Efficacy of Honey-based Ophthalmic Formulation in Patients with Corneal Ulcer: A Randomized Clinical Trial.

AIM: The aim of this study was to evaluate the efficacy of honey-based ophthalmic drop in patients with foreign body induced corneal ulcer. BACKGROUND: Honey is traditionally used for skin, mucosal and corneal ulcers. Its use is well studied in human skin and mucosal ulcers and animal model of corneal ulcer with promising effects. METHODS: In this randomized clinical trial, 50 patients with foreign body induced corneal ulcer were allocated to receive 70% sterile honey-based ophthalmic formulation or 0.3% ophthalmic ciprofloxacin, as the standard treatment every 6 hours. All the patients were examined for the size of corneal epithelial defect, corneal infiltration and depth and followed on a daily basis until complete healing. Duration for complete healing was considered as the outcome measure. Smear, culture, antibiogram and minimum inhibition concentration (MIC) tests were performed for honey and ciprofloxacin in all patients. RESULTS: The average durations of complete healing of corneal epithelial defect in the honey and ciprofloxacin groups were 3.88 ± 3.44 vs. 6.32 ± 3.69days, respectively (p=0.020). No significant difference was observed between two groups regarding an average duration of healing of corneal infiltration (8.12 ±1.94 days vs. 8.64±2.15 days, p=0.375). MIC of honey for pseudomonas aeruginosa was 60%w/w, for E.Coli 40% w/w, and for staphylococcus aureus 30% w/w. CONCLUSION: Honey based ophthalmic drop can acceleratethe corneal epithelial defect healing in patients with foreign body induced corneal ulcer, compared to ophthalmic ciprofloxacin as a standard treatment. The study was registered in Iranian registry of clinical trial center (IRCT) with registration number IRCT2015020120892N1.

Corneal bee sting: improvement in the acute stage in the absence of treatment.

Bee sting injuries to the eye are relatively uncommon. The outcomes of corneal bee sting injuries are highly variable, and there is no consensus on the management at the time of initial presentation. We report a case of a 17-year-old male with a corneal bee sting injury that significantly improved in the acute stage without any treatment, which to the best of our knowledge is the first report in the literature documenting the natural history of a corneal bee sting injury in the acute stage.

Minimal surgery achieved good visual acuity in selected patients with magnetic intravitreal foreign body and traumatic cataract.

BACKGROUND: To explore minimal surgery in selected patients with intravitreal foreign body (IVFD) and traumatic cataract. METHODS: Twelve eyes of 12 patients with small ferrous IVFD and traumatic cataract without endophthalmitis, retinal injury and secondary glaucoma, between September 2015 and March 2017 were retrospectively analyzed. Primary removal of IVFD was performed by external magnetic extraction through the pars plana incision. Secondary removal of traumatic cataract by phacoemulsification and intraocular lens (IOL) implantation with or without anterior vitrectomy were performed. Patients were followed up at 1 day, 1 week, 1 month, 3 months, 6 months and 12 months after surgery. RESULTS: All patients were male with a mean age of 32 years old. All IVFDs were successfully removed without retinal injury. Two to 6 months later, the traumatic cataract was successfully removed by phacoemulsification combined with IOL implantation in the capsule bag in 10 patients. Anterior vitrectomy was implied in 2 patients with large posterior capsule rupture, and the IOLs were placed in the ciliary sulcus. Best-corrected visual acuity ranged from hand movement to 20/100 before surgery and improved ranging from 20/32 to 20/20 at the final follow-up. The IOLs were well centered. Complications such as secondary glaucoma, endophthalmitis and retinal detachment were not found. CONCLUSIONS: Primary removal of small ferrous IVFD by external magnetic extraction followed by secondary cataract removal and IOL implantation is an appropriate choice. Minimal surgery may obtain good visual outcome without complications in selected patients.

Effect of gatifloxacin in the treatment of ophthalmological diseases and continuous nursing intervention.

Gatifloxacin is a fourth-generation antibiotic and its antibacterial activity is better. It can play an obvious antiseptic effect in gram-positive bacteria, mycobacterium, mycoplasma, anaerobes and chlamydia. This study analyzed the treatment of the foreign body of the cornea by gatifloxacin eye drops. The results showed that gatifloxacin has a high bacterial clearance rate, which can reach 96.1%. The clinical effect is accurate and the adverse reaction is less. Compared with the control drug levofloxacin, its efficacy and safety were not statistically significant. Moreover, MIC determination of bacteria isolated from the study showed that gatifloxacin had stronger antibacterial activity. At the same time, it can be seen that nursing intervention can effectively improve the satisfaction of the treatment, before the operation, the patient's eye abnormalities, the psychological status of the patient, and the suitability of drug allergy should be evaluated.

Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 3: In suspected corneal foreign body should local anaesthetic be applied before or after eye examination?

A short cut review was carried out to establish whether local anaesthetic should be instilled before or after eye examination in suspected corneal foreign body. 83 papers were found in Medline, Embase and the Cochrane Library using the reported searches, but none presented any evidence to answer the clinical question. It is concluded that there is no evidence to guide the time of installation and that local advice should be followed.

Retained Intraocular Perfluoro-n-octane After Valved Cannula Pars Plana Vitrectomy for Retinal Detachment.

BACKGROUND AND OBJECTIVE: To investigate cases of retained intraocular perfluoro-n-octane (PFO) after pars plana vitrectomy (PPV) for retinal detachment (RD). PATIENTS AND METHODS: Retrospective, noncomparative case series of six eyes with retained intraocular PFO after RD repair. Clinical data were supplemented with an experimental silicone eye model. RESULTS: A cluster of six cases of retained intraocular PFO after PPV for RD repair were noted shortly after transitioning to valved cannulas. PFO was noted in the anterior chamber (AC) and/or vitreous and removed with AC paracentesis, AC wash-out, and/or PPV. A silicone eye model demonstrated that PFO levels are maintained anterior to cannula insertion with valved cannulas only. CONCLUSION: The authors hypothesize that anterior PFO fill using valved cannulas can lead to sequestration within the AC, zonules, ciliary sulcus, ciliary teeth, and/or capsular bag. They suggest vigilance in not overfilling PFO, particularly when transitioning to use of valved cannulas, to minimize the risk of intraocular retention.

Vitreoretinal surgery for shotgun eye injuries: outcomes and complications.

PURPOSE: To analyse the postoperative anatomic and functional outcomes in addition to complications after vitreoretinal surgery for patients with shotgun eye injuries related to hunting accidents. MATERIALS: Retrospective review of the clinical records of all cases of shotgun eye injuries presented between January 2000 and January 2011 and with a minimum follow-up of 1 year. Collection of demographics, type of injury, choice of management, complications and final surgical success with final visual acuity is reported. RESULTS: Twenty eyes of 19 patients (all male) with a mean age of 36.1 years (range 16-60 years) were included in the study. Mean postoperative follow-up was 47.5 months (range 15-118 months). Best corrected visual acuity (BCVA) at presentation ranged from perception of light to 20/200. Ten eyes had a penetrating injury and 10 others had a perforating injury. All the eyes underwent an initial vitrectomy and the intraocular pellet was removed in all the 10 penetrating injuries. Concurrent cataract surgery was performed in 12 cases, internal tamponade was used in 15 cases and a supplemental encircling scleral buckle was inserted in 12 cases. One additional vitreoretinal surgery was required in seven cases (35%) and two additional surgeries required in two other cases (10%). At last follow-up BCVA ranged from NPL to 20/20 and was 20/100 or better in 10 eyes (50%). All patients had a flat retina except for two cases (10%) that developed severe proliferative vitreoretinopathy. CONCLUSION: These results suggest that vitreoretinal surgery can offer good visual rehabilitation in patients with shotgun eye injuries.

Experimental measure of retinal impact force resulting from intraocular foreign body dropped onto retina through media of differing viscosity.

BACKGROUND: To evaluate and compare the perfluorocarbon liquid, silicone oil, and viscoelastic against standard saline, in their ability to dampen the impact force of a foreign body, dropped within the eye. In an experimental surgical model in where cohesive and adhesive forces of the substances are not enough to float heavy-than-water foreign bodies. METHODS: A model of ophthalmic surgery was constructed. A BB pellet was dropped from 24 mm onto a force transducer through four different fluids: balanced salt solution, perfluoro-n-octane, viscoelastic, and silicone oil. The impact energy (force) for each case was measured and recorded by the force transducer. The mean force of impact for each fluid was compared using the Student t-test. RESULTS: Silicone oil resulted in the lowest force of impact. Both silicone oil and viscoelastic dampened the impact an order of magnitude more than perfluoro-n-octane and balanced salt solution. CONCLUSIONS: Silicone oil and viscoelastic cushioned the force from a dropped BB. They may be useful adjuncts to prevent iatrogenic retinal injury during vitrectomy for intraocular foreign body removal.

