RESUMO
Acute bacterial conjunctivitis, the most common cause of conjunctivitis, is responsible for approximately 1% of all primary-care consultations. Of the topical ophthalmic antibiotics used to treat acute bacterial conjunctivitis, fluoroquinolones are especially useful because they possess a broad antibacterial spectrum, are bactericidal in action, are generally well tolerated, and have been less prone to development of bacterial resistance. Besifloxacin, the latest advanced fluoroquinolone approved for treating bacterial conjunctivitis, is the first fluoroquinolone developed specifically for topical ophthalmic use. It has a C-8 chlorine substituent and is known as a chloro-fluoroquinolone. Besifloxacin possesses relatively balanced dual-targeting activity against bacterial topoisomerase IV and DNA gyrase (topoisomerse II), two essential enzymes involved in bacterial DNA replication, leading to increased potency and decreased likelihood of bacterial resistance developing to besifloxacin. Microbiological data suggest a relatively high potency and rapid bactericidal activity for besifloxacin against common ocular pathogens, including bacteria resistant to other fluoroquinolones, especially resistant staphylococcal species. Randomized, double-masked, controlled clinical studies demonstrated the clinical efficacy of besifloxacin ophthalmic suspension 0.6% administered three-times daily for 5 days to be superior to the vehicle alone and similar to moxifloxacin ophthalmic solution 0.5% for bacterial conjunctivitis. In addition, besifloxacin ophthalmic suspension 0.6% administered two-times daily for 3 days was clinically more effective than the vehicle alone for bacterial conjunctivitis. Besifloxacin has also been shown in preclinical animal studies to be potentially effective for the "off-label" treatment of infections following ocular surgery, prophylaxis of endophthalmitis, and the treatment of bacterial keratitis. Taken together, clinical and preclinical animal studies indicate that besifloxacin is an important new option for the treatment of ocular infections.
Assuntos
Antibacterianos/uso terapêutico , Azepinas/uso terapêutico , Conjuntivite Bacteriana/tratamento farmacológico , Fluoroquinolonas/uso terapêutico , Doença Aguda , Antibacterianos/efeitos adversos , Antibacterianos/farmacocinética , Azepinas/efeitos adversos , Azepinas/farmacocinética , Técnicas Bacteriológicas , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Fluoroquinolonas/efeitos adversos , Fluoroquinolonas/farmacocinética , Humanos , Testes de Sensibilidade Microbiana , Procedimentos Cirúrgicos Oftalmológicos/métodos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
PURPOSE: To promote awareness and prevention of ocular damage that can occur during Intense Pulsed Light (IPL) treatments of the periocular areas. METHODS: A retrospective chart review was conducted of 2 cases involving ocular damage following IPL procedures that were treated at Bascom Palmer Eye Institute for ocular complications. Routine data were collected during ophthalmic examinations. RESULTS: Case 1: A 36-year-old female presented with eye pain, marked pupillary constriction, and anterior uveitis an hour after receiving IPL treatment to the face. Within 1 month, the damage had progressed to posterior synechiae and iris transillumination defects. She continues to have pain and severe photophobia due to permanent iris atrophy and transillumination that have persisted for years. Case 2: A 27-year-old female presented with severe eye pain, vision disturbances, pupillary defects, and anterior uveitis 3 days after IPL of an eyelid freckle. At 2 months follow up, the iris and pupillary defects remain permanent. The patient continues to suffer from photophobia and pain. CONCLUSIONS: The pigmented iris absorbs light in the same wavelength range of IPL, thus remaining vulnerable to IPL exposure, especially when applied to the periocular area. The fact that IPL is not a laser may give people a false sense of security regarding damage to the eye. The cases presented give evidence that periorbital IPL treatment may permanently affect pigmented intraocular structures. It is imperative for treating physicians to be aware of these hazards and to use appropriate eye protection to prevent ocular damage.
