[Isolated corneal squamous cell intraepithelial neoplasia in a patient with unilateral dry eye symptoms]

To report a case of isolated corneal squamous cell intraepithelial neoplasia in a patient with unilateral dry eye symptoms. A 48 year old man presented with history of thermal corneal injury in his left eye two years ago, with decreased visual acuity and dry eye symptoms a short time thereafter. He was treated for dry eye with no improvement in symptoms. Upon presentation, slit lamp examination revealed near total hypertrophy of the corneal epithelium with distinct and scalloped border, without limbal or conjunctival involvement. The patient underwent excisional biopsy [debridement] of the corneal epithelium. Histopathology revealed severe corneal dysplasia [carcinoma in situ]. After excision, the patient was treated with fluorouracil drops 50 mg/dl QID and there was no sign of recurrence up to 1.5 months after surgery. At final follow-up, visual acuity was 9/10 and dry eye symptoms had completely disappeared. In patients with unilateral chronic dry eye refractory to treatment and signs of corneal epithelial involvement, isolated corneal neoplasia should be considered even without limbal or conjunctival involvement

[Medical treatment in prevention of rebleeding in traumatic hyphema]

Traumatic hyphema is among the most common challenges in ophthalmologic emergency. Its most common complication, rebleeding, is accompanied with poor prognosis. Rebleeding could cause corneal blood staining, glaucoma, and optic atrophy. Thus, the most important goal in hyphema treatment is prevention of rebleeding. This study was aimed to evaluate epidemiology, medical treatment, and short term complications of traumatic hyphema. This was a descriptive cross-sectional study, done in the year in Khatam- al- Anbia Ophthalmologic Hospital in Mashhad. 100 patients with traumatic hyphema were evaluated by an epidemiologic questionnaire and complete eye examination in emergency room. They all were treated by topical corticosteroid and cycloplegic with or without systemic medication [prednisone or tranexamic acid] according to degree of hyphema .All patients were followed for at least 10 days. Data was analyzed, using descriptive statistics and frequency distribution tables. 81% of patients were male with male to female ratio of 4:1. The patients' mean age was 26.5 +/- 15.4 years old. 62% of patients were under 30 years of age. The patients' right and left eyes were affected in 48% and 50%, respectively; 2% had both eyes affected. No statistically significant difference was found between right and left eye involvement. The mean visual acuity at presenting time was 4/10. There was a direct correlation between presenting visual acuity and severity of hyphema [p=0.043]. No correlation was found between age, sex, and the type of trauma with severity of hyphema. The mean intraocular pressure [IOP] was 18 mmHg at presenting time. There wasn't any correlation between IOP and severity of hyphema. The mean visual acuity at the last follow up visit was 8/10. Rebleeding occurred in 10 patients out of 100 cases. The risk of rebleeding with medical treatment was 10%. Rebleeding was found to occur 4.3 days after trauma, averagely. In this study, it was seen in the cases with hyphema of the degree of 4 or more [the only risk factor for rebleeding, in this study]. Traumatic hyphema is a common cause of refer to ophthalmology emergency room. Results of this study showed that complications of traumatic hyphema, especially rebleeding, could be prevented, significantly, with medical treatment

[Investigation of changes in levels of liver trans-aminases in measles affected patients hospitalized in Be'sat hospital in 1379]

Background: One of measles manifestations -especially in adolescents- is liver malfunction which can vary from just changes in liver enzymes to hepatitis with prominent jaundice. It is important to screen hepatitis patients in order to special medical treatment and avoidance of prescribing hapatotoxic drugs and some pain relief medications. In addition, patients of such complications are high risk for long duration of hospitalization and secondary complications and long duration of the disease

Materials and methods: This was a cross-sectional study of 172 patients selected from 180 patients with clinical measles admitted in Be'sat hospital of NAHAJA. CBC and liver enzymes were checked

Results: Patients aged between 18 to 24 years. Mean of hospitalization time was 6.48 +/- 2.37days and ranged from 2 to 14. Mean of white blood count was 4153.85 +/-1706.08 and ranged from 1700 to 13000. PMNs percentage was 61.01+/-16.27 in mean and ranged from 26% to 89%. Mean of total PMN count was 2591.38+/-1409.42 [from 513 to 10270]. ALT [SGPT] was 40.86+/-33.68 in mean [from 10 to 280]. Mean of AST [SGOT] was 53.23+/- 35.76 ranged from 15 to 250. Total bilirobin was 0.9+/-0.31 [from 0.2 to 2.1] in mean. Mean of direct bilirobin was 0.2+/-0.8 ranged from 0.1 to 0.8. ALKP was 195.19+/-88.6 [from 41 to 590]. 9.5 %of patients [16 patients] had liver malfunction [2 times increase of enzymes levels]. No one had jaundice at the time of admit. Comparison of evaluation of lab values of the patients with duration of hospitalization with Pearson test, only in two cases PMN percentage and total PMN had significant relation [P<0.05]

