Long-term intraocular pressure changes after intravitreal injection of bevacizumab

Purpose: To assess the long-term intraocular pressure (IOP) changes after the intravitreal injection of bevacizumab (Avastin; Genentech, Inc., South San Francisco, CA) for treatment of age-related macular degeneration (AMD) and diabetic macular edema (DME) patients and evaluate the correlation factors.

Material and methods: Patients with neovascular AMD or DME underwent treat-and-extended anti-VEGF regimen in one eye and followed more than 12 months were enrolled in this study. We set three criteria of IOP elevation: (1) the IOP of the treated eye increased above the contralateral eye for at least two consecutive visits; (2) the IOP of the treated eye increased above the pre-injection IOP for at least two consecutive visits; (3) and the IOP of the treated eye increased more than 5?mmHg above the baseline IOP for at least two consecutive visits. We used mixed model univariate and multivariate analysis to assess the association between IOP elevation and independent parameters including age, sex, lens status, the number of injections, and underlying disease.

Results: In total 152 patients, 83 patients with AMD and 69 patients with DME, were included in this study. Mean follow-up time was 18.7 months, with a maximum of 50 months. In IOP elevation, 54 eyes (35.6%) showed an IOP increase above that of the contralateral eye (criteria 1), 50 eyes (33.4%) showed an IOP increase above the baseline IOP (criteria 2), and an IOP increase greater than 5?mmHg above the baseline IOP observed in nine eyes (5.9%) (criteria 3). In the univariate analysis, lens status and total number of injections were statistically significant for criteria 2 and 3 (all ps?<?0.05). However, in the multivariable analysis, only the number of intravitreal injections was statistically correlated with sustained IOP elevation for criteria 2 and 3 (p?<?0.001 and p?=?0.039, respectively).

Conclusions: Our results suggest that under long-term monitoring, with a treat-and-extended regimen, intravitreal bevacizumab injections were associated with sustained IOP elevation. In particular, multiple intravitreal injections could be associated with sustained IOP elevation.     

Direct and crossover effects of brinzolamide,betaxolol, and latanoprost on choroidal thickness

Purpose: To investigate the acute effects of brinzolamide, betaxolol, and latanoprost (drugs commonly used in the medical management of glaucoma) on choroidal thickness using enhanced depth imaging optical coherence tomography (EDI-OCT).

Methods: Ninety healthy volunteers were evaluated in this prospective study. Participants were randomly divided into 3 groups. Brinzolamide, betaxolol, and latanoprost were administered into the left eyes of the first group (n?=?30), second group (n?=?30), and third group (n?=?30), respectively, and artificial tear (Sodium hyaluronate) was instilled into the right eyes of all participants. Subfoveal choroidal thickness (SFCT) was measured using EDI-OCT before and 45?minutes after administration of the antiglaucomatous drops.

Results: SFCT revealed a significant increase in the left eye (administered antiglaucomatous drop) in the brinzolamide (p?=?0.001) and betaxolol groups (p?=?0.049) and a significant increase also in the right eye (administered artificial drop) in the brinzolamide (p?=?0.001) and betaxolol groups (p?=?0.001). However, SFCT did not reveal a significant increase in the left eye (p?=?0.213) or in the right eye (p?=?0.062) in the latanoprost group.

Conclusion: Brinzolamide and betaxolol caused an increase in SFCT, while latanoprost had no significant effect on SFCT.     

Intraocular pressure reduction in the untreated fellow eye after selective laser trabeculoplasty

ABSTRACT

Objective: To investigate the effect of selective laser trabeculoplasty (SLT) on the intraocular pressure (IOP) of untreated fellow eyes in patients with open-angle glaucoma.

Study design: Retrospective chart review.

Patients and methods: Charts of all patients who underwent SLT at the University of Texas Southwestern Medical Center at Dallas between September 2003 and May 2006 were reviewed. Each patient had IOP measurements by Goldmann applanation tonometry in both eyes preoperatively, and at 1 hour, 2 weeks, 3 months, and 6 months postoperatively. Patient age, gender, diagnosis, central corneal thickness (CCT), previous intraocular surgeries, and degrees of laser treatment were tabulated for each patient. Patients with a history of previous glaucoma surgery in either eye were excluded as were those who underwent any change in glaucoma medications or further laser or surgical intervention in either eye within 6 months of SLT. Data were analyzed using a paired two-tailed t-test, an unpaired two-tailed t-test, ANOVA, and linear regression.

