Prednisolone Eye Drops Research Articles

A 32-Year-Old Male with Corneal Hydrops

Case Presentation: A 32-year-old male with a history of left eye keratoconus presented to the emergency department with left eye pain and blurry vision for two days. Out of concern for corneal hydrops, ophthalmology was consulted, and the diagnosis was confirmed. Per ophthalmology recommendations, the patient was started on hypertonic saline and prednisolone eye drops and referred to a corneal specialist. Discussion: Corneal hydrops is characterized by stromal edema caused by leakage of aqueous humor due to rupture of Descemet membrane. This case describes a patient with a keratoconus deformity who developed corneal hydrops.

OA24 Extended oligoarthritis with proximal muscle weakness and antinuclear antibody positivity associated with a novel genetic variant of uncertain significance in lipopolysaccharide-responsive and beige-like anchor protein (LRBA) gene

Abstract Introduction LRBA deficiency is associated with recurrent infections and immune dysregulation, particularly autoimmune cytopenias, enteropathy and intestitial lung disease, and in a few cases chronic polyarthritis and uveitis. Case description A girl presented at three years old with history of not walking for two months with no history of trauma or fever. Examination revealed arthritis in her ankles and knees. Ultrasound showed synovial thickening in both knees and small effusion to hips. There was no evidence of uveitis at presentation. Her bloods showed raised C-Reactive Protein (CRP) 33 mg/L and Erythrocyte Sedimentation rate (ESR) 45 mm/h. Anti-nuclear and anti-centromere antibodies were positive. Diagnosis was made of oligoarticular JIA and she was treated with intra-articular steroids in both knees and ankles and was started on oral prednisolone, weekly oral methotrexate. On subsequent clinic review, she had started to walk with mild restriction to internal rotation of hips and difficulty in getting up from sitting. She was started on regular hydrotherapy, physiotherapy and occupational therapy. From five to 11 years old, she had four flares of uveitis, treated with prednisolone eye drops; and two flares of arthritis, treated with steroids. Her methotrexate was changed to subcutaneous and at eight years of age she was also started on subcutaneous adalimumab fortnightly. Due to prolonged proximal muscle weakness, abnormal gait and chronic pain in leg joints without clinical or radiological evidence of synovitis during clinic reviews, she underwent thorough neurological work up which was inconclusive for myopathies. Her creatinine kinase levels, thyroid profile, MRI brain and spine were normal. Genetic work up showed two variants in the LRBA gene, one pathogenic and the other was variant of uncertain significance (VUS). Her CTLA4 expression was normal by flow cytometry. Discussion Three case reports have previously associated homozygous LRBA deficiency with polyarthritis. Compound heterozygous LRBA deficiency may present with various phenotypes including autoimmune disease affecting multiple organs, immune cytopenia and immune dysregulations including CTLA-4 expression. This report potentially widens the clinical spectrum of LRBA deficiency and given that it is a novel variant, prompts us to screen for this gene mutation in patients with JIA where remission is challenging and there is a need for continuous immunosuppressive or immune-modulatory therapy. Three case reports have previously associated homozygous LRBA deficiency with polyarthritis. Compound heterozygous LRBA deficiency may present with various phenotypes including autoimmune disease affecting multiple organs, immune cytopenia and immune dysregulations including CTLA-4 expression. This report potentially widens the clinical spectrum of LRBA deficiency and given that it is a novel variant, prompts us to screen for this gene mutation in patients with JIA where remission is challenging and there is a need for continuous immunosuppressive or immune-modulatory therapy. Three case reports have previously associated homozygous LRBA deficiency with polyarthritis. Compound heterozygous LRBA deficiency may present with various phenotypes including autoimmune disease affecting multiple organs, immune cytopenia and immune dysregulations including CTLA-4 expression. This report potentially widens the clinical spectrum of LRBA deficiency and given that it is a novel variant, prompts us to screen for this gene mutation in patients with JIA where remission is challenging and there is a need for continuous immunosuppressive or immune-modulatory therapy. Key learning points • There is no single diagnostic investigation for JIA as the aetiology is complex and there are currently no specific clinical guidelines of when to consider genetic testing in patients with JIA. With the mainstreaming of genetic services and improved access to cheaper, advanced next-generation sequencing, we should consider looking into monogenic conditions that mimic JIA. • The case illustrates the challenges of determining whether VUS are pathogenic in causing arthritis, or just incidental findings. Compound heterozygous LRBA may present within a spectrum of clinical features, further analysis with CTLA4 expression by flow cytometry and genetic analysis of siblings and parents will be helpful. • Compound heterozygous LRBA variation has different clinical manifestation which needs personalised treatment. Treatment with abatacept (a soluble CTLA4 immunoglobulin fusion protein) which is reported in a case series of LRBA deficiency. Risks of continuous immunosuppressive treatment need to be balanced with more definitive hematopoietic stem cell transplantation (HSCT) previously used to achieved complete remission in LRBA deficiency.

