Opsoclonus in Hemophilus influenzae meningitis.

We studied a 3-month-old boy who had opsoclonus in association with acute bacterial meningitis. The CSF IgG and IgM were elevated acutely, gradually returning to normal with clinical improvement. Correspondingly, CSF cytomorphology showed excessive plasmocytosis and a higher proportion of reactive lymphocytes than expected in an acute bacterial meningitis. These abnormalities in CSF cytology are effects of an abnormal immune response in the CNS, and provide evidence to support an immunopathic basis to opsoclonus.

Iontophoresis of gentamicin into aphakic rabbit eyes. Sustained vitreal levels.

The authors evaluated the intraocular penetration of gentamicin (50 mg/ml) into aphakic rabbit eyes following anodal iontophoresis (0.75 mA for 10 min). Gentamicin levels were determined at 0.5, 4, 8, 16, and 24 hrs after iontophoresis (n = 6 eyes for each time) using an agar diffusion bioassay. Peak levels of 72.04 +/- 6.1 (means +/- SE) micrograms/ml for the corneas and 77.8 +/- 3.0 micrograms/ml for the aqueous humor were obtained at 30 min after iontophoresis. The peak vitreous level was 10.4 +/- 0.4 micrograms/ml, which was found at 16 hrs after iontophoresis. Therapeutic levels of 6.2 +/- 3.0 micrograms/ml were still present in the vitreous humor 24 hrs after iontophoresis. Iontophoresis appears to be an effective noninvasive method for delivering therapeutic levels of gentamicin into ocular tissues and fluids of the aphakic rabbit eye.

Multiple-drop study of topically applied 1% delta 9-tetrahydrocannabinol in human eyes.

Twenty-eight male volunteers were given either 1% delta 9-tetrahydrocannabinol (delta 9-THC) or vehicle alone (light mineral oil). They used the medication four times per day for one week. Five volunteers, four of which used vehicle alone, discontinued the study because of burning sensation and lid swelling. In the 23 volunteers who completed the study, there was no difference in intraocular pressure between eyes treated with 1% delta 9-THC and controls.

Ocular pharmacokinetics of ceftriaxone following subconjunctival injection in rabbits.

Aqueous and vitreous kinetics were studied after anterior subconjunctival injection of 100 mg of ceftriaxone sodium in phakic and aphakic rabbit eyes. Mean peak ceftriaxone concentrations (microgram per milliliter +/- SE, n = 3 to 5 rabbits per determination) were as follows: phakic eyes, 159.5 +/- 42 at one hour in aqueous humor and 25.3 +/- 6.6 at two hours in vitreous fluid; aphakic eyes, 105.1 +/- 20.5 at one hour in aqueous humor and 43.1 +/- 15.4 at one hour in vitreous humor. The ability of ceftriaxone to eliminate an incipient bacterial infection was also evaluated. Ten aphakic rabbits were challenged intravitreally with 700 colony-forming units of Staphylococcus aureus. Six of the ten immediately received subconjunctival injections of ceftriaxone sodium (100 mg). At 48 hours following the challenge, all four control eyes yielded greater than 5.6 X 10(5) colonies per milliliter. In the six eyes receiving ceftriaxone, five were sterile and one yielded 1.4 X 10(2) colonies per milliliter.

Pharmacokinetic analysis of intravitreal ceftriaxone in monkeys.

Ocular toxic effects of intravitreally injected ceftriaxone sodium and its rate of clearance after a single dose were studied in rhesus and cynomolgus monkeys. Doses of 2, 2.5, and 3 mg/0.1 mL were injected into the vitreous cavity. Electroretinograms performed 15 minutes, 24 hours, one week, and two weeks after injection were not significantly different from preinjection electroretinograms. Lens opacification occurred in one eye receiving 2.5 mg of ceftriaxone. Histopathologic findings in the retina were normal in all eyes injected intravitreally. Levels of ceftriaxone after a 2-mg intravitreal dose were 609 mg/L at 0 hours, 434 mg/L at 24 hours, and 19 mg/L at 100 hours in the vitreous; and 1 mg/L at 0 hours, 116 mg/L at 24 hours, and 9 mg/L at 100 hours in the aqueous.

Subconjunctival administration of ceftazidime in pigmented rabbit eyes.

