Evaluation of diclofenac sodium 0.1% ophthalmic solution in the treatment of ocular symptoms after bilateral radial keratotomy.

PURPOSE: Patients frequently have ocular pain, photophobia, foreign-body sensation, and burning/stinging after radial keratotomy. This study was a prospective, randomized, double-masked, multicenter, fellow-eye comparison of diclofenac sodium (Voltaren Ophthalmic, 0.1% solution) and placebo for controlling these ocular symptoms after bilateral radial keratotomy. METHODS: Patients who were pain free in both eyes before surgery were randomly assigned to treatment with diclofenac sodium in one eye and placebo in the other. One drop of each masked trial medication was administered 30-60 min before surgery, 5 min and 6 h after surgery, at bedtime on the day of surgery, and four times daily for 2 additional days. Patients evaluated ocular symptoms in each eye 0.5, 1, 2, 4, 6, 24, and 48 h after surgery and provided a global evaluation 6, 24, and 48 h after surgery. For each assessment, the difference in scores between eyes was analyzed by using a paired t test. RESULTS: Diclofenac sodium was significantly (p < 0.001) superior to placebo in controlling each ocular symptom at each interval after surgery and for patient global assessments 6, 24, and 48 h after surgery. CONCLUSION: Diclofenac sodium 0.1% ophthalmic solution is clinically effective in controlling adverse ocular symptoms occurring after bilateral radial keratotomy.

Conjunctival autograft transplantation for advanced and recurrent pterygium.

The technique and results of conjunctival autograft transplantation for advanced and recurrent pterygium are presented for 57 eyes of 54 patients. The pterygia were primary in 16 eyes and recurrent in 41; among the latter group, 14 patients had diplopia resulting from cicatricial involvement of the medial rectus muscle. In all cases, free conjunctival grafts from the superotemporal bulbar conjunctiva of the same eye were used to resurface exposed sclera and extraocular muscle. There were no intraoperative complications. Postoperative follow-up ranges from 1 to 67 months, with a mean of 24 months. Only three pterygia have recurred (5.3%); two were successfully remedied by a second conjunctival autograft, whereas the third did not require an additional procedure. In all 14 patients with diplopia, extraocular movement was restored. We recommend this surgical approach as a safe and effective means of treating pterygia complicated by conjunctival scarring with extraocular muscle involvement and requiring concurrent fornix reconstruction.

Endothelial and epithelial-like cell formations in a case of posterior polymorphous dystrophy.

Histology of the endothelial and epithelial-like cells, vesicles, and membranes seen on the posterior corneal surface in posterior polymorphous dystrophy were examined by light microscopy and scanning and transmission electron microscopy in a 3-month-old female infant. The entire posterior surface of both corneas was covered by a geographic pattern of endothelial and epithelial-like cells, sometimes creating vesicles and sometimes creating partially detached sheets of cells. The thickness of Descemet's membrane varied widely, showing a tendency to be most complete under the remaining endothelial cells and thinner or absent under the epithelial-like cells. Details of this histology have important implications for our understanding of congenital diseases of corneal endothelium.

Congenital cysts of the iris stroma.

We studed the clinical and histopathologic findings in two congenital iris cysts, one in a 19-month-old girl and one in a 7-year-old boy. Our second case showed the resilience of these lesions, with the cyst returning to its original size after needle aspiration, argon iridotomy, marsupialization, and excisional iridotomy. Cryogenic therapy was needed to eliminate the cyst. In both cases, histologic studies showed squamous epithelium with few (Case 1) or no (Case 2) goblet cells.

Development of oral HSV-1 infection model in mice. Evaluation of efficacy of 5'-amino-5-iodo-2',5'-dideoxyuridine.

We developed a new model of oral HSV-1 infection in mice. After oral inoculation, 100 percent of mice developed the clinical lesions at the inoculated area and latent HVS infection in their trigeminal ganglia without mortality. The antiherpetic efficacy of AIdUrd, an agent specifically activated by herpesvirus-encoded enzyme, has been evaluated in this animal model. Early topical or systemic treatment of AIdUrd notably reduced the development of clinical lesions and the virus content in the inoculated lips. However, the establishment of latent HSV infection in the sensory ganglia was not influenced by AIdUrd treatment.

Ac2IDU, BVDU, and thymine arabinoside therapy in experimental herpes keratitis.

The therapeutic efficacy of three new antiviral agents-5-iodo-3',5'-diacetyl-2'-deoxyuridine (diacetylidoxuridine, 1% Ac2IDU), E-5-(2-bromovinyl)-2'-deoxyuridine (0.25% BVDU), and 3% thymine arabinoside-is compared with available antivirals in an experimental model of herpes simplex virus type 1 (HSV-1) keratitis in New Zealand white rabbits. Compared with placebo, Ac2IDU significantly reduced ulcerative keratitis on days 4 through 8 after inoculation with virus and iritis on day 8 after inoculation. Compared with placebo, thymine arabinoside reduced ulcerative keratitis but not significantly. Thymine arabinoside caused significant iritis in all eyes. The epithelial disease in BVDU-treated eyes was significantly less than that in placebo-treated eyes on days 5 through 8 after inoculation. The results indicate that 1% Ac2IDU and 0.25% BVDU were effective in our ocular model of HSV-1 keratitis, whereas thymine arabinoside was not.

Topical therapeutic efficacy of 9-(2-hydroxyethoxymethyl)guanine and 5-iodo-5'-amino-2',5'-dideoxyuridine on oral infection with herpes simplex virus in mice.

The therapeutic efficacy of two new antiviral agents, 5-iodo-5'-amino-2', 5'-dideoxyuridine (AIdUrd) and 9-(2-hydroxyethoxymethyl)guanine (ACV), in the model of mouse lip inoculated with herpes simplex virus type 2 is reported. The effects on development of clinical lesions, viral replication in the inoculated lips, and establishment of latent viral infection in the trigeminal ganglia were observed. The earlier the treatment with AIdUrd and ACV was initiated after inoculation, the better was the chemotherapeutic effect. AIdUrd and ACV treatment, when initiated 48 and 72 hr after inoculation, respectively, showed no chemotherapeutic efficacy. Establishment of viral latent infection in sensory ganglia was significantly prevented only when ACV treatment was initiated very early (1 or 3 hr) after inoculation. The results indicate that both drugs have significant antiviral activity, in part dependent on the time of initiation of therapy, and that ACV is superior to AIdUrd as a topical agent for therapy of herpes simplex virus type 2 infections.