Activity of newer fluoroquinolones against gram-positive and gram-negative bacteria isolated from ocular infections: an in vitro comparison

BACKGROUND: To determine the antibacterial activity of newer fluoroquinolones and compare their activity between ciprofloxacin-susceptible and resistant bacterial isolates from patients with keratitis and endophthalmitis. MATERIALS AND METHODS: The minimum inhibitory concentration (MIC) of ciprofloxacin, ofloxacin, levofloxacin, gatifloxacin and moxifloxacin was determined for 123 bacterial isolates, using E test. Among the 123 isolates, 68 were gram-positive (Staphylococcus spp, Streptococcus spp, Corynebacterium spp, Bacillus spp.) and 55 were gram-negative (Pseudomonas aeruginosa). The bacterial isolates were divided into three groups: susceptible/intermediate/resistant to ciprofloxacin. The MIC values for various fluoroquinolones were compared between the three groups and between gram-positive and gram-negative bacteria. RESULTS: For gram-positive isolates, median MICs of fourth generation fluoroquinolones were lower than second generation. The median MIC was lowest for gatifloxacin and moxifloxacin (0.094 mg/ml) in ciprofloxacin-susceptible isolates of gram-positive bacteria. For ciprofloxacin-susceptible gram-negative bacteria, the median MIC of ciprofloxacin (0.19 mg/ml) was significantly lower than ofloxacin, levofloxacin, gatifloxacin and moxifloxacin (1.5, 0.5, 0.5 and 2 mg/ml respectively). Ciprofloxacin-resistant isolates of gram-positive bacteria showed higher MIC of levofloxacin, moxifloxacin and gatifloxacin though they remained susceptible to them. None of the fluoroquinolones were effective against ciprofloxacin-resistant gram-negative bacteria. Overall, for gram-positive bacteria, median MICs of levofloxacin, moxifloxacin and gatifloxacin were below ciprofloxacin, the MIC of gatifloxacin and moxifloxacin was equal for gram-positive bacteria. CONCLUSIONS: Levofloxacin, gatifloxacin and moxifloxacin are statistically more effective against gram-positive bacteria, the latter two being equally effective. Ciprofloxacin remains the most effective fluoroquinolone against gram-negative bacteria.     

Eficacia de la aplicación tópica de 0,3% ciprofloxacina en la reducción de la biota conjuntival de pacientes operados de cataratas

ObjectiveTo determine the efficacy of topical 0.3% ciprofloxacin in reducing conjunctival biota in patients undergoing cataract surgery.Patients and methodsExperimental, prospective, randomized, controlled and single-blind study. Forty-six eyes of 46 patients were randomized into 2 groups, the study group (n = 23) received topical 0.3% ciprofloxacin one day before surgery for six times, and on the day of the surgery one drop every 15 minutes starting one hour before surgery until 3 doses were completed. The control group (n = 23) did not receive any antibiotics. For both groups for the surgical field 10% povidone-iodine was applied. Samples from the conjunctiva were taken at four different times and then cultured on solid media (chocolate agar, blood agar) and enrichment broth (thioglycolate). The aqueous humor samples were also cultured in thioglycolate. The presence of bacteria was identified quantitatively and qualitatively, and the frequency of contamination was measured by considering the presence of bacteria in liquid and solid culture media. The number of colony forming units (CFU) was counted in the solid culture medium.ResultsPositive cultures were obtained in 82.6% and 78.2% of the patients in the study and control groups, respectively, before the administration of 0.3% ciprofloxacin. The administration of 0.3% ciprofloxacin significantly reduced the CFU compared to the control group (P < .05). Immediately after the use of povidone-iodine, the proportion of patients with a positive culture decreased to 21.7% in the study group, and 8.7% in the control group. At the end of the surgery, this percentage was 26% and 30.4%, respectively. The most common isolated pathogen was negative-coagulase Staphylococcus (66.7%).ConclusionThe administration of 0.3% ciprofloxacin reduces conjunctival bacterial load in the preoperative period. However, it was unable to eradicate the bacteria completely. The administration of povidone-iodine reduced conjunctival biota in 50%-70% of patients undergoing cataract surgery.     

