Intravitreal Clindamycin and Dexamethasone Combined with Systemic Oral Antitoxoplasma Therapy versus Intravitreal Therapy Alone in the Management of Toxoplasma Retinochoroiditis: A Retrospective Study.

PURPOSE: To compare clinical outcome of IVCD combined with oral therapy with IVCD alone in patients with toxoplasmic retinochoroiditis. PATIENTS AND METHODS: Thirty eyes were reviewed. Two equal groups were identified (15 eyes each). Clinical outcome measures were resolution of active inflammation, changes in BCVA and CMT, adverse drug reactions, and rate of recurrence. RESULTS: Mean baseline of BCVA 1.08 ± 0.17 and 1.03 ± 0.15 improved to 0.64 ± 0.18 and 0.69 ± 0.17 at the end of follow-up in group I and II, respectively. No statistically significant difference was observed. CMT was 392.6 ± 33.16 µm and 397.3 ± 14.6 µm significantly decreased to 314.7 ± 4.43 µm and 319.6 ± 7.8 µm. Resolution of acute inflammation was achieved in all cases in both groups. There were no recurrent cases in group I, and only one out of 15 (6.7%) in group II. No ocular or systemic adverse events were recorded. CONCLUSION: IVCD is an effective route of treatment for active toxoplasmic retinochoroiditis that can be used solely without the need to use systemic medications..

Efficacy of intravitreal bevacizumab with panretinal photocoagulation followed by Ahmed valve implantation in neovascular glaucoma.

PURPOSE: To establish the efficacy and safety of intravitreal bevacizumab (Avastin) with panretinal photocoagulation (PRP) followed by Ahmed valve implantation in the treatment of neovascular glaucoma (NVG). METHOD: This prospective randomized study included 40 eyes of 40 patients with refractory NVG. Twenty eyes underwent Ahmed valve implantation with intravitreal bevacizumab (Avastin) (1.25 mg in 0.5 mL) and PRP and 20 eyes were managed by Ahmed valve and PRP (control group). The follow-up period was 18 months. RESULTS: Complete success was defined as an intraocular pressure ≤ 21 mm Hg. Qualified success was considered when the above criteria were fulfilled but with additions of antiglaucoma topical medical treatment. The results revealed 95% total success (75% complete success and 20% qualified success) in the first group in which Avastin-augmented Ahmed valve was performed compared with 50% total success in the control group in which Ahmed valve implantation was performed alone (25% complete success and 25% qualified success). CONCLUSIONS: Intravitreal bevacizumab (Avastin) with PRP followed by Ahmed valve implantation appears to be effective in the management of NVG.

Subcutaneous allergen-specific immunotherapy versus topical treatment in vernal keratoconjunctivitis.

PURPOSE: The study evaluated the treatment of cases with vernal keratoconjunctivitis by subcutaneous allergen-specific immunotherapy (SCIT) versus topical treatment according to clinical improvement and total serum immunoglobulin (Ig) E. DESIGN: Prospective randomized study. METHODS: The study included 64 patients with bilateral vernal keratoconjunctivitis. Cases were divided into 2 groups: group 1, 32 patients who were subjected to topical treatment; and group 2, 32 patients who were subjected to intradermal skin reactions to different allergens. Prepared subcutaneous injections of different allergens were administered. Follow-up was performed to detect criteria of improvement according to clinical data and total serum IgE. RESULTS: The study revealed that the treatment by SCIT was more effective in improving the clinical symptoms and reducing the serum IgE than topical treatment because there was a greater reduction in symptoms in group 1 of immunotherapy (72%) than in group 2 of medical treatment (59%) (P < 0.05). Also, there was a significant reduction in total serum IgE (P < 0.05) in group 1 (62%) compared to group 2 (42%). However, the intradermal test for each group of patients showed that 62% of the patients were sensitive to pollens, 19% to house dust, and 19% to more than one allergen. CONCLUSIONS: Treatment of vernal keratoconjunctivitis by SCIT was more effective than topical treatment in improving the clinical symptoms and reducing the total serum IgE.

Evaluation of the role of vascular endothelial growth factor in diabetic retinopathy.

PURPOSE: The study is aiming at investigating the correlation between vascular endothelial growth factor (VEGF) as an angiogenic factor and diabetic retinopathy in type 2 diabetic patients and the effect of panretinal coagulation and glycemic control on VEGF. METHODS: The study included 30 patients of type 2 diabetes, 10 of them did not suffer from any of the vascular complications of type 2 diabetes mellitus (group 1), 10 patients had nonproliferative diabetic retinopathy (group 2), 10 patients had proliferative diabetic retinopathy (PDR) (group 3) and (group 4), as well as 10 healthy subjects that served as control group. All participants were subjected to complete clinical examination including ophthalmic and medical examination, laboratory investigations comprising complete blood count, liver function test, serum creatinine, 24-hour urinary albumin excretion, lipid profile, fasting and 2-hour postprandial blood glucose, HbA(1C) and serum VEGF. RESULTS: The study reported a highly significant increase in the serum VEGF in the diabetic patients compared to the control group (p < 0.001), and there was also a highly significant increase in the serum VEGF in the patients with PDR versus nonproliferative diabetic retinopathy (40.55 ± 8.28 vs. 20.3 ± 2.45, p < 0.001). There was a reduction in the serum VEGF in a group of diabetic patients with poor glycemic control when their diabetic state corrected through 4 months of follow-up was highly significant (17.29 ± 1.61 before vs. 9.39 ± 0.82 after control p < 0.001) as well as the reduction in the serum VEGF which was observed in a group of patients with PDR when proper panretinal photocoagulation (PRP) was applied to their retinae with 4 months of follow-up (40.55 ± 8.28 before vs. 21.15 ± 1.76 after PRP, p < 0.001). CONCLUSION: Serum VEGF is significantly increased in diabetic patients, especially those with PDR, and this elevation of VEGF was reduced in uncontrolled diabetic patients with proper gycemic control, and in patients with PDR with proper PRP, indicating that VEGF is an angiogenic factor that reflects the degree of neovascularization in diabetic complications.

