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1.
Cornea ; 41(10): 1305-1307, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-36107850

RESUMO

PURPOSE: Oleander is a poisonous plant with extensively documented systemic side effects; however, oleander's ophthalmic side effects have not been detailed in the literature. We report a case of oleander-associated keratitis with subsequent corneal edema and anterior uveitis. METHODS: This is a case report and review of relevant literature. RESULTS: A 58-year-old woman presented with large corneal epithelial defect after being struck in the eye with an oleander leaf. Despite treatment with topical moxifloxacin, she developed severe corneal edema and anterior uveitis. A diagnosis of oleander-associated ocular inflammation with secondary corneal edema was made, given the temporal relationship, and treatment was initiated with topical prednisolone and cyclopentolate. However, the corneal edema and inflammation continued to progress until oral prednisone and topical difluprednate were initiated. Visual acuity, anterior uveitis, and corneal edema significantly improved with aggressive immunomodulation. Follow-up at 1 month confirmed complete recovery of symptoms, corneal edema and anterior uveitis. CONCLUSIONS: Severe corneal edema and anterior uveitis can be associated with oleander exposure. Aggressive treatment with oral and topical steroids may be required without persistent sequelae at the 5-month follow-up. Ophthalmologists should consider this inflammatory reaction if patients experience ocular exposure to oleander.


Assuntos
Edema da Córnea , Ceratite , Nerium , Uveíte Anterior , Edema da Córnea/etiologia , Ciclopentolato/uso terapêutico , Feminino , Humanos , Inflamação , Ceratite/diagnóstico , Ceratite/tratamento farmacológico , Ceratite/etiologia , Pessoa de Meia-Idade , Moxifloxacina/uso terapêutico , Prednisolona/uso terapêutico , Prednisona/uso terapêutico , Uveíte Anterior/diagnóstico , Uveíte Anterior/tratamento farmacológico , Uveíte Anterior/etiologia
2.
Eur J Ophthalmol ; 32(6): NP24-NP27, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34015953

RESUMO

INTRODUCTION: Moraxella nonliquefaciens (M. nonliquefaciens) is a low pathogenicity microorganism, which rarely causes ocular infections, unless there is a predisposing factor. The main clinical manifestation of M. nonliquefaciens ocular infections is endophthalmitis and only five cases of corneal infection have been reported. This work shows an update in M. nonliquefaciens corneal infections, and the first reported case of keratitis due to M. nonliquefaciens superinfecting herpes simplex infection. CASE REPORT: A 84-year old woman with worsening of her herpes simplex keratitis, diagnosed, and treated 2 days before. The slit lamp showed deep paracentral infiltrate and hypopyon. A corneal sample was collected for culture prior to initiation of empiric antibiotic therapy with vancomycin and ceftazidime fortified, oral acyclovir, and cyclopentolate. The strain was identified as M. nonliquefaciens and topical antibiotic therapy was adjusted to ciprofloxacin and ceftazidime. After 2 weeks, the epithelial defect and the infiltrate were resolved and prednisolone was added to the regimen. As the corneal oedema and neovascularization decreased, acyclovir, and prednisolone were slowly tapered. About 4 months later, the visual outcome was 20/50 and the ophthalmic examination showed a clear cornea with a paracentral leucoma. CONCLUSION: Keratitis due to M. nonliquefaciens is rare and should be suspected in patients with local predisposing factors such as corneal damage or previous corneal infection. Prompt and appropriate combined treatment for the predisposing lesions and the keratitis may improve the prognosis and avoid a more aggressive approach.


Assuntos
Ceftazidima , Ceratite Herpética , Aciclovir/uso terapêutico , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Ceftazidima/uso terapêutico , Ciprofloxacina/uso terapêutico , Ciclopentolato/uso terapêutico , Feminino , Humanos , Ceratite Herpética/diagnóstico , Ceratite Herpética/tratamento farmacológico , Moraxella , Prednisolona/uso terapêutico , Vancomicina/uso terapêutico
3.
Arch. Soc. Esp. Oftalmol ; 95(9): 447-450, sept. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-201786

