Clinical Experience of Using a Combination of Dexamethasone and Levofloxacin After Cataract Surgery.

Background: Where routine prophylactic antibiotics have been adopted following cataract surgery, rates of endophthalmitis have been decreasing. Intracameral and topical antibiotics are currently used to prevent endophthalmitis after cataract surgery. When applying topical antibiotics, there are different recommendations on the frequency and duration of therapy. The development of bacterial resistance to the excessive and long-term use of antibiotics is a growing problem worldwide. The goal is to achieve a good antibiotic effect with the shortest possible use of antibiotics. Objective: The aim of this study was to compare the effectiveness of a new combination therapy of dexamethasone and levofloxacin for seven days after cataract surgery with the previous regimen of dexamethasone, neomycin sulfate, and polymyxin B, which was given for 21 days. Methods: A retrospective analysis of medical records and administered a questionnaire was conducted to assess the effectiveness of postoperative therapy in our cataract surgery patients. The study involved 52 patients who underwent surgery within the last year, performed by a single surgeon at our institution. The findings can help us improve the quality of care we provide and optimize our patients' overall quality of life. Results: We conducted an in-depth study on 52 individuals who underwent cataract surgery at our institution. The prescribed therapeutic regimen for the participants included administering Ducressa solution four times daily for the first seven days and Maxidex solution three times daily for the subsequent 14 days. The study found that none of the participants experienced complications after surgery, and all found it easy to instill the medication. The prescribed regimen effectively managed the postoperative recovery of the participants, and the medication was well-tolerated. Conclusion: Our research found that a new combination of levofloxacin and dexamethasone, when used topically, may require a shorter treatment period, reducing the risk of antibiotic resistance and providing a safe alternative for endophthalmitis prevention.

Functional Classification of the ATM Variant c.7157C>A and In Vitro Effects of Dexamethasone.

Most of the ATM variants associated with Ataxia Telangiectasia are still classified as variants with uncertain significance. Ataxia Telangiectasia is a multisystemic disorder characterized by "typical" and "atypical" phenotypes, with early-onset and severe symptoms or with late-onset and mild symptoms, respectively. Here we classified the c.7157C > A ATM variant found in homozygosity in two brothers of Lebanese ethnicity. The brothers presented with an atypical phenotype, showing less than 50% of the positive criteria considered for classification. We performed several in silico analyses to predict the effect of c.7157C > A at the DNA, mRNA and protein levels, revealing that the alteration causes a missense substitution in a highly conserved alpha helix in the FAT domain. 3D structural analyses suggested that the variant might be pathogenic due to either loss of activity or to a structural damage affecting protein stability. Our subsequent in vitro studies showed that the second hypothesis is the most likely, as indicated by the reduced protein abundance found in the cells carrying the variant. Moreover, two different functional assays showed that the mutant protein partially retains its kinase activity. Finally, we investigated the in vitro effect of Dexamethasone showing that the drug is able to increase both protein abundance and activity. In conclusion, our results suggest that the c.7157C > A variant is pathogenic, although it causes an atypical phenotype, and that dexamethasone could be therapeutically effective on this and possibly other missense ATM variants.

Vittaforma Corneae keratoconjunctivitis: An emerging pathology among travelers returning from Southeast Asia. / Queratoconjuntivitis por Vittaforma corneae: una enfermedad emergente entre los viajeros que regresan del sudeste asiático.

Microsporidium keratoconjunctivitis is an very rare disease. It is related to outbreaks in Asia due to exposure to contaminated water or soil. Microsporidium keratoconjunctivitis is a a self-limited disease, but it could have long term courses. We present the case of a 29 year old woman who started with pain, redness and blurred vision after a holiday in Singapore and did not respond to conjunctivitis treatment. PCR sequencing and PAS staining of corneal epithelial biopsy identified Vittaforma corneae as the causative organism. Treatment was initiated with corneal debridement, oral albendazol, and intensive topical voriconazole, levofloxacin and propamidine, but the conjunctival and corneal disease was only resolved 5 months later with the introduction of topical steroids to treat her severe limbitis. Suspicion of Microsporidium keratoconjunctivitis should be raised amongst ophthalmologists in unilateral keratitis with mild conjunctivitis in travelers from Asia.

Uso de corticoides en niños con meningitis bacteriana ¿Cuál es la evidencia actual? / Use of steroids in children with bacterial meningitis. What is the current evidence?

