Postoperative safety outcomes in patients undergoing routine Phacoemulsification Cataract Surgery with Intraoperative Intracameral Injection of Preservative-Free Moxifloxacin versus Levofloxacin

Purpose@#This study compared the safety outcomes of two intracameral fluoroquinolone antibiotics, moxifloxacin and levofloxacin, as prophylaxis treatment in eyes that underwent uncomplicated cataract surgery. @*Methods@#This is a prospective, double-masked, randomized, interventional, single-center clinical trial. Eyes with visually-significant cataracts underwent phacoemulsification and received preservative-free intracameral 0.5% moxifloxacin [58 eyes (M group)] or 0.5% levofloxacin [56 eyes (L group)] at the end of the surgery as antibiotic prophylaxis. The following safety parameters were evaluated postoperatively at Day 1, Week 1 and Month 1: central retinal thickness (CRT), macular volume (MV), central corneal thickness (CCT), and endothelial cell density (ECD). In-between group comparison was made at each of the 4 study visits using Student’s t-test. @*Results@#Both M and L groups had similar baseline characteristics. There were no significant differences in CRT, MV, CCT and ECD between the 2 groups at each time point in the study. There were no significant differences in the mean changes in CRT, MV, CCT and ECD from baseline to final visit between the 2 groups. No study-related adverse events were observed during the study period. @*Conclusion@#Intracameral application of preservative-free 0.5% moxifloxacin and 0.5% levofloxacin appear to have similar safety outcomes when used as antibacterial prophylaxis among eyes undergoing cataract surgery. Based on the results, both fluoroquinolone agents are potentially suitable options for endophthalmitis chemoprophylaxis.

Mitochondrial oxygen consumption by the foreskin and its fibroblast-rich culture

This study investigated the feasibility of using a phosphorescence oxygen analyser to measure cellular respiration [mitochondrial O[2] consumption] in foreskin samples and their fibroblast-rich cultures. Foreskin specimens from normal infants were collected immediately after circumcision and processed for measuring cellular respiration and for culture. Cellular mitochondrial O[2] consumption was determined as a function of time from the phosphorescence decay of the Pd [II] meso-tetra-[4-sulfonatophenyl]-tetrabenzoporphyrin. In sealed vials containing a foreskin specimen and glucose, O[2] concentration decreased linearly with time, confirming the zero-order kinetics of O[2] consumption by cytochrome oxidase. Cyanide inhibited O[2] consumption, confirming that the oxidation occurred mainly in the mitochondrial respiratory chain. The rate of foreskin respiration [mean +/- SD] was 0.074 +/- 0.02 microM O[2] min[-1] mg[-1] [n = 23]. The corresponding rate for fibroblast-rich cultures was 9.84 +/- 2.43 microM O[2] min[-1] per 10[7] cells [n = 15]. Fibroblast respiration was significantly lower in a male infant with dihydrolipoamide dehydrogenase gene mutations, but normalised with the addition of thiamine or carnitine. The foreskin and its fibroblast-rich culture are suitable for assessment of cellular respiration. However, the clinical utility of foreskin specimens to detect disorders of impaired cellular bioenergetics requires further investigation

Refractive errors in Filipino eyes in a single-center study population

Objective@#We determined the frequency of refractive errors among Filipino patients undergoing refractive or cataract screening at an ambulatory eye-care center, correlated them with demographic and ophthalmic variables, and compared refractive and keratometric astigmatism.@*Methods@#Clinical records of 666 consecutive patients who had optical interferometry were reviewed and the demographic and clinical parameters obtained were subjected to statistical analyses.

