Cataract surgery for congenital cataract: Endothelial cell characteristics, corneal thickness, and impact on intraocular pressure

Purpose: To investigate whether central corneal thickness (CCT), endothelial cell characteristics, and intraocular pressure (IOP) are affected in patients with previous congenital cataract surgery and to focus on their clinical significance. Methods: CCT and IOP measurements and specular microscopy were performed in 31 eyes of 17 cases of extracted congenital cataracts and 40 eyes of 20 age- and sex-matched participants as control group. The mean of three pachymetry measurements of the central cornea was taken as CCT. IOP was checked using an applanation tonometer. Results: The mean corneal thickness of the eyes with extracted congenital cataract (632 ± 45 μm) was significantly greater than that of the control eyes (546 ± 33 μm; p < 0.001). There was no significant difference in the corneal endothelial cell count, coefficient of variation (CV), and mean cell area (AVG) of endothelial cells between operated eyes and the control group. The mean measured IOP in the operated group (22.8 ± 3.3 mm Hg) was significantly greater than IOP in controls (14.1±1.8 mm Hg, p < 0.001). Conclusions: Although the corneas were clinically clear and there was no significant difference in endothelial characteristics of eyes with extracted congenital cataract and controls, central corneas of operated eyes were significantly thicker than those of controls. To differentiate the actual glaucoma from ocular hypertension in these patients, the central corneal thickness measurement should strongly be considered. © 2007 American Association for Pediatric Ophthalmology and Strabismus

Comparison of Ciprofloxacin ophthalmic solution 0.3 with fortified Cephazolin-Gentamicin in treating bacterial corneal ulcer

Background: Bacterial corneal ulcer is a common ophthalmic problem. Still controversies are exist for the treatment of bacterial corneal ulcer, thus, the present study was carried out in Namazi hospital in Shiraz to determine the efficacy and side effects of ciprofloxacin ophthalmic solution 0.3% and compare this with fortified cephazolin-gentamicin. Materials and Methods: It was a clinical trial. Having the physical examination and patient’s history completed, two samples were obtained for culture and smear. Patients were randomly distributed in two groups. One received the standard protocol (Cephazolin 5% and gentamicin 9% ophthalmic solutions) and the other was given ciprofloxacin ophthalmic solution 0.3%. Efficacy was evaluated according to the days of treatment and side effects were surveyed by eye burning and white deposit. Results: Of 45 cases, 6 were excluded due to the altered regimen. Of 39 studied cases, 20 received ciprofloxacin ophthalmic solution 0.3% and the remaining 19 were given standard regimen. Success rate was 90% and 89.5% for the ciprofloxacin and standard regimen, respectively (NS). Eye burning was reported 5% and 36.8%, respectively meanwhile, white deposits were reported in 36.8% of patients who have received standard regimen (P<0.02). Of cultured bacteria, one had shown intermediate resistance to ciprofloxacin, however, resistance was noted to cephalexin and gentamicin. Conclusion: Ciprofloxacin can be a suitable alternative for fortified cephazolin-gentamicin sine it has better outcome and less side effects. Further studies are highly recommended

Ocular refractive and biometric characteristics in patients with tilted disc syndrome

Purpose: To evaluate the ocular refractive and biometric characteristics in patients with tilted disc syndrome (TDS). Methods: This case-control study comprised 41 eyes of 25 patients with established TDS and forty eyes of 20 age- and sex-matched healthy control subjects. All had a complete ocular examination including refraction and analysis using Fourier transformation, slit lamp biomicroscopy, pachymetry keratometry, and ocular biometry. Corneal topography examinations were performed in the syndrome group only. Results: There were no significant differences in spherical equivalent (p = 0.334) and total astigmatism (p= 0.246) between groups. However, mean best spectacular corrected visual acuity was significantly worse in TDS patients (P < 0.001). The lenticular astigmatism was significantly greater in the syndrome group, while the corneal component was greater in the controls (p = 0.004 and p = 0.002, respectively). The measured biometric features were the same in both groups, except for the lens thickness, relative lens position, and lens-axial length factor which were greater in the TDS group (p = 0.002, p = 0.015, and p = 0.025, respectively). Conclusions: Clinically significant lenticular astigmatism, more oblique corneal astigmatism, and thicker lens were characteristic findings in patients with TDS

Traumatic optic neuropathy treatment trial (TONTT): open label, phase 3, multicenter, semi-experimental trial

Purpose: Intravenously administered erythropoietin (EPO) was firstly commenced (phase 1) in patients with indirect traumatic optic neuropathy (TON) by this group in 2011. It was re-tested by another group (phase 2) in 2014. This multicenter clinical trial was designed to compare its effect with intravenous steroid and observation. Methods: Included were TON patients �5 years of age and with trauma-treatment interval of �3 weeks. Follow-up visits were set at 1, 2, 3, 7, 14, 30, and at least 90 days after treatment. EPO and methylprednisolone were infused intravenously every day for three consecutive days. Primary outcome measure was change in the best corrected visual acuity (BCVA). Secondary outcomes included change in color vision and relative afferent pupillary defect (RAPD), side effects, and factors affecting the final visual improvement. Results: Out of 120 patients, 100 (EPO: 69, steroid: 15, observation: 16) were finally included. All three groups showed a significant improvement of BCVA which was not significantly different between the groups (adjusted for pretreatment BCVA). Color vision was significantly improved in the EPO group. Late treatment (>3 days) (odds ratio = 2.53) and initial BCVA of NLP (odds ratio = 5.74) significantly worsened visual recovery. No side effect was observed in any group. Conclusion: EPO, steroid, and observation showed a significant improvement of BCVA in patients with TON. Initial BCVA of NLP and late treatment (>3 days) were significant risk factors for visual improvement. © 2017, Springer-Verlag GmbH Germany

Traumatic optic neuropathy treatment trial (TONTT): open label, phase 3, multicenter, semi-experimental trial

Purpose: Intravenously administered erythropoietin (EPO) was firstly commenced (phase 1) in patients with indirect traumatic optic neuropathy (TON) by this group in 2011. It was re-tested by another group (phase 2) in 2014. This multicenter clinical trial was designed to compare its effect with intravenous steroid and observation. Methods: Included were TON patients �5 years of age and with trauma-treatment interval of �3 weeks. Follow-up visits were set at 1, 2, 3, 7, 14, 30, and at least 90 days after treatment. EPO and methylprednisolone were infused intravenously every day for three consecutive days. Primary outcome measure was change in the best corrected visual acuity (BCVA). Secondary outcomes included change in color vision and relative afferent pupillary defect (RAPD), side effects, and factors affecting the final visual improvement. Results: Out of 120 patients, 100 (EPO: 69, steroid: 15, observation: 16) were finally included. All three groups showed a significant improvement of BCVA which was not significantly different between the groups (adjusted for pretreatment BCVA). Color vision was significantly improved in the EPO group. Late treatment (>3 days) (odds ratio = 2.53) and initial BCVA of NLP (odds ratio = 5.74) significantly worsened visual recovery. No side effect was observed in any group. Conclusion: EPO, steroid, and observation showed a significant improvement of BCVA in patients with TON. Initial BCVA of NLP and late treatment (>3 days) were significant risk factors for visual improvement. © 2017, Springer-Verlag GmbH Germany