Ocular surface changes in the treatment of rosacea: comparison between low-dose oral isotretinoin and doxycycline / Alterações da superfície ocular no tratamento da Rosácea: comparação entre isotretinoína oral em baixa dosagem e doxiciclina

ABSTRACT Purpose: To compare the impact of ocular changes between systemic treatment with doxycycline and low-dose oral isotretinoin in patients with moderate-to-severe papulopustular rosacea. Methods: Patients were randomized to receive either isotretinoin 0.3-0.4 mg/kg (group A) or doxycycline 100 mg/day (group B) for 16 weeks. Ocular symptoms were searched and evaluated, including best-corrected visual acuity (BCVA), Schirmer test, breakup time, rose bengal staining score, and meibomian gland dysfunction grading. The patients were retested at the end of treatment. Results: The present study included 39 patients (30 females and 9 males). Best-corrected visual acuity was > 20/30 in >90% of patients in both groups and did not change after treatment. After treatment, improvement in ocular symptoms and meibomian gland dysfunction was more pronounced in group B (p<0.05); the other parameters did not reach statistical significance. Conclusion: Doxycycline improved meibomian gland dysfunction, ocular symptoms, and ocular surface in patients with rosacea. Even though some patients experienced worsening meibomian gland dysfunction and symptoms, no subject experienced any serious complications after administration of low-dose isotretinoin.

RESUMO Objetivos: Comparar o impacto das alterações oculares entre o tratamento sistêmico de doxiciclina e isotretinoína em baixa dosagem em pacientes com rosácea papulopustulosa moderada a grave. Métodos: Os pacientes form randomizados para receber isotretinoína 0,3 a 0,4 mg/kg (grupo A) ou doxiciclina 100mg/dia (grupo B) por 16 semanas. Os sintomas oculares foram pesquisados e avaliados, incluindo melhor acuidade visual corrigida, teste de Schirmer, tempo de ruptura do filme lacrimal, coloração de rosa bengala e graduação da disfunção de glândula de Meibomius. Os pacientes foram novamente testados no final do tratamento. Resultados: O presente estudo incluiu 39 pacientes (30 mulheres e 9 homens). A melhor acuidade visual corrigida foi >20/30 em >90% dos pacientes em ambos os grupos e não se alterou após o tratamento. A melhora dos sintomas oculares e da disfunção de glândula de Meibomius foi mais pronunciada no grupo B (p<0,05) após o tratamento; as demais variáveis não atingiram significância estatística. Conclusão: A doxiciclina melhorou a disfunção de glândula de Meibomius, os sintomas oculares e a superfície ocular de pa cientes com rosácea. Mesmo que alguns pacientes tenham piorado a disfunção e os sintomas da glândula de Meibomius, nenhum indivíduo apresentou complicações graves após a admi nistração de baixas doses de isotretinoína.

Ophthalmic adverse effects of nasal decongestants on an experimental rat model / Efeitos oftálmicos adversos de descongestionantes nasais em modelo experimental com ratos

ABSTRACT Purpose: To investigate the potential effects of chronic exposure to a nasal decongestant and its excipients on ocular tissues using an experimental rat model. Methods: Sixty adult male Wistar rats were randomized into six groups. The first two groups were control (serum physiologic) and Otrivine® groups. The remaining four groups received the Otrivine excipients xylometazoline, benzalkonium chloride, sorbitol, and ethylene diamine tetra acetic acid. Medications were applied into both nostrils twice a day for 8 weeks. Before the rats were sacrificed, epithelial staining, the Schirmer test, and intraocular pressure measurements were performed under ketamine/xylasine anesthesia (50 and 5 mg/kg, respectively). Results: Epithelial defects and dry eye were common findings in all study groups. Cataracts developed in two cases clinically. Histopathological evaluation revealed many different pathological alterations in all parts of the ocular tissues such as corneal edema, polypoid proliferation and hyalinization of the vessel wall, cystic formation of the lens, retinal nerve fiber layer degeneration, and corpora amylacea formation of the lacrimal gland. Conclusions: Prolonged usage of the nasal decongestant xylometazoline and its excipients may cause ophthalmic problems such as dry eyes, corneal edema, cataracts, retinal nerve fiber layer, and vascular damage in rats. Although these results were obtained from experimental animals, ophthalmologists should keep in mind the potential ophthalmic adverse effects of this medicine and/or its excipients and exercise caution with drugs containing xylometazoline, ethylene diamine tetra acetic acid, benzalkonium chloride and sorbitol for patients with underlying ocular problems.

