Effects of topical azithromycin, moxifloxacin, and povidone iodine on conjunctival bacterial flora in patients undergoing intravitreal injection

Abstract

| Purpose: To investigate the frequency of toxic retinopathy in patients with lupus erythematosus and rheumatoid arthritis with long-term use of chloroquine diphosphate or hydroxychloroquine through spectral domain optical coherence tomography and the outcomes of ophthalmological exams (visual acuity -Snellen's table, color vision test -Ishihara's table, fundoscopy, and retinography -red-free). Methods: A cross-sectional study was carried out involving the ophthalmologic evaluation of patients using regular chloroquine diphosphate or hydroxychloroquine for a period of 1 year or longer. The patients completed a questionnaire on their opinions and treatment regularity. The same patients underwent ophthalmologic examination and spectral domain optical coherence tomography. Results: The prevalence of toxic retinopathy caused by antimalarials was 4.15% (9 of 217 patients), 7.4% (4 of 54 patients) following chloroquine diphosphate usage, and 0.82% (1 of 121 patients) following hydroxychloroquine usage. Only patients with advanced stage maculopathy presented abnormalities during the ophthalmologic exam: the color vision test was altered in 11.1%, and visual acuity and fundoscopy were altered in 33.3%. Identification of early toxic retinopathy, detected in six patients, was possible using spectral domain optical coherence tomography. The mean duration of antimalarial drug usage among patients with toxic retinopathy was 10.4 years. Only 31% of the patients reported some symptoms during treatment, and although 24% were afraid to use the medication, they did so as prescribed. Conclusion: Use of spectral domain optical coherence tomography was essential for the diagnosis of early-stage antimalarial toxic retinopathy in patients with the following characteristics: asymptomatic, antimalarial use 7 days a week for a period of more than 5 years, and normal clinical ophthalmologic examination.Keywords: Retinopathy/etiology; Antimalarials/adverse effects; Hydroxychloroquine/adverse effects; Chloroquine/adverse effects; Tomography, optical coherence/methods RESUMO | Objetivo: Investigar a frequência da retinopatia tóxica em pacientes com lúpus eritematoso e artrite reumatóide com uso crônico de difosfato de cloroquina ou hidroxicloroquina, através de tomografia de coerência óptica de domínio espectral e os resultados dos exames oftalmológicos (acuidade visual -tabela de Snellen, teste de visão de cor -tabela de Ishihara, fundoscopia e retinografia -red free). Métodos: Foi realizado um estudo transversal envolvendo a avaliação oftalmológica de pacientes em uso regular de difosfato de cloroquina ou hidroxicloroquina por um período de um ano ou mais. Os pacientes responderam a um questionário sobre a sua opinião e regularidade do tratamento. Os mesmos pacientes realizaram exame oftalmológico clínico e tomografia de coerência óptica de domínio espectral. Resultados: A prevalência de retinopatia tóxica por antimaláricos foi de 4,15% (9 dos 217 pacientes), 7,4% (4 de 54 pacientes) após uso de difosfato de cloroquina e 0,82% (1 de 121 pac...

Antimicrobials and antiseptics: Lowering effect on ocular surface bacterial flora – A systematic review

“…With the advent of anti‐vascular endothelial growth factor (VEGF) agents, the number of IVI has increased exponentially over the last decade (Lau et al, 2018). So far, there are no worldwide accepted protocols or guidelines regarding the endophthalmitis prophylaxis pre‐ and post‐IVI (Patel et al, 2020; Teberik et al, 2019). As for cataract surgery, PVI or, less commonly, CLX are used for periocular skin and ocular surface antisepsis due to their recognized safety and efficacy in reducing IVI‐related endophthalmitis rate (Bhavsar et al, 2016; Mulcahy et al, 2021).…”

“…Topical fluoroquinolones and macrolides can be effective in reducing OSBF in patients receiving IVI (Plotas et al, 2017; Teberik et al, 2019). Moreover, topical antimicrobials may have a synergistic or additive effect with PVI resulting in a higher eradication rate when compared with PVI alone (Teberik et al, 2019). In general, topical antimicrobials may need more time than PVI to achieve their antimicrobial effect (Wykoff et al, 2011).…”