Retinal changes in rabbit after intravitreal injection of sunitinib encapsulated into solid lipid nanoparticles and polymeric nanocapsules / Avaliação das alterações retinais no coelho após injeção intravítrea de sunitinib encapsulado em nanoparticulas lípidas sólidas e nanocapsulas polímeros

ABSTRACT Purpose: We aimed to evaluate the safety of single intravitreal injection of each of two concentrations of 0.1 ml of sunitinib (1 and 10 mg/ml), 0.1 ml of a drug-free dispersion containing solid lipid nanoparticles, and 0.1 ml of a drug-free dispersion containing polymeric nanocapsules for analyzing the possible toxic effects using electrophysiology and histology in albino rabbit retina. Methods: We conducted an experimental controlled study of 20 eyes of albino rabbits. Intravitreal injections of each specific agent were applied to one eye per rabbit in each 5-rabbit group, while the contralateral eyes received no treatment and were used as controls. Results: We noted no electroretinographic changes in the sunitinib (1 and 10 mg/ml) or in solid lipid nanoparticles groups. However, we observed significant abnormalities in ocular morphology and in the electroretinogram in the nanocapsules group. At the histological level, only the nanocapsules group demonstrated abnormal changes, including severe edema and cytoplasmic vacuole formation. Conclusions: While nanocapsules intravitreal injections indicated retinal toxic effects, sunitinib and solid lipid nanoparticles intravitreal injections were not toxic to the retina. Our results suggest that a sunitinib preparation with solid lipid nanoparticles for controlled release may offer a significant therapeutic approach for vasoproliferative ocular disease.

RESUMO Objetivos: O presente estudo teve por objetivo avaliar a segurança da injeção intravítrea de 0,1 ml de sunitinibe em duas concentrações (1 mg/ml e 10 mg/ml), 0,1 ml de dispersão contendo nanopartículas lipídicas sólidas sem droga e 0,1 ml de dispersão contendo nanocápsulas poliméricas livre de drogas analisando os possíveis efeitos tóxicos à retina de coelhos albinos detectados pela eletrofisiologia e histologia por microscopia óptica. Métodos: Um estudo controlado experimental foi rea­lizado com 20 olhos de coelhos albinos. Foram realizadas injeções intravítrea de duas concentrações diferentes de suniti­nibe, uma dispersão contendo nanopartículas lipídicas sólidas e uma dispersão contendo nanocápsulas. O olho contralateral não recebeu tratamento e foi utilizado como controle. Resultados: Não foram observadas alterações eletrorretinográficas nos grupos do sunitinibe (1 mg/ml e 10 mg/ml) e no grupo das nanopartículas lipídicas sólidas. No grupo das nanocápsulas, houve alterações significativas tanto na morfologia, quanto na amplitude e tempo das ondas do eletrorretinograma. Ao estudo histológico, somente o grupo das nanocápsulas apresentou al­terações degenerativas (núcleos tumefeitos) com acentuado edema e formação de vacúolos citoplasmáticos, sugerindo toxidade retiniana. Conclusões: As injeções intravítreas de sunitinibe e nanopartículas lipídicas sólidas não foram tóxicas para a retina. No entanto, nanocápsulas mostraram ser tóxicas para a retina. Sendo assim, a possibilidade de poder combinar o potencial de uma droga que possui a capacidade de inibir duas importantes vias da angiogênese, às vantagens de liberação controlada das nanopartículas lipídicas sólidas, pode ser um importante recurso terapêutico para doenças vasoproliferativas oculares.

Initial experience with ocriplasmin in the treatment of vitreomacular traction / Experiência inicial com ocriplasmina no tratamento da tração vitreorretiniana

ABSTRACT This study aimed to report the clinical and structural outcomes of intravitreal ocriplasmin in the treatment of vitreomacular interface disorders in two tertiary centers in Brazil. A retrospective study was performed by reviewing medical records and spectral domain optical coherence tomography (SD-OCT) findings of seven patients who were treated with a single ocriplasmin injection. A total of 57.14% of patients achieved resolution of vitreomacular traction as evidenced by SD-OCT. Regarding our functional results, 87.71% maintained or improved visual acuity after follow-up. To the best of our knowledge, this is the first study reporting initial results of ocriplasmin therapy in Brazil.

