[Bacterial corneal ulcer treated with intrastromal antibiotic. Experimental model in vivo]. / Ulcera corneal bacteriana tratada con antibiótico intraestromal. Modelo experimental in vivo.

OBJECTIVE: To compare the therapeutic effectiveness of a single intrastromal dose of gentamycin, tobramycin, ciprofloxacin and ofloxacin for the treatment of corneal ulcers due to Pseudomonas aeruginosa. METHODS: Twelve white female New Zealand rabbits underwent mechanical removal of corneal epithelium; then one drop of salt suspension containing Pseudomonas aeruginosa (75,000,000 colony forming units) was instilled over the Bowman's layer. Rabbits were distributed in five groups according to the type of antibiotic used: group A: gentamycin, group B: tobramycin, group C: ciprofloxacin, group D: ofloxacin and control groups. A single intrastromal dose of antibiotic (0.3 mg/ml) was injected 48 to 72 hours post-inoculation. A clinical digital picture was taken daily for a week. Then rabbits were sacrificed, all the corneas were collected and a histopathologic study was performed. RESULTS: We observed a significant reduction of the size of the corneal ulcer in all groups (F = 8.861; p = 0.000). Rabbits treated with ciprofloxacin, had a significant reduction in the size of the ulcer (21.1 SD 5.7 mm(2)). The epithelial growth was slow and incomplete in all groups. The histopathologic study showed Bowman's layer absence. The antibiotic used was not effective in groups A, B and D for the control of the corneal ulcer showing tissular necrosis. CONCLUSION: Group C showed greater degree of epithelization, with increased number of keratocites as well as inflammatory infiltrate as a result of greater therapeutic effectiveness (CIM < 1 mcg).

Úlcera corneal bacteriana tratada con antibiótico intraestromal. Modelo experimental in vivo / Bacterial corneal ulcer treated with intrastromal antibiotic. Experimental model in vivo

Objetivo: Estudio experimental in vivo con la finalidad de comparar la efectividad terapéutica de la administración intraestromal en dosis única diaria de gentamicina, tobramicina, ciprofloxacina y ofloxacinapara el tratamiento de úlceras corneales por Pseudomonas aeruginosa.Métodos: Se incluyeron 12 conejas blancas de Nueva Zelanda. Se les practicó desepitelización corneal central con hoja de bisturí No. 15 y se lesaplicó una gota de cultivo Pseudomonas aeruginosa en suspensión (75.000.000 unidades de colonias formadoras de bacterias). Todas las conejas recibieronantibioticoterapia a través de infiltraciónintraestromal. Se distribuyeron en cinco grupos según el antibiótico empleado: Grupo A: gentamicina, grupo B: tobramicina, grupo C: ciprofloxacina,grupo D: ofloxacina y grupos controles. A todos los ojos se les inyectó en el estroma corneal 0,3 mg/ml como dosis única antibiótica (9 mcg/0,03 ml), iniciando la terapia entre las 48-72 horas a partir de la formación de la úlcera corneal. Para su control se tomaron diariamente fotografías clínicas digitales. A los siete días los ojos fueron enucleados y las córneas extraídas para su estudio histopatológico.Resultados: Se observó disminución del tamaño de la úlcera en forma significativa en cada uno de losgrupos estudiados (F = 8,861; p = 0,000). Las conejas tratadas con ciprofloxacino, tuvieron una reducciónmás importante del tamaño de la úlcera (21,1 DE 5,7 mm2). La reepitelización corneal fue lenta y en ningún grupo se completó. El estudio histopatológicomostró ausencia de la membrana de Bowman. La concentración de los antibióticos utilizados en los grupos A, B y D no fue lo suficientementeefectiva para controlar la infección corneal por lo que ocasionó necrosis tisular.Conclusión: El grupo C presentó mayor grado de epitelización, con incremento del número de queratocitos,así como infiltrado inflamatorio mixto,como resultado de la mayor efectividad terapéutica (CIM establecida < 1 mcg)(AU)

Objective: To compare the therapeutic effectivenessof a single intrastromal dose of gentamycin,tobramycin, ciprofloxacin and ofloxacin for the treatmentof corneal ulcers due to Pseudomonas aeruginosa.Methods: Twelve white female New Zealand rabbitsunderwent mechanical removal of corneal epithelium;then one drop of salt suspension containingPseudomonas aeruginosa (75,000,000 colonyforming units) was instilled over the Bowman’slayer. Rabbits were distributed in five groups accordingto the type of antibiotic used: group A: gentamycin,group B: tobramycin, group C: ciprofloxacin,group D: ofloxacin and control groups. A singleintrastromal dose of antibiotic (0.3 mg/ml) wasinjected 48 to 72 hours post-inoculation. A clinicaldigital picture was taken daily for a week. Then rabbitswere sacrificed, all the corneas were collectedand a histopathologic study was performed.Results: We observed a significant reduction of thesize of the corneal ulcer in all groups (F = 8.861;p = 0.000). Rabbits treated with ciprofloxacin, hada significant reduction in the size of the ulcer (21.1SD 5.7 mm2). The epithelial growth was slow and incomplete in all groups. The histopathologic studyshowed Bowman’s layer absence. The antibioticused was not effective in groups A, B and D for thecontrol of the corneal ulcer showing tissular necrosis.Conclusion: Group C showed greater degree ofepithelization, with increased number of keratocitesas well as inflammatory infiltrate as a result of greatertherapeutic effectiveness(AU)

Comparison of the efficacy and safety of a novel meloxicam ophthalmic formulation with a reference diclofenac solution in cataract surgery.

