[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 aberrations after photorefractive keratectomy using tissue saving and personalized techniques]

To compare the effects of standard tissue saving method and personalized techniques of photorefractive keratectomy [PRK] on aberration changes in fellow eyes. This randomized controlled trial was performed on patients who were referred to Isfahan Parsian Clinic during 2007. After a comprehensive ophthalmologic examination, PRK was randomly performed using tissue saving [TS] technique in one eye and personalized [P] technique in the fellow eye. Aberrometry was performed pre- and 6 months postoperatively. This study included 296 eyes of 148 [67 male and 81 female] patients with mean age of 29.1 +/- 7.0 years. The two groups had no significant difference in terms of laterality, pupil size and level of myopia preoperatively [P=0.65]. Uncorrected visual acuity was 20/25 or more in 88.9% of the TS group and 92.6% of the P group [P=0.83]. Mean refractive error 6 months postoperatively was -0.50 +/- 0.36 diopter [D] in the TS group and 0.31 +/- 0.43 D in the P group [P=0.95]. Mean root-mean-square [RMS] value was -0.41 +/- 0.17 preoperatively and 0.86 +/- 0.43 postoperatively in the group TS [P<0.01]. Corresponding figures were 0.47 +/- 0.39 and 0.77 +/- 0.43 in the P group [P<0.01]. The two groups did not differ regarding pre- and postoperative RMS. Postoperative aberrations may be increased with both tissues saving and personalized techniques of PRK with no significant difference between them in this regard

[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

[Effect of Ramadan fasting on physiologic myopia]

Simple myopia is one of the most common ocular abnormalities. Diet is amongst the factors that affect on myopia. Therefore, this study was aimed to evaluate the effect of Ramadan fasting on physiologic myopia. This descriptive-analytical study was conducted on a total of 61 individuals [122 eyes]. The subjects were male myopic with simple myopia ranged 0.50 to -8D, aged 22-50 years. The refraction of their eyes was examined before and after Ramadan [3-4 days after Ramadan] using cycloplegic refraction. At the end of fasting month, the same examination was administrated and the findings obtained were compared using t test. The mean age of the patients was 31.20 +/- 11.24 [ranged 22-50 years]. Visual intensity of the patients was 20.20. The mean of refraction deficiency of the individuals before and after the fasting was -3.21 +/- 2.80 and -3.16 +/- 3.00 D [P>0.05]. Fasting has no effect on myopia in the male individuals aged above 23 years

[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

[Evaluation of ophthalmologists' sitting position]

To evaluate ophthalmologists' sitting position during ocular examination and surgery and to evaluate any correlation between musculoskeletal disorders and mean work time. This cross-sectional study was performed on ophthalmologists in Isfahan, Iran in different occupational positions including the office, during slitlamp examination and in the operating room. The evaluation included neck angle, lumbar lordosis, pelvic angle and the position of lower leg and foot. Ophthalmologists were asked about spinal and shoulder pains and mean work time in the office and operating room. Among 73 studied ophthalmologists [including 60 male and 13 female subjects], there were malpositions in neck angle in 43 [58.9%], lumbar lordosis in 36 [49.3%], hip angle in 9 [12.3%], lower leg in 49 [67.1%] and foot in 31 [42.4%] cases. Among 62 ophthalmologists who performed surgery there were malpositions in neck angle in 38 [61.3%], lumbar lordosis in 38 [61.3%], hip angle in 2 [37.1%], knee angle in 43 [69.4%] and foot in 44 [71.0%] cases. There was a significant correlation between spinal pains and mean work time in the office [P=0.02] and operating room [P=0.01]. According to the correlation between spinal pains and work time, it is necessary to educate ophthalmologists for correct sitting position during work

[Ocular symptoms and signs in professional video-display users]

To compare the prevalence of ocular symptoms and signs in professional video-display users [VDU] and non-users. This cross-sectional case-control study was performed on bank staff who used computer for their task as the VDU group and staff who did not work with computer as controls. Ocular symptoms were evaluated based on a questionnaire and signs were detected according to complete ocular examination. The VDU group included 34 male and 23 female subjects with mean age of 30.7 +/- 6.8 years and controls included 25 male and 31 female subjects with mean age of 27.6 +/- 7.2 years. There was no statistically significant difference between the two groups regarding age and sex. Ocular symptoms included burning and tearing in 79% vs 45% [P=0.037], dry eye sensation in 66% vs 32% [P= 0.022] and asthenopia in 64.8% vs 40% [P=0.044] of the VDU group vs controls, respectively. Dry eye based on Schirmer test of less than 10 mm after 5 minutes was found in 40.3% vs 10.7% in the VDU group and controls, respectively [P=0.012]. Tear break up time of less than 10 seconds was seen in 43.8% of the VDU group and 8.9% of the control group [P=0.044]. Heterophoria was present in 33.2% of the VDU group vs 5.3% of controls [P=0.032]. There was no difference between the two groups regarding myopia [54.3% in the VDU group vs 39.2% in controls]. Ocular complaints such as burning and tearing, dry eye sensation and asthenopia were more prevalent in video-display users

[Efficacy of preoperative topical diclofenac for prevention of post-cataract surgery inflammation]