Ocular TRUST: nationwide antimicrobial susceptibility patterns in ocular isolates

PURPOSE: Ocular Tracking Resistance in U.S. Today (TRUST) annually evaluates in vitro antimicrobial susceptibility of Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae to ciprofloxacin, gatifloxacin, levofloxacin, moxifloxacin, penicillin, azithromycin, tobramycin, trimethoprim, and polymyxin B in national samples of ocular isolates. DESIGN: Laboratory investigation. METHODS: Prospectively collected ocular isolates (197 S. aureus, 49 S. pneumoniae, and 32 H. influenzae) from 35 institutions and archived ocular isolates (760 S. pneumoniae and 356 H. influenzae) from 34 institutions were tested by an independent, central laboratory. Mean minimum inhibitory concentrations that would inhibit growth of 90% of the tested isolates (MIC(90)) were interpreted as susceptible, intermediate, or resistant according to standardized breakpoints for systemic treatment. S. aureus isolates were classified as methicillin susceptible (MSSA) or methicillin resistant (MRSA). RESULTS: MSSA or MRSA susceptibility patterns were virtually identical for the fluoroquinolones, that is, MSSA susceptibility was 79.9% to 81.1% and MRSA susceptibility was 15.2%. Trimethoprim was the only agent tested with high activity against MRSA. All S. pneumoniae isolates were susceptible to gatifloxacin, levofloxacin, and moxifloxacin; 89.8% were susceptible to ciprofloxacin. H. influenzae isolates were 100% susceptible to all tested agents but trimethoprim. Ocular TRUST 1 data were consistent with the eight-year longitudinal sample of archived ocular isolates. CONCLUSIONS: The fluoroquinolones were consistently active in MSSA, S. pneumoniae, and H. influenzae. After more than a decade of intensive ciprofloxacin and levofloxacin use as systemic therapy, 100% of ocular S. pneumoniae isolates were susceptible to gatifloxacin, levofloxacin, and moxifloxacin; nonsusceptibility to ciprofloxacin was less than 15%. High-level in vitro MRSA resistance suggests the need to consider alternative therapy to fluoroquinolones when MRSA is a likely pathogen.     

In vitro activity of fluoroquinolones against ocular bacterial isolates in São Paulo, Brazil

PURPOSE: To compare the in vitro susceptibility profiles of bacterial ocular isolates and to determine minimum inhibitory concentrations (MICs) of gatifloxacin and moxifloxacin (fourth-generation fluoroquinolones) versus ciprofloxacin and ofloxacin (second-generation fluoroquinolones). METHODS: Gram-positive and gram-negative isolates were recovered from cases of keratitis, conjunctivitis, and endophthalmitis between 2002 and 2004 and were identified and extracted from the Microbiology Data Bank of the Federal University of S?o Paulo, S?o Paulo, Brazil. The comparison of in vitro MIC and susceptibility profiles for ofloxacin, ciprofloxacin, gatifloxacin, and moxifloxacin in gram-positive and gram-negative (n = 219) isolates was performed using the E test method. RESULTS: The fourth-generation fluoroquinolones were statistically more potent than the second generations for gram-positive bacteria. The MIC90 level was lower for moxifloxacin than that for gatifloxacin against Staphylococcus aureus, methicillin-susceptible coagulase-negative Staphylococcus (CoNS), and S. pneumoniae, whereas the levels were equal against S. viridans and the gatifloxacin MIC90 was lower in methicillin-resistant CoNS. There was no statistically significant difference between moxifloxacin and gatifloxacin when the permutation method from the MULTTEST procedure (SAS proc multtest) was used to obtain the adjusted P value. MIC90 for ciprofloxacin was lower in gram-negative bacteria. MIC90 for ofloxacin was higher against Haemophilus spp. and Moraxella spp. Ciprofloxacin was the most statistically potent fluoroquinolone for Pseudomonas spp. Ciprofloxacin was statistically just as potent as gatifloxacin for the other gram-negative isolates. CONCLUSION: From susceptibility profiles achieved with in vitro testing, the fourth-generation fluoroquinolones may offer some advantages over the currently available fluoroquinolones; however, a combination of the pharmacodynamics and pharmacokinetics of the drug, infection site, and the MIC is needed to predict the in vivo efficacy and best clinical applicability.     

