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Akmaz B, Kilic D, Duru N. The safety and efficacy of phacoemulsification surgery in uncomplicated cataracts with and without an ophthalmic-viscosurgical-device. Eur J Ophthalmol 2023; 33:269-277. [PMID: 35895295 DOI: 10.1177/11206721221116701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE To compare and evaluate the results of phacoemulsification surgery involving and not involving an ophthalmic-viscosurgical-device (OVD). METHODS A prospective, randomized controlled trial included 60 eyes of 60 patients scheduled to receive phacoemulsification surgery. In order of presentation, patients were randomized into two groups to undergo different surgical techniques: the OVD-free group (n = 30) and the OVD group (n = 30). Each patient's operating time, total ultrasonography (U/S) time, cumulative dissipated energy (CDE), aspiration time, and volume of balanced salt solution (BSS) aspirated were recorded. At 1 day, 1 week, and 1 and 3 months postoperation, measurements of endothelial cell density (ECD) and intraocular pressure (IOP), were taken and compared between the groups. RESULTS Total U/S time (p = .567) and CDE (p = .168) were similar between the groups. In the OVD group, operating time (p = .011), aspiration time (p < .001), and volume of BSS aspirated (p < .001) were greater than in the OVD-free group. The change in ECD between the groups was not statistically significant at all visits (p = .433, p = .147, p = .379, p = .534; respectively). Although IOP increased in the OVD group at 1 day postoperation (p = .001), no difference emerged between the groups at 3 months postoperation (p = .121). CONCLUSION Phacoemulsification surgery without an OVD took less time than with the OVD and caused no significant loss in ECD. Surgeons concerned about elevated IOP following cataract surgery should apply the OVD-free method.
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Affiliation(s)
- Berkay Akmaz
- Department of Ophthalmology, 169317Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Deniz Kilic
- Department of Ophthalmology, Health Science University, 147026Kayseri City Training and Research Hospital, Kayseri, Turkey
| | - Necati Duru
- Department of Ophthalmology, Ideal Eye Center, Kayseri, Turkey
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2
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Abstract
The ophthalmic viscosurgical device (OVD) is an essential part of modern phacoemulsification surgery. Many times, OVDs are blamed for intraocular pressure spikes, toxic anterior segment syndrome, and capsular bag distension syndrome. To avoid these complications, we developed a technique in which phacoemulsification can be done without using OVDs. The irrigating cannula, on a continuous irrigation mode, was introduced through a side port, and capsulorhexis and incision construction were performed under an irrigating balanced salt solution. No hydroprocedure was performed. Phacoemulsification was done by chopping technique. At the end of the procedure, the intraocular lens was implanted by wound assistance technique under a continuous irrigation mode.
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3
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Abstract
Clear vision is dependent on features that protect the anatomical integrity of the eye (cornea and sclera) and those that contribute to internal ocular homeostasis by conferring hemangiogenic (avascular tissues and antiangiogenic factors), lymphangiogenic (lack of draining lymphatics), and immunologic (tight junctions that form blood-ocular barriers, immunosuppressive cells, and modulators) privileges. The later examples are necessary components that enable the eye to maintain an immunosuppressive environment that responds to foreign invaders in a deviated manner, minimizing destructive inflammation that would impair vision. These conditions allowed for the observations made by Medawar, in 1948, of delayed rejection of allogenic tissue grafts in the anterior chamber of mouse eye and permit the sequestration of foreign invaders (eg, Toxoplasma gondii) within the retina of healthy individuals. Yet successful development of intraocular drugs (biologics and delivery devices) has been stymied by adverse ocular pathology, much of which is driven by immune pathways. The eye can be intolerant of foreign protein irrespective of delivery route, and endogenous ocular cells have remarkable plasticity when recruited to preserve visual function. This article provides a review of current understanding of ocular immunology and the potential role of immune mechanisms in pathology observed with intraocular drug delivery.
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Affiliation(s)
| | | | - Sharmila Masli
- 12259Boston University School of Medicine, Boston, MA, USA
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4
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Hernandez-Bogantes E, Navas A, Naranjo A, Amescua G, Graue-Hernandez EO, Flynn HW, Ahmed I. Toxic anterior segment syndrome: A review. Surv Ophthalmol 2019; 64:463-476. [PMID: 30703402 DOI: 10.1016/j.survophthal.2019.01.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 01/10/2019] [Accepted: 01/17/2019] [Indexed: 01/29/2023]
Abstract
Toxic anterior segment syndrome is a surgical complication characterized by a noninfectious anterior chamber inflammatory reaction having multiple etiologies. The clinical signs (prominent limbus-to-limbus corneal edema, anterior chamber inflammation) and symptoms (decreased visual acuity, discomfort) generally occur within the first 12-48 hours after intraocular surgery. Most patients achieve good clinical and visual outcomes when there is a prompt clinical diagnosis and adequate treatment. We review the literature on toxic anterior segment syndrome, emphasizing its etiology, pathophysiology, and clinical and surgical management, as well as prognosis and sequelae. Our goal is to reduce the frequency of toxic anterior segment syndrome by highlighting the importance of prevention, early recognition, and distinguishing toxic anterior segment syndrome from infectious endophthalmitis.
