Antiproliferative effects of preservative-free triamcinolone acetonide on cultured human retinal pigment epithelial cells

BACKGROUND

The control of retinal pigment epithelial cell proliferation is an essential factor in the clinical management of proliferative vitreoretinopathy (PVR). Factors inhibiting PVR without toxic potential are of special interest in ophthalmology. The aim of the study was to investigate the antiproliferative and cytotoxic effects of a preservative-free triamcinolone acetonide (PFTA) suspension on a human retinal pigment epithelial (ARPE19) cell line in vitro.

MATERIAL/METHODS

ARPE19 cells (immortal non-transformed cells from a human donor) were seeded and incubated in vitro with increasing concentrations of PFTA (0.01-1 mg/ml). After 1, 3, and 7 days, cellular proliferative activity was assessed by 5'-bromo-2'-deoxyuridine (BrdU) incorporation into cellular DNA and cell proliferation was determined using the 3-(4,5-dimethylthiazol-2yl)-2,5-diphenyltetrazolium bromide (MTT) assay. To determine cytotoxicity, ARPE19 cells were grown to confluence and subsequently cultured in serum-deficient medium to ensure a static milieu and the MTT test was performed after 24 hours of incubation with PFTA. Cell recovery after transient PFTA exposure was also compared with continuous exposure after 7 days.

RESULTS

PFTA inhibits ARPE19 cell proliferation in a dose-dependent manner. Significant inhibition of cell proliferation was observed on the first day of the study at 1, 0.1, and 0.01 mg/ml PFTA and significant reductions in ARPE19 cells were noted for 1 and 0.1 mg/ml PFTA. Proliferation was resumed in all ARPE19 cultures and was dependent on the initial PFTA concentration. PFTA did not cause a cytotoxic effect.

CONCLUSIONS

PFTA influences the proliferation of vital ARPE19 cells in a reversible manner without cytotoxic effect.

Clinical evaluation of an HP-guar gellable lubricant eye drop for the relief of dryness of the eye

PURPOSE

To evaluate the efficacy of a new lubricant eye drop containing polyethylene glycol 400 and propylene glycol demulcents with hydroxypropyl-guar as a gelling agent (Test Product) to a system with carboxymethylcellulose (Control Product) for reducing dry eye signs and symptoms.

METHODS

Eighty-seven dry eye volunteers were enrolled at seven sites for this six-week, concurrently controlled, double-masked clinical study.

RESULTS

The Test Product significantly reduced conjunctival staining (p = 0.025) and temporal corneal staining (p = 0.024) compared to the Control. The Test Product also significantly reduced symptoms of dryness in the morning and evening, compared to the Control (p = 0.015 and p = 0.023, respectively). Subjects in the Test treatment group reported lower frequencies of foreign body sensation and felt their eyes were "refreshed longer" compared to those in the Control group (p = 0.033 and p = 0.037, respectively).

CONCLUSIONS

The Test Product was more effective at reducing both the signs and symptoms of dry eye compared to the carboxymethylcellulose containing Control.

Three-year follow-up of a randomized trial comparing focal/grid photocoagulation and intravitreal triamcinolone for diabetic macular edema

OBJECTIVE

To report 3-year outcomes of patients who participated in a randomized trial evaluating 1-mg and 4-mg doses of preservative-free intravitreal triamcinolone compared with focal/grid photocoagulation for treatment of diabetic macular edema.

METHODS

Eyes with diabetic macular edema and visual acuities of 20/40 to 20/320 were randomly assigned to focal/grid photocoagulation or 1 mg or 4 mg of triamcinolone. At the conclusion of the trial, 3-year follow-up data were available in 306 eyes.

RESULTS

Between 2 years (time of the primary outcome) and 3 years, more eyes improved than worsened in all 3 treatment groups. Change in visual acuity letter score from baseline to 3 years was +5 in the laser group and 0 in each triamcinolone group. The cumulative probability of cataract surgery by 3 years was 31%, 46%, and 83% in the laser and 1-mg and 4-mg triamcinolone groups, respectively. Intraocular pressure increased by more than 10 mm Hg at any visit in 4%, 18%, and 33% of eyes, respectively.

CONCLUSIONS

Results in a subset of randomized subjects who completed the 3-year follow-up are consistent with previously published 2-year results and do not indicate a long-term benefit of intravitreal triamcinolone relative to focal/grid photocoagulation in patients with diabetic macular edema similar to those studied in this clinical trial. Most eyes receiving 4 mg of triamcinolone as given in this study are likely to require cataract surgery.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00367133.