RESUMO

Describir los signos clínicos y el manejo del desprendimiento de la membrana de Descemet (MD) secundario a un traumatismo relacionado con fórceps durante el parto. Un recién nacido a término de 2 días de edad se presentó con opacidad corneal del ojo derecho y antecedentes de parto con fórceps. La evaluación oftalmológica fue consistente para traumatismo corneal, y en la tomografía de coherencia óptica del segmento anterior (OCT-SA Visante®) se objetivó un desprendimiento de la membrana de Descemet (MD). El tratamiento tópico prolongado redujo considerablemente el edema, y después de 4 meses con este, el desprendimiento persistía en su porción superior, la inyección de aire en la cámara anterior llegado a este punto tampoco logró la reaplicación. El eje visual se mantuvo parcialmente transparente durante los meses siguientes, y se indicó terapia visual intensiva para evitar la ambliopía. El tratamiento tópico prolongado puede ser útil para reducir el edema y el riesgo de ambliopía severa en las lesiones de la MD secundarias al traumatismo por fórceps durante el parto, pero puede ser insuficiente en casos donde coexista también un desprendimiento de esta


To describe the clinical signs and management of Descemet membrane (DM) detachment after forceps-related trauma during birth. A 2-day-old term infant presented with right eye corneal clouding and history of forceps assisted delivery. Ophthalmic assessment was consistent for corneal trauma and anterior segment optical coherence tomography (AS-OCT Visante®) revealed DM detachment. Prolonged topical treatment considerably reduced edema, but after four months of treatment superior DM detachment persisted, anterior chamber air injection at this point also failed to achieve apposition. Central visual axis remained partially spared in the months to follow, and intensive amblyopia treatment was indicated. Prolonged topical treatment may be helpful to reduce edema and risk of severe amblyopia in DM tears secondary to forceps traumatism at birth, but insufficient in cases of large DM detachment


Assuntos
Humanos , Recém-Nascido , Lâmina Limitante Posterior/lesões , Edema da Córnea/etiologia , Opacidade da Córnea/etiologia , Forceps Obstétrico/efeitos adversos , Lâmina Limitante Posterior/cirurgia , Lâmina Limitante Posterior/diagnóstico por imagem , Edema da Córnea/diagnóstico por imagem , Opacidade da Córnea/diagnóstico por imagem , Opacidade da Córnea/cirurgia , Complicações do Trabalho de Parto/terapia , Dexametasona/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Timolol/uso terapêutico , Antagonistas Adrenérgicos beta/uso terapêutico , Ciclopentolato/uso terapêutico , Tomografia de Coerência Óptica
4.
J Glaucoma ; 29(8): e83-e86, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32487951

RESUMO

Daratumumab is an anti-CD38 monoclonal antibody approved for use in multiple myeloma in 2015 and under investigation for use in light-chain amyloidosis. We report a case of a patient with amyloidosis who developed bilateral, acute secondary angle closure during an infusion of daratumumab. Ultrasound biomicroscopy obtained 3 days after the onset of her symptoms demonstrated the cause to be bilateral choroidal effusions. Taken together with several previous case reports, the evidence suggests that, like topiramate, daratumumab is associated with the idiosyncratic reaction of choroidal effusions, resulting in a spectrum of clinical outcomes from myopic shift to acute angle closure. The treating oncologist and eye care provider should be aware of these adverse outcomes in any patient undergoing treatment with this medication, as swift recognition and intervention may be vision-saving.


Assuntos
Anticorpos Monoclonais/efeitos adversos , Antineoplásicos/efeitos adversos , Glaucoma de Ângulo Fechado/induzido quimicamente , Administração Oftálmica , Amiloidose/tratamento farmacológico , Anticorpos Monoclonais/administração & dosagem , Antineoplásicos/administração & dosagem , Efusões Coroides/diagnóstico por imagem , Efusões Coroides/tratamento farmacológico , Ciclopentolato/uso terapêutico , Combinação de Medicamentos , Oftalmopatias/tratamento farmacológico , Feminino , Glaucoma de Ângulo Fechado/diagnóstico por imagem , Glaucoma de Ângulo Fechado/tratamento farmacológico , Glucocorticoides/uso terapêutico , Gonioscopia , Humanos , Infusões Intravenosas , Pressão Intraocular/efeitos dos fármacos , Microscopia Acústica , Pessoa de Meia-Idade , Antagonistas Muscarínicos/uso terapêutico , Prednisolona/uso terapêutico
5.
Sci Rep ; 10(1): 9646, 2020 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-32541775

RESUMO

Posterior chamber phakic intraocular lens (pIOL) implantation is a common option for correcting moderate-to-high ocular refractive defects. Because this pIOL is implanted on ciliary sulcus, the distance between the back surface of the pIOL and the anterior surface of the crystalline lens, that it is known as vault, should be measured in different conditions to ensure the technique's safety. Cyclopentolate is a drug that dilates the pupil and relaxes accommodation (cycloplegia). It is often used for different ocular examinations and for other medical purposes. However, there is no evidence of the effect of this drug on vault. This study quantified central vault changes associated with cyclopentolate instillation. We measured the vault under normal conditions (pre-cycloplegic instillation) and after instilling cyclopentolate on 39 eyes of 39 patients with implanted pIOL. Our results suggest that cyclopentolate instillation may induce changes to vault in eyes with implanted pIOL. These changes seem safe and are mainly associated with vault under normal conditions, but also with anterior chamber depth, pupillary diameter and pIOL size.