Conclusions: When measles patients had no complications such as secondary bacterial infections and had no history of hepatotoxic drugs, increase in liver enzymes levels is mild and had no significant clinical interest

Investigation of changes in levels of liver trans-aminases in measles affected patients hospitalized in Be'sat hospital in 1379

One of measles manifestations -especially in adolescents- is liver malfunction which can vary from just changes in liver enzymes to hepatitis with prominent jaundice. It is important to screen hepatitis patients in order to special medical treatment and avoidance of prescribing hapatotoxic drugs and some pain relief medications. In addition, patients of such complications are high risk for long duration of hospitalization and secondary complications and long duration of the disease. This was a cross-sectional study of 172 patients selected from 180 patients with clinical measles admitted in Be'sat hospital of NAHAJA. CBC and liver enzymes were checked. Patients aged between 18 to 24 years. Mean of hospitalization time was 6.48 +/- 2.37days and ranged from 2 to 14. Mean of white blood count was 4153.85 +/- 1706.08 and ranged from 1700 to 13000. PMNs percentage was 61.01 +/- 16.27 in mean and ranged from 26% to 89%. Mean of total PMN count was 2591.38 +/- 1409.42 [from 513 to 10270]. ALT [SGPT] was 40.86 +/- 33.68 in mean [from 10 to 280]. Mean of AST [SGOT] was 53.23+7- 35.76 ranged from 15 to 250. Total bilirobin was 0.9 +/- 0.31 [from 0.2 to 2.1] in mean. Mean of direct bilirobin was 0.2 +/- 0.8 ranged from 0.1 to 0.8. ALKP was 195.19+7-88.6 [from 41 to 590]. 9.5%of patients [16 patients] had liver malfunction [2 times increase of enzymes levels]. No one had jaundice at the time of admit. Comparison of evaluation of lab values of the patients with duration of hospitalization with Pearson test, only in two cases PMN percentage and total PMN had significant relation [P<0.05]. When measles patients had no complications such as secondary bacterial infections and had no history of hepatotoxic drugs, increase in liver enzymes levels is mild and had no significant clinical interest

[Clinical outcomes of surgery for double elevator palsy]

To evaluate the clinical findings and surgical management of patients with congenital unilateral double elevator palsy [DEP] or monocular elevation deficiency [MED]. In a non-comparative interventional case series, 27 consecutive cases of DEP were studied. Hypotropia, elevation deficiency, and pseudoptosis were corrected by Knapp or Callahan procedure with or without inferior rectus recess. Ptosis was corrected by anterior levator resection [ALR] and brow suspension. Levator excision and brow suspension was performed for correction of accompanying jaw winking ptosis. Horizontal strabismus repair, belpharoplasty, and double Z- plasty for epicanthal folds were done in some cases. This series included 15 female and 12 male subjects with mean age of 13 +/- 10 years. All patients except two were sporadic cases. Definite congenital DEP was present in two members of a consanguineous family. In most cases, the presenting complaint was ipsilateral ptosis [74%]. Hypotropia with various degrees of severity was found in 20 cases [74%]. Six patients [22%] had jaw winking ptosis of the ipsilateral eye. Knapp procedure was performed in 6 and Callahan procedure was performed in 4 cases. True ptosis was corrected by anterior levator resection in 9 and brow suspension in 8 eyes. Levator excision and brow suspension was performed in 3 patients with accompanying jaw winking ptosis. In one case with mild jaw winking, levator resection was done. Hypotropia was corrected in 80% after surgery and eye elevation increased by 25 +/- 15 PD. Ptosis correction procedures successfully improved chin up position and cosmetic appearance in addition to opening the visual axis. Anterior segment ischemia was not found in any cases after one year of follow up. Blepharoptosis and hypotropia the chief clinical features and presenting complaints in this condition. Knapp and Callahan procedure with or without inferior rectus recess are effective and should be consider prior to considering surgical intervention for the ptosis