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Catinis AM, Fernandez J, Ranario JS. A Blind Spot: The Role of Topical Ocular Anesthesia in Mohs Micrographic Surgery. Dermatol Surg 2024:00042728-990000000-00921. [PMID: 39106358 DOI: 10.1097/dss.0000000000004366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024]
Affiliation(s)
- Anna M Catinis
- All authors are affiliated with the Department of Dermatology and Dermatologic Surgery, Baylor College of Medicine, Houston, Texas
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Dias PB, Rodrigues Parchen MDA, Wasilewski D. Comparison of Proparacaine, Tetracaine, and Oxybuprocaine in Corneal Sensitivity Measurement. J Ocul Pharmacol Ther 2024; 40:215-221. [PMID: 38597912 DOI: 10.1089/jop.2023.0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Purpose: This study aimed to determine the onset and duration of action of 3 commercially available topical anesthetic solutions in Brazil, using the Cochet-Bonnet esthesiometer (Luneau®, Paris, France) and to quantitatively assess patient-reported discomfort during application. Methods: A prospective, randomized, masked, and double-blind study was conducted, involving 40 eyes from 21 patients. Patients were administered each one of the topical anesthetics weekly, and corneal sensitivity was measured using the Cochet-Bonnet esthesiometer's corneal touch threshold (CTT). Patients rated the burning sensation using a visual analogue scale (VAS). Results: Among the 21 patients (42.9% male), with a mean age of 31.95 years (±standard deviation = 10.17, range = 22.0-58.0), corneal sensitivity significantly decreased 30 s after application, returning to baseline after 30 min for all groups (P < 0.0001). Significant differences in CTT were observed at 5 min, with proparacaine exhibiting a superior anesthetic effect (P = 0.0003), at 10 min, where tetracaine displayed the most substantial anesthetic effect (P = 0.0135), and at 20 min, where tetracaine demonstrated the highest anesthetic efficacy (P < 0.0001). VAS scores indicated the most intense burning sensation with tetracaine (P < 0.0001). Men reported experiencing more discomfort during instillation compared with women (P = 0.0168). Conclusions: Proparacaine exhibited the fastest onset of action among the 3 topical anesthetics and provided a more comfortable eye sensation during instillation. However, tetracaine demonstrated the longest duration of action despite causing more discomfort.
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Affiliation(s)
- Paula Basso Dias
- Department of Ophthalmology, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | | | - Daniel Wasilewski
- Department of Ophthalmology, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Paraná, Brazil
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Kauser D, Das AV, Warjri GB, George KP, Rao RN, Pediredla S. Clinical Profile, Complications and Trends of Ocular Anaesthesia in a Multi-tier Ophthalmology Network in India: An Eight-Year Experience. Cureus 2024; 16:e57564. [PMID: 38707167 PMCID: PMC11068979 DOI: 10.7759/cureus.57564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 05/07/2024] Open
Abstract
INTRODUCTION To describe the clinical profile, complications and trends of ocular anaesthesia in a multi-tier ophthalmology network in India. METHODS This retrospective hospital-based study included 417,622 patients presenting between January 2013 and December 2020. Patients who were administered either topical, local or general anaesthesia for ocular surgery in at least one eye were included as cases. The data were collected using an electronic medical record system. RESULTS Among the 417,622 patients, local anaesthesia was administered to 280,638, (67.2%) patients and was the most commonly administered type followed by topical anaesthesia in 84,117 (20.14%) patients. The most common complication encountered in administering local anaesthesia was retrobulbar haemorrhage in 103 (0.037%) patients followed by lid haematoma in 49 (0.017%) patients. Tooth damage occurred in 40 (0.076%) patients followed by delayed recovery in 30 (0.057%) patients during general anaesthesia. The trend of local anaesthesia decreased (83.48% vs 53.36%), whereas the trend of topical anaesthesia increased (8.61% vs 32.42%) over the study period. CONCLUSION There is a notable trend towards the adoption of less invasive anaesthetic methods, particularly in common surgeries such as cataract, intravitreal injection, and vitreoretinal surgery. However, despite this trend, a significant proportion of oculoplastic/orbital surgeries, trauma, and strabismus surgeries continue to be performed under general anaesthesia. These observations underscore the ongoing evolution of ocular anaesthesia practices, reflecting advancements in surgical techniques and patient preferences.
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Affiliation(s)
- Dilshad Kauser
- Anaesthesiology, L V Prasad Eye Institute, Hyderabad, IND
| | | | | | - Koshy P George
- Anaesthesiology, L V Prasad Eye Institute, Hyderabad, IND
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Spaide RF. METHOD OF POVIDONE-IODINE APPLICATION AND ENDOPHTHALMITIS RISK. Retin Cases Brief Rep 2024; 18:141-144. [PMID: 36730810 DOI: 10.1097/icb.0000000000001367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/25/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To evaluate the proportion of patients developing endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents according to the mode of povidone-iodine (PI) antisepsis. METHODS A retrospective review of the anti-vascular endothelial growth factor injections given in a 7-year period at a community-based retinal practice. Endophthalmitis was diagnosed to have occurred if an eye developed intraocular inflammation and was given antibiotics with or without supportive culture identification of an organism. As part of their habitual clinical practice, component physicians used 5% PI as two drops, one drop, or just a dot of PI administered with a cotton-tipped applicator to the site before injection. RESULTS There were 113,610 intravitreal injections administered and 23 cases were diagnosed with endophthalmitis over the 7-year period, for a rate of 1 case per 4,940 injections. The mode of PI antisepsis showed no significant relation to the rate of endophthalmitis ( P = 0.55, chi-square test). The proportion of endophthalmitis by physician demonstrated no significant difference ( P = 0.39, chi-square test). CONCLUSION The use of PI has been associated with decreased incidence of endophthalmitis, but the mode of application has not been standardized. The results of this study suggest that "more is not better" in PI antisepsis in endophthalmitis. Moreover, the toxicity of PI on the ocular surface is known to be dose-related.
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Affiliation(s)
- Richard F Spaide
- Vitreous, Retina, Macula Consultants of New York, New York, New York
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Figus M, Giansanti F, Villani E, Alió JL, Jančo L, Mercuri S, Camnasio S, Cagini C. Chloroprocaine 3% Gel as a Novel Ocular Topical Anesthetic: Results from a Multicenter, Randomized Clinical Trial in Patients Undergoing Cataract Surgery. J Ocul Pharmacol Ther 2024; 40:117-125. [PMID: 38489057 PMCID: PMC10951689 DOI: 10.1089/jop.2023.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/16/2023] [Indexed: 03/17/2024] Open
Abstract
Purpose: To compare the efficacy and safety of a novel ophthalmic anesthetic, chloroprocaine 3% gel to tetracaine 0.5% eye drops in patients undergoing cataract surgery with phacoemulsification. Methods: This was a prospective, randomized, multicenter, active-controlled, masked-observer, parallel group competitive equivalence study. The study comprised 338 patients having routine cataract extraction by clear corneal phacoemulsification, randomized to receive 3 drops of chloroprocaine gel (n = 166) or tetracaine eye drops (n = 172) before surgery. The primary objective of the study was to assess the equivalence of chloroprocaine gel to tetracaine eye drops as proportion of patients with successful ocular surface anesthesia, without any supplementation just before intraocular lens implantation. Safety measurements were pain, irritation, burning, stinging, photophobia, and foreign body sensation, graded by the patient and objective ocular signs. Results: Equivalence was demonstrated, with a somewhat higher success rate of chloroprocaine gel: 152/166 (92.0%) chloroprocaine versus 153/172 (90.5%) tetracaine patients achieved ocular surface anesthesia with no supplementation. Difference in proportions was 1.5% confidence interval [95% CI: (-3.6 to 6.6)] and 90% CI fell within (-10 to 10). Mean onset of anesthesia was 1.35 ± 0.87 min for chloroprocaine and 1.57 ± 1.85 for tetracaine (P = 0.083). Mean duration of anesthesia was 21.57 ± 12.26 min for chloroprocaine and 22.04 ± 12.58 for tetracaine (P = 0.574). No treatment emergent adverse events related to chloroprocaine were reported and no relevant findings related to local tolerance or vital signs were observed in both arms. Conclusions: Results obtained from the present cataract study demonstrated that chloroprocaine 3% ophthalmic gel is safe and effective, representing a valid alternative in ocular topical anesthesia. Clinical Trial Registration number: NCT04685538.
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Affiliation(s)
- Michele Figus
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Fabrizio Giansanti
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Edoardo Villani
- Eye Clinica, San Giuseppe Hospital, IRCCS Multimedica Milano, Milan, Italy
| | - Jorge L. Alió
- Opthalmology Department, Vissum Miranza Alicante, Alicante, Spain
| | - Ladislav Jančo
- Očná klinika SZU Nám., F.D.Roosevelt Hospital, Banská Bystrica, Slovakia
| | | | | | - Carlo Cagini
- Department of Medicine and Surgery, Section of Ophthalmology, University of Perugia, Perugia, Italy
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Kovalcuka L, Mālniece A, Vanaga J. Comparison of Tonovet® and Tonovet plus® tonometers for measuring intraocular pressure in dogs, cats, horses, cattle, and sheep. Vet World 2024; 17:384-388. [PMID: 38595645 PMCID: PMC11000490 DOI: 10.14202/vetworld.2024.384-388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/24/2024] [Indexed: 04/11/2024] Open
Abstract
Background and Aim Reference ranges for intraocular pressure (IOP) in healthy animals are device-specific; therefore, it is strongly recommended to use appropriate reference values according to the device. Therefore, our aim was to compare IOP readings made by TonoVet® and TonoVet Plus® in healthy dogs, cats, sheep, cattle, and horses. We compared IOP values measured by TonoVet® and TonoVet Plus® tonometers in clinically normal eyes of dogs, cats, horses, cattle, and sheep. Materials and Methods Five groups comprising 20 animals each of dogs (various breeds, 9 months-10 years old, 14 females, 6 males), cats (various breeds, 6 months-12 years old, 8 females, 12 males), horses (various breeds, 5-12 years old, 12 females, 8 males), cattle (Holstein, 1-7 lactation, female), and sheep (Latvian Darkhead ewes, 1-8 years old) were included in the study. Both eyes of all animals were subjected to ophthalmic examination, including evaluation of IOP by rebound tonometry using TonoVet® and TonoVet Plus® devices. Normality was determined using the Shapiro-Wilk test. The independent t-test was used to determine differences between IOP values in the right and left eyes and between both tonometers. This study was approved by the Ethical Commission of the Latvia University of Life Sciences and Technologies (Nr. LLU_Dzaep_2022-2-4). Results No differences in IOP between the right and left eyes were found in all cases (p > 0.05). The mean IOP ± standard deviation values in both eyes for TonoVet® and TonoVet Plus® tonometers were as follows: for dogs, 15.25 ± 2.73 mmHg and 19.65 ± 3.46 mmHg; and in cats, 18.88 ± 3.98 mmHg and 18.78 ± 4.26 mmHg, respectively. In horses, mean IOP was 22.15 ± 3.74 mmHg and 24.28 ± 3.00 mmHg; in cattle, 24.73 ± 2.89 mmHg and 23.28 ± 2.97 mmHg; and in sheep, 18.05 ± 3.54 mmHg and 22.49 ± 4.66 mmHg, respectively. Significant differences in IOP values were observed between the tonometers in sheep, dog, and horse groups (mean difference -4.40, -4.48, and 2.13, respectively). Conclusion This study showed significantly higher IOP values measured by the TonoVet Plus® tonometer in dogs and sheep.
