Archives of Ophthalmology

Fiscella, Richard G.

1995 Archives of Ophthalmology

doi: 10.1001/archopht.1995.01100110013001pmid: 7487582

Abstract The Centers for Disease Control and Prevention (CDC), Atlanta, Ga, recently published guidelines for controlling vancomycin hydrochloride resistance in hospitals.1 It was reported by the CDC's National Noscomial Infections Surveillance System that the percentage of vancomycin-resistant enterococcal infections increased from 0.3% to 7.9% between 1989 and 1993. Certain patient populations are more at risk for vancomycin-resistant enterococci infection or colonization, including critically ill patients, those who are immunosuppressed, patients requiring cardiothoracic or abdominal surgical procedures, patients with indwelling catheters, and those requiring prolonged hospital stays or receiving multiple antibiotics. The current treatment recommendations for severe enterococcal infections require a combination of antimicrobial agents for effective treatment.2 Many antibiotics commonly used to treat enterococcal infection, including penicillin, ampicillin, gentamicin, streptomycin, and, now, vancomycin, have already demonstrated resistance. Recent reports indicate that vancomycin-resistant enterococci can spread by patient-to-patient contact, by hand carriage of personnel, or via patient-care equipment or environmental References 1. Hospital Infection Control Practices Advisory Committee (HICAC). Recommendations for preventing the spread of vancomycin resistance . Infect Control Hosp Epidemiol . 1995;16: (2) :105-113.Crossref 2. The choice of antibacterial drugs . Med Lett . 1994;36:53-60. 3. Doft BH, Barza M. Endophthalmitis Vitrectomy Study . Arch Ophthalmol . 1991;109:1061.Crossref 4. Gritz DC, Cevallos AV, Smolin G, Whitcher JP. Antibiotic supplementation of intraoperative infusions . Invest Ophthalmol Vis Sci . 1995;36( (suppl) ):S154.

To, King W.;Tsiaras, William G.;Thayer, Walter R.

1995 Archives of Ophthalmology

doi: 10.1001/archopht.1995.01100110014002pmid: 7487583

Abstract In the September 1994 issue of the Archives, Dr Saran and colleagues1 reported the association of acute hypopyon uveitis in patients with acquired immunodeficiency syndrome (AIDS) who had been treated for systemic Mycobacterium avium complex infection with rifabutin. Other investigators2-4 have also noted an association of uveitis with rifabutin use in their patients with human immunodeficiency virus infection. In this country, rifabutin has been approved for only a handful of uses, such as the prophylactic treatment for disseminated M avium complex infections in patients with advanced AIDS. Other approved uses for this drug include treatment of refractory cases of pulmonary tuberculosis and inflammatory bowel disease (IBD). We would like to share our experience with the use of rifabutin in the treatment of IBD. Ten years ago, one of us (W.R.T.) noted that when a Mycobacterium species that was isolated from the diseased bowels of two patients with Crohn's References 1. Saran BR, Maquire AM, Nichols C, et al. Hypopyon uveitis in patients with acquired immunodeficiency syndrome treated for systemic Mycobacterium avium complex infection with rifabutin . Arch Ophthalmol . 1994;112:1159-1165.Crossref 2. Siegel FP, Eilbott D, Burger H, et al. Dose-limiting toxicity of rifabutin in AIDS-related complex syndrome of arthraligia/arthritis . AIDS . 1991;4:433-441.Crossref 3. Shafran SD, Deschenes J, Miller M, et al. The MAC study group of the Canadian HIV trials network: uveitis and pseudojaundice during a regimen of clarithromycin, rifabutin and ethambutol . N Engl J Med . 1994;330:438-439.Crossref 4. Jacobs DS, Piliero PJ, Kuperwaser MG, et al. Acute uveitis associated with rifabutin use in patients with human immunodeficiency virus infection . Am J Ophthalmol . 1994;118:716-722. 5. Chiodini RJ, Van Kruiningen HJ, Thayer WR, et al. Possible role of Mycobacteria in inflammatory bowel disease, I: an unclassified Mycobacterium species isolated from patients with Crohn's disease . Dig Dis Sci . 1984;29:1073-1079.Crossref 6. Thayer WR, Coutu JA, Chiodini RJ, et al. Possible role of Mycobacteria in inflammatory bowel disease, II: mycobacterial antibodies in Crohn's disease . Dig Dis Sci . 1984;29:1080-1085.Crossref 7. Thayer WR, Coutu J, Chiodini R, et al. Use of rifabutin and streptomycin in the therapy of Crohn's disease: preliminary results . In: MacDermott RP, ed. Inflammatory Bowel Disease . Amsterdam, the Netherlands: Elsevier Science Publishers BV; 1988:565-568.

