Endophthalmitis caused by staphylococcus epidermidis: in vitro antibiotic susceptibilities and clinical outcomes.

BACKGROUND AND OBJECTIVE: To investigate the antibiotic sensitivities and clinical outcomes of eyes with endophthalmitis caused by methicillin-sensitive versus methicillin-resistant Staphylococcus epidermidis (MSSE/MRSE). PATIENTS AND METHODS: A retrospective, consecutive case series of all patients with endophthalmitis caused by S. epidermidis from January 1, 1996, through July 1, 2004, was conducted. The antibiotic sensitivities and clinical outcomes were obtained from the corresponding medical records. RESULTS: The study included 86 eyes of 86 patients with S. epidermidis endophthalmitis (34 MSSE and 52 MRSE). Endophthalmitis categories included cataract surgery (58), glaucoma surgery (12), trauma (7), vitrectomy (4), penetrating keratoplasty (4), and corneal suture ulcer (1). In vitro testing revealed that all MSSE and MRSE isolates were sensitive to vancomycin, 67% of MSSE isolates and 67% of MRSE isolates were sensitive to gatifloxacin, and 73% of MSSE isolates and 67% of MRSE isolates were sensitive to moxifloxacin (overall 68% sensitive). All eyes were treated with intravitreal vancomycin and either ceftazidime or amikacin. Visual acuity improved to a median of 20/80 at 3 months and 20/60 at 1 year. I CONCLUSIONS: In the current study, all MSSE and MRSE isolates were sensitive to vancomycin and 68% were sensitive to the fourth-generation fluoroquinolones. There were no significant differences in visual acuity outcomes of endophthalmitis caused by MSSE versus MRSE isolates.

Is it safe to have an ophthalmic emergency in July?

BACKGROUND AND OBJECTIVE: To deter-mine whether house staff experience affects the quality of acute ophthalmic care delivered in an emergency room at one teaching hospital. PATIENTS AND METHODS: The medical records of 360 patients who were seen by first-year ophthalmology residents in the Bascom Palmer Eye Institute emergency department were retrospectively reviewed. Records reviewed included 180 patients seen between July 15, 2002, and August 14, 2002 (the beginning of the training year), and 180 patients seen between June 1, 2003, and June 30, 2003 (the end of the training year). RESULTS: The rate of unscheduled return visits to the emergency department at the beginning and end of the training year was 6.1% (11 of 180) and 5.0% (9 of 180), respectively (P = .82). Agreement between initial and final diagnoses occurred in 96% of patients (108 of 113) at the beginning of the training year and 98% of patients (84 of 86) at the end of the training year (P = .70). CONCLUSION: There was no difference in the quality of medical care delivered by first-year ophthalmology residents at the beginning and end of the training year.

Estimation of intraocular pressure in rabbits with commonly used tonometers.

BACKGROUND AND OBJECTIVES: To validate accuracy and reproducibility of the Perkins tonometer, pneumatonometer, and Tono-Pen XL (Medtronic Solan, Jacksonville, FL) in estimating intraocular pressure (IOP) in rabbits. MATERIALS AND METHODS: IOP was increased from 5 to 50 mm Hg in 5-mm increments. Measurements were compared to readings of two digital manometers simultaneously measuring real IOP in the anterior chamber and vitreous cavity. Interobserver accuracy was evaluated using 4 eyes with the Perkins tonometer. RESULTS: The Perkins tonometer and Tono-Pen XL underestimated IOP and were more accurate at pressures less than 30 mm Hg. No statistically significant difference was found between real IOP and Tono-Pen XL readings. The pneumatonometer overestimated pressures in the low ranges but was accurate at pressures greater than 40 mm Hg. The Tono-Pen XL had more variability than the Perkins tonometer and pneumatonometer at high IOP. CONCLUSIONS: None of the tonometers are accurate or reproducible in estimating IOP in rabbits over the tested range. Pneumatonometry, although not very accurate, has the advantage of having acceptable variability.

Systemic bevacizumab (Avastin) therapy for neovascular age-related macular degeneration: twenty-four-week results of an uncontrolled open-label clinical study.