Results: A total of 43 patients were included through 6 months of follow-up. Mean reduction in IOP in the treated eye was 3.9?±?0.6?mmHg or 18.8% (p?<?0.001) at final exam. Mean IOP reduction in the fellow untreated eye was 2.1?±?0.5?mmHg or 11.2% (p?<?0.01). Patients with higher preoperative IOPs had a greater reduction in IOP in both eyes (p?<?0.001 for treated eyes, and p?=?0.02 for untreated eyes). Patients who were on a larger number of glaucoma medications preoperatively had a greater response in both eyes (treated eye p?=?0.002, untreated eye p?=?0.008). There was no significant difference in IOP response in either eye based on age, gender, CCT, degrees of treatment, or phakic status.

Conclusions: SLT produces a sustained and statistically significant IOP reduction in the fellow untreated eyes of patients with open-angle glaucoma. The results of our study support a biological mechanism of action for SLT. Limitations of this study include its retrospective design, relatively small sample size, a possible effect of increased compliance with medical therapy following SLT, and an inherent bias of excluding patients who underwent a change in medications or further laser or surgical therapy during the period under review.     

Safety and efficacy of autologous serum eye drop for treatment of dry eyes in graft-versus-host disease

Purpose: To evaluate the treatment of autologous serum eye drops (ASED) on dry eyes in patients with graft-versus-host disease (GVHD).

Methods: A retrospective chart review of 35 patients with a history of ocular GVHD following hematopoietic stem cell transplantation that used ASED to alleviate dry eye symptoms was performed. Patients were categorized into three different groups. If patients had available ophthalmic data before and after starting treatment was group 1 (n?=?14), had available ophthalmic data after starting treatment in group 2 (n?=?10) and had available ophthalmic data before treatment or did not have any data after starting treatment in group 3 (n?=?11). Data were collected on patient’s age, gender, primary diagnosis, visual acuity and fluorescein corneal staining were collected on individual eyes in order to evaluate the efficacy of the ASED on alleviating dry eye-related signs and symptoms.

Results: No adverse ocular effect from the ASED was found in our series (except one fungal keratitis). All patients reported either improvement (55%) or stability (45%) in their ocular symptoms upon the use of ASED. In patients with available data before and after starting treatment, the corneal staining score improved by a median of 1 (p?=?0.003) and the LogMAR visual acuity had a non-significant improvement.

Conclusion: In our study, ASED used by patients with ocular GVHD were both safe and effective. ASED should be considered in patients with GVHD who suffer from dry eyes.     

Evaluation of the clinical effectiveness of fluocinolone acetonide 190 µg intravitreal implant in diabetic macular edema: a comparison between study and fellow eyes

Abstract

Objectives: To compare visual and anatomical outcomes between eyes treated with fluocinolone acetonide (FAc) 190 µg intravitreal implant for clinically significant chronic diabetic macular edema (DME) and fellow eyes not treated with FAc implant using data from the Iluvien Clinical Evidence study in the UK (ICE-UK) study.

Methods: In this retrospective cohort study, data on people attending hospital eye services and treated with the FAc implant between April 1, 2013 and April 15, 2015 were collected. Changes in visual acuity (VA), central foveal thickness (CFT) and intraocular pressure (IOP) were compared between study eyes (intervention) and fellow eyes.

Results: A total of 208 people were selected. Mean age was 68.1 years and 62% were male. Mean change in VA was ?0.09 LogMAR units for study eyes and 0.04 LogMAR units for fellow eyes at 12 months post-implant (p?<?.001). Over the same period, ≥5 letter, ≥10 letter and ≥15 letter improvements in Early Treatment Diabetic Retinopathy Study (ETDRS) score were achieved by more FAc treated eyes than by fellow eyes (41% versus 23%, p?<?.001; 28% versus 11%, p?<?.001; and 18% versus 4%, p?<?.001 at 12 months, respectively). Differences in the mean change in CFT (?113?µm versus ?13?µm, p?<?.001) and IOP (3.2?mmHg versus ?0.2?mmHg, p?<?.001) were also observed between study and fellow eyes at 12 months.

Conclusion: Visual acuity improved in study eyes over the 12 months following FAc implant and worsened in fellow eyes. Over the same period, study eyes showed a larger improvement in central foveal thickness. Intraocular pressure worsened in study eyes only. Change in visual acuity, central foveal thickness and intraocular pressure between FAc implant and the end of the 12-month follow-up period differed significantly between study and fellow eyes.     