PREDNISOLONE EYE DROPS AS A POTENTIAL TREATMENT IN NONNEOVASCULAR PACHYCHOROID-RELATED DISEASES.

To investigate the functional and structural outcomes after treatment with prednisolone eye drops in the following pachychoroid-related diseases: chronic central serous chorioretinopathy, pachychoroid pigment epitheliopathy, and peripapillary pachychoroid syndrome. In this retrospective study, 54 eyes of 48 patients with pachychoroid-related disease were treated with prednisolone acetate 1% eye drops 3 times a day. Change in macular volume and retinal central subfield thickness on optical coherence tomography was measured. In addition, the foveal or complete resolution of fluid and the change in visual acuity were studied. The follow-up visit was at a mean of 41.2 ± 14.5 days. In the 44 eyes with chronic central serous chorioretinopathy, a significant reduction in retinal central subfield thickness ( P < 0.001) and macular volume ( P < 0.001) was observed. Foveal intra- or subretinal fluid resolved completely in 22% of the eyes. In the 8 peripapillary pachychoroid syndrome eyes, a reduction in the nasal retinal thickness was observed ( P = 0.025). One of the 2 pachychoroid pigment epitheliopathy eyes showed structural improvement. No significant change in visual acuity was observed in any of the pachychoroid spectrum diseases. In patients with chronic central serous chorioretinopathy, peripapillary pachychoroid syndrome, and pachychoroid pigment epitheliopathy, anatomical improvement was observed after therapy with prednisolone eye drops. Visual acuity did not change significantly.

Frosted Branch Angiitis Associated with COVID-19-related Multisystem Inflammatory Syndrome in Children

Purpose: To report a case of frosted branch angiitis associated with COVID-19-related multisystem inflammatory syndrome in children (MIS-C).Case summary: An 8-year-old boy was referred to the ophthalmology clinic with decreased visual acuity in his right eye. The initial best-corrected visual acuity (BCVA) was 20/63 in the right eye and 20/32 in the left eye. Upon fundus examination, bilateral frosted branch-like vascular sheathing and retinal hemorrhage were observed. Optical coherence tomography (OCT) demonstrated macular edema. Fluorescein angiography revealed late staining and leakage of affected retinal vessels. The patient exhibited persistent fever, rash, and gastrointestinal symptoms, accompanied by an increase in inflammatory markers in laboratory tests. Testing for SARS-CoV-2 immunoglobulin G (IgG) was positive, although there was no evidence of any other autoimmune diseases or viral infections. The patient was diagnosed with frosted branch angiitis associated with MIS-C. Treatment included systemic steroids and 1% prednisolone eye drops. After 2 weeks, the BCVA improved to 20/20 in both eyes, and all clinical signs resolved without recurrence.Conclusions: In patients with frosted branch angiitis without any other apparent cause, the possibility of MIS-C should be considered. Testing for COVID-19 infection is recommended.

Impact of prednisolone, dexamethasone, and fluorometholone eye drops on intraocular pressure in patients post-cataract surgery: A randomized controlled study

After cataract surgery, topical corticosteroids are prescribed for inflammation reduction, but prolonged use may lead to side effects like steroid-induced glaucoma. These steroids can elevate intraocular pressure (IOP), and if elevated IOP isn't promptly addressed, it may advance to glaucoma. Vigilant monitoring of IOP changes is crucial for early detection and intervention, forming the basis for this study.The objective of this study was to evaluate and compare the impact of post-cataract surgery administration of eye drops containing prednisolone, dexamethasone, and fluramethalone on Intra-Ocular pressure (IOP) in patients. Seventy-five patients were randomly allocated to three groups, each comprising thirty individuals. Participants were administered prednisolone, dexamethasone, and fluramethalone eye drops, respectively, with a tapered dosage over a 42-day period. The study involved documenting intraocular pressure (IOP) measurements both before and after the surgery. Subsequently, patients were monitored for a duration of three months. Among the 75 patients, approximately 5.77% (n = 4) exhibited an increase in intraocular pressure (IOP) of ≥10 mmHg from their baseline. A moderate elevation in IOP (≥5 mmHg) was observed in about 13.44% (n = 13) of the patients. Notably, a clinically significant rise in IOP, defined as an increase of ≥10 mmHg and an overall IOP of ≥20 mmHg, occurred in 4.98% (n = 4) of the patients, all of whom were in the fluramethalone group. The mean post-operative IOP differed significantly among the three treatment groups. Fluromethalone possesses a heightened propensity to induce an early and substantial increase in intraocular pressure (IOP), necessitating careful and vigilant usage with continuous monitoring.

