- Email: [email protected]
Effect of a fixed dorzolamide\Ntimolol combination on intraocular pressure after small-incision cataract surgery with Viscoat
A
*Aaron E. Carroll, MD, MS, Indiana University School of Medicine, 699 West Drive, Riley Research, Room 330, Indianapolis, IN 46202; e-mail, [email protected]. Current author addresses and author contributions are available at www.annals.org . See also editorial by Kellermann AL. Physician support for covering the uninsured: Is the cup half empty or half full ? Ann Intern Med 2003; 139: 858 – 859.
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Effect of a fixed dorzolamide–timolol combination on intraocular pressure after small-incision cataract surgery with Viscoat. Rainer G,* Menapace R, Findl O, Sacu S, Schmid K, Petternel V, Kiss B, Georgopoulos M. J Cataract Refract Surg 2003;29:1748 –1752.
T
HE EFFECT OF A FIXED DORZOLAMIDE-TIMOLOL COMBI-
nation (Cosopt) on intraocular pressure (IOP) after small-incision cataract surgery with sodium chondroitin sulfate 4%-sodium hyaluronate 3% (Viscoat) was evaluated in a prospective, randomized study. Seventy-six eyes of 38 patients scheduled for small-incision cataract surgery in both eyes were randomized to receive 1 drop of dorzolamide-timolol in one eye or no treatment immediately after surgery. The fellow eye received the other assigned treatment following surgery at a later date. Smallincision cataract surgery was performed with sodium chondroitin sulfate 4%-sodium hyaluronate 3% in an identical fashion in both eyes. The baseline IOP was measured by Goldmann applanation tonometry 1 day before surgery and 6 hours and 20 to24 hours after surgery by a masked observer. The intraocular pressure was measured by Schiotz tonometry at the conclusion of the case and was adjusted to 20 mm Hg. Six hours after surgery, the mean increase in IOP was significantly lower in the dorzolamide-timolol group than in the control group (4.3 ⫾ 5.6 mm Hg vs 8.4 ⫾ 6.1 mmHg, respectively; p⫽ 0.003). Two eyes in the dorzolamide-timolol group had IOP spikes of 30 mm of higher vs 9 eyes in the control group (p ⫽ 0.022). Twenty to 24 hours after surgery, the mean IOP change was ⫺2.6 ⫾ 3.3 mm Hg in the dorzolamide-timolol group vs 1.5 ⫾ 3.2 mm Hg in the control group (p ⬍ 0.001). A single topical drop of dorzolamide-timolol was effective in reducing IOP 6 hours and 20 to 24 hours after cataract surgery, and it reduces, but does not eliminate, the risk of sodium chondroitin sulfate 4%sodium hyaluronate 3%-induced IOP spikes of 30 mm Hg or higher.—Michael D. Wagoner.
*Department of Ophthalmology, Toronto Western Hospital, 7 Edith Cavell Wing, 399 Bathurst Street, Toronto, Ontario M5T 2S8. Email: [email protected]
● Aqueous humor levels of topically applied levofloxacin, norfloxacin, and lomefloxacin in the same human eyes. Yamada M,* Mochizuki H, Yamada K, Kawai M, Mashima Y. J Cataract Refract Surg 2003;29:1771–1775.