RESUMO Objetivo: Investigar os possíveis efeitos da exposição crônica de descongestionante nasal e seus excipientes em tecidos oculares, utilizando um modelo experimental com ratos. Métodos: Sessenta ratos Wistar adultos machos foram divididos aleatoriamente em seis grupos. Os primeiros dois grupos foram controle (soro fisiológico) e Otrivina®. Os quatro grupos restantes receberam os excipientes de Otrivina, tais como Xilometazolina, Benzalcônio, Sorbitol e Ácido Etilenodiamino Tetracético (EDTA). Os medicamentos foram aplicados em ambas as narinas dos ratos, duas vezes ao dia, durante 8 semanas. Antes que os ratos fossem sacrificados, a coloração epitelial, o teste de Schirmer e a medida da pressão intraocular foram realizados sob anestesia com Ketamina/Xilasina (50 e 5 mg/kg, respectivamente). Resultados: Defeitos epiteliais e olho seco foram achados comuns nos grupos de estudo. A catarata desenvolveu-se clinicamente em dois casos. A avaliação histopatológica revelou a existência de alterações em todas as partes dos tecidos oculares, tais como edema de córnea, proliferação polipoide e hialinização da parede vascular, formação cística da lente, degeneração da camada de fibra nervosa da retina (RNFL) e formação de corpos amiláceos da glândula lacrimal. Conclusões: O uso prolongado do descongestionante nasal Xilometazolina e seus excipientes pode causar vários problemas oftalmológicos, como olho seco, edema de córnea, catarata, RNFL e dano vascular em ratos. Embora esses resultados tenham sido obtidos a partir de animais experimentais, os oftalmologistas devem ter em mente os potenciais efeitos oftalmológicos adversos desse medicamento e/ou de seus excipientes.

Efeito midriático da fenilefrina a 10% na comparação entre a autoinstilação de gota em olhos abertos e a vaporização em olhos fechados / Phenylephrine 10% mydriatic effect: comparison between self instillation of eye drop in open eyes and spray in closed eyes

RESUMO Objetivo: Comparar a eficácia fenilefrina a 10% aplicada pelo próprio paciente por vaporização em olho fechado em relação à instilação de gota em olho aberto em indivíduos que irão realizar exame de fundoscopia e avaliar o nível de dificuldade e a adequação técnica entre os métodos de administração. Métodos: Ensaio clínico controlado, randomizado e pareado realizado em 2014 envolvendo 100 olhos de 50 pacientes na Policlínica Ronaldo Gazolla - RJ, sem doenças oculares ou sistêmicas que comprometiam a dilatação pupilar. Os pacientes foram submetidos à instilação de 1 gota de fenilefrina a 10% e aplicação de vaporizador do mesmo midriático no olho contralateral. O olho em que se instilou o colírio permaneceu aberto, enquanto o olho vaporizado ficou fechado durante as aplicações da medicação. O diâmetro pupilar foi medido antes da aplicação, 10, 20 e 30 minutos após. O processo de instilação ou vaporização foi observado quanto a sua adequação técnica por um dos autores. Após o processo foi perguntado ao paciente questões pré-formuladas sobre a praticidade de ambos os métodos. Resultados: A diferença de midríase média entre os grupos de olhos avaliados em um determinado tempo foi no máximo 0,3 mm , o que não foi clinicamente ou estatisticamente significativo (ANOVA: F = 1,97 e p = 0,163609) . Porém, ao longo do tempo, a diferença entre o diâmetro da pupila no tempo inicial e no tempo de 30 minutos foi 1,15 mm para os olhos vaporizados e 1,58 mm para os olhos instilados com gotas (ANOVA: F = 129,22 e p ≤ 0,0001). Percentual de 60% dos pacientes tocaram a ponta do frasco de colírio nos olhos, enquanto que 12% tocaram o orifício na ponta do vaporizador com os dedos (p < 0,000001). Setenta de dois por cento (72%) consideraram a instilação de gotas fácil ou muito fácil enquanto 62% consideraram a vaporização em olho fechado fácil ou muito fácil (p = 0,238). Conclusão: A instilação de gotas em olhos abertos e a vaporização de olhos fechados da fenilefrina a 10% apresentou eficácia clínica semelhante. A vaporização foi mais segura e apresentou nível de dificuldade um pouco maior do que a instilação, apesar dos pacientes serem experientes para instilar gotas e inexperientes para vaporizar a medicação em olho fechado.

