ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose.To determine whether investment in a novel pharmacologic agent for the treatment of dry eye would be worthwhile from a financial perspective.Methods.Estimates were made of the cost and time required to develop a novel pharmacologic treatment of dry eye and the potential revenues for the product. These estimates were used to compute the value of the investment, adjusting for the time value of money.Results.Development was estimated to cost $42 million and to take 55 months from investigational new drug exemption filing to new drug application approval. The potential market for this treatment was estimated at $542 million per year at year 5. Adding in the cost of development and marketing as well as other costs, net present value was very positive at the 5, 8, 10, and 40% cost of financing. The internal rate of return was 90%.Conclusion.In summary, if there were a successful pharmacologic treatment of dry eye and if a firm could manage the cash flow during the development, then the market potential approaches that of other treatment of chronic ophthalmic conditions (e.g., glaucoma), and it would be a worthwhile investment.

ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose.To evaluate topical interferon alpha-2b (IFN&agr;2b) as a lone therapy in the treatment of primary conjunctival and corneal intraepithelial neoplasia (CIN).Methods.Noncomparative, prospective, interventional case series. Seven patients from three institutions, treated between February and October 1999, with presumed primary CIN lesions (clinically diagnosed by corneal specialists) were given topical IFN&agr;2b drops (1 million units/mL) four to six times daily. Follow-up was performed biweekly until there was complete clinical resolution of the presumed CIN lesions. Patients were to continue topical IFN&agr;2b drops for 1 month after clinical resolution. Patient charts and clinical photographs were reviewed, and data were analyzed.Results.All seven eyes had complete resolution of the presumed CIN lesions after an average of 77.0 ± 59.2 days (range, 28–188 days). Average posttreatment follow up was 12.4 ± 2.5 months (range, 9–16 months). No patients were lost to follow-up. No recurrences have yet been seen. Side effects of treatment were limited to mild conjunctival hyperemia and follicular conjunctivitis in four (57.1%) eyes. In all cases, there was total resolution of conjunctival hyperemia and follicular changes within 1 month after cessation of the medication, without additional treatment.Conclusions.Topical IFN&agr;2b alone may be an effective treatment of primary CIN. It appears to be a safe alternative to radiation, intralesional IFN&agr;2b injection, and surgical excision with cryotherapy. Larger population studies with longer follow-up are recommended to better assess the risk of recurrence and other possible adverse effects.

ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose.To evaluate the efficacy of intraoperative mitomycin-C in excision of ocular surface neoplasia for prevention of recurrence.Methods.Seven patients (eight eyes), three men and four women, aged 56 to 87 years (mean, 73.8 years), with lesions suspicious for corneal or conjunctival neoplasia, were operated on between October 1998 and March 2000. During excision of the lesion, mitomycin-C 0.02% was applied intraoperatively for 5 minutes. In two cases, excision was combined with conjunctival limbal autograft transplantation. All excised lesions were sent for histopathologic evaluation.Results.During the follow-up period ranging from 6 to 28 months (mean, 16 months) one patient (one eye) died of an unrelated cause. Histopathologic study showed four cases of squamous cell carcinoma, one case of carcinoma in situ, two cases of dysplasia, and one case of actinic keratosis. Of the eight eyes, no clinical recurrence of the lesion occurred in seven eyes, whereas one eye with squamous cell carcinoma showed mild recurrence 5 months after surgery and was successfully treated with topical mitomycin-C. Up to the last follow-up of this case 10 months later, the lesion did not recur.Conclusion.The excision of conjunctival and corneal epithelial neoplasia combined with the intraoperative use of mitomycin-C seems to reduce the recurrence rate. The combined use of mitomycin-C and conjunctival limbal autograft transplantation in two cases did not alter the surgical outcome. More cases and a longer follow-up are needed to establish the efficacy of such an approach.

ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose.Surgeons must mark the donor and recipient tissues precisely during penetrating keratoplasty, and verify the correct position of these marks in the actual donor button and trephine sites to minimize asymmetric placement of the graft within the host wound.Methods.A unique surgical reticule has been developed that simplifies proper marking of both the donor and recipient tissues with gentian violet. The reticule is placed within the oculars of the operating microscope. The circumference of the donor tissue and partial-thickness trephined host wound are aligned with a 5 mm inscribed circle. Eight equidistant lines, separated by 45 degrees around the circle, are used to place marks on the donor tissue and confirm the correct peripheral placement of limbal lines on the host tissue. The surgeon uses these landmarks for cardinal suture placement.Results.The reticule is easy to use with any size of trephine, and does not interfere with other surgical maneuvers during surgery.Conclusions.Correct suturing of the first eight cardinal sutures can occur only if the donor button is marked after it has been prepared, and the location of the recipient marks are verified after the actual trephination impression has been made. This reticule should minimize the role of asymmetric suturing on final graft astigmatism.

ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose.To evaluate the efficacy and safety of amniotic membrane implantation as a therapeutic contact lens in the treatment of different epithelial defects without stromal ulceration.Methods.We used amniotic membrane implantation as a therapeutic contact lens in 20 consecutive patients with epithelial defects. Group 1 included 10 patients with persistent epithelial defects that did not respond to medical treatment. Group 2 included 10 patients with surgically induced epithelial defects.Results.No intra-or postoperative complications were observed. The amniotic membrane implant remained in place for a mean of 12.5 days (range, 3–34). In 11 of the 20 patients, the amniotic membrane implant became detached within the first 8 days. When the corneal implant was postoperatively covered with a soft contact lens, this time increased. In group 1, complete epithelialization was achieved in three of the four cases in which the amniotic membrane remained in place for 2 or more weeks. There were no cases of complete epithelialization in which the implant remained in place for less than 1 week. In group 2, epithelialization was achieved in all cases, regardless of the time that the implant remained in place.Conclusion.Amniotic membrane implanted as a therapeutic contact lens can be an effective and safe option for the treatment of different epithelial defects. In patients with persistent epithelial defects, the number of cases with complete postoperative epithelialization was higher when the amniotic membrane remained in place longer. The early detachment of the amniotic membrane implant remains a major problem, even with the use of multiple fixation sutures.

ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose.To assess the clinical changes induced by the use of BioMask as an adjunct to phototherapeutic keratectomy (PTK) using the excimer laser.Methods.A nonrandomized, prospective clinical trial was conducted. Twenty-two consecutive patients were enrolled for BioMask treatment with reduced visual acuity caused by irregular astigmatism or corneal scarring. Patients were treated with a broad-beam excimer laser using the standard PTK mode. The BioMask collagen material was applied as a liquid at 47°C and molded using custom-made, rigid, gas-permeable contact lenses. After allowing the material to cool for approximately 3 minutes, the lens was removed and the gel was ablated at a fluence of 130–140 mJ/cm2at a frequency of 10 Hz, until the stromal bed appeared smooth. After surgery, patients were followed at day 1, week 1, and months 1, 3, 6, 9, and 12. The main outcome measures were best spectacle-corrected visual acuity (BSCVA) and uncorrected visual acuity (UVA).Results.Comparison of the preoperative and postoperative BSCVAs showed a statistically significant change in vision (p= 0.0356). Before surgery, the mean Snellen BSCVA was 20/90, whereas after surgery, BSCVA increased to 20/60. Sixty-five percent of the patients had an improved BSCVA, with an average gain of 3.7 lines per patient (range, +2 to +10). Fifteen percent of the patients lost an average of 3.0 lines (range, −2 to −6), and 20% had no change. UVA averaged 20/180 before surgery and 20/123 after surgery, but the change was not statistically significant. With respect to UVA, 63% improved by an average of 4.25 lines per patient (range, +2 to +9). Twenty-six percent (26%) lost an average of 5.6 lines (range, −2 to −8), and 10% had no change. The average follow-up time was 8 months for both BSCVA and UVA. When patients were stratified by their treatment indications and ranked in order of BSCVA outcome, patients with Salzmann's nodular degeneration did the best, followed by those with prior refractive surgery, corneal dystrophies, and corneal scars. Even though BSCVA did not improve as much in the corneal scar group, 50% of the patients reported an improvement in the symptoms they experienced before surgery based on questionnaires.Conclusion.BioMask appears to have potential as an ablatable mask material when used in conjunction with PTK for the treatment of corneal surface irregularities.

ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose.To determine the therapeutic value of lamellar keratoplasty (LKP) in the treatment of fungal keratitis not curable by antifungal chemotherapy.Methods.Fifty-five patients, in whom a diagnosis of fungal keratitis was confirmed by microscopic analysis of corneal scrapings or confocal microscopy, and who were not cured by topical and oral antifungal medication, were given LKP. After LKP, topical antifungal treatment was continued for 2 weeks with gradual tapering of the drugs. The excised recipient lamella was used for microbial culture and histopathologic examination.Results.Therapeutically beneficial results were achieved in 51 cases (92.7%) of the 55 LKPs that were performed. In these 51 cases, there was no recurrence of infection, and the resulting visual acuity ranged from 20/63 to 20/20. Patient follow-up ranged from 6 to 18 months. In four cases (7.3%), there was a recurrence of the fungal infection within 2 weeks of LKP. In these four patients, the infection was cured by performing a penetrating keratoplasty (PKP). Forty-six of the recipient lamellae were culture positive for fungi. Thirty-three of these cultures were identified asFusarium, six asAspergillus, three asCandida, one asPenicilliumspecies, and in the other three cases, unidentified septate hyphae were noted. In the four cases of recurrent infection, microbiologic culture revealed three cases withFusariumspecies and one case withAspergillusspecies. Histopathologic analysis of periodic acid-Schiff (PAS)–stained tissue sections of donor lamellae revealed fungal filaments in all samples. Immune reactions to the lamellar grafts were not observed and the donor lamellae remained clear for the duration of follow-up.Conclusion.Lamellar keratoplasty can be effective for treating fungal keratitis that is not cured by antifungal therapeutics. In addition, LKP can provide useful vision with few complications. Furthermore, corneal tissue used in LKP may be obtained more easily than healthy tissue used in PKP.

ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose.To evaluate ocular surface abnormalities in eyes with pterygium.Methods.Impression cytology was performed on 56 pterygia in 50 eyes with primary or recurrent pterygium. Superior, inferior, nasal, and temporal bulbar conjunctivae were evaluated.Results.The ocular surface morphology directly over the pterygium was found to be abnormal in 100% of cases. This was significant compared with abnormalities in 2.4% in the superior bulbar conjunctiva, 54.5% in the inferior bulbar conjunctiva, and 58.1% in the clinically unaffected interpalpebral conjunctiva. The epithelial cells in pterygium demonstrated squamous metaplasia in 73.2% of cases, with marked enlargement and elongation of the cells and pyknotic changes in the nuclei. Squamous metaplasia was also seen in the inferior conjunctiva (31.7%) and the clinically unaffected interpalpebral conjunctiva (54.8%) but without the advanced changes seen over the pterygium (p< 0.001). A low cellular yield was obtained over the pterygium in 98.2% of cases but only 22.7% in the inferior conjunctiva and 22.6% in the clinically unaffected interpalpebral conjunctiva (p< 0.001). Mucinous hyperplasia signifying increased goblet cell density was observed over the surface of the pterygium in 87.5% compared with 2.4% in the superior conjunctiva, 15.9% in the inferior conjunctiva, and 12.9% in the clinically unaffected interpalpebral conjunctiva (p< 0.001).Conclusion.The cytology of surface cells in pterygium exhibits squamous metaplasia with increased goblet cell density. A graded series of ocular surface changes exists throughout the bulbar conjunctiva in eyes with pterygium, with the most advanced changes occurring directly over the pterygium surface.

ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Purpose.This study compares the clinical and microbiologic value of topical netilmicin with that of gentamicin in the treatment of acute bacterial conjunctivitis.Methods.A double-blind, randomized, prospective, controlled study was performed in 209 patients. One to two drop(s) of either antibiotic was applied to the affected eye(s) four times a day for up to 10 days. Patients were examined at the time of diagnosis and after 3, 5, and 10 days. Clinical efficacy was measured as the cumulative sum score (CSS) of the key signs and symptoms of acute bacterial ocular infection. Sensitivity/resistance was evaluated using the disk diffusion method.Results.Drug efficacy assessment was restricted only to patients with positive baseline culture results (n= 121). Of the isolated organisms, 96.9% were sensitive to netilmicin, whereas only 75.0% were sensitive to gentamicin (p= 0.00001). Netilmicin provided a broad-spectrum coverage comparable with that of ciprofloxacin, ofloxacin, and norfloxacin. Netilmicin also was more effective than gentamicin in eradicating infections (p= 0.001 at day 5 andp= 0.037 at day 10) and in ameliorating the CSS (p= 0.037 at day 3,p= 0.001 at both day 5 and day 10). Only minor adverse events occurred in patients treated with either netilmicin or gentamicin.Conclusions.This study demonstrates that netilmicin is a safe and effective antibiotic that can be used as first-line therapy for the treatment of acute bacterial conjunctivitis.

ISSN:0277-3740    

出版商:OVID    

年代:2002

数据来源: OVID