JOURNAL OF CURRENT OPHTHALMOLOGY
Year:2003 | Volume:16 | Issue:1|Papers Count:10

Purpose: Voltaren (Diclofenac sodium 0.1%) is the first NSAID eye care product approved by FDA for use immediately after cataract surgery to treat ocular inflammation. There are numerous reports of corneal complications of generic Diclofenac (Falcon). This article is aimed at elucidating the impact of Voltaren on tear film of 24 patients with idiopathic episcleritis after a period of 14 days treatment.Materials & Methods: This research designed as a double-blind randomized clinical trial.Baseline values of tear film function of both control and experimental groups obtained through tear breakup time (TBUT) and Schirmer I tests and reassessed on day 15.Voltaren and placebo (normal saline 0.9%) were given to experimental and control groups, respectively. Both groups received Ibuprofen 400mg q8h. Results were analyzed using pooled-t-test.Results: Among 24 patients in experimental group, mean baseline TBUT and Schirmer I values were 15.88 (11-25) seconds and 16.58 (10-35) mm, respectively. At the end of the treatment period, mean TBUT and Schirmer I values measured 14.62 (8-20) seconds and 14.25 (7-31) mm, respectively.In 27 patients of control group, mean baseline TBUT and Schirmer I values were 14.54 (10-22) seconds and 14.58 (10-37) mm, respectively, and on day 15 recorded as 13.62 (9-18) seconds for TBUT and 13.41 (8-25) mm for Schirmer I. A statistically significant difference in schirmer I observed between experimental and control groups (0.89 mm with P=0.008, CI=95%).Conclusion: Despite statistically significant reduction in Schirmer I values among experimental group, it seems to be too small to be clinically important. However, with prolonged application of Voltaren, the impact may become more obvious. Additional time expanded clinical trials are recommended.

Background and Obiectives: The aim of this study was to evaluate the results and complications of early vitrectomy in eyes with severe proliferative diabetic retinopathy and useful vision.Patients & Methods: In a retrospective study, we reviwed the hospital records of 31 patients who had undergone early vitrectomy for active and sever proliferative diabetic retinopathy at Labbafi-Nejad Eye Center from 1991 to 1999, and the collected data were analysed statistically.Results: There were 21 male (67.7%) and 10 female (32.3%) patients. The mean age of the patients was 50 yrs (range: 21-71 yrs.) and the mean age at the time of operation was 45.5 yrs (range: 21-66 yrs.). The mean duration of the diabetes and ocular involvement were 15.5 (range: 3-31 yrs.) and 2.37 (range: 0.17-10 yrs.) years respectively. The operation had performed on the right eyes in 16 cases (51.6%) and the left eyes in 15 cases (48.4%). 6 patients had had Type I, 17 patients Type 11and 8 patients Mixed Type of diabetes mellitus. In 26 patients (84%), the fellow eye also had had proliferative diabetic retinopathy. Preoperative VA was 10/200or better in all of the patients and BCVA was in the range of 10/200 to 20/200in 48.3% and 20/30or better in 13% of patients. At 1 year after the operation, VA increased in 16 patients (51.6%) and decreased in 12 patients (38.7%). VA was less than 10/200in 3 patients and 20/30or better in 7 patients. The most common causes of visual loss at 1 year after operation were macular changes (38.7%) and opacity of lens (19.4%). The most frequent intraoperative complications were retinal breaks in 9 patients (29%) and vitreous hemorrhage in 5 patients (16%).Conclusion: Early vitrectomy in eyes with severe proliferative diabetic retinopathy and useful vision can increase the chance of restoring or maintaining good vision specially in patients with type I diabetes mellitus.

Purpose: Determination of ideal incision in phacoemulsification to decrease pre-existing and eventual astigmatism.Patients & Methods: 100 patients with cataract were included in the study and preoperative keratometery was done in all of them.An incision was performed on the steeper axis. Seven different kinds of incisions were done overall: Superior scleral tunnel; Large superior clear corneal incision with sutures (6mm); small superior clear corneal incision (3.2 mm) with and without sutures; Large temporal clear corneal incision (6mm) with sutures; small temporal clear corneal incision (3.2 mm) with and without sutures.Keratometery was performed preoperatively, at one day, one week, one month, three months and one year following surgery.Results: Mean preoperative astigmatism was 1.1 diopter and postoperatively it was 2.9, 2.3, 1.9, 1.5, 1.5 diopters at one day, one week, one month, three months and one year following surgery respectively. There was less surgically induced corneal astigmtism in small temporal clear corneal incision without sutures and superior scleral tunnel incision (0.9 diopter corneal astigmatisn change during one year).Surgically induced corneal astigmatism was greater in small superior clear corneal incision without suture. (2.3 diopter corneal astigmatism change during one year) The rate of against the rule astigmatism was increased postoperatively in all incisions.Conclusion: Upper lid pressure on the superior corneal incision led to against the rule astigmatism that was higher than that induced by temporal incision.Comparison between small temporal clear conreal incisions (between 3.2 mm and smaller) is recommended.