In vitro activity of fluoroquinolones, vancomycin, and gentamicin against methicillin-resistant Staphylococcus aureus ocular isolates

PURPOSE: To determine the antibacterial activity of fluoroquinolones, vancomycin, and gentamicin against methicillin-resistant Staphylococcus aureus (MRSA) ocular surface isolates. DESIGN: Retrospective review. METHODS: MRSA isolates were obtained from 21 patients. The MIC(50) (mean inhibitory concentration)(microg/ml) values of 31 MRSA ocular surface isolates were determined for gatifloxacin, moxifloxacin, ciprofloxacin, ofloxacin, vancomycin, and gentamicin using the Etest (AB Biodisk, Solna, Sweden) or the VITEK system (bioMérieux, Inc, Durham, North Carolina, USA). Susceptibility data were interpreted based on criteria specified by the Clinical and Laboratory Standards Institute (CLSI). MAIN OUTCOME MEASURES: MIC(50) values in microg/ml and interpretation of susceptibility or resistance. RESULTS: In vitro resistance rates and median MIC(50) in microg/ml for the MRSA isolates were: gatifloxacin (71%, 8.0), moxifloxacin (68%, 8.0), ciprofloxacin (94%, 8.0), ofloxacin (94%, 8.0), vancomycin (0%, 1.0), and gentamicin (3%, 0.5). CONCLUSIONS: MRSA ocular isolates exhibited a relatively high rate of in vitro resistance to all fluoroquinolones tested, including the fourth generation. In contrast, MRSA isolates were found to be highly sensitive to vancomycin and gentamicin.     

Overview of the potency of moxifloxacin ophthalmic solution 0.5% (VIGAMOX)

Antibiotics have been the mainstay of therapy for infectious diseases since their origins in the 1940s. As microorganisms changed and resistance developed, more advanced antibiotics were ultimately needed to provide adequate coverage and spectrum. By selecting optimal antibiotics and dosing regimens, clinicians can avoid treatment failures and adverse events and can help prevent the emergence of further antibiotic resistance. The fourth-generation ophthalmic fluoroquinolones include moxifloxacin (VIGAMOX, Alcon Laboratories, Inc., Fort Worth, TX) and gatifloxacin (Zymar, Allergan, Irvine, CA), and they are now approved for the treatment of bacterial conjunctivitis. This review highlights four scientific methods that compare and rank antibiotic potencies and predict their clinical efficacy and their propensity to develop resistance: 1) in vitro assay for minimum inhibitory concentrations, 2) in vivo models for pharmacokinetic and pharamacodynamic properties, 3) therapeutic index or inhibitory quotient, and 4) in vitro assay for mutant prevention concentration. The fourth-generation ophthalmic fluoroquinolones perform well in these assays. Both antibiotics have better in vitro activity against gram-positive bacteria than ciprofloxacin or ofloxacin. Moxifloxacin penetrates better into ocular tissues than gatifloxacin and older fluoroquinolones; in vitro activity of moxifloxacin and gatifloxacin against gram-negative bacteria is similar to that of older fluoroquinolones. Moxifloxacin also has better mutant prevention characteristics than other fluoroquinolones. These findings support the use of the newer fluoroquinolones for the prevention and treatment of serious ophthalmic infections (e.g., keratitis, endophthalmitis) caused by susceptible bacteria.     

Ocular pharmacokinetics of moxifloxacin after topical treatment of animals and humans

The ocular penetration and pharmacokinetics of moxifloxacin in comparison to other fluoroquinolones (ofloxacin, ciprofloxacin, gatifloxacin, norfloxacin, levofloxacin, and lomefloxacin) have been determined by in vitro and ex vivo techniques, as well as in animal and human studies. This article reviews the original pharmacokinetics work performed by Alcon and other studies reported in the ocular fluoroquinolone literature. The results consistently demonstrate higher maximum concentrations for moxifloxacin relative to the other fluoroquinolones in ocular tissues with levels well above its minimum inhibitory concentrations for relevant ocular pathogens. This superior performance is due to the unique structure of moxifloxacin that combines high lipophilicity for enhanced corneal penetration with high aqueous solubility at physiological pH. The latter property creates a high concentration gradient at the tear film/corneal epithelial interface providing a driving force for better ocular penetration for moxifloxacin. In addition, the higher concentration of moxifloxacin in VIGAMOX (i.e., 0.5% vs. 0.3%) allows more antibiotic to be available to ocular tissues. It is clear from the array of studies summarized in this report that moxifloxacin penetrates ocular tissues better (two- to three-fold) than gatifloxacin, ciprofloxacin, ofloxacin, or levofloxacin. This consistent, enhanced penetration of topical moxifloxacin offers powerful advantages for ophthalmic therapy.     