Intracanalicular Dexamethasone Insert for Post-Corneal Cross-Linking Inflammation and Pain - The LINK Study.

There is no standard-of-care treatment regimen for post-corneal crosslinking (CXL) inflammation & pain. This study compared efficacy of intracanalicular dexamethasone insert to tapered topical steroid over 28 days post-CXL. Single-private practice, outpatient setting. Prospective, observational, randomized study. This prospective, randomized study investigated the efficacy of a dexamethasone intracanalicular insert on post-CXL pain and inflammation in progressive keratoconus patients. Twenty patients (40 eyes) were enrolled; half were randomized to the dexamethasone intracanalicular insert group; half were prescribed a 28-day topical tapering steroid regimen. All patients were evaluated for pain scores, rate of re-epithelialization, ease of post-CXL regimen & need for rescue pain medication following standard bilateral epithelium-off CXL on postoperative day (POD) 1, POD-3, POD4-7, postoperative week (POW)-1, POW2, POW3 and POW4. Twenty patients (40 eyes) underwent standard-of-care epithelium-off bilateral CXL for progressive keratoconus. Ten patients were randomized to receive prednisolone eye drops on a tapering schedule post-CXL; 10 patients received dexamethasone intracanalicular inserts at the time of CXL. Regardless of postoperative steroid regimen, there was no significant difference in rate of re-epithelialization or use of rescue pain medication between groups. There was a nominal, however statistical difference in pain scores between groups, favoring prednisolone eye drops. Both groups stated no difficulty in following postoperative regimens. There were no adverse events noted in relation to treatment or CXL procedure. Utilizing a dexamethasone insert to alleviate pain and inflammation can be considered as a safe and efficacious part of a post-CXL regimen.

NOn-Pachychoroid PEripapillary Schisis (NOPPES) of the Retina: A New Phenotype and its Differential Diagnosis.

The presence of peripapillary intraretinal fluid (IRF) has a broad differential diagnosis, including several types of neovascular and pachychoroid-related diseases. However, the clinician may encounter cases without signs of neovascular or pachychoroid disease, or any other previously described diagnosis. For these patients, we propose the term NOn-Pachychoroid PEripapillary Schisis (NOPPES) of the retina, and we discuss the differential diagnosis. A retrospective chart study set in a tertiary referral center for retinal diseases in Amsterdam, the Netherlands. Using multimodal imaging, cases suspected of peripapillary pachychoroid syndrome were reviewed. Cases without signs of neovascular or pachychoroid disease were included in this study. These cases were discussed in a group of senior retinal specialists to establish a diagnosis, and if there was no evidence for any previously described diagnostic entity, these cases were categorized as NOPPES. Four cases of NOPPES were identified, 3 female patients and 1 male patient, aged between 58 and 75 years. Two patients were myopic, and 1 patient had a mild hyperopia. Three out of 4 cases showed unilateral peripapillary IRF, and 1 case had bilateral IRF. No improvement was seen after intravitreal bevacizumab or aflibercept, nepafenac eye drops, oral acetazolamide, vitrectomy with internal limiting membrane peeling, or surgery for carotid stenosis. One case showed a reduction in IRF after starting prednisolone eye drops. We describe NOPPES, a new form of peripapillary schisis-like IRF. NOPPES seems relatively therapy-resistant. More research is needed to delineate the clinical spectrum of NOPPES and its pathogenesis and treatment.

