Prevalence of Ocular Surface Disease and Associated Risk Factors in Glaucoma Patients: A Survey Study of Ophthalmologists.

Objectives: This survey study of ophthalmologists investigated the prevalence and clinical manifestations of ocular surface disease (OSD) in glaucoma patients, assessment methods used, risk factors, glaucoma drugs considered responsible, and treatment approaches. Materials and Methods: A questionnaire prepared jointly by the Turkish Ophthalmological Association Cornea and Ocular Surface Society and Glaucoma Society using SurveyMonkey was sent to ophthalmologists via e-mail. The distribution of parameters was compared with chi-square test and p<0.05 was considered statistically significant. Results: Forty-five percent of the ophthalmologists reported that OSD was evident in least 25% of their patients. The most common symptom was redness (91.9%), while the most common ocular surface finding was conjunctival hyperemia (75.6%). The tests considered to be the most important in ocular surface assessment were ocular staining (38.7%) and tear film break-up time (TBUT) (21.9%). Ninety percent of the physicians stated that the main cause of OSD was benzalkonium chloride (BAC) in medications. Prostaglandin analogs and alpha-2 agonists were reported to be the most common medications causing OSD. In case of OSD, the ophthalmologists often switch to a glaucoma drug from a different group (38%), a non-preservative glaucoma drug (33.7%) or a drug with a preservative other than BAC (20.4%). Most physicians prescribed artificial tears (84.6%). Conclusion: In this cross-sectional survey study, ophthalmologists detected varying rates of OSD in glaucoma patients depending on chronic drug use and BAC exposure. Although ocular surface examination was performed by physicians, tests such as TBUT and ocular surface staining were rarely used. Detecting OSD in glaucoma patients and planning personalized treatment increase patient comfort, drug compliance, and treatment effectiveness. For this reason, it is important to prepare an algorithm for the management of comorbid OSD in glaucoma patients.

The Profile and Management of Glaucoma in Adult Aphakic Patients Following Complicated Cataract Surgery.

OBJECTIVES: To determine the profile and clinical course of glaucoma in adult aphakic patients following complicated cataract surgery. MATERIALS AND METHODS: Retrospective chart review of 22 adult aphakic patients (29 eyes) with glaucoma. RESULTS: Mean age was 57.69±14.18 years when aphakia occurred. Mean age at time of presentation to our glaucoma clinic was 62.57±12.47 years. Mean follow-up time was 42.83±57.04 months. Changes between the first and last follow-up visits were as follows: mean intraocular pressure decreased from 26.21±13.86 mmHg to 18.14±9.63 mmHg (p=0.003); mean number of glaucoma medications used increased from 1.41±1.27 to 2.07±1.04 (p=0.005); and mean vertical cup/disc ratio increased from 0.69±0.25 to 0.78±0.24 (p=0.024). Glaucoma was managed using medications in 26 eyes (89.7%), whereas 3 eyes underwent surgical treatment. However, surgery alone was not sufficient to control intraocular pressure and additional glaucoma medications were needed. CONCLUSION: Prevention of glaucomatous optic neuropathy in aphakic patients is challenging both medically and surgically. Although a significant decrease in intraocular pressure can be achieved with glaucoma medications, glaucomatous disc changes may progress.

Outcomes of Trabeculectomy and Glaucoma Drainage Devices for Elevated Intraocular Pressure After Penetrating Keratoplasty.

