No change in ST segment during instillation of eyedrops for ophthalmic surgery: A study in elderly patients with heart disease (is present software/technology sufficiently sensitive?)

Study Objective: To study the safety of instillation of eyedrops prior to ophthalmic surgery, which may potentially affect myocardial function, using continuous ST segment recording.Design: Prospective study.Setting: Ambulatory surgery preoperative area at a university hospital.Patients: 30 nonpremedicated ASA status III adults (aged 73 to 92 years) scheduled for cataract surgery with monitored anesthesia care (MAC).Interventions: All patients were given ophthalmic drugs consisting of phenylephrine 2.5%, flubiprofen 0.03%, mydriacyl 1%, and cydopentolate 1%.Measurements and Main Results: ST segments were continuously monitored after the instillation of the eyedrops for a period of up to 15 minutes. A change of 2 mm or more in ST segments from baseline was considered significant. Results showed no significant change in ST segment. No patient reported any new cardiac symptoms or showed any evidence of dysrhythmias or hemodynamic changes.Conclusions: The lack of significant finding most likely reflects the safety of these ophthalmic drops in their present dilute concentration, but it is also possible that the software and/or monitors used were not sensitive enough in their current configuration to detect possible subtle changes. Based on the results of this study, we conclude that the preoperative ophthalmic drugs used in our institution do not seem to have any adverse cardiovascular effects in this elderly patient population who are about to undergo cataract surgery with MAC.     

The wound healing effects of vitamin A eye drops after a corneal alkali burn in rats

Purpose:  We investigated the wound healing effect of retinyl palmitate eyedrops following a corneal alkali burn in rats. Methods:  A total of 160 Sprague‐Dawley male rats were divided into two groups and central corneas were injured by contacting eyes with filter paper saturated with 0.01 m NaOH for 45 seconds. Vitamin A group was treated with retinyl palmitate and antibiotic (Cravit^®: 0.5% levofloxacin) eye drops four times daily for 3 days and the control group with vehicle and antibiotic eye drops. Corneal wound healing by fluorescein staining and impression cytologic analysis were conducted at 0, 24, 48 and 72 hr after injury. Vascular endothelial growth factor A (VEGF‐A), thrombospondin 2, matrix metalloproteinase 9 (MMP 9) and transforming growth factor‐β (TGF‐β) were measured in corneas by ELISA, immunofluorescent staining and real‐time PCR. Results:  Corneal wound healing was better in the vitamin A group than in the control group. Early sprouting of new vessel was observed in the control group at 72 hr, but not in the vitamin A group. Corneal thrombospondin 2 proteins in ELISA were higher in the vitamin A group, but VEGF‐A, MMP 9 and TGF‐β proteins were higher in the control group (p < 0.05). Similarly, thrombospondin 2 immunofluorescent staining was stronger, whereas VEGF‐A, MMP 9 and TGF‐β staining were weaker in the vitamin A group (p < 0.05). In addition, thrombospondin 2 mRNA levels were higher, whereas VEGF‐A, MMP 9 and TGF‐β mRNA levels were lower in the vitamin A group (p < 0.05). Conclusions:  Retinyl palmitate eye drops can inhibit VEGF‐A and activate thrombospondin 2 and improve conjunctival impression cytologic findings. Furthermore, retinyl palmitate eye drops were found to promote corneal healing after an alkali burn in rats.     

