Panagiotis Plotas

A UPLC–MS Method for the Determination of Ofloxacin Concentrations in Aqueous Humor

A rapid, simple, and specific method based on ultra performance liquid chromatography (UPLC) with mass spectrometry detection has been developed for quantitative analysis of ofloxacin in human aqueous humor using tobramycin as internal standard (IS). Chromatographic separation was achieved on a Waters Acquity UPLC BEH C18 Shield column (150 × 2.1 mm, 1.7 μm) eluted with 95:5 water: acetonitrile (v/v) containing 0.1% formic acid and a flow rate of 0.3 mL/minute. The total analysis time was three minutes with ofloxacin eluting at 1.67 ± 0.03 minutes. The linearity of the method ranged from 0.1 to 8 μg/mL with r2 = 0.998. The method was validated according to FDA guidelines with respect to linearity, accuracy, precision, specificity, and stability. The limits of detection and quantification were 0.03 and 0.10 μg/mL, respectively. The developed method was successfully applied to the analysis of samples that have been obtained from patients.

Brinzolamide-timolol fixed combination for the prevention of intraocular pressure elevation after phacoemulsification

To evaluate the efficacy of brinzolamide‐timolol fixed combination in intraocular pressure during the first 24 h after uneventful phacoemulsification cataract surgery using Viscoat and Provisc.

Intravitreal aflibercept for choroidal neovascularization secondary to angioid streaks in a non-responder to intravitreal ranibizumab

Purpose To report the 12-month outcomes of a patient switching from intravitreal ranibizumab to aflibercept for choroidal neovascularization (CNV) associated with angioid streaks (AS). Results A 42-year-old Caucasian female with CNV associated with AS underwent intensive treatment with ranibizumab without significant functional or anatomic change. Treatment was then switched to aflibercept and the patient received the proposed age-related macular degeneration treatment regimen. After 3 loading doses of aflibercept, best-corrected visual acuity (BCVA) improved from 3/10 to 6/10, while optical coherence tomography (OCT) demonstrated resolution of the subretinal fluid with a reduction of the intraretinal fluid. After 12 months and 7 intravitreal injections of aflibercept, BCVA returned to 3/10, while OCT had demonstrated further morphologic improvement. Conclusion Our case shows that aflibercept may be an alternative treatment for advanced cases of CNV associated with AS that respond insufficiently to ranibizumab injections. Prospective studies are required to further evaluate the effect of aflibercept and to propose a standardized treatment protocol for this entity.

Analgesic Effect of Topical Nepafenac 0.1% on Pain Related to Intravitreal Injections: A Randomized Crossover Study

ABSTRACT Purpose: To evaluate the analgesic effect of nepafenac 0.1%, a topical non-steroidal anti-inflammatory agent, in patients undergoing treatment with intravitreal injections (IVIs). Material and methods: It is a single center, prospective, randomized, double-blinded, placebo-controlled, crossover interventional study. Fifty-two patients scheduled to undergo IVI of anti-vascular endothelial growth factors were included in the study. Patients were randomized in a 1:1 ratio to receive topical nepafenac 0.1% or placebo 1 h before subsequent IVIs. Using the short form of the McGill Pain Questionnaire (SF-MPQ), pain intensity was assessed with the Visual Analogue Scale (VAS), the Main Component of the SF-MPQ (MC-SF-MPQ), and the Present Pain Intensity (PPI) scores immediately and 6-h post-injection. Results: The VAS pain score was statistically significant lower immediately and 6-h post-IVI in patients treated with nepafenac (p = 0.001 and < 0.001, respectively). The MC-SF-MPQ scores were also statistically significant lower after nepafenac administration at both time points (p < 0.001). Finally, the PPI score was statistically significant lower when nepafenac was instilled before IVI (p = 0.015 immediately and p < 0.001 at 6-h post-injection). Conclusions: A single drop of nepafenac 0.1% before IVI could effectively alleviate the IVI-related pain immediately and up to 6 h after the injection.

Cystoid Macular Edema Due to Accidental Latanoprost Overdose After Uncomplicated Phacoemulsification

OBJECTIVE We present an interesting case of accidental overdose of latanoprost eye drops. CASE REPORT A 71-year-old patient underwent an uncomplicated cataract surgery in his right eye. During the first postsurgical week he mistakenly used latanoprost eye drops six times daily instead of the prescribed tobramycin/dexamethasone eye drops. The patient experienced gradually decreasing visual acuity and was diagnosed with cystoid macular edema seven weeks after surgery. The cystoid macular edema resolved 4 weeks later after treatment with nepafenac 0.3% eye drops and oral acetazolamide. The cystoid macular edema recurred 2 weeks after rechallenge with latanoprost. The rechallenge-induced cystoid macular edema once again resolved after cessation of latanoprost and retreatment with nepafenac eye drops. A Naranjo assessment score of 7 was obtained, indicating a probable relationship between the patients symptoms and the suspect drug.

