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Leanpolchareanchai J, Tangteerakoon P, Supapsophon P, Sukavatcharin S, Simaroj P, Suksiriworapong J. Extemporaneous Preparation of 20 mg/mL Ganciclovir in Artificial Tears in Comparison with Sterile Water for Ophthalmic Administration: Formulation and Stability Study. Pharmaceutics 2023; 15:pharmaceutics15010208. [PMID: 36678836 PMCID: PMC9866864 DOI: 10.3390/pharmaceutics15010208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/28/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
Ganciclovir is available as a lyophilized powder for reconstitution and is normally used to treat ophthalmic viral infections. The use of ganciclovir in artificial tears containing hydrocolloid polymers may prove beneficial to patients during drug application, by prolonging contact time and providing a moistening effect. Therefore, this study aimed to extemporaneously prepare 20 mg/mL ganciclovir in artificial tears and compare its stability with that of a similar concentration of ganciclovir in sterile water (SWI) for ophthalmic administration. First, a compatibility study of the drug with commercial artificial tears found that it was compatible with artificial tears containing sodium hyaluronate (HYA). Subsequently, ganciclovir/0.1% HYA (HYA0.1) and ganciclovir/SWI eyedrops (EDs) in low-density polyethylene (LDPE) eyedrop bottles packed in light-shielded zipper bags were evaluated for their stability at 5 ± 3 °C and 30 ± 2 °C. The results revealed that ganciclovir/SWI ED had good physicochemical and microbiological stability when stored at 5 ± 3 °C for 12 weeks and at 30 ± 2 °C for 8 weeks. Meanwhile, ganciclovir/HYA0.1 ED was stable for 8 weeks when kept at 5 ± 3 °C and at 30 ± 2 °C, but ganciclovir in 0.3% HYA ED could be stored at 5 ± 3 °C for 8 weeks. Nevertheless, particulate matter may need to be investigated using a suitable method to ensure the absence of invisible particles in these preparations. Of these results, ganciclovir/HYA artificial tears and SWI EDs show potential for use as home medications for the treatment of ophthalmic viral infections.
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Affiliation(s)
| | - Patamaporn Tangteerakoon
- Chemotherapy Pharmacy Unit, Drug Compounding Section, Pharmacy Department, Faculty of Medicine, Ramathibodi Hospital, Bangkok 10400, Thailand
| | - Patcharin Supapsophon
- Pharmacy Services, Somdech Phra Debaratana Medical Center, Faculty of Medicine, Ramathibodi Hospital, Bangkok 10400, Thailand
| | - Somsiri Sukavatcharin
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Pornchai Simaroj
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Jiraphong Suksiriworapong
- Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand
- Correspondence:
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Abstract
PURPOSE To study the etiology and pattern of uveitis in a tertiary ophthalmology center in Thailand. METHODS A cross-sectional study was conducted on uveitis patients presenting to a uveitis clinic at Ramathibodi Hospital, Thailand, between February 2014 and January 2015. RESULTS A total of 758 uveitis patients were enrolled into this study. The most common identified cause was herpetic uveitis (17.2%), followed by Vogt-Koyanagi-Harada disease (13.5%), cytomegalovirus uveitis (12.7%), and HLA-B27/spondyloarthropathy-associated uveitis (12.4%). CONCLUSIONS Herpetic uveitis was the commonest form of infectious uveitis, whereas Vogt-Koyanagi-Harada disease was most frequently seen as the non-infectious cause of uveitis in Thailand.
