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ABSTRACT: PURPOSE:: To evaluate the effects of oral ambroxol on tear film and ocular surface. METHODS:: Twenty healthy male subjects with no ocular disease were recruited. Subjects were divided into 2 groups: a control group and an ambroxol group. Ambroxol hydrochloride was administered orally to the ambroxol group. The tear film and ocular surface were evaluated at baseline (10 AM), 12 PM, 6 PM, and 10 AM the next day. Visual analog pain scale, tear film break-up time, fluorescein corneal staining, Schirmer test, tear osmolality, and fluorescein clearance test were measured. RESULTS:: The mean visual analog pain scale score increased at 6 PM and 10 AM the next day in the ambroxol group (P = 0.007 and P = 0.018, respectively). The tear film break-up time did not show any significant change in the control group and shortened at 6 PM in the ambroxol group (P = 0.011). The fluorescein corneal staining scores increased at 6 PM in both groups (P = 0.007 and P = 0.004, respectively), and they were higher in the ambroxol group compared with control group at 10 AM the next day (P = 0.035). The mean tear secretion did not show a significant change in the control group and increased at 10 AM the next day in the ambroxol group (P = 0.022). In both groups, the tear osmolality increased at 6 PM (P = 0.009 and P = 0.005, respectively), but the tear osmolality in the ambroxol group was higher compared with control group at 6 PM (P = 0.043). CONCLUSIONS:: Oral ambroxol may disturb tear film and ocular surfaces by attenuating the mucin layer of the tear film. This study was registered as Clinical Trial at ClinicalTrials.gov. as NCT01713179.
Cornea 03/2013; · 1.73 Impact Factor
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ABSTRACT: BACKGROUND: Intraocular CMV infections, including endotheliitis and retinitis, have been reported to threaten the host's vision. These infections have been treated with systemic or intravitreal GCV injection. Intracameral GCV injection can be an effective treatment option with avoiding the systemic side effect. The cytotoxic effect of ganciclovir (GCV) on cultured human corneal endothelial cells (HCECs) was evaluated. METHODS: HCECs were cultured and exposed to various concentrations (0-20 mg/mL) of GCV (Cytovene®, Roche, Colorado). Cell viability was assessed by the Cell Counting Kit-8 method and Live/Dead Viability/Cytotoxicity assays. Cell morphology was assessed using phase-contrast microscopy after 48 h exposure to GCV. Cell cycle and apoptosis were analyzed using NC-3000 to evaluate the effect of GCV on HCECs. The cell proliferation rate was evaluated by a BrdU proliferation assay. RESULTS: Cytotoxicity tests showed that GCV had a dose-dependent cytotoxic effect on HCECs. GCV concentrations of ≥ 5 mg/mL resulted in a significant reduction in cell viability. Higher concentrations of GCV resulted in cell cycle delay, low proliferation rate, and an increased number of apoptotic cells, indicating activation of the pro-apoptotic pathway. CONCLUSIONS: Our results suggest that intracameral GCV concentrations of ≥ 5 mg/mL may increase the risk of corneal endothelial damage, although GCV concentrations of ≤ 0.5 mg/mL do not decrease cell viability.
Antiviral therapy 03/2013; · 3.16 Impact Factor
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ABSTRACT: PURPOSE: To report the clinical features of cataracts in eyes with ocular toxocariasis. SETTING: Department of Ophthalmology, Seoul National University Bundang Hosptal, Seongnam, South Korea. DESIGN: Retrospective observational case series. METHODS: The clinical diagnosis of ocular toxocariasis was based on the following characteristic features: retinal granuloma with or without ocular inflammation and positive results in serum antibody enzyme-linked immunosorbent assay. Patients younger than 60 years who presented with a unilateral cataract and were diagnosed with ocular toxocariasis between January 2009 and January 2012 were included. Demographic and ocular examination data for all patients showing atypical cataract features were collected. All cataracts were documented with anterior segment photography. RESULTS: Seven of 83 patients (8.4%) presented with an atypical cataract in the eye with ocular toxocariasis only. The mean patient age was 49.7 years ± 8.3 (SD) (range 38 to 59 years). All patients had small, round, white lens opacities resembling retinal granulomas. The granuloma-like opacities were located primarily in the lens midperiphery and in the subcapsular level. The lens opacity migrated in 1 patient. CONCLUSIONS: Ocular toxocariasis can cause a cataract with distinctive clinical features. These cataracts show a granuloma-like opacity primarily in the posterior subcapsular level; the opacity can migrate. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.