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Affiliation(s)
- Liga Kovalcuka
- Clinical Institute, Faculty of Veterinary Medicine, Latvia University of Life Sciences and Technologies, Jelgava, LV-3004, Latvia
| | - Aija Mālniece
- Clinical Institute, Faculty of Veterinary Medicine, Latvia University of Life Sciences and Technologies, Jelgava, LV-3004, Latvia
| | - Jana Vanaga
- Clinical Institute, Faculty of Veterinary Medicine, Latvia University of Life Sciences and Technologies, Jelgava, LV-3004, Latvia
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Eshraghi B, Ghorbani S, Pourazizi M, Derakhshan M, Rastegarnasab F, Abtahi‐Naeini B. Unusual cause of bilateral periocular ulceronecrotic wound: Tetracaine abuse-associated bullous drug eruption. Int Wound J 2024; 21:e14397. [PMID: 37734730 PMCID: PMC10788476 DOI: 10.1111/iwj.14397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/23/2023] Open
Affiliation(s)
- Bahram Eshraghi
- Department of Ophthalmology, Isfahan Eye Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Sarah Ghorbani
- Department of Ophthalmology, Isfahan Eye Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Mohsen Pourazizi
- Department of Ophthalmology, Isfahan Eye Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Maryam Derakhshan
- Department of Pathology, School of MedicineIsfahan University of Medical SciencesIsfahanIran
| | | | - Bahareh Abtahi‐Naeini
- Pediatric Dermatology Division, Department of Pediatrics, Imam Hossein Children's HospitalIsfahan University of Medical SciencesIsfahanIran
- Skin Diseases and Leishmaniasis Research CenterIsfahan University of Medical SciencesIsfahanIran
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Chen S, Zhang J, Tian J, Zhao C, Liu C, Sun X, Gao X, Zhang Y, Wang J, Li N, Liu H, Gao Y, Ma X, Li J, Deng A, Wang T, Yuan G. A Multicenter Prospective Randomized Controlled Study of a New Corneal Wetting Agent During Ophthalmologic Surgery. Ophthalmol Ther 2023; 12:3211-3218. [PMID: 37768528 PMCID: PMC10640533 DOI: 10.1007/s40123-023-00818-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION A multicenter prospective randomized controlled study was used to investigate the effect and safety of a new corneal wetting agent called the Corneal Surface Viscoelastic Protector (CsVisc, Success Bio-Tech Co., Ltd, China), on the corneal epithelium during ophthalmic surgery by comparison with the commercially available Cornea Protect (CP, Valeant Med Sp. zo. o. Leobendorf, Austria). METHODS This multicenter prospective randomized controlled study comprised patients scheduled for cataract surgery and pars plana vitrectomy. The patients were randomly assigned to receive either a new corneal wetting agent (CsVisc) or Cornea Protect (CP, Valeant Med Sp. zo. o. Leobendorf, Austria). Optical clarity during surgery, application frequency, duration of effect, diffusion time of corneal wetting agents, fluorescein staining, intraocular pressure (IOP), tear-film break-up time (TBUT), and Schirmer I test (SIT) were assessed. Adverse events were noted on the designated patient case report forms. RESULTS A total of 149 eyes (149 patients, mean age 62 years; range 25-80 years) were included in the study. There were 74 eyes in the control group and 75 eyes in the study group. In patients who underwent vitrectomy, the frequency of application was 1.62 ± 1.03 in the study group and 1.39 ± 0.66 in the control group, with no significant difference (P = 0.399), and the duration of effect was 19.16 ± 6.94 min in the study group and 19.06 ± 7.22 min in the control group, with no significant difference (P = 0.835). The optical clarity of the study group was not significantly different from that of the control group (P = 0.485). In patients who underwent cataract surgery, the frequency of application was 1.10 ± 0.38 in the study group and 1.07 ± 0.26 in the control group, and the difference was not significant (P = 0.950). The difference between the duration of effect in the study group (8.32 ± 2.50 min) and the control group (7.63 ± 2.52 min) was not significant (P = 0.310). The difference in optical clarity scores between the two groups was not statistically significant (P = 0.600). Among all patients in this study, the diffusion time of the corneal wetting agent was 14.97 ± 10.07 s in the control group and 11.23 ± 8.41 s in the study group, with a statistically significant difference (p = 0.008). The frequency of adverse events was 20.00% (15/75) in the study group and 14.86% (11/74) in the control group, with no statistically significant difference (P = 0.409). There were no serious adverse events related to the test medical device or causing patients to withdraw from the study. CONCLUSIONS The CsVisc is safe and effective in preventing intraoperative corneal epithelial damage due to corneal dryness and can be comparable to the CP. In addition, the CsVisc has a shorter diffusion time.
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Affiliation(s)
- Shijiu Chen
- Qingdao University, Qingdao, Shandong, China
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, Shandong, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
| | - Jingjing Zhang
- Qingdao University, Qingdao, Shandong, China
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, Shandong, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China
| | - Jingyi Tian
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, Shandong, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China
| | - Can Zhao
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, Shandong, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China
| | - Chunli Liu
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, Shandong, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China
| | - Xiaolei Sun
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, Shandong, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China
| | - Xiang Gao
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, Shandong, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China
| | - Ying Zhang
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, Shandong, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China
| | - Jun Wang
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, 261000, Shandong, China
| | - Na Li
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, 261000, Shandong, China
| | - Hong Liu
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, 261000, Shandong, China
| | - Yan Gao
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, 5 Yanerdao Road, Qingdao, 266073, Shandong, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China
| | - Xiubin Ma
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, 5 Yanerdao Road, Qingdao, 266073, Shandong, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China
| | - Jun Li
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, 5 Yanerdao Road, Qingdao, 266073, Shandong, China.
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China.
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China.
| | - Aijun Deng
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, 261000, Shandong, China.
| | - Ting Wang
- Qingdao University, Qingdao, Shandong, China.
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, Shandong, China.
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China.
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China.
| | - Gongqiang Yuan
- Qingdao University, Qingdao, Shandong, China.
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), 372 Jingsi Road, Jinan, 250021, Shandong, China.
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China.
- School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China.
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Lafreniere JD, Szczesniak AM, Courtney E, Kelly MEM, Faktorovich EG. Topical analgesics for acute corneal pain: current options and emerging therapeutics. J Cataract Refract Surg 2023; 49:1160-1167. [PMID: 37232414 DOI: 10.1097/j.jcrs.0000000000001225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Abstract
Acute corneal pain is a common complaint that causes significant distress to patients and continues to challenge therapeutic avenues for pain management. Current topical treatment options have marked limitations in terms of both efficacy and safety, thus often prompting the adjunctive use of systemic analgesics, including opioids. In general, there have not been extensive advancements in pharmacologic options for the management of corneal pain over the past several decades. Despite this, multiple promising therapeutic avenues exist which hold the potential to transform the ocular pain landscape, including druggable targets within the endocannabinoid system. This review will summarize the current evidence base for topical nonsteroidal anti-inflammatory drugs, anticholinergic agents, and anesthetics before focusing on several potential avenues in the setting of acute corneal pain management, including autologous tear serum, topical opioids and endocannabinoid system modulators.
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Affiliation(s)
- J Daniel Lafreniere
- From the Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada (Lafreniere, Szczesniak, Courtney, Kelly); Department of Ophthalmology & Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada (Kelly); Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada (Kelly); Pacific Vision Institute, San Francisco, California (Faktorovich)
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Wang Q, Zhang Z, Gao X. Effects of ophthalmic surface anesthetic alcaine on the proliferation and apoptosis of human corneal endothelial cells through HIF-1α regulation. Cell Tissue Bank 2023; 24:561-570. [PMID: 36572744 DOI: 10.1007/s10561-022-10057-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/22/2022] [Indexed: 12/27/2022]
Abstract
The corneal endothelium is a monolayer, which mediates solute and water flux across the posterior corneal surface. Alcaine's main component proparacaine is paramount in human corneal endothelium (HCE) cell regulation. This study explored the mechanism of alcaine in regulating HCE cells. HCE cell morphology under gradient concentrations was observed by an optical microscope. Cell proliferation and viability were detected by MTT assay to determine the half inhibitory concentration (IC 50). Cell apoptosis rate, HIF-1α mRNA expression, and HIF-1α, p/t-JNK and Caspase-3 protein levels were detected by flow cytometry, RT-qPCR, and Western blot. After treatment with alcaine at 0.625-5 g/L concentration range for 24 h, HCE cells showed cytoplasmic vacuolation, cell shrinkage, separation from culture matrix, and eventual death. Alcaine treated-HCE cell proliferation was decreased in a dose-dependent manner. The IC 50 of alcaine was 1.26 g/L. After alcaine treatment, HCE cell apoptosis rate was promoted and HIF-1α levels in HCE cells were stimulated. Knockdown of HIF-1α partially annulled the effects of alcaine on inhibiting HCE cell proliferation and facilitating apoptosis. Alcaine might activate the JNK/caspase-3 pathway by increasing HIF-1α. The inhibition of the JNK/caspase-3 pathway partially abrogated the effects of alcaine on inhibiting HCE cell proliferation and promoting apoptosis. Alcaine might affect HCE cell proliferation and apoptosis by upregulating HIF-1α and activating the JNK/caspase-3 pathway.
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Affiliation(s)
- Quan Wang
- Department of Anesthesiology, Tianjin Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, No. 4 Gansu Road, Heping District, Tianjin, 300022, China
| | - Zhao Zhang
- Department of Anesthesiology, Tianjin Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, No. 4 Gansu Road, Heping District, Tianjin, 300022, China
| | - Xuesong Gao
- Department of Anesthesiology, Tianjin Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, No. 4 Gansu Road, Heping District, Tianjin, 300022, China.
