Herein we describe a staged surgical technique consisting of PENETRATING sclerokeratoplasty (PSKP) followed by PENETRATING keratoplasty (PKP) and present its clinical course and complications over two years of follow-up. A 23-year-old man presented with cosmetically unacceptable protrusion of the globe corresponding to the cornea and sclera. PSKP was performed transplanting a full-thickness beveled 13 mm corneoscleral tectonic graft. Hypotony developed subsequently and was successfully managed medically, however corneal graft failure occurred. After 15 months, a 7.5 mm PKP was performed for optical reasons, which subsequently remained clear with a healthy epithelium. In this particular case, cosmetic, tectonic, therapeutic, and optical requirements were met. PSKP is a surgical procedure which entails a high rate of complications but may be the only alternative when the main goal of intervention is restoration of the globe in complicated cases such as our patient.

PENETRATING cardiac trauma is a medical emergency and should be managed as soon as possible. There are some different causes of cardiothoracic injury, which gun and stab wounds are the most important direct cause of PENETRATING cardiac trauma. Pepending on the wound size, PENETRATING cardiac trauma causes different clinical manifestations. Small stab wounds lead to cardiac tamponade, meanwhile severe hemorrhage and shock are reported for gun wounds. A 45 years old man was admitted with complaints of dyspnea, weakness and severe hemorrhage during a dispute. There were two wounds on the thorax the first wound was in 5th intercostal space at left mid clavicle and the second was in 10th intercostal space at left mid axillary. Breath sounds were going to diminish in the left base. After performing CPR in emergency room, the patient was sent to operation room immediately. In operation room a left thoracotomy was performed. There was a bleeding area on apex. Apex rupture and pericardial rupture were repaired and bleeding was controlled. After 48 hours echocardiography and chest x-rays were normal and the patient was discharged in good conditions after 7 days.

Background and Aim: Emergency Laparatomy is a therapeutic and surgical method which is applied for many kinds of diseases especially abdominal trauma. Abdominal trauma (PENETRATING and blunt trauma) is one of the most common causes of emergency laparatomy. Some years ago all the patients with abdominal PENETRATING trauma underwent laparatomy but since the results were incredible and negative laparatomy had increased, some new criteria were determined for surgery and as a result the elective laparatomy replaced the obligatory laparatomy.Materials and Methods: This is a descriptive prospective study on the patients who had undergone emergency laparatomy following the abdominal trauma. The data were based on the available dossiers in Hospital.Result: out of 138 trauma patients who had undergone laparatomy, 96 of them contacted blunt trauma and 42 PENETRATING trauma. The largest number of laparatomy patients was in the third decade of their life. The most common reasons for trauma were stab and car accident. CT scan and abdominal lavage were not used for any of the patients. In blunt trauma, clinical symptoms and examinations were used but in PENETRATING trauma just because it is PENETRATING, laparatomy was used. In PENETRATING and blunt trauma there were respectively 20 and 8 cases of negative laparatomy. The rate of mortality in traumatic patients was reported just 5 cases.Conclusion: 52.2% of laparatomy in blunt trauma was the result of car accident and 26.1% of laparatomies in PENETRATING trauma was the result of stab. This statistics show that social-cultural problems should be taken more seriously. The prevalence of negative laparatomy in PENETRATING trauma is the best reason for changing the obligatory laparatomy to the elective laparatomy, so being penetrative isn't sufficient for laparatomy .

Purpose: Glaucoma following PENETRATING keratoplasty (PK) continues to be a serious problem that may ultimately become sight threatening. Knowledge of the risk factors for development of glaucoma following PK, such as preexisting glaucoma, pseudophakia, aphakia, and previous PK, can limit the occurrence and improve the outcome of the keratoplasty. The management of postkeratoplasty (Post-PK) glaucoma remains controversial with a wide range of treatment modalities available, including newer classes of drugs, laser therapy, filtering surgery with mitomycin C, and implantation of glaucoma drainage devices (GDDs), as well as various cycloablative treatment modalities, including cyclocryotherapy and cyclophotocoagulation (CPC) with noncontact and contact neodymium: yttrium-aluminum-garnet (Nd: YAG) laser, a semiconductor diode, and endoscopic cyclophotocoagulation (ECP).Methods: A literature search was conducted on the Medline database using the search terms glaucoma, PK, trabeculectomy, GDDs, cyclocryotherapy, Nd: YAG CPC, diode laser CPC, and ECP for the 35-year period between 1975 and 2010. Several articles that were not found by Medline search were cited in the references of other articles. Articles were included because of their subject relevance or were excluded so as to avoid redundancy. Abstracts written in English of non-English-language articles were also reviewed.