Assuntos
Câmara Anterior/efeitos dos fármacos , Ciclopentolato/uso terapêutico , Implante de Lente Intraocular/métodos , Midriáticos/uso terapêutico , Lentes Intraoculares Fácicas , Adulto , Câmara Anterior/anatomia & histologia , Câmara Anterior/diagnóstico por imagem , Ciclopentolato/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Midriáticos/administração & dosagem , Soluções Oftálmicas , Tomografia de Coerência Óptica , Adulto Jovem
6.
Open Vet J ; 10(1): 59-67, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32426258

RESUMO

Background: Cyclopentolate is not commonly used as mydriatic drug in veterinary medicine because of limited data on the local and systemic effects in animals. Aim: To determine the effects of topical 1% cyclopentolate hydrochloride on intraocular pressure (IOP), horizontal pupil diameter (HPD) and tear production in the cat and rabbit's eye during the first hour and up to 36 hours after treatment. Methods: One drop of 1% cyclopentolate hydrochloride was used in the left eye in 10 clinically and ophthalmologically healthy domestic cats and 10 rabbits. IOP and HPD were recorded every 5 minutes during the first hour, then every 2 hours during the following 12-hour period, and at 24 and 36 hours after application. Schirmer tear test (STT) was measured at 30 and 60 minute after treatment, then in same time points as IOP and HPD. Rebound tonometer (TonoVet®) was used to assess IOP, Jameson calliper to measure HPD and STT to determine the tear production. Results: 1% cyclopentolate increased IOP in cats, reaching a maximum (28.1 ± 5.4 mmHg) at T50 and in rabbits at T25 (16.7 ± 1.3 mmHg). Maximal mydriasis in cats was observed at T40 and lasted 24-36 hours, but in rabbits at T25, and returned to pre-treatment values at T10h-T12h. In cats, STT decreased in both eyes 30 minutes after treatment and remained lower throughout the 36-hour period. In rabbits, STT decreased in the treated eye 30 minutes after treatment, but all following STT measurements returned to normal pre-treatment levels. Conclusion: Study showed novel data about the effects of 1% cyclopentolate to IOP, HPD, STT in cats and rabbits. Cyclopentolate in cats caused mydriasis 20-40 minutes after the treatment by increasing IOP, at the same time, pupil diameter reached pre-treatment values 24-36 hours after treatment. In rabbit's mydriasis occurred faster, 10-25 minutes after treatment without significant IOP increase and mydriasis lasted 10-12 hours. Significant STT decrease was recorded in cats, but more likely were connected to stress factors. This drug could be considered as a therapeutical alternative in rabbit more than in cats.


Assuntos
Doenças do Gato/tratamento farmacológico , Ciclopentolato/farmacologia , Doenças do Aparelho Lacrimal/veterinária , Midriáticos/farmacologia , Soluções Oftálmicas/farmacologia , Animais , Gatos , Ciclopentolato/administração & dosagem , Ciclopentolato/uso terapêutico , Pressão Intraocular/efeitos dos fármacos , Doenças do Aparelho Lacrimal/tratamento farmacológico , Midriáticos/administração & dosagem , Midriáticos/uso terapêutico , Soluções Oftálmicas/administração & dosagem , Soluções Oftálmicas/uso terapêutico , Pupila/efeitos dos fármacos , Coelhos , Valores de Referência , Lágrimas/efeitos dos fármacos , Tonometria Ocular/veterinária
8.
Cochrane Database Syst Rev ; 1: CD004916, 2020 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-31930781

