Purpose To evaluate the association between donor-related factors and the risk of rejection in pa... more Purpose To evaluate the association between donor-related factors and the risk of rejection in patients undergoing penetrating keratoplasty (PKP) for keratoconus. Methods A Retrospective review was performed of keratoconus patients with no corneal neovascularization who underwent PKP from November 2014 to December 2016 and completed at least two years of follow-up. Preoperative, donor, operative, and postoperative data were collected and analyzed to identify factors leading to corneal graft rejection. Results Among the 201 patients (201 eyes) who underwent PKP, 46 patients (22.9%) had an episode of graft rejection. The graft survival rate was 98.5%. Grafts with a death-to-excision time (DET) greater than 8 hours had a 0.53X lower risk of rejection compared with grafts with DET within 8 hours or less (P = 0.05). Rejection was higher in patients receiving grafts with a preservation time within 7 days or less compared with preservation time greater than 7 days (30.6% vs. 21.2%, respect...
Purpose This study aims to determine the incidence of fungal-culture-positive corneoscleral donor... more Purpose This study aims to determine the incidence of fungal-culture-positive corneoscleral donor rim in patients undergoing keratoplasty and evaluate clinical outcomes of eyes that received these contaminated donor tissues. Methods Patients who had optical keratoplasty between 2006 and 2016 and were found to have fungal-culture-positive donor rim were included. Microbiological and eye bank records were reviewed to determine the incidence of positive fungal rim cultures. Data were collected on visual and clinical outcomes. The main outcome measures were fungalculture-positive donor rim and development of fungal keratitis or endophthalmitis post keratoplasty. Longterm clinical outcome and associated complications were the secondary outcome measures. Results Out of 9620 cases of corneal transplants, 145 (1.5%) had fungal-culture-positive donor rim. Candida was the most common organism, cultured in 127 (87.6%) cases. There were no cases of postoperative fungal keratitis or endophthalmitis. Median follow-up was 4.8 years (interquartile range 3.8-7.2 years). Only eight cases (5.5%) received prophylactic antifungal treatment. There were 34 (23.4%) cases of rejection, 13 (8.9%) developed glaucoma, and 7 (4.8%) developed late bacterial keratitis. At last follow-up, best corrected visual acuity was 20/60 or better in 88 cases (60.7%) and 115 eyes (79.3%) had a clear graft. Conclusion The incidence of fungal-culture-positive donor rim is extremely low. The risk of developing fungal keratitis or endophthalmitis in patients who received contaminated donor tissue was almost negligible. Further studies are warranted to prove whether prophylaxis or adding amphotericin B in Optisol-GS confers any added benefit.
Iris thickness (IT), a known risk factor for angle closure glaucoma, has not been evaluated in th... more Iris thickness (IT), a known risk factor for angle closure glaucoma, has not been evaluated in the normal Saudi population. Quantitative information on IT was evaluated in healthy Saudi eyes using anterior segment optical coherence tomography (ASOCT). IT and iris volume was measured with the room 'light on' (LON) and 'light off' (LOFF) using Image J software. IT in the nasal and temporal iris was measured at 500 µm (IT500) and 750 µm (IT750) from the scleral spur (SS). Differences in IT measurements by age, gender and type of refractive error were evaluated. We included 100 eyes of 50 healthy adult Saudis without ocular disease other than refractive errors. The mean age of 56 males and 44 females in the study group was 41.7 ± 14.5 years. The refractive status was as follows: emmetropia (35 eyes), mild/moderate myopia (33 eyes), high myopia (17 eyes) and hyperopia (15 eyes). The IT750 with LON was significantly more than IT500 both nasally (P = 0.03) and temporally (P < 0.001). The difference in IT750 and IT500 with LOFF was significantly more nasally (P = 0.03), temporally (P = 0.02), and with LON nasally (P = 0.005). IT was thicker in males when compared to females and variation of IT by refractive error was significant but not by age. The mean pupil diameter and anterior chamber depth decreased with age (P < 0.001). Anterior chamber width was not affected by age or illumination. The baseline iris thickness in the Saudi eyes could be used to compare iris thickness in eyes with angle closure glaucoma among the Arab population.