To evaluate the efficacy of pretreatment with diclofenac sodium 1% eye drop for prevention of post-cataract surgery ocular inflammation. A double blind clinical trial was performed on 111 patients who were scheduled for phacoemulsification and intraocular lens implantation [PE+IOL] at Feiz Hospital, Isfahan-Iran. Cases with traumatic cataract and complicated surgery were excluded. Patients were randomly assigned to three groups: [1] controls; [2] treatment with one drop of diclofenac sodium 1% QID one day before surgery; and [3] treatment with one drop of diclofenac sodium 1% QID for three days preoperatively. All eyes received topical steroid and antibiotic, postoperatively. Postoperative anterior chamber [AC] reaction, ocular pain, burning, red eye, atonic mydriasis and intraocular pressure were evaluated on days 1, 3, 14 and 30. The study included 70 male and 41 female subjects with mean age of 61.03+8.35 years. Ocular pain was significantly more prevalent and severe in controls compared to other groups on postoperative days 1, 3 and 14. AC reaction was also more prevalent and severe in controls than the other two groups only on the first postoperative day. The prevalence and severity of red eye on days 1, 14 and 30 postoperatively were higher in controls compared to the two other groups without any difference by the third postoperative day. Eye burning was more prevalent in the control group than the other two groups only on days 1 and 3. The active treatment groups had no difference in terms of the above-mentioned characteristics at any stage; except for AC reaction on the first postoperative day which was more severe in the one-day treatment group compared to the three-day group. There was no significant difference between the three groups regarding relative miosis intraoperatively. Postoperative changes in intraocular pressure were within normal limits in all groups. Pretreatment with diclofenac sodium 1% can reduces the incidence and severity of post-cataract surgery AC reaction, eye burning, red eye and ocular pain, particularly during the first postoperative week

[Dry eye following keratorefractive surgery]

To compare tear secretion values following LASIK [laser in situ keratomileusis] and photorefractive keratectomy [PRK]. Patients referred to Aban Eye Clinic [Isfahan, Iran] for refractive surgery were randomly assigned to LASIK or PRK. Exclusion criteria were contraindications for refractive surgery, usage of topical ocular drugs, dry eye and reoperation. Schirmer test was performed pre- and 1, 3 and 6 months postoperatively. The study included 176 eyes of 88 patients [30 male and 58 female] with mean age of 24.7 +/- 3.5 [range 19-34] years. Each group included 44 patients without any statistically significant difference regarding age, sex, mean spherical equivalent and corneal thickness. Mean values of Schirmer test were 13.5 +/- 5.3 mm in the PRK group and 14.5 +/- 7.1 mm in the LASIK group [P=0.08] preoperatively which reached 11.7 +/- 4.2, 12 +/- 4.1 and 12.7 +/- 5 mm in the PRK group and 13.5 +/- 3.6, 14.3 +/- 5 and 14.2 +/- 5.1 mm in the LASIK group at 1, 3 and 6 months postoperatively, respectively [P=0.07, P=0.09 and P=0.17, respectively]. There were 4 cases [4.5%] of dry eye 6 months postoperatively in the LASIK group vs nill in the PRK group [P= 0.04]. Tear secretion decreases following both PRK and LASIK, however it seems to be more severe after LASIK

[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

Ocular disorders in renal transplant patients

To evaluate patients with renal transplantation for abnormal ocular findings and to determine the association of these findings with pretreatment dialysis duration, immunosuppressive regimen and underlying disease causing renal failure. This cross-sectional study was performed on 150 patients who had undergone kidney transplantation for at least three months and with serum creatinin < 3 mg/dl. All patients underwent ophthalmologic examination including visual acuity, slit lamp biomicroscopy and dilated funduscopy. This study included 91 male and 59 female subjects with mean age of 39 years. No abnormal ocular findings was found in 10.7%; there was at least one ocular disorder in 89.3% including visual acuity

[Short-term Vs long-term systemic corticosteroid in ocular toxoplasmosis]

To compare the effects of short-tem and long-term systemic corticosteroids in the treatment of confirmed ocular toxoplasmosis. This randomized comparative clinical trial was performed on 69 patients with confirmed active ocular toxoplasmosis with typical clinical manifestations. The subjects were randomly assigned to receive either 10 days [group A, 33 cases] or 4-6 weeks [group B, 36 cases] of systemic corticosteroids in addition to classic antibiotic. All patients were visited and followed weekly until complete improvement of vision. Mean visual acuity, inflammatory cell count in the vitreous, lesion size and severity of the condition were compared between the two groups. There was no statistically significant difference between the two group, regarding mean values of visual acuity in LogMAR [before; group A: 0.24 +/- 0.6, group B: 0.28 +/- 0.07, P=0.43 and after; group A: 0.11 +/- 0.08, group B: 0.60 +/- 0.07, P=0.09], vitreal inflammatory cell count [before; group A: 1.8 +/- 0.56, group B: 1.9 +/- 0.06, P=0.45 and after; group A: 1.5 +/- 0.65, group B: 1.5 +/- 0.5, P=0.94], and size of the lesion in disc diameter [before; group A: 0.94 +/- 0.37, group B: 1.03 +/- 0.37, P= 0.49 and after; group A: 0.94 +/- 0.44, group B: 1.12 +/- 0.38, P=0.4]. The study revealed that there is no significant difference between the effects of short-term and long- term systemic corticosteroid therapy in the treatment of ocular toxoplasmosis. It is reasonable to perform an equivalence trial study on this issue

Burden of coronary heart disease on the Iranian oil industry [1999-2000]

To estimate the direct cost of coronary heart disease [CHD] to the Iranian oil industry, we calculated the cost of essential services for 1253 CHD patients admitted to the National Iranian Oil Corporation [NIOC] Central Hospital. The direct cost of CHD at the Hospital was 10940 million rials [US$ 1 = 8000 rials], or 8.7 million rials per patient. The direct cost of CHD to the Iranian oil industry was estimated at 22 770 million rials. Working days lost to workers hospitalized for CHD amounted to 62 832. The heavy burden of CHD on the Iranian oil industry necessitates the introduction of an industry-wide prevention programme