Penetration of norfloxacin into the aqueous humor of the human eye.

Forty six patients received a topical application of a 0.3% norfloxacin (Zoroxin; MSD, Austria) solution into the lower fornix at different time intervals and frequencies before undergoing planned extracapsular cataract extraction. Aqueous humor was sampled at the beginning of surgery and assayed for the level of the antibiotic with high performance liquid chromatography. The highest aqueous humor level observed 30 min after the administration of the last drop in four patients who received five drops of norfloxacin into the lower fornix was 660.25 +/- 378.2 ng/ml. These concentrations are above the minimum inhibitory concentration of norfloxacin for 90% (MIC90) of most of the gram-negative microorganisms, but below the MIC90 of most of the staphylococci (coagulase negative Staph. and Staphylococcus aureus range between 0.25-1 mg/ml).

Effect of timolol on aqueous humor protein concentration in the human eye.

We performed a double-masked, controlled study investigating the increase in the protein concentration in aqueous humor after topical timolol maleate administration. Forty patients scheduled to undergo intracapsular cataract surgery were included in the study. Either timolol ophthalmic solution or the vehicle of timolol alone (control) were applied topically in a randomized fashion, and aqueous humor was collected during surgery. Protein concentrations were determined by gel-filtration chromatography. The total protein concentration as well as the concentration of high and medium molecular weight proteins were significantly elevated in the timolol-treated group. The relation of the levels of the three different molecular weight classes did not differ significantly between the two groups, indicating that undisturbed protein filtration in the face of reduced aqueous humor production--and not a change in the permeability of the blood-aqueous barrier--is responsible for the increase in concentration.

Ulcerative blepharitis in atopic patients--is Candida species the causative agent?

A total of 50 patients suffering both from atopic skin disease and different clinical forms of blepharitis have been included in this study. Microbiological investigations (for bacteria and fungi) of the lid margins were performed in all cases. In 21 (42%) of the patients an ulcerative blepharitis which heavily involved the follicles of the lashes was diagnosed. The remaining 29 cases presented with blepharitis of the squamous type. The cultures revealed that 19 of the 21 patients with ulcerative blepharitis were found to grow Candida species, whereas fungi could not be detected in any of the other cases of blepharitis. The frequencies of concomitant bacterial organisms found in the cultures were similar in both groups. As atopic patients are known to exhibit a defect in their cell-mediated immunity and possibly also a defective IgA antibody response it is a widely accepted assumption that these immunological changes are contributing factors to the development of a localised inflammation of the lids which is initiated by a variety of micro-organisms. We postulate that when Candida species happen to coincide with severe inflammation in atopic patients a blepharitis of the ulcerative type will develop or deteriorate thereby implying that these microorganisms may play an important role in the development or deterioration of this severe chronic inflammation. It is therefore advisable to perform repeated scrapings and cultures in every case of recalcitrant blepharitis.

Circulating ICAM-1 levels in serum of uveitis patients.

Intercellular Adhesion Molecule-1 (ICAM-1) is a cytokine-inducible adhesion molecule expressed on cells of multiple lineages at sites of inflammation. Recently a truncated form of ICAM-1 has been discovered to be circulating in serum. This study reports on circulating serum (cICAM-1) levels in 132 uveitis patients (HLA-B 27 pos. acute anterior uveitis (AAU); HLA-B27 neg. anterior uveitis (AU); intermediate uveitis (IU); heterochromic cyclitis Fuchs (HCF); sarcoidosis; Toxoplasmosis). Measurement of circulating ICAM-1 serum levels was performed using a monoclonal antibody based ELISA, with healthy blood donors serving as the control group. Applying multiple variance analysis and the Student Newmann-Keuls test we found a statistically significant elevation of serum cICAM-1 level in the HLA-B 27 neg. AU group (n:31), in the IU group (n:25) and in patients with sarcoidosis (n:18). Serum levels of HLA-B27 pos. AAU patients, patients with HCF and patients suffering from ocular toxoplasmosis did not differ significantly from levels of the control group.

Necrotizing destruction of the ocular adnexa by Pseudomonas aeruginosa.

In a six weeks old boy, a necrotizing Pseudomonas infection had destroyed nearly the whole lid apparatus, the lacrimal structures of the right eye and the medial canthal region, the medial thirds of the eyelids and the lacrimal passages on the left side. The infection was only controlled by intensive antibiotic therapy after more than two weeks. The exposure keratitis of the right eye was followed by corneal perforation, two months after the beginning of the therapy. A keratoplasty was performed, but soon a staphyloma and later, dense scarring developed. After the haematological and immunological situation was under control we could contemplate covering the large defect in the medial canthal area (open right canalis nasolacrimalis) at the age of seven months. The right lower lid has to be reconstructed later. The left eyelid defects have closed by spontaneous granulation. The little boy is no longer receiving antibiotic treatment and is developing very well.