THU443 Acute Iridocyclitis Associated With Intravenous Zoledronic Acid

Abstract Disclosure: A.R. Ankireddypalli: None. S.D. Sibley: None. Introduction: Bisphosphonates are widely used for osteoporosis. Intravenous (IV) zoledronic acid (ZA) is frequently prescribed in cases of oral bisphosphonate intolerance or noncompliance. Well known immediate ZA side effects include flu-like symptoms such as nausea, myalgias and fever. Here we report a case of a rare side effect of acute anterior uveitis following initial ZA dosing. CASE: A 71-year-old female was diagnosed with osteoporosis; DEXA scan had lowest T score of -2.6 at the lumbar spine. Vitamin D level was 10 ng/mL. She received calcium and vitamin D supplementation. Two months later vitamin D level was 31 ng/mL. ZA was recommended due to difficulty with adherence to oral bisphosphonate. Five days after infusion she presented to our emergency department (ED) with progressive symptoms of bilateral eye itching, redness, excessive tearing, blurry vision, photosensitivity, floaters, pain and headaches that had begun 1 day post infusion. She’d had 2 prior outside ED visits for these symptoms and received polymyxin B and later ofloxacin eye drops which did not relieve them. She denied fever, chills, arthralgias and myalgia. She denied any prior known autoimmune disorder or prior history of eye symptoms. On examination she was afebrile and had bilateral conjunctival injection, excess tearing and watery discharge. She was discharged with olopatadine eye drops and cetirizine, diagnosed with allergic conjunctivitis, and referred to ophthalmology. On ophthalmic exam 7 days after her infusion, visual acuity was 20/60 in the right eye, and 20/60 in the left eye. Intraocular pressure was 12 mmHg in the right eye and 16 mmHg in the left eye. Slit lamp eye exam showed diffuse conjunctival injection of the right eye, mild corneal endothelial folds, and flare with cells in anterior chamber and synechiae posterior to the iris. Right acute iridocyclitis was diagnosed, she received prednisolone eye drops and cyclopentolate eye drops. Symptoms improved in 1 week with almost complete resolution after 3 weeks of therapy. She has not had a recurrence of these symptoms; she has declined future treatment with ZA. Conclusion: ZA-associated ocular inflammation is a rare but serious side effect. This adverse effect has been hypothesized to be associated with increased levels of pro-inflammatory cytokines including Interleukin (IL)-1, IL-6, and tumor necrosis factor (TNF)-alpha. As with other acute phase reactions to ZA, it does not appear that ocular inflammation tends to recur with subsequent ZA. Optimizing vitamin D levels prior to treatment may help to prevent this condition. There is some evidence for higher rates of acute phase reaction in patients with lower levels of vitamin D but this patient’s vitamin D status was adequate at the time of treatment. Clinicians should be aware of the rare occurrence of post-ZA ocular inflammation. Early recognition and prompt treatment are essential. Presentation: Thursday, June 15, 2023

A Case of Hypertensive Anterior Uveitis with Endotheliitis of the Cornea Following COVID-19 Pneumonia

Purpose: We report a patient diagnosed with COVID-19-associated hypertensive anterior uveitis and endotheliitis of the cornea.Case Summary: A 71-year-old male visited our hospital with decreased visual acuity, ocular pain, eyelid swelling of in his right eye, and headache for 8 days. He had been diagnosed with COVID-19 pneumonia 10 days before the visit. The best-corrected visual acuity was 0.04 in his right eye and 0.15 in his left eye. Severe conjunctival injection, moderate corneal edema with Descemet membrane folding, diffuse keratic precipitates and mild anterior chamber reaction were observed in the right eye, which were not present in the previous examination. Pupils in both eyes were moderately dilated and slow to react in response to direct light. The density of endothelial cells in the right eye was 711 cells/mm&lt;sup&gt;2&lt;/sup&gt; and an owl’s eye morphology of endothelial cells was observed via specular microscopy. During follow up, elevated intraocular pressure (IOP) in the right eye was noted. Polymerase chain reaction (PCR) examination of the aqueous humor for cytomegalovirus was negative. After 2 weeks of applying prednisolone eye drops and anti-glaucoma eye drops, corneal edema decreased, and his vision improved to 0.5. However, the density of the corneal endothelium remained low.Conclusions: Although there have been worldwide case reports of conjunctivitis, keratitis, or uveitis after COVID-19 infection, this study presents the first reported case of COVID-19 associated hypertensive anterior uveitis and endotheliitis of the cornea.

Choroidal detachment and hypotony following selective laser trabeculoplasty: a case report

BackgroundSelective laser trabeculoplasty (SLT) is relatively safe and effective in lowering intraocular pressure (IOP). However, although rare, complications can occur after SLT. This report describes a patient with choroidal detachment due to hypotony following SLT without anterior chamber (AC) inflammation.Case presentationA 67-year-old man was referred for elevated IOP in his left eye with advanced glaucomatous visual field loss. He had previously been diagnosed with idiopathic uveitic glaucoma in the left eye, for which he underwent laser iridotomy, trabeculectomy, and cataract surgery. At the first visit, the IOP of his left eye measured by Goldmann tonometry was 28 mmHg despite maximally tolerated medical treatment. SLT was performed in his left eye, resulting in an IOP of 7 mmHg 7 days later. At 3 weeks post-procedure, the patient experienced ocular pain and decreased visual acuity in his left eye. Slit-lamp examination revealed deep anterior chamber depth and no inflammation reaction, but the IOP in his left eye was 4 mmHg, and both fundus and B-scan ultrasonography showed serous choroidal detachment. All anti-glaucoma agents were stopped, and the patient was started on treatment with oral prednisolone and cyclopentolate eye drops. Three weeks later, choroidal detachment had resolved and the IOP in his left eye had stabilized at 8 mmHg. Follow-up 3 months later showed that the IOP in his left eye remained stable.ConclusionsChoroidal detachment-related hypotony is a rare complication of SLT. This possible complication following SLT should be informed to the patients and considered when performing the procedure.

Preventive Inflammation Management with Steroids before Retreatment with Anti-VEGF after Severe Inflammation due to Brolucizumab.