Purpose: To assess the effectiveness, safety and stability of Laser epithelial keratomileusis (LASEK) for moderate to high myopia.Methods: Fifty-one eyes of 28 myopic patients were enrolled in this prospective, uncontrolled clinical study. All eyes operated by one surgeon. Slit-lamp examination, manifest refraction, uncorrected and spectacle-corrected visual acuity, and videokeratography were done before surgery. Patients assessed at first 7 days, 1 and 3 months after surgery. A questionnaire assessed glare and halo in the scale of 0 to 5 (5 for very severe) 1 and 3 month after surgery. Pain was assessed in the scale of 0 to 3 (3 for severe) subjectively. A grading score (in the scale of 0 to 4+) was used for assessment of corneal haze.Results: All patients were examined at 1 month, and 37 eyes (74%) were examined at 3 month. One month after surgery, 49 eyes (98%) achieved an uncorrected visual acuity of 20/40 or better. The mean epithelial healing time was 3.26 days ±1.14, the mean subjective pain score was 1.11±0.83. The mean spherical equivalent refraction was - 6.54 diopters (D) ±1.17 before surgery, and it was 0.32 D±0.55 at 1 month, and 0.16 D ± 0.77 at 3 months after surgery. At 1 month and 3 months after surgery, 46.0% and 45.9% of eyes had up to grade 1 of haze. One eye had grade 2 of haze at 1 and 3 months postoperatively. At 3 months after surgery, the mean glare score was 1.83:t0.99 and the mean halo score was 2.43:t1.44.Conclusion: In this study, LASEK showed its efficacy, safety, and predictability for treatment of moderate to high myopia.

Background and Objectives: Acute elevations in intraocular pressure (lOP) commonly follow extracapsular cataract extraction (ECCE) and posterior chamber IOL implantation in glaucoma patients. The objectives of this study were to compare the results and complication rates between trabeculectomies combined with ECCE and posterior chamber IOL implantation versus those with separate procedures.Patients & Methods: This prospective clinical trial involved 38 eyes of 35 patients with cataract and coexisting glaucoma. 19 eyes underwent combined extracapsular cataract extraction and posterior chamber IOL implantation with trabeculectomy and clear cornea cataract surgery performed after successful trabeculectomy in 19 eyes. The age and sex of the patients, glaucoma type, follow up duration, visual acuity, lOP and the number of glaucoma medications was measured and recorded pre- and postoperatively. The results analysed with appropriate statistical tests.Results: At 18.5±12.3 months of follow-up, lOP decreased from 23.4±7 mmHg to 14±4 mmHg in the combined group (p<0.001) and in the clear cornea group, after 22.2±14 months of follow-up, lOP changed from preoperative 11±5.3 mmHg to 15±4 mmHg postoperatively (p<0.01). There was no statistically significant difference in postoperative lOP between two groups. The number of glaucoma medications changed from 1.3±O.99 preoperativelyto 0.84±0.52 postoperatively in combined group and from 0.36±0.77 to 1.11±1.1 in clear cornea group. There were no statistically significant differences in terms of postoperative lOP levels, visual acuity and numbers of postoperative glaucoma medications between the two groups at the final follow up visit. The operation complications; anterior uveitis and hyphaema were more frequent in combined group. However, all of them were well controllable with the current treatments.Conclusion: There were no significant differences in terms of VA, lOP and numbers of postoperative glaucoma medications between the two groups, so the results suggest that combined surgery may be a relatively safe procedure and can be done in cataract patients with coexisting glaucoma.

Purpose: To evaluate the visual and refractive results of laser in situ keratomileusis (LASIK) for mild to severe hyperopia with or without astigmatism.Setting: Private Aban Clinic, ISFAHAN; IRAN.Material & Methods: This quasi-experimental study comprised 51 eyes of 26 patients. All patients were operated by one surgen (M.G) using technolas 217 excimer laser.Hansatome microkeratome was used to create a corneal Flap with diameter of 9.50 mm and thickness of 160-180 mm.Results: 51 eyes of 26 patients (61.5% Male and 38.5% Female) ranging in age from 19 to 54 years were operared. Of these; 13 eyes had simple hyperopia and other 38 eyes had hyperopic astigmatism.Mean preoperative refractive error was +4.40±1.70 D. which reduced to +0.99 :1:0.640 postoperativly (P<0.001).Pre-operative mean astigmatism was 1.07+1.14 D. which regressed to 0.58 diopter following operation.Pre-op. BSCVA of 20/20 was found in 25. 47% of eyes whilst it was found in 27.45% of eyes postoperatively.Pre-op UCVA 20/20 and 20/40 or greater were seen in 00.00% & 05.88% eyes respectively whilst were seen in 15.68 and 82.35% eyes post-op.Symptoms of blured vsion in 73.10% ; glare in 69.20%, forgin body sensation in 34.60% and eye strain in 19.30% were detected postoperatively.Pseudo-fleischer ring and SPK were visible in ophathalmologic examination of 56.80% and 09.80% of patients in postoperative examination respectively.Conclusion: LASIK was an effective procedure for correction of mild to moderate degrees of simple and astigmatic hyperopia in our experience although some minor complications has been occured.

