|Year : 1967 | Volume
| Issue : 4 | Page : 153-156
The management of iridocyclitis with neo-ledercort eye drops
Ophthalmic dept., St. George's Hospital, Bombay, India
|Date of Web Publication||21-Jan-2008|
H K Dordi
Ophthalmic dept., St. George's Hospital, Bombay
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dordi H K. The management of iridocyclitis with neo-ledercort eye drops. Indian J Ophthalmol 1967;15:153-6
Irdocyclitis is a condition which is frequently seen in ophthalmic practice. The management of this condition poses a problem in certain cases. Among the numerous agents employed the most commonly used are corticosteroids. A new formulation, i.e. Neo-Ledercort eye drops was made available to us for a clinical trial in iridocyclitis. Neo-Ledercort eye drops contains triamcinolone acetonide hemisuccinate 0.1 per cent, neomycin sulfate 0.35 per cent and phenylmercuric acetate as a preservative. The preparation is reported to be fairly stable in aqueous solution. Rooney (1966).
Amongst the few published reports on the use of these drops in ophthalmological practice, Ortiz de Fresco (1966) and Rooney (1965) report good results with Neo-Ledercort drops in their series of cases.
| Material and Method|| |
This report comprises a study of 105 patients who had iridocyclitis of varied etiology as shown in the accompanying table. These patients were seen as indoor and outdoor patients who attended the Ophthalmological Department of the St. George's Hospital and the K. B. Haji Bachooali Ophthalmic Hospital, Bombay. There were 77 males and 28 females ranging in age from 12 to 72 years.
All patients were asked to instil Neo-Ledercort drops in the affected eye. On an average, usually 1 drop was instilled 4 to 6 times a day for a period of approximately 7 days. In a few cases where the condition was quite severe, the drops were instilled 8 to 10 times daily for about 15 to 20 days. Atropine sulphate, 1 per cent, for its mydriatic effect was used in every case until clinical signs did not warrant its further continuance. In a few cases (as detailed below), antibiotics either locally or systemically were also given. In this series, eight patients, after a period of observation, did not report for check-up, and the ultimate results of therapy in them could not be assessed.[Table - 1]
| Results|| |
In all patients, the response was immediate in relieving the symptoms; improvement in clinical signs occurred later. In a few cases, therapy was irregular probably because the patients felt better; eight patients as mentioned above were lost on follow-up.
Among the 49 cases with non-specific iridocyclitis, marked amelioration and eventual complete relief was obtained in 40 cases. In two of these cases improvement was evident after the 3rd and 4th instillation; in another 2 cases, improvement was noticed on the day after instillation of 'Neo-Ledercort' was started. On an average, in 2 to 3 days, congestion was reduced by about 80 to 90 per cent in this group of patients; the medication was however given on an average for a total duration of about 7 days. However, in 6 cases recurrence of iridocyelitis occurred after an initial period of improvement whilst under observation; persistence of the medication for a longer period of time usually controlled this condition. Finally, no assessment could be made in 3 cases as although improvement was evident after 2 to 4 days, these cases were lost on followup.
Twentyfive cases from the postoperative iridocyclitis group were patients in whom iridocyclitis developed after cataract operation which were mainly extracapsular. These patients who developed iridocyclitis usually had pain and irritation of the eye and corneal haziness. In these cases, Neo-Ledercort drops were usually instilled 4 to 5 times daily for a period of two to three weeks. Relief was evident within a week. In one of the 25 patients however, therapy was irregular and he was ultimately lost on follow-up. Of the remaining two cases, one had iridocyclitis following optical iridectomy, whilst the other developed iridocyclitis following removal of a corneal foreign body. This latter patient was initially asked to instil one drop of Neo-Ledercort 4 times daily. He felt better on the 3rd day, but following a recurrence on the 4th day, medication was increased to 2 drops 6 times a day; he was completely relieved by the 15th day.
Among the 17 cases of traumatic iridocyclitis, complete relief was obtained from 2 to 10 days in 16 of these cases; results of the remaining case could not be assessed as therapy was irregular and discontinued though the patient reported amelioration of symptoms after 5 days of therapy with Neo-Ledercort drops. Depending on the severity of the inflammation, the total duration of therapy varied from 5 to 15 days, on an average it was about 8 days. In 13 of these 16 cases no adjuvant therapy was used; however in the remaining 3 cases, antibiotics were given systemically. It is interesting to record that 3 of these 13 cases were formerly unsuccessfullly treated with other antibiotic and corticosteroid preparations.