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Affiliation(s)
| | - Ornsirin Kijdaoroong
- a Department of Ophthalmology , Ramathibodi Hospital , Oomyai , Sampran , Thailand
| | - Kaevalin Lekhanont
- a Department of Ophthalmology , Ramathibodi Hospital , Oomyai , Sampran , Thailand
| | - Sakda Arj-Ong Vallipakorn
- b Section for Epidemiology and Biostatistics , Faculty of Medicine, Ramathibodi Hospital, Mahidol University , Bangkok , Thailand
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Cao S, Chee SP, Yu HG, Sukavatcharin S, Wu L, Kijlstra A, Hou S, Yang P. Investigation of the association of Vogt-Koyanagi-Harada syndrome with IL23R-C1orf141 in Han Chinese Singaporean and ADO-ZNF365-EGR2 in Thai. Br J Ophthalmol 2015; 100:436-42. [PMID: 26628628 DOI: 10.1136/bjophthalmol-2015-307366] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 11/01/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND We performed a multistage genome-wide association study of Vogt-Koyanagi-Harada (VKH) syndrome in a Han Chinese population and identified two novel non-human leukocyte antigen candidate regions previously. The aim of the study was to replicate the association of IL23R-C1orf141 and ADO-ZNF365-EGR2 with VKH syndrome in four sets of multinational populations in Asia. METHOD We conducted a candidate genes association study involving 185 patients with VKH syndrome and 287 normal controls from Han Chinese Singaporeans, non-Han Chinese, Thais and Koreans. Genotyping of 16 single nucleotide polymorphisms (SNPs) within IL23R-C1orf141 and ADO-ZNF365-EGR2 loci was performed using the Sequenom MassARRAY system or by Taqman SNP assays. RESULTS Eight SNPs in IL23R-Clorf141 showed an association with VKH syndrome only in Han Chinese Singaporeans (p=8.49×10(-5) to 1.02×10(-3), pcorrection=1.69×10(-4) to 2.04×10(-3)) but not in the other groups tested. One SNP rs1884444 in IL23R-Clorf141 was found to be weakly associated with VKH syndrome in the Han Chinese Singaporeans, but significance was lost following Bonferroni correction for multiple comparisons. Five SNPs in ADO-ZNF365-EGR2 were found to be associated with VKH syndrome in Thai patients with VKH (p=0.014, pc=0.028) but not in the other three ethnic groups tested. CONCLUSIONS This study confirmed the genetic associations between SNPs in IL23R-C1orf141 and VKH syndrome in Han Chinese Singaporeans but not in other Asian populations. In addition, we also successfully replicated the association of VKH syndrome with ADO-ZNF365-EGR2 in a Thai population.
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Affiliation(s)
- Shuang Cao
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P. R. China Chongqing Eye Institute, Chongqing, P. R. China Chongqing Key Laboratory of Ophthalmology, Chongqing, P. R. China
| | - Soon Phaik Chee
- Singapore National Eye Centre, Singapore, Singapore Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore Singapore Eye Research Institute, Singapore, Singapore Department of Ophthalmology and Visual Sciences, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
| | - Hyeong Gon Yu
- Department of Ophthalmology, College of Medicine, Seoul National University, Seoul, Korea Sensory Organs Institute, Medical Research Center, Seoul National University, Seoul, Korea
| | - Somsiri Sukavatcharin
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Lili Wu
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P. R. China
| | - Aize Kijlstra
- University Eye Clinic Maastricht, Maastricht, The Netherlands
| | - Shengping Hou
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P. R. China Chongqing Eye Institute, Chongqing, P. R. China Chongqing Key Laboratory of Ophthalmology, Chongqing, P. R. China
| | - Peizeng Yang
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P. R. China Chongqing Eye Institute, Chongqing, P. R. China Chongqing Key Laboratory of Ophthalmology, Chongqing, P. R. China
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Abstract
Ocular involvement after primary infection with varicella zoster virus is very rare. We report a case of a healthy 18-year-old man who presented with unilateral ischemic retinal vasculitis 10 days after the onset of chickenpox. He developed acute severe visual loss and a relative afferent pupillary defect in his right eye. Fundus imaging, optical coherence tomography, fundus fluorescence angiography, and electrophysiologic studies confirmed the diagnosis of retinal vasculitis, which led to generalized retinal ischemia. Although aggressive treatment with systemic steroids and antiviral drugs was administered, a poor visual outcome still resulted.
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Affiliation(s)
- Anuchit Poonyathalang
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Somsiri Sukavatcharin
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tharikarn Sujirakul
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Abstract
Several different sets of criteria have been proposed to establish the diagnosis of Vogt-Koyanagi-Harada disease (VKH). Various investigators have used the criteria proposed by Sugiura, those proposed by by the American Uveitis Society as well as the revised diagnostic criteria proposed by the First VKH International Workshop group. These three sets of criteria share several clinical features that are considered to be essential for establishing the diagnosis of VKH, including bilateral uveitis, meningismus, and other extraocular changes. The detection of cerebrospinal fluid pleocytosis is considered to be an absolute in the criteria proposed by Sugiura but is not required for the diagnosis of VKH by the revised diagnostic criteria. We applied the latter diagnostic criteria to 28 well-documented patients with early phase VKH and to 88 patients examined during the late phase of VKH. All of these early and late phase patients fulfilled the criteria of the revised diagnostic criteria proposed by the workshop group, indicating 100% concurrence. However, none of the above proposed criteria were prospectively validated to show the positive and negative predictive value of the proposed criteria. Such a prospective study should be undertaken to address the validity of any one or all of the above sets of VKH diagnostic criteria.
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Affiliation(s)
- Narsing A Rao
- The USC Doheny Eye Institute and the Department of Ophthalmology, Keck School of Medicine, University of Southern California, 1355 San Pablo Street, DVRC 211, Los Angeles, CA 90033, USA.
