[Epidemiologic aspects of penetrating eye trauma in subjects younger than sixteen years at feiz hospital in 2009]

To report the characteristics of children referred to the emergency department of Feiz Medical Center with penetrating eye injuries. In a cross-sectional study, children with penetrating eye trauma were evaluated. Age, sex, parents educational level, time, location, and cause of trauma recorded and compared. Overall, 100 patients with mean age of 7 +/- 3.8 [range 2 to 16 years] including 69 male and 31 female were assessed. 57 eye injuries occurred at home, time of trauma was in the morning in 47% of patients. The most common cause of injury was knife [26%] and wood was the second common cause [17%]. Overall, 29 child were alone at the time of injury .The most common type of injury was corneal laceration [71%]. All traumatic cases were unilateral. Most children were injured in the early morning, therefore education of parents and other child care givers for more attention to children and improvement of health education about eye trauma may prevent pediatric eye injuries

[Endogenous klebsiella endophthalmitis associated with liver abscess]

To report a case of endogenous Klebsiella endophthalmitis associated with liver abscess in Iran. A 79 year old man was referred with chief complaint of left eye pain and visual loss. The patient had conjunctival hyperemia, corneal edema, hypopyon and severe vitreous cellular reaction in the left eye and yellowish conjunctival discoloration which was apparent in the right eye. Abdominal CT scan revealed a right liver lobe abscess that underwent percutaneous liver biopsy under sonography guide. Blood, vitreous and liver mass cultures revealed Klebsiella Pneumonia growth. The patient was diagnosed as a case of endogenous Klebsiella endophthalmitis secondary to bacteremia associated with liver abscess. This report suggests that rather than being confined to Far East, endogenous endophthalmitis secondary to liver abscess due to Klebsiella pneumonia may be a global problem

[Clinical evaluation of drug induced acute angle closure glaucoma]

To evaluate all cases of drug induced angle closure glaucoma cases who presented to Feiz Hospital, Isfahan during 2008-2010. In this retrospective case series, we present 7 cases of drug induced angle closure glaucoma after administration of Topiramate. All patients were female. The average age of patients was 33.28 years old [ranging from 19 to 44]. With sufficient corneal clarity, mean BCVA was 20/400 and mean refractive error was -6.50 [rang -3.00 to-12.00] diopters. Mean intraocular pressure was 44.71 [rang 34 to 60] mmHg. Mean time normalization of intraocular pressure was 12.30 [rang 8 to 23] hours. Acute myopia and acute angle closure glaucoma are serious adverse effects of Topiramate, both of which are reversible with immediate discontinuation of the drug. So, taking a complete drug history and thinking about culprit drugs is critical in the evaluation of such cases

[Postoperative pain after cooling PRK]

To compare post-operative pain with cooling photorefractive keratectomy [PRK] versus conventional PRK. A prospective clinical trial was performed on 94 eyes from 47 patients scheduled for PRK. Patients were randomly assigned to either cooling or conventional PRK. Pain was evaluated 6, 12, 24 and 48 hours post-operation using a visual analogue scale [VAS]. Corneal haze, conjunctival and palpebral edema, and complications were also assessed. Mean age of the patients was 24.8 +/- 4.5 [range: 18-36 years] and mean refractive error was 3.6 +/- 1.6 diopters. Median pain score in the cooling group at 6 and 12 hours was 15 and 10, respectively and zero at 24 and 48 hours. Median pain score in the conventional group at 6 and 12 hours was 30 and 15 and was zero at 24 and 48 hours. There was no adverse effect in either of the groups. Cooling PRK effectively reduces post-operative pain after PRK without any additional adverse effect

[Comparison of intraocular pressure measurement with the noncontact pulsair 3000 tonometer and goldmann applanation tonometer]

