SUMMARY A randomised double blind study was performed on 59 patients with dendritic herpetic keratitis treated with 3% acyclovir or 2% trifluorothymidine ointment. Both drugs were highly effective and gave 87% (ACV) and 82% (T1F') success rates. Punctate keratopathy occurred in 70% of the patients, but serious side effects were not observed.Since the introduction of idoxuridine (IDU) as an antiviral drug for the treatment of herpetic keratitis more potent drugs have become available. Arabinoside adenine and trifluorothymidine (TFT) are both effective and relatively nontoxic alternatives widely used in the management of herpetic disease.' Acyclovir (ACV) (9-(2-hydroxyethoxymethyl) guanine)2 and (E)-5(2-bromovinyl)-2' deoxyuridine),3 recently developed antiviral compounds with potent inhibitory activity against herpes simplex DNA polymerase, do not inhibit normal human cell DNA polymerase.For a comparative study we selected 2 of the antiviral drugs which we considered to be the most potent -acyclovir and trifluorothymidine.45 Material and methods Fifty-nine patients with dendritic keratitis were studied. Patients with stromal keratitis and patients treated by antiviral agents and/or corticosteroids prior to referral were excluded. In a randomised double-blind study we used 3% acyclovir and 2% trifluorothymidine ointment, both specially prepared for this trial and packed in identical tubes obtained through the kind co-operation of Wellcome Laboratories (England) and Dr Gerhard Mann, Hamburg (FRG), respectively. The ointment was prescribed 5 times daily. Cycloplegics were given for intraocular irritation.After healing was complete the treatment was continued for 7 days. It was discontinued if after 7 days no therapeutic effect was observed or if after 14 days the keratitis had not healed completely.

SUMMARY In a group of 68 patients a double-blind study was performed to assess the effect of preoperative oxybuprocaine 0O4% (Dorsacaine, Novesin) eye drops in comparison with a placebo in preventing surgically induced miosis during extracapsular cataract extraction. One drop of oxybuprocaine 0O4% or placebo was instilled 10 and 5 minutes preoperatively. The pupil diameter was recorded at different stages of the operation. It was found that oxybuprocaine reduced the amount of pupil constriction during the operation significantly as compared with the placebo group, facilitating the removal of lens material and the implantation of an intraocular lens. The effect of oxybuprocaine is considered to be due to anaesthetic action on sensory nerves in the eye, which may inhibit the release of a miotic substance.Miosis induced by surgical trauma is a frequent problem during extracapsular cataract surgery. In spite of vigorous preoperative dilatation with both anticholinergic and sympathicomimetic agents the pupil diameter constricts during the operation. The removal of lens material and the implantation of an intraocular lens in the posterior capsule bag are hampered by this pupil constriction. Epinephrine can be used in the irrigating solution' or injected in small quantities into the anterior chamber.2 3 These solutions are toxic for the endothelium and cause a loss of corneal endothelial cells.4Mechanical and chemical stimulation of the iris-99 and intracranial stimulation of the trigeminal nerve6 '1 produce miosis, increased vascular permeability, and elevation of the intraocular pressure. The reaction seems to be mediated by prostaglandins and by an atropine-resistant neurogenic pathway. The relative contribution of these 2 depends upon the type of stimulus applied.8 Prostaglandin-synthesis inhibitors reduce the amount of miosis during mechanical irritation of the iris significantly both in animals69 [14][15][16][17]

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