Doxycycline treatment of high-risk COVID-19-positive patients with comorbid pulmonary disease.

Infection with novel SARS-CoV-2 carries significant morbidity and mortality in patients with pulmonary compromise, such as lung cancer, autoimmune disease, and pneumonia. For early stages of mild to moderate disease, care is entirely supportive.Antiviral drugs such as remdesivir may be of some benefit but are reserved for severe cases given limited availability and potential toxicity. Repurposing of safer, established medications that may have antiviral activity is a possible approach for treatment of earlier-stage disease. Tetracycline and its derivatives (e.g. doxycycline and minocycline) are nontraditional antibiotics with a well-established safety profile, potential efficacy against viral pathogens such as dengue fever and chikungunya, and may regulate pathways important in initial infection, replication, and systemic response to SARS-CoV-2. We present a series of four high-risk, symptomatic, COVID-19+ patients, with known pulmonary disease, treated with doxycycline with subsequent rapid clinical improvement. No safety issues were noted with use of doxycycline.Doxycycline is an attractive candidate as a repurposed drug in the treatment of COVID-19 infection, with an established safety profile, strong preclinical rationale, and compelling initial clinical experience described here.The reviews of this paper are available via the supplemental material section.

Overview of ocular anesthesia: past and present.

PURPOSE OF REVIEW: Many choices of ocular anesthetic techniques are available to the ophthalmologist. This study reviews currently used techniques of topical, subconjunctival and regional block anesthesia used in ophthalmic procedures. RECENT FINDINGS: The choices of anesthetics that are available are considered and a new ocular anesthetic gel is described that provides sustained ocular surface anesthesia, minimal side-effects and may also have antimicrobial properties. SUMMARY: Consideration of ocular anesthetic techniques and anesthetic choice plays a critical role for the success and safety of ophthalmic surgery.

Lidocaine hydrochloride gel for ocular anesthesia: results of a prospective, randomized study.

BACKGROUND AND OBJECTIVE: This study evaluates the effectiveness of Akten (Akorn, Inc., Buffalo Grove, IL), a novel ophthalmic gel anesthetic agent for complete ocular anesthesia. PATIENTS AND METHODS: This study was conducted as a prospective, randomized, double-blinded, multicenter Phase III clinical trial to evaluate Akten gel. The study had four cohorts of subjects who received sham gel, Akten 1.5%, Akten 2.5%, and Akten 3.5%, respectively. Subjects were assessed for achievement of anesthesia at defined time intervals and questioned for "pain" or "no pain" following pinching of the conjunctiva with 0.3-mm forceps at predetermined intervals. RESULTS: A total of 209 subjects were entered into the study. The percentages of patients achieving the primary endpoint (ie, anesthesia within 5 minutes) were as follows: 22% for sham, 88% for Akten 1.5%, 89% for Akten 2.5%, and 92% for Akten 3.5%, respectively. Safety measures including corneal staining, conjunctival hyperemia, and eye pain with administra-tion were low and comparable in all cohorts. CONCLUSION: Akten gel appears to be an effective and safe ocular anesthetic. All doses were well tolerated and no dose-related corneal toxicity was observed.

Large spot endolaser for retinal photocoagulation and transvitreal thermotherapy.

BACKGROUND AND OBJECTIVE: Diode laser transpupillary thermotherapy can be used for the treatment and choroidal tumors. A large spot endolaser probe was developed for endophotocoagulation and transvitreal thermotherapy. The aim of this study was to assess the probe's clinical performance for photocoagulation and transvitreal thermotherapy combined with macular elevation. MATERIALS AND METHODS: Endolaser with a divergent beam giving a 3 mm spot size on the retina was developed. Vitrectomy was performed on ten eyes of five Dutch Belted rabbits. Threshold for photocoagulation was determined for the diode (810 nm) laser in four eyes. In another six eyes, the retina was detached with balanced salt solution prior to laser irradiation. The tissue effects were monitored clinically and with photography and microscopy. RESULTS: Threshold photocoagulation was induced with 150 mW power, for 1 minute, in attached retina. Following retinal detachment, no coagulation occurred at 200 mW (suprathreshold) power for 1 minute. CONCLUSIONS: A large spot endolaser probe may be useful for endophotocoagulation. It generates more gradual photocoagulation than standard endolaser probes, giving a more controllable reaction over a larger area. This may be useful for treatment of large areas of the retina when treating retinal detachments or ischemic retinopathies. When detached retina was irradiated, no retinal damage occurred at suprathreshold power. This development may allow for intraoperative transvitreal thermotherapy of choroidal neovascularization while protecting the retina with intentional intraoperative detachment of the retina.

Current indications of transpupillary thermotherapy for the treatment of posterior segment diseases.

Transpupillary thermotherapy has recently emerged as a therapeutic option for patients with numerous posterior segment disorders. During the past decade, it has been used for the management of benign and malignant tumors, either as sole therapy or in combination with other treatments such a plaque radiotherapy. More recently, it has been used for management of choroidal neovascularization (CNV) secondary to age-related macular degeneration. A prospective, randomized, sham-controlled multicenter clinical trial (TTT4CNV) is currently underway to evaluate the effectiveness of TTT for the management of CNV.

Subthreshold infrared footprinting with indocyanine green for localizing low-intensity infrared photocoagulation.

A novel technique for localizing subthreshold infrared (810 nm) laser treatment and its use in three patients is described. Two patients were treated for choroidal neovascularization with transpupillary thermotherapy or focal subthreshold photocoagulation, and the third patient was treated with grid laser photocoagulation for diabetic macular edema using the 810-nm laser after undergoing indocyanine green angiography for diagnostic purposes. Postoperative indocyanine green images, obtained without reinjection of indocyanine green, revealed areas of hypofluorescence that corresponded to the laser treatment spots. This technique, named subthreshold infrared footprinting, can precisely localize subthreshold infrared laser photocoagulation sites and is potentially useful for evaluating treatment postoperatively and planning additional therapy if necessary.

A wide-field, high-resolution ophthalmoscopic contact lens.

A new inverted-image ophthalmoscopic contact lens provides 2X laser spot magnification and a 117 degrees degree instantaneous field of view. It has three times the resolution of very wide-field, inverted-image ophthalmoscopic contact lenses to permit effective use of higher slit-lamp magnifications. The lens was designed for transpupillary thermotherapy with large lesions and panretinal photocoagulation with hazy ocular media.