[Persistent corneal epithelial defect as a complication of tetracaine abuse]

To describe the clinical signs, diagnosis and treatment of toxic keratopathy in a patient who abused tetracaine drops. A 32-year-old man was referred to the emergency ward of our center with persistent corneal epithelial defect associated with a ring infiltrate in the corneal stroma, without any history of ocular trauma or contact lens use. The patient was hospitalized and a thorough ocular examination was accomplished. A detailed history in our patient revealed topical anesthetic abuse keratitis. The topical anesthetic was deliberately taken from the pharmacy without a prescription. The hallmark of topical anesthetic abuse keratitis was a persistent corneal epithelial defect and a complete ring infiltration in the corneal stroma in our case. Functional and anatomic results after appropriate treatment were not favorable in this case. Although topical anesthetic abuse keratitis is rare, it should be carefully explained to patients that although topical anesthetics numb the eye, more than a few drops can actually prevent healing and may lead to permanent damage. The unrestricted availability of topically applied ophthalmic anesthetics as over-the-counter medications in Iran must be reevaluated

[Keratocyte density in normal and keratoconic corneas using confoscan]

To compare keratocyte density between normal and keratoconic corneas in non-contact lens wearers. Confocal scanning was performed on 39 corneas of 26 patients with keratoconus and 28 corneas of 14 normal control subjects. None of the cases were contact lens wearer. All individuals underwent ophthalmic examination and computed topography in addition to confocal microscopy. Main outcome measures were anterior [10%], middle [33-67%] and posterior [10%] stromal keratocyte densities. Mean age of the subjects was 27.7 +/- 6.6 [range 18-45] years. Mean keratocyte density in the control group was 736.7 +/- 65.6 cell/mm2 in the anterior stroma, 623.4 +/- 72.6 cell/mm2 in the middle stroma and 608.6 +/- 45.8 cell/mm2 in the posterior stroma. Corresponding values in the keratoconus group were 787.9 +/- 103.5, 665.2 +/- 58.1 and 604.2 +/- 69.0 respectively. No significant difference was noted between the two groups regarding stromal keratocyte density; however stromal keratocyte density significantly decreased from anterior toward posterior stromal layers within both groups. Keratocyte density showed statistically insignificant decrease with aging. Keratocyte density was significantly higher in female subjects [P= 0.019]. No significant difference was seen between normal and keratoconic corneas in terms of stromal keratocyte density

[Phacoemulsification and intraocular lens implantation in patients with congenital iris coloboma]

To evaluate the outcomes and complications of phacoemulsification and posterior chamber intraocular lens implantation [PE+PCIOL] in patients with congenital iris coloboma. In a prospective noncomparative interventional case series, 13 eyes of 9 patients [six female and three male] with congenital iris coloboma and cataract underwent PE+PCIOL using clear corneal incision and in-the-bag foldable hydrophilic acrylic IOL implantation by one surgeon. Best corrected visual acuity [BCVA] and complications were evaluated six months postoperatively. Mean age was 46.5 +/- 5.7 years. BCVA was counting finger in six eyes and between 20/200-20/100 in seven eyes, preoperatively which increased to 20/50-20/20 in 11 eyes, postoperatively [P<0.001]. No serious complications occurred intraoperatively. Two eyes had concomitant ocular pathology causing no improvement in their visual acuity after surgery. Two patients developed postoperative monocular dioplopia. No case of retinal detachment occurred during the follow up period. PE+PCIOL seems to be safe and effective in terms of visual improvement in patients with typical congenital iris coloboma and cataract

[Comparison of trabeculectomy with and without releasable suture]

To compare the short and long-term efficacy and complications of releasable suture vs. conventional interrupted suture for scleral flap in trabeculectomy. In a prospective randomized clinical trial, 42 eyes of 42 consecutive patients requiring trabeculectomy for uncontrolled primary glaucoma underwent conventional trabeculectomy [group A] and trabeculectomy with releasable sutures [group B]; 21 eyes of 21 patients for each group. Short-term hypotony related complications and long-term intraocular pressure were measured and compared. The mean follow up was 11.7 +/- 6.5 months in group A and 9.4 +/- 6.4 months in group B. The mean 5 SD final intraocular pressure at the end of follow up period was 13.95 +/- 4 mrnHg in group A and 14.57 +/- 3 mmHg in group B [P= 0.58]. Mean reduction in intraocular pressure at the end of follow up was 54.5% in group A and 56% in group B. Final intraocular pressure was controlled [lOP

