Comparing anatomical pattern of topical anti-glaucoma medications associated lacrimal obstruction with a control group.

PURPOSE: To compare the anatomical pattern of lacrimal drainage system obstruction (LDSO) associated with topical anti-glaucoma medications (AGM) with a control group. METHODS: In a cross-sectional controlled study, case group included patients on topical anti-glaucoma medications and control group included patients with no history of glaucoma, free of ocular disease, and not using topical medications. Data recording, eye examination, and categorization of patients into case and control groups were performed by a senior ophthalmology resident. Diagnostic probing and irrigation test was performed by an oculoplastic surgeon who was masked to the patients' data. Chi-square (X(2)) and tests were used to assess the effect of sex and systemic diseases, as well as logistic regression analysis with intra-cluster correlation for the effect of topical anti-glaucoma medications on lacrimal drainage system, and then independent sample t-tests to compare the mean ages, plus the binary logistic regression test for the effect of increasing age on LDSO. RESULTS: There were 128 eyes of 96 patients in the case and 277 eyes of 172 patients in the control group. Two groups were similar regarding to the age, sex, and associated systemic disorders (0.3

Traumatic wound dehiscence and lens extrusion after penetrating keratoplasty.

PURPOSE: The purpose of this study was to investigate risk factors for and results of treatments in patients with traumatic wound dehiscence and lens extrusion after penetrating keratoplasty. METHODS: In this retrospective case series, 7 eyes (4 right eyes and 3 left eyes) of 7 patients who had traumatic wound dehiscence and lens extrusion were studied at Rassoul Akram Hospital. Six patients were male and one patient was female. After emergency treatment for the trauma, the wound was checked under general anesthesia, and anterior vitrectomy was performed. The iris was repositioned as needed and the dehiscence site was sutured in all patients using 10-0 nylon thread. Follow up was similar to that after keratoplasty. All recorded data were statistically analyzed using SPSS software (version 15; SPSS Inc., Chicago, IL). RESULTS: Mean age at trauma was 21 years (range, 10-30 years), and the mean interval between keratoplasty and trauma was 15.6 months (range, 2.5-26.5 months). Mean best-corrected visual acuity of patients before blunt trauma and after final treatment was 20/80 and 20/160, respectively. In one case, visual acuity decreased to light perception after final treatment. The dehiscence site was superior to the graft in 4 patients. Hitting by a hand was the cause of most cases of blunt trauma. No cases of endophthalmitis were seen. CONCLUSION: Patients who undergo penetrating keratoplasty are susceptible to graft wound dehiscence resulting from trauma, especially during the first year after keratoplasty. This type of dehiscence is more prevalent in young people, who engage in more social activities and are more exposed to trauma that may lead to blindness. Patient education about the effects of trauma, use of protective eye shields by patients, and performance of lamellar keratoplasty instead of penetrating keratoplasty can decrease trauma and its effects in these patients.

Intraoperative mitomycin C use during filtration surgery and lacrimal drainage system obstruction.

PURPOSE: To evaluate the effect of intraoperative mitomycin C (MMC) application during filtration surgery on lacrimal drainage system. DESIGN: Prospective, nonrandomized, comparative, observational case series. METHODS: All glaucomatous patients with previous filtration surgery with or without intraoperative MMC application were included. An ophthalmology resident took a detailed history and performed a general eye examination. Patients with ocular and periocular diseases and previous procedures that could affect the lacrimal drainage system were excluded. Diagnostic probing and irrigation of lacrimal drainage system were performed by a masked oculoplastic surgeon. RESULTS: There were 76 eyes from 60 patients with intraoperative MMC (MMC group) and 35 eyes from 24 patients without intraoperative MMC (non-MMC group) application. Two groups were matched for all the variables except for significantly longer duration of being on topical anti-glaucoma medications in the non-MMC group. Lacrimal drainage system obstruction was found in 18.4% of MMC and 22.8% of non-MMC group (P = .61). Upper lacrimal drainage system obstruction was insignificantly more in the MMC group. Duration of MMC application (one to five minutes) did not have significant impact on lacrimal drainage system obstruction. Patients with lacrimal drainage system obstruction were significantly more symptomatic (wet eye). CONCLUSION: Intraoperative MMC application during filtration surgery did not have a statistically significant impact on the rate of lacrimal drainage system obstruction.