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ARTICLE
Year : 1968  |  Volume : 16  |  Issue : 3  |  Page : 116-120

Comparative study of the mode of therapy of iontophoresis of penicillin and subconjunctival soframycine in the treatment of corneal ulcers


Department of Ophthalmology, Medical College, Rohtak, India

Date of Web Publication24-Dec-2007

Correspondence Address:
G C Gulati
Department of Ophthalmology, Medical College, Rohtak
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Gulati G C, Chouhan B S. Comparative study of the mode of therapy of iontophoresis of penicillin and subconjunctival soframycine in the treatment of corneal ulcers. Indian J Ophthalmol 1968;16:116-20

How to cite this URL:
Gulati G C, Chouhan B S. Comparative study of the mode of therapy of iontophoresis of penicillin and subconjunctival soframycine in the treatment of corneal ulcers. Indian J Ophthalmol [serial online] 1968 [cited 2020 Jul 5];16:116-20. Available from: http://www.ijo.in/text.asp?1968/16/3/116/37532

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Table 1

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Table 1

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In order to assess the comparative value of various modes of adminis­tration in eye infections, extensive work has been done by von SALLMAN [10],[11] THYGESON, [15] LEOPOLD AND NICHOLS [7] and SCHULTZ AND GRUNWELL [10] . von SALL­MAN [10],[11] found that eye infections respond in a better way when treat­ed by iontophoresis than when cor­neal bath is used. THYGESON while treating various eye infec­tions with sulphacetamide consider­ed iontophoretic medication better than oral therapy of the same drug. von SALLMAN [10],[11] while working on experimental pneumococcal in­fections of rabbit eyes observed the superiority of iontophoretic medica­tion of penicillin over its applications by corneal bath, cotton packs and subconjunctival injections. LEO­POLD AND NICHOLS [7] recommend­ed iontophoretic medication better than local drops and ointments. A I N S L E, [1] used soframycine sub­conjunctivally in cases of eye in­fections and found it to be a pain­less injection with no local and gene­ral untoward reaction. AINSLE AND HENDERSON [3] , PETERKIN [8] consi­dered soframycine as the most effec­ive drug against Stapylococci, Pseu­domonas Pyocyaneous and proteus. KHOSLA, OM PARKASH AND ACARWAL [6] considered soframycinc as a useful and safe antibiotic. In order to establish as to which mode of administration is better, a com­parative study of ionotophoresis with Penicillin and subconjunctival Sofra­mycine was taken.


  Method and material Top


The present study was conducted on 20 cases of corneal ulcers in two series of 10 each.

Ist series (Iontophoretic Medica­tion). Cases in this series were ex­amined with respect to complete his­tory taking, oblique illumination, flouresceine staining of corneal ulcer, slit lamp examination and culture of conjunctival swab and ulcer scrap­ings. The apparatus used consisted of (1) D. C. converter with milliampe­remeter (2) Electrodes (3) Eye cup.

Converter. It has the capacity to convert 230 volts A.C. to 45 volts D. C. With a potentiometer the desired voltage can be obtained which can be shown on the Milliamperemter from 0-10 mamp.

Electrodes. A platinum wire fix­ed in a wooden handle connected to the negative pole of the apparatus acted as active electrode because of negative charge of Penicillin ion. The indifferent electrode was an iron plate wrapped in wet cotton connect­ed to the positive pole of the appa­ratus. Cryst. Penicillin solutions of 1000 units and 1500 units per ml were used. Strength and duration of the current used varied from 2-4 mamp and 5-10 mts. respectively.

Procedure of Iontophoresis. The plastic eye cup was fixed under the lids. A solution of Penicillin was injected in the cup while the patient was lying in supine position. The active electrode was introduced in the cup, while the indifferent electrode was held by the patient in his hand. The desired strength of the current passed was indicated by pointer of the milliamperemeter. Patient was examined immediately after the procedure. Next morning the conjunctival swab was sent for culture. Experience of sensation dur­ing the procedure and patients' signs and symptoms were enquired, ob­served and recorded twice or thrice daily.

2ND SERIES. (Subconjunctival Soframycine). Procedure with res­pect to examination was the same as in iontophoresis but culture exam­inations were not relied upon much because patients already had appli­cations of antibiotic eye drops or ointments before coming to us. More­over broad spectrum activity of so­framycine has been very well estab­lished by RYCROFT, [9] STRIDE, [13] STRADFORD, [14] PETERKIN [8] and KHOSLA et al. [6]

The strength of soframycine used was 5 mgm/ml. 0.50 ml. of soframy­cine was injected subconjunctivally for 5 consecutive days. Local and general changes were observed im­mediately after the treatment. On successive mornings, examination of the treated eye was done with res­pect to the progress of the corneal ulcer.


  Observations Top


[Table - 1] shows the results of the culture after daily iontophoretic ap­plications for 5 days. [Table - 2] shows incidence of local sensations and ge­neral body sensations during Ionto­phoretic and sub-conjunctival treat­ments. [Table - 3] shows the compa­rative study of signs and symptoms of corneal ulcers treated by iontophoresis and sub-conjunctival medi­cations.


