[Endogenous klebsiella endophthalmitis associated with liver abscess]

To report a case of endogenous Klebsiella endophthalmitis associated with liver abscess in Iran. A 79 year old man was referred with chief complaint of left eye pain and visual loss. The patient had conjunctival hyperemia, corneal edema, hypopyon and severe vitreous cellular reaction in the left eye and yellowish conjunctival discoloration which was apparent in the right eye. Abdominal CT scan revealed a right liver lobe abscess that underwent percutaneous liver biopsy under sonography guide. Blood, vitreous and liver mass cultures revealed Klebsiella Pneumonia growth. The patient was diagnosed as a case of endogenous Klebsiella endophthalmitis secondary to bacteremia associated with liver abscess. This report suggests that rather than being confined to Far East, endogenous endophthalmitis secondary to liver abscess due to Klebsiella pneumonia may be a global problem

[Postoperative pain after cooling PRK]

To compare post-operative pain with cooling photorefractive keratectomy [PRK] versus conventional PRK. A prospective clinical trial was performed on 94 eyes from 47 patients scheduled for PRK. Patients were randomly assigned to either cooling or conventional PRK. Pain was evaluated 6, 12, 24 and 48 hours post-operation using a visual analogue scale [VAS]. Corneal haze, conjunctival and palpebral edema, and complications were also assessed. Mean age of the patients was 24.8 +/- 4.5 [range: 18-36 years] and mean refractive error was 3.6 +/- 1.6 diopters. Median pain score in the cooling group at 6 and 12 hours was 15 and 10, respectively and zero at 24 and 48 hours. Median pain score in the conventional group at 6 and 12 hours was 30 and 15 and was zero at 24 and 48 hours. There was no adverse effect in either of the groups. Cooling PRK effectively reduces post-operative pain after PRK without any additional adverse effect

[Fortified cefazolin-gentamicin versus fortified vancomycin-ceftazidime drops for treatment of bacterial corneal ulcers]

To compare the efficacy of treatment with fortified cefazolin-gentamicin versus fortified vancomycin-ceftazidime eye drops for treatment of bacterial corneal ulcers. A double-blind clinical trial was performed on 89 patients with bacterial corneal ulcers who were referred to Feiz Hospital, Isfahan, Iran from 2004 to 2005. Patients were randomly assigned to two groups: one group included 41 patients who received fortified cefazolin-gentamicin eye drops and the other group included 48 patients who received fortified vancomycin-ceftazidime eye drops. Patients were evaluated in terms of time for re-epithelization, reduction of stromal infiltration and reduction in anterior chamber inflammation as well as culture results and drug complications. The patients included 57 [64%] male and 32 [36%] female subjects. Cultures were negative in 46%. Re-epithelization time was 13.2 +/- 3.1 days in the cefazolin-gentamicin group and 9.6 +/- 2.7 days in the vancomycin-ceftazidime group [P=0.01]. Time for reduction of stromal infiltration and corneal ulcer treatment was 17.7 +/- 4.3 days in the cefazolin-gentamicin group vs 13.8 +/- 3.6 days in the vancomycin-ceftazidime group [P=0.04]. The most common complaint of patients was eye burning in 73.1% of cases in the cefazolin-gentamicin group and 62.9% of cases in the vancomycin-ceftazidime group [P=0.007]. Fortified vancomycin-ceftazidime eye drops are more effective than fortified cefazolin-gentamicin eye drops for the treatment of bacterial corneal ulcers and seem to entail fewer adverse effects

[Dry eye following keratorefractive surgery]