Leech on the eye in a child.

PURPOSE: to present the case of a 4-year-old girl with leech infestation of the ocular surface. DESIGN: observational case report. RESULTS: a 4-year-old girl presented with a two-day history of bleeding from the left eye. Examination under anesthesia revealed a leech adhering to the cornea and bulbar conjunctiva. Irrigation with normal saline released the leech from the conjunctiva. Detaching from the cornea was successful after injection of suxamethonium 50 mg/ml into the worm. CONCLUSIONS: The possibility of leech infestation need to be considered in the differential diagnosis of open-globe injury with prolapse of uveal tissue. The use of a muscle relaxant for leech removal was not previously documented.

Self-medication: initial treatments used by patients seen in an ophthalmologic emergency room.

OBJECTIVE: This study seeks to identify practices of self-medication in the treatment of ocular emergencies. We examine patients' use of both homemade preparations and manufactured products before seeking specialized care. MATERIALS AND METHODS: We conducted a cross-sectional analytic survey of consecutive patients seen in the ophthalmology emergency room of a teaching hospital. RESULTS: The sample included 561 subjects, 51.3% males and 48.7% females, with a mean age of 39.8 years. Prior to seeking emergency care, 40.5% reported self-medicating; 29.4% used a homemade preparation (13.9% referred to an industrialized product like boric acid as a homemade preparation), and 11.1% used a manufactured product. The most frequently used products included a boric acid solution (53.3%), a normal saline solution (35.7%), herbal infusions (6.1%) and breast milk (4.8%). Viral conjunctivitis was the most frequent diagnosis (24.4%), followed by the presence of a corneal foreign body (7.4%). No significant differences were found in the self-treatment of ocular injuries according to gender (p = 0.95), level of education (p = 0.21) or age (p = 0.14). In addition, self-medication practices were not related to the medically judged severity of the condition. CONCLUSION: Patients often attempt to treat conditions that require ophthalmologic emergency care by self-medicating with homemade or manufactured products. The most widely used products include boric acid, normal saline, leaf infusions and breast milk. This behavior occurs independently of educational level, gender, age or the nature of the ocular condition. Self-medication is a culturally driven practice that is used even in cases of acute ocular injuries.

Leech on the eye: a novel use for hypertonic saline.

Although human interaction with leeches is common in Australia, there is little documented literature on ocular injuries as a result of contact with a leech. We report a case of ocular leech attachment and a previously undocumented method of removal with hypertonic saline solution.

Self-medication: initial treatments used by patients seen in an ophthalmologic emergency room

OBJECTIVE: This study seeks to identify practices of self-medication in the treatment of ocular emergencies. We examine patients' use of both homemade preparations and manufactured products before seeking specialized care. MATERIALS AND METHODS: We conducted a cross-sectional analytic survey of consecutive patients seen in the ophthalmology emergency room of a teaching hospital. RESULTS: The sample included 561 subjects, 51.3 percent males and 48.7 percent females, with a mean age of 39.8 years. Prior to seeking emergency care, 40.5 percent reported self-medicating; 29.4 percent used a homemade preparation (13.9 percent referred to an industrialized product like boric acid as a homemade preparation), and 11.1 percent used a manufactured product. The most frequently used products included a boric acid solution (53.3 percent), a normal saline solution (35.7 percent), herbal infusions (6.1 percent) and breast milk (4.8 percent). Viral conjunctivitis was the most frequent diagnosis (24.4 percent), followed by the presence of a corneal foreign body (7.4 percent). No significant differences were found in the self-treatment of ocular injuries according to gender (p = 0.95), level of education (p = 0.21) or age (p = 0.14). In addition, self-medication practices were not related to the medically judged severity of the condition. CONCLUSION: Patients often attempt to treat conditions that require ophthalmologic emergency care by self-medicating with homemade or manufactured products. The most widely used products include boric acid, normal saline, leaf infusions and breast milk. This behavior occurs independently of educational level, gender, age or the nature of the ocular condition. Self-medication is a culturally driven practice that is used even in cases of acute ocular injuries.

