BINA
Year:2001 | Volume:7 | Issue:1|Papers Count:11

Purpose: To determine the etiology and associated factors of infectious keratitis in patients referring to the Totoonkaran hospital of Rasht.Material and methods: All patients with infectious keratitis admitted to the hospital from autumn 1997 till summer 1998 were included in this study. Specimens were taken from the cornea, and conjunctiva of both eyes and send for direct smear, and culture on blood agar, chocolate agar, and Saboroud agar. The cultures were incubated at 37 C and 25 C for bacteriological and mycological investigations, respectively.Results: Nineteen patients (36%) were female and 34 (64%) were male. Thirty-five (66%) of them were farmers; 55% of the cases had a history of trauma, over 50% of which were abrasions with rice stem or leaves. Mycotic keratitis was more prevalent in summer (71.5% of the patients were admitted during summer) which is rice harvesting season in Guillan. Seven of 11 cases of diagnosed mycotic keratitis were due to trauma from which 4 were accidental abrasions with rice stem or leaves. In mycotic keratitis, Cladosporium species (27%) and Candida albicans (27%) were the most common fungi and in bacterial keratitis, coagulase negative staphylococci (33%) were the most common isolated bacteria.Conclusion: The majority of the patients were farmers and more than 50% of mycotic keratitis was post-traumatic, particularly rice stem abrasion. This may be of epidemiological concern. Considering the higher number of male patients and the higher number of cases in summer (rice harvesting season) providing farmers with medical advices (including the use of protective eyeglasses at work) through mass media may prove beneficial.

Purpose: Penetrating keratoplasty in children has been reported with variable results. This study reports the visual results and success rate of PKP in a series of young children with CHED.Patients and methods: In a retrospective study, children less than 12 years old who underwent PKP and were followed at least for 6 months post-operatively, were recalled. They were operated between 1987-1997 by one surgeon. Demographic characteristics of the patients, indication for PKP, pre and post-op management along with final visual outcome and graft clarity were evaluated. Visual result was evaluated by McNemmar test and graft survival by Kaplan-Meyer analysis. Linear regression was used for evaluating the correlation of visual outcome and age at which PKP was done.Results: Twenty-four eyes of 15 patients (7 males and 8 females) were operated. Age of patients at the time of diagnosis was 6.5± 3.6 years. The first PKP was performed at 8.1± 2.5 years of age. Mean follow-up period was 35.5 ±36.2 months. Pre and Post operative VA could be evaluated with Snellen chart in 19 eyes of these cases. Pre-op VA was 20/80 or less in all cases, which decreased to 44.4% post operatively (P<0.002). Post-op VA improved in 94.7% of the eyes. There was no relation between age at which PKP was done and final visual outcome (R2= 0.007). At the last examination, 19 of 23 corneal grafts were clear (82.6%) while 3 cases were hazy (13%) and one was opaque (4%). Allograft rejection was seen in 10 eyes (43.4%) of which 7 were endothelial. All graft failures were due to endothelial rejection. The probability of first graft survival was estimated to be 88% at 3 years and the overall survival rate was 55%.Conclusion: PKP for CHED in children has an acceptable visual outcome and surgical success rate, but appropriate timing for achieving the best results is still controversial.

Purpose: To determine epidemiologic and clinical characteristics of keratoconus patients.Material and methods: This prospective descriptive study was done on 388 eyes of 200 keratoconus patients. Demographic characteristics, family history, and history of contact lens wear were recorded. All patients underwent ophthalmologic examination.Results: The mean age of patients was 18.2 years (SD = 5.7; range, 5-48 years), 57% were male, and positive family history was seen in 5.5% of the cases. It was unilateral in 6% of patients. Uncorrected visual acuity less than 20/40 was seen in 87% of the eyes and 34% had best corrected visual acuity of 20/40 or better. Corneal ectasia and central or paracentral thinning were seen in 35.5% of the eyes. Fleisher's ring, vogt's striae, and corneal opacity were seen in 40%, 31.4%, and 17.2% of the eyes, respectively. About 75% of the patients had acceptable visual acuity with spectacles or hard contact lenses and 21.2% was candidate for penetrating keratoplasty.Conclusion: Epidemiologic and clinical characteristics of our patients were compatible with other studies.

Purpose: To show the efficacy of adjuvant topical 0.04% mytomycin-C with concurrent surgery for the treatment of conjunctival-corneal intraepithelial neoplasia (CCIN) and squamous cell carcinoma (SCC). This study was performed in Farabi Eye Hospital between February 1999 and May 2001.Method: This uncontrolled clinical trial was performed on 5 patients with CCIN and 3 affected by SCC (seven cases were primary and one was recurrent). All of them underwent complete excision with intraoperative application of 0.04 % mitomycin-C and postoperative application of topical 0.04% mitomycin-C, 4 times daily for 3 week.Results: Patients were followed between 9 to 15 months (10.3± 4.7 months). One patient was lost to follow up and others showed clinical regression. An acute transient toxic keratoconjunctivitis was observed in all treated cases. One patient showed early evidence of corneal melting.Conclusion: Application of topical 0.04% mitomycin-C may be a useful adjunct with complete excision to prevent recurrence. Further research is recommended.