To evaluate the outcome and safety of implantable collamer lens (ICL; (Visian, STAAR Surgical, Mo... more To evaluate the outcome and safety of implantable collamer lens (ICL; (Visian, STAAR Surgical, Monrovia, CA, USA) in mild to advance keratoconus patients with myopia and myopic astigmatism. This retrospective study evaluated all patients who underwent ICL implantation for the management of keratoconus at a tertiary care eye hospital from January 2012 to January 2018. The mean duration of follow-up was 15.3 months (range, 3.13 to 38.97 months). Data were collected on preoperative and postoperative uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), refraction was compared, and adverse effects were evaluated. Thirty-two eyes (32 patients) were evaluated. The median CDVA was 20/30 preoperatively and 20/20 at last follow-up. The median UDVA was 20/25 at last follow-up. Thirteen patients (40.6%) had 20/20 UDVA in comparison to none at baseline. The median spherical equivalent in diopters (D) was −7.875 D (−4.125 to −10.0 D) preoperatively and decreased to −0.3125 D at last follow-up. The median manifest refractive cylinder was 3.00 D (2.25 to 5.25 D) preoperatively and decreased to 1.125 D postoperatively. Cylinder axis rotation of 10° or greater occurred in 3 eyes (9.375%) and required repositioning of the ICL. One patient (3%) developed nonvisually significant anterior subcapsular cataract. One ICL (3.125%) had to be explanted due to residual refractive error and unsatisfactory vision. ICLs are a suitable refractive option for the correction of refractive error associated with stable, nonprogressive keratoconus even in advance cases. However, the risk of ICL rotation and subsequent repositioning remain. Careful patient selection is necessary for achieving good outcomes and mitigating intraoperative and postoperative complications.
Objectives: To compare the results of lateral tarsal strip procedure with fullthickness pentagona... more Objectives: To compare the results of lateral tarsal strip procedure with fullthickness pentagonal lid resection in the correction of involutional ectropion. Material and Method: A retrospectivestudy of 102 patients who underwent surgery for senile ectropion of lower lid. All the patients underwent either lateraltarsal strip operation or full thickness pentagonal resection. On the basis of signs and site of ectropion, the patientswere divided into three main groups; 1) Medial ectropion, 2) General ectropion and 3) ectropion with chronic lid marginchanges. Success was defined as relief of symptoms and good lid position. Results: 69% of patients had lateral tarsalstrip and 31% of patients had full thickness pentagon resection. Overall success was achieved in 90% patients whounderwent lateral strip operation and in 91% patients with full thickness pentagonal lid resection. In patients with medialectropion the success rate was 87% in lateral tarsal strip procedure compared to 96% with f...
Pseudoexfoliation syndrome (PXS) is the most common identifiable cause of secondary glaucoma, the... more Pseudoexfoliation syndrome (PXS) is the most common identifiable cause of secondary glaucoma, the prevalence of which varies considerably among different ethnicities. The aim of this study was to assess the prevalence of pseudoexfoliation syndrome in Pakistan. A prospective study conducted in the period from January 2003 to June 2004 in a teaching hospital serving a population of about 7.6 million. 1860 patients aged 45 or above attending the general ophthalmic clinics were recruited for this study. A detailed evaluation including ophthalmic and general history, slit lamp biomicroscopy, intraocular pressure measurement, gonioscopy and dilated eye examination was performed on all patients. 120(6.45%) subjects were found to have PXS with a male to female ratio of 1.5:1. All 120 (100%) cases were bilateral and 48(40%) patients had high intraocular pressure. To the best of our knowledge, this is the first study conducted in a Pakistani population to determine the prevalence of PXS. The ...
