BINA
Year:2000 | Volume:6 | Issue:1|Papers Count:13

Purpose: To determine the role of mitomycin-C in the success rate of secondary dacryocystorhinostomy (DCR).Method: Twenty eyes from 20 patients with previous history of unsuccessful DCR were randomly divided in two equal groups (A and B). Secondary DCR was performed equally in both groups with the exception that in group B a piece of sponge soaked in mitomycin-C 4% was placed between the anastomosis area and the osteotomy for 10 minutes and then washed out with 20ml of normal saline solution. All patients were visited at first week, and first, third, and sixth months after the operation. The results of the two groups were compared.Result: The success rate in both groups was 100%. Conclusion: Mytomicin-C dose not increase the success rate of secondary external DCR.

Purpose: To report amniotic membrane graft in treatment of distichiasis.Method: This quasiexperimental study was performed on 20 eyes affected by distichiasis in 20 patients. The amniotic membrane was retrieved from a healthy pregnant woman through a cesarean section.Results: Successful surgical results were obtained in 19 eyes. In one case recurrence of distichiasis was observed.Conclusion: This method may be a suitable and a safe alternative for mucous membrane grafting especially in patients suffering from Stevens-Johnson syndrome, in whom the use of mucous membrane is not recommended.

Purpose: To evaluate the efficiency of human amniotic membrane transplantation in ocular surface disorders due to chemical and thermal burns or Stevens-Johnson syndrome.Method: Two eyes from two patients with chemical burn and four eyes from four patients with thermal burn, and one eye from one patient with Stevens-Johnson syndrome underwent amniotic membrane transplantation.Results: After a mean follow up of 6.3 months (range 1-12 months) successful ocular surface reconstruction was achieved with minimal recurrence of symblepharon. Failure of surgery was seen in two eyes. Conclusion: Amniotic membrane transplantation can reconstruct the ocular surface in most cases. Despite the short period follow up and relatively few patients in this study, this approach appear to be an effective treatment in ocular surface lesions due to chemical or thermal burns or Stevens-Johnson syndrome.

Purpose: To describe prophylactic effects of oral acyclovir on recurrence of herpetic keratitis after penetrating keratoplasty.Methods: Records of 15 patients who had undergone penetrating keratoplasty due to sequels of herpetic keratitis during the years 1989-1995 were reviewed. Results: All the patients were receiving prophylactic oral acyclovir at a dosage of 800mg/day after penetrating keratoplasty for one year. There was a 20% recurrence rate of herpetic keratitis after surgery; 30% of those were accompanied by graft rejection.Conclusion: Oral acyclovir may be effective in reducing recurrence of herpetic keratitis after penetrating keratoplasty.

Purpose: To investigate the differences between conjunctival bacterial flora before and after cataract surgery with or without intraocular lens implantation, and to investigate the possible effects of prophylactic antibiotics on these changes.Method: The bacterial strains in lid margin and conjunctival samples of 80 eyes from 80 patients were examined at 1 week before surgery, at the end of operation, and 1 week after surgery. The patients underwent extracapsular cataract extraction with or without intraocular lens implantation.Results: At 1 week before operation, 45 eyes (56.7%) were culture positive. At the end of operation 7 eyes (8.7%) were contaminated which just two of them had the same bacterial strain as the preoperation. Regarding to the antibiogram study; 27 cases (60%) of the preoperative positive samples, 5 cases (71.4%) of the positive samples at the end of surgery, and 18 cases (56.2%) of the postoperative positive samples were sensitive to the applied antibiotic.Conclusion: The predominant bacterial strain at the three different sampling times was Staphylococcus epidermidis. Prophylactic antibiotics did not play any effective role in sterilizing or changing the conjuctival bacterial flora during the cataract surgery.

Purpose: To determine the extent, magnitude and direction of changes in axial length and corneal power after extracapsular cataract extraction with or without IOL implantaion.Materials and methods: This clinical trial was done on 125 eyes of 125 patients in two groups. In one group 106 eyes underwent extracapsular cataract extraction with IOL implantation in the posterior chamber and in the other group, 19 eyes underwent the same operation but without IOL implantation. The axial length was measured by means of A-scan ultrasonography in all patients before, and 3 months after the operation.Results: In both groups the axial and corneal power were decreased but the IOL power increased. None of these changes were significant statistically or clinically.Conclusion: Extracapsular cataract extraction with or without IOL implantation does not change the axial length and corneal power, and So preoperative measured values may be used as a fairly accurate estimate of postoperative values and there is no need to consider these changes in the IOL power calculation formulas.

