Intravitreal Administration of Antiviral Agents in Silicone Oil–Filled Human Eyes

Meshi, Amit; Friehmann, Asaf; Sella, Sarah; Gepstein, Raz; Armarnik, Sharon; Assia, Ehud I.; Rubowitz, Alexander

doi:10.1016/j.oret.2016.12.006

Cited by 14 publications

(9 citation statements)

References 25 publications

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“…The drug presumably disperses only to the aqueous phase in the posterior segment in a silicone oil-filled eye, potentially elevating concentrations well above the intended final vitreous concentration. A case report in which 2 patients received half-dose foscarnet injections over a period of 6–8 weeks after silicone oil fill demonstrated retinitis regression without clear evidence of overt toxicity [11]. In our case, we closely monitored our patient with oral valacyclovir only after vitrectomy with silicone oil fill.…”

Section: Discussion/conclusionmentioning

confidence: 84%

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The Diagnostic Conundrum of Retinitis and a Pigmented Scar

Khandwala

Miller

Hyde

et al. 2021

Case Rep Ophthalmol

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We report a finding of a pigmented chorioretinal scar with acute retinal necrosis (ARN) caused by herpes simplex virus 2 (HSV-2) infection rather than toxoplasma, creating an initial diagnostic dilemma. A 53-year-old functionally monocular male presented with painless floaters and blurry vision in his seeing eye over a period of 4 days. An exam demonstrated anterior chamber (AC) reaction, vitritis, multifocal patches of whitening, and an occlusive retinal vasculitis. A superior pigmented chorioretinal scar with overlying contracted vitreous was noted in the periphery with no adjacent retinal whitening. The patient was treated for both ARN and toxoplasma chorioretinitis until PCR study of the vitreous and AC returned positive for HSV-2 and negative for toxoplasmosis. Management consisted of a dual therapy regimen of both oral and intravitreal antiviral agents as well as oral corticosteroids. The patient’s clinical course was complicated by rhegmatogenous retinal detachment within 2 weeks after symptom onset, requiring pars plana vitrectomy with silicone oil and intraoperative intraocular incubation with foscarnet. We review emerging evidence for pigmented chorioretinal scars in ARN specifically caused by HSV-2, as well as diagnostic and treatment dilemmas in the management of ARN and ARN detachments.

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Section: Discussion/conclusionmentioning

confidence: 84%

“…First, foscarnet does not require enzymatic activation and rapidly inactivates the virus after short exposure times [10]. Second, foscarnet covers CMV in cases where the cause of retinitis is ambiguous [11]. Finally, foscarnet works against acyclovir-resistant strains of HSV and VZV [5].…”

Section: Discussion/conclusionmentioning

confidence: 99%

The Diagnostic Conundrum of Retinitis and a Pigmented Scar

Khandwala

Miller

Hyde

et al. 2021

Case Rep Ophthalmol

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“…[ 87,88 ] For ethical reasons it is not possible to perform these types of pharmacokinetic studies in patients. Nevertheless, a few studies have evaluated the safety and efficacy of treatment versus no‐treatment in SO‐filled eyes with antivirals [ 89 ] or bevacizumab injections, [ 90,91 ] observing positive clinical outcomes in the treated patients. Several other case reports have shown that the Ozurdex implant (dexamethasone 0.7 mg loaded in a biodegradable sustained‐release intravitreal implant (Allergan Inc., Irvine, CA)) appears to be tolerated by and beneficial to patients with SO tamponade.…”

Section: Influence Of Vitreous Substitution On Pharmacokinetics Of Intravitreal Drugsmentioning

confidence: 99%

Current Situation and Challenges in Vitreous Substitutes

García

Bandín-Vilar

García-Quintanilla

et al. 2021

Macromolecular Bioscience

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Vitreo‐retinal disorders constitute a significant portion of treatable ocular diseases. These pathologies often require vitreo‐retinal surgery and, as a consequence, the use of vitreous substitutes. Nowadays, the vitreous substitutes that are used in clinical practice are mainly divided into gases (air, SF6, C2F6, C3F8) and liquids (perfluorocarbon liquids, silicone oils, and heavy silicone oils). There are specific advantages and drawbacks to each of these, which determine their clinical indications. However, developing the ideal biomaterial for vitreous substitution continues to be one of the most important challenges in ophthalmology, and a multidisciplinary approach is required. In this sense, recent research has focused on the development of biocompatible, biodegradable, and injectable hydrogels (natural, synthetic, and smart), which also act as medium and long‐term internal tamponade agents. This comprehensive review aims to cover the main characteristics and indications for use of the extensive range of vitreous substitutes that are currently used in clinical practice, before going on to describe the hydrogels that have been developed recently and which have emerged as promising biomaterials for vitreous substitution.

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“…If a retinal tear or detachment is found or caused during vitrectomy, silicone oil may be a possible tamponade. [11][12][13] Intravitreal vancomycin and ceftazidime should be continued even after surgery. In addition, endophthalmitis may occur after retinal detachment surgery that requires silicone oil tamponade.…”

Section: Introductionmentioning

confidence: 99%

“…However, the pharmacokinetics of these drugs are likely to differ in silicone oil-filled eyes compared to normal eyes, as they are not oil-soluble and the volume of water distribution is much smaller in silicone oil-filled eyes. 12,[14][15][16] Therefore, the maximum concentrations and excretion rates are expected to be higher in silicone oilfilled eyes. Not only is it unclear how long effective antibiotic concentrations can be maintained, but there is also concern regarding ocular toxicity due to the temporarily high concentrations of vancomycin and ceftazidime.…”

Section: Introductionmentioning

confidence: 99%