Safety and feasibility of the use of a bevacizumab-methylcellulose mixture as an adjunct to glaucoma surgery: a pilot study.

Bevacizumab, a monoclonal anti-vascular endothelial growth factor antibody, has been suggested as a potential healing therapeutic following glaucoma surgery. Here, we aimed to improve the bioavailability of bevacizumab when used as an adjunct therapy to non-penetrating deep sclerectomy (DS) by using a bevacizumab-methylcellulose mixture (BMM). Ten previously non-operated eyes in ten patients diagnosed with primary open angle glaucoma underwent DS with a subconjunctival injection of 0.3 ml of BMM (bevacizumab 3.75 mg incorporated into 4% methylcellulose) at the surgical site. Bevacizumab release was evaluated in vitro using size-exclusion high performance liquid chromatography (HPLC). Intraocular pressure (IOP), bleb morphology, corneal endothelial cell count (CECC), and complications were evaluated at 6 months after surgery. Using HPLC, bevacizumab was detected in BMM for up to 72 h. Moreover, all surgical blebs remained expanded with hyaline material during the first week. A significant IOP reduction (mean ± SD= -10.3 ± 5.4 mmHg, P<0.001) and diffuse blebs were observed at the final follow-up period. Although CECC was slightly reduced (-7.4%), no complications were observed. In conclusion, bevacizumab was released from BMM, and the use of this innovative mixture yielded good results following DS with no complications. Further studies are required to determine its efficacy prior to establishing BMM as an adjunct treatment for penetrating and non-penetrating glaucoma surgeries.

Safety and feasibility of the use of a bevacizumab-methylcellulose mixture as an adjunct to glaucoma surgery: a pilot study / Segurança e viabilidade do uso de uma mistura de bevacizumabe-metilcelulose como terapia adjuvante à cirurgia anti-glaucomatosa: um estudo piloto

ABSTRACT Bevacizumab, a monoclonal anti-vascular endothelial growth factor antibody, has been suggested as a potential healing therapeutic following glaucoma surgery. Here, we aimed to improve the bioavailability of bevacizumab when used as an adjunct therapy to non-penetrating deep sclerectomy (DS) by using a bevacizumab-methylcellulose mixture (BMM). Ten previously non-operated eyes in ten patients diagnosed with primary open angle glaucoma underwent DS with a subconjunctival injection of 0.3 ml of BMM (bevacizumab 3.75 mg incorporated into 4% methylcellulose) at the surgical site. Bevacizumab release was evaluated in vitro using size-exclusion high performance liquid chromatography (HPLC). Intraocular pressure (IOP), bleb morphology, corneal endothelial cell count (CECC), and complications were evaluated at 6 months after surgery. Using HPLC, bevacizumab was detected in BMM for up to 72 h. Moreover, all surgical blebs remained expanded with hyaline material during the first week. A significant IOP reduction (mean ± SD= -10.3 ± 5.4 mmHg, P<0.001) and diffuse blebs were observed at the final follow-up period. Although CECC was slightly reduced (-7.4%), no complications were observed. In conclusion, bevacizumab was released from BMM, and the use of this innovative mixture yielded good results following DS with no complications. Further studies are required to determine its efficacy prior to establishing BMM as an adjunct treatment for penetrating and non-penetrating glaucoma surgeries.

RESUMO O bevacizumabe (um agente anti-fator de crescimento endotelial vascular) tem sido sugerido como potencial modulador cicatricial na cirurgia do glaucoma. Este estudo objetivou melhorar a biodisponibilidade do bevacizumabe, investigando a viabilidade de uma nova mistura de bevacizumabe-metilcelulose (BMM) como terapia adjuvante para a esclerectomia profunda não-penetrante (DS). Dez olhos sem cirurgias prévias de 10 pacientes com glaucoma primário de ângulo aberto foram submetidos à DS associada à uma injeção subconjuntival de 0,3 ml da mistura de bevacizumabe-metilcelulose (bevacizumabe 3,75 mg incorporado em metilcelulose 4%) no sítio cirúrgico. A liberação de bevacizumabe foi avaliada in vitro através de cromatografia líquida de alta performance por exclusão de tamanho (HPLC). A pressão intraocular (PIO), a morfologia da ampola de filtração, a contagem de células endoteliais da córnea (CECC) e as complicações foram estudadas aos seis meses de seguimento. O bevacizumabe foi detectado a partir da mistura de bevacizumabe-metilcelulose por meio do HPLC até 72 horas. Além disso, todas as ampolas cirúrgicas permaneceram expandidas com material hialino durante a primeira semana. Uma redução significativa da pressão intraocular (média ± DP= -10,3 ± 5,4 mmHg, P<0,001) e ampolas difusas foram observadas ao final do período de seguimento. Embora a contagem de células endoteliais da córnea se mostrou discretamente diminuída (-7,4%), nenhuma complicação foi observada. Neste estudo, o bevacizumabe foi liberado da mistura de bevacizumabe-metilcelulose e o uso desta nova mistura se associou com bons resultados cirúrgicos e nenhuma complicação. Estudos futuros serão necessários para determinar sua eficácia, antes de se estabelecer a mistura de bevacizumabe-metilcelulose como um tratamento adjuvante às cirurgias penetrantes e não-penetrantes para o glaucoma.