Journal of cataract and refractive surgery 03/2013; · 2.75 Impact Factor
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ABSTRACT: To evaluate the levels of satisfaction among physicians who have undergone corneal refractive surgery.
This study included 212 eyes of 107 consecutive patients who underwent laser in situ keratomileusis or laser sub-epithelial keratomileusis surgery. Patients were divided into two groups: one group of physicians and one group of other healthcare workers (HCWs). The physicians' group was also subdivided into two different groups: surgeons or doctors using microscopes and medical physicians. The main outcome measures were scale scores obtained by using the Visual Function Index-14 questionnaires; uncorrected distance visual acuity (UDVA), residual spherical equivalent (SE), optical zone diameter, and residual corneal thickness were also compared between the groups.
No significant differences in preoperative parameters, with the exception of the ratio of types of refractive surgery, were noted between the physicians and the HCWs group. Additionally, no differences between the groups were noted in the postoperative UDVA, residual SE, optical zone diameter, residual corneal thickness, and level of satisfaction. When comparing the two subgroups of physicians, the differences in satisfaction rates were not statistically significant, even in terms of the performance of delicate manual work.
No statistically significant differences in the clinical outcomes and satisfaction scores were detected after surgery between the physicians and HCWs groups, nor were any significant differences detected between the surgeons and medical physicians groups. Corneal refractive surgery can conceivably be recommended even for physicians who perform intensive near vision-dependent activities and delicate operations.
Korean Journal of Ophthalmology 10/2012; 26(5):331-8.
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ABSTRACT: The aim of this retrospective study was to identify factors affecting myopic shift from predicted values of refraction after sulcus fixation of foldable acrylic intraocular lenses (IOLs).
A total of 91 eyes from 91 consecutive patients, each of whom underwent primary implantation of sulcus-fixated foldable acrylic IOLs, were assessed. AcrySof MA60BM and Sensar AR40e multi-piece IOLs, and AcrySof SA60AT and BioVue single-piece IOLs were implanted. The type of IOL and axial length (AL) were analysed to identify differences in the spherical equivalent between the predicted refraction values obtained using the SRK/T formula and the manifested refraction values.
The mean myopic shift from the predicted refraction calculated using the SRK/T formula was -1.04 dioptres (D) ±0.85 SD with sulcus fixation of the foldable acrylic IOLs. The type of IOL (multi-piece vs single-piece) did not affect the degree of myopic shift (p=0.100, independent t-test). However, as the AL increased, the myopic shift decreased (p=0.033, r=0.223, Pearson's correlation).
The myopic shift from the predicted refraction differed following sulcus fixation of foldable acrylic IOLs based on the AL, and therefore surgeons should take the AL into account when they determine the IOL power for sulcus fixation procedures.
The British journal of ophthalmology 08/2012; 96(10):1316-9. · 2.92 Impact Factor
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ABSTRACT: BACKGROUND: To compare the symptom scores of children with those of adults with the same degree of mild ocular surface signs. METHODS: This study included patients with at least one ocular surface symptom and sign. Data obtained from 45 subjects aged 8.79 ± 2.95 yr (Mean ± SD) (pediatric group) and 45 adults aged 52.87 ± 10.87 yr (adult group) who were matched to each pediatric patient based on ocular surface signs were analyzed. Demographic data including age and sex; parameters of ocular surface signs including fluorescein staining score, tear film breakup time and Schirmer test score; symptom scores including ocular surface disease index (OSDI) and visual analog scale (VAS) were assessed and compared between the two groups. RESULTS: Significant differences emerged in sex ratio as well as in age between the two groups (P < 0.001, for both). Regarding ocular surface signs and tear film tests, the study revealed no significant differences in fluorescein staining score (1.44 ± 1.95 vs. 1.40 ± 1.68 P = 0.913), tear film break up time (4.96 ± 1.94 vs. 3.82 ± 1.85 s, P = 0.612) and Schirmer score (12.79 ± 9.05 vs. 10.11 ± 8.45 mm / 5 min, P = 0.370). Regarding dry eye symptoms, both OSDI and VAS were significantly lower in the pediatric group (P = 0.001 and < 0.001, respectively) than in the adult group. CONCLUSION: Pediatric patients with mild ocular surface damage may report fewer dry eye symptoms compared to adult patients with similar stages of ocular surface damage.