Regression of language and non-language skills in pervasive developmental disorders

BACKGROUND

As part of the pervasive developmental disorders (PDD), there is a subgroup of individuals reported to have a different onset of symptom appearance consisting of an apparently normal early development, followed by a loss of verbal and/or non-verbal skills prior to 2 years of age. This study aims at comparing the symptomatology of children who displayed a regression and often an associated intellectual disability through investigation of two types of loss, namely language and other skill regression.

METHODS

This study examined the occurrence of regression in 135 children with PDD, mean age 6.3 years. The sample was composed of 80 (59.4%) children diagnosed with autism, 44 (32.6%) with pervasive developmental disorder-not otherwise specified (PDD-NOS) and 11 (8%) with Asperger syndrome. The Autism Diagnostic Interview Revised (ADI-R) was used to evaluate the type of loss and to characterise associated factors including birth rank, gender and thimerosal exposure through vaccination.

RESULTS

A total of 30 (22%) subjects regressed: nine (30%) underwent language regression alone, 17 (57%) lost a skill other than language and four (13%) lost both language and another skill. Significantly higher levels of regression were found in autism (30%) compared with PDD-NOS (14%) and Asperger syndrome (0%). Children who regressed in language skills spoke at a significantly earlier age ( = 12 months) than those who did not regress in this domain ( = 26 months). Parents and interviewers consistently reported developmental abnormalities prior to the loss. ADI-R domain mean scores indicated a more severe autistic symptomatology profile in children who regressed compared with those who did not, especially in the repetitive behaviour domain. Regression was not associated to thimerosal exposure, indirectly estimated by year of birth.

CONCLUSIONS

A loss of skill, present in one out of five children with PDD, is associated with a slightly more severe symptomatology as measured by the ADI-R, particularly in the repetitive behaviours domain. Furthermore, although abnormalities are often noticed by the caregivers at the time of regression, the ADI-R reveals that other atypical behaviours were in fact present prior to the onset of regression in most cases. None of the secondary factors investigated were associated with regression. In children unexposed to thimerosal-containing vaccines, the rate of regression was similar to that reported in studies of samples exposed to thimerosal, suggesting that thimerosal has no specific association with regressive autism.

[Vaccine excipients]

Several substances other than antigens are included in vaccines. These are classified as follows: stabilizers, preservatives, buffer, adjuvants, antibiotics etc. Some of these substances, for example gelatin and thimerosal, have been removed from vaccines because of their undesirable side effects. However, stability and sterility are very important conditions for vaccines. Therefore, removal of excipients from vaccines should be investigated very carefully. Impurities derived from culture substrates for bacteria and viruses should be reduced as much as possible. Japanese vaccines are highly purified. For example, influenza vaccines contain only a few ng/dose of OVA which are significantly lower than the WHO standards (5 microg/dose).

Maternal Rh D status, anti-D immune globulin exposure during pregnancy, and risk of autism spectrum disorders

OBJECTIVE

The objective of the study was to investigate the association between maternal Rh D status, prenatal exposure to anti-D immune globulin, and the risk of autism in the offspring.

STUDY DESIGN

Case-control study among children born from 1995 to 1999 at Kaiser Permanente Northern California hospitals. Cases (n = 400) were children with an autism diagnosis; controls (n = 410) were children without autism, randomly sampled and frequency matched to cases on sex, birth year, and birth hospital. Maternal Rh D status and anti-D immune globulin exposure were ascertained from prenatal medical records.

RESULTS

No case-control differences were observed for maternal Rh negative status (11.5% vs 10.0%, P = .5) or prenatal anti-D immune globulin exposure (10.0% vs. 9.3%, P = .7). Risk of autism remained unassociated with maternal Rh status or prenatal exposure to anti-D immune globulins after adjustment for covariates.

CONCLUSION

These data support previous findings that prenatal exposure to thimerosal-containing anti-D immune globulins does not increase the risk of autism.

A randomized trial comparing intravitreal triamcinolone acetonide and focal/grid photocoagulation for diabetic macular edema

OBJECTIVE

To evaluate the efficacy and safety of 1-mg and 4-mg doses of preservative-free intravitreal triamcinolone in comparison with focal/grid photocoagulation for the treatment of diabetic macular edema (DME).

DESIGN

Multicenter, randomized clinical trial.

