Itzchak Beiran

The efficacy of calcium gluconate in ocular hydrofluoric acid burns

1 Although calcium gluconate (CG) is recommended in the treatment of hydrofluoric acid (HF) eye burn its efficacy seems to be controversial, and controlled human or animal studies are limited. The studys objective is to compare the efficacy of 1% CG and normal saline irrigation for the treatment of HF eye injury in animals. 2 0.05 ml 2% HF was instilled to anesthetized rabbits eyes. One minute later, four treatment groups were studies: (1) irrigation with normal saline followed by topical antibiotics, corticosteroids and cycloplegics for 48 h (n=10); (2) irrigation with 1% CG followed by the same topical treatment (n=9); (3) as group 1 and 1% CG drops over 48 h (n=10); (4) as group 3, and injection of 1% CG subconjunctivally after irrigation (n=9). 3 Corneal erosion area, corneal haziness, conjunctival status, vascularization (pannus) and acidity were assessed before injury, immediately after intitial treatment and 1, 2, 7 and 14 days thereafter by slit lamp aided by fluorescein staining. 4 Conjunctival pH dropped from 6.0 - 6.5 to 2.5 - 3 after injury and increased to 6 - 6.5 after irrigation. Corneal erosion: smaller in groups 2, 3, significantly so at 2 days, but not different at 14 days. Corneal haziness: more severe in group 4, at 14 days, insignificant. Conjunctival damage: significantly worse in group 4 at 2, 7 and 14 days. Pannus appeared in 2 - 4 eyes in each group. 5 It seems that for HF injury 1% CG did not have any significant advantage over saline irrigation and topical treatment only. It might have some initial and temporary effect on healing process especially that involving erosion. Given subconjunctivally, 1% CG may be toxic and worsens clinical outcome.

Hyperbaric Oxygenation Combined with Nifedipine Treatment for Recent-Onset Retinal Artery Occlusion

We describe the results of early hyperbaric oxygenation combined with nifedipine treatment for central retinal artery occlusion, and explain the results pathophysiologically. We report four cases in which hyperbaric oxygenation therapy was applied in combination with nifedipine, eyeball massage, and glycerol for the treatment of central retinal artery occlusion. In two of the cases in which therapy was started less than 100 minutes after the acute onset of visual loss and one case in which therapy was started during the course of central arterial occlusion, considerable improvement in visual acuity was observed, while in the fourth case in which therapy was started six hours after the acute onset of visual loss, no improvement appeared. We conclude from these results that hyperbaric oxygenation therapy has a beneficial effect on the final visual outcome of central retinal artery occlusion, provided it is applied early enough. Further investigation is needed to fully define the nature and terms of this beneficial effect.

Hyperbaric oxygenation therapy for ischemic optic neuropathy.

Hyperbaric oxygenation is the application of highconcentration high-pressure oxygen breathing to patients. In spite of the retinal vasoconstruction caused by high-oxygen partial pressure during this therapy, the oxygen supply to tissues increases (2). A 66-year-old woman was referred to our clinic because of visual loss which had developed during the four days before admission. No additional complaints were reported. Her history included insulin-dependent diabetes mellitus and ischemic heart disease. Three months prior to her present admission, the patient had had ischemic optic neuropathy in her left eye. Temporal artery biopsy was negative for temporal arteritis. On admission, the patients best corrected visual acuity was 3 meters finger counting in her right eye, and hand movement only in her left eye. Intraocular pressure was 14 mmHg in each eye. A left relative afferent pupillary defect was observed. Fundus examination showed disc edema of 360 degrees, with hemorrhages at the disc margin in the right eye and optic atrophy in the left. Both eyes showed background diabetic retinopathy of similar severity. Erythrocyte sedimentation rate was 60/80 mm. The patient was treated in the hyperbaric chamber for five sessions of 90 minutes each at 2.5 atmospheres absolute. During the first treatment session the patient reported subjective improvement in visual acuity. After the second session her best corrected visual acuity was 6/24. No further improvement in visual acuity was achieved during three additional treatment sessions. Visual acuity was stable over one year of follow-up. The natural history of ischemic optic neuropathy is of chronic visual loss, and a patient having this pathology in one eye has a one-in-three chance of suffering similar pathology in his fellow eye (1). Previous reports have described hyperbaric oxygenation treatment as successful in cases of ischemic ocular events (2-4). The mechanism accounting for this improvement of visual acuity after ischemic ocular events is not clearly understood. Possible explanation are: a) Providing oxygen to hypoxic cells permits oxygen-dependent organelles not irreversibly damaged to resume their activity; b) Vasoconstriction lowers fluid inflow to the injured tissue. This reductions decongests the endothelial cells, thus breaking the vicious circle of hypoxia-edema. Three points deserve special attention in the present case: a) Visual acuity before treatment was declining. Immediately after starting hyperbaric oxygenation, this tendency reversed and visual acuity seemed to improve; b) If final visual outcome is considered in a comparison of the two eyes, it was definitely better in the hyperbaric oxygenation-treated eye; c) On entering the hyperbaric chamber, the patient was legally blind. Upon completion of the treatment, she was lowvisioned. To the best of our knowledge, no report published in the English literature deals with hyperbaric oxygenation treatment for ischemic optic neuropathy. Although the present case, being single and uncontrolled, cannot prove the beneficial effect of hyperbaric oxygenation in ischemic optic neuropathy, it provides a good basis for considering the possibility of such an effect.

