ABSTRACT
To evaluate the outcomes of keratorefractive surgery for correction of postkeratoplasty astigmatism in keratoconus. In this retrospective study, surgical records of 45 eyes of 45 patients that underwent relaxing incisions with or without compressive sutures were evaluated. The minimum interval between complete suture removal and operation was 1 month. Location and extent of incisions were determined by topography. Intraoperative keratoscopy was performed to determine if compressive sutures were needed. Mean age at the time of corneal graft surgery was 29.6 +/- 9.1 years. Mean interval between keratoplasty and keratorefi-active surgery was 18.4 +/- 8.8 months. Follow up period was 17.2 +/- 12.3 months. Preoperative refractive astigmatism was 7.25 +/- 1.59 D and keratometric astigmatism was 8.33 +/- 2.37 D. After surgery, these values reached 4.14 +/- 1.67 D and 4.42 +/- 1.88 D, respectively [P<0.0001]. Moderately 0.34 D myopic shift occurred. BSCVA was 2 20140 in 76.5% of the eyes before and 93.3% after surgery. Mean BSCVA in Log MAR was 0.28]20140] before and 0.17 [20130] after surgery [one Snellen line increase of vision], P<0.0001. Keratorefractive surgery by relaxing incisions with or without compressive sutures is a safe and effective procedure to reduce postkeratoplasty astigmatism in keratoconus
ABSTRACT
To report two cases of bilateral bacterial keratitis as a sight-threatening complication following photorefractive keratectomy [PRK] Patients and findings: The first case was a 45-year-old man referred due to bilateral ocular pain and purulent discharge two days after bilateral PRK. Based on his clinical picture, smear and cultures from both corneal ulcers were taken with a diagnosis of bacterial keratitis. Frequent topical fortified antibiotic treatment was started. Smear showed many PMN cells but the culture was negative. Corneal ulcers were controlled with medical treatment. The second case was a 24-year-old man who presented with bilateral severe pain and discharge. He was diagnosed as bilateral corneal ulcers 2 days after PRK and topical antibiotics were started for him, but because of poor response he was referred to our center. Culture result was positive for staphylococcus aureus. He had severe bilateral blepharitis. Frequent fortified antibiotics were started which controlled his condition. Infectious keratitis after PRK is a rare, but potentially devasting complication. The predisposing risk factors are breakdown of the barrier function of the corneal epithelium, active blepharitis, use of bandage contact lens on an extended wear basis and use of topical steroids to control wound healing. It is recommended not to operate bilateral eyes simultaneously in those at risk
ABSTRACT
Purpose: to report the clinical features of 93 eyes with chronic and delayed onset mustard gas keratitis in 48 patients
Methods: forty-eight Iranian survivors of Iraqi chemical warfare with chronic or delayed onset mustard gas keratitis were enrolled. We reviewed the symptoms, signs, clinical course, and treatment of our patients. In 5 cases, histopathologic features of corneal and conjunctival specimens are presented
Results: of 48 patients, 3 1 [64.6%] had chronic symptomatology whereas 17 [3 5.4%] experienced delayed onset lesions. Visual acuity at referral ranged from hand motions to 20120. Ocular surface changes included chronic blepharitis and decreased tear meniscus in all, limbal ischemia [81.3%] and conjunctival vascular abnormalities [50%]. Corneal signs in order of frequency were: scar/opacity [87.5%], neovascularization [70.8%], thinning [58.3%], lipoid deposits [52. I%], amyloid deposits [43.8%], and epithelial defects and irregularity [3 1.3%]. Twenty patients received conservative treatment; others underwent allograft stem cell transplantation [20 eyes of 17 patients], penetrating keratoplasty [12 eyes of 12 patients], and lamellar keratoplasty [4 eyes of 3 patients]. Conjunctival specimens were evaluated by light microscopy. Decreased goblet cell density, attenuated or thickened epithelium, scarring in the substantia propria associated with plasmacytic and lymphocytic infiltration, and dilated lymphatic vessels were noted. Excised corneal buttons disclosed absence of epithelium and Bowman's layer, firbrovascular pannus, stromal scarring, and vascularization
Conclusion: mustard gas may cause chronic and delayed destructive lesions in the ocular surface and cornea leading to progressive visual deterioration and ocular irritation. The pathophysiology of these changes is not clearly identified. Excised conjunctival and corneal specimens revealed a mixed inflammatory response without any specific features. Based on the clinical appearance of the lesions and histopathologic findings, an immune-mediated component seems possible
ABSTRACT
Purpose: to evaluate the outcomes of penetrating keratoplasty [PIS] in macular corneal dystrophy [MCD] at Labbafinejad Medical Center, Tehran-Iran [1986-2002]
Methods: in a descriptive study, records of patients with MCD who had undergone PK were reviewed. All cases were recalled for a complete ocular examination. Patients who participated in the recall examination with at least 6 months follow up were enrolled in the study