PARTICIPANTS

Eight hundred forty study eyes of 693 subjects with DME involving the fovea and with visual acuity of 20/40 to 20/320.

METHODS

Eyes were randomized to focal/grid photocoagulation (n = 330), 1 mg intravitreal triamcinolone (n = 256), or 4 mg intravitreal triamcinolone (n = 254). Retreatment was given for persistent or new edema at 4-month intervals. The primary outcome was evaluated at 2 years.

MAIN OUTCOME MEASURES

Visual acuity measured with the electronic Early Treatment Diabetic Retinopathy Study method (primary), optical coherence tomography-measured retinal thickness (secondary), and safety.

RESULTS

At 4 months, mean visual acuity was better in the 4-mg triamcinolone group than in either the laser group (P<0.001) or the 1-mg triamcinolone group (P = 0.001). By 1 year, there were no significant differences among groups in mean visual acuity. At the 16-month visit and extending through the primary outcome visit at 2 years, mean visual acuity was better in the laser group than in the other 2 groups (at 2 years, P = 0.02 comparing the laser and 1-mg groups, P = 0.002 comparing the laser and 4-mg groups, and P = 0.49 comparing the 1-mg and 4-mg groups). Treatment group differences in the visual acuity outcome could not be attributed solely to cataract formation. Optical coherence tomography results generally paralleled the visual acuity results. Intraocular pressure increased from baseline by 10 mmHg or more at any visit in 4%, 16%, and 33% of eyes in the 3 treatment groups, respectively, and cataract surgery was performed in 13%, 23%, and 51% of eyes in the 3 treatment groups, respectively.

CONCLUSIONS

Over a 2-year period, focal/grid photocoagulation is more effective and has fewer side effects than 1-mg or 4-mg doses of preservative-free intravitreal triamcinolone for most patients with DME who have characteristics similar to the cohort in this clinical trial. The results of this study also support that focal/grid photocoagulation currently should be the benchmark against which other treatments are compared in clinical trials of DME.

Intranasal mucoadhesive buspirone formulation: in vitro characterization and nasal clearance studies

Oral administration is unsuitable for drugs prone to extensive first-pass metabolism, like buspirone. Thus, in the present study an attempt has been made to develop a mucoadhesive intranasal formulation improving permeation characteristics of buspirone HCl. Nasal formulations containing different concentrations of chitosan HCl and hydroxypropyl-beta-cyclodextrins (HP-beta-CD) were prepared and compared with control buspirone HCl solution regarding permeability, in vitro duration of mucoadhesion, in vivo nasal clearance in rats and in vitro cytotoxicity on cell culture. Nearly two fold increase in buspirone permeation was observed with 1% chitosan HCl and a 3.5 fold increase with 1% chitosan HCI and 5% HP-beta-CD. Nasal clearance studies showed retention of 50% radioactivity up to about 3.5 h for formulation F7 containing 1% chitosan HCI compared to 1.5 h for control buspirone solution (F1). Results conclusively demonstrated enhancement in permeation with no cytotoxicity. Thus formulations can be used to improve bioavailability of buspirone HCl.

Disappearance of ethyl glucuronide during heavy putrefaction

INTRODUCTION

There are previous publications showing the use of ethyl glucuronide (EtG), a non-oxidative metabolite of ethanol, as a marker of ante-mortem ingestion of alcohol in forensic autopsy cases. The problem of possible degradation or formation of EtG during putrefaction is however not well studied and the aim of this study was to investigate the possibility of false negative and false positive EtG results by an in vitro study. Further, we used the information from the in vitro study on real cases, to get an impression of the practical problem of degradation or formation of EtG.

METHODS

An in vitro study was carried out to study the concentrations of EtG in blood samples under controlled conditions during putrefaction. In addition, to illustrate the practical problem of degradation or formation of EtG, we used routine samples analysed for EtG in blood. Blood samples from forensic autopsies with ethanol detected but EtG not detected in blood, and therefore suspected post-mortem ethanol formation, were identified. Fifteen such cases had urine samples available, and these were analysed for EtG. We hypothesised that since concentrations are often higher in urine, there would still be traces of EtG left in this medium if post-mortem degradation was the reason for the negative result in blood.

