Swiss S1 guideline for the treatment of rosacea.

Rosacea (in German sometimes called 'Kupferfinne', in French 'Couperose' and in Italian 'Copparosa') is a chronic and frequently relapsing inflammatory skin disease primarily affecting the central areas of the face. Its geographic prevalence varies from 1% to 22%. The differential diagnosis is wide, and the treatment is sometimes difficult and varies by stage of rosacea. For erythematous lesions and telangiectasia, intense pulsed light (IPL) therapy and lasers are popular treatment option. In addition, a vasoconstrictor agent, brimonidine, has recently been developed. For papulopustular rosacea, topical antibiotics, topical and systemic retinoids, as well as systemic antibiotics are used. A topical acaricidal agent, ivermectin, has undergone clinical development and is now on the market. In the later stages, hyperplasia of the sebaceous glands develops, resulting in phymatous growths such as the frequently observed bulbous nose or rhinophyma. Ablative laser treatments have largely replaced classical abrasive tools. Here, we reviewed the current evidence on the treatment of rosacea, provide a guideline (S1 level) and discuss the differential diagnosis of rosacea.

[Is it still Necessary to Discontinue Using Daily Wear Soft Contact Lenses for a Period before LASIK?]. / Braucht es noch eine Tragekarenz bei weichen Kontaktlinsen vor LASIK?

PURPOSE: The aim of this study was to verify whether soft contact lenses (SCL) can have a clinically significant impact on refraction before LASIK. METHODS: Retrospective analysis of 113 eyes for which the refraction was measured initially and after discontinuing soft contact lenses for at least 7 days. Both spherical and cylindrical measurements were performed. In addition, the difference between postoperative refraction and the target refraction for these eyes was calculated for both spherical and cylindrical refraction. RESULTS: In 8 % (18 %) of the eyes, the spherical or cylindrical refraction changed by 0.5 dioptre or more after a week of not wearing soft contact lenses. Total spherical refraction changed by an average of 0.15 dioptre (p = 0.58) and cylindrical refraction by 0.18 dioptre (p = 0.006). After LASIK, the difference between postoperative and target refraction was significantly different for both spherical refraction (0.3 dioptre) and for cylindrical refraction (0.21 dioptre). DISCUSSION: The differences in the measurements during this study suggest that a modern soft contact lenses should still be discontinued before LASIK. The optimal duration of the discontinuation remains to be determined.

[Toric intraocular lenses: a valuable method for correcting corneal astigmatism]. / Torische Intraokularlinsen: Eine nützliche Methode in der Korrektur des kornealen Astigmatismus.

BACKGROUND: The aim of this stud was to assess clinical outcomes after implantation of a hydrophobic toric intraocular lens (IOL) in patients undergoing cataract surgery. PATIENTS AND METHODS: 22 eyes (16 patients) with at least 0.8 diopter (D) of corneal astigmatism having routine cataract surgery were included. After marking the final axis of the IOL, phacoemulsification, implantation and alignment of a toric IOL was performed. Uncorrected distance visual acuity (UDVA), best corrected distance visual acuity (BDVA), manifest refraction, and keratometry were measured 5 to 19 months postoperatively. Individual patient satisfaction was also recorded. The cylinder axis of the toric IOL was determined at a slitlamp examination. RESULTS: The mean UDVA postoperatively was 0.3 logMAR±0.23 (SD) and was 0.3 logMAR or better in 63.6% of eyes. The mean refractive cylinder decreased significantly postoperatively, ranging from -3.3±1.5 D to -1.3±0.7 D. The mean absolute IOL misalignment was 7.5 degrees (range 0 to 21°). The good UDVA resulted in high levels of patient satisfaction. CONCLUSIONS: Implantation of a toric IOL during cataract surgery was an effective and safe method to manage corneal astigmatism in this series of patients.

Combined meropenem and linezolid as a systemic treatment for postoperative endophthalmitis.

