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PubMed1991

Effects of topical suprofen and flurbiprofen on the miosis produced by anterior chamber irrigation with cholinergic agonists.

Pretreatment with topical nonsteroidal anti-inflammatory drugs is common practice to maintain maximal pupil dilation for cataract surgery. Most surgeons also inject a cholinergic agent intracamerally for miosis after intraocular lens insertion. We evaluated the effects of topical suprofen and flurbiprofen on the miosis induced by anterior chamber irrigation with either acetylcholine or carbachol. One eye of 30 pigmented rabbits was dilated with cyclopentolate HCl and phenylephrine HCl. Three groups, each composed of ten eyes, received flurbiprofen, suprofen, or a control. In each group, five eyes received acetylcholine by anterior chamber irrigation and five received carbachol. Pupil diameters were measured with calipers before and five minutes after irrigation by an observer unaware of the treatment regimen. Irides irrigated with carbachol constricted less than those irrigated with acetylcholine (P = .016). In anterior chambers irrigated with carbachol, suprofen was associated with less miosis than either tears (P = .005) or flurbiprofen (P = .009); however, if the infusion was performed with acetylcholine, no differences between the three groups were noted (P = .44).

Acetylcholine↗
PubMed1990

Evaluation of flurbiprofen-exposed irises to acetylcholine anterior chamber irrigation.

Flurbiprofen (Ocufen), an antiprostaglandin, has been introduced into cataract surgery. It is used to prevent intraoperative miosis by blocking inflammatory mediator formation. Ocufen has been noted to diminish the controlled miosis produced by using acetylcholine in the operative period. This study evaluated the pupillary response to acetylcholine after it had been exposed to Ocufen. This was done using a control versus a study eye in 16 rabbits dilated with phenylephrine hydrochloride and cyclopentolate hydrochloride. The pupil diameters were measured at baseline, then the rabbits' anterior chambers were irrigated with an acetylcholine solution. The resultant pupillary diameters were measured at one and five minutes. At five minutes post-irrigation there was a statistically significant greater constriction in the control group than in the Ocufen group. This implies that Ocufen dampens the iris musculature's response to acetylcholine.

Acetylcholine↗
PubMed1999

Posterior capsule opacification after phacoemulsification in patients with diabetes mellitus.

PURPOSE: To compare posterior capsule opacification (PCO) after phacoemulsification and implantation of heparin-surface-modified (HSM) poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs) in the capsular bag in patients with diabetes mellitus with that in a control group. SETTING: St. Erik's Eye Hospital, Stockholm, Sweden. METHODS: This prospective study comprised 26 patients with diabetes mellitus and 26 control patients without diabetes. Those with glaucoma, exfoliation syndrome, uveitis, and pupil size smaller than 6.0 mm after dilation were excluded. All patients received the same standardized phacoemulsification procedure with implantation of an HSM PMMA IOL in the capsular bag. Posterior capsule opacification was scored 1 and 2 years after surgery by evaluating retroillumination images taken with a Scheimpflug camera (Nidek Anterior Eye Segment Analysis System) after pupil dilation with phenylephrine 10% and cyclopentolate 1%. The PCO density behind the IOL optic was graded clinically from 0 to 4 (0 = none, 1 = minimal, 2 = mild, 3 = moderate, 4 = severe) and scored using the Evaluation of Posterior Capsule Opacification medical software developing system. RESULTS: No differences in PCO were found between the diabetic and control groups 1 year after surgery. The total PCO score was significantly less in diabetic than in control eyes 2 years after surgery (P < .05, Mann-Whitney). In addition, progression of PCO from 1 year to 2 years after surgery was significantly less in diabetic groups with different stages of diabetic retinopathy than in the control group (P < or = .05, Kruskal-Wallis analysis of variance and multiple comparisons). CONCLUSION: The rate of PCO after phacoemulsification was statistically significantly lower in patients with diabetes mellitus than in those without diabetes.

Aged↗
PubMed1999

Pseudoaccommodation: BioComFold versus a foldable silicone intraocular lens.