ABSTRACT Objective: To compare the effectiveness of phenylephrine 10% applied by a spray onto the eye closed over drop instillation onto an open eye on patients who will perform ophthalmoscopy and assess the level of difficulty and technical adequacy of the administration methods. Methods: The study was a clinical trial, controlled, randomized and paired, performed in 2014, involving 100 eyes of 50 patients in the Polyclinic Ronaldo Gazolla - RJ, with no ocular or systemic diseases that compromised the pupillary dilation. Patients underwent 10% phenylephrine eye drop instillation onto one open eye and spray application onto the other eye, which was closed. Pupillary diameter was measured before application and 10, 20, 30 minutes after. The process of instillation or vaporization was observed for its technical correctness by one of the authors. A questionnaire was asked to the patient about the difficulty of both methods after topical administration. Results: The average mydriasis difference between the eye groups assessed at a given time was at most 0.3 mm, which was not clinically or statistically significant (ANOVA: F = 1.97 and p = 0.163609). However, over time, the difference between the average pupil diameter before application and after 30 minutes was 1.15 mm to vaporized eyes and to 1.58 mm in eyes instilled with drops (ANOVA: F = 129, 22 and p ≤ 0.0001). Sixty per cent of patients touched the tip of the eye drop bottle onto the eye, while 12% touched the tip of the vaporizer with their fingers (p <0.000001). Seventy two percent (72%) considered the drops instillation easy or very easy, while 62% considered vaporization in a closed eye easy or very easy (p = 0.238). Conclusion: The instillation of drops phenylephrine 10% in open eyes and the vaporization onto closed eyes showed similar clinical efficacy. Vaporization was safer and a little more difficult than instillation, despite the patients being experienced for instilling drops and inexperienced to vaporize the medication in a closed eye.

Percepção de autoinstilação de gotas oculares em idosos com ou sem dispositivo de apoio facial / Self instillation perception of eye drops in elderly patients with and without facial support device

RESUMO Objetivo: Determinar o grau de dificuldade para instilação tópica ocular em idosos, com ou sem o auxílio de dispositivo de apoio facial, por meio de questionário. Observar qual método foi tecnicamente melhor para aplicação tópica ocular de gotas. Métodos: O estudo foi um ensaio clínico, controlado, randomizado e pareado, realizado em 50 pacientes idosos de setembro de 2015 a junho de 2016 na Policlínica Ronaldo Gazolla, Lapa-Rio de Janeiro. Um frasco de colírio Optive® foi acoplado ao dispositivo de apoio facial denominado Eyedrop®. Cada participante instilou o colírio com ou sem o auxílio do dispositivo em cada um dos olhos, sendo que a seleção ocular foi feita aleatoriamente. Foi perguntado ao paciente questões pré-formuladas sobre a dificuldade de ambos os métodos e a técnica de administração tópica ocular foi avaliada. Resultados: A instilação de gotas foi considerada difícil ou muito difícil por 10% dos idosos com o auxílio do dispositivo e por 36% sem o auxílio (p = 0,0047). Houve toque da ponta do colírio com os tecidos oculares em 64% dos pacientes que não usaram o Eyedrop® e em 4% dos que o utilizaram (p=0,000001). A maior dificuldade descrita na instilação tradicional foi acertar o olho com a gota (32%) e com o dispositivo de apoio foi entender seu uso(4%). Conclusão: A maioria dos idosos instila colírios erroneamente, tocando a ponta do frasco em tecidos oculares, o que favorece sua contaminação. O dispositivo de apoio facial tornou mais segura e fácil a instilação.

ABSTRACT Objective: To determine the degree of difficulty for topical ocular instillation in the elderly, through a questionnaire, with or without the aid of facial support device. Observe which method was technically better to topical ocular application of drops. Methods: The study was a clinical trial, controlled, randomized and paired, which was conducted in 50 elderly patients from September 2015 to June 2016 at the Polyclinic Ronaldo Gazolla, Lapa, Rio de Janeiro. A Optive® eyedrop bottle was attached to a facial support device called Eyedrop®. Each participant instilled an eye drop with or without the device help in each of both eyes, wherein the eye selection was made randomly. He was asked to answer pre-formulated questions about the difficulty of both methods and the topical ocular administration technique was evaluated. Results: Eye drop instillation was difficult or very difficult for 10% of the elderly with the device aid and for 36% without it (p = 0.0047). There were bottle tip touch onto the ocular tissues in 64% of patients who did not use Eyedrop® and 4% who used it (p = 0.000001). The greatest difficulty described in traditional instillation was to head properly the eye drop (32%) and when the support device was used, it was to understand how to use it (4%). Conclusion: Most elderly instills eye drops mistakenly, touching the tip of the bottle onto ocular tissues, which favors contamination. The facial support device increased security and facility in instillation.

