ABSTRACT
Tears have antimicrobial, nourishing, mechanical, and optical properties and contain components such as growth factors, fibronectin and vitamins to support proliferation, migration and differentiation of corneal and conjunctival epithelial cells. Lack of these epitheliotrophic factors, as in dry eye, can result in severe ocular surface disorders such as persistent epithelial defects. Recently, the use of autologous serum in the form of eye drops has been reported as a new treatment for severe ocular surface disorders. Serum eye drops may be produced as an unpreserved blood preparation. They are by nature non-allergenic and their biomechanical and biochemical properties are similar to normal tears. In vitro cell culture experiments showed that corneal epithelial cell morphology and function are better maintained by serum than by pharmaceutical tear substitutes. Clinical cohort studies have reported its successful use for severe dry eyes and persistent epithelial defects. However, the protocols to prepare and use autologous serum eye drops varied considerably between the studies. In addition to different biochemical properties, protocol variations may also influence the epitheliotrophic effect of the product. Before establishing the definitive role of serum eye drops in the management of severe ocular surface diseases in a large randomized controlled trial, this has to be evaluated in more detail. Based upon the literature reviewed here, two preliminary standard operating procedures for the preparation of serum eye drops are proposed
ABSTRACT
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
Subject(s)
Humans , Male , Female , Cataract Extraction/adverse effects , Visual Acuity , Phacoemulsification , Astigmatism , Lenses, Intraocular , Corneal Topography , Corneal EdemaABSTRACT
To evaluate the results of laser in situ keratomileusis [LASIK] retreatment in patients with postoperative regression. In a retrospective interventional case series, 153 eyes of 113 patients who had undergone LASIK retreatment for postoperative regression were evaluated. Both initial LASIK and retreatment were performed with a Nidek: EC 5000 excimer laser, and flap was made with a Moria microkeratome. Mean age was 29.63 +/- 2.2 yr [range, 20 to 54 yr] and mean follow-up was 11 months [range, 3 to 34 mth] after the initial surgery and 13.1 months [range, 12 to 18 mth] after retreatment. Retreatment was performed 3-34 months after the primary LASIK. Mean spherical equivalent [SE] was -5.39 +/- 2.69 diopters [D] [range, -1.50 to -14.00 D] before initial LASIK and -1.76 +/- 1.08 D [range, -0.50 to -5.00 D] before retreatment. Mean astigmatism was -1.38 +/- 1.07 D [range, -0.50 to -5.00 D] before initial LASIK and -1.12 +/- 0.50 D [range, -0.50 to -2.50 D] before retreatment. One year after retreatment, mean UCVA was 20/25, and mean SE was -0.29 +/- 0.02 D. Best corrected visual acuity [BCVA] improved in all eyes. Two eyes received more than one retreatment. Twenty eyes had flap wrinkling, 2 eyes had diffuse lamellar keratitis [DLK], and 2 eyes had epithelial ingrowth after the initial LASIK. Four eyes had epithelial ingrowth and 2 eyes developed mild keratectasia after retreatment. LASIK retreatment is a safe and effective option with small amounts of myopia and myopic astigmatism regression. The rate of retreatment is higher in patients with myopic astigmatism and in patients with less than 40 years of age, also the risk of complications in retreatment is higher than the initial LASIK. Refractive changes are more stable after retreatment. The risk of keratectasia is higher in final residual stromal bed thickness less than 250 lam after the reoperation
ABSTRACT
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
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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
ABSTRACT
To evaluate the effect of amniotic membrane transplantation in trabeculectomy. The study was conducted on 25 eyes of 25 patients with advanced and medically uncontrolled glaucoma. All patients underwent trabeculectomy with a fornix based conjunctival flap, amniotic membrane was than placed under the scleral flap and fixed using 10-0 nylon suture. Amniotic membrane was retrieved from healthy pregnant women during elective cesarean section. Preoperative intraocular pressure was 33.5 +/- 5.0 mmHg [26-50 mmHg] with full medication, which decreased to 12.4 +/- 1.8 mmHg [9-15 mmHg] post-operatively [P=0.0001]. intraocular pressure was less than 21 mmHg after surgery in all eyes, with [8%] or without [92%] use of antiglaucoma medications after six months. The use of amniotic membrane in trabeculectomy can increase the chance of success in terms of maintenance of a functional bleb and prevention of failure. This method may be superior to antimetabolites due to lack of complications
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Purpose: To evaluate the in-vitro susceptibility of bacterial isolates from the cases of corneal ulcer to povidone iodine. Setting: Department of ophthalmology, and clinical microbiology research center, Shiraz University of Medical Sciences, Shiraz, Iran. Patients and The in-vitro susceptibility and Minimum Inhibitory Concentration [MIC] of the bacteria isolated from the cornea of 50 cases of bacterial corneal ulcer to povidone iodine was determined by broth dilution method. Concentrations of 1%, 2%, 5% and 10% of povidone iodine were tested. Bacterial isolates included 50% S. epidermidis, 20% P. aerogenosa, 10% S. aureus, 4% Acintobacter, 4% S. pneumoniae, 4% E-coli, 2% Proteous, 2% S. viridance, 2% Diphtheroid and 2% Bacillous. Povidone iodine bactericidal efficacy for gram positive bacteria was at least 82.36%, 91.2%, 100% and 100% in 1%, 2%, 5% and 10% concentrations after 5 minutes exposure time. The bactericidal efficacy of this agent over the gram negative bacteria was at least 62.5%, 87.5%, 100% and 100% in 1%, 2%, 5% and 10% concentrations after 5 minutes exposure time, respectively. Povidone iodine was shown to have a broad spectrum in- vitro bactericidal efficacy in cases of bacterial keratitis. If further invivo studies confirm the efficacy of this agent over the bacterial keratitis, it would be suggested as a broad spectrum medication for the treatment of these cases
Subject(s)
Humans , Male , Female , Keratitis , Povidone-Iodine , Bacteria , Microbial Sensitivity TestsABSTRACT
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
Subject(s)
Humans , Female , Male , Graft Rejection , Transplantation, Homologous , Tumor Necrosis Factor-alpha/genetics , Polymorphism, Genetic , GenesABSTRACT
Agricultural utilization of wastewater sludge is practiced in many parts of the world. Sludge may contain a variety of pathogenic microorganisms, which can spread diseases if there is human exposure to the sludge. Therefore, sludge must be treated before disposal and reuse. In this study the effect of liming on the microbiological quality of urban liquid raw sludge in Isfahan Wastewater Treatment Plant [IWTP] was investigated. Sludge samples were taken from IWTP, and the initial concentrations of total solids, volatile solids, total coliform, fecal coliform. Salmonella and ova of parasites were determined. Then adding lime to increase the pH of sludge to 11 and 12 and the effect of liming on the parameters was carried out after 2, 24, 72 and 120 hours. Salmonella was inactivated completely in treated sludge after two hours. The removal of up to 99% of fecal coliform was obtained for two ranges of pH. However, reduction of ova of parasites at pH 11 and 12 after five days were found only 56% and 83.8% respectively. Sludge treated with lime meets USA Environmental Protection Agency [EPA] st and ards regarding Class B and Class A after 2 and 24 hours respectively. At pH higher than 11 and 12 treated sludge with lime meets vector attraction reduction requirements after two hours. However, at a pH higher than 11 and 12 treated sludge with lime does not meet the guideline for pathogen reduction of class a regarding eggs of parasites