Efficacy of three different formulations of brimonidine for control of intraocular pressure in primary open-angle glaucoma: A 6-week randomized trial.

BACKGROUND: To compare the intraocular pressure (IOP)-lowering efficacy and safety of brimonidine (0.2%), brimonidine purite (0.15%), and brimonidine purite (0.1%) in patients of primary open-angle glaucoma (POAG). MATERIALS AND METHODS: Sixty patients of POAG with IOP >21 mmHg were enrolled into this study for 6-week duration. The patients were randomly divided into three groups with 20 patients in each group. Group A instilled brimonidine 0.2%, Group B instilled brimonidine purite 0.15%, and Group C instilled brimonidine purite 0.1% twice daily. IOP was recorded by applanation tonometry at baseline and subsequently at 2, 4, and 6 weeks at 9:00-10:00 am during each visit around 30 min after instillation of eye drops. RESULTS: Mean IOP reduction in Group A was from 25.55 ± 2.01 to 19.85 ± 2.05 mmHg at the end of study, thus resulting in fall of 5.70 mmHg (22.30%), in Group B, it decreased from 25.65 ± 2.41 to 19.55 ± 2.43 mmHg, thus resulting in fall of 6.10 mmHg (23.78%), and in Group C, it decreased from 25.80 ± 2.26 mmHg to 19.85 ± 2.16 mmHg, thus resulting in fall of 6.35 mmHg (24.61%). There was no statistically significant difference in IOP-lowering efficacy of study drugs. Conjunctival hyperemia, foreign body sensation, dry eye, and papillary reaction were the important side effects seen with study drugs. Brimonidine 0.2% caused more side effects than brimonidine purite 0.15% and brimonidine purite 0.1%. CONCLUSION: All the three formulations of brimonidine produced statistically equal lowering of IOP in patients of POAG with reduced systemic and ocular adverse reactions with brimonidine purite 0.15% and 0.1%.

Indications and graft survival analysis in optical penetrating keratoplasty in a tertiary care center in North India: a 5-year study.

PURPOSE: To study the indications and variables correlating with graft survival in optical penetrating keratoplasty in a tertiary care hospital in north India. PARTICIPANTS: All patients who underwent optical keratoplasty, except those undergoing lamellar grafts, tectonic grafts transplants and penetrating keratoplasty done for therapeutic purposes were included in the study. Patients with follow-up less than 2 years were excluded from the study. MATERIALS AND METHODS: Data were obtained by reviewing the records of 101 patients who underwent optical penetrating keratoplasty from 2008 to 2013 for various indications. RESULTS: Out of 101 patients who underwent optical penetrating keratoplasty, 71 were males and 30 were females. The mean age of the recipient was 48.53 years with range 1-82 years. The main indications were previous failed graft (29.7%), healed keratitis except HSV (15.8%), pseudophakic or aphakic bullous keratopathy (14.8%), corneal dystrophies/degenerations (12.9%), adherent leucoma (9.9%), post-HSV scars (8.9%), and others like anterior staphyloma, congenital corneal opacities, buphthalmos and keratoconus (7.9%). The graft survival rate was 67.33% at 1-year follow-up and 59.4% at 2-year follow-up. The mean survival time of the grafts was 22.42 months. The mean time for graft failure was 7.12 (±0.9) months. CONCLUSION: One- and 2-year survival of grafts at our center is lower as compared to western studies, probably due to higher percentage of poor prognosis indications for surgery and a relative scarcity of excellent-quality donor corneas.

A Case of Bilateral Corneal Perforation in a Patient with Severe Dry Eye.

Dry eye is a common problem affecting mainly the adult population. In severe cases, it can result in sterile corneal ulcer and perforation. We report a rare case of a 26-year-old male, a known patient of severe dry eye who presented with sterile corneal ulcer with corneal perforation in both the eyes. The patient was managed by applying cyanoacrylate glue and bandage contact lens in both eyes and topical antibiotic, topical cyclosporine and preservative free artificial tears at two hourly intervals. The patient was investigated for the systemic cause of severe dry eye but no cause could be ascertained. On follow up, the patient reported marked relief in photophobia. On examination, both eyes showed sealed perforation with well formed anterior chamber. In conclusion, one should examine a dry eye patient carefully and detect corneal ulcers and perforations in time so as to prevent its sequelae.

Simple Limbal Epithelial Transplantation in Acid Injury and Severe Dry Eye.

The epithelial cells of cornea constantly undergo renewal and regeneration and the stem cells responsible for renewal resides within basal epithelium at the limbus in palisades of Vogt. Simple limbal epithelial transplantation (SLET) is a simplified technique for limbal stem cell deficiency and it combines the benefits of both conjunctival limbal autografting and cultivated limbal epithelial transplantation by being single-stage and utilizing minimal donor tissue. We will be discussing two cases of ocular surface disorder which were managed successfully by new technique simple limbal epithelial transplantation. Two patients one with unilateral Limbal Stem Cell Deficiency (LSCD) following acid injury and other with bilateral LSCD due to severe dry eye underwent limbal epithelial transplantation using the SLET method after taking prior consent for the procedure. Success was termed complete when a completely epithelialized, avascular and stable corneal surface was seen. The follow up examinations were done on first day, at 1 week, 2 weeks, 4 weeks and at 3 months after the surgery. A completely epithelialised, avascular and stable corneal surface was achieved by 4 weeks in both patients. Simple limbal epithelial transplantation is a new technique which is simple, cheap and easily affordable and it has decreased the dependence on stem cell laboratory.