ABSTRACT
Introducción y objetivos Investigamos si la autoadministración de riboflavina por parte de los pacientes podría ser una opción viable para el cross-linking corneal (CXL), teniendo en cuenta los importantes recursos necesarios para la impregnación de la córnea. Analizamos si administrar la riboflavina en el fórnix inferior (lugar de autoadministración) resulta en concentraciones de riboflavina no menores a cuando se aplica directamente en la córnea (zona de aplicación por personal médico). Pacientes y métodos Realizamos un estudio prospectivo para evaluar las concentraciones de riboflavina en seis puntos de tiempo (basal, cinco, 15, 30, 45 y 60 minutos) en 18 voluntarios para cada uno de los dos lugares de aplicación: córnea y fórnix. Las concentraciones de riboflavina (Peschke® TE 0,25%; Peschke Trade GmbH, Huenenberg, Suiza) en la cámara anterior fueron medidas por fluorofotometría (FluorotronTM Master FM-2; OcuMetrics Inc., Mountain View, CA, EE. UU.). Resultados En los dos lugares de aplicación, córnea y fórnix, se observó una autofluorescencia de 16,7 ng/mL (desviación estándar [DE] 5,5) y 14,6 ng/mL (DE 4,6) al inicio de la serie de mediciones (p = 0,221). Después de 30 minutos, las concentraciones de fluorescencia en la cámara anterior habían aumentado a 55,1 ng/mL (DE 25,5) y a 46,1 ng/mL (DE 25,1) (p = 0,293) sin un incremento relevante adicional a los 60 minutos. Conclusiones Este estudio encontró que la aplicación de gotas de riboflavina en el fórnix inferior no fue menor a la aplicación directa en la córnea, según las mediciones fluorométricas de las concentraciones de riboflavina en la cámara anterior. Sugiere que la autoadministración es viable en términos de impregnación corneal de riboflavina (AU)
Introduction and objectives We investigated whether riboflavin self-administration by patients could be a feasible option for corneal cross-linking, given the considerable resources required to impregnate the cornea with riboflavin. We analysed whether administering riboflavin in the inferior fornix (the site of self-administration) results in non-inferior riboflavin concentrations as when applied directly on the cornea (the site of administration by medical personnel). Patients and methods We conducted a prospective study to evaluate riboflavin concentrations at six time-points (baseline, 5, 15, 30, 45 and 60min) in 18 healthy volunteers for each of two application sites: cornea and fornix. Anterior chamber riboflavin (Peschke® TE 0.25%) concentrations were measured by fluorophotometry (Fluorotron Master FM-2). Results For the two application sites cornea and fornix, participants did not differ in terms of age and sex. At baseline, the autofluorescence in the anterior chamber was 16.7ng/ml (SD 5.5) and 14.6ng/ml (SD 4.6) (p=0.221). After 30min, anterior chamber fluorescein concentrations had risen to 55.1ng/ml (SD 25.5) and 46.1ng/ml (SD 25.1) (p=0.293) without a further relevant increase by 60min. Conclusions This study found that applying riboflavin drops in the inferior fornix was non-inferior to applying it directly to the cornea, based on fluorophotometric measurements of anterior chamber riboflavin concentrations. This suggests that self-application of riboflavin is feasible in terms of corneal riboflavin impregnation (AU)
Subject(s)
Humans , Riboflavin/administration & dosage , Riboflavin/analysis , Vitamin B Complex/administration & dosage , Fluorophotometry , Cornea/chemistry , Prospective Studies , Self AdministrationABSTRACT
INTRODUCTION AND OBJECTIVES: We investigated whether riboflavin self-administration by patients could be a feasible option for corneal cross-linking, given the considerable resources required to impregnate the cornea with riboflavin. We analysed whether administering riboflavin in the inferior fornix (the site of self-administration) results in non-inferior riboflavin concentrations as when applied directly on the cornea (the site of administration by medical personnel). PATIENTS AND METHODS: We conducted a prospective study to evaluate riboflavin concentrations at six time-points (baseline, 5, 15, 30, 45 and 60min) in 18 healthy volunteers for each of two application sites: cornea and fornix. Anterior chamber riboflavin (Peschke® TE 0.25%) concentrations were measured by fluorophotometry (Fluorotron™ Master FM-2). RESULTS: For the two application sites cornea and fornix, participants did not differ in terms of age and sex. At baseline, the autofluorescence in the anterior chamber was 16.7ng/mL (SD 5.5) and 14.6ng/mL (SD 4.6) (P=.221). After 30min, anterior chamber fluorescein concentrations had risen to 55.1ng/mL (SD 25.5) and 46.1ng/mL (SD 25.1) (P=.293) without a further relevant increase by 60min. CONCLUSIONS: This study found that applying riboflavin drops in the inferior fornix was non-inferior to applying it directly to the cornea, based on fluorophotometric measurements of anterior chamber riboflavin concentrations. This suggests that self-application of riboflavin is feasible in terms of corneal riboflavin impregnation.