RESUMO O objetivo desse estudo é relatar os resultados iniciais, tanto do ponto de vista funcional quanto anatômico, no tratamento das doenças da interface vítreo-macular com a ocriplasmina em 2 serviços terciários no Brasil. Um estudo retrospectivo foi realizado através de revisão de prontuários, além de análise de achados em tomografia de coerência óptica de domínio espectral (SD-OCT) em 7 pacientes tratados com uma única injeção intravítrea de ocriplasmina. Em nosso estudo 57,14% dos pacientes apresentaram resolução da tração vítreo-macular no SD-OCT. Em relação aos resultados funcionais, 87,71% dos pacientes mantiveram, ou melhoraram sua acuidade visual durante o acompanhamento. Para nosso conhecimento, trata-se do primeiro estudo em nosso país, mostrando resultados iniciais com ocriplasmina em pacientes tratados no Brasil.

Rabdomiólisis grave secundaria a deshidratación hipernatrémica / Severe rhabdomyolysis secondary to severe hypernatraemic dehydration

Introducción: La rabdomiólisis es una enfermedad poco frecuente en pediatría. El objetivo es presentar un paciente en el que se desarrolló secundario a una deshidratación hipernatrémica grave tras una diarrea aguda. Caso clínico: Lactante de 11 meses que consultó por fiebre, vómitos, diarrea y anuria. Presentó convulsión tónico-clónica autolimitada. Ingresó en mal estado general, severamente deshidratado, con escasa reactividad. En las pruebas complementarias destacó acidosis metabólica grave, hipernatremia e insuficiencia renal prerrenal. Al tercer día apreció leve hipotonía axial y elevación de creatín fosfokinasa 75.076 UI/l, interpretado como rabdomiólisis. Se inició hiperhidratación y alcalinización sistémica, con buena respuesta clínica y bioquímica, siendo dado de alta sin secuelas motoras. Conclusiones: La hipernatremia grave está descrita como causa rara de rabdomiólisis e insuficiencia renal. En pacientes críticos es importante un alto índice de sospecha de rabdomiólisis y determinación seriada de la creatín fosfokinasa para su detección y tratamiento precoz.

Introduction: Rhabdomyolysis is a rare paediatric condition. The case is presented of a patient in whom this developed secondary to severe hypernatraemic dehydration following acute diarrhoea. Case report: Infant 11 months of age who presented with vomiting, fever, diarrhoea and anuria for 15 hours. Parents reported adequate preparation of artificial formula and oral rehydration solution. He was admitted with malaise, severe dehydration signs and symptoms, cyanosis, and low reactivity. The laboratory tests highlighted severe metabolic acidosis, hypernatraemia and pre-renal kidney failure (Sodium [Na] plasma 181 mEq/L, urine density> 1030). He was managed in Intensive Care Unit with gradual clinical and renal function improvement. On the third day, slight axial hypotonia and elevated cell lysis enzymes (creatine phosphokinase 75,076 IU/L) were observed, interpreted as rhabdomyolysis. He was treated with intravenous rehydration up to 1.5 times the basal requirements, and he showed a good clinical and biochemical response, being discharged 12 days after admission without motor sequelae. Conclusions: Severe hypernatraemia is described as a rare cause of rhabdomyolysis and renal failure. In critically ill patients, it is important to have a high index of suspicion for rhabdomyolysis and performing serial determinations of creatine phosphokinase for early detection and treatment.