PURPOSE: To assess and compare the outcomes of trabeculectomy with and without antimetabolites (AMs) and glaucoma drainage devices (GDDs) in the management of elevated intraocular pressure (IOP) after penetrating keratoplasty (PK). METHODS: Data of 84 eyes of 81 patients who underwent trabeculectomy (12 eyes without an AM and 42 eyes with an AM) or GDD implantation (30 eyes) after PK were reviewed retrospectively. The main outcome measures were IOP control, corneal graft survival, and postoperative ocular complications. RESULTS: At the final visit, IOP success (<22 mm Hg) was 58.3% in trabeculectomy alone, 64.3% in trabeculectomy with an AM (TrabAM), and 86.7% in GDD groups (P = 0.047). The median time from surgery to IOP failure was 1 month after trabeculectomy alone, 13 months after TrabAM, and 20 months after GDD implantation (P = 0.042). The cumulative probability of IOP success rates at 1 and 3 years postoperatively was as follows: 66.7% and 57.1% in trabeculectomy alone, 80.6% and 64.8% in TrabAM, and 92.3% and 84.6 in GDD groups (P = 0.063). The cumulative probability of corneal graft survival rates at 1 and 3 years postoperatively was as follows: 70.0% and 60.0% in trabeculectomy alone, 76.7% and 67.7% in TrabAM, and 65.8% and 52.6% in GDD groups (P = 0.549). CONCLUSIONS: GDDs are more successful than trabeculectomy in controlling IOP in eyes that have undergone PK, but they tend to have low corneal graft survival rates. Trabeculectomy without an AM has limited success and may be considered in a limited number of patients with a low risk for bleb failure.

Comparison of the neuroprotective effects of brimonidine tartrate and melatonin on retinal ganglion cells.

PURPOSE: We aimed to compare the neuroprotective effects of brimonidine tartrate (BRT) and melatonin (MEL) on retinal ganglion cells (RGCs) in a rat glaucoma model. METHODS: Thirty-six adult Wistar albino rats were allocated into six groups: control (C), glaucoma (G), BRT, MEL, G + BRT and G + MEL. After establishing the glaucoma model, intraocular pressure (IOP) of all animals measured at day 4 and day 30 was compared statistically with day 0 and day 4, respectively. Prior to sacrification at day 30 for histological evaluation and TUNEL analysis, retrograde labeling of non-apoptotic RGCs with 3% Fluorogold was performed and RGCs were evaluated under fluorescein microscope. RESULTS: IOP measurements at day 4 were significantly higher than basal measurements in all glaucoma groups. BRT alone induced a time-dependent decrease in IOP (p < 0.05), while MEL alone failed to reduce IOP. However, both BRT and MEL reduced IOP in the presence of glaucoma at day 30 (p < 0.05). BRT treatment significantly reversed the reduced non-apoptotic RGC counts (p < 0.01) and increased TUNEL-positive RGCs (p < 0.001) to control group levels in the presence of glaucoma. However, no statistical significance was found between groups G and G + MEL considering 3% Fluorogold-labeled cell counts and apoptotic index values. CONCLUSION: Our study revealed that systemic administration of BRT also has an IOP reducing effect. MEL has no neuroprotective effect on RGCs; on the other hand, BRT acts as a neuroprotective agent against glaucomatous injury, when applied systemically.

Ahmed Glaucoma Valve Implantation for Uveitic Glaucoma Secondary to Behçet Disease.

PURPOSE: To evaluate outcomes of patients with uveitic glaucoma secondary to Behçet disease (BD) who underwent Ahmed glaucoma valve (AGV) implantation. PATIENTS AND METHODS: A retrospective chart review of 14 eyes of 10 patients with uveitic glaucoma associated with BD who underwent AGV implantation at a tertiary referral center. Treatment success was defined as intraocular pressure (IOP) between 6 and 21 mm Hg with or without antiglaucoma medication, without further additional glaucoma surgery or loss of light perception. The main outcome measures were IOP, best-corrected visual acuity measured with Snellen charts, and number of glaucoma medications. RESULTS: Mean duration of postoperative follow-up was 18.2±6.6 months (range, 6 to 31 mo). Of the 14 eyes, 10 (71.4%) were pseudophakic and 5 (35.7%) had primary AGV implantation without a history of previous glaucoma surgery. At the most recent follow-up visit, 13 of the 14 eyes had an IOP between 6 and 21 mm Hg. Mean IOP was significantly reduced during follow-up, as compared with preoperative values (P≤0.005). The cumulative probability of surgical success rate was 90.9% at 18 months based on Kaplan-Meier survival analysis. The mean number of antiglaucoma medications required to achieve the desired IOP decreased from 3.4±0.5 preoperatively to 1.0±1.1 postoperatively (P≤0.05). Visual acuity loss of >2 lines occurred in 4 eyes (28.5%) due to optic atrophy associated with retinal vasculitis. Temporary hypotony developed during follow-up in 4 eyes (28.5%) at first postoperative week. CONCLUSIONS: For the management of uveitic glaucoma associated with BD, AGV implantation is a successful method for glaucoma control but requires additional surgical interventions for high early hypotony rates.