Albrecht von Graæes Archiv für Ophthalmologie 07/2012; · 2.17 Impact Factor
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Canadian Journal of Ophthalmology 06/2012; 47(3):e6-8. · 1.47 Impact Factor
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ABSTRACT: To establish an in vitro model to study the role of keratocytes in corneal chemical burns and to investigate the interaction between chemically injured keratocytes and human peripheral blood mononuclear cells (PBMCs).
Human keratocytes, epithelial cells, and PBMCs were cultured. The PBMC stimulation assay was then performed using cultured human keratocytes, epithelial cells, and NaOH-treated keratocytes. Matrix metalloprotease-9 (MMP-9), transforming growth factor-beta 1 (TGF-β1), and macrophage migration inhibitory factor (MIF) secretion profiles of activated PBMCs stimulated by NaOH-treated keratocytes were determined by ELISA.
Human keratocytes stimulated PBMC proliferation (p=0.016), and keratocytes treated with various concentrations of NaOH further stimulated PBMC proliferation compared to control cells in a dose-dependent manner (p=0.028 and 0.009). MMP-9 and MIF levels were higher than in the negative controls, while TGF-β1 levels did not differ from those of the negative controls.
Our results suggest that PBMCs are stimulated by chemically injured keratocytes, and produce inflammatory cytokines in response. This may be a major mechanism underlying the process causing corneal chemical burn injuries. This model can be used as an in vitro model for further studies on corneal chemical burns.
Cytokine 05/2012; 59(2):280-5. · 3.02 Impact Factor
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ABSTRACT: To determine the effect of intracamerally injected voriconazole on corneal endothelial cells in rabbit eyes.
Various concentrations of voriconazole (0%, 0.03%, 0.1%, 0.25%, 0.5% and 1%) were injected intracamerally in 36 eyes of 18 rabbits (six eyes for each concentration). Measurements of endothelial cell counts and central corneal thickness were performed at 30, 60, 90 and 120 min after the injection. In each group, five of six corneas were used for the live/dead cell assay; staining with alizarin red and trypan was done. In one cornea from each group, scanning electron microscopy was performed.
There was no significant difference in endothelial cell counts and central corneal thickness among the six groups at any time points. The live/dead cell assay revealed no difference in the mean percentage of dead endothelial cells among the six groups (p=0.504). However, scanning electron microscopy revealed blurring of cell border at voriconazole concentrations ≥ 0.25%, indicating cell wall damage.
Intracameral injection of voriconazole did not induce a significant gross change in rabbit corneal endothelial cells up to a concentration of 1%. However, risk of microstructural damages might exist with a concentration of ≥ 0.25%.
The British journal of ophthalmology 03/2012; 96(6):905-8. · 2.92 Impact Factor
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ABSTRACT: To investigate whether ethanol administration disturbs the tear film and ocular surface.
Case-control study.
Twenty healthy male subjects were recruited. Ethanol was administered to 10 subjects and another 10 subjects served as controls.
Twenty healthy male subjects with no ocular disease were recruited. Ethanol (0.75 g/kg) was administered orally at 8 pm for 2 hours to 10 subjects.
The tear film and ocular surface were evaluated at 6 pm before drinking, at midnight, and immediately (6 am) and 2 hours (8 am) after waking the next morning. Tear osmolarity, ethanol concentration in tears and serum, Schirmer's test results, tear film break-up time (TBUT), corneal punctuate erosion, and corneal sensitivity were measured.
Ethanol was detected in tears and serum at midnight, but it was not detected the next morning. The mean tear osmolarity level increased in the alcohol group at midnight compared with that in the control group (P<0.001). The alcohol group showed a significantly shorter TBUT compared with the control group after drinking alcohol (P<0.001 at 12 am, P<0.001 at 6 am, and P = 0.002 at 8 am). There were significantly higher fluorescein staining scores in the alcohol group compared with those in the control group at 6 am and 8 am (P = 0.001 and P<0.001, respectively). No significant change was shown in corneal sensitivity or Schirmer's test results in either group.
