- Email: [email protected]
Cautions on Sodium Hyaluronate
132
AMERICAN JOURNAL OF OPHTHALMOLOGY
however, no one had reported the use of the same brand name for two products with completely different formulations. One of my patients was given a 5-ml container of Vasocidin Ophthalmic at a hospital clinic in Tel Aviv. According to the label, the product contained 2 mg of chloramphenicol and 2,500 units/ml of polymixin B sulfate. The expiration date was November 1981, and "Smith, Miller, Patch Ltd., mfd. under licence by Taro" was printed on the label. The Smith, Miller, Patch Vasocidin Ophthalmic Solution marketed in the United States contains 0.25% prednisolone sodium phosphate, 0.125% phenylephrine HCl, and 10% sulfacetamide sodium (Figure). An attempt to find an explanation for this unusual occurrence resulted in the following reply from the Director of International Marketing for CooperVision, Inc., the manufacturer of Smith, Miller, Patch products: On June 30, 1980, Taro purchased a discontinued formulation for "Vasocidin" from CooperVision, Incorporated. This formula dated back to November 1963, and contained chloramphenicol. Nothing in our agreement gave Taro the right to use of Vasocidin trademark, our SMP logo, or our current Vasocidin formulation containing prednisolone.
The
letter
added
that
Taro
has
Figure (Lederman). Two containers of Vasocidin. The product on the left was obtained in Israel and the product on the right is marketed in the United States.
JANUARY, 1982
now "renamed the product Tarocidin" and that "apparently, remaining vials of the 'Vasocidin' product made by Taro have been removed from pharmacy shelves." It seems obvious that similarities in drug names and packaging should be avoided when dealing with preparations having different purposes. It also seems prudent to require that generic components be displayed prominently on the label, particularly since the ease of modern travel permits drugs, which are not necessarily subject to uniform international regulations, to be transported from one country to another. IRA R. LEDERMAN, M . D .
Norfolk,
Virginia
REFERENCES 1. Duane, T. D. : Fluorescite-fluorouacil. A nearly tragic confusion in identity. Am. J. Ophthalmol. 77:277, 1974. 2. Rumelt, M. B.: Dangers of similar packaging. Am. J. Ophthalmol. 91:804, 1981.
Cautions on Sodium Hyaluronate Editor: Since the publication of my letter, "Doubling the supply of sodium hyaluronate" (Am. J . Ophthalmol. 92:438, 1981), I have received the following communication from the manufacturer: Healon (sodium hyaluronate) is packaged in a special syringe that maintains sterility and avoids breakdown. It is imperative that this substance is not divided and placed in other types of syringes. Especially important is to realize that once the seal is broken, the product must be used at once and not resterilized under any circumstances. We cannot guarantee sterility unless these simple rules are followed. Healon is now available in adequate quantities and will be offered in a smaller syringe shortly,
VOL. 93, NO. 1
BOOK REVIEWS
which will make the use of such potentially dangerous procedures unnecessary. FRANK J . WEINSTOCK, M . D .
Canton,
Ohio
133
in the treatment of severe bacterial ocular infections. I hope other investigators will continue research in this new field. RICHARD A. EIFERMAN, M . D .
Louisville,
Kentucky
Pseudomonas Scleritis
REFERENCES
Editor: Pseudomonas aeruginosa can cause severe scleritis (Figure). I recently treated two patients who had this condition with localized cryotherapy at — 79 C and topical and subconjunctival aminoglycosides; both patients responded to this therapy. These cases, however, were not as severe as those described by Räber and associates. They documented corneal and scleral devastation in these infections and the ineffectiveness of medical therapyAlpren and associates demonstrated the in vivo efficacy of cryotherapy in Pseudomonas keratitis in animals. They reported a 99% reduction in bacteria in rabbit corneas after one application of a brass probe at —79 C for six seconds. When they combined cryotherapy with topical applications of tobramycin, they achieved a 99.9% kill rate. Presumably, the same results can be obtained in the sclera. Cryotherapy appears to be promising
1. Codère, F., Brownstein, S., and Jackson, W. B.: Pseudomonas aeruginosa scleritis. Am. J. Ophthalmol. 91:706, 1981. 2. Raber, I. M., Laibson, P. R., Kurz, G. H., and Bernardino, V. B.: Pseudomonas corneoscleral ulcers. Am. J. Ophthalmol. 92:353, 1981. 3. Alpren, T. V. P., Hyndiuk, R. A., Davis, S. D., and Sarff, L. D.: Cryotherapyforexperimental Pseudomonas keratitis. Arch. Ophthalmol. 97:711, 1979.
1,2
2
3
Figure (Eiferman). Severe scleritis (arrows) caused by Pseudomonas aeruginosa.