PURPOSE: To evaluate the safety, efficacy, and durability of bevacizumab for the treatment of subfoveal choroidal neovascularization (CNV) in patients with neovascular age-related macular degeneration (AMD). DESIGN: Open-label, single-center, uncontrolled clinical study. PARTICIPANTS: Age-related macular degeneration patients with subfoveal CNV (n = 18) and best-corrected visual acuity (VA) letter scores of 70 to 20 (approximate Snellen equivalent, 20/40-20/400). METHODS: Patients were treated at baseline with an intravenous infusion of bevacizumab (5 mg/kg) followed by 1 or 2 additional doses given at 2-week intervals. Safety assessments were performed at all visits. Ophthalmologic evaluations included protocol VA measurements, ocular examinations, and optical coherence tomography (OCT) imaging at each visit. Retreatment with bevacizumab was performed if there was evidence of recurrent CNV. MAIN OUTCOME MEASURES: Assessments of safety and changes from baseline in VA scores and OCT measurements were performed through 24 weeks. RESULTS: No serious ocular or systemic adverse events were identified through 24 weeks. The only adverse event identified was a mild elevation of mean systolic and diastolic blood pressure measurements (+11 mmHg, P = 0.004; +8 mmHg, P<0.001) evident by 3 weeks and easily controlled with antihypertensive medications. By 24 weeks, the systolic and diastolic mean blood pressures were at or below baseline measurements. Visual acuity in the study eyes improved within the first 2 weeks, and by 24 weeks, the mean VA letter score increased by 14 letters in the study eyes (P<0.001), and the mean OCT central retinal thickness measurement decreased by 112 microm (P<0.001). By 24 weeks, retreatment was needed for only 6 of the 18 study eyes, and after retreatment, the recurrent leakage was eliminated, with restoration of any lost VA. CONCLUSIONS: Systemic bevacizumab therapy for neovascular AMD was well tolerated and effective for all 18 patients through 24 weeks. By 6 months, most patients did not require any additional treatment beyond the initial 2 or 3 infusions. Despite these impressive results, it is unlikely that systemic bevacizumab will be studied in a large clinical trial because of the potential risks associated with systemic anti-VEGF therapy and the perception that intravitreal therapy is safer.

The effect of moxifloxacin on the normal human cornea.

OBJECTIVE: To investigate the effects of moxifloxacin on the cornea of normal human eyes using confocal microscopy and slit-lamp biomicroscopy. METHODS: This study enrolled adult volunteers who had a normal baseline ophthalmic examination. The dose regimen, similar to that of patients undergoing cataract extraction, was one drop of moxifloxacin in one eye four times a day for 3 days. The untreated fellow eye served as the control. Subjects had a baseline examination (Visit 1), started moxifloxacin the next day, and were examined 24 h (Visit 2) and 72 h (Visit 3) after starting medication. At each visit, visual acuity and adverse effects were recorded, slit-lamp examination with fluorescein was used to measure tear break-up time, and endothelial and epithelial cell counts were determined using confocal microscopy. RESULTS: Fifteen volunteers (mean age 37 +/- 7 years) enrolled. No significant difference in visual acuity, tear break-up time, endothelial or epithelial cell counts was noted between the treated and fellow eye. Subjects experienced no significant decrease in visual acuity, tear break-up time, or endothelial cell counts during the 3-day treatment period in either eye. Epithelial cell counts were stable at Visits 1 and 2, and decreased similarly in the treated and control eye at Visit 3. CONCLUSIONS: Moxifloxacin was safe for use during the 3-day treatment period. Moxifloxacin causes no significant epithelial or endothelial toxicity, and has no effect on visual acuity or ocular surface integrity in healthy subjects treated using a dosing regimen that simulated prophylactic use following cataract surgery.

Systemic bevacizumab (Avastin) therapy for neovascular age-related macular degeneration twelve-week results of an uncontrolled open-label clinical study.