En modelos experimentales los corticoides redujeron la gravedad del proceso inflamatorio del espacio subaracnoideo, causante de complicaciones de meningitis bacteriana. Su uso se ha propuesto como medicación coadyuvante para disminuir las muertes, secuelas neurológicas e hipoacusia post meningitis. Numerosos estudios efectuados informaron resultados contradictorios en cuanto su eficacia. En el presente trabajo se analizó la evidencia actual de los corticoides como medicación coadyuvante en meningitis bacteriana en pediatría. Material y métodos: la búsqueda se realizó en MEDLINE, Cochrane Library, motores de búsqueda Google y Yahoo de artículos publicados en los últimos 5 años. De los 28 artículos que encontramos con las palabras claves steroids AND bacterial meningitis, 9 constituyen esta revisión. Resultados: ninguno de los 5 trabajos que analizaron la mortalidad encontró que la dexametasona la disminuía al compararlo con placebo. Los corticoides tampoco disminuían las secuelas neurológicas en los 3 artículos que trataron esta complicación. Los corticoides estaban asociados a menor tasa de hipoacusia que el placebo en meningitis por Haemophilus influenzae en 3 trabajos, no así en otros 4. Conclusiones: no hay evidencia que los corticoides prevengan la muerte o las secuelas neurológicas en niños con meningitis. Los efectos protectores en la audición son contradictorios y no existe evidencia firme que apoye su uso. El análisis de esta complicación es particularmente complejo dado los diferentes niveles de evidencia, de metodología de estudios, de evaluaciones audiométricas y de poblaciones disímiles en cuanto a acceso a servicios de salud y situación sanitaria (AU)

In experimental models dexamethasone, reduces the severity of inflammation in de subarachnoid space responsible for complications of bacterial meningitis. Dexamethasone has been proposed as adjuvant therapy to reduce postmeningitis, death, neurologic sequelae and hearing loss. Numerous studies have been performed, but contradictory results have been reported regarding its efficacy. We analyzed the current evidence of steroids as adjuvant therapy in children with bacterial meningitis. Material and methods: we reviewed the MEDLINE database, Cochrane Library, Yahoo and Google search engines for articles published in the last 5 years. We found 28 articles that matched the keywords "steroids" and "bacterial meningitis" and narrowed the analysis to 9 articles containing adequate evidence. Results: mortality rates were not reduced with dexamethasone compared to placebo in the 5 articles that addressed this endpoint. Neither were neurologic sequelae reduced with steroids in the 3 articles that addressed this outcome. Steroids were associated with prevention of post meningitis hearing loss in 3 studies, but not in the other 4. Conclusions: there is no current evidence that steroids prevent death or neurologic sequelae after bacterial meningitis in children. The protective properties of steroids in hearing loss are contradictory and no firm evidence favors their use. Different levels of evidence, different methodological studies, audiometric evaluation, and dissimilar health care and sanitary conditions, make the analysis of this endpoint particularly complex (AU)

The Effect Intravitreal Dexamethasone and Antibiotic Therapy after Vitrectomy

Bacterial endophthalmitis is an ocular emergency that requires rapid diagnosis and therapeutic decision making. The introdection of intravitreal injection of antibiotics has been a major advancement because it has resulted in a marked improvement in visual outcome. The intravitreal injection of steroids may be potentially useful in the treatment of endophthalmitis and other ocular inflammatory diseases. Forty eyes of pigmented rabbits were used, and divided into two groups. Group I was eyes without vitrectomy. In the right eye, 100 microliter of 1mgvancomycin, 400 microliter amikacin and 400 microliter dexamethasone injected was done. Group II was eyes with vitrectomy and lensectomy. At 2 weeks after lens and vitreous removal, rabbit eyes received an injection of a combination of 1mg vancomycin, 400 microliter amikacin and 400 microliter dexamethasone in right eye and BSS in left eye. The effect of combination injection was examined by light and transmission, scanning electron microscope at 3 days, 1 week, 2 weeks and 6 weeks following injection. The injection of combination without vitrectomy produced no toxicity. After injections of either combination or BSS after vitrectomy, macrophages were observed on the surface of retinal pigment epithelium and disorganized outer segments. This finding seems to be produced by vitrectomy procedure rather than drug toxicity. These results supports the hypothesis that the injection of these combinations is not toxic to aphakic/vitrectomized eyes.