Intraocular gentamicin sulfate and postcataract anterior chamber aspirate cultures.

We cultured anterior chamber aspirates of 28 patients who had uncomplicated cataract surgery. Fourteen patients had received 80 micrograms/ml of gentamicin in balanced salt solution through irrigation of the anterior chamber throughout cataract extraction, and 14 patients had received 8 micrograms/ml of gentamicin. Cultures of anterior chamber fluid obtained at the end of surgery from all 28 patients had no growth on two nonselective media. There was no clinical evidence of ocular toxicity. This study demonstrates that antibiotic in the intraocular irrigation fluid can reduce or eliminate the expected intraocular bacterial load after cataract surgery.

Toxicity and pharmacokinetics of ciprofloxacin.

Ciprofloxacin is a fluorinated quinolone antibiotic with a broad spectrum of activity against both gram positive and gram negative organisms. Previous studies have indicated that oral or parenteral preparations of ciprofloxacin resulted in therapeutic concentrations in the aqueous humor but intravitreal levels were found to be only marginally higher than the MIC90 for gram positive cocci. Toxicity was evaluated following intravitreal doses of ciprofloxacin injected into the mid-vitreous cavity of one eye of pigmented rabbits. As a control, an identical volume of normal saline was injected into the fellow eye. Four doses of ciprofloxacin were studied, 100 micrograms, 250 micrograms, 500 micrograms and 1000 micrograms. Electroretinograms (ERGs) were recorded prior to injection and 1, 7 and 14 days after injection. These were analyzed as b-wave amplitude ratios between treated and untreated eyes. On ophthalmoscopic examination focal areas of retinitis were observed following injection of both 500 micrograms and 1000 micrograms of ciprofloxacin but not at 250 micrograms. Additionally, ERG amplitude ratios were significantly reduced following the 1000 micrograms dose. At the 100 or 250 micrograms ciprofloxacin dose histological sections are comparable with control eyes and appear normal; ERG ratios were unchanged from the baseline level and careful indirect ophthalmoscopic examination revealed no alterations. Pharmacokinetic analysis after single intravitreal injection of 250 micrograms of ciprofloxacin (N = 3 rabbits/dose) disclosed vitreous fluid levels (microgram/ml) of 146 at 0 hr, 77 at 4 hr, 32 at 8 hr, 0.49 at 24 hr and 0.24 at 48 hr.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of arm exercise and ocular massage on postural hand tremor.

In this pilot study, the effect of exertion on hand tremor was investigated. Postural head tremor was measured in eight ophthalmology residents before and after lifting a barbell and before and after massaging a phantom eye. All subjects showed an increase in postural hand tremor after lifting a barbell for five minutes (mean, 79% +/- 59%). Postural hand tremor increased 38% +/- 79% after ocular massage, which was not statistically significant (P greater than .5). The peak pressures generated during ocular massage ranged from 25 to 265 mmHg (mean, 134 +/- 80.4 mmHg). There was also no correlation between change in postural hand tremor and the pressure generated by ocular massage (P greater than .2). The authors conclude that strenuous arm exercise, such as lifting a barbell, increases postural hand tremor and should be avoided before doing microsurgery; ocular massage is not sufficient exercise to affect postural hand tremor adversely.

Anterior chamber aspirate cultures after uncomplicated cataract surgery.

We cultured anterior chamber aspirates of 30 patients who had uncomplicated extracapsular cataract extraction or phacoemulsification. The aspirate was obtained at the time of wound closure. Of 30 patients, 13 (43%) had culture-positive anterior chamber aspirates. The total number of organisms recovered was 18, with three patients having multiple organisms identified. The most commonly isolated organisms were coagulase-negative Staphylococcus sp., occurring in eight of 18 isolates (44%). No eyes in our study developed endophthalmitis, even though almost one half had viable organisms growing from the anterior chamber aspirates. Inoculum sizes were extremely small (10 to 20 colony-forming units/ml). This study suggests that in humans, the anterior chamber is capable of clearing a low inoculum of bacteria after cataract surgery without the development of endophthalmitis.

The effect of preoperative flurbiprofen on miosis produced by acetylcholine during cataract surgery.

Sustained pupillary dilation during cataract surgery may be achieved with preoperative noncorticosteroidal anti-inflammatory agents such as flurbiprofen. However, these agents may interfere with miosis after injection of acetylcholine. Thirty patients for extracapsular cataract extraction were randomly assigned in a double-masked fashion to receive either a placebo or preoperative 0.03% flurbiprofen every 30 minutes for four doses. All patients also received three doses of 2.5% phenylephrine and 2% cyclopentolate. Pupillary diameter was measured the day before surgery, immediately before the surgical incision, immediately before and five minutes after acetylcholine injection, and the morning after surgery. The flurbiprofen group had a larger mean pupillary diameter before injection of acetylcholine (P less than .001), five minutes after acetylcholine (P less than .001), and on the first postoperative day (P less than .005).

Intermittent unidirectional nystagmus.