Wirksamkeit neuer Fluorchinolone gegenüber der bakteriellen Normalflora der Bindehaut

BACKGROUND: Our aim was to determine the antibiotic susceptibility of the preoperative conjunctival bacterial flora against 25 commonly used antibiotics, especially the new fluoroquinolones levofloxacin, gatifloxacin, and moxifloxacin. PATIENTS AND METHODS: The Kirby-Bauer disk-diffusion technique was used to test for the in vitro antibiotic susceptibility of conjunctival bacterial strains isolated from 160 patients (median=74 years, mean=71 years) undergoing cataract surgery at the Department of Ophthalmology, Stanford University, CA, USA. RESULTS: Among the 256 bacteria isolated, 201 (79%) were coagulase-negative staphylococci (CNS), 26 Staphylococcus aureus, 15 Streptococcus group D and 14 gram-negative rods. A total of 100 of these 256 strains (39%) were classified as multiresitant (resistant to>or=five antibiotics). The resistance rate (RR) of commonly used antibiotics for all CNS was: gatifloxacin=moxifloxacin相似文献   

In Vitro Antifungal Activity of the Fourth Generation Fluoroquinolones Against Candida Isolates from Human Ocular Infections

Purpose: To evaluate and compare the in vitro antifungal activity of moxifloxacin and gatifloxacin against Candida species isolated from ocular infections. Methods: Tube microdilutions test was used to determine antifungal activity of the agents for 21 Candida isolates and one quality control strain. Drugs evaluated included topical preparations of fluoroquinolones (FQs), moxifloxacin (Vigamox), and gatifloxacin (Zymar). Serial dilutions of moxifloxacin (0.5%, 0.25%, 0.125%) and gatifloxacin (0.3%, 0.15%, 0.075%) were prepared for the microtube dilutions test. Aliquots (0.01 ul) were plated onto Sabouraud agar and colonies were counted. Results: Both drugs undiluted inhibited greater than 95% of growth at 24 hrs. There was no significant difference between moxifloxacin and gatifloxacin at undiluted concentrations (p = 1.00); however, the mean number of colony forming units in gatifloxacin group was significantly less than that of moxifloxacin at diluted concentrations of the drugs (p < 0.05). Conclusions: Current commercial topical preparations of moxifloxacin and gatifloxacin demonstrated a definite in vitro antifungal activity against ocular Candida species; however, clinical efficacy of these agents remains unproven. The greater inhibition of growth of organisms with gatifloxacin compared to moxifloxacin is possibly because of the presence of BAK in Zymar.     

In vitro and in vivo potency of moxifloxacin and moxifloxacin ophthalmic solution 0.5%, a new topical fluoroquinolone

Fluoroquinolones are a class of synthetic antibacterial agents that were approved for ocular therapy in 1991 and have become popular therapy for the treatment and prevention of various ocular infections. These agents are synthetic, broad-spectrum, rapidly bactericidal, and have good penetration into ocular tissues. Their main mechanism of action is the inhibition of bacterial enzymes needed for bacterial DNA synthesis. However, antibiotic resistance occurred swiftly to the earlier fluoroquinolones and better fluoroquinolones were needed. The fourth-generation fluoroquinolones, such as moxifloxacin and gatifloxacin, have enhanced activity against gram-positive bacteria while retaining potent activity against most gram-negative bacteria. These fourth-generation fluoroquinolones have improved penetration into the anterior chamber and have also demonstrated increased in vivo efficacy in several animal models of ocular infections. In addition, topical ophthalmic antibiotic products can deliver antibiotic concentrations directly to the eye that are thousands of times higher than their MICs. This article reviews published data describing the in vitro potency of moxifloxacin and its in vivo activity for treating and preventing experimental ocular infections.     

In vitro antifungal activity of the fourth generation fluoroquinolones against Candida isolates from human ocular infections