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Sikiric P, Kokot A, Kralj T, Zlatar M, Masnec S, Lazic R, Loncaric K, Oroz K, Sablic M, Boljesic M, Antunovic M, Sikiric S, Strbe S, Stambolija V, Beketic Oreskovic L, Kavelj I, Novosel L, Zubcic S, Krezic I, Skrtic A, Jurjevic I, Boban Blagaic A, Seiwerth S, Staresinic M. Stable Gastric Pentadecapeptide BPC 157-Possible Novel Therapy of Glaucoma and Other Ocular Conditions. Pharmaceuticals (Basel) 2023; 16:1052. [PMID: 37513963 PMCID: PMC10385428 DOI: 10.3390/ph16071052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/01/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
Recently, stable gastric pentadecapeptide BPC 157 therapy by activation of collateral pathways counteracted various occlusion/occlusion-like syndromes, vascular, and multiorgan failure, and blood pressure disturbances in rats with permanent major vessel occlusion and similar procedures disabling endothelium function. Thereby, we revealed BPC 157 cytoprotective therapy with strong vascular rescuing capabilities in glaucoma therapy. With these capabilities, BPC 157 therapy can recover glaucomatous rats, normalize intraocular pressure, maintain retinal integrity, recover pupil function, recover retinal ischemia, and corneal injuries (i.e., maintained transparency after complete corneal abrasion, corneal ulceration, and counteracted dry eye after lacrimal gland removal or corneal insensitivity). The most important point is that in glaucomatous rats (three of four episcleral veins cauterized) with high intraocular pressure, all BPC 157 regimens immediately normalized intraocular pressure. BPC 157-treated rats exhibited normal pupil diameter, microscopically well-preserved ganglion cells and optic nerve presentation, normal fundus presentation, nor- mal retinal and choroidal blood vessel presentation, and normal optic nerve presentation. The one episcleral vein rapidly upgraded to accomplish all functions in glaucomatous rats may correspond with occlusion/occlusion-like syndromes of the activated rescuing collateral pathway (azygos vein direct blood flow delivery). Normalized intraocular pressure in glaucomatous rats corresponded to the counteracted intra-cranial (superior sagittal sinus), portal, and caval hypertension, and aortal hypotension in occlusion/occlusion-like syndromes, were all attenuated/eliminated by BPC 157 therapy. Furthermore, given in other eye disturbances (i.e., retinal ischemia), BPC 157 instantly breaks a noxious chain of events, both at an early stage and an already advanced stage. Thus, we further advocate BPC 157 as a therapeutic agent in ocular disease.
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Affiliation(s)
- Predrag Sikiric
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Antonio Kokot
- Department of Anatomy and Neuroscience, Faculty of Medicine, J.J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Tamara Kralj
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Mirna Zlatar
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Sanja Masnec
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ratimir Lazic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Kristina Loncaric
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Katarina Oroz
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Marko Sablic
- Department of Anatomy and Neuroscience, Faculty of Medicine, J.J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Marta Boljesic
- Department of Anatomy and Neuroscience, Faculty of Medicine, J.J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Marko Antunovic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Suncana Sikiric
- Department of Pathology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Sanja Strbe
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Vasilije Stambolija
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | | | - Ivana Kavelj
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Luka Novosel
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Slavica Zubcic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ivan Krezic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Anita Skrtic
- Department of Pathology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ivana Jurjevic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Alenka Boban Blagaic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Sven Seiwerth
- Department of Pathology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Mario Staresinic
- Department of Surgery, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
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12
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Kovalcuka L, König NAM, Petersen PVH, Sneidere A, Malniece A. Normal Range for the Schirmer Tear Test and Intraocular Pressure in Healthy Latvian Darkhead Lambs and Ewes. Vet Sci 2023; 10:392. [PMID: 37368778 DOI: 10.3390/vetsci10060392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
A complete ophthalmological examination, including basic diagnostic tests such as the Schirmer tear test (STT) and intraocular pressure (IOP) measurement performed by tonometry in particular species and breeds, is essential for obtaining a clear diagnostic result and avoiding diagnostic misinterpretations. STT and IOP values have been poorly described for sheep. Therefore, this study aimed to determine the normal range for STT and tonometry values in clinically normal Latvian Darkhead lambs and ewes. Both eyes of 100 sheep (200 eyes)-50 lambs (1-3 months old) and 50 ewes (1-8 years old)-underwent complete ophthalmic examinations, including STT and IOP evaluation. The mean ± standard deviation of STT values for both eyes in lambs and ewes were 13.12 ± 3.91 mm/min and 13.68 ± 4.09 mm/min, respectively. The IOP in lambs and ewes was 14.04 ± 3.68 mmHg and 19.16 ± 3.24 mmHg, respectively. Furthermore, the suggested reference range for the STT was 12.00-14.23 mm/min in lambs and 12.52-14.84 mm/min in ewes, while the reference IOP range was determined to be 13.00-15.08 mmHg in lambs and 18.24-20.08 mmHg in ewes. No statistically significant differences in STT and IOP values were observed for both eyes. However, the IOP value for both eyes was statistically significantly higher in ewes compared to lambs (p < 0.01). This study provides reference values for the STT and IOP in healthy Latvian Darkhead lambs and ewes.
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Affiliation(s)
- Liga Kovalcuka
- Clinical Institute, Faculty of Veterinary Medicine, Latvia University of Life Sciences and Technologies, LV-3004 Jelgava, Latvia
| | - Nelli Alexandra Margarethe König
- Clinical Institute, Faculty of Veterinary Medicine, Latvia University of Life Sciences and Technologies, LV-3004 Jelgava, Latvia
| | - Pia Valentina Helen Petersen
- Clinical Institute, Faculty of Veterinary Medicine, Latvia University of Life Sciences and Technologies, LV-3004 Jelgava, Latvia
| | - Aija Sneidere
- Clinical Institute, Faculty of Veterinary Medicine, Latvia University of Life Sciences and Technologies, LV-3004 Jelgava, Latvia
| | - Aija Malniece
- Clinical Institute, Faculty of Veterinary Medicine, Latvia University of Life Sciences and Technologies, LV-3004 Jelgava, Latvia
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13
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Ruiz-Lozano RE, Salan-Gomez M, Rodriguez-Garcia A, Quiroga-Garza ME, Ramos-Dávila EM, Perez VL, Azar NS, Merayo-Lloves J, Hernandez-Camarena JC, Valdez-García JE. Wessely corneal ring phenomenon: An unsolved pathophysiological dilemma. Surv Ophthalmol 2023:S0039-6257(23)00041-3. [PMID: 36882129 DOI: 10.1016/j.survophthal.2023.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
The cornea is a densely innervated, avascular tissue showing exceptional inflammatory and immune responses. The cornea is a site of lymphangiogenic and angiogenic privilege devoid of blood and lymphatic vessels that limits the entry of inflammatory cells from the adjacent and highly immunoreactive conjunctiva. Immunological and anatomical differences between the central and peripheral cornea are also necessary to sustain passive immune privilege. The lower density of antigen-presenting cells in the central cornea and the 5:1 peripheral-to-central corneal ratio of C1 are 2 main features conferring passive immune privilege. C1 activates the complement system by antigen-antibody complexes more effectively in the peripheral cornea and, thus, protects the central corneas' transparency from immune-driven and inflammatory reactions. Wessely rings, also known as corneal immune rings, are non-infectious ring-shaped stromal infiltrates usually formed in the peripheral cornea. They result from a hypersensitivity reaction to foreign antigens, including those of microorganism origin. Thus, they are thought to be composed of inflammatory cells and antigen-antibody complexes. Corneal immune rings have been associated with various infectious and non-infectious causes, including foreign bodies, contact lens wear, refractive procedures, and drugs. We describe the anatomical and immunologic basis underlying Wessely ring formation, its causes, clinical presentation, and management.
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Affiliation(s)
- Raul E Ruiz-Lozano
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences. Monterrey, Mexico
| | - Marcelo Salan-Gomez
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences. Monterrey, Mexico
| | - Alejandro Rodriguez-Garcia
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences. Monterrey, Mexico
| | - Manuel E Quiroga-Garza
- Foster Center for Ocular Immunology, Duke Eye Center, Duke University, Durham, NC, United States
| | - Eugenia M Ramos-Dávila
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences. Monterrey, Mexico
| | - Victor L Perez
- Foster Center for Ocular Immunology, Duke Eye Center, Duke University, Durham, NC, United States
| | - Nadim S Azar
- Foster Center for Ocular Immunology, Duke Eye Center, Duke University, Durham, NC, United States
| | - Jesus Merayo-Lloves
- Instituto Universitario Fernández Vega, Universidad de Oviedo, Oviedo, Spain
| | - Julio C Hernandez-Camarena
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences. Monterrey, Mexico
| | - Jorge E Valdez-García
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences. Monterrey, Mexico.
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14
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Stasi K, Alshare Q, Jain M, Wald M, Li Y. Topical Ocular TRPV1 Antagonist SAF312 (Libvatrep) Demonstrates Safety, Low Systemic Exposure, and No Anesthetic Effect in Healthy Participants. Transl Vis Sci Technol 2022; 11:15. [DOI: 10.1167/tvst.11.11.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Kalliopi Stasi
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Qusai Alshare
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Monish Jain
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Michael Wald
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Yifang Li
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
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15
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Zhang E, Gupta S, Olson E, Sinha PR, Hesemann NP, Fraunfelder FW, Mohan RR. Effects of Regular/Dilute Proparacaine Anesthetic Eye Drops in Combination with Ophthalmic Antibiotics on Corneal Wound Healing. J Ocul Pharmacol Ther 2022; 38:232-239. [PMID: 35275738 PMCID: PMC9048177 DOI: 10.1089/jop.2021.0116] [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: 11/13/2022] Open
Abstract
Purpose: Topical, local anesthetic eye drops in conjunction with antibiotics are commonly used to reduce ocular pain and treat patients in emergency clinics; however, their effects on corneal healing are poorly understood. This study examined whether regular or diluted proparacaine eye drops given in combination with common ophthalmic antibiotics affect corneal wound healing parameters using in vitro and in vivo models. Methods: Primary human corneal fibroblasts generated from donor corneas and New Zealand white rabbits were used. Regular (0.5%) and diluted (0.05%) proparacaine eye drops, twice daily for 3 days, were applied to cultures and rabbit eyes, with or without ophthalmic antibiotics (polymyxin B sulfate and trimethoprim). Trypan blue, 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT), and scratch wound assays measured cellular viability, proliferation, and migration, respectively, in vitro. Slit lamp biomicroscopy, tonometry, fluorescein eye test, hematoxylin and eosin (H&E) staining, and 4',6-diamidino-2-phenylindole (DAPI) immunofluorescence were used for in vivo studies. Results: Both regular and diluted proparacaine affected wound healing response in the cornea in vitro and in vivo in a time-dependent manner. Adjunct antibiotic treatments had additive effects characterized by reduced corneal fibroblast viability, proliferation, and migration in vitro and corneal epithelial recovery in vivo. Regular proparacaine with antibiotics showed most pronounced effects on corneal wound healing parameters, and diluted proparacaine without antibiotics had minimal negative effects in vitro and in vivo. Conclusions: Both methods of regular (0.5%) and diluted (0.05%) proparacaine topical application to the cornea are safe, but impede corneal wound healing in vitro and in vivo. Adjunct antibiotic treatments had additive negative effects on corneal wound repair.