To compare intraocular pressure [IOP] measurement with Pulsair non-contact tonometer and Goldmann applanation tonometer [GAT]. In this cross-sectional study, during a complete ophthalmologic examination, each patient underwent Pulsair tonometry three times at 5 minutes intervals and then Goldmann tonometry at the same intervals. Mean IOP values were measured and analyzed. We evaluated 458 eyes of 250 patients [138 males and 112 female subjects]. Mean IOP was 19.45 +/- 9.04 mmHg with GAT and 20.11 +/- 8.42 mmHg with Pulsair [P=0.075]. Correlation coefficient between the two methods was 0.96 [P= 0.004] and the mean difference [Pulsair-GAT] was 0.65 +/- 1.52 [confidence interval 95%, +3.5 to -2.29]. With IOPs between 10-25mmHg, mean difference between the two methods was 0.49 +/- 1.23 [P= 0.32] mmHg, however it was -1.75 +/- 1.91 [P= 0.06] at IOPs over than 25 mm Hg. Pulsair tonometry has acceptable accuracy in comparison with GAT, especially in IOP ranging from 10 to 25 mmHg

[Effect of intravitreal triamcinolone [IVT] injection on visual acuity in patients with ischemic CRVO]

To determine the effect of intravitreal triamcinolone [IVT] injection on visual acuity in patients with ischemic central retinal occlusion [CRVO]. This randomized clinical trial was performed on patients with ischemic CRVO referred to the retina clinic at Feiz Hospital in 2007-2008. Inclusion criteria were: duration of CRVO less than one month, normal IOP, no sign of diabetic retinopathy or hypertensive retinopathy, no history of laser therapy and ocular surgery and vascular diseases. Patients were randomly allocated to two groups: intervention group [injection of 0.1cc IVT] and control group [no injection]. Follow up examinations for all patients were scheduled 1, 2, 3 and 6 months after injection. The results were analyzed by SPSS13 and t-test. Overall, 52 patients [22 male and 30 female] entered the study. Mean age was 60.5 +/- 9.7 [range: 30-80] years. Duration of signs was 21 +/- 5.5 days in the control group and 19 +/- 6 days in the IVT group [P= 0.66]. All patients had signs of ischemic CRVO. Mean baseline visual acuity was 1.75 +/- 0.20 logMAR in the IVT group and 1.91 +/- 0.08 logMAR in the control group [P= 0.1]. VA improvement in the IVT group was greater in comparison with the control group at one month [P= 0.019] however this difference was not significant at other follow-up examinations. In addition, the difference in IOP between before and after the injection was not significant [P= 0.802]. This study showed that in patients with CRVO, intravitreal injection of triamcinolone, has no significant long-term effect on visual acuity

[Fortified cefazolin-gentamicin versus fortified vancomycin-ceftazidime drops for treatment of bacterial corneal ulcers]

To compare the efficacy of treatment with fortified cefazolin-gentamicin versus fortified vancomycin-ceftazidime eye drops for treatment of bacterial corneal ulcers. A double-blind clinical trial was performed on 89 patients with bacterial corneal ulcers who were referred to Feiz Hospital, Isfahan, Iran from 2004 to 2005. Patients were randomly assigned to two groups: one group included 41 patients who received fortified cefazolin-gentamicin eye drops and the other group included 48 patients who received fortified vancomycin-ceftazidime eye drops. Patients were evaluated in terms of time for re-epithelization, reduction of stromal infiltration and reduction in anterior chamber inflammation as well as culture results and drug complications. The patients included 57 [64%] male and 32 [36%] female subjects. Cultures were negative in 46%. Re-epithelization time was 13.2 +/- 3.1 days in the cefazolin-gentamicin group and 9.6 +/- 2.7 days in the vancomycin-ceftazidime group [P=0.01]. Time for reduction of stromal infiltration and corneal ulcer treatment was 17.7 +/- 4.3 days in the cefazolin-gentamicin group vs 13.8 +/- 3.6 days in the vancomycin-ceftazidime group [P=0.04]. The most common complaint of patients was eye burning in 73.1% of cases in the cefazolin-gentamicin group and 62.9% of cases in the vancomycin-ceftazidime group [P=0.007]. Fortified vancomycin-ceftazidime eye drops are more effective than fortified cefazolin-gentamicin eye drops for the treatment of bacterial corneal ulcers and seem to entail fewer adverse effects

[Specifity and sensitivity of ocular sonography in the diagnosis of retinal detachment with vitreous hemorrhage]