Hyposensitization in the treatment of resistant cases of vernal keratoconjunctivitis.

PURPOSE: The study evaluated the treatment of resistant cases of vernal keratoconjunctivitis by hyposensitization resulting from intradermal skin reactions of different allergens. METHODS: This prospective study was carried out in the Department of Ophthalmology and the Department of Microbiology and Immunology, Zagazig University, and included 36 patients with bilateral vernal keratoconjunctivitis that was resistant to topical corticosteroids and antihistaminic drugs. Patients were subjected to intradermal skin reactions to different allergens after stoppage of the medication. Subcutaneous injections of different allergens were administered in addition to topical vasoconstrictor and antihistaminic eye drops for different durations of 12, 18, and 24 months. RESULTS: The study revealed that most of the patients were sensitive to pollens (65%), house dust (55%), and tobacco smoke (40%). Among 36 total patients who received different doses of allergens, 10 of 20 patients showed marked improvement following a 24-month treatment period, with a 50% success rate. Another 3 of 9 patients showed marked improvement following an 18-month treatment period, with a 33.3% success rate. CONCLUSION: The use of intradermal skin reactions to determine the sensitivity for different stimulating allergens in resistant cases of vernal keratoconjunctivitis was conclusive. Treatment by hyposensitization using prepared vaccines had an acceptable success rate especially in patients treated for 24 months. Future studies will be needed to determine how effective this treatment is with other allergens and for longer durations of hyposensitization. Additional immunologic studies will be essential for developing a strategy of management of resistance in such cases of resistant vernal keratoconjunctivitis.

Assessment safety and efficacy of a combination therapy of topical amphotericin B and subconjunctival fluconazole for the treatment of fungal keratitis.

PURPOSE: The study was aimed at evaluating the treatment of fungal keratitis using a combination therapy of a low concentration of topical amphotericin B (0.2 mg/mL) eye drops together with subconjunctival injections of 2 mg/mL of fluconazole. METHODS: The study was carried out in the Ophthalmology Department of Zagazig University Hospital and included 12 patients with 12 pairs of eyes with resistant corneal ulcers that had the following clinical features suggesting fungal keratitis: thick elevated ulcer, feathery edge, and gutter formation. Cultures of corneal specimens were grown on Sabouraud agar medium. Topical amphotericin B eye drops in a concentration of 0.2 mg/mL in dextrose 5% were used every 2 hours for 21 days together with subconjunctival injections of fluconazole 2 mg/mL. RESULTS: Among the eyes subjected to culture of corneal specimens, 8 eyes had positive results: Candida was detected in 5 eyes (66%) and filamentous fungi grew from the cultures of 3 eyes. Nine eyes improved as a result of treatment, showing complete healing of the ulcers (75%). Three cases showed no improvement (25%); 2 cases developed endophthalmitis; and 1 case was negative. A single case with corneal perforation had negative results on culture. CONCLUSION: The use of a combination of topical amphotericin B eye drops at a concentration of 0.2 mg/mL in dextrose 5% with subconjunctival injection of fluconazole 2 mg/mL had the advantage of a lower incidence of the complications of local use of amphotericin B and a broader spectrum of antifungal coverage. This study reports a relatively high success rate of healing of fungal keratitis, with a significant reduction of the potential side effects of the local use of antifungal agents.

A freeze-dried (lyophilized) amniotic membrane transplantation with mitomycin C and trabeculectomy for pediatric glaucoma.

PURPOSE: To evaluate the potential usefulness of a freeze-dried (lyophilized) amniotic membrane transplantation with mitomycin C (MMC) in the maintenance of functioning glaucoma surgery in cases of pediatric glaucoma. METHODS: Thirty eyes of pediatric patients with glaucoma were included in this study. Trabeculectomy with amniotic membrane implantation and MMC was done in group 1 (15 eyes), and trabeculectomy with MMC only was done in group 2 (15 eyes). The preserved amniotic membrane was placed over the scleral flap and under the conjunctiva. The mean intraocular pressure (IOP) was measured pre- and postoperatively and bleb appearance was noted. The follow-up time was 18 months after surgery. RESULTS: The mean postoperative IOP was significantly decreased to 15 +/- 1 mm Hg and 17.2 +/- 2.9 mm Hg in the 2 groups, respectively. The bleb was functioning well in the follow-up period in most of the cases, except 5 cases that needed another surgery. Complications such as inflammation, choroidal detachment, or toxic keratopathy were not noted in group 1 but were noted in group 2. CONCLUSION: Trabeculectomy with amniotic membrane transplantation and MMC can effectively control the elevated IOP in pediatric patients with glaucoma without significant postoperative complications.