Intraocular pressure control among patients transitioned from latanoprost to travoprost at a Veterans Affairs Medical Center Eye Clinic.

PURPOSE: To evaluate intraocular pressure (IOP) control and the ocular adverse effects resulting from a large-scale transition from latanoprost to travoprost among patients at a Veterans Affairs Medical Center (VAMC) Eye Clinic. METHODS: Retrospective chart review of patients transitioned from latanoprost to travoprost after a revision of the drug formulary used by the VAMC in Houston, Texas. IOP control after changing medications and the incidence of ocular adverse effects attributed to travoprost were the main outcomes measured. For patients who were using IOP-lowering medications bilaterally, the worse eye was used for all IOP analyses. Long-term retention in IOP control plus a cost-saving analysis were presented as a secondary assessment. RESULTS: Five hundred ninety-nine (599) patients with 1,041 treated eyes were evaluated. Mean IOP was 15.86 +/- 4.15 mmHg among patients using latanoprost prior to the prostaglandin analog transition. After transitioning to travoprost, the mean IOP was 15.78 +/- 4.38 mmHg. The mean within-eye change in IOP in the worse eye when transitioned from latanoprost to travoprost was -0.07 +/- 3.27 mmHg (P = 0.5914). Twenty-four (24) patients (4%) experienced an ocular adverse effect while using travoprost. In the long-term retention analysis at 1 year, mean change in IOP from the time of the original change to travoprost was +0.21 +/- 3.71 mmHg (P = 0.2683). CONCLUSIONS: The large-scale transition from latanoprost to travoprost maintained long-term IOP control. Only a small percentage of clinic patients experienced mild ocular adverse effects after being transitioned to the new prostaglandin analog.

Cytokine expression in pediatric subperiosteal orbital abscesses.

BACKGROUND: Cytokines have been shown to play a key role in infectious and inflammatory processes. The purpose of the study was to characterize the pattern of cytokine expression in subperiosteal orbital abscesses associated with pediatric orbital cellulitis. METHODS: All pediatric patients over a 5-month period who had orbital cellulitis and a subperiosteal abscess with an adjacent sinusitis requiring surgical drainage of the orbital abscess were given the opportunity to enroll in the study. A protein array membrane and a chemiluminescent detection system were used to identify the presence of 45 cytokines in the subperiosteal abscess fluid. RESULTS: Four abscesses were analyzed with the protein array membrane. Of the 45 cytokines studied for this report, interleukin (IL)-1alpha, IL-1beta, IL-1 receptor antagonist (ra), IL-6, tumor necrosis factor (TNF)-alpha, and TNF-beta were detected in all specimens. Additionally, IL-16, epidermal growth factor related protein, and soluble TNF receptor II were detected in 3 of the 4 specimens. INTERPRETATION: Pediatric orbital cellulitis with subperiosteal abscess is an inflammatory condition with a distinct pattern of cytokine expression. The detection of IL-1, IL-1 ra, IL-6, and TNF suggests that in the future these cytokines may play a role in monitoring disease activity or as potential targets for immunotherapy.

Microbiology of pediatric orbital cellulitis.

PURPOSE: To evaluate the microbiology of pediatric orbital cellulitis associated with sinusitis. DESIGN: Retrospective review of medical records of pediatric patients treated for orbital cellulitis. METHODS: All pediatric patients treated for orbital cellulitis associated with sinusitis at Texas Children's Hospital between December 1, 2001 and September 30, 2005 were reviewed. Data collected included patient age, history, microbiology results, and surgical intervention. RESULTS: Thirty-eight cases were identified. Fifteen cases required medical management, whereas 23 patients received a combination of medical and surgical intervention. Three patients had multiple surgical procedures performed. Of the procedures performed, four were sinus irrigation, 12 were sinusotomy and drainage, nine were orbitotomy with drainage of abscess, and one was craniotomy with drainage of abscess. Surgical aspirate specimens yielded a higher positive culture result rate with 9/9 of orbital abscesses and 13/16 of sinus aspirates demonstrating a positive yield. Two of the 27 blood cultures had a positive yield. Staphylococcus species was the most common organism isolated. Methicillin-resistant S. aureus (MRSA) represented 73% of S. aureus isolates. Streptococcus species was the next most common pathogen. Three cultures yielded Haemophilus species with one being positive for H. influenzae. CONCLUSIONS: Organisms responsible for causing pediatric orbital cellulitis are evolving, with Staphylococcus followed by Streptococcus species being the most common pathogens. The occurrence of MRSA in pediatric orbital cellulitis is increasing, and empiric antimicrobial therapy should be directed against these organisms if they are prevalent in the community. Sinus and orbital abscess aspirates yielded the greatest number of positive cultures, though these invasive surgical procedures should be performed only when clinically indicated.

Octyl-2-cyanoacrylate tissue adhesive in external dacryocystorhinostomy.

PURPOSE: To review our experience using octyl-2-cyanoacrylate for closing the cutaneous incision in external dacryocystorhinostomy (DCR). METHODS: A retrospective review was performed of all cases of external DCR with cyanoacrylate wound closure performed during a 12-month period. At the completion of the DCR, octyl-2-cyanoacrylate was used to close the incision. No subcutaneous sutures were placed to approximate the wound edges. Fifteen seconds of drying time elapsed before a second application of the adhesive was applied. Follow-up consisted of examinations at 1 week, 1 month, and 3 months after surgery. RESULTS: Twenty-one cases of wound closure using octyl-2-cyanoacrylate in external DCR were performed on 19 patients. Cyanoacrylate was applied to the wound without complications, and all patients had excellent closure of the wound with the cyanoacrylate at the end of the case. No wound infections were noted during the follow-up period. One patient had a wound dehiscence that was treated with forceps debridement of residual cyanoacrylate and reapplication of additional octyl-2-cyanoacrylate. One patient had hypertrophic scar formation that resolved with daily massage. In all patients, the incision was believed to be aesthetically equivalent to the expected appearance of suture closed DCR incisions. CONCLUSIONS: Closure of the DCR incision with cyanoacrylate is safe, quick, does not compromise wound integrity, and provides an aesthetic result that is equivalent to suture wound closure. Additional benefits could potentially include safer operative environment and postoperative convenience for patient and surgeon.

Optic neuropathy associated with linezolid treatment.

Two patients undergoing long-term treatment with linezolid for pneumonia had decreased visual acuity, dyschromatopsia, and cecocentral scotomas characteristic of toxic optic neuropathy. Visual function slowly recovered 3 to 4 months after discontinuation of the antibiotic treatment in both patients. Toxic optic neuropathy may occur from linezolid. Early withdrawal of the antibiotic may be associated with visual recovery.