No description available.

No description available.

Purpose: To describe the clinical presentation, ocular complications and clinical implications of acute HZO in HIV positive patients. Method: Prospective descriptive clinical case series of 54 individuals aged 18 – 50 years with confirmed HIV infection and acute presentation of HZO. Results: A female preponderance (1.7:1) and mean age of 36.6 years (range 18 – 49 years) was recorded. The majority of patients were referred from CHC and only 28% of referred patients received appropriate antiviral treatment at the referral site. Mean duration of rash at presentation was 4.7 days (range 1 – 12 days) with 31% of patients presenting within 3 days of rash eruption. Patients attended a mean of 2.7 clinical visits. Equal proportions had known and unknown HIV serostatus at presentation. Mean CD4+ was 276 cells/mm3 (range 44 - 859 cells/mm3). 67% of patients had a CD4+ count < 350 cells/mm3. Periocular discomfort was the most common presenting symptom (70%); decreased VA (2%) was an uncommon presenting symptom. Multidermatomal involvement was uncommon (7%). At presentation normal VA was seen in 69% of patients and 94% had no global visual impairment. Corneal complications (89%) and intraocular inflammation (46%) were the most common ocular complications. Ocular complications at presentation and multiple complications were the rule (70% and 61%). Hutchinson sign was found to be of little clinical value. Visual outcome was fair, 22% of patients having residual visual impairment. Post-herpetic neuralgia was common (74%). Conclusion: HZO is a common HIV marker condition with ocular complications. It may have an application as an indication for the initiation of ARV treatment.

Thesis (M. Pharm.)--University of the Witwatersrand, Faculty of Health Sciences, 2013. / Ocular diseases of the anterior segment are ubiquitous, especially among elderly patients. The development of novel drug delivery systems on the journey for improved treatment is therefore imperative. Aside from anatomical and physiological barriers of the eye, the actual dosage form plays a crucial role. Although liquid eye drops are the first-choice dosage form, the shortcomings do not go unnoticed. In an attempt to circumvent these drawbacks, a novel instantly soluble eye drop device was developed. The system aimed to provide an easier administration form, comfort for the patient and improve drug bioavailability to anterior chamber. This was a steer toward attaining patient-convenience and compliance which are critically challenging factors. Preformulatory studies allowed for the screening and selection of candidate components and key processing conditions. Hydrophilic polymers and excipients were selected for attainment of small, rapid disintegrating yet robust matrices via lyophilization of solutions. Design of experiments generated formulations by means of a Face centred central composite design (FCCCD) that underwent thorough physicochemical and mechanical assessment. Overall, robust rapidly disintegrating solid eye drops were produced. Fastest disintegration time was noted to be 0.200s. Drug content ranged from 79-96%. An improved permeation of formulations compared to a pure drug dispersion was seen. Mathematical modeling was conducted for better insight into the behavior of the device on the eye surface. Statistical analysis through constraint optimization yielded a single optimal formulation. Thermal and molecular transition analysis showed congruent findings with no incompatibility between components. Combinatory surface morphology and porositometric studies confirmed the presence of interconnecting pores across the matrix surface. Drug release kinetic evaluation predicted that best model fit was first-order release. Ocular irritancy studies by means of the HET-CAM test indicated that both drug-loaded and drug-free eye drops had an irritation score of 0 with the inference of good tolerability. Ex vivo permeation across excised rabbit cornea showed an improved steady state drug flux (0.00052mg.cm-2.min-1) and permeability co-efficient (1.7x10-4cm.min-1) for the optimized device compared to pure drug and a marketed eye drop preparation. In vivo analysis was conducted on the rabbit model with insertion of the device into the ocular cul-de-sac. Subsequently, ultra performance liquid chromatography (UPLC) analysis of the aspirated aqueous humour for model drug timolol maleate detection was conducted. The device demonstrated improved drug levels (Cmax = 3ug/mL) in comparison to commercial eye drops (Cmax = 1.97ug/mL) and was well tolerated. Level A point-to-point IVIVC plots indicated a R2 value of 0.84. This served to imply that the in vitro dissolution data can be compared to and may serve as a surrogate to that of in vivo pK data. Histopathological assessment on the enucleated eye ball confirmed the lack of noxious effects of the device on ocular tissue. From this study, the solid eye drop device was concluded to be safe as a drug delivery system for the anterior eye. Looking toward innovative trends and modifications, a bi-layered solid eye drop system with enhanced permeability capabilities employing low molecular weight chitosan was further fabricated for preliminary investigation.