Correlation between optical coherence tomography results and the Scoring Tool for Assessing Risk (STAR) score in patients with ocular hypertension.

PURPOSE: To correlate retinal nerve fiber layer thickness (RNFL) and optic nerve head (ONH) parameters measured with optical coherence tomography (OCT) with the Scoring Tool for Assessing Risk (STAR) threshold in patients with ocular hypertension (OH). METHODS: The study included 92 patients with OH. They were divided into low-risk (n=32), moderate-risk (n=36), and high-risk (n=24) groups according to STAR criteria. RNFL and ONH OCT protocols were used to evaluate all study participants. Major parameters for RNFL analysis were average RNFL thickness, superior quadrant, nasal quadrant, inferior quadrant, temporal quadrant, and segmental thickness per 12 o'clock hour position. ONH parameters were vertical integrated rim area (VIRA), horizontal integrated rim width (HIRW), disc diameter, disc area, cup area, rim area, cup-to-disc (C/D) area ratio, horizontal C/D ratio, and vertical C/D ratio. RESULTS: The highest area under receiver operating characteristics curves for distinguishing the high-risk group from the other groups were vertical C/D ratio (0.88), C/D area (0.88), VIRA (0.87), and HIRW (0.81) for ONH parameters, and inferior (0.82) and 6 o'clock hour position (0.77) for peripapillary RNFL thickness measurements. CONCLUSIONS: Inferior average, 6 o'clock hour position analyses for RNFL measurement, and VIRA, HIRW, C/D area, and vertical C/D ratio for ONH measurement were the best parameters for STAR staging in patients with OH.

Quantitative assessment of anterior chamber parameters in pigmentary glaucoma using slit-lamp optical coherence tomography.

PURPOSE: To quantitatively assess the parameters of anterior chamber and angle dimensions by slit-lamp optical coherence tomography (SL-OCT) in eyes with pigmentary glaucoma (PG). METHODS: A total of 18 eyes of 11 patients with PG and 18 eyes of 11 healthy volunteers were included in the study. Anterior chamber depth (ACD), anterior chamber volume (ACV), spur distance (internal horizontal anterior chamber diameter), central corneal thickness (CCT), angle opening distance at 500 microm from the scleral spur (AOD 500), and trabecular iris space area at 500 microm from the scleral spur (TISA 500) parameters were detected by SL-OCT. The differences of anterior chamber parameters between patients with PG and the control group were analyzed by Mann-Whitney U test. RESULTS: Mean ACD and ACV were measured as 3.28 +/- 0.38 mm and 191.6 +/- 39.7 mm3 respectively in the PG group. Mean AOD 500 and TISA 500 were 0.88 +/- 0.47 mm and 0.29 +/- 0.15 mm2 at the nasal angle and 1.14 +/- 0.67 mm and 0.41 +/- 0.23 mm2 at the temporal angle, respectively. Nasal and temporal angles were 49.83 +/- 11.1 degrees and 53.83 +/- 10.46 degrees. In eyes with PG, the midperipheral iris configuration was found to be considerably concave in 15 eyes (83.3%). Except CCT and spur distance, all anterior chamber dimension and angle parameters detected by SL-OCT were found to be significantly higher in the eyes with PG (Mann-Whitney U test, p < 0.05). CONCLUSIONS. SL-OCT provided highly quantitative data on the parameters of anterior chamber and angle dimensions in PG. The evaluation of the anterior segment anatomy using SL-OCT revealed increased anterior chamber dimensions and posterior bowing of the iris consistent with the increase in angle parameters in patients with PG.

Assessment of anterior chamber angle using Visante OCT, slit-lamp OCT, and Pentacam.