PURPOSE: To evaluate the short-term safety of systemic bevacizumab (Avastin, Genentech, Inc., South San Francisco, CA) and its effects on visual acuity (VA) and subfoveal choroidal neovascularization (CNV) in patients with neovascular age-related macular degeneration (AMD). DESIGN: Open-label, single-center, uncontrolled clinical study. PARTICIPANTS: Age-related macular degeneration patients with subfoveal CNV (N = 9) and best-corrected VA letter scores of 70 to 20 (approximate Snellen equivalent, 20/40-20/400). METHODS: Patients were treated at baseline with an infusion of bevacizumab (5 mg/kg), followed by 1 or 2 additional doses given at 2-week intervals. Safety assessments were performed at all visits. Ophthalmologic evaluations included protocol VA measurements and ocular examinations, along with optical coherence tomography (OCT) imaging, fluorescein angiography, and indocyanine green angiography. MAIN OUTCOME MEASUREMENTS: Safety assessments were performed, along with assessments of changes from baseline in VA scores, OCT measurements, and angiographic lesion characteristics. RESULTS: There were no serious ocular or systemic adverse events identified. By 6 weeks, the only adverse event identified was a mild elevation of systolic blood pressure (BP) (+12 mmHg; P = 0.035), and this elevation was controlled by either changing or initiating antihypertensive medication. By 12 weeks, the elevation of systolic BP was no longer significant (P = 0.51). In the study eyes, significant increases in VA were evident within 1 week of treatment, and by 12 weeks, the median and mean VA letter scores increased by 8 letters (P = 0.011) and 12 letters (P = 0.008), respectively. The median and mean central retinal thickness measurements decreased by 157 microm (P = 0.008) and 177 microm (P = 0.001), respectively. In the fellow eyes at 12 weeks, the median and mean VA letter scores increased by 27 letters (P = 0.018) and 16 letters (P = 0.012), and the median and mean central retinal thickness measurements decreased by 59 mum (P = 0.028) and 92 microm (P = 0.06). In all study eyes, angiography revealed a marked reduction or an absence of leakage from CNV. CONCLUSION: Overall, bevacizumab therapy was well tolerated, with an improvement in VA, OCT, and angiographic outcomes. Although these preliminary results are promising, a randomized controlled clinical trial is necessary before concluding that systemic bevacizumab therapy is safe and effective for patients with neovascular AMD.

Noncontact optical measurement of lens capsule thickness in human, monkey, and rabbit postmortem eyes.

PURPOSE: To measure interspecies thickness differences in the central anterior and posterior capsules of postmortem crystalline lenses, by a technique that maintains the anatomic integrity of the lens. METHODS: Central capsule thickness was measured with a custom-built, noncontact optical system, using a focus detection technique. Anterior and posterior lens capsule thickness measurements were performed on 22 human, 29 monkey, and 34 New Zealand White rabbit intact postmortem lenses in situ. Eyes were prepared for optical measurements by bonding a PMMA ring to the sclera in the region of the ciliary body after the conjunctiva, adipose, and muscle tissues were removed. The posterior pole was removed by making a circumferential incision through the sclera approximately 7 mm posterior to the limbus. Excess vitreous was removed to expose the posterior capsule surface, and the eye assembly was placed on a Teflon slide. The cornea and iris were sectioned to expose the anterior capsule surface. After the experiments, the lenses were excised, placed in 10% buffered formalin, and prepared for histology. Lens capsule thickness was measured from the histologic slides and compared to the optical RESULTS: results. Central anterior lens capsule thickness was 8.2 +/- 5.5 (human), 7.5 +/- 4.4 (monkey), and 10.7 +/- 4.2 (rabbit) microm optically and 12.4 +/- 2.5 (human), 10.7 +/- 3.7 (monkey), and 10.4 +/- 2.0 (rabbit) microm histologically. Central posterior capsule thickness was 6.3 +/- 2.2 (human), 5.9 +/- 1.7 (monkey), and 7.8 +/- 2.3 (rabbit) microm optically and 4.1 +/- 1.5 (human), 3.5 +/- 1.6 (monkey), and 4.7 +/- 2.5 (rabbit) microm histologically. CONCLUSIONS: The central anterior and posterior lens capsule thicknesses do not appear to vary considerably among human, rabbit, and monkey eyes. There were significant differences between optical in situ measurements and histology, which indicates that histologic preparation may affect lens capsule thickness.