Preventing the Argentinian flag sign and managing anterior capsular tears: A review.

The Argentinian flag sign (AFS) is a feared complication during cataract extraction. Intralenticular pressures, especially excessive posterior pressure, have been identified as potential mechanisms for capsular stress and tearing associated with AFS. Capsular tension is created by positive intralenticular pressures, which cause the irido-lens diaphragm to move anteriorly once the manual capsulorhexis has been initiated. This tension can cause inadvertent tears that self-propagate to the lens equator, causing an AFS, among other intraoperative complications. Thus, this review highlights the importance of identifying intumescent cataracts as well as a combination of techniques to relieve intracapsular pressures needed to prevent AFS. However, some instances of anterior capsular tears are unavoidable. Therefore, focus will also be placed on techniques during cataract extraction used to manage anterior capsular tears, mitigating extension to the posterior capsule.

Polyuria in patients with lower urinary tract symptoms: Prevalence and etiology.

INTRODUCTION: Patients with lower urinary tract symptoms (LUTS) can be subcategorized into polyuria, normal or oliguria groups. Polyuria may be caused by pathologies including diabetes mellitus (DM), chronic kidney disease (CKD), diabetes insipidus (DI), or primary polydipsia (PPD). While fluid restriction is appropriate for some, doing so in all may result in serious complications. This study investigates the prevalence of these pathologies in LUTS patients with polyuria. MATERIALS AND METHODS: Two databases were retrospectively queried for men and women who filled out a lower urinary tract symptom score (LUTSS) questionnaire, 24-h bladder diary (24HBD) and were polyuric (>2.5 L/day). Patients were divided into four groups: poorly controlled DM, DI, an CKD grade 3 and PPD. One-way analysis of variance compared 24HBD and LUTSS questionnaires. Pearson correlation examined LUTSS and bother with 24-h voided volume (24 HVV), maximum voided volume (MVV) and total voids. RESULTS: Among 814 patients who completed a 24HBD, 176 had polyuria (22%). Of the patients with complete data, 7.8% had poorly-controlled DM, 3.1% had DI, 4.7% had CKD grade 3% and 84.4% had PPD. Amongst the four different sub-groups, significant differences were seen in 24 HVV (p < 0.001), nocturnal urine volume (NUV) (p < 0.001), MVV (p = 0.003), daytime voids (p = 0.05), nocturnal polyuria index (NPi) (p < 0.001) and nocturia index (Ni) (p = 0.002). Significance was also seen between LUTSS and bother subscore (r = 0.68, p < 0.001), LUTSS and total voids (r = 0.29, p = 0.001) and bother sub-score and total voids (r = 0.21, p = 0.019). CONCLUSIONS: 22% of patients with LUTS were found to have polyuria based on a 24HBD. Within this cohort, four sub-populations were identified as being demonstrating statistically significant differences in 24 HVV, NUV, MVV, daytime voids, NPi and Ni. Identifying the underlying etiology of polyuria should be carried out to safely treat patients with LUTS.

A review of needle-free sumatriptan injection for rapid control of migraine.

The treatment of migraine was transformed in 1992 with the introduction of the first triptan-based therapy, subcutaneous (SC) sumatriptan. SC sumatriptan has high efficacy and a rapid onset of action compared with other available triptans and formulations presumably because of its short Tmax, high Cmax, and avoidance of enteral absorption. Because of these characteristics, SC sumatriptan is still considered the most reliably and rapidly effective self-administered medication available for acute migraine. Even so, it is relatively little used possibly in part because of patient "needle-phobia." The needle-free sumatriptan injection system (Sumavel DosePro) was developed to address this concern. Clinical trials have shown that the needle-free system is bioequivalent to needle-based injection systems, easy to use, and capable of providing rapid and effective symptom relief for many migraine episodes. Sumavel DosePro is an effective treatment for migraine and should be part of the therapeutic armamentarium, particularly in cases where a rapid onset of action is critical or where oral administration is problematic.

Can intraocular lenses deliver antibiotics intracamerally?

PURPOSE: To determine the therapeutic concentrations of moxifloxacin achieved in an artificial anterior chamber by soaking the hydrophobic acrylic AcrySof™ SA60 (Alcon Inc.) intraocular lens (IOL) and the hydrophilic collamer Afinity™ CQ2015 (Staar Inc.) IOL in commercially available moxifloxacin 0.5% (Vigamox™; Alcon Inc.). METHODS: Forty IOLs (20 Acrysof SA60 and 20 Afinity CQ2015) were soaked in 1 mL of commercially available moxifloxacin 0.5%: 10 of each IOL for 1 min, and another 10 of each IOL for 10 min. The IOLs were placed on absorbent pads for 10 s on each side to dry excess liquid, and then placed in vials of 10 mL balanced salt solution (BSS™) for 30 min. Five milliliters of the balanced salt solution was removed and analyzed by high-pressure liquid chromatography to determine antibiotic levels. RESULTS: The moxifloxacin levels achieved after soaking the hydrophobic SA60 lens were 0.238 and 0.342 µg/mL for 1 and 10-min soaks, respectively. The moxifloxacin levels achieved after soaking the hydrophilic CQ2015 lens were 0.283 and 0.717 µg/mL for 1 and 10-min soaks, respectively. CONCLUSIONS: Both lenses were capable of delivering clinically significant antibiotic levels after a 1-min soak. Moxifloxacin concentrations reached at both 1 and 10-min soak times exceed the MIC(90) of the most common pathogens responsible for postoperative endophthalmitis. The antibiotic-soaked IOL has potential to become a clinically significant technique in the prevention of postoperative endophthalmitis.

