Hikmet Hasiripi

A randomized trial of low-dose, topical mitomycin-C in the treatment of severe vernal keratoconjunctivitis

OBJECTIVEnTo evaluate the efficacy and safety of low-dose, topical mitomycin-C in patients with severe vernal keratoconjunctivitis.nnnDESIGNnPlacebo-controlled, double-masked, randomized clinical trial.nnnPARTICIPANTSnTwenty-six patients with vernal keratoconjunctivitis refractory to combination of steroid and mast-cell stabilizer treatment.nnnINTERVENTIONnPatients were randomly assigned (2:1) to treatment with topical 0.01% mitomycin-C eye drops (n = 17) or placebo (n = 9) three times daily for 2 weeks.nnnMAIN OUTCOME MEASURESnSymptoms (itching, tearing, photophobia, ropy mucous discharge, foreign body sensation) and signs (conjunctival hyperemia, epithelial punctate keratitis, Trantas dots, limbal edema, and palpebral conjunctival giant papillae) of vernal keratoconjunctivitis recorded on the day of enrollment and at the end of the treatment period.nnnRESULTSnThere was a statistically significant decrease in ropy mucous discharge, photophobia, conjunctival hyperemia, and limbal edema in the mitomycin-C treated group compared with the placebo group at the end of the 2-week treatment period. In addition, none of the 17 treated patients, but all 9 of the placebo patients, required medication during the 4-week posttreatment follow-up period. No adverse effects of treatment with mitomycin-C were observed.nnnCONCLUSIONSnShort-term, low-dose, topical mitomycin-C may be considered in the acute exacerbation periods of patients with severe vernal keratoconjunctivitis refractory to conventional treatment.

POSTOPERATIVE TOPICAL MITOMYCIN C IN CONJUNCTIVAL SQUAMOUS CELL NEOPLASIA

PURPOSEnTo report the efficacy of topical mitomycin C in preventing local recurrences after incomplete surgical excision of conjunctival squamous cell neoplasia.nnnMETHODSnFour patients presented with unilateral conjunctival tumors. Excisional biopsy results revealed conjunctival intraepithelial neoplasia with an intact basement membrane. Neoplastic cells were present in at least one of the surgical borders of the excised conjunctiva in all four cases. Patients were treated with topical mitomycin C 0.02% three times daily for 2 weeks to prevent recurrences.nnnRESULTSnAll four patients were free of clinically detectable tumors after a mean follow-up period of 20 months (range, 16-23 months). Side effects included mild discomfort, redness, photophobia, and punctate epithelial keratopathy that subsided on discontinuation of the medication.nnnCONCLUSIONnPostoperative topical mitomycin C application may be a useful adjunct to prevent recurrences in patients with incompletely excised conjunctival squamous cell neoplasia.

Hemodynamic changes after strabismus surgery.

AIM: The aim of this study was to investigate the hemodynamic changes that may occur in the retrobulbar circulation after strabismus surgery, using color Doppler ultrasonography (CDI). METHODS. Fifteen healthy volunteers (control group, n=15) and sixteen patients diagnosed with strabismus were enrolled in the study. Either recession or resection was planned on one horizontal rectus muscle in the eyes of Group 1 (n=11) and on two horizontal rectus muscles in the eyes of Group 2 (n=10). CDI was performed to measure peak systolic velocity (V max ), end-diastolic velocity (V min ) and mean blood flow velocity (V mean ) in the ophthalmic artery (OA), central retinal artery (CRA) and posterior ciliary artery (PCA) in the control group and in Groups 1 and 2, both preoperatively and 2-7 days postoperatively. RESULTS. The postoperative resistivity indexes in Groups 1 and 2 were found to be different from those in the control group. Preoperative V max and postoperative V min and V mean values of the vessels in Group 2 were different from those in both Group 1 and the control group (p<0.001). In both treatment groups, the differences between postoperative and preoperative measurements of the parameters in the OA, CRA and PCA demonstrated statistical significance (p<0.001). CONCLUSION. After strabismus surgery on the horizontal recti, there are some alterations in the retrobulbar blood flow with a significant difference between pre- and postoperative blood flow velocities after single and double rectus surgery. The clinical significance of these results needs to be determined because CDI may be a useful tool in the investigation of hemodynamic alterations after anterior segment interventions that may cause anterior segment ischemia.

Penetration of topical 0.3 % ciprofloxacin into human aqueous humor

BACKGROUND AND OBJECTIVEnInvestigation of the penetration of topical ciprofloxacin into aqueous humor.nnnPATIENTS AND METHODSnTopical 0.3% ciprofloxacin drops were administered to 17 patients with cataracts before lens extraction surgery. The time interval between the first dose and sampling was 3 hours in 9 patients (group A) and 6 hours in 8 (group B). In both groups, aqueous samples were collected 30 minutes after the last ciprofloxacin application. Ciprofloxacin concentration was determined by high-performance liquid chromatography-fluorescence detection.nnnRESULTSnMean aqueous concentration was 0.83+/-0.48 microgram/ml in group A and 2.42+/-1.42 micrograms/ml in group B.nnnCONCLUSIONnTopical 0.3% ciprofloxacin penetrates into the aqueous in a significant concentration.

The effect of latanoprost on aqueous humor PGF2alpha levels in glaucoma patients.

Aim: The purpose of this study is to evaluate the effect of the PGF2α isopropyl ester analogue, Latanoprost which is a new ocular hypotensive topical agent, on the aqueous humor PGF2α levels in open-angle glaucoma patients.Methods: Patients diagnosed with either capsular or primary open-angle glaucoma and scheduled for trabeculectomy, were consecutively enrolled in the study. Group 1 represented the control group (n = 17) and Group 2 represented the Latanoprost treatment group (n = 9). All the topical drugs were stopped 10 days preoperatively and only systemic carbonic anhydraseinhibitors were continued if necessary. Group 2 patients received topical 0.005% Latanoprost once daily for 5–10 days preoperatively. During trabeculectomy operation, aqueous samples were taken through paracentesis from the patients. Aqueous humor levels of PGF2α and its metabolite 13,14-dihydro-15-keto- PGF2αwere measured using enzyme-immunoassay.Results: The mean PGF2α levels were 24.38 ± 5.79 pg/ml in the control group and 10.99 ± 4.11 pg/ml in the Latanoprost group, the difference of which was statistically significant (p < 0.05). In the Latanoprost group, there was a positive correlation between levels of PGF2α and its metabolite (p < 0.05).Conclusion: Pretreatment with PGF2αisopropyl ester analogue, Latanoprost topically decreased PGF2α levels in the aqueous humor of glaucomatous eyes, probably due to its uveoscleral outflow increasing effect. The clinical importance and application of this result has to be determined.