RESUMEN
To compare the efficacy of intravitreal clindamycin and dexamethasone with classic treatment for ocular toxoplasmosis. In this prospective, randomized single-masked clinical trial a total of 68 patients with active ocular toxoplasmosis were assigned randomly to 2 treatment groups: 34 in the intravitreal clindamycin plus dexamethasone [IVCD] group and 34 in the classic treatment [CT] group. The IVCD group received 1 to 3 injection[s] of 1 mg intravitreal clindamycin and 400 microg dexamethasone, and the CT group received 6 weeks of treatment with pyrimethamine and sulfadiazine plus prednisolone. Antitoxoplasmosis antibodies [immunoglobulin [Ig] M and IgG] were measured using an enzyme-linked immunosorbent assay. The mean number of injections in the IVCD group was 1.6. Lesion size reduction was statistically significant after treatment in both IVCD and CT groups [P< 0.001 and P: 0.009, respectiveiy]. The difference in mean percentage of reduction at 6 weeks was not significant: 57 +/- 27.6% in the IVCD group versus 58.4 +/- 29.3% in the CT group. In comparison to baseline, VA increased by 0.44 +/- 0.24 and 0.29 +/- 0.19 logarithm of the minimum angle of resolution units in the IVCD and CT groups, respectively [P< 0.001]; however, the difference in VA improvement between the groups was not significant. The interaction effect of IgM and treatment group on lesion size reduction was significant [P= 0.002]; this indicated that IgM-positive cases responded better to CT and IgM-negative cases responded better to IVCD treatment. Vitreous inflammation reduction was comparable between the groups. Within 2 years, 4 eyes [2 in each group] had 1 episode of recurrence. Adverse drug reactions occurred in 2 patients in the CT group. No major injection-related complication was encountered in the IVCD group. Intravitreal injection of clindamycin and dexamethasone may be an acceptable alternative to classic treatment in ocular toxoplasmosis. It may offer more convenience, a safer systemic profile, greater availability, and fewer follow-up visits and hematologic evaluations
RESUMEN
To investigate indications and methods of surgery in corneal transplantation in Labbafinejad medical center from 2007 to 2009. Records of 1083 patients who had undergone corneal transplantation from 2007 to 2009 were reviewed. Age, sex and indication and type of surgery were evaluated. Patients included 709 [65.5%] male and 374 [34.5%] female subjects with mean age of 43.2 +/- 10.2 year [range, 17 days to 33 years] keratoconus [36.7%] was the most common indication followed by cataract extraction with or without IOL insertion [12.8%]; corneal ulcers due to bacterial, fungal and acanthamoba infections [11.7%]; non herpetic scar and opacities [7.4%]; trachoma keratopathy [5.6%]; corneal dystrophy [4.6%] and mustard gas keratopathy [4%]. The most common type of surgery was penetrating keratoplasty [56.2%] followed by deep anterior lamellar keratoplasty [24.5], tectonic grafts [9.4%], lamellar keratoplasty [3.4%], endothelial graft [3.5%] and keratolimbal allograft without penetrating keratoplasty [3.1%]. During this 3 years period, keratoconus was still the most common indication for corneal transplantation but rate of regraft is increasing in comparison with previous reports. Corneal edema following cataract surgery with or without intraocular lens implantation was the second most common indication. Rate of endothelial grafts and keratolimbal alografts have increased since our previous reports