A 38-year-old woman developed intermittent oscillopsia occurring every 45 to 90 minutes and lasting 20 to 40 seconds. She had a right-beating jerk nystagmus during these episodes. At other times, her neurologic examination was normal, and no nystagmus could be elicited. The nystagmus resolved when her classic migraine headaches were controlled with medical therapy. This intermittent unidirectional nystagmus may represent dormant periodic alternating nystagmus or another type of dormant nystagmus appearing intermittently due to episodic migrainous brainstem ischemia.

Ocular blood flow and vascular permeability in endotoxin-induced inflammation.

Blood flow was measured in several tissues of the rabbit eye following intravitreal injection of a dose of endotoxin that induces an inflammatory response. In separate experiments, the vascular permeability of the inflamed eye was estimated by iris fluorescein angiography and by measuring protein influx into the aqueous humor. The effect of topical corticosteroid treatment upon blood flow and vascular permeability was also measured. Following intravitreal endotoxin injection, minor changes in blood flow occurred in retina and optic nerve head. Marked changes were observed in blood flow in iris, ciliary processes, and choroid. Steroid treatment had no effect upon the increased blood flow 24 h after the endotoxin injection, although from a clinical standpoint the steroid-treated eyes appeared less inflamed. Fluorescein angiography demonstrated a massive increase in iris vessel permeability 6 and 24 h following endotoxin injection. Topical steroid treatment reduced fluorescein entry into the anterior chamber at both time periods. On the other hand, the increase in protein influx into the aqueous humor in the endotoxin-inflamed eye was not inhibited by steroid pretreatment. It is suggested that corticosteroids have a selective effect upon the permeability of different components of the blood-aqueous barrier, namely the ciliary processes and the iris vasculature.

Ocular involvement in mycotic sinusitis caused by Bipolaris.

We examined two patients with unilateral ophthalmologic findings secondary to pansinusitis caused by Bipolaris. Both patients were healthy young men. One patient had a gradual visual loss, whereas the other showed proptosis. Surgical debridement was the primary treatment in both patients. One patient received antifungal therapy, whereas the other was cured with surgery alone.

Bilateral optic neuropathy associated with amiodarone therapy.

Amiodarone, an antiarrhythmic agent, has been associated with mild visual loss secondary to papillopathy and papilledema. We report a patient who developed bilateral optic neuropathy 4 weeks after initiation of amiodarone therapy. Nine months later, his vision was 20/50 in the right eye and 20/200 in the left. This report provides additional evidence that amiodarone may cause toxic optic neuropathy.

Toxicity and pharmacokinetics of cefepime (BMY-28142) following intravitreal injection in pigmented rabbit eyes.

We delineated the dose- and time-dependent retinal toxicity of cefepime (BMY-28142), a new third generation cephalosporin, using electroretinography in pigmented rabbit eyes. Toxicity was evaluated following intravitreal doses ranging from 0.5 to 20mg/0.1ml (N = 18). Electroretinographic patterns at one and two weeks indicated a toxic response to 20 mg of cefepime. B-waves were normal at one and two weeks for rabbits receiving doses of 0.5 to 10mg. Pharmacokinetic analysis after single intravitreal injection of 1 mg of cefepime (N = 3 rabbits/dose) disclosed the following vitreous fluid levels (ug/ml): 645 at Oh, 431 at 8h, 235 at 24h and 23 at 72h. Peak aqueous humor levels (56 ug/ml) were observed at 8h after injection. At 72h, ug/ml was detected in the aqueous fluid.

Incidence of subcortical lesions not increased in nonarteritic ischemic optic neuropathy on magnetic resonance imaging.

We performed magnetic resonance imaging on nine patients with nonarteritic ischemic optic neuropathy and 11 control patients with sensorineural hearing loss and suspected acoustic neuroma. We then counted the number of subcortical lesions in each patient, which may represent an index of generalized cerebral vascular disease. Although patients in the ischemic optic neuropathy group had an average of 3.2 subcortical lesions and those in the control group had an average of 0.9 lesions, this difference was not significant. Based on the presence of subcortical lesions, patients with nonarteritic ischemic optic neuropathy do not appear to have an increased incidence of generalized cerebral vascular disease.

Pseudo-internuclear ophthalmoplegia with downshoot in myasthenia gravis.

Internuclear ophthalmoplegia is characterized by an adduction deficit on lateral gaze with dissociated nystagmus of the abducting eye. It is seen with lesions of the medial longitudinal fasciculus. In myasthenia gravis, extraocular muscle weakness can cause the same oculomotor pattern, which has been referred to as pseudo-internuclear ophthalmoplegia. We report the additional finding of downshoot in the adducting eye in two patients with pseudo-internuclear ophthalmoplegia and positive Tensilon tests.

Oculomotor palsy and papilledema with pial-dural arteriovenous malformation.

A 62-year-old man presented with papilledema, a cranial bruit, and a partial left oculomotor nerve palsy. Arteriography revealed a large mixed pial-dural arteriovenous malformation involving the superior sagittal and both transverse sinuses. After the superior part of the malformation was embolized, the patient's papilledema and ocular motility disturbance resolved. The oculomotor disturbance may have been a nonspecific sign of increased intracranial pressure. Cranial auscultation should be performed in all cases of papilledema and cranial nerve palsy.

