To compare the efficacy of intravenous methylprednisolone and intravenous dexamethasone on visual... more To compare the efficacy of intravenous methylprednisolone and intravenous dexamethasone on visual recovery and evaluate their side-effects for the treatment of optic neuritis. Prospective, randomized case-controlled study including 21 patients of acute optic neuritis presenting within eight days of onset and with visual acuity less then 20/60 in the affected eye who were randomly divided into two groups. Group I received intravenous dexamethasone 200 mg once daily for three days and Group II received intravenous methylprednisolone 250 mg/six-hourly for three days followed by oral prednisolone for 11 days. Parameters tested were pupillary reactions, visual acuity, fundus findings, color vision, contrast sensitivity, Goldmann visual fields and biochemical investigations for all patients at presentation and follow-up. Both groups were age and sex-matched. LOGMAR visual acuity at presentation was 1.10 +/- 0.52 in Group I and 1.52 +/- 0.43 in Group II. On day 90 of steroid therapy, visual acuity improved to 0.28 +/- 0.33 in Group I and 0.36 +/- 0.41 in Group II ( P =0.59). At three months there was no statistically significant difference in the color vision, contrast sensitivity, stereoacuity, Goldman fields and the amplitude and latency of visually evoked response between the two groups. The concentration of vitamin C, glucose, sodium, potassium, urea and creatinine were within the reported normal limits. Intravenous dexamethasone is an effective treatment for optic neuritis. However, larger studies are required to establish it as a safe, inexpensive and effective modality for the treatment of optic neuritis.
Tear and serum concentrations of IgG, IgA, and IgM were estimated in serially drawn samples of 50... more Tear and serum concentrations of IgG, IgA, and IgM were estimated in serially drawn samples of 50 patients undergoing optical keratoplasty. Fifteen healthy individuals served as controls. Samples were collected at different postoperative intervals. An immunological rejection phenomenon was observed in nine patients. The rejection could be reversed in five of these nine cases. A decline in serum immunoglobulins was observed during the postoperative follow-up of these cases. This was unrelated to rejection phenomenon and was attributed to systemic steroid therapy. In tears, IgM was not detectable in majority of samples. No significant variation in tear IgA levels was observed between the cases where rejection was reversed and the ones in which it resulted in an opaque graft. In contrast, significant tear IgG increase was observed during the rejection phenomenon. The increased IgG levels returned to the basal value in each case in which rejection was reversed, but remained elevated much above basal and maximum control values in cases in which rejection could not be reversed. This differential response of tear IgG was highly significant. Our results suggest that raised tear IgG levels and its persistence despite therapy may be an indicator of corneal transplant rejection.
To compare the efficacy of intravenous methylprednisolone and intravenous dexamethasone on visual... more To compare the efficacy of intravenous methylprednisolone and intravenous dexamethasone on visual recovery and evaluate their side-effects for the treatment of optic neuritis. Prospective, randomized case-controlled study including 21 patients of acute optic neuritis presenting within eight days of onset and with visual acuity less then 20/60 in the affected eye who were randomly divided into two groups. Group I received intravenous dexamethasone 200 mg once daily for three days and Group II received intravenous methylprednisolone 250 mg/six-hourly for three days followed by oral prednisolone for 11 days. Parameters tested were pupillary reactions, visual acuity, fundus findings, color vision, contrast sensitivity, Goldmann visual fields and biochemical investigations for all patients at presentation and follow-up. Both groups were age and sex-matched. LOGMAR visual acuity at presentation was 1.10 +/- 0.52 in Group I and 1.52 +/- 0.43 in Group II. On day 90 of steroid therapy, visual acuity improved to 0.28 +/- 0.33 in Group I and 0.36 +/- 0.41 in Group II ( P =0.59). At three months there was no statistically significant difference in the color vision, contrast sensitivity, stereoacuity, Goldman fields and the amplitude and latency of visually evoked response between the two groups. The concentration of vitamin C, glucose, sodium, potassium, urea and creatinine were within the reported normal limits. Intravenous dexamethasone is an effective treatment for optic neuritis. However, larger studies are required to establish it as a safe, inexpensive and effective modality for the treatment of optic neuritis.
Tear and serum concentrations of IgG, IgA, and IgM were estimated in serially drawn samples of 50... more Tear and serum concentrations of IgG, IgA, and IgM were estimated in serially drawn samples of 50 patients undergoing optical keratoplasty. Fifteen healthy individuals served as controls. Samples were collected at different postoperative intervals. An immunological rejection phenomenon was observed in nine patients. The rejection could be reversed in five of these nine cases. A decline in serum immunoglobulins was observed during the postoperative follow-up of these cases. This was unrelated to rejection phenomenon and was attributed to systemic steroid therapy. In tears, IgM was not detectable in majority of samples. No significant variation in tear IgA levels was observed between the cases where rejection was reversed and the ones in which it resulted in an opaque graft. In contrast, significant tear IgG increase was observed during the rejection phenomenon. The increased IgG levels returned to the basal value in each case in which rejection was reversed, but remained elevated much above basal and maximum control values in cases in which rejection could not be reversed. This differential response of tear IgG was highly significant. Our results suggest that raised tear IgG levels and its persistence despite therapy may be an indicator of corneal transplant rejection.
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