PURPOSE: To assess the degree of pseudoaccommodation amplitude correlated with shifts along the anteroposterior axis of the BioComFold foldable intraocular lens (IOL). SETTING: Department of Ophthalmology, Hôtel-Dieu Hospital, Paris, France. METHODS: This prospective study comprised 30 eyes of 30 patients operated on consecutively for cataract by phacoemulsification and in-the-bag implantation of a BioComFold (15 patients) or a foldable control (15 patients) IOL. The BioComFold IOL has a peripheral bulging ring that pushes the optic forward during the effort to accommodate, creating a zoom effect. Pseudoaccommodation amplitude was evaluated using the blurring of controlled vision by adding spheres, with the best correction for distance vision in place. Pupil diameter was measured with a Goldmann campimeter under constant illumination. Anterior chamber depth was determined by A-scan (Paxial, Biophysic Medical) 30 minutes after cyclopentolate 1% was instilled and again 30 minutes after pilocarpine 2% was instilled. RESULTS: The difference in pseudoaccommodation amplitude and pupil diameter between the 2 groups was not statistically significant (P = .6737 and P = .4014, respectively). The IOL's forward shifts from maximal ciliary relaxation to maximal ciliary contraction were significantly greater in the BioComFold group (P = .0215). CONCLUSION: The design of the BioComFold IOL allowed greater forward optic shifts along the anteroposterior axis during the effort to accommodate. Nevertheless, this shift was not correlated with a significantly greater pseudoaccommodation amplitude.

Accommodation, Ocular↗
PubMed2001

Randomised controlled trial of ketorolac in the management of corneal abrasions.

PURPOSE: To evaluate the role of topical non-steroidal anti-inflammatory agents (NSAIDs) in the management of corneal abrasions with respect to symptoms and healing. METHODS: The study was designed as a prospective, single center, randomised, placebo controlled, double-blinded trial. Eighty-eight consecutive patients with non-infective, non-contact lens related traumatic or foreign body removal related corneal abrasions were recruited to this study. They were randomised into two groups. Both groups were given a single instillation of Gutt. cyclopentolate 0.5% followed by chloramphenicol eye ointment four times a day until the following day. In addition, the treatment group received topical Ketorolac trometamol 0.5% ophthalmic solution while the control group received placebo Liquifilm tears. Patients were assessed at presentation and about twenty-four hours later for subjective symptoms, abrasion size and any associated complications. RESULTS: There was no statistical difference in the two groups at base line and twenty-four hour follow-up when assessed for five subjective symptoms of pain, photophobia, grittiness, watering and blurring of vision. However, those receiving topical ketorolac required significantly less additional oral analgesics (p=0.001). There was no difference in the rate of healing. CONCLUSION: Use of topical ketorolac may be a useful adjunct in the management of corneal abrasions.

Administration, Topical↗
PubMed2003

Surgically induced miosis during phacoemulsification in patients with diabetes mellitus.

PURPOSE: To assess the incidence of surgically induced miosis during phacoemulsification in diabetic patients. METHODS: A total of 76 patients with diabetes mellitus were compared to 76 age- and race-matched controls. A combination of cyclopentolate 1%, phenylephrine 2.5% and diclofenac sodium 0.1% was applied topically 60, 45 and 30 min before surgery. Adrenaline mixed with buffered saline solution was used for irrigation during surgery. The procedure included phacoemulsification and implantation into the bag of a foldable acrylic implant. Measurements of the horizontal pupillary diameter were taken at three stages: before corneal incision, after phacoemulsification, and at the end of surgery. The duration of phacoemulsification was also recorded. RESULTS: Surgically induced miosis or dilation of the pupil was defined as constriction or dilation noted at any interval during surgery. The pairs of diabetic-control were grouped into three groups: those in which constriction was noted, those in which dilation was noted, and those in which there was no change in pupil size during the procedure. Surgically induced miosis was noted more often in the diabetics (McNemar's test, chi(2), P=0.016). The mean pupil size at the beginning of surgery was 7.38 (+/-0.95) mm in the diabetics as compared to 7.65 (+/-0.89) mm in the control group. No statistically significant difference was noted between the two groups (paired t-test, P=0.07). The mean (+/-SD) duration of phacoemulsification in the diabetic group was 2.31 (+/-1) min as compared to 2.05 (+/-0.82) min in the control group. No statistically significant difference was found between the two groups (paired t-test, P=0.08). CONCLUSION: Surgically induced miosis occurred more often in the diabetics. Therefore, it is advisable that phacoemulsification in this group of patients is undertaken by an experienced surgeon.

Aged↗
PubMed2001

[Biochemical stress monitoring during cataract surgery; phenylephrine 10% shows no changes in serum-catecholamines in comparison with phenylephrine 5%].

