Ocular Congestion Research Articles

Adverse drug reactions of intravesical instillation therapy for bladder cancer: based on FDA adverse event reporting system

ABSTRACT Background Intravesical chemotherapy and immunotherapy are common adjuvant treatments for non-muscle invasive bladder cancer post-surgery. Analyzing adverse events linked to these therapies, can assist in clinical decision-making and risk assessment. Study design and methods Disproportionality analysis was conducted to analyze data from the Food and Drug Administration Adverse Event Reporting System database from the first quarter of 2004 to the first quarter of 2024, exploring potential positive signals between Bacillus Calmette-Guérin, mitomycin-C, epirubicin, gemcitabine, and adverse events. Results The database retrieved 2018, 140, 31, and 85 adverse event reports associated with Bacillus Calmette-Guérin, mitomycin-C, epirubicin, and gemcitabine, respectively. Adverse reactions not mentioned in the label, such as aortic aneurysm and ocular congestion, were observed in preferred term level related to Bacillus Calmette-Guérin. Mitomycin-C exhibited specificity in skin and subcutaneous tissue diseases not reflected in the package insert. Gemcitabine-induced adverse drug reactions showed signals in vascular and lymphatic diseases meeting the screening criteria of all 4 indicators, with capillary leakage syndrome being the preferred term with the highest signal intensity. Conclusion This study observed new adverse event signals, providing important assistance for drug selection in adjuvant therapy for non-muscle invasive bladder cancer postoperatively.

Surtos de filoftalmíase em avestruzes (Struthio camelus) no Nordeste do Brasil

ABSTRACT: This study discusses the epidemiological, clinical, and pathological characteristics of two outbreaks of ocular infection in ostriches (Struthio camelus) caused by the trematode Philophthalmus sp. The outbreaks occurred in the states of Ceará and Rio Grande do Norte in Northeast Brazil. Ostrich farming was categorized as semi-intensive farming with free access to the weir and river. The clinical symptoms for infection included nictitating membrane inflammation, epiphora (tearing), eyelid edema, ocular congestion, eyeball destruction, emaciation, and death, and the infection period ranged from 8 to 16 months. Macroscopically, thickening of the eyelids and conjunctiva were observed, with orange parasites infestation. Histologically, the lesions were characterized as lymphoplasmacytic and heterophilic, multifocal to coalescing, moderate, chronic conjunctivitis associated with hyperplasia and ectasia of the Harderian gland, and numerous parasites. The parasites were oval and flattened with an oral suction cup, acetabulum, and thick cuticle containing spicules. The diagnosis of philophthalmiasis was based on epidemiological, clinical, and pathological findings associated with the morphological characteristics of the parasites present in the conjunctival sacs which were similar to the trematode Philophthalmus sp. Philophthalmiasis can occur in ostriches raised on urban and rural properties in Northeastern Brazil, probably associated with the contact of birds with contaminated water, and is characterized by severe conjunctivitis that can result in the loss of the eyeball and death of the animals.

Formulation and Pathohistological Study of Mizolastine-Solid Lipid Nanoparticles-Loaded Ocular Hydrogels.

BackgroundMizolastine (MZL) is a dual-action nonsedating topical antihistamine anti-inflammatory agent that is used to relieve allergic conditions, such as rhinitis and conjunctivitis. Solid lipid nanoparticles (SLNs) are advanced delivery system in ophthalmology, with the merits of increasing the corneal drug absorption and hence improved bioavailability with the objective of ocular drug targeting.MethodsFirst, MZL was formulated as MZL-SLNs by hot homogenization/ultrasonication adopting a 32 full factorial design. Solid-state characterization, in vitro release, and stability studies have been performed. Then, the optimized MZL-SLNs formula has been incorporated into ocular hydrogels using 1.5% w/v Na alginate and 5% w/v polyvinylpyrrolidone K90. The gels were evaluated via in vitro release as well as in vivo studies by applying allergic conjunctivitis congestion in a rabbit-eye model.ResultsThe optimized formula (F4) was characterized by the highest entrapment efficiency (86.5±1.47%), the smallest mean particle size (202.3±13.59 nm), and reasonable zeta potential (−22.03±3.65 mV). Solid-state characterization of the encapsulation of MZL in SLNs was undertaken. In vitro results showed a sustained release profile from MZL-SLNs up to 30 hours with a non-Fickian Higuchi kinetic model. Stability studies confirmed immutability of freeze-dried MZL-SLNs (F4) upon storage for 6 months. Finally, hydrogel formulations containing MZL-SLNs, proved ocular congestion disappearance with completely repaired conjunctiva after 24 hours. Moreover, pretreatment with MZL-SLNs–loaded hydrogel imparted markedly decreased TNF-α and VEGF-expression levels in rabbits conjunctivae compared with post-treatment with the same formula.ConclusionMZL-SLNs could be considered a promising stable sustained-release nanoparticulate system for preparing ocular hydrogel as effective antiallergy ocular delivery systems.

