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| Issue 26 |
Treating Bacterial Conjunctivitis in the Age of Resistance
2011, Issue 26
Learning Objectives
• Make evidence-based clinical judgments about the use of vancomycin in the prophylaxis and treatment of confirmed or suspected resistant bacteria.
• Use data from major surveillance studies to plan appropriate strategies for surgical prophylaxis and empirical antibiotic selection.
• Discuss the changes necessary to adapt clinical practice to changes in antibiotic resistance patterns among ocular isolates.Faculty: Nisha Acharya, MD, MS;
Penny Asbell, MD, MBA, FACS
Pharmacokinetic and Pharmacodynamic Considerations in the Use of Ocular Antibacterials
2011, Issue 25
Learning Objectives
• Describe the basic processes of pharmacokinetics and pharmacodynamics and their relevance in clinical ophthalmology.
• Utilize pharmacokinetic/pharmacodynamic principles to improve drug selection for empirical therapy of infection and surgical prophylaxis.
• Apply large-scale strategic thinking on ways to minimize resistance to individual patient encounters.Faculty: Joseph M. Blondeau, PhD;
David G. Hwang, MD, FACS
Ocular Microbiology:
Studies Every Ophthalmologist Should Know
2011, Issue 24
Learning Objectives
• Apply the results of major epidemiological studies to the selection of topical antibiotics for the prevention and treatment of ocular infections.
• Apply the results of the HEDS study to create a prophylactic regimen against ocular herpetic disease.
• Make evidence-based clinical judgments about the possible benefit of antibiotic prophylaxis in ophthalmic surgery
• Evaluate and implement variations in povidone-iodine disinfection techniques.Faculty: Sonia H. Yoo, MD; Khayyam Durrani, MD;
C. Stephen Foster, MD, FACS
Infectious Blepharitis and Ocular Surgery
2011, Issue 23
Learning Objectives
•State three reasons why it is important to resolve blepharitis prior to ocular surgery and describe a proactive approach to diagnosing and treating blepharitis.
• Improve their selection of ophthalmic antibiotics based on an improved understanding of multidrug resistance in common ocular pathogens including MRSA.
• Improve practice-based infection control protocols and antibiotic use patterns based on greater understanding of their role in the emergence of drug-resistant pathogens.Faculty: Thomas John, MD; Gail L. Torkildsen, MD
Issues in Prophylaxis with Keratoplasty
2011, Issue 22
Learning Objectives
• Apply peer-reviewed research findings to maximize the efficacy of perioperative antibiotic and antiviral prophylaxis for patients undergoing corneal transplant.
• Assess the appropriateness and risks of keratoplasty for patients with corneal scars due to viral infection.
• Assemble a useful smear-and-culture kit for in-office diagnosis of external ocular infections.
• Improve the reliability of cultures and smears sent out for laboratory analysis.Faculty: Natalie Afshari, MD, FACS; Henry D. Perry, MD, FACS
Is There Value to Preoperative Prophylaxis?
2011, Issue 21
Learning Objectives
• Design an infection prophylaxis regimen for a patient with a history of herpetic keratitis.
• Apply knowledge of age-related ocular surface changes to improve the preoperative assessment of geriatric candidates for cataract surgery.
• Enhance the perioperative antiinfective prophylaxis of nursing home patients based on a greater understanding of their special risk factors for invasive, drug-resistant ocular infections.Faculty: Stephen C. Pflugfelder, MD; Herbert Kaufman, MD
An Ounce of Prevention: Minimizing the Risk of Bacterial Keratitis in Contact Lens Wearers
2011, Issue 20
Learning Objectives
• Describe two mechanisms by which contact lens wear may increase risk of infection.
• Discuss the importance of educating patients on the risks of contact lens wear and strategies to reduce those risks.
• List the signs and symptoms of gonococcal neonatal conjunctivitis and state the accepted protocol for its management.