PURPOSE: To evaluate and compare the in vitro antifungal activity of moxifloxacin and gatifloxacin against Candida species isolated from ocular infections. METHODS: Tube microdilutions test was used to determine antifungal activity of the agents for 21 Candida isolates and one quality control strain. Drugs evaluated included topical preparations of fluoroquinolones (FQs), moxifloxacin (Vigamox), and gatifloxacin (Zymar). Serial dilutions of moxifloxacin (0.5%, 0.25%, 0.125%) and gatifloxacin (0.3%, 0.15%, 0.075%) were prepared for the microtube dilutions test. Aliquots (0.01 ul) were plated onto Sabouraud agar and colonies were counted. RESULTS: Both drugs undiluted inhibited greater than 95% of growth at 24 hrs. There was no significant difference between moxifloxacin and gatifloxacin at undiluted concentrations (p = 1.00); however, the mean number of colony forming units in gatifloxacin group was significantly less than that of moxifloxacin at diluted concentrations of the drugs (p < 0.05). CONCLUSIONS: Current commercial topical preparations of moxifloxacin and gatifloxacin demonstrated a definite in vitro antifungal activity against ocular Candida species; however, clinical efficacy of these agents remains unproven. The greater inhibition of growth of organisms with gatifloxacin compared to moxifloxacin is possibly because of the presence of BAK in Zymar.     

Análisis de fiabilidad y concordancia entre 5 métodos subjetivos de medición de la torsión ocular

ObjectiveTo evaluate the reliability in the measurement of ocular torsion and the agreement of the following subjective methods: double Maddox test, synoptophore, Gracis torsionometer, Harms screen and Awaya cyclodeviation test.MethodPatients with vertical strabismus acquired in adulthood were recruited and ocular torsion was measured with the 5 methods described on 3 occasions. As a gold standard test does not exist, the one that obtained the best repeatability data was chosen as the reference test.ResultsTwenty-five patients were included in the study. The repeatability of each test was studied: double Maddox test (ICC = 0.783, CV = 29.33%), synoptophore (ICC = 0.976, CV = 6.71%), Gracis torsionometer (ICC = 0.937, CV = 20.10%), Harms screen (ICC = 0.962, CV = 11.86%) and Awaya test (ICC = 0.987, CV = 52.58%). The reference test to compare the agreement was the synoptophore. Statistically significant differences were found when comparing the ocular torsion ranges between the synoptophore and the Gracis torsionometer (P = .008) and between the synoptophore and the Awaya test (P = .02).ConclusionsThe double Maddox test, the synoptophore, the Gracis torsionometer, and the Harms screen are reliable methods with good reproducibility indices. Among them, the synoptophore is the most consistent method. The Awaya test did not show good reliability. The bilateral Maddox test, the Gracis torsionometer, and the Harms screen were methods with good agreement with the synoptophore, which was determined as the reference test. The Awaya test did not show good agreement with the synoptophore.     

Los hallazgos oculares relacionados con el uso de bisfosfonatos orales

ObjectiveWe aimed to investigate ocular involvement findings in female osteoporosis patients using oral bisphosphonate (BP).MethodsA total of 51 female osteoporosis patients aged 50-75 years using oral BP for at least one year for the study group and 64 age-matched non-osteoporosis female patients for the control group were included in the study. The BP type and exposure time were noted. The ophthalmic examination findings and measurements of the flare of the patients who received oral BP due to osteoporosis and the controls were evaluated.ResultsThe mean duration of BP use was 3.96 years. In the study group, it was detected 4 of 51 patients were diagnosed with meibomian gland dysfunction (MGD) (7.8%), 7 of 102 eyes had erythematous, irregular, thickened lid margin or telangiectasia around the glandular orifices. There were no pathological findings on fondus examination. The mean value of measurements of the flare (ph/ms) was 7.90 ± 7.96 in the study group, and 5.02 ± 0.81 in the control group. When the mean values were compared, there was a significant difference between the 2 groups (P = 0.001). A significant difference was found in the mean value of measurements of the flare between the patients using alendronate, and ibandronate with the control group (P = 0.001; P = 0.005, respectively).ConclusionOur study showed that the flare in the anterior chamber associated with chronic ocular inflammation can be seen higher rate in patients using oral alendronate, and ibandronate compared to those who do not. Morever it can be said that oral BPs may cause similar ocular side effects like as intravascular BPs.     

