Charles B. Slonim

Long-term safety of loteprednol etabonate 0.2% in the treatment of seasonal and perennial allergic conjunctivitis.

Purpose. To determine the long-term safety of the topical steroid, loteprednol etabonate 0.2%, in the treatment of seasonal and perennial allergic conjunctivitis. Methods. A retrospective review of 397 patients from three private ophthalmologic practices treating seasonal and perennial allergic conjunctivitis with long-term loteprednol etabonate 0.2% was performed. Chart review of slitlamp findings and intraocular pressure measurements during follow-up visits was performed to determine the incidence of adverse effects, such as steroid-induced intraocular pressure increase, cataract formation, and any other possible topical steroid-induced adverse event. One hundred fifty-nine of the 397 patients had been continuously using loteprednol for more than 12 months. Results. There were no reported adverse effects of long-term loteprednol etabonate 0.2% use in any of the 159 patients, whose continuous use ranged from a cumulative total of 120 drops per eye to 3,741 drops per eye. Conclusions. Loteprednol etabonate 0.2% is a safe topical steroid when used on a long-term basis for the treatment of seasonal and perennial allergic conjunctivitis.

Dog bite-induced canalicular lacerations : A review of 17 cases

Canalicular lacerations are frequently found in conjunction with other facial lacerations occurring in dog bite injuries. A review of the treatment of 17 dog bite-induced Canalicular lacerations is presented. Certain pathogens commonly found in the canine oral flora may cause severe secondary infections, which may result in sepsis and even death. These pathogens are reviewed along with a description of appropriate plans for antimicrobial prophylaxis. A surgical approach to such injuries is described.

Propranolol for the treatment of orbital infantile hemangiomas.

Purpose: To evaluate the treatment of orbital infantile hemangiomas with systemic (oral) propranolol. Methods: This study was a retrospective observational case series of 5 infants who were diagnosed with orbital infantile hemangiomas between March and July of 2009. Results: The average age at presentation was 3.1 months (3 weeks to 9 months). The patients received oral propranolol, with dosage varying among study centers. The patients were treated for an average of 7.1 months. Treatment of 5 infantile hemangioma patients with oral propranolol produced a significant reduction in the size of the hemangioma in 4 (80%) of the patients and a minimal improvement in one patient. No patient had significant adverse events during the treatment period. Conclusion: Oral propranolol may be an effective treatment for orbital infantile hemangiomas.

Anatomic and histopathologic findings following a failed ahmed glaucoma valve device.

Ahmed glaucoma valve implant (AGV) is one of the more commonly used implants in difficult glaucomas. The histology of a functioning bleb following AGV implantation and its anatomic relationship to the optic nerve when placed in the superionasal quadrant has been described. We report the histology of a failed bleb and the anatomic relationship between the optic nerve and the AGV end-plate when placed 9 mm from the limbus in a patient with neovascular glaucoma.

Effect of water hardness on the tolerance of the guppy to beryllium sulfate

I t has been known for a number of years that various sal ts and metals are more toxic to aquatic organisms in sof t water than in hard water, due par t l y to the buffer ing capacity and calcium antagonism of hard water solut ions (see reviews by DOUDOROFF and KATZ 1950, 1953). Very l i t t l e data ex is t , however, regarding the t ox i c i t y of beryl l ium sal ts to aquatic organisms in spire of the wide indus t r ia l usage of beryl l ium (Be) for over 40 years.

Effect of Loteprednol Etabonate 0.5% on Initiation of Dry Eye Treatment With Topical Cyclosporine 0.05%

