Efficacy of local conjunctival immunotherapy in allergic conjunctivitis.

Background: Allergic conjunctivitis was a chronic inflammatory disease, usually associated with rhinitis. Several modalities of treatment were available, but few studies mentioned of immunotherapy which might had benefits in chronic and severe cases. Objective: To evaluate efficacy and safety of local conjunctival immunotherapy (LCIT) using a mixed Dermatophagoides extracts for treatment of allergic conjunctivitis (AC) Methods: A prospective, double-blind and randomized controlled trial (RCT) was performed on eighteen patients with positive skin prick test (SPT) reactions to house dust mites. They were randomized into 2 groups: 1) treated with LCIT and 2) treated with balanced salt solution (BSS) as a control for a 6-month period. Allergen extracts were prepared in eyedrops and given once daily in LCIT group. Efficacy was assessed by clinical scores and conjunctival provocation test (CPT). Results: At 6 months, the CPT scores for the LCIT group reached statistical significance compared to the control group (p = 0.038), but there were no statistically significant differences in signs (p = 0.591), symptoms (p =0.885) and medication scores (p = 0.338) between both groups. Patients in LCIT group were able to tolerate the allergen without developing any serious adverse events. Conclusion: LCIT treatment significantly reduced CPT scores which indicated that the patients were able to tolerate the antigen better than their counterparts. However, LCIT alone at short period did not alleviate symptoms and signs of allergic conjunctivitis from multiple allergens.

Clinical evaluation of ophthalmic lomefloxacin 0.3% in comparison with fortified cefazolin and gentamicin ophthalmic solutions in the treatment of presumed bacterial keratitis.

OBJECTIVE: To evaluate the efficacy and safety of 0.3% lomefloxacin single agent solution, by comparing to a combination of fortified ophthalmic solutions of cefazolin sodium 50 mg/ml and gentamicin sulfate 14 mg/ml, in the treatment of acute bacterial keratitis. DESIGN: Prospective, double-masked, randomized comparative trial. METHOD: Forty patients with clinical diagnosis of any grade of severity of acute bacterial keratitis were randomized into 2 treatment groups: 20 to fortified cefazolin-gentamicin group, and 20 to lomefloxacin-normal saline group. The dosing of the drugs were scheduled for both treatment groups as follows: 1 drop of each solution was alternately instilled every 5 minutes for the first 30 minutes (as loading dose), then 1 drop with 5-minute interval between 2 bottles instilled hourly for day 1-3, tapering to every 2 hours on day 4-6, and every 4 hours on day 7-14. After day 14, dosing discretion was clinically adjusted, based on the clinical condition and finally discontinued after complete healing. Corneal scraping for cultures was obtained before starting the treatment. Ocular symptoms and signs, time to heal and adverse reactions were evaluated and compared between the 2 groups on day 2, 4, 7, 14, 21 and 28. RESULTS: No clinically or statistically significant difference were noted between two treatment groups, regarding demographic, symptoms and signs associated with bacterial keratitis. Positive results of bacterial corneal cultures were obtained in 27.5%. There was no statistically significant difference in time to complete re-epithelialization in all types of bacterial keratitis (P=0.251). By day 7, the keratitis was healed: 44% in lomefloxacin group, and 33% in fortified antibiotic group. Both study medications were well-tolerated, with no incidence of reported adverse event. CONCLUSION: In this study, eventhough there is no statistically significant difference of symptoms and signs between the two study groups at any study visit, we found clinical improvement in all patients in lomefloxacin group. So, lomefloxacin may be used as an alternative to standard treatment in acute bacterial keratitis.

Infectious keratitis at King Chulalongkorn Memorial Hospital: a 12-year retrospective study of 391 cases.

A retrospective study of 391 severe infectious keratitis admitted to King Chulalongkorn Memorial Hospital from January 1988 to December 2000 were analyzed. Most patients came from the central part of Thailand. There were 2 bimodal peak incidence distributions which fell in the age group 21-30 and 51-60 years of age. The most common predisposing to corneal ulceration was trauma from several materials, including leaves, branches, dust and stone, which accounted for 47.82 per cent. Culture results were collected 74.68 per cent (292/391). The data showed negative culture results of 52.74 per cent (154/292), positive results occurred in 47.26 per cent (138/292); including bacteria 32.53 per cent (95/292), fungus 11.64 per cent (34/292), virus 2.05 per cent (6/292) and mixed organism 1.02 per cent (3/292). Pseudomonas aeruginosa was the most common bacteria isolated; 47 per cent. The second most common was Streptococcus pneumoniae which accounted for 9 per cent. Fusarium spp was the most common fungus found (34.29%); Aspergillus and Curvularia spp were the next (20.0% each). Herpes simplex was the most common virus isolated; 83.3 per cent. The treatment of infectious keratitis included application of topical/intraocular injection of antimicrobial agent and surgery, which accounted for 184 cases. Penetrating keratoplasty was the most common surgery performed, 34.24 per cent (63/184), followed by evisceration and enucleation accounted for 25 per cent (46/184).