PURPOSE: To assess and compare the anterior chamber angle (ACA) by different anterior segment imaging techniques. METHODS: Forty healthy eyes of 40 normal subjects were recruited and 3 consecutive measurements of ACA were determined prospectively utilizing Visante optical coherence tomography (OCT), slit-lamp OCT (SL-OCT), and Pentacam. Statistical significance of interdevice differences between measurements was evaluated by Wilcoxon signed rank test and Bland-Altman analysis. The repeatability of 3 consecutive measurements was analyzed by repeated measured analysis of variance. RESULTS: Mean nasal and temporal ACA were detected as 31.2+/-8.7 and 32.1+/-8.5 degrees by Visante OCT; 41.6+/-5.9 and 41.8+/-5.2 degrees by Pentacam; and 42.9+/-10.0 and 43.3+/-10.1 degrees by SL-OCT. All devices displayed a high intrasession repeatability (Scheffe multiple comparison, p>0.05). ACA detected by Visante OCT were found significantly different from ACA calculated by Pentacam and SL-OCT (p<0.05). On the other hand, ACA data obtained by Pentacam and SL-OCT were found to be statistically similar (p>0.05). CONCLUSIONS: Although noncontact ACA measurements using all modalities were easy to handle and demonstrated good repeatability in healthy participants, the tested devices were not regarded as comparable. Hence, the clinician should take the different modalities into consideration during ACA assessment using various devices.

Incidence and prognosis of ocular hypertension secondary to viral uveitis.

This retrospective study was designed to estimate the cumulative incidence of glaucoma in viral uveitis. Seventy-six consecutive patients with viral stromal keratouveitis were divided into two groups according to the etiologic agents herpes simplex virus (HSV) keratouveitis (n = 58) and herpes zoster virus (HZV) keratouveitis (n = 18). The groups were evaluated for the incidence and prognosis of ocular hypertension. Etiologic agents were determined with the help of clinical observation supported by the polymerase chain reaction (PCR) of aqueous humor. All patients received oral acyclovir therapy for at least six months and topical prednisolone in tapered doses. There was no significant difference in the recurrences of HSV and varicella zoster virus (VZV) keratouveitis between groups (P = 0.431). The total incidence of secondary glaucoma was 13.1%. Most of the patients responded to antiviral and antiglaucomatous therapy. Trabeculectomy with mitomycin C was performed in only two patients. Secondary glaucoma can be regarded as a frequent complication of viral uveitis. As it has a good prognosis, surgical intervention is rarely required.

A comparative study between diode laser cyclophotocoagulation and the Ahmed glaucoma valve implant in neovascular glaucoma: a long-term follow-up.

BACKGROUND: To compare the efficacy, safety, and long-term results of intraocular pressure (IOP) reduction by diode laser contact cyclophotocoagulation (DCPC) and Ahmed glaucoma valve (AGV) implant in cases of neovascular glaucoma. METHODS: A total of 66 eyes of 66 patients with neovascular glaucoma were prospectively assigned to either DCPC or AGV implantation. All patients underwent a baseline complete ophthalmologic examination and IOP measurement by Goldmann applanation tonometry before and after 1,3, 6, 12, and 24 months follow-up. Complications and the number of medications were recorded. RESULTS: Mean age of the patients was 60.0+/-11.7 years (range: 20 to 85) in the DCPC group and 57.2+/-10.3 years (range: 20 to 85) in the AGV group. The preoperative IOP was 43.4+/-11.9 mm Hg and 43.3+/-7.4 mm Hg for the DCPC and AGV group, respectively (P>0.05). The postoperative IOP was 16.5+/-11.3 mm Hg and 22.09+/-7.6 mm Hg for the DCPC and AGV groups, respectively (P>0.05) at the last visit. Kaplan-Meier survival analysis showed a probability of success at 24 months of 61.18% and 59.26% for the DCPC and AGV groups (P>0.05). All the patients had a visual acuity of hand movement or worse preoperatively. Visual acuity decreased in 6 eyes (24%) in the DCPC group and 9 eyes (27%) in AGV group. Complications included anterior segment inflammation in 5 eyes (20%), neurotrophic keratitis in 2 eyes (8%), and hypotony in 3 eyes (15%) in the DCPC group and hyphema in 5 eyes (15%) and tube occlusion in 3 eyes (9%) in AGV group. CONCLUSIONS: There was no significant difference in the success rate between the DCPC and AGV implantation in neovascular glaucoma treatment. However, DCPC is less time consuming and easier method for lowering IOP in patients with neovascular glaucoma.