  Discussion Top


The superiority of iontophoresis of Penicillin and sub-conjunctival so­gramycine has been equally well brought out by different observers. The experimental and clinical data of these workers show the evalua­tion of various modes of administra­tion using only one drug. The ob­ject of the present study is to know the comparative value of two well claimed modes of administration using drugs of low antibacterial and broad spectrum antibacterial activity. [Table - 1] shows that growths of Staph. pyo. coag. positive, Staph. pyo. coag. ne­gative, streptococcus haemolyticus became sterile after the first ionto­phoretic application. B. pyocyaneous never became sterile throughout treatment. STRADFORD [14] observed that soframycine killed staphylococci in less than a minute in the presence of 50 per cent serum. PETERKIN [8] considered soframycine as most ef­fective against B. pyocyaneous. The observation of effect of ionotophore­sis on microorganisms showed that iontophoresis itself has no effect on the microorganisms but it is the sen­sitivity of the organism to specific antibiotic which is of significance.

Subconjunctival soframycine has proved to be a painless procedure whereas tingling, prickly and painful sensations were observed with ionto­phoresis. Immediately after the sub­conjunctival injection sneezing by patients was observed in 8 out of 10 patients.

[Table - 3] and A helped us in evaluating the modes of therapy. Absence of staining of corneal ulcer with regression of signs and symptoms started on an average 2-3 days by iontophoresis and 3-4 days by sub­conjunctival injections. The observa­tion shows that reparative process starts earlier by iontophoresis than by subconjunctival injection. Stimula­tion of the various cells in the cor­nea by the movement of the Penicil­lin ions may be responsible for this early start of healing. The average time of healing taken in two groups is about 4-5 days. Two cases did not respond to treatment during ionto­phoretic medication whereas all cases responded to treatment by subcon­junctival soframycine. One case of sloughing corneal ulcer with fulmi­nating iridocyclitis having absence of light projection recovered his percep­tion of light, by subconjunctival so­framycine treatment. Subconjuncti­val haemmorrhage resulted in 5 out of 10 cases because of marked congestion of the conjunctiva. The time taken for disappearance of signs and symptoms was the same in both the series. During iontophoresis of Pe­nicillin, transient haziness of the cor­nea was observed in every case which used to disappear after ½-2 hours.

In both the modes of therapy, the resulting opacity corresponded with the size of the ulcer.


  Conclusion Top


Subconjunctival soframycine can be considered as superior to iontopho­resis with respect to:­

a) Antibacterial activity.

b) Easy mode of administration.

c) No local untoward side effects such as pain and necrosis of con­conjunctiva.

d) Response of majority of corneal ulcer cases irrespective of their organisms.

So far as intensity of disappearance of signs and symptoms is concerned it remained the same in both the groups. Iontophoretic medication though quite effective but impracti­cable because it is a lengthy and time consuming procedure and de­mands more co-operation of the pa­tient than sub-conjunctival injections.

 
  References Top

1.
AINSLE D.: Chemotherapy in ophthal­mology. Practitioner, 188: 45-52 (1962).  Back to cited text no. 1
    
2.
AINSLE, D. AND CAIRANS, J. E.: Subconjunctival administration of So­framycine in the treatment of corneal infections. Brit. J. Ophth. 44: 25 (1960).  Back to cited text no. 2
    
3.
AINSLE, D. AND HENDERSON, G. W.: Soframycine its penetration into the eye and its effect upon experi­mentally produced Staph. aureus and Ps. pyocyaneous corneal infections. Brit. J. Ophth. 42: 513 (1958).  Back to cited text no. 3
    
4.
DUKE-ELDER, W. S.: System of ophthalmology, Vol. VII, Henry Kimp­ton London pp. 488-519 (1962).  Back to cited text no. 4
    
5.
ERLANGER, G.: Scientific and prac­tical value of ionization in ophthalmo­logy. Brit. J. Ophth. 20: 312 (1936).  Back to cited text no. 5
    
6.
KHOSLA, OM PARKASH AND AGARWAL: Clinico-bacterial study of Sotramycine in conjunctival flora. Orient. Arch. Ophth. 1: 212 (1963).  Back to cited text no. 6
    
7.
LEOPOLD, I AND NICHOLS: Streptomycine iontophoresis in clinical ophthalmology. Arch. Ophth. (Chicago) 35: 33 (1946).  Back to cited text no. 7
    
8.
PETERKIN: Quoted by Franco-Indian Pharmaceuticals, Bombay, about Soframycine.  Back to cited text no. 8
    
9.
RYCROFT, B.: The organisation of re­gional eye bank. Lancet. ii, 1225 (1962).  Back to cited text no. 9
    
10.
SALLMAN, L. von: Penicillin and Sulphadiazine in the treatment of ex­perimental intraocular infections with pneumococcus. Arch. Ophth. (Chicago). 30: 426 (1943).  Back to cited text no. 10
    
11.
SALLMAN, von: Penetration of Pe­nicillin into the eye. Arch. Ophth. (Chicago). 34: 195 (1945).  Back to cited text no. 11
    
12.
SCHULTZ AND GRUNWELL: Strep­tomycine in clinical ophthalmology. Amer. J. Ophth. 32: 813 (1949).  Back to cited text no. 12
    
13.
STRIDE: Quoted by Franco-Indian Pharmaceuticals, Bombay, about Soframycine.  Back to cited text no. 13
    
14.
STRADFORD: Quoted by Franco­Indian Pharmaceuticals, Bombay, about Soframycine.  Back to cited text no. 14
    
15.
THYGESON, P.: Sulphonamide com­pound in the treatment of ocular in­fections. Arch. Ophth. (Chicago). 29: 1004 (1943).  Back to cited text no. 15
    



 
 
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