Bicanalicular silicone tubes versus otologic T-tubes in endonasal dacryocystorhinostomy.

OBJECTIVE: We compared the efficacy of T-tubes and bicanalicular silicone tubes in endonasal dacryocystorhinostomy (DCR). METHOD: We retrospectively reviewed 54 eyes of 49 patients who had experienced nasolacrimal duct obstruction and undergone endoscopic DCR. Group one had bicanalicular silicone tube stents implanted (24 eyes), and group two consisted of patients who had otologic T-tubes (30 eyes). The duration of stent placement, follow-up time, and the subjective and objective success of the procedures were evaluated. Cases were grouped as failure or success according to improvement in epiphora complaint. RESULTS: An endoscopic DCR procedure was successful in 19 (79.2%) cases in the silicone group and in 23 (76.7%) cases in the T-tube group. The success rate did not differ significantly between the groups (p = 0.83). The most common cause of failure was granuloma formation in the bicanalicular silicone tube group and spontaneous tube loss in the otologic T-tube group. CONCLUSIONS: The findings revealed that both the otologic T-tube and the bicanalicular silicone tube had similar success rates (76.7% and 79.2%, respectively). We believe that otologic T-tubes, which are less expensive and more easily acquired, might be offered as an alternative to bicanalicular silicone tubes in patients with nasolacrimal duct obstruction.

Opportunistic posterior uveal infections in renal transplant patients.

AIMS: To describe the cases of opportunistic posterior uveal infection diagnosed in renal transplant recipients at a single center over a 10-year period. METHODS: The study involved 1156 patients who underwent renal transplantation. Five of the recipients were diagnosed with posterior uveal infection. The specific diagnoses were acute retinal necrosis (two cases), cytomegalovirus retinitis (one case), nocardial chorioretinitis (one case), or tuberculoid granuloma (one case). RESULTS: The five patients were aged 27 to 55 years, and the interval from renal transplantation to uveal infection ranged from 7 months to 16 years. All patients were receiving immunosuppressive treatment at the time of the posterior uveal infection. Acute retinal necrosis was diagnosed in cases I and II at 2 and 3 years after transplantation, respectively. In both cases, fundus examination revealed moderate vitritis and yellow-white lesions representing confluent retinitis. In case III (cytomegalovirus retinitis), 7 months after transplantation the patient developed extensive hemorrhage and confluent white exudates, periphlebitis, and perivascular sheathing in the right eye. In case IV, culture of a fine-needle aspirate from a well-demarcated, white-yellow, elevated choroidal lesion in the superotemporal region of the macula revealed nocardial infection. Fundus examination of the right eye of case V revealed a small, hypopigmented choroidal lesion superior to the optic disc. The lesion was identified as a choroidal tuberculoid granuloma. CONCLUSIONS: Opportunistic chorioretinal infections can occur at any time after renal transplantation. So it is important that every kidney recipient undergo regular ophthalmic examinations throughout his or her lifetime.

Spontaneous corneal perforation in a patient with unusual unilateral pellucid marginal degeneration.

A 56-year-old man presented with acute loss of vision and tearing in his left eye. Slitlamp examination demonstrated peripheral corneal edema extending between the 2 and 6 o'clock positions as well as a perforation located inferiorly. The right eye was unremarkable. An emergent crescentic lamellar keratoplasty was performed. The patch graft remained clear during the 30-month follow-up, and visual acuity improved significantly. No changes occurred in the right eye. This case represents an unusual, unilateral corneal ectatic disorder, most likely pellucid marginal degeneration.

The effects of beta-blockers on ocular blood flow in patients with primary open angle glaucoma: a color Doppler imaging study.

PURPOSE: To evaluate the effects of four commonly used beta-blockers on ocular blood flow in patients with primary open angle glaucoma (POAG). METHODS: Eighty eyes of 40 subjects with POAG were included in the study. Subjects were randomly divided into four groups given timolol maleate 0.50%, betaxolol HCl 0.50%, carteolol 1% or levobunolol 0.50% drops, applied twice daily (one drug to each group). Before beginning the treatment and at the end of the first month ocular blood flow velocity was measured using the color Doppler imaging (CDI) method. In the ophthalmic artery (OA), central retinal artery (CRA) and temporal posterior ciliary artery (TPCA) the peak systolic (PS) and end-diastolic (ED) blood flow velocities were measured and resistive index (RI) values were calculated. The results within each group were analysed using the matched paired student's t-test. The data between groups was compared with one-way analysis of variance (ANOVA) and Tukey-Kramer multiple comparison tests. RESULTS: The timolol group showed a significant increase in RI values of TPCA. In the betaxolol group RI decreased significantly in CRA and TPCA, whereas in the carteolol group there was a significant decrease only in CRA. In the levobunolol group there was no change in any artery. CONCLUSIONS. Betaxolol seemed to have a greater vasodilator effect than carteolol, and levobunolol had no effect on the retinal and choroidal vasculature. Timolol may have some vasoconstrictive effect in the ciliary vasculature.