Orally administered ethanol was secreted into the tears. Ethanol in tears induced tear hyperosmolarity and shortened TBUT and triggered the development of ocular surface diseases. Similar changes could exacerbate signs and symptoms in patients with ocular surface disease.
Ophthalmology 02/2012; 119(5):965-71. · 5.45 Impact Factor
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ABSTRACT: To evaluate the efficacy and safety of limbal-conjunctival autografting with limbal fixation sutures after pterygium excision.
We retrospectively reviewed the records of 90 patients (103 eyes) who received limbal-conjunctival autografts with limbal fixation sutures after excision of the primary pterygium (82 eyes) and recurrent pterygium (21 eyes). ResuLTS: The study subjects comprised 41 male patients (47 eyes) and 49 female patients (56 eyes) with a mean age of 51.1 ± 10.5 years (range 32-77). The mean follow-up period was 18.9 ± 9.2 months (range 12-50). Among the 103 eyes, recurrence occurred in 2 eyes (1.9%) after 2 and 4 months, respectively. As complications, 1 case of conjunctival cyst and 2 cases of pseudopterygium at the donor site were reported.
Limbal-conjunctival autografting with limbal fixation sutures appears to be an effective and safe method of reducing the recurrence rate after pterygium excision.
Ophthalmologica 02/2012; 227(4):210-4. · 1.42 Impact Factor
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Canadian Journal of Ophthalmology 02/2012; 47(1):e1-2. · 1.47 Impact Factor
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ABSTRACT: A 40-year-old man with a history of laser in situ keratomileusis (LASIK) 13 years earlier had combined cataract extraction and vitreoretinal surgery due to rhegmatogenous retinal detachment and posterior subcapsular cataract. Two weeks postoperatively, he complained of painless visual blurring. Diffuse interface haze was observed, and antiinflammatory treatment including topical steroid and cyclosporine was started. One week later, visual blurring had not improved and intraocular pressure was 27 mm Hg. Interface haze, fluid collection, and flap edema were observed and confirmed by spectral-domain anterior segment optical coherence tomography. After discontinuation of the steroid and addition of IOP-lowering medication, visual acuity and interface fluid collection and haze improved. This case illustrates that interface fluid syndrome can develop more than 10 years after LASIK, triggered by ocular hypertension and inflammation after intraocular surgery. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.
Journal of cataract and refractive surgery 12/2011; 38(3):548-50. · 2.75 Impact Factor
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ABSTRACT: To investigate the protective effect of rapamycin on oxidative stress-induced cell death of human corneal endothelial cells (HCECs).
HCECs were cultured according to previously published methods. With treatment of 0 mM or 5 mM of tert-butyl hydroperoxide (tBHP) with various concentrations (0, 25 and 50 nM) of rapamycin, reactive oxygen species (ROS) production was measured using an oxidation-sensitive fluorescent probe, 2'7'-dichlorofluorescin diacetate (DCFH-DA, USA) methods. Cell viability was assayed by the method of Cell Counting Kit-8 (CCK-8, Wako). The levels of cellular glutathione were also assessed enzymatically with glutathione reductase by using a commercial glutathione (GSH) assay kit (Cayman Chemical, USA).
Rapamycin reduced 2'7'-dihydrodichlorofluorescein oxidation and increased GSH in HCECs. Rapamycin significantly inhibited tBHP-induced ROS production. Cells treated with rapamycin showed higher viability compared to control at 5 mM tBHP. Rapamycin effectively protected HCECs from ROS-induced cell death through increasing intracellular GSH.
Our data suggest that rapamycin protects HCECs from oxidative injury-mediated cell death via inhibition of ROS production and enhancement of GSH.
Current eye research 12/2011; 36(12):1116-22. · 1.51 Impact Factor
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ABSTRACT: To compare salivary cytokine profiles in patients with primary Sjögren's syndrome (pSS), non-SS sicca controls, and non-sicca controls, and to investigate whether cytokine levels are correlated with clinical parameters of pSS patients.