Refractive errors in Filipino eyes in a single-center study population

Objective We determined the frequency of refractive errors among Filipino patients undergoing refractive or cataract screening at an ambulatory eye-care center, correlated them with demographic and ophthalmic variables, and compared refractive and keratometric astigmatism. Methods Clinical records of 666 consecutive patients who had optical interferometry were reviewed and the demographic and clinical parameters obtained were subjected to statistical analyses. Results The mean axial length (AL) was 24.43 ± 1.56 mm, significantly shorter among females (p < 0.001). Axial length (AL) was also inversely correlated with age (r = –0.50). Mean sphere was –1.3 ± 3.4D, and correlated with age (r = 0.57); younger age groups had higher negative values. Myopia was the major refractive-error type (90 to 100%) in the 17- to 30-year-old age bracket. Hyperopia was the predominant refractive error (50 to 75%) among the elderly. The mean keratometry reading was 44 ± 1.5D. Females had steeper K readings than males (p = 0.000). Refractive astigmatism was observed in 47.88% and keratometric astigmatism in 71.7%. Against-the-rule (ATR) was the prevalent type (46.1%) in refractive astigmatism and with-the-rule (WTR) (59.1%) in keratometric astigmatism. Conclusion In the older population, AL was shorter and hyperopia was more prevalent; in the younger population, myopia was more prevalent. Astigmatism did not differ between gender groups but differed among age groups. WTR astigmatism was more prevalent in the younger age group and ATR in the elderly.

Pegaptanib sodium for macular edema due to retinal-vein occlusion among patients intolerant to intravitreal triamcinolone acetonide

Objective@#To report the efficacy and safety of intravitreal pegaptanib sodium (IVP) on macular edema (ME) due to branch retinal-vein occlusion (BRVO) among patients intolerant to intravitreal triamcinolone acetonide (IVTA). @*Methods@#Four eyes with ME due to BRVO were included in this interventional case series. The main outcome measures were best-corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure (IOP), and adverse effects.@*Results@#There was a significant decrease in mean CMT from 524.50 ± 141.12 to 293.75 ± 130.75 microns (p = 0.009) after IVP injection. BCVA improved in all 4 eyes after IVP. Mean IOP after IVP was 13.60 ± 3.21. No ocular or systemic complications were observed.@*Conclusion@#IVP appears to be safe and effective in decreasing retinal thickness and improving VA in eyes with ME due to BRVO. IVP is a potential treatment for eyes that are intolerant to IVTA.

Rapid visual recovery after inadvertent embolization of retinal arterioles with triamcinolone acetonide

@#Objective To describe a case of acute visual loss due to retinal arteriolar embolization caused by transeptal triamcinolone-acetonide injection, with rapid visual recovery following immediate intervention. Methods This is a case report. Results A 39-year-old female developed loss of vision (no light perception) after transeptal triamcinolone-acetonide injection. Examination revealed yellowish, particulate emboli within the retinal arterioles. Strategies to relieve the obstructed vessel (anterior-chamber paracentesis, intraocular-pressurelowering medications, and ocular massage) were immediately performed. Full recovery of vision occurred within 24 hours. Conclusion Retinal vascular embolization should be suspected when there is loss of vision after corticosteroid injection. Immediate ocular decompression may lead to rapid improvement and favorable visual outcomes.

Caffeine impairs HL-60 cellular respiration

We investigated the effect of caffeine on mitochondrial O[2] consumption in human promyelocytic leukemia [HL-60] cells. A phosphorescence analyzer that measures O[2] concentrations in cell suspensions as function of time was used for this purpose. O[2] concentrations were determined from the phosphorescence of Pd phosphor, calculated by fitting the phosphorescence decays to exponentials. In sealed vials, O[2] concentrations in the cell suspensions containing glucose declined linearly with time, showing zero-order kinetics for O[2] consumption. NaCN inhibited O[2] consumption, confirming the oxidation occurred in the mitochondrial respiratory chain. A rapid decline in the rate of respiration was observed when 50 [micro]M to 4.0 mM caffeine was added to HL-60 cells in cell growth media [containing 1.41 mM Ca[2+]] or phosphate-buffered-salts [containing 0.91 mM Ca[2+]]. This reversible inhibition was blocked by verapamil and was concentration-dependent, reaching a plateau [43 +/- 7% inhibition] at 50 [micro]M caffeine. The inhibition was not observed when cellular Can+ stores were depleted. T-cell lymphoma [Jurkat] cells and isolated mitochondria were less sensitive to caffeine. Thus, caffeine is a potent inhibitor of HL-60 respiration. This effect is possibly mediated by Ca[2+]-flooding into the cytosol and neighboring mitochondria