Subject(s)
Cornea , Riboflavin , Humans , Fluorophotometry , Prospective Studies , Anterior ChamberABSTRACT
Background This review reports the epidemiology, laboratory results, treatment regimens and costs of fungal keratitis at a tertiary referral center in Lucerne, Switzerland. Patients and Methods Culture-proven fungal infections between January 2010 and December 2015 were reviewed retrospectively. Results Seventeen patients with a mean age of 52 years were identified. Contact lens wear was the most important risk factor (n = 11) (65â% of all cases), with filamentous fungi being identified as the most common fungus type (n = 10) (91â% of all cases of contact lens-associated fungal keratitis). All non-contact lens-associated fungal infections (n = 6) (35â% of all cases) were related to Candida spp. Six patients (35â%) were treated on an outpatient basis; 11 cases (65â%) required hospitalisation. Systemic voriconazole was the treatment regimen prescribed most often (n = 12) (71â%), followed by topical natamycin 5â% (n = 11) (65â%). Corneal crosslinking and penetrating keratoplasty were required in 4 cases each (24â%). One case ended up in enucleation (6â%). Average costs per case were EUR 15â952 for hospitalised patients if surgical intervention was required, and EUR 7415 if no intervention was performed. Average costs for outpatients were EUR 7079. In a majority of cases, visual acuity could be improved (n = 9) (53â%) or preserved (n = 2) (12â%). Conclusion Despite the relatively low incidence of culture-proven keratitis (17 cases in 6 years), a clear pattern with regard to risk factors and fungus species was noted. In the absence of a gold standard for the treatment of fungal keratitis, the combination of systemic voriconazole and topical natamycin seems to be one of the most commonly used antifungal treatment regimens. The costs of outpatient versus inpatient non-surgical treatment were approximately the same.
Subject(s)
Contact Lenses/economics , Eye Infections, Fungal/economics , Eye Infections, Fungal/therapy , Health Care Costs/statistics & numerical data , Keratitis/economics , Keratitis/therapy , Tertiary Care Centers/economics , Adult , Aged , Antifungal Agents/economics , Antifungal Agents/therapeutic use , Contact Lenses/statistics & numerical data , Eye Infections, Fungal/epidemiology , Female , Humans , Incidence , Keratitis/epidemiology , Keratoplasty, Penetrating/economics , Keratoplasty, Penetrating/statistics & numerical data , Male , Middle Aged , Risk Factors , Switzerland/epidemiology , Tertiary Care Centers/statistics & numerical dataSubject(s)
Anti-Inflammatory Agents/administration & dosage , Eye Foreign Bodies/complications , Eye Foreign Bodies/surgery , Keratitis/drug therapy , Keratomileusis, Laser In Situ/adverse effects , Adult , Device Removal/adverse effects , Humans , Keratitis/etiology , Keratitis/pathology , Male , Treatment OutcomeSubject(s)
Ascorbic Acid/administration & dosage , Burns, Chemical/drug therapy , Eye Burns/chemically induced , Eye Burns/drug therapy , Plant Extracts/poisoning , Tear Gases/poisoning , Tetracycline/administration & dosage , Anti-Bacterial Agents/administration & dosage , Antioxidants/administration & dosage , Burns, Chemical/diagnosis , Burns, Chemical/etiology , Drug Therapy, Combination , Eye Burns/diagnosis , Humans , Male , Middle Aged , Ophthalmic Solutions/administration & dosage , Treatment OutcomeSubject(s)
Ciliary Body/injuries , Ciliary Body/pathology , Eye Injuries, Penetrating/pathology , Ocular Hypotension/diagnosis , Ocular Hypotension/etiology , Wounds, Gunshot/pathology , Child , Eye Injuries, Penetrating/drug therapy , Humans , Male , Ocular Hypotension/drug therapy , Ophthalmic Solutions/therapeutic use , Treatment Outcome , Wounds, Gunshot/drug therapyABSTRACT
PURPOSE: To compare the effect, failure rate and the risks of corneal cross-linking (CXL) in keratoconus patients aged ≥35 years to patients <35 years. METHODS: In 141 eyes of 116 keratoconus patients we compared the changes in best phoropter-corrected visual acuity (BCVA) and maximum keratometry values (Kmax) before and 12 months after CLX in patients aged ≥35 years (n=34, 38 eyes) to the cohort of patients below 35 years of age. RESULTS: Overall, CXL significantly improved BCVA from 0.487 logMAR (95% confidence interval (CI) 0.426-0.548) by -0.197 logMAR (95% CI -0.243 to -0.150; P<0.001) and reduced Kmax from 48.96 diopter (Dpt) by -1.33 Dpt (95% CI -1.85 to -0.81: P<0.001). Age ≥35 years had no effect on the changes of BCVA (-0.02 (95% CI -0.13 to 0.09); P=0.757) or Kmax (0.58 (95%CI -0.51 to 1.68); P=0.294) as compared with younger patients. In 54 patients (55 eyes, 38.5%) aged <35 years and in 18 patients (18 eyes, 47.4%) aged ≥35 years, BCVA increased by ≥2 Snellen lines. Failure (increase in Kmax ≥1 Dpt) was observed in 17 eyes (16.5%) of patients aged <35 years and in 3 eyes (7.9%) of patients aged ≥35 years during the 12-month follow-up period. Adverse outcomes (loss of ≥2 Snellen lines) occurred in 4 (3.9%) eyes of patients aged <35 years and 1 (2.6%) eye of a patient aged ≥35 years. CONCLUSION: Effects and adverse events of CXL treatment do not seem to differ between subjects younger or older than 35 years.