The effect of tea tree oil on dry eye treatment after phacoemulsification cataract surgery: A randomized clinical trial.

PURPOSE: To evaluate the effect of eyelid scrubbing with eye shampoo containing tea tree oil on dry eye disease following phacoemulsification cataract surgery. METHODS: This prospective triple-blinded randomized clinical trial was performed on 62 eyes of 62 patients. Patients were randomly assigned to two groups-(1) treatment group: for 33 patients in the treatment group, artificial tears, topical steroid drops, and eye shampoos with tea tree oil and (2) for 29 patients in the control group, artificial tears, topical steroids, and eye shampoos without tea tree oil were used. In the first and second (after 1 month) follow-up visits, microscopic Demodex examination, refraction, corrected distance visual acuity, the ocular surface disease index score (by the questionnaire), Schirmer test, tear break-up time test, and osmolarity of tears (by TearLab) were recorded in treatment and control groups. RESULTS: The mean age of patients was 66.37 ± 8.83 (range: 37-82) years, of which 49 (79%) were female and 13 (21%) were male. The results showed a significant improvement in tear break-up time test, corrected distance visual acuity, osmolarity, and ocular surface disease index score in both groups (p < 0.05). However, the number of Demodex decreases significantly only in the treatment group after treatment (p <0.001). Tear break-up time, osmolarity, and ocular surface disease index scores in the treatment group were significantly better than the control group (p < 0.05). However, there was no significant difference between the two groups in the pre- and post-Schirmer test results (p > 0.05). CONCLUSION: Eyelid scrubbing with eye shampoo containing tea tree oil is recommended for dry eye treatment after cataract surgery, especially decrease in the number of Demodex.

Leukocytosis and neutrophilia after laparoscopic gastric plication.

BACKGROUND: Laparoscopic gastric plication (LGP) is a relatively novel bariatric surgery technique. We have encountered a noticeable proportion of our LGP patients with findings such as leukocytosis and neutrophilia and hypothesized that they are part of normal body response to the operation. OBJECTIVE: To evaluate the prevalence and clinical importance of leukocytosis, neutrophilia and abnormal vital signs in patients undergoing LGP during postoperative period. METHODS: Forty-four consecutive LGP patients were prospectively followed for 3 months. Records of 44 laparoscopic cholecystectomy patients were also reviewed for comparison. Preoperative and postoperative laboratory test were performed. Minor and major complications were recorded during the study period. RESULTS: Mean body mass index (BMI) and age were 37and 42.5, respectively. Mean hospital stay was 3.6 days (range: 3-8 days). Leukocytosis and neutrophilia were detected in 63% and 72% of the LGP patients, respectively, 48 h after the procedure. Whereas, after cholecystectomy only 38.5% and 18% of patients had leukocytosis and neutrophilia, respectively. 25% of the patients suffered from at least one minor complication after LGP. There was no mortality. CONCLUSIONS: Leukocytosis and neutrophilia are very common after LGP in both the complicated and uncomplicated cases, and may be a part of normal response to surgery.

Recurrent Corneal Perforation due to Chronic Graft versus Host Disease; a Clinicopathologic Report.

PURPOSE: To describe a case of chronic graft versus host disease (GVHD) leading to severe dry eye and recurrent corneal perforation in both eyes, its stepwise management and histopathological reports. CASE REPORT: A 22-year-old woman with a history of thalassemia and subsequent high-dose chemotherapy followed by allogeneic bone marrow transplant (BMT) was referred to Farabi Eye Hospital. Despite aggressive medical and surgical intervention, corneal vascularization in her right eye progressed and led to corneal perforation. Cyanoacrylate glue was applied to seal the perforation, however it recurred. Multilayer amniotic membrane transplantation (AMT) was performed to seal the corneal perforation, which was effective for a short period. Subsequently, the corneal perforation recurred and penetrating keratoplasty was performed. After a few months deep vascularization and descemetocele occurred in the fellow left eye and the patient finally underwent therapeutic lamellar keratoplasty. CONCLUSION: Patients with GVHD are at risk of severe dry eye and subsequent corneal vascularization. Recurrent and recalcitrant corneal perforation resistant to cyanoacrylate glue and multilayer AMT may occur. Proper systemic and ocular management alongside close collaboration with the hematologist is strongly recommended to control the condition.