Reiter's syndrome in an adolescent female with systemic sequelae.

Reiter's syndrome (RS) generally affects adult white males. It occurs infrequently in adolescents. This condition is characterized by a triad of symptoms: arthritis, urethritis, and ocular abnormalities, and it usually has a benign course. We report an atypical case of RS in a black adolescent female who developed articular and ocular sequelae. Despite aggressive medical therapy, one year after diagnosis her condition has deteriorated and she is confined to a wheelchair. Although RS is believed to be a brief illness predominantly affecting the joints of the lower extremity, this condition may have severe systemic manifestations with chronic sequelae.

Effect of oral or intravenous pentoxifylline on ocular and optic nerve blood flow.

The effect of oral and intravenous pentoxifylline administration on ocular and optic nerve blood flow was studied in phakic rabbit eyes using a radioactive microsphere (85Sr) technique. Blood flow measurements were performed either 30 min after intravenous injection of 20 mg of pentoxifylline, or 2-3 h after oral administration of 20 mg of pentoxifylline. Blood flow measurements were determined for the iris, scraped ciliary processes, choroid, retina, and optic nerve. The only statistically significant difference noted was for blood flow in the optic nerve in the oral- versus intravenous-treated groups. Neither was significantly different from the control group.

Intravitreal ceftazidime in a rabbit model: dose- and time-dependent toxicity and pharmacokinetic analysis.

We delineated the dose-and time-dependent retinal toxicity of intravitreal ceftazidime using electroretinography (ERG) in phakic rabbit eyes. Toxicity was evaluated following intravitreal doses ranging from 0.5 to 50 mg/0.1 ml. Eyes were examined prior to injection, at one day, and at seven days after injection. ERG patterns at one and seven days indicated a toxic response to doses of 20 to 50 mg. Doses of 10 mg or less gave a transient depression of the B-wave at one day, but a return to normal was observed at the seven-day evaluation. Pharmacokinetic analysis following intravitreal injection of 2 mg of ceftazidime into uninfected phakic rabbit eyes disclosed vitreous levels of: 1711 micrograms/ml at 0 hr; 1340 micrograms/ml at 8 hr; 451 micrograms/ml at 24 hr; 270 micrograms/ml at 48 hr and 67 micrograms/ml at 72 hr. Peak aqueous humor level was 139 micrograms/ml 8 hr post-injection. Potentially therapeutic drug levels were obtained in the aqueous and vitreous humors following a nontoxic intravitreal dose of ceftazidime in a rabbit model.

Bilateral sixth nerve pareses with temporal arteritis and diabetes.

A 78-year-old white woman presented with a 1-month history of neck and right shoulder pain and a 12-day history of acute horizontal diplopia. On examination, bilateral sixth nerve pareses were present, right greater than left. On evaluation, the patient was noted to have normal fasting blood sugars, but moderately elevated blood sugars after a glucose load. A temporal artery biopsy was performed which was positive. Whether diabetic or arteritic, bilateral sixth nerve pareses resulted in our patient seeking medical attention. By considering temporal arteritis, it is possible that blindness was avoided.

The effect of retrobulbar lidocaine injection on ocular and optic nerve blood flow.

The effect of retrobulbar lidocaine administration on ocular and optic nerve blood flow was studied in phakic rabbit eyes using a radioactive microsphere (85Sr) technique. Blood flow measurements were performed 15 minutes after retrobulbar injection of 40 mg of lidocaine in ethanol to the right eye of each rabbit. Blood flow measurements were determined for the iris, scraped ciliary processes, choroid, retina, and optic nerve. There was no statistically significant (P less than 0.05) difference in lidocaine treated eyes compared to contralateral control eyes. An identical volume of retrobulbar ethanol alone had no effect on regional blood flow.

Subconjunctival administration of ceftazidime in pigmented rabbit eyes.

The ocular kinetics of ceftazidime, a third-generation cephalosporin, were examined in phakic and aphakic pigmented eyes of rabbits following subconjunctival injection (100 mg). Peak ceftazidime concentrations (mean +/- SE, n = three to five rabbits per determination) were as follows: phakic eyes, 40.2 +/- 7.3 mg/L in aqueous humor and 11.2 +/- 0.6 mg/L in vitreous humor at one hour; aphakic eyes, 30.5 +/- 4.8 mg/L in aqueous humor and 15.8 +/- 2.4 mg/L in vitreous humor at one hour. The ability of ceftazidime to eliminate an incipient bacterial infection was also studied. Ten aphakic rabbits received intravitreal injections of 50 colony-forming units (cfu) of Pseudomonas aeruginosa. Six of the ten immediately received a subconjunctival injection of ceftazidime (100 mg). At 48 hours following injections, four of four control eyes yielded bacterial counts greater than 6.2 X 10(6) cfu/mL. Of the six that received ceftazidime, five were sterile and one yielded 10 cfu/mL.