Fibrin glue versus sutures for conjunctival autografting in pterygium surgery: a prospective comparative study.

AIM: To compare the use of fibrin glue versus sutures for fixating conjunctival autografts in patients undergoing pterygium excision. METHODS: Fifty patients (50 eyes) with primary pterygium were randomised to undergo pterygium surgery using either fibrin glue (25 eyes) or 8-0 Vicryl sutures (25 eyes) to attach the conjunctival autograft. The patients were followed up for 12 months. Outcome measures were postoperative patient comfort, duration of surgery and recurrence of pterygium. RESULTS: In the fibrin glue group, the mean operation time was 15.7 (SD 2.4) min (range 12-18 min) and in the suture group (p<0.001) it was 32.5 (6.7) min (range 25-40 min). The intensity of the postoperative pain, foreign-body sensation, irritation and epiphora were significantly lower in the fibrin glue group than in the suture group (p<0.001). The intensity of itchy sensation at the first two postoperative visits was lower among patients in the fibrin glue group (five patients, 20%) than in the suture group (12 patients, 48%) (p<0.05). Two patients in the fibrin glue group had partial graft dehiscence; these grafts were successfully reattached with fibrin glue. At the end of follow-up, pterygium recurrence was observed in one eye (4%) in the fibrin glue group and in three eyes (12%) in the suture group (p<0.05). CONCLUSION: The use of fibrin glue in pterygium surgery with conjunctival autografting significantly reduces surgery time, improves postoperative patient comfort and results in a lower recurrence rate compared with suturing.

Ocular side-effects of tolterodine and oxybutynin, a single-blind prospective randomized trial.

AIM: To evaluate the effects of tolterodine and oxybutynin on visual accommodation, pupillary diameter, intraocular pressure and tear secretion in women with overactive bladder. METHODS: One hundred and four eyes from 52 consecutive female patients (age range: 22-60 years) with a urodynamic diagnosis of overactive bladder were prospectively investigated. Patients with a history of ocular disease or surgery were excluded. The subjects were randomly assigned to one of two groups: Group I received 2 mg tolterodine bid and Group II received 5 mg oxybutynin tid. All patients were evaluated at baseline (day 0) and after 1 month of treatment (day 28) by an ophthalmologist who was blinded to the medication. At each time point, a complete ophthalmic examination was performed and accommodation amplitude (AA), and pupillary diameter (PD) in dim and bright light were recorded. As well, tear secretion was assessed based on tear film break-up time and Schirmer I-test results. Statistical comparisons were made using the chi-square test, Student's t-test and Mann-Whitney U-test, as appropriate. RESULTS: Twenty-eight patients (56 eyes) received tolterodine and 24 patients (48 eyes) received oxybutynin. The mean ages of the two groups were similar (P = 0.523). After 4 weeks of treatment, AA was significantly lower in the oxybutynin treated group (P = 0.003, 95% CI 0.15, 0.62) whereas there was no significant change in AA in the tolterodine treated group (P = 0.155, 95% CI -0.042, 0.86). At day 28, PD in dim light was significantly larger in the tolterodine treated group (P = 0.031, 95% CI -0.82, -0.06), whereas no significant change in PD in dim light was noted in the oxybutynin treated group (P = 0.330, 95% CI -0.38, 0.18). Neither group showed a significant change in PD in bright light values on day 28 (P > 0.05 for both). In each group, the differences from day 0 to day 28 for intraocular pressure, and Schirmer-I results were insignificant (P > 0.05 for all). Both groups had significantly shorter tear film break-up time after 1 month of therapy (P = 0.014 (95% CI 0.47, 3.81) and P = 0.02 (95% CI 1.14, 4.61) for the tolterodine and oxybutynin treated groups, respectively). CONCLUSION: Four weeks of standard-dose oxybutynin treatment in women with overactive bladder decreases AA significantly, whereas the same duration of standard-dose tolterodine does not have this effect. However, tolterodine seemed to affect PD in dim light. One month of treatment with either of these anticholinergic drugs shortens tear film break-up time significantly. Concerning ocular side-effects, tolterodine seems to offer an advantage over oxybutynin because it does not affect AA, however, the shorter tear film break-up time with both agents suggests potential problems for patients who already have dry eye.