Effect of intravitreal injection of dexamethasone implant on corneal endothelium in macular edema due to retinal vein occlusion

Objective: To evaluate the effects of dexamethasone (DEX) implant (Ozurdex®) on corneal endothelium in patients with retinal vein occlusion complicated with macular edema.

Materials and methods: Patients (n?=?31) received 1–3 intravitreal DEX implants in one eye. Measurements were intraocular pressure (IOP) at baseline and 1, 3, and 6 months after the first intravitreal injection and corneal specular microscopy and central corneal thickness (CCT) at baseline and 1 and 6 months. We analyzed endothelial cell density (ECD), coefficient of variation of cell size (CV), and percentage of hexagonality.

Results: Mean follow-up period was 9.7?±?3.3 months. Mean number of injections was 1.5?±?0.8. Mean IOP values were 15.6?±?2.6?mm Hg at baseline, 17.7?±?3.6?mm Hg at one month, 16.4?±?4.1?mm Hg at three months, and 16.0?±?2.7?mm Hg at six months. There was a significant difference in mean IOPs at one month and six months (p?=?0.008). There were no significant differences in mean ECD (p?=?0.375), CV (p?=?0.661), percentage of hexagonality (p?=?0.287), and CCT (p?=?0.331).

Conclusion: Although intravitreal injection of 0.7?mg DEX causes moderate elevation of IOP, it does not seem to have detrimental effects on corneal endothelium at six months.     

A novel lipid prodrug strategy for sustained delivery of hexadecyloxypropyl 9-[2-(phosphonomethoxy)ethyl]guanine (HDP-PMEG) on unwanted ocular proliferation

Proliferative vitreoretinopathy (PVR) is a blinding eye disease and there is no effective pharmacological measure to prevent PVR development. The difficulty comes from lack of potent antiproliferative agent and lack of sustained delivery to cover high-risk time window for PVR to develop. Lipid prodrug of PMEG, hexadecyloxypropyl 9-[(2-phosphonomethoxy)ethyl]guanine (HDP-PMEG), was prepared and was evaluated as a pharmacological adjuvant to surgical management of PVR. A dose-escalation study determined that the highest nontoxic dose for intravitreal use in pigmented rabbits was 3?µg per eye. The genotoxicity of HDP-PMEG was harnessed as a perioperative preventative measure against PVR in a rabbit eye model while the sustained intravitreal pharmacological effect was evaluated on a laser-induced fibrovascular model in rat eye. After intravitreal 3?µg, HDP-PMEG particles in the rabbit vitreous was visible for at least 6?weeks. A single 50-min intravitreal infusion of HDP-PMEG demonstrated significant inhibition of PVR formation when compared with the eyes infused with only BSS (BSS vs. HDP-PMEG: estimate?=?1.14, OR?=?3.1, p?=?.027). A single intravitreal 104?ng (equivalent to 3?µg for rabbit eye) of HDP-PMEG significantly inhibit laser-induced fibrovascular proliferation in rat eye by 55% (least square mean pixel, BSS?=?4763569.5 vs. HDP-PMEG?=?2148129.7, p?p?相似文献   

The effect and safety of intravitreal injection of ranibizumab and bevacizumab on the corneal endothelium in the treatment of diabetic macular edema

Objective: To investigate the effect and safety of intravitreal injection (IVI) of bevacizumab and ranibizumab on corneal endothelial cell count and morphology in patients with diabetic macular edema.

Materials and methods: A total of 60 eyes from 60 consecutive patients who received 0.5?mg/0.05?ml IVIs of bevacizumab (n?=?30, IVB group) or 1.25?mg/0.05?ml ranibizumab (n?=?30, IVR group) for three consecutive months were investigated prospectively. Specular microscopy was performed to evaluate endothelial cell count, the percentage of hexagonal cells (pleomorphism), and the coefficient of variation of the cell size (polymegathism); optical biometry was performed to evaluate central corneal thickness. Results before injection and 1 month after the first and third injections were compared.