A novel topical ophthalmic formulation of the preferential COX-2 inhibitor meloxicam has recently been developed. The purpose of the present study was to evaluate the efficacy and safety of this novel 0.03% meloxicam solution with regard to a reference 0.1% diclofenac formulation in a prospective, parallel, randomized, multicenter, double-blind study. Two groups of patients submitted to phacoemulsification with intraocular lens implantation were formed. Patients in one group were treated with meloxicam and those in the other group with diclofenac. Dosing was 1 drop t.i.d. for 30 days, beginning the first day after surgery, for both treatments. Inflammation was assessed by the presence of cells in the anterior chamber, anterior chamber flare, ciliary flush, photophobia and pain. Both treatments significantly reduced these indicators. Topical meloxicam and diclofenac produced a similar degree of burning sensation and conjunctival hyperemia. There was no significant difference between treatments in any of the measured parameters. It is concluded that the novel meloxicam solution is effective and safe. Meloxicam, however, did not offer any significant benefit over the diclofenac formulation in patients submitted to cataract surgery.

[Phacoemulsification cataract surgery in vitrectomized eyes]. / Facoemulsificación en ojos post-vitrectomía pars plana.

OBJECTIVE: This study focuses on determining the intra- and post-operative complications stemming from technical difficulties, anatomical aspects, intraoperatory management and visual outcome of post-vitrectomized patients that undergo phacoemulsification. METHOD: In this prospective, longitudinal, observational and descriptive study phacoemulsification was performed in 25 post-vitrectomized eyes that required cataract surgery. Pre-surgical variables: sex, age, affected eye, visual accuity, underlying vitreoretinal disease, anterior segment morphological findings such as: cataract density and pupil alterations. Intrasurgical variables: characteristic of anterior chamber and pupil, phacoemulsification technique and time and the presence of complications. Post-surgical variables were also registered: visual capacity and the presence of complications. Minimum six-month follow-up period. RESULTS: The average interval between pars plana vitrectomy and phacoemulsification was 18.5 months. Silicone oil was the most frequent tamponade used in our serie (44%). Biomicroscopical findings were miosis 28% and posterior synechies 24%. The average interval of phaco time was 2.26 minutes. The intraoperative findings were fluctuations in the anterior chamber depth (24%) and anterior capsular tears (12%). The postoperative complications most frequently seen were posterior capsular plaque (28%) and corneal edema (16%). CONCLUSIONS: Phacoemulsification is a safe and effective technique in eyes after pars plana vitrectomy that require cataract surgery. The surgeon must be aware of the morphological and anatomical findings of these eyes. Visual rehabilitation will generally be determined by the presence of an underlying vitreo-retinal pathology.

Facoemulsificación en ojos post-vitrectomía pars plana / Phacoemulsification cataract surgery in vitrectomized eyes

Objetivo: Determinar las complicaciones intra y postoperatorias en ojos de pacientes post-vitrectomizados que ameritan cirugía de catarata con técnica de facoemulsificación. Método: Estudio prospectivo, longitudinal observacional y descriptivo en 25 ojos de 25 pacientes, previa vitrectomía pars plana que requerían cirugía de catarata. Variables prequirúrguicas: edad, sexo, ojo afectado, capacidad visual, patología vitreorretiniana, características morfológicas del segmento anterior tales como grado de opacidad del cristalino, características de la cámara anterior y de la pupila. Variables intraoperatorias: técnica, tiempo de facoemulsificación y complicaciones intraoperatorias. Variables post-operatorias: Complicaciones y capacidad visual. Seguimiento no menor de 6 meses. Resultados: El tiempo promedio entre la vitrectomía pars plana y la facoemulsificación fue de 18,5 meses. La silicona fue el material de tamponamiento utilizado con mayor frecuencia 44%. Hallazgos biomicroscópicos: miosis 28% y sinequias posteriores 24%. El tiempo promedio de facoemulsificación: 2,26 minutos. Complicaciones intraoperatorias: cámara anterior inestable 24% y el desgarro de la capsulorrexis anterior 12%. La complicación post-operatoria más frecuente fue la placa subcapsular posterior 28% y el edema corneal 16%. Conclusiones: La facoemulsificación en ojos con vitrectomía pars plana previa que ameriten cirugía de catarata, es una técnica bastante segura y efectiva. El cirujano debe familiarizarse con los hallazgos y modificaciones anatómicas que sufren estos ojos. La rehabilitación visual por lo general va a estar limitada por la patología vitreo-retiniana de base(AU)

Objective: This study focuses on determining the intra- and post-operative complications stemming from technical difficulties, anatomical aspects, intraoperatory management and visual outcome of post-vitrectomized patients that undergo phacoemulsification. Method: In this prospective, longitudinal, observational and descriptive study phacoemulsification was performed in 25 post-vitrectomized eyes that required cataract surgery. Pre-surgical variables: sex, age, affected eye, visual accuity, underlying vitreoretinal disease, anterior segment morphological findings such as: cataract density and pupil alterations. Intrasurgical variables: characteristic of anterior chamber and pupil, phacoemulsification technique and time and the presence of complications. Post-surgical variables were also registered: visual capacity and the presence of complications. Minimum six-month follow-up period. Results: The average interval between pars plana vitrectomy and phacoemulsification was 18.5 months. Silicone oil was the most frequent tamponade used in our serie (44%). Biomicroscopical findings were miosis 28% and posterior synechies 24%. The average interval of phaco time was 2.26 minutes. The intraoperative findings were fluctuations in the anterior chamber depth (24%) and anterior capsular tears (12%). The postoperative complications most frequently seen were posterior capsular plaque (28%) and corneal edema (16%). Conclusions: Phacoemulsification is a safe and effective technique in eyes after pars plana vitrectomy that require cataract surgery. The surgeon must be aware of the morphological and anatomical findings of these eyes. Visual rehabilitation will generally be determined by the presence of an underlying vitreo-retinal pathology(AU)