环孢素滴眼液联合抗感染治疗中重度化脓性角膜炎的临床疗效

目的 探讨应用环孢素滴眼液联合抗感染治疗中重度化脓性角膜炎的效果。 设计 回顾性病例系列。 研究对象 2018年10月至2019年11月在北京同仁眼科中心就诊的连续中重度化脓性角膜炎患者20例（20眼）。 方法 对20例中重度化脓性角膜炎患者应用环孢素滴眼液联合抗感染治疗，治疗方法：患眼用1%环孢素滴眼液点眼，每日4次；同时根据角膜炎类型先进行经验性抗感染治疗，待微生物培养及药敏结果回报后再调整用药；出现前房炎性反应（如角膜后沉着物，大量浮游细胞，前房积脓）可加用硫酸阿托品眼用凝胶。所有患者随访至停药后6个月，记录患者的一般情况、病因、外院诊疗情况、角膜感染程度分级、角膜炎类型、视力、眼压、药物不良反应，停药后复发情况等资料，并根据患者首诊、治疗1周、1、2、3个月后的眼前节照相进行结膜充血、角膜水肿分级，并测量角膜溃疡面积，前房积脓高度。疗效判断标准：有效：疼痛症状减轻或消失，角膜溃疡部分或全部愈合，荧光素染色（±），后弹力层皱褶及水肿明显减轻或消失，前房积脓减少或消失，视力无变化或有提高；无效：各种症状改善不明显，病灶无变化或扩大，前房积脓无消失或有并发症发生。主要指标 视力、眼压、结膜充血、角膜水肿分级，角膜溃疡面积，前房积脓高度，药物不良反应，停药后复发情况等。 结果 20例患眼首诊时结膜充血评分[中位数（M），25%分位数（Q25）~75%分位数（Q75）]为2.50，2.00～3.00；治疗1周、1、2、3个月后结膜充血评分分别为2.00，2.00~3.00；1.50，1.00~2.00；1.00，0~1.00；0，0~1.00；治疗后各时间点与首诊时的差异均有统计学意义（P均<0.05）。首诊时角膜水肿评分为2.00，2.00～3.00；治疗1周、1、2、3个月后角膜水肿评分分别为1.50，1.00～2.75；1.00，0～1.75；0，0～0；0，0～0；治疗后各时间点与首诊时的差异均有统计学意义（P均<0.05）。首诊时角膜溃疡面积为7.63 mm2，6.00～29.81 mm2；治疗1周、1、2、3个月后角膜溃疡面积分别为4.50 mm2，3.00～21.88 mm2；0 mm2，0～4.88 mm2；0 mm2，0～0 mm2；0 mm2，0～0 mm2；治疗后各时间点与首诊时的差异均有统计学意义（P均<0.05）。首诊时前房积脓高度为0.25 mm，0～1.88 mm；治疗1周、1、2、3个月后前房积脓高度分别为0 mm，0～0.95 mm；0 mm，0～0 mm；0 mm，0～0 mm；0 mm，0～0 mm；治疗后各时间点与首诊时的差异均有统计学意义（P均<0.05）。12例患眼的首诊视力＜0.05，6例患眼视力在0.05～0.3之间，2例患眼视力＞0.3；治疗后，6例患眼的愈后视力＜0.05，8例患眼视力在0.05～0.3之间，6例患眼视力＞0.3，治疗后所有患眼视力均有不同程度的提高，但愈后视力与首诊视力比较，差异无统计学意义（χ2=4.286，P=0.134）。仅1例患眼治疗过程中出现眼压升高。所有患者均治疗有效，且未出现药物刺激症状及不良反应，停药后6个月内均无复发。 结论 眼局部应用环孢素滴眼液联合抗感染治疗中重度化脓性角膜炎安全、有效。     

氯替泼诺与妥布霉素地塞米松滴眼液对白内障超声乳化术后的抗炎效果比较

目的探讨氯替泼诺与妥布霉素地塞米松滴眼液在白内障超声乳化术后的抗炎效果。方法对32例患双眼白内障术后患者左右眼分别应用氯替泼诺+妥布霉素眼液和妥布霉素地塞米松眼液局部滴眼治疗,对抗炎效果进行对比观察。结果两种药物组间眼不适感、眼球充血、角膜及前房炎症发生率比较差异无统计学意义(P0.05);但在对眼压影响方面,氯替泼诺+妥布霉素眼液对眼压影响更小,差异有统计学意义(P0.05),相对更安全。结论氯替泼诺眼液+妥布霉素眼液与妥布霉素地塞米松眼液抗炎效果相同,不良反应少,可作为白内障超声乳化术后的常规用药。     

