Ophthalmological Monitoring Research Articles

Ocular Ethambutol Toxicity

Ethambutol is an antimicrobial agent used frequently to treat tuberculosis. The most commonly recognized toxic effect of ethambutol is optic neuropathy, which generally is considered uncommon and reversible in medical literature. We describe a 43-year-old man who developed signs and symptoms of bilateral optic neuropathy during treatment with ethambutol. This case and a review of the literature show the severe and unpredictable nature of ethambutol toxicity and its potential for irreversible vision loss despite careful ophthalmologic monitoring.

La rétinopathie diabétique du sujet jeune: l'enfant et l'adolescent

Diabetic retinopathy rarely occurs before puberty and is never proliferative in prepubescent children. On the opposite, puberty and adolescence are high-risk periods for diabetic retinopathy progression, and call for strict ophthalmologic monitoring. The period between 16 and 18 years of age is particularly critical. Progression towards florid diabetic retinopathy is to be especially feared and should be prevented in the course of adolescence, as this form can be severe and can lead to blindness. Risk factors are probably many, including diabetes duration, difficulties in achieving glycemic control due to increase in insulin requirements, low compliance to treatment, and hormonal changes related to puberty (abnormalities of the growth hormone (GH)/insulin-like growth factor-I (IGF-1) axis). Systematical diabetic retinopathy screening should be performed in adolescents, notably by non-mydriatic fundus photographs. Furthermore, the anticipation of the switch from pediatric to adult structures, together with the careful information and education of parents and children may improve visual prognosis of young diabetic patients, whose life expectancy is high.

Ophthalmological monitoring for hydroxychloroquine toxicity: a scientific review of available data.

Ophthalmological monitoring for hydroxychloroquine toxicity: a scientific review of available data.

Bright light therapy in focus: lamp emission spectra and ocular safety

In recent years, bright light treatment of seasonal affective disorder (SAD), recurrent depressions in fall and winter, has been discovered. Newer applications include circadian sleep phase disorder, shift work and jet lag. Apart from creating the visual signal, light can modify retinal structure and physiology. UV and visible light lead to distinct lesions of ocular tissues under certain experimental und naturalistic conditions. In light therapy, a large variety of fixtures is used but the spectral emission of lamps is mostly unknown to the user and clinician leading to the potential hazard of ocular lesions. Therefore, we have analyzed a wide selection of light sources commonly used for treatment. We measured the spectral emission and calculated irradiant doses for several light therapy regimens. Based on these measurements, potential hazards are analyzed, physiological mechanisms of light action are discussed and safety measures for bright light therapy are proposed. They include recommendations for lamps devoid of damaging spectral emissions and standardized therapy fixtures, ophthalmological monitoring of patients with eye diseases and control by optometrists for patients with healthy eyes who are likely to undergo light treatment for extended periods.

Ophthalmologic Safety Profile of Antimalarial Drugs

The ophthalmologic safety of antimalarial drugs is well established, but absolute safety cannot be assured. Three types of side effects may develop. Corneal deposits and neuromuscular-associated blurred vision are always reversible and therefore benign. Visual loss has occurred in patients with retinopathy. Retinopathy may be divided into true retinopathy and premaculopathy. It is true retinopathy that may be associated with visual loss, while premaculopathy consists of subtle visual field and funduscopic abnormalities. These premaculopathic changes are generally completely reversible with drug discontinuation and have not been shown to progress. Hydroxychloroquine appears safer than chloroquine when currently accepted equivalent doses are used. Fewer than 20 patients with true retinopathy caused by hydroxychloroquine have been reported; more patients have developed true retinopathy when taking chloroquine. The safety profile is most dependent on low daily dose and regular ophthalmologic monitoring. The optimal strategy of ophthalmologic testing has not yet been determined, but visual acuity, funduscopic examination and visual field examination should be monitored. Self-administered ophthalmologic testing with Amsler grids may contribute additional safety but is not a replacement for physician testing.

Corticosteroid treatment for inflammatory bowel disease in pediatric patients increases intraocular pressure

Intraocular pressure (IOP) was measured in 54 pediatric patients (aged 7–21 years) with inflammatory bowel disease (IBD) who were treated with oral prednisone for 1–104 months. The difference in mean IOP between the treated patients (mean ± SD, 15.62 ± 4.11 mm Hg) and 55 age-matched controls (13.83 ± 2.42 mm Hg) was statistically significant (P = 0.007). The IBD patients were classified as group I, IOP ≤19 mm Hg in both eyes, and group II, IOP ≥ 20 mm Hg in either eye. Twelve of the 54 patients (22.2%) and none of the controls had IOP ≥ 20 mm Hg (P < 0.001). Seventeen of the 54 patients (31.5%) were characterized as “steroid responders” (IOP of ≥ 20 mm Hg, change in IOP of ≥ 6 mm Hg between visits, or difference in IOP of ≥ 6 mm Hg between the two eyes). When the dose of prednisone was reduced to 0–10 mg/day 30 days or more before measurement, 9 steroid responders showed a decrease in IOP to within 2 SD of the mean control IOP; 7 of the 9 showed a decrease in IOP of ≥ 6 mm Hg. These observations indicate that while prednisone is a causative factor in increasing the IOP, susceptibility to average doses of prednisone is highly variable, and patients need to be monitored on an individual basis. Because IBD is a chronic disorder that requires prolonged corticosteroid treatment, these children are at risk of developing steroid-induced glaucoma. Careful ophthalmologic monitoring of pediatric IBD patients, as well as of other pediatric patients who receive corticosteroid therapy, is recommended.

The prescribing of chloroquine and hydroxychloroquine by consultant rheumatologists in the UK.

A questionnaire on chloroquine and hydroxychloroquine prescribing was circulated nationally to 212 consultant rheumatologists and 119 replies were analysed. Of all patients receiving second-line drugs, 10% were prescribed antimalarials, with hydroxychloroquine being used four times more frequently than chloroquine. Eighty-five per cent of rheumatologists always used the same dose of hydroxychloroquine or chloroquine. Only 5% considered patient's weight in deciding the dose. Fear of ocular toxicity was expressed by many physicians; 54% had experienced corneal deposits; 4% retinopathy and 40% believed cumulative dose determined toxicity. Much confusion existed over the necessity for and frequency of ophthalmological monitoring. Only 56% requested ophthalmological tests before commencing treatment, although 86% monitored the eyes during therapy. Other side-effects were believed to affect 1-10% of patients, with no anticipated difference between doses of 250 mg chloroquine and 400 mg hydroxychloroquine daily.

The Clinical Characteristics and Course of Adult Gonococcal Conjunctivitis

We studied 21 cases of adult conjunctivitis caused by Neisseria gonorrhoeae, confirmed by either Gram's stain or culture, that were seen between 1972 and 1986. The patients, typically young men, had irritation or pain, a copious purulent discharge, and marked conjunctival inflammation. Keratitis, anterior chamber inflammation, periocular edema and tenderness, gaze restriction, and preauricular lymphadenopathy were common. All patients were hospitalized and treated with high doses of parenterally administered antibiotics. Two patients had severe ulcerative keratitis at initial examination, which ultimately resulted in light-perception visual acuity, despite antibiotic therapy and keratoplasty. In the remainder of the patients, corneal involvement was milder and transient, and treatment with parenteral penicillin and topical antibiotics was uniformly effective in reversing the course of the infection and preventing significant visual loss. Careful ophthalmologic and microbiologic monitoring is suggested to prevent possible complications caused by penicillin-resistant strains.