Subconjunctival injection of bevacizumab for treatment of pterygium

@#Objectives This study determined the biologic effect and safety of subconjunctival administration of bevacizumab in patients with primary and recurrent pterygium. Methods We conducted an off-label, multiple-dosing, interventional case series involving 15 patients with primary and recurrent pterygium. They received subconjunctival bevacizumab (1.25 mg) every 2 weeks for 10 weeks. Pterygium vascularity and thickness were graded (1 for atrophic, 2 for intermediate, and 3 for fleshy) by 3 masked observers. The size of the pterygium (measured by surface area in cm2) was recorded from baseline to 16 weeks postinjection. Treatment-related complications and adverse events were reported. The main outcome measures were changes in pterygium size, vascularity, thickness, and treatment safety. Results There was no statistically significant difference in the mean surface area of the pterygia at different intervals (p > 0.05). The mean surface area was 1.22 ± 0.19 cm2 at baseline, 1.22 ± 0.18 cm2 and 1.22 ± 0.17 cm2 at 10 and 16 weeks postinjection respectively. There was a significant difference in the mean pteygium grading by the 3 masked observers at different intervals (p < 0.01). At baseline, there were 11 patients (73.3%) with grade 2 pterygium and 4 (26.7%) with grade 3. At 1.5 months postinjection, there were 5 (33.3%) with grade 1 pterygium, 7 (46.7%) with grade 2, and 3 (20%) with grade 3. The 5 patients with grade 1 pterygium at the end of the study period had a baseline pterygium grading of 2. Snellen visual acuity, refraction, intraocular pressure, and blood pressure remained stable. No serious ocular or systemic side effects were observed. Conclusion Subconjunctival injection of 1.25 mg of bevacizumab given every 2 weeks for 10 weeks resulted in no significant change in size of the pterygium. However, local application of bevacizumab showed promise in inducing regression in pterygium vascularity and thickness. Further evaluation of bevacizumab for the treatment of pterygia is warranted.

Intravitreal bevacizumab for neovascular age-related macular degeneration

Objectives@#Anti-vascular endothelial growth factor (anti-VEGF) drugs delivered intravitreally have been proven effective and safe for the treatment of patients diagnosed with neovascular age-related macular degeneration (ARMD). This study evaluated the short-term biologic efficacy and safety of multiple intravitreal injections of bevacizumab in patients with neovascular ARMD.@*Methods@#A prospective, interventional, placebo-controlled, randomized clinical trial was done involving patients with active subfoveal neovascular ARMD. Excluded were patients with significant media opacity, concomitant retinal/ocular diseases, previous intravitreal injections, recent laser treatment or intraocular surgery, and contraindications to the drug. Demographic data were taken and a complete ocular examination, fluorescein angiogram (FA), and optical coherence tomogram (OCT) were performed. Patients received either 3 monthly intravitreal injections of 1.25mg bevacizumab or sham injections. Best-corrected visual acuity (BCVA) and central macular thickness were recorded at baseline, 2, 4, 8, and 12 weeks follow-up. Ocular/Periocular or systemic drug-related side effects or toxicities and iatrogenic complications were noted.@*Results@#Thirty eyes (15 per group) were included in the final analysis. Both treatment and control groups were comparable in baseline characteristics. There was a significant increase in the mean visual acuity (p < 0.001) in eyes treated with bevacizumab across all time periods. The average gain at the end of the study was 11.6 letters. This paralleled a similar significant decrease in central macular thickness for the treatment group (p < 0.02). No major ocular adverse events were noted.@*Conclusion@#This study supported the growing body of evidence that intravitreal injections of bevacizumab 1.25 mg result in short-term anatomical as well as functional improvement with minimal adverse events in patients with neovascular ARMD.

Comparison of preoperative anti-infective preparations for extracapsular lens extraction

Objective: To investigate the effect of three preoperative anti-infective regimens on the sterility of anterior-chamber aspirates (ACA) in eyes undergoing extracapsular cataract extraction (ECCE). Methods: Ninety eyes scheduled to undergo ECCE were randomly assigned to receive one of the following preoperative anti-infective regimens: Group 1 (Control) - no additional preoperative preparation; Group 2 (Eye drop) - neomycin/ polymixin B/gramicidin eye drops applied 3 times daily for 3 days prior to surgery; and Group 3 (Lid scrub) - neomycin/polymixin B/ bacitracin ointment lid scrub applied 3 times prior to surgery. ACAs were obtained from all eyes at the conclusion of surgery and cultured. The patients were followed up for 3 months after the surgery. Results: Positive cultures developed from ACAs in 5 (16.6 percent) of 30 eyes from Group 1, in 0 of 30 from Group 2, and in 3 (10 percent) of 30 from Group 3. No eye developed endophthalmitis. Compared with the control group, preoperative neomycin/polymixin B/gramicidin eye drops significantly reduced the ACA contamination rate (p= 0.03). Conclusion: Preoperative neomycin/polymixin B/bacitracin eyedrops can improve the sterility of the anterior chamber during ECCE.

