Clinical Outcomes of Silk versus Nylon Sutures for Suturing of Conjunctival Autograft in Pterygium Surgery.

PURPOSE: The purpose is to compare the clinical results of using silk versus nylon sutures for conjunctival autograft suturing in pterygium surgery. METHODS: In this prospective, randomized, controlled, clinical trial 50 eyes from 50 patients with primary nasal pterygium were randomized to undergo pterygium surgery with the use of either nylon sutures or silk sutures for conjunctival autograft suturing. Patients were followed up for 6 months. Main outcome measures included recurrence, postoperative discomfort according to a visual analog scale (VAS), graft hyperemia, and graft edema. RESULTS: According to the results, there was no significant difference between groups regarding recurrence rate of pterygium (P = 0.72). A significant decrease in the mean VAS discomfort score from day 1 to day 14 was observed in both groups (P = 0.001); postoperative discomfort during the first 2 weeks, was not significantly different between the two groups. At 2 weeks' postoperatively, significantly greater number of nylon sutures remained on the autograft (P = 0.021), some of which were buried and could not be removed. CONCLUSION: Both silk and nylon are effective suture materials for autograft suturing in pterygium surgery with similar postoperative discomfort and recurrence rate. Significantly greater number of nylon sutures remains buried on the autograft and could not be removed easily.

Corneal Cross-linking as an Adjunct for The Management of Refractory Fungal Keratitis.

PURPOSE: To evaluate the effectiveness of ultraviolet (UV)-A/Riboflavin corneal cross-linking (CXL) for the treatment of the refractory cases of fungal keratitis. METHODS: In this prospective interventional study, 9 patients with the diagnosis of fungal keratitis that were referred to our emergency eye center were included. These patients were resistant to conventional treatment and underwent therapeutic UV-A/Riboflavin CXL. Response to the treatment was considered as good if rapid epithelialization and rapid decrease in stromal infiltration was occurred after PACK-CXL, and poor when the emergency transplantation was necessary to eradicate the infection. RESULTS: Nine patients treated with CXL due to recalcitrant fungal keratitis. Culture of the corneal scrapings showed Aspergillus species in 4 patients, Candida albicans in 1 patient and Fusarium species in the remainder of them. CXL was performed from 1 to 20 days after the presentation of corneal ulcers (Mean: 9.12 ± 4.02; range: 5-20 days). Postoperatively, the mean time to epithelialization was 14.25 ± 2.38 days, and mean time to resolution of stromal infiltration was 22.5 ± 7.29 days, in responsive cases. Four out of 9 eyes showed good response, and five patients showed no response, and corneal transplantation was performed to eradicate the infection. There was no statistically significant difference in mean depth of infiltration and mean size of ulcer between responsive and unresponsive patients (P = 0.86 and 0.08, respectively). CONCLUSION: Although UV-A/Riboflavin CXL is not a definite treatment for all of the fungal keratitis, it seems promising in the management of some refractory cases.

The effects of microwave radiation on rabbit's retina.

PURPOSE: Mobile cell phones are used extensively these days, and their microwave (MW) radiation has been shown to affect the eye. The purpose of the present study was to evaluate the effects of MW radiation on rabbit retina. METHODS: This experimental study (concluded in 2015) was conducted on 40 adult white New Zealand rabbits. A Global System for Mobile Communications (GSM) cell phone simulator was used for MW irradiation. The rabbits were randomized into five groups (8 in each) and treated as follows: Group 1: no irradiation (sham); Group 2: irradiation at 10 cm for 1 day; Group 3: irradiation at 30 cm for 1 day; Group 4: irradiation at 10 cm for 3 days; and Group 5: irradiation at 30 cm for 3 days. Scotopic and photopic electroretinography (ERG) responses were obtained at baseline and 7 days after the last exposure. Then all the rabbits were euthanized, and their eyes were enucleated and sent for pathology examination. Kruskal-Wallis and Chi-Square tests were used to evaluate intergroup differences in ERG parameters and histological findings, respectively. RESULTS: ERG responses obtained 7 days after irradiation did not show any statistically significant difference between the groups (P > 0.1, for all tested parameters). There were statistically non-significant trends toward greater changes in the MW irradiated eyes. In pathological examination, retina was normal with no sign of degeneration or infiltration. Ciliary body congestion was observed in greater fraction of those who received higher MW doses. (P = 0.005). CONCLUSIONS: Histopathologically, cell phone simulated MW irradiation had no significant detrimental effect on the retina. However, ciliary body congestion was observed in greater fraction of those who received higher MW doses. Although there was no significant difference between post-treatment mean ERG values, there were statistically non-significant trends toward greater changes in the MW irradiated eyes.

Multiple keratoacanthoma centrifugum marginatum associated with juvenile idiopathic arthritis and persistent corneal epithelial defect: an unusual case.

We report here a case of a child with multiple keratoacanthoma centrifugum marginatum in association with corneal epithelial defect and juvenile arthritis. Keratoacanthoma is a skin tumor and the patient presented with an uncommon type of it.

Intravitreal infliximab in experimental endotoxin-induced uveitis.