Intraocular lens (IOL) opacification is a rare but serious complication that may necessitate its ... more Intraocular lens (IOL) opacification is a rare but serious complication that may necessitate its exchange. The use of intraocular gases is a known precipitant. Descemet stripping endothelial keratoplasty (DSAEK) involves injecting air into the anterior chamber. IOL opacification has been described after this procedure; however its incidence is currently unknown. Methods: A retrospective review of case notes from a single center of all patients undergoing DSAEK, who were either already pseudophakic or had simultaneous cataract surgery. Cases with IOL opacification were analyzed, and any risk factors were identified. Results: One hundred sixty-eight DSAEK were performed on 154 eyes of 137 patients. Fifty-four cases had simultaneous cataract surgery with implantation of an IOL. Fifteen (9.7%) eyes developed IOL opacification. This had a distinctive pattern, being limited to the anterior lens surface, in the pupillary zone. Median time interval from keratoplasty to the first observation of IOL opacification was 17 months (range, 4-34 months). The only statistically significant risk factor was rebubbling of detached endothelial grafts. Rebubbling was performed in 62.5% (10/15) of cases with IOL opacification, compared with 23% (32/139) with no opacification (P = 0.0009). Conclusions: This is the first study to report the incidence of IOL opacification after undergoing DSAEK. Although the mechanism is unknown, multiple injections of air into the anterior chamber statistically increase the risk of IOL opacification.
To assess the effect and efficacy of botulinum toxin type A (BTX-A) at reducing and maintaining e... more To assess the effect and efficacy of botulinum toxin type A (BTX-A) at reducing and maintaining eyelid synkinesia in aberrant facial nerve regeneration, while concurrently observing for the presence of side effects to differing treatment doses. A prospective interventional study of five patients with eyelid synkinesia resulting from aberrant regeneration of the facial nerve. Patients were treated with injections of either 120, 80 or 40 units of BTX-A (Dysport) into the orbicularis oculi. Objective and subjective reduction in synkinesia, maintenance of response and presence of side effects were recorded. All five patients had improvement of the synkinesia with BTX-A treatment. Lower doses were found to be as effective as higher doses. Mean duration of abolished synkinesia was three months. Two patients developed a ptosis which resolved spontaneously. None of the patients treated with the lowest dose of 40 units developed a ptosis. Low-dose BTX-A has a lower incidence of ptosis and is effective in the treatment of aberrant facial nerve regeneration.
involvement. A diagnosis of bilateral anterior uveitis secondary to brimonidine was made and she ... more involvement. A diagnosis of bilateral anterior uveitis secondary to brimonidine was made and she was treated with 2 hourly topical dexamethasone 0.1% and cyclopentolate 1% thrice daily to both eyes. Both timolol and brimonidine were discontinued and the intraocular pressure initially managed with oral acetazolamide. The inflammation settled within 3 weeks and timolol was restarted without any side effect. Systemic evaluation comprising full blood count, urea and electrolytes, liver function tests, serum angiotensin converting enzyme, ESR, CRP, syphilis serology, and chest X-ray were all normal. The patient was understandably reluctant to consider a subsequent rechallenge test with topical brimonidine, feeling that it posed a threat to her already limited vision. After 1 month, she restarted brimonidine to the right eye but presented after only three instillations with florid conjunctival injection and an anterior chamber flare in the right eye. There were no cells and the intraocular pressure was normal. The left eye remained quiet. The challenge was discontinued and the conjunctival reaction settled quickly on topical steroids.
The aim of this study was to determine whether there are any associations between single nucleoti... more The aim of this study was to determine whether there are any associations between single nucleotide polymorphisms of the chemokine genes IL-8, MCP-1, their corresponding receptors CXCR1 and CCR2 and disease outcome in patients with acute idiopathic anterior uveitis. 60 Caucasian patients with idiopathic acute recurrent anterior uveitis together with 120 healthy Caucasian control subjects were tested for the presence of 16 bi-allelic polymorphisms and HLA-B27 using polymerase chain reaction in association with sequence-specific primers with mismatches at the 3&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; end. The genetic data was then compared between patients and controls, and within the patient group itself for association with clinical disease outcome. As expected, the frequency of HLA-B27 was significantly higher in the patient group than the control group (63.33% versus 15.83%; Pearson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001, Fisher&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001). In addition, the frequency of the T allele of MCP-1 63555 was found to be significantly higher in the control group when compared to the patient group (P=0.0160). This study describes an association between acute anterior uveitis and MCP-1 63555 polymorphisms where the T allele may be a protective marker against the disease.