Sistemas biodegradáveis contendo acetato de prednisolona para administração orbitária / Biodegradable systems containing prednisolone acetate for orbital administration

OBJETIVO: O presente estudo objetivou o desenvolvimento e a avaliação de um sistema biodegradável de liberação de fármacos com característica de liberação prolongada, destinado à administração orbitária de acetato de prednisolona (AP). MÉTODOS: O sistema desenvolvido, na forma de microesferas (MEs) de poli-e-caprolactona (PCL) contendo o AP, foi obtido pelo método de evaporação de solvente. As MEs foram caracterizadas por microscopia eletrônica de varredura (MEV), calorimetria diferencial exploratória (DSC), avaliação do teor de encapsulação e pelo perfil de liberação in vitro. O perfil de liberação in vivo foi avaliado em coelhos após administração peribulbar de uma suspensão aquosa das MEs. A biocompatibilidade local do sistema foi verificada por meio de análise histopatológica da região de implantação. RESULTADOS: Após obtenção das MEs, a análise morfológica por MEV mostrou a viabilidade do método de obtenção do sistema. O teor de AP encapsulado foi de 43 ± 7 por cento e pode ser considerado bastante satisfatório. A caracterização do sistema por DSC, além de confirmar a sua estabilidade, não indicou a existência de interação entre o fármaco e o polímero. O estudo de liberação in vitro indicou que o sistema apresenta perfil de liberação prolongada. O estudo in vivo confirmou o perfil de liberação prolongado do AP a partir das MEs, sugerindo, também, a viabilidade do sistema devido à ausência de toxicidade local. CONCLUSÃO: O conjunto dos resultados obtidos neste trabalho é relevante e credencia o sistema desenvolvido como uma possível alternativa ao tratamento de orbitopatias inflamatórias.

PURPOSE: The present study aimed to evaluate an injectable extended-release formulation of prednisolone acetate (PA) for orbital administration. METHODS: Microspheres (MEs) of poly-e-caprolactone (PCL) containing PA were developed by the method of solvent evaporation. The MEs obtained were characterized by scanning electron microscopy (SEM), differential scanning calorimetry (DSC), encapsulation efficiency and in vitro release profile. The in vivo release profile was evaluated in rabbits after periocular injection of an aqueous suspension of MEs. The local biocompatibility of the system was verified by histopathologic analysis of the deployment region. RESULTS: After MEs preparation, morphological analysis by SEM showed the feasibility of the employed method. The content of PA encapsulated was 43 ± 7 percent and can be considered as satisfactory. The system characterization by DSC technique, in addition to confirm the system stability, did not indicate the existence of interaction between the drug and the polymer. The in vitro release study showed the prolonged-release features of the developed system. Preliminary in vivo study showed the absence of local toxicity and confirmed the prolonged release profile of PA from MEs, suggesting the viability of the developed system for the treatment of orbital inflammatory diseases. CONCLUSION: The results obtained in this work are relevant and accredit the system developed as a possible alternative to the treatment of inflammatory orbitopathy.

Successful management of presumed Candida endogenous endophthalmitis with oral voriconazole.

Endogenous fungal endophthalmitis is most commonly caused by Candida species and usually occurs in patients with chronic diseases such as diabetes mellitus and renal insufficiency. Voriconazole, a broad-spectrum triazole antifungal agent, attains therapeutically significant concentrations in the vitreous cavity after systemic administration. We report, the successful management of presumed endogenous Candida endophthalmitis in a patient with multiple diseases and unstable systemic status with oral voriconazole. Though fungal endophthalmitis has been successfully treated with a combination of intravenous and intravitreal voriconazole, to the best of our knowledge this is the first report in ophthalmic literature (Medline Search) on the treatment of fungal endophthalmitis with only the oral route of administration of voriconazole.

Testing intravitreal toxicity of rapamycin in rabbit eyes / Toxicidade intravítrea da rapamicina em olhos de coelhos

