topical Betamethasone Sodium Phosphate tetracycline hydrochloride and nonsteroidal anti inflammatory drugs in the treatment of diabetic macular edema a case report

Purpose
To report a case of clinically significant diabetic macula edema (DME) cured only with topical Betamethasone Sodium Phosphate, Tetracycline Hydrochloride and nonsteroidal anti-inflammatory drugs.

Methods
A 44-year-old type I diabetic woman was referred to our Unit after a partial tarsorrhaphy procedure for exposure keratopathy in her left eye. OCT examination of her right eye revealed a clinically significant DME with important visual loss (Central Macular Thickness [CMT] 716 μm, Best Correct Visual Acuity [BCVA] 20/100 Snellen). The patient refused the suggested intravitreal therapy (Ranibizumab injections with PRN protocol). Topical treatment with Betamethasone Sodium Phosphate, Naphazoline Nitrate, Tetracycline Hydrochloride (Alfaflor®, Alfa Intest, Italy) and Diclofenac (Voltaren Oftabak®, Thea, France) eye-drops 4 times/day was started.

Results
In the following 10 months, right CMT decreased to 335 μm and right BCVA increased to 20/25 Snellen. However, OCT scans still showed some intraretinal cysts. Topical Diclofenac was then replaced with Bromfenac (Yellox®, Bausch & Lomb, Italy) eye-drops 2 times/day. After 4 months’ treatment, right BCVA was 20/20 Snellen and OCT scans showed a normal CMT. This treatment was continued and there was no recurrence of DME in the next 11 months of follow-up. No adverse events were noted.

Conclusions
Topical Betamethasone Sodium Phosphate and Tetracycline Hydrochloride, together with nonsteroidal anti-inflammatory eye-drops, might be an effective alternative for the treatment of newly diagnosed DME in patients not suitable for intravitreal therapy. Future case-control studies are necessary to confirm these results.

Topical Betamethasone Sodium Phosphate, tetracycline hydrochloride and nonsteroidal anti‐inflammatory drugs in the treatment of diabetic macular edema: a case report

Purpose
To report a case of clinically significant diabetic macula edema (DME) cured only with topical Betamethasone Sodium Phosphate, Tetracycline Hydrochloride and nonsteroidal anti-inflammatory drugs.

Methods
A 44-year-old type I diabetic woman was referred to our Unit after a partial tarsorrhaphy procedure for exposure keratopathy in her left eye. OCT examination of her right eye revealed a clinically significant DME with important visual loss (Central Macular Thickness [CMT] 716 μm, Best Correct Visual Acuity [BCVA] 20/100 Snellen). The patient refused the suggested intravitreal therapy (Ranibizumab injections with PRN protocol). Topical treatment with Betamethasone Sodium Phosphate, Naphazoline Nitrate, Tetracycline Hydrochloride (Alfaflor®, Alfa Intest, Italy) and Diclofenac (Voltaren Oftabak®, Thea, France) eye-drops 4 times/day was started.

Results
In the following 10 months, right CMT decreased to 335 μm and right BCVA increased to 20/25 Snellen. However, OCT scans still showed some intraretinal cysts. Topical Diclofenac was then replaced with Bromfenac (Yellox®, Bausch & Lomb, Italy) eye-drops 2 times/day. After 4 months’ treatment, right BCVA was 20/20 Snellen and OCT scans showed a normal CMT. This treatment was continued and there was no recurrence of DME in the next 11 months of follow-up. No adverse events were noted.

Conclusions
Topical Betamethasone Sodium Phosphate and Tetracycline Hydrochloride, together with nonsteroidal anti-inflammatory eye-drops, might be an effective alternative for the treatment of newly diagnosed DME in patients not suitable for intravitreal therapy. Future case-control studies are necessary to confirm these results.

Prevention of cytarabine-induced kerato-conjunctivitis by eye rinse in patients receiving high-dose cytarabine and total body irradiation as a conditioning for hematopoietic stem cell transplantation

We previously reported a high incidence of kerato-conjunctivitis in patients receiving high-dose cytarabine following total body irradiation (TBI) as a conditioning for hematopoietic stem cell transplantation (HSCT) even on prophylaxis with topical corticosteroid. This study aimed to evaluate whether addition of eye rinse, which was designed to remove cytarabine from ocular surface, further reduces the incidence of kerato-conjunctivitis in the same setting. Seventy-six patients receiving cytarabine at a dose of 3 g/m^2 every 12 h for 4 days after receiving TBI (12 Gy) as conditioning for HSCT were evaluated. All patients received Betamethasone Sodium Phosphate eye drops. Twenty-three patients were further instructed to rinse their eyes with sterile saline every 10–15 min during and for two additional hours after the completion of each cytarabine infusion. Among 23 patients with eye rinse, Grades 2–3 and 1–3 kerato-conjunctivitis were observed in 4 (17.4%) and 5 patients (21.7%), respectively. These incidences were significantly lower than those [35 (66.0%) and 41 (77.4%)] observed in 53 patients without eye rinse ( P < 0.001 and P < 0.00001, respectively). These results strongly suggest that eye rinse effectively reduces the incidence and severity of cytarabine-induced kerato-conjunctivitis in HSCT recipients who receive high-dose cytarabine following TBI.