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Affiliation(s)
- Eric Zhang
- Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri, USA.,Mason Eye Institute, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Suneel Gupta
- Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri, USA.,Department of Veterinary Medicine and Surgery and Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - Evan Olson
- Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri, USA.,Mason Eye Institute, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Prashant R Sinha
- Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri, USA.,Department of Veterinary Medicine and Surgery and Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - Nathan P Hesemann
- Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri, USA.,Mason Eye Institute, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Fredrick W Fraunfelder
- Mason Eye Institute, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Rajiv R Mohan
- Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri, USA.,Mason Eye Institute, School of Medicine, University of Missouri, Columbia, Missouri, USA.,Department of Veterinary Medicine and Surgery and Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
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16
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Rapid and Sensitive Simultaneous Separation and Electrochemical Detection of Tetracaine Hydrochloride and Oxymetazoline Hydrochloride in Pharmaceutical Formulations via Core-shell Reversed-phase Liquid Chromatography. J Pharm Biomed Anal 2022; 214:114717. [DOI: 10.1016/j.jpba.2022.114717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/28/2022] [Accepted: 03/05/2022] [Indexed: 11/20/2022]
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17
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Gohil H, Miskovic M, Buxton JA, Holland SP, Strike C. Smoke Gets in the Eye: A systematic review of case reports of ocular complications of crack cocaine use. Drug Alcohol Rev 2022; 41:347-355. [PMID: 34337815 DOI: 10.1111/dar.13366] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/23/2021] [Accepted: 07/14/2021] [Indexed: 11/27/2022]
Abstract
ISSUES Use of crack cocaine and associated medical complications persists globally. Some reports in medical literature describe a sight-threatening condition commonly referred to as 'crack eye' or 'crack eye syndrome'. The purpose of this review is to describe what is known about crack eye from case reports in peer-reviewed literature. APPROACH A structured search was completed in MEDLINE, TOXLINE, EMBASE, PsychInfo, Scopus and Biomed Central, to collect case reports and case series on corneal complications attributed to crack cocaine smoking. KEY FINDINGS Of 111 articles screened, 11 contained case reports or series. Thirty individual cases of 'crack eye' were reported. The majority (63%) of cases had bilateral involvement; 83% of all cases with microbial culture results had corneal infections. Aggressive treatment caused an improvement in 95% of all cases and 23% of all cases were lost to follow up. Of those who received treatment for corneal complications associated with crack cocaine, 22% remained with significant visual impairment (hand motions only) in the affected eye. IMPLICATIONS Clinicians should consider crack cocaine involvement in patients presenting with corneal disease without known predisposing factors, and elicit comprehensive drug histories to prevent a reduction in visual acuity. CONCLUSION Corneal complications of crack cocaine smoking are caused by a number of synergistic factors, including direct toxicity of crack cocaine vapours to surface cells, impairment of neurogenic support to corneal epithelial integrity, desiccation of the eye surface due to diminished blinking reflex, low level chemical burns and mechanical denudement of surface cells through eye rubbing.
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Affiliation(s)
- Hemant Gohil
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Miroslav Miskovic
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Simon P Holland
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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18
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Treatment of Non-Infectious Corneal Injury: Review of Diagnostic Agents, Therapeutic Medications, and Future Targets. Drugs 2022; 82:145-167. [PMID: 35025078 PMCID: PMC8843898 DOI: 10.1007/s40265-021-01660-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/03/2022]
Abstract
Corneal injuries can occur secondary to traumatic, chemical, inflammatory, metabolic, autoimmune, and iatrogenic causes. Ocular infection may frequently occur concurrent to corneal injury; however, antimicrobial agents are excluded from this present review. While practitioners may primarily rely on clinical examination techniques to assess these injuries, several pharmacological agents, such as fluorescein, lissamine green, and rose bengal, can be used to formulate a diagnosis and develop effective treatment strategies. Practitioners may choose from several analgesic medications to help with patient comfort without risking further injury or delaying ocular healing. Atropine, cyclopentolate, scopolamine, and homatropine are among the most frequently used medications for this purpose. Additional topical analgesic agents may be used judiciously to augment patient comfort to facilitate diagnosis. Steroidal anti-inflammatory agents are frequently used as part of the therapeutic regimen. A variety of commonly used agents, including prednisolone acetate, loteprednol, difluprednate, dexamethasone, fluorometholone, and methylprednisolone are discussed. While these medications are effective for controlling ocular inflammation, side effects, such as elevated intraocular pressure and cataract formation, must be monitored by clinicians. Non-steroidal medications, such as ketorolac, bromfenac, nepafenac, and diclofenac, are additionally used for their efficacy in controlling ocular inflammation without incurring side effects seen with steroids. However, these agents have their own respective side effects, warranting close monitoring by clinicians. Additionally, ophthalmologists routinely employ several agents in an off-label manner for supplementary control of inflammation and treatment of corneal injuries. Patients with corneal injuries not infrequently have significant ocular surface disease, either as a concurrent pathology or as an exacerbation of previously existing disease. Several agents used in the management of ocular surface disease have also been found to be useful as part of the therapeutic armamentarium for treatment of corneal injuries. For example, several antibiotics, such as doxycycline and macrolides, have been used for their anti-inflammatory effects on specific cytokines that are upregulated during acute injuries. There has been a recent wave of interest in amniotic membrane therapies (AMTs), including topical, cryopreserved and dehydrated variants. AMT is particularly effective in ocular injuries with violation of corneal surface integrity due to its ability to promote re-epithelialization of the corneal epithelium. Blood-based therapies, including autologous serum tears, plasma-enriched growth factor eyedrops and autologous blood drops, have additionally been explored in small case series for effectiveness in challenging and recalcitrant cases. Protection of the ocular surface is also a vital component in the treatment of corneal injuries. Temporary protective methods, such as bandage contact lenses and mechanical closure of the eyelids (tarsorrhaphy) can be particularly helpful in selective cases. Glue therapies, including biologic and non-biologic variants, can also be used in cases of severe injury and risk of corneal perforation. Finally, there are a variety of recently introduced and in-development agents that may be used as adjuvant therapies in challenging patient populations. Neurotrophic corneal disease may occur as a result of severe or chronic injury. In such cases, recombinant human nerve growth factor (cenegermin), topical insulin, and several other novel agents may be an alternate and effective option for clinicians to consider.
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Mahajan A, Coelho A, Pissurlenkar R, Fernandes A, Tagalpallewar A. OUP accepted manuscript. J Chromatogr Sci 2022; 61:393-401. [PMID: 35543315 DOI: 10.1093/chromsci/bmac039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Proparacaine hydrochloric ophthalmic solution (0.5%) is widely used as ophthalmic anesthetic for short conjunctival and corneal procedures. In connection to this, present research work was conducted to investigate ocular toxicity of its probable degradation products (DPs), which were generated after treating drug with stressors mentioned under International Conference on Harmonization (ICH) guideline Q1A (R2). RESULT The probable DPs were generated by placing drug under various stress conditions to generate similarity of the effect of stressor which drug supposed to face during its life cycle. The hydrolytic stress condition under acidic, basic and neutral environment formed two major DPs, while the drug was stable and did not generate any DP when subjected to oxidative, dry heat and photolytic stress. The separation of DPs was carried out using high performance liquid chromatographic system. The structural identification of DPs was carried out by subjecting degradation samples to liquid chromatography coupled with mass spectrometry. These DPs were screened using in-silico ocular toxicity prediction models Pub-SVM to predict their potential to cause irritation/corrosion to eye. CONCLUSIONS The DPs identified were DP 1 (2-(diethyl amino) ethanol) and DP 2 (3-amino-4-propoxybenzoic acid). The in-silico ocular toxicity study predicted that DP 1 has potential of eye corrosion (EC) and eye irritation (EI), whereas DP 2 has a potential EI. The drug was found safe and devoid of any EC and EI potential.
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Affiliation(s)
- Anand Mahajan
- Department of Pharmaceutical Analysis, Goa College of Pharmacy, 18th June Road, Panaji 403001, Goa, India
| | - Allan Coelho
- Department of Pharmaceutical Analysis, Goa College of Pharmacy, 18th June Road, Panaji 403001, Goa, India
| | - Raghuvir Pissurlenkar
- Department of Pharmaceutical Chemistry, Goa College of Pharmacy, 18th June Road, Panaji 403001, Goa, India
| | - Adison Fernandes
- Department of Pharmaceutical Analysis, Goa College of Pharmacy, 18th June Road, Panaji 403001, Goa, India
| | - Amol Tagalpallewar
- Department of Pharmaceutics, School of Pharmacy, Dr. Vishwanath Karad MIT World Peace University, Pune 411038, Maharashtra, India
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20
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Taleb A, Zhou YP, Meng LT, Zhu MY, Zhang Q, Naveed M, Li LD, Wang P, Zhou QG, Meng F, Han F. New application of an old drug proparacaine in treating epilepsy via liposomal hydrogel formulation. Pharmacol Res 2021; 169:105636. [PMID: 33932606 DOI: 10.1016/j.phrs.2021.105636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 01/06/2023]
Abstract
Proparacaine (PPC) is a previously discovered topical anesthetic for ophthalmic optometry and surgery by blocking the central Nav1.3. In this study, we found that proparacaine hydrochloride (PPC-HCl) exerted an acute robust antiepileptic effect in pilocarpine-induced epilepsy mice. More importantly, chronic treatment with PPC-HCl totally terminated spontaneous recurrent seizure occurrence without significant toxicity. Chronic treatment with PPC-HCl did not cause obvious cytotoxicity, neuropsychiatric adverse effects, hepatotoxicity, cardiotoxicity, and even genotoxicity that evaluated by whole genome-scale transcriptomic analyses. Only when in a high dose (50 mg/kg), the QRS interval measured by electrocardiography was slightly prolonged, which was similar to the impact of levetiracetam. Nevertheless, to overcome this potential issue, we adopt a liposome encapsulation strategy that could alleviate cardiotoxicity and prepared a type of hydrogel containing PPC-HCl for sustained release. Implantation of thermosensitive chitosan-based hydrogel containing liposomal PPC-HCl into the subcutaneous tissue exerted immediate and long-lasting remission from spontaneous recurrent seizure in epileptic mice without affecting QRS interval. Therefore, this new liposomal hydrogel formulation of proparacaine could be developed as a transdermal patch for treating epilepsy, avoiding the severe toxicity after chronic treatment with current antiepileptic drugs in clinic.
