, 1.30 +/- 1.23 microg/ml in topical-oral group. Mean vitreous levels in inflamed eyes were: 0.35 +/- 0.22 microg/ml in topical group, 3.48 +/- 2.69 microg/ml in topical-oral group. There was no significant difference among the groups (P > 0.05), however.

CONCLUSIONS

The result of this study suggests that oral supplementation of ofloxacin to topical instillation increased the ocular levels of ofloxacin in the post-traumatic endophthalmitis model. Mean drug concentrations in aqueous and vitreous humors were above the 90% minimum inhibitory concentrations (MIC90) for most of the common microorganisms causing endophthalmitis in all eyes, except in the vitreous humors of the intact eyes instilled topically.

The effects of prolonged acute use and inflammation on the ocular penetration of topical ciprofloxacin

PURPOSE

To study the aqueous and vitreous penetration of ciprofloxacin after prolonged acute topical administration and to investigate the effects of inflammation on drug penetration.

METHODS

A standardized model of intraocular infection after penetrating injury was made in the right eyes of eight rabbits. The intact left eyes were maintained as the control. Two drops of ciprofloxacin 0.3% eyedrops were instilled topically every 1 h for 7 h to all eyes of the rabbits. Aqueous and vitreous samples (100 microl) were obtained half an hour after the last drop. Instillation was continued for 7 h more and samples were obtained as before. Drug concentrations were measured using HPLC.

RESULTS

The mean aqueous humor levels of ciprofloxacin were: in control eyes 1.31 +/- 0.78 microg/ml after 7 h and 1.85 +/- 1.69 microg/ml after 14 h of instillation: in inflamed eyes 2.18 +/- 1.02 microg/ml after 7 h and 2.91 +/- 2.12 microg/ml after 14 h. The mean vitreous humor levels were: in control eyes 0.65 +/- 0.44 microg/ml after 7 h and 0.72 +/- 0.8 microg/ml after 14 h of instillation; in inflamed eyes 0.67 +/- 0.77 microg/ml after 7 h and 1.01 +/- 0.43 microg/ml after 14 h. However, the differences among the groups were not significant (P > 0.05).

CONCLUSIONS

Ciprofloxacin penetration into aqueous humor was higher in 14-h topical application than that for 7 h. Inflammation increased the penetration of topical ciprofloxacin into aqueous while administered for 7 h and into both aqueous and vitreous humor while administered for 14 h. c

Endoscopic dacryocystorhinostomy without stents

OBJECTIVE

The aim of this study is to present our endoscopic DCR operation method without the use of silicone tubing and our results on the patients suffering from chronic epiphora with postsaccal stenosis.

METHODS

Endoscopic dacryocystorhinostomy operations were performed to 21 sides of 18 patients who had chronic epiphora. No silicone tubing was used in any of the cases. In the postoperative healing period, the rhinostomy opening was maintained with frequent removal of nasal debris and using eyedrops. The patients were evaluated by fluoresceine test and endoscopic controls.

RESULTS

Symptomatic improvement was achieved in 19 out of 21 sides of the patients (90.5%) and the results were confirmed by the fluoresceine test under endoscopic control.

CONCLUSION

Our results of 21 sides of 18 cases underwent primary DCR without stents are as successful as those reported in the literature and the technique seems to be promising.

The effect of long-term use and inflammation on the ocular penetration of topical ofloxacin

PURPOSE

To study the penetration of ofloxacin into the aqueous and vitreous humors after long-term topical administration and to investigate the effects of inflammation on drug penetration in rabbits.

METHODS

A standardized model of intraocular infection after penetrating injury was achieved in the right eyes of 16 rabbits. The animals were randomly and equally divided into two groups. The intact left eyes of the groups were maintained as the control. Ofloxacin eyedrops (0.3%) were instilled into all eyes at a frequency of 2 drops every hour for 7 hours in the first group and for 14 hours in the second group. Half an hour after the last drop, samples of the aqueous and vitreous humors were taken and ofloxacin concentrations were measured by using HPLC.

RESULTS

The mean aqueous humor concentrations of ofloxacin in control eyes after 7 and 14 hours of instillation were: 1.45 +/- 0.93 microg/ml and 2.48 +/- 0.33 microg/ml, respectively; those in infected eyes 2.35 +/- 1. 84 microg/ml and 3.49 +/- 1.47 microg/ml, respectively. However the differences among the groups were not significant (p > 0.05). The vitreous ofloxacin concentrations in the control eyes were similar after 7 and 14 hours of instillation (0.23 +/- 0.14 microg/ml, 0.27 +/- 0.10 microg/ml, respectively). In infected eyes, the mean vitreous ofloxacin concentration after 14 hour of instillation was significantly higher than that in control eyes (p < 0.05; 0.4 +/- 0. 09 microg/ml, 0.29 +/- 0.11 microg/ml, respectively). The mean vitreous ofloxacin concentration in infected eyes after 14 hours instillation was not significantly higher than that after 7 hours instillation.

