A comparative study of transcanalicular diode laser supported endoscopic dacryocystorhinostomy and non-laser endoscopic dacryocystorhinostomy.

OBJECTIVE: The primary surgical procedure for nasolacrimal duct obstruction is dacryocystorhinostomy (DCR). The purpose of this study was to compare non-laser endoscopic dacryocystorhinostomy (NL-EnDCR) and transcanalicular diode laser-supported endoscopic dacryocystorhinostomy (TDLS-EnDCR). MATERIALS AND METHOD: The data of patients who underwent DCR with the diagnosis of epiphora and chronic dacryocystitis between the years 2010 and 2016 were examined retrospectively. The patients who underwent NL-EnDCR and TDLS-EnDCR were included in the study. Success of the procedure was defined as the complete disappearance of epiphora, and lack of anatomical occlusions with lacrimal serum irrigation. RESULTS: 74 patients who met the study criteria were included in the study. 39 patients (21 males and 18 females) who underwent TDLS-EnDCR were assigned as Group 1, and their mean age was 46 (33-64). 35 patients (18 males and 17 females) who underwent NL-EnDCR were assigned as Group 2, and their mean age was 48 (24-81). In the postoperative follow-ups, no watering of the eyes was demonstrated in 34 (87.2%) out of 39 patients in Group 1 (TDLS-EnDCR), and 22 (62.9%) out of 35 patients in Group 2 (NL-EnDCR), and that the newly formed ostium was clear with serum irrigations. A statistically significant difference in success rate was observed between the two groups (p=0.028). CONCLUSIONS: The TDLS-EnDCR procedure was more successful than NL-EnDCR with respect to the outcomes assigned. Use of transcanalicular diode laser in endoscopic DCR may increase the success of endoscopic DCR.

Peripapillary choroidal thickness in patients with chronic obstructive pulmonary disease.

OBJECTIVE: To evaluate the peripapillary choroidal thickness of patients with chronic obstructive pulmonary disease (COPD) via enhanced depth imaging optical coherence tomography (EDI-OCT). MATERIALS AND METHODS: A total of 80 patients with COPD (80 eyes) and 50 control subjects (50 eyes) were enrolled. Choroidal scans and the retinal nerve fiber layer (RNFL) thickness were obtained for all eyes using OCT. RESULTS: The average peripapillary choroidal thickness measurements of the COPD group (147.58 ± 53.53 µm) were lower than the control group (160.84 ± 44.73 µm) (p = 0.068). Inferior segment thicknesses were significantly thinner than the other segments (p < 0.05). Subfoveal choroidal thickness and RNFL thickness measurements of the COPD group were also lower than those of the control group (p = 0.111). CONCLUSION: Hypoxia in COPD seems to affect the choroidal thickness. Thinning of the choroid may be attributed to increased vascular resistance and reduced blood flow in patients with COPD. The possible effects of the disease to the eye may be clarified through the role of the choroidal vasculature in the blood supply of the anterior optic nerve head.

Discrimination of Epithelial Face of Conjunctival Autograft in Pterygium Surgery with Fibrin Glue.

A 48-year-old male patient was operated for pterygium. During surgery, the autograft surface was lost because of sponge contact. Presumed epithelial face of the autograft subsequently was attached to the bare sclera with fibrin glue. It was observed that the center of the autograft was freely movable with sponge. This finding showed the inverse implantation of the autograft. Because the glue does not stick to intact corneal or conjunctival epithelium, free movement of the center of the autograft shows that the graft is inversely implanted.

Effect of nepafenac eye drops on pain associated with pterygium surgery.

OBJECTIVE: To assess the effects of nepafenac ophthalmic suspension 0.1% for control of pain in patients undergoing pterygium surgery. METHODS: This randomized, double-masked placebo-controlled study included 62 adults undergoing pterygium surgery. Patients were randomly assigned to receive nepafenac ophthalmic suspension 0.1% or balanced salt solution placebo. They were asked to assess the level of pain using an 11-point numeric rating scale at 6, 12, 24, 48, and 72 hr after surgery. Patients also were evaluated daily for the progression of corneal epithelial healing until complete closure was observed. RESULTS: Except at 72 hr after surgery, the patients reported significantly less pain in eyes receiving nepafenac than in eyes receiving placebo. There was no statistical difference between the two groups in corneal epithelial healing. CONCLUSIONS: Treatment with nepafenac ophthalmic suspension 0.1% significantly reduced postoperative pain compared with placebo after pterygium surgery.

