Lower Conjunctival Fornix Packing for Mydriasis in Premature Infants: A Randomized Trial

Objective: To compare the mydriatic effect of lower conjunctival fornix packing to conventional instillation of eyedrops containing 2.5% phenylephrine and 1% tropicamide in premature infants undergoing examination for retinopathy of prematurity. Methods The patients were randomized to receive either conventional instillation of mydriatic drops or lower conjunctival fornix packing in one eye and the alternate method in the fellow eye. For the eyes receiving lower conjunctival fornix packing (study group), one small piece of the cotton wool soaked with one drop of 2.5% phenylephrine and one drop of 1% tropicamide was packed in the lower conjunctival fornix for 15 minutes. For the eyes receiving the conventional instillation (control group), 2.5% phenylephrine and 1% tropicamide were alternately instilled every 5 minutes for two doses each. Horizontal pupil diameter was measured with a ruler in millimeters 40 minutes later. Results: The mean dilated pupil diameter in study group and control group were 5.76 ± 1.01 mm and 4.50 ± 1.08 mm, respectively. This difference was statistically significant (P < 0.05). Conclusion: The dilated pupil diameter after receiving the lower conjunctival fornix packing was larger than conventional instillation with a statistically significant difference. We recommended the packing method to dilate the preterm infant pupil, especially if the pupil is difficult to dilate

Conjunctivitis: Systematic Approach to Diagnosis and Therapy

Conjunctivitis is a common problem in primary health care. Inflammation of the conjunctiva may result from infection or noninfectious causes. Microbial conjunctivitis may be caused by bacteria, viruses, or parasites. Although usually a benign, self-limited disease in healthy individuals, serious complications (eg, keratitis) may be sight-threatening. Accurate diagnosis and specific treatment of conjunctivitis remain challenging. History taking and physical examination are occasionally insufficient for correct diagnosis, thus laboratory testing may play a vital role in identification of specific pathogen(s). However, diagnostic testing has several limitations, including time-consuming methods, increased cost, and requirement for expertise in performance and interpretation. Treatment with empirical topical antibiotics for suspected infectious conjunctivitis is controversial. Although antibiotic treatment can diminish risk of adverse events and shorten the course of disease, drug resistance, toxicity, and expense are important considerations in management of acute infectious conjunctivitis

Successful treatment of Chrysosporium keratitis with voriconazole

Onsiri Thanathanee, Chavakij Bhoomibunchoo,&nbsp;Orapin Anutarapongpan,&nbsp;Olan Suwan-apichon,&nbsp;Yosanan Yospaiboon KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Objective: To report a patient with severe Chrysosporium keratitis successfully treated by voriconazole.Method: Case report.Results: A 37-year-old healthy male presented with irritation, pain and reduced vision in his left eye after mud contamination. Examination demonstrated corneal stromal infiltration, endothelial plaque and hypopyon. Corneal scrapings demonstrated numerous septate hyphae, and specimen cultures were positive for Chrysosporium sp. The lesion did not respond to aggressive topical 5% natamycin, 0.15% topical amphotericin B and oral itraconazole. The patient was then treated by topical 1% voriconazole every hour. Intracameral and intrastromal voriconazole injections (50  &mu;g/0.1  mL) were also undertaken. The keratitis was significantly improved after voriconazole.Conclusion: To the best of the authors&rsquo; knowledge, this is the first report on the use of voriconazole for Chrysosporium keratitis. Voriconazole may be an effective alternative to conventional antifungal agents in some cases of fungal keratitis. It should be considered before shifting to therapeutic keratoplasty. Keywords: Chrysosporium, keratitis, keratoplasty, voriconazol

Comparative In Vitro

Purpose: To compare in vitro susceptibility of amphotericin B (AMB) and amphotericin B methyl ester (AME) (a more soluble and less toxic formulation of AMB) against Candida albicans isolates recovered from human cases of endophthalmitis. Methods: The in vitro susceptibility of AMB and AME was determined for C. albicans isolates recovered from endophthalmitis ( N =10) and for C. albicans ATCC reference strain 90028 using the Clinical and Laboratory Standards Institute M27-A2 (NCCLS/CLSI) broth dilution method. All isolates were obtained from samples of vitreous humor of patients with suspected endophthalmitis within the last 5 years at the Bascom Palmer Eye Institute, University of Miami Miller School of Medicine (Miami, FL). Results: The minimal inhibitory concentrations (MICs) of AME were equal to or lower than values for AMB in 7 of the 10 isolates; range: AME (0.125–1 μg/mL) versus (0.5–1 μg/mL) for AMB. The MIC 90 value of both drugs was equal (1 μg/mL). Compared with AMB, the minimal fungicidal concentrations (MFCs) of AME were equal to or lower in 8 of 10 isolates; range: AME (0.125–2 μg/mL) versus AMB (0.25–4 μg/mL). MFC 90 values of AME (1 μg/mL) was slightly superior to AMB (2 μg/mL). The MIC of the quality control strain (ATCC ® 90028) was within an acceptable range. Conclusions: AME was equivalent to AMB in vitro against C. albicans . This formula may offer a slightly more efficient and less toxic formulation for the treatment of Candida endophthalmitis