Un-stimulated whole saliva samples were obtained from pSS patients (n=30) classified according to the criteria of the American European Consensus Group. Age- and gender-matched non-SS sicca patients (n=30) and non-sicca subjects (n=25) served as controls. Salivary IFN-γ, TNF-α, IL-1, IL-4, IL-6, IL-10, IL-12p40, and IL-17 levels were measured using a multiplex Luminex® bead-based assay.
pSS patients and non-SS sicca controls had significantly lower salivary flow rates (SFRs) than non-sicca controls, and pSS patients showed a more profound decrease than non-SS sicca controls. In addition, pSS patients and non-SS sicca controls had higher levels of IFN-γ, TNF-α, IL-1, IL-4, IL-10, IL-12p40, and IL-17 in their saliva than non-sicca controls. Salivary TNF-α levels were higher in pSS patients than in non-SS sicca controls. Th-1/Th-2 ratios, represented by INF-γ/IL-4 and TNF-α /IL-4 ratios, were significantly higher in pSS patients than in non-SS sicca controls. SFR was found to be correlated with INF-γ/IL-4 ratio (r=0.411 p=0.024), and focus score to be correlated with TNF-α/IL-4 ratio (r=0.581, p=0.023) in pSS patients.
Th-1, Th-2, and Th17 cytokine levels were found to be elevated in the saliva of pSS patients compared with non-sicca controls. However, considerable overlap was observed between the salivary cytokine levels of pSS patients and of non-SS sicca controls. The features that most differentiated pSS and non-SS sicca were higher TNF-α levels and Th-1/Th-2 ratios. Th-1/Th-2 ratio was also found to be correlated with the clinical parameters of pSS.
Clinical and experimental rheumatology 11/2011; 29(6):970-6. · 2.15 Impact Factor
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ABSTRACT: We report a case of vortex keratopathy in a patient treated with vandetanib for non-small cell lung cancer (NSCLC). A 44-year-old female who underwent two cycles of chemotherapy for NSCLC complained of visual blurring in both eyes after the initiation of vandetanib, an anti-epidermal growth factor receptor (EGFR) and anti-vascular endothelial growth factor receptor 2 protein tyrosine kinase inhibitor. On ophthalmic examination, visual acuities were 20 / 20 OU and, with the exception of diffuse vortex keratopathy in both eyes, other findings were unremarkable. Vandetanib is believed to have caused vortex keratopathy in this patient. Anti-EGFR properties affecting normal corneal epithelial cell migration and wound healing or drug associated metabolite deposition, which is the case in numerous drug-associated vortex keratopathies, may be possible underlying mechanisms in the formation of this corneal complication.
Korean Journal of Ophthalmology 10/2011; 25(5):355-7.
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ABSTRACT: The principal objective of this study was to evaluate the protective effect of cysteamine against the oxidative stress-induced cell death of human corneal endothelial cells.
In this study, human corneal endothelial cells (HCECs) were cultured according to a previously published method. With treatment of 0 mM or 5 mM of tert-butyl hydroperoxide (tBHP) with various concentrations (0-50 mM) of cysteamine, reactive oxygen species (ROS) production was measured using an oxidation-sensitive fluorescent probe, and dichlorofluorescein diacetate (DCFH-DA) methods. Cell viability was assayed via the Cell Counting Kit-8 method. The levels of cellular glutathione were also assessed enzymatically with glutathione reductase using a commercial glutathione assay kit (Cayman Chemical, USA).
This study showed that cysteamine reduced 2',7'-dihydrodichlorofluorescein oxidation and increased glutathione. Cysteamine significantly inhibited tBHP-induced ROS production. Cysteamine-treated cells evidenced higher viability relative to the controls at 5 mM tBHP, and cysteamine also effectively protected HCECs against ROS-induced cell death via an increase in intracellular glutathione.
Our data indicate that cysteamine was not toxic at low concentrations and, at high concentrations, protects HCECs against oxidative injury-mediated cell death via the inhibition of ROS production, although cysteamine is toxic in cells at high concentrations without oxidative stress.