Purpose: To determine the efficacy and safety of preserved human amniotic membrane transplant in patients with exposed Hydroxyapatite implants.Methods: Preserved amniotic membrane was used for 14 eyes of 14 patients with exposed Hydroxyapatite larger than 3 milimeters.In the first 7 patients, single-layered amniotic membranes and in the next 7 patients multi-layered amniotic membranes were used.The patients were followed for 2-5 weeks.Results: In the cases of single-layered amniotic membrane within a mean period of 1.7 weeks and in the cases of multi-layered amniotic membrane within a mean period of 3.9 weeks, the amniotic membranes were degraded.The size of defect did not decreased in any of the cases.Conclusion: In this study, amniotic membrane transplantation was not successful in the treatment of Hydroxyapatite Exposure.

Purpose: Comparison of short-term efficacy and safety of topical cyclosporine-A and mitomycin-C in the treatment of refractory vernal keratoconjunctivitis.Methods: A fellow-eye controlled trial in which topical 2% cyclosporine-A and 0.005% mitomycin-C, four times daily for four weeks were administered concurrently for fellow eyes of 21 patients.Results: Cyclosporine-A brought about significant objective improvement relative to the baseline (P=0.012) and more objective improvement in comparison with mitomycin-C (P=0.046). Cyclosporine-A was associated with a better relative ocular comfort (P=0.003). Mitomycin-C was associated with 14 new cases/exacerbations (67%) of punctate keratopathy and five cases (24%) of hypotony. Hypotony was associated with limbal involvement, disease duration, and severity (P values<0.05). Six patients (29%) reported remarkable burning sensation following application of cyclosporine-A.Conclusion: Topical mitomycin-C, even at low doses and in the short-term does not seem to be a safe management of vernal keratoconjunctivitis as it can result in significant punctate keratopathy and hypotony. Short-term topical Cyclosporine-A is an efficacious safe adjuvant to current modalities for severe vernal keratoconjunctivitis. Its long-term efficacy and safety (including tolerability of its pharmacological formulation) are the areas of future research and development.

Background& Purpose: IOL power calculation is one of the current problems in cataract surgery. This study was performed to evaluate the accuracy of six IOL power calculation formulas in patients undergoing senile cataract surgery.Patients & Methods: This was a clinical trial on 61 eyes in 58 patients with senile cataract.All eyes underwent uncomplicated phacoemulsification or extracapsular cataract extraction and posterior chamber intraocular lens (PCIOL) implantation.Final refraction was performed 6 months after surgery; absolute refractive error was calculated as observed error minus expected error. Eyes were divided into three groups regarding axial length: <22mm, 22-24.5 mm and >24.5mm. Results were analyzed using the ANOVA and LSD tests.Results: Out of 58 cases, 32 subjects (55.0%) were male and (45.0%) were female. Patients age ranged from 35-80 y (mean 65±11.2 y) overall mean absolute error was 1.09±0.67 and there was no significant difference among the six formulas. In eyes of short axial length SRKI yielded better results in terms of final absolute error (P<0.05) However in medium and long eyes no significant difference was observed among the six formulas.Conclusion: Overall, the mean absolute errors of the six formulas were similar. We suggest that the choice of IOL calculation formulas should be based on availability, familiarity and simplicity; a higher level of caution should be considered in short eyes.

Purpose: We investigated the usefulness of amniotic membrane transplantation on ocular surface (conjunctiva, cornea and sclera) reconstruction.Design: Retrospective case series. Material & Methods: 29 eyes of 28 patients who underwent amniotic membrane transplant in a 14 months period in Farabi Eye Hospital were included in our study. Follow up duration ranged from 4-14 months (mean 6.7 months). In conjunctival reconstruction; scar tissue was excised and amniotic membrane graft was secured in place by interrupted 8-0 vicryl sutures. In persistent corneal epithelial defect, after fine debridment, amniotic membrane was spread on epithelial side up and secured by interrupted or continuous 10-0 nylon sutures.Results: Of 17 eyes which underwent conjunctival reconstruction, 14 eyes had successful results; but operation failure was occurred due to fornical contraction in 2 eyes and implant exposure in 1 eye. All the remaining cases (with scleral melting after petrygium excision and persistent corneal epithelial defect) had good results.Conclusion: Preserved human amniotic membrane may be considered as an alternative substrate for ocular surface reconstruction.