Assuntos
Dor Ocular/etiologia , Fototerapia/efeitos adversos , Distúrbios Pupilares/etiologia , Lesões por Radiação/etiologia , Uveíte Anterior/etiologia , Adulto , Dor Ocular/tratamento farmacológico , Doenças Palpebrais/terapia , Dermatoses Faciais/terapia , Feminino , Glucocorticoides/administração & dosagem , Humanos , Melanose/terapia , Pomadas , Soluções Oftálmicas/administração & dosagem , Distúrbios Pupilares/tratamento farmacológico , Lesões por Radiação/tratamento farmacológico , Estudos Retrospectivos , Uveíte Anterior/tratamento farmacológicoRESUMO
PURPOSE: To report the technique and small case series results of femtosecond laser-assisted sutureless anterior lamellar keratoplasty (FALK) for anterior corneal pathology. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Twelve consecutive eyes from 12 patients with anterior corneal scarring. INTERVENTION: Femtosecond laser-assisted sutureless anterior lamellar keratoplasty. MAIN OUTCOME MEASURES: Measured parameters included femtosecond laser settings, technique, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and complications. RESULTS: Mean follow-up was 12.7 months (range, 6-24). No intraoperative complications were found. Uncorrected visual acuity (VA) improved in 7 eyes (58.3%) compared with preoperative VA. The mean difference between preoperative and postoperative UCVAs was a gain of 2.5 lines (range, unchanged-7 lines). Best-corrected VA was unchanged or improved in all eyes compared with preoperative levels. The mean difference between preoperative and postoperative BCVAs was a gain of 3.8 lines (range, unchanged-8 lines). In 2 eyes, adjuvant surgical procedures were performed (one treated with phototherapeutic keratectomy and the other with photorefractive keratectomy). Six patients (50%) developed dry eye after FALK, which improved during the follow-up period. No graft rejection, infection, or epithelial ingrowth was found in this series of patients. CONCLUSIONS: Femtosecond laser-assisted sutureless anterior lamellar keratoplasty could improve UCVA and BCVA in patients with anterior corneal pathology.
Assuntos
Doenças da Córnea/cirurgia , Transplante de Córnea/métodos , Lasers de Estado Sólido/uso terapêutico , Adolescente , Adulto , Idoso , Criança , Doenças da Córnea/fisiopatologia , Feminino , Seguimentos , Humanos , Complicações Intraoperatórias , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Técnicas de Sutura , Tomografia de Coerência Óptica , Acuidade Visual/fisiologiaRESUMO
To aid the cataract surgeon's understanding of rational approaches to antimicrobial prophylaxis and place the European Society of Cataract & Refractive Surgeons (ESCRS) postoperative endophthalmitis study in perspective, a review was conducted of published and unpublished data on intracameral antibiotic use during cataract surgery and the antimicrobial efficacy, pharmacodynamics, ocular penetration, and safety of moxifloxacin. The ESCRS-sponsored study of postoperative endophthalmitis prophylaxis reported rates of presumed infectious postoperative endophthalmitis of 0.07% with intracameral cefuroxime treatment and 0.34% in control groups. Postoperative endophthalmitis after cefuroxime use was mostly due to cefuroxime-resistant gram-positive bacteria. Intracameral cefuroxime also requires extemporaneous compounding, has short-term stability, and carries a risk for hypersensitivity. Moxifloxacin, a fourth-generation fluoroquinolone, has potent and rapid bactericidal activity against the most common gram-positive postoperative endophthalmitis pathogens, has excellent ocular penetration after topical administration, and is available in a self-preserved ophthalmic formulation that has been shown safe and effective in preventing endophthalmitis when administered intracamerally in an animal model. Available data suggest that the optimum antibiotic regimen and route of delivery for cataract surgery antimicrobial prophylaxis require further study. Moxifloxacin offers many theoretical advantages that make it an attractive first-line choice for topical use and of interest for intracameral administration.
Assuntos
Anti-Infecciosos/uso terapêutico , Antibioticoprofilaxia , Compostos Aza/uso terapêutico , Endoftalmite/prevenção & controle , Infecções Oculares Bacterianas/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Quinolinas/uso terapêutico , Câmara Anterior/efeitos dos fármacos , Anti-Infecciosos/farmacocinética , Anti-Infecciosos/farmacologia , Compostos Aza/farmacocinética , Compostos Aza/farmacologia , Extração de Catarata , Endoftalmite/microbiologia , Infecções Oculares Bacterianas/microbiologia , Fluoroquinolonas , Humanos , Moxifloxacina , Complicações Pós-Operatórias/microbiologia , Quinolinas/farmacocinética , Quinolinas/farmacologiaAssuntos
Anti-Infecciosos/uso terapêutico , Compostos Aza/uso terapêutico , Infecções Oculares Bacterianas/tratamento farmacológico , Quinolinas/uso terapêutico , Animais , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/farmacocinética , Compostos Aza/administração & dosagem , Compostos Aza/farmacocinética , Infecções Oculares Bacterianas/metabolismo , Fluoroquinolonas , Humanos , Moxifloxacina , Soluções Oftálmicas , Quinolinas/administração & dosagem , Quinolinas/farmacocinética , Resultado do TratamentoRESUMO