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Affiliation(s)
- Abdoh Taleb
- Key Lab of Cardiovascular and Cerebrovascular Medicine, Drug Target and Drug Discovery Center, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
| | - Ya-Ping Zhou
- Department of Clinical Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
| | - Ling-Tong Meng
- Key Lab of Cardiovascular and Cerebrovascular Medicine, Drug Target and Drug Discovery Center, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
| | - Ming-Yi Zhu
- Department of Clinical Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
| | - Qiao Zhang
- Department of Clinical Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
| | - Muhammad Naveed
- Key Lab of Cardiovascular and Cerebrovascular Medicine, Drug Target and Drug Discovery Center, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
| | - Lian-Di Li
- Department of Clinical Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
| | - Peng Wang
- State Key Laboratory of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Pharmaceutical Co., Ltd., Nanjing 210042, China
| | - Qi-Gang Zhou
- Key Lab of Cardiovascular and Cerebrovascular Medicine, Drug Target and Drug Discovery Center, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China; Department of Clinical Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China; Sir Run Run Hospital, Nanjing Medical University, Nanjing 211166, Jiangsu Province, China.
| | - Fan Meng
- Department of Clinical Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China; State Key Laboratory of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Pharmaceutical Co., Ltd., Nanjing 210042, China.
| | - Feng Han
- Key Lab of Cardiovascular and Cerebrovascular Medicine, Drug Target and Drug Discovery Center, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China; Department of Clinical Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China.
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Lelescu CA, Dumitras DA, Iurian S, Staffieri F, Muresan C. Effects of topical application of tramadol with/without dexmedetomidine and proparacaine on corneal sensitivity in rats. Int Ophthalmol 2021; 41:465-473. [PMID: 33095346 DOI: 10.1007/s10792-020-01596-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the corneal anesthetic effect following topical application of tramadol alone and in combination with dexmedetomidine, and compare it to proparacaine, in clinically healthy rats. METHODS A randomized, crossover study was performed. Twenty Wistar albino rats (n = 40 eyes) were used. Corneal touch threshold (CTT) measurements (in mm) were obtained using a Cochet-Bonnet aesthesiometer. CTT measurements were obtained at baseline, 1-min following application of the topical anesthetic agent, and repeated at 5-min intervals up to 75 min. The topical protocol involved 3 treatment conditions, separated by a 2-week washout period: proparacaine, tramadol alone, and tramadol in combination with dexmedetomidine. RESULTS CTT values were significantly decreased compared to baseline at each timepoint until completion of the 75-min evaluation in all treated eyes, regardless of the assigned treatment (p < 0.0083). With tramadol, complete corneal anesthesia (CTT = 0) was achieved within 1-5 min in 18 eyes and ranged from 5 to 25 min. Co-administration of dexmedetomidine to tramadol resulted in significantly increased CTT values from 5 to 20 min following topical application, compared to tramadol alone (p < 0.0083), and complete corneal anesthesia was achieved in only 14 out of 20 treated eyes. CONCLUSION Tramadol might be a useful alternative to topical anesthetic agents, providing a dose-related corneal anesthetic effect. Co-administration of dexmedetomidine does not potentiate its anesthetic effect. The underlying mechanism(s) of drug antagonism between tramadol and dexmedetomidine remains to be determined.
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Affiliation(s)
- Cristina A Lelescu
- Modis Competence Center, Modis Life Sciences Belgium, Mureșului 9, 400000, Cluj-Napoca, Romania
| | - Daria A Dumitras
- Department of Biochemistry, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine, Calea Mănăştur 3-5, 400372, Cluj-Napoca, Romania
| | - Sonia Iurian
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Pharmacy, University of Medicine and Pharmacy "Iuliu Hațieganu", V. Babeș 41, 400012, Cluj-Napoca, Romania
| | - Francesco Staffieri
- Division of Veterinary Surgery, Department of Emergency and Organ Transplantation, Faculty of Veterinary Medicine, University "Aldo Moro" of Bari, SP Per Casamassima Km. 3, 70010, Valenzano, Bari, Italy
| | - Cosmin Muresan
- Department of Surgery, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine, Calea Mănăştur 3-5, 400372, Cluj-Napoca, Romania.
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Röper K, Lohmann CP, Lanzl I. Massive Augenschmerzen beidseits – Kurioser Fall in Zeiten der Corona-Pandemie. Ophthalmologe 2020; 117:1041-1044. [PMID: 32705326 PMCID: PMC7377206 DOI: 10.1007/s00347-020-01201-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Kristin Röper
- Klinikum rechts der Isar, Klinik und Poliklinik für Augenheilkunde, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - Chris Patrick Lohmann
- Klinikum rechts der Isar, Klinik und Poliklinik für Augenheilkunde, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Ines Lanzl
- Klinikum rechts der Isar, Klinik und Poliklinik für Augenheilkunde, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
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Mirković I, Kralj T, Lozić M, Stambolija V, Kovačević J, Vrdoljak L, Zlatar M, Milanović K, Drmić D, Predović J, Masnec S, Jurjević M, Bušić M, Seiwerth S, Kokot A, Sikirić P. Pentadecapeptide BPC 157 shortens duration of tetracaine- and oxybuprocaine-induced corneal anesthesia in rats. Acta Clin Croat 2020; 59:394-406. [PMID: 34177048 PMCID: PMC8212645 DOI: 10.20471/acc.2020.59.03.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
We focused on the relationship of 0.5% tetracaine- and 0.4% oxybuprocaine-induced corneal anesthesia in rats, and pentadecapeptide BPC 157 (0.4 µg/eye), along with nitric oxide synthase (NOS) inhibitor N(gamma)-nitro-L-arginine methyl ester (L-NAME) (0.1 mg/eye) and/or NOS substrate L-arginine (2 mg/eye), applied in the form of eye drops. We assessed corneal sensitivity recovery (Cochet-Bonnet esthesiometer), corneal lesion elimination (staining with 10% fluorescein) and decrease in tear volume (Schirmer test). BPC 157 administration had a full counteracting effect. Recovery also occurred in the presence of NOS blockade and NOS substrate application. L-arginine eventually shortened duration of corneal insensitivity and exerted corneal lesion counteraction (and counteraction of tetracaine-induced decrease of tear volume) only in earlier but not in later period. L-NAME application led to longer duration of corneal insensitivity, increase in corneal lesions and decrease in tear volume. When L-NAME and L-arginine were applied together, they antagonized each other’s effect. These distinctions may indicate particular NOS involvement (corneal insensitivity vs. corneal lesion along with tear production), distinctively affected by the administration of NO agents. However, additional BPC 157 co-administration would re-establish counteraction over topical ophthalmic anesthetic-induced effect, be it in its early or late course. We suggest BPC 157 as an antidote to topical ophthalmic anesthetics.
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Affiliation(s)
| | - Tamara Kralj
- 1Department of Pharmacology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Anatomy and Neuroscience, Osijek Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Ophthalmology, Sveti Duh University Hospital, Zagreb, Croatia; 4Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Marin Lozić
- 1Department of Pharmacology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Anatomy and Neuroscience, Osijek Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Ophthalmology, Sveti Duh University Hospital, Zagreb, Croatia; 4Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Vasilije Stambolija
- 1Department of Pharmacology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Anatomy and Neuroscience, Osijek Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Ophthalmology, Sveti Duh University Hospital, Zagreb, Croatia; 4Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Josip Kovačević
- 1Department of Pharmacology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Anatomy and Neuroscience, Osijek Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Ophthalmology, Sveti Duh University Hospital, Zagreb, Croatia; 4Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Luka Vrdoljak
- 1Department of Pharmacology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Anatomy and Neuroscience, Osijek Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Ophthalmology, Sveti Duh University Hospital, Zagreb, Croatia; 4Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Mirna Zlatar
- 1Department of Pharmacology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Anatomy and Neuroscience, Osijek Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Ophthalmology, Sveti Duh University Hospital, Zagreb, Croatia; 4Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Kristina Milanović
- 1Department of Pharmacology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Anatomy and Neuroscience, Osijek Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Ophthalmology, Sveti Duh University Hospital, Zagreb, Croatia; 4Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Domagoj Drmić
- 1Department of Pharmacology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Anatomy and Neuroscience, Osijek Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Ophthalmology, Sveti Duh University Hospital, Zagreb, Croatia; 4Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Jurica Predović
- 1Department of Pharmacology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Anatomy and Neuroscience, Osijek Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Ophthalmology, Sveti Duh University Hospital, Zagreb, Croatia; 4Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Sanja Masnec
- 1Department of Pharmacology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Anatomy and Neuroscience, Osijek Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Ophthalmology, Sveti Duh University Hospital, Zagreb, Croatia; 4Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Matija Jurjević
- 1Department of Pharmacology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Anatomy and Neuroscience, Osijek Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Ophthalmology, Sveti Duh University Hospital, Zagreb, Croatia; 4Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Mladen Bušić
- 1Department of Pharmacology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Anatomy and Neuroscience, Osijek Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Ophthalmology, Sveti Duh University Hospital, Zagreb, Croatia; 4Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Sven Seiwerth
- 1Department of Pharmacology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Anatomy and Neuroscience, Osijek Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Ophthalmology, Sveti Duh University Hospital, Zagreb, Croatia; 4Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Antonio Kokot
- 1Department of Pharmacology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Anatomy and Neuroscience, Osijek Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Ophthalmology, Sveti Duh University Hospital, Zagreb, Croatia; 4Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Predrag Sikirić
- 1Department of Pharmacology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Anatomy and Neuroscience, Osijek Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Ophthalmology, Sveti Duh University Hospital, Zagreb, Croatia; 4Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
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Kovaļčuka L, Mūrniece G. Normal reference ranges of ocular physiology and sonographic biometry of Latvian Hunting dogs. Vet World 2020; 13:807-811. [PMID: 32546930 PMCID: PMC7245716 DOI: 10.14202/vetworld.2020.807-811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/03/2020] [Indexed: 11/30/2022] Open
Abstract
Background and Aim: The Latvian Hunting dog is the only national dog breed in Latvia and so far, there are no data on the important ophthalmological data pertaining to clinical tests and ocular biometry. The aim of this study was to improve the ocular examination and to document normal reference ranges of the globe axial length (AXL), anterior chamber depth (ACD), lens thickness (LT), intraocular pressure (IOP), and Schirmer tear test (STT). Materials and Methods: Sixteen Latvian Hunting dogs (32 eyes) of varying age and sex were included in this study. All dogs underwent an ophthalmic examination followed by tear production (STT) and IOP (TonoVet®) measurements. Biometric examination using A-mode ultrasonography was done under topical corneal anesthesia using 0.5% proparacaine hydrochloride. The eyes were scanned using A-mode ultrasonography with a 10 MHz transducer by transcorneal approach. The reference values of IOP, STT, AXL, ACD, and LT are expressed as mean ± standard deviation (SD). Results: Statistical analysis using the SPSS v.23 and Microsoft Excel 2013 showed no statistically significant differences between the right and left eyes for either of the tests. The mean±SD value of STT and IOP values was 20.9±3.2 mm/min and 17.7±3.2 mmHg, respectively. The mean±SD of the AXL, ACD, and LT obtained by A-mode ultrasound was 2.21±0.1 cm, 0.35±0.1cm, and 0.42±0.06cm, respectively. Conclusion: This study documents the normal reference ranges of important ophthalmological clinical tests (IOP and STT) and ocular biometry (AXL, ACD, and LT) in Latvian Hunting dogs.