PURPOSE: The aim of this study was to evaluate the antibiotic treatment of postoperative endophthalmitis with combined systemic meropenem and linezolid. METHODS: A retrospective analysis of endophthalmitis treated with systemic meropenem and linezolid compared to conventional systemic antibiotics by evaluation of outcome and adverse effects was carried out. RESULTS: 26 patients with unilateral postoperative endophthalmitis with a systemic combination regimen of meropenem (2 g TID, mean duration of treatment 5.5 days) and linezolid (600 mg BID, mean duration of treatment 8.9 days) (group 1, mean follow-up time 140 days) were included in this study and compared to 45 postoperative endophthalmitis patients treated with conventional systemic antibiotics (group 2; mean follow-up time 320 days). In group 1, 69.2 % of eyes additionally received intravitreal amikacin and vancomycin (vs. 24.4 % in group 2; p < 0.001), in 92.3 % pars plana vitrectomy was performed (vs. 68.9 % in group 2, p = 0.047). Mean best corrected visual acuity improved from a baseline of 1.76 logMar for group 1 and 1.83 logMar for group 2 to 0.91 logMar (p = 0.0001) and 0.90 logMar (p < 0.0001), respectively, at the end of the follow-up, revealing no significant differences between the two groups at any time point (p > 0.05). Ocular complications were observed in 34.6 % of eyes in group 1 (vs. 37.8 % in group 2; p > 0.05). Adverse drug effects occurred significantly more frequently in group 1 (26.9 % vs. 4.4 % p = 0.02). CONCLUSION: In spite of the reported better penetration through the blood-ocular barrier and the broader antibacterial spectrum of meropenem and linezolid, no benefit in outcome was found in the present study. In contrast, adverse effects and costs of the combination regimen were significantly higher.

[Case report of osteo-odonto keratoprosthesis (Strampelli) and of Dacron keratoprosthesis (Pintucci)]. / Fallbeschreibung einer Osteo-odonto-Keratoprothese (Strampelli) und einer Dacron-fixierten-Keratoprothese (Pintucci).

BACKGROUND: In severe forms of ocular surface disorders keratoprostheses provide the ultimate possibility to restore vision. They are made of an optical cylinder integrated with a supporting biocompatible or biological haptic. CASE REPORT: We report on two patients with different types of keratoprostheses. An 88-year-old woman with ocular pemphigoid received in 1970 a bilateral osteo-odonto-keratoprosthesis (Strampelli). A 59-year-old man with refractory corneal ulcer after corneal grafting received in 2003 a keratoprosthesis with supporting Dacron tissue (Pintucci). RESULTS: The course 35 years after implantation of the osteo-odonto-keratoprosthesis was uneventful. Histologically there were no signs of loosening, rejection or infection. The autologous dentin, which was used for the fixation, was still present. The eye with the Dacron fixated prosthesis (Pintucci) had to be enucleated due to a loosening with endophthalmitis one and a half year after implantation. CONCLUSIONS: Keratoprostheses with autologous fixation often show good long-term results. On the other hand, prostheses with synthetic material are more often complicated by dislocation and inflammation.

Revisiting systemic treatment of bacterial endophthalmitis: a review of intravitreal penetration of systemic antibiotics.

BACKGROUND: Adjunctive systemic antibiotic therapy for treatment of bacterial endophthalmitis is controversial but common practice due to the severity of the disease. In the absence of guidance documents, several antibiotic regimens are being used without applying evidence-based prescribing, leading to inappropriate treatment of this serious eye condition. OBJECTIVES: To summarize available data on intravitreal penetration of systemically administered antibiotics and to discuss their usefulness from a microbiological and pharmacological point of view. SOURCES: We performed a systematic PubMed search of studies investigating antibiotic concentrations in the vitreous after systemic administration in humans, and selected animal models. CONTENT: The best-documented agents achieving therapeutic levels in the vitreous are meropenem, linezolid and moxifloxacin. Vancomycin, cefazoline, ceftriaxone, ceftazidime, imipenem and trimethoprim-sulfamethoxazole reach levels justifying their use in specific situations. Available data do not support the use of ciprofloxacin, levofloxacin, aminoglycosides, aminopenicillins, piperacillin, cefepime and clarithromycin. With very limited but available promising data, the use of daptomycin and rifampicin deserves further investigation. IMPLICATIONS: The choice of the adjunctive systemic antibiotic agent-in situations where it is considered relevant for treatment-must to date be made on an individual basis, considering microbiological aspects as well as operative status and inflammation of the eye. This review gives a systematic overview of antibiotic options and provides guidance to the clinician striving for optimal systemic antibiotic treatment of bacterial endophthalmitis.