Traumatic optic neuropathy: to treat or not to treat? Report of two cases.

CASE REPORTS: We present two cases of blunt ocular trauma with clinical findings and complementary tests compatible with traumatic optic neuropathy (TON), and progression to sectorial optic atrophy. DISCUSSION: TON have an essentially clinical diagnosis, and in the last few years has been treated with high doses of intravenous steroids, based on weak evidence of the benefit of the steroids in cases of medular trauma. Nevertheless, subsequent studies have concluded that there is a relatively high proportion of cases in all series with spontaneous visual recovery, and there was no convincing evidence of a benefit of steroids compared to observation only.

Neuropatía óptica traumática: ¿tratar o no tratar? A propósito de dos casos / Traumatic optic neuropathy: To treat or not to treat? Report of two cases

Casos clínicos: Se presentan dos casos de traumatismo ocular contuso con hallazgos clínicos y pruebas complementarias compatibles con neuropatía óptica traumática (NOT), y evolución a atrofia sectorial de la papila. Discusión: La NOT tiene un diagnóstico primordialmente clínico y se ha tratado en los últimos años con altas dosis de corticoesteroides intravenosos, basándose en una evidencia débil de beneficio de los esteroides en traumatismos medulares. Sin embargo, estudios posteriores llevan a concluir que existe en todas las series una proporción relativamente alta de casos con recuperación visual espontánea, y ningún dato convincente de beneficio de los esteroides sobre la observación(AU)

Case reports: We present two cases of blunt ocular trauma with clinical findings and complementary tests compatible with traumatic optic neuropathy (TON), and progression to sectorial optic atrophy. Discussion: TON have an essentially clinical diagnosis, and in the last few years has been treated with high doses of intravenous steroids, based on weak evidence of the benefit of the steroids in cases of medular trauma. Nevertheless, subsequent studies have concluded that there is a relatively high proportion of cases in all series with spontaneous visual recovery, and there was no convincing evidence of a benefit of steroids compared to observation only(AU)

Nuevos fármacos en el tratamiento de las uveítis no infecciosas / New drugs in the treatment of noninfectious uveitis

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[Drug induced uveitis]. / Uveítis inducida por fármacos.

PURPOSE: To review the world literature about drug induced uveitis. METHODS: We used the OMS and Naranjo criteria of causality of adverse drug reactions to classify the causes of drug induced uveitis. These have been classified into certain, probable and possible causes. We described the clinical features associated with each drug. RESULTS: Certain causes of uveitis are byphosphonates, topiramato and metipranolol eyedrops. Probable causes are rifabutin, sulfonamides, cidofovir, immunorecovery in patients following HAART therapy, topical corticosteroids, latanoprost, and intravitreous triamcinolone acetate. Possible causes of uveitis include bimatoprost, travoprost, brimonidine, other eyedrops and intraocular drugs, tubulointerstitial nephritis and uveitis (TINU) produced by nonsteroidal drugs, iopamidol, diethylcarbamazepine, interleukins 3 and 6, oral contraceptives, quinidine, vaccines and cobalt, ibuprofen and moxifloxacin. CONCLUSION: Drug induced uveitis is an entity of low incidence, anterior iridocyclitis is the commonest clinical picture, visual acuity is moderately diminished, and if use of the drug is ceased uveitis does not recur.

Uveítis inducida por fármacos / Drug induced uveitis

Objetivo: Revisión de la literatura de los casos de uveítis inducida por fármacos.Métodos: Aplicación de los criterios de la OMS y de Naranjo para clasificar según lo publicado en la literatura los casos de uveítis inducida por fármacos en reacciones de causalidad cierta, probable y posible. Descripción de los cuadros clínicos de uveítis asociados a cada fármaco.Resultados: Uveítis de causalidad cierta son la causadas: por bifosfonatos, topiramato y metipranolol tópico. Uveítis de causalidad probable: Rifabutina, sulfonamidas, cidofovir, inmunorrecuperación por terapia HAART, corticoides tópicos, latanoprost y acetato de triamcinolona intravítreo. Uveítis de causalidad sólo posible por: bimatoprost, travopost, brimonidina, otras medicaciones tópicas y fármacos intraoculares, síndrome TINU asociado a AINES, contraste yodado no iónico (iopamidol), dietilcarbamazepina, interleukina 3 y 6, contraceptivos orales, quinidina vacunas y cobalto, ibuprofeno y moxifloxacino.Conclusiones: La uveítis inducida por fármacos es una entidad de baja frecuencia, que produce uveítis principalmente anterior solamente, con afectación moderada de agudeza visual y que cuando se suspende el fármaco no tiene recurrencias

Purpose: To review the world literature about drug induced uveitis.Methods: We used the OMS and Naranjo criteria of causality of adverse drug reactions to classify the causes of drug induced uveitis. These have been classified into certain, probable and possible causes. We described the clinical features associated with each drug.Results: Certain causes of uveitis are byphosphonates, topiramato and metipranolol eyedrops. Probable causes are rifabutin, sulfonamides, cidofovir, immunorecovery in patients following HAART therapy, topical corticosteroids, latanoprost, and intravitreous triamcinolone acetate. Possible causes of uveitis include bimatoprost, travoprost, brimonidine, other eyedrops and intraocular drugs, tubulointerstitial nephritis and uveitis (TINU) produced by nonsteroidal drugs, iopamidol, diethylcarbamazepine, interleukins 3 and 6, oral contraceptives, quinidine, vaccines and cobalt, ibuprofen and moxifloxacin.Conclusion: Drug induced uveitis is an entity of low incidence, anterior iridocyclitis is the commonest clinical picture, visual acuity is moderately diminished, and if use of the drug is ceased uveitis does not recur

Acute iridocyclitis in a patient with AIDS diagnosed as toxoplasmosis by PCR.

