Purpose To investigate the effectiveness and safety of a dexamethasone implant (Ozurdex) to treat pseudophakic macular edema (Irvine-Gass syndrome). Setting Department of Ophthalmology, ...Ludwig-Maximilians-University Munich, Munich, Germany. Design Prospective nonrandomized study. Methods Preoperatively and in 12 monthly postoperative intervals, a complete ophthalmic examination was performed in study patients, including measurement of corrected distance visual acuity (CDVA) using the standard Early Treatment Diabetic Retinopathy Study chart, intraocular pressure, foveal thickness using spectral-domain optical coherence tomography (SD-OCT), and retinal sensitivity (mean defect depth) using microperimetry. Morphological aspects of the inner segment–outer segment junction and visual function were correlated. Results Twenty-three eyes (23 patients) with pseudophakic macular edema after uneventful cataract surgery were included. The mean duration of macular edema before treatment with a dexamethasone implant was 5.4 months (range 2 to 8 months). The CDVA increased in all patients from 30.2 letters ± 4.3 (SD) at baseline to 50.4 ± 4.9 letters at 12 months ( P = .0016), regardless of the time of macular edema duration. Foveal thickness decreased from 520.8 ± 71.4 μm to 232.7 ± 26.6 μm ( P < .002). Retinal sensitivity (mean defect depth) increased significantly over a 12-month follow-up, correlating positively with a restored inner segment–outer segment junction on SD-OCT analyses. No relevant adverse events were reported, and 9 recurrences occurred with a peak after 3 months and required a second dexamethasone implant injection. Conclusion The dexamethasone implant was safe and effective in treating pseudophakic macular edema regardless of the duration of the edema. Financial Disclosure Drs. Mayer and Haritoglou are consultants to Allergan, Inc. No author has a financial or proprietary interest in any material or method mentioned.
Purpose To evaluate the prevalence of dual platelet inhibition in cases of severe retrobulbar hemorrhage following retrobulbar and peribulbar anesthesia. Setting Department of Ophthalmology, ...Ludwig-Maximilans Universität, München, Germany. Design Retrospective study. Methods Two groups of patients were screened retrospectively over a 5-year period for the inclusion criterion of severe retrobulbar hematoma after retrobulbar or parabulbar injection. The first group consisted of emergency cases referred to the clinic. A second group of patients had received retrobulbar block at the hospital. All cases were collected and screened for the presence of antiplatelet therapy. Results Among roughly 160 000 patient records screened, 3 patients with grade IV retrobulbar hematoma were identified. Two of these patients were taking dual antiplatelet medications and 2 were on anticoagulation therapy during the time of retrobulbar or peribulbar anesthesia. None of the cases showed single medication platelet inhibition. The visual acuity of all patients stayed low at the 6-month follow-up (1.2 logMAR in 1 patient and no light perception in 2 patients). Conclusions Retrobulbar hematoma is a rare but severe complication of retrobulbar anesthesia. With the high prevalence of dual platelet inhibition found in these cases, a prospective controlled trial seems unethical. In these high-risk patients, surgery should be performed under topical anesthesia if possible or general anesthesia if necessary. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
Identifying the cause of a bleeding complication after cardiac surgery can be crucial. This study sought to clarify whether the application of unprocessed autologous pump blood influences anti-factor ...Xa activity after cardiac surgery and evaluated 2 point-of-care methods regarding their ability to identify an elevated anti-factor Xa activity at different timepoints after cardiopulmonary bypass. Anti-factor Xa activity, heparin/protamine titration and the clotting time ratio of thromboelastometry in the INTEM and HEPTEM were measured at baseline (T1), after the application of protamine (T2) and after the complete application of autologous pump blood (T3). Anti-factor Xa activity decreased significantly between T2 and T3 as well did the absolute number of patients with an elevated anti-factor Xa activity. Receiver Operating Curve analyses were performed for both point-of-care methods. At T2 neither could identify patients with an elevated anti-factor Xa activity, while both methods were able to do so at T3 with high sensitivity and specificity. This difference suggests that an interference in the detection of residual heparinization with point-of-care methods exists right after the application of protamine, which seems to subside after a short time span. Nevertheless, results of point-of-care testing for residual heparinization after cardiopulmonary bypass need to be interpreted considering the protamine-heparin ratio and the timepoint of protamine administration.
Purpose To determine whether erufosine alone or erufosine-loaded intraocular lenses (IOLs) can inhibit growth of human lens epithelial cells after a single administration in the human capsular bag ...model. Setting Laboratory for Cell Biology, Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany. Design Experimental study. Methods Sixteen human cadaver eyes had sham cataract surgery. The capsular bag was transferred into cell culture. The tissue was exposed to the half maximum inhibitory concentrations of erufosine alone for 72 hours; solvent-only tissue served as a control. Erufosine is a potent inhibitor of phosphoinositide-3-kinase, a downstream kinase with major implications in posterior capsule opacification (PCO) pathogenesis. The IOLs were soaked with erufosine and implanted in the capsular bags; unsoaked IOLs served as controls. For both settings, the time until confluence of the capsular bag was measured. Cell growth was observed and photodocumented. Results Erufosine as a single therapeutic agent increased the time until confluence of the capsular bag, but not significantly compared with the control. When IOLs were soaked with erufosine, a long-term prophylactic effect was observed in this organ model for PCO, which is known to closely reflect the clinical situation. Conclusion Erufosine-soaked IOLs effectively inhibited PCO formation as seen in long-term organ culture and might become of clinical relevance. Financial Disclosures Drs. Kampik and Eibl-Lindner are inventors of IOLs treated with alkylphosphocholines for pharmacological after-cataract prophylaxis, patent international application PCT/EP2010/051490. No other author has a financial or proprietary interest in any material or method mentioned.