Purpose: To report a case of recurrent keratoconus after PENETRATING keratoplasty (PK). Patient and findings: A 31-year-old male patient who had undergone PK in his right eye for keratoconus 10 years ago presented with gradually decreased vision in the right eye. Clinical, topographic, and histopathologic features of the cornea including irregular myopic astigmatism, central and paracentral corneal thinning, and foci of break and fragmentation in Bowman's layer were in keeping with the diagnosis of keratoconus.Conclusion: Slow recurrence of keratoconus characteristics in the corneal graft after PK may result from graft repopulation by recipient's keratocytes, graft aging or both and may occur along with the process of cellular invasion from the recipient and renewal of resident cells.

Introduction: PENETRATING traumata"s to the skull is important cause of death special in industrial societies. The present study was done on twenty cases of PENETRATING traumas to base of skull; and patients were studied for Epidemiology, clinical symptoms, treatment procedures, evolution and prognosis. Study Methods: This research was done in a retrospective method on patients admitted to Mashhad Emdadi Hospital (Mashhad Emergency Hospital) from September 2003 to January 2004. Data concerning cause of incidence, clinical symptom, accompanying damage, procedures taken, and kind of treatment and prognosis were studied in all patients. Results: On this study all twenty patients were male ranging in age from 20 to 58 years. Causes for hospital admittance were; fighting 17 cases (80%) war injuries, 3 cases and suicide, 1 case (5%). (65%) received medical treatment and seven cases received surgery (35%) Surgery included extraction of hematoma from brain tissue or Subdural, brain debridement, repair of depressed skull fracture and orbit. Thirteen patients were treated concretively and seven patients had surgical operation and five died during treatment. Primary low GCS, shock and hypertension upon hospital admission abnormal pupil and high age of the person were all influential factors causing high-rate death level in patients. Conclusion: In addition to the result of this study, the literature show quick primary cure and accessibility to medical center are extremely important factors to decrease death rate and lessen damage due to PENETRATING trauma to the skull.

Purpose: To report a case of acute comitant esotropia in a patient with bilateral keratoconus presenting after PENETRATING keratoplasty (PKP) in the fellow eye.Case Report: A 17-year-old male patient with bilateral keratoconus underwent PKP in his right eye. He experienced diplopia after removal of the patch from the operated eye 12 hour postoperatively due to esotropia in his left (unoperated) eye. Diplopia was controlled using prism glasses and botulinum toxin A injections until PKP was performed in his left eye which resulted in restoration of stable fusion up to 3 years of follow up.Conclusion: Acute comitant esotropia may occur after loss of fusion due to ocular patching in a vulnerable patient. In this patient fusion was preserved with non-surgical methods until it was restored by surgical means.

Objective: PENETRATING injuries in the maxillofacial region pose a great challenge due to the anatomical complexity inherent to the area compounded with vital functions such as vision and airway. This paper highlights the importance of meticulous preoperative planning and a concerted effort of a multidisciplinary team in managing PENETRATING maxillofacial injuries. Case Presentation: A 38-year-old man reported to the emergency department with a knife impacted in the medial wall of the orbit, travelling up to the base of the cranium. A CT scan aided in evaluating the site, depth, and relation of the foreign body to the adjacent structures. A team of oral and maxillofacial surgeons, ENT and neurosurgeon successfully retrieved the knife and the patient recovered with no morbidities. Conclusions: PENETRATING injuries in the maxillofacial region are rare and there is a dearth of documentation in literature. A quick response with proper preoperative planning and a team approach is paramount in the successful management of these patients.

Purpose: To report a case of bilateral kertatoconus who presented with acute comitant esotropia after PENETRATING keratoplasty in the fellow eye. Patient and Findings: A 17-year-oldmale with keratoconus underwent PENETRATING keratoplasty in his right eye. He experienced diplopia after removal of the patch from the operated eye 12 hour postoperatively due to esotropia in his left (unoperated) eye. Diplopia was controlled using prism glasses and botulinum toxin A until PENETRATING keratoplasty was performed in his left eye which resulted in return of fusion which remained stable after 3 years of follow up.Conclusion: Acute comitant esotropia may occur after loss of fusion due to patching of one eye in a vulnerable patient. In this patient fusion was preserved with non-surgical methods until it was permanently returned surgically.