Efficacy comparison between povidone iodine 2.5% and tetracycline 1% in prevention of ophthalmia neonatorum.

PURPOSE: To evaluate the efficacy of povidone iodine solution 2.5% and tetracycline ointment 1% in prevention of ophthalmia neonatorum (ON). DESIGN: Prospective, randomized, controlled observational study. PARTICIPANTS: Three-hundred ninety-four full-term neonates. METHODS: A randomized comparison between 201 neonates randomly treated with povidone iodine 2.5% solution and 193 treated with tetracycline 1% ointment. MAIN OUTCOMES MEASURES: Incidence of ON. RESULTS: The incidence of ON was significantly higher after povidone iodine than tetracycline prophylaxis (15.4% and 5.2% respectively; P = 0.001). Noninfective ON developed in 10 (5%) of the 201 neonates treated with povidone iodine and in none (0%) of the neonates treated with tetracycline (P = .002). Infective ON was detected in 21 (10.4%) of the neonates treated with povidone iodine and in 10 (5.2%) after treatment with tetracycline (P = .052). Ophthalmia neonatorum appeared more commonly in the first 3 days after treatment with povidone iodine (P = .043). The spectrum of the infective isolates was similar in the 2 groups. CONCLUSIONS: Povidone iodine was associated with noninfective (sterile) conjunctivitis, probably because of its toxicity to the ocular surface in neonates. Tetracycline was marginally more effective against infective ON. For these reasons, tetracycline, rather than povidone iodine, is recommended for prevention of ON.

Central retinal artery occlusion after peribulbar anesthesia.

We describe the development of central retinal artery occlusion (CRAO) in 2 patients after peribulbar (periconal) anesthesia during uneventful phacoemulsification. Although peribulbar anesthesia avoids direct optic-nerve injury, indirect injury presenting as CRAO may occur from vasospasm in response to the injection.

Update on treatment of retinal arterial occlusions.

Retinal arterial occlusion remains a difficult clinical entity to manage. Treatment can best be categorized as conservative (ocular massage, pharmacologic, anterior chamber paracentesis) and invasive (catheterization of the proximal ophthalmic artery through the femoral artery with the infusion of thrombolytic agents). Most reports remain anecdotal due to its low incidence (0.85/100,000/y).

Detachment of subfoveal choroidal neovascularization in age-related macular degeneration.

PURPOSE: To report the entity of partial detachment and folding of subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (ARMD). DESIGN: Interventional case reports. METHODS: Review of the features of CNV detachment in two patients with CNV due to ARMD by contact lens slit-lamp biomicroscopy, fluorescein angiography, optical coherence tomography, and three-dimensional confocal scanning laser indocyanine green (ICG) angiography. RESULTS: One patient out of approximately 300 (0.5%) ARMD patients treated by photodynamic therapy (PDT) developed partial CNV detachment and folding 6 weeks after the second PDT treatment. Another patient out of approximately 100 (1.0%) ARMD patients treated by transpupillary thermotherapy (TTT) developed partial CNV detachment and folding 6 weeks after the second TTT treatment. The CNVs were large (2,500 microm to 4,500 microm) and located between the retina and the retinal pigment epithelium. In each, these findings were clearly visualized by slit-lamp biomicroscopy. Fluorescein angiography demonstrated an associated retinal pigment epithelium tear in one patient. Optical coherence tomography showed distinctive features and confocal scanning laser ICG further delineated the detached folded CNV. The best-corrected visual acuity improved in one patient from 20/80 to 20/40 and in the other from counting fingers at 6 feet to 20/200 after the CNV detachment. CONCLUSIONS: Partial CNV detachment and folding represent a unique, not previously reported, and possibly favorable outcome of PDT and TTT. The low energy and selectivity of these treatments may explain this phenomenon.