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Affiliation(s)
- Erick Hernandez-Bogantes
- Centro Ocular, Heredia, Costa Rica; Instituto de Oftalmología Fundación Conde de Valenciana, Ciudad de México, México
| | - Alejandro Navas
- Instituto de Oftalmología Fundación Conde de Valenciana, Ciudad de México, México
| | - Andrea Naranjo
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Guillermo Amescua
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | | | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Ike Ahmed
- Prism Eye Institute, University of Toronto, Ontario, Canada.
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5
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Eaton JS, Miller PE, Bentley E, Thomasy SM, Murphy CJ. The SPOTS System: An Ocular Scoring System Optimized for Use in Modern Preclinical Drug Development and Toxicology. J Ocul Pharmacol Ther 2017; 33:718-734. [DOI: 10.1089/jop.2017.0108] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Joshua Seth Eaton
- Ocular Services On Demand (OSOD), LLC, Madison, Wisconsin
- Department of Surgical & Radiological Sciences, School of Veterinary Medicine, University of California—Davis, Davis, California
| | - Paul E. Miller
- Ocular Services On Demand (OSOD), LLC, Madison, Wisconsin
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin—Madison, Madison, Wisconsin
| | - Ellison Bentley
- Ocular Services On Demand (OSOD), LLC, Madison, Wisconsin
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin—Madison, Madison, Wisconsin
| | - Sara M. Thomasy
- Ocular Services On Demand (OSOD), LLC, Madison, Wisconsin
- Department of Surgical & Radiological Sciences, School of Veterinary Medicine, University of California—Davis, Davis, California
| | - Christopher J. Murphy
- Ocular Services On Demand (OSOD), LLC, Madison, Wisconsin
- Department of Surgical & Radiological Sciences, School of Veterinary Medicine, University of California—Davis, Davis, California
- Department of Ophthalmology & Vision Science, School of Medicine, University of California—Davis, Sacramento, California
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6
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Li H, Hitchins VM, Wickramasekara S. Rapid detection of bacterial endotoxins in ophthalmic viscosurgical device materials by direct analysis in real time mass spectrometry. Anal Chim Acta 2016; 943:98-105. [PMID: 27769383 PMCID: PMC5500980 DOI: 10.1016/j.aca.2016.09.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/23/2016] [Accepted: 09/24/2016] [Indexed: 01/17/2023]
Abstract
Bacterial endotoxins are lipopolysaccharides bound to the bacterial cell wall and released when bacteria rupture or disintegrate. Possible contamination of endotoxin in ophthalmic devices can cause a painful eye inflammation or result in toxic anterior segment syndrome after cataract surgery. Measurement of bacterial endotoxin in medical device materials is difficult since endotoxin binds with polymer matrix and some of the materials are very viscous and non-water soluble, where traditional enzyme-based Limulus amebocyte lysate (LAL) assay cannot be applied. Here we propose a rapid and high throughput ambient ionization mass spectrometric (MS) method using direct analysis in real time (DART) for the evaluation of endotoxin contamination in medical device materials. Large and structurally complex endotoxin instantaneously breaks down into low-mass characteristic fragment ions using DART and is detected by MS in both positive and negative ion modes. This method enables the identification and separation of endotoxin from medical materials with a detection limit of 0.03 ng mL-1 endotoxins in aqueous solution. Ophthalmic viscosurgical device materials including sodium hyaluronate (NaHA), non-water soluble perfluoro-n-octane (PFO) and silicone oil (SO) were spiked with different known concentrations of endotoxin and analyzed by DART MS, where the presence of endotoxin was successfully detected and featured small mass fragment ions were generated for NaHA, PFO and SO as well. Current findings showed the feasibility of measuring endotoxin contamination in medical device materials using DART-MS, which can lead to a one-step analysis of endotoxins in different matrices, avoiding any potential contamination during sample pre-treatment steps.