BOOK REVIEWS Untersuchungemethoden des Auges. By W. Leydhecker and G. K. Krieglstein. Stuttgart, Gustav Fischer Verlag, 1981. Softcover, 223 pages, index, approximately 115 black and white figures. This German compendium describes the various tests and devices used for ocular examinations. The authors wrote this text for medical students and interns as well as for general practitioners and those in specialties such as internal medicine and neurology. The booklet introduces the various techniques used in ophthalmology, from careful historytaking, and simple observation, and the use of the penlight and ophthalmoscope to the more specialized tests used by ophthalmologists in daily practice. It ends with chapters on advanced clinical techniques such as electroretinography, ultrasonography, fluorescein angiography, and the radioactive phosphorus uptake test. Since the senior author's research is primarily in the area of glaucoma, it is not surprising that the clinical tests in this
AMERICAN JOURNAL OF OPHTHALMOLOGY
however, no one had reported the use of the same brand name for two products with completely different formulations. One of my patients was given a 5-ml container of Vasocidin Ophthalmic at a hospital clinic in Tel Aviv. According to the label, the product contained 2 mg of chloramphenicol and 2,500 units/ml of polymixin B sulfate. The expiration date was November 1981, and "Smith, Miller, Patch Ltd., mfd. under licence by Taro" was printed on the label. The Smith, Miller, Patch Vasocidin Ophthalmic Solution marketed in the United States contains 0.25% prednisolone sodium phosphate, 0.125% phenylephrine HCl, and 10% sulfacetamide sodium (Figure). An attempt to find an explanation for this unusual occurrence resulted in the following reply from the Director of International Marketing for CooperVision, Inc., the manufacturer of Smith, Miller, Patch products: On June 30, 1980, Taro purchased a discontinued formulation for "Vasocidin" from CooperVision, Incorporated. This formula dated back to November 1963, and contained chloramphenicol. Nothing in our agreement gave Taro the right to use of Vasocidin trademark, our SMP logo, or our current Vasocidin formulation containing prednisolone.
The
letter
added
that
Taro
has
Figure (Lederman). Two containers of Vasocidin. The product on the left was obtained in Israel and the product on the right is marketed in the United States.
JANUARY, 1982
now "renamed the product Tarocidin" and that "apparently, remaining vials of the 'Vasocidin' product made by Taro have been removed from pharmacy shelves." It seems obvious that similarities in drug names and packaging should be avoided when dealing with preparations having different purposes. It also seems prudent to require that generic components be displayed prominently on the label, particularly since the ease of modern travel permits drugs, which are not necessarily subject to uniform international regulations, to be transported from one country to another. IRA R. LEDERMAN, M . D .
Norfolk,
Virginia
REFERENCES 1. Duane, T. D. : Fluorescite-fluorouacil. A nearly tragic confusion in identity. Am. J. Ophthalmol. 77:277, 1974. 2. Rumelt, M. B.: Dangers of similar packaging. Am. J. Ophthalmol. 91:804, 1981.
Cautions on Sodium Hyaluronate Editor: Since the publication of my letter, "Doubling the supply of sodium hyaluronate" (Am. J . Ophthalmol. 92:438, 1981), I have received the following communication from the manufacturer: Healon (sodium hyaluronate) is packaged in a special syringe that maintains sterility and avoids breakdown. It is imperative that this substance is not divided and placed in other types of syringes. Especially important is to realize that once the seal is broken, the product must be used at once and not resterilized under any circumstances. We cannot guarantee sterility unless these simple rules are followed. Healon is now available in adequate quantities and will be offered in a smaller syringe shortly,
VOL. 93, NO. 1
BOOK REVIEWS
which will make the use of such potentially dangerous procedures unnecessary. FRANK J . WEINSTOCK, M . D .
Canton,
Ohio
133
in the treatment of severe bacterial ocular infections. I hope other investigators will continue research in this new field. RICHARD A. EIFERMAN, M . D .
Louisville,
Kentucky
Pseudomonas Scleritis
REFERENCES
Editor: Pseudomonas aeruginosa can cause severe scleritis (Figure). I recently treated two patients who had this condition with localized cryotherapy at — 79 C and topical and subconjunctival aminoglycosides; both patients responded to this therapy. These cases, however, were not as severe as those described by Räber and associates. They documented corneal and scleral devastation in these infections and the ineffectiveness of medical therapyAlpren and associates demonstrated the in vivo efficacy of cryotherapy in Pseudomonas keratitis in animals. They reported a 99% reduction in bacteria in rabbit corneas after one application of a brass probe at —79 C for six seconds. When they combined cryotherapy with topical applications of tobramycin, they achieved a 99.9% kill rate. Presumably, the same results can be obtained in the sclera. Cryotherapy appears to be promising
1. Codère, F., Brownstein, S., and Jackson, W. B.: Pseudomonas aeruginosa scleritis. Am. J. Ophthalmol. 91:706, 1981. 2. Raber, I. M., Laibson, P. R., Kurz, G. H., and Bernardino, V. B.: Pseudomonas corneoscleral ulcers. Am. J. Ophthalmol. 92:353, 1981. 3. Alpren, T. V. P., Hyndiuk, R. A., Davis, S. D., and Sarff, L. D.: Cryotherapyforexperimental Pseudomonas keratitis. Arch. Ophthalmol. 97:711, 1979.
1,2
2
3
Figure (Eiferman). Severe scleritis (arrows) caused by Pseudomonas aeruginosa.
BOOK REVIEWS Untersuchungemethoden des Auges. By W. Leydhecker and G. K. Krieglstein. Stuttgart, Gustav Fischer Verlag, 1981. Softcover, 223 pages, index, approximately 115 black and white figures. This German compendium describes the various tests and devices used for ocular examinations. The authors wrote this text for medical students and interns as well as for general practitioners and those in specialties such as internal medicine and neurology. The booklet introduces the various techniques used in ophthalmology, from careful historytaking, and simple observation, and the use of the penlight and ophthalmoscope to the more specialized tests used by ophthalmologists in daily practice. It ends with chapters on advanced clinical techniques such as electroretinography, ultrasonography, fluorescein angiography, and the radioactive phosphorus uptake test. Since the senior author's research is primarily in the area of glaucoma, it is not surprising that the clinical tests in this