RESUMO

BACKGROUND: Nearsightedness (myopia) causes blurry vision when one is looking at distant objects. Interventions to slow the progression of myopia in children include multifocal spectacles, contact lenses, and pharmaceutical agents. OBJECTIVES: To assess the effects of interventions, including spectacles, contact lenses, and pharmaceutical agents in slowing myopia progression in children. SEARCH METHODS: We searched CENTRAL; Ovid MEDLINE; Embase.com; PubMed; the LILACS Database; and two trial registrations up to February 2018. A top up search was done in February 2019. SELECTION CRITERIA: We included randomized controlled trials (RCTs). We excluded studies when most participants were older than 18 years at baseline. We also excluded studies when participants had less than -0.25 diopters (D) spherical equivalent myopia. DATA COLLECTION AND ANALYSIS: We followed standard Cochrane methods. MAIN RESULTS: We included 41 studies (6772 participants). Twenty-one studies contributed data to at least one meta-analysis. Interventions included spectacles, contact lenses, pharmaceutical agents, and combination treatments. Most studies were conducted in Asia or in the United States. Except one, all studies included children 18 years or younger. Many studies were at high risk of performance and attrition bias. Spectacle lenses: undercorrection of myopia increased myopia progression slightly in two studies; children whose vision was undercorrected progressed on average -0.15 D (95% confidence interval [CI] -0.29 to 0.00; n = 142; low-certainty evidence) more than those wearing fully corrected single vision lenses (SVLs). In one study, axial length increased 0.05 mm (95% CI -0.01 to 0.11) more in the undercorrected group than in the fully corrected group (n = 94; low-certainty evidence). Multifocal lenses (bifocal spectacles or progressive addition lenses) yielded small effect in slowing myopia progression; children wearing multifocal lenses progressed on average 0.14 D (95% CI 0.08 to 0.21; n = 1463; moderate-certainty evidence) less than children wearing SVLs. In four studies, axial elongation was less for multifocal lens wearers than for SVL wearers (-0.06 mm, 95% CI -0.09 to -0.04; n = 896; moderate-certainty evidence). Three studies evaluating different peripheral plus spectacle lenses versus SVLs reported inconsistent results for refractive error and axial length outcomes (n = 597; low-certainty evidence). Contact lenses: there may be little or no difference between vision of children wearing bifocal soft contact lenses (SCLs) and children wearing single vision SCLs (mean difference (MD) 0.20D, 95% CI -0.06 to 0.47; n = 300; low-certainty evidence). Axial elongation was less for bifocal SCL wearers than for single vision SCL wearers (MD -0.11 mm, 95% CI -0.14 to -0.08; n = 300; low-certainty evidence). Two studies investigating rigid gas permeable contact lenses (RGPCLs) showed inconsistent results in myopia progression; these two studies also found no evidence of difference in axial elongation (MD 0.02mm, 95% CI -0.05 to 0.10; n = 415; very low-certainty evidence). Orthokeratology contact lenses were more effective than SVLs in slowing axial elongation (MD -0.28 mm, 95% CI -0.38 to -0.19; n = 106; moderate-certainty evidence). Two studies comparing spherical aberration SCLs with single vision SCLs reported no difference in myopia progression nor in axial length (n = 209; low-certainty evidence). Pharmaceutical agents: at one year, children receiving atropine eye drops (3 studies; n = 629), pirenzepine gel (2 studies; n = 326), or cyclopentolate eye drops (1 study; n = 64) showed significantly less myopic progression compared with children receiving placebo: MD 1.00 D (95% CI 0.93 to 1.07), 0.31 D (95% CI 0.17 to 0.44), and 0.34 (95% CI 0.08 to 0.60), respectively (moderate-certainty evidence). Axial elongation was less for children treated with atropine (MD -0.35 mm, 95% CI -0.38 to -0.31; n = 502) and pirenzepine (MD -0.13 mm, 95% CI -0.14 to -0.12; n = 326) than for those treated with placebo (moderate-certainty evidence) in two studies. Another study showed favorable results for three different doses of atropine eye drops compared with tropicamide eye drops (MD 0.78 D, 95% CI 0.49 to 1.07 for 0.1% atropine; MD 0.81 D, 95% CI 0.57 to 1.05 for 0.25% atropine; and MD 1.01 D, 95% CI 0.74 to 1.28 for 0.5% atropine; n = 196; low-certainty evidence) but did not report axial length. Systemic 7-methylxanthine had little to no effect on myopic progression (MD 0.07 D, 95% CI -0.09 to 0.24) nor on axial elongation (MD -0.03 mm, 95% CI -0.10 to 0.03) compared with placebo in one study (n = 77; moderate-certainty evidence). One study did not find slowed myopia progression when comparing timolol eye drops with no drops (MD -0.05 D, 95% CI -0.21 to 0.11; n = 95; low-certainty evidence). Combinations of interventions: two studies found that children treated with atropine plus multifocal spectacles progressed 0.78 D (95% CI 0.54 to 1.02) less than children treated with placebo plus SVLs (n = 191; moderate-certainty evidence). One study reported -0.37 mm (95% CI -0.47 to -0.27) axial elongation for atropine and multifocal spectacles when compared with placebo plus SVLs (n = 127; moderate-certainty evidence). Compared with children treated with cyclopentolate plus SVLs, those treated with atropine plus multifocal spectacles progressed 0.36 D less (95% CI 0.11 to 0.61; n = 64; moderate-certainty evidence). Bifocal spectacles showed small or negligible effect compared with SVLs plus timolol drops in one study (MD 0.19 D, 95% CI 0.06 to 0.32; n = 97; moderate-certainty evidence). One study comparing tropicamide plus bifocal spectacles versus SVLs reported no statistically significant differences between groups without quantitative results. No serious adverse events were reported across all interventions. Participants receiving antimuscarinic topical medications were more likely to experience accommodation difficulties (Risk Ratio [RR] 9.05, 95% CI 4.09 to 20.01) and papillae and follicles (RR 3.22, 95% CI 2.11 to 4.90) than participants receiving placebo (n=387; moderate-certainty evidence). AUTHORS' CONCLUSIONS: Antimuscarinic topical medication is effective in slowing myopia progression in children. Multifocal lenses, either spectacles or contact lenses, may also confer a small benefit. Orthokeratology contact lenses, although not intended to modify refractive error, were more effective than SVLs in slowing axial elongation. We found only low or very low-certainty evidence to support RGPCLs and sperical aberration SCLs.


