Effect of preoperative topical nepafenac 0.1% on inflammatory response after uncomplicated cataract surgery in healthy subjects.

PURPOSE: To determine the effect of preoperative topical Nepafenac administration on anterior chamber flare after uneventful cataract surgery in healthy subjects. METHODS: Prospective randomized clinical trial. Seventy-three eyes of 73 healthy patients undergoing routine cataract surgery were randomized to receive (group A) topical nepafenac (1 mg/ml) or not to receive (group B) 1 drop 3 times per day for 3 days before surgery. All eyes received the same postoperative anti-inflammatory therapy. Clinical outcome parameters such as best corrected visual acuity, intraocular pressure, retinal central foveal thickness and aqueous flare were recorded preoperatively, 1, 15, 30 and 60 days after surgery. RESULTS: Three patients were excluded for poor compliance, and three patients were excluded or developing pseudophakic macular oedema during the follow-up. Both groups were comparable for age, gender, and showed similar BCVA, intraocular pressure and central macular thickness values preoperatively and during the entire follow-up (p > 0.01). Aqueous flare values showed a statistically increase in both groups respect to preoperative values through follow-up evaluations (p < 0.01), while values were significantly lower in group A than in group B 30 days after surgery (p < 0.01). CONCLUSION: Preoperative administration of topical Nepafenac reduces the inflammatory response in healthy patients undergoing uncomplicated cataract surgery one month after surgery respect to non-treated group.

Ethyl Glucuronide and Ethyl Sulphate in Urine: Caution in their use as markers of recent alcohol use.

AIM: To clarify the role of the ethanol metabolites, ethyl glucuronide (EtG) and ethyl sulfate (EtS), in monitoring alcohol consumption. METHOD: We recruited 7 female and 17 male volunteers who were instructed to consume a quantity of beer (containing 48 gm ethanol) with food in one session. We examined urinary excretion of EtG and EtS over time and looked for correlations between the concentrations of the metabolites EtG and EtS. RESULTS: EtG concentrations in urine varied between 0.026 and 430.372 µg/ml with average values between 11.85 µg/ml (SD 19.75), 30 min after alcohol intake, and 100.39 µg/ml (SD 101.34), 4.5 h after alcohol intake. EtS urinary concentration ranged from 0.006 to 101.432 µg/ml with average values between 4.77 µg/ml (SD 5.42), 30 min after alcohol intake, and 30.14 µg/ml (SD 27.20), 4.5 h after alcohol intake. Spearman's test showed that urinary EtG and EtS correlated significantly at several time points. CONCLUSION: The great interindividual variability in their excretion suggests caution in the use of urinary measurement of these metabolites in forensic investigations.

Comparison of anti-inflammatory effects of eye drops formulations after uncomplicated cataract surgery.

AIM: The aim of this study is to compare the efficacy of different dexamethasone eye drops formulations in controlling postoperative inflammation. METHODS: Cataract surgery was carried out in 72 patients (35 males) divided into two groups: group A (36 patients, mean age = 78.0 ± 5.6) received four times daily for 2 weeks a suspension containing tobramycin 0.3% mg/ml + dexamethasone 0.1% mg/ml, and group B (36 patients, mean age = 76.2 ± 6.8) a solution containing tobramycin 0.3% mg/ml + dexamethasone 0.1% mg/ml. Both groups received ofloxacin 0.5% four times daily for 7 days, and nepafenac 0.1% three times daily for 3 weeks. Best-corrected visual acuity, intraocular pressure, corneal thickness, endothelial cells count, aqueous flare and macular thickness were evaluated preoperatively and at 1 day, 15 days, 1 and 2 months. RESULTS: In group A, intraocular pressure, corneal thickness and aqueous humour flare values preoperatively and at the end of follow-up were 14.3 ± 1.8 and 13.2 ± 1.8 mmHg, 546.4 ± 34.6 and 539.6 ± 36.1 µm, 11.84 ± 4.44 and 13.52 ± 5.54 ph/ms, respectively, with no statistically significant difference. In group B, intraocular pressure, corneal thickness and aqueous humour flare values preoperatively and at the end of follow-up were 14.3 ± 1.5 and 13.1 ± 1.7 mmHg, 552.9 ± 37.4 and 548.1 ± 39.3 µm, 11.45 ± 4.06 and 13.73 ± 4.99 ph/ms, respectively, with no statistically significant difference. No difference was detected in the macular thickness values in the parafoveal area preoperatively and at 2 months follow-up in group A (332.18 ± 16.19 and 337.71 ± 16.33 µm) and group B (329.11 ± 18.28 and 334.37 ± 20.86 µm), respectively. CONCLUSION: The two different formulations of dexamethasone eye drops reached the same anti-inflammatory effects.