Therapeutic Ocular Surface Medium (TOSM) is a potential new treatment for patients with ocular surface disorders such as dry eye and persistent epithelial defect (PED). New therapies are needed as many patients with dry eye and PED continue to suffer despite maximal standard therapy, and while efficacious autologous serum therapy is not routinely available. Like serum, TOSM contains tear components and was expected to have some of the physiological effects of tears. Clinical and in vitro studies were used to evaluate two similar formulations of TOSM. To comply with local pharmacy manufacturing policies, components were omitted from TOSM v1 to produce TOSM v2. In pilot studies, conducted over 1 month, TOSM v1 improved dry eye signs and symptoms and healed over a quarter of PED. In a 2 month randomised double-masked trial, TOSM v2 improved the signs and symptoms of dry eye but was not superior to saline (placebo). No serious or irreversible side-effects occurred. The altered composition of TOSM v2 may have reduced its efficacy. However, a significant improvement in blepharitis (eyelid margin disease) and conjunctival impression cytology (an objective measure of ocular surface health) was found with TOSM v2. Improvement in blepharitis is an encouraging finding as it has not been reported in other dry eye trials. It was hypothesised that TOSM would benefit ocular surface disorders by improving ocular surface health. In vitro, primary and cell line human corneal epithelial cells were supported by TOSM v1 and TOSM v2. Outgrowth from limbal explants and corneal reepithelialisation following wounding occurred with TOSM v2. This and the impression cytology findings support our hypothesis. Further, ocular surface damage with dry eye and PED may activate the corneal wound healing response. For wound healing, compared to human serum, TOSM v1 and TOSM v2 had beneficial effects in vitro on epithelial cells and human corneal fibroblasts. This may translate into a reduction in potentially vision-threatening corneal scarring in vivo with TOSM. However, ocular surface disorders are a heterogenous group and wound healing is a complex process such that different preparations of TOSM may be needed for use in different disorders and at different stages of the disease process.

No description available.

Therapeutic Ocular Surface Medium (TOSM) is a potential new treatment for patients with ocular surface disorders such as dry eye and persistent epithelial defect (PED). New therapies are needed as many patients with dry eye and PED continue to suffer despite maximal standard therapy, and while efficacious autologous serum therapy is not routinely available. Like serum, TOSM contains tear components and was expected to have some of the physiological effects of tears. Clinical and in vitro studies were used to evaluate two similar formulations of TOSM. To comply with local pharmacy manufacturing policies, components were omitted from TOSM v1 to produce TOSM v2. In pilot studies, conducted over 1 month, TOSM v1 improved dry eye signs and symptoms and healed over a quarter of PED. In a 2 month randomised double-masked trial, TOSM v2 improved the signs and symptoms of dry eye but was not superior to saline (placebo). No serious or irreversible side-effects occurred. The altered composition of TOSM v2 may have reduced its efficacy. However, a significant improvement in blepharitis (eyelid margin disease) and conjunctival impression cytology (an objective measure of ocular surface health) was found with TOSM v2. Improvement in blepharitis is an encouraging finding as it has not been reported in other dry eye trials. It was hypothesised that TOSM would benefit ocular surface disorders by improving ocular surface health. In vitro, primary and cell line human corneal epithelial cells were supported by TOSM v1 and TOSM v2. Outgrowth from limbal explants and corneal reepithelialisation following wounding occurred with TOSM v2. This and the impression cytology findings support our hypothesis. Further, ocular surface damage with dry eye and PED may activate the corneal wound healing response. For wound healing, compared to human serum, TOSM v1 and TOSM v2 had beneficial effects in vitro on epithelial cells and human corneal fibroblasts. This may translate into a reduction in potentially vision-threatening corneal scarring in vivo with TOSM. However, ocular surface disorders are a heterogenous group and wound healing is a complex process such that different preparations of TOSM may be needed for use in different disorders and at different stages of the disease process.

Therapeutic Ocular Surface Medium (TOSM) is a potential new treatment for patients with ocular surface disorders such as dry eye and persistent epithelial defect (PED). New therapies are needed as many patients with dry eye and PED continue to suffer despite maximal standard therapy, and while efficacious autologous serum therapy is not routinely available. Like serum, TOSM contains tear components and was expected to have some of the physiological effects of tears. Clinical and in vitro studies were used to evaluate two similar formulations of TOSM. To comply with local pharmacy manufacturing policies, components were omitted from TOSM v1 to produce TOSM v2. In pilot studies, conducted over 1 month, TOSM v1 improved dry eye signs and symptoms and healed over a quarter of PED. In a 2 month randomised double-masked trial, TOSM v2 improved the signs and symptoms of dry eye but was not superior to saline (placebo). No serious or irreversible side-effects occurred. The altered composition of TOSM v2 may have reduced its efficacy. However, a significant improvement in blepharitis (eyelid margin disease) and conjunctival impression cytology (an objective measure of ocular surface health) was found with TOSM v2. Improvement in blepharitis is an encouraging finding as it has not been reported in other dry eye trials. It was hypothesised that TOSM would benefit ocular surface disorders by improving ocular surface health. In vitro, primary and cell line human corneal epithelial cells were supported by TOSM v1 and TOSM v2. Outgrowth from limbal explants and corneal reepithelialisation following wounding occurred with TOSM v2. This and the impression cytology findings support our hypothesis. Further, ocular surface damage with dry eye and PED may activate the corneal wound healing response. For wound healing, compared to human serum, TOSM v1 and TOSM v2 had beneficial effects in vitro on epithelial cells and human corneal fibroblasts. This may translate into a reduction in potentially vision-threatening corneal scarring in vivo with TOSM. However, ocular surface disorders are a heterogenous group and wound healing is a complex process such that different preparations of TOSM may be needed for use in different disorders and at different stages of the disease process.

Diss. Linköping : Univ.

Inaug.-Diss.--Berlin. / "Lebenslauf".