鱼腥草滴眼液治疗流行性角结膜炎的临床疗效观察

目的观察中药制剂鱼腥草滴眼液对流行性角结膜炎的临床疗效和安全性。方法本文为随机、对照临床试验。将40例47眼流行性角结膜炎患者随机分为鱼腥草治疗组和病毒唑对照组,每组各20例。试验组滴用鱼腥草滴眼液6次·d-1,每次1滴。对照组滴用0.5%病毒唑滴眼液6次·天-1,每次1滴,疗程为10d。在用药后第1d、4d、7d、10d复查。对2组患者的症状、体征进行观察评分,同时对不良反应进行观察。结果试验组和对照组治疗有效率分别为80.0%和81.8%,2组有效率无统计学差异(P=0.242)。中药鱼腥草滴眼液能明显改善流行性角结膜炎患者的主要症状和体征,这种改变的趋势与0.5%病毒唑滴眼液相似。试验组1例发生不良反应,对照组无不良反应发生。结论鱼腥草滴眼液用于治疗流行性角结膜炎效果与0.5%病毒唑滴眼液相同,安全性好。     

加替沙星滴眼剂的制备及质量控制

目的:建立加替沙星滴眼剂的制备方法及质量标准。方法:以苯扎溴铵为抑菌剂,氯化钠为渗透压调节剂,聚乙烯吡咯烷酮(PVP)为增黏剂,制备加替沙星滴眼剂;采用高效液相色谱法测定含量。结果:制剂质量稳定,家兔眼刺激性实验表明,本制剂对家兔眼睛无刺激性,符合《中国药典》对滴眼剂的质量要求;质量控制方法准确、可靠。结论:本制剂生产工艺简单,质量稳定,可用于临床。     

Increased corneal permeability induced by the dual effects of transient tear film acidification and exposure to benzalkonium chloride

A number of common eyedrop solutions were found to be at acid pH and to have considerable acidic buffering capacity. Rabbit tears were shown to have weak buffering capacity at physiologic pH; a single drop of acidic ophthalmic preparation markedly reduced tear film pH for 10 to 15 min. One drop of pH 4 buffer eyedrop without other components reduced rabbit tear film pH in vivo by the same magnitude as the ophthalmic formulations; depressed pH persisted for at least 5 min. To assess the integrity of the corneal epithelial barrier after exposure to transiently acidified tear film, trace amounts of [¹⁴C]inulin were added to buffer solutions and the inulin concentrations in cornea and aqueous humor determined as ¹⁴C (d/min)/mg. Even 15 min after a pH 4 buffer eyedrop, mean corneal inulin concentration was three times that in pH 7 buffer-treated eyes. A concomitant increase in aqueous humor inulin concentration was observed. Corneal permeability was also assayed with the [¹⁴C]inulin instilled 15 min after application of a buffered eyedrop containing either 0·01 or 0·02% benzalkonium chloride, a common eyedrop preservative. In neutral pH solution, 0·01% benzalkonium chloride did not alter corneal permeability significantly, but the 0·02% solution increased corneal inulin concentration by a factor of seven compared to controls. In pH 4 buffer, however, both the 0·01% and 0·02% benzalkonium chloride solutions increased corneal inulin penetration—by tenfold and eighteenfold, respectively. Thus, the combined effects of acid buffering and benzalkonium chloride on corneal permeability were more than double the effects of either one alone.     

Eyedrop-induced allergy: clinical evaluation and diagnostic protocol

Background. In the last few years, adverse reactions to mydriatic eyedrops have been investigated. However, is not still available a standardized protocol, capable of identify the pathogenetic mechanism. In the light of these findings we have evaluated the reliability of a protocol with well established concentration of specific allergens. Methods. The diagnostic method includes the application of patch test series Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali (GIRDCA), medicaments, corticosteroids, local anesthetics, main eyedrops' excipients, pure active principles and extemporaneous preparations with mydriatic eyewashes. At the same time, skin prick test with a solution of atropine sulfate at 1‰ and an intradermal test with injection of atropine at 0.01‰ were carried out. Results. After patch tests were removed, we detected seven positiveness to the phenylephrine, two to the benzalkonium chloride, one to thiomersal, one to the ethylendiamine and one to the atropine sulfate 1‰. With intradermal tests we obtained three positiveness in patients who reported adverse reactions to atropine. Conclusions. Our results show that phenylephrine is frequently responsible for allergic conjunctivitis (53.8%). In the case of atropine, even though the limited number of patients suggests to perform more extensive studies, it emerges that our diagnostic protocol is safe and might be able to screen allergic reactions in the field of ophthalmopathies.