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Abstract
PURPOSE To describe the clinical features of Vogt-Koyanagi-Harada disease (VKH) in Hispanic patients. METHODS Retrospective review of the records of 48 Hispanic patients diagnosed with VKH. The patients were divided into two groups: patients in the early phase of VKH (n = 11) were those who presented within 1 month after the onset of symptoms; patients in the late or chronic VKH phase (n = 37) were those who presented 6 months after onset of symptoms. Demographic data, clinical features, complications and initial and final visual acuity for each patient were recorded. RESULTS All 11 patients in early phase VKH presented with bilateral uveitis (100%). Meningismus was noted in six cases and auditory disturbances in three. Ocular findings for these 11 patients included exudative retinal detachment in ten patients (91%) and marked optic disc edema in one patient. In the late phase VKH, ocular findings included sunset glow fundus in 26 patients (70%), peripheral nummular scars in 27 (73%), and retinal pigment epithelium hyperplasia in seven (19%). Extraocular manifestations noted in this group of patients included vitiligo in four, poliosis in six, and alopecia in five; auditory disturbances were found in four patients. The visual acuity improved in 60-70% of the patients after treatment with corticosteroids alone or in combination with immunosuppressive agents. CONCLUSION Hispanic patients with VKH often present without extraocular changes during early phase of the disease. However, once the disease evolves into the chronic phase, integumentary system involvement may become apparent in some patients.
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Tsai JH, Sukavatcharin S, Rao NA. Utility of lumbar puncture in diagnosis of Vogt-Koyanagi-Harada disease. Int Ophthalmol 2007; 27:189-94. [PMID: 17340216 DOI: 10.1007/s10792-007-9044-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Accepted: 01/13/2007] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the significance of lumbar puncture in diagnosis of Vogt-Koyanagi-Harada disease (VKH). METHOD A retrospective analysis was conducted on 116 consecutive patients diagnosed with VKH. Two additional patients who presented with acute VKH were included in the analysis. Demographic characteristics, including gender, age, and ethnicity, were extracted from the medical record. The stage of disease at presentation was documented. Pertinent laboratory results and diagnostic procedures such as lumbar puncture, fluorescein angiography, and echography that contributed to the diagnosis of VKH were collected. RESULTS Lumbar puncture results for 10 patients were available. Eight of these patients presented with pleocytosis consistent with a diagnosis of VKH. Clinical features and fluorescein angiography confirmed the diagnosis in these patients. Both of the patients who did not exhibit cerebrospinal fluid (CSF) pleocytosis presented with headache, vision loss, and bilateral uveitis. Fluorescein angiography disclosed multiple foci of leakage at the retinal pigment epithelium level with accumulation of dye under the retina and disc leakage, confirming diagnosis of VKH. CONCLUSION The utility of lumbar puncture as a diagnostic criterion for VKH should be re-evaluated given that clinical features and fluorescein angiography alone often support the diagnosis. The inherent risks and complications associated with the procedure must prompt the clinician to reserve this evaluation for atypical presentations.
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Affiliation(s)
- Julie H Tsai
- Doheny Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, 1355 San Pablo Street DVRC211, Los Angeles, CA, USA
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Sukavatcharin S, Cursino S, Li G, Green RL, Lim JI, Rao NA. Xanthogranuloma of the iris simulating melanoma in an adult. Am J Ophthalmol 2007; 143:529-31. [PMID: 17317408 DOI: 10.1016/j.ajo.2006.10.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Revised: 10/05/2006] [Accepted: 10/06/2006] [Indexed: 11/19/2022]
Abstract
PURPOSE To report a case in an adult of xanthogranuloma of the iris that clinically simulated iris melanoma. DESIGN Observational case report. METHODS Clinical and histopathologic examination of iris mass obtained from a 77-year-old white woman. RESULTS High-frequency ultrasonography of the right eye revealed a small, echodense lesion involving the iris root. The mass revealed histopathologic features identical to juvenile xanthogranuloma (JXG), including histiocytes and lymphocytes mixed with multinucleated giant cells, and eosinophilic leukocytes. The histiocytes stained positive for CD68, CD45, and factor XIIIa and negative for S-100 and CD1a. CONCLUSIONS Xanthogranuloma of the iris can occur in elderly patients. Such lesions should be considered in the differential diagnosis of iris melanoma.
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Affiliation(s)
- Somsiri Sukavatcharin
- Doheny Eye Institute and Department of Ophthalmology, Keck School of Medicine of University of Southern California, Los Angeles, California 90033, USA
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