Current eye research 10/2011; 36(10):910-7. · 1.51 Impact Factor
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ABSTRACT: A population-based cross-sectional study to investigate the association between depression and dry eye disease (DED) in a community-dwelling elderly population.
The subjects were 657 Korean elders ≥ 65 years of age randomly selected from an official household registration database in Yongin, Korea. DED symptoms were assessed using the six-item Dry Eye Questionnaire. DED signs were evaluated using the Schirmer test, fluorescein stain score, tear film break-up time (BUT). Depression was assessed using the Korean version of the Short Geriatric Depression Scale (SGDS-K). The association between DED and depression was evaluated using logistic linear analyses.
The SGDS-K score correlated with the number of positive responses in the Dry Eye Questionnaire (r = 0.229, P < 0.001), but not with tear film break-up time (r = 0.041, P = 0.139) or Schirmer test score (r = 0.048, P = 0.642). In the binary logistic regression model, female sex (P = 0.014), residence in urban areas (P < 0.001), depression (P < 0.001), and Schirmer score of ≤ 5 mm (P = 0.035) were associated with the risk of DED. Depression was associated with the risk of DED (P < 0.001) in the patients with Schirmer score > 5 mm but not in those with Schirmer score ≤ 5 mm (P = 0.290).
Depression was associated with DED symptoms in subjects with normal or mildly reduced tear production.
Investigative ophthalmology & visual science 09/2011; 52(11):7954-8. · 3.43 Impact Factor
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ABSTRACT: To evaluate the efficacy of a computerized optokinetic nystagmus (OKN) test in detecting visual acuity (VA) of >20/200.
This was a combined retrospective and prospective, noninterventional study. In phase I of the study, data from 168 eyes of 154 subjects who underwent the computerized objective VA test using OKN responses at Seoul National University Bundang Hospital were reviewed and reanalyzed, and a table for predicting the range of subjective VA for each step of objective VA was made. From the table, the cutoff value for detecting VA of >20/200 was determined. In phase II of the study, the distribution of subjective VA according to each objective VA step was determined for 80 eyes of 40 subjects at Seoul Veteran's Hospital. The sensitivity and the specificity of our cutoff value were evaluated in the two groups.
No significant difference was found in the distribution of subjective VA according to objective VA steps between the two groups. For the subjects in phase I of the study, the sensitivity of our cutoff value was 91.7% and the specificity was 88.3%. For patients in phase II of the study, the sensitivity of our cutoff was 86% and the specificity was 96.7%.
This study shows that an objective VA test using OKN responses can be effective in predicting real VA and detecting VA of >20/200.
Investigative ophthalmology & visual science 08/2011; 52(10):7492-7. · 3.43 Impact Factor
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ABSTRACT: The purpose of the present study was to evaluate the toxicity of voriconazole on cultured human corneal endothelial cells (HCECs). HCECs were cultured and exposed to various concentrations of voriconazole (5.0 to 1,000 μg/ml). Cell viability was measured using a Cell Counting Kit-8 (CCK-8) and live/dead viability/cytotoxicity assays. Cell damage was assessed using phase-contrast microscopy after 24 h of exposure to voriconazole. To analyze the effect of voriconazole on the intercellular barrier, immunolocalization of zonula occludens 1 (ZO1) was performed. A flow cytometric assay was performed to evaluate the apoptotic and necrotic effects of voriconazole on HCECs. Cytotoxicity tests demonstrated the dose-dependent toxic effect of voriconazole on HCECs. Voriconazole concentrations of ≥100 μg/ml led to a significant reduction in cell viability. The morphological characteristics of HCECs also changed in a dose-dependent manner. Increasing concentrations of voriconazole resulted in fading staining for ZO1. Higher concentrations of voriconazole resulted in an increased number of propidium iodide (PI)-positive cells, indicating activation of the proapoptotic pathway. In conclusion, voriconazole may have a dose-dependent toxic effect on cultured HCECs. The results of this study suggest that although voriconazole concentrations of up to 50 μg/ml do not decrease cell viability, intracameral voriconazole concentrations of ≥100 μg/ml may increase the risk of corneal endothelial damage.
Antimicrobial Agents and Chemotherapy 07/2011; 55(10):4519-23. · 4.84 Impact Factor