Assuntos
Miopia Degenerativa/terapia , Soluções Oftálmicas/uso terapêutico , Atropina/uso terapêutico , Criança , Lentes de Contato , Ciclopentolato/uso terapêutico , Humanos , Antagonistas Muscarínicos/uso terapêutico , Pirenzepina/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
Toxicol Lett ; 303: 9-15, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30572106

RESUMO

Sulfur mustard (SM) was responsible for more than 80% of all documented chemical casualties during the Great War. Recent literature on clinic picture of SM exposure remained so limited with the sporadic cases who were accidentally exposed to SM especially either in Western Europe or China. We reported a Syrian family of four who became victims of chemical terrorism due to SM exposure and we described the detailed clinical course of the family including the medical history, initial symptomatology, clinical examination, hematological data, and initial treatment in the first 48 hours after exposure at Kilis State Hospital, Turkey. The principles of our therapeutic approaches were designed according to the total affected body surface area, severity of cutaneous and respiratory lesions, and existing hematological disorders. SM is still considered as a critical vesicant agent and a current threat because of its ease of synthesis. Chemical terrorist attacks of non-state actors or terrorist organizations with "home-made" SM is likely such a threat which is targeting health systems of developed and developing countries. Except sarin attacks in Japan, the literature depends on real incidents of chemical terrorism is so rare and for this reason we have gaps and challanges in the prepardness of medical response system against chemical terrorism. Medical management could be performed adequetly only if the response system is well planned, well equipped, and well prepared for overburdened medical facilities filled with SM contaminated casualties after a chemical terrorist attack.


Assuntos
Terrorismo Químico , Gás de Mostarda/toxicidade , Acetaminofen/uso terapêutico , Acetilcisteína/uso terapêutico , Administração Cutânea , Administração por Inalação , Adulto , Albuterol/uso terapêutico , Povo Asiático , Pré-Escolar , Ciclopentolato/uso terapêutico , Feminino , Gentamicinas/uso terapêutico , Humanos , Recém-Nascido , Lidocaína/uso terapêutico , Masculino , Metilprednisolona/uso terapêutico , Sulfadiazina de Prata/uso terapêutico , Pele/efeitos dos fármacos , Pele/patologia , Síria , Terrorismo , Turquia
10.
Arch Soc Esp Oftalmol (Engl Ed) ; 93(10): 511-514, 2018 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29910082