The effect of rebreathing and hyperventilation on retinal and choroidal vessels measured by spectral domain optical coherence tomography.

OBJECTIVE: The purpose of this study was to examine the vasoreactivity in retina and choroid of the healthy eyes in response to experimentally altered partial arterial pressure of carbon dioxide (PaCO(2)) using a non-invasive technique, spectral domain optical coherence tomography (SD-OCT). MATERIALS AND METHODS: The study included non-smoking participants between 18 and 35 years of age, having visual acuity of 20/20 and with no systemic and ocular diseases. At baseline, the participants breathed room air (normocapnia). Hypocapnia was created with the help of hyperventilation; for this, the participants were instructed to draw deep and quick breaths, resulting one breathing cycle per 2 s. To create hypercapnia subjects rebreathed from a 5 l bag at least 3 min. Choroidal thickness and retinal artery diameter were measured at baseline, and hyperventilation and rebreathing conditions by SD-OCT. RESULTS: Twenty eyes of 20 healthy subjects were included in this study. Their mean age was 24.90 ± 5.32 years. Hyperventilation caused a significant reduction in choroidal thickness, compared with baseline, at all points; whereas rebreathing caused no significant change at all points. The mean diameters of the arteries were 151.80 ± 7.88 µm, with a significant decline to 148.90 ± 7.25 µm at hyperventilation condition and a significant increase to 153.50 ± 7.88 µm at rebreathing condition (p = 0.018, p = 0.043, respectively). CONCLUSION: This study demonstrated that, SD-OCT was a useful tool in measuring the ocular vascular response under hypercapnia and hypocapnia conditions. These findings may be helpful for further understanding the physiological nature of ocular blood flow and this preliminary study provides a basis for future studies.

Pharmacokinetics of intravenously administered tigecycline in eye compartments: an experimental study.

PURPOSE: The purpose of this study was to evaluate the ocular distribution of intravenously administered tigecycline in a rabbit uveitis model. METHODS: Tigecycline, which has a broad spectrum of activity against many gram-positive, gram-negative, and anaerobic organisms, was given intravenously to rabbits at 7 mg/kg of body weight starting 24 h after induction of uveitis by intravitreal endotoxin injection. Tigecycline concentrations were determined by high performance liquid chromatography-mass spectrometry (LC-MS/MS) assay in the aqueous humor, vitreous humor, and plasma 1, 3, 6, and 24 h after administration of a single dose. RESULTS: The maximum concentrations were found within 1 h after the end of the intravenously given tigecycline, and were 1,308.60 ± 301.76 ng/mL in plasma, 181.40 ± 51.32 ng/mL in vitreous humor and 145.00 ± 55.29 ng/mL in aqueous humor of the inflamed eye. After 24 h, no drug was detectable in the aqueous and vitreous of the normal eyes, whereas small amounts of drug were detectable in inflamed eyes and in plasma. CONCLUSIONS: Tigecycline did not reach therapeutically significant levels in the aqueous and the vitreous humor of rabbit eyes. The findings suggest a limited role for intravenously administered tigecycline in the treatment of bacterial endophthalmitis.

Antiangiogenic effect of itraconazole on corneal neovascularization: a pilot experimental investigation.

PURPOSE: To investigate the antiangiogenic effect of itraconazole for the prevention of experimentally induced corneal neovascularization and whether the efficacy depends on the route of administration. MATERIALS AND METHODS: Thirty-six rats were randomly divided into 6 groups with 6 rats in each group. Chemical cauterization of the cornea was performed using silver nitrate/potassium nitrate sticks, and the rats were subsequently treated daily with topical (10 mg/ml), subconjunctival (10 mg/ml) or intraperitoneal (19 mg/kg) itraconazole for 7 days. Control rats received topical, subconjunctival or intraperitoneal 0.9% saline. On the 8th day of the experiment, the rat corneas were photographed to determine the percentage area of the cornea covered by neovascularization. The maximum density of corneal neovascularization was determined by microscopy. RESULTS: The median percentage of corneal neovascularization for group 1 was 31.5% (95% confidence interval, 27.5-35.5%); in group 3, it was 32% (23.5-39.8%); in group 5, it was 47% (36.3-60.0%). The percentages of corneal neovascularization in groups 2, 4 and 6 (the control groups) were 70% (95% confidence interval, 60.7-77.3%), 69% (63.0-77.7%) and 68% (56.5-78.5%), respectively. The area of neovascularization was smaller after itraconazole treatment as compared to saline treatment. Further, the area of neovascularization was smaller after topical and subconjunctival administration than after intraperitoneal administration. Histological evaluation of the corneas showed the most extensive corneal neovascularization in the control group. No local or systemic adverse effects were seen from either treatment group. CONCLUSION: Itraconazole reduces corneal neovascularization shortly after chemical burn. However, a larger experimental study is necessary to confirm the data of this investigation.

