Ciprofloxacin as Treatment for Conjunctivitis

The authors studied the bactericidal action and therapeutic effectiveness of ciprofloxacin in treating external ocular infections (bacterial conjunctivitis and bacterial blepharoconjunctivitis). 108 ambulatory patients with clinical signs of conjunctivitis and blepharoconjunctivitis were enrolled in the study. All subjects underwent a conjunctival swab before starting therapy and at 10 days, to identify the causative bacteria and their susceptibility to ciprofloxacin, following routine microbiological methods. The reported therapeutic success rate (95%) and bacteriological analysis confirmed the effectiveness of ciprofloxacin in subjects with bacterial conjunctivitis and bacterial blepharoconjunctivitis. In vitro tests conducted 10 days after treatment confirmed the in vivo therapeutic effectiveness, even for those infections characterized by a difficult etiological identification which interferes with specific antibiotic therapy.

Pneumatic trabeculoplasty versus argon laser trabeculoplasty in primary open-angle glaucoma

AIMS

To compare the efficacy of pneumatic trabeculoplasty (PNT) and argon laser trabeculoplasty (ALT) in primary open-angle glaucoma (POAG) uncontrolled with two topical therapies.

METHODS

In a randomized, prospective clinical study, 32 patients received in 1 eye PNT or ALT.

RESULTS

At 1 month, in PNT- and in ALT-treated eyes respectively, mean intraocular pressure (IOP) decreased by 3 +/- 2.3 and 5.7 +/- 1.7 mm Hg (12.7 +/- 9.6 and 24.4 +/- 7.4%, both paired t test p < 0.001); 5 and 13 eyes (31 vs. 81%, chi(2) test p = 0.013) had an IOP reduction >or=20%, 7 and 1 eyes had an insufficient effect (IOP >20 mm Hg). Only 1 PNT-treated eye had IOP reduction >or=20% until 4 months. At 6 months, 10 ALT-treated eyes (62.5%) had IOP reduction >or=20%; 15 PNT- and 3 ALT-treated eyes had an insufficient effect (94 vs. 19%, p < 0.001). Transient anterior segment side effects, but not visual field or fundus changes, occurred after both treatments.

CONCLUSIONS

PNT is less effective than ALT in POAG uncontrolled with two topical therapies.

Pneumatic trabeculoplasty versus argon laser trabeculoplasty in primary open-angle glaucoma

AIMS

To compare the efficacy of pneumatic trabeculoplasty (PNT) and argon laser trabeculoplasty (ALT) in primary open-angle glaucoma (POAG) uncontrolled with two topical therapies.

METHODS

In a randomized, prospective clinical study, 32 patients received in 1 eye PNT or ALT.

RESULTS

At 1 month, in PNT- and in ALT-treated eyes respectively, mean intraocular pressure (IOP) decreased by 3 +/- 2.3 and 5.7 +/- 1.7 mm Hg (12.7 +/- 9.6 and 24.4 +/- 7.4%, both paired t test p < 0.001); 5 and 13 eyes (31 vs. 81%, chi(2) test p = 0.013) had an IOP reduction >or=20%, 7 and 1 eyes had an insufficient effect (IOP >20 mm Hg). Only 1 PNT-treated eye had IOP reduction >or=20% until 4 months. At 6 months, 10 ALT-treated eyes (62.5%) had IOP reduction >or=20%; 15 PNT- and 3 ALT-treated eyes had an insufficient effect (94 vs. 19%, p < 0.001). Transient anterior segment side effects, but not visual field or fundus changes, occurred after both treatments.

CONCLUSIONS

PNT is less effective than ALT in POAG uncontrolled with two topical therapies.

Low-fluence photodynamic therapy in longstanding chronic central serous chorioretinopathy with foveal and gravitational atrophy

PURPOSE

To describe anatomic and functional outcomes in two patients with long-standing severe chronic central serous chorioretinopathy (CSC) with foveal and gravitational atrophy treated with low-fluence photodynamic therapy (PDT).

METHODS

Two patients with a history of over 10 years of chronic CSC and development of gravitational tracts, with best-corrected visual acuity <or=20/200, were treated with PDT guided by indocyanine green angiography (ICGA) with a fluence of 25 J/cm2 at an irradiance of 300 mW. Follow-up examinations 1 and 9 months after therapy included measurement of near and far best-corrected visual acuity, fundus biomicroscopy, fluorescein angiography and ICGA, optical coherence tomography, and microperimetry.

RESULTS

At 1 and 9 months after low-fluence PDT, complete resolution of subretinal, intraretinal, and under retinal pigment epithelium fluid was observed in both patients. Far and near visual acuity improved in both eyes. Improvement of sensitivity and fixation stability were demonstrated by microperimetry. No treatment-related side effects were seen.

CONCLUSIONS

ICGA-guided low-fluence PDT seems effective and safe for treating long-standing chronic CSC.

Pneumatic trabeculoplasty vs latanoprost as adjunctive therapy to timolol in primary open-angle glaucoma or ocular hypertension

PURPOSE

To evaluate the efficacy and safety of pneumatic trabeculoplasty (PNT) compared with latanoprost 0.005%, in primary open-angle glaucoma (POAG) and ocular hypertension (OH) not controlled by timolol 0.5%.