[Intraoperative ultrasound diagnosis in the removal of intraocular foreign bodies].

The paper provides a rationale and indications for diascleral removal of foreign bodies from the anterior chamber of the eyeball, by intraoperatively using ultrasound study. The clinical material presents 148 cases of diascleral removal of foreign (49 magnetic and 49 amagnetic) bodes impacted into the tunics of the anterior eye without evident opacities of optical media and without signs of endophthalmitis. The paper provides a pathogenetic rationale for the method that is lowly traumatic and highly effective (foreign bodies being removed in 99.9% of cases) due to the high precision of location of a scleral cut in the projection of foreign body bedding owing to intraoperative sound usage. A model clinical case of fragment removal is also shown in the paper. The specific features of criteria for using the method are described, by taking into account the anatomic characteristics of orbital eyeball location.

Ocular disorders in a petroleum industry in Nigeria.

OBJECTIVE: To determine the ocular disorders in the petroleum industry in Warri, Nigeria. METHODS: A clinic-based prospective study of the pattern of ocular disorders in workers of the Nigerian National Petroleum Corporation in Warri, Delta state of Nigeria was carried out over a 1-year period. Technical and non-technical workers were interviewed and examined using the Snellen's chart, pen-torch, direct ophthalmoscope, slit-lamp biomicroscope, Perkin's hand-held applanation tonometer, and the Kowa automatic visual field plotter where indicated. RESULTS: A total of 154 technical workers comprising 146 males (94.8%) and eight females (5.2%), and 116 non-technical workers comprising 90 males (77.6%) and 26 females (22.4%) were seen. There was no reported case of ocular trauma. Symptoms suggestive of ocular irritation were much more common in technical workers. Allergic conjunctivitis, pterygium, corneal abrasion, and foreign body on the cornea were significantly more common in technical workers P<0.0001. CONCLUSIONS: Exposure to irritant chemicals in the petroleum industry makes the technical workers more prone to allergic conjunctivitis, pterygium, corneal abrasion, and foreign body on the cornea. Protection goggles should be provided for all the technical workers.

Iris intraocular foreign bodies: safe and successful removal through limbus.

Metallic iris intra ocular foreign body (IOFBs) with minimal ocular damage pose an interventional challenge. We report safe removal of metallic intraocular foreign bodies embedded on the iris, in three cases by use of intraocular magnets. Two eyes had a clear lens with best corrected visual acuity (BCVA) of 20/20, while the third eye had a BCVA of 20/200 with siderotic cataract. Ultrasound biomicroscopy confirmed the superficial impaction of IOFB into the iris. Foreign bodies were successfully removed via the limbal route with a 20 g intravitreal magnet atraumatically in all 3 cases with preservation of their pre-operative BCVA. Case series highlights the usefulness and safety of intraocular magnet for removal of metallic iris foreign bodies in selected cases. Prior ultrasound biomicroscopy to know the actual depth of penetration of IOFB into the iris and preoperative confirmation of magnetic property of IOFB are essential.

Topical anesthesia for transpupillary silicone oil removal combined with cataract surgery.

PURPOSE: To assess safety of topical anesthesia for transpupillary silicone oil removal in combination with cataract surgery. SETTING: Department of Ophthalmology Mannheim, University of Heidelberg, Mannheim, Germany. METHODS: The clinical interventional study included 37 consecutive patients having transpupillary silicone oil removal combined with cataract surgery. Without exception, surgery was carried out in topical anesthesia for all patients. During the study period, there were no patients having transpupillary silicone oil removal in another type of local anesthesia than topical anesthesia. Topical anesthesia was achieved with oxybuprocaine 0.4% eyedrops installed 4 to 5 times prior to surgery. Cataract surgery was performed using the clear cornea technique with implantation of a foldable intraocular posterior chamber lens. Silicone oil was released through a planned posterior capsulotomy during cataract surgery prior to implantation of the intraocular lens (IOL). RESULTS: For all patients, surgery could be carried out in topical anesthesia without switching to peribulbar or any other type of anesthesia. None of the patients complained about severe pain intraoperatively or postoperatively. No severe complications such as expulsive hemorrhage, luxation of the IOL, or iris incarceration were encountered in any of the surgeries. CONCLUSION: Transpupillary silicone oil through a planned posterior capsulotomy during cataract surgery may be performed in topical surgery.