Excision and cryosurgery in the treatment of conjunctival malignant epithelial tumours.

PURPOSE: To evaluate the long-term results of combined treatment with excision and cryosurgery for malignant epithelial tumours of the conjunctiva. METHODS: We retrospectively reviewed the medical records of patients diagnosed with conjunctival malignant epithelial tumours and treated with excision and cryosurgery between 1980 and 1998. The demographic features of the patients, characteristics of the tumours, and the peculiarities of the recurrences were recorded. The SPSS V 9.05 computed program was used for the statistical analysis of the results. Kaplan-Meier plots were used to determine the recurrence-free survival, and the logrank test was used to compare the recurrences according to histological classification. RESULTS: A total of 55 subjects (57 eyes), 19 female and 36 male, were included in the study. Their ages ranged between 15 and 82 years (mean 55+/-14 years). Histological diagnosis was conjunctival intraepithelial neoplasia (CIN) in 26 (46%) and invasive squamous cell carcinoma (SCC) of the conjunctiva in 31 eyes (54%). All eyes were treated with excision and cryosurgery with nitrous oxide probe. During the follow-up period of 6 months to 15 years, seven (12.3%) recurrences were observed. The success rate for patients with CIN and invasive SCC was 88.5 and 87.1%, respectively. There was no difference for recurrence rates between CIN and invasive SCC groups according to logrank test (P=0.68). CONCLUSIONS: Over the long-term follow-up, cryosurgery following excision is a successful method in the treatment of conjunctival intraepithelial tumours and invasive squamous cell carcinoma of conjunctiva with favourable outcome and minimal complications.

Microbiological evaluation of contact lenses and contact lens disinfection solutions in an asymptomatic population and in medical personnel.

PURPOSE: To compare the contamination of contact lenses and contact lens disinfection solutions in a population of contact lenses wearers comprised of medical personnel and non-medical subjects. METHODS: Forty-six medical personnel working in an infectious environment and 35 non-medical subjects were enrolled in the study. Contact lenses and contact lens disinfecting solutions were cultured and potential pathogens were isolated. RESULTS: The frequency of isolation of pathogens from the contact lenses of medical personnel was significantly higher than from non-medical subjects. There was no growth in both the contact lens and the disinfecting solution cultures in 56.5% of the subjects in the medical personnel group, and in 57.1% of non-medical group of subjects. Both the contact lens and disinfecting solution cultures were positive in 21.7% of the medical personnel group, while in the non-medical group, only 2.9% of subjects had positive cultures. CONCLUSIONS: Microbacterial contamination of contact lenses and disinfection solution was more frequent in the medical personnel group compared with non-medical subjects. In the medical personnel group, the most frequently isolated microorganism was Staphylococcus albus (19.8%), which is seen in hospital infections. Because soft and rigid gas permeable contact lens usage was approximately equal, we conclude that medical personnel are more prone to contamination.

Visual performance of acrylic and PMMA intraocular lenses.

AIM: To evaluate the quality of visual functions after cataract surgery and intraocular lens (IOL) implantation with different lens materials and compare the results with age-matched subjects with clear phakic eyes. METHODS: Control and pseudophakic groups involved individuals aged between 50 and 75 years, without any accompanying ocular or systemic disease. In all, 50 eyes implanted with foldable acrylic IOLs, and 41 eyes implanted with polymethyl-methacrylate (PMMA) IOLs were compared with 45 phakic eyes as controls. Visual functions were evaluated for contrast sensitivity function and glare disability. The results were compared statistically using one-way analysis of variance (ANOVA). RESULTS: At high luminance levels, the difference among groups for contrast sensitivity was statistically significant for all spatial frequencies (P<0.05). Although the acrylic IOL-implanted eyes had better results at all three spatial frequencies, no significant difference existed between the two study groups for these spatial frequencies (P>0.05). Glare disability scores were significantly higher in the PMMA-IOL group compared to the control and acrylic-IOL groups. CONCLUSION: The visual quality achieved in pseudophakic eyes was not as good as in clear phakic eyes in regard to contrast sensitivity and glare. However, acrylic IOLs fared better than PMMA IOLs.