Efficacy of norfloxacin in bacterial conjunctivitis.

We investigated the efficacy and safety of norfloxacin 0.3% ophthalmic solution in 120 patients with bacterial conjunctivitis or blepharitis. Patients were selected for the study if they showed conjunctival hyperemia and at least three of the following criteria: a) symptoms of a surface ocular infection; b) a purulent discharge; c) crusting of the eyelids, and d) thickened, red lid margins. After taking a specimen for culture from the conjunctiva or skin-lash margin, the test drug was administered to the infected eye every two hours for one day, then 4 times daily for one week. Of the 120 patients who entered the study, 84.1% were cured. No serious adverse reactions occurred.

[Etiology of infectious diseases of the outside of the eye]. / Uber die Atiologie infektiöser Erkrankungen des äusseren Auges.

This study emphasizes the importance of accurate diagnosis and therapy. Modern laboratory techniques were used to scan conjunctival swabs from 287 patients with 305 red eyes between 1.1. 1985 and 1.6. 1985. 17 patients (5.9%) showed Chlamydia infection. The main bacterial organism found was Staphylococcus, mostly of a resistant strain. Allergic conjunctivitis and typical viral infections were not considered in this study. As reported in the recent literature eye infections caused by Chlamydia trachomatis are increasing in number.

[Treatment of venous thrombosis of the retina with prostacyclin]. / Zur Behandlung venöser Verschlüsse der Netzhaut mit Prostazyklin.

Prostacyclin (PGI2) was used in the treatment of 10 patients with retinal venous thrombosis. All changes in 6 eyes with the non-ischaemic type of venous obstruction resolved completely, with marked visual improvement. The course of 3 ischaemic venous thromboses was unaffected by the treatment. In one eye ischaemic retinal areas were first noted months after therapy. All ischaemic fundi were subjected to adequate laser coagulation. In spite of the small number of patients it can be concluded that PGI2 does not seem to alter the course of the ischaemic type of retinal venous thrombosis.

[Multicenter double-blind study with 0.25% timolol in Gelrite (TG) once daily vs. 0.25% timolol solution (TS) twice daily. German Study Group]. / Multizentrische Doppelblindstudie mit 0,25% Timolol in Gelrite (TG) 1mal täglich vs. 0,25% Timolol-Lösung (TS) 2mal täglich. Studiengruppe Deutschland.

In a 12-week double-masked trial we compared the ocular hypotensive effect of 0.25% timolol in Gelrite administered once daily (TG) to that of 0.25% timolol solution administered twice daily (TS). A second objective was to compare the tolerability and the safety of these treatments. Timolol in Gelrite is a new topical formulation of timolol in an anionic heteropolysaccharide gellan gum. A total of 156 patients entered the study after an appropriate wash-out. The medication schedule included one drop of test drug in each eye at 9 a.m. (active drug for both groups) and 9 p.m. (placebo for the TG group, active drug for the TS group). At trough, the mean decrease from baseline intraocular pressure (after appropriate wash-out) ranged from 5.7 to 6.3 mmHg for the TG group and from 5.9 to 6.2 mmHg for the TS group. The difference between the treatment group means ranged from -0.4 to 0.4 mmHg. At peak, the mean decrease from baseline IOP ranged from 5.3 to 6.2 mmHg for TG group and from 5.1 to 6.1 mmHg for the TS group. The difference between the treatment group means ranged from -0.7 to 0.4 mmHg. The results of this study support the hypothesis of a comparable hypotensive effect at peak and trough of 0.25% timolol in Gelrite q.d. to 0.25% timolol solution b.i.d. Furthermore, timolol in Gelrite has an acceptable tolerability profile. The incidence of blurred vision was higher in the Gelrite group, but this different was not statistically significant. The incidence of foreign body sensation was significantly higher in the Gelrite group (P < 0.022).(ABSTRACT TRUNCATED AT 250 WORDS)

[Isotretinoin administration in treatment of acne vulgaris. A prospective study of the kind and extent of ocular complications]. / Isotretinoinapplikation zur Behandlung der Akne vulgaris. Prospektive Studie über Art und Ausmass der okulären Komplikationen.