OBJECTIVE: To determine the comparative efficacy of topical gatifloxacin with ciprofloxacin, fortified amikacin, and clarithromycin against Mycobacterium chelonae keratitis in an animal model. METHODS: Experimental M chelonae keratitis was induced via intrastromal inoculation in a rabbit model. Thirty-five rabbits were randomly divided into 5 groups and each group was treated hourly for 12 hours with topical 0.9% balanced salt solution, 0.3% gatifloxacin, 0.3% ciprofloxacin hydrochloride, a combination of topical fortified amikacin sulfate (50 mg/mL) and clarithromycin (10 mg/mL), or a triple combination of topical 0.3% gatifloxacin, fortified amikacin sulfate (50 mg/mL), and clarithromycin (10 mg/mL). Antibacterial efficacy of each regimen was determined by quantitative bacteriologic analysis. RESULTS: Treatment with 0.3% gatifloxacin or the triple combination of 0.3% gatifloxacin, topical fortified amikacin sulfate (50 mg/mL), and clarithromycin (10 mg/mL) reduced the number of mycobacterial organisms more significantly than the controls that were treated with a topical balanced salt solution (both P<.001). Therapy with 0.3% gatifloxacin was more effective than 0.3% ciprofloxacin alone (P<.001) and demonstrated synergy by enhancing the efficacy of the combination of fortified amikacin (50 mg/mL) and clarithromycin (10 mg/mL) (P<.001). Neither 0.3% ciprofloxacin nor the combination of fortified amikacin (50 mg/mL) and clarithromycin (10 mg/mL) demonstrated a significant difference in activity against mycobacteria compared with the topical balanced salt solution. CONCLUSION: These results suggest that topical 0.3% gatifloxacin ophthalmic solution can be a new initial treatment agent against M chelonae keratitis.Clinical Relevance Topical gatifloxacin 0.3% may provide an initial alternative in therapy of M chelonae keratitis.
Assuntos
Antibacterianos/uso terapêutico , Úlcera da Córnea/tratamento farmacológico , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Mycobacterium chelonae/isolamento & purificação , Administração Tópica , Amicacina/administração & dosagem , Amicacina/uso terapêutico , Animais , Antibacterianos/administração & dosagem , Ciprofloxacina/administração & dosagem , Ciprofloxacina/uso terapêutico , Claritromicina/administração & dosagem , Claritromicina/uso terapêutico , Córnea/microbiologia , Úlcera da Córnea/microbiologia , Modelos Animais de Doenças , Quimioterapia Combinada , Infecções Oculares Bacterianas/microbiologia , Fluoroquinolonas/administração & dosagem , Fluoroquinolonas/uso terapêutico , Gatifloxacina , Masculino , Infecções por Mycobacterium não Tuberculosas/microbiologia , Soluções Oftálmicas/administração & dosagem , Soluções Oftálmicas/uso terapêutico , CoelhosRESUMO
OBJECTIVE: To investigate the therapeutic role of trovafloxacin mesylate, a newer-generation fluoroquinolone with an expanded spectrum of activity, in the treatment of experimental bacterial keratitis. METHODS: Susceptibility studies were performed on various strains of ocular isolates to determine the minimum inhibitory concentration (MIC) of trovafloxacin compared with ciprofloxacin and ofloxacin, using the E-test method. Pharmacokinetic studies were performed by a single topical administration of trovafloxacin to rabbit eyes with either an intact or denuded corneal epithelium. Aqueous humor, vitreous, and corneal concentrations of trovafloxacin were determined at different time points. Experimental bacterial keratitis studies were performed in rabbit eyes. Three identical studies were conducted using Staphylococcus aureus, Streptococcus pneumoniae, or Pseudomonas aeruginosa. Therapy groups included 0.5% trovafloxacin, 0.3% ciprofloxacin, 0.3% ofloxacin, and isotonic sodium chloride solution. After 12 hours of drops administration, corneas were excised, homogenized, and serially plated. The main outcome measure was quantitative bacteriologic analysis for residual colony-forming units. RESULTS: In vitro susceptibility study findings indicated that the MIC of trovafloxacin was significantly lower than the MIC of ciprofloxacin and ofloxacin for S. aureus, S. pneumoniae, and Haemophilus influenzae, lower than the MIC of ciprofloxacin and ofloxacin for Staphylococcus epidermidis, and intermediate between ciprofloxacin and ofloxacin for P. aeruginosa. Pharmacokinetic studies showed a significant concentration of trovafloxacin in the treated corneas, especially in eyes with a denuded epithelium. All serum samples had undetectable trovafloxacin concentrations. Experimental keratitis studies showed a statistically significant decrease of colony-forming units in trovafloxacin-treated eyes in the S. aureus model and a similar decrease in the S pneumoniae and P aeruginosa models. CONCLUSIONS: Topical 0.5% trovafloxacin proved to be an effective ocular medication for the therapy of gram-positive and gram-negative keratitis. Clinical Relevance Trovafloxacin may provide an excellent therapeutic alternative in bacterial keratitis.