Ocular surface evaluation in patients treated with a fixed combination of prostaglandin analogues with 0.5% timolol maleate topical monotherapy: a randomized clinical trial

OBJECTIVES: To compare ocular surface changes induced via glaucoma treatment in patients using fixed combinations of prostaglandin analogues (travoprost, latanoprost and bimatoprost) with 0.5% timolol maleate METHODS: A prospective, multicenter, randomized, parallel group, single-blind clinical trial was performed in 33 patients with ocular hypertension or open angle glaucoma who had not been previously treated. The ocular surface was evaluated prior to and three months after treatment, with a daily drop instillation of one of the three medications. The main outcome measurements included the tear film break-up time, Schirmer's test, Lissamine green staining, the Ocular Surface Disease Index questionnaire, impression cytology using HE and PAS and immunocytochemistry for interleukin-6 and HLA-DR. Ensaiosclinicos.gov.br: UTN - U1111-1129-2872 RESULTS: All of the drugs induced a significant reduction in intraocular pressure. Decreases in the Schirmer's test results were observed with all of the drugs. Decreases in tear-film break-up time were noted with travoprost/timolol and latanoprost/timolol. An increase in the Lissamine green score was noted with travoprost/timolol and bimatoprost/timolol. The Ocular Surface Disease Index score increased after treatment in the travoprost/timolol group. Impression cytology revealed a significant difference in cell-to-cell contact in the same group, an increase in cellularity in all of the groups and an increase in the number of goblet cells in all of the groups. The fixed combinations induced an increase in IL-6 expression in the travoprost/timolol group, in which there was also an increase in HLA-DR expression. CONCLUSIONS: All of the fixed combinations induced a significant reduction in intraocular pressure, and the travoprost/timolol group showed increased expression of the inflammatory markers HLA-DR and interleukin-6. All three tested medications resulted in some degree of deterioration in ...

Assessment of ocular surface toxicity after topical instillation of nitric oxide donors / Avaliação da toxicidade na superfície ocular após instilação tópica de doadores de óxido nítrico

PURPOSE: To evaluate the ocular surface toxicity of two nitric oxide donors in ex vivo and in vivo animal models: S-nitrosoglutathione (GSNO) and S-nitroso-N-acetylcysteine (SNAC) in a hydroxypropyl methylcellulose (HPMC) matrix at final concentrations 1.0 and 10.0 mM. METHODS: Ex vivo GSNO and SNAC toxicities were clinically and histologically analyzed using freshly excised pig eyeballs. In vivo experiments were performed with 20 albino rabbits which were randomized into 4 groups (5 animals each): Groups 1 and 2 received instillations of 150 µL of aqueous HPMC solution containing GSNO 1.0 and 10.0 mM, respectively, in one of the eyes; Groups 3 and 4 received instillations of 150 µL of aqueous HPMC solution-containing SNAC 1.0 and 10.0 mM, respectively, in one of the eyes. The contralateral eyes in each group received aqueous HPMC as a control. All animals underwent clinical evaluation on a slit lamp and the eyes were scored according to a modified Draize eye test and were histologically analyzed. RESULTS: Pig eyeballs showed no signs of perforation, erosion, corneal opacity or other gross damage. These findings were confirmed by histological analysis. There was no difference between control and treated rabbit eyes according to the Draize eye test score in all groups (p>0.05). All formulations showed a mean score under 1 and were classified as "non-irritating". There was no evidence of tissue toxicity in the histological analysis in all animals. CONCLUSION: Aqueous HPMC solutions containing GSNO and SNAC at concentrations up to 10.0 mM do not induce ocular irritation.

