Chronic unilateral external ocular inflammation

To diagnose the cause of chronic unilateral external ocular inflammation, the physician must take into account many factors usually not considered in bilateral cases. We report on the diagnosis and treatment of ten unilateral cases encompassing a variety of ocular and systemic problems. The purpose of this report is to emphasize the importance of systematic consideration of all diagnostic possibilities and to suggest a diagnostic protocol to aid in the study of patients with chronic unilateral external ocular inflammation.     

妥布霉素治疗外眼细菌性感染的临床研究

目的：评价托百上（０．３％妥布霉素）眼药的临床疗效。方法：外眼感染患者随机分成托百士治疗组与氧氟沙星治疗组进行对照研究,于用药前、用药后４￣５天、９￣１０天分别作细菌培养,根据临床观察（症状和体征综合评分）及菌培养结果判定药物的治疗效果。结果：１５例菌培养阳性的外眼感染患者,托百士组７５例,显效３６例,有效３４例,总有效７０例,有效率９３．３３％;氧氟沙星组４０例,显效１５例,有效２１例,总有效３     

Drug delivery options for the treatment of ocular inflammation

Treatments available for ocular inflammatory diseases and their associated complications have expanded significantly over the course of the last ten years. While corticosteroids are a mainstay of therapy for uveitis and macular edema, the methods of delivering corticosteroids have evolved. Intravitreal triamcinolone acetonide provides a local therapy for persistent cystoid macular edema (CME) and posterior uveitis. Other intravitreal therapies, such as bevacizumab and methotrexate, have also been used successfully in uveitic CME. Sustained release intravitreal implants, including the fluocinolone acetonide implant and the dexamethasone drug delivery system, offer an alternative therapy for chronic, recalcitrant posterior uveitis and CME. Their design was inspired by the ganciclovir implant, which prevented the progression of CMV retinitis in AIDS patients. Technological advances in drug delivery have supplied new treatments for patients with ocular inflammatory disease.     

Demodex treatment in external ocular disease: the outcomes of a Tasmanian case series

Demodex species (spp.) have previously been implicated in the pathogenesis of blepharitis. This study aims to correlate improvement in symptoms of external ocular disease with treatment of underlying Demodex spp. This is a prospective, observational case series of patients with chronic external ocular disease. Demodicosis was confirmed by microscopic examination of epilated eyelashes. The main outcome measure was response to the treatment (5 % tee tree oil) in regard to change in subjective symptoms utilising a symptom-based patient questionnaire assessment. Overall patients had a good response to the treatment in terms of improvement or resolution of symptoms, with 91 % of patients reporting at least some improvement in symptoms. The treatment of underlying Demodex spp. appears to result in improvement of symptoms in patients with long standing external ocular disease and underlying Demodex spp. infestation.     

Mycophenolate mofetil in the treatment of ocular inflammation in ANCA-associated vasculitis.

AIM: The aim of this study was to describe the use of mycophenolate mofetil (MMF) in the treatment of patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis with ocular involvement. METHODS: A retrospective review was performed. Ocular and systemic manifestations, history of previous immunosuppressive drug therapy, concurrent therapy with MMF, response to treatment, side effects related to the use of MMF, and follow-up period were recorded. RESULTS: Nine (9) eyes of 5 patients were evaluated. Ocular involvement included scleritis, choroidal and orbital granuloma, multifocal choroiditis, intermediate uveitis, and lacrimal gland involvement. Mycophenolate was started at 2 g daily. Mean follow-up after the initiation of MMF was 36 months. Mean prednisolone dose at onset of treatment with MMF was 27 mg daily and was reduced to 7 mg daily as disease control was achieved. Visual acuity was maintained or improved in all eyes, apart from 1 eye, which developed cataract formation. One (1) patient required a reduction in the dose of mycophenolate owing to diarrhea. CONCLUSIONS: Our study suggests that mycophenolate mofetil may be a safe, effective therapeutic modality for ocular inflammation associated with ANCA-associated vasculitis.     

Quantification of ocular inflammation: evaluation of polymorphonuclear leucocyte infiltration by measuring myeloperoxidase activity

Myeloperoxidase (MPO) activity was measured in rabbit cornea and iris-ciliary body to quantitate the infiltration and accumulation of polymorphonuclear leucocytes (PMN's) following an inflammatory stimulus. Following injection of clove oil into the cornea, MPO activity could be detected in the cornea at 6 hr, reaching a maximum at 12 hr, and falling to non-detectable levels at 72 hr. MPO activity was only detected in the iris-ciliary body 24 hr after intracorneal clove oil injection. MPO activity in the iris-ciliary body increased in a dose-dependent manner following intravitreal injection of endotoxin. No MPO activity could be detected in cornea. Topical administration of dexamethasone inhibited MPO activity in cornea and iris-ciliary body 24 hr after intracorneal clove oil and intravitreal endotoxin injection, respectively. Measurement of MPO activity in ocular tissues could provide a useful tool to quantitatively evaluate the severity and time course of inflammation.     