Double-layered mucoadhesive tablets containing nystatin.

The objective of this work was to design a mucoadhesive tablet with a potential use in the treatment of oral candidosis. A 2-layered tablet containing nystatin was formulated. Lactose CD (direct compression), carbomer (CB), and hydroxypropylmethylcellulose (HPMC) were used as excipients. Tablets were obtained through direct compression. Properties such as in vitro mucoadhesion, water uptake, front movements, and drug release were evaluated. The immediate release layer was made of lactose CD (100 mg) and nystatin (30 mg). The CB:HPMC 9:1 mixture showed the best mucoadhesion properties and was selected as excipient for the mucoadhesive polymeric layer (200 mg). The incorporation of nystatin (33.3 mg) in this layer affected the water uptake, which, in turn, modified the erosion front behavior. Nystatin showed a first-order release. The polymeric layer presented an anomalous kinetic (n = 0.82) when this layer was individually evaluated. The mucoadhesive tablet formulated in this work releases nystatin quickly from the lactose layer and then in a sustained way, during approximately 6 hours, from the polymeric layer. The mixture CB:HPMC 9:1 showed good in vitro mucoadhesion. A swelling-diffusion process modulates the release of nystatin from this layer. A non-Fickian (anomalous) kinetic was observed.

Hydroxypropylmethylcellulose and sodium hyaluronate in adjustable strabismus surgery.

The efficacy of hydroxypropylmethylcellulose and sodium hyaluronate as adjuncts during adjustable strabismus surgery was evaluated experimentally. Fifteen randomized NZA rabbits underwent a bilateral 4-mm recession of the superior rectus followed by a 0.05 mL injection of submuscular hydroxypropylmethylcellulose 2% (HPMC) in one eye and sodium hyaluronate 1% (Healon) in the other eye. Five additional rabbits (10 eyes), used as controls, underwent the same procedure, but no viscoelastic was injected after surgery. The force needed to move the muscle 4 mm toward its original insertion was measured immediately and 24 hours after the operation, using a force gauge. The force needed to adjust the muscles increased 326.0%, 98%, and 124.7%, respectively in the control, Healon and HPMC groups (p < 0.001). No significant difference was found between the two viscoelastic substances. Histologic evaluation of the operation sites disclosed similar inflammation in both controls and viscoelastic groups (p = .5960).

Nuestra experiencia en embolización por cateterismo arterial percutáneo / Therapeutic embolization by percutaneous arterial catheterization

Se presenta la experiencia con 72 pacientes con diferentes patologías, en quienes se realizó tratamiento endovascular con embolización selectiva. Se discuten la técnica, diferentes materiales utilizados, resultados y complicaciones. Se concluye que la EE constituye una excelente alternativa terapéutica pre-quirúrgica, paliativa o definitiva, de fácil realización en centros especialmente entrenados

Nuestra experiencia en embolización por cateterismo arterial percutáneo / Therapeutic embolization by percutaneous arterial catheterization

Se presenta la experiencia con 72 pacientes con diferentes patologías, en quienes se realizó tratamiento endovascular con embolización selectiva. Se discuten la técnica, diferentes materiales utilizados, resultados y complicaciones. Se concluye que la EE constituye una excelente alternativa terapéutica pre-quirúrgica, paliativa o definitiva, de fácil realización en centros especialmente entrenados

Metilcelulose a 6% na cirurgia da catarata com implante / Methylose 6% in extracapsular cataract extraction with implant

Apresentamos os resultados do uso de metilose 6% na capsulotomia anterior para cirurgia extracapsular da catarata

Nova técnica no uso de metilcelulose para o implante de lentes intraoculares: resultados de 100 casos consecutivos / A new technic in the use of methylcellulose for the implantation of intraocular lenses: results of 100 consecutive cases

Comparam-se os resultados de 100 facectomias extracapsulares com implante de LIO, utilizando metilcelulose a 2% somente sobre a incisäo (extra ocular), com os de outras técnicas já descritas. Observam que seus resultados também foram muito bons. Descrevem-se a técnica, que tem como principais vantagens a näo colocaçäo da metilcelulose dentro do olho e o impedimento à saída brusca da bolha de ar da câmara anterior