Epithelial healing rates with topical ciprofloxacin, ofloxacin, and ofloxacin with artificial tears after photorefractive keratectomy.

PURPOSE: To determine whether corneal epithelial healing differs after the use of topical ciprofloxacin alone, topical ofloxacin alone, or topical ofloxacin with artificial tears in patients having photorefractive keratectomy (PRK). SETTING: Department of Ophthalmology and Visual Science, The University of Texas Health Science Center at Houston, Houston, Texas, USA. METHODS: Eighteen patients (6 women, 12 men) with moderate myopia (-1.50 to -6.00 diopters [D]) had standardized PRK. Patient age ranged from 25 to 62 years. The 28 eyes (16 right, 12 left) were randomized into 3 treatment groups: ofloxacin alone, n = 9 eyes; ciprofloxacin, n = 9 eyes; and ofloxacin with Refresh Plus, n = 10 eyes. The drugs were administered immediately after surgery and then every 6 hours. Video recordings of the corneal wounds stained with fluorescein were performed at 8:00 AM and 4:00 PM using a video slitlamp camera with a cobalt-blue light until the wound completely healed. The videotaped images were recorded and analyzed by a computer planimetry program. Wound areas were recorded and compared among the 3 drugs. The square-root transformation was applied to the wound area to obtain a constant healing rate. Statistical comparisons were analyzed using an analysis of variance test. RESULTS: Mean recovery time was 82.67 hours +/- 14.42 (SD) in the ofloxacin eyes, 120.89 +/- 34.05 hours in the ciprofloxacin eyes, and 76.80 +/- 19.30 hours in the ofloxacin with Refresh Plus eyes. Mean healing rate was 0.66 +/- 0.17 hours, 0.54 +/- 0.16 hours, and 0.67 +/- 0.15 hours, respectively. The healing rate was significantly higher in the ofloxacin with Refresh Plus eyes than in the ciprofloxacin eyes (P < .0001). There was no significant difference between the ofloxacin eyes and the ofloxacin with Refresh Plus eyes (P = .42). CONCLUSION: Ofloxacin with Refresh Plus and ofloxacin alone had a more positive effect on epithelial healing than ciprofloxacin. The ciprofloxacin eyes were significantly more prone to impaired or delayed wound healing and to the development of corneal haze.

The use of topical cyclosporin A in ocular graft-versus-host-disease.

Ocular manifestations of GVHD include keratoconjunctivitis sicca, cicatricial lagophthalmos, sterile conjunctivitis, persistent corneal epithelial defects, corneal ulcers and corneal melting. Conventional initial therapy such as lubrication and topical steroids is directed to treat decreased tear production and ocular surface abnormalities. The purpose of this study was to illustrate the possible benefit of topical cyclosporin A 1% (CsA) as an adjunct in managing ocular surface abnormalities in five cases of GVHD refractory to conventional therapy. Five clinical case reports of chronic GVHD patients in whom conventional therapy was inadequate to stop the progression from its initial presentation are described. Patient presentation varied in severity on a spectrum of mild to moderate diffuse punctate epithelial erosions to sterile necrotizing corneal melts. Although systemic therapy for GVHD consisting of systemic immunosuppressants (ie cyclosporin A and corticosteroids) was given to these patients, this therapy was insufficient in managing the ocular manifestations of the disease. Topical CsA was added to the treatment regimen and the progression of the ocular disease was recorded. The addition of topical CsA 1% probably helped in controlling the epithelial keratitis and melting process in our reported cases and we conclude that topical CsA may be an appropriate modality in managing ocular surface abnormalities in patients with ocular GVHD after conventional treatments have been tried. However, a further randomized clinical prospective study is needed to evaluate the efficacy of topical CsA in managing these problems in GVHD patients.

The significance of white-centered retinal hemorrhages in the shaken baby syndrome.

Retinal hemorrhages in healthy children with or without a history of associated trauma are a strong indicator of child abuse. This report describes six cases of battered infants who presented with white-centered retinal hemorrhages. We discuss potential mechanisms for the presence of white-centered retinal hemorrhages in battered children.

Membrane antigen and ligand receptor expression on neonatal monocytes.

The monocyte/macrophage cell lineage is an essential component of host defense. Functional deficiencies have been described in neonatal monocytes, but knowledge of membrane antigen and receptor ligand expression in neonatal monocytes is incomplete. In this study, antigen and receptor ligand expression of cord blood monocytes (CBM) was examined and compared to adult peripheral blood monocytes (PBM). Leu-M3 and Leu-M5 antigens were shown to be present on all CBM. Using dual fluorescence microfluorometry, the percentage and intensity of expression of HLA-DR, CD4 antigens, Fc gamma and IL-2 receptors (IL-2R) on Leu-M3+ and Leu-M5+ CBM were compared to PBM. A lower percentage of expression of HLA-DR+ (87 +/- 3% vs. 95 +/- 1%, p = 0.02) and FC gamma RII+ (96 +/- 1% vs. 99 +/- 0.2%, p = 0.04) was noted on CBM. CD4, FC gamma RI, and FC gamma RIII expression on CBM were comparable to PBM. LPS stimulation of CBM induced IL-2R expression and enhanced HLA-DR antigen expression as seen previously on PBM. These findings indicate that CBM are phenotypically comparable to adult PBM with deficiencies localized only to a few specific areas.