托百士滴液治疗眼表细菌性炎症的疗效观察

目的：评价托百士治疗眼青细菌性炎症的临床疗效。方法：应用托百士（妥布霉素）滴眼液治疗27例细菌性结膜炎、25例细菌性角膜炎、5例细菌性泪囊炎,治疗前后做结膜囊分泌物培养,观察患眼的恢复时间和治疗效果。结果：托百士治疗细菌性结膜炎、细菌性角膜炎和细菌性泪囊炎的有效率分别为96．3％、92％、60％,平均恢复时间分别是5．8天、12．4天、14．7天,药物副作用除个别患者用药后有眼睑发痒、轻微刺痛外,无其它副作用,结论：该药是治疗眼表细菌性炎症的有效局部抗菌眼药,尤其对细菌性结膜炎和细菌性角膜炎疗效显著。     

Treatment of ocular inflammation

Acute immunosuppression induced by total body irradiation (TBI) or cyclophosphamide (Cy) treatment, followed by syngeneic bone marrow transplantation (SBMT), was reported to be effective in inducing long-term tolerance in some autoimmune disease models. We examined the efficacy of this approach in the mouse model of experimental auto-immune uveoretinitis (EAU). Development of EAU induced by the interphotoreceptor retinoid binding protein (IRBP) was abolished almost completely by either TBI or Cy treatment, followed by SBMT, instituted one week after priming. In parallel, IRBP-specific delayed-type hyper-sensitivity (DTH) responses and lymph node cell proliferation were strongly suppressed or abolished. However, when these IRBP-immunized, lympho-ablated and BM reconstituted mice were rechallenged with the immunizing antigen seven weeks after the primary immunization, they were not protected from developing disease, despite the fact that DTH and lymph node cell proliferation to the antigen were suppressed relative to controls. TBI treatment appeared somewhat more effective than Cy treatment as judged by its more profound effect on immunological responses. These results demonstrate the ability of acute immunosuppression followed by reconstitution of the immune system to inhibit the development of EAU, although long-term protection from disease was not achieved.     

Tumor necrosis factor antagonists: preliminary evidence for an emerging approach in the treatment of ocular inflammation

The anti-tumor necrosis factor (TNF) monoclonal antibody infliximab and the soluble TNF receptor etanercept inhibit the pleiotropic actions of TNF and are widely used for the treatment of rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), spondyloarthropathies (SpA), Crohn's disease, and psoriasis with an acceptable safety profile. A pathogenetic role of TNF in ocular inflammatory conditions has recently emerged from small trials reporting preliminary results on the efficacy of these agents in patients with noninfectious uveitis, regardless of the origin of the disease. The authors review the published experience, derived mostly from investigator-sponsored trials and uncontrolled case series, on the use of TNF antagonists in approximately 280 patients with various ocular conditions who were inadequately controlled on currently available therapy. These reports suggest that TNF antagonists, mainly infliximab, which may have better efficacy than etanercept, are useful in the treatment of ocular inflammation associated with Adamantiades-Beh?et's disease, RA, JIA, SpA, Crohn's, sarcoidosis, and Graves' disease ophthalmopathy. Infliximab was also beneficial in small numbers of patients with idiopathic uveitis or scleritis, birdshot retinochoroiditis, uveitic and diabetic cystoid macular edema, and age-related macular degeneration. The currently available data are nonrandomized and thus preliminary, providing the foundation and justification for randomized trials to assess efficacy and safety. Until such results are available, knowledge regarding the use of anti-TNF regimens in ophthalmology is incomplete. However, the preliminary evidence points to a growing optimism for targeting TNF in patients with ocular inflammation.     

普拉洛芬滴眼液治疗干眼症眼表炎症的临床评价

目的:观察1g/L普拉洛芬滴眼液控制干眼症患者眼表炎症的疗效和安全性。方法:选择我院2008-04/2008-10门诊诊断为干眼症的患者60眼,随机分成两组,A组为试验组:1g/L普拉洛芬滴眼液及人工泪液联合应用,4次/d点眼,每次1滴。B组为对照组:人工泪液单独应用,4次/d点眼,每次1滴。试验疗程为14d。所有的患者符合入选标准,用药后3,7,14d观察患者的自觉症状、体征、泪膜破裂时间(BUT)、SchirmerⅠ试验、荧光素染色评分等。比较两组的结果,进行统计分析。结果:1g/L普拉洛芬滴眼液及人工泪液联合应用治疗干眼症患者的效果明显优于单纯使用人工泪液治疗组,两组结果有统计学差异。结论:普拉洛芬可以有效控制干眼症患者眼表炎症,是辅助治疗干眼症的有效药物。     

Ketorolac tromethamine 0.5% ophthalmic solution in the treatment of moderate to severe ocular inflammation after cataract surgery: a randomized, vehicle-controlled clinical trial

PURPOSE: To investigate the efficacy and safety of ketorolac tromethamine 0.5% ophthalmic solution (Acular; Allergan, Inc, Irvine, California) in the treatment of moderate to severe anterior segment inflammation developing after unilateral cataract surgery with intraocular lens implantation. METHODS: Only patients who exhibited moderate or greater levels of cells and flare 1 day after surgery were included in this multicenter, double-masked, randomly assigned, parallel-group study. Topical ketorolac or vehicle solution (Allergan, Inc) was administered to the treated eye four times daily, starting the day after surgery and continuing for 14 days. RESULTS: Ketorolac was significantly more effective than the vehicle solution in reducing anterior chamber cells (P < or = .030) and flare (P < or = .025), conjunctival erythema (P < or = .046), ciliary flush (P < or = .006), tearing (P < or = .012), photophobia (P < or = .014), and pain (P < or = .049). Half as many patients from the ketorolac group (14/51) were discontinued from the study for lack of efficacy, compared with the vehicle group (28/51; P = .005). There was no significant difference between ketorolac and the vehicle solution in changes in visual acuity, intraocular pressure, biomicroscopic or ophthalmoscopic variables, or adverse events. CONCLUSIONS: Ketorolac tromethamine 0.5% ophthalmic solution is safe and provides substantial anti-inflammatory activity in the treatment of moderate to severe anterior segment inflammation developing after cataract surgery and intraocular lens implantation.