[Posterior capsular opacification: hydrophilic acrylic versus PMMA intraocular lenses]

To compare the effect of implantation of a single-piece hydrophilic foldable acrylic intraocular lens [IOL] with rectangular optic edge and a single-piece polymethyl methacrylate [PMMA] IOL with rounded optic edges on posterior capsular opacification [PCO]. This randomized clinical trial study comprised 74 eyes with senile cataract in an otherwise normal eye in patients older than 50 years. Patients were randomized to receive hydrophilic foldable acrylic or PMMA IOLs. The operations were performed using standard phacoemulsification by the same surgeon. Patients were followed for at least 9 months. PC0 was graded according to slit lamp examination [retroillumination] and best corrected visual acuity [BCVA]. The PC0 values and BCVA at 6 and 9 months after surgery, capsulorrhexis diameter, and post- operative inflammation were compared between the two groups. From 74 patients enrolled in the study, 56 patients including 28 in each group, had complete follow up and examinations. Mean age was 67.64 +/- 7.71 years. Six months after surgery visually significant PCo occurred in 2 patients [7.1%] in the acrylic group and 7 patients [25%] in the PMMA group. [P=0.00l] At 9 months YAG capsulotomy was performed in one eye [3.6%] in the acrylic group and 3 eyes [10.7%] in the PMMA group.[P=0.61] There was no correlation between PC0 with age [P=O.13] or capsulorrhexis diameter [P= 0.8]. Hydrophilic acrylic IOLs cause less PC0 than PMMA IOLs. However, the results cannot attribute to the IOL material alone as they show the importance of both material and design

[Keratectasia after LASIK versus PRK: a case report]

To report a case who had undergone LASIK in his right eye and PRK in the fellow eye for correction of equivalent myopia but developed progressive post-operative keratectasia only in the right eye. A 30-year-old man had undergone LASIK in right eye 3 years ago for correction of refractive error of - 1.75 - 1.50@48[degree] and PRJS in left eye 2 years ago for correction of refractive error of -1.00 - 1.75@ 100[degree]. Preoperative pachymetry was 447 [micro]m in the right eye and 446 pm in left eye. However, post-operative pachymetry decreased to 341 [micro]m in the right and 384 [micro]m in the left eye, but only the right eye revealed progressive corneal ectasia that led to severe visual loss [20/400]. PRJS may be a better choice for surgical correction of low amounts of myopia due to lack of flap creation; a factor that may weaken the anterior corneal structure and subsequently lead to progressive keratectasia. However, it is prudent to avoid any refractive surgery in eyes with central corneal thickness less than 500 [micro]m

[Topographic evaluation in relatives of patients with keratoconus]

To evaluate topographic corneal changes in relatives of patients with keratoconus [KCN]. This study was performed on 300 eyes on 150 relatives of 45 KCN patients. Complete slit lamp examination, refraction, and corneal topography was performed on all eyes. The topographic indices for diagnosis of keratoconus was based on Rabinowitz criteria. The study included 84 [56%] female and 66 [44%] male subjects. Mean age was 32.4 +/- 15 years [range, 16-83]. KCN was detected in 14% of the subjects and 7.3% were diagnosed as KCN suspect. The overall prevalence of astigmatism was 58% including in 42.1% in the KCN group, 66.7% in the KCN suspect group, and 49.6% in the normal group. Thirty one eyes had high regular astigmatism [>1.5 diopters] including, 17 [54.8%] in the KCN group and 14 [45.2%] in the normal group. Oblique astigmatism was seen in 33 eyes [11%] including 34.2% in the KCN group, 47.6% in the KCN suspect group, and 4.6% in the normal group. Relatives of KCN patients have a high prevalence of undiagnosed KCN. Corneal topography is very important for the diagnosis of KCN and KCN suspects in family members of KCN patients. Therefore, keratorefractive surgery should be considered cautiously in these individuals