ABSTRACT
To evaluate the microbiological characteristics of lid margin flora in chronic blepharitis in individuals exposed to mustard gas in comparison to nonexposed patients. In this case-control study, among 289 patients with documented ocular manifestations of mustard gas, 150 patients with clinical sings of blepharitis served as the case group. Microbiologic evaluation was conducted in these patients and compared to that of 100 unexposed patients with chronic blepharitis. In 150 patients with mustard gas exposure and chronic blepharitis, staphylococcus epidermidis [78%] and staphylococcus aureus [57%] were significantly higher than control group [P< 0.01]. Moreover, staphylococcus aureus had more resistance to common antibiotics in the case group. Fungi were isolated more frequently in cases compared with controls [30% vs. 4%, P<0.01]. Cladosporium and Candida were the most common species. Microbiological evaluation in patients with chronic blepharitis associated with mustard gas is significantly different from other patients. Staphylococcus spp, including strains resistant to Methicillin, and fungi were more frequently isolated in exposed patients. The relationship between microbial culture and the severity of ocular manifestations in mustard gas exposed cases warrants further investigation
ABSTRACT
To report 3 cases of nocardia keratitis following photorefractive keratectomy [PRK]. Report of Outbreak: Four eyes of 3 patients [2 female and one male] who had undergone PRK by a single surgeon at a single center developed nocardia keartitis 3 to 6 weeks postoperatively. Mean age was 25 [range 23-28] years and mean onset of corneal manifestations was 29 [range 21-40] days after PRK. Corneal smear and culture and confocal scan were performed in all eyes. Two eyes from the first two patients required lamellar keratectomy to debulk the involved stroma and to obtain specimens for microbiologic and histopathologic evaluation. Light microscopic examination disclosed gram-positive and acid-fast filaments of nocardia which were confirmed by the microbiologic results. Diagnosis of nocardia keratitis in the third case was not as challenging as the first two cases because of a high index of suspicion. Confocal scan in all cases disclosed hyperreflective and slender fibril-like structures in the corneal stroma. All eyes responded favourably to topical amikacin and the infection resolved without recurrence. Nocardia is a rare cause of keratitis following PRK. Clinical suspicion along with microbiologic, histopathologic and confocal scanning help to establish the correct diagnosis. The most probable cause of the outbreak was inadequate attention to sterility during surgery
ABSTRACT
To determine the indications for and surgical techniques of corneal transplantation at Labbafinejad Medical Center [LMC] from 2004 to 2007. In this descriptive study, records of 756 patients who had undergone corneal transplantation from October 2004 to October 2007 were reviewed. Overall, 504 male [64.9%] and 272 female [35.1%] subjects with mean age of 41.29 +/- 21.25 [range: 10 days to 89 years] were operated. Keratoconous [40.8%] was the leading indication for keratoplasty, followed by bullous keratopathy [11.7%], non herpetic corneal scar and opacity [8%], regrafts [7.8%], corneal ulcers [bacterial, fungal, acanthamoeba] [7.8%], herpetic corneal ulcer and scar [4.9%], corneal dystrophies [3.6%] and trachoma keratopathy [3.4%]. The most common type of corneal transplantation was penetrating keratoplasty [PKP] [67.6%], other types included: deep anterior lamellar keratoplasty [DALK] [13.9%], tectonic PK [10.3%], lamellar keratoplasty [LK] and automated lamellar therapeutic keratoplasty [ALTK] [6.7%], descemet's stripping automated endothelial keratoplasty [DSAEK] [0.9%] and keratolimbal allograft [KLAL] [0.5%]. Keratoconus remains the leading indication for corneal transplantation PK at LMC accounting for 40.9% of all grafts. But in comparison with previous studies, bullous keratopathy has increased. In our study the rate of lamellar keratoplasty, especially DALK, has also increased significantly. DSAEK which was begun in 2007 at LMC is rapidly becoming the preferred treatment for corneal endothelial dysfunction at this center
ABSTRACT
To report bilateral Terrien's marginal degeneration, circumferential peripheral corneal ectasia and posterior polymorphous dystrophy in a patient with rheumatoid arthritis. A 24-year-old male patient, who was known case of rheumatoid arthritis from 8 years before, presented with decreased vision since four years ago. Comprehensive ophthalmic eye examination revealed bilateral circumferential peripheral corneal thinning and bulging with vascularization and lipid deposition in addition to band-like lesions in Descemet's membrane. Previous records revealed no gross abnormalities up to four years ago. Corneal lesions were consistent with bilateral circumferential Terrien's marginal degeneration concomitant with posterior polymorphous dystrophy. To our knowledge, this is the first report of concomitant bilateral Terrien's marginal degeneration with total peripheral corneal ectasia and posterior polymorphous dystrophy in a patient with rheumatoid arthritis. Circumferential involvement, younger age at presentation and bilateral total peripheral corneal ectasia in this case are not typical for classic Terrien's marginal degeneration. The underlying rheumatoid arthritis may have aggravated the condition leading to this atypical and severe presentation of Terrien's marginal degeneration
ABSTRACT
To report the outcomes of combined aniridic intraocular lens [IOL] implantation via scleral fixation and penetrating keratoplasty [PKP] in three patients. This study included 3 patients who required PKP and had aniridia and/or aphakia requiring IOL implantation. All subjects underwent aniridic IOL scleral fixation after vitrectomy and removal of capsular remnants followed by PKP thereafter. We used a single-piece black-diaphragm aniridic IOLs [Morcher, Stuttgart, Germany] in all cases. Mean postoperative follow-up was 24 [range 18-30] months. No complications occurred during surgery. Visual acuity improved in all patients and all reported a subjective reduction in glare sensation. Two cases developed elevated intraocular pressure [IOP] after surgery. In one eye, IOP was controlled with timolol but the other required Ahmed glaucoma valve implantation. No patient developed chronic uveitis, cystoid macular edema or retinal detachment and all the patients were satisfied with the cosmetic results. Combined scleral fixation of an aniridic IOL and penetrating keratoplasty improves visual disability and aesthetic appearance. It seems to be an acceptable procedure in patients suffering from corneal opacity and cataracts or aphakia but insufficient iris and zonulae
ABSTRACT
To evaluate anophthalmic socket complications and the incidence of sympathetic ophthalmia among individuals who had undergone primary enucleation or severe ocular trauma during the war between Iran and Iraq. All monocular veterans of the mentioned war in Khorasan province, Iran were recalled during a 7-month period. Preliminary data including age at the time of injury, occupation, previous operations and ocular symptoms were evaluated and all participants underwent a complete ophthalmologic examination particularly regarding the anophthalmic socket, orbital implant and prosthesis condition. Overall, 135 male individuals participated in this study. Mean age was 42 +/- 7 years and 86% were 30-50 years. Patients had undergone complete enucleation in 39 [28.9%], partial enucleation in 21 [15.6%] and evisceration in 6 [4.4%] cases. In 34 cases [25.2%] pthisis bulbi had occurred after trauma and the type of surgery was not identifiable in the remaining 35 cases [25.9%]. The most common symptom in injured eyes was mucoid or mucopurulent discharge [71%]. Common complications in 101 subjects with previous operations were superior sulcus deformity [72.3%] and socket contracture [44.5%]. Socket motility was satisfactory only in 18%. All signs of the anophthalmic syndrome are more severe and more prevalent among enucleated cases secondary to war injuries. Due to the rarity of sympathetic ophthalmia, we suggest enucleation and orbital implantation in an elective setting