Coexistence of optic nerve head drusen and pseudotumor cerebri : a clinical dilemma

The coexistence of optic nerve head drusen and pseudotumor cerebri is a potential clinical problem since diagnosing only one of two clinical abormalities in a patient may delay or prevent the appropriate treatment. To the best of our knowledge, only four cases of such coexistence have been described. We report three cases diagnosed as having both optic nerve head drusen and pseudotumor cerebri and propose possible explanations. The report draws attention to the need for awareness of this potential coexistence in order to assure proper treatment.

A change in ocular involvement in a patient suffering from ankylosing spondylitis and Behçet's disease.

We report a case of a young man suffering from both ankylosing spondylitis and Behçets disease in whom the character of the ocular involvement changed according to the predominant disease at a given time. When the clinical picture was one of ankylosing spondylitis, only anterior uveitis was observed, while the clinical picture of Behçets disease occurred with panuveitis and retinal vasculitis. To the best of our knowledge, this is the first report in the English literature of two different patterns of ocular involvement in the same patient with two seronegative arthritides.

Haptoglobin phenotype in age-related macular degeneration patients ☆

PURPOSEnTo investigate a possible role of the haptoglobin phenotype in the development of exudative age-related macular degeneration (AMD) in human subjects.nnnDESIGNnProspective, observational, comparative population study.nnnMETHODSnThe study was carried out in an institutional setting. All patients referred because of exudative AMD in one eye during an 18-month period were included in the study group. A group of patients treated for other ocular diseases and not having AMD in either eye served as control. Haptoglobin phenotype was determined from a blood sample drawn from each patient in both the study and control groups. The main outcome measure was the distribution of the haptoglobin phenotype in the study and control group.nnnRESULTSnOne hundred eighty-five participants were included in the study. Ninety-eight had exudative AMD, and 87 were AMD-free. The difference between the study and control groups in distribution of the haptoglobin phenotype was found to be statistically insignificant.nnnCONCLUSIONSnOur results suggest that the haptoglobin phenotype has no effect on the prevalence of exudative AMD.

Synthetic patch for scleral tissue loss.

We report a case in which traumatic scleral tissue loss was surgically treated by a synthetic patch used in neurosurgical procedures. In the present case the patch served as a permanent solution to scleral loss. The patch is available commercially and easily stored. In the light of our experience, we suggest that this patch material be considered for both urgent and semi-elective scleral patching procedures.

Erythropoietin-induced iritis-like reaction

The present report describes an iritis-like reaction found in 13 patients treated with recombinant human erythropoietin (Eprex), a drug given to hemodialysis patients for their chronic anemia. Among 120 patients being treated by hemodialysis in two centers affiliated with our medical center, ten out of 30 Eprex-treated patients but none of 90 not being treated with Eprex developed this reaction. The observations described support a causal relation between Eprex treatment and the iritis-like reaction. Further investigative effort is needed to establish the mechanism.