PURPOSE: To evaluate retinal toxicity of varying doses of rapamycin when injected intravitreally in rabbits. Rapamycin is a potent immunosuppressive agent with significant antitumor and antiangiogenic properties, clinically approved for prevention of organ transplant rejection. METHODS: Twelve New Zealand albino rabbits were divided into four groups. Four different doses of rapamycin were prepared in 0.1 ml: 20 µg, 50 µg, 200 µg, and 1000 µg. Each concentration was injected in one eye of three rabbits, and 0.1 ml volume of sterile BSS was injected into the contralateral eye of the three rabbits. Slit-lamp and fundoscopic examinations were performed and the animals were observed for 2 weeks for signs of infection, inflammation, and toxicity. A baseline ERG was performed before drug treatment and at day 14, after which the rabbits were euthanized. Histology of the enucleated eyes was studied to look for retinal toxicity. RESULTS: ERG results showed some decrease in scotopic response; however this was not dose related. ERG results were normal at 20 µg. Histological results showed no retinal toxicity in all groups. CONCLUSION: Although ERG changes were identified at dosages between 50-1000 µg, the histology of all groups up to 1000 µg did not show any discernable abnormalities.

OBJETIVO: Avaliar a toxicidade da injeção intravítrea de diferentes doses de rapamicina para a retina de coelhos. Rapamicina é uma potente droga imunossupressora aprovada clinicamente para a prevenção da rejeição de transplantes de orgãos. MÉTODOS: Doze coelhos albinos da Nova Zelândia foram usados neste estudo. Foram divididos em quatro grupos. Quatro diferentes doses de rapamicina foram preparadas nas seguintes concentrações: 20 µg, 50 µg, 200 µg, 1000 µg. Foram realizadas injeções intravítreas de 0,1 ml de cada concentração em um olho de três coelhos e 0,1 ml de solução salina foi injetada no olho contralateral de cada coelho. Foram realizadas biomicroscopia e fundoscopia e observamos sinais de inflamação, infecção ou toxicidade durante duas semanas. Fizemos um ERG antes do tratamento e outro 14 dias depois da injeção intravítrea. Os animais foram sacrificados, fizemos a enucleação dos olhos e preparamos o tecido para a avaliação histológica. RESULTADOS: Os resultados do ERG e da histologia demonstraram diminuição da resposta escotópica, entretanto essa diminuiçãão foi dose dependente. A histologia foi normal em todos os grupos. CONCLUSÃO: A injeção intravítrea de rapamicina levou a alterações eletrorretinográficas nos grupos de 50-1000 µg, entretanto a histologia foi normal em todos os grupos até 1000 µg.

Aqueous and vitreous penetration of oral cefixime and ciprofloxacin in rabbit eye

To investigate the penetration of cefixime and ciprofloxacin to the rabbit eye on the basis of microbial inhibition of aqueous and vitreous humour after oral administration. In this experimental study, 36 rabbits [72 eyes] were randomly divided into two groups; group A consisted of 20 rabbits and group B 16 rabbits. Each group was divided into four equal subgroups. The rabbits in each subgroup of group A received 4, 8, 12, and 20 mg/kg of syrup of cefixime every 12 hr respectively and the rabbits in each subgroup of group B received 20, 40, 60, and 80 mg/kg tablet of ciprofloxacin respectively every 12 hr. Immediately after the first dose of the drugs, the anterior chamber of one eye was irrigated randomly by 30-40 cc of ringer lactate solution alongside with mild traumatization of iris. Then by 4, 8, 12, 24 and 72 hr intervals after the 3rd dose, 0.1 cc of aqueous, 0.2-0.5 cc of vitreous, 3 cc of blood and one standard disk of the used antibiotic was placed on culture media of a known bacteria which was completely sensitive to the respective antibiotic. Forty eight hours later, the microbial inhibition zone of each sample and the standard disk of antibiotic were compared. No microbial inhibition was seen by sample of aqueous and vitreous, although very large zone of inhibition was seen by blood sample and standard disk of antibiotic. It seems that oral cefixime and ciprofloxacin do not produce an effective dose for microbial inhibition in rabbit eye

The effect of infliximab, cyclosporine A and recombinant IL-10 on vitreous cytokine levels in experimental autoimmune uveitis.