We report two successful cases of treatment by steroids after severe inflammation due to an intravitreal injection (IVI) of brolucizumab and their retreatment with another type of anti-vascular endothelial growth factor (VEGF), with steroid treatments to prevent severe inflammatory recurrence in patients with exudative age-related macular degeneration (AMD). CLINICAL CASES, CASE 1: An 88-year-old woman with exudative AMD in her left eye who had persistent subretinal fluid despite receiving an IVI, including ranibizumab and, subsequently, aflibercept. A switch to brolucizumab was decided. Two weeks after the third dose, she had a visual loss decreasing from 20/40 to counting fingers at 50 cm. Fundus examination revealed retinal whitening and perivenous sheathing. Fluoresceine angiography confirmed retinal arterial occlusion. Differential diagnoses were ruled out. She was treated with intravenous methylprednisolone and prednisolone eye drops. Three months after the treatment, visual acuity improved to 20/80 with no intraocular inflammation but subretinal fluid recurred. IVI of ranibizumab was rescheduled with preventive treatment by oral and local prednisolone without any inflammation recurrence. CASE 2: An 80-year-old man with exudative AMD in his right eye who had persistent subretinal fluid despite an IVI of aflibercept. Switching him to brolucizumab was decided. Two months after the third dose, he had blurred vision with no pain. Visual acuity decreased from 20/20 to 20/25. Examination showed 1+ anterior chamber cells and hyalitis. We confirmed the diagnosis of anterior uveitis with hyalitis. Differential diagnoses were ruled out. Treatment by prednisolone eye drops was initiated every 30 minutes for 1 day with a gradual decrease for 6 weeks. One week later, visual acuity improved to 20/20 with no inflammation. Three weeks later, subretinal fluid due to AMD increased. The patient was retreated by aflibercept with prednisolone eye drops, 48 hours before and after the IVI, with no recurrence of inflammation. Brolucizumab is one of the latest FDA-approved anti-VEGF agents for wet AMD. Since its wider use, few cases of severe ocular inflammation have been reported in post-marketing analysis. Because wet AMD recurrences should be expected after intraocular inflammation, insight is needed into treatment tolerance in cases that received further IVI retreatment. Our cases demonstrate that an IVI reinjection with a different anti-VEGF drug for exudative AMD recurrence can be safely reperformed. The use of local steroids could be effective in preventing recurrence of ocular inflammation after severe intraocular inflammation due to brolucizumab.

A randomized controlled study to evaluate and compare the effect of prednisolone, dexamethasone, and difluprednate eye drops on intraocular pressure in post-cataract surgery patients

Background: Topical corticosteroids are the effective anti-inflammatory agents prescribed following the cataract surgery. Their prolonged use can produce many side effects and one of them is steroid-induced glaucoma. Commonly used steroids in ocular therapy have tendency to cause rise in intraocular pressure (IOP). Elevated IOP if left untreated can ultimately progress to steroid-induced glaucoma. Any change in IOP should be monitored so that it can be detected and treated on time. Hence, the present study is planned. Aims and Objectives: The aims and objectives of the study are to evaluate and compare the effect of prednisolone, dexamethasone, and difluprednate eye drops on IOP in post-cataract surgery patients. Materials and Methods: A total of 90 patients were randomly allocated into three groups of thirty each receiving prednisolone, dexamethasone, and difluprednate eye drops, respectively, for 6 weeks in a tapering dose. Pre-operative and post-operative IOP measurements were noted and the patients were followed up for 1½ months. Results: Among 90 patients about 4.44% (n = 4) of them showed IOP elevation of ≥10 mmHg from baseline. About 14.44% (n = 13) patients showed moderate rise in IOP that is ≥5 mmHg. Clinically significant IOP elevation that is IOP increase of ≥10 mmHg and overall IOP of ≥21 mmHg was seen in 3.33% (n = 3) of the patients, and all of them belonged to difluprednate group. The mean post-operative IOP between the three treatment groups was not statistically significant. Conclusion: Difluprednate is having a higher potential of causing early and significant rise in IOP and hence has to be used judiciously with constant monitoring.

Herpes zoster masquerading viral endophthalmitis after ozurdex intravitreal implant

A 64-year-old gentleman presented with decreased vision, raised intraocular pressure, and anterior chamber reaction of 1+ with grade 3 vitreous exudates on day 5 after intravitreal Ozurdex® implant. Microbiological culture showed no bacterial or fungal growth. On suspicion of viral endophthalmitis, the patient was started on topical prednisolone, moxifloxacin, atropine, dorzolamide, and timolol eye drops and oral valacyclovir 1 g twice a day for 10 days. On day 9, a vesicular eruption was noted on the left forehead, confirming the diagnosis of herpes zoster-related shingles infection. Complete resolution of inflammation was noted on day 30. This is the first case report highlighting the occurrence of ocular zoster infection after an intravitreal Ozurdex® implant.