RESUMO

CLINICAL CASE: The case concerns an 81-year-old woman on treatment with a topical fixed combination of timolol and brimonidine who was diagnosed in the Emergency Department with acute anterior granulomatous hypertensive uveitis. The patient responded favourably to the withdrawal of the eye drops without showing any subsequent relapse. DISCUSSION: Uveitis due to brimonidine is a rare adverse effect, but it must be known. Once the diagnosis is suspected, the effective treatment is the withdrawal of brimonidine, with or without the addition of topical corticosteroids to control inflammation depending on the severity of the condition. It is a process with an excellent prognosis.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/efeitos adversos , Tartarato de Brimonidina/efeitos adversos , Soluções Oftálmicas/efeitos adversos , Uveíte Anterior/induzido quimicamente , Doença Aguda , Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Idoso de 80 Anos ou mais , Tartarato de Brimonidina/uso terapêutico , Conjuntivite Alérgica/induzido quimicamente , Ciclopentolato/uso terapêutico , Quimioterapia Combinada , Epitélio Corneano/patologia , Feminino , Glaucoma de Ângulo Aberto/tratamento farmacológico , Granuloma/induzido quimicamente , Humanos , Latanoprosta/uso terapêutico , Lubrificantes Oftálmicos , Hipertensão Ocular/induzido quimicamente , Prednisolona/análogos & derivados , Prednisolona/uso terapêutico , Sulfonamidas/uso terapêutico , Tiofenos/uso terapêutico , Timolol/uso terapêutico , Uveíte Anterior/diagnóstico , Uveíte Anterior/tratamento farmacológico
13.
J Fam Pract ; 66(12): E9-E11, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29202152

RESUMO

A 67-year-old man presented to the hospital with subacute loss of vision in his left eye. The visual changes began 2 weeks earlier, with a central area of visual loss that had since progressed to near complete vision loss in the left eye. Physical examination revealed patchy alopecia, a scaling and hyperkeratotic rash of his hands and feet, and blanching, erythematous plaques with associated scaling on the scrotum and glans penis. Ophthalmologic examination revealed 1/200 vision in his left eye with a large plaque occupying a substantial portion of the superior quadrant, smaller perifoveal plaques in both of his eyes, and a small infiltrate above the left optic nerve head. The patient also described fatigue, loss of taste, and an unintentional weight loss of 7 to 10 kg over the previous 6 months. He had seen his primary care provider 3 months prior for a burning sensation and scaling rash on his feet and hands, and was prescribed a topical steroid.


Assuntos
Infecções por HIV/diagnóstico , Sífilis/diagnóstico , Idoso , Antibacterianos/uso terapêutico , Fármacos Anti-HIV/uso terapêutico , Biópsia , Coinfecção , Ciclopentolato/uso terapêutico , Diagnóstico Diferencial , Exantema/diagnóstico , Exantema/tratamento farmacológico , Glucocorticoides/uso terapêutico , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Midriáticos/uso terapêutico , Penicilinas/uso terapêutico , Prednisolona/uso terapêutico , Sífilis/tratamento farmacológico , Transtornos da Visão/diagnóstico , Transtornos da Visão/tratamento farmacológico
14.
Clin Exp Optom ; 100(6): 595-597, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28125856

RESUMO

OBJECTIVES: The aim was to evaluate the effectiveness of topical cyclopentolate following pterygium surgery for post-operative ocular pain. METHODS: All participants had nasal pterygium and underwent pterygium excision and conjunctival autografting with fibrin glue. Participants were randomised into two groups. Participants in group 1 received one per cent cyclopentolate eye drops and artificial tears upon completing surgery and were prescribed self-administered drops three times daily for three days, while participants in group 2 received a control (artificial tears) in a manner identical to group 1. Data were gathered regarding post-operative pain intensity experienced during each of the three days. Pain was graded from zero to 10 according to a visual analogue scale, in which zero signified no pain and 10 signified severe, unbearable pain. RESULTS: This study analysed data regarding 38 participants in group 1 and 40 participants in group 2. Results were defined as median with interquartile range (IQR); median of the pain scores at days one, two and three were as follows, respectively: 4 (IQR 2), 2.5 (IQR 1) and 2 (IQR 1.25) for group 1 and 5 (IQR 1), 3 (IQR 1.75) and 3 (IQR 1) for group 2. Pain scores were significantly lower for group 1 compared with group 2 at days one, two and three (p < 0.05). CONCLUSIONS: Topical cyclopentolate seems to be effective and well tolerated following pterygium surgery for post-operative ocular pain.


