Local injection of bevacizumab as an alternative method for management of recurrent pterygium

Surgery has so far been used for primary treatment of pterygium; however, one of the major limitations is its high recurrence rate. This study was performed to determine the effect of bevacizumab in recurrent pterygium. Patients with recurrent pterygium were divided into two groups, receiving bevacizumab [Group 1] or normal saline [Group 2]. They were evaluated for photophobia and any conjunctival congestion and were scored from 0 to 4 prior to any injection. The size of pterygium was assessed in relation to extension of pterygium on the cornea over the limbus. All patients were followed in regular 48 hour intervals weekly up to one month and then monthly up to 6 months after the injection. There were 50 patients in group 1 and 48 in group 2 and the mean age of the patients was 40.94 +/- 13.82 and 47.10 +/- 5.9 years, respectively with a male to female ratio of 1 2. The mean size of ptrygium was 52.84 in group 1 and 46.02 in group 2. In group 1, photophobia and conjunctival congestion were 59.53 and 61.27, respectively while in group 2, they were 39.16, and 37.24, respectively. In the first 48 hours, conjunctival congestion and photophobia were higher in group 1 but there was no significant difference regarding the size of pterygium. After one week, the scores were significantly lower in group 1 while the mean rank for the size of pterygium was 52.84 in group 1, and 46.02 in group 2. After 1 and 6 months, the scores were lower in group 1. Subconjunctival injection of bevacizumab can be considered as an effective temporary treatment in the management of recurrent pterygium in those who are not a candidate for secondary operation. It can decrease conjunctival congestion and photophobia and prevent further progression even in the long term

Corneal Pachymetry using Ultrasound Vs Orbscan II in Normal and Post-LASIK Eyes

To compare orbscan II [0 II] and ultrasound [US] pachymetry in normal and post-LASH[eyes. In a comparative prospective study, central corneal thickness [CCT] was measured in 168 eyes of 84 normal subjects and 42 eyes without corneal opacity of 21 post-LASIK patients by 0 II and US. Paired t test was used to identify significant differences between the two methods and Pearson test was used to identify the correlation of measurments between the two methods. Mean CCT measured by ultrasound [538.7 +/- 47.4 gm] was less than that of 0 II [542.7 +/- 52.2 gm] in the normal eyes [P<0.04], but mean CCT measured by ultrasound [477.8 +/- 38.2 lam] was greater than that of 0 II [469.5 +/- 47.2 gm] in the post-LASIK eyes. [p<0.02] There was significant linear correlation between US and 0 II in both groups. [r=0.87, P=0.000 and r=0.88, P=0.000, respectively]. Mean difference of CCT measurements between 0 II and US in normal and post LASIK clear cornea is not clinically significant and interchangeable use of data in planning or assessing corneal surgery is possible

[Topical cyclosporine A 2% in management of endothelial corneal allograft rejection]

To determine whether adding 2% topical cyclosporine [CSA] to local and systemic steroids in treatment of endothelial corneal allograft rejection improves the outcome. A prospective randomized treatment trial was carried out on 40 consecutive corneal graft recipients, presenting with the first episode of endothelial graft rejection in two groups. Group one [20 patients] received topical steroid eye drops and oral prednisolone [1mg/kg]. Group two [20 Patients] received the same topical and systemic therapy plus 2% cyclosporine eye drops. The patients were followed up for three months and their clinical outcomes were evaluated by the rates and time for reversal of rejection. In group one, 14 [70%] cases had total reversal of graft rejection episode which started within a mean period of three days, but in the CSA group, it occurred in 18 [90%] cases which started within a mean period of 1.5 days [P=0.21]. Among patients who sought treatment early [< 6 days], survival rates were 85% and loo%, respectively [P=0.2]. In high risk patients, the rejection reversal rate was 66% in CSA group and 25% in the control group [P=0.5]. Addition of 2% CSA eye drop to topical and systemic steroids may improve the rates of graft rejection reversal. It may also decrease the interval between initiation of treatment and improvement of clinical signs

Comparative evaluation of visual acuity and complications in ECCE+P/C IOL and phacoemulsification+ P/C IOL in Senile Cataract

