Dental inflammation and central retinitis--it is important to protect the retina from the harmful sunlight

During 3-year study of 73 patients with dental inflammation, sinusitis, otitis and 5 cases with granuloma, in 9 cases we observed the development of central retinitis. All patients were medicated with the same antibiotics and parabulbar depo of Prednisolonacetate. To 50% of these patients, we suggested eye protection with Yellow Medical filters during two months. In the first group with medication we observed better vision in 69%, but in the second group with eye protection with Yellow Medical filters we observed normalization of vision in 100%.

Hyoscine skin patches for drooling dilate pupils and impair accommodation: spectacle correction for photophobia and blurred vision may be warranted

Hyoscine skin patches diminish salivation by their anticholinergic action. The aim of reporting this case series is to present the ophthalmic side effects in children, and to highlight the precautions to take. Five children (two males, three females; age range 8-18y) with quadraplegic cerebral palsy (Gross Motor Function Classification System Level V) and profound intellectual impairment, wearing hyoscine skin patches to control excessive salivation, were examined. Binocular visual acuity, pupil reaction, pupil diameter, and dynamic retinoscopy were recorded before and after instilling guttae cyclopentolate 1%. The accommodative responses were compared with the expected norms. Spectacle correction was provided for refractive error and to compensate for lack of accommodation. Tinted lenses were provided for photophobia. Visual assessment was repeated 6 months later. All children had dilated pupils with a mean diameter of 7.8mm (range 7-9mm) before instilling guttae cyclopentolate. Mean pupil constriction to bright light was only 1.8mm (range 1-2mm). Mean resting accommodation was 0.45 dioptres (D; range 0-1D) and no accommodative responses were detected on dynamic retinoscopy. Three children were photophobic. Visual behaviour was seen to improve after the use of appropriate spectacles. Photophobia was relieved by tinted lenses. The anticholinergic effects of hyoscine skin patches can cause photophobia and impair vision due to pupil dilatation and paralysis of accommodation. Appropriate spectacles are recommended.

Crossover, double-blind clinical trial comparing almotriptan and ergotamine plus caffeine for acute migraine therapy

In this randomized, double-blind, crossover clinical trial, adult patients treated two migraine attacks: one with almotriptan 12.5 mg and the other with ergotamine 2 mg plus caffeine 200 mg. Treatment with almotriptan was associated with a significantly greater proportion of patients achieving 2-h pain free (20.9% vs. 13.7%; P < 0.05) and 2-h pain relief (57.7% vs. 44.5%; P < 0.01) compared with ergotamine plus caffeine therapy; significant differences were not seen at 1 h. Rates for sustained pain free and sustained pain free plus no adverse events (AEs) also were significantly greater after almotriptan treatment than after the use of ergotamine plus caffeine (P < 0.05). Almotriptan was associated with a significantly lower rate of photophobia at 90 min (P < 0.05), phonophobia at 60, 90, and 120 min (P < 0.05 to <0.01), and nausea and vomiting at 90 and 120 min (P < 0.01) compared with ergotamine plus caffeine. A significantly greater proportion of patients were more satisfied with almotriptan than with ergotamine plus caffeine (P < 0.05). Sixteen patients reported adverse events during almotriptan treatment and 27 patients reported AEs during the ergotamine plus caffeine therapy. Most AEs were mild-to-moderate and did not result in treatment-related discontinuations. In conclusion, almotriptan was associated with significantly greater efficacy for treating migraine compared with ergotamine plus caffeine, was generally well tolerated and was associated with greater rate of treatment satisfaction.

Transient light-sensitivity syndrome after laser in situ keratomileusis with the femtosecond laser

PURPOSE

To describe the incidence of transient light-sensitivity syndrome (TLSS) after laser in situ keratomileusis (LASIK) with the femtosecond laser and to identify preventive strategies.

SETTING

Hospital NISA Virgen del Consuelo, Valencia, Spain.

METHODS

The first 765 eyes operated on with the 15 KHz femtosecond laser were prospectively analyzed for subjective complaints and clinical findings compatible with TLSS. Intraoperative settings, postoperative treatment, and development of complications were analyzed.