OBJETIVO: Avaliar a toxidade na superfície ocular de dois compostos doadores de óxido nítrico em modelos ex vivo e in vivo: S-nitrosoglutationa (GSNO) e S-nitroso-N-acetilcisteína (SNAC), em uma matriz de hidroxipropil metilcelulose (HPMC) nas concentrações finais de 1,0 and 10,0 mM. MÉTODOS: As toxicidades de GSNO e SNAC foram avaliadas clinicamente e histologicamente em modelo ex vivo usando globos oculares porcinos recém excisados. Experimentos in vivo foram realizados com 20 coelhos albinos que foram randomizados em 4 grupos (5 animais em cada): Os grupos 1 e 2 receberam instilações de 150 µL de solução aquosa de HPMC contendo GSNO 1,0 e 10,0 mM, respectivamente, em um dos olhos; Os grupos 3 e 4 receberam instilações de 150 µL de solução aquosa de HPMC contendo SNAC 1,0 and 10,0 mM, respectivamente, em um dos olhos. Os olhos contralaterias em cada grupo receberam solução aquosa de HPMC como controle. Todos os animais foram clinicamente avaliados em lâmpada de fenda e os olhos foram pontuados de acordo com o teste de Draize modificado e analisados histologicamente. RESULTADOS: Os globos oculares porcinos não apresentaram sinais de perfuração, erosão, opacidade da córnea ou outros danos graves. Esses resultados foram confirmados pela análise histológica. Não houve diferença entre os olhos dos coelhos tratados e controles de acordo com a pontuação do teste de Draize em todos os grupos (p>0,05). Todas as formulações apresentaram um escore médio menor do que 1 e foram classificadas como "não-irritantes". Não houve evidência de toxicidade tecidual nas análises histológicas em todos os animais. CONCLUSÃO: Soluções aquosas de HPMC contendo GSNO e SNAC em concentrações até 10,0 mM não induzem irritação ocular.

Oral glucose for pain relief during examination for retinopathy of prematurity: a masked randomized clinical trial

OBJECTIVE: Ophthalmologic examination for retinopathy of prematurity is a painful procedure. Pharmacological and non-pharmacological interventions have been proposed to reduce pain during eye examinations. This study aims to evaluate the analgesic effect of 25% glucose using a validated pain scale during the first eye examination for retinopathy of prematurity in preterm infants with birth weight <1,500 g and/or gestational age <32 weeks. METHODS: A masked, randomized clinical trial for one dose of 1 ml of oral 25% glucose solution 2 minutes before the first ophthalmologic examination for retinopathy of prematurity was conducted between March 2008 and April 2010. The results were compared to those of a control group that did not receive oral glucose solution. Pain was evaluated using a Neonatal Infant Pain Scale immediately before and immediately after the ophthalmologic examination in both groups. Clinicaltrials.gov: NCT00648687 RESULTS: One hundred and twenty-four patients who were examined for the first time for retinopathy of prematurity were included. Seventy were included in the intervention group and 54 in the control group. The number of patients with pain immediately before the procedure was similar in both groups. The number of patients with pain after ophthalmologic examination was 15.7% in the intervention group and 68.5% in the control group (p<0.001). CONCLUSIONS: One ml of oral 25% glucose solution given 2 minutes before an ophthalmologic examination for retinopathy of prematurity was an effective measure for pain relief.

Ocular surface adverse effects of ambient levels of air pollution / Efeitos adversos na superfície ocular relacionados à poluição ambiental

It is widely recognized today that outdoor air pollution can affect human health. Various chemical components that are present in ambient pollution may have an irritant effect on the mucous membranes of the body, particularly those of the respiratory tract. Much less attention has been focused on the adverse effect on the ocular surface, despite the fact that this structure is even more exposed to air pollution than the respiratory mucosa since only a very thin tear film separates the corneal and conjunctival epithelia from the air pollutants. So far, clinical data are the more widespread tools used by ophthalmologists for assessing possible aggression to the ocular surface; however, clinical findings alone appears not to correlate properly with the complaints presented by the patients pointing out the need for further clinical and laboratory studies on the subject. The purpose of this study is to review signs and symptoms associated with chronic long-term exposure to environmental air pollutants on the ocular structures currently defined as the ocular surface and to review clinical and laboratory tests used to investigate the adverse effects of air pollutants on such structures. We also review previous studies that investigated the adverse effects of air pollution on the ocular surface and discuss the need for further investigation on the subject.