Infarction of Percheron artery: A rare case report

The thalamus has strategic cores, which are divided into different functional classes and manage important cortical functions in harmony with each other. The mechanism proposed in the bilateral paramedian thalamic infarction is an occlusion of a single undifferentiated thalamo-perforating artery which is an anatomic variant. This artery, called the Percheron artery, appears from the first segment of the posterior cerebral artery and gives bilateral medial thalamic perforating branches. Bilateral paramedian thalamic infarction causes specific clinical signs and symptoms such as changes in consciousness ranging from letarj to coma, vertical gaze paralysis, ocular congestion loss and amnesia. In this case we aimed to present clinical and radiological features of a rare condition with infarction of percheron artery.

A prospective study of efficacy and safety of olopatadine versus azelastine in allergic conjunctivitis at a tertiary care hospital

Background: Allergic conjunctivitis, an ocular surface inflammatory disease with significant social and economic impact affects approximately 25% of the general population. H1 receptor blockers, mast cell stabilizers and drugs that block cytokine and prostaglandin formation form the treatment armamentarium. Olopatadine hydrochloride and Azelastine hydrochloride are dual-acting selective H1 receptor antagonist with mast-cell stabilizing property. This study was undertaken to assess the efficacy and safety of olopatadine hydrochloride 0.1% and Azelastine hydrochloride 0.05% in allergic conjunctivitis amongst Indians.Methods: After obtaining Institutional Ethics Committee approval and written informed consent, 120 patients diagnosed with allergic conjunctivitis fulfilling the inclusion/exclusion criteria were enrolled in the study. Study was done from April 2014 to June 2015 at Minto eye hospital. Study subjects were treated with olopatadine hydrochloride 0.1% and Azelastine hydrochloride 0.05% eye drops BD for 15 days. Ocular symptoms, instead of and signs and adverse events, if any were recorded on the day 8 and day 15 follow up visits.Results: At the end of the study period, the reduction in the ocular itching score from baseline was higher in the olopatadine group compared to the azelastine group (p<0.002). Similarly, the scores of ocular congestion (p<0.008), foreign body sensation (p<0.009), tearing (p<0.001), erythema (p<0.002) and chemosis (p<0.015) also showed larger reduction in the olopatadine treated patients. The common adverse events encountered in both the groups were stinging after instillation, burning, bitter taste and headache.Conclusions: In allergic conjunctivitis, both olopatadine and azelastine were found to be effective in relieving ocular signs and symptoms, but olopatadine was found to be superior in terms of efficacy, safety and tolerability with minimal side effects.

Eyesight quality and Computer Vision Syndrome.