Análisis de la expresión inmunohistoquímica de OVOL1 como herramienta diagnóstica de invasión en las neoplasias escamosas de la superficie ocular

Background and objectivesOVOL1 is a gene that negatively regulates mesenchymal transformation, which allows epithelial cells to invade the stroma. On the other hand, it negatively regulates c-Myc, which has a positive effect on cell proliferation. The aim of this study is to evaluate the expression of OVOL1 and c-Myc in ocular surface squamous neoplasia (OSSN).Patients and methodsCross-sectional cohort study of 36 samples including 6 squamous papillomas, 19 conjunctival intraepithelial neoplasms, 6 squamous carcinomas and 7 normal conjunctivae were evaluated using immunohistochemistry against OVOL1 and c-Myc. The expression of both markers was analysed using the H-score (intensity 1-3 multiplied by the percentage of positive cells).ResultsPercentages of 98 and 100 of the OSSN, and 57 and 71% of the normal conjunctivae expressed OVOL1 and c-Myc respectively, however, the mean H-score of OVOL1 and c-Myc was higher in the OSSN than in normal conjunctivae group (P = .0001 in both). Within the OSSN, OVOL1 demonstrated a higher H-score in the conjunctival intraepithelial neoplasms and papilloma, compared to the squamous carcinoma (P < .01) group. c-Myc did not show differences between the OSSN groups. An H-score lower than 35 differentiates a squamous cell carcinoma from other OSSN lesions with a sensitivity of 83.3% and a specificity of 100%.ConclusionsThe expression of OVOL1 is a useful tool to differentiate between a squamous carcinoma of conjunctival intraepithelial neoplasms and papilloma. OVOL1 could play a role in the invasiveness of squamous neoplasms and places it as a potential therapeutic target.     

Manejo del cristalino subluxado en pacientes jóvenes

ObjectivesTo evaluate visual outcomes in patients treated for lens subluxation. Secondary objectives are to report best corrected visual acuity (BCVA) in LogMAR and compare the outcomes of patients managed conservatively with those treated surgically.MethodsRetrospective comparison of BCVA in patients under 50 years-old with lens subluxation, managed conservatively or surgically.ResultsA total of 49 eyes of 28 patients were included. Demographic characteristics were similar in both groups. Twenty eyes were treated surgically (40.8%) compared to 29 with medical treatment (59.2%). Marfan syndrome (79.6%) was diagnosed in 39 eyes. LogMAR BCVA post intervention was 0.35 ± 0.31 for medical treatment and 0.39 ± 0.32 for the surgical group, with no significant differences (P=.63). Improvements in LogMAR lines were 2.7 ± 4.2 and 4.11 ± 4.2 (P=.35), respectively. Two eyes in the surgery group developed ocular hypertension (0.04%), none with retinal detachment.ConclusionsThe final BCVA showed no significant differences in this group of patients. BCVA depends on the visual potential of the rehabilitated eye rather than a specific type of intervention.     

Comparación de tonómetro de contorno dinámico,Goldmann y neumotonómetro en pacientes con hipertensión ocular y su relación con la paquimetría y amplitud del pulso ocular

PurposeTo determine the relationship between dynamic contour tonometry (DCT), Goldmann applanation tonometry (GAT) and pneumotonometry (PNT) in ocular hypertension patients (OHT) and their relationship to central corneal thickness (CCT) and ocular pulse amplitude (OPA).MethodsSixty patients (101 eyes) with intraocular pressure (IOP) ≥21 mmHg using GAT and normal appearing optic nerve heads and normal visual fields were included. The following tests were performed simultaneously during a single visit: IOP using DCT, GAT and PNT, OPA using DCT and CCT using ultrasound pachymetry. We studied the difference IOP between these 3 tonometers using Wilcoxon non-parametric test and the effect of CCT on IOP and OPA, as well as the relationship between OPA and IOP using Spearman correlation coefficient.ResultsThe median PNT IOP was 24 mmHg (Inter-quartile range [IQR]: 22-26), median GAT IOP was 22 mmHg (IQR: 22-24), and median DCT IOP was 28.2 mmHg (IQR: 24.1-30.7). PNT and DCT had higher IOP values than GAT (median 2 mmHg and 6.2 mmHg, respectively). Mean CCT was 594.5 μm (SD 30.0). GAT IOP and DCT IOP showed an increase with increased corneal thickness (r: 0.209; P = .036 and r: 0.195; P = .051, respectively). PNT IOP did not change with CCT (r: 0.15; P = .12). The median OPA was 4.8 mmHg (IQR: 3.6-6.1), and significantly increased with GAT IOP (r: 0,38; P < .001) and with CCT (r: 0.287; P = .004). This association was unclear with IOP PNT and IOP DCT (r: 0.067; P = .50 and r: 0,17, P = .08, respectively).ConclusionsDCT and PNT IOP values were higher than GAT IOP measurements in ocular hypertension patients. GAT IOP showed a significant increase with increased corneal thickness. Increased OPA seems to correlate with increased CCT and IOP, particularly if GAT is used.     

