A prospective, observational, open-label study from Kentucky suggests that the signs and symptoms of meibomian gland dysfunction, as well as spectroscopic characteristics of the meibomian gland lipids, improve after therapy with topical azithromycin ophthalmic solution and oral doxycycline treatment. However, the mechanism of action of doxycycline may be different from that of azithromycin.
Signs of MGD were evaluated with a slit lamp in subjects with symptomatic MGD and symptoms were measured by questionnaire. Meibum lipid-lipid interaction strength, conformation and phase transition parameters, and meibum protein content, were measured using Fourier transform infrared spectroscopy and principal component analysis. Terpenoids, short-chain CH3 moieties, lipid oxidation, wax, cholesterylesters and glycerides were measured with a proton nuclear magnetic resonance (1H-NMR) spectrometer.
Topical therapy with azithromycin and oral therapy with doxycycline relieved signs and symptoms and restored the lipid properties of the meibomian gland secretion towards normal. Compared with four weeks of azithromycin treatment reported in a previous study, oral doxycycline treatment was slightly less effective in improving foreign body sensation and the signs of plugging and secretion. In subjects with clinical evidence of MGD, changes in ordering of the lipids and phase transition temperature were brought closer to normal with azithromycin treatment than doxycycline treatment. Treatment with doxycycline but not azithromycin restored the Fourier transform infrared spectroscopy-principal component analysis scores and relative area of the 1H-NMR resonance at 1.26 ppm. Both doxycycline and azithromycin treatment restored the levels of the relative areas of the 1H-NMR resonance at 5.2 and 7.9 ppm to normal levels. The levels of meibum protein and meibum lipid oxidation were not influenced by azithromycin or doxycycline treatment.
Foulks G, Borchman D, Yappert M, Kakar S.
Sensitivity and Specificity of AdenoPlus Test
U.S. researchers have determined that the AdenoPlus test is both sensitive and specific at detecting adenoviral conjunctivitis. Of the 128 patients presenting with a clinical diagnosis of acute viral conjunctivitis who were enrolled in this prospective, sequential, masked and multicenter trial, the tear fluid of 36 patients was found to be positive for adenovirus either by viral cell culture with confirmatory immunofluorescence assay or polymerase chain reaction, while 29 patients results were found to be positive by both CC-IFA and PCR. When compared only with CC-IFA, AdenoPlus showed a sensitivity of 90 percent (28/31) and specificity of 96 percent (93/97). When compared only with PCR, AdenoPlus showed a sensitivity of 85 percent (29/34) and a specificity of 98 percent (89/91). When compared with both CC-IFA and PCR, AdenoPlus showed a sensitivity of 93 percent (27/29) and a specificity of 98 percent (88/90). When compared with PCR, CC-IFA showed a sensitivity of 85 percent (29/34) and specificity of 99 percent (90/91).
JAMA Ophthalmol 2013;131:17-22
Sambursky R, Trattler W, Tauber S, Starr C, et al.
Glaucoma Control with Drainage Device and PK
Doctors from the University of Florida College of Medicine performed a review of records of all patients at their institution who underwent both a glaucoma drainage device placement and penetrating keratoplasty from January 1, 1998 to December 31, 2003, and determined that GDD placement can provide glaucoma control in a high percentage (71 percent) of eyes with PK, even at five years. Glaucoma outcome was assessed by postoperative intraocular pressure, number of glaucoma medications and need for further glaucoma surgery, while corneal grafts were assessed for clarity.
Twenty-eight eyes of 27 patients were studied. All eyes had GDD placement in the anterior chamber. The mean pre-GDD IOP was 28.8 ±10.3 mmHg on a mean of 2.6 ±0.8 glaucoma medications. At five-year follow-up, the mean IOP was 13.0 ±5.9 mmHg on a mean of 0.9 ±1.0 medications. GDD implantation successfully controlled glaucoma in 96 percent at one year, 86 at two years, 79 at three, 75 at four and 71 percent at five years. Grafts remained clear in 96 percent at one year, 82 at two years, 75 at three, 57 at four and 54 percent at five years. The success of PK in GGD remains reasonable (54 percent) at five years. IOP control and graft survival rates are comparable with earlier published studies with shorter follow-up or tube placement in the vitreous cavity. Failure of glaucoma outcome or graft survival was associated with prior intraocular surgeries.
J Glaucoma 2012;21:608-614
Knape R, Szymarek T, Tuli S, Driebe W, et al.
Decreased Postop Endophthalmitis Rates After Institution of Intracameral Antibiotics
Physicians at Kaiser Permanente in the Diablo Service Area in California performed a time-trend study on increasing adoption of intracameral injections after phacoemulsification cataract surgery, and concluded that the adoption coincided with a decline in the rate of postoperative endophthalmitis.
Three time periods were identified for this study: 2007; 2008 to 2009; and 2010 to 2011. In 2007, patients primarily received postop antibiotic drops without intracameral injection. During 2008 and 2009, patients received intracameral cefuroxime unless contraindicated by allergy or posterior capsule rupture and the surgeons’ usual postop topical drop regimen. During 2010 and 1011, all patients received an intracameral injection of cefuroxime, moxifloxacin or vancomycin while topical antibiotics were used according to surgeon preferences. The rates of postop endophthalmitis during these three periods were calculated; 19 cases of endophthalmitis occurred in 16,264 cataract surgeries. The respective rates per 1,000 during the three time periods (2007; 2008 to 2009; 2010 to 2011) were as follows: 3.13 (95 percent CI, 1.43-5.93); 1.43 (95 percent CI, 0.66-2.72); 0.14 (95 percent CI, 0-0.78).
Evaluated separately were consecutive patients without PCR from a subgroup of three surgeons who used intracameral injection alone without preop topical antibiotics; a low infection rate was observed with injection alone, with only one case of endophthalmitis observed in 2,038 patients (rate per 1,000: 0.49; 95 percent CI, 0.01-2.73).
J Cataract Refract Surg 2013;39:8-14
Shorstein N, Winthrop K, Herrinton L.