A
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Combined mitomycin C application and free flap conjunctival autograft in pterygium surgery. Segev F,* Jaeger-Roshu S, Gefen-Carmi N, Assia E. Cornea 2003;22: 598 – 603. AMERICAN JOURNAL
QUEOUS HUMOR PENETRATION OF TOPICALLY AP-
plied levofloxacin, norfloxacin, and lomefloxacin was evaluated in this study. Fifty-nine cataract patients received 3 drops each of levofloxacin 0.5%, norfloxacin 0.3%, and lomefloxacin 0.3% in the same eye at 15-minute intervals beginning 90 minutes prior to cataract surgery. Each of the 3 drops was instilled at 2-minute intervals. Patients were randomly divided into three groups according to the order in which the drops were given. At the beginning of surgery, 50 l of aqueous humor was aspirated from the anterior chamber and stored at ⫺80 C until analyzed. The drug concentrations in the samples were analyzed using high-performance liquid chromatography. Five patients were excluded from the study because their sample volumes were insufficient. Levofloxacin was detected in all 54 eyes with a mean aqueous humor level of
*Department of Ophthalmology, University of Vienna, Waehringer Guertel 18 –20, A-1090, Vienna, Austria. Email: [email protected]
602
PROSPECTIVE, CONSECUTIVE, NONCOMPARATIVE SE-
ries evaluated the long-term postoperative outcome and complication rate of combined intraoperative lowdose mitomycin C application and free conjunctival autograft for the treatment of pterygium. Forty-six consecutive patients (50 eyes) with primary pterygium (43 eyes) or recurrent pterygium (7 eyes) were studied. The mean patient age was 53.4 years (range, 23– 80). All patients underwent pterygium excision with intraoperative application of mitomycin C 0.02% to the bare scleral bed for 2 minutes followed by free conjunctival autograft. Postoperatively all patients were treated with a slow topical corticosteroid taper over 3 to 4 months. The mean follow-up period was 29.2 months (range, 12– 41). There were no intraoperative complications. Pterygium recurred to a small extent (0.5 mm) in one eye (2%) of a patient with recurrent pterygium. Twenty-two eyes (47.8%) experienced 2 or more lines of improvement in best-corrected Snellen acuity. Subconjunctival graft hematoma appeared soon after surgery and resolved spontaneously in five eyes (10%). One eye developed a suture granuloma, one eye developed transient high intraocular pressure without optic nerve or visual field defect, and one eye developed mild symblepharon. No eyes lost best-corrected visual acuity due to sight-threatening complications or side effects. Addition of low-dose intraoperative mitomycin C to standard conjunctival autograft may further reduce the recurrence rate without introducing an increased the risk of significant side effects.—Michael D. Wagoner.
OF
OPHTHALMOLOGY
MARCH 2004
*Aaron E. Carroll, MD, MS, Indiana University School of Medicine, 699 West Drive, Riley Research, Room 330, Indianapolis, IN 46202; e-mail, [email protected]. Current author addresses and author contributions are available at www.annals.org . See also editorial by Kellermann AL. Physician support for covering the uninsured: Is the cup half empty or half full ? Ann Intern Med 2003; 139: 858 – 859.
●
Effect of a fixed dorzolamide–timolol combination on intraocular pressure after small-incision cataract surgery with Viscoat. Rainer G,* Menapace R, Findl O, Sacu S, Schmid K, Petternel V, Kiss B, Georgopoulos M. J Cataract Refract Surg 2003;29:1748 –1752.
T
HE EFFECT OF A FIXED DORZOLAMIDE-TIMOLOL COMBI-
nation (Cosopt) on intraocular pressure (IOP) after small-incision cataract surgery with sodium chondroitin sulfate 4%-sodium hyaluronate 3% (Viscoat) was evaluated in a prospective, randomized study. Seventy-six eyes of 38 patients scheduled for small-incision cataract surgery in both eyes were randomized to receive 1 drop of dorzolamide-timolol in one eye or no treatment immediately after surgery. The fellow eye received the other assigned treatment following surgery at a later date. Smallincision cataract surgery was performed with sodium chondroitin sulfate 4%-sodium hyaluronate 3% in an identical fashion in both eyes. The baseline IOP was measured by Goldmann applanation tonometry 1 day before surgery and 6 hours and 20 to24 hours after surgery by a masked observer. The intraocular pressure was measured by Schiotz tonometry at the conclusion of the case and was adjusted to 20 mm Hg. Six hours after surgery, the mean increase in IOP was significantly lower in the dorzolamide-timolol group than in the control group (4.3 ⫾ 5.6 mm Hg vs 8.4 ⫾ 6.1 mmHg, respectively; p⫽ 0.003). Two eyes in the dorzolamide-timolol group had IOP spikes of 30 mm of higher vs 9 eyes in the control group (p ⫽ 0.022). Twenty to 24 hours after surgery, the mean IOP change was ⫺2.6 ⫾ 3.3 mm Hg in the dorzolamide-timolol group vs 1.5 ⫾ 3.2 mm Hg in the control group (p ⬍ 0.001). A single topical drop of dorzolamide-timolol was effective in reducing IOP 6 hours and 20 to 24 hours after cataract surgery, and it reduces, but does not eliminate, the risk of sodium chondroitin sulfate 4%sodium hyaluronate 3%-induced IOP spikes of 30 mm Hg or higher.—Michael D. Wagoner.