RESULTS

In this in vitro experiment, EtG was very unstable in blood samples at 30/40 degrees C without preservatives. On the other hand, EtG was stable with potassium fluoride at room temperature, and there was no formation of EtG either at 30 degrees C without preservatives, or at room temperature with potassium fluoride. Of the 15 routine cases where EtG in blood was negative, and the ethanol detected was assumed endogenous, six were positive for EtG in urine. In these cases, ethanol was probably ingested, and the negative EtG in blood may be a false negative result due to degradation during putrefaction.

CONCLUSION

Analysis of EtG in blood is a helpful tool to determine in vivo ingestion of ethanol in post-mortem cases. A negative result, however, especially in heavily putrefied cases, must be interpreted with caution. Analysis of an additional medium would be valuable in these cases.

Brimonidine 0.2% versus brimonidine Purite 0.15% in Asian ocular hypertension

PURPOSE

The aim of this study was to evaluate the efficacy and safety of brimonidine 0.2% versus brimonidine Purite 0.15% in Asians with ocular hypertension.

METHODS

This study was a prospective, randomized, observer-masked, short-term crossover trial. Eighty-six (86) Asian subjects with newly diagnosed ocular hypertension were randomly assigned to receive either brimonidine 0.2% or brimonidine Purite 0.15%, both dosed twice a day for 4 weeks. Subjects were then washed out for 6 weeks and switched to the opposite treatment for 4 weeks.

RESULTS

The baseline intraocular pressure (IOP) was 24.4 +/- 2.45 mmHg for brimonidine 0.2% and 24.39 +/- 2.56 mmHg for brimonidine Purite 0.15% (P = 0.985). The IOP was at trough drug effect after 4 weeks of brimonidine 0.2% and brimonidine Purite 0.15% therapy were 20.10 +/- 2.01 mmHg and 21.00 +/- 1.67 mmHg (P = 0.001), respectively. The IOP at peak drug effect after 4 weeks of brimonidine 0.2% and brimonidine Purite 0.15% treatment were 18.10 +/- 1.73 mmHg and 18.20 +/- 1.71 mmHg (P = 0.518), respectively. Brimonidine 0.2% was found to cause more allergic conjunctivitis than brimonidine Purite 0.15% (P < 0.001).

CONCLUSIONS

Brimonidine 0.2% has a higher potency of lowering IOP than brimonidine Purite 0.15% at trough when used twice-daily. However, ocular allergic reaction was more frequent and severe with brimonidine 0.2% than with brimonidine Purite 0.15%.

Clinical and biological efficacy of preservative-free NAAGA eye-drops versus levocabastine eye-drops in vernal keratoconjunctivitis patients

AIMS

This comparative and randomised pilot study assessed the clinical and biological efficacy of Naaxia Sine(R) eye-drops versus levocabastine eye-drops in the treatment of vernal keratoconjunctivitis (VKC).

METHODS

Twenty-three VKC patients were randomised and treated bilaterally for 28 days with N-acetyl-aspartyl-glutamate (NAAGA) or levocabastine (LEVO) eye-drops. The primary efficacy variable, overall evolution of eosinophil cationic protein (ECP) tear concentrations, was assessed in a masked fashion on D0, D7 and D28. Clinical symptoms and signs were reported at the same time points. Biological parameters were analysed with a non-parametric rank-based approach. Global tolerance was assessed by the investigator and patient.

RESULTS

At all time points, ECP tear levels were significantly reduced in the NAAGA compared with the LEVO group (p = 0.023). Reduction of eosinophil leucocytes and tear lymphocytes was higher not significant in the NAAGA group. The same trend was observed for the evolution of total ocular symptom score. There were no significant differences between treatment groups in the occurrence of adverse effects, except for burning which was more frequent in the LEVO group (p = 0.002).

CONCLUSION

The anti-eosinophilic actions of NAAGA were shown by a significant reduction of ECP tear concentrations. A decreased lymphocyte count and an overall improvement of the symptomatology were also noted. Moreover, the tolerability of NAAGA appeared to be better.

Classification of plastic eye dropper tips using Harkins and Brown's factor

In this work, the weights of drops produced by seven commercially available eye drop dispensing systems were investigated using benzalkonium chloride solutions in concentration range of 0-0.02%. The effect of the surface tension, the effective diameter of the dropper tip, and the dropper bottle volume on the drop weights was studied at the vertical position. Based on the principle of Tate's law, the theoretical maximal weights of drops were expressed. In all cases, the lower the surface tension, the lower drop weights were noted. Simultaneously, effect of both the effective diameter of the dropper tip and the dropper bottle volume on the drop weights could be described. A regression equation characterized a significantly negative linear interaction of both variables. Comparing the theoretical drop weights with those measured experimentally, Harkins and Brown's factors, FHB, were received. The mean drop weights obtained for the Traube's stalagmometer were 62% that of the theoretical values. FHB values detected for the plastic dropper tips were significantly greater ranging from 0.66 to 0.76. In contrast to the obvious characterization of dropper tips by geometrical parameters, a classification of dropper tips with Harkins and Brown's factor is proposed.