PURPOSE: Tumor necrosis factor-alpha (TNF-alpha) plays a central role in the pathogenesis of ocular inflammation and the level of TNF-alpha is increased in ocular fluids of patients with uveitis. Intravenous infliximab, a monoclonal antibody against TNF-alpha, has been used for the treatment of uveitis with promising preliminary results. The aim of this study was to evaluate the effect of intravitreal injection of infliximab on experimental uveitis. METHODS: Thirty-three white New Zealand rabbits were divided randomly into three groups. Group 1 (n=5) received intravitreal injection of 1 mg/0.1 cc infliximab plus 0.1 cc normal saline, group 2 (n=14) received intravitreal injection of 2 microg Salmonella typhimurium endotoxin plus 1 mg/0.1 cc infliximab, and group 3 (n=14) animals received intravitreal endotoxin 2 microg/0.1 cc plus normal saline 0.1 cc. Inflammation was evaluated by clinical examinations on days 1, 3, 5, and 7 after the injections; measuring the protein concentration and inflammatory cell content of the aqueous humor; and histopathologic examination. RESULTS: No inflammation occurred in group 1 animals. There was a statistically significant difference between group 2 and 3 animals with regard to clinical examination on the third, fifth, and seventh postinjection days. The differences between groups 2 and 3 were significant with regard to aqueous cell counts and protein content at day 7 (p=0.02 and p=0.001, respectively). Histopathologic examination results showed less inflammation in group 2 animals compared to group 3 animals (p=0.009). CONCLUSIONS: The results provide evidence that intravitreal injection of infliximab suppresses ocular inflammation in a rabbit model of severe endotoxin-induced uveitis.

Aqueous concentration of tranexamic acid after 5% and 10% eyedrop administration.

PURPOSE: To determine whether topical tranexamic acid can provide acceptable therapeutic concentration in the aqueous humor. METHODS: A total of 47 patients with cataract as the sole eye disease who have been scheduled for cataract operation received one drop of tranexamic acid 5% solution at various time intervals prior to operation (from 15 minutes to 9 hours). Two patients received 10% solution of the drug. Paracentesis of the anterior chamber was done and the aqueous humor was aspirated in the operation room. The aqueous samples were analyzed using high-performance liquid chromatography method with the limit of quantification around 0.1 microg/mL. Systemic and ocular side effects were evaluated. RESULTS: Aqueous concentrations of tranexamic acid was higher than 1.5 microg/mL up to 160 minutes after administration of a single drop of 5% solution of the drug and then declined to an average concentration of 1 microg/mL at 300 minutes which persisted up to 9 hours after administration.In two patients for whom a single drop of 10% tranexamic acid solution was used, aqueous concentrations of 2.72 and 2.90 microg/mL were detected 60 minutes after administration. None of the patients experienced ocular or systemic side effects. CONCLUSIONS: Topical administration of tranexamic acid is effective in yielding therapeutic intraocular concentrations of drug without any ocular or systemic toxicity.

Normalization of conjunctival flora after dacryocystorhinostomy.

PURPOSE: To determine the time of normalization of conjunctival flora after successful dacryocystorhinostomy. METHODS: Forty consecutive adult patients with nasolacrimal duct obstruction and chronic dacryocystitis who had been referred for dacryocystorhinostomy were included in the study. Conjunctival cultures were obtained preoperatively from the involved and normal sides of each patient. Cultures from the lacrimal sac contents were obtained at the time of dacryocystorhinostomy. Postoperatively, conjunctival specimens were obtained from the operated side weekly until the result of the cultures was negative or the colony count was less than that of the normal side. RESULTS: The mean time of normalization was 4.5 weeks (range, 3-8 weeks). The time of normalization was significantly related to the type of organisms (p = 0.04) and the colony count (p < 0.001). The mean time of normalization was 3.5 weeks in patients with a colony count <10 and 4.93 weeks in patients with a colony count > or =10. The time of normalization was significantly related to the presence of a silicone tube (p < 0.0001). The mean time of normalization was 6.2 weeks and 3.9 weeks in patients with and without a silicone tube, respectively. CONCLUSION: A few weeks is needed for the conjunctival flora to normalize after dacryocystorhinostomy. The time of normalization is related to the type of bacteria, colony count, and presence of silicone tube.

Deep anterior lamellar keratoplasty with melles technique for granular corneal dystrophy.

PURPOSE: The purpose of this study was to evaluate the clinical results of deep anterior lamellar keratoplasty (DALK) using the Melles technique in granular corneal dystrophy. METHODS: Seven eyes from 5 patients who underwent DALK using Melles technique for granular corneal dystrophy were included in this study. The parameters evaluated included patients' demographics, preoperative and postoperative best spectacle-corrected visual acuities (BSCVAs), and timing and pattern of recurrence. RESULTS: The mean age of the patients was 37 +/- 9.4 years (range 29-46 years) at the time of surgery. The mean length of follow-up (DALK to last visit) was 38.4 +/- 18.6 months (range 10-63 months). The procedure was performed without any major complication in all eyes. Mean preoperative BSCVA was 20/220 (range 20/400 to 20/100), which improved to 20/27 (range 20/30 to 20/25) at 6 months after DALK. Mean BSCVA was 20/50 (range 20/400-20/20) at last follow-up. Simple recurrence occurred in 5 (71%) of 7 eyes. The mean time from surgery to recurrence was 15.6 +/- 1.8 months (range 13-16 months). Clinically significant recurrences occurred 34 +/- 2 months after the procedures in 3 (43%) of 7 eyes. Two (30%) of 7 eyes had no recurrence at all. CONCLUSIONS: Although granular corneal dystrophy is likely to recur after DALK, this technique can restore and preserve useful visual function for a significant period in these patients.