In the group of 4 cases of traumatic iridocyclitis with cataract formation, 'Neo-Ledercort' was first used for a period of 10 to 15 days to control the inflammation (two of these patients were also given antibiotics systemically). Three of these four cases were subsequently operated for cataract and 'Neo-Ledercort' was re-started a week after the operation although there was no evidence of iridocyclitis, and continued for a period of about 15 days. All these 3 cases made an uneventful recovery. The "protective action" of `Neo-Ledercort' in these cases was striking. The fourth case felt better within 5 days of 'Neo-Ledercort' therapy, but therapy was later interrupted and the patient did not return for the operation.
In the two cases of iridocyclitis with hypopyon, in addition to 'Leo-Ledercort,' penicillin ointment was used in one, and systemic antibiotics in the other. Clearing of the lesions was very rapid, occurring in 2 and 5 days respectively. Both cases were completely relieved at the end of 8 and 15 days respectively of 'Neo-Ledercort' therapy.
One of the cases of adherent leucoma with iridocyclitis did not return for check-up and hence the result of 'Neo-Ledercort' therapy could not be assessed. The other case who had an old adherent leucoma with persistent iridocyclitis had unsuccessfully used another similar preparation for 10 days previously, but felt better after 5 days of `Neo-Ledercort' therapy. Clinically, congestion and irritation was much less and was completely relieved at the end of 10 days.
In the two cases of secondary glaucoma with iridocyclitis, a slightly higher dosage of `Neo-Ledercort' (2 drops 4 to 6 times a day) was used. Unfortunately, therapy was interrupted in both these cases. However, one case felt better after the first day though he had a recurrence of iridocyclitis later; whilst the other case had a 75 per cent improvement after 5 days (he was also given Diamox).
The case of keratoconjunctivitis with iridocyclitis had been unsuccessfully treated with injections of streptopencillin, but relief was complete after 10 days of 'Neo-Ledercort' therapy. Similarly, the case of old corneal ulcer with iridocyclities had been unsuccessfully treated for a month with another medication, but was completely relieved after 15 days of 'Neo-Ledercort' therapy.
None of the patients complained of any side-effects after instillation of 'Neo-Ledercort' drops.
| Discussion|| |
From the results given above, it is evident that Neo-Ledercort drops have proved an effective remedy in the management of iridocyclitis. If the eight cases (see Table) who were lost on follow-up and whose results of therapy could not be assessed are eliminated, the relief rate is about 93 per cent. The largest group treated was of nonspecific iridocyclitis, followed by postoperative iridocylitis and traumatic iridocyclitis. None of the 40 cases of non-specific iridocyclitis group which are indicated as completely relieved in the Table developed any recurrence during the 12 months of period of the above trial. Recurrences, however, did take place in 6 cases during the period of the trial, but these were controlled when therapy was prolonged. Neo-Ledercort drops have been extremely beneficial in the post-operative iridocyclitis group where symptoms like pain and irritation, and signs like congestion and corneal haziness have subsided in a very short interval, after instillation of the drops. It is our impression that regression of the signs and symptoms mentioned above have been quickest with Neo-Ledercort drops than that of any other corticosteroid drops available. A prompt relief in iridocyclitis was observed in the group of 4 cases with traumatic iridocyclitis with cataract. In 3 of these cases, Neo-Ledercort drops were used after their cataract was operated though there was no evidence of iridocyclitis. In this instance, Neo-Ledercort drops were instilled as a protective agent. Among the other groups, a very striking relief was obtained in a patient with an old adherent leucoma with persistent iridocyclitis who was previously unsuccessfully treated with other agents.
| Summary|| |
1. The results of a trial on 105 cases of iridocyclitis of varied etiology treated with Neo-Ledercort drops, a new ophthalmic preparation containing triamcinolone and neomycin, are recorded.
2. Relief from pain was obtained within 4 to 5 instillations and congestion reduced by 80 to 90 per cent in 2 to 3 days. The total duration of treatment varied; on an average it was 7 days.
3. A total of seven recurrences were observed, one in a case of glaucoma and six in the group with nonspecific iridocyclitis; these subsided when therapy was persisted for a longer time.
| Acknowledgement|| |
Our thanks are due to Lederle Division, Cyanamid India Limited, who supplied us Neo-Ledercort Eye Drops.
| References|| |
Ortiz de Fresco, M. V., (1965) Revista Medica De Paraguay, 7: 15-18.
Rooney: J. T.: (1966) The Practitioner, 197: 667-670.
[Table - 1]