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Purpose@#To study the ocular manifestations, its severity and sequelae in patients with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). @*Methods@#Prospective study of 44 consecutive patients (30 SJS and 14 TEN) presenting in the acute phase of the disease. Patients were evaluated by dermatologist as well as physician for systemic status, skin lesions and mucosal involvement. Detailed history taking, visual acuity, ophthalmic evaluation (lid margin, corneal, conjunctival changes, tear film and ocular surface). Ocular severity score (OSS) was assessed at baseline (acute) and at 6 months (chronic / OSS6), graded as mild, moderate and severe. @*Results@#Mean age was 28.15 ± 15.78 years. Sixty-five eyes of 33 patients were included for final analysis. Thirty-eight patients (86.4%) had ocular manifestations. Drugs were the most common causative factor (95.4%). At base line mild, moderate, and severe OSS was seen in 43.1%, 44.6%, and 12.3% eyes. At 6 months mild, moderate, and severe OSS was seen in 44.6%, 7.7%, and 6.2% of eyes. There was a significant correlation between age of the patient and OSS at 6 months (p = 0.02). Younger age had higher chronic OSS. Patients with TEN had higher acute (p = 0.001) and chronic (p = 0.001) OSS than SJS. Three mucosal surface involvement associated with higher acute and chronic OSS (p = 0.001). No long-term ocular complications observed in 27 / 65 (41.5%) eyes. Acute OSS correlated significantly with chronic OSS, at 1 and 6 months (p = 0.001). @*Conclusions@#Greater severity of the disease, more number of mucosal surfaces involved and shorter symptom lag correlated with more severe acute and chronic ocular manifestations. The severity of lid margin involvement and corneal involvement in acute stage were good predictors of severity of chronic ocular findings. Initial severity of ocular involvement correlated with severity of ocular sequelae.
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Purpose@#To study the ocular manifestations, its severity and sequelae in patients with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). @*Methods@#Prospective study of 44 consecutive patients (30 SJS and 14 TEN) presenting in the acute phase of the disease. Patients were evaluated by dermatologist as well as physician for systemic status, skin lesions and mucosal involvement. Detailed history taking, visual acuity, ophthalmic evaluation (lid margin, corneal, conjunctival changes, tear film and ocular surface). Ocular severity score (OSS) was assessed at baseline (acute) and at 6 months (chronic / OSS6), graded as mild, moderate and severe. @*Results@#Mean age was 28.15 ± 15.78 years. Sixty-five eyes of 33 patients were included for final analysis. Thirty-eight patients (86.4%) had ocular manifestations. Drugs were the most common causative factor (95.4%). At base line mild, moderate, and severe OSS was seen in 43.1%, 44.6%, and 12.3% eyes. At 6 months mild, moderate, and severe OSS was seen in 44.6%, 7.7%, and 6.2% of eyes. There was a significant correlation between age of the patient and OSS at 6 months (p = 0.02). Younger age had higher chronic OSS. Patients with TEN had higher acute (p = 0.001) and chronic (p = 0.001) OSS than SJS. Three mucosal surface involvement associated with higher acute and chronic OSS (p = 0.001). No long-term ocular complications observed in 27 / 65 (41.5%) eyes. Acute OSS correlated significantly with chronic OSS, at 1 and 6 months (p = 0.001). @*Conclusions@#Greater severity of the disease, more number of mucosal surfaces involved and shorter symptom lag correlated with more severe acute and chronic ocular manifestations. The severity of lid margin involvement and corneal involvement in acute stage were good predictors of severity of chronic ocular findings. Initial severity of ocular involvement correlated with severity of ocular sequelae.
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To evaluate the efficacy of a combination of 5-fluorouracil [5-FU] and low molecular weight heparin [LMWH] during vitrectomy, as adjuvants in preventing proliferative vitreoretinopathy [PVR]. Double-blind, prospective, randomized placebo-controlled trial. Forty consecutive patients diagnosed with rhegmatogenous retinal detachment with high-risk PVR, were randomized to study and control groups [n = 20 each]. Study group [group 1] patients underwent vitrectomy with the use of both intraoperative 5- FU [0.2 mg/ml] and LMWH [5 IU/ml]. In the control group [group 2], a similar surgery was performed without the use of adjuvants. Patients were evaluated at 1 month, 3 months and 6 months after surgery. Postoperative retinal reattachment, recurrence of PVR, best-corrected visual acuity and complications at the end of 6 months were compared between the two groups. A Chi-square statistical analysis was used on all of the outcome measures. At 6 months post-surgery, 62.5% of patients had reattached retina. There was no significant difference [Chi-square test showed x[2] = 0.106, P = 0.7447, P > 0.05] in retinal reattachment in both of the groups. The rate of postoperative PVR in the control group was 55%; in the study group, the rate was 45% [the Chi-square test showed x[2] = 0.4, P = 0.5271, P > 0.05], which proves statistically insignificant. In addition, there was no statistically significant difference in visual outcomes between the two groups [Chi-square test showed x[2] = 0.1002, P>0.05], no significant difference in the complication rate and drug toxicity was noted between two groups. This study fails to prove the efficacy of the intraoperative use of 5-FU and LMWH in combination as an antiproliferative regiment for the prevention of postoperative PVR or improvement in final visual acuity. At the same time, no significant complications could be attributed to the treatment
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To compare the morphological [cell density, coefficient of variation and standard deviation] and functional [central corneal thickness] endothelial changes after phacoemulsification versus manual small-incision cataract surgery [MSICS]. Prospective randomized control study. In this prospective randomized control study, patients were randomly allocated to undergo phacoemulsification [Group 1, n = 100] or MSICS [Group 2, n = 100] using a random number Table. The patients underwent complete ophthalmic evaluation and specular microscopy preoperatively and at land 6 weeks postoperatively. Functional and morphological endothelial evaluation was Noncon ROBO PACHY SP-9000 specular microscope. Phacoemulsification was performed, the chop technique and MSICS, by the viscoexpression technique. The mean difference in central corneal thickness at baseline and 1 week between Group 1 and Group 2 was statistically significant [P- 0.027]. However, this difference at baseline when compared to 6 week and 1 week, 6 weeks was not statistically significant [P> 0.05]. The difference in mean endothelial cell density between groups at 1 week and 6 weeks was statistically significant [P = 0.016]. The mean coefficient of variation and mean standard deviation between groups were not statistically significant [P> 0.05, both comparisons]. The central corneal thickness, coefficient of variation, and standard deviation were maintained in both groups indicating that the function and morphology of endothelial cells was not affected despite an initial reduction in endothelial cell number in MSICS. Thus, MSICS remains a safe option in the developing world