*Department of Ophthalmology, Toronto Western Hospital, 7 Edith Cavell Wing, 399 Bathurst Street, Toronto, Ontario M5T 2S8. Email: [email protected]
● Aqueous humor levels of topically applied levofloxacin, norfloxacin, and lomefloxacin in the same human eyes. Yamada M,* Mochizuki H, Yamada K, Kawai M, Mashima Y. J Cataract Refract Surg 2003;29:1771–1775.
A
●
Combined mitomycin C application and free flap conjunctival autograft in pterygium surgery. Segev F,* Jaeger-Roshu S, Gefen-Carmi N, Assia E. Cornea 2003;22: 598 – 603. AMERICAN JOURNAL
QUEOUS HUMOR PENETRATION OF TOPICALLY AP-
plied levofloxacin, norfloxacin, and lomefloxacin was evaluated in this study. Fifty-nine cataract patients received 3 drops each of levofloxacin 0.5%, norfloxacin 0.3%, and lomefloxacin 0.3% in the same eye at 15-minute intervals beginning 90 minutes prior to cataract surgery. Each of the 3 drops was instilled at 2-minute intervals. Patients were randomly divided into three groups according to the order in which the drops were given. At the beginning of surgery, 50 l of aqueous humor was aspirated from the anterior chamber and stored at ⫺80 C until analyzed. The drug concentrations in the samples were analyzed using high-performance liquid chromatography. Five patients were excluded from the study because their sample volumes were insufficient. Levofloxacin was detected in all 54 eyes with a mean aqueous humor level of
*Department of Ophthalmology, University of Vienna, Waehringer Guertel 18 –20, A-1090, Vienna, Austria. Email: [email protected]
602
PROSPECTIVE, CONSECUTIVE, NONCOMPARATIVE SE-
ries evaluated the long-term postoperative outcome and complication rate of combined intraoperative lowdose mitomycin C application and free conjunctival autograft for the treatment of pterygium. Forty-six consecutive patients (50 eyes) with primary pterygium (43 eyes) or recurrent pterygium (7 eyes) were studied. The mean patient age was 53.4 years (range, 23– 80). All patients underwent pterygium excision with intraoperative application of mitomycin C 0.02% to the bare scleral bed for 2 minutes followed by free conjunctival autograft. Postoperatively all patients were treated with a slow topical corticosteroid taper over 3 to 4 months. The mean follow-up period was 29.2 months (range, 12– 41). There were no intraoperative complications. Pterygium recurred to a small extent (0.5 mm) in one eye (2%) of a patient with recurrent pterygium. Twenty-two eyes (47.8%) experienced 2 or more lines of improvement in best-corrected Snellen acuity. Subconjunctival graft hematoma appeared soon after surgery and resolved spontaneously in five eyes (10%). One eye developed a suture granuloma, one eye developed transient high intraocular pressure without optic nerve or visual field defect, and one eye developed mild symblepharon. No eyes lost best-corrected visual acuity due to sight-threatening complications or side effects. Addition of low-dose intraoperative mitomycin C to standard conjunctival autograft may further reduce the recurrence rate without introducing an increased the risk of significant side effects.—Michael D. Wagoner.
OF
OPHTHALMOLOGY
MARCH 2004