Sabe-se hoje que a poluição ambiental pode afetar a saúde humana. Vários componentes químicos presentes na poluição atmosférica podem acarretar uma irritação nas mucosas, particularmente no trato respiratório. Pouca ênfase tem sido dada à superfície ocular, embora esta estrutura seja até mais exposta à poluição ambiental do que o trato respiratório visto que apenas uma fina camada de filme lacrimal separa a córnea e a conjuntiva dos poluentes presentes no ar. Até o momento, a avaliação clínica é o método mais utilizado pelos oftalmologistas para se detectar uma possível agressão à superfície ocular; entretanto esta avaliação apenas não parece correlacionar-se com as queixas e sinais apresentados pelos pacientes demonstrando a necessidade de mais estudos clínicos e laboratoriais sobre o assunto. O objetivo deste estudo é revisar os sinais e sintomas associados à exposição crônica aos poluentes ambientais no ar nas estruturas oculares definidas atualmente como superfície ocular e revisar os testes clínicos e laboratoriais usados para investigar os efeitos adversos dos poluentes em tais estruturas. Também revisamos estudos prévios que analisaram os efeitos adversos da poluição do ar na superfície ocular e discutimos a necessidade de mais estudos sobre o assunto.

[Lead levels in powders of surma [Kohl] used in Kerman]

Lead poisoning is a global problem and considered to be the most important environmental disease in children. Exposure to even low amounts of lead is dangerous. Lead containing eye make ups due to the long time contact with skin and eye mucosa can lead to blood and eye symptoms. The purpose of this study was to evaluate the amount of lead in powders of kohl in Kerman. In this study, from 12 types of kohl in Kerman sale centers, 48 samples were prepared. After preparation, the lead content of samples has been measured by Atomic Absorption Spectrophotometery. Mean concentration of lead in measured samples was 254.5micro g/g. Minimum and maximum concentrations of lead were 3.2micro g/g and 1219.4micro g/g, respectively. Totally, average lead concentrations of plant-base samples were lower than that of mineral-base ones. According to the results, high levels of lead in available Surmas in Kerman city requires some cultural measures for changing peoples' attitudes toward using this cosmetics as eyeliner or revision in their formulation in order to remove lead or decrease it to the standard limit. Since use of Kohl is associated with increase of lead in blood and ocular problems, determination of blood lead concentration and ocular problems in consumer groups are highly recommended

Fluconazole-loaded liposomes for ocular delivery: characterization and antifungal activity

Fluconazole loaded liposomes were prepared using reverse phase evaporation technique for ocular delivery of the drug. Characterization of fluconazole liposomes including; particle size and physical morphology were studied. The effects of different variables [cholesterol weight ratio and charge type] on the loading efficiency of liposomes as well as particle size were determined. Inclusion of cholesterol in liposomal formulations improved the encapsulation of fluconazole into liposomes at certain Phosphatidylcholine: Cholesterol [PC: Ch] weight ratios further increase in cholesterol content resulted in a decrease in the encapsulation percent of the drug. A significant increase in the encapsulation at ratio 7:3 was noticed. At ratio 7:6, the encapsulation significantly decreased. Incorporation of stearylamine [SA] into liposomes decreased the loading efficiency of fluconazole at ratio [PC: Ch: SA] 5: 5: 0.25 followed by insignificant increase in the entrapment of the drug into liposomes at ratio 5: 5: 0.5. On the other hand, addition of dicetyl phosphate [DP] into liposomes resulted in a significant increase in fluconazole encapsulation into liposomes at all tested [PC: Ch: DP] ratios. The loading efficiency of the neutral liposomes was found to be in between those of positively and negatively charged liposomes. The particle size studies showed that, increasing cholesterol amount, led to an increase in the particle size. While increasing stearylamine and dicetyl phosphate led to decrease in the particle size of liposomes. An in-vitro study was done to know the effect of fluconazole loaded liposomes on different fungi isolated from eye

Ocular side effects of chloroquine in patients with rheumatoid arthritis, systemic lupus erythematosus and scleroderma.