Results: sixty-two eyes of 39 patients were included. The age of patients at first examination [before keratoplasty] was 30 +/- 12 [12-58] and at the time of keratoplasty was 34 +/- 10.3 [13-58] years. Duration of follow up after PK was 52 +/- 47.3[6-190] months. Best corrected vision before surgery in LogMAR notation was 1.4 +/- 0.4 [4/100]. After PK, uncorrected visual acuity improved to 0.6 +/- 0.44 LogMAR [20/28] [P<0.0001] and best spectacle corrected visual acuity [BSCVA] at the end of follow up was 0.2 +/- 0.32 LogMAR [20/32]. Spherical equivalent refractive error after surgery was -2.28 +/- 3.24 diopters and refractive astigmatism was 3.32 +/- 2.05 diopters. Suturing technique had no effect on final astigmatism after PK [P=0.9]. BSCVA in 36 eyes who were operated before 35 years of age was 0.16 +/- 0.37 LogMAR and in 26 eyes operated at or after age 35 was 0.26 +/- 0.25 [P=0.005]. Immunologic graft rejection occurred in 12 eyes [1 9.4%] during the follow up period. The first rejection occurred at 6.1 +/- 3.5 [2-14] months after PK. Graft opacification and failure occurred only in one eye following ocular trauma and wound dehiscence. The rest of the grafts [98.4%] were clear at the end of follow up
Conclusion: PK in patients with MCD improves vision significantly with excellent graft survival rates. In this study, patients who underwent PK before 35 years of age had better final visual acuity
ABSTRACT
Purpose: to compare two viscoelastics, hydroxypropylmethylcellulose [Coatel] and sodium hynluronate] [Healon] as causative factors for postoperative uveitis [POU] following cataract surgery
Methods: in this clinical trial, 81 eyes from 80 patients underwent phacoemulsification and IOL implantation [PMMA AGENA 550 Opsia]. Patients with uveitis, diabetes, and pseudoexfoliation syndrome were excluded. In 39 eyes [48%] Coatel and in 42 eyes [52%] Healon was used randomly. Patients were followed three months for appearance of POU
Results: the incidence of POU in the Coatel and Healon groups was 20.5% and 2.4%, respectively
Conclusion: use of Healon in comparison to Coatel decreases the incidence of POU in cataract surgery. Thus, it is better to use Healon in patients at high risk for POU
ABSTRACT
Purpose: to evaluate the prevalence of contat lens wear among highschool girls and their general knowledge about contact lenses and also to evaluate the specific knowledge of contact lens wearers about the lens
Methods: in a cross-sectional study, 1664 students of 22 randomly selected girl highschools were enrolled. A questionaire including questions about wearing contact lens, age of first use, cause of lens wear, type of lens, source of providing, way of wearing, and medical and hygienic care was filled out by the participants. Contact lens wearers were classified in two groups according to the main cause of lens wear: cosmetic and therapeutic
Results: the prevalence of contact lens wear was 16.5% including 81.8% for cosmetic purposes and 18.2% for therapeutic reasons. The age of starting lens wear was before 14 in 36%. About 50% of contact lens wearers had at least once worn the lens of another person. General knowledge was often weak or little and the knowledge about serious complications of contact lens wear was good only in 43% of the students. There was no significant differences between weares and nonwearers regarding these issues. The source of providing of lens among the therapeutic group was physicians in 90% and boutiques in 2% corresponding figures were 9.8% and 32% respectively in the cosmetic group. The most common type of lens was soft [98%] and colored [84.3%]. Lens handling was bad or inappropriate in 73.1 %; however appropriate handling was greater in the therapeutic group [42%] than the cosmetic group [23.6%]. Medical care was appropriate in 30.9% [68% in the therapeutic group and 22.7% in the cosmetic group]. Hygienic care of lens was appropriate in 53.8% [62% in the therapeutic group and 52% in the cosmetic group]. Hygienic care of lens container was appropriate in 16.4% [24% in the therapeutic group vs 4.7% in the cosmetic group]. Specific knowledge of lens wearers was appropriate in 46.6% [58% in the therapeutic group vs 44% in the cosmetic group]
Conclusion: the prevalence of contact lens wear among highschool girls in Tehran is considerable especially for cosmetic purposes. Furthermore, general and specific knowledge about contact lens use was inadequate in the majority of lens wearers
ABSTRACT
Purpose: to compare the refractive results of penetrating keratoplasty [PK] in two groups of patients with keratoconus undergoing corneal grafting with different amounts of donor-recipient disparity [0.25 and 0.5 mm]
Methods: as a randomized clinical trial and after performing a complete ocular examination and vitreous length measurement, 30 patients with keratoconus were randomly assigned in two groups: 15 patients underwent PK with 0.25 mm graft-recipient disparity and the other 15 patients underwent the operation with 0.5 mm disparity. One surgeon performed all the operations using a single running suture technique. Best corrected visual acuity and refractive errors were evaluated 1 year after PK and also two months after suture removal
Results: one year after PK and also 2 months after suture removal there was no statistically significant difference in BCVA between the two groups. Mean spherical and mean spherical equivalent refractive error was better in the 0.25 mm group, however this difference was not statistically significant [P> 0.05]. In vitreous length range of 16.2-17.7 mm [20 patients] mean spherical equivalent refractive error was -1.6 and -3.6 D in the 0.25 mm and 0.50 mm disparity groups, respectively [P= 0.03]. Mean spherical error was also better in the 0.25 mm group as compared with the 0.5 mm group [-0.8 versus -2.6 D, P= 0.05]. Mean astigmatic refractive error was minimally different between the two groups
Conclusion: less donor-recipient disparity [0.25 mm Vs 0.50 mm] seems to lead to better refractive outcomes in penetrating keratoplasty for eyes with keratoconus and vitreous length of 16.2- 17.7 mm