Purpose: To examine the effects of intraocular epinephrine on systemic blood pressure and heart rate during cataract surgery with retrobulbar block.Patients and methods: Sixty-five patients with American Society of Anesthesia class I, II and III were studied. All patients had received an intraocular infusion of BSS with 0.5ml of epinephrine 1:1000.Results: There was no statistically significant change in blood pressure or heart rate during the time of administration of the epinephrine. Electrocardiographic monitoring during the surgery showed no changes.Conclusion: Administration of dilated epinephrine during extracapsular cataract surgery showed low systemic toxicity, and may be a safe and effective way for maintaining mydriasis during the surgery.

Purpose: To determine the prevalence and risk factors of intraoperative suprachroidal hemorrhage (SCH) during scleral buckling (SB) surgery.Material & Methods: The records of patients who underwent SB surgery were reviewed. Probable risk factors including age, sex, and history of diabetes mellitus, hypertension, hemorrhagic disorders, ophthalmic diseases (uveitis, glauocoma), stroke, ischemic heart disease, chronic obstructive pulmonary disease, previous ophthalmic surgery, subretinal fluid drainage, use of anticoagulative drugs, and intraocular injection (air, BSS) were evaluated. Result: There were 405 eyes from 389 patients underwent SB surgery due to retinal detachment. Eleven eyes in 11 patients were afflicted with SCH (prevalence of 2.7%). One case suffered from SCH two times in two intraocular surgeries. Statistically significant risk factors for this complication were myopia (P value=0.066) and previous SCH (P value=0.027).Conclusion: In Patients with myopia or previous history of SCH, it is recommended to perform SB surgery with special precautions.

Purpose: To evaluate the soft tissue complications, management and improvement of hydroxyapatite implantation.Materials and methods: In this prospective interventional case series study, 40 patients suffering from complications of hydroxyapatite implantation were evaluated during one year (1998-99).The patients were categorized in four groups according to the complications and then appropriate management was performed. The four groups include patients with: (1) discharge, (2) tenon hypertrophy, (3) hydroxyapatite exposure and (4) hydroxyapatite exposure with discharge. The patients were evaluated until complete cure or diagnosed as non-responsive state. Results: The most common cause of anophthalmic socket was eye trauma, most of the patients underwent enucleation. The most common complication was hydroxyapatite exposure with dis-charge. There was evidence of infection (culture positive discharge) in 70% of the patients. The most frequent organism was staphylococcus aureus. The highest rate of improvement (100%) was seen in the patients with tenon hypertrophy and the least rate (56.2%) in the patientrs with hydroxyapatite exposure (77.5%), and no improvement in 9 cases (22.5%). Conclusion: Early appropriate diagnosis and treatment of the complications of hydroxyapatite implantation will decreases removing of the implant. Despite the complications, hydroxyapatite implantation is still one of the most effective, useful, and common operations in anophthalmic sockets.

Purpose: To recommend an ideal incision for cataract surgery.Method: After searching the MedLine by using the keywords "incision, cataract surgery" the author reviewed 311 relevant articles which were published from 1966 to 2000. Among those articles the author selected some articles about postoperative astigmatism, hyphema or infection, and compared the results of them with his own experiences.Results and conclusion: An ideal cataract incision should have proper relative strength to prevent leakage from the wound with least hyphema, least induced astigmatism, and least wound infection after the operation and should decrease unnecessary manipulation during and after the surgery. This evaluation showed that a 3-step tunnel incision with an internal corneal lip has no leakage at the intraocular pressure more than 400mmHg. Analyzing the structural components of the incision showed that changing the shape of the external incision from the limbus-parallel to a linear incision or to a curved incision away from the limbus, results in a more stable incision with less induced astigmatism. Corneal stability is directly related to the internal entry of the incision. This stability improves as the closure sutures change from radial to horizontal, especially when they are closer to the internal entry. The rate of the postoperative hyphema also decreases when the horizontal closure is nearer to the internal entry of the incision. This 3-step incision is a self-sealing incision and there is no need for postoperative manipulation.

Purpose: To report a case of bilateral acute retinal necrosis (ARN) syndrome following herpetic encephalitis.Patient and method: A 35 years old man presented with acute painful loss of vision in both eyes and a history of nausea, vomiting and headache for 3 weeks. After ophthalmologic examination, ocular B-scan, brain MRI, cerebrospinal fluid (CSF) analysis, and hematologic and serologic tests were requested. Results: At the presentation the visual acuity was light perception in both eyes. Anterior segment showed moderate ciliary injection, mutton fat (KPs), and fibrinoid reaction over the iris and lens, associated with posterior synechiae due to dense vitreous organization. Fundus was not visible. B-scan showed diffuse echodensity of vitreous cavity. Brain MRI findings and CSF analysis were suggestive for herpes simplex encephalitis.Conclusion: Any patient with painful loss of vision due to uveitis associated with nausea, vomiting, and headache should be considered as herpes simplex encephalitis until otherwise is proved, because early diagnosis and management may prevent some devastating ophthalmic complications.