Isotretinoin (13-cis-retinoic acid) is commonly used for the treatment of acne vulgaris. In the skin this substance causes an atrophy of sebaceous gland acini and a decrease in sebum production. Systemic treatment also alters meibomian gland function and structure. These alterations seem to be responsible for ocular complications (dryness of the eye, blepharitis, conjunctivitis) during therapy with isotretinoin. We inspected 30 patients before, during and after therapy with isotretinoin with regard to ocular side effects. Examination included careful slit-lamp inspection, measurement of break-up time (BUT) and the Schirmer test. Conjunctival smears were taken from every patient. The most frequently observed side-effects were decreased tear break up time and alterations of the lid margin. In addition, an enormous increase of Staphylococcus aureus in conjunctival flora was noticed. However, all ocular complications of systemic treatment with isotretinoin were reversible after cessation of therapy.

[Contamination of intraocular fluid in pars plana vitrectomy]. / Kontamination intraokularer Flüssigkeiten bei Pars-plana-Vitrektomien.

UNLABELLED: Endophthalmitis after pars plana vitrectomy is rare, with an incidence of 0.05-0.14%. The aim of this study was to evaluate the microbiological situation during pars plana vitrectomy and to ascertain what organisms and how many enter the eye during the operation. PATIENTS AND METHODS: Twenty-five consecutive subjects undergoing primary pars plana vitrectomy were included in the study. Patients were excluded if they had evidence of local or systemic infections or had undergone antibiotic therapy within 3 weeks before surgery. A standard three-port pars plana vitrectomy was performed on each patient. Preoperative smears of the conjunctiva and intraoperative aspirates of the vitreous were taken immediately after sclerotomy, and aspirates of the intraocular fluid at the conclusion of operation. RESULTS: We obtained preoperative smears from the conjunctival sac of all patients, and found that 19 patients (76%) had positive cultures, with coagulase-negative staphylococci as the most commonly isolated organisms, (n = 14; 56%). Vitreous--aspirated immediately after sclerotomy--was sterile in 68% (n = 17). In 32% (n = 8) contamination occurred, the microorganisms isolated being coagulase-negative staphylococci (20%) and Staphylococcus aureus (12%). Five of the samples (20%) of intraocular fluid from the vitreous cavity--aspirated before wound closure--were contaminated, coagulase-negative staphylococci (8%) and Staphylococcus aureus (12%) again being found in culture. In no case did postoperative endophthalmitis develop. CONCLUSIONS: This study demonstrates that bacteria enter the eye during pars plana vitrectomy and that there is a change in the contaminating bacterial species during operation. Even if bacteria remain in the eye after pars plana vitrectomy, postoperative endopthalamitis does not necessarily develop.

[Computer eyeglasses--aspects of a confusing topic]. / Die Bildschirmbrille--Aspekte zu einem verwirrenden Thema.

With the coming into force of the new Austrian Employee Protection Act the issue of the so called "computer glasses" will also gain added importance in our country. Such glasses have been defined as vision aids to be exclusively used for the work on computer monitors and include single-vision glasses solely intended for reading computer screen, glasses with bifocal lenses for reading computer screen and hard-copy documents as well as those with varifocal lenses featuring a thickened central section. There is still a considerable controversy among those concerned as to who will bear the costs for such glasses--most likely it will be the employer. Prescription of such vision aids will be exclusively restricted to ophthalmologists, based on a thorough ophthalmological examination under adequate consideration of the specific working environment and the workplace requirements of the individual employee concerned.

[The pathogen spectrum in neonatal dacryocystitis]. / Das Erregerspektrum bei Dacryocystitis neonatorum.

The most common cause of congenital dacryostenosis is the persistence of Hasner's membrane, which in more than 90% of cases perforates during the first 4 to 6 weeks. If no perforation occurs, the tears gather in the lacrimal duct and lacrimal sac until the system is full and an inflammation starts. Formerly, dacryocystitis neonatorum was caused mainly by gram-positive cocci, in particular Streptococcus Pneumoniae; the primary cause now, in consequence of the abuse of antibiotics, are the gram-negative enterobacteriaceae. The most common agent still is Staphylococcus, which is becoming more and more resistant to gentamycin (26.5%). During the past 3 years 64 infants have been examined at the Second Eye Clinic of Vienna University. Smears were taken from the purulent discharge and tested in the usual microbiological way. The study shows the importance of exact diagnosis and specific therapy.

[Ophthalmia neonatorum]. / Ophthalmia neonatorum.