To compare the efficacy of povidone-iodine 1.0%, 5.0%, and 10.0% in combination with topical levofloxacin 0.3% in reducing the preoperative conjunctival bacterial load before cataract surgery.
...Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany.
Randomized clinical trial.
This study enrolled patients scheduled for cataract surgery between July 2010 and January 2011. All patients received topical levofloxacin 0.3% 4 times on the preoperative day and were randomly assigned to these study groups: Group 1 (povidone-iodine 1.0%), Group 2 (povidone-iodine 5.0%), and Group 3 (povidone-iodine 10.0%). In all groups, the conjunctiva was flush irrigated with 10 mL of povidone-iodine of the respective concentration. Conjunctival specimens were obtained at 4 timepoints: baseline (no-surgery eye), before povidone-iodine irrigation, after povidone-iodine irrigation, and at the end of surgery. All specimens were inoculated onto blood and chocolate agars and into thioglycolate broth.
The study was completed by 271 patients. In the control smear (no-surgery eye), no significant difference in positive cultures was found. After 10 mL povidone-iodine irrigation, a considerable reduction in the conjunctival bacterial load occurred in all groups. The difference in positive cultures was statistically significant between Group 1 and Group 3 (P=.024) and between Group 2 and Group 3 (P=.029). Coagulase-negative Staphylococcus was the most commonly isolated bacteria in all groups.
Povidone-iodine 10.0% was more effective than povidone-iodine 1.0% and 5.0% in decreasing the conjunctival bacterial load before surgery.
No author has a financial or proprietary interest in any material or method mentioned.
Purpose To compare the efficacy of 2 prophylaxis regimens before cataract surgery using topical antibiotics (1 hour before surgery versus the day before), both with povidone–iodine, with regard to ...reducing the preoperative conjunctival bacterial load. Setting Tertiary ophthalmic referral center, Munich, Germany. Design Prospective comparative case series. Methods Eyes were treated with topical antibiotics and their conjunctival sac flush irrigated using 10 mL of povidone–iodine 1.0%. All eyes were randomized to receive either 4 applications of topical 3500 IU/mL neomycin sulfate/6000 IU/mL polymyxin-B sulfate within 1 hour preoperatively (Group 1) or on the day before surgery (Group 2). Conjunctival specimens were obtained at 4 timepoints: T 0 C untreated fellow eye (control), T0 surgery eye (after antibiotic prophylaxis but before povidone–iodine irrigation), T1 after povidone–iodine, and T2 at the conclusion of surgery. All specimens were inoculated onto blood and chocolate–blood agar and into thioglycollate broth. Results One hundred thirty-three eyes of 133 consecutive patients were included (Group 1, 64 eyes; Group 2, 69 eyes). The antibiotic regimens were equally effective in reducing the aerobic and microaerophilic conjunctival flora (Group 1, P =.028; Group 2, P =.000), but had no significant effect on anaerobic bacteria (Group 1, P =.201; Group 2, P =.117). Flush irrigation of the conjunctival sac using 10.0 mL povidone–iodine 1.0% significantly decreased the conjunctival bacterial load in both groups. Conclusion Topical neomycin/polymyxin-B was equally effective in reducing the conjunctival bacterial load whether given 1 day or 1 hour before surgery. The greatest effect was achieved by irrigating the conjunctival sac using povidone–iodine. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
Abstract Background Brugada phenocopies (BrP) are clinical entities characterized by ECG patterns that are identical to true Brugada syndrome (BrS), but are elicited by various clinical ...circumstances. A recent study demonstrated that the patterns of BrP and BrS are indistinguishable under the naked eye, thereby validating the concept that the patterns are identical. Objective The aim of our study was to determine whether recently developed ECG criteria would allow for discrimination between type-2 BrS ECG pattern and type-2 BrP ECG pattern. Methods Ten ECGs from confirmed BrS (aborted sudden death, transformation into type 1 upon sodium channel blocking test and/or ventricular arrhythmias, positive genetics) cases and 9 ECGs from confirmed BrP were included in the study. Surface 12-lead ECGs were scanned, saved in JPEG format for blind measurement of two values: (i) β-angle; and (ii) the base of the triangle. Cut-off values of ≥ 58° for the β-angle and ≥ 4 mm for the base of the triangle were used to determine the BrS ECG pattern. Results Mean values for the β-angle in leads V1 and V2 were 66.7 ± 25.5 and 55.4 ± 28.1 for BrS and 54.1 ± 26.5 and 43.1 ± 16.1 for BrP respectively (p = NS). Mean values for the base of the triangle in V1 and V2 were 7.5 ± 3.9 and 5.7 ± 3.9 for BrS and 5.6 ± 3.2 and 4.7 ± 2.7 for BrP respectively (p = NS). The β-angle had a sensitivity of 60%, specificity of 78% (LR + 2.7, LR − 0.5). The base of the triangle had a sensitivity of 80%, specificity of 40% (LR + 1.4, LR − 0.5). Conclusions New ECG criteria presented relatively low sensitivity and specificity, positive and negative predictive values to discriminate between BrS and BrP ECG patterns, providing further evidence that the two patterns are identical.
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