The aim of the study was to analyze the effects that gadgets have on eyesight quality. A prospective observational study was conducted from January to July 2016, on 60 people who were divided into two groups: Group 1 - 30 middle school pupils with a mean age of 11.9 ± 1.86 and Group 2 - 30 patients evaluated in the Ophthalmology Clinic, "Sf. Spiridon" Hospital, Iași, with a mean age of 21.36 ± 7.16 years. The clinical parameters observed were the following: visual acuity (VA), objective refraction, binocular vision (BV), fusional amplitude (FA), Schirmer's test. A questionnaire was also distributed, which contained 8 questions that highlighted the gadget's impact on the eyesight. The use of different gadgets, such as computer, laptops, mobile phones or other displays become part of our everyday life and people experience a variety of ocular symptoms or vision problems related to these. Computer Vision Syndrome (CVS) represents a group of visual and extraocular symptoms associated with sustained use of visual display terminals. Headache, blurred vision, and ocular congestion are the most frequent manifestations determined by the long time use of gadgets. Mobile phones and laptops are the most frequently used gadgets. People who use gadgets for a long time have a sustained effort for accommodation. A small amount of refractive errors (especially myopic shift) was objectively recorded by various studies on near work. Dry eye syndrome could also be identified, and an improvement of visual comfort could be observed after the instillation of artificial tears drops. Computer Vision Syndrome is still under-diagnosed, and people should be made aware of the bad effects the prolonged use of gadgets has on eyesight.

Microparticles based on natural and synthetic polymers for ophthalmic applications

Sodium salt of carboxymethylcellulose/poly(vinyl alcohol) particles suitable for application in ocular drug administration were prepared by crosslinking with epichlorohydrin in an alkaline medium, in reverse emulsion. The influence of parameters related with the particles elaboration process (ratio between polymer mixture and crosslinking agent, concentration of polymer solution, duration of crosslinking reaction, stirring intensity, etc.) based on their composition, size, and swelling ability was studied. Obtained microparticles fulfill the requirements for biomaterials-they are formed from biocompatible polymers; the acute toxicity value (LD(50)) is high enough to consider these materials as weakly toxic (hence able to introduce within the organism); they are able to include and release drugs in a controlled way. The in vivo adrenalin ocular delivery from the microparticles was tested on voluntary human patient. The particles showed good adhesion properties without irritation to the patient and proved the capability to treat the ocular congestion.

POSTERIOR SCLERITIS IN A 9-YEAR-OLD BOY: A CASE REPORT

To report a case of posterior scleritis in a 9-year-old boy. A case report. Uniocular presentation in a 9-year-old boy. Posterior scleritis is seen commonly in middle-aged women, associated with mild ocular congestion, globe tenderness, and varying amount of vision loss. We report an uncommon presentation of posterior scleritis in a young male child. The patient presented with decreased vision and extraocular and intraocular inflammatory signs in the left eye. Fundus examination showed disk and macular edema with a T-sign on B-scan ultrasound. The patient showed good response to oral steroids with resolution of inflammation and recovery of vision.

Ophthalmic alterations in horses with leptospirosis by serovar Icterohaemorrhagiae in Rio de Janeiro, Brazil

The objective of the study was to determine the association between clinical ophthalmic alterations and seroreactivity to leptospirosis by serovar Icterohaemorrhagiae in horses in Rio de Janeiro, Brazil. A total of 199 horses were studied. A microscopic agglutination test (MAT) was used to detect specific anti-Leptospira antibodies in blood serum. A total of 107 (53.8%) horses were seroreactive (titres > 200); 54 had high (> 800) titres, of which 44 were against serovar Icterohaemorrhagiae. Forty-two out of these 44, plus 40 seronegative horses (titers < 100) were given detailed ophthalmic examinations. Epiphora, ocular congestion, blepharospasm, photophobia, and peripapillary focal depigmentation were the most frequent alterations in seroreactive horses. Most ocular alterations were significantly more frequent in seroreactive horses. Horses seroreactive for leptospirosis (serovar Icterohaemorrhagiae) had a significantly higher prevalence of ophthalmic alterations than seronegative horses, providing additional evidence for an association between leptospirosis and equine uveitis.