BACKGROUND: There is a controversy about the concentration of topical phenylephrine recommended for diagnostic or therapeutic mydriasis. Phenylephrine 10% leads to a faster and more pronounced mydriasis but cardio-vascular side-effects like hypertension and arrhythmia have been reported. A maximal pupillary dilatation is a prerequisite for successful cataract surgery. The aim of this study was to evaluate the risk-benefit ratio of phenylephrine 10% in comparison to 5% in the daily practice of the cataract-surgery unit in our clinic by clinical assessment and monitoring of biochemical stress parameters. PATIENTS AND METHODS: 30 informed and consenting patients were randomly allocated to 2 groups of equal size. After a single application of 2 drops of phenylephrine 5% in group 1 and 10% in group 2 respectively and 1 drops of cyclopentolate 1% with neutral pupil (time 0), an ECG was recorded and blood pressure, pulse, oxygen-saturation and pupil size were measured. Simultaneously a blood-sample was taken and the serum-catecholamines adrenaline and noradrenaline were determined by HPLC (High Pressure Liquid Chromatography). These measurements were repeated after 5, 10 and 30 minutes. RESULTS: The mean pupil area after 30 minutes in group 1 was 31.97 (+/- 0.43) mm2 compared to 45.72 (+/- 0.39) mm2 in group 2. Our data showed no other significant variation between the groups: neither clinical monitoring nor catecholamine measurements showed concentration-dependent patterns in blood pressure development or serum levels. No systemic cardiovascular effects were observed. CONCLUSION: These results demonstrate that a controlled application of phenylephrine 10%--under observation of contraindications--yields no increased risk for the occurrence of cardio-vascular side-effects in comparison with phenylephrine 5%. Therefore, we recommend the use of phenylephrine 10% in the described dosage as routine medication for cataract surgery.

Aged↗
PubMed1999

[Perioperative circulatory side effects of topical 5% phenylephrine for mydriasis].

PURPOSE: To study the systemic effects of topically applied 5% phenylephrine. To investigate intraoperative injection of epinephrine in the anterior chamber as an alternative. METHOD: 75 patients undergoing cataract surgery were randomized into three groups. In group 1, the pupil was dilated using topically 5% phenylephrine and 1% cyclopentolate, the patients blocked the lacrimal drainage system themselves by digital compression. Group 2 received the same drops, digital compression was performed by one of the investigators. In Group 3, no preoperative phenylephrine was used--instead, epinephrine 1:25,000 was injected in the anterior chamber at the beginning of surgery. Retrobulbar anesthesia was performed in a short narcosis with ketamine and propofol. RESULTS: Mean preoperative blood pressure values were higher than the day before. They fell during narcosis, to increase significantly after the injection of the local anesthetics. At the beginning of surgery they were back to prenarcotic values. Intraoperative blood pressure remained stable. Preoperative day values were found two hours postop. There was no significant difference in the circulatory behavior between the three groups. For mydriasis, intraoperative intracameral epinephrine was not as effective as preoperative phenylephrine. CONCLUSION: In normotonic or medically treated arterial hypertensive patients, preoperative mydriasis using 5% phenylephrine is safe--proceeding the way described above. Compression of the lacrimal drainage system can be performed by the patients effectively. Intraoperative intracameral epinephrine does not replace preoperative phenylephrine.

Administration, Topical↗
PubMed2004

Indocyanine green angiography in ocular tuberculosis.

PURPOSE: To assess indocyanine green (ICG) angiography as a method for evaluating the extent of choroidal involvement and to compare ICG angiography with fundus fluorescein angiography (FFA) in ocular tuberculosis. METHODS: FFA and ICG angiography were performed on two patients who had ocular tuberculosis findings during fundus examination. The patients were given topical dexamethasone phosphate, topical cyclopentolate, and oral prednisolone acetate in addition to systemic antimicrobial therapy. Both examinations were repeated after treatment. RESULTS: In one patient, two hypofluorescent lesions that corresponded to the choroidal tuberculomas were noted with ICG angiography. Only one lesion was found during ophthalmoscopic examination and FFA. After treatment, these lesions persisted, but became less hypofluorescent. In the other patient, ICG angiography showed a hypofluorescent choroidal lesion corresponding to the choroidal tuberculoma that was larger than its appearance on FFA. This lesion remained hypofluorescent in all phases of ICG angiography and became less hypofluorescent after treatment. CONCLUSIONS: ICG angiography is a useful method to determine the extent of the choroidal lesion and the stage of disease and to evaluate treatment results in tuberculosis patients.