OBJECTIVE: Ocular complication is a major long term adverse event of chloroquine. The present study was carried out to determine the ocular side effects of chloroquine in patients with rheumatic diseases. MATERIAL AND METHOD: Medical records of patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and scleroderma (Scl), who received chloroquine for their treatment, at the Division of Rheumatology, Faculty of Medicine, Chiang Mai University between 1 January 1992 and 31 August 2005 were reviewed. Only patients who were older than 16 years, had a clear total accumulative dose and duration of chloroquine therapy, and a regular ophthalmologic examination by ophthalmologists were included in the present study. RESULTS: One hundred and thirty-nine patients (54, 49, and 36 cases of RA, SLE and Scl, respectively) were studied. Forty-eight patients (34.5%) had ocular adverse effects (retinopathy in 37 and corneal deposition in 13 while two patients had both defects). There was no statistical difference in age, mean lean body weight adjusted daily dose, total dosage, and duration of treatment between those with and without ocular side effects. However those with ocular side effects had significantly lower creatinine clearance (66.9 +/- 26.9 vs 72.3 +/- 20.0 ml/min, p = 0.046). CONCLUSION: Ocular side effects of chloroquine were more common in patients with connective tissue diseases who had decreased creatinine clearance. The use of chloroquine in patients with impaired renal function should be of greater concern.

Comparative evaluation of possible ocular photochemical toxicity of fluoroquinolones meant for ocular use in experimental models.

Fluoroquinolones (FQs) are extensively used in bacterial keratitis and other intraocular infections. Since eye is constantly exposed to light, incidence of ocular phototoxicity due to commonly used FQs is of great interest for their safe use. Phototoxicity of commonly used FQs (ciprofloxacin, lomefloxacin, pefloxacin, ofloxacin, sparfloxacin and gatifloxacin), has been evaluated by using HET-CAM-UV model (Photo Hen Egg Test-C Chorioallantoic Membrane model). This study was further extended by adding lomefloxacin dissolved in bovine vitreous (0.5 ml) on the chorioallantoic membrane (CAM). Using a standard scale, the phototoxic damage was assessed at different time intervals. Respective controls were kept in dark to distinguish the toxicity of the drugs per se. The results showed that the phototoxicity induced by lomefloxacin was very high followed by gatifloxacin and sparfloxacin and least for other drugs studied. Interestingly, lomefloxacin along with vitreous showed significantly low phototoxicity. This could be due to the antioxidant property of ascorbic acid present in the vitreous.

Ocular side effects of desferal in patients with beta thalassemia

To evaluate the ocular side effects of desferal in beta-thalassemia major patients. This cross-sectional study was conducted on 100 beta-thalassemia major subjects. All patients underwent complete ophthalmic examination, color vision test, and visual field evaluation. Electroretinography [ERG] was performed for 50 patients. Mean patient age was 14.4 years. Only 9 patients complained from ocular problems including nyctalopia [8 subjects] and permanent visual loss [one case], but eye examination revealed abnormalities in 74 subjects including cataract in 43, fundus abnormality in 9; abnormal visual field in 71 with the most common abnormality being paracentral scotoma [64%], and abnormal color vision in 35 with the most common abnormality being tritanopia [81%]. All patients had abnormal ERG with abnormal amplitude of "a" and "b" waves in scotopic phase. There was no significant correlation between age, duration of desferal usage or serum ferritin with ocular findings. All patients who received more than 40 mg/kg/day of desferal had ocular abnormalities. The main risk factor for ocular finding in desferal users is the dosage- ERG and perimetry are useful for early detection of ocular problems in these patients

The "third eye"-- a new concept of trans-differentiation of pineal gland into median eye in amphibian tadpoles of Bufo melanostictus.

Median third eye was found to develop from transplanted pineal gland of external gill stage tadpoles in the recipient 5 toe stage tadpoles of Bufo melanostictus. Pineal gland along with a bit part of brain tissue of the donor external gill stage tadpole was cut out and transplanted into a pit made between two lateral eyes of 5 toe stage recipient tadpoles. Half of the operated tadpoles were treated with vitamin A (15 IU/ml.) for 15 days. Median "third eye" was found to develop in the both untreated and vitamin A treated tadpoles. However, vitamin A increased the percentage of the development of median eyes. Morphological and histological study revealed that newly transformed median eyes were similar to that of normal functional eyes. A stalk like structure developed which connects the median eye to the brain. The median third eye could not develop when pineal gland of 5 toe stage mature tadpole was transplanted into the tadpole of the same age.