Double Cross-linked Chitosan—Gelatin Particulate Systems for Ophthalmic Applications

Gelatin/chitosan particles suitable for application in ocular drug administration were prepared by a two-step cross-linking process performed in an emulsion-phase separation system. The particles were characterized by scanning electron microscopy and laser diffractometry, and the diameters were 0.202—4.596 µm. The microparticles pH-dependent behavior was monitored by their mean diameter changes in aqueous environment. Adrenalin was drug used to study loading and release characteristics. The prepared particles were nontoxic, with the DL50 values of 6.9—8.19 g/kg body mass. The in vivo biocompatibility tests consisted of subcutaneous administration of a microparticle suspension in physiological serum followed by morpho histological analysis of the implantation site. The in vivo adrenalin ocular delivery was tested on both animals and a voluntary human patient to determine the adrenalin action and by tears. The particles showed good adherent properties without irritation to the patient; adrenalin was released cleared the ocular congestion.

Effect of Enzymatically Modified Isoquercitrin, a Flavonoid, on Symptoms of Japanese Cedar Pollinosis: A Randomized Double-Blind Placebo-Controlled Trial

Background: Flavonoids exert antiallergic and antioxidant effects. We investigated the efficacy of enzymatically modified isoquercitrin (EMIQ), a flavonoid, to relieve symptoms of pollinosis. Methods: In a parallel-group, double-blind placebo-controlled study design, 20 subjects with Japanese cedar pollinosis took two capsules daily of 100 mg EMIQ or a placebo for 8 weeks during the pollen season. Subjective symptoms and activities of daily living (ADL) scores were recorded every day, and the quality of life (QOL) score was obtained every 4 weeks. Blood sampling was performed before and after the study to measure serum cytokines, chemokines, IgE, quercetin and oxidized biomarkers. Results: During the entire study period, total ocular score and ocular itching score for the EMIQ group were significantly lower (p < 0.05) than for the placebo group. When limited to the individual periods, total symptom score for the EMIQ group was significantly lower (p < 0.05, week 4–5) than that for the placebo group while other scores for the EMIQ group, such as total nasal score (p = 0.06, week 4–5), nasal obstruction score (p = 0.08, week 4–5), lacrimation score (p = 0.06, week 5–6), ocular congestion score (p = 0.08, week 4–7) and ADL score (p = 0.08, week 4–7), all tended to be lower. The levels of serum cytokines such as interleukin (IL)-4, IL-5, IL-12, IL-13, interferon-γ, and eotaxin and IgE were not significantly downregulated by the intake of EMIQ but the serum concentrations of oxidized low-density lipoprotein and thymus and activation-regulated chemokine were reduced. Conclusion: Intake of the quercetin glycoside EMIQ was safe and influenced ocular symptoms caused by pollinosis.

Preventative Effect of a Flavonoid, Enzymatically Modified Isoquercitrin on Ocular Symptoms of Japanese Cedar Pollinosis

Flavonoids are nutrients that exert anti-allergic effects. We investigated the preventative effect of enzymatically modified isoquercitrin (EMIQ), a flavonoid, to relieve the symptoms of Japanese cedar pollinosis. In a parallel-group, double-blind placebo-controlled study design, 24 subjects with Japanese cedar pollinosis took 100mg EMIQ or a placebo for 8 weeks, starting 4 weeks prior to the onset of pollen release. Subjective symptoms, ADL scores and the usage of drugs were recorded daily, and the QOL score was obtained every 4 weeks. Blood sampling was performed before and after the study to measure serum levels of IgE and flavonoids. During the entire study period, ocular symptom + medication score for the EMIQ group was significantly lower (p < 0.05) than that of the placebo group. When limited to the period, ocular symptom scores (p < 0.05, weeks 5-6), and ocular congestion scores (p < 0.05, weeks 5-6) for the EMIQ group was significantly lower than that for the placebo group while other scores for the EMIQ group, such as ocular itching scores (p = 0.09, weeks 4-5), lacrimation scores (p = 0.07, weeks 5-6), and ocular congestion scores (p = 0.06, weeks 4-5), all tended to be lower. However no significant differences were found in nasal symptoms between the two groups. Serum concentrations of IgE were not significantly downregulated but the serum concentrations of quercetin and its derivatives were elevated significantly by the intake of EMIQ. Intake of the quercetin glycoside EMIQ proved to be effective for the relief of ocular symptoms caused by Japanese cedar pollinosis.