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Affiliation(s)
- Līga Kovaļčuka
- Clinical Institute, Faculty of Veterinary Medicine, Latvia University of Life Science and Technologies, Jelgava, Latvia
| | - Gundega Mūrniece
- Clinical Institute, Faculty of Veterinary Medicine, Latvia University of Life Science and Technologies, Jelgava, Latvia
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Abstract
Background:
This review investigates the ophthalmic drugs that have been studied with
voltammetry in the web of science database in the last 10 years.
Introduction:
Ophthalmic drugs are used in the diagnosis, evaluation and treatment of various ophthalmological
diseases and conditions. A significant literature has emerged in recent years that investigates
determination of these active compounds via electroanalytical methods, particularly voltammetry. Low
cost, rapid determination, high availability, efficient sensitivity and simple application make voltammetry
one of the most used methods for determining various kinds of drugs including ophthalmic ones.
Methods:
In this particular review, we searched the literature via the web of science database for ophthalmic
drugs which are investigated with voltammetric techniques using the keywords of voltammetry,
electrochemistry, determination and electroanalytical methods.
Results:
We found 33 types of pharmaceuticals in nearly 140 articles. We grouped them clinically into
seven major groups as antibiotics, antivirals, non-steroidal anti-inflammatory drugs, anti-glaucomatous
drugs, steroidal drugs, local anesthetics and miscellaneous. Voltammetric techniques, electrodes, optimum
pHs, peak potentials, limit of detection values, limit of quantification values, linearity ranges,
sample type and interference effects were compared.
Conclusion:
Ophthalmic drugs are widely used in the clinic and it is important to determine trace
amounts of these species analytically. Voltammetry is a preferred method for its ease of use, high sensitivity,
low cost, and high availability for the determination of ophthalmic drugs as well as many other
medical drugs. The low limits of detection values indicate that voltammetry is quite sufficient for determining
ophthalmic drugs in many media such as human serum, urine and ophthalmic eye drops.
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Affiliation(s)
- Onur Inam
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ersin Demir
- Department of Analytical Chemistry, Faculty of Pharmacy, Afyonkarahisar University of Health Sciences, Afyonkarahisar, 03200, Turkey
| | - Bengi Uslu
- Department of Analytical Chemistry, Ankara University, Faculty of Pharmacy, Ankara, Turkey
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Rigas B, Huang W, Honkanen R. NSAID-induced corneal melt: Clinical importance, pathogenesis, and risk mitigation. Surv Ophthalmol 2020; 65:1-11. [DOI: 10.1016/j.survophthal.2019.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 12/21/2022]
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Chou AK, Chiu CC, Wang JJ, Chen YW, Hung CH. Serotonin enhances oxybuprocaine- and proxymetacaine-induced cutaneous analgesia in rats. Eur J Pharmacol 2019; 846:73-78. [PMID: 30639797 DOI: 10.1016/j.ejphar.2019.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 12/28/2018] [Accepted: 01/09/2019] [Indexed: 02/07/2023]
Abstract
The aim of the study was to investigate the analgesic effects of adding serotonin to oxybuprocaine or proxymetacaine preparations. We employed a rat model of the cutaneous trunci muscle reflex (CTMR) to conduct the dose-response curves and duration of drugs (oxybuprocaine, proxymetacaine, or serotonin) as an infiltrative anesthetic. The use of isobolographic methods to analyze the drug-drug interactions. We showed that oxybuprocaine and proxymetacaine, as well as serotonin produced dose-dependent skin antinociception. On the basis of 50% effective dose (ED50), the rank order of drug potency was serotonin [7.22 (6.45-8.09) μmol/kg] < oxybuprocaine [1.03 (0.93-1.15) μmol/kg] < proxymetacaine [0.59 (0.53-0.66) μmol/kg] (P < 0.01 for each comparison). The sensory block duration of serotonin was longer (P < 0.01) than that of oxybuprocaine or proxymetacaine at the equipotent doses (ED25, ED50, and ED75). The mixture of serotonin with oxybuprocaine or proxymetacaine produced a better analgesic effect than the drug itself. We have concluded that oxybuprocaine, proxymetacaine, or serotonin displays dose-related cutaneous analgesia. Oxybuprocaine or proxymetacaine is more potent and has a shorter duration of cutaneous analgesia than serotonin. Serotonin produces a synergistic antinociceptive interaction with oxybuprocaine or proxymetacaine.
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Affiliation(s)
- An-Kuo Chou
- Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chong-Chi Chiu
- Department of General Surgery, Chi-Mei Medical Center, Tainan and Liouying, Taiwan; Department of Electrical Engineering, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; AI Biomed Center, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Yu-Wen Chen
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Department of Physical Therapy, College of Health Care, China Medical University, Taichung, Taiwan
| | - Ching-Hsia Hung
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Abstract
Toxic keratoconjunctivitis (TK) is an underrecognized complication of ophthalmic drug use and various environmental or occupational exposures. A detailed history and clinical examination are important to identify the offending agent(s). Common drug-related causes of TK include preservatives in ophthalmic medications, topical antimicrobials, and topical anesthetics. Alternatives to benzalkonium chloride as well as preservative-free formulations should be considered in patients requiring long-term topical medication. More advanced cases of TK may require preservative-free topical steroids and/or antibiotics, and occasionally surgical intervention. Early recognition and appropriate management of TK may help prevent permanent ocular and visual damage.
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Pepin M, Rineau E, Caignard A, Leruez S, Gohier P. L’anesthésie topique sans recours à un médecin anesthésiste dans la chirurgie de la cataracte ambulatoire de l’adulte : évaluation des critères de sélection en consultation, à propos de 248 cas. J Fr Ophtalmol 2018; 41:441-446. [DOI: 10.1016/j.jfo.2017.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 10/09/2017] [Accepted: 11/08/2017] [Indexed: 11/29/2022]
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Regnier A, Berton I, Concordet D, Douet JY. Effect of topical application of 2% lidocaine gel on corneal sensitivity of clinically normal equine eyes. Vet Anaesth Analg 2018; 45:158-164. [DOI: 10.1016/j.vaa.2017.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 08/14/2017] [Accepted: 08/31/2017] [Indexed: 11/29/2022]
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Alizadeh S, Mohebbi N, Gholami K, Jabbarvand M. Adverse drug events leading to emergency department visits at an eye hospital: A brief report. J Curr Ophthalmol 2017. [PMID: 28626826 PMCID: PMC5463018 DOI: 10.1016/j.joco.2017.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate adverse drug events (ADEs) resulting in emergency department visits in an eye hospital. METHOD Emergency department visits at Farabi Eye Hospital were assessed for a 7-day period. The patients' eye disorders and drug history were evaluated to detect ADEs. RESULTS Of 1631 emergency visits, 5 (0.3%, 95% CI: 0.13-0.71%) were drug related. Tetracaine eye drops accounted for 4 (80%, 95% CI: 38-96%) cases with corneal involvement. The other case was an intense conjunctival injection due to naphazoline eye drops. CONCLUSION ADEs should be considered in differential diagnosis of ocular emergency problems and preventive measure should be considered.
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Affiliation(s)
| | - Niayesh Mohebbi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Kheirollah Gholami
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Jabbarvand
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Stuard WL, Gallerson BK, Robertson DM. Alterations in corneal nerves following crack cocaine use mimic diabetes-induced nerve damage. Endocrinol Diabetes Metab Case Rep 2017; 2017:EDM160131. [PMID: 28458887 PMCID: PMC5404459 DOI: 10.1530/edm-16-0131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 02/10/2017] [Indexed: 11/30/2022] Open
Abstract
Summary The use of in vivo confocal microscopy (IVCM) is rapidly emerging as an important clinical tool to evaluate changes in corneal sensory nerves as a surrogate measure for diabetic peripheral neuropathy. Commonly used metrics to document and grade the severity of diabetes and risk for diabetic peripheral neuropathy include nerve fiber length, density, branching and tortuosity. In addition to corneal nerves, thinning of the retinal fiber layer has been shown to correlate with the severity of diabetic disease. Here, we present a case report on a pre-diabetic 60-year-old native American woman with abnormal corneal nerve morphology and retinal nerve fiber layer thinning. Her past medical history was positive for illicit substance abuse. IVCM showed a decrease in nerve fiber density and length, in addition to abnormally high levels of tortuosity. OCT revealed focal areas of reduced retinal nerve fiber layer thickness that were asymmetric between eyes. This is the first report of abnormally high levels of tortuosity in the corneal sub-basal nerve plexus in a patient with a past history of cocaine abuse. It also demonstrates, for the first time, that illicit substance abuse can have long-term adverse effects on ocular nerves for years following discontinued use of the drug. Studies using IVCM to evaluate changes in corneal nerve morphology in patients with diabetes need to consider a past history of illicit drug use as an exclusionary measure. Learning points:
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Affiliation(s)
- Whitney L Stuard
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TexasUSA
| | - Bryan K Gallerson
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TexasUSA
| | - Danielle M Robertson
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TexasUSA
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Little WB, Jean GS, Sithole F, Little E, Jean KYS. Degree of corneal anaesthesia after topical application of 0.4% oxybuprocaine hydrochloride and 0.5% proparacaine hydrochloride ophthalmic solution in clinically normal cattle. Aust Vet J 2017; 94:181-5. [PMID: 27237118 DOI: 10.1111/avj.12443] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 08/10/2015] [Accepted: 09/07/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The use of corneal anaesthesia is necessary for a range of clinical purposes. Therefore, we assessed and compared the efficacy of corneal anaesthesia after application of 0.4% oxybuprocaine hydrochloride and 0.5% proparacaine hydrochloride ophthalmic solution in clinically normal cattle. METHODS The 24 clinically normal cows were allocated into two groups. Cows in group 1 (n = 12) received 0.2 mL of 0.4% oxybuprocaine hydrochloride with fluorescein ophthalmic solution in one eye and 0.2 mL of sterile saline (0.9% NaCl) with fluorescein in the contralateral eye (control). Group 2 (n = 12) received 0.2 mL of 0.4% oxybuprocaine hydrochloride with fluorescein ophthalmic solution in one eye and 0.2 mL of 0.5% proparacaine hydrochloride with fluorescein in the contralateral eye (control). In each group, corneal touch threshold was determined by Cochet-Bonnet aesthesiometer for both eyes immediately prior to topical administration of solutions, at 1 min and 5 min after administration of topical solutions and every 5 min thereafter for a total of 75 min. RESULTS Significant corneal anaesthesia was noted immediately following topical application of both oxybuprocaine and proparacaine as compared with controls, with maximal corneal anaesthesia noted 1 min after administration. Both oxybuprocaine and proparacaine produced significant corneal anaesthesia for the duration of the 75-min study. Neither oxybuprocaine hydrochloride nor proparacaine hydrochloride treatment resulted in visible adverse effects. CONCLUSION There are limited data available demonstrating the efficacy and duration of corneal anaesthetic agents in cattle. Both oxybuprocaine hydrochloride and proparacaine hydrochloride should be considered practical options for providing corneal anaesthesia in cattle in a clinical setting.