Cefuroxime dilution error.

PURPOSE: To present clinical findings of a cluster of cases of inadvertent high-dose intracameral cefuroxime injection after uneventful phacoemulsification cataract surgery. METHODS: Six eyes of 6 patients (mean age 68.33 years, range 61-75, 4 male, 2 female) were operated on the same day by the same surgeon. At the end of surgery, 3 mg in 0.1 mL cefuroxime (30 mg/mL, Zinnat, GlaxoSmithKline) was erroneously injected into anterior chamber of 6 eyes. Incorrect dilution of cefuroxime was noticed at the end of operation day. RESULTS: The 6 patients were followed up very closely every day during the first week. No adverse reaction or inflammation was observed at postoperative examination. All patients achieved 20/20 or better vision at the end of the first week. CONCLUSIONS: Inadvertent intracameral (3 mg in 0.1 mL) cefuroxime injection did not cause any detectable adverse effect on ocular tissues.

Electrolysis treatment of trichiasis by using ultra-fine needle.

PURPOSE: To determine the safety and efficacy of electrolysis treatment of trichiasis by using ultrafine needle. METHODS: The medical records of 24 lids of 24 patients who underwent electrolysis treatment for trichiasis by the same surgeon (Y.S.) during the period from May 2006 through December 2008 were reviewed. The average age of the 24 patients was 59.2 years (range, 43 to 76 years). Thirteen of the patients were women. RESULTS: The results were considered satisfactory if no recurrence of trichiasis occurred for at least 6 months after the last electrolysis procedure. Sixteen of the 24 patients (66.6%) had a satisfactory result with 1 treatment. Of the 8 patients (33.3%) who had an unsatisfactory result, while 5 (20.8%) responded well to 1 additional electrolysis, 3 (12.5%) responded well to 2 additional electrolyses to the recurrent cilia. The procedure was well tolerated by the patients. All eyelids healed within 2 weeks after treatment without any scarring. Faint hypopigmentation was visible in 2 patients (8.3%). Mild notching of eyelid occurred in 4 patients (16.6%). CONCLUSIONS: Electrolysis treatment by using ultrafine (55-microm thickness) needle is an effective and safe method for treatment of trichiasis with many advantages over other recognized modalities of therapy.

Retinal Nerve Fiber Layer Thickness in Children With ADHD.

OBJECTIVES: The current study aims to compare retinal nerve fiber layer (RNFL) thickness, macular thickness, and macular volume between children with ADHD and a control group. METHOD: The study group included children with ADHD and the control group consisted of age- and gender-matched participants without any psychiatric disorder. In all participants, RNFL thickness, macular thickness, and macular volume were measured by using spectral domain-optical coherence tomography (SD-OCT). ADHD symptom severity was evaluated by using parent-report measures, including Conners' Parent Rating Scale-Revised: Short Form (CPRS-R: S) and the Strengths and Difficulties Questionnaire: Parent Form (SDQ: P). RESULTS: We compared 90 eyes of 45 children with ADHD and 90 eyes of 45 controls. ADHD group had significantly lower RNFL thickness only in nasal quadrant than the controls. The remaining RNFL quadrants, macular thickness, and volume were not significantly different between groups. There was a reverse correlation between RNFL thickness and ADHD symptom severity. CONCLUSION: This is the first study examining the RNFL thickness in ADHD. Our findings showed that nasal RNFL thickness was lower, indicating reduced unmyelinated axons in the retina of children with ADHD. The results of this study support the evidence that ADHD involves a lag in cortical maturation and this is measurable in the retina.

Effect of topical cyclopentolate on post-operative pain after pterygium surgery.

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.

Ocular penetration of topically applied 1% tigecycline in a rabbit model.

