[Fuchs heterochromic iridocyclitis and pellucid corneal marginal degeneration: a co-incidence or a developmental defect?]

To report a patient with Fuchs' heterochromic iridocyclitis and pellucid corneal marginal degeneration. A 37-year-old woman referred to Poostchi Eye Clinic, Shiraz, Iran with complaint of low vision in both eyes especially in the left side since many years ago. On ophthalmologic examination, best-corrected visual acuity was 20/50 in right eye with refraction of -6.50-7.5@90 and 20/80 in left eye with refraction of -8.50-11.00x90. Slitlamp examination revealed inferior thinning of cornea in both eyes and diffuse keratic precipitates on corneal endothelium, 1+ cell and flare in the anterior chamber and posterior subcapsular cataract in left eye. There was a moderate iris hetererchromia between the eyes which beside other findings was suggestive of Fuchs' heterochromic iridocyclitis. Corneal topography was in favor of pellucid marginal degeneration. To our knowledge this is the first case of pellucid marginal degeneration associated with Fuchs' heterochromic iridocyclitis in the literature. This may be a co-incidence or might have occurred due to a defect in embryonic ocular development

[Cataract etiology in children less than 3 years of age at Khalili hospital, Shiraz-Iran]

To evaluate the etiology of cataracts in children less than 3 years of age particularly the association of rubella virus infection and galactosuria with congenital cataracts at Khalili Hospital, Shiraz-Iran from 2003 to 2006. This prospective study included 46 patients less than 3 years undergoing lensectomy for the management of significant cataracts. Lens aspirate specimens were obtained from some cases. Serum samples for detection of anti-rubella IgM and IgG antibodies and urine samples for detection of galactose were also obtained. Out of 46 patients, 78.3% had congenital cataracts and 21.7% had traumatic cataracts. Patients with congenital cataracts were male in 45% and female in 55% with mean age of 5.12 +/- 5.23 months at the time of diagnosis. In the congenital cataract group, 2.8% had history of failure to thrive and 16.7% had low birth weight; 80.6% had bilateral and 19.4% had unilateral cataracts; 77.8% had isolated cataracts, 16.7% were associated with other ocular disorders and 5.6% were associated with systemic diseases; 11.1% had family history of congenital cataracts and 10.5% had galactosuria. Rubella virus was isolated from one [5.3%] of 19 cultured lens aspirates. No cases had anti-rubella IgM antibody. Congenital cataract is the most common type of cataracts in children under age 3 years in our area and most of them are idiopathic. The prevalence of rubella induced cataract in our country is less than developing countries but more than developed countries

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

[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

[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

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

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