Clinical Evaluation of Silicone Hydrogel Lens Wear With a New Multipurpose Disinfection Care Product

PURPOSE

To evaluate subjective symptoms and clinical signs in silicone hydrogel contact lens wearers with three different multipurpose solution (MPS) lens care regimens.

METHODS

In a double-masked, randomized, concurrently controlled study, 233 subjects from 12 clinical sites wore one of two silicone hydrogel lens brands (ACUVUE Advance or Focus NIGHT & DAY) for 1 month on a daily-wear basis supported by a new reconditioning multipurpose disinfecting solution (MPDS) preserved with POLYQUAD and ALDOX, regimen 1 (OPTI-FREE RepleniSH Multi-Purpose Disinfecting Solution), or by one of two MPSs preserved with polyhexamethyl biguanide, regimen 2 (ReNu MultiPlus Multi-Purpose Solution No Rub Formula) or regimen 3 (Complete MoisturePLUS Multi-Purpose Solution).

RESULTS

Significant differences in favor of regimen 1 were found in subjective responses of subjects wearing ACUVUE Advance lenses. For Focus NIGHT & DAY lens wearers, regimen 1 was associated with significantly less corneal staining (severity [P=0.0019], area [P=0.0077]) than regimen 2 was. The average number of times per day that rewetting drops were used was significantly higher for subjects randomized to regimen 3 than for subjects using regimen 1.

CONCLUSIONS

The clinical performance of the new MPDS product with silicone hydrogel lenses was generally as good as or better than the two comparative polyhexamethyl biguanide-preserved MPSs. Clinical differences were evident between the products. Practitioners should be aware that MPS product choice for use with silicone hydrogel lenses may lead to different clinical outcomes, particularly in regard to stress on the ocular surface, as evidenced by the corneal staining response.

Chemical stability of oseltamivir in oral solutions

The stability of oseltamivir in oral aqueous solutions containing the preservative sodium benzoate was studied by a stability indicating HPLC-method. The separation was achieved on a RP-18 ec column using a gradient of mobile phase A (aqueous solution of 50 mM ammonium acetate) and mobile phase B (60% (v/v) acetonitrile/40% (v/v) mobile phase A). The assay was subsequently validated according to the ICH guideline Q2(R1). The extemporaneously prepared "Oseltamivir Oral Solution 15 mg/ml for Adults or for Children" (NRF 31.2.) according to the German National Formulary ("Neues Rezeptur-Formularium") was stable for 84 days if stored under refrigeration. After storage at 25 degrees C the content of oseltamivir decreased to 98.4%. Considering the toxicological limit of 0.5% of the 5-acetylamino derivative (the so-called isomer I) the solution is stable for 46 days. Oseltamivir was less stable in a solution prepared with potable water instead of purified water. Due to an increasing pH the stability of this solution decreased to 14 days. Furthermore a white precipitate of mainly calcium phosphate was observed. The addition of 0.1% anhydrous citric acid avoided these problems and improved the stability of the solution prepared with potable water to 63 days. Sodium benzoate was stable in all oral solutions tested.

A further characteristic of susceptibility to contact allergy: sensitization to a weak contact allergen is associated with polysensitization. Results of the IVDK

Although genetic factors probably account for differences in susceptibility to contact allergy, they have not yet been identified, partly due to an insufficient understanding of 'susceptibility'. Regarding polysensitization (PS) as a sign of increased susceptibility, we studied the relationship between PS and sensitization to weak versus strong allergens. Patch test data from 66,835 patients registered by the multicentre project, Information Network of Departments of Dermatology (IVDK) between 1 January 1997 and 31 December 2004, were analysed. The association between the number of sensitization to standard series allergens, and contact allergy to a strong allergen methyldibromoglutaronitrile (MDBGN) and to a weak allergen (paraben mix), was analysed with adjusted logistic regression analysis. In paraben-positive (++/+++) patients, the risk of > or = 2, > or = 3 or > or = 4 additional reactions were significantly increased by a factor of 2.1-4.6 compared to MDBGN-sensitized (++/+++) patients. Varying the basic model, a higher risk of additional positive reactions associated with paraben sensitization was consistently identified. The association between PS and sensitization to weak allergens adds a further characteristic of susceptibility to former findings of the IVDK, where PS was related to an increased risk of induction, elicitation, and cytokine polymorphisms. PS can be regarded as a phenotype to be considered in genetic studies.

