[Therapeutic effect of corneal collagen cross-linking in necrotizing herpetic stromal keratitis, report of two cases]

To evaluate the effectiveness of corneal collagen cross-linking with UV-A and riboflavin [CXL] for treatment of refractory herpes simplex virus necrotizing keratitis. Two patients with a diagnosis of HSV necrotizing stromal keratitis referred to Khalili hospital eye emergency room and who were resistant to conventional treatment underwent CXL. Response to treatment was evaluated clinically by speed of reepithelialization and decrease in stromal infiltration. One patient had history of previous corneal graft because of HSV kerstitis and had a good response to CXL. Another patient had a relatively good response, but recurrence was occurred. Although CXL seems promising in the treatment of patients with refractory necrotizing keratitis, in some cases it may less effective and recurrence is possible

[Advanced retinopathy of prematurity at poostchi ROP clinic, Shiraz]

To evaluate patients with advanced retinopathy of prematurity [ROP] among neonates referred to Poostchi ROP clinic in Shiraz from March 2006 to February 2008. Among referred infants to Poostchi clinic for screening and management of ROP, medical records of patients with advanced ROP [stage 5] at initial examination or during disease progression were evaluated. Information regarding gestational age, time of diagnosis, follow-up programs and causes of delayed screening were recorded. Overall, 20 patients [11 male, 9 female] out of 1024 reffered neonates had advanced ROP which was unilateral in 3 [15%] and bilateral in 17 [85%] patients. Advanced ROP was due to late diagnosis and treatment in 17 [85%] patients and treatment failure in 3 [15%] patients. Main causes of delayed diagnosis were uninformed parents in 10 [50%] patients, misdiagnosis by an ophthalmologist in 3 [15%] patients, socioeconomic problems and parental ignorance in 3 [15%] patients and poor systemic condition of the neonate in 1 [5%] patient. The main cause of visual loss due to advanced ROP is uninformed parents and health care providers as well as absence of an organized screening program

Histopathologic changes of extraocular muscle fibers after injection of botulinum toxin

Use of botulinum toxin is becoming a popular way in treatment of some forms of strabismus. To evaluate the morphological changes in the orbital surface layer muscles of the rabbit eye following a single injection of botulinum toxin. 10 white Dutch rabbits weighing 2-3 kg received either 10 units [group 1; n=5] or 20 units [group 2; n=5] of botulinum toxin into the superior rectus muscle of right eye. The superior rectus muscle of the left eye in each rabbit was considered as control. The diameter of at least 20 muscle fibers of the orbital layer of the superior rectus muscle was measured with an ocular micrometer on histological sections after extirpation 2 and 1 0 days, and 4, 8 and 1 2 weeks after the injection. Marked decrease in size of muscle fibers was observed, especially on 2 and 10 days post-injection. It was more sever in animals which received 20 units of the toxin. In both groups, between 4 and 12 weeks after injection, the size of some fibers returned back to normal; rarely, the fibers became hypertrophic while atrophic changes were still present. Hypertrophy of neuro-muscular end-plate was seen accompanied with atrophic changes. Fibrosis around the muscle fibers was rarely seen. Injection of botulinum toxin into extraocular muscles causes atrophic changes which seems to be more severe with higher doses. The effect of botulinum toxin has been persisted up to 8 weeks

[Microbial inhibitional in non-inflamed human aqueous after oral antibiotic intake]

To investigate the penetration of cefixime, cephalexin and ciprofloxacin into the human eye based on microbial inhibition by human aqueous samples after oral administration. Sixty patients aged 40 to 75 years who were scheduled for cataract surgery were divided into three equal groups. One group received 500 mg oral ciprofloxacin 24, 12 and 2 hours preoperatively; another group received 500 mg oral cephalexin 24, 18, 12, 6 and 2 hours before the operation and the third group received 400 mg oral cefixime 24, 12 and 2 hours prior to surgery. Immediately before opening the anterior chamber, 0.1 ml of aqueous was taped with an insulin syringe. A 4 ml sample of the patient's blood was obtained simultaneously. Aqueous and serum specimens as well as a standard antibiotic disc were placed on the culture media of a known bacterium which was completely sensitive to the respective antibiotic. After 48 hours microbial inhibition zone of each sample was compared to the standard antibiotic disc. No microbial inhibition zone was seen by aqueous samples, however very large zones of inhibition were seen by discs of serum samples and antibiotics. It seems that oral cefixime, cephalexin and ciprofloxacin do not achieve effective concentrations in human aqueous for microbial inhibition

Myotonic muscular dystrophy with bilateral uveitis and swan neck deformity of fingers

Myotonic muscular dystrophy [MMD] is a heredofamilial disease with multi-system involvement. In particular, it involves the skeletal muscles [as well as cardiac and smooth muscles], eye, cranial bones and the endocrine system, while other organs such as the gastrointestinal system,skin, and respiratory system are less frequently involved [1,2]. The disease is inherited in an autosomal dominant manner with complete penetrance and highly variable expression.It has a prevalence rate of 3-5/100,000 [2,4]. The symptoms appear from birth to 60 years of age [the majority in the second decade of life] [4,5]. In the large series of 67 cases presented by Pruzanski [1],males comprised 61% of the cases while in other series male to female ratios have been 1:5 [6] and 1:1 [7]. The patient reported below suffered from progressive HMD. In addition, during the course of his disease he developed bilateral uveitis and severe swan neck deformity of all fingers both of which have not been reported in English literature in association with MMD