Effects of pterygium surgery on front and back corneal surfaces and anterior segment parameters.

The purpose of this study was to evaluate the effects of pterygium surgery on front and back corneal surfaces and anterior segment parameters. This prospective study included 96 eyes with primary pterygium that underwent surgery. Preoperatively and at 1, 3, and 6 months postoperatively, Pentacam was used to evaluate front and back corneal surfaces, anterior chamber depth (ACD), anterior chamber angle (ACA) and anterior chamber volume (ACV). Mean simulated keratometry at the front corneal surface increased from 42.73 ± 2.21 D preoperatively to 44.45 ± 2.05 D at 1 month (P < 0.001); it then decreased to 44.32 ± 2.07 D at 3 months (P < 0.001) and 44.19 ± 2.10 D at 6 months (P = 0.01). There was no statistically significant change in mean simulated keratometry at the back corneal surface. Radius of the front corneal best-fit sphere (BFS) decreased from 7.99 ± 0.29 mm preoperatively to 7.77 ± 0.25 mm at 1 month postoperatively (P < 0.001), without further change up to 6 months. Radius of the back corneal BFS increased from 6.42 ± 0.24 mm preoperatively to 6.50 ± 0.24 mm at 1 month (P < 0.001), without further change. Postoperative changes in mean simulated keratometry and radii of BFS had statistically significant positive correlations with pterygium extension onto the cornea and grade of pterygium morphology but, not with the surgical technique. There were no significant changes in ACD, ACA, and ACV values after pterygium surgery. Furthermore, the spherical equivalent of manifest refraction changed from +0.75 ± 1.06 D preoperatively to -0.72 ± 1.33 D at 1 month postoperatively (P = 0.001), with no further significant change. In conclusion, after pterygium surgery there were significant changes in front mean keratometry and front and back corneal radii of BFS. These were correlated with preoperative pterygium size and morphology grade. No significant changes in anterior segment parameters were noted postoperatively.

High-density porous polyethylene wedge implant in correction of enophthalmos and hypoglobus in seeing eyes.

INTRODUCTION: To report the results of post-traumatic enophthalmos/hypophthalmos correction with high-density porous polyethylene wedge implants in seeing eyes. METHODS: This is an interventional case series of 25 patients (25 eyes) with post-traumatic enophthalmos and hypophthalmos, who underwent orbital reconstruction to correct the enophthalmos and hypophthalmos using Medpor® wedge implant. The aim was an overcorrection of 1 mm in comparison to the other eye, intra-operatively. If needed, trimming of the wedge implant or adding Medpor® sheets were used to achieve the goal. Success was defined as achieving the globe position within 1 mm of the other eye in the last follow-up. Improvement and failure were considered as correction outside the success range of 1 mm and no change in the amount of enophthalmos/hypophthalmos, respectively. RESULTS: Patients were followed for at least 6 months (mean= 12.66, SD= 12.32). Success, improvement and failure of enophthalmos correction were: 58.3% (14/24), 37.5% (9/24) and 1 (1/24, 4.1%), respectively. Success, improvement and failure of hypophthalmos correction were 73.68% (14/19), 15.78% (3/19) and 5.26% (1/19), respectively. There was no significant difference between the success rate of enophthalmos versus hypophthalmos correction (P= 0.8). Results of 1-month follow up change in enophthalmos and hypophthalmos significantly correlated (r= 0.92, P= 0.000) with the change recorded at last follow up. CONCLUSIONS: Porous polyethylene wedge implants are useful and safe in correction of enophthalmos and hypoglobus in seeing eyes. Appropriately positioned implant yields no significant difference in correction of enophthalmos versus hypophthalmos.

Pathogenesis of primary acquired nasolacrimal duct obstruction.