Friedberg, Dorothy N.

1995 Archives of Ophthalmology

doi: 10.1001/archopht.1995.01100110014003pmid: 7487584

Abstract Dr Martin and his colleagues are to be congratulated on their important article, "Treatment of Cytomegalovirus [CMV] Retinitis With Intraocular Sustained-Release Ganciclovir Implant."1 The implant is clearly effective in delaying progression of CMV retinitis in newly diagnosed patients. The absence of smoldering retinitis is of particular interest. Earlier studies of the implant were not randomized and included previously treated and newly diagnosed patients, making it difficult to draw conclusions concerning efficacy. There is a good discussion of the two major pitfalls with the implant, development of retinitis in a previously unaffected eye and development of visceral disease. However, the rate and timing of retinal detachment is of some concern. Although the patients had peripheral retinitis, there was no description of the percentage of retinal involvement or the zones involved at baseline. The extent, location, and activity of retinitis are important factors in determining the risk for development of retinal References 1. Martin DF, Parks DJ, Mellow SD, et al. Treatment of cytomegalovirus retinitis with an intraocular sustained-release ganciclovir implant . Arch Ophthalmol . 1994;112:1531-1539.Crossref 2. Freeman WR, Friedberg DN, Berry C, et al. Risk factors for development of rhegmatogenous retinal detachment in patients with cytomegalovirus . Am J Ophthalmol . 1993;116:713-720.

Martin, Daniel F.;Ferris, Frederick L.;Brothers, Rosemary J.;Remaley, Nancy A.;Nussenblatt, Robert B.

1995 Archives of Ophthalmology

doi: 10.1001/archopht.1995.01100110014004

Abstract In reply We thank Dr Friedberg for her letter and the important questions she raises. Thirty-seven of the 39 eyes treated with an implant in our study had only peripheral retinitis; two eyes had some involvement of the posterior pole. Twenty eyes had less than 10% of the retina involved by CMV, 12 eyes had 10% to 25% retinal involvement, and seven eyes had more than 25% involvement. Of the eyes that developed retinal detachment, two had less than 10% involvement, four had 10% to 25% involvement, and one had more than 25% involvement. At the time of detachment, the CMV retinitis was inactive in all cases.Given our limited sample size, definitive conclusions regarding the risk for retinal detachment are not possible. Although most patients in our study had relatively small CMV lesions that may be associated with a lower risk for retinal detachment, nearly all lesions were located References 1. Freeman WR, Friedberg DN, Berry C, et al. Risk factors for development of rhegmatogenous retinal detachment in patients with cytomegalovirus retinitis . Am J Ophthalmol . 1993;116:713-720. 2. Martin DF, Parks DJ, Mellow SD, et al. Treatment of cytomegalovirus retinitis with an intraocular sustained-release ganciclovir implant . Arch Ophthalmol . 1994;112:1531-1539.Crossref

Weinstock, Frank J.