To investigate the efficacy of bandage contact lenses (BCLs) in comparison with that of ocular lu... more To investigate the efficacy of bandage contact lenses (BCLs) in comparison with that of ocular lubricants (OLs) in the initial management of recurrent corneal erosion syndrome. A randomized controlled trial of 29 patients with recurrent corneal erosion syndrome presenting to the ophthalmology departments of the Oxford Eye Hospital and the Royal Berkshire Hospital, United Kingdom. The patients were randomized to wear either BCLs (for a 3-month duration, replaced every 30 days) or use OLs (4 times a day, with Lacri-Lube ointment at night for 3 months). The patients were assessed monthly for 4 months, and their symptoms were graded by visual analog scores. The main outcome measure was the complete resolution of symptoms with no noticeable corneal surface abnormality. Patients with a complete resolution were followed up for another 3 months to check for recurrence. Fourteen patients were randomized to the BCL arm, and 15 were randomized to the OL arm. After 3 months, a complete resolution was achieved in 71% of the patients (10/14) with BCLs compared with that achieved in 73% of the patients (11/15) on OLs (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). Partial resolution was noted in 7% of the patients with BCLs versus 13% of the patients on OLs. Twenty-one percent of the patients in the BCL group and 13% of the patients in the OL group failed to respond to the treatment. Patients on BCLs had earlier resolution of symptoms, with a mean time of 5 weeks compared with 9 weeks for OLs (P = 0.02). None of the patients with BCLs developed adverse side effects. BCLs do not increase the likelihood of complete resolution when compared with OLs in the initial management of RCES. However, BCL treatment seems safe, and some patients experience earlier relief from symptoms.
PURPOSE: To report a case in which observation of increased ocular pulse amplitude (OPA) estimate... more PURPOSE: To report a case in which observation of increased ocular pulse amplitude (OPA) estimates in both eyes lead to a diagnosis of, and was presumably due to, aortic regurgitation. DESIGN: Case report. METHODS: An incidental finding of high OPA estimates in both eyes lead to a finding of widened arterial pulse pressure and aortic regurgitation. OPA estimates were taken after aortic valve surgery when arterial pulse pressure was normal. RESULTS: OPA estimates were 9 mm Hg in both eyes when arterial pulse pressure was high and 3 mm Hg in each eye when normal. CONCLUSION: Widened arterial pulse pressure may lead to increased OPA. (Am J Ophthalmol 2004;138:503.
Purpose To evaluate the association between donor-related factors and the risk of rejection in pa... more Purpose To evaluate the association between donor-related factors and the risk of rejection in patients undergoing penetrating keratoplasty (PKP) for keratoconus. Methods A Retrospective review was performed of keratoconus patients with no corneal neovascularization who underwent PKP from November 2014 to December 2016 and completed at least two years of follow-up. Preoperative, donor, operative, and postoperative data were collected and analyzed to identify factors leading to corneal graft rejection. Results Among the 201 patients (201 eyes) who underwent PKP, 46 patients (22.9%) had an episode of graft rejection. The graft survival rate was 98.5%. Grafts with a death-to-excision time (DET) greater than 8 hours had a 0.53X lower risk of rejection compared with grafts with DET within 8 hours or less (P = 0.05). Rejection was higher in patients receiving grafts with a preservation time within 7 days or less compared with preservation time greater than 7 days (30.6% vs. 21.2%, respect...
Purpose This study aims to determine the incidence of fungal-culture-positive corneoscleral donor... more Purpose This study aims to determine the incidence of fungal-culture-positive corneoscleral donor rim in patients undergoing keratoplasty and evaluate clinical outcomes of eyes that received these contaminated donor tissues. Methods Patients who had optical keratoplasty between 2006 and 2016 and were found to have fungal-culture-positive donor rim were included. Microbiological and eye bank records were reviewed to determine the incidence of positive fungal rim cultures. Data were collected on visual and clinical outcomes. The main outcome measures were fungalculture-positive donor rim and development of fungal keratitis or endophthalmitis post keratoplasty. Longterm clinical outcome and associated complications were the secondary outcome measures. Results Out of 9620 cases of corneal transplants, 145 (1.5%) had fungal-culture-positive donor rim. Candida was the most common organism, cultured in 127 (87.6%) cases. There were no cases of postoperative fungal keratitis or endophthalmitis. Median follow-up was 4.8 years (interquartile range 3.8-7.2 years). Only eight cases (5.5%) received prophylactic antifungal treatment. There were 34 (23.4%) cases of rejection, 13 (8.9%) developed glaucoma, and 7 (4.8%) developed late bacterial keratitis. At last follow-up, best corrected visual acuity was 20/60 or better in 88 cases (60.7%) and 115 eyes (79.3%) had a clear graft. Conclusion The incidence of fungal-culture-positive donor rim is extremely low. The risk of developing fungal keratitis or endophthalmitis in patients who received contaminated donor tissue was almost negligible. Further studies are warranted to prove whether prophylaxis or adding amphotericin B in Optisol-GS confers any added benefit.