Intraocular levels of pigment epithelium-derived factor in patients with active uveitis

ObjectivePigment epithelium-derived factor (PEDF) is an antiangiogenic/neurotrophic dual functional factor, and recently it was also shown to mediate antioxidative and anti-inflammatory action. The purpose of this study was to evaluate the levels of PEDF in the aqueous humor in eyes with idiopathic acute anterior uveitis (IAAU).MethodsA comparative control study. Aqueous humor was collected from 20 eyes of 20 patients with IAAU. The control group included 20 aqueous humor samples from 20 patients who underwent a cataract surgery and without any other ocular or systemic diseases. Levels of PEDF were determined with the ELISA test.ResultsConcentration of PEDF in aqueous humor was remarkably higher in patients with IAAU than in control subjects (Mann-Whitney U test, P < .001). Levels of PEDF were 6,291,637.70 ± 8,564,836.48 pg/ml (mean ± SD) in eyes with IAAU and 449,178.10 ± 158,670.19 pg/ml in the eyes of the control group.ConclusionThe aqueous humor PEDF levels are increased in eyes with IAAU and may be increased as self-protection against inflammation.     

Influencia de la longitud axial ocular en el grosor de la capa de fibras nerviosas peripapilar medido con tomografía de coherencia óptica

BackgroundOptical coherence tomography (OCT) allows the measurement of the peripapillary optic nerve fiber layer (RNFL) thickness. The effect of ocular axial length (AL) on RNFL thickness measurement may be relevant in the interpretation of OCT results in diagnosing optic nerve diseases.PurposesTo assess the influence of ocular AL on RNFL thickness and on optic disc topographic parameters (optic disc area, rim area and cup volume) measured by OCT, in healthy individuals.MethodA sample of 109 healthy eyes classified into three groups according to AL (A: AL <22 mm; B: AL 22–24.5 mm; C: AL >24.5 mm) was studied. RNFL thickness and optic disc topographic parameters were measured using Swept-Source OCT Triton (Topcon Corporation, Tokyo, Japan) and were compared between groups using a variance analysis. Correlation between the AL and the study variables was performed using a Pearson's correlation coefficient test.ResultsThe RNFL thickness was lower in eyes with higher AL in the superior (r = −0.41; p < 0.001), inferior (r = 0.58; p < 0.001) and nasal (r = −0.43; p < 0.001) quadrants, in the mean value of the RNFL (r = −0.49; p < 0.001), optic disc area (r = −0.40; p < 0.001) and rim area (r = −0.25; p = 0.01).ConclusionAL is negatively correlated with RNFL thickness and optic disc topographic parameters measured by Swept-Source OCT Triton (Topcon).     

Value of microbiology study in congenital nasolacrimal duct obstruction

PurposeEvaluation of the effect of different microorganisms on congenital nasolacrimal duct obstruction (CNLDO) tightness and whether probing or silastic intubation is likely to fail in a particular microorganism infection.MethodsThe culture and sensitivity results of lacrimal drainage system (LDS) discharge samples from patients with CNLDO were reviewed. Different microorganisms were correlated with the severity of nasolacrimal duct (NLD) obstruction observed during surgical intervention. The success rates of probing and silastic intubation as a primary procedure for each identifiable microorganism were documented. Statistical analysis was conducted to correlate the type of microorganism with the tightness of CNLDO and treatment failure.ResultsOut of 181 specimens, 22 had no growth (12.1%). LDS with positive culture had 76.6% successful probing (n = 49) and 82.1% successful silastic intubation (n = 78). Gram-positive and Gram-negative species were almost equally detected. The most prevalent organisms were Streptococcus pneumoniae and Hemophilus influenzae (48.1% and 39.2%, respectively). Tight CNLDO was more prevalent in Serratia marcescens (n = 2; 100%) and Staphylococcus aureus (n = 4; 33.3%) infections with a 7.75 Odds ratio [95% confidence interval (CI), 1.67–34.63]. Staphylococcus aureus had 37.5% successful probing; however, success was achieved in all cases with silastic intubation. Serratia marcescens infections had 100% successful silastic intubation.ConclusionMicrobiology study can predict tight CNLDO and helps in choosing the most successful treatment option. CNLDO with Staphylococcus infection and Serratia marcescens were likely to have tight NLD obstruction and silastic intubation had better outcomes.