Assuntos
Ciclopentolato/uso terapêutico , Dor Ocular/tratamento farmacológico , Midriáticos/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Pterígio/cirurgia , Administração Oftálmica , Adulto , Túnica Conjuntiva/transplante , Ciclopentolato/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Midriáticos/administração & dosagem , Soluções Oftálmicas , Procedimentos Cirúrgicos Oftalmológicos , Medição da Dor , Satisfação do Paciente , Inquéritos e Questionários , Transplante Autólogo , Adulto Jovem
15.
Arch Soc Esp Oftalmol ; 91(11): 543-546, 2016 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27179669

RESUMO

CLINICAL CASE: A 44-year-old woman arrived in the emergency department complaining of decreased visual acuity (VA) in oculus uterque (OU) of 4hours onset. Signs of myopia, increased intraocular pressure (IOP) in OU, and a narrow grade II anterior chamber (AC) were observed. In the posterior segment ultrasound scan, a choroidal peripheral detachment is evident, and a lenticular thickness of 4.05mm is measured in the anterior segment of the right eye (OD) and 4.00mm in the left eye (OS). On treatment with oral with naproxen (non-steroidal anti-inflammatory drug), and acetazolamide for migraine. The acetazolamide is suspended and topical treatment is started with timolol and brimonidine every 12hours, with prednisolone and ayclopentolate every 8hours. In the follow-up, a gradual reduction of myopia and lens thickness is observed, as well as anterior chamber expansion. In the last control, the patient had a sphere of -0.75 diopters (D) in OD and -0.25 D in OS. IOP was 15mmHg in OU and AC was grade III. The ultrasound showed a lens thickness of 3.59mm in OD and 3.61mm in OS. CONCLUSION: This was an iatrogenic case of acute angle closure induced by an anterior displacement of the irido-lenticular complex, secondary to the use of acetazolamide. The treatment of this condition involves suspending the drug responsible and applying topical corticosteroids, hypotensive and cycloplegic eye drops, with the aim of lowering the eye pressure and the degree of myopia due to the re-positioning of the irido-lenticular complex.


Assuntos
Acetazolamida/efeitos adversos , Glaucoma de Ângulo Fechado/induzido quimicamente , Prednisolona/uso terapêutico , Acetazolamida/farmacologia , Acetazolamida/uso terapêutico , Doença Aguda , Adulto , Tartarato de Brimonidina/uso terapêutico , Ciclopentolato/uso terapêutico , Quimioterapia Combinada , Feminino , Glaucoma de Ângulo Fechado/tratamento farmacológico , Humanos , Iris/efeitos dos fármacos , Cristalino/efeitos dos fármacos , Transtornos de Enxaqueca/tratamento farmacológico , Timolol/uso terapêutico
18.
J Refract Surg ; 31(12): 851-3, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26653732

RESUMO

PURPOSE: To report the role of aberrometry in a case of accommodative spasm following myopic photorefractive keratectomy (PRK). METHODS: Observational case report. RESULTS: One month following myopic PRK, a 33-year-old healthy woman complained of seeing multiple images and headache that interfered with her daily activities. Her corrected distance visual acuity (CDVA) was 20/40 in the right eye and 20/25 in the left eye with a manifest refraction of -0.75 -0.50 × 165° in the right eye and plano -0.50 × 20° in the left eye. Cycloplegic refraction was plano -0.50 × 165° in the right eye and plano -0.5 × 20° in the left eye. Ray tracing aberrometry showed variable refraction with increase in internal defocus, which after cycloplegia reduced from 1.019 to 0.142 µm in the right eye and 0.366 to 0.230 µm in the left eye. Total ocular aberrations decreased by 53.16% in the right eye (range: 1.511 to 0.708 µm) and 18.77% (range: 0.671 to 0.545 µm) in the left eye; corresponding simulated Snellen visual acuity charts also showed improvement. The patient was treated with one drop of cyclopentolate 1% three times a day for 6 weeks, following which headache and ghosting of images completely resolved. CONCLUSIONS: Accommodative spasm should be considered in patients with visual disturbances of uncertain causes following myopic refractive surgery. Ray tracing aberrometry can serve as a diagnostic and educative tool in managing such patients.


Assuntos
Aberrometria , Acomodação Ocular/fisiologia , Oftalmopatias/etiologia , Miopia/cirurgia , Ceratectomia Fotorrefrativa/efeitos adversos , Espasmo/fisiopatologia , Administração Tópica , Adulto , Ciclopentolato/administração & dosagem , Ciclopentolato/uso terapêutico , Oftalmopatias/diagnóstico , Oftalmopatias/tratamento farmacológico , Oftalmopatias/fisiopatologia , Feminino , Humanos , Midriáticos/administração & dosagem , Midriáticos/uso terapêutico , Soluções Oftálmicas , Refração Ocular/fisiologia , Acuidade Visual/fisiologia
19.
Optom Vis Sci ; 92(10): e368-70, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26258277