The Effect of Ranibizumab on Normal Neurosensory Retina in the Eyes of Patients with Exudative Age Related Macular Degeneration

Background: Anti-vascular endothelial growth factors have become the mainstay treatment for neovascular age related macular degeneration. Prolonged suppression of vascular endothelial growth factor raises concerns as it may result in harmful effects on retina. Objective: The purpose of this retrospective chart review is to evaluate the 1-year effect of treatment with intravitreal injections of ranibizumab on normal neurosensory retinal tissue of patients with exudative age related macular degeneration using the Optical Coherence Tomography (OCT). Method: The study included sixty five eyes of 62 patients (32 male and 30 female; mean age 74.97±8.5 years) with exudative age related macular degeneration treated with intravitreal injections of ranibizumab with a pro re nata treatment regimen over a period of 1 year. The MM5 thickness maps acquired with the Optovue RTVue-100 Fourier-domain OCT at baseline, at 3 months, after the 3 loading doses of ranibizumab, and at the 1 year follow-up visit were used for analysis. Changes of inner and outer retinal thickness in four selected points of normal retina on the MM5 scan were evaluated. Results: The patients received a mean of 6.4 ± 1.8 (median 6, range 3-11) intravitreal injections of ranibizumab over a period of 12 months. No significant change was observed in inner and outer retinal thickness at pre-selected spots of normal retina during the first year of intravitreal administration of ranibizumab. Conclusion: One year treatment with ranibizumab on an individualized, according to need dosing regimen does not seem to induce any detectable structural damage in the unaffected, normal retina.

Efficacy of Topical Ofloxacin 0.3 % Administration on Conjunctival Bacterial Flora in Diabetic Patients Undergoing Intravitreal Injections

ABSTRACT Purpose: This prospective, randomized case series study aims to evaluate the efficacy of ofloxacin 0.3% eye drops in eradication of conjunctival bacterial flora in diabetic patients undergoing intravitreal injections (IVI). Methods: Ninety-two diabetic patients (92 eyes) scheduled to undergo intravitreal injection of ranibizumab due to diabetic macular edema were enrolled in the study. Patients were randomly assigned to three different groups. Group 1 (n=32) received ofloxacin eye drops the day before before IVI (four times); patients in Group 2 (n=29) were administered ofloxacin one hour before IVI (every 15 minutes), while Group 3 (n=31) comprised patients that received combined administration of ofloxacin both one day and one hour before IVI (eight doses). Samples were collected from the injection site before and after antibiotic administration. Culture results from BACTEC broth and positive cultures in blood agar and Sabouraud’s dextrose agar plates were measured. Results: In Group 1, BACTEC broth positive cultures decreased from 84.4% at baseline to 50% after ofloxacin administration (p=0.007), and blood agar positive cultures reduced from 65.63% to 34.38% (p=0.02). In Group 2, positive cultures significantly decreased in BACTEC broth (from 79.3% at baseline to 48.28%; p=0.027) and in blood agar (from 68.97% to 37.13%; p=0.034). In Group 3, positive cultures decreased from 77.42% at baseline to 32.26% (p=0.0008) and from 58.06% at baseline to 22.58% (p=0.009) in BACTEC broth and blood agar, respectively. No microorganisms were isolated from Sabouraud’s dextrose agar plates. Conclusions: The combined one day/one hour (eight doses) ofloxacin administration in diabetic patients is extremely effective in reducing conjunctival bacterial flora. The application of topical ofloxacin for one day or one hour before IVI is also significantly effective.

Fibrinous Anterior Uveitis Following Topical Tetracaine Abuse

BACKGROUND A 54-year-old man presented complaining of severe pain and blurred vision in his left eye. Slit-lamp biomicroscopy revealed a large epithelial defect with an underlying prominent ring infiltrate and severe anterior uveitis with fibrinous exudates and hypopyon. Patient admitted abuse of topical tetracaine, which was discontinued and topical treatment with a non-steroidal antiinflammatory agent, an antibiotic, a cycloplegic agent were instituted while a therapeutic contact lens was applied. Response to treatment was favorable with a rapid resolution of anterior uveitis within days while the epithelial defect fully healed within a month. Four months later the patient returned with a new subtotal epithelial defect with no previous history of trauma or topical anesthetic abuse. CONCLUSION In conclusion, while a common complication of topical tetracaine abuse is toxic keratopathy, we describe a case where tetracaine abuse was also complicated with a severe fibrinous anterior uveitis. Interestingly, in our case, anaesthetic abuse was complicated in the mid-term with a spontaneous corneal epithelial defect attributed to possible anaesthetic-induced anatomical changes, such as poor adhesion between the stroma and the epithelium.

Α molecular epidemiological analysis of adenoviruses from excess conjunctivitis cases

BackgroundΤo perform a molecular epidemiological analysis of viral conjunctivitis among excess conjunctivitis cases recorded at the University Hospital of Patras, Greece, for the period March to June 2012.MethodsA structured questionnaire containing demographic and clinical data was developed in order to collect retrospective data on the cases. Eye swab specimens were collected and molecular detection of adenoviruses was performed by nested PCR. Positive results were confirmed by sequencing. To determine the relatedness between the isolated sequences, a phylogenetic analysis was conducted.ResultsThe epidemiological analysis (including retrospective data) included 231 conjunctivitis cases (47.1% male, and 52.8% female). Based on clinical features 205 of the cases were diagnosed of viral origin (46.3% male and 53.7% female), 4 of bacterial origin (50% male and 50% female) while 22 were undefined conjunctivitis. The outbreak excess cases (included 156 cases) affected all age groups regardless gender predilection. For the positive samples indicated that 29 samples (72.5%) were AdV17, and 5 (12.5%) as AdV54.ConclusionsMolecular analysis could define the cause of viral conjunctivitis, while epidemiological data contributed to the assessment of the risk factors and underlined possible preventive measures. This study is one of the very few on viral conjunctivitis in Greece. This outbreak underscores the need for a national surveillance system for acute infectious conjunctivitis outbreaks. The epidemiological as well as molecular investigation on HAdV ocular infections is rather absent in Greece, which has no surveillance system for viral conjunctivitis.