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Affiliation(s)
- W B Little
- Department of Clinical Sciences, Ross University College of Veterinary Medicine, Island Main Road, West farm, St Kitts 00265, West Indies.
| | - G St Jean
- Department of Clinical Sciences, Ross University College of Veterinary Medicine, Island Main Road, West farm, St Kitts 00265, West Indies
| | - F Sithole
- Department of Biomedical Sciences, Ross University College of Veterinary Medicine, St Kitts, West Indies
| | - E Little
- Department of Clinical Sciences, Ross University College of Veterinary Medicine, Island Main Road, West farm, St Kitts 00265, West Indies
| | - K Yvorchuk-St Jean
- Department of Clinical Sciences, Ross University College of Veterinary Medicine, Island Main Road, West farm, St Kitts 00265, West Indies
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Perioperative Corneal Abrasion: Updated Guidelines for Prevention and Management. Plast Reconstr Surg 2016; 137:790e-798e. [PMID: 27119941 DOI: 10.1097/prs.0000000000002108] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Corneal abrasion is the most common ocular complication in surgery. Treatment requires pain control, antimicrobial prophylaxis, and close monitoring. Pain improves significantly after 24 hours and should be resolved by 48 hours. Persistent, worsening, or new symptoms warrant immediate specialist consultation. The authors review the pathophysiology of perioperative corneal abrasion, and propose updated evidence-based guidelines for improved patient care.
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Wu H, Hu Y, Shi XR, Xu F, Jiang CY, Huang R, Jia H. Keratopathy due to ophthalmic drug abuse with corneal melting and perforation presenting as Mooren-like ulcer: A case report. Exp Ther Med 2016; 12:343-346. [PMID: 27347060 DOI: 10.3892/etm.2016.3296] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 02/11/2016] [Indexed: 11/05/2022] Open
Abstract
The present report describes the clinical course and treatment of a Mooren-like ulcer associated with abuse of topical anesthetics and dexamethasone. A 38-year-old male physician treated himself with lidocaine, tetracaine and dexamethasone (DEX) eye drops for severe pain and decline of vision in both eyes. After six months of treatment, his right cornea exhibited annular melting with full-thickness stromal infiltration at the limbus and central corneal haze. His left cornea was completely melted and exhibited iris prolapse. The patient was treated with topical antibiotics, lubricants and underwent a binocular keratoplasty. The surgery was successful and after eight months the postoperative best-corrected visual acuities were counting fingers in the right eye and light perception in the left eye. In summary, this report documents a severe case of keratopathy presenting as Mooren-like ulcer caused by topical anesthetics and DEX, which were treated via keratoplasty, resulting in useful vision being retained.
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Affiliation(s)
- Hui Wu
- Department of Ophthalmology, First Affiliated Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yuan Hu
- Department of Pathology, Mount Sinai School of Medicine, New York, NY 10029, USA
| | - Xiao-Ru Shi
- Department of Ophthalmology, First Affiliated Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Feihong Xu
- Department of Pathology, Mount Sinai School of Medicine, New York, NY 10029, USA
| | - Chun-Ying Jiang
- Department of Ophthalmology, First Affiliated Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Rong Huang
- Department of Ophthalmology, First Affiliated Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Hui Jia
- Department of Ophthalmology, First Affiliated Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Cuvas Apan O, Ozer MA, Takir S, Apan A, Sengul D. Effect of topical administration of tramadol on corneal wound healing in rats. Int Ophthalmol 2016; 36:675-80. [PMID: 26820482 DOI: 10.1007/s10792-016-0184-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/19/2016] [Indexed: 12/17/2022]
Abstract
In this study, we aimed to investigate the effects of topical tramadol administration on corneal wound healing, and examine ophthalmic structures and intraocular pressure 7 days after tramadol administration. The experiments were conducted on eight male Wistar rats (250-300 g). After ophthalmic examination, epithelial cell layers in the central cornea were wounded. Rats received 30 μL of tramadol hydrochloride in one eye (Group Tramadol) and the same volume of vehicle in the other (Group Control) every 12 h for 7 days. Both eyes were stained with fluorescein dye, photographed, and wound area was calculated every 8 h until complete healing was observed. Eye blink frequency and corneal reflex tests were measured before and after drug administrations. After 7 days, slit lamp biomicroscopy, fundoscopy, Goldmann applanation tonometry, and histological evaluation were performed. There was no difference in the corneal wound healing rates between the tramadol and control groups. Reduction in wound area over time was also similar; group-time interaction was insignificant (F = 738.911; p = 0.225). Tramadol application resulted in blinking and blepharospasm for 30 s, but vehicle did not. Corneal reflex was intact and eye blink frequency test results were similar in all measurement times in both groups. Slit lamp biomicroscopy, fundoscopy, and intraocular pressures were within normal range. Corneal cells appeared unaffected by the repeated doses of tramadol for 7 days. Topical tramadol application on the cornea did not cause any side effect, except for initial temporary blinking and blepharospasm. Corneal wound healing was not affected, either.
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Affiliation(s)
- Ozgun Cuvas Apan
- Department of Anesthesiology and Intensive Care Medicine, Giresun University Medical Faculty, Nizamiye Yerleskesi, Orhan Yılmaz Caddesi, Mumcular Sokak No:1, Merkez, 28200, Giresun, Turkey.
| | - Murat Atabey Ozer
- Department of Ophthalmology, Giresun University Medical Faculty, Giresun, Turkey
| | - Selcuk Takir
- Department of Clinical Pharmacology, Giresun University Medical Faculty, Giresun, Turkey
| | - Alparslan Apan
- Department of Anesthesiology and Intensive Care Medicine, Giresun University Medical Faculty, Nizamiye Yerleskesi, Orhan Yılmaz Caddesi, Mumcular Sokak No:1, Merkez, 28200, Giresun, Turkey
| | - Demet Sengul
- Department of Pathology, Giresun University Medical Faculty, Giresun, Turkey
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Shiroma HF, Shimono KE, Farah ME, Goldhardt R, Grumann A, Rodrigues EB. Comparative Study Between Lidocaine Gel 2% and 5% for Ophthalmic Procedures. J Ocul Pharmacol Ther 2016; 32:192-5. [PMID: 26790036 DOI: 10.1089/jop.2015.0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To compare same-day pain control and safety of 2 different anesthetic gels utilizing 5% and 2% lidocaine gel. Main outcome is to determine whether 5% lidocaine gel is more effective in decreasing pain during conjunctival clamping compared to 2% lidocaine gel 5 and 10 min after gel application. METHODS This is a prospective, randomized double-blind clinical trial. Patients were randomized to receive 2% or 5% lidocaine gel in each eye. Discomfort during the gel instillation and pain during conjunctival clamping 5 and 10 min after gel application were compared. Extent of corneal conjunctival staining was graded according to the Oxford scale. RESULTS Eighty eyes of 40 patients were enrolled. The groups were similar in gender, with a mean age of 48 ± 16.26 years. The 5% lidocaine gel resulted in higher discomfort during initial instillation (P = 0.092), however, the pain during conjunctival clamping was lower in the 5% lidocaine gel eyes (P = 0.564) in both 5 and 10 min later (P < 0.001). The majority of patients (80%) had no corneal conjunctival dye staining. The tear break-up time was not statistically different after lidocaine gel 2% (20.35 ± 7.37 s) and lidocaine 5% (19.75 ± 7.00 s). CONCLUSION Five percent and 2% lidocaine gel have similar efficacy controlling pain 5 min after instillation, however, 5% lidocaine gel appears to be more effective with a longer duration of action, without corneal toxicity. There was no corneal toxicity noted with either concentration.
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Affiliation(s)
- Hélio Francisco Shiroma
- 1 Department of Ophthalmology and Visual Sciences, Paulista School of Medicina, Federal University of São Paulo , São Paulo, Brazil
| | - Kleber Eidi Shimono
- 1 Department of Ophthalmology and Visual Sciences, Paulista School of Medicina, Federal University of São Paulo , São Paulo, Brazil
| | - Michel Eid Farah
- 1 Department of Ophthalmology and Visual Sciences, Paulista School of Medicina, Federal University of São Paulo , São Paulo, Brazil
| | - Raquel Goldhardt
- 2 Department of Ophthalmology, Bascom Palmer Eye Institute , Miami, Florida
| | - Astor Grumann
- 1 Department of Ophthalmology and Visual Sciences, Paulista School of Medicina, Federal University of São Paulo , São Paulo, Brazil
| | - Eduardo Buchele Rodrigues
- 1 Department of Ophthalmology and Visual Sciences, Paulista School of Medicina, Federal University of São Paulo , São Paulo, Brazil
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Abstract
PURPOSE Topical nonsteroidal antiinflammatory drugs (NSAIDs) are administered topically for a variety of ophthalmologic conditions. Brand diclofenac and brand ketorolac were previously shown to have topical anesthetic effects in addition to analgesic effects. Using the same method, we measured similar anesthetic effects of the 4 currently available topical NSAIDs--generic diclofenac, generic ketorolac, brand bromfenac, and brand nepafenac. METHODS Baseline corneal sensitivity was measured on 10 healthy adult volunteers with a Cochet-Bonnet esthesiometer. One drop of the agent being studied was applied to the right eye every 5 minutes for a total of 4 drops. Corneal sensitivity was measured immediately after the last topical application and every 15 minutes for 60 minutes. After a 1-week washout period, a different agent was studied until all 4 NSAIDs were evaluated. RESULTS Corneal sensitivity profiles over time were similar for all NSAIDs. Corneal sensitivity decreased significantly from baseline immediately after topical application remaining flat from 0 to 30 minutes and then rising from 45 to 60 minutes back toward baseline in all treatment groups (P < 0.001). The maximal absolute drop in corneal sensitivity as measured by pressure thresholds was greatest for diclofenac [28.6 mm (95% confidence intervals {CI}, 19.8-37.4)], followed by ketorolac [21.1 mm (95% CI, 15.1-27.1)], bromfenac [16.9 mm (10.7-23.1)], and nepafenac [16.4 mm (95% CI, 12.7-20.1)]. Only diclofenac and nepafenac were statistically different in maximal decrease in sensitivity. CONCLUSIONS All 4 currently available NSAIDs demonstrated anesthetic effects similar to brand diclofenac and brand ketorolac.