The correlation between visual field defects and focal nerve fiber layer thickness measured with optical coherence tomography in the evaluation of glaucoma.

PURPOSE: To study the correlation between known visual field defects and retinal nerve fiber layer (RNFL) thickness detected by optical coherence tomography (OCT) in glaucomatous eyes. MATERIALS AND METHODS: Visual field parameters and OCT RNFL measurements of 28 eyes of 28 glaucoma patients with various stages of glaucoma were compared with 38 eyes of 38 normal age-matched controls. A perimetric nerve fiber bundle map was built by dividing the visual field area into 21 zones. Mean deviation and pattern standard deviation values within these 21 zones were compared with OCT RNFL thickness measurements in 12 sectors and the results were analyzed. RESULTS: Average RNFL thickness was 62.90+/-16.56 microm in the glaucoma group and 111.90+/-6.00 microm in the control group (P<0.05). Pattern standard deviation and mean deviation visual field zones and corresponding OCT RNFL thickness sectors were significantly correlated at specific sectors in the glaucoma group (P<0.01). CONCLUSIONS: Analysis of RNFL thickness in eyes with focal glaucomatous visual field defects showed good structural and functional correlation with OCT. OCT contributes to the identification of focal defects in the RNFL of glaucoma patients.

Incidence and risk factors in secondary glaucomas after blunt and penetrating ocular trauma.

PURPOSE: This retrospective study was designed to evaluate the risk factors for the development of posttraumatic glaucoma after ocular trauma. METHODS: Data were obtained from the records of 102 patients (105 eyes) that experienced blunt or penetrating ocular trauma and presented to our center between January 1987 and April 2006. Logistic regression was used to evaluate the association between the baseline structural and functional ocular characteristics and posttraumatic glaucoma. Odds ratios with 95% confidence intervals (CI) were obtained. RESULTS: Need for glaucoma surgery was independently associated with hyphema (odds ratio: 0.279; 95% CI: 0.085-0.916), corneal injury (odds ratio: 12.143; 95% CI: 2.029-72.66), presence of optic atrophy (odds ratio: 8.000; 95% CI: 1.615-39.636), visual acuity <20/200 (odds ratio: 50.00; 95% CI: 10.183-245.501), and a history of penetrating ocular trauma (odds ratio: 10.00; 95% CI: 2.819-38.635). Corneal (odds ratio: 1.113; 95% CI: 1.022-1.213) and vitreal injuries (odds ratio: 10.410; 95% CI: 1.232-87.97) were found to be statistically significant factors for the development of early glaucoma. CONCLUSIONS: This study found several independent predictive factors that were significantly associated with the need for glaucoma surgery in cases of posttraumatic glaucoma, including hyphema, corneal injury, presence of optic atrophy, visual acuity <20/200, and a history of penetrating ocular trauma. Additionally, some factors were found to affect the development of early glaucoma after ocular trauma, such as corneal and vitreal injury.

Macular edema and iridocorneal endothelial syndrome: a case report.

PURPOSE: To report a case of cystoid macular edema (CME) in iridocorneal endothelial syndrome. METHODS: Case report. RESULTS: The authors describe the clinical history and ocular examination of a 38-year-old woman with iridocorneal endothelial syndrome and CME. This association has never been reported before. The mechanism of CME is unknown. CONCLUSION: CME may cause visual deterioration in iridocorneal endothelial syndrome. We emphasize the importance of posterior segment examination in these cases.

Trabeculectomy with mitomycin-C in uveitic glaucoma associated with Behçet disease.