Iris thickness (IT), a known risk factor for angle closure glaucoma, has not been evaluated in th... more Iris thickness (IT), a known risk factor for angle closure glaucoma, has not been evaluated in the normal Saudi population. Quantitative information on IT was evaluated in healthy Saudi eyes using anterior segment optical coherence tomography (ASOCT). IT and iris volume was measured with the room 'light on' (LON) and 'light off' (LOFF) using Image J software. IT in the nasal and temporal iris was measured at 500 µm (IT500) and 750 µm (IT750) from the scleral spur (SS). Differences in IT measurements by age, gender and type of refractive error were evaluated. We included 100 eyes of 50 healthy adult Saudis without ocular disease other than refractive errors. The mean age of 56 males and 44 females in the study group was 41.7 ± 14.5 years. The refractive status was as follows: emmetropia (35 eyes), mild/moderate myopia (33 eyes), high myopia (17 eyes) and hyperopia (15 eyes). The IT750 with LON was significantly more than IT500 both nasally (P = 0.03) and temporally (P < 0.001). The difference in IT750 and IT500 with LOFF was significantly more nasally (P = 0.03), temporally (P = 0.02), and with LON nasally (P = 0.005). IT was thicker in males when compared to females and variation of IT by refractive error was significant but not by age. The mean pupil diameter and anterior chamber depth decreased with age (P < 0.001). Anterior chamber width was not affected by age or illumination. The baseline iris thickness in the Saudi eyes could be used to compare iris thickness in eyes with angle closure glaucoma among the Arab population.
To evaluate the outcome and safety of implantable collamer lens (ICL; (Visian, STAAR Surgical, Mo... more To evaluate the outcome and safety of implantable collamer lens (ICL; (Visian, STAAR Surgical, Monrovia, CA, USA) in mild to advance keratoconus patients with myopia and myopic astigmatism. This retrospective study evaluated all patients who underwent ICL implantation for the management of keratoconus at a tertiary care eye hospital from January 2012 to January 2018. The mean duration of follow-up was 15.3 months (range, 3.13 to 38.97 months). Data were collected on preoperative and postoperative uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), refraction was compared, and adverse effects were evaluated. Thirty-two eyes (32 patients) were evaluated. The median CDVA was 20/30 preoperatively and 20/20 at last follow-up. The median UDVA was 20/25 at last follow-up. Thirteen patients (40.6%) had 20/20 UDVA in comparison to none at baseline. The median spherical equivalent in diopters (D) was −7.875 D (−4.125 to −10.0 D) preoperatively and decreased to −0.3125 D at last follow-up. The median manifest refractive cylinder was 3.00 D (2.25 to 5.25 D) preoperatively and decreased to 1.125 D postoperatively. Cylinder axis rotation of 10° or greater occurred in 3 eyes (9.375%) and required repositioning of the ICL. One patient (3%) developed nonvisually significant anterior subcapsular cataract. One ICL (3.125%) had to be explanted due to residual refractive error and unsatisfactory vision. ICLs are a suitable refractive option for the correction of refractive error associated with stable, nonprogressive keratoconus even in advance cases. However, the risk of ICL rotation and subsequent repositioning remain. Careful patient selection is necessary for achieving good outcomes and mitigating intraoperative and postoperative complications.