RESULTS

Overall, TLSS developed in 10 eyes (incidence 1.3%). However, the incidence decreased from 2.8% to 0.4% when aggressive topical steroids were used during the first 3 postoperative days. Postoperative interface inflammation and postoperative use of a low-dose topical steroid regimen were associated with a higher incidence of TLSS.

CONCLUSIONS

Transient light-sensitivity syndrome is a relatively uncommon complication related to the use of the femtosecond laser. Postoperative interface inflammation may increase the probability of developing TLSS, whereas an aggressive postoperative steroid regimen seemed to provide protection against it.

[Changes of retinal light sensitivity after YAG-laser capsulotomy]

BACKGROUND

The aim of this prospective study was firstly to investigate the changes of retinal light sensitivity of the central visual field in patients with posterior capsule opacification (PCO) after YAG-laser capsulotomy and secondly to determine the correlation between changes in retinal light sensitivity and patient's age and the diameter of posterior laser capsulotomy.

PATIENTS AND METHODS

Our study includes 25 eyes (25 patients) with PCO after phacoemulsification and intraocular lens implantation. In all patients YAG-laser capsulotomy was performed. In all patients, a threshold visual field analysis was carried out with the C 30 - 2 programme of the automated Humphrey Field Analyzer before and one month after the procedure.

RESULTS

In all patients a significant improvement of visual acuity was observed one month after capsulotomy (p = 0,00003). One month after YAG-laser treatment, a significant improvement of retinal light sensitivity in the central visual field was also observed. The average MD (mean deviation) before the procedure was - 6.05 db (+/- 3.2, max. - 11.7, min. + 2.17) and after the procedure - 3.61 db (+/- 3.7, max. - 10.87, min. + 0.71). Before laser capsulotomy obvious areas of reduced retinal sensitivity in 19 of 25 eyes (76 %) were found with MD p values of less than 5 %. One month after the procedure the MD p values were less than 5 % only in 8 eyes (32 %). The improvement in MD was statistically significant (p = 0,0002). No correlation was established between the improvement of retinal light sensitivity and patient's age or the size of the capsulotomy.

CONCLUSIONS

Our study shows that the improvement of retinal light sensitivity is significant after YAG-laser capsulotomy and not depends on patient age or capsulotomy size.

Autoimmune retinal dysfunction in sarcoid chorioretinopathy

BACKGROUND

Visual loss, photophobia and night-blindness in a middle-aged patient with a previous history of cancer are highly suggestive of cancer-associated retinopathy.

HISTORY AND SIGNS

A 63-year-old man complained of slowly progressive bilateral visual loss, photophobia and night-blindness. His past medical history was remarkable for surgical and medical treatment of a carcinoma of the base of his tongue nine years earlier. Visual acuity was 0.3 RE and 0.15 LE, with constricted visual field in both eyes. Ocular examination and fluorescein angiography were non-relevant. Electroretinography revealed diffuse cone and rod dysfunction. ICG angiography showed multiple small widespread hyperfluorescent spots. A chest CT scan revealed multiple focal lesions which were biopsied. Histological diagnosis was sarcoidosis.

THERAPY AND OUTCOME

Upon systemic steroid therapy, visual function gradually improved, and ICG anomalies disappeared. Vision recovered to 1.0 RE and 0.8 LE with normal visual field in both eyes.

CONCLUSION

Sarcoidosis may present as an autoimmune retinal dysfunction with photophobia and night blindness as the presenting symptoms.

A randomized trial of frovatriptan for the intermittent prevention of menstrual migraine

BACKGROUND

Menstrually associated migraine (MAM) is often prolonged and difficult to manage with conventional therapies. Frovatriptan is a new selective 5HT(1B/1D) receptor agonist indicated for short-term management of migraine. It has a long half-life and good tolerability. These characteristics suggest that frovatriptan may be useful for the intermittent prevention of MAM.