PURPOSE: To determine the effect of intraoperative application of Mitomycin-C (MMC) with trabeculectomy in uveitic glaucoma associated with Behçet disease. MATERIALS AND METHODS: Twenty-six eyes of 26 patients with uveitic glaucoma associated with Behçet disease who underwent trabeculectomy with MMC between 1996 and 2001 were reviewed in this retrospective, noncomparative study. Trabeculectomy + MMC in concentration of 0.4 mg/mL for 3 minutes was performed to all patients. Main outcome measures were control of IOP, the number of antiglaucoma medications required to achieve the desired IOP, visual acuity and complications. The surgical success was defined as IOP less than 22 mm Hg and greater than 5 mm Hg without additional further glaucoma surgery or loss of light perception. RESULTS: The cumulative probability of success was 83.3% at 1 year, 76.2% at 2 years, 70% at 3 years, 66.7% at 4 years and 62.5% at 5 years after surgery. The mean follow-up was 40.0+/-18.0 months. At last follow-up 23% of the patients required no antiglaucoma medications. Best-corrected visual acuity improved or remained within two lines of preoperative visual acuity in 19 eyes (73.1%). Glaucomatous (1 eye 3.8%) and nonglaucomatous optic atrophy (3 eyes 11.5%) was the most frequent reason for visual decrease (total 4 eyes 15.2%). The most common complications were cataract formation in 6 eyes (23.1%), bleb leakage in 4 eyes (15.3%) and choroidal effusion in 3 eyes (11.5%). Phthisis bulbi was found in one (3.8%) patient. CONCLUSION: Trabeculectomy and intraoperative application of MMC appears to provide long term safety and effectiveness in uveitic glaucoma associated with Behçet disease.

Primary viscocanalostomy versus trabeculectomy for primary open-angle glaucoma: three-year prospective randomized clinical trial.

PURPOSE: To compare the efficacy and safety of viscocanalostomy and trabeculectomy in patients with primary open-angle glaucoma (POAG). SETTING: Department of Ophthalmology, Ankara Education and Research Hospital, Ankara, Turkey. METHODS: In this prospective randomized trial, 50 eyes of 50 patients with medically uncontrolled POAG were randomized to have a trabeculectomy (25 eyes) or a viscocanalostomy (25 eyes). Visual acuity, intraocular pressure (IOP), and slitlamp examinations were performed before surgery and 1 day, 1 week, 1, 3, and 6 months, and 1, 2, and 3 years postoperatively. RESULTS: At 3 years, the mean IOP was 16.0 mmHg +/- 7.07 (SD) in the trabeculectomy group and 17.8 +/- 4.6 mmHg in the viscocanalostomy group (P=.694). Complete success (IOP 6 to 21 mm Hg without medication) was achieved in 66.2% of eyes at 6 months and 55.1% at 3 years in the trabeculectomy group and in 52.9% and 35.3%, respectively, in the viscocanalostomy group (P>.05). Qualified success (IOP 6 to 21 mmHg with medication) was achieved in 95.8% of eyes at 6 months and 79.2% at 3 years in the trabeculectomy group and in 90.7% and 73.9%, respectively, in the viscocanalostomy group (P>.05). Postoperative hypotony and cataract formation occurred more frequently in the trabeculectomy group than in the viscocanalostomy group (P=.002). CONCLUSIONS: Primary trabeculectomy lowered IOP more than viscocanalostomy in POAG patients. However, the complication rate was lower in the viscocanalostomy group.

Decompression retinopathy after Ahmed glaucoma valve implantation in a patient with congenital aniridia and pseudophakia.

We present the case of a 16-year-old adolescent boy with congenital aniridia and pseudophakia who developed decompression retinopathy in a glaucomatous eye after Ahmed glaucoma valve implantation combined with anterior vitrectomy. On the first postoperative day, dot and blot-shaped hemorrhages scattered in the posterior pole were observed. The hemorrhages resolved over 6 months, and the visual acuity returned to the preoperative level. Severe deterioration of the visual field was not observed in the late postoperative period. Despite the sudden visual acuity decrease postoperatively, decompression retinopathy is a benign condition and resolution of hemorrhages without sequelae is the natural course.

Hemorrhagic Descemet's membrane detachment after viscocanalostomy.