• State two means of diagnosing adenovirus conjunctivitis and discuss its management.Faculty: Elmer Tu, MD; Gerhard W. Cibis, MD
Preventing the Iatrogenic Spread of Adenovirus Keratoconjunctivitis
2011, Issue 19
Learning Objectives
• Implement infection control protocols proven effective for the prevention and control of iatrogenic adenovirus keratoconjunctivitis.
• Evaluate the advantages and limitations of diagnostic and treatment options for adenovirus keratoconjunctivitis.
• State the rationale for and implement infection control practices necessary for safe performance of in-office refractive procedures and intravitreal injections.
• Discuss potential routes of introduction of contaminants into the operative field and list measures to avoid such contamination.Faculty: Shachar Tauber, MD; David G. Hwang, MD, FACS
MRSA: An Evolving Enemy
2011, Issue 18
Learning Objectives
• Revise and update their assessment of patient risk factors for MRSA carriage.
• List the genetic distinctions between CA-MRSA and HA-MRSA lineages, and apply this knowledge to the effective treatment of ocular infections.
• Describe the increasing importance of drug susceptibility testing in the treatment of ophthalmic infections, and apply this understanding to clinical practice.
• Describe the retinal signs of latent T. gondii infection, and state how these signs can be used to assess the patient’s risk from ocular toxoplasmosis.
• Discuss how patients latently infected with T. gondii can be protected against recurrent ocular toxoplasmosis.Faculty: Joseph Blondeau, PhD, FCCP; Rubens Belfort Jr, MD, PhD
Assessing and Maximizing the Value of Topical Prophylaxis
2011, Issue 17
Learning Objectives
• State two risks associated with intracameral injection.
• Discuss two study findings that support the use of topical antibiotic prophylaxis.
• Describe two significant trends in the data provided by the last three ASCRS Cornea Clinical Committee surveys.Faculty: Christopher E. Starr, MD, FACS; Terry Kim, MD; Francis S. Mah, MD
Advances in the Prevention of Ocular Herpes Simplex Disease and its Recurrence
2011, Issue 16
Learning Objectives
• State the factors that strengthen or weaken herpes simplex latency.
• List the antiherpetic medications that strengthen latency.
• State two factors expected to increase the incidence of zoster disease over the next 50 years.
• Discuss the factors that make heightened clinical awareness and prompt treatment crucial for preventing zoster’s sight-threatening ocular complications.Faculty: C. Stephen Foster, MD, FACS, FAAO, FACR; Christopher N. Ta, MD
Advances in Treating Herpetic Eye Infections
2010, Issue 15
Learning Objectives
• Describe the standard treatment of herpes simplex keratitis with and without stromal involvement.
• List three physical characteristics that can be used to distinguish ocular infection caused by herpes simplex from infection caused by herpes zoster.
• Name two factors that distinguish possible treatment options for adenovirus conjunctivitis.Faculty: Joseph Colin, MD; Shachar Tauber, MD
The Changing Spectrum of Ocular Pathogens
2010, Issue 14
Learning Objectives
• Discuss changes in the prevalence of methicillin- and fluoroquinolone-resistant pathogens and how associated infections can be best prevented and treated.
• Discuss how high tissue penetration and ocular surface concentration may increase antibiotic efficacy in the face of culture-confirmed resistance.
• List three findings that would indicate an intraocular infection is caused by fungi rather than bacteria.Faculty: Penny A. Asbell, MD; Dennis P. Han, MD
The MRSA Challenge in Ophthalmology
2010, Issue 13
Learning Objectives
• Discuss how rising rates of MRSA can and should influence antibiotic selection for treatment of ocular and periocular infections.
• List the factors an ophthalmologist should consider when determining whether to add an anti-MRSA agent as part of the empiric treatment of bacterial keratitis.
• Discuss the arguments for and against testing patients for MRSA carriage prior to ocular surgery.Faculty: David G. Hwang, MD, FACS; Eric D. Donnenfeld, MD
Surgical Prophylaxis: Optimizing Drug Selection for Different Patients and Procedures
2010, Issue 12
Learning Objectives
• Discuss the evidence for and against using topical antibiotics to prevent infection during ocular surgery.