METHODS

The study was a randomized, double-blind, placebo-controlled, three-way crossover design. Patients treated each of three perimenstrual periods (PMPs) with placebo, frovatriptan 2.5 mg QD, and frovatriptan 2.5 mg BID. The 6-day treatment started 2 days before the anticipated start of MAM headache. The primary efficacy endpoint was incidence of MAM headache during the 6-day PMP.

RESULTS

The population comprised 546 women (mean age, 37.6 years). Use of frovatriptan reduced the occurrence of MAM headache. The incidence of MAM headache during the 6-day PMP was 67% for placebo, 52% for frovatriptan 2.5 mg QD, and 41% for frovatriptan 2.5 mg BID. Both frovatriptan regimens were superior to placebo (p < 0.0001), and the BID regimen was superior to the QD regimen (p < 0.001). Both frovatriptan regimens also reduced MAM severity (p < 0.0001), duration (p < 0.0001), and the use of rescue medication (p < 0.01 QD; p < 0.0001 BID) in a dose-dependent manner. The incidence and type of adverse events for both regimens were similar to placebo and consistent with those reported for short-term migraine management.

CONCLUSION

Frovatriptan given prophylactically for 6 days was effective in reducing the incidence of menstrually associated migraine. More than half of patients who used frovatriptan 2.5 mg BID had no menstrually associated migraine headache during the 6-day perimenstrual period. The findings are consistent with the long duration of action and good tolerability of frovatriptan observed in short-term migraine management.

Ophtec iris reconstruction lens United States clinical trial phase I

PURPOSE

To determine the safety and efficacy of the Ophtec model 311 iris reconstruction lens for treatment of visual disturbances, such as glare or photophobia, related to partial or total absence of the human iris.

DESIGN

Phase I multicenter, nonrandomized, investigational device study.

PARTICIPANTS

Ten iris reconstruction lenses were placed in 10 subjects at 6 sites.

METHODS

Iris reconstruction lenses were placed in 9 patients who had lost all or part of their iris from trauma and in 1 patient who lacked iris pigmentation due to congenital albinism. Patients were examined preoperatively, intraoperatively, and postoperatively at day 1; week 1; and months 1, 3, 6, and 12.

MAIN OUTCOME MEASURES

Efficacy measures were uncorrected visual acuity (UCVA), glare, starbursts, and photophobia. Safety measures were best-corrected visual acuity (VA), surgical complications, and adverse events.

RESULTS

Uncorrected VA improved in all eyes after implantation of the iris reconstruction lens. Best-corrected VA did not change significantly (P = 0.24). Postoperative photophobia was reduced in all 9 eyes that experienced moderate to severe preoperative photophobia. Likewise, postoperative glare was reduced in all 6 eyes with moderate to severe preoperative glare. There were no surgical complications. Adverse events included 2 cases of iritis and 1 case of macular edema.

CONCLUSIONS

Preliminary results suggest that the Ophtec model 311 iris reconstruction lens can improve UCVA and reduce glare and photophobia in patients with partial or total absence of the iris or iris pigmentation.

Schwerwiegender Verlauf und belastende Faktoren bei Optikusneuropathie und Myelopathie durch Tuberkulostatika

A male patient with tuberculous lymphadenopathy was treated with a four-fold therapy of ethambutol, isoniacide, rifampicin and pyracinamide. After 10 weeks the patient suffered from photophobia. Although ethambutol was discontinued vision decreased and visual field defects occurred as well as signs of myelopathy. Isoniacide was then discontinued and in the subsequent phase the vision was slowly restored over a period of 36 months. The combined toxicity of ethambutol and isoniacide seems to have been the main cause of the severe and protracted optic neuropathy.

