Efficacy and comfort of olopatadine vs ketotifen ophthalmic solutions

BACKGROUND: Ocular allergies cause itching, redness, chemosis, tearing, and swelling of the eyelids in sensitized individuals. The options available for treatment of ocular allergy include olopatadine 0.1% (Opatanol; Patanol [US]) and ketotifen 0.025% (Zaditen; Zaditor [US]). Patient preference for an eye drop can often be a primary factor in determining the level of compliance and satisfaction with any given therapy. OBJECTIVE: This study sought patient perspective on eye drop efficacy in controlling signs and symptoms of allergic conjunctivitis and eye drop comfort. Also evaluated were the factors considered by patients when making decisions of preference. METHODS: One hundred patients with previous history and current symptoms of seasonal or perennial allergic conjunctivitis were enrolled at two centers (Athens, Greece, N = 50; Padova, Italy, N = 50) for this two visit, double-masked study. Qualified patients received two masked bottles of medication (one olopatadine, one ketotifen) and were asked to use both medications as needed over the course of four weeks, but not to exceed usage of two drops of medication per eye per day. At the second visit, patients answered five questions comparing the two masked medications in terms of preference, drop comfort, and efficacy in treatment of signs and symptoms. Patients also defined the factors upon which they based these decisions. RESULTS: A significantly greater percentage of patients (81%) selected olopatadine when asked which medication they preferred; which they found more comfortable; which they found more efficacious in reducing symptoms of allergy; and which they would select if visiting the doctor's office (P < 0.0001). Seventy-six percent (76%) of patients considered both efficacy and comfort when making their preference decisions (P < 0.0001). No adverse events were volunteered or elicited. CONCLUSION: In this study, patients preferred to use the anti-allergy eye drop olopatadine over ketotifen after using both drops and evaluating relative efficacy and comfort during the course of four weeks. A significantly greater percentage of the patients preferred to use olopatadine during the study period, found it more efficacious and comfortable, and would select olopatadine if visiting their doctor's office during allergy seaso

Corneal graft detachment without corneal edema after descemet stripping automated endothelial keratoplasty.

To report the case of a patient who underwent Descemet stripping automated endothelial keratoplasty complicated by corneal graft detachment without corneal edema. Case report. A 60-year-old man with bilateral decompensated endothelium 10 years after cataract extraction and anterior chamber intraocular lens implantation underwent combined anterior chamber intraocular lens explantation with iris-sutured posterior chamber intraocular lens implantation and Descemet stripping automated endothelial keratoplasty on the right eye. On the second postoperative day, the corneal graft was attached. Two weeks postoperatively, slit lamp examination revealed a double anterior chamber resulting from corneal graft detachment. The corneal graft was reattached by repositioning and injecting air. One week later, the corneal graft had detached again, creating a double anterior chamber. No corneal edema was present. Nine months postoperatively, the cornea remained clear, although a double anterior chamber was still evident as a result of the detached corneal graft. Despite post-Descemet stripping automated endothelial keratoplasty corneal graft detachment, the cornea remained without edema

Cystoid macular edema in a patient with acquired immunodeficiency syndrome and past ocular history of cytomegalovirus retinitis after initiation of protease inhibitors

Purpose: To describe a patient with acquired immunodeficiency syndrome (AIDS) who presented with cystoid macular edema (CME) which was not associated with active cytomegalovirus (CMV) retinitis or AIDS-related microvasculopathy. Method: A 32-year-old man with AIDS and a past ocular history of inactive CMV retinitis was placed on protease inhibitors when his CD4(+) T lymphocyte counts dropped to 8 cells/mm(3). Three months later, after his CD4(+) T lymphocyte counts had increased to 196 cells/mm(3) he complained of micropsia and metamorphopsia in his right eye of 1 week duration. The patient had a complete ocular examination including fluorescein angiography (FA). Results: Visual acuity (VA) was 7/10 OD. Fundus examination revealed CME and inactive CMV retinitis, and FA demonstrated CME and a hot disc. Two transseptal injections of corticosteroids were administered 2 weeks apart in the right eye as treatment of the CME. The patient reported gradual visual improvement and 6 weeks later, his VA was 10/10(-2). CME had resolved clinically and angiographically. Conclusions: CME in our case is associated with inactive CMV retinitis and gradually increasing number of CD4(+) T lymphocytes after initiation of treatment with protease inhibitors. It may be amenable to regional administration of corticosteroids without reactivation of retinitis