To evaluate the specifity and sensitivity of ocular sonography in the diagnosis of retinal detachment in the presence of vitreous hemorrhage. This cross-sectional study included 47 [23 right eyes and 24 left eyes] eyes of 47 patients [18 male and 29 female subjects] with vitreous hemorrhage suspected of retinal detachment requiring surgery. Preoperative ocular sonography was compared with intraoperative findings to determine the sensitivity and specifity of ocular sonography. Mean age of the patients was 43.8+23.1 years [range 4 months to 81 years]. Causes of vitreous hemorrhage included trauma in 20 eyes [42.6%], diabetes mellitus in 9 eyes [19.1%], hypertension in 6 eyes [12.8%], following cataract surgery in 3 eyes [6.4%], following penetrating keratoplasty in one eye [2.1%] and unknown in 8 eyes [17.1%]. Visual acuity was counting fingers in 2 [4%], hand motion in 12 [27%] and light perception in 31 [69%] eyes. The diagnostic data of sonography were as follows: sensitivity 87.5%, specifity 64.5%, accuracy 72.4%, positive predictive value 56% and negative predictive value 90.9%. Ocular sonography is a useful diagnostic tool for evaluation of retinal detachment in patients with vitreous hemorrhage

[Stereoacuity after LASIK]

To evaluate the effect of laser in situ keratomileusis [LASIK] on stereoacuity [SA]. In this prospective study, 200 patients scheduled for LASIK were evaluated for SA preoperatively and one week and one and three months postoperatively by Random Dot test. Patients with preoperative SA worse than 480 sec/arc were excluded. Patients included 138 female [69%] and 62 male [31%] subjects. Spherical equivalent was between -0.5 and -12.0 D. Mean preoperative SA was 124.80 +/- 124.64 [range 480-15] sec/arc which deteriorated to 138.30 +/- 126.48 sec/arc one week after surgery [P= 0.158] and improved to 111.30 +/- 112.15 sec/arc [P=0.002] one month and 103.65+112.20 sec/arc [P=0.001] three months postoperatively. Patients with anisometropia had lower SA. Eventually, SA increased in 5 nonamblyopic anisometropic patients. Overall, stereoacuity decreased in 9.5%, increased in 32.5% and remained unchanged in 58% of patients [P=0.007]. Despite the overall improvement in mean SA after LASIK, a considerable number of patients experienced decreased SA. It seems that anisometropic patients without amblyopia have a higher chance for improvement in SA

Effects of preoperative sub-tenon block on intra- and post-operative complications in retinal detachment surgery

To evaluate the efficacy of sub-tenon block [preemptive analgesia] following general anesthesia and before the beginning of scleral buckling and cryopexy in retinal detachment [RD] surgery on decreasing intra- and post-operative complications. Sixty eight patients scheduled for RD surgical repair with ASA [American Society of Anesthesiologists] class I or II were enrolled in this clinical trial. The patients were randomly divided into two groups. Both groups underwent general anesthesia [GA], but one group received sub-tenon block as preemptive analgesia following induction of general anesthesia [treatment group]. Intra- and post-operative [up to 24 hours] incidence of oculocardiac reflex [OCR], mean blood pressure [BP], heart rate [HR], post-operative ischemic heart disease [IHD] changes, nausea and vomiting [PONV], delirium, total analgesic consumption, severity of ocular pain, frequency of analgesic requirement, and duration of hospitalization were compared between the two groups. There was no statistically significant difference between the two groups regarding age, sex, and preoperative blood pressure [BP] and heart rate. Mean BP of patients in the treatment group and the control group was 126.6/74.8 and 126.4/74.4 mmHg, preoperatively [P>0.2] and 12 6.4/76.4 and 134.6/74.4 mmHg, postoperatively [P=0.01]. Pain complaint of any degree was more frequent in the control group such that 38% in the recovery room and 25% 6 hours after surgery complained of severe pain compared to none in the treatment group. [P= 0.001] Incidence of delirium in the recovery room was 3.7% in the treatment group vs. 24.1% in the control group. [P= 0.001] Mean duration of hospitalization after surgery was 26.6 +/- 1.5 hr in the treatment group and 34.0 +/- 1.5 hr in the control group. [P<0.01]. Sub-tenon block following induction of CA for RD surgery reduces intra- and post-operative complications effectively, therefore it is recommended for routine ophthalmologic procedures