PURPOSE: To assess the factors assumed to be contributed in pathogenesis of primary acquired nasolacrimal duct obstruction (PANDO). METHODS: In a prospective, controlled, interventional case series, 87 patients with symptomatic PANDO (case), 7 with traumatic nasolacrimal duct obstruction (NLDO) (control), 2 with congenital NLDO (control), and 70 asymptomatic females (control) were enrolled. Frequency of putting eye make-up (PANDO versus normal females), level of sexual hormones consisting of follicular stimulating hormone (FSH), luteal hormone (LH), estradiol, progesterone and testosterone (standard laboratory level), lacrimal sac biopsy for inflammation and fibrosis and immunohistochemistry for herpes simplex virus (HSV) type 1 and 2, and human papilloma virus were recorded. RESULTS: Severity of inflammation and fibrosis were not significantly different between case and control groups (P = 0.69), and between smokers and nonsmokers with PANDO (P = 0.15). Patients with severe preoperative symptoms showed significantly more lacrimal sac fibrosis (P = 0.018). No lacrimal sac pathology was found. Frequency of putting eye make-up was not significantly different between case and control group (0.596). Immunohistochemistry was negative for the viruses in all cases. There was no abnormal sexual hormone level in any case in this series. CONCLUSION: This study did not find any evidence in favor of the role of viral infection (HSV1, HSV2, HPV), eye make-up, and sex hormones in pathogenesis of PANDO. No abnormal pathology was found in lacrimal sac biopsy of patients with PANDO.

A combined approach of amniotic membrane and oral mucosa transplantation for fornix reconstruction in severe symblepharon.

PURPOSE: To evaluate the results of a combined approach of cicatrix lysis, intraoperative mitomycin C (MMC) application, oral mucosal transplantation (OMT), and amniotic membrane transplantation (AMT) for surgery of severe symblepharon. METHODS: This prospective study included 32 eyes with severe symblepharon in which after cicatrix lysis the residual conjunctiva was not enough to cover the tarsus (grade III symblepharon) or there was no residual conjunctiva (grade IV symblepharon). After symblepharon lysis and MMC application, OMT was used to cover the tarsus throughout to fornix, and AMT with fibrin glue was performed to cover the exposed sclera. Outcome was defined as complete success (restoration of an anatomically deep fornix), partial success (focal recurrence of scar), or failure (return of symblepharon). RESULTS: Etiology of symblepharon included chemical burn (n = 16), thermal burn (n = 7), Stevens-Johnson syndrome (n = 5), mucous membrane pemphigoid (n = 2), xeroderma pigmentosum (n = 1), and graft-versus-host disease (n = 1). Motility restriction was present in 87.5% preoperatively. After a mean follow-up of 16.4 ± 7.6 months, the anatomical outcome included complete success in 84.4%, partial success in 9.4%, and failure in 6.2%. In grades III and IV symblephara, the outcomes were complete success in 89.5% and 76.9%, partial success in 10.5% and 7.7%, and failure in none and 15.4%, respectively. No motility restriction was noted in any eye postoperatively. Complications included entropion (n = 2), ocular surface keratinization (n = 1), and pyogenic granuloma (n = 4). CONCLUSIONS: In severe symblepharon, a combined approach of cicatrix lysis, MMC application, OMT, and sutureless AMT was a safe and effective technique for fornix reconstruction.

Bilateral versus unilateral thyroid eye disease.

AIMS: The aim of this study was to compare demographics, clinical manifestations, associated systemic and ocular factors, severity and activity of patients with unilateral thyroid eye disease (U-TED) versus bilateral thyroid eye disease (B-TED). MATERIALS AND METHODS: In a cross-sectional study, all patients with Graves' hyperthyroidism and primary hypothyroidism seen in an endocrinology clinic were included from September 2003 to July 2006. Demographics, complete eye examination, severity score (NOSPECS, total eye score), and clinical activity score were recorded and compared in the B-TED and U-TED groups of patients. RESULTS: From 851 patients with thyroid disorders, 303 (35.6%) had TED. Thirty-two patients (32/ 303, 10.56%) were found to have U-TED. Patients with U-TED (mean age 31.6 ± 11.6 years) were significantly younger than patients with B-TED (mean age 37.7 ± 14.7 years). Monovariate analysis (Chi-square and independent sample t-test) showed a significantly higher severity score in B-TED (U-TED 4.09±4.05, B-TED: 6.7±6.3; P= 0.002) and more activity score in B-TED (U-TED= 1.03±0.96, B-TED: 1.74±1.6, P= 0.001). However, multivariate analysis did not show any significant difference between the two groups in terms of age, gender, type of thyroid disease, duration of thyroid disease and TED, severity and activity of TED, smoking habit, and presentation of TED before or after the presentation of thyroid disease (0.1