Nevirapine-induced Stevens-Johnson Syndrome in an HIV Patient

To report a case of nevirapine-induced Stevens-Johnson syndrome (SJS) misdiagnosed as viral keratitis. A 35-year-old AIDS patient, on antiretroviral therapy (ART) with stavudine, nevirapine, and lamivudine, developed bilateral ocular congestion and irritation. He was being treated elsewhere for bilateral herpetic epithelial keratitis. On progressive worsening of symptoms, he presented with complaints of severe photophobia and foreign-body sensation in both eyes. The patient's history was evaluated in detail. The patient had apparently been on multidrug ART until he developed SJS 3.5 months ago. Nevirapine was subsequently discontinued. No ophthalmologic opinion was sought until a month before. He was diagnosed and was treated for bilateral herpetic epithelial keratitis for 1 month. Ocular surface examination revealed bilateral severe dry eyes, with multiple corneal erosions. The inferior fornices showed cicatricial bands. The patient was suspected to have SJS-induced dry eyes, with associated epithelial defects. The epithelial defect edges were debrided and subjected to viral cell culture and polymerase chain reaction for herpes simplex. The patient was started on hourly preservative-free tear substitutes. Amniotic membrane transplantation (as a patch graft) was performed. A successful response to therapy within 10 days, along with a negative viral culture and polymerase chain reaction report, confirmed our diagnosis. Ophthalmologists need to be aware of the high risk of development of ocular adverse reactions in AIDS patients on ART before ascribing the ocular symptoms to more severe opportunistic infections.

Behηet′s disease with HIV infection: Response to antiretroviral therapy

The differential diagnosis of oral ulcerations in a patient with AIDS/HIV infection is often challenging to the clinician. While old diseases have appeared in a new garb, many new ones are also being recognized. The association of Behetaet's disease and AIDS/HIV infection has been recently recognized. We present an HIV-positive patient having oro-genital aphthosis conforming to the diagnostic criteria for Behetaet's disease. Erythema nodosum, periphlebitis, erythematous papulopustular lesions, half and half nails, ocular congestion, raised ESR and dimorphic anemia were some other features present. He had low CD4+/CD8+ counts. He had no other HIV-related disease. He responded well to triple anti-retroviral treatment alone. The possible pathomechanism of the occurrence of both diseases is also discussed.

Extraocular muscle cysticercosis - a clinical challenge to the ophthalmologists

purpose To report our experience with extraocular myocysticercosis, to highlight the role of ultrasound and orbital computerized tomography (CT) scan in these cases and to discuss the management. methods This is retrospective study of 35 cases of orbital myocysticercosis confirmed on ultrasound and CT scan of the orbit. results There were 18 males and 17 females. The average age of these patients was 19.6 years. The most common presenting feature was restricted ocular motility with diplopia and recurrent pain and redness. Ultrasound examination and CT scan of the orbit done for all these patients identified the cyst and the affected muscle. All extraocular muscles were noted to be involved in myocysticercosis. However the lateral rectus, medial rectus and the superior oblique were affected to a greater extent. All cases dramatically improved on treatment with albendazole and oral steroids. Surgical excision of cyst was done in 6 cases. conclusion A high index of suspicion should be entertained for extraocular muscle cysticercosis, especially in cases of acquired ocular motility disorder with recurrent ocular congestion. Ultrasound and CT scans of orbit play a vital role in diagnosis. Medical therapy with albendazole under cover of steroids is effective in most of the cases.

Retained lens fragments after cataract surgery.

In conclusion, the incidence of retained lens fragments appears to have increased in recent years. The timing of vitrectomy can be delayed to permit improvement of corneal edema, ocular congestion, and acute postoperative inflammation. Placement of a posterior chamber intraocular lens at the time of the initial cataract surgery does not adversely affect final visual results. Retinal detachment is a frequent adverse event in these eyes. Vitrectomy and removal of retained lens fragments restores good visual acuity and reduces secondary glaucoma in the majority of patients.

Innervation of the cavernous body of the human efferent tear ducts and function in tear outflow mechanism.