PURPOSE: To study the etiology of an acute iridocyclitis in a patient with AIDS using polymerase chain reaction (PCR) analysis of aqueous humor. METHODS: Case report describing a patient diagnosed with toxoplasmic retinochoroiditis in his left eye. He stopped his treatment after three weeks and subsequently developed an acute iridocyclitis without chorioretinitis in the fellow eye. Anterior chamber paracentesis was performed and aqueous humor was assayed by PCR. RESULTS: PCR of the aqueous humor showed positivity for Toxoplasma gondii. The iridocyclitis responded to topical dexamethasone and oral treatment with pyrimethamine and sulfadiazine. CONCLUSION: PCR is an effective method to diagnose toxoplasmic iridocyclitis in a patient with AIDS.

Antibacterial and antifungal effects of soft contact lens disinfection solutions.

AIMS: To study the antibacterial and antifungal effects of soft contact lens disinfection solutions. METHODS: Eight contact lens disinfection solutions containing hydrogen peroxide or biguanides or polyquad compounds were evaluated with respect to their ability to disinfect a saline solution experimentally contaminated with different bacteria and with a fungus. We used cultures in blood Agar, MuellerHinton agar and Saboureaud's agar to identify the bacterial and fungal growth following 14 h of exposure to the disinfection solutions. RESULTS: Hydrogen peroxide, DYMED and polyhexamide solutions prevented the growth of the four bacteria studied. The solution containing biguanide prevented the growth of Escherichia coli and Staphylococcus epidermidis. The solution with polyquad solution only prevented the growth of Staphylococcus epidermidis and none of the disinfection solutions prevented the growth of Candida albicans. The control solution, which was saline, did not prevent the growth of either bacteria or fungi. CONCLUSIONS: Disinfection solutions containing hydrogen peroxide, or DYMED or polyhexamide can disinfect these four bacteria but none of them prevented the growth of Candida albicans.

Goldmann applanation tonometry using sterile disposable silicone tonometer shields.

PURPOSE: Placement of a sterile single-use cover over the tonometer tip may be a convenient and safe alternative method to repeated chemical disinfection. This study was undertaken to evaluate the accuracy and performance of Goldmann applanation tonometry using a sterile disposable silicone tonometer shield over the biprism tip. METHODS: The same investigator measured intraocular pressure in 120 eyes with and without the shield. The eyes were tested randomly first with either the uncovered or the covered tonometer to control for the possible effects of repeated tonometry influencing measurement differences. Readings were recorded independently in a masked fashion. RESULTS: The intraocular pressure measurements evaluated with the silicone shield caused an average overestimation of the true intraocular pressure of 1.9 +/- 1.9 mmHg (P = 0.0001). Covered and uncovered readings correlated well (r = 0.91, P = 0.0001). The sensitivity and specificity of the covered tonometry in detection intraocular pressures of 21 mmHg or higher (as measured without the shield) were 96.3% and 68.8%, respectively. Minor distortions of the normal-appearing fluorescein bands were seen in 5% of the tonometries, and the shield had to be replaced because of bubbles or wrinkles on the applanating surface in 3.3% of the measurements, which means that care must be taken when fitting the shield. CONCLUSIONS: Although covered and uncovered tonometry readings correlated well, an overall trend for a slightly increased measured intraocular pressure as a result of using the silicone shield over the Goldmann tonometer tip was found. The outstanding sensitivity of this procedure in detecting increased intraocular pressure suggests that it can be useful in screening for ocular hypertension and glaucoma.

Prospective trial of intraoperative mitomycin C in the treatment of primary pterygium.

AIMS: A prospective, randomised, double blind, placebo controlled study of intraoperative mitomycin C as adjunctive treatment of primary pterygium was conducted. METHODS: A total of 66 eyes of 54 patients with primary pterygium were treated with excision, with or without a single intraoperative application of mitomycin C (0.1 mg/ml for 5 minutes) to evaluate the efficacy and toxicity of this adjunctive treatment. The mean follow up was 14.1 months (range 12-23 months). RESULTS: Of the 36 eyes that underwent simple excision, 14 (38.8%) exhibited recurrences whereas only one of 30 eyes (3.33%) treated with excision and intraoperative application of mitomycin C had recurrence (p = 0.0006). Neither serious ocular complications nor systemic toxicity were noted in the mitomycin C treated group. CONCLUSION: Intraoperative mitomycin C appears to be an effective and safe adjunctive treatment of primary pterygium.