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Affiliation(s)
- Hongli Li
- Division of Biology, Chemistry, and Materials Science, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, 20993, United States; Jiangsu Collaborative Innovation Center of Biomedical Functional Materials, Jiangsu Key Laboratory of Biomedical Materials, College of Chemistry and Materials Science, Nanjing Normal University, Nanjing 210023, China
| | - Victoria M Hitchins
- Division of Biology, Chemistry, and Materials Science, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, 20993, United States
| | - Samanthi Wickramasekara
- Division of Biology, Chemistry, and Materials Science, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, 20993, United States.
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7
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Baeva LF, Sarkar Das S, Hitchins VM. Bacterial endotoxin detection in hyaluronic acid-based medical devices. J Biomed Mater Res B Appl Biomater 2016; 105:1210-1215. [DOI: 10.1002/jbm.b.33659] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 02/19/2016] [Accepted: 03/10/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Larissa F. Baeva
- Division of Biology, Chemistry, and Materials Science, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health; US Food and Drug Administration; Silver Spring Maryland 20993
| | - Srilekha Sarkar Das
- Division of Biology, Chemistry, and Materials Science, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health; US Food and Drug Administration; Silver Spring Maryland 20993
| | - Victoria M. Hitchins
- Division of Biology, Chemistry, and Materials Science, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health; US Food and Drug Administration; Silver Spring Maryland 20993
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8
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McLellan GJ, Aktas Z, Hennes-Beean E, Kolb AW, Larsen IV, Schmitz EJ, Clausius HR, Yang J, Hwang SH, Morisseau C, Inceoglu B, Hammock BD, Brandt CR. Effect of a Soluble Epoxide Hydrolase Inhibitor, UC1728, on LPS-Induced Uveitis in the Rabbit. ACTA ACUST UNITED AC 2016; 4. [PMID: 28066796 PMCID: PMC5218821 DOI: 10.13188/2334-2838.1000024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Cytochrome P450 epoxygenase isozymes convert free arachidonic acid into eicosanoids named epoxyeicosatrienoic acids (EETs) that have roles in regulating inflammation. EETs are rapidly converted to dihydroxyeicosatrienoic acids (DiHETs) by soluble epoxide hydrolase (sEH). Little is known about the potential role of these metabolites in uveitis, but conversion of EETs to DiHETs could contribute to the inflammation. We tested a potent and orally available inhibitor of sEH for its ability to reduce ocular inflammation in a rabbit LPS-induced model of uveitis. Rabbits were treated by subcutaneous injection with the sEH inhibitor (UC1728, 3 mg/kg), or the vehicle control (PEG400) and uveitis was assessed at 6, 24 and 48 h post-intracameral LPS injection using a modified Hackett-McDonald scoring system. Eyes treated by intra-cameral injection of PBS, or by aseptic preparation served as further controls. Signs of inflammation in this model were mild and transient. Treatment with UC1728 did not significantly reduce inflammation compared to animals treated with the PEG400 vehicle. Blood levels of UC1728 were a thousand fold higher than the in vitro determined inhibitory potency (IC50) of the compound suggesting a significant degree of inhibition of sEH in the rabbit. The lack of efficacy suggests that sEH or its substrates the EETs may not be involved in mediating inflammation in this model of uveitis.