Incidence and risk factors for postoperative intraocular pressure response to topical prednisolone eye drops in patients undergoing phacoemulsification.

To report the incidence, risk factors, and magnitude of steroid response in individuals receiving topical 1% prednisolone acetate eye drops following phacoemulsification surgery MATERIALS AND METHODS: Postoperative IOP of 1118 consecutive patients who had uneventful cataract surgery and used 1% topical prednisolone acetate were studied. Baseline ocular parameters like best-corrected visual acuity, IOP, and slit-lamp examination findings were noted preoperatively and at postoperative day 30. Incidence of postoperative intraocular pressure response to steroid was analyzed and graded as mild, moderate, or severe and risk factors studied. The mean age of our study cohort was 59.49 ± 7.25years. The overall incidence of steroid response was 3.2%, (2.8% being moderate responders, and 0.4% high responders). Mean preoperative IOP was 14.67 ± 2.2mm Hg in the study cohort (n = 1118). Mean postoperative IOP was 21.33 ± 7.97mm Hg in the steroid responder (SR) and 14.66 ± 2.8mm Hg in the non-responder (NR), with a statistically significant difference from the baseline IOP in the SR group (p < 0.001) and no difference in the NR. Univariate analysis revealed younger age and high axial length as risk factors but on multiple regression analysis, only younger age < 50years was found to be a significant risk factor for steroid response. The overall steroid response in this population post-cataract surgery was low with most being moderate responders. Younger age and higher axial length were identified as risk factors for steroid response, and hence this warrants the judicious use of steroids in such individuals.

Systemic detectability of dexamethasone and prednisolone after eye drop application in horses.

Equine sport agencies list steroids as prohibited substances for competing horses. The objective of this study was to investigate if the controlled substances dexamethasone and prednisolone are detectable in equine serum and urine samples during and after treatment with eye drops and if this can generate a positive doping test. Prospective cohort study. The study cohort included 11 horses. One eye of the horses was treated with either dexamethasone (Maxitrol® 0.1%, n=5 eyes) or prednisolone (Pred forte® 1%, n=6 eyes) eye drops 3 times daily for 14days. Dexamethasone and prednisolone concentrations were determined in serum and urine at day 0 (negative control), 1, 7, 14, 15, 17 and 21 using liquid chromatography-tandem mass spectrometry. Blood samples were collected within 2hours post application. Urine samples were collected during spontaneous urination. All serum samples (range: 0.7-43ng/mL, mean 2.1ng/mL) and urine samples (range 1.2-5ng/mL, mean 0.8ng/mL) showed measurable amounts of dexamethasone during the course of treatment. Concentrations in both serum and urine samples were below limit of detection (LOD) 24hours after the last dexamethasone treatment (day 15). All serum samples (range 1.1-32.5ng/mL, mean 6.4ng/mL) and urine samples (range 3.7-19ng/mL, mean 4.6ng/mL) were positive for prednisolone during treatment. Urine samples were below LOD on day 15; serum samples on day 21. Dexamethasone and prednisolone eye drops can induce detectable drug levels in serum and urine samples of horses after a 14-day treatment plan. This can lead to a positive doping result. All samples tested negative (below LOD of the analytical method) for dexamethasone one day and for prednisolone one week after treatment cessation.

Management of suprachoroidal hemorrhage during cataract surgery

A 61-year-old patient with end-stage liver cirrhosis was admitted for cataract surgery with corrected distance visual acuities (CDVAs) of 0.3, in both eyes. His international correction ratio (INR) for blood coagulation was 2.1 without any anticoagulants, and general anesthesia was contraindicated. He was deemed inoperable for liver transplantation. Two weeks after uneventful phacoemulsification in his right eye under topical anesthesia, he underwent phacoemulsification for the cataract in the left eye. However, during surgery, extensive zonular dialysis was noted and the surgery proceeded with extracapsular cataract extraction and anterior vitrectomy, during which a rapid suprachoroidal hemorrhage (SCH) was noted. The incisions were then rapidly sutured. Intravenous 150 cc of 18% mannitol and 2 mg midazolam and sublingual 5 drops of nifedipine were given, and he was placed in the slightly reverse-trendelenburg position. Following suturation of the incision, the globe was left aphakic, slightly hypertonic with no loss of vitreous through the incisions. The postoperative treatment regimen of topical prednisolone and moxifloxacin eye drops of each per hour, cyclopentolate three times a day, and peroral prednisolone 40 mg was commenced. Despite no retinal reflex on the first day and no light perception for 2 weeks, transscleral SCH evacuation with limited pars plana vitrectomy was performed in the postoperative third week. Despite recurrent hemorrhage and intravitreal inflammatory bands, choroidal detachments regressed slowly with the improvement of CDVA up to 0.6 with aphakic contact lens correction at 3 months. The patient passed away due to complications of liver cirrhosis at 6 months.