PROCEDURES

In a randomized clinical study, 18 patients affected with primary open-angle glaucoma (POAG) or ocular hypertension (OH) with intraocular pressure (IOP) >20 mmHg after timolol 0.5% in one eye were treated with PNT; 18 control eyes received adjunctive therapy with latanoprost 0.005%. Visual acuity, IOP, visual field, biomicroscopy findings and fundus appearance were evaluated at each month. Patients with IOP >20 mmHg were excluded from the study. The study was continued until in one group no patients were left.

RESULTS

At 1 month, IOP had decreased significantly in both groups. In PNT-treated eyes the mean IOP decrease was 4.5 +/- 1.8 mmHg (19.1 +/- 7.8%) and in latanoprost-treated eyes was 6.6 +/- 1.3 mmHg (28.2 +/- 5.7%) (between two groups, P < 0.001). Eleven PNT-treated eyes (61%) and 17 latanoprost-treated eyes (94%) had an IOP reduction of more than 20% of baseline value (P = 0.049); two PNT-treated patients received additional therapy. At the following months, in the latanoprost group, IOP was stable: an IOP reduction of 20% or more was seen in 89% of the eyes. In some PNT-treated eyes IOP increased: at 2 months, an IOP reduction> or =20% was seen in 50%, at 3 months in 33%, and at 4 months in 17% of the eyes. (between the two groups, respectively, P = 0.03, P = 0.002, P < 0.001). The number of eyes that required therapy increased progressively in the PNT group, and at 8 months all eyes had required therapy, whereas one latanoprost-treated eye had had additional therapy. After PNT, no patients had visual acuity reduction or intraocular inflammation; three eyes had subconjunctival hemorrhage and five eyes a hyperemia that regressed within 1 week. No posterior segment changes or visual field progression were detected in either groups.

CONCLUSIONS

In eyes with glaucomatous damage that is not advanced, PNT can reduce the IOP in 60% of the eyes at 1 month, and in 33% of the eyes at 3 months, without significant side-effects. The indications, efficacy and safety of PNT retreatments remain to be investigated. IOP reduction is less and of shorter duration than that obtained by latanoprost adjunctive therapy.

Presurgical antimicrobial prophylaxis: effect on ocular flora in healthy patients

OBJECTIVE

Evaluation of presurgical antimicrobial prophylaxis for reduction of ocular flora.

SETTING

Ophthalmology Section, Department of Medicine and Surgery, University of Catania, Italy.

METHODS

Three days before photorefractive keratectomy (PRK), conjunctiva of 70 healthy patients (100 eyes) were swabbed. After 3 days of instillation of ofloxacin 0.3% (3 times daily), conjunctival swabs were taken again. Bacteria were isolated and identified from each swab.

RESULTS

A total of 191 independent isolates were obtained prior to antimicrobial treatment. Bacteria were isolated from all 100 eyes sampled. Gram-positive species predominated, with Staphylococcus epidermidis and Staphylococcus aureus cultured from 69% and 25% of eyes sampled, respectively. Species of the anaerobic genera Peptococcus and Peptostreptococcus were found in 22% and 14% of eyes, respectively. After prophylaxis with ofloxacin, bacteria could be cultured from only 7% of eyes (10 independent isolates). All isolates were sensitive to ofloxacin except 5 strains of S. epidermidis, which displayed intermediate sensitivity. No infections occurred after PRK.

CONCLUSION

Prophylaxis by instillation of ofloxacin 0.3% 3 times daily for 3 days substantially reduced the ocular flora of 100 healthy eyes prior to refractive surgery.

Diabetic patients and retinal proliferation: an evaluation of the role of vascular endothelial growth factor (VEGF)

Vascular endothelial growth factor (VEGF) has been shown to play a major role in intraocular neovascularisation in ischaemic retinal diseases. The aim of this study was to evaluate the concentration of VEGF in vitreous, aqueous and epiretinal membranes of diabetic and non-diabetic patients, with other pathological conditions requiring surgical intervention. Higher VEGF concentration were found in samples from the eyes of diabetic patients versus other pathologies as well as in epiretinal membranes versus the other eye compartments in diabetic patients. However, high VEGF levels were also found in retinal detachment and proliferative vitreoretinopathy of non-diabetic patients. We concluded that VEGF is produced locally and plays a fundamental, but not specific, role in diabetic retinal neovascularisation and proliferation.

Effect of aminoglycosides (sub-MICs) on adherence of coagulase-negative Staphylococci to intraocular lens surface

The authors evaluated the in vitro effects of subinhibitory concentrations (sub-MICs) of aminoglycosides (gentamicin, netilmicin and tobramycin) on the adherence of coagulase-negative staphylococcus to intraocular lens (PMMA, acrylic and heparin) surface. The five strains of coagulase-negative Staphylococcus epidermidis used (S. epidermidis IMe7, IMe11, IMe27, IMe29 and IMe31) were tested for their ability to produce slime. The minimum inhibitory concentrations (MIC) indicated high susceptibility in vitro to the antibiotics and homogeneous values. The adhesion tests without antibiotics (K1, K2 and K3) for every time considered (30 min, 60 min and 180 min) and for all examined strains showed more constant adhesive activity on the surface of acrylic intraocular lens (IOLs) than on the surface of heparin IOLs. The aminoglycosides tested were able to reduce adhesivity by coagulase-negative S. epidermidis slime to the IOL surfaces, even at sub-MICs. The documentation obtained by scanning electron microscope shows the growth of a strain of S. epidermidis IMe11 after 180 minutes of contact which remains adherent to the surface of the acrylic IOLs.