BACKGROUND: To identify the effect of infliximab, cyclosporine A and recombinant IL-10 in experimental autoimmune uveitis. MATERIALS AND METHODS: Sixty male rats were assigned to five groups of 12 each. All the groups (except the control group) were administered 30 microg retinal-S antigen intraperitoneally. On the 14th day, after confirmation of uveitis with histopathological study, daily cyclosporine A injection was given in cyclosporine A treatment group and physiological serum in the uveitis-induced placebo treatment and control groups. In the infliximab treatment group, infliximab was administered on the 14th, 15th, 17th, 19th and 21st days. In the recombinant IL-10 treatment group, three doses of recombinant IL-10 were given four hours and a half hours before and eight hours after retinal-S antigen administration. On the 21st day of the study, all rats were sacrificed and vitreous cytokine levels (IL-1, IL-6, IL-8 and TNF-alpha) were studied with ELISA. RESULTS: In the treatment groups, cytokine levels (IL-1, IL-6 and TNF-alpha) were significantly lower than the uveitis-induced placebo treatment group. Compared with the control group, there was no significant difference with respect to TNF-alpha and IL-8 in the infliximab treatment group; IL-8 in the cyclosporine A treatment group; IL-6 and IL-8 in the recombinant IL-10 treatment group. The drugs used did not significantly differ in respect to their effects on vitreous IL-6, IL-8 and TNF-alpha levels. CONCLUSION: Cyclosporine A, infliximab and recombinant IL-10 reduce the vitreous cytokines levels. Among these drugs, recombinant IL-10, which is still in its experimental phase, might be considered as a new therapeutic agent.

Avaliação clínica e incidência de endoftalmite infecciosa e não-infecciosa após injeção intravítrea de acetonida de triancinolona / Clinical characteristics and incidence of infectious and non-infectious endophthalmitis after intravitreous injection of triamcinolone acetonide

OBJETIVO: Relatar a incidência de endoftalmite infecciosa e não-infecciosa após injeção intravítrea de 4 mg de triancinolona (Kenalog® - 40 mg/ml; 0,1 ml) e avaliar aspectos clínicos relevantes para o diagnóstico diferencial entre estas duas entidades. Desenho: Estudo prospectivo não-concorrente. MÉTODOS: Foram analisados os prontuários de 121 pacientes (154 injeções) que, consecutivamente, foram submetidos à injeção intravítrea de triancinolona para o tratamento de diversas doenças coriorretinianas. Todas as injeções foram realizadas em centro cirúrgico em condições de assepsia e anti-sepsia, comuns às cirurgias oftalmológicas. RESULTADOS: Nenhum olho apresentou endoftalmite infecciosa. Dois olhos (1,29 por cento/injeção e 1,65 por cento/paciente) apresentaram endoftalmite não-infecciosa caracterizada pela observação, no primeiro dia pós-operatório, de baixa de acuidade visual, hiperemia, hipópio e reação inflamatória no vítreo. Estes dois olhos evoluíram com resolução do quadro inflamatório, após o uso de corticóide tópico e subconjuntival. CONCLUSÕES: Na presente série, nenhum olho apresentou endoftalmite infecciosa. A ocorrência de endoftalmite não-infecciosa após a injeção intravítrea de triancinolona é relativamente rara e, geralmente, pode ser diferenciada da endoftalmite infecciosa por meio da análise criteriosa das suas manifestações clínicas.

PURPOSE: To report the incidence of infectious and noninfectious endophthalmitis after intravitreal injection of 4 mg of triamcinolone acetonide (Kenalog® - 40 mg/ml; 0.1 ml) and to evaluate distinguishing characteristics that may assist the clinician in differentiating these entities. Design: Observational nonconcurrent prospective study. METHODS: Charts of 121 patients (154 injections) who consecutively underwent intravitreal injection of triamcinolone acetonide to treat various chorioretinal diseases were evaluated. All procedures were performed in an operating room with careful antiseptic protocol. RESULTS: Two eyes (1.29 percent/injection and 1.65 percent/patient) presented a noninfectious endophthalmitis characterized by decreased vision, hyperemia, hypopyon and vitreous inflammatory reaction, on the first day after the injection. These eyes were treated with topical and subconjunctival corticosteroids with complete resolution of the inflammatory reaction. CONCLUSION: In the present case series, no case of infectious endophthalmitis occurred. Despite being relatively rare, noninfectious endophthalmitis can be associated with intravitreal injection of triamcinolone simulating an infectious endophthalmitis. In selected cases, the differential diagnosis can be made solely by clinical evaluation.