Results: The groups were matched for age (p?=?0.11) and gender (p?=?0.32). There was no significant difference in endothelial cell count (IVB group, p?=?0.66; IVR group, p?=?0.74), pleomorphism (IVB group, p?=?0.44; IVR group, p?=?0.88) and polymegathism (IVB group, p?=?0.21; IVR group, p?=?0.24) before injection or 1 month after the first and third injections. There was also no difference in central corneal thickness (IVB group, p?=?0.15; IVR group, p?=?0.58) before injection or 1 month after the first and third injections.

Conclusion: Monthly 1.25?mg/0.05?ml IVIs of bevacizumab or 0.5?mg/0.05?ml of ranibizumab for three consecutive months in the treatment of diabetic macular edema does not affect corneal morphology and has no harmful effects on the endothelium.     

Evaluation of the tear film instability in children with allergic diseases

Context: The presence of dry eye syndrome (DES) in ocular allergic diseases was evaluated in several studies. Despite this, little exists about the tear film instability in atopic children including patients with allergic rhinitis (AR), allergic conjunctivitis (AC) and asthma. This is a study which presents intriguing findings regarding the relationship of tear film instability with clinical aspects in atopic children.

Objective: To determine the tear film instability in children with AR, AC and asthma.

Materials and methods: One hundred and thirty-five consecutive children with AR, AC and asthma as study group and 45 children without any systemic and ocular abnormality as control group were included in the study. Skin prick tests, measurement of tear film breakup time (TFBUT), serum immunoglobulin E and eosinophil counts were performed in all patients. Also four subgroups of patients were designated as AR group (Group I), AC group (Group II), asthma group (Group III) and control group (Group IV).

Results: Socio-demographic characteristics were similar except for family atopy between the groups (p?>?0.05). The mean TFBUT was significantly lower in the study group (15.5?±?4.4?s) than the control group (18.4?±?2.9?s; p?=?0.000). Also, there was no significant differences in the percentage of the patients who has TFBUT<10?s (p?=?0.066). In logistic regression analysis, atopy was found to be the determinant of lower TFBUT (OR?=?16.33, 95%; CI?=?1.17 to 228.05, p?=?0.03).

Conclusion: The presence of tear film instability was higher in children with AC, AR and asthma. This finding should be taken in consideration in atopic children.     

Effect of trospium chloride therapy on intraocular pressure and tear secretion in overactive bladder patients

Purpose: To investigate the effect of trospium chloride, which has an anticholinergic effect, used in overactive bladder (OAB) treatment on the intraocular pressure (IOP) and tear secretion after 12 weeks of treatment.

Materials and methods: This prospective study was performed at a single center between October 2014 and January 2016. A detailed history was obtained from the female OAB patients at the eye outpatient department. After checking the exclusion criteria, oral trospium chloride 30?mg bd was started. The patients were followed-up in terms of drug effectiveness and ophthalmic and other side effects at the 4th and 12th weeks. All procedures were repeated at both of these time-points.

Results: The mean age of the patients was 48.98?±?11.98 years (range 19–75). The data of 80 OAB patients were evaluated in the study. Trospium chloride did not cause any significant change in the OAB patients regarding their 4th week and 12th week IOP measurements (p?=?0.251, p?=?0.340, respectively). It was found to decrease tear secretion significantly at both time-points (p?=?0.020, p?=?0.001, respectively). Trospium chloride treatment of one patient (1.25%) was discontinued due to dry eye.

Conclusions: Trospium chloride decreases the symptoms in female OAB patients. Trospium chloride can be safely used in female OAB patients with normal IOP and no comorbidity as regards IOP changes as it did not cause a significant change in IOP in these patients. Pre-treatment and post-treatment dry eye symptoms of OAB patients about to start using trospium chloride should be queried beforehand as it can cause a statistically significant decrease in tear secretion. We concluded that it would be appropriate to refer the patients to an ophthalmologist before starting the drug if relevant symptoms are present.     

Determination of the toxicity of intravitreal minocycline in rabbit eyes

Purpose: To evaluate the retinal toxicity of intravitreal minocycline in rabbit eyes.

Methods: Intravitreal injection of minocycline with concentrations of 1000, 500, 250, 125 and 62.5?μg in 0.1?ml was performed in 10 New Zealand albino rabbits. Each concentration was injected into two rabbit eyes. For each dose, normal saline was injected in one contralateral eye and the other fellow eye remained non-injected. Electrophysiologic testing was performed before and 4 weeks after injections. The eyes were enucleated 4 weeks after injections and examined using light microscopy.