Radiolysis of 2-[18F]fluoro-2-deoxy-D-glucose (FDG) and the role of reductant stabilisers

2-[18F]Fluoro-2-deoxy-D-glucose (FDG) is unstable at elevated temperatures, alkaline pH and in highly radioactive concentrated solutions. Radiolysis generates hydrogen peroxide in situ that accelerates the FDG decomposition rate and shortens the shelf life of the radiopharmaceutical. Reductant stabilisers slow down the decomposition rate and improve the shelf life for large-scale FDG manufacture in highly radioactive concentrated solutions.

Recurrence after topical nonpreserved methylprednisolone therapy for keratoconjunctivitis sicca in Sjögren's syndrome

BACKGROUND

The aim of this study was to evaluate the prevalence of long-term recurrence after topical nonpreserved methylprednisolone pulse therapy for the treatment of keratoconjunctivitis sicca (KCS) with Sjögren's syndrome.

METHODS

A total of 106 eyes of 53 Sjögren's syndrome patients were included in the study. All patients were treated with topical nonpreserved 1% methylprednisolone solution. Initial therapy consisted of eyedrops 4 times a day for 2 weeks, and then patients were reevaluated and tapered off the medication every 2 weeks until discontinuation. Tear film breakup time (TBUT), Schirmer test, corneal fluorescein staining, and subjective symptom scores were measured. Additionally, impression cytology of the bulbar conjunctiva was performed. The over-all success rates and success period were determined using the Kaplan-Meier survival curve.

RESULTS

A reduction in subjective symptoms and fluorescein staining, and an improvement in TBUT and Schirmer test results, was observed after treatment (P<0.001). Impression cytology specimens revealed a significantly increased number of periodic acid-Schiff-positive cells after treatment. After the first pulse therapy, mean survival was 56.6 weeks and 11 (20.8%) patients recurred. After the second pulse therapy, mean survival was 72.4 weeks and only 1 patient recurred. No serious complications, including intraocular pressure elevation and cataract formation, were encountered during the entire follow-up period.

CONCLUSIONS

Topical nonpreserved methylprednisolone pulse therapy proved to be a safe, effective long-term treatment of improving subjective and objective dry eye factors in KCS patients with Sjögren's syndrome.

Introduction en pratique transfusionnelle des concentrés de plaquettes en solution de conservation

Platelet additive solutions (PAS) have been developed since the years 1980. However, decisive improvements have been made in the last five years, leading nowadays to several PAS available for transfusion practice. Few compounds are present in PAS, with the intention of controlling platelet metabolic alterations and activation that occur during storage: acetate, which is a substrate for the tricarboxylic acid cycle, enables to maintain oxidative metabolism, is present in all PAS; a buffer effect is required to prevent the progressive pH fall during storage, and is obtained either with sodium phosphate or gluconate; platelet activation is controlled by citrate, and in the latest PAS, by magnesium and potassium. It is important to note that whatever the PAS used, it is mandatory to maintain a final concentration of 20-40% of plasma, mainly in order to ensure glucose availability. The use of PAS leads to a more rationalized blood processing, as it provides an additional volume of plasma available for plasma fractionation, it contributes to standardization of blood components, and it is part of at least one pathogen reduction process. The expected benefit for patient is the reduction of adverse reactions related to plasma. There is already evidence that the incidence of allergic adverse reactions is reduced. In the case of other less frequent adverse reactions such as transfusion related acute lung injury (TRALI) or haemolytic reaction due to minor ABO incompatibility, only a long-term follow-up through haemovigilance organization will be informative.