To compare tear secretion values following LASIK [laser in situ keratomileusis] and photorefractive keratectomy [PRK]. Patients referred to Aban Eye Clinic [Isfahan, Iran] for refractive surgery were randomly assigned to LASIK or PRK. Exclusion criteria were contraindications for refractive surgery, usage of topical ocular drugs, dry eye and reoperation. Schirmer test was performed pre- and 1, 3 and 6 months postoperatively. The study included 176 eyes of 88 patients [30 male and 58 female] with mean age of 24.7 +/- 3.5 [range 19-34] years. Each group included 44 patients without any statistically significant difference regarding age, sex, mean spherical equivalent and corneal thickness. Mean values of Schirmer test were 13.5 +/- 5.3 mm in the PRK group and 14.5 +/- 7.1 mm in the LASIK group [P=0.08] preoperatively which reached 11.7 +/- 4.2, 12 +/- 4.1 and 12.7 +/- 5 mm in the PRK group and 13.5 +/- 3.6, 14.3 +/- 5 and 14.2 +/- 5.1 mm in the LASIK group at 1, 3 and 6 months postoperatively, respectively [P=0.07, P=0.09 and P=0.17, respectively]. There were 4 cases [4.5%] of dry eye 6 months postoperatively in the LASIK group vs nill in the PRK group [P= 0.04]. Tear secretion decreases following both PRK and LASIK, however it seems to be more severe after LASIK

Deep Vitrectomy with and without Silicone Oil in Infectious Endophthalmitis

To evaluate the efficacy of silicone oil injection after deep vitrectomy in infectious endophthalmitis regarding visual acuity. This single-blind randomized clinical trial was performed on 50 cases of infectious endophthalmitis undergoing deep vitrectomy. Patients were randomly assigned to two groups: in one group silicone oil was injected into the eye at the end of the operation [silicone group] and in the second group the eye was formed with balanced salt solution [non-silicone group]. All patients were followed for more than six months. The underlying cause of endophthalmitis was cataract surgery in 23 patients [46%], trauma in 20 patients [40%], bleb-associated endophthalmitis in 3 patients [6%], corneal graft in 2 patients [4%] and endogenous in 2 patients [4%]. Mean visual acuity was 2.1 LogMAR in the silicone group and 4.0 LogMAR in the non-silicone group [P< 0.0001]. Silicone oil injection may be beneficial in terms of visual outcomes in deep vitrectomy for infectious endophthalmitis

[A comparision of success rate between Ext. D.C.R and end D.C.R]

Currently, many patients are referred to our department because of continuous or inflammatory tearing; and the diagnosis is Dacriocystitis. Dacriocystitis is an infection of the lachrymal sac and is treated with External Dacriocystorhinostomy [Ext. D.C.R], an operative approach that has a failure rate ranging from 3% to 15%. Most of the failures are related to the incomplete inspection of the intranasal cavity during the operation. Endoscopic D.C.R. is another approach that has two advantages 1] avoid incision and prevent scar formation. 2] According to the perfect inspection of the intranasal cavity, the success rate is expected to increase. The aim of this study is to compare the success rates of End. D.C.R and Ext. D.C.R. This study tries to complete the previous studies that introduced End. D.C.R as a new approach to surgeons. In the previous studies, End. D.C.R was performed by using of YAG Laser that is expensive and inaccessible; whereas, we performed the procedure by using of suction cautery and punch forceps. For collecting the data, we designed a check list that was filled by one physician. Then the data was analyzed. Each of the groups included 43 patients. According to the statistical analysis, overall 28 males and 58 females underwent one of the operational approaches. The difference between the two groups in the duration of the disease and the patient complaints were not statistically significant On the other hand, the difference between the two groups in the duration of surgical approaches, presentation of tearing, regurgitation and bleeding one week after surgery were not statistically significant. But the presentation of the pain in End. D.C.R was less than in Ext. D.C.R. Three months after surgery, the difference between the two groups in presentation of tearing and open ducts were not statistically significant, but the regurgitation in End D.C.R. was less than Ext. D.C.R. Patient satisfaction of elimination of symptoms is not different, but satisfaction of scar in End. D. C.R is significantly less than Ext.D.C.R. The endoscopic approach appears to have two major benefits against the Ext. D.C.R; first, it avoids an external incision; and second, it allows a perfect view of intranasal cavity at the time of surgery so that a common cause of D.C.R. failure could be avoided. With this approach YAG laser is replaced with suction cautery and punch forceps