effect of nutririon and supplements on ocular health

Nutrition is a subject of interest in many fields of medicine. So ophthalmologists have also attempted to find possible ways to preserve vision through diet and supplements. Ocular disorders such as cataracts, age-related macular degeneration and glaucoma are the leading causes of visual impairment and blindness in the world, so most of the studies have focused on these major disorders and nutritions containing antioxidant such as vitamin C and E. Zexanthin/luteins and omega 3 have been the main substances studied in this relation. Although benefits of the regimens with high amounts of antioxidants were observed in reducing progression of cataract, agerelated macular degeneration and so on, as many of these studies have been observational, the cause and effect relationship cannot be definitely concluded and multiple cohort prospective studies will be desired to evaluate the exact role of nutrition. Somehow, a healthy diet which means the diet which increases our health can be achieved in regimens with low saturated fatty acids and rich in fresh fruits, vegetables and fish. On the whole, even though they may not affect disease progression, they are generally good for overall health

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

[Local injection of bevacizumab for treatment of primary active pterygium]

To report subconjunctival injection of bevacizumab [Avastin] for treatment of primary active pterygium. Patients with primary active pterygia without other ocular disease, pregnancy or diabetes mellitus were enrolled. Patients were randomly allocated into two groups to receive injection of Avastin or placebo. Patients were evaluated for changes in photophobia, conjunctival congestion and size of the pterygium. In the first 48 hours, conjunctival congestion was greater in the treatment group as compared to the placebo group [125.76 vs 73.98, P<0.001]. The same was observed for photophobia [139.01 vs 69.18, P<0.001], but there was no difference in the size of pterygium between the two groups [105.86 vs 94.08, P= 0.130]. After one week, conjunctival congestion [90.98 vs 108.20, P= 0.01] and photophobia [85.08 vs 114.36 P<0.001] were less marked in the treatment group; however, mean pterygium size did not differ between the two groups [105.89 vs 94.06, P= 0.120]. This trend continued up to 6 months after the injection, the time at which the results regressed to become similar to those observed 48 hours after injection. Local injection of bevacizumab may be effective in treatment of pterygium; however, repeat injections should be considered

Prevention of selenite-induced cataract by L-cysteine and vitamin C in rats

Development of a drug which could prevent or delay the onset or progression of cataract will help to reduce the number of people getting blind due to cataract worldwide. This study was undertaken to evaluate the clinical and biochemical changes of the crystalline lens and gel-electrophoresis of water soluble proteins in a selenite- induced cataract and to assess the preventive role of L-Cysteine and vitamin C in rat as an animal model. Cataracts were induced in rats by administration of sodium selenite. In control group, saline was injected subcutaneously [SC]. In experimental groups [groups 2-5], sodium selenite [20 micro mol/kg] was injected SC. Rats in group 3 received SC injections of 0.1 ml of vitamin C [0.3 mM], in group 4 received SC injection of 0.1 ml of L-cysteine [0.05 micro mol] and those in group 5 received SC injection of 0.1 ml of L-cysteine [0.1 micro mol]. The development of cataract was assessed clinically. Then, the lenses were checked for total and soluble protein concentrations and eletrophoretic pattern [SDS-PAGE]. Sodium selenite could induce cataract and cause biochemical and eletrophoretic changes in the lens. L-cysteine and vitamin C were highly effective in preventing or minimizing selenite-induced cataract and in maintaining near-normal total protein and soluble protein concentrations of the lens. These reagents were also effective in restoring the near normal pattern of lens proteins in SDS-PAGE. L-cystein was more effective than vitamin C in prevention of cataract but the difference was not statistically significant. Our results showed that cataractous and biochemical changes of the crystalline lens proteins due to selenite can be minimized or prevented by L-cysteine and vitamin C

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

In-vitro susceptibility of infective keratitis causative bacteria to topical povidone iodine

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

LASIK retreatment for Myopia and Myopic Astigmatism

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

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

[Amniotic membrane transplantation in trabeculectomy]

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

Primary malignant melanoma of eye in a 17 - ytear - old girl with acute lymphoblastic leukemia

Herein we describe a case of intraocular melanoma in a17-year old leukemic patient. The history, histological findings of the enucleated eye, blood and bone marrow of the patient were investigated. The enucleated eye contained epitheloid cell type melanoma instead of leukemic cell infiltration. We conclude that intraocular malignant melanoma can occur in acute lymphoblastic leukemia

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