Results: The clinical examination was unremarkable after injections. Electroretinography recordings were significantly affected at all doses in at least one of the a- or b-waves of photopic or scotopic responses. Histopathologic examination revealed marked atrophy and loss of integrity in all retinal layers in all minocycline injected eyes. Contralateral eyes were normal.

Conclusion: In our study, intravitreal minocycline was toxic to the retina in albino rabbits even at a concentration of 62.5?µg/0.1?ml.     

Intravitreal bevacizumab effects on VEGF levels in distant organs: an experimental study

Purpose: The aim of this study was to determine the effects of single-dose intravitreal bevacizumab on the levels of vascular endothelial growth factor (VEGF) in serum and distant organs.

Methods: Adult New Zealand albino rabbits (n?=?40) were divided into experimental and control groups. Experimental rabbits received a single 0.05?ml intravitreal injection of 1.25?mg bevacizumab (Avastin) into the right eye, and control rabbits (n?=?8) received no injection. Following injection, group 1 rabbits (n?=?8) were sacrificed on day 1, group 2 rabbits (n?=?8) on day 7, group 3 rabbits (n?=?8) on day 14, and group 4 rabbits (n?=?8) on day 28; control rabbits were sacrificed on day 28. After sacrifice, samples of brain, heart, liver, kidney and blood were collected. Levels of VEGF in serum and tissue were measured using enzyme-linked immunosorbent assay. The presence of bevacizumab was evaluated by immunofluorescence staining in tissues.

Results: Positive bevacizumab immunoreactivity was observed in brain, heart and kidney. Serum VEGF levels significantly decreased in groups 3 and 4 compared with controls (p?p?Conclusions: Intravitreal bevacizumab not only may escape from the blood-retinal barrier and enter the general circulation, but also may be disseminated to distant organs. Our study demonstrates that a single dose of intravitreally injected bevacizumab decreases VEGF levels in serum and liver.     

Retrospective analysis of the effect of aflibercept loading dose on the retinal vessel diameters in patients with treatment-naive neovascular AMD*

Background: To evaluate the effects of intravitreal aflibercept (IVA) on retinal vessel diameters in patients with neovascular age-related macular degeneration (AMD).

Design, setting, and participants: A retrospective study conducted at the Kutahya Dumlupinar University Faculty of Medicine included 15 eyes of 15 patients with treatment naive neovascular AMD.

Methods: All eyes received IVA injections once per month for 3?months; untreated contralateral eyes were used as controls. The central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and artery-vein ratio (AVR) values were measured using a computer-based program before the first IVA injection and 30?days after the first, second, and third injections. The main outcome measurements were the central macular thickness (CMT), best-corrected visual acuity (BCVA), choroidal thickness, CRAE, CRVE, and AVR.

Results: Significant vasoconstriction of the retinal arterioles was observed in all eyes treated with IVA when compared to baseline (p?=?0.009). However, no significant differences were found for CRVE or AVR throughout the study period in treated eyes. In the control group, all parameters measured during each visit were similar to baseline measurements (p?>?0.05). The mean BCVA significantly improved at the end of the loading dose of IVA, when compared to baseline (p?=?0.006). After the IVA injections, the mean CMT and choroidal thickness were significantly reduced at all visits, compared to baseline (p?Conclusions: The current study showed that IVA led to significant retinal arteriolar vasoconstriction and choroidal thinning, which may cause reduced retinal blood flow.     

Effectiveness of a new tobramycin (0.3 % ) and dexamethasone (0.05 % ) formulation in the treatment of experimental Pseudomonas keratitis

ABSTRACT

Objective: To quantitatively determine, in a Pseudomonas keratitis model, the anti-inflammatory and bactericidal properties of a new formulation of tobramycin (0.3?%?) and dexamethasone (0.05?%?) that utilizes a xanthan gum vehicle.

Research methods: In a randomized and masked fashion, rabbit corneas (n?≥?16 eyes per group) were intrastromally injected with 10³ colony-forming units (CFU) of P. aeruginosa. Eyes were untreated or were administered a single drop every 15?min between 16 and 17?h postinfection (PI) and then a single drop every 30?min between 17 and 22?h PI, a total of 15 drops of either 0.1?%?dexamethasone and 0.3?%?tobramycin (TobraDex; Tdex) or a new formulation 0.3?%?tobramycin and 0.05?%?dexamethasone with xanthan gum (TobraDex ST; ST). Slit lamp examination scores (SLE?±?SEM) were derived from grading seven parameters at 22?h PI. Rabbits were sacrificed at 23?h PI and the log CFU?±?SEM per cornea was determined.

