Pilot Study Comparing Topical Anesthetic Agents in Pterygium Surgery: Subconjunctival Injection Versus 2% Lidocaine Gel Versus 5% Lidocaine Gel.

PURPOSE: To compare the efficacy of different concentrations of topical lidocaine gel with standard subconjunctival anesthesia. METHODS: This was a prospective randomized controlled pilot study with 3 different groups. Group SC received subconjunctival lidocaine and proparacaine drops as needed during surgery. Group L2 received 2% lidocaine gel and group L5 received 5% lidocaine gel. Both lidocaine gel groups could receive another gel dose as needed during the procedure. The primary outcome was pain, which was experienced during and after surgery. The assessment was done using a 10-point linear analog scale at predetermined stages of surgery (1-first incision, 2-pterygium body excision, 3-conjunctival suturing, 4-immediate postoperative period after patching, and 5-assessment by a trained nurse in the absence of a surgeon after operation). RESULTS: We enrolled 45 consecutive patients who underwent primary pterygium surgery. Statistical significance between groups was found in mean pain at administration (2.2 vs. 0.4 vs. 0.0 in SC, L2, and L5 groups, respectively, with P < 0.05). The number of reapplications of anesthetic drops did not differ between the groups. We found a correlation between reapplication of the anesthetic and pain at administration and duration of the procedure. CONCLUSIONS: We demonstrated that the use of lidocaine gel at concentrations of 2% and 5% in pterygium surgery was as effective as subconjunctival injection of lidocaine in reducing intraoperative and postoperative pain, producing significantly less pain during initial administration of the anesthetic.

Aqueous humor concentrations of topical fluoroquinolones alone or in combination with a steroid.

PURPOSE: To compare the aqueous humor (AH) concentrations of moxifloxacin 0.5% and gatifloxacin 0.3% solutions alone or when treatment was combined with steroids, and to correlate these concentrations with the minimum inhibitory concentrations (MIC) for the most common endophthalmitis-causing organisms. METHODS: Patients undergoing phacoemulsification were enrolled to receive one drop of one of the following solutions: moxifloxacin (G1), moxifloxacin + dexamethasone (G2), gatifloxacin (G3), or gatifloxacin + c (G4), every 15 min, 1h before surgery. AH samples were collected before surgery and analyzed using HPLC-tandem mass spectrometry. RESULTS: The mean antibiotic concentrations in the AH were: G1= 1280.8 ng/mL; G2= 1644.3 ng/mL; G3= 433.7 ng/mL; and G4= 308.1 ng/mL. The mean concentrations statistically differed between G1 and G2 (p=0.01), and G3 and G4 (p=0.008). All samples achieved the MIC for Staphylococcus epidermidis; 100% of the samples from G1 and G2, and 97% from G3 and G4 reached the MIC for fluoroquinolone-sensitive Staphylococcus aureus; 100% of the samples from G1 and G2, 88% from G3, and 72% from G4 reached the MIC for enterococci (p<0.001); and 100% of samples from G1 and G2, 59% from G3, and 36% from G4 reached the MIC for Streptococcus pneumoniae (p<0.001). For fluoroquinolone-resistant S. aureus, 23% from G1, 44% from G2, and no samples from G3 or G4 achieved the MIC (p<0.001). CONCLUSIONS: Moxifloxacin + dexamethasone demonstrated a higher concen-tration in the AH than the moxifloxacin alone. Gatifloxacin + steroids demonstrated less penetration into the anterior chamber than gatifloxacin alone. Moxifloxacin was superior to gatifloxacin considering the MIC for enterococci, S. pneumoniae, and fluoroquinolone-resistant S. aureus.

Novel use of trypan blue in ocular surface staining: redefining implications for this vital dye / Nova aplicação do azul de tripano para superfície ocular: redefinindo corantes vitais

Different applications of trypan blue (TB) for intraocular surgery have been reported, with very high levels of safety and efficacy. We describe the use of TB as an alternative vital dye for staining the ocular surface to assess the integrity of superficial cell layers of the cornea and the surface environment. This facilitates the diagnosis of various ocular surface disorders, including screening for dry eye disease (DED) among refractive and cataract patients. TB staining properties are different from fluorescein and both are stable in a solution, so that a double staining technique is introduced.

Diferentes aplicações do azul de tripano (AT) foram descritas para cirurgia intraocular, com elevados patamares de eficácia e segurança. Neste relato, é descrito a aplicação do AT como corante vital para superfíce ocular, de modo a estudar a integridade das células da superfície corneana e conjuntival na superfície ocular. Tal abordagem permite um diagnóstico mais sensível de desordens da superfície ocular, destacando-se disfunção lacrimal ou síndrome do olho seco. O AT tem propriedades distintas da fluoresceína, com a qual se mantém estável em solução permitindo a técnica de coloração dupla que é introduzida.

Avaliação de um cianoacrilato quanto à esterilidade e atividade biocida / Evaluation of sterility and biocide activity on microorganisms of commercially available cyanoacrylate

OBJETIVO: Avaliar a esterilidade do cianoacrilato Super Bonder® e sua atividade biocida sobre microrganismos. MÉTODOS: Para verificação de contaminação, vinte amostras de cianoacrilato Super Bonder® foram aplicadas em meio brain heart infusion (BHI) e incubadas a 37º C. Após 7 dias de incubação, foram retiradas e semeadas em placas de ágar sangue, chocolate e Sabouraud. Para determinação do efeito biocida, as cepas Staphylococcus xylosis, Staphylococcus aureus e Pseudomonas aeruginosa da American Type Culture Collection (ATCC) foram utilizadas em três diferentes modelos, alterando a maneira de aplicação do adesivo cianoacrilato Super Bonder® (em microescavações, em tubos e sobre o ágar). RESULTADOS: Não foi observado crescimento positivo nas amostras de cianoacrilato semeadas em brain heart infusion. Nas placas com microescavações observou-se crescimento de P. aeruginosa e inibição de S. aureus e S. xylosis. Após a retirada do adesivo, houve crescimento bacteriano em todas as microescavações. Nas placas semeadas com S. aureus e S. xylosis houve formação aparente de halos de inibição, o que não ocorreu com P. aeruginosa. Como resultado não é verdade que não foi demonstrado atividade biocida do cianoacrilato em relação às bactérias S. aureus, S. xylosis e P. aeroginosa. CONCLUSAO: Os testes de esterilidade realizados demonstraram que o cianoacrilato Super Bonder® é alternativa segura quanto à esterilidade. Não foi demonstrado nenhum efeito bacteriostático ou bactericida em relação a S. aureus, S. xylosis e P. aeruginosa, o que indica a necessidade da manutenção da antibioticoterapia.