Crystallization after intravitreal ganciclovir injection

Pitipol Choopong, Nattaporn Tesavibul, Nattawut RodanantDepartment of Ophthalmology, Siriraj Hospital, Mahidol University, Bangkok, ThailandPurpose: To report crystal formation as a complication of intravitreal ganciclovir injection.Patients and methods: A 73-year-old female patient with unilateral cytomegalovirus retinitis was treated with intravitreous ganciclovir (4 mg/0.04 mL).Results: After the intravitreal injection, sudden crystallization was observed in the vitreous. The patient experienced marked reduction in visual acuity and increased intraocular pressure. Despite aqueous paracenthesis and pars plana vitrectomy, optic atrophy was observed and her visual acuity remained unimproved after 12 months.Conclusion: Crystal formation can occur as a complication of intravitreal ganciclovir injection. Associated retinal and optic nerve damage was found which results in permanent visual morbidity.Keywords: ganciclovir, intravitreal injection, intraocular, CMV, toxicit

Laser treatment of drusen to prevent progression to advanced age-related macular degeneration.

BACKGROUND: Drusen are amorphous yellowish deposits beneath the sensory retina. People with drusen, particularly large drusen, are at higher risk of developing age-related macular degeneration (AMD). The most common complication in AMD is choroidal neovascularisation (CNV), the growth of new blood vessels in the centre of the macula. The risk of CNV is higher among patients who are already affected by CNV in one eye.It has been observed clinically that laser photocoagulation of drusen leads to their disappearance and may prevent the occurrence of advanced disease (CNV or geographic atrophy) associated with visual loss. OBJECTIVES: To examine the effectiveness and adverse effects of laser photocoagulation of drusen in AMD. SEARCH STRATEGY: We searched CENTRAL, MEDLINE and EMBASE on 14 November 2008. SELECTION CRITERIA: Randomised controlled trials (RCTs) of laser treatment of drusen in AMD in which laser treatment had been compared with no intervention or sham treatment. Two types of trials were included. Some trials studied one eye of each patient (unilateral studies); other studies recruited patients with bilateral drusen and randomised one eye to photocoagulation or control and the fellow eye to the other group. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies and extracted data. We pooled data from unilateral and bilateral studies using a random-effects model. For the bilateral studies, we estimated the within-patient correlation coefficient from one study and assumed it was valid for the others. MAIN RESULTS: We found nine studies which randomised 2216 people: four unilateral trials, three bilateral trials and two trials that included both a unilateral and a bilateral study arm.Overall, the studies were of moderate quality. Only half of the trials reported adequate allocation sequence generation, allocation concealment and masking of visual acuity outcome assessors.Although two (of the nine) studies reported significant drusen disappearance at two years, photocoagulation did not appear to affect the development of CNV at two years follow up (nine studies, 1767 people followed up, odds ratio (OR) 1.04, 95% CI 0.71 to 1.51) or the loss of three or more lines of visual acuity (six studies, 1628 people followed up, OR 1.17, 95% CI 0.75 to 1.82). AUTHORS' CONCLUSIONS: The trials included in this review confirm the clinical observation that laser photocoagulation of drusen leads to their disappearance. However, there is no evidence that this subsequently results in a reduction in the risk of developing CNV, geographic atrophy or visual acuity loss

In vitro evaluation of the antibacterial and anti-inflammation activities of Clausena lansium (Lour.) Skeels

Crude extracts of twigs and roots of Clausena lansium (Lour.) Skeels were separated and purified using repeated silica gel column chromatography to yield 12 compounds identified as xanthotoxol (1), imperatorin (2), heraclenol (3), heraclenin (4), wampetin (5), indicolactonediol (6), murrayanine (7), O-demethylmurrayanine (8), indizoline (9), 3-formyl-6-methoxycarbazole (10), lansine (11) and glycozolidal (12). All pure compounds were tested for their antibacterial and anti-inflammation activities using disc diffusion method and enzyme-linked immunosorbent assay (ELISA), respectively. At a concentration of 50 µg/mL, three carbazole alkaloid components (compounds 10, 11, and 12) demonstrated moderate antibacterial activity against the periodontopathic bacteria, Porphyromonas gingivalis. Compound 10 and the crude extract of twig revealed impressive antiinflammation potency. From these results, selected carbazole alkaloid compounds from Clausena lansium might be potential raw products in generating new anti-inflammation and antibacterial agent used as an adjunctive medication in treating periodontal disease

Non- Mydriatic Fundus Photograph Diabetic Retinopathy Screening in Primary Care Unit Setting by Paramedic Personnel

Objective: To study the accuracy and agreement of non-mydriatic fundus photographic screening of diabetic retinopathy (DR) by well-trained paramedic personnel compared to retinal specialists and to obtain the prevalence of DR stages in primary care unit (PCU). Methods: The non-mydriatic fundus photographs of diabetic patients taken at PCU were retrospectively reviewed and graded into three groups; no DR, non-proliferative DR (NPDR), proliferative DR (PDR) by two independent well-trained nurses compared to retinal specialists between November, 2015 to March, 2016. The results were statistically analyzed to determine the level of agreement between the nurses and the retinal specialists. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of each nurse were also calculated. Results: Fundus photographs of 475 patients were obtained. The patients included 129 (27.2%) males and 346 (72.8%) females with the age of 59.94 ± 8.62 years. The agreements between two readers and the retinal specialists were moderate (κ =0.46 and 0.54). The sensitivity and specificity of the first reader were 71.69% and 87.91% and the second reader were 75.50% and 90.8%, respectively. The PPV and NPV were 42.69% and 98.11% for the first reader and 50.60% and 96.70% for the second. The overall accuracy of the first nurse was 86.1% while the second was 96.0%. The prevalence of any stages of DR was 11.1%, NPDR 10.5% and PDR 0.6%. Conclusion: The single field non-mydriatic fundus photography read by trained paramedic personnel is one of the effective preliminary screening modalities. However, the continuous evaluation of the capabilities of the readers should be performed so that the patients with any stages of DR would be appropriately referred to ophthalmologists. This strategy would lead to the significant improvement of the DR screening in the country with high burden of diabetic patients