Multicenter survey of badminton-related eye injuries

Objective: To determine the patient profile and risk factors for badminton-related eye injuries in Metro Manila. Methods: We conducted a cross-sectional survey of badminton-related eye injuries in Metro Manila. A survey form was sent to 13 ophthalmologists who were asked to report on patients treated for badminton-related eye injuries from July 1 to December 1, 2004. The following data were collected: patient age, gender, and sports experience; details of eye injury; use of protective eyewear; and visual outcomes. Logistic regression analysis was performed to predict sight-threatening injuries. Results: The average patient age was 34.7 +/- 6.2 years (range 18 to 46). There were more males than females (1.55:1). All patients sustained eye injury while playing doubles. None of the patients were wearing protective eyewear at the time of injury. Blunt trauma due to shuttlecock impact was the cause of injury in 74 % of cases. The most common ocular findings were iridocyclitis (n = 11), secondary glaucoma (n = 6), and hyphema (n = 5). Twenty-nine sight-threatening conditions were reported. Six (26 %) patients developed chronic ocular sequelae. Conclusion: Sight-threatening injuries can occur in individuals playing badminton. While vision loss is uncommon, treatment outcomes are generally good. Since all injuries were sustained without the use of protective eyewear, ophthalmologists have a responsibility to promote its use when playing badminton.

Frosted-branch angiitis

OBJECTIVE: To report a case of frosted-branch angiitis. METHOD: This is a case report of frosted-branch angiitis seen at the University of the Philippines-Philippine General Hospital. RESULTS: A 42 year-old male presented with progressive blurring of vision of the left eye. Indirect funduscopy showed dilated retinal veins with perivascular sheathing, giving the appearance of frosted-branches of a tree. CONCLUSION: Frosted-branch angiitis is a rare form of retinal vasculitis with various etiologies. Despite the severe retinal appearance, the prognosis is usually good, with rapid recovery of visual acuity after prompt steroid treatment.

Patterns of uveitis in a Philippine eye clinic

OBJECTIVE: To describe the distribution and clinical characteristics of endogenous uveitis among patients in a Philippine eye clinic. METHODS: The demographic and clinical data of 103 uveitis patients consulting at the Asian Eye Institute over an 18-month period were analyzed and compared with a previous report. RESULTS: The mean age at consultation was 43 +/- 17 years (range 5 to 83). The maleto-female ratio was 1:1.3. The racial distribution consisted of Malay (77 %), Chinese (22%), and Indian (1%). Forty-one patients (40%) presented with anterior uveitis, 15 (15%) with intermediate uveitis, 19 (18 %) with posterior uveitis, and 28 (27%) with panuveitis. The most frequent diagnoses were idiopathic anterior uveitis (24 %), pars planitis (14 %), multifocal choroiditis and panuveitis (9 %), Vogt-Koyanagi-Harada syndrome (9 %), and Behcets disease (8%). Long-term systemic therapy was needed for control of uveitis in 66 (64%) patients. Twenty patients (20 %) developed sight-threatening ocular complications. Twelve patients (12%) with panuveitis became bilaterally blind. CONCLUSIONS: The patterns of uveitis in the Philippines have markedly changed over the past 2 decades. Significant rates of ocular complications and blindness were found in this series, particularly among patients with panuveitis. These patients should be treated aggressively with corticosteroids and long-term immunosuppressive therapy.

