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Biomedical subjects

Bruce I Gaynes

Publications and source records attributed to Bruce I Gaynes.

9 recordsLinked to original sources
PubMed2005

"Star" suture opacities of the crystalline lens: an illustrative report in AIDS patients.

BACKGROUND: Acquired immunodeficiency syndrome (AIDS) is disease of epidemic proportion associated with significant visual morbidity. Visual complications of AIDS have been described as a result of cytomegaloviral retinitis as well as fungal and protozoan opportunistic eye disease. Although cataracts have been established as a direct consequence of human immunodeficiency virus (HIV) or AIDS, studies suggest that HIV disease may indeed be a risk factor for the development of cortical cataract. This report further characterizes potential lens abnormalities associated with HIV and AIDS by clearly demonstrating opacities associated with lens sutures in two AIDS patients with long-term use of nucleoside analogue reverse transcriptase inhibitors (NRTIs). MATERIAL/METHODS: Case series demonstrating digitized slit lamp biomicroscopic anterior segment photos using indirect lens illumination. RESULTS: Prominent "star" lens sutures of assumed abnormality typified by unusual branching and irregular caliber are photo-documented. CONCLUSIONS: Normally inconspicuous star suture branches are clearly demonstrated in two patients with AIDS and diabetes mellitus. Uncharacteristic star lens sutures have not Been previously reported in AIDS patients however the occurrence of lens opacities due to HIV disease and AIDS is not without precedent. Despite the prominence and atypical nature of the illustrated lens sutures, assessment of morphologic abnormality is limited by lack of appropriate normative data describing star sutures clinically as a function of age and lens development.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Safety of verteporfin for treatment of subfoveal choroidal neovascular membranes associated with age-related macular degeneration.

Photodynamic therapy (PDT) is a novel treatment entity that exploits the photophysical properties of various photosensitive chemical entities which, upon light activation, results in targeted photooxidation and subsequent tissue destruction. The antiangiogenic properties of PDT have been adapted for treatment of subfoveal choroidal neovascular membranes due to disease states such as age-related macular degeneration (AMD). Historically, PDT has been limited by a lack of suitable photosensitive dyes. However, agents such as verteporfin, a second-generation benzoporphyrin derivative, appear to be free from the extensive phototoxicity that limited the success of previous agents. Verteporfin has a high affinity for choroidal neovascular membranes, typically found with exudative AMD, and upon photoactivation results in targeted microvascular damage and thrombus formation with resultant vessel occlusion. Scrutiny of diagnostic indicators for verteporfin administration, including critical angiographic evaluation of lesion size and visual acuity, is essential to treatment success. Large lesions with relatively good visual acuity (20/50 or better) may be at particular risk for marked vision loss following verteporfin administration. Lesion composition also appears to influence visual outcome with verteporfin use. The safety of verteporfin is directly dependent upon the appropriate integration of dosage, infusion and light activation required for a suitable pharmacotherapeutic outcome. When used appropriately, and with adequate patient education regarding photosensitivity, the risk-benefit of verteporfin for the medical treatment of neovascular AMD is favourable.

Aged↗
PubMed2002

Topical nonsteroidal anti-inflammatory drugs for ophthalmic use: a safety review.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used agents that despite chemically heterogeneity, share similar therapeutic properties and adverse effects. Topical ophthalmic NSAIDs are limited to the relatively water soluble phenylacetic and phenylalkanoic acids as well as indole derivatives, which are more suitable for ophthalmic use. Topical ophthalmic NSAIDs are commonly used in the treatment of post-operative inflammation following cataract extraction and various surgical refractive procedures. They are also used in the prevention and treatment of cystoid macular oedema and for the treatment of allergic conjunctivitis. Absorption of topical ophthalmic NSAIDs through the nasal mucosa results in systemic exposure and the occurrence of adverse systemic events, including exacerbation of bronchial asthma. Local irritant effects of topical ophthalmic NSAIDs include conjunctival hyperaemia, burning, stinging and corneal anaesthesia. A more serious complication involves the association of topical ophthalmic NSAIDs with indolent corneal ulceration and full-thickness corneal melts. Analysis of NSAID-associated corneal events implicates the now defunct generic dicolfenac product, diclofenac sodium ophthalmic solution as the agent primarily responsible. However, these events generated a renewed interest in the safety of ophthalmic NSAIDs and a scrutiny of the pharmacology regarding NSAID action in the eye. An elucidation of possible pharmacodynamic explanations of NSAID-induced corneal injury includes the role of epithelial hypoxia, which not only appears to aid in determining the metabolic destination of arachidonate, it may play a key role in orchestrating a novel inflammatory response unrelated to prostanoid formation. The use of NSAIDs under conditions of corneal hypoxia may therefore not only result in a disappointing therapeutic response, it may result in a paradoxical inflammatory exacerbation. Other potential mechanisms include the relationship between NSAIDs and corneal matrix metalloproteinase and direct toxicity due to cytotoxic excipients such as surfactants, solubilisers and preservatives found in topical NSAID ophthalmic preparations. In general, ophthalmic NSAIDs may be used safely with other ophthalmic pharmaceuticals; however, concurrent use of agents known to adversely effect the corneal epithelium, such as gentamicin, may lead to increased corneal penetration of the NSAID. The concurrent use of NSAIDs with topical corticosteorids in the face of significant pre-existing corneal inflammation has been identified as a risk factor in precipitating corneal erosions and melts and should be undertaken with caution. Until clinical evidence dictates otherwise, data supporting theories of potential pharmacodynamic mechanisms of NSAID injury do not alter the favorable benefit-risk ratio of ophthalmic NSAID use when employed in an appropriate and judicious manner.

Administration, Topical↗