Objectives: To compare the results of lateral tarsal strip procedure with fullthickness pentagona... more Objectives: To compare the results of lateral tarsal strip procedure with fullthickness pentagonal lid resection in the correction of involutional ectropion. Material and Method: A retrospectivestudy of 102 patients who underwent surgery for senile ectropion of lower lid. All the patients underwent either lateraltarsal strip operation or full thickness pentagonal resection. On the basis of signs and site of ectropion, the patientswere divided into three main groups; 1) Medial ectropion, 2) General ectropion and 3) ectropion with chronic lid marginchanges. Success was defined as relief of symptoms and good lid position. Results: 69% of patients had lateral tarsalstrip and 31% of patients had full thickness pentagon resection. Overall success was achieved in 90% patients whounderwent lateral strip operation and in 91% patients with full thickness pentagonal lid resection. In patients with medialectropion the success rate was 87% in lateral tarsal strip procedure compared to 96% with f...
Pseudoexfoliation syndrome (PXS) is the most common identifiable cause of secondary glaucoma, the... more Pseudoexfoliation syndrome (PXS) is the most common identifiable cause of secondary glaucoma, the prevalence of which varies considerably among different ethnicities. The aim of this study was to assess the prevalence of pseudoexfoliation syndrome in Pakistan. A prospective study conducted in the period from January 2003 to June 2004 in a teaching hospital serving a population of about 7.6 million. 1860 patients aged 45 or above attending the general ophthalmic clinics were recruited for this study. A detailed evaluation including ophthalmic and general history, slit lamp biomicroscopy, intraocular pressure measurement, gonioscopy and dilated eye examination was performed on all patients. 120(6.45%) subjects were found to have PXS with a male to female ratio of 1.5:1. All 120 (100%) cases were bilateral and 48(40%) patients had high intraocular pressure. To the best of our knowledge, this is the first study conducted in a Pakistani population to determine the prevalence of PXS. The ...
Intraocular lens (IOL) opacification is a rare but serious complication that may necessitate its ... more Intraocular lens (IOL) opacification is a rare but serious complication that may necessitate its exchange. The use of intraocular gases is a known precipitant. Descemet stripping endothelial keratoplasty (DSAEK) involves injecting air into the anterior chamber. IOL opacification has been described after this procedure; however its incidence is currently unknown. Methods: A retrospective review of case notes from a single center of all patients undergoing DSAEK, who were either already pseudophakic or had simultaneous cataract surgery. Cases with IOL opacification were analyzed, and any risk factors were identified. Results: One hundred sixty-eight DSAEK were performed on 154 eyes of 137 patients. Fifty-four cases had simultaneous cataract surgery with implantation of an IOL. Fifteen (9.7%) eyes developed IOL opacification. This had a distinctive pattern, being limited to the anterior lens surface, in the pupillary zone. Median time interval from keratoplasty to the first observation of IOL opacification was 17 months (range, 4-34 months). The only statistically significant risk factor was rebubbling of detached endothelial grafts. Rebubbling was performed in 62.5% (10/15) of cases with IOL opacification, compared with 23% (32/139) with no opacification (P = 0.0009). Conclusions: This is the first study to report the incidence of IOL opacification after undergoing DSAEK. Although the mechanism is unknown, multiple injections of air into the anterior chamber statistically increase the risk of IOL opacification.
To assess the effect and efficacy of botulinum toxin type A (BTX-A) at reducing and maintaining e... more To assess the effect and efficacy of botulinum toxin type A (BTX-A) at reducing and maintaining eyelid synkinesia in aberrant facial nerve regeneration, while concurrently observing for the presence of side effects to differing treatment doses. A prospective interventional study of five patients with eyelid synkinesia resulting from aberrant regeneration of the facial nerve. Patients were treated with injections of either 120, 80 or 40 units of BTX-A (Dysport) into the orbicularis oculi. Objective and subjective reduction in synkinesia, maintenance of response and presence of side effects were recorded. All five patients had improvement of the synkinesia with BTX-A treatment. Lower doses were found to be as effective as higher doses. Mean duration of abolished synkinesia was three months. Two patients developed a ptosis which resolved spontaneously. None of the patients treated with the lowest dose of 40 units developed a ptosis. Low-dose BTX-A has a lower incidence of ptosis and is effective in the treatment of aberrant facial nerve regeneration.