AIM: To evaluate ocular penetration of topically applied 1% tigecycline. METHODS: Forty-two New Zealand White rabbits were divided into 3 groups. A 50 µL drop of 1% tigecycline was administered in group 1. In groups 2 and 3, the drop was administered every 15min for 60min (keratitis protocol). Aqueous humor samples in groups 1 and 2 were collected under general anesthesia at 15, 30, 45, 60, 120, and 180min after the last drop. All animals in group 3 were euthanatized. Cornea, vitreous and blood samples were collected 60 and 120min after the last drop. Tigecycline concentrations were measured using high performance liquid chromatography-mass spectrometry (LC-MS/MS). RESULTS: The peak aqueous humor tigecycline concentration [mean 0.73±0.14 mg/L (SD) and 2.41±0.14 mg/L, respectively] occurred 45min after topical drug application in groups 1 and 2. Group 3 mean values in the cornea, and vitreous, were 3.27±0.50 µg/g, and 0.17±0.10 mg/L at 60min and 3.17±0.77 µg/g and 0.20±0.07 mg/L at 120min, respectively. Tigecycline serum concentrations were negligible. CONCLUSION: Tigecycline levels in the aqueous humor in groups 1 and 2, and in the cornea in group 3 exceeded the minimum inhibitory concentrations of most gram-positive organisms that cause bacterial keratitis and endophthalmitis.

Daptomycin versus Vancomycin in an Enterococcus faecalis Endophthalmitis Rabbit Model.

PURPOSE: To compare bactericidal activities of daptomycin (DAP) and vancomycin (VAN) in an experimental rabbit model of Enterococcus faecalis endophthalmitis. MATERIALS AND METHODS: The right vitreous cavities of 24 New Zealand rabbits were inoculated with 100 colony-forming units of E. faecalis; and after 24 h, rabbits were randomly divided into three groups. DAP group (n = 8, 0.2 mg/0.05 ml intravitreally), VAN group (n = 8, 1 mg/0.05 ml intravitreally) and balanced salt solution group (BSS, n = 8, 0.05 ml intravitreally). Clinical examination scores were recorded, and vitreous aspirates were obtained for microbiological analysis on days 0, 1, 2, 3 and 4. Rabbits were sacrificed, and the eyes were enucleated for histopathological assessment. RESULTS: There was no difference between the DAP, VAN and BSS groups in terms of the clinical grading of endophthalmitis 24 h after the inoculation. The bacterial counts were similar between the VAN and DAP groups except on day 1, where it was significantly lower than those in the VAN group (p = 0.003). On day 4, 62% of the eyes treated with DAP, and 50% of the eyes treated with VAN were sterilized. All of the eyes from the BSS group showed increasing bacterial growth from day 0 to day 4. There was no difference between the DAP and VAN groups in terms of the histopathological and clinical examination scores, while they were significantly lower than those in the BSS group. CONCLUSIONS: This study demonstrates evidence of the effectiveness of DAP for the treatment of experimental E. faecalis endophthalmitis.

Clearance of intravitreal daptomycin in uveitis-induced rabbit model.

PURPOSE: To investigate the elimination rate of daptomycin after intravitreal injection in uveitis-induced rabbits. MATERIALS AND METHODS: Intravitreal injection of the single dose of 200 µg/0.05 mL daptomycin was administered to rabbits starting 24 h after induction of uveitis by an intravitreal endotoxin injection. Aqueous humor and vitreous humor samples of eight eyes per time point were collected at selected time intervals (1, 3, 6, 24, 48, 72 and 96 h), and the in vitreous half-life was calculated. Daptomycin concentrations in vitreous and aqueous humor were assayed with high-performance liquid chromatography. RESULTS: The vitreous concentration was noted to decline slowly with time. The mean vitreous concentration was 23.25 ± 10.99 µg/mL and 11.10 ± 3.33 µg/mL at 96 h in inflamed and normal eyes, respectively. The vitreous daptomycin concentration showed an exponential decay with a half-life of 25.67 h in normal eyes and 34.6 h in inflamed eyes. The aqueous levels of daptomycin in normal eyes were low but remained significantly higher than those of inflamed eyes. CONCLUSIONS: Given that the injected dose corresponds to several times the minimum inhibitory concentrations of organisms most involved in endophthalmitis, and that therapeutic levels are present up to 96 h after injection, intravitreal daptomycin should be considered for the treatment of endophthalmitis caused by Gram-positive bacteria.