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At least 1,009 records · Page 56Linked to original sources
PubMed2005

Subconjunctival antibiotics in the treatment of endophthalmitis managed without vitrectomy.

PURPOSE: To determine if the treatment outcomes for endophthalmitis are influenced by subconjunctival antibiotics. METHODS: A retrospective, nonrandomized consecutive series of patients with clinically diagnosed bacterial endophthalmitis confirmed with positive cultures who presented between December 1, 1995, and February 28, 2002, was studied. Patients with cataract surgery, glaucoma filtering blebs, or trauma who presented with visual acuity of hand motions or better were included. All patients received intravitreal and topical antibiotics. Management by pars plana vitrectomy or vitreous tap and use or nonuse of subconjunctival antibiotics were at the discretion of the treating physician. RESULTS: There were 59 patients identified; 54 met the follow-up criteria. These patients were divided into two groups based on whether subconjunctival antibiotics were used (group ABX; n = 21) or not used (group noABX; n = 33). The median pretreatment visual acuity was hand motions in both groups. The median age in both groups was 74 years. Etiology, duration of symptoms, vitreous culture organisms, percentage of cases with wound complications such as leaks or vitreous incarceration, and intraocular lens type were similar in the two study groups. Intravitreal and topical antibiotics and corticosteroids used were not significantly different in the two groups, except that topical ceftazidime was used less frequently in group ABX than in group noABX (43% vs. 82%, respectively; P = 0.007). The median follow-up was 13 months in both groups (range: 3-87 months for group ABX and 3-63 months for group noABX). Final visual acuity in groups ABX and noABX was at least 20/50 (33% vs. 39%, respectively), 20/60 to 5/200 (29% vs. 39%, respectively), 4/200 to better than hand motions (0 vs. 3%, respectively), or hand motions or worse (38% vs. 18%, respectively). These differences were not significant (P = 0.37). Reinjection rates (14% vs. 15%, respectively) were also similar in groups ABX and noABX. The additional procedures rate was significantly higher in group ABX than in group noABX (P = 0.024), with cumulative rates of 33% and 3%, respectively, at the 12-month follow-up. CONCLUSIONS: These data suggest that subconjunctival antibiotics may not be necessary to treat infectious endophthalmitis managed with otherwise standard tap and injection techniques and topical antibiotics.

Administration, Topical↗
PubMed1996

Side effects of antiglaucomatous drugs on the ocular surface.

An increasing number of studies, both experimental and epidemiologic, have shown that filtering glaucoma surgery has progressively become less effective than initially described. Of a number of risk factors for failure, duration and number of antiglaucoma drugs before surgery seem to play a critical role, and high accumulated antiglaucoma topical treatments significantly reduce success rates. Histopathologic studies have confirmed that topically applied drugs may exert toxic effects to the corneoconjunctival surface and induce chronic infraclinical inflammation, as shown by the presence of immunologic changes and inflammatory infiltrates in multitreated eyes. The origin of topical inflammation has not yet been clearly determined, but benzalkonium chloride, which is used as a preservative in almost all antiglaucoma preparations, has shown strong evidence of toxicity to the ocular surface. A number of questions remain to be investigated, but suppression of preservatives from chronically applied drugs should be a critical issue in the near future.

Adrenergic beta-Antagonists↗
PubMed1999

Glaucoma.

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Filtering Surgery↗
PubMed2003

Glaucoma-filtering bleb infections.

PURPOSE OF REVIEW: To present a review of the current literature regarding the management of glaucoma-filtering bleb infections. RECENT FINDINGS: With the increased use of intraoperative antifibrotic (eg, mitomycin and fluorouracil) as an adjunct to standard trabeculectomy, an increased incidence is seen of late-onset filtering bleb-related infections. These infections range from infections localized to the bleb (blebitis) to endophthalmitis. Risk factors for bleb-related infections include an inferior or nasally located bleb; presence of a high bleb or blepharitis; development of a late-onset bleb leak; use of antifibrotic agents; chronic antibiotic use; and performance of a trabeculectomy alone versus a combined procedure. SUMMARY: The optimal treatment for bleb-related infections is evolving, but consensus is that a high degree of vigilance and aggressive treatment are key to minimizing the potentially blinding nature of this complication. It is important to note that those glaucoma procedures that provide the lowest intraocular pressure are often those that predispose to bleb-related infections.

Anti-Bacterial Agents↗
PubMed2004

Management of inflammatory glaucomas.