Intraocular lens removal patients with uveitis

PURPOSE: To report a series of patients with uveitis and cataract who had undergone cataract extraction with posterior chamber intraocular lens implantation and who subsequently had the intraocular lens removed because of progressive intraocular damage from inflammation. METHODS: Review of the records of 19 patients after removal of a posterior chamber intraocular lens. The decision to perform surgery was based on standard criteria after evaluation at a single uveitis referral center. RESULTS: The complications leading to intraocular lens removal were perilental membrane (eight eyes), chronic low-grade inflammation not responding to antiinflammatory treatment (eight eyes), and cyclitic membrane resulting in hypotony and maculopathy (three eyes). After intraocular lens removal the inflammation subsided and the visual acuity improved or stabilized in 14 of the 19 eyes. The causes of further reduction in the visual acuity of the other five patients were macular edema (two patients), maculopathy resulting from hypotony (one patient), retinal detachment (one patient), and vitreous hemorrhage (one patient). CONCLUSIONS: Intraocular lens implantation can form part of a reasonable plan for visual rehabilitation of patients with uveitic cataract, but inclusion of an intraocular lens in the plan is not always in the overall long-term best interest of the patient, Intraocular lens removal may salvage useful vision for patients who continue to exhibit complications secondary to uveitis after cataract extraction and intraocular lens implantation, provided the intraocular lens is removed before irreparable damage has been done to macula or optic nerve. (Am J Ophthalmol 1999;128:31-37. (C) 1999 by Elsevier Science Inc. All rights reserved.

Topical 2.0% dorzolamide vs oral acetazolamide for prevention of intraocular pressure rise after neodymium:YAG laser posterior capsulotomy

Objective: To compare the efficacy and safety of topical 2.0% dorzolamide hydrochloride with oral acetazolamide in preventing intraocular pressure (IOP) rise following neodymium:YAG (Nd:YAG) laser posterior capsulotomy. Design: A prospective,randomized, double-masked, placebo-controlled study. Patients: Two hundred ten patients undergoing Nd: YAG laser posterior capsulotomy. Intervention: Pretreatment with dorzolamide, acetazolamide, or placebo. Dorzolamide administration as a single drop (1 drop approximate to 20 mu L) 1 hour before capsulotomy. Acetazolamide administration as a single dose of 125 mg orally 1 hour before capsulotomy. Results: At first and third hour postoperatively, IOPs and IOP changes from baseline were significantly (P&lt;.001) higher in the placebo group than in the dorzolamide or acetazolamide group. At the same time, IOPs and IOP changes from baseline were similar (P&gt;.50) in the dorzolamide and acetazolamide groups. No patient treated with dorzolamide or acetazolamide experienced an IOP higher than 30 mm Hg after capsulotomy, but 15.7% of patients receiving placebo had an IOP above this level (P&lt;.001). Of patients receiving placebo, 5.7% experienced IOP higher than 35 mm Hg. No serious side effects were recorded in any of the studied patients. Conclusion: Topical 2.0% dorzolamide and oral acetazolamide, given prophylactically as a single administration 1 hour before Nd:YAG laser posterior capsulotomy, have comparable high efficacy and safety in preventing IOP elevation following this procedure

Acute comitant esotropia after cataract surgery

A 52-year-old woman developed comitant esotropia after cataract surgery. The ocular history was significant for accommodative esotropia; preoperatively, she manifested peripheral fusion with central suppression. Immediately postoperatively, the patient was diplopic with comitant esotropia and was treated with extraocular muscle surgery. The appearance of horizontal strabismus after cataract surgery in patients with a history of accommodative esotropia, especially those with subnormal binocularity, is a possible complication that should be discussed with the patient. © 2002 ASCRS and ESCRS

Twelve years&apos; continuous wear of the same therapeutic soft contact lens: a case report

Purpose. To describe a case of a patient who had worn the same therapeutic soft contact lens (TSCL) continuously for twelve years, since he had failed to attend normal follow-up visits. Methods. Microbiological histological and scanning electron microscopic (SEM) studies of conjunctiva, cornea and TSCL were done. Results. Cultures were negative. Corneal histology revealed mild stromal edema and mild epithelial parakeratosis. Corneal SEM was remarkable for the preservation to some extent of normal corneal epithelial specialization with microtricae and microvillae. SEM of the TSCL showed a ruffed multi-layer surface with several cracks including different types of cells. Conclusions. The patient showed surprising tolerance to the continuous wear of the same contact lens for 12 years