1995 Archives of Ophthalmology

doi: 10.1001/archopht.1995.01100110015005pmid: 7487585

Abstract The editorial by Dr Sommer, "Disease Prevention and Health Promotion: A Clinical Primer,"1 exemplifies what Dr Sommer and many others have stressed for many years. Although these concepts are often voiced by government and private agencies, it should be noted, especially by Medicare, that many reimbursement programs will not cover well care, preventive care, or routine examinations. It is difficult to reap the savings from preventive care when the third parties will not reimburse patients who seek it. References 1. Sommer A. Disease prevention and health promotion: a clinical primer . Arch Ophthalmol . 1995;113:419-420.Crossref

Sommer, Alfred

1995 Archives of Ophthalmology

doi: 10.1001/archopht.1995.01100110015006

Abstract In reply Dr Weinstock has insightfully identified a maddeningly frustrating problem. Many reimbursement programs do not cover preventive services—services that would improve the quality of life, health, and well-being of our patients. A recent article in The New England Journal of Medicine reported that Medicare patients with private insurance were "three times as likely, and those with Medicaid, twice as likely to have a mammogram than... Medicare beneficiaries who must pay out-of-their-pocket a portion of the mammogram cost."1More and more, however, the situation is changing. As managed care, particularly capitated systems, recognizes that the individuals constituting their panel are going to be there for the long haul, it increasingly makes more sense, economic and otherwise, to provide preventive services now than to hope subsequent problems will have an impact on someone else's "bottom line." References 1. Blustein J. Medicare coverage, supplemental insurance, and the use of mammography by older women . N Engl J Med . 1995;332:1138-1143.Crossref

Maldonado, Miguel J.;Cano-Parra, Juan;Navea-Tejerina, Amparo;Cisneros, Angel L.;Vila, Emilio;Menezo, José L.

1995 Archives of Ophthalmology

doi: 10.1001/archopht.1995.01100110016008pmid: 7487587

Abstract We have recently reported a 3.3% recurrence rate for pterygium after the intraoperative use of 0.1-mg/mL mitomycin as an adjunctive therapy to surgery.1 However, all the cases showed delayed conjunctival wound healing, which could create a predisposition to infectious scleritis. Fluorouracil, a weaker antiproliferative drug,2 might be a valid and safe alternative to mitomycin. Because we know of no studies using placebo as a control, we undertook a randomized double-masked, placebo-controlled prospective study comparing simple excision of primary pterygium with excision plus a single low-dose intraoperative application of fluorouracil to evaluate the effectiveness and safety of fluorouracil. Ethical approval was obtained from the La Fe Hospital (Valencia, Spain) Ethics Committee and informed consent was signed by all patients. All the procedures were performed by two surgeons (M.J.M.,J.C. -P.). Pterygia were excised leaving a bare sclera measuring 3×4 mm. Patients were randomized in a masked fashion to receive a References 1. Cano-Parra J, Díaz-Llopis M, Maldonado MJ, Vila E, Menezo JL. Prospective trial of intraoperative mitomycin C in the treatment of primary pterygium . Br J Ophthalmol . 1995;79:439-441.Crossref 2. Smith S, D'Amore PA, Dreyer EB. Comparative toxicity of mitomycin C and 5-fluorouracil in vitro . Am J Ophthalmol . 1994;118:332-337. 3. Kawase K, Nishimura K, Yamamoto T, Jikihara S, Kitazawa Y. Anterior chamber reaction after mitomycin and 5-fluorouracil trabeculectomy: a comparative study . Ophthalmic Surg . 1993;24:24-27.

Soto-Pedre, Enrique;Hernéz-Ortega, Concepción

1995 Archives of Ophthalmology

doi: 10.1001/archopht.1995.01100110016007pmid: 7487586

Abstract Dr Carones et al1 concluded in their article published in the July 1994 issue of the Archives that photorefractive keratectomy caused no damage to the corneal endothelium. This conclusion was reached after comparing preoperative with postoperative values of cell density, coefficients of cell area variation, and percentages of hexagonal cells and after testing for a linear association of endothelial cell loss, coefficient of cell area variation, and percentage of hexagonal cells with depth of photoablation (ie, Pearson's correlation coefficient). However, we would like to point out a methodological problem in their article that could invalidate their conclusions. The fact that they did not find any linear association (ie, correlation coefficients of.23 or less) does not necessarily mean there is no association.2 Dr Carones et al should have noted that a correlation coefficient could be zero and there still could be a nonlinear relation between the two variables. We References 1. Carones F, Brancato R, Venturi E, Morico A. The corneal endothelium after myopic excimer laser photorefractive keratectomy . Arch Ophthalmol . 1994;112:920-924.Crossref 2. Dunn OJ. Basic Statistics: A Primer for the Biomedical Sciences . 2nd ed. New York, NY: John Wiley & Sons Inc; 1977. 3. Greenland S. Modeling and variable selection in epidemiologic analysis . Am J Public Health . 1989;79:340-349.Crossref