The ocular kinetics of ceftazidime, a third-generation cephalosporin, were examined in phakic and aphakic pigmented eyes of rabbits following subconjunctival injection (100 mg). Peak ceftazidime concentrations (mean +/- SE, n = three to five rabbits per determination) were as follows: phakic eyes, 40.2 +/- 7.3 mg/L in aqueous humor and 11.2 +/- 0.6 mg/L in vitreous humor at one hour; aphakic eyes, 30.5 +/- 4.8 mg/L in aqueous humor and 15.8 +/- 2.4 mg/L in vitreous humor at one hour. The ability of ceftazidime to eliminate an incipient bacterial infection was also studied. Ten aphakic rabbits received intravitreal injections of 50 colony-forming units (cfu) of Pseudomonas aeruginosa. Six of the ten immediately received a subconjunctival injection of ceftazidime (100 mg). At 48 hours following injections, four of four control eyes yielded bacterial counts greater than 6.2 X 10(6) cfu/mL. Of the six that received ceftazidime, five were sterile and one yielded 10 cfu/mL.

Intravitreal ceftriaxone in a rabbit model. Dose- and time-dependent toxic effects and pharmacokinetic analysis.

Ceftriaxone's toxic effects were assessed in albino rabbits after intravitreal injection. Doses up to 5 mg did not alter the B-wave amplitude. Following 7.5-and 20-mg doses, B-wave amplitude ratios were depressed at 24 hours and normal at seven and 14 days. A 50-mg dose caused a temporarily flat B-wave 24 hours after injection. At two weeks this ratio exhibited a moderate increase but remained 2 SDs below the mean preinjection ratio. Eyes receiving up to 20 mg were normal histologically at 14 days. A 50-mg dose induced generalized retinal edema and disruption of the retinal layers 24 hours after injection; at two weeks there were no histologic changes in the retina. Immediately after a 2-mg intravitreal injection, vitreous ceftriaxone levels were 1,345 +/- 4.9 mg/L; by 72 hours they had decreased to 17.6 +/- 1.4 mg/L. The mean peak aqueous level was 80.2 +/- 12.2 mg/L at 72 hours.

Abnormal brain stem auditory-evoked potentials in Stilling-Türk-Duane retraction syndrome.

We performed brain stem auditory-evoked potentials on 14 patients who had the Stilling-Türk-Duane retraction syndrome. Nine of the 14 had an increased latency in Wave III, implicating a pontine anomaly as the cause of the retraction syndrome in these patients.

Incidence of subcortical lesions not increased in nonarteritic ischemic optic neuropathy on magnetic resonance imaging.

We performed magnetic resonance imaging on nine patients with nonarteritic ischemic optic neuropathy and 11 control patients with sensorineural hearing loss and suspected acoustic neuroma. We then counted the number of subcortical lesions in each patient, which may represent an index of generalized cerebral vascular disease. Although patients in the ischemic optic neuropathy group had an average of 3.2 subcortical lesions and those in the control group had an average of 0.9 lesions, this difference was not significant. Based on the presence of subcortical lesions, patients with nonarteritic ischemic optic neuropathy do not appear to have an increased incidence of generalized cerebral vascular disease.

The effect of preoperative flurbiprofen on miosis produced by acetylcholine during cataract surgery.

Sustained pupillary dilation during cataract surgery may be achieved with preoperative noncorticosteroidal anti-inflammatory agents such as flurbiprofen. However, these agents may interfere with miosis after injection of acetylcholine. Thirty patients for extracapsular cataract extraction were randomly assigned in a double-masked fashion to receive either a placebo or preoperative 0.03% flurbiprofen every 30 minutes for four doses. All patients also received three doses of 2.5% phenylephrine and 2% cyclopentolate. Pupillary diameter was measured the day before surgery, immediately before the surgical incision, immediately before and five minutes after acetylcholine injection, and the morning after surgery. The flurbiprofen group had a larger mean pupillary diameter before injection of acetylcholine (P less than .001), five minutes after acetylcholine (P less than .001), and on the first postoperative day (P less than .005).

Treatment of chronic ocular pain by selective thermocoagulation of the trigeminal ganglion.

We used graded radiofrequency heating to destroy pain fibers in the ophthalmic division of the trigeminal ganglion while sparing most of the touch fibers in nine patients (seven men and two women, ranging in age from 51 to 74 years) with chronic ocular pain. All nine experienced immediate and complete pain relief. Although one patient required a second procedure after 57 months, the other eight have been pain-free for 44 to 59 months. There were no serious complications. The corneal reflex was preserved and there was no damage to the optic or extraocular muscles.

Medical therapy of metastatic meningococcal endophthalmitis.

We treated a 15-year-old girl who had meningococcal meningitis and metastatic endophthalmitis with large doses of intravenously administered penicillin G. The patient promptly improved with this therapy, and the visual axis completely cleared during the subsequent five months.

Anterior chamber aspirate cultures after uncomplicated cataract surgery.

