Dexamethasone 0.1% / Tobramycin 0.3% eye drops

PURPOSE: To determine whether topical tobramycin 0.3%/dexamethasone 0.1% plus ozonized oil eye drops reduces clinical signs and infectious viral titers of presumed viral conjunctivitis more than tobramycin/dexamethasone eye drops alone. METHODS: Prospective, single-blind, randomized, parallel-groups trial. Eighty patients with a clinical diagnosis of presumed viral conjunctivitis were randomizedly divided into two treatment groups: a study group and a control group, 40 for each group. Patients in the study group received topical tobramycin 0.3%/dexamethasone 0.1% eye drops, plus ozonized oil eye drops, both four times daily; patients in the control group received only topical tobramycin 0.3%/dexamethasone eye drops four times daily. The treatment was for seven days in both groups. Swabs were taken from the conjunctival fornix for adenovirus PCR analysis on the day of recruitment and at seven days follow-up. Clinical signs were also recorded on the day of recruitment and at follow-up examination: the main outcomes were conjunctival injection and conjunctival chemosis, graded on a 4-point clinical scale, presence or absence of superficial punctate keratitis and subepithelial corneal infiltrates. RESULTS: No statistically significant difference was reached in adenoviral infection negativization between the two groups, although the study group showed a higher number of PCR negative results at seven days follow-up. PCR real time detected adenoviral infection in 17 of 24 patients on the day of recruitment and it was positive in 4 patients on the seventh day (viral positivity reduction of 76%). In the control group PCR was positive for adenovirus in 18 of 24 patients on the day of recruitment and in 7 patients at seven days follow-up (reduction of 61%). There was statistically significant difference on conjunctival clinical signs between the study and control groups. Significant difference was also found on superficial punctate keratitis resolution between the study and the control group. In the former superficial punctate keratitis was detected in 14 eyes on the first day and in 5 eyes after seven days while in the latter superficial punctate keratitis was found in 124 eyes on the first day and in 6 eyes on the seventh day. No difference was found in subepithelial corneal infiltrates appearance between the two groups. CONCLUSIONS: The use of ozonized-oil containing eye drops in combination with topical tobramycin 0.3%/dexamethasone 0.1% eye drops four times daily seems to reduce the signs of conjunctivitis, and the duration of viral infection, although it does not affect the subepithelial corneal infiltrates appearance.

Abstract licence: CC BY 4.0

Phacoemulsification cataract surgery can be complicated by the inadvertent introduction of antibiotic ointment into the anterior chamber, resulting in rare but severe complications such as endothelial cell loss. We reviewed 35 cases from 23 studies and also presented a case report of an older female with a lipid droplet-like foreign body in the anterior chamber postoperatively. The foreign body was surgically removed and confirmed to contain dexamethasone via ultra-high performance liquid chromatography-tandem mass spectrometry. Clinical data indicated that 82.9% of cases required ointment removal, and 37.1% needed intraocular lens exchange. In the present case, the patient's corneal endothelial cell density decreased, whereas visual acuity remained stable following cataract surgery. The primary causes of endothelial cell loss included contact with white petrolatum, mineral oil present in tobramycin-dexamethasone ointment, and mechanical compression within the anterior chamber. We conclude that antibiotic eye ointment should not be used immediately after cataract surgery, and prompt removal is recommended if ointment is detected in the anterior chamber. To reduce intraocular lens contamination, ointment removal surgery should be performed without preoperative pupil dilation. Vigilance and timely intervention are essential, given the potential severity of these rare complications.

Abstract licence: CC BY-NC

BackgroundMannitol is Food and Drug Administration-approved for the reduction of intracranial pressure associated with cerebral edema and the reduction of intraocular pressure and is a commonly used drug in clinical practice. Hypersensitivity to mannitol is rarely reported, and only nine cases have been documented in English since 1967, all of which exhibited a rapid onset. We report a case of delayed anaphylactic shock induced by mannitol, aiming to alert clinical practitioners to the potential occurrence of such rare and serious adverse drug reactions (ADRs).Case presentationA 62-year-old Asian Chinese male patient was administered mannitol to reduce intraocular pressure following eye trauma. He did not report any discomfort during the first five intravenous infusions of mannitol. However, upon the sixth administration, the patient presented with anaphylactic shock, characterized by an abrupt loss of consciousness and hypotension. In response, the intravenous infusion was promptly discontinued, and a balanced salt solution was administered for fluid replacement. Epinephrine was administered to elevate blood pressure, while dexamethasone was utilized for its properties of inhibiting allergic responses. Subsequently, the patient's level of consciousness and blood pressure stabilized.DiscussionWe examined the correlation between anaphylactic shock in patients and mannitol, providing a concise summary of the characteristics noted in previous reports of mannitol-induced allergies. Additionally, we highlighted the distinctions of this particular case through a comprehensive literature review, as well as exploring the potential mechanisms behind delayed drug hypersensitivity reactions attributed to mannitol.ConclusionIt is crucial to be aware of the delayed allergic reactions associated with mannitol. Further post-marketing surveillance studies are necessary to identify rare and unknown adverse drug reactions following therapy with mannitol.

Abstract licence: CC BY-NC-ND

Abstract Introduction: Chemical cornea injury is a true ocular emergency and requires immediate intervention. Diagnoses rely on clinical assessment and classification. Treatment is directed to improve the epithelial integrity and stromal stability, reduce undue inflammation and prevent or timely management of complications. Case presentation A 45-year-old male presented with chemical injury to his left eye by a painting agent. He was classified as Grade 1 ocular surface chemical burn with a large central corneal ulcer and spared limbal area and conjunctiva. Treated successfully with the addition of combined dexamethasone and tobramycin eye drops to the standard treatment starting from the second day, with complete healing after 5 days. Conclusion Grade 1 ocular surface chemical burn with a large central corneal ulcer can be treated successfully with the administration of combined dexamethasone and neomycin eye drops.

Abstract licence: CC BY 4.0