Silver nitrate prophylaxis against ophthalmia neonatorum due to Neissera Gonorrhoeae was introduced by Crédé in 1884, when he instilled a drop of 2% silver nitrate into the cul-de-sac of a newborn. Today, the prime cause of ophthalmia neonatorum is infection by Chlamydia trachomatis. The high incidence of this type of conjunctivitis is due to the frequent exposure of the newborn during delivery and to the ineffectiveness of silver nitrate as a prophylaxis against Chlamydia. In the study reported here, 198 infants less than one month old were examined because of severe bilateral conjunctivitis. In the first week of life a chemical irritation caused by Crédé's prophylaxis was found in the majority (59.7%), but in the second and third weeks infections with Chlamydia trachomatis were found in 27% of all cases. Bacteria were responsible for the infection in 52% of the cases. No gonococci were found in any of the patients examined in the course of the study.

[Syndrome of the flaccid eyelid (floppy eyelid syndrome]. / Das Syndrom des schlaffen Oberlides (Floppy Eyelid-Syndrom).

Three patients with increasing swelling of the lateral half of the upper lid associated with chronic papillary conjunctivitis which did not respond to therapy were observed. The history, clinical findings, keratinized epithelial cells in the scrapings and the therapeutic success with a protective shield over night suggested the diagnosis of floppy eyelid syndrome.

[Hydrogel posterior chamber lenses--an improvement?]. / Hydrogel-Hinterkammerlinsen--ein Fortschritt?

Although the design of PMMA intraocular lenses has reached a stage of sophistication at which further modifications are unlikely to result in any major improvements in implant surgery, new materials with possibly improved mechanical and biologic properties should be evaluated carefully. The hydrogel lens (containing 38% poly-HEMA) is a soft, flexible, hydrophilic "single-piece" posterior chamber lens which could help to minimize intraoperative and postoperative IOL trauma. Fifty hydrogel intraocular lenses were implanted during a ten-month period using a standard extracapsular cataract extraction technique. Implantation was considered easy in most cases. As regards biocompatibility, stability of lens position, and visual acuity, the postoperative results are promising. In the follow-up period reported on, no central opacification of the posterior lens capsule was observed.

[Necrotizing pseudomonas infection of the eyelids and lacrimal ducts with orbital involvement in a newborn infant]. / Nekrotisierende Pseudomonasinfektion der Lider und Tränenwege mit orbitaler Beteiligung bei einem Neugeborenen.

A newborn boy presented with severe, bilateral, necrotic blepharitis and dacryocystitis caused by Pseudomonas aeruginosa. The possible etiology of this infection would be a transient neutropenia and a chemical blepharoconjunctivitis caused by Credé's prophylaxis. The relentless course of the necrosis could only be stopped by maximum-dose topical and systemic antibiotic therapy; the visual function of the right eye, however, was lost owing to a keratititis e lagophthalmo.

[Clinical aspects, diagnosis and therapy of ocular Chlamydia infection]. / Klinik, Diagnose und Therapie der okulären Chlamydieninfektion.

As reported in the recent literature, eye infections caused by Chlamydia trachomatis are increasing in number. Modern laboratory techniques were used in this study to scan a total of 114 patients with unilateral follicular conjunctivitis for these organisms. The authors describe the clinical picture, course, and results of therapy in a total of 6 (5.3%) young patients with chlamydial infections diagnosed by scraping and cell culture.

[Post-traumatic endophthalmitis caused by Bacillus cereus]. / Posttraumatische Endophthalmitis durch Bacillus cereus.

A young man with severe endophthalmitis caused by B. cereus is described following a trauma with an intraocular foreign body. Although this organism was isolated from the aqueous with 18 hours and specific antibiotic therapy instituted, the eye subsequently lost all function and had to be enucleated because of severe pain. An extremely rapidly developing corneal ring abscess seems to be the hallmark of an intraocular infection with B. cereus organisms.

Canaliculitis: difficulties in diagnosis, differential diagnosis and comparison between conservative and surgical treatment.

The most important clinical features of canaliculitis include a red, swollen eyelid in the area of the affected canaliculus, a unilateral conjunctivitis, a mucopurulent discharge and in some cases dacryoliths visible in the lacrimal punctum. Conservative therapy was found to be little effective: only 10% of the patients could be cured, 40% showed a recurrence after conservative treatment. 20 patients (50%) were treated by canaliculotomy: 16 of these were cured by this surgical treatment, 4 patients complained of epiphora, although diagnostic syringing showed free lacrimal pathways. The surgical treatment of canaliculitis in combination with conservative therapy yields far better results than conservative therapy alone.