CONCLUSIONS

Topical ofloxacin instillation for 7 or 14 hours yields aqueous concentrations above the MIC(90) for common ocular pathogens. Prolonged application and the presence of inflammation increased the penetration of ofloxacin into the vitreous humor.

The effects of acetylcholine and propolis extract on corneal epithelial wound healing in rats

PURPOSE

To investigate the effects of topical acetylcholine and topical administration of propolis, a natural beehive product, on corneal epithelial wound healing.

METHODS

The whole corneal epithelium was debrided in 42 eyes of 21 rats by mechanical scraping with a dulled scalpel blade. Animals were divided into three groups. Group 1 received topical 1% water extract of propolis (WEP), group 2 received topical acetylcholine (ACh), and group 3 (control group) received topical phosphate-buffered saline, 6 times a day for 3 days, starting immediately after debridement. The area of the corneal epithelial defect was stained with fluorescein, photographed, and then measured every 12 h. The mean epithelial defect area and the mean percentage of epithelial defect remaining at each follow-up were compared between the groups.

RESULTS

The mean epithelial defect area and the mean percentage of epithelial defect remaining at each time were significantly smaller (p < 0.001, p < 0.05, respectively) in the ACh and propolis groups as compared with control groups. There was no statistically significant difference between the propolis or ACh groups at any time (p > 0.05). At 72 h, the mean percentage of defect remaining was 2.58% in the ACh group, 1.3% in the propolis-treated group, and 8.68% in the control group.

CONCLUSIONS

This study demonstrated that ACh and propolis facilitated corneal epithelial wound healing of rats. Although the mechanisms of the effect of propolis on wound healing and its clinical use still remain to be determined, ACh may have a place in the treatment of corneal epithelial injuries.

Effect of propolis on endotoxin-induced uveitis in rabbits

PURPOSE

To test the anti-inflammatory effect of propolis, a natural bee-produced compound, and compare it with corticosteroids for the treatment of endotoxin-induced uveitis (EIU).

METHODS

EIU was produced in all rabbits by unilateral intravitreal injection of 2,000 ng Salmonella typhimurium endotoxin. The animals were then divided randomly into three groups as follows: group A received no treatment (control); group B received methylprednisolone (5 mg/0.1 mL) (positive control); and group C received propolis (5 mg/0.16 mL) by anterior sub-Tenon injection at the time of uveitis induction and at 4 and 8 hours after induction. Inflammation was evaluated by clinical manifestations and by measuring the protein concentration and inflammatory cell content of the aqueous humor.

RESULTS

The clinical grade, cell count, and protein levels in the aqueous humor were: control group (6.0 +/- 0.8, 2,519 +/- 470 cells/microL, 32.9 +/- 2.4 mg/mL); methylprednisolone group (1.8 +/- 0.7, 572 +/- 137 cells/microL, 15.2 +/- 1.8 mg/mL); and propolis group (2.3 +/- 0.5, 503 +/- 124 cells/microL, 13.8 +/- 1.5 mg/mL). Statistically significant differences were recorded in the treatment groups when compared to the control group (P < .001). The effects of methylprednisolone and propolis on EIU were similar (P > .05).

CONCLUSIONS

Propolis showed significant anti-inflammatory effects on EIU in rabbits. The mechanism of its action warrants further investigation.

Penetration of topical and oral ciprofloxacin into the aqueous and vitreous humor in inflamed eyes

PURPOSE

To assess the aqueous and vitreous penetration of ciprofloxacin after topical and combined topical and oral administration and investigate the effects of inflammation on drug penetration.

METHODS

A standardized penetrating injury was made in the right eyes of 16 rabbits. Intraocular inflammation was induced by intravitreal injection of a suspension of Staphylococcus aureus in these eyes. The animals were divided into two groups according to treatment methodology: topical and topical-oral. The intact left eyes of the animals were maintained as controls. In the topical treatment group, two drops of ciprofloxacin 0.3% were instilled to both eyes every 30 minutes for 4 hours. In the topical-oral treatment group, animals were given two oral 40 mg/kg doses of ciprofloxacin at 12-hour intervals. After the last oral dose, the protocol of the topical group was applied to these eyes. Half an hour after the last drop, 100-microL samples were taken from aqueous and vitreous humor of all eyes. Drug concentrations were measured using high-pressure liquid chromatography.

RESULTS

Mean aqueous levels of ciprofloxacin in control eyes were 2.31 microg/mL (range, 1.02-6.27 microg/mL) in the topical group and 5.88 microg/mL (1.52-17.81) in the topical-oral group. Mean aqueous levels in inflamed eyes were 7.36 microg/mL (2.34-17.15) in the topical group and 14.43 microg/mL (2.18-18.66) in the topical-oral group. Mean vitreous levels in control eyes were 0.77 microg/mL (0.09-1.93) in the topical group and 1.01 microg/mL (0.49-1.57) in the topical-oral group. Mean vitreous levels in inflamed eyes were 0.95 microg/mL (0.18-1.27) in the topical group and 1.98 microg/mL (0.51-3.34) in the topical-oral group. There was no significant difference among the groups (P > 0.05). Mean aqueous levels in all eyes and mean vitreous levels in the combined topical and oral group of inflamed eyes were above the 90% minimum inhibitory concentration for most of the common microorganisms causing endophthalmitis.