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Affiliation(s)
- Gillian J McLellan
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, USA; Department of Medical Microbiology and Immunology, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, USA; Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Wisconsin, USA; Comparative Ophthalmic Research Laboratories, School of Veterinary Medicine, University of Wisconsin-Madison, Wisconsin, USA; Department of Ophthalmology and Visual Sciences, McPherson Eye Research Institute, University of Wisconsin-Madison, Wisconsin, USA
| | - Zeynep Aktas
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, USA; Department of Surgical Sciences, Gazi University, Turkey
| | - Elizabeth Hennes-Beean
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, USA
| | - Aaron W Kolb
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, USA
| | - Inna V Larsen
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, USA
| | - Emily J Schmitz
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, USA
| | - Hilary R Clausius
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, USA
| | - Jun Yang
- Department of Entomology and Comprehensive Cancer Center, University of California, Davis, CA 95616, USA
| | - Sung Hee Hwang
- Department of Entomology and Comprehensive Cancer Center, University of California, Davis, CA 95616, USA
| | - Christophe Morisseau
- Department of Entomology and Comprehensive Cancer Center, University of California, Davis, CA 95616, USA
| | - Bora Inceoglu
- Department of Entomology and Comprehensive Cancer Center, University of California, Davis, CA 95616, USA
| | - Bruce D Hammock
- Department of Entomology and Comprehensive Cancer Center, University of California, Davis, CA 95616, USA
| | - Curtis R Brandt
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, USA; Department of Medical Microbiology and Immunology, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, USA; Comparative Ophthalmic Research Laboratories, School of Veterinary Medicine, University of Wisconsin-Madison, Wisconsin, USA; Department of Ophthalmology and Visual Sciences, McPherson Eye Research Institute, University of Wisconsin-Madison, Wisconsin, USA
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9
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Burkhard Dick H, Gerste RD, Schultz T. Femtosecond cataract surgery overcoming clinical challenges. EXPERT REVIEW OF OPHTHALMOLOGY 2013. [DOI: 10.1586/17469899.2014.857273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Dick HB, Gerste RD, Rivera RP, Schultz T. Femtosecond Laser-Assisted Cataract Surgery Without Ophthalmic Viscosurgical Devices. J Refract Surg 2013; 29:784-7. [DOI: 10.3928/1081597x-20130816-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 06/26/2013] [Indexed: 11/20/2022]
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11
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Hassan M, Tan X, Welle E, Ilev I. Fiber-optic Fourier transform infrared spectroscopy for remote label-free sensing of medical device surface contamination. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2013; 84:053101. [PMID: 23742526 DOI: 10.1063/1.4803182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
As a potential major source of biochemical contamination, medical device surfaces are of critical safety concerns in the clinical practice and public health. The development of innovative sensing methods for accurate and real-time detection of medical device surface contamination is essential to protect patients from high risk infection. In this paper, we demonstrate an alternative fiber-optic Fourier Transform Infrared (FTIR) spectroscopy based sensing approach for remote, non-contact, and label-free detection of biochemical contaminants in the mid-infrared (mid-IR) region. The sensing probe is designed using mid-IR hollow fibers and FTIR measurements are carried out in reflection mode. Bovine Serum Albumin (BSA) and bacterial endotoxin of different concentrations under thoroughly dry condition are used to evaluate the detection sensitivity. The devised system can identify ≤0.0025% (≤4 × 10(11) molecules) BSA and 0.5% (0.5 EU/ml) endotoxin concentration. The developed sensing approach may be applied to detect various pathogens that pose public health threats.
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Affiliation(s)
- Moinuddin Hassan
- Optical Therapeutics and Medical Nanophotonics Laboratory, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland 20993, USA.
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Gottsch JD, Schein OD. Taking TASS to task. Ophthalmology 2012; 119:1295-6. [PMID: 22749087 DOI: 10.1016/j.ophtha.2012.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 05/08/2012] [Accepted: 05/08/2012] [Indexed: 10/28/2022] Open
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13
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Eydelman MB, Tarver ME, Calogero D, Buchen SY, Alexander KY. The Food and Drug Administration's Proactive toxic anterior segment syndrome Program. Ophthalmology 2012; 119:1297-302. [PMID: 22578447 DOI: 10.1016/j.ophtha.2012.04.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 02/27/2012] [Accepted: 04/05/2012] [Indexed: 11/30/2022] Open
Abstract
Toxic anterior segment syndrome (TASS) is a rare inflammatory condition usually observed within the first 48 hours after uncomplicated anterior segment surgery. Over the decades since its initial description, a number of TASS outbreaks have been reported. For a few of these outbreaks, the inciting factors were identified, but for the majority, the precipitating factors were often postulated but not confirmed. In light of the limitations identified in these outbreak investigations, the Food and Drug Administration's (FDA's) Center for Devices and Radiological Health staff has embarked on a number of activities aimed at mitigating medical device-related TASS outbreaks. Under the FDA-designed Proactive TASS Program (PTP), FDA scientists have conducted animal studies to better explore the inflammatory potential of suspected ophthalmic device contaminants implicated in prior cases of TASS. For contaminants displaying a TASS-like reaction in these animal models, the FDA scientists have developed analytic test methods to measure the level of those contaminants in or on ophthalmic devices. Moreover, FDA researchers have developed methods to better capture the clinical information necessary to assist investigations of potential future outbreaks. Last, the FDA has partnered with the Centers for Disease Control and Prevention to facilitate a potential TASS investigation, including expediting the analysis of potentially contaminated medical devices. The PTP is an example of the FDA proactively developing test methods and disease surveillance methods geared toward protecting the public's health.
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Affiliation(s)
- Malvina B Eydelman
- Food and Drug Administration, Center for Devices and Radiological Health, Office of Device Evaluation, Division of Ophthalmic, Neurological, and Ear, Nose, and Throat Devices, Silver Spring, Maryland 20993, USA.
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