Purpose: To report results of A/V crossing adventitial sheathotomy for the treatment of branch retinal vein occlusion (BRVO) associated with macular edema and hemorrhage. Methods: We performed surgical decompression of BRVO via pars plana deep vitrectomy (lens sparing), PVD induction, and A/V crossing adventitial sheathotomy in 3 patients with severely decreased visual acuity (20/200<). Because of macular hemorrhage, edema, and ischemia, these cases were not good candidates for grid macular photocoagulation. Reperfusion of the retina was observed by surgically separating the overlying retinal arteriole from the venule following vitrectomy and adventitial sheathotomy techniques.Results: Intraoperative decompression of the A/V crossing was achieved in all three patients. All patients showed improvement as determined by fundus examination, photography, and fluorescein angiography. Post operative visual acuities improved in all cases.Conclusion: Surgical decompression of BRVO via A/V crossing sheathotomy is a technically feasible procedure that can result in rapid reperfusion of the retina. Resolution of macular hemorrhage, edema, and ischemia may improve visual prognosis in patients with this common retinal vascular disorder.

Purpose: To determine the effect of laser photocoagulation in the treatment of active foci of toxoplasma retinochoroiditis.Methods: Fifteen eyes from 15 patients with active toxoplasma retinochoroiditis underwent photocoagulation with diode laser (810 nm). Lesions were at least one disc diameter (DD) far from the foveola and optic nerve head and less than 2 DD in size. The patients were followed up at least to 6 months.Results: Resolution of active toxoplasma retinochoroiditis was achieved in 13 out of 15 cases, thus the success rate was 87.7%. Two cases had recurrence after 6 months. One was in the border of the first laser-therapy area and in the other was further away from it. No significant complications occurred following the laser therapy, only one patient had hemorrhage peripheral to the retinochoroiditis lesion probably due to vasculitis secondary to toxoplasmosis. The lesion regressed within 2-8 weeks.Conclusion: This investigation offers encouraging short-term results and establishes that there is low chance of complication with diode laser treatment to be expected in active lesions of toxoplasma retinochoroiditis.

Purpose: To evaluate the effectiveness of combined intraocular injection of gentamicin and clindamycin in the prevention of acute post-traumatic bacterial endophthalmitis following penetrating ocular injuries.Materials and methods: A prospective double-masked randomized pilot study was conducted on 60 eyes of 60 patients with penetrating ocular injuries. Following primary repair, the eyes were randomized into two groups: 1- Antibiotic injection group (treatment): intracameral or intravitreal injection of 0.1 ml of antibiotic (40 µg of gentamicin and 45 µg of clindamycin).2- BSS injection group (controls): intracameral or intravitreal injection of 0.1 ml BSS.For all patients standard prophylactic antibiotic therapy was initiated too. Incidence of acute post-traumatic bacterial endophthalmitis and rate of "injection related posterior segment complication" in treated and controlled eyes were the main outcome measures. Result: The overall incidence of acute post-traumatic bacterial endophthalmitis was 6.6% (four eyes) and interestingly all happened in BSS injection group (P= 0.056).The incidence rate for those with retained intra-ocular foreign bodies (IOFB) was 13.3% and for those without IOFB was 4.4%. No cases of retinal toxicity developed.Conclusion: Combined intraocular injection of gentamicin and clindamycin may be an effective modality in the prevention of acute post-traumatic bacterial endophthalmitis without any significant side effects at the dosage used.

Purpose: To evaluate the etiology and risk factors of post-PK endophthalmitis.Materials and method: Published articles from 1976 to 2000 were reviewed from literature and internet web sites.Results: Reported post-op endophthalmitis is between 1 to 7%. Of 8883 donor corneas sent by the I.R.I. Eye Bank, endophthalmitis has been reported in 8 cases (1%).Conclusion: Despite all preventive measures, post PK endophthalmitis is a night-mare for all corneal surgeons.

Purpose: To report a patient with metastatic cutaneous melanoma presenting as intermediate uveitis.Patient and Finding: We examined a 49 year old man with Clark's level IV cutaneous melanoma and metastasis who was treated for bilateral intermediate uveitis. Biomicroscopic examination disclosed a normal anterior segment and vitreous organization with presence of RBCs and some non-pigmented cells in both eyes. Funduscopy disclosed a retinal metastasis in the right eye, but vitreous organization precluded visualization of the retina in the left eye. The first diagnostic vitrectomy was negative for malignant cells in the left eye. However progressive worsening of the condition persuaded us to repeat vitrectomy in the left eye and to perfrom it in the right eye. Harvested vitreous samples were positive for malignant melanoma cells in both eyes.Conclusion: Metastatic cutaneous melanoma to the vitreous cavity is exceedingly rare and may masquerade as intermediate uveitis. It should be considered in the differential diagnosis of unusual uveitides and masquerade syndromes.