CONCLUSION

There is an increase in both aqueous and vitreous humor concentrations with inflammation and with oral and topical administrations, as opposed to topical only, of ciprofloxacin. Using oral as well as topical treatment may be a beneficial method of antibiotic prophylaxis in ocular trauma once a patient has received intravenous or intravitreal therapy.

Effects of trauma and infection on ciprofloxacin levels in the vitreous cavity

OBJECTIVE

This study was designed to determine the effects of trauma and infection on vitreous ciprofloxacin levels after intravitreal injection of ciprofloxacin in rabbits.

METHODS

A penetrating injury was made in the right eyes of 24 rabbits. In the eyes of half of the traumatized animals, a standardized intraocular infection was induced by intravitreal injection of a suspension of Staphylococcus aureus. The intact left eyes of the traumatized group were maintained as controls. Ciprofloxacin (200 microg/0.1 mL) was injected into the midvitreous cavity of both eyes in all animals and samples were obtained at 2, 8, 24, and 48 hours after injection. Drug concentrations were measured using high-pressure liquid chromatography analysis.

RESULTS

At the second hour, the mean vitreous concentration of ciprofloxacin in the traumatized eyes was lower than that in control eyes (P<0.05). The mean ciprofloxacin concentrations were significantly higher (P<0.05) in the traumatized-infected eyes than were those in control or traumatized eyes at 24 and 48 hours. The elimination half-life of ciprofloxacin in control and traumatized eyes was 6.02 hours and 5.02 hours, respectively, and infection prolonged the half-life to 15.06 hours. Vitreous levels of ciprofloxacin were above the minimum inhibitory concentration (MIC90) for most of the common microorganisms causing endophthalmitis in all groups at 2 and 8 hours, but also at 24 and 48 hours in traumatized-infected eyes.

CONCLUSION

Infection appears to decrease the clearance of ciprofloxacin. Therapeutic drug levels in traumatized-infected eyes were maintained up to 48 hours. Assuming that the animal model used may have a predictive value for the drug elimination in traumatized-infected human eyes, we suggest that local administration of ciprofloxacin every 2 days may be relevant from the therapeutic perspective.

Ophthalmic findings in GAPO syndrome

BACKGROUND

The main manifestations of GAPO syndrome are growth retardation (G), alopecia (A), pseudoanodontia (P), and optic atrophy (O).

CASES

This syndrome has been described in 21 patients from 16 different families. Four cases are from Turkey and have been presented by Sayli and Gül. The purpose of our study is to document the cases from Turkey and discuss the ophthalmological and neuro-ophthalmolgical findings of these and other reported GAPO cases.

OBSERVATIONS

All patients in the literature and our 4 cases have severe growth retardation with delayed bone age in infancy, characteristic facial appearance (high and bossed forehead, midface hypoplasia), alopecia or severe hypotrichosis, and pseudoanodontia. Optic atrophy was present in 1 of our cases and in 5 previous cases. Glaucoma was present in 5 cases, including 2 of ours. Buphthalmia and keratopathy secondary to glaucoma were also observed. White eyelashes, seen only in our cases, may be a sign of "early senility."

CONCLUSIONS

Optic atrophy is not a constant finding in GAPO syndrome. Glaucoma may accompany the ocular findings. This syndrome has been attributed to either ectodermal dysplasia or the accumulation of extracellular connective tissue matrix, due to an enzyme deficiency involved in its metabolism. Current studies show that an elastin defect and secondary changes in collagen may be important in the pathogenesis of the disease.

Evaluation of intraocular pressure and cataract formation following the long-term use of nasal corticosteroids

It is possible that corticosteroids administered via nasal spray might reach ocular structures in levels sufficient to provoke an ocular hypertensive response and cause posterior subcapsular cataracts (PSCs) in susceptible individuals. In the present study, 26 patients who had undergone endoscopic sinus surgery were evaluated prospectively with respect to intraocular pressure and PSC formation following the use of nasal steroids for at least three months. Eighteen patients (69%) self-administered 200 micrograms/day of budesonide nasal spray twice daily, and eight patients (31%) self-administered 200 micrograms/day of beclomethasone dipropionate nasal spray twice daily, for a period of three to 19 months (mean 8.8 +/- 3.6 months). Ophthalmologic examination, tonometry, visual field testing and biomicroscopic studies revealed no evidence of ocular hypertension or PSCs during postoperative follow-up. We conclude that intranasal corticosteroids can be used safely for prolonged periods without increasing the risk of ocular hypertension or PSCs.