Results: Untreated eyes had SLE scores of 11.11?±?0.43 and had log CFU of 7.27?±?0.06. Eyes treated with Tdex, as compared to the untreated eyes, had significantly lower SLE scores (7.39?±?0.21, p?<?0.0001) and significantly fewer bacteria (6.32?±?0.29 log CFU, p?=?0.0213). Eyes treated with ST had a SLE score (6.56?±?0.19) that was significantly lower than both the untreated eyes (p?<?0.0001) and the eyes treated with Tdex (p?=?0.0124). Furthermore, eyes treated with ST had significantly fewer log CFU (5.78?±?0.30) than untreated eyes (p?=?0.0001) or eyes treated with Tdex (p?=?0.0434).

Conclusions: The ST formulation with xanthan gum demonstrated statistically superior anti-inflammatory and bactericidal properties as compared to Tdex.

Limitations: Variations in inoculation procedures produced limited eye-to-eye differences in the infection.     

Morphologic changes and visual outcomes in resolved central serous chorioretinopathy treated with ranibizumab

Context: Central serous chorioretinopathy (CSC).

Objective: To evaluate the effect of intravitreal ranibizumab injection and the correlation between foveal morphologic changes and visual outcomes in patients with resolved CSC.

Materials and methods: We measured outer nuclear layer (ONL) thickness, outer layer (OL) thickness and evaluated the integrity of the photoreceptor inner-outer segment (IS/OS) junction, the status of the external limiting membrane (ELM) at the central fovea using spectral-domain optical coherence tomography (OCT) in 35 eyes of 35 patients with resolved CSC. The eyes were divided into two groups: The initial medical treatment administered to Group1 (n?=?17) then received intravitreal ranibizumab injections, Group 2 (n?=?18) received medical treatment. Group 3 was composed of normal eyes (n?=?20, as a control). We also investigated a correlation between the ONL thickness and best corrected visual acuity (BCVA).

Results: The mean age was 45.7?±?7.2 (ranged from 27 to 55 years). The mean follow-up period was 14.2 months (minimum 6, maximum 24 months). The mean ONL and OL thickness in Group 1 were significantly thinner than Group 3 (p?r?=?0.681, p?=?0.001). Thirty-tree patients had improvement in BCVA after treatment. Discontinuity of the IS/OS junction was found in 15 eyes (88.2%) in Group 1, in 5 eyes (27.7%) in Group 2 and in no eyes in Group 3.

Discussion: We demonstrated that prolonged serous detachment results in photoreceptor cell loss (apoptosis) and thinning of the ONL. Thinning of the ONL correlates with poorer vision, which has been found by other investigators. Furthermore, vascular endothelial growth factor (VEGF) may be neuroprotective to the photoreceptors which might explain the additional thinning in the patients treated with ranibizumab. This raises the possibility that treatment with VEGF inhibitors may be unfavourable to patients with CSC, even though it speeds recovery and vision does improve.

Conclusion: Intravitreal ranibizumab injection leads to thinning of the ONL and the OL in patients with resolved CSC. The ONL thickness reduction and discontinuity of the IS/OS junction results in poor visual prognosis in resolved CSC eyes.     

Effectiveness of heparin eye drops in paraquat-induced ocular injury

Purpose: To evaluate the efficacy of heparin eye drops in the treatment of paraquat-induced ocular surface injury.

Design and methods: In this retrospective study, we included 25 patients (31 eyes) with paraquat-induced ocular surface injury, who attended the Affiliated Hospital of Weifang Medical University between October 2008 and October 2013. The patients were split into two groups according to whether or not received heparin eye drops. The clinical data were compared between the two groups, i.e. clinical histories, results of examinations, treatments and outcomes.