Management and Therapy of Dry Eye Disease: Report of the Management and Therapy Subcommittee of the International Dry Eye WorkShop (2007)

The members of the Management and Therapy Subcommittee assessed current dry eye therapies. Each member wrote a succinct evidence-based review on an assigned aspect of the topic, and the final report was written after review by and with consensus of all subcommittee members and the entire Dry Eye WorkShop membership. In addition to its own review of the literature, the Subcommittee reviewed the Dry Eye Preferred Practice Patterns of the American Academy of Ophthalmology and the International Task Force (ITF) Delphi Panel on Dry Eye. The Subcommittee favored the approach taken by the ITF, whose recommended treatments were based on level of disease severity. the recommendations of the Subcommittee are based on a modification of the ITF severity grading scheme, and suggested treatments were chosen from a menu of therapies for which evidence of therapeutic effect had been presented.

Combined preoperative topical atropine sulfate 1% and intracameral nonpreserved epinephrine hydrochloride 1:2500 for management of intraoperative floppy-iris syndrome

We describe a technique combining preoperative atropine sulfate 1% and intraoperative intracameral epinephrine in a 1:2500 dilution for the management of intraoperative floppy-iris syndrome (IFIS) induced by alpha(1A)-blocking agents such as tamsulosin. Patients on alpha(1A)-blocking agents used topical atropine sulfate 1% 3 times a day for 2 days before surgery. In addition to routine topical mydriatics before surgery, they received intracameral epinephrine diluted 1:2500 with BSS. In 19 of 20 eyes, there were no clinical manifestations of IFIS with this regimen. Stimulation of the iris dilator by a direct-acting sympathomimetic (epinephrine) combined with strong pupiloplegia (atropine) provides powerful synergism. Preoperative identification of patients on alpha(1)-blockers is important as complications can be reduced significantly by using appropriate strategies to deal with this condition. It is also important that patients suffering from benign prostatic hyperplasia do not stop using an alpha(1A)-blocker, especially when preoperative atropine is used, as acute urinary retention may ensue.

Pupil dilation with intracameral lidocaine during phacoemulsification

PURPOSE

To evaluate pupil dilation by an intracameral injection of nonpreserved lidocaine 1% during phacoemulsification cataract extraction and compare the results with those using conventional topical mydriatics.

SETTING

Department of Ophthalmology, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.

METHODS

A prospective comparative case series study was conducted. The study included 57 patients who were given topical mydriatics (30 eyes) or intracameral lidocaine (27 eyes) to dilate the pupil for phacoemulsification and intraocular lens implantation. The topical group received 3 drops of cyclopentolate 1% and phenylephrine 5% given 5 minutes apart starting 60 minutes before surgery. The intracameral group received preservative-free lidocaine 1% (0.2 to 0.3 mL) injected just before the procedure began. No epinephrine was added to the irrigating solution. In both groups, the horizontal pupil diameter was measured before and after pupil dilation using the same caliper. Total surgical time, need for a mydriatic agent during the procedure, and subjective surgical performance were recorded.

RESULTS

The mean age, sex, cataract density, baseline horizontal pupil diameter, and mean duration of the surgery were the same between the topical group and intracameral group. The mean pupil dilation was 4.52 mm +/- 0.08 (SD) in the intracameral group and 4.06 +/- 0.09 mm in the topical group; the difference between groups was statistically significant (P = .001). There was no significant difference between groups in the overall subjective surgical performance (P = .74). No patient in the intracameral group and 2 patients in the topical group required an intracameral mydriatic injection.

CONCLUSION

During phacoemulsification, intracameral preservative-free lidocaine 1% provided rapid, effective mydriasis comparable that of topical mydriatics.

Effect of formulation factors on in-vitro permeation of diclofenac from experimental and marketed aqueous eye drops through excised goat cornea

The effect of formulation factors on permeation of diclofenac from some experimental and marketed aqueous eye drops through excised goat cornea was evaluated. Raising the pH of formulation from 6.0 to 8.0 or diclofenac concentration from 0.05 to 0.15% (w/v) or adjusting tonicity with mannitol or addition of viscolizing agent decreased apparent permeability coefficient (Papp). Formulation (pH 7.4) containing sodium metabisulfite or EDTA or combination of methyl and propyl paraben showed significantly (p<0.05) higher Papp whereas benzalkonium chloride (BAC) had no effect and sorbic acid (SA) had reduced permeation. Surprisingly marketed drops containing BAC or SA, showed significantly (p<0.05) higher Papp and decreased in the order of Difen>Voveran>NSAID>Dicol>Diclolab. Lower pH (7.1-7.3) and surface tension of drops indicating presence of surfactant, could mediate increased permeation and presence of buffer could cause irritation on in vivo instillation. The marketed formulations showed corneal hydration >83% suggesting corneal damaging potential.