Injeção intravítrea de triancinolona no tratamento da telangiectasia retiniana justafoveolar idiopática / Intravitreal triamcinolone injection in the treatment of idiopathic juxtafoveal telangiectasis

Relato de caso de um paciente com telangiectasia justafoveal idiopática (TJI) tipo 1A, no olho direito, submetido a 4 mg de triancinolona intravítrea. O resultado foi avaliado por meio da acuidade visual e da tomografia de coerência óptica. A acuidade visual e a espessura retiniana macular medida na tomografia de coerência óptica, antes da injeção intravítrea de triancinolona, foram respectivamente de 20/100 e 569 æm e, após três semanas do tratamento foram de 20/60 e 371 æm e na sexta semana de 20/100 e 614 æm. A estabilização da parede vascular obtida com injeção intravítrea de triancinolona proporciona melhora transitória da visão e do edema macular em olhos com TJI-1A. Não foi demonstrada nenhuma ajuda permanente à fotocoagulação prévia.

Case report of one idiopathic juxtafoveal telangiectasis (IJT) 1A patient whose right eye was treated with a 4 mg intravitreal triamcinolone acetonide injection. The outcome was evaluated by visual acuity and optic coherence tomography. The visual acuity and the caliper retinal thickness before triamcinolone injection were respectively 20/100 and 569 æm, and 20/60 and 371 æm after three weeks and 20/100 and 614 æm after six week of follow-up. The stabilization of the vascular wall due to the intravitreal triamcinolone injection leads to a transitory improvement in vision and reduction in macular edema in the TJI 1A eyes. No permanent help by the photocoagulation could be shown.

[Complications of triamcinolone intravitreal injection]

Intravitreal tnaincinolone acetonide has been used in numerous pathologies diabetic macular edema is one of them Our study is prospective including 20 eyes of diabetic patients with diabetic macular edema They underwent intravitreal injection of 4 mg of triamcinolone when visual acuity is under 3/10 Our aim is to describe the main complications noted High intraocular pressure was noted in 20% of cases but this elevation was transitory and controlled with topical medications in all patients. Lens opacification occurs also in 20% of our patients and interested among all posterior subcapsular but also cortical layers. We noted that half of the patients that presented high intraocular pressure developed cataract. None of our patients developed the other intraocular injection complications: no case of endophtalmitis or pseudohypopion, no retinal detachment or intravitreal hemorrhage, no case of cortisone crystals settling on the macular region. We think that these complications may not dissuade of practicing intravitreal injection of Triamcinolone

The high-dose, alternate-week intravitreal ganciclovir injections for cytomegalovirus retinitis in acquired immune deficiency syndrome patients on highly active antiretroviral therapy.

OBJECTIVES: To evaluate the efficacy, and complications of the high-dose, alternate-week, intravitreal ganciclovir injection for cytomegaloviral retinitis (CMVR) in acquired immune deficiency syndrome (AIDS) patients on highly active antiretroviral therapy (HAART). DESIGN: Retrospective case series. PARTICIPANTS: AIDS patients with CMVR and on HAART MATERIAL AND METHOD: The high-dose, 4 mg/0.1 ml, ganciclovir was injected intravitreally to the enrolled patients on an alternate-week basis. The patients were monitored clinically until the retinitis was inactive, then the injections were withdrawn. The injections were re-initiated if relapse occurred. MAIN OUTCOME MEASURES: The number of eyes achieved inactive retinitis and corresponded to the number of injections, number of relapses and corresponded duration, visual acuity during the injection, and complications of the injection. RESULTS: Inactive lesions were found in 42/51 eyes (82.40%), the corresponding mean number of injections was 5.4 (1-18) per eye. There was no relapse and the corresponded duration of follow-up was 5.1 months (1-16). The final visual outcomes were improved or stable in 26 eyes (50.9%). These visual outcomes were statistically related to initial visual acuity (p = 0.022) but not statistically related to the number of injections (p = 0.929). Complications were found in 7/51 eyes (13.7%). They were vitreous haze, immune recovery uveitis, rhegmatogenous retinal detachment, and infectious endophthalmitis. CONCLUSION: The high-dose, alternate-week, intravitreal injection of ganciclovir may be an alternative for the treatment of CMVR in AIDS patients who are on HAART However, the induction course is longer than the weekly regimen and close monitoring of patients is essential.

