[Therapeutic effect of corneal collagen cross-linking in necrotizing herpetic stromal keratitis, report of two cases]

To evaluate the effectiveness of corneal collagen cross-linking with UV-A and riboflavin [CXL] for treatment of refractory herpes simplex virus necrotizing keratitis. Two patients with a diagnosis of HSV necrotizing stromal keratitis referred to Khalili hospital eye emergency room and who were resistant to conventional treatment underwent CXL. Response to treatment was evaluated clinically by speed of reepithelialization and decrease in stromal infiltration. One patient had history of previous corneal graft because of HSV kerstitis and had a good response to CXL. Another patient had a relatively good response, but recurrence was occurred. Although CXL seems promising in the treatment of patients with refractory necrotizing keratitis, in some cases it may less effective and recurrence is possible

[Thyroid function tests in patients with chalazia]

To evaluate the prevalence of clinical and subclinical thyroid disorders using thyroid function tests in patients with single and multiple chalazia. A complete ophthalmologic examination and thyroid function tests including thyroid stimulating hormone [TSH], thyroxine [T4] and triiodothyronine [T3] were performed in 60 patients with single chalazia and 50 patients with multiple chalazia, consecutively referred to Poostchi Eye Clinic, Shiraz, Iran and compared with 60 age- and gender-matched control subjects. Mean TSH values were higher in patients with single [3.89 Mu/l] and multiple [4.80 Mu/l] chalazia as compared to controls [3.02 Mu/l] [P= 0.23]. No significant difference was detected for T4 levels between patients with single or multiple chalazia as compared to controls. The prevalence of blepharitis was 18% in patients with single chalazia, 34% in patients with multiple chalazia, both of which were higher than controls [5%] [P<0.001]. The difference between patients with single and multiple chalazia in terms of the prevalence of blepharitis was also significant [P<0.05]. There was no significant difference between patients with single and multiple chalazia in comparison with controls regarding thyroid function tests; however the prevalence of blepharitis in patients with multiple chalazia was higher than patients with single chalazia and both figures were higher than controls

[Ocular trauma in subjects older than 60 years]

To evaluate the demographic data, mechanisms of injury and complications of ocular trauma in patients over 60 year of age. We retrospectively reviewed the medical records of 91 patients older than 60 who were admitted and treated in the Ophthalmology Department of Khalili Hospital, between September 2002 and November 2008, due to ocular trauma. Data were retrieved from admission charts including demographic information, mechanisms of injury, site of penetrating or perforating trauma, associated injuries such as endophthalmitis and intraocular foreign bodies, complications of trauma, the time interval between trauma and referral to our center and the initial visual acuities. X2 analysis were performed using SPSS 11.5 program to analyze the data. Patient age ranged from 60 to 87 years with mean [ +/- SD] of 69.6 [ +/- 7.8] years. 11 patients [21.1%] were monocular. 61 patients [67%] belonged to rural and 30 patients [33%] were from urban areas. Mean [ +/- SD] time interval from trauma to referral was 102 [ +/- 130] hours [range: 1 to 480 hours]. The most common mechanisms of trauma were trauma with tree spines [24.2%], sharp trauma with wood [22%], blunt trauma with wood [11%], blunt trauma with hand [11%] and falling down [9.9%]. Three patients had intraocular foreign bodies and 14 eyes [15.4%] were complicated by endophthalmitis. The most common complications of trauma were corneal ulcer [27.5%], surgical wound dehiscence [22%] and corneal laceration [22%]. There was significant correlation between corneal ulcer and also surgical wound dehiscence and profound visual loss. There was also significant correlation between referral later than 48 hours and profound visual loss. The results of this study provide some information about elderly eye trauma. These results may be valuable in planning, education, prevention programs and surveillance of this susceptible population of the community

[Advanced retinopathy of prematurity at poostchi ROP clinic, Shiraz]

To evaluate patients with advanced retinopathy of prematurity [ROP] among neonates referred to Poostchi ROP clinic in Shiraz from March 2006 to February 2008. Among referred infants to Poostchi clinic for screening and management of ROP, medical records of patients with advanced ROP [stage 5] at initial examination or during disease progression were evaluated. Information regarding gestational age, time of diagnosis, follow-up programs and causes of delayed screening were recorded. Overall, 20 patients [11 male, 9 female] out of 1024 reffered neonates had advanced ROP which was unilateral in 3 [15%] and bilateral in 17 [85%] patients. Advanced ROP was due to late diagnosis and treatment in 17 [85%] patients and treatment failure in 3 [15%] patients. Main causes of delayed diagnosis were uninformed parents in 10 [50%] patients, misdiagnosis by an ophthalmologist in 3 [15%] patients, socioeconomic problems and parental ignorance in 3 [15%] patients and poor systemic condition of the neonate in 1 [5%] patient. The main cause of visual loss due to advanced ROP is uninformed parents and health care providers as well as absence of an organized screening program