Reduced efficacy of topical corticosteroid in preventing cytarabine-induced kerato-conjunctivitis in patients receiving high-dose cytarabine and total body irradiation for allogeneic hematopoietic stem cell transplantation

This study aimed to retrospectively evaluate the incidence of kerato-conjunctivitis in patients receiving TBI followed by high-dose cytarabine, and to clarify how effectively topical corticosteroid eye drops prevent kerato-conjunctivitis in these patients. Fifty-three patients who received cytarabine at a dose of 3 g/m^2 every 12 h for 4 days after receiving TBI (12 Gy) as a conditioning for allogeneic hematopoietic stem cell transplantation (HSCT) were evaluated. For the prophylaxis of kerato-conjunctivitis, all patients received Betamethasone Sodium Phosphate eye drops every 6 h, starting 1 day before the first dose of cytarabine and continuing until 1 day after the last dose of cytarabine or the complete resolution of ocular symptoms. For grading of kerato-conjuncitivitis, the National Cancer Institute-Common Toxicity Criteria were used. Among the 53 patients, the grades of kerato-conjunctivitis were grade 0 in 13 patients, grade 1 in 6 patients (11.3%), grade 2 in 10 patients (18.9%) and grade 3 in 25 patients (47.2%). These results strongly suggest that topical corticosteroid eye drops could not effectively prevent the development of cytarabine-induced kerato-conjunctivitis in HSCT recipients who receive high-dose cytarabine following TBI. Further investigation into a more effective prophylaxis for cytarabine-induced kerato-conjunctivitis in this setting is required.

Prevention of cytarabine-induced kerato-conjunctivitis by eye rinse in patients receiving high-dose cytarabine and total body irradiation as a conditioning for hematopoietic stem cell transplantation

We previously reported a high incidence of kerato-conjunctivitis in patients receiving high-dose cytarabine following total body irradiation (TBI) as a conditioning for hematopoietic stem cell transplantation (HSCT) even on prophylaxis with topical corticosteroid. This study aimed to evaluate whether addition of eye rinse, which was designed to remove cytarabine from ocular surface, further reduces the incidence of kerato-conjunctivitis in the same setting. Seventy-six patients receiving cytarabine at a dose of 3 g/m^2 every 12 h for 4 days after receiving TBI (12 Gy) as conditioning for HSCT were evaluated. All patients received Betamethasone Sodium Phosphate eye drops. Twenty-three patients were further instructed to rinse their eyes with sterile saline every 10–15 min during and for two additional hours after the completion of each cytarabine infusion. Among 23 patients with eye rinse, Grades 2–3 and 1–3 kerato-conjunctivitis were observed in 4 (17.4%) and 5 patients (21.7%), respectively. These incidences were significantly lower than those [35 (66.0%) and 41 (77.4%)] observed in 53 patients without eye rinse ( P < 0.001 and P < 0.00001, respectively). These results strongly suggest that eye rinse effectively reduces the incidence and severity of cytarabine-induced kerato-conjunctivitis in HSCT recipients who receive high-dose cytarabine following TBI.

Reduced efficacy of topical corticosteroid in preventing cytarabine-induced kerato-conjunctivitis in patients receiving high-dose cytarabine and total body irradiation for allogeneic hematopoietic stem cell transplantation

This study aimed to retrospectively evaluate the incidence of kerato-conjunctivitis in patients receiving TBI followed by high-dose cytarabine, and to clarify how effectively topical corticosteroid eye drops prevent kerato-conjunctivitis in these patients. Fifty-three patients who received cytarabine at a dose of 3 g/m^2 every 12 h for 4 days after receiving TBI (12 Gy) as a conditioning for allogeneic hematopoietic stem cell transplantation (HSCT) were evaluated. For the prophylaxis of kerato-conjunctivitis, all patients received Betamethasone Sodium Phosphate eye drops every 6 h, starting 1 day before the first dose of cytarabine and continuing until 1 day after the last dose of cytarabine or the complete resolution of ocular symptoms. For grading of kerato-conjuncitivitis, the National Cancer Institute-Common Toxicity Criteria were used. Among the 53 patients, the grades of kerato-conjunctivitis were grade 0 in 13 patients, grade 1 in 6 patients (11.3%), grade 2 in 10 patients (18.9%) and grade 3 in 25 patients (47.2%). These results strongly suggest that topical corticosteroid eye drops could not effectively prevent the development of cytarabine-induced kerato-conjunctivitis in HSCT recipients who receive high-dose cytarabine following TBI. Further investigation into a more effective prophylaxis for cytarabine-induced kerato-conjunctivitis in this setting is required.