Antitubercular Agents↗
PubMed2005

Methods for a population-based study of myopia and other eye conditions in school children: the Sydney Myopia Study.

PURPOSE: The Sydney Myopia Study will establish the prevalence of myopia and other eye diseases in a large representative sample of Sydney school children. It will also examine the relationship between myopia and potential modifiable risk factors and will assess potential gene-environment interactions by examining parents and siblings. METHODS: The target population is a stratified random cluster sample of 1750 Year 1 (age 6 years) and 1500 Year 7 (age 12 years) students from Sydney metropolitan schools. Procedures (comprehensive parent-administered questionnaire and examination) involve standardized protocols to allow for comparison with international population-based data. Examinations include a detailed assessment of visual acuity, cover testing for strabismus, identification of amblyopia, slit-lamp examination, non-contact ocular biometry and cycloplegia (cyclopentolate) followed by autorefraction, optical coherence tomography, retinal thickness measurement, digital mydriatic retinal photography and aberrometry. CONCLUSIONS: The Sydney Myopia Study design and methodology will ensure valid findings on ocular development and health in a large representative sample of Sydney school children, for comparison with other population-based refraction data.

Adolescent↗
PubMed1998

Selectivity of muscarinic agonists including (+/-)-aceclidine and antimuscarinics on the human intraocular muscles.

The average EC50 value and the maximum response of carbachol on the human circular ciliary muscle obtained within 24 h of postmortem hypoxia was 517 nmol/l and 135 mg, respectively. These values for carbachol did not differ significantly from that of the longitudinal ciliary muscle. However, when tested at 1 mumol/l of carbachol, the peak response of the longitudinal muscle occurred at 59 sec vs 173 sec for that of the circular muscle of 70 year old donors. The relative potency of the muscarinic agonists on the circular muscle was oxotremorine-M, 1 > carbachol, 1/4 > pilocarpine, 1/19 > aceclidine, 1/132. The relative order of potency of agonists was similar for the longitudinal muscle. Only pilocarpine and aceclidine were partial agonists which produced 80-85% of the maximum response. When compared with the EC50 values of aceclidine on the iris sphincter and the longitudinal ciliary muscles, the agonist potency was only 1/28 for the latter tissue. Implications of these findings in relation to the use of these agonists in glaucoma are discussed. The pKB values of muscarinic antagonists on the circular ciliary muscle were: atropine, 8.8; cyclopentolate, 7.8; tropicamide, 7.4; P.F. HHSiD, 7.0; pirenzepine, 6.4; and methoctramine, 5.7. Nearly equal pKB values of each antagonist were obtained for the longitudinal ciliary muscle and iris sphincter. Based on the affinity constants of various competitive antagonists, the human iris as well as ciliary muscles may contain M3, M2 or M4 subtypes of muscarinic receptors.

Adult↗
PubMed2004

Keratitis due to a coelomycetous fungus: case reports and review of the literature.

PURPOSE: To describe a series of 7 patients with ulcerative keratitis caused by species of Colletotrichum, which are coelomycetous fungal pathogens. METHODS: The patients presented with keratitis of varying degrees of severity. Multiple scrapes from the corneal lesions of 6 of the 7 patients were used for microbiological investigations by a standard protocol. In the seventh patient, scraping was not performed due to the presence of deep infiltration and a descemetocele at presentation. All 7 patients were hospitalized and treatment was initiated with topical applications of natamycin (5%) and ciprofloxacin (0.3%) every hour and cyclopentolate (1%) drops 3 times daily. An emergency therapeutic penetrating keratoplasty was performed after 48 hours in the patient who had presented with a descemetocele and for another patient whose keratitis did not respond to 10 days of medical therapy. RESULTS: The corneal samples of all 7 patients yielded significant growth of filamentous fungi in culture. On the basis of macroscopic and microscopic characteristics, the fungal isolates were identified as Colletotrichum spp. Corneal lesions completely resolved with medical therapy alone in 5 patients. In the 2 patients who had undergone therapeutic penetrating keratoplasty, the infection was eradicated and the corneal graft remained clear even after several months of follow-up. CONCLUSION: Colletotrichum spp may be more frequent causes of keratitis than previously thought. Keratitis due to Colletotrichum spp frequently responds to medical therapy alone, although surgery may be indicated in a small proportion of patients.