Yamamoto, Shuji;Tada, Rei;Shimomura, Yoshikazu;Pavan-Langston, Deborah;Dunkel, Edmund C.;Tano, Yasuo

1995 Archives of Ophthalmology

doi: 10.1001/archopht.1995.01100110018009pmid: 7487588

Abstract Varicella-zoster virus (VZV) is a recognized etiologic agent in iridocyclitis.1 However, diagnosing zoster iridocyclitis without the presence of dermatitis (zoster sine herpete2) is difficult. We describe a patient with iridocyclitis in whom VZV DNA was detected using the polymerase chain reaction (PCR). To our knowledge, this is the first such case of PCR detection of VZV DNA in zoster keratouveitis. Report of a Case. A healthy 72-year-old woman, referred to us with a diagnosis of anterior uveitis in the right eye, complained of redness and photophobia in the right eye. Best corrected visual acuities were 20/40 OD and 20/20 OS. Intraocular pressures were 2 mm Hg in the right eye and 12 mm Hg in the left. Slit-lamp examination showed severe Descemet's folds with pigmented keratic precipitates in the right eye (Figure 1, left) and mild cells and flare in the anterior chamber. The corneal epithelium was intact. References 1. Womack LW, Liesegang TJ. Complications of herpes zoster ophthalmicus . Arch Ophthalmol . 1983;101:42-45.Crossref 2. Easton HG. Zoster sine herpete causing acute trigeminal neuralgia . Lancet . 1970;2:1065-1066.Crossref 3. Inoue S, Hondo R. Microplate hybridization of amplified viral DNA segment . J Clin Microbiol . 1990;28:1469-1472.

Kanter, Eric D.;Brucker, Alexander J.

1995 Archives of Ophthalmology

doi: 10.1001/archopht.1995.01100110019010pmid: 7487589

Abstract Presoaked collagen corneal shields are used as a means for the delivery of antibiotics to the corneal epithelium and stroma and the anterior chamber. We report a case of macular infarction that occurred in a patient after the placement of a gentamicin sulfate-impregnated collagen corneal shield following cataract surgery. Report of a Case. An 80-year-old man underwent extracapsular cataract extraction with phacoemulsification of the lens nucleus and implantation of a posterior chamber intraocular lens in the left eye. Preoperative visual acuity was 6/120 OS. Clinical evaluation demonstrated a visually significant cataract and mild atrophic retinal pigment epithelial changes. Visual acuity in the fellow eye was 6/12 with similar retinal pigment epithelial changes noted. A 5-mL peribulbar injection was performed with a 1.6-cm 27-gauge needle using equal amounts of 1% lidocaine hydrochloride (without epinephrine) and 0.5% bupivacaine hydrochloride and 0.5 mL (75 U) of hyaluronidase. Light digital massage of the globe References 1. Conway BP, Tabatabay CA, Campochiaro PA, et al. Gentamicin toxicity in the primate retina . Arch Ophthalmol . 1989;107:107-112.Crossref 2. Judson PH. Aminoglycoside macular toxicity after subconjunctival injection . Arch Ophthalmol . 1989;107:1282-1283.Crossref 3. Phinney RB, Schwartz SD, Lee DA, Mondino BJ. Collagen shield delivery of gentamicin and vancomycin . Arch Ophthalmol . 1988;106:1599-1604.Crossref 4. Campochiaro PA, Lim JI. Aminoglycoside toxicity in the treatment of endophthalmitis . Arch Ophthalmol . 1994;112:48-53.Crossref