We report a case of hemorrhagic detachment of Descemet's membrane after viscocanalostomy. A 60-year-old man with pseudoexfoliative glaucoma had an uneventful viscocanalostomy in the right eye. On the first postoperative day, a 5.0 mm x 5.0 mm Descemet's membrane detachment was present in the superior nasal quadrant. The space between Descemet's membrane and the stroma was filled with a hemorrhage. The hemorrhage resorbed by 6 months postoperatively, and Descemet's membrane completely reattached without surgical manipulation. The final visual acuity dropped from 20/40 to 20/100, final intraocular pressure was 20 mm Hg with 1 medication, and a paracentral fibrinoid scar persisted 18 months after surgery. Hemorrhagic detachment of Descemet's membrane can cause visual acuity deterioration and should be recognized as a rare complication of viscocanalostomy.

Penetration of topically applied ciprofloxacin and ofloxacin into the aqueous humor and vitreous.

PURPOSE: To determine the intraocular penetration of topical drops of 2 antibiotics, ciprofloxacin 0.3% and ofloxacin 0.3%, into the aqueous humor and vitreous and to relate these levels to the miminum inhibitory concentration (MIC(90)) for organisms associated with ocular bacterial infections. SETTING: Department of Ophthalmology, Ankara Hospital, and Department of Pharmacology, Faculty of Medicine, Hacettepe University, Ankara, Turkey. METHODS: This prospective randomized clinical trial comprised 18 patients having cataract surgery, all with an intact corneal epithelium. The patients were randomly assigned to receive topical ciprofloxacin 0.3% (n = 10) or topical ofloxacin 0.3% (n = 8) 1 drop every 15 minutes 5 times and every 30 minutes 3 times before surgery. Aqueous and vitreous samples (if vitreous loss occurred during the cataract surgery) were collected 30 minutes after the administration of the last dose. Drug concentrations were determined by high-performance liquid chromatography (HPLC) fluorescence. RESULTS: All patients had detectable drug concentrations in the aqueous humor and vitreous measurable by HPLC. The mean aqueous humor concentration of ciprofloxacin was 1.13 microg/mL +/- 1.90 (SD) and the mean vitreous concentration, 0.23 +/- 0.06 microg/mL. Topical administration of ciprofloxacin yielded 4.9 times more drug concentration in the anterior chamber than in the vitreous. The mean aqueous concentration of ofloxacin was 2.06 +/- 1.06 microg/mL and the mean vitreous concentration, 0.46 +/- 0.10 microg/mL. Topical administration of ofloxacin yielded 4.7 times more drug concentration in the anterior chamber than in the vitreous. Aqueous humor concentrations of ofloxacin and ciprofloxacin were not statistically significantly different (P =.353). Intravitreal concentrations of ofloxacin were statistically significantly higher than those of ciprofloxacin (P =.001). CONCLUSIONS: Topical ofloxacin 0.3% penetrated better than topical ciprofloxacin 0.3% into the anterior chamber and vitreous in noninflamed eyes. Both drugs were above the MIC(90) for most ocular pathogens in the anterior chamber. The mean concentration in the vitreous of topically applied ofloxacin 0.3% was statistically significantly higher than that of ciprofloxacin 0.3%, but it was not sufficiently above the MIC(90) for most ocular pathogens in terms of empirical endopthalmitis therapy.

Determination of betaxolol in human aqueous humour by high-performance liquid chromatography with fluorescence detection.

A reversed-phase high-performance liquid chromatographic method is described for the determination of betaxolol in human aqueous humour. Betaxolol and the internal standard metoprolol were extracted with cyclohexane and separated on a reversed-phase column (Luna C(18), 250 x 4.6 mm, 5 microm) with a mobile phase containing acetonitrile-phosphate buffer (40:60, v/v) at a flow-rate of 0.8 ml/min. The column effluent was monitored with a fluorescence detector at 227 nm (excitation) and 301 nm (emission). The retention times for metoprolol and betaxolol were 3.55 and 5.63 min, respectively. The recovery from aqueous humour was found to be 71.6% for betaxolol at 1.25 microg/ml. The within-day and day-to-day accuracy values were in the range of 96.17-105.2% for betaxolol at 0.1, 4 and 12 microg/ml (n=6), within-day and day-to-day precision values were less than 10% for betaxolol at the concentrations given above. The detection limit corresponding to the signal-to-noise ratio of 3:1 was 15 ng/ml. The presented method was suitable for measuring betaxolol levels in human aqueous humour samples obtained from patients after topical administration.