ABSTRACT
PURPOSE: The purpose of this study is to evaluate the efficacy of systemic antiparasitic medications alone or in combination with surgical aspiration in management of presumed trematode-induced anterior uveitis in children. PATIENTS AND METHODS: Prospective case series. Children who presented with anterior chamber (AC) granuloma were included in the study. All patients received antiparasitic treatment and after 2 weeks; patients were divided based on their clinical improvement in terms of the baseline granuloma area into two groups: group A (<2.5 mm2) who continued on antiparasitic medications only (n = 15) and group B (≥2.5 mm2) who underwent surgical aspiration (n = 15). Basic demographics data, visual acuity (VA), corneal thickness, granuloma area and AC activity (cells and flare) were recorded and analysed. Systemic work-up including stool and urine analysis, full blood count, chest X-ray and schistosomiasis titre were performed. RESULTS: Thirty eyes of 30 patients were included in the study with a mean age of 13.4 ± 2.42 years. All patients were male. Patients were examined and followed at Mansoura Ophthalmic Center, Mansoura University. Both groups showed statistically significant improvement in VA, AC activity, corneal thickness and granuloma area (p-value < 0.001), which was achieved with medical treatment only in group A. However, in group B granuloma required aspiration and did not recur after that. CONCLUSION: Presumed trematode-induced AC granuloma is common among children living in the rural areas of Egypt. Antiparasitic medication alone was found to be effective for small-sized granulomas. Surgical aspiration is an effective adjuvant procedure to treat large-sized ones.
Subject(s)
Antiprotozoal Agents/therapeutic use , Eye Infections, Parasitic/therapy , Granuloma/therapy , Ophthalmologic Surgical Procedures , Trematoda/isolation & purification , Trematode Infections/therapy , Uveitis, Anterior/therapy , Adolescent , Animals , Child , Child, Preschool , Combined Modality Therapy , Corneal Pachymetry , Drug Therapy, Combination , Egypt/epidemiology , Eye Infections, Parasitic/drug therapy , Eye Infections, Parasitic/parasitology , Eye Infections, Parasitic/surgery , Feces/parasitology , Granuloma/drug therapy , Granuloma/parasitology , Granuloma/surgery , Humans , Male , Metronidazole/therapeutic use , Parasite Egg Count , Praziquantel/therapeutic use , Prospective Studies , Rural Population/statistics & numerical data , Trematode Infections/drug therapy , Trematode Infections/parasitology , Trematode Infections/surgery , Uveitis, Anterior/drug therapy , Uveitis, Anterior/parasitology , Uveitis, Anterior/surgery , Visual Acuity/physiologyABSTRACT
AIM: To evaluate the efficacy of prophylactic administration of topical non-steroidal anti-inflammatory drugs (NSAIDs) on macular edema following cataract surgery in diabetic patients, and to compare between types of NSAIDs (ketorolac tromethamine 0.4% and nepafenac 0.1%). METHODS: Group 1 (control) received artificial tears substitute as a placebo group, group 2 (nepafenac) received topical nepafenac 0.1%, and group 3 (ketorolac) received topical ketorolac tromethamine 0.4%. Patients were examined postoperatively after completing one week, one month, two months and three months' intervals for evaluating cystoid macular edema (CME) development. The main study outcomes were achieving the best corrected visual acuity (BCVA) and change in the central macular thickness (CMT) measured with optical coherence topography (OCT). RESULTS: Eighty eyes of 76 patients were included in this study. BCVA showed a statistically significant difference at the third month postoperative follow up between the control group and the NSAIDs groups (P=0.04). There was an increase in the CMT in all cases starting from postoperative first week until third month. CMT showed a statistically significant difference between control group and NSAIDs groups from postoperative first month until third month (P=0.008, 0.027, 0.004). There was no statistically significant difference between nepafenac and ketorolac groups in BCVA and OCT CMT. CONCLUSION: Prophylactic preoperative and postoperative NSAIDs may have a role in reducing the frequency and severity of CME in diabetic eyes following cataract surgery.