Objective: The purpose of this work was to evaluate the effect of loteprednol etabonate (LE) before the initiation of topical cyclosporine A (tCsA) therapy in patients with mild-to-moderate dry eye disease. Prospective, multicenter randomized double-masked parallel group clinical study (NCT00407043). Methods: Hundred and eighteen patients with dry eye disease were randomized to receive either LE and tCsA (n=61) or artificial tears (AT) and tCsA (n=57). Hundred and twelve patients completed the study (LE: n=57, AT: n=55) and are included in the data analysis. Patients self-administered either LE or AT for 2 weeks 4 times per day, followed by tCsA twice per day accompanied by either LE twice per day or AT twice per day for an additional 6 weeks of treatment. Primary outcome measures included the Ocular Surface Disease Index (OSDI) questionnaire, the Likert scale using standardized facial expressions, lissamine green staining, fluorescein staining, and the Schirmer test. Additional measures included global self-assessment, and safety outcomes included slitlamp examination, intraocular pressure, and assessment of visual acuity. Results: Loteprednol etabonate pretreatment significantly reduced tCsA stinging (P<0.05). Both groups showed significantly improved OSDI scores at the 14-, 30-, and 60-day visits. Loteprednol etabonate showed significantly more OSDI improvement than AT. Both pretreatment strategies improved global self-assessment scores, Schirmer test, fluorescein staining, lissamine staining, and adjunctive AT use. Loteprednol etabonate showed superior improvement in Schirmer test, fluorescein staining, and lissamine staining. Intraocular pressure did not increase in either group. Conclusions: Loteprednol etabonate induction therapy 2 weeks before the initiation of long-term tCsA treatment for chronic dry eye disease provides more rapid relief of dry eye signs and symptoms with greater efficacy than tCsA and AT alone.

Bilateral lymphocytic infiltrates causing dacryostenosis after bilateral successful dacryocystorhinostomies.

A 73-year-old woman with a history of chronic lymphocytic leukemia had bilateral dacryocystorhinostomies for bilateral chronic dacryocystitis. The procedures were performed 7 months apart. Twenty-four months after the first dacryocystorhinostomy on the left side, the patient developed a mass in the area of the left lacrimal sac causing epiphora. A repeat dacryocystorhinostomy revealed a lymphocytic infiltrate causing the left dacryostenosis. Thirty-three months after the right dacryocystorhinostomy, the patient developed a right dacryostenosis with epiphora and no mass. Pathology specimens obtained during a repeat dacryocystorhinostomy on the right side revealed a similar lymphocytic infiltrate. This case is an unusual presentation of solid lymphoma in a traumatized area in a patient with chronic lymphocytic leukemia.

The correction of astigmatism with soft contact lenses

Soft contact lens correction for astigmatism has made significant advances over the last 20 years. Soft toric tinted lenses, disposables lenses, and bifocal lenses are now available at lower costs with greater reproducibility, enhanced parameters, and better comfort. Because of these innovations and significant design changes, a greater percentage of astigmatic patients are being treated with soft toric lenses than before.

Surgery of the Punctum and Canaliculus

The lacrimal drainage system can be obstructed anywhere along its pathway. An obstruction can range from partial blockage or stenosis to complete atresia or anatomic absence of a structure. The anatomic details of the lacrimal system have been described in Chapter 1. The most common indication for lacrimal probing is epiphora. Probing in children with congenital nasolacrimal obstruction is a delicate procedure. Probing can be performed in an offi ce setting; however, the majority of ophthalmologists perform pediatric nasolacrimal probings in an ambulatory surgery setting with heavy sedation or general anesthesia. Adults can be probed in the offi ce with only topical anesthesia and, occasionally, with a small amount of local or regional anesthetic blocks. In preparation for the probing, a nasal decongestant/vasoconstrictor (e.g., oxymetazoline or 2.5% phenylephrine) should be placed in the nostril on the side of the probing. This can be accomplished by placing presoaked neurosurgical cottonoids or cotton-tipped applicators in the nose under the inferior turbinate in the region of the valve of Hasner. The surgeon allows a few minutes for the nasal mucosa to shrink. If the procedure is done in the offi ce, a topical anesthetic drop should be instilled in the eye before probing. When attempting to probe, the surgeon should remember that the upper system begins vertically at each punctum followed by a 2-mm dilated vertical segment (the ampulla) followed by an 8-mm horizontal segment (the canaliculus).

Botox Therapy for Hyperhydrosis: How I Do It

Hyperhidrosis is the poor man’s detection method for determining where to inject botox: 1. Paint the area (e.g., axilla) with betadine solution (a betadine wipe will do) 2. Allow the betadine to dry 3. Apply a thin layer of cornstarch or fine talc powder over the betadine 4. Shine a handheld spotlight with a 100 W bulb directly on the area 5. The areas of hyperhidrosis will be stimulated and the moisture will cause the betadine to “bleed” through the white powder or cornstarch 6. Photograph the area for documentation 7. Apply a layer of a topical anesthetic (e.g., betacaine, EMLA, etc.) 8. Inject Botox into the dermis in a grid pattern in the targeted area with approximately 1 cm between injections 9. Use 2.5 units in 0.05 cc per injection site