Treatment of cytomegalovirus retinitis in AIDS patients with intravitreal ganciclovir.

BACKGROUND: Cytomegalovirus (CMV) retinitis is the most common opportunistic ocular infection in AIDS patients, and frequently leads to blindness if untreated. Intravitreal ganciclovir proved to be effective in stopping the progression of the disease. OBJECTIVES: To determine the efficacy and complications of intravitreal ganciclovir (2 mg in 0.1 ml per injection) to control CMV retinitis. STUDY DESIGN: A retrospective non-randomized interventional case series. MATERIAL AND METHOD: The participants were 363 consecutive patients with CMV retinitis treated at the CMV Retinitis Clinic, Maharaj Nakorn Chiang Mai Hospital over the period from June 2001 to December 2003. The affected eyes received weekly intravitreal injections of 2 mg of ganciclovir until the lesions were inactive, then 2-4 weeks each time continuously or until relapse. If the lesions relapsed, then the weekly schedule was re-started. RESULTS: In 568 treated eyes at the time of last follow up, visual acuity remained stable in 343 (60%), improved in 76 (13%), and decreased in 149 (26%). Of these, 33 retinal detachments, 6 intravitreal hemorrhages, 6 endophthalmitis, and 2 cataract occurred. Bilateral disease occurred in 22% of patients who first came with unilateral involvement. CONCLUSION: Intravitreal ganciclovir appeared to be a worthwhile therapeutic alternative for CMV retinitis patients with unaffordable or intolerant to systemic anti-CMV therapy, but the complications of intravitreal injections should also be recognized.

Toxicidade retiniana do gás hexafluoreto de enxofre, líquido perfluorocarbono, ar e solução salina balanceada em olhos de coelhos / Sulfur hexafluoride gas, perfluorocarbon liquid, air and balanced salt solution retinal toxicity in rabbit eyes

OBJETIVOS: Determinar a toxicidade retiniana do gás hexafluoreto de enxofre, líquido perfluorocarbono e solução salina balanceada em olhos de coelhos. MÉTODOS: Foram analisados 22 olhos de 16 coelhos albinos da raça Nova Zelândia divididos em grupos: solução salina balanceada (7 olhos); hexafluoreto de enxofre (4 olhos), líquido perfluorocarbono (5 olhos) e controle (6 olhos). Após aspiração de 0,3 ml de humor vítreo, foi injetado a mesma quantidade de solução salina balanceada ou hexafluoreto de enxofre a 100 por cento ou líquido perfluorocarbono na cavidade vítrea. O grupo controle não foi submetido a nenhum procedimento. Três semanas depois o humor vítreo foi coletado para análise bioquímica e o olho enucleado para análise histológica. RESULTADOS: Os olhos dos animais que receberam injeção de hexafluoreto de enxofre e líquido perfluorocarbono mostraram significativo aumento da concentração vítrea de glutamato quando comparado aos grupos solução salina balanceada e controle (p<0,05). A análise histológica confirmou os achados bioquímicos mostrando alterações como disrupção do segmento externo dos fotorreceptores, afilamento das camadas plexiforme interna e externa, diminuição do número de núcleos na camada ganglionar e nuclear interna, edema e presença de macrófagos nas camadas superficiais. Estas alterações foram mais acentuadas no grupo líquido de perfluorocarbono em relação ao grupo hexafluoreto de enxofre. Não foram observadas alterações histológicas retinianas significativas nos grupos solução salina balanceada e controle. CONCLUSAO: A presença de gás hexafluoreto de enxofre e líquido perfluorocarbono na câmara vítrea se mostrou potencialmente tóxica para a retina de coelhos quando comparado ao grupo controle e solução salina balanceada.