The age related cataract surgery is most common ophthalmic surgery. Today the method of choice for cataract surgery is phacoemulsification. This study was conducted to compare the visual acuity, pre-operation and post operation ECCE and Phacoemulsification complication in patients referring to Khalili and Dastgheib Hospital in Shiraz during 1380-1381. This prospective non randomized concurrent control study was conducted on 100 cases [52 case of ECCE and 48 case of Phaco]. Pre-operative evaluation included age, sex, visual acuity, astigmatism according to keratometry difference and type of cataract. The patients were evaluated during the operation for size, site of incision, posterior capsular rupture, vitreous loss and nucleus dropped in vitreous. Then in 1, 5, 14, 90,180 days post operation, they were examined for BCVA, UNCVA, astigmatism [keratometry and refraction], inflammation, corneal edema, posterior capsular opacity and clinical CME. In this study 100 cases [48 phacoemulsification, 52 ECCE] aged 48-76 for cataract surgery were included. Patients were followed for 6 months after operation. Mean age in phacoemulsification was 58.27 +/- 7.26 and in ECCE was 64.71 +/- 6.84. On the fifth day after ECCE, UNCVA >/= 30.60 was 15.3% and in phaco was 62.5%. On the fifth day mean UNCVA in phaco was 30.60 and in ECCE, 20.60. Mean astigmatism on the first day post-operation according to keratometry difference in ECCE was 4.84 +/- 2.08D and in phaco was 2.27 +/- 1.67D and according to refraction in ECCE was 3.62 +/- 2.08D and in phaco was1.91 +/- 1.34D. Posterior capsular rupture in ECCE was 7.6% and in phaco was 12.5%. Vitreous loss in ECCE was 5.7% and in phaco was 10.7%. Corneal edema in the first day post-operation in ECCE was 19.2% and in phaco was 43.8%. Two weeks after operation in all patients who underwent phacoemulsification, corneal edema was cleared, but in ECCE 3.8% corneal edema continued for 6 months after operation. Nucleus dropped in vitreous occurred only in phaco [2.1%] IOL dislocation after phacoernulsification was 4.1% and 2.1% [1 case] need to IOL removal, but this complication was not visible in ECCE. Success rate, Intra operative and post-operative complications in phacoernulsification in comparison to other studies were in an acceptable range. We recommend further study in this case for more documented results

Correlation of corneal allograft rejection with tumor necrosis factors-alpha gene polymorphism

Correlations between bone marrow, heart, kidney, liver, skin and lung transplant rejection or survival with human cytokine gene polymorphisms have been described. There are also reports about the role of cytokines and Tumor Necrosis Factors-Alpha [TNF-alpha] on corneal transplant in animal models. Further studies are needed to clarify the role of cytokines in corneal allograft rejection in humans. To study whether corneal allograft rejection is associated with TNF-alpha gene polymorphism. A total of 105 cases of corneal transplant were followed for a mean period of 25.9 months and the episodes of rejections recorded. We determined allele-specific PCR [ASPCR] TNF-alpha gene polymorphism of the patients and evaluated their association with rejection. Results; The overall incidence of corneal graft rejection and its subsequent recovery were 21% and 63.6% respectively. Rejection was more common in the vascularized corneas [5.4 folds; P<0.001], and in eyes with anterior synechia [3.9 fold; P<0.05]. There was no correlation between TNF-alpha gene polymorphism and the chance of allograft rejection. No association was found between human TNF-alpha 308 G/A promoter gene polymorphism and corneal allograft rejection in our cases of uncomplicated penetrating keratoplasty

In vitro susceptibility of fungal isolates of keratomycosis to antiseptic agents

Fungal corneal ulcer is the most dangerous and challenging type of infective keratitis. Since most of the ophthalmic antifungal drops are scarce and expensive in developing countries, attempts have been made to study fungicidal property of some readily available antiseptic agents as a substitute. Povidone iodine [PI] and chlorhexidine gluconate [CHx] has been postulated to be effective against fungi. To study in vitro antifungal efficacy of PI and CHx. Fungi isolated from cases of keratomycosis were entered in a prospective study from June 2001 to March 2002. In vitro susceptibility of these fungi was tested by broth dilution method of NCCLS Standard to PI [1%, 2%, 5%, 10%] and CHx [0.04%, 0.1%, 0.2%] after 5 minutes, 1 hr, 24 hrs and 48 hrs exposure times. From a total of 16 culture-proven cases of fungal keratitis, the isolated fungi were 8 Aspergillus sp, 3 Fusarium sp, 2 sterile hyphae, 1 Candida sp, 1 Drechslera sp, 1 Rhodotorula sp. PI showed 100% fungicidal effect with all tested concentrations, after 5 minutes of exposure to all fungal species. CHx. 0.1% and 0.2% after 1 hr exposure were as effective as PI [p>0.34]. The fungicidal efficacy of CHx 0.1% and 0.2% was significantly less than PI after 5 minutes [p<0.001]. Both PI and CHx have strong in vitro fungicidal effect. The kill rate of CHx, however, is less than PI. Since in vitro efficacy of topical ophthalmic preparations is affected by multiple factors, our study provides a good idea for further in vivo investigations about this subject