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
GC Gulati, BS Chouhan
Department of Ophthalmology, Medical College, Rohtak, India
G C Gulati
Department of Ophthalmology, Medical College, Rohtak
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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;16:116-120
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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 2021 Jun 15 ];16:116-120
Available from: https://www.ijo.in/text.asp?1968/16/3/116/37532
In order to assess the comparative value of various modes of administration in eye infections, extensive work has been done by von SALLMAN , THYGESON,  LEOPOLD AND NICHOLS  and SCHULTZ AND GRUNWELL  . von SALLMAN , 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 , 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  recommended iontophoretic medication better than local drops and ointments. A I N S L E,  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  , PETERKIN  considered soframycine as the most effecive drug against Stapylococci, Pseudomonas Pyocyaneous and proteus. KHOSLA, OM PARKASH AND ACARWAL  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
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,  STRIDE,  STRADFORD,  PETERKIN  and KHOSLA et al. 
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.
[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.
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  observed that soframycine killed staphylococci in less than a minute in the presence of 50 per cent serum. PETERKIN  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.
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.
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