Adolescent↗
PubMed1985

Comparison of refraction obtained by "near retinoscopy" and retinoscopy under cycloplegia.

This study compared refractive error obtained by the "near retinoscopy" method as described by Mohindra and static retinoscopy under cycloplegic conditions. Twenty-two patients between the age of 3.6 and 10.0 years were objectively refracted. The examiner performed a near retinoscopy on each patient. Immediately after this procedure, 2 drops of 1% Cyclogyl (cyclopentolate) were administered to each eye, 5 min apart. Cycloplegic retinoscopy was performed 35 to 40 min after the 2nd drop was administered. In order to reduce examiner bias, the specific powers of the neutralizing lenses were unknown to the examiner throughout the entire procedure. On average, retinoscopy under cycloplegic conditions revealed +0.50 to +0.75 D more plus than near retinoscopy. Although the Student's t-test indicated the values were significantly different on an absolute basis, a Pearson's r of +0.85 was found when all meridians were compared. In addition, if a "cut" factor is introduced to adjust for normal accommodative tonus eliminated under cycloplegic conditions, the two procedures produce essentially the same results.

Child↗
PubMed1993

Dark focus of accommodation and uncorrected visual acuity.

We compared the dark focus of accommodation in 33 healthy children, 19 eyes with good uncorrected visual acuity (1.0 or more) vs. 14 with poor uncorrected visual acuity (below 1.0). The two groups were matched for age and cycloplegic refractive error. Cycloplegic refractive error ranged from +0.15 to +1.75 D in the good visual acuity group and from +0.25 to +1.87 D in the poor visual acuity group. The dark focus was defined as the difference between the refractive error in the dark and the refractive error under cycloplegia. Initially, visual acuity was measured subjectively. Next, refractive error in the dark was measured using the Nidek Autorefractometer AR1600 with its optical target light off. Refractive error under cycloplegia was measured 40 min after the instillation of cyclopentolate hydrochloride using the same autorefractometer. There was a significant correlation between the dark focus and the cycloplegic refractive error (r = -0.53, p < 0.01). Despite an equal refractive error under cycloplegia the dark focus was significantly larger in the eyes with good uncorrected visual acuity than in those with poor uncorrected visual acuity (p < 0.01). Tonic accommodation may influence uncorrected visual acuity.

Accommodation, Ocular↗
PubMed1995

Ocular dimensions and refraction in Tibetan children.

A cross-sectional study of 404 Tibetan children (212 males, 192 females) aged 6 to 16 years was conducted in the Bouda region of Kathmandu, Napal in April, 1992. Examination procedures included retinoscopy (1% cyclopentolate HCl), keratometry A-scan ultrasonography, and video ophthalmophakometry. The mean refractive error was +1.11 D (SD: 0.56 D) at age 6 years decreasing to +0.63 D (SD: 0.34 D) at age 16 years with a prevalence of myopia in this group of 3.9%. Most children examined had low refractive errors, with 95.5% having errors in the range -0.50 to +1.50 D. Crystalline lens power decreased by 2.59 D, with an associated increase in its anterior radius of curvature of 1.98 mm and 0.49 mm in its posterior radius of curvature over the age range studied. Vitreous chamber depth increased by 0.69 mm, but no significant changes were recorded in anterior chamber depth, lens thickness, or corneal curvature. We conclude that the balance between the decrease in crystalline lens power and the increase in vitreous length is the major factor in maintaining the tendency to emmetropia in these children.

Adolescent↗
PubMed2004

Refractive astigmatism and the toricity of ocular components in human infants.

