Incidence and risk factors of retinopathy of prematurity among preterm infants in Shiraz/Iran

Retinopathy of prematurity [ROP] is a serious complication in preterm infants. To avoid this complication the risk factors leading to the disabling This is a descriptive study. All preterm infants with birth weight under 1500 g and preterm infants with birth weight between 1500-2000 g who had unstable clinical condition and admitted in neonatal intensive care unit from February 2006-March 2007 at tertiary hospitals of Shiraz University, Iran, were introduced into the study. All infants are examined by indirect ophthalmoscopy. Risk factors analysis was performed in two groups. Group 1 consisted of infants with no ROP or ROP that regressed spontaneously, and Group 2 of those with severe ROP that needed laser therapy. Of 199 preterms, ROP that needed laser therapy was detected in 19 [9.5%]; 65 [32.6%] had ROP that regressed spontaneously and 115[57.8%] had no ROP. Risk factor analysis showed significant P-values for gestational age, birth weight, Apgar score of first minute, mean duration of mechanical ventilation, mean duration of oxygen therapy, eclampsia-preeclampsia, hypoxia, hyperoxia, Pa CO2 >60 mmHg, pH>7.45 and frequent blood transfusions. Using stepwise logistic forward regression showed the three factors mean duration of oxygen therapy, birth weight and mechanical ventilation to be independently significant variables for increasing the rate of ROP. The main risk factors for development of threshold ROP are low birth weight, mechanical ventilation and duration of oxygen therapy. So it seems that prevention of premature delivery and judicious oxygen therapy is the main step for prophylaxis of ROP

Reliability of fixation preference for detecting amblyopia in strabismic patients

To evaluate the association between fixation preference [FP] and amblyopia in strabismic patients. This study includes 50 patients with horizontal, vertical or mixed strabismus of at least 10 prism diopters. Best-corrected monocular visual acuity [VA] was measured using Snellen E-chart and the presence of amblyopia was determined accordingly; FP was evaluated and graded from 0 to 3. Of 50 patients, including 27 female and 23 male subjects, 29 [58%] patients had FP but 18 [36%] subjects were truly amblyopic. Overall, the sensitivity and specificity of FP for detection of amblyopia was 88.9% and 59.4% respectively. The positive predictive value [PPV] and negative predictive value [NPV] were 55.2% and 90.5% respectively. Sensitivity, PPV and NPV were significantly higher in esotropic as compared to exotropic patients. Strong monocular FP was correlated with more than 3 lines of interocular difference [IOD] in visual acuity [P=0.001]. Although FP is not an ideal method for diagnosis of strabismic amblyopia, it has high sensitivity, PPV and NPV in esotropic patients and in subjects with more than 3 lines of IOD in VA

Combined maximum levator resection and septal sling in correction of severe blepharoptosis with poor levator function: a novel surgical technique

The aim of this study is to present a novel surgical technique in the management of severe blepharoptosis with poor levator function. Four patients [five eyes] were included in this study. Mean age of the patients was 15.3 years [range, 3-28 years]. Preoperative levator function averaged 3.4_0.9 mm. All of the patients underwent combined maximum levator resection and septal sling in the ptotic eye. The follow-up ranged from 4 to 10 months [mean, 8 months]. Preoperative palpebral apertures averaged 4.4 +/- 0.7 mm and postoperative apertures averaged 8.5 +/- 0.4 mm [P<0.001]. There was marked improvement in the aperture [4.1 mm]. The mean of margin reflex distance-1 [MRD-1] was increased from 0 +/- 1 preoperatively to 4.1 +/- 0.4 postoperatively [P<0.001]. All the patients demonstrated symmetry of the upper eyelid position [less than 1 mm], good lid crease position, and acceptable cosmetic outcome. All of the patients revealed some degree of lid lag and lagophthalmus. One patient developed exposure keratopathy associated with lagophthalmus which was treated successfully with lubrication. This preliminary study shows that this new technique may be a useful alternative in the management of severe blepharoptosis associated with poor levator function

Aqueous and vitreous penetration of oral cefixime and ciprofloxacin in rabbit eye

To investigate the penetration of cefixime and ciprofloxacin to the rabbit eye on the basis of microbial inhibition of aqueous and vitreous humour after oral administration. In this experimental study, 36 rabbits [72 eyes] were randomly divided into two groups; group A consisted of 20 rabbits and group B 16 rabbits. Each group was divided into four equal subgroups. The rabbits in each subgroup of group A received 4, 8, 12, and 20 mg/kg of syrup of cefixime every 12 hr respectively and the rabbits in each subgroup of group B received 20, 40, 60, and 80 mg/kg tablet of ciprofloxacin respectively every 12 hr. Immediately after the first dose of the drugs, the anterior chamber of one eye was irrigated randomly by 30-40 cc of ringer lactate solution alongside with mild traumatization of iris. Then by 4, 8, 12, 24 and 72 hr intervals after the 3rd dose, 0.1 cc of aqueous, 0.2-0.5 cc of vitreous, 3 cc of blood and one standard disk of the used antibiotic was placed on culture media of a known bacteria which was completely sensitive to the respective antibiotic. Forty eight hours later, the microbial inhibition zone of each sample and the standard disk of antibiotic were compared. No microbial inhibition was seen by sample of aqueous and vitreous, although very large zone of inhibition was seen by blood sample and standard disk of antibiotic. It seems that oral cefixime and ciprofloxacin do not produce an effective dose for microbial inhibition in rabbit eye