Preseptal and orbital cellulitis at the Philippine General Hospital

OBJECTIVE: To describe the clinical features, causative agents, management practices, and outcomes of preseptal and orbital cellulitis at a tertiary-care center in a developing country. METHODS: This is a retrospective case series of preseptal and orbital cellulitis seen at the Orbit Clinic of the Philippine General Hospital from January 1990 to December 1995. The medical records were reviewed and the following data obtained: age, gender, manner of disease presentation, causative agent, medical interventions, and outcomes. RESULTS: Fifty-six patients with preseptal cellulitis and 35 with orbital cellulitis were identified. Among the patients with preseptal cellulitis, the mean age at presentation was 12.6 +/- 17.0 years. No gender predilection was observed. The most common presenting signs were lid swelling (all patients), eye redness (34 %), fever (29%), and eye discharge (27 %). Bilateral involvement occurred in 9 patients. Among those with orbital cellulitis, 25 were classified as orbital cellulitis, 5 as orbital abscess, and 5 as cavernous sinus thrombosis. There were slightly more females than males (1.3:1). The mean age at presentation was 17.1 +/- 18.6 years. The most common symptoms were lid swelling (94 %), ophthalmoplegia (89 %), chemosis (77%), proptosis (71%), and decreased vision (51%). Both conditions were associated with antecedent infectious conditions such as skin and lid infection, sinusitis, dental abscess, respiratory-tract infection, and trauma. Staphylococcus was the most common organism isolated. The most common initial antibiotics used were beta-lactamase-resistant penicillins. Other antibiotics were added based on clinical response and microbial studies. Orbital cellulitis was associated with sight threatening complications such as glaucoma, retinal vascular occlusion, exposure keratitis, and optic-nerve compression. CONCLUSIONS: The etiology of preseptal and orbital cellulitis in this series differs from that in developed countries. Preseptal and orbital cellulitis should be distinguished early so that proper management can be instituted. Orbital cellulitis is associated with greater mortality and morbidity. CT scan and microbial studies are invaluable for appropriate diagnosis and management of orbital cellulitis.

The cost-effectiveness of management of Filipino patients with chronic primary glaucoma in a tertiary charity hospital setting

Chronic primary glaucoma affects sight very quietly - until such time that the progression of the disease is considerably advanced. The search for the ideal therapeutic approach to the disease can only provide, at best, for the arrest of the damage to the optic nerve head by bringing down the intraocular pressure to a level low enough to elude harm. Patients afflicted with the disease are bound to a therapy of a lifetime. This has implications of understated proportions in the economic scenario of a developing country. This study is conceived to determine the cost-effectiveness of chronic primary glaucoma management. A cross-sectional study design is employed to answer this objective. Medical records of 290 study eyes of 148 patients with chronic primary glaucoma (aged 14 - 88 years) are evaluated for cost-effectiveness of therapy. Results have shown that on one hand, medical therapy has a mean annual cost of PhP 5,830.00 + 278.00. On the other hand, surgical therapy has a one-time mean annual cost of PhP 8,100.00 + 359.00.Comparing cost-effectiveness using analysis of covariance (ANCOVA), one finds that filtering surgery is at least twice more cost effective than medical management (p0.001). Surgical complications, however, may hamper the effectiveness of filtering surgery. The study recommends that young patients with advanced disease and with higher IOP at the time of consult could be served more efficiently with a filter, whereas elderly patients approaching their life expectancy who can comply with the demands of effective medical management may not benefit much from it.

Tersons syndrome as a prognosticating factor in aneurysmal subarachnoid hemorrhage

This is a descriptive study of Tersons syndrome among patients with aneurysmal subarachnoid hemorrhage at the Philippine General Hospital. The incidence of Tersons syndrome was 13.4 percent. There were no statistically significant differences in outcomes among patients with and without Tersons syndrome. (Author)

Colecistocolangiografía transhepática percutánea en pediatría / Pecotaneous transhepatic cholecystcholangiography in childhood

En algunos casos para llegar a un diagnóstico de colestasis en pacientes pediátricos se requiere un estudio radiológico con una buena opacificación de la vía biliar, aún en ausencia de dilatación de los conductos biliares. En 29 niños , entre 50 días y 15 años,con colestasis clínica y/o tumoral, se realizó , bajo guía ecográfica colecistocolangiografía transhepática percutánea, sin complicaciones significativas.Once fueron estudios normales,7 permitieron diagnosticar colangitis esclerosante;4 litiasis biliar (en 2 de ellos con "litiasis primaria" siendo el procedimiento terapeútico ); 3 casos de canal común,en uno atresia de vías biliares y otros 2 presentaron amputación de la vía biliar.En un paciente , la vía biliar no se opacificó satisfactoriamente.