Incidence of endophthalmitis after intravitreal injection of an anti-VEGF agent with or without topical antibiotics

Intravitreal injection (IVI) of anti-vascular endothelial growth factor (VEGF) is the standard treatment modality in various types of retinal diseases. However, endophthalmitis remains the most serious complication. Despite the lack of evidence that antibiotics prevent endophthalmitis, topical antibiotics are still used routinely in Japan. We conducted a retrospective multicenter study by analyzing records from patients who underwent IVI of anti-VEGF agents with or without antibiotic treatment. In the analysis of a total of 147,440 eyes, the incidence of endophthalmitis was 0.007%: 0.005% with no use of antibiotics, 0.009% with antibiotic pretreatment, 0.012% with posttreatment, and 0.005% with pre- and posttreatment. There was no statistically significant difference among the four groups (chi-square test, p = 0.57). Most facilities used masks, sterilized gloves, and drapes. Nine of the 10 eyes that developed endophthalmitis received topical antibiotics, and all infected eyes underwent IVI with aflibercept, not the prefilled syringe delivery system. In four patients who received multiple IVI, the detection of causative bacteria revealed resistance to used antibiotics. Data from this large population, treated with or without antibiotics, suggests that antibiotic prophylaxis does not reduce the rate of endophthalmitis after IVI

The many faces of nitric oxide: cytotoxic, cytoprotective or both

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74882/1/j.1365-2982.2007.00958.x.pd

Overexpression of Pax6 results in microphthalmia, retinal dysplasia and defective retinal ganglion cell axon guidance

Background: The transcription factor Pax6 is expressed by many cell types in the developing eye. Eyes do not form in homozygous loss-of-function mouse mutants (Pax6(Sey/Sey)) and are abnormally small in Pax6(Sey/+) mutants. Eyes are also abnormally small in PAX77 mice expressing multiple copies of human PAX6 in addition to endogenous Pax6; protein sequences are identical in the two species. The developmental events that lead to microphthalmia in PAX77 mice are not well-characterised, so it is not clear whether over- and under-expression of Pax6/PAX6 cause microphthalmia through similar mechanisms. Here, we examined the consequences of over-expression for the eye and its axonal connections. Results: Eyes form in PAX77(+/+) embryos but subsequently degenerate. At E12.5, we found no abnormalities in ocular morphology, retinal cell cycle parameters and the incidence of retinal cell death. From E14.5 on, we observed malformations of the optic disc. From E16.5 into postnatal life there is progressively more severe retinal dysplasia and microphthalmia. Analyses of patterns of gene expression indicated that PAX77(+/+) retinae produce a normal range of cell types, including retinal ganglion cells (RGCs). At E14.5 and E16.5, quantitative RT-PCR with probes for a range of molecules associated with retinal development showed only one significant change: a slight reduction in levels of mRNA encoding the secreted morphogen Shh at E16.5. At E16.5, tract-tracing with carbocyanine dyes in PAX77(+/+) embryos revealed errors in intraretinal navigation by RGC axons, a decrease in the number of RGC axons reaching the thalamus and an increase in the proportion of ipsilateral projections among those RGC axons that do reach the thalamus. A survey of embryos with different Pax6/PAX6 gene dosage (Pax6(Sey/+), Pax6(+/+), PAX77(+) and PAX77(+/+)) showed that (1) the total number of RGC axons projected by the retina and (2) the proportions that are sorted into the ipsilateral and contralateral optic tracts at the optic chiasm vary differently with gene dosage. Increasing dosage increases the proportion projecting ipsilaterally regardless of the size of the total projection. Conclusion: Pax6 overexpression does not obviously impair the initial formation of the eye and its major cell-types but prevents normal development of the retina from about E14.5, leading eventually to severe retinal degeneration in postnatal life. This sequence is different to that underlying microphthalmia in Pax6(+/-) heterozygotes, which is due primarily to defects in the initial stages of lens formation. Before the onset of severe retinal dysplasia, Pax6 overexpression causes defects of retinal axons, preventing their normal growth and navigation through the optic chiasm

Conjunctival Advancement With Subconjunctival Amniotic Membrane Draping Technique for Leaking Cystic Blebs

To describe the successful use of a technique involving amniotic membrane graft for the repair of leaking cystic blebs following mitomycin C (MMC) trabeculectomy. A retrospective review of 17 eyes of 16 patients who had undergone trabeculectomy with MMC or combined cataract phacoemulsification and trabeculectomy with MMC and presented with leaky cystic blebs with or without hypotony was conducted. All patients were treated with amniotic membrane graft over the leaking area with conjunctival advancement without excision of the cystic bleb and had a minimum of 1-year follow-up. Success was defined as a final intraocular pressure (IOP) ≥ 6 and ≤ 21 mm Hg without glaucoma medications. Qualified success that met the above criteria, however, required the use of glaucoma medication for optimal IOP control. Failure was defined as any patient with persistent bleb leak requiring additional procedures and/or the presence of hypotony (IOP<6 mm Hg ± clinical evidence of hypotony maculopathy). Seventeen of the 17 eyes had complete resolution of bleb leak at last follow-up. Total success rate was 15 of the 17 patients, or 88%. Eleven eyes (64.7%) met criteria for complete success. Four eyes (23.5%) required glaucoma medications after the procedure and met criteria for qualified success. Two eyes (11.8%) met criteria for failure, as they presented with a pinpoint limbal leak requiring a suture at the slit lamp in the postoperative period. Mean IOP increased from 5.7 ± 2.8 mm Hg preoperatively to 13.1 ± 3.4 mm Hg at most recent follow-up (P<0.000007). LogMAR visual acuity likewise improved from 0.7 ± 0.8 preoperatively to 0.1 ± 0.1 LogMAR units at most recent follow-up (P<0.030). Mean follow-up time was 21.4 ± 7.3 months. The technique of amniotic membrane bleb draping with conjunctival advancement successfully restored bleb function, while facilitating fast resolution and stabilization of IOP and visual acuity

Intraocular Pressure Lowering Effect of Once Daily versus Once Weekly Latanoprost Instillation in the Same Normal Individuals

This study tested whether once weekly instillation of latanoprost exerts the similarIOP lowering effect as once daily instillation in the same individuals. Latanoprost wasadministered on right eyes of eight healthy male volunteers once daily first for 24 days,which was followed by the 31-day washout and the subsequent once weekly instillationfor another 24 days. The mean baseline IOP was 12.06 ± 1.50 (range, 10.0 to 14.0)mmHg, whereas the mean IOP during once daily treatment was 9.87 ± 1.71 mmHg,which was significantly lower than the former (p=0.025). The mean washout IOP was12.56 ± 2.16 mmHg, which was similar to the baseline IOP. The mean IOP during onceweekly instillation of latanoprost was 11.34 ± 1.51 mmHg, which was not statisticallydifferent from the washout IOP. Four of the 8 subjects showed 15% or more reductionin IOP both during once daily and once weekly instillations, two of whom wereoverlapped. Since the magnitude of the IOP reduction with once daily use was higherthan that with once weekly use even in the responders, the current protocol of oncedaily instillation should be respected