Adverse effects of systemic isotretinoin therapy: a study of 78 patients

Isotretinoin is an effective treatment for severe forms of acne refractory to other therapies, but it is a teratogen and can cause serious side effects. The side effects, in addition to the constitutional features are related to skin, mucosae, eyes, sexual organs, central nervous system, respiratory system and gastrointestinal tract. Deranged biochemical profile may also be seen in few patients. The current study was aimed to determine the frequency of side effects of systemic isotretinoin therapy in patients treated for acne, thereby assessing its safety. During the calendar year 2004, all the acne patients attending the outpatient department of dermatology, Ziauddin Medical University, KDLB campus, Karachi, fulfilling the inclusion criteria, managed on systemic isotretinoin were enrolled. All were taking isotretinoin at a dose of 0.5mg/kg body weight daily. Baseline investigations were performed in all the patients i.e. liver function tests, lipid profile, complete blood picture and renal function tests. They were followed up for any side effects and clinical improvement. The baseline investigations were repeated monthly to see any biochemical and hematological derangements. 78 patients, 42 females [53.8%] and 36 males [46.2%], with ages ranging from 18 to 24 years, were enrolled. 72 patients [92.2%, p<0.001] developed side effects with a variable frequency of at least one feature in each of these subjects. The side effects, in addition to the constitutional features, observed were related to skin [87.2%], mucosae [10.3%], central nervous system [5.2%], eyes [3.8%], reproductive organs [2.6%], respiratory system [1.3%] and gastrointestinal tract [1.3%]. Deranged biochemical profile was also a feature in few patients [6.3%]. The majority of the patients on systemic isotretinoin have side effects, the most common being cutaneous and mucosal but are trivial. Side effects pertaining to the other systems are less frequent

Centbucridine, a newer topical anaesthetic compared with lignocaine: a randomized double masked single drop instillation clinical trial.

A randomized double-masked single drop instillation clinical trial was conducted on 60 healthy volunteers divided into 3 equal groups to compare the efficacies of centbucridine and lignocaine. One eye of each volunteer was instilled with a single drop of either 0.5% centbucridine hydrochloride, 1% centbucridine hydrochloride or 4% lignocaine hydrochloride, with the other eye as an unanaesthetized control-side effects, if any, were also recorded. The onset of anaesthesia assessed both objectively and subjectively, was quickest with lignocaine 4% (P < 0.001) followed by centbucridine 0.5% and 1%. However, the period of peak activity as well as the total duration of surface anaesthesia, and also the depth of analgesia, were significantly highest with 1% centbucridine, followed by 0.5% centbucridine and 4% lignocaine respectively. Minor side effects like burning sensations were longest with 1% centbucridine--no significant adverse effects, local or systemic, were observed. Prolonged surface anaesthetic and analgesic actions of centbucridine 1% may be advantages for longer duration ophthalmic microsurgeries.

Alteraciones oculares por tamoxifen en pacientes con cáncer mamario / Ocular alterations induced for the tamoxifen in patients with breast cancer

Objetivo: Identificar las alteraciones oculares inducidas por el tamoxifen en pacientes con cáncer mamario. Diseño del estudio: transversal, analítico y observacional. Material y métodos: Se estudiaron 74 pacientes divididos en dos grupos, Grupo I (n = 37) pacientes que han tomado tamoxifen 20 mg diarios por 3 meses a 5 años y grupo II (n = 37) recibieron sólo quimioterapia. Se les realizó una exploración oftalmológica completa para identificar alteraciones oculares. Los resultados se analizaron con medidas de resumen de tendencia central y de dispersión. Análisis no paramétrico para determinar la diferencia en los grupos. Resultados: No se encontró diferencia significativa en la agudeza visual de ambos grupos (p > 0.05), 15 pacientes que tomaron tamoxifen presentaron disminución de la agudeza visual promedio de -X de 0.37 ñ 0.25. En tres pacientes (8 por ciento), se estableció el diagnóstico de retinopatía por tamoxifen caracterizada por disminución de la agudeza visual, edema macular bilateral y cristales paramaculares.Conclusiones: Toda paciente con cáncer mamario debe ser evaluada periódicamente. El tamoxifen a dosis de 20 mg diarios no se asocia con alteraciones oculares graves.

Neuroleptic administration and eye changes in Jordanians

To investigate the effects of neuroleptics on the eyes. The eyes of 88 Jordanian patients [50 males, 38 females] receiving neuroleptics were examined and compared to a control group of 73 subjects of similar age and sex distribution who had never taken neuroleptics. The duration of treatment with neuroleptics was 24 months or longer. About 68.2% of those taking neuroleptics showed ocular pigmentation compared to only 15% of the control group; a difference which was statistically significant. Pigmentation affected the conjunctiva in 73% of them. Patients receiving neuroleptics showed ocular pigmentation. Prevalence increased with the age of the patient, higher total dosage of neuroleptics and was greater in males than in females