In vitro antimicrobial efficacy of riboflavin and ultraviolet light on Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, and Pseudomonas aeruginosa.

PURPOSE: Ultraviolet (UV) light and riboflavin has been developed as a collagen cross-linking treatment for corneal ectasia. This treatment has also been used to treat infectious corneal ulcers with apparent favorable results. In this experiment, the antibacterial action of riboflavin alone, UV light alone, and the combination of riboflavin and UV light was tested on Staphylococcus aureus, methicillin-resistant S aureus (MRSA), and Pseudomonas aeruginosa. METHODS: Thirty agar plates with S aureus overlays were used. Ten plates were exposed to riboflavin (0.1% solution in dextran) alone, 10 plates were exposed to UV light (365 nm) alone, and 10 plates were exposed to a combination of riboflavin and UV light. Fifteen agar plates with MRSA and 15 plates with P aeruginosa were tested. Five plates of each group were exposed to riboflavin, 5 plates of each group were exposed to UV light alone, and 5 plates of each group were exposed to a combination of riboflavin and UV light. All plates were incubated for 24 hours and then analyzed. RESULTS: All plates exposed to riboflavin alone showed no bacterial death. All S aureus and MRSA plates exposed to UV light alone showed no bacterial growth. Three of five P aeruginosa plates exposed to UV light alone showed no bacterial death; two of five P aeruginosa plates exposed to UV light alone showed minimal inhibition. All plates exposed to the combination of riboflavin and UV light showed bacterial death. CONCLUSIONS: Riboflavin in combination with UV light is an effective modality to eradicate the bacteria S aureus, MRSA, and P aeruginosa.

Antimicrobial activity of acrylic intraocular lenses soaked in fourth generation fluoroquinolones.

PURPOSE: The aim of this study was to determine whether a commercially available brand of intraocular lenses (IOLs) soaked in moxifloxacin or gatifloxacin for 1 or 60 min have antimicrobial properties. METHODS: The IOLs (N = 8-10/group) were soaked in saline, physiologic-strength moxifloxacin (1.8 microg/mL), or gatifloxacin (0.48 microg/mL) for 60 min or commercial-strength moxifloxacin (5 mg/mL) or gatifloxacin (3 mg/mL) for 1 or 60 min. Presoaked IOLs and gatifloxacin antibiotic disks were plated on agar with quality-controlled ATCC 25923 Staphylococcus aureus overlay. Bacterial kill zones were measured after 24 h. RESULTS: IOLs soaked in physiologic-strength gatifloxacin or saline for 60 min produced no measurable bacterial kill zone, and the mean bacterial kill zone for IOLs soaked in physiologic-strength moxifloxacin was significantly greater (P = 0.011, 0 vs. 3.88 +/- 3.18 mm, respectively). Soaking the IOLs in commercial-strength moxifloxacin or gatifloxacin for 1 or 60 min produced significantly larger bacterial kill zones (P < 0.0001, mean: > or =33 mm for all groups). Soaking for 1 min produced a significantly larger mean bacterial kill zone by moxifloxacinthan gatifloxacin-treated IOLs (P = 0.002, 38.80 +/- 3.74 mm, 34.30 +/- 1.34 mm, respectively). The mean bacterial kill zone was significantly larger for IOLs soaked in commercial-strength moxifloxacin for 1 versus 60 min (P = 0.002, 38.80 +/- 3.74 mm, 33.56 +/- 1.42 mm, respectively). There was no significant difference in the mean bacterial kill zone between IOLs soaked for 1 or 60 min in commercial-strength gatifloxacin (34.30 +/- 1.34 mm, 33.67 +/- 0.50 mm, respectively).

Regression of presumed primary conjunctival and corneal intraepithelial neoplasia with topical interferon alpha-2b.

PURPOSE: To evaluate topical interferon alpha-2b (IFNalpha2b) as a lone therapy in the treatment of primary conjunctival and corneal intraepithelial neoplasia (CIN). METHODS: Noncomparative, prospective, interventional case series. Seven patients from three institutions, treated between February and October 1999, with presumed primary CIN lesions (clinically diagnosed by corneal specialists) were given topical IFNalpha2b drops (1 million units/mL) four to six times daily. Follow-up was performed biweekly until there was complete clinical resolution of the presumed CIN lesions. Patients were to continue topical IFNalpha2b drops for 1 month after clinical resolution. Patient charts and clinical photographs were reviewed, and data were analyzed. RESULTS: All seven eyes had complete resolution of the presumed CIN lesions after an average of 77.0 +/- 59.2 days (range, 28-188 days). Average posttreatment follow up was 12.4 +/- 2.5 months (range, 9-16 months). No patients were lost to follow-up. No recurrences have yet been seen. Side effects of treatment were limited to mild conjunctival hyperemia and follicular conjunctivitis in four (57.1%) eyes. In all cases, there was total resolution of conjunctival hyperemia and follicular changes within 1 month after cessation of the medication, without additional treatment. CONCLUSIONS: Topical IFNalpha2b alone may be an effective treatment of primary CIN. It appears to be a safe alternative to radiation, intralesional IFNalpha2b injection, and surgical excision with cryotherapy. Larger population studies with longer follow-up are recommended to better assess the risk of recurrence and other possible adverse effects.