ABSTRACT
To report the outcomes of conjunctival-limbal autograft [CLAU] in patients with unilateral total limbal stem cell deficiency [LSCD] emphasizing surgical problems, complications, and their management. In this prospective interventional case series, CLAU combined with amniotic membrane transplantation as a graft was performed on 26 patients with unilateral total LSCD due to chemical or thermal injuries. Penetrating keratoplasty [PKP] was performed on eyes with dense corneal opacification. Main outcome measures were visual acuity, corneal transparency and vascularization, and complications. Optical PKP was performed on 18 eyes. Best spectacle-corrected visual acuity [BCVA] was 2.28 +/- 0.45 LogMAR before CLAU which improved to 0.64 +/- 0.52 LogMAR and 0.35 +/- 0.13 LogMAR at final follow-up in eyes with and without PKP, respectively. Corneal transparency and vascularization, which were graded as 4+ before surgery, improved to a mean of 1.7 +/- 0.8 and 2.1 +/- 0.7 three months after surgery. Mean epithelial healing time was 8.8 +/- 4.1 [range 5 to 20] days. Longer healing occurred in 5 eyes due to small lenticules [n=2], exposure [n=2], and conjunctival encroachment [n=1]. Mean healing period for epithelial defects over PKP was 8.8 +/- 5.5 [range 4 to 14] days. Persistent epithelial defects occurred in 8 cases with cut lenticules [n=2], small-sized lenticules [n=2], and chronic exposure [n=4]. Lenticule-related complications were thick lenticules [n=4], conjunctival mantle encroachment [n=2], dislodging [n=4], progressive thinning [n=2], small size [n=3], and accidental trephination [n=2]. CLAU combined with AMT with or without PKP is effective in anatomical and visual rehabilitation of eyes with unilateral total LSCD. This procedure increases corneal transparency and decreases vascularization. The lenticules should be handled carefully in order to avoid most common lenticule-related complications
ABSTRACT
To report 3 cases of nocardia keratitis following photorefractive keratectomy [PRK]. Report of Outbreak: Four eyes of 3 patients [2 female and one male] who had undergone PRK by a single surgeon at a single center developed nocardia keartitis 3 to 6 weeks postoperatively. Mean age was 25 [range 23-28] years and mean onset of corneal manifestations was 29 [range 21-40] days after PRK. Corneal smear and culture and confocal scan were performed in all eyes. Two eyes from the first two patients required lamellar keratectomy to debulk the involved stroma and to obtain specimens for microbiologic and histopathologic evaluation. Light microscopic examination disclosed gram-positive and acid-fast filaments of nocardia which were confirmed by the microbiologic results. Diagnosis of nocardia keratitis in the third case was not as challenging as the first two cases because of a high index of suspicion. Confocal scan in all cases disclosed hyperreflective and slender fibril-like structures in the corneal stroma. All eyes responded favourably to topical amikacin and the infection resolved without recurrence. Nocardia is a rare cause of keratitis following PRK. Clinical suspicion along with microbiologic, histopathologic and confocal scanning help to establish the correct diagnosis. The most probable cause of the outbreak was inadequate attention to sterility during surgery
ABSTRACT
To evaluate stem cell deficiency using impression cytology [IC] in patients with chronic and delayed-onset mustard gas keratopathy [MGK]. A consecutive series of patients with MGK underwent IC Thirty-five eyes of 18 patients [all male] with mustard gas keratopathy were included in this observational case series. Presence of goblet cells on the corneal side of specimens was considered to indicate stem cell deficiency. Corneal involvement was graded as mild, moderate and severe. Relation between IC findings and clinical grading was evaluated. There was limbal stem cell deficiency in at least one quadrant of the cornea in all 35 eyes [100% of cases]. No differences was found between impression cytology findings [positive versus negative for corneal goblet cells] among different quadrants [p= 0.378]. Clinical grading was the same between nasal and temporal quadrants [P=0.266] and between superior and inferior quadrants [P= 0.263]. Combining the superior and inferior quadrants [vertical zone] and also the nasal and temporal quadrants [horizontal zone] together, clinical grading was more severe in horizontal versus vertical zones [p< 0.001]. There was no correlation between stem cell deficiency and clinical corneal severity [p=0.893]. Varying degrees of stem cell deficiency was demonstrated in all patients with chronic or delayed-onset MGK using IC Clinical corneal manifestations are more severe in nasal and temporal quadrants. We found no correlation between stem cell deficiency and clinical manifestations. Other factors such as perilimbal conjunctival ischemia might play a role
ABSTRACT
To compare clear corneal incision and scleral tunnel incision in terms of intraocular pressure [IOP], post-operative inflammation, induced astigmatism, and corneal edema in phacoemulcification. This non-controlled clinical trial was conducted on 78 eyes with senile cataract. A clear corneal incision was made in 40 eyes and a scleral tunnel incision was made in 38 eyes. All eyes underwent standard phacoemulsification. Post-operative inflammation and corneal edema was measured 1, 7, and 60 days post-operatively. IOP was also measured preoperatively and 1, 7, and 60 days post-operatively. Corneal astigmatism was measured before and 7 and 60 days after surgery. Results: Post-operative inflammation was greatest on the first post-operative day in both groups, but there was no significant difference between them. In both groups, IOP was highest on the first postoperative day with no significant differences at any times of follow up. Mean decrease of IOP at 2 month comparing to preoperative value was 1.4 mmHg in the scleral tunnel group and 1.1 mmHg in the clear corneal group. Mean astigmatism preoperatively and on post-operative days 7 and 60 was 1.052 +/- 0.805, 0.993 +/- 0.653, and 0.730 +/- 0.527 diopter, and 0.893 +/- 0.850, 1.137 +/- 1.011, and 0.975 +/- 1.012 diopter in the scleral tunnel and clear cornea groups, respectively. Astigmatism on days 7 and 60 were grater in clear cornea incision. Against the rule induced astigmatism was more frequent in the clear corneal group. [p<0.04] In both groups, corneal edema was highest on the first post-operative day with no significant differences between the two groups. Scleral tunnel incision is better than clear corneal incision for minimizing post-operative corneal astigmatism in small incision cataract surgery
ABSTRACT
Background: Entering of raw wastewater from textile industries would damage the environment. Mutiple purpose wastewater treatment processes, would probably be of interest to industries' owners
Objective: The study aimed to use potassium ferrate to refine textile industry's wastewater and compare its efficiency with ferric chloride method
Methods: This study was done in Tarbiat Modarres university in 1997 which a number of wastewater samples from several textile industries were randomly taken. The potassium ferrate was synthesized with the help of Jartest, the optimum PH and doses of k[2]fe0[4] were determined. The surveyed indices were C.O.D, T.S.S, sludge index, percentage of light in /I max absorption. Also, the samples were microbiologically assessed
Findings: Using potassium ferrate, removal efficiency for C.O.D and T.S.S in the range of 89-92.4% and 94-96% were concluded. The optimum PH and doses of K[2]fe0[4] were in range of 5-6 and 60-85 mg/1, respectively. The volume of sludge produced were 1.5-2.5% of the primary wastewater volume. Light transmittance in /I max was shown 77-79%. To analyse microbicidal efficiency of this chemical the M.P.N/100ml of samples were performed which all showed figures less than 100
Conclusion: Because of using less potassium Ferrate, the amount of chemicals and sludge volume were considerably reduced. Also, costs for establishment and conduction of wastewater treatment foundations maybe significantly reduced. In removing C.O.D, T.S.S, color and disinfection of wastewater, K[2]Fe0[4] has a great efficiency