• List the critical steps of a comprehensive perioperative regimen that aims to prevent infection.
• Discuss the mistaken beliefs behind the idea that late-generation cephalosporins pose a significantly increased risk to individuals who are allergic to penicillin.
• State the reasons for not using topical antibiotic prophylaxis in conjunction with intravitreal drug injections.Faculty: William B. Trattler, MD; Dennis P. Han, MD
**The CME exam for Issue 12 is expired.**
Formulation and Efficacy: The Effects of Concentration and Excipients
2010, Issue 11
Learning Objectives
• List two ways in which drug formulation can impact the efficacy of a topical ophthalmic antibiotic.
• Given the relatively modest intraocular penetration of topical antibiotics, state two alternative means of preventing intraocular infection following surgery.
• Describe two metrics of in vitro antibiotic potency that are affected when benzalkonium chloride is used to preserve a topical fluoroquinolone.Faculty: Marguerite B. McDonald, MD; Joseph M. Blondeau, PhD
**The CME exam for Issue 11 is expired.**
Besifloxacin in the Context of Ophthalmic Fluoroquinolones
2010, Issue 10
Learning Objectives
• Compare and contrast ocular fluoroquinolones with respect to efficacy against resistant and non-resistant strains of common ocular pathogens.
• Discuss the concentrations acheived by current topical fluoroquinolones on the ocular surface tear film, in the conjunctiva, in the cornea, and in the aqueous humor.
• Discuss the directional trend of MICs among older and newer fluoroquinolones.Faculty: John Sheppard, MD, MMSc; Susanne Gardner, PharmD
**The CME exam for Issue 10 is expired.**
Topical vs Intracameral Antibiotic Delivery: Insights from the Data
2010, Issue 9
Learning Objectives
• Based on recent study findings, discuss the efficacy of fluoroquinolones in sterilizing the ocular surface.
• Name two factors that diminish the amount of topically administered antibiotics in the tear film.
• State three strategies for increasing the prophylactic
effectiveness of topical ocular antibiotics.Faculty: Susanne Gardner, PharmD; Terrence P. O’Brien, MD
**The CME exam for Issue 9 is expired.**
Clinical Implications of Current Trends in Fluoroquinolone Resistance
2010, Issue 8
Learning Objectives
• Explain why the terms ‘susceptible’ and ‘resistant’, as used by microbiology laboratories, can be misleading when discussing ocular isolates.
• Cite one unique advantage and one limitation of the Ocular TRUST study.
• Describe two findings from the most recent Ocular TRUST study.Faculty: David G. Hwang, MD, FACS; Susanne Gardner, PharmD
**The CME exam for Issue 8 is expired.**
Pharmacokinetics / Pharmacodynamics of Topical Ocular Antibiotics
2010, Issue 7
Learning Objectives
• Describe two pharmacodynamic parameters that relate drug concentration to efficacy.
• List the mechanisms by which a drug penetrates the corneal epithelium.
• Discuss the reasons why a topically applied drug is lost rapidly at the ocular surface.Faculty: Christopher N. Ta, MD; Susanne Gardner, PharmD
**The CME exam for Issue 7 is expired.**
Bacterial Resistance Mechanisms
2009, Issue 6
Learning Objectives
• Discuss the mechanisms by which the drugs used to treat ocular infections kill bacteria.
• List three typical fi ndings in toxic anterior segment syndrome that are not typical of endophthalmitis.
will resolve on its own.
• State four conditions that must be met prior to switching from an intravenous to an oral antibiotic.Faculty: Marguerite B. McDonald, MD
**The CME exam for Issue 6 is expired.**
Bacterial Resistance Mechanisms
2009, Issue 5
Learning Objectives
• List the mechanisms that bacteria may employ to
thwart the effect of antibiotics.
• Provide two reasons for treating bacterial conjunctivitis
despite the strong probability that the condition
will resolve on its own.