Relapsing polychondritis: A clinical review

Objective: This study comprehensively reviews the literature related to relapsing polychondritis (RP). Methods: A detailed search via MEDLINE (PubMed) was performed using relapsing polychondritis as the key term. Relevant articles were analyzed with a focus on history, epidemiology, etiology, pathogenesis, clinical manifestations, diagnosis, treatment, and prognosis of RP. Results: RP is a rare episodic and progressive inflammatory disease of presumed autoimmune etiology first described in 1923, RP affects cartilage in multiple organs, such as the ear, nose, larynx, trachea, bronchi, and joints. In addition, it can affect proteoglycan-rich tissues, such as the eyes, aorta, heart, and skin. The diagnosis of RP is based on the presence of clinical criteria. A standardized therapeutic protocol for RP has not been established. Nonsteroidal anti-inflammatory drugs, dapsone and/or colchicine, may control disease activity in some patients. In other patients, immunosuppressive drugs and prednisone have been effective, RP is a potentially lethal disease; pulmonary infection, systemic vasculitis, airway collapse, and renal failure are the most common causes of death. Earlier studies indicate survival rates between 70% at 4 years and 55% at 10 years. In a recent study, a survival rate of 94% at 8 years may be due to improved medical and surgical management. Conclusions: RP is a rare, multisystemic, and potentially fatal disease. The pathogenesis and optimal therapeutic approach to patients with RP is poorly understood

Herpes simplex virus type 2: a cause of acute retinal necrosis syndrome

Purpose: To describe a case of herpes simplex virus type 2 (HSV-2) acute retinal necrosis syndrome (ARN) in a 13-year-old immunocompetent girl. Methods: Polymerase chain reaction (PCR), cultures, flow cytometry, and cytology were performed on the vitreous sample. Results: Both PCR studies and vitreous cultures revealed HSV-2 as the cause of ARN. Flow cytometry showed CD4+, CD8+, and natural killer cells. The visual outcome of the patient was 20/200. Conclusion: Successful culture of HSV-2 from the vitreous specimen in a patient with ARN proved HSV-2 to be one of the causes of ARN. The successful culture of HSV-2 has not been previously reported

Cell populations and adhesion molecules expression in conjunctiva before and after bone marrow transplantation

We were interested to analyse the composition of the cellular infiltrate and adhesion molecules expression in the conjunctiva before and at least one hundred days after autologous and allogenic bone marrow transplantation (BMT) and its relation with the presence of dry eye. We used immunohistochemistry on cryopreserved human conjunctiva with monoclonal antibodies to T-lymphocytes (CD3, CD4 and CD8), B-lymphocytes (CD19), macrophages (CD14), natural killer cells (NK, CD57), intercellular adhesion molecule 1 (ICAM-1), E-selectin, vascular cell adhesion molecule-1 (VCAM-1), lymphocyte function associated antigen-1 (LFA-1), very late antigen-4 (VLA-4), interleukin 2 receptor (IL2r, CD25) and HLA-DR. Our autologous recipients had no graft-versus-host disease (GVHD) but allogenic patients had chronic GVHD. After autologous BMT the conjunctiva had significantly more: (1) T lymphocytes (CD3+, CD4+, CD8+) in the epithelium; (2) CD4+ and CD 14+ cells in the stroma; and (3) VLA-4 expression in the stroma than before BMT. After allogenic BMT, the conjunctiva exhibited a significant increase of: (1) CD3+ and CD 14+ cells in the epithelium; (2) T lymphocytes (CD3+, CD4+, CD8+) and CD 14+ cells in the stroma; and (3) VLA-4 and LFA-1 expression in the stroma than before BMT. After the engraftment, the comparison between autologous and allogenic recipients revealed that: (1) there were no significant differences in adhesion molecule expression; (2) the epithelium of autologous recipients had significantly more CD3+ cells; and (3) the stroma of allogenic patients had significantly more CD3+ and CD8+ cells. Among allogenic recipients, CD14+ cells were significantly increased both in the epithelium and in the stroma of patients with signs or symptoms of dry eye in comparison with patients without ocular involvement. Additionally, those having keratoconjunetivitis sicca (KCS) had CD4/CD8 ratios significantly higher than those without KCS.In conclusion, in the conjunctiva after autologous BMT a subclinical cell mediated immune reaction seems to take place. the conjunctivitis of chronic GVHD is complex, with T cells and macrophages dramatically contributing to the process. (c) 2005 Elsevier B.V. All rights reserved.Univ Complutense Madrid, Inst Invest Oftalmol Ramon Castroviejo, Fac Med, E-28040 Madrid, SpainHarvard Univ, Sch Med, Massachusetts Eye & Ear Infirm, Hilles Immunol Lab,Dept Ophthalmol, Boston, MA 02114 USAUniversidade Federal de São Paulo, Paulista Sch Med, Dept Ophthalmol, São Paulo, BrazilHosp Gen Albacete, Dept Prevent Med, Madrid, SpainUniversidade Federal de São Paulo, Paulista Sch Med, Dept Ophthalmol, São Paulo, BrazilWeb of Scienc