A health intervention programme for children with albinism at a special school in South Africa

The genetic condition albinism has a high frequency among the Sotho people of northern South Africa. Affected children have pale hair, eyes and skin-a dramatic contrast to the normal dark pigmentation. Their visual performance is poor and many attend special schools for the visually impaired. Children with albinism experience problems that are, on the one hand, physiological, and, on the other, social-psychological and educational in nature. In this self-report study 38 children at a rural special school described their eye and skin problems, a direct result of their lack of pigmentation, as well as strategies they adopted to manage their condition. A further section of the study deals with the social adaptation difficulties experienced by these children. The questionnaire tested for local belief systems about albinism and how these impact on the socialization of children with albinism. The intervention strategy proposed in this study is based on the assumption that any attempt to address both the health and social problems should be of a holistic, interactionist nature, and be based on the values and belief systems of the local community. In addressing the physical problems, the proposed intervention programme focuses on sensible sun protection habits from a young age and the active participation of the children. To alleviate the social problems a team (interactionist) approach including children, teachers, parents, health officials and the wider community is recommended.

Zolmitriptan is effective and well tolerated in Japanese patients with migraine: a dose-response study

This phase II study investigated the efficacy, tolerability and dose-response relationship of oral zolmitriptan in the treatment of a single migraine attack in Japanese patients. A bridging analysis then assessed the validity of extrapolating western clinical data to these Japanese patients. In this multicentre, randomized, double-blind, placebo-controlled study, patients received a single dose of placebo or zolmitriptan 1, 2.5 or 5 mg. The primary endpoints were 2-h headache response and the tolerability of zolmitriptan. A statistically significant dose-response relationship was observed for the 2-h headache response (P=0.003). The 2.5 mg group had significantly greater 2-h headache response than the placebo group (P=0.032). The adverse event profile was similar to that reported in western patients, and no adverse events unique to the Japanese population were observed. The bridging analysis report confirmed similar efficacy and tolerability of zolmitriptan in Japanese and western populations. In the Japanese patients, the estimated response rates were 34.3%, 45.2%, 57.7% and 66.2% for placebo, and zolmitriptan 1, 2.5 and 5 mg, respectively, while in the western population the corresponding rates were 39.9%, 49.6%, 61.2% and 71.7%. Zolmitriptan is effective and well tolerated in the acute treatment of migraine in Japanese patients. The optimal dose was 2.5 mg, although the 5 mg dose may provide further benefit for some patients. The bridging analysis supports extrapolation of data from western to Japanese patients.

Pain, photophobia, and retinal and optic nerve function after phacoemulsification with intracameral lidocaine

OBJECTIVE

To evaluate differences in pain, photophobia, retinal and optic nerve function in test eyes given intracameral lidocaine compared with control eyes given intracameral saline after phacoemulsification under topical anesthesia.

DESIGN

Prospective paired-eye intervention study with random treatment allocation.

PARTICIPANTS

Thirty eyes of 15 patients underwent cataract surgery in both eyes under topical anesthesia.

INTERVENTION

The first eye of each patient was randomly assigned to either 0.5 ml preservative-free 2% intracameral lidocaine or 0.5 ml of intracameral sterile saline. Within 5 months, the second eye automatically received intracameral saline if the first eye received intracameral lidocaine or vice versa.

MAIN OUTCOME MEASURES

The duration of surgery was recorded. Immediately after surgery, each patient was asked to evaluate the degree of pain and photophobia experienced during surgery using a nominal scale. In addition, in five patients, electroretinography (ERG) and visual evoked response (VER) were performed within 1 week before surgery, immediately after surgery, and 1 day after surgery. Amplitudes and latencies were calculated.

RESULTS

There was no difference in the duration of surgery comparing test eyes given intracameral lidocaine with control eyes given sterile saline (P = 0.81). There was no significant difference in the level of pain reported when comparing test eyes given intracameral lidocaine with control eyes (P = 1.00). None of the patients reported any significant difference in photophobia between their two eyes (P = 1.00). When comparing ERG measurements, test eyes given intracameral lidocaine did not show any significant decrease in ERG amplitudes or prolonged latencies compared with control eyes. When comparing VER measurements, test eyes given intracameral lidocaine did not show any increase in P1 latencies compared with control eyes (P = 0.31). When evaluating all postoperative ERG results 1 day after surgery, there was a suggestion of improved cone function.

CONCLUSIONS

Although intracameral lidocaine does not depress retinal or optic nerve function, the addition of intracameral lidocaine to topical anesthesia during phacoemulsification does not significantly reduce intraoperative pain or photophobia.