• State the relationship between a drug’s half life and
the time required to achieve steady state.Faculty: Marguerite B. McDonald, MD
**The CME exam for Issue 5 is expired.**
National Surveillance
2009, Issue 4
Learning Objectives
• Discuss the findings of Ocular TRUST 2 with respect to MRSA and state their importance for antibiotic selection in ophthalmology.
• State the rationale for, and the dangers of, using a corticosteroid to treat microbial keratitis.
• Define the terms “concentration-dependent” and “time-dependent” as they apply to the antibiotics used to treat ocular infections.Faculty: Marguerite B. McDonald, MD
**The CME exam for Issue 4 is expired.**
Major Bacterial Pathogens in Ophthalmology
2009, Issue 3
Learning Objectives
• List and discuss the pathogens of greatest interest in ophthalmology
• Describe a paradigm for deciding when it is necessary to culture a suspected corneal infection
• Define the terms bactericidal and bacteriostatic and discuss the use of this classification in selecting an ocular antibioticFaculty: Edward J. Holland, MD; Burke A. Cunha, MD
**The CME exam for Issue 3 is expired.**
Antibiotic Prophylaxis in Common Ocular Surgeries
2008, Issue 2
Learning Objectives
• Describe the differences between second- and thirdgeneration quinolone antibiotics and relate this to their efficacy against common pathogens.
• State three strategies for reducing the chances of postoperative ocular infection in high infection-risk patients.
• List the pharmacodynamic differences between timedependent and dose-dependent antibiotics.Faculty: Edward J. Holland, MD; Burke A. Cunha, MD;
**The CME Exam for Issue 2 is expired.**
Antibiotic Prophylaxis in Common Ocular Surgeries
2008, Issue 1
Learning Objectives
• Based on the most recent evidence, describe optimal
procedures for antibiotic prophylaxis in cataract and
refractive surgery and intravitreal injection.
• Compare and contrast hospital-acquired MRSA to community-
acquired MRSA to community-onset MRSA.
• List four sites at which bacteria can develop antibiotic
resistance.Faculty: Edward J. Holland, MD; Burke A. Cunha, MD;
**The CME Exam for Issue 1 is expired.**
Topics in Ocular Antiinfectives
Topics in Ocular Antiinfectives will keep ophthalmologists abreast of important issues, clinical and basic research findings, and other matters that affect the use of topical ocular anti-infectives in patient care.
The ophthalmic antiinfective market is made complex by a number of factors:
- The preponderance of anti-infective drug given in ophthalmology is for surgical prophylaxis, an off-label use. As a consequence, manufacturers are (or should be) constrained in what they can say about their products for this important application.
- The leading topical antiinfectives are approved only for the treatment of bacterial conjunctivitis, although they are widely used for the treatment of far more serious conditions, as well as for surgical prophylaxis.
- A number of new ocular antiinfectives have recently been introduced to the market, with more in the pipeline.
- Novel drug delivery techniques are being discussed and adopted outside the US
- Novel formulations
- The ophthalmic pharmaceutical market hasn’t been as closely monitored as systemic pharmaceutical markets, with the result that many questionable claims are widely believed.
- Rising resistance to current market leading drugs is raising concern among ophthalmologists. This is a particular concern in a field where the primary use of antibiotics is for surgical prophylaxis.
As the number of drugs proliferates, Topics in Ocular Antiinfectives will provide a reliable, accessible source of information that brings unbiased, evidence-based information to clinicians. Such a resource will allow physicians to make rational anti-infective choices across a range of clinical situations.
Educational Design Within each issue are four articles, each of which treats some aspect of the theme in a specific way:
- The “Special Feature” is a major review that outlines the expert consensus on the topic area, bringing together research findings and the judgment of highly regarded clinical scientists and physicians.
- Each issue will also include a “Clinical Sidebar”, which complements the content of the Special Feature and relates research to clinical practice.
Topics in Ocular Antiinfectives is produced as an independent Continuing Medical Education enduring material, sponsored by Bausch + Lomb, Inc.
Editors: C. Stephen Foster, MD, FACS, FAAO, FACR; Terry Kim, MD; Marguerite B. McDonald, MD, FACS
For additional information, please contact us.