The lacrimal sac and nasolacrimal duct are surrounded by a wide cavernous system of veins and arteries comparable to a cavernous body. The present study aimed to demonstrate the ultrastructure of the nervous tissue and the localisation of neuropeptides involved in the innervation of the cavernous body, a topic not previously investigated. Different S-100 protein antisera, neuronal markers (neuron-specific enolase, anti-200 kDa neurofilament), neuropeptides (substance P, neuropeptide Y, calcitonin gene-related peptide, vasoactive intestinal polypeptide) and the neuronal enzyme tyrosine hydroxylase were used to demonstrate the distribution pattern of the nervous tissue. The ultrastructure of the innervating nerve fibres was also examined by means of standard transmission electron microscopy. The cavernous body contained specialised arteries and veins known as barrier arteries, capacitance veins, and throttle veins. Perivascularly, the tissue was rich in myelinated and unmyelinated nerve fibres in a plexus-like network. Small seromucous glands found in the region of the fundus of the lacrimal sac were contacted by nerve fibres forming a plexus around their alveoli. Many nerve fibres were positive for S-100 protein (S 100), neuron-specific enolase (NSE), anti-200 kDa neurofilament (RT 97), calcitonin gene-related peptide (CGRP), substance P (SP), tyrosine hydroxylase (TH), and neuropeptide Y (NPY). Vasoactive intestinal polypeptide (VIP) immunoreactivity was only demonstrated adjacent to the seromucous glands. Both the density of nerve fibres as well as the presence of various neuropeptides emphasises the neural control of the cavernous body of the human efferent tear ducts. By means of this innervation, the specialised blood vessels permit regulation of blood flow by opening and closing the lumen of the lacrimal passage as effected by the engorgement and subsidence of the cavernous body, at the same time regulating tear outflow. Related functions such as a role in the occurrence of epiphora related to emotional responses are relevant. Moreover, malfunction in the innervation of the cavernous body may lead to disturbances in the tear outflow cycle, ocular congestion or total occlusion of the lacrimal passages.

The "triple technique" for treating stable Graves' ophthalmopathy.

Graves' ophthalmopathy may range from mild eyelid retraction to a devastating process that involves the entire orbit and culminates in gross ocular congestion, massive proptosis, and even blindness. Whether the ophthalmopathy is mild or severe, patients are managed on an individual basis according to the predominant clinical findings, which may include congestion, myopathy, lid retraction, proptosis, and optic neuropathy. The process usually becomes quiescent after 6 months to 3 years; however, the changes caused by fibrosis (lid retraction and ocular muscle enlargement) are permanent. The cornerstone of surgical treatment for severe cases is bony orbital decompression; however, in our experience, mild to moderate Graves' ophthalmopathy is better treated by combining eyelid surgery and orbital lipectomy. Our approach consists of a conservative orbital lipectomy, the lengthening of the levator-Müller complex by means of marginal myotomies, and a limited lateral tarsal apposition. These three different surgical steps, which have been described previously as isolated procedures, are undertaken on both eyes at the same time and modulated according to the deformity of the patient. The operation can be performed under local anesthesia with sedation, thus allowing intraoperative monitoring of the correction; the patient can be discharged after a few hours. The results in 32 operated eyes of 16 patients have been a marked aesthetic and functional improvement, with no complications after 6 to 18 months of follow-up. The relative simplicity and very low morbidity of this procedure, as well as its reliability, make it ideal in patients with mild to moderate aesthetic and functional impairment who are looking for a substantial improvement but are unwilling to undergo a relatively major procedure such as a transosseous decompression, which, in our opinion, is the operation of choice only when the patient presents with optic neuropathy or major proptosis.

Isolated Oculomotor Nerve Palsy due to Dural Cavernous Sinus Fistula

Two patients with a dural carotid-cavernous sinus fistula presented with unilateral oculomotor nerve palsies without signs of ocular congestion or proptosis. According to this, dural carotid-cavernous sinus fistula should be included in the differential diagnosis of any case of painful ophthalmoplegia, even in the absence of other ocular signs.