Effect of anti-inflammatory regimen on early postoperative inflammation after cataract surgery.

To investigate whether a combination of topical nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids were superior in controlling early postoperative inflammation after cataract surgery compared with topical NSAIDs alone and with dropless surgery where a sub-Tenon depot of steroid was placed during surgery. Department of Ophthalmology, Rigshospitalet-Glostrup, Denmark. Prospective randomized controlled trial with masked statistical analyses. Patients undergoing phacoemulsification for age-related cataract were randomized to 1 of 5 regimens: ketorolac and prednisolone eyedrops combined (Pred+NSAID-Pre [control group] and Pred+NSAID-Post group) vs ketorolac monotherapy (NSAID-Pre and NSAID-Post groups) vs sub-Tenon depot of dexamethasone (dropless group). Drops were used until 3 weeks postoperatively, starting 3 days preoperatively in the Pre groups and on the day of surgery in the Post groups. Aqueous flare was measured at baseline and 3 days postoperatively. Four hundred fifty-six participants, with a mean age of 72.1 (SD 7.0) years and 283 (62%) women, were included. Flare increased significantly more in the dropless group compared with the control group (Pred+NSAID-Pre), but none of the other groups differed significantly from the control group. Intraocular pressure decreased in all groups but significantly less in groups receiving prednisolone eyedrops (Pred+NSAID-Pre and Pred+NSAID-Post groups) compared with NSAID monotherapy and dropless groups. No differences in postoperative visual acuity were found compared with the control group. No differences were found between groups randomized to NSAID monotherapy or combination of NSAID and steroid in controlling early inflammation after cataract surgery, but sub-Tenon depot of dexamethasone was less efficient. Initiating prophylactic eyedrops prior to surgery did not influence early postoperative anterior chamber inflammation.

Steroidal versus non-steroidal eye drops in prevention of cystoid macular edema after cataract extraction in diabetic patients

Background: Cystoid macular edema (CME) is addressed as one of the most important complication responsible for suboptimal visual acuity outcome after cataract surgery. Objective: Comparison between topical steroids versus NSAIDs regarding ability to reduce CME after uneventful cataract surgery of foldable intraocular lens (IOL) implantation in diabetic patients. Patients and methods: In this study, 30 patients underwent phacoemulsification surgery with posterior chamber foldable intraocular lens implantation in Ophthalmology Department, Al-AzharUniversityHospital between December 2017 and November 2018. Patients were randomly categorized into 2 groups. Group 1: Nepafenac eye drops (0.1%) 3 times daily for one month, Group 2: Prednisolone eye drops (1%) 5 times daily for one month. Results: At the end of the follow up, foveal thickness changes in optical coherence tomography (OCT) were found to be slightly less in the no steroidal anti-inflammatory eye drops (NSAIDs) group than in the steroidal group with no significant change in the final visual outcome between the two groups. Conclusion: There was no significant statistical difference between NSAIDs drops and steroids drops in prevention of development of pseudophakic macular edema post cataract surgery.

Severe Corneal Edema in a Dog Naturally Infected by Leishmania spp.

Background: Visceral leishmaniasis (VL) is an infectious disease caused by the protozoan Leishmania infantum that is transmitted to dogs and humans by sandflies. The incidence of eye injuries in VL is high. They occur in 20 to 81% of infected dogs and include blepharitis, granulomatous conjunctivitis, scleritis, keratitis, anterior uveitis, keratoconjunctivitis sicca, and secondary glaucoma. However, some dogs present only the clinical signs of eye damage. The main objective of this manuscript is to report a case of anterior uveitis with severe corneal edema in a dog with VL that underwent clinical and surgical ophthalmic treatments after miltefosine therapy.Case: An 8-month-old, intact male Labrador Retriever with brown fur presented with pruritus, diffuse desquamation, and conjunctival hyperemia on physical evaluation. On the basis of an ophthalmic examination, nodular conjunctivitis and uveitis were diagnosed in both eyes. Moreover, laboratory examination results showed hyperproteinemia, increased serum alkaline phosphatase activity, and positive reactions to immunochromatographic tests for VL. Clinical treatment was instituted from the moment of diagnosis, when miltefosine and allopurinol were prescribed. At the end of treatment, based on laboratory examination results, only allopurinol was prescribed at a lower dose than initially prescribed for treatment continuation. Topical medications (prednisolone eye drops and sodium hyaluronate) were recommended for the ophthalmic changes. One week after the start of topical treatment, the dog showed an improvement in eye inflammation but still had bilateral corneal edema. A hyperosmotic agent was prescribed to improve edema, and a surgical procedure was recommended if there was no improvement. The physician opted for the surgical procedure in one of the eyes that had not shown significant improvement after the clinical treatment.Discussion: VL is a zoonosis, and the domestic dog is the main reservoir. These animals often have dermatological conditions, and the ophthalmic changes observed can be unilateral or bilateral, with more than one change in the same eye. Lymphoplasmacytic or granulomatous anterior uveitis is the most prevalent change, as the uvea and conjunctiva are important lymphoid areas of the eye; this also explains the high incidence of uveitis and conjunctivitis in dogs with VL. In uveitis, corneal edema is driven by endothelial cell damage induced by prostaglandins, which interfere with the function of the endothelial pump and interrupt the normal dehydrated state of the cornea. Severe corneal edema can result in the formation of fluid-filled multifocal bubbles in the corneal stroma—a condition called bullous keratopathy. These bubbles accumulate under or inside the corneal epithelium, and they can burst spontaneously, leading to corneal erosions or ulcerations. Drug therapy with hyperosmotic agents could, in principle, reduce the formation of bubbles. Surgical options to decrease edema and blistering include a permanent conjunctival graft or thermokeratoplasty. Thermokeratoplasty induces the formation of superficial scars in the corneal stroma, applying multiple cauterization foci to the stroma exposed in the areas of bullous keratopathy and epithelial ulceration. In conclusion, the surgical therapeutic choice results in better visual quality in patients who do not respond well to clinical treatment.