PURPOSE OF REVIEW: To review the epidemiology, pathogenesis and management of uveitic glaucoma in the light of significant studies published during the review period (October 2002-2003). RECENT FINDINGS: The visual prognosis of glaucoma secondary to certain types of uveitis, for example Juvenile Idopathic Arthritis, remains poor because of late presentation and a high rate of corticosteroid responsiveness. Production of Myocilin is intimately linked with outflow resistance and corticosteroid responsiveness. Although Myocilin gene expression is widespread in the eye, corticosteroid-induction is specific for trabecular meshwork. The hypotensive effect of some glaucoma medications such as Latanoprost and Brimonidine may be partially blocked by concurrent administration of NSAIDs, though the risk of redcrudescence of uveitis with Latanoprost appears to be much lower than initially feared. Use of Mitomycin C in uveitic trabeculectomy has not clearly translated into better long-term IOP control, though this may be due to an absence of prospective studies. Glaucoma drainage devices appear to be more successful in uveitic glaucoma than in other recalcitrant types. SUMMARY: The management of uveitic glaucoma requires a careful balance between adequate anti-inflammatory therapy and appropriate intraocular pressure (IOP)-lowering to prevent long-term visual loss. In the foreseeable future, successful elucidation of the function of Myocilin is most likely to lead to improvements in the management of corticosteroid-induced and hence uveitic glaucoma.

Antihypertensive Agents↗
PubMed2000

Performance of a new, low-volume, high-surface area aqueous shunt in normal rabbit eyes.

PURPOSE: This experimental study was conducted to report perfusion characteristics of small diameter, cylindrical aqueous shunts in normal rabbit eyes and to test the hypothesis that decreasing bleb diameter would decrease capsular fibrosis, as evidenced by a thinner capsule forming around the implant. These two properties increase hydraulic conductivity of the fibrous membrane forming around the device, resulting in a more effective filtering shunt. METHODS: Cylindrical latex tubes with the distal portion of the sidewall removed were implanted under the conjunctiva. The proximal, intact end of tubing was inserted into the anterior chamber and ligated to prevent hypotony. The ligature was released after 1 week to inflate the bleb. Animals were again anesthetized at 6 or 12 weeks after ligature release and in vivo perfusion experiments conducted using a miniperfusion system and a water manometer. Perfusion of the implant with latex microspheres was performed before the animals were killed. Capsule diameters were measured in situ using calipers under a dissecting microscope after excision of orbital tissues and before fixation for histologic study. Membrane hydraulic conductivity (outflow per unit membrane area at unitary pressure gradient, microL/min/mm2/mmHg) was calculated using data obtained during perfusion experiments and compared with results of other studies. Capsule thickness was measured histologically. RESULTS: Cylindrical filtration membranes with thin (15-20 microm) capsules formed around latex implants. Bleb diameters consistently measured 1 mm at all points along their length before formaldehyde fixation. Hydraulic conductivity was measured and found to be eight times higher than that reported for capsules around conventional implants. Decreased diameter (16:1 for Baerveldt and 13:1 for Molteno implants) produced a proportional decrease in surface tension on the wall. This resulted in decreased capsule thickness, from 222 microm for Baerveldt implants in rabbit eyes and from 150 microm for Molteno implants in monkey eyes to less than 20 microm for the shunting device studied here. CONCLUSION: As a consequence of Laplace's law, reduction in bleb diameter reduces surface tension on the bleb, reducing capsular fibrosis and consequently capsule thickness, thus increasing hydraulic conductivity. Increased hydraulic conductivity increases the effectiveness of the filtering surface. Cylindrical geometry allows reduced bleb volume yet maintains total surface area that is proportional to the length of the implant, which is unlimited and customizable for each eye by simply cutting the length of implant needed.

Animals↗
PubMed2005

Update on treatment strategies for bleb-associated endophthalmitis.

PURPOSE OF REVIEW: Visual preservation in the setting of bleb-associated endophthalmitis has been difficult with existing management strategies. In this article, established findings are compared and potential new treatments that may improve visual outcomes in bleb-associated endophthalmitis are evaluated. RECENT FINDINGS: Recent reports have contributed to the existing database of results from bleb-associated endophthalmitis. New systemic antibiotics and novel surgical techniques are also described. SUMMARY: More options are now available to treat bleb-associated endophthalmitis. No one treatment paradigm is definitively superior in producing desired visual outcomes.

Anti-Infective Agents↗