Results: Eleven patients (group A, 15 eyes) received prompt irrigation with 0.9% saline every two hours, 0.1% pranoprofen eye drops four times a day, 20% autologous serum every two hours, recombinant bovine basic fibroblast growth factor eye-gel two times a day, oral vitamin C 2.0?g and prednisone 30?mg daily. Fourteen patients (group B, 16 eyes) received additional treatment with heparin eye drops. Ten eyes in group A and seven eyes in group B developed a pseudomembrane on the ocular surface at significantly different rate (mean?±?SD) of 1.20?±?1.01 and 0.43?±?0.51, respectively (t?=?2.66, p?=?0.01). Seven eyes among 10 had a pseudomembrane reoccurred in group A while none had a pseudomembrane reoccurred in group B (Fisher’s exact test, p?=?0.01). No significant differences were seen in the duration of epithelial recovery between the two groups: 15.13?±?5.13 days in group A and 16.81?±?5.56 days in group B (t?=?0.87, p?=?0.39). After the treatment, mild corneal opacity and pannus were observed in five patients of group A and four patients of group B, without any significant difference between the two groups (p?=?0.70).

Conclusions: The paraquat-induced ocular surface injury observed in this case series was characterized by the formation of conjunctival pseudomembrane with good prognosis and mild complications. Heparin eye drops reduce the occurrence, especially the reoccurrence of pseudomembrane. Further studies are warranted.     

Effects of chronic smoking on central corneal thickness,endothelial cell,and dry eye parameters

Objective: To evaluate the effect of chronic cigarette smoking on dry eye parameters, endothelial cells, and corneal thickness.

Design: Prospective cross-sectional case series.

Methods: In this cross-sectional study, 49 eyes of 49 chronic smokers (smoker group) and 53 eyes of 53 age-matched, healthy non-smokers (non-smoker group) were enrolled. All participants underwent measurements of tear breakup time (TBUT), central corneal thickness (CCT) measurements with contact pachymeter and the Schirmer test with anesthesia. Corneal endothelial cells were evaluated by non-contact specular microscopy and photographed for analysis of cell density and hexagonality and the coefficient of variation in cell size.

Results: The mean Schirmer score and TBUT value were significantly lower in the smoker group compared to the non-smoker group (p?=?0.015) and p?p?>?0.05). However, a lower percentage of endothelial hexagonal cells were observed in smokers than non-smokers (p?Discussion and conclusion: Our results suggest that cigarette smoking seems to affect the Schirmer score, TBUT value, and hexagonal cells of the corneal endothelium.     

Clinical efficacy of olopatadine vs epinastine ophthalmic solution in the conjunctival allergen challenge model

SUMMARY

Background: Olopatadine hydrochloride 0.1% ophthalmic solution (Patanol*) and epinastine hydrochloride 0.05% ophthalmic solution (Elestat?) are two topical antiallergic agents. Olopatadine is indicated for the treatment of the signs and symptoms of allergic conjunctivitis that include itching, redness, tearing, lid swelling, and chemosis. Epinastine is indicated for the prevention of itching associated with allergic conjunctivitis.

Objective: This study compared the clinical efficacy of olopatadine and epinastine in the prevention of itching and conjunctival redness in the conjunctival allergen challenge (CAC) model.

Research design and methods: This was a prospective, randomized, double-masked, contralaterally-controlled, single center allergen challenge study. Ninety-six subjects with a history of allergic conjunctivitis were screened, and the 66 who responded to conjunctival allergen challenge at visits 1 and 2 were randomized into 1 of 3 treatment groups at visit 3 to receive one drop of study medication in each eye: (1) olopatadine in one eye and epinastine in the fellow eye, (2) olopatadine in one eye and placebo in the fellow eye, and (3) epinastine in one eye and placebo in the fellow eye. Five minutes after study drop instillation, subjects were bilaterally challenged with the allergen concentration that had elicited a positive conjunctival allergic response at Visits 1 and 2. Subjective itching assessments were given at 3?min, 5?min, and 7?min post challenge. Objective redness and chemosis assessments were made at 10?min, 15?min, and 20?min post challenge. Paired sample two-tailed t-tests were performed on the mean scores at each time point to assess statistical significance in the differences between treatments.

Main outcome measures; results: Fifty-three subjects were randomized into the olopatadine/epinastine treatment group, the primary analysis group. Olopatadine treated eyes exhibited significantly lower mean itching and conjunctival redness scores than the contralateral epinastine treated eyes, –0.19 (?p = 0.003) and –0.52 (?p < 0.001), respectively. Olopatadine treated eyes also exhibited significantly less chemosis –0.24 (?p < 0.001), ciliary redness –0.55 (?p < 0.001), and episcleral redness –0.58 (?p < 0.001) than epinastine treated eyes.