Comparison of the Effect of Diclofenac 0.1% and Nepafenac 0.1% on Aqueous Flare in Patients Undergoing Cataract Surgery: A Prospective Randomized Study.

OBJECTIVES: To compare, using laser flare meter (LFM), the efficacy of topical nepafenac 0.1, % and diclofenac 0.1% ophthalmic solution in the control of anterior chamber inflammation after uncomplicated cataract surgery. METHODS: Patients undergoing phacoemulsification for age-related cataract were recruited. Complete evaluation with visual acuity, slit-lamp examination, endothelial cell density, intraocular pressure, retinal tomography and anterior chamber flare evaluation was performed before surgery and 1, 15, 30 and 60 days after surgery. Patients were randomly assigned to receive topical diclofenac 0.1% 4 times a day for four weeks or nepafenac 0.1% 3 times a day for three weeks in addition to topical steroids and antibiotic. RESULTS: 64 (31 males, mean age 77.3 ± 5.9) patients were enrolled. Half of them were randomly assigned to group A (diclofenac 0.1%) and half to group B (nepafenac 0.1%). There was a statistically significant visual acuity improvement postoperatively in both groups, with no statistical difference between the groups. Intraocular pressure, corneal thickness, endothelial cells count and macular thickness parameters didn't significantly vary between before and after surgery. One-day after surgery, aqueous flare was significantly higher (22,27 ± 9,25 ph/ms in group A and 22,36 ± 7,47 in group B) than before surgery (14,59 ± 7,16 ph/ms in group A and 11,84 ± 4,44 in group B) in both groups, then declining in the first month and reaching preoperative levels again by 2 months in both groups. In group B, LFM values at 15 and 30 days after surgery were significantly lower (13,59 ± 4,80 and 14,07 ± 5,01) than in group A (17,00 ± 6,97 and 16,96 ± 6,13). CONCLUSIONS: Nepafenac ensured a better inflammation control than diclofenac during the first month.

Hypotonic maculopathy secondary to scleral defect in atypical retinochoroidal coloboma.

PURPOSE: To describe a patient with unilateral hypotonic maculopathy and optic disc edema after spontaneous bulbar perforation of a full-thickness scleral defect. METHODS: An 11-year-old girl underwent scleral buckling surgery. Preoperative and postoperative evaluation included optical coherence tomography and high-resolution 3T magnetic resonance imaging. RESULTS: The scleral defect was covered with Tenon capsule sheaths and a meridional silicone buckle. One year postoperatively, visual acuity and macular and optic disc morphology were completely restored. CONCLUSIONS: Ocular hypotony related to a defect of the sclera forming the roof of a retinochoroidal coloboma is a rare event. Hypotony was a consequence of a defect at the level of an atypical retinochoroidal coloboma where the scleral wall was found to be absent.

Dexamethasone Disodium Phosphate Penetration Into the Human Aqueous Humor After Topical Application.

PURPOSE: To study the amount of steroids that is found in the aqueous humor after topical administration of dexamethasone solution eye-drops and dexamethasone suspension eye-drops. MATERIALS AND METHODS: One hundred seventeen consecutive patients of both genders 18 years or older, candidates for cataract surgery were randomly assigned to one of three groups. Fifty-one patients (group A) received a single instillation of a suspension containing tobramicin 0.3% mg/ml + dexamethasone 0.1% mg/ml; 56 patients (group B) received a single instillation of a solution containing tobramicin 0.3% mg/ml + dexamethasone 0.1% mg/ml; 10 patients (group C), control group, did not receive any drops. Samples were taken immediately before surgery from the anterior chamber and dexamethasone levels were measured using gas chromatography/mass spectrometry. RESULTS: The mean dexamethasone concentrations were 0.56 µM (min 0.00, max 3.25) in group A and 0.15 µM (min 0.00, max 2.93) in group B. Dexamethasone was not detected in samples from group C. CONCLUSIONS: Dexamethasone suspension gives concentrations of steroids in the aqueous humor approximately three times higher than with dexamethasone solution drops.