Corneal biomechanical changes after trabeculectomy with mitomycin C in primary open-angle glaucoma and pseudoexfoliation glaucoma.

PURPOSE: This study aimed to examine the effect of trabeculectomy with mitomycin C on corneal biomechanical characteristics in PEXG and POAG patients. METHODS: In this prospective comparative case series study, 32 glaucoma patients of whom 17 patients were suffering from PEXG and 15 patients from POAG were enrolled. All patients underwent complete ocular examination, CCT using ultrasound pachymetry and corneal biomechanical study using ORA. The patients were hospitalized, and trabeculectomy surgery with mitomycin was done. Three months after surgery, patients were examined and ORA was obtained again. RESULTS: The mean CH in patients with PEXG was lower compared to patients with POAG (5.66 ± 1.13, 7.49 ± 0.88, respectively) before surgery, which had a statistically significant difference (P < 0.001). CRF in patients with PEXG was significantly lower compared to patients with POAG (8.19 ± 1.48 vs. 9.35 ± 1.60, respectively) before surgery, with P = 0.049. CH remarkably increased and reached 6.69 ± 0.78 (P < 0.001) in the PEXG group after TBX + MMC surgery. CH increased in the POAG group after TBX + MIC surgery and reached 8.23 ± 1.09, which was statistically significant (P = 0.001). There was a significant relationship between CH and IOPg changes in both PEXG and POAG groups (P < 0.001 and P = 0.01, respectively). Although TBX + MMC surgery changed the amount of CH in PEXG and POAG groups, no significant difference was shown in the parameters between the two groups comparing the CH changes (P = 0.33). CONCLUSION: According to the results of this study, the biomechanical characteristics of cornea, particularly CH, shows certain changes following surgery and is increased, reflecting the dynamic nature of these parameters. Our knowledge of the biomechanical changes after glaucoma surgery can help us better understand the pathophysiology of glaucoma diseases and make the right decisions for follow-up of the patients.

Long-Term Endovascular Treatment Outcome of 46 Patients with Cavernous Sinus Dural Arteriovenous Fistulas Presenting with Ophthalmic Symptoms. A Non-Controlled Trial with Clinical and Angiographic Follow-up.

Ocular symptoms are regularly observed in patients with cavernous sinus dural arteriovenous fistulas (cDAVF). We aimed to evaluate the long-term efficacy and safety of endovascular approaches in patients with cDAVF presenting with different ocular symptoms. In a prospective study between June 2008 and March 2013, 46 patients with ocular symptoms due to cDAVF who were not eligible for conservative therapy, met the inclusion criteria and underwent endovascular treatment. They underwent a transarterial approach with histoacryl glue injections or transvenous coil embolization, all in one session. They were followed up for a mean period of 17.3 months (range 7 to 30 months) clinically and using angiography. The mean age of patients was 36.8 years (18-60) and 65% of them were male. All patients showed venous drainage into the superior and inferior orbital veins. Access to the cavernous sinus was transvenous in ten patients, transarterial in 26 patients, and mixed in ten patients. Initial symptoms were improved in 97.8% of patients and did not recur during the study follow-up. The procedural complications included: blurred vision, transient sixth nerve palsy and exacerbation of chemoproptosis in two, one and two patients respectively that completely resolved in initial weeks with no recurrence. No patient worsened or developed new symptoms suggestive of a recurrent fistula during the follow-up period. One patient experienced intracranial dissection of the internal carotid artery and ischemic stroke with an unfinished procedure. The relief of early presentation was durable in long-term follow-up and the cured lesions were stable in angiographic controls. Favorable and durable outcomes could be obtained following endovascular approaches for cDAVF presenting with different ocular symptoms.

Collagen cross-linking for resistant corneal ulcer.

Corneal ulcer is a devastating corneal disease which is potentially sight-threatening and conventionally is treated by topical antibiotics and in some cases with more invasive procedures such as keratoplasty. The aim of this study is to evaluate the efficacy of corneal collagen cross-linking in resistant corneal ulcers. Ten patients with resistant infectious corneal ulcers who had not responded properly to maximal treatment with topical and subconjunctival antibiotics were enrolled in the study and underwent classic corneal collagen cross-linking with riboflavin and UV-A under sterile conditions in the operating room and were followed up regularly. The result was healing and scar formation with improvement of vision in all patients except for two who underwent enucleation and tectonic penetrating keratoplasty. Corneal collagen cross-linking is a viable therapeutic option for treatment of corneal ulcers and can be used as an adjuvant for conventional treatment in resistant cases.

Intravitreal clindamycin plus dexamethasone versus classic oral therapy in toxoplasmic retinochoroiditis: a prospective randomized clinical trial.

Both oral and intraocular routes have been recommended for medication administration in toxoplasmic retinochoroiditis; however, available data, in support or against, are scarce. The objective of this study was to compare the efficacy of intravitreal clindamycin plus dexamethasone (IVCD) and conventional oral therapy (COT) including pyrimethamine, sulfadiazine, folinic acid and prednisone in active toxoplasmic retinochoroiditis. In this prospective randomized single-blind clinical trial, patients with active toxoplasmic retinochoroiditis received either IVCD (n = 32), or COT (n = 34) for 6 weeks. Changes of best-corrected visual acuity, retinal lesion size, and vitreous inflammation before and after treatment, as well as complications/side-effects and recurrence rate within at least 2 years of follow-up were compared between groups. Although all the variables improved significantly at 6 weeks within each group, changes were comparable between the IVCD and COT receivers. There was only one case with hepatotoxicity in the COT group which responded favorably to drug change. No injection-related complication was observed. Recurrence rates were 12.5 and 14.7 % in the IVCD and COT groups, respectively (p = 0.54). In conclusion, both IVCD and COT are equally effective against active toxoplasmic retinochoroiditis but the former is apparently safer and more convenient.

Hyaluronidase in sub-Tenon's anesthesia for phacoemulsification, a double-blind randomized clinical trial.

AIM: To investigate the effect of hyaluronidase use on the quality of sub-Tenon's anaesthesia for phacoemulsification. METHODS: This was a randomized, double-blind clinical trial which was conducted at Nikookari Eye Hospital for 5 months. Forty-two eyes of candidates for phacoemulsification under sub-Tenon's anaesthesia were randomly allocated to two equal groups and received either 2 mL of lidocaine 2% solution with (LH), or without (L) addition of hyaluronidase (150IU/mL). Akinesia was assessed 15 minutes after sub-Tenon's injection. Patients and surgeon's satisfaction, as well as the postoperative pain (the visual analogue scale, VAS) were investigated after operation. The contingency tables (including the Chi-square or Fisher's exact tests, when appropriate) and parametric analysis (the independent samples t test) were used for statistical analysis. RESULTS: Complete akinesia (33.3% vs 4.8%, P=0.04), as well as the patients (85.7% vs 57.1%, P=0.04) and surgeon's satisfaction (87.5% vs 52.4%, P=0.02) were significantly more frequent in LH than in L group. The mean VAS was significantly lower in the same group (1.90±1.45 vs 3.00±1.55, P=0.04). CONCLUSION: Addition of hyaluronidase to lidocaine solution for sub-Tenon's anesthesia significantly improves the ocular akinesia, enhances the intra-operative patients and surgeons' satisfaction, and attenuates the postoperative pain.