PURPOSE: Many studies have characterized astigmatism in infancy, but few have been longitudinal or contained ocular component data. This study characterized the frequency, orientation, and longitudinal change with age of infant astigmatism. Additional factors investigated were the influence of early astigmatism on emmetropization and its relation to corneal and lenticular toricity. METHODS: Three hundred two infants were enrolled in the study. Of these, 298 provided data for at least one visit at 3 +/- 1 months, 9 +/- 1 months, 18 +/- 2 months, and 36 +/- 3 months. Testing included cycloplegic retinoscopy (cyclopentolate 1%), video-based keratophakometry, and ultrasonography over the closed eyelid. RESULTS: Astigmatism > or =1.00 DC was common at 3 months of age (41.6%) but decreased in prevalence to 4.1% by 36 months (p < 0.0001). The most common orientation was with-the-rule at 3 months (37.0% compared with 2.7% for against-the-rule) but against-the-rule at 36 months (3.2% compared with 0.9% for with-the-rule). Most of the change in the average value of the horizontal/vertical component of astigmatism (J0) occurred between 3 and 9 months (-0.26 +/- 0.36 D; p < 0.0001) with no significant change between 9 and 36 months (-0.05 +/- 0.36 D; p=0.09). Spherical equivalent refractive error was not correlated with J0 at 3 and 9 months (R=0.002, p=0.48 and R=0.001, p=0.56, respectively). The two were only weakly correlated at 18 and 36 months (R=0.06 for each age, p <0.0001, p=0.0002, respectively). Changes in spherical equivalent between 3 and 9 months were unrelated to either the initial value of J0 (partial R for J0=0.0001; p=0.85) or the change in J0 (partial R for change in J0=0.0031; p=0.31). Across all the ages, corneal toricity was with-the-rule, and lenticular toricity was against-the-rule (produced by the toricity of the posterior lens surface). The cornea and anterior lens surface became more spherical with age, contributing to the shift away from with-the-rule refractive astigmatism. Toricity of all the refractive surfaces became less variable with age. CONCLUSIONS: Consistent with many reports, astigmatism was common in early infancy but decreased in prevalence with age, particularly when with-the-rule in orientation. The reduction in percentage of infants with astigmatism appeared to be caused by decreases in the toricity of the cornea and the anterior lens combined with decreases in the variability of corneal and lenticular surfaces. Astigmatism in infancy appeared to be unrelated to emmetropization of spherical equivalent refractive error.

Age Distribution↗
PubMed2000

The role of preoperative subconjunctival mydricaine and topical diclofenac sodium 0.1% in maintaining mydriasis during vitrectomy.

PURPOSE: To establish the role of preoperative subconjunctival mydricaine and diclofenac 0.1% in maintaining mydriasis during vitrectomy. METHODS: Fifty-seven patients were entered into the study. All were given cyclopentolate 1% and phenylephrine 2.5% preoperatively. Each patient was randomly allocated to one of three groups. In Group 1, patients received mydricaine by subconjunctival injection and diclofenac 0.1% topically preoperatively. In Group 2, patients received only subconjunctival mydricaine. Group 3 patients received only topical diclofenac preoperatively. Pupil diameter was measured with calipers before and at the end of the operation. RESULTS: There was no statistically significant difference in the change in pupil size between Groups 2 and 3. In all patients in Group 1 (who received both subconjunctival mydricaine and diclofenac preoperatively), pupil size was either maintained or increased after vitrectomy. This result was statistically significant when compared with the other groups (for Group 1 versus Group 2, P<0.005; for Group 1 versus Group 3, P<4.7x10(-06)). CONCLUSION: Topical diclofenac is useful for maintaining pupil size during vitrectomy only when used in conjunction with subconjunctival mydricaine, especially in patients in whom prolonged surgery is anticipated.

Adolescent↗
PubMed1995

Ocular toxicology.

In this review of recent articles on ocular toxicology, the author concentrates on undesirable effects on the eye induced by systemically used xenobiotics. These effects include increased tear flow elicited by systemic cyclosporine; uveitis associated with inactivated influenza vaccine, intravenous immunoglobulins, or skin tattoos; iritis associated with intravenous streptokinase; corneal epithelial erosion associated with the use of an alcohol-based antimisting spray; decreased color vision associated with workplace exposure to perchloroethylene, or to digoxin; myocardial ischemia induced by topical atropine; and systemic exposure to cyclopentolate after topical instillation. Ocular irritation associated with systemic use of 5-fluorouracil may be attenuated with prophylactic ice packs. At doses evaluated for treatment of choroidal neovascularization, systemic alpha interferon leads to toxicity in multiple organ systems. Promethazine precipitates when injected into intravenous lines with fluorescein. No drug achieves ultimate efficacy or ultimate safety. Thus, the decision to employ a given therapy involves a physician's evaluation of its therapeutic index-the ratio between efficacy and toxicity.

Drug-Related Side Effects and Adverse Reactions↗