[Cyanoacrylate tissue adhesive for management of exposed hydroxyapatite orbital implant]

To present our experience with cyanoacrylate tissue adhesive in eyes with exposed hydroxyapatite orbital implants. Cyanoacrylate tissue adhesive was used in 3 patients with hydroxyapatite orbital implant exposure defects. Cyanoacrylate glue was applied on the defective area of 3 patients presenting with small exposure [<4mm]. The patients were followed for 33 months [range: 20-58 months], no complication developed and the defect size was stable. In one patient after 12 months, the glue was removed and a mucous membrane graft was performed without any complications over a 9 month period. Cyanoacrylate tissue adhesive application is safe and easy to use; it can be used for treatment of exposed hydroxyapatite orbital implant in selected cases

[Polymerase chain reaction versus conventional laboratory methods in the diagnosis of fungal keratitis]

To compare the value of conventional laboratory methods and polymerase chain reaction [PCR] in the diagnosis of fungal keratitis. This cross sectional study was conducted at Khalili Hospital, Shiraz, Iran. Samples were taken from thirty-eight patients with findings suspicious for fungal keratitis. Corneal scrapings were used for Gram, Giemsa and KOH stains, culture and PCR analysis. Of 38 enrolled eyes, 25 eyes [68.5%] were judged to have fungal infection based on positive cultures, staining, PCR or response to antifungal treatment. PCR detected fungi DNA in 17 of 25 samples [68% sensitivity]. Staining [Gram, Giemsa and KOH] and culture yielded a positive result in 40% and 24% of samples respectively. Twenty one [84%] of 25 patients showed fungal elements in at least one laboratory work up and 4 patients were diagnosed as fungal keratitis only based on response to antifungal drugs. Compared to conventional laboratory methods, PCR based methods offer higher sensitivity and a faster diagnosis in fungal keratitis

[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

[Conjunctival and lacrimal sac bacterial flora in adults with nasolacrimal duct obstruction in comparison with normal subjects]

To determine bacterial flora of the conjunctiva and lacrimal sac in adult patients with nasolacrimal duct obstruction [NLDO] in comparison with normal flora. This study included 40 consecutive adult patients with NLDO and 40 age- and sex matched healthy controls. Specimens for bacterial culture were obtained from the involved and normal conjunctiva preoperatively and from the lacrimal sac of the involved eye at the time of dacryocystorhinostomy in the patients as well as from the conjunctiva of the control group. Culture growth and colony count were determined in each group. Conjunctival cultures were positive in 100% of involved eyes and 97.5% of sound eyes in the patients as well as in 82.5% of controls. The most prevalent organisms were Staphylococcus epidermidis and S. aureus in both NLDO and control groups. The isolated organisms were the same in 90% of specimens obtained from the sac and conjunctiva of the involved eyes. Mean colony counts were significantly higher in the lacrimal sac and conjunctival culture of the involved eye as compared to the normal side and the control group. The predominant microorganism is S. epidermidis in normal ocular surface but S. aureus in eyes with NLDO. Conjunctival culture can be used as a predictor of lacrimal sac flora in cases with NLDO

[Homonymous hemianopia visual field defect following sildenafil consumption]

To describe the clinical and photographic features of a patient who developed left homonymous hemianopia due to right occipital lobe hemorrhage after ingestion of sildenafil citrate [Viagra]. A 63-year-old man was referred for acute blurred of vision in both eyes five hours after taking 50 mg Viagra [sildenafil citrate]. Visual field testing revealed left homonymous hemianopia and brain MRI disclosed a right occipital lobe hemorrhage. Sildenafil may cause intracranial hemorrhage leading to visual disturbance and visual field defects

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

[ prevalence of Giardia spp. among the pet dogs of Isfahan]

Study on Giardia spp, among the pet dogs of Isfahan. Cross-sectional study. One hundered and twenty dogs. Faecal specimens of 120 pet dogs which were referred to the small animal clinic of Isfahan were tested for Giardia spp. The diagnosis of Giardia spp was based on identification of cycts or trophozoietes in faece. Direct and formalin -ether methods as well as trichorme staining were appllied for identification of Giardia spp. Fisher exact test. The results indicated that 4 dogs [3.33%] were infected with Giardia spp. Because of probable infection of human by this species, our findings recommend killing of stray dogs and treatment of infected ones