Pseudohypopyon immediately after intravitreal injection of triamcinolone acetonide: case reports

Descrição de dois casos de pacientes submetidos à injeção intravítrea de acetonida de triancinolona (AT), que desenvolveram pseudo-hipópio transitório. Um paciente apresentava edema macular diabético clinicamente significativo com componente cistóide e o outro, com descolamento seroso de retina agudo com Vogt-Koyanagi-Harada, e ambos desenvolveram pseudo-hipópio com presença de depósitos de cristais no endotélio corneano; em um caso o pseudo-hipópio desapareceu espontaneamente em 24 horas, no outro caso o pseudo-hipópio teve duração de 2 dias. O pseudo-hipópio é importante sinal que pode ser observado após injeção intravítrea de AT, em pacientes fácicos, apresentando resolução espontânea sem complicações. Este pseudo-hipópio causado por depósitos de cristais de AT deve ser considerado diagnóstico diferencial para hipópio infeccioso associado a este tipo de tratamento.

Long-term Effect of Plasmin on the Vitreolysis in Rabbit Eyes

The aim was to investigate the proteolytic activity of plasmin and its long-term complications. Plasmin was injected into the vitreous cavity of rabbits' eyes. Slit lamp biomicroscopy and electroretinography were performed. Rabbits were serially sacrificed at four months, and globes fixated and prepared for light and transmission electron microscopy. In both the plasmin-injected and control eyes, electroretinography showed a transient decrease in the amplitude, but this recovered to the baseline level in a week. Under the light microscope, the plasmin-treated eyes had a smooth retinal surface, implying separation of the vitreous cortex from the retina. In the control eyes, the collagen fibers remained on the retinal surface. By transmission electron microscopy, the plasmin-treated eyes showed a vitreous-free retinal surface, but no vitreoretinal separation was observed in the control eyes. Plasmin induces a cleavage between the vitreous and the internal limiting membrane, with no long-term complications, so may be a useful pharmacologic adjunct to vitrectomy.

Role of prophylactic intravitreal antibiotics in open globe injuries.

PURPOSE: To determine the efficacy of prophylactic intravitreal antibiotics in reducing the incidence of endophthalmitis after trauma. METHODS: This was a prospective, randomised, case control study of 70 consecutive patients with open globe injury. The patients were prospectively randomised into group I (32 eyes) and group II (38 eyes). Group I patients were given prophylactic intravitreal injection of vancomycin 1 mg and ceftazidime 2.25 mg at the conclusion of primary repair. Group II patients were not given prophylactic intravitreal antibiotics. All the patients received intravenous ciprofloxacin. RESULTS: The incidence of endophthalmitis was higher in group II (7 of 38 eyes; 18.42%) compared to group I (2 of 32 eyes; 6.25%). Both the patients who developed endophthalmitis despite prophylactic intravitreal antibiotics in group I had an initially undetected intraocular foreign body (eyelash) in the vitreous cavity. CONCLUSIONS: Prophylactic intravitreal broad spectrum antibiotic injection decreases the risk of post-traumatic endophthalmitis.

Management of postoperative endophthalmitis: intravitreal antibiotics versus vitrectomy plus intravitreal antibiotics

This study comprises 20 cases of postoperative endophthalmitis following cataract surgery. Twelve patients were male and 8 female. Age of the cases varied from 40 to 82 years with a mean age of 54 years. Patients were distributed into two equal groups. Group I/[n=10] were given intravitreal antibiotics whereas group II underwent vitrectomy and intravitreal antibiotics at the time of surgery. Both the groups had postoperative supplement of topical fortified antibiotics as well as systemic I/V ceftazidine 1 gm bd from 7 to 12 days. In group I, seven out of 10 patients responded clinically and the visual recovery was from 3/60 to 6/24. Two patients had improvement of 1/60 while one patient did not improve from vision of HM. In group II, seven out of 10 patients showed visual recovery between 3/60-6/18. Two patients showed no improvement clinically, one patient had CRVO, while the other went into phthisis