Slow versus rapid fluorescein injection in angiographic studies for retinal vascular disorders

To compare the incidence of adverse reactions following rapid versus slow fluorescein injection for fundus angiography. This randomized controlled trial was performed on 500 patients with retinal vascular disorders. Subjects with central serous retinopathy, age-related macular degeneration and retinal pigment epithelial changes were excluded. Pregnancy, asthma, allergic diseases and previous history of reactions to fluorescein were other exclusion criteria. Patients were randomly divided into two equal groups who received slow infusion of dye [over 15-25 seconds] versus the usual rapid injection [in 5-8 seconds], and were compared for adverse effects. Overall, 47 [9.4%] patients including 34 [13.6%] subjects in the rapid group and 13 [5.2%] cases in the slow group developed adverse reactions [P=0.001, relative risk=2.6]. All adverse reactions were categorized as mild; no instance of moderate or severe reactions was observed. There was a lower incidence of nausea and vomiting with slow infusion of fluorescein [P=0.02], however no statistically significant difference was observed in the frequency of vertigo and vasovagal reactions between the study groups. Slow fluorescein injection during fundus angiography, instead of the usual rapid application, can be an effective way to reduce the incidence of nausea and vomiting in patients whose first phase of angiography is of little diagnostic importance

Short-term results of two treatment regimens in ocular toxoplasmosis: trimethoprim/sulfamethoxazole versus pyrimethamine and sulfadiazine

To compare the efficacy of classic treatment for ocular toxoplasmosis [pyrimethamine, sulfadiazine and prednisolone] with a regimen consisting of trimethoprim/sulfamethoxazole [TMP/SMX] [co-trimoxazole] plus prednisolone. In a prospective randomized single-blind clinical trial, 59 patients with active ocular toxoplasmosis were randomly assigned to two treatment groups: 29 were treated with pyrimethamine/sulfadiazine and 30 patients received TMP/SMX. Treatment consisted of six weeks of treatment with antibiotics plus steroids. Anti-toxoplasmosis antibodies [IgM and IgG] were measured using ELISA. Outcome measures included changes in retinochoroidal lesion size after six weeks of treatment, visual acuity before and after intervention, adverse drug reactions during follow up and rate of recurrence. Active toxoplasmosis retinochoroiditis resolved in all patients over six weeks of treatment with no significant difference in mean reduction in retinochoroidal lesion size between the two treatment groups [61% reduction in the classic treatment group and 59% in the TMP/SMX group, P=0.75]. Similarly no significant difference was found in visual acuity after treatment between the two groups [mean visual acuity after treatment was 0.12 LogMAR [20/25] in classic treatment group and 0.09 LogMAR [20/25] in TMP/SMX group, P=0.56]. Adverse events were similar in both groups with one patient in each suffering from any significant drug side effects, The overall recurrence rate after 14 months of follow up was 6.7% with no significant difference between the treatment groups [P = 0.48]. Drug efficacy in terms of reduction in retinal lesion size and improvement in visual acuity was similar between a regimen of TMP/SMX and the classic treatment of ocular toxoplasmosis with pyrimetbamine and sulfadiazine. Therapy with TMP/SMX appears to be an acceptable alternative for the treatment of ocular toxoplasmosis