Conclusion: Olopatadine is significantly more effective than epinastine in controlling itching, redness and chemosis associated with allergic conjunctivitis in the CAC model.

* Patanol is a registered tradename of Alcon Laboratories Inc, Forth Worth, TX, USA     

Comparison of data characterizing the clinical effectiveness of the fluocinolone intravitreal implant (ILUVIEN) in patients with diabetic macular edema from the real world,non-interventional ICE-UK study and the FAME randomized controlled trials

Objective: To compare the effectiveness and safety of the fluocinolone acetonide (FAc) intravitreal implant between the observational Iluvien Clinical Evidence study in the United Kingdom (ICE-UK) and the Fluocinolone Acetonide in Diabetic Macular Edema (FAME) randomized controlled trials (RCTs) in people with diabetic macular edema (DME). Clinical Trials Registration: NCT00344968.

Methods: This study selected patients randomized to receive 0.2?µg/day FAc insert (FAc treated eyes) or sham injection (control eyes) from the FAME RCTs, and patients’ first FAc treated eye and non-FAc treated fellow (control) eye from the ICE-UK study. Outcomes included change in visual acuity (VA), central foveal thickness (CFT), and intraocular pressure (IOP).

Results: After 12 months follow-up, mean change in VA was 5.0 letters improvement (p?<?.001) and 1.6 letters improvement (p?=?.003) in FAME FAc treated and control eyes, and 3.8 letters (p?=?.012) and –2.1 letters (p?=?.056) in ICE-UK FAc treated and control eyes, respectively. Mean change in CFT was –144?µm (p?<?.001) vs –72?µm (p?<?.001) in FAME FAc treated and control eyes and –113 µm (p?<?.001) vs –13?µm (p?<?.001) in ICE-UK FAc treated and control eyes. For eyes with a follow-up of 12 months, 77 (22.3%) and 15 (8.6%) FAME FAc treated and control eyes and 25 (18.7%) and six (4.3%) ICE-UK FAc treated and control eyes required emergent IOP-lowering therapy.

Conclusions: Statistically significant improvements in VA 12 months after FAc implantation were observed in both the real-world study and in the RCTs. The improvement in VA and CFT in the RCTs was marginally greater than in the real-world study; however, recruits in the real-world study had more severe visual morbidity at baseline. Whilst there were many changes in the care of people with DME over this time, these data all support the value of treatment with FAc intravitreal implant.     

Local infiltration for postsurgical analgesia following total hip arthroplasty: a comparison of liposomal bupivacaine to traditional bupivacaine

Objective: To assess postsurgical clinical and economic outcomes of patients who received local infiltration containing liposomal bupivacaine versus traditional bupivacaine for pain management following total hip arthroplasty (THA).

Methods: This retrospective study included two groups of consecutive patients undergoing THA. The experimental group received local infiltration with a combination of liposomal bupivacaine, bupivacaine HCl 0.25% with epinephrine 1:200,000, and ketorolac for postsurgical analgesia. The historical control group received the previous standard of care: local infiltration with a combination of bupivacaine HCl 0.25% with epinephrine 1:200,000 and ketorolac. Key outcomes included distance walked, length of stay (LOS), opioid medication use, numeric pain scores, hospital charges, hospital costs, all-cause 30?day readmission rate, and adverse events (AEs). Both unadjusted and adjusted (i.e. age, sex, insurance type, living situation, body mass index, procedure side, and comorbidity) outcomes were compared between the two groups.

Results: The experimental group (n?=?64) demonstrated statistically significant improvement versus the historical control group (n?=?66) in mean distance walked on discharge day (249.2 vs. 180.0 feet; unadjusted p?=?.025, adjusted p?=?.070), mean LOS (2.0 vs. 2.7 days; p?p?=?.002), proportion of patients who used opioid rescue medication on postoperative day (POD) 1 (29.7% vs. 56.1%; p?=?.002, p?=?.003) and POD 2 (7.8% vs. 30.3%; p?=?.001, p?=?.003), mean cumulative area under the curve for pain score on POD 0 (127.6 vs. 292.5; p?p?p?=?.006, both). Among a subgroup of patients with available financial information, mean hospital charges were lower in the experimental group ($43,794 [n?=?24] vs. $48,010 [n?=?66]; p?Conclusions: Infiltration at the surgical site with liposomal bupivacaine was associated with improved postsurgical outcomes when compared with traditional bupivacaine in patients undergoing THA.