[Specular microscopy evaluation of corneal endothelial cells after intravitreal and subconjuctival injection of avastin]

To evaluate corneal endothelial cell changes after intravitreal and subconjunctival injection of avastin [bevacizumab] based on specular microscopic findings. This prospective interventional study was performed on 82 eyes of 82 patients. Forty-two cases with ptrygia received a subconjunctival injection of bevacizumab [2.5mg/0.2ml] and 40 diabetic subjects with retinal neovascularization or macular edema received an intravitreal injection of bevacizumab [1.25mg/0.1ml]. Specular microscopy, including corneal endothelial cell count, size and shape, was performed in all patients for the injected eye before, and one and three month after injection and the results were compared and analyzed. There was no change in the corneal endothelial cells count after one month but there was mild reduction of endothelial cells after 3 months which was not statistically significant.[P=0.75 and 0.29, respectively]. Subconjunctival and intravitreal injection of bevacizumab [up to 1.25 mg/0.1 ml and 2.5 mg/0.2 ml, respectively] entails no harmful effect on human corneal endothelial cells up to three months following the injection

Comparison of intraocular pressure and hemodynamic response subsequent to tracheal tube versus laryngeal tube insertion during general anesthesia

It is well accepted that intraocular pressure should be controlled during general anesthesia [G/A] for intraocular procedures. This study was performed to compare the effects of the laryngeal and tracheal tubes on intraocular pressure [IOP], mean arterial pressure [MAP] and heart rate [HR] during the course of G/A. Eighty adult patients were randomly allocated to two groups for cataract surgery. Group A [n=40] underwent laryngeal tube [LT] placement and group B [n=40] had tracheal tube [TT] insertion. Anesthesia was induced by midazolam, fentanyl, propofol and atracurium and was maintained by propofol and 50% nitrous oxide in oxygen. IOP, MAP and HR were measured before and 3 minutes after induction of G/A, 1 and 5 minutes after tube placement, at the end of the operation, and 1 minute after extubation. The IOP at 1 minute after removal of the tubes was significantly higher in the TT group than the LT group. The MAP at 1 minute and heart rate at 1 and 5 minutes after placement of the tubes were significantly higher in TT group than the LT group. In the course of G/A, using the same anesthetic agents such as propofol, and atracurium, LT had better control than TT on IOP, MAP and HR

[Microbial inhibitional in non-inflamed human aqueous after oral antibiotic intake]

To investigate the penetration of cefixime, cephalexin and ciprofloxacin into the human eye based on microbial inhibition by human aqueous samples after oral administration. Sixty patients aged 40 to 75 years who were scheduled for cataract surgery were divided into three equal groups. One group received 500 mg oral ciprofloxacin 24, 12 and 2 hours preoperatively; another group received 500 mg oral cephalexin 24, 18, 12, 6 and 2 hours before the operation and the third group received 400 mg oral cefixime 24, 12 and 2 hours prior to surgery. Immediately before opening the anterior chamber, 0.1 ml of aqueous was taped with an insulin syringe. A 4 ml sample of the patient's blood was obtained simultaneously. Aqueous and serum specimens as well as a standard antibiotic disc were placed on the culture media of a known bacterium which was completely sensitive to the respective antibiotic. After 48 hours microbial inhibition zone of each sample was compared to the standard antibiotic disc. No microbial inhibition zone was seen by aqueous samples, however very large zones of inhibition were seen by discs of serum samples and antibiotics. It seems that oral cefixime, cephalexin and ciprofloxacin do not achieve effective concentrations in human aqueous for microbial inhibition

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

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

[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

[Tear secretion before and after cyclosporine administration in kidney transplantation recipients]

Purpose: to determine tear secretion changes after prescribing cyclosporine as an immunosuppressive agent in patients receiving allograft kidney transplantation

Methods: patients with end stage renal failure who underwent kidney transplantation at Namazi Hospital, Shiraz, from September 2000 to January 2001were included in the study. Shirmer II test [4 minutes] using local anesthesia was performed in both eyes before and 3 times after receiving cyclosporine

Results: fifteen patients [8 males and 7 females] with mean age of 32.2k2.96 years were evaluated. Tear secretion increased from 18.8350.953 md4 min [measured 1-7 days before prescribing cyclosporine] to 28.433 +/- 1.564,28.633 +/- 1.267, and 28.467 +/- 1.369 mm/4min at 1, 3, and 5 months after prescribing cyclosporine, respectively [P<0.001]

Conclusion: there was a statistically significant increase in tear secretion of patients receiving kidney transplantation and systemic cyclosporine as an immunosuppressive agent. Increased tear secretion continued during 6 months follow up and can be considered as a favorable side effect of cyclosporine. The increased tear secretion was also observed in patients with normal levels of tear secretion

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