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Green PG, Alvarez P, Levine JD. Topical Tetrodotoxin Attenuates Photophobia Induced by Corneal Injury in the Rat. THE JOURNAL OF PAIN 2015; 16:881-6. [PMID: 26086898 DOI: 10.1016/j.jpain.2015.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 05/27/2015] [Accepted: 06/04/2015] [Indexed: 11/24/2022]
Abstract
Corneal injury can produce photophobia, an aversive sensitivity to light. Using topical application of lidocaine, a local anesthetic, and tetrodotoxin (TTX), a selective voltage-sensitive sodium channel blocker, we assessed whether enhanced aversiveness to light induced by corneal injury in rats was caused by enhanced activity in corneal afferents. Eye closure induced by 30 seconds of exposure to bright light (460-485 nm) was increased 24 hours after corneal injury induced by de-epithelialization. Although the topical application of lidocaine did not affect the baseline eye closure response to bright light in control rats, it eliminated the enhancement of the response to the light stimulus after corneal injury (photophobia). Similarly, topical application of TTX had no effect on the eye closure response to bright light in rats with intact corneas, but it markedly attenuated photophobia in rats with corneal injury. Given the well-established corneal toxicity of local anesthetics, we suggest TTX as a therapeutic option to treat photophobia and possibly other symptoms that occur in clinical diseases that involve corneal nociceptor sensitization. Perspective: We show that lidocaine and TTX attenuate photophobia induced by corneal injury. Although corneal toxicity limits use of local anesthetics, TTX may be a safer therapeutic option to reduce the symptom of photophobia associated with corneal injury.
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Affiliation(s)
- Paul G Green
- Department of Oral & Maxillofacial Surgery, University of California at San Francisco, San Francisco, California; Department of Preventative & Restorative Dental Sciences, University of California at San Francisco, San Francisco, California; Division of Neuroscience, University of California at San Francisco, San Francisco, California
| | - Pedro Alvarez
- Department of Oral & Maxillofacial Surgery, University of California at San Francisco, San Francisco, California; Division of Neuroscience, University of California at San Francisco, San Francisco, California
| | - Jon D Levine
- Department of Oral & Maxillofacial Surgery, University of California at San Francisco, San Francisco, California; Division of Neuroscience, University of California at San Francisco, San Francisco, California; Department of Dental Science and Medicine, University of California at San Francisco, San Francisco, California.
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Kumar A. Diffuse epithelial keratopathy following a single instillation of topical lignocaine: the damaging drop. Cutan Ocul Toxicol 2015; 35:173-5. [PMID: 25936643 DOI: 10.3109/15569527.2015.1039126] [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: 11/13/2022]
Abstract
Toxic corneal epitheliopathies are a known occurrence following chronic use of topical anesthetic agents in ophthalmology. We report two cases of diffuse epithelial keratopathy following a single drop of 4% lignocaine in two diabetic patients scheduled for fundus fluorescein angiography.
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Affiliation(s)
- Annapurna Kumar
- a Karpaga Vinayaga Institute of Medical Sciences , Tamil Nadu , India
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Efficacy and safety of pain relief medications after photorefractive keratectomy: review of prospective randomized trials. J Cataract Refract Surg 2015; 40:1716-30. [PMID: 25263042 DOI: 10.1016/j.jcrs.2014.08.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 01/29/2014] [Accepted: 02/03/2014] [Indexed: 11/23/2022]
Abstract
UNLABELLED The objective of this review was to provide a comprehensive overview and comparison of results from all prospective randomized trials published to date of medications used to treat pain after photorefrative keratectomy (PRK). A PubMed database search revealed 23 prospective and randomized studies. They included the following classes of medications: nonsteroidal antiimflammatory drugs (NSAIDs), anesthetics, opiates, acetaminophen, gabapentin, and pregabalin. The studies found that although the efficacy of drugs tended to be similar, tetracaine 1% and nepafenac 0.1% tended to have the most analgesic effect. Delayed corneal reepithelialization was a common side effect of both topical anesthetics and topical NSAIDs. Tetracaine 1% resulted in the most significant delay in reepithelialization when tested against placebo control compared with other topical medications tested against placebo. Concomitant use of topical NSAIDs and topical anesthetics, especially tetracaine, may have to be avoided to minimize the risk for delayed corneal healing. FINANCIAL DISCLOSURE Neither author has a financial or proprietary interest in any material or method mentioned.
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Mashige KP. Repeatability and reproducibility of axial length, anterior chamber depth and crystalline lens thickness measurements using the Nidek US-500 Echoscan. AFRICAN VISION AND EYE HEALTH 2015. [DOI: 10.4102/aveh.v74i1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Aim: The reliability of an instrument used to collect data for clinical and research purposes is greatly important, especially when it is used to determine changes in measured ocular parameters over time. The purpose of this study was to determine the intra-session repeatability and inter-session reproducibility of axial length (AL), anterior chamber depth (ACD) and crystalline lens thickness (LT) measurements using the Nidek US-500 Echoscan.Method: Fifty successive automatic measurements of the above parameters were taken on the right eyes only of 12 healthy subjects aged 23–44 years old, followed by similar repeated measures after 1 week. Sample standard deviations (s.d.), precision (P) and coefficient of repeatability (COR) were calculated to determine intra-session repeatability. Coefficient of reproducibility (CRP), Bland and Altman plots, concordance correlation coefficients (CCC) and paired t-tests that compared measurements obtained in the first and second sessions, were used to determine inter-session reproducibility.Results: Both the intra-session repeatability and inter-session reproducibility were within acceptable limits for the three variables assessed.Conclusion: The study showed that the Nidek US-500 Echoscan provides accurate, repeatable and reproducible measurements of AL, ACD and LT in healthy eyes. This finding will be of interest to optometrists and ophthalmologists who measure these parameters when diagnosing, managing and investigating conditions such as primary angle-closure glaucoma and keratoconus.
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Yung E, Trubnik V, Katz LJ. An overview of home tonometry and telemetry for intraocular pressure monitoring in humans. Graefes Arch Clin Exp Ophthalmol 2014; 252:1179-88. [DOI: 10.1007/s00417-014-2668-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 04/29/2014] [Accepted: 05/06/2014] [Indexed: 11/24/2022] Open
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Douet JY, Michel J, Regnier A. Degree and duration of corneal anesthesia after topical application of 0.4% oxybuprocaine hydrochloride ophthalmic solution in ophthalmically normal dogs. Am J Vet Res 2014; 74:1321-6. [PMID: 24066916 DOI: 10.2460/ajvr.74.10.1321] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the anesthetic efficacy and local tolerance of topically applied 0.4% oxybuprocaine ophthalmic solution to in dogs and compare its effects with those of 1% tetracaine solution. ANIMALS 34 ophthalmically normal Beagles. PROCEDURES Dogs were assigned to 2 groups, and baseline corneal touch threshold (CTT) was measured bilaterally with a Cochet-Bonnet aesthesiometer. Dogs of group 1 (n = 22) received a single drop of 0.4% oxybuprocaine ophthalmic solution in one eye and saline (0.9% NaCl) solution (control treatment) in the contralateral eye. Dogs of group 2 (n = 12) received a single drop of 0.4% oxybuprocaine ophthalmic solution in one eye and 1% tetracaine ophthalmic solution in the contralateral eye. The CTT of each eye was measured 1 and 5 minutes after topical application and then at 5-minute intervals until 75 minutes after topical application. RESULTS CTT changes over time differed significantly between oxybuprocaine-treated and control eyes. After instillation of oxybuprocaine, maximal corneal anesthesia (CTT = 0) was achieved within 1 minute, and CTT was significantly decreased from 1 to 45 minutes, compared with the baseline value. No significant difference in onset, depth, and duration of corneal anesthesia was found between oxybuprocaine-treated and tetracaine-treated eyes. Conjunctival hyperemia and chemosis were detected more frequently in tetracaine-treated eyes than in oxybuprocaine-treated eyes. CONCLUSIONS AND CLINICAL RELEVANCE Topical application of oxybuprocaine and tetracaine similarly reduced corneal sensitivity in dogs, but oxybuprocaine was less irritating to the conjunctiva than was tetracaine.
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Affiliation(s)
- Jean-Yves Douet
- Département des sciences cliniques, INP-Ecole nationale vétérinaire, 31076 Toulouse Cedex 3, France
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Sharifi A, Sharifi H, Karamouzian M, Mokhtari M, Esmaeili HH, Nejad AS, Rahmatian M. Topical ocular anesthetic abuse among Iranian welders: time for action. Middle East Afr J Ophthalmol 2014; 20:336-40. [PMID: 24339685 PMCID: PMC3841953 DOI: 10.4103/0974-9233.120023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose: The purpose of this study is to estimate the prevalence of topical ocular anesthetic abuse among welders in Iran and suggest public health solutions for this issue. Methods: In this cross-sectional study, 390 welders were randomly recruited and queried on the use of anesthetic drops. A questionnaire was administered through structured one-on-one interviews conducted by the first author. Results: A total of 314 welders (80.5%) declared that they had used topical anesthetics at least once during their working lives. Almost 90% of them stated a preference for self-treatment over seeking help from a physician due to cultural and financial reasons. The most commonly used topical anesthetic was tetracaine. Most of the subjects (97.4%) had obtained the drugs from pharmacies without a prescription. Conclusions: The prevalence of topical ocular anesthetic abuse among welders in Iran is alarmingly high and may partially be due to cultural issues. Although most physicians are aware that topical anesthetics should only be used as a diagnostic tool, there is a crucial need to re-emphasize the ocular risks associated with chronic use of these medications. Educational programs for both physicians and the public are necessary to address the problem.
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Affiliation(s)
- Ali Sharifi
- Department of Ophthalmology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
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Thomson SM, Oliver JA, Gould DJ, Mendl M, Leece EA. Preliminary investigations into the analgesic effects of topical ocular 1% morphine solution in dogs and cats. Vet Anaesth Analg 2013; 40:632-40. [DOI: 10.1111/vaa.12069] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 01/23/2013] [Accepted: 01/23/2013] [Indexed: 11/28/2022]
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Ansari H, Weinberg L, Spencer N. Toxic epitheliopathy from a single application of preservative free oxybuprocaine (0.4%) in a patient with Sjogren's syndrome. BMJ Case Rep 2013; 2013:bcr2013010487. [PMID: 24038291 PMCID: PMC3794119 DOI: 10.1136/bcr-2013-010487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Topical ocular anaesthetic agents are frequently used for ophthalmic diagnosis and surgery. While corneal complications following long-term use or misuse of local anaesthetic solutions have been described, toxic epitheliopathy after a single application of six drops of preservative free oxybuprocaine is rare. In order to increase the awareness of this ocular complication, we report such a case in a patient with Sjogren's syndrome who presented for elective cataract surgery. We outline the mechanisms proposed to explain the ocular toxic effects of oxybuprocaine and discuss the management principles in preventing this complication in the context of Sjogren's syndrome.
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Affiliation(s)
- Humaira Ansari
- Department of Medicine, The Northern Hospital, Epping, Victoria, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
| | - Narelle Spencer
- Department of Ophthalmology, Austin Hospital, Heidelberg, Victoria, Australia
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