Primary Ocular Transmissible Venereal Tumor in a Prepubescent Female Dog

Background: Canine transmissible venereal tumor (CTVT) is a peculiar neoplasm resulting from the transmission of host cancerous cells to another canid by implantation. Transmission occurs among reproductive age dogs, especially those with unrestricted sexual activity. It usually occurs on the external genitalia of dogs and other areas are unusual. However, implants have been described in injured mucosa, as well as metastases in lymph nodes, spleen, skin, anus and perianal space, oral mucosa, nasal mucosa, eyeball and brain. The purpose of this report is to describe the first case of exclusively extragenital ocular CTVT in a prepubescent female dog.Case: A 6-month-old mixed-breed, non-spayed and prepubescent female dog, showing a fast-growing reddish-colored mass in the right eye (RE), was examined. Blepharospasm, mild serosanguineous secretion, chemosis and a smooth surface reddish mass with 2.5 cm in length occupying the orbital area were observed during physical examination, impairing the visualization of the right eyeball. For ocular ultrasonography examination of the affected eye, acepromazine was used (0.03 mg/kg) associated with methadone (0.3 mg/kg) intramuscularly, and propofol (4 mg/kg) for induction and 0.2 mg/kg for maintenance, intravenously. Ultrasonography examination evidenced an amorphous hyperechogenic structure, medial to the RE, with homogeneous echotexture, punctiform vascularization to amplitude Doppler (Power Doppler), measuring 2.8 cm in length and 1.4 cm in diameter, causing eyeball distortion and rejection. Based on ultrasonography results and with the patient still anesthetized, an incisional biopsy of the peribulbar mass was performed with a 5 mm disposable punch. The final CTVT diagnosis was possible after histopathological analysis. No more CTVT nodules were found, especially in the vulva, which had a prepubescent appearance, consistent with age. Treatment with 4 sessions of chemotherapy with vincristine sulfate resulted in complete remission of the tumor mass. In the second session, it was already possible to visualize the eyeball with a significant remission of the tumor mass, ruling out neoplastic exceresis. At this time, threat response, normal direct and consensual photopupillary reflexes, normal eyelid reflex, corneal surface without slit lamp biomicroscopy and fluorescein staining were present in the RE. Nevertheless, there were mild diffuse corneal edema and slight ciliary injection. One percent prednisolone eye drops (8/8 h) and tobramycin eye drops (6/6 h) were prescribed for 1 week. In the fourth session of chemotherapy, no changes were observed in the RE.Discussion: In the present case, the diagnosis of CPVD in a prepubertal patient, primary orbital TVTV, and the fact that the structure of the eye bulb and visual function remain intact, even with the significant volume of orbital neoplasia, are highlighted. A single report of skin CTVT in an 11-month-old prepubescent female dog was found. It is important to emphasize that CTVT is typically of dogs of reproductive age that have genital masses. Usually, extragenital masses are related to the act of licking, scratching, biting or sniffing the primary tumor (self-implantation), or rarely, by metastasis, a fact not observed in the present report, since the ocular mass was the only manifestation. Treatment was conducted according to indications of the literature. Four injections of vincristine sulfate were necessary, observing complete remission of the tumor mass with no relapse after 30 days. In this case report, it was possible to observe that CTVT may reveal unusual behaviors regarding epidemiology, which, added to the rare form of exclusively extragenital ocular clinical manifestation, impose a diagnostic challenge, making the histopathological examination an important tool for diagnosis.