We cultured anterior chamber aspirates of 30 patients who had uncomplicated extracapsular cataract extraction or phacoemulsification. The aspirate was obtained at the time of wound closure. Of 30 patients, 13 (43%) had culture-positive anterior chamber aspirates. The total number of organisms recovered was 18, with three patients having multiple organisms identified. The most commonly isolated organisms were coagulase-negative Staphylococcus sp., occurring in eight of 18 isolates (44%). No eyes in our study developed endophthalmitis, even though almost one half had viable organisms growing from the anterior chamber aspirates. Inoculum sizes were extremely small (10 to 20 colony-forming units/ml). This study suggests that in humans, the anterior chamber is capable of clearing a low inoculum of bacteria after cataract surgery without the development of endophthalmitis.

Effect of applying the Honan intraocular pressure reducer before cataract surgery.

We studied 48 patients undergoing cataract extraction with local anesthesia. In 41 patients, after administering the retrobulbar injection, we applied the Honan intraocular pressure reducer for seven to ten minutes at a pressure setting of 30 mm Hg. Of these 41 patients, 13 received 3-ml injections, 14 received 4-ml injections, and 14 received 5-ml injections. No differences in intraocular pressure related to the quantity of retrobulbar injection were noted. After retrobulbar injection, the mean intraocular pressure for the study population as a whole increased 4.4 mm Hg; after application of the Honan device, it decreased 6.2 mm Hg. In a control group of seven patients, who received 4-ml retrobulbar injections but no applications of the Honan device, mean intraocular pressure increased 6.1 mm Hg immediately after retrobulbar injection and decreased only 0.7 mm Hg after seven to ten minutes.

Ocular involvement in mycotic sinusitis caused by Bipolaris.

We examined two patients with unilateral ophthalmologic findings secondary to pansinusitis caused by Bipolaris. Both patients were healthy young men. One patient had a gradual visual loss, whereas the other showed proptosis. Surgical debridement was the primary treatment in both patients. One patient received antifungal therapy, whereas the other was cured with surgery alone.

Lymphocyte stimulation by yeast phase Histoplasma capsulatum in presumed ocular histoplasmosis syndrome.

We measured skin reactions serum antibody, and lymphocyte stimulation to Histoplasma antigens in a series of patients with presumed ocular histoplasmosis syndrome and in controls. The most sensitive test, lymphocyte stimulation to H. capsulatum sonicate, also correlated with severity of the disease. Lymphocyte stimulation to Histoplasma may be a useful adjunct to the monitoring of presumed ocular histoplasmosis syndrome.

Intraocular gentamicin sulfate and postcataract anterior chamber aspirate cultures.

We cultured anterior chamber aspirates of 28 patients who had uncomplicated cataract surgery. Fourteen patients had received 80 micrograms/ml of gentamicin in balanced salt solution through irrigation of the anterior chamber throughout cataract extraction, and 14 patients had received 8 micrograms/ml of gentamicin. Cultures of anterior chamber fluid obtained at the end of surgery from all 28 patients had no growth on two nonselective media. There was no clinical evidence of ocular toxicity. This study demonstrates that antibiotic in the intraocular irrigation fluid can reduce or eliminate the expected intraocular bacterial load after cataract surgery.

Benign intracranial hypertension in pregnancy: current diagnostic and therapeutic approach.

Four cases of benign intracranial hypertension (BIH) in pregnancy are presented. Literature regarding this rare entity is reviewed. Various diagnostic and therapeutic approaches in the management of BIH are described, with special emphasis on the newer neurodiagnostic and neurosurgical approaches. Guidelines have been suggested in diagnosing and managing this syndrome in pregnancy.

A revised technique for extracapsular lens extraction in the rabbit.

The surgical procedure described here for extracapsular lens extraction utilizes a bent 25 gauge needle as an irrigating cystotome , a 100 degrees superior clear corneal incision, a single clean incision of the lens capsule, a muscle hook for expression of the nucleus, no cortical cleanup, and interrupted 9-0 nylon sutures to close the incision. We have found it a simple and effective technique which utilizes inexpensive instruments commonly available in an ophthalmology department or ophthalmic research laboratory.

Effect of topical epinephrine and timolol on ocular and optic nerve blood flow in phakic and aphakic rabbit eyes.

The effects of 4% epinephrine bitartrate and 0.5% timolol on ocular and optic nerve blood flow were studied in phakic and aphakic rabbit eyes using a radioactive microsphere (85Sr) technique. Either epinephrine or timolol was given topically as eight drops in the hour immediately preceding blood flow measurements (one drop every 7.5 minutes). Epinephrine decreased anterior uveal blood flow in both phakic and aphakic eyes, whereas timolol exhibited no effect. Retinal and choroidal blood flow were not affected by either timolol or epinephrine in phakic eyes. In aphakic eyes, epinephrine increased choroidal blood flow without altering retinal blood flow, whereas timolol increased both retinal and choroidal blood flow. Optic nerve blood flow was increased in epinephrine treated phakic and aphakic eyes and also in timolol treated aphakic eyes.