RESUMO

PURPOSE: Bacille Calmette-Guérin (BCG) is a vaccine that can be instilled into the urinary bladder as immunotherapy against superficial bladder cancer. Several case reports have implicated intravesical BCG in the development of uveitis. Patients treated with BCG therapy may present with systemic symptoms resembling reactive arthritis and, less frequently, have ocular adverse effects including bilateral panuveitis or chorioretinitis. In all but three previously reported cases of uveitis associated with BCG treatment, HLA-B27 has been positive. No patients have been reported to be positive for rheumatoid factor or antinuclear antibody (ANA). CASE REPORT: An HLA-B27-negative and low-positive ANA patient presented with bilateral uveitis after treatment with BCG therapy for superficial bladder cancer. CONCLUSIONS: There is a need for greater awareness among urologists, primary care physicians, and optometrists of the potential for BCG to cause uveitis. These doctors should look for indicators of uveitis, such as circumlimbal conjunctival injection, photophobia, irregular pupils, and keratic precipitates. Together with appropriate treatment or prompt referral, this could prevent unnecessary morbidity. Future studies are needed to further elucidate the possible reasons for ANA positivity in these patients and the future role of the test in diagnosis and management.


Assuntos
Adjuvantes Imunológicos/efeitos adversos , Vacina BCG/efeitos adversos , Irite/induzido quimicamente , Neoplasias da Bexiga Urinária/terapia , Uveíte Anterior/induzido quimicamente , Administração Intravesical , Anticorpos Antinucleares/sangue , Ciclopentolato/uso terapêutico , Dexametasona/uso terapêutico , Combinação de Medicamentos , Glucocorticoides/uso terapêutico , Antígeno HLA-B27/sangue , Humanos , Imunoterapia , Irite/diagnóstico , Irite/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Midriáticos/uso terapêutico , Uveíte Anterior/diagnóstico , Uveíte Anterior/tratamento farmacológico
20.
Rev. cuba. farm ; 49(2)abr.-jun. 2015. tab
Artigo em Espanhol | CUMED | ID: cum-63291

RESUMO

Introducción: el colirio de ciclopentolato al 1 por ciento, se indica para medir los errores de la refracción, producir cicloplejía en procedimientos diagnósticos y también midriasis preoperatoria y postoperatoria, en el tratamiento de la uveítis y en los estados inflamatorios del iris. Objetivo: evaluar el desempeño del método de cromatografía líquida de alta resolución, aplicable al control de la calidad y estudio de estabilidad del colirio. Métodos: para cuantificar el ingrediente farmacéutico activo en el producto terminado, se empleó el método descrito en la Farmacopea de los Estados Unidos (USP 32, 2009). El estudio de vida de estante se desarrolló por un periodo de 24 meses a temperatura controlada entre 15-25 °C; mientras que el de estabilidad acelerada a 40 ± 2 °C y 75 ± 5 por ciento de humedad relativa, durante 6 meses. Resultados: los resultados obtenidos en la evaluación del desempeño del método analítico se encontraron dentro de los límites establecidos. Los resultados del estudio de estabilidad por vida de estante después de transcurridos los 24 meses indicaron que el producto mantiene los parámetros que determinan su calidad durante ese tiempo, y en los acelerados no se observó degradación significativa del producto. Conclusiones: la evaluación del desempeño del método analítico evaluado por cromatografía líquida de alta resolución demostró la confiabilidad del mismo. Se estableció 2 años como fecha de vencimiento en las condiciones señaladas(AU)


Introduction: the 1 percent cyclopentolate eye drops is indicated to measure the refractive errors, to cause cycloplexy in diagnostic procedures and also preoperative and postoperative midriasis in treating uveitis and in inflammatory conditions of the iris. Objective: to evaluate the performance of a high performance liquid chromatography applicable to the quality control and the study of the eye drops stability. Methods: with the purpose of quantifying the active ingredient in the finished product, the method described in the US Pharmacopea (USP 32,2009) was used. The shelf life study was conducted for 24 months at controlled 15-25 ºC temperature whereas the study of accelerated stability at40±2 ºC and 75± 5 percent relative humidity lasted 6 months. Results: the achieved results in the evaluation of the performance of the analytical method were within the set limits. The results for the shelf life stability after 24 months yielded that the product keeps the quality parameters during this time and in the accelerated stability study, there was no sign of significant degradation. Conclusions: the evaluation of the performance of the analytical method based on high performance liquid chromatography showed its reliability. The expiry date was set at 2 years under the stated conditions(AU)


Assuntos
Humanos , Ciclopentolato/uso terapêutico , Cromatografia Líquida de Alta Pressão/métodos , Estabilidade Enzimática , Controle de Qualidade , Soluções Oftálmicas/normas
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