involvement. A diagnosis of bilateral anterior uveitis secondary to brimonidine was made and she ... more involvement. A diagnosis of bilateral anterior uveitis secondary to brimonidine was made and she was treated with 2 hourly topical dexamethasone 0.1% and cyclopentolate 1% thrice daily to both eyes. Both timolol and brimonidine were discontinued and the intraocular pressure initially managed with oral acetazolamide. The inflammation settled within 3 weeks and timolol was restarted without any side effect. Systemic evaluation comprising full blood count, urea and electrolytes, liver function tests, serum angiotensin converting enzyme, ESR, CRP, syphilis serology, and chest X-ray were all normal. The patient was understandably reluctant to consider a subsequent rechallenge test with topical brimonidine, feeling that it posed a threat to her already limited vision. After 1 month, she restarted brimonidine to the right eye but presented after only three instillations with florid conjunctival injection and an anterior chamber flare in the right eye. There were no cells and the intraocular pressure was normal. The left eye remained quiet. The challenge was discontinued and the conjunctival reaction settled quickly on topical steroids.
The aim of this study was to determine whether there are any associations between single nucleoti... more The aim of this study was to determine whether there are any associations between single nucleotide polymorphisms of the chemokine genes IL-8, MCP-1, their corresponding receptors CXCR1 and CCR2 and disease outcome in patients with acute idiopathic anterior uveitis. 60 Caucasian patients with idiopathic acute recurrent anterior uveitis together with 120 healthy Caucasian control subjects were tested for the presence of 16 bi-allelic polymorphisms and HLA-B27 using polymerase chain reaction in association with sequence-specific primers with mismatches at the 3&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; end. The genetic data was then compared between patients and controls, and within the patient group itself for association with clinical disease outcome. As expected, the frequency of HLA-B27 was significantly higher in the patient group than the control group (63.33% versus 15.83%; Pearson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001, Fisher&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001). In addition, the frequency of the T allele of MCP-1 63555 was found to be significantly higher in the control group when compared to the patient group (P=0.0160). This study describes an association between acute anterior uveitis and MCP-1 63555 polymorphisms where the T allele may be a protective marker against the disease.
To investigate the efficacy of bandage contact lenses (BCLs) in comparison with that of ocular lu... more To investigate the efficacy of bandage contact lenses (BCLs) in comparison with that of ocular lubricants (OLs) in the initial management of recurrent corneal erosion syndrome. A randomized controlled trial of 29 patients with recurrent corneal erosion syndrome presenting to the ophthalmology departments of the Oxford Eye Hospital and the Royal Berkshire Hospital, United Kingdom. The patients were randomized to wear either BCLs (for a 3-month duration, replaced every 30 days) or use OLs (4 times a day, with Lacri-Lube ointment at night for 3 months). The patients were assessed monthly for 4 months, and their symptoms were graded by visual analog scores. The main outcome measure was the complete resolution of symptoms with no noticeable corneal surface abnormality. Patients with a complete resolution were followed up for another 3 months to check for recurrence. Fourteen patients were randomized to the BCL arm, and 15 were randomized to the OL arm. After 3 months, a complete resolution was achieved in 71% of the patients (10/14) with BCLs compared with that achieved in 73% of the patients (11/15) on OLs (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). Partial resolution was noted in 7% of the patients with BCLs versus 13% of the patients on OLs. Twenty-one percent of the patients in the BCL group and 13% of the patients in the OL group failed to respond to the treatment. Patients on BCLs had earlier resolution of symptoms, with a mean time of 5 weeks compared with 9 weeks for OLs (P = 0.02). None of the patients with BCLs developed adverse side effects. BCLs do not increase the likelihood of complete resolution when compared with OLs in the initial management of RCES. However, BCL treatment seems safe, and some patients experience earlier relief from symptoms.
PURPOSE: To report a case in which observation of increased ocular pulse amplitude (OPA) estimate... more PURPOSE: To report a case in which observation of increased ocular pulse amplitude (OPA) estimates in both eyes lead to a diagnosis of, and was presumably due to, aortic regurgitation. DESIGN: Case report. METHODS: An incidental finding of high OPA estimates in both eyes lead to a finding of widened arterial pulse pressure and aortic regurgitation. OPA estimates were taken after aortic valve surgery when arterial pulse pressure was normal. RESULTS: OPA estimates were 9 mm Hg in both eyes when arterial pulse pressure was high and 3 mm Hg in each eye when normal. CONCLUSION: Widened arterial pulse pressure may lead to increased OPA. (Am J Ophthalmol 2004;138:503.
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