Treatment of periocular capillary hemangioma with topical clobetasol propionate.

BACKGROUND: Hemangiomas pose a therapeutic challenge because they can threaten vision in infancy and early childhood. Intralesional injection of corticosteroid is widely regarded as the treatment of choice for hemangiomas which induce strabismus or significant refractive error, or occlude the visual axis. Ocular and systemic complications such as eyelid necrosis, central retinal artery occlusion, and adrenal suppression have been reported rarely after corticosteroid injection. METHODS: Three infants were treated with clobetasol propionate (Temovate) cream for vision-threatening eyelid hemangiomas. RESULTS: Treatment with this topical fluorinated corticosteroid produced a measurable reduction in the size of the hemangiomas, which permitted clearing of the visual axis. No regional side effects were noted. In addition, the patients did not demonstrate evidence of hypothalamic-pituitary-adrenal axis suppression. CONCLUSIONS: This treatment modality appears to provide an additional alternative for managing superficial periocular hemangiomas which threaten vision.

Visual outcome after penetrating keratoplasty with double continuous or combined interrupted and continuous suture wound closure.

We reviewed the consecutive records of 296 patients who underwent corneal transplantation at our institution to compare visual outcome between those who underwent double continuous suture wound closure and those who underwent a combination of interrupted and continuous suture wound closure. Of 156 patients on whom one of these closure techniques was performed, 33 patients satisfied our inclusion and exclusion criteria. Visual outcome between the two groups was compared at three, six, and 12 months. We found significant differences (P less than .05) in average corneal curvature and refractive spherical equivalents (steeper and more myopic, respectively, for double continuous suture wound closure); keratoscopic astigmatism, refractive cylindrical error; and average number of postoperative visits (greater for combined interrupted and continuous suture wound). Visual acuity without correction was significantly better at three months in the group that received double continuous sutures (P = .026). We found no marked difference in best-corrected visual acuity, frequency of graft rejection, requirement for contact lens fit, ratio of refracted vs potential visual acuity, or intraocular pressure. Patients who underwent double continuous suture closure had more rapid visual rehabilitation, had steeper corneas, and less astigmatism than patients who underwent the combined technique suture closure.

Efficacy of tobramycin-soaked collagen shields vs tobramycin eyedrop loading dose for sustained treatment of experimental Pseudomonas aeruginosa-induced keratitis in rabbits.

We compared the efficacy of a fortified tobramycin-soaked collagen shield to the efficacy of a single loading dose (four 50-microliters drops) of fortified tobramycin eyedrops in the treatment of New Zealand White rabbits with Pseudomonas aeruginosa-induced keratitis. Eyedrop loading-dose efficacy was evaluated with and without lateral tarsorrhaphy. Six hours after a single treatment, significantly fewer Pseudomonas colonies were present in the corneas of all three drug-treated groups as compared to the number of colonies in the corneas of balanced salt solution-treated control rabbits (P less than .006). Although no significant difference was observed between any of the drug-treated groups, lateral tarsorrhaphy was associated with a greater than tenfold decrease in the number of colony-forming units (P = .073). We found no significant difference in efficacy between a collagen shield presoaked in tobramycin, and a single loading dose of tobramycin eyedrops, in the treatment of rabbits with P. aeruginosa-induced keratitis.

Protective effect of N-methyl-D-aspartate antagonists after focal cerebral ischemia in rabbits.

We studied the efficacy of postischemic, systemic treatment with the N-methyl-D-aspartate (NMDA) receptor antagonists dextromethorphan and dextrorphan in a rabbit model of transient focal cerebral ischemia. Twenty-two rabbits underwent 1-hour occlusion of the left internal carotid and anterior cerebral arteries followed by 4.5 hours of reperfusion before sacrifice. One hour after the onset of ischemia, immediately after removing the arterial clips, the rabbits were blindly assigned to treatment with dextromethorphan (20 mg/kg i.v. loading dose followed by 10 mg/kg/hr maintenance infusion, n = 7), dextrorphan (15 mg/kg i.v. loading dose followed by 15 mg/kg/hr maintenance infusion, n = 7), or an equivalent volume of normal saline alone (n = 8). The maintenance infusion of drugs or saline was continued for the duration of the experiment. The formalin-fixed brains were analyzed with magnetic resonance imaging using coronal T2-weighted images, and ischemic neuronal damage was assessed on standard coronal hematoxylin-and- eosin-stained sections. The area of neocortical ischemic neuronal damage was significantly reduced in the groups treated with dextromethorphan (4.2%, p less than 0.01) and dextrorphan (6.1%, p less than 0.01) compared with the controls (36.2%). Magnetic resonance imaging demonstrated significantly smaller areas of cortical edema in the groups treated with dextromethorphan (14.6%, p less than 0.01) and dextrorphan (8.0%, p less than 0.01) compared with the controls (32.9%). These clinically tested antitussives with NMDA-antagonist properties may have therapeutic value in the treatment of human cerebrovascular disease.

Pretreatment with the NMDA antagonist dextrorphan reduces cerebral injury following transient focal ischemia in rabbits.

We studied the efficacy of systemic pre-treatment with dextrorphan (DX), a clinically tested N-methyl-D-aspartate (NMDA) antagonist, in a rabbit model of transient focal cerebral ischemia. Rabbits were treated with either a 24 mg/kg i.v. loading dose followed by 12 mg/kg/h i.v. infusion of 0.48% DX in normal saline (NS), or with an equivalent volume of NS alone. One and 1/2 h after starting the drug or NS, the rabbits underwent a 1 h occlusion of the left internal carotid and anterior cerebral arteries, followed by 4 h of reperfusion. The DX-treated rabbits had significantly less neocortical ischemic neuronal damage (7.4%) than the normal saline group (31.6%) and demonstrated a significant decrease in ischemic cortical edema. DX may prove useful in the treatment of clinical cerebrovascular disease.