Allergic conjunctivitis

The purpose of this research is to study the clinical features and risk factors of various types of allergic conjunctivitis. Four hundred and forty-five patients with a history of itching, foreign body sensation, lacrimation and red eyes were examined, and a skin test was performed and assessed to grade the severity. The mean age of the subjects was 24.5 +/- 16.3 years with female preponderance, except for vernal keratoconjunctivitis. The majority of the patients had perennial allergic conjunctivitis. Ninety-five percent of the patients had associated allergic diseases, especially allergic rhinitis. Sixty-six percent of the patients had a family history of atopy. Most patients had symptoms at night. Symptoms persisted throughout the year and were generally triggered by exposure to house dust. The allergy skin tests to common aero-allergens were positive in 95% of patients tested. Common allergens causing sensitization were house-dust mites, house dust, cockroaches, and grass pollen. Environmental control and avoidance of these allergens should be stressed in the management of these conditions.

Corneal abnormalities in diabetes

OBJECTIVE

To compare corneal thickness and endothelial morphology in patients with diabetes mellitus and age-matched normal subjects, and to determine whether the duration of diabetes mellitus, severity of diabetic retinopathy, and glycemic control are correlated with these measurements.

DESIGN

Single center, case-control study.

PARTICIPANTS

Sixty eyes of thirty diabetic patients and sixty eyes of thirty healthy nondiabetic subjects were studied.

INTERVENTION

Corneal thickness was measured by ultrasonic pachymeter. Corneal endothelial morphology was examined with a contact specular microscope.

MAIN OUTCOME MEASURES

Corneal endothelial cell density, mean,cell area, coefficient of variation, percentages of hexagonal cells, and corneal thickness were measured.

RESULTS

There was statistically significant increased corneal endothelial cell density and decreased mean endothelial cell area in the diabetic patients. The diabetic corneas had an increased coefficient of variation of endothelial cell area, a decreased percentage of hexagonal endothelial cell and an increased corneal thickness compared with the control subjects, but these differences were not statistically significant. The duration of diabetes mellitus was significantly correlated with pleomorphism, polymegathism and corneal thickness. Severity of diabetic retinopathy was correlated with endothelial cell density, but these correlations were low. The corneal changes were not correlated with glycemic control.

CONCLUSIONS

The diabetic corneas tended to be thicker and had more pleomorphism and polymegathism, though this was not statistically significant. Duration of diabetes mellitus correlated significantly with these corneal changes. This suggests that corneal changes should be evaluated and confirmed before intraocular surgery in chronic diabetic patients.

Topical ketorolac tromethamine in the reduction of adverse effects of laser in situ keratomileusist

PURPOSE

To evaluate whether topical ketorolac tromethamine can reduce the adverse effect of laser in situ keratomileusis (LASIK).

DESIGN

A prospective randomized controlled clinical study.

PARTICIPANTS

Nineteen patients who underwent bilateral simultaneous LASIK performed at Siriraj Hospital.

INTERVENTION

Patients received two drops of ketorolac tromethamine in one eye immediately after surgery.

MAIN OUTCOME MEASURES

Symptoms of tearing, photophobia, foreign body sensation and pain were evaluated at 30 minutes, 6 hours and 24 hours.

RESULTS

There was no statistically significant difference in symptoms at 30 minutes. At 6 and 24 hours, ketorolac-treated eyes had significantly fewer symptoms compared to non-treated eyes.

CONCLUSIONS

Ketorolac tromethamine reduces some unfavorable symptoms within the first 24 hours after LASIK.

Amniotic membrane transplantation for ocular surface reconstruction

OBJECTIVE

To study the efficacy of amniotic membrane transplantation in various indications for ocular surface reconstruction.

METHOD

Amniotic membrane transplantations were performed in 140 eyes (130 patients) for ocular surface reconstruction. The indications for the corneal group were limbal stem cell deficiency, bullous keratopathy, persistent epithelial defect, band keratopathy, prosthesis, corneal ulcer and acute chemical burn. The indications for the conjunctival group were grafts for pterygium, conjunctival tumors, symblepharon, and covering the scleral graft.

RESULTS

Success was noted in 75.7 per cent (106/140) eyes, partial success in 17.9 per cent (25/140) eyes, and failure in 6.4 per cent (9/140) eyes for a mean follow-up of 6.6 months (1-19 months). The success and partial success rate were 80.6 per cent (54/67), 14.9 per cent (10/67) in the corneal group and 71.2 per cent (52/73), 20.6 per cent (15/73) in the conjunctival group.

CONCLUSION

Amniotic membrane transplantation can solve some difficult ocular surface problems, and can be used to promote epithelial healing, reduce inflammation and scarring.

Topical ciprofloxacin for bacterial corneal ulcer

OBJECTIVE

To assess topical ciprofloxacin in patients with moderate severity of suspected bacterial corneal ulcers.

STUDY DESIGN

Randomized, controlled clinical trial.

SETTING

Inpatient at Siriraj Hospital.

PARTICIPANTS

All patients with suspected corneal ulcers. Patients with fungal cause known before admission and an allergy to any medication, were excluded.

INTERVENTION

Topical ciprofloxacin 0.3 per cent or cefazolin (50 mg/ml) and fortified gentamicin (14 mg/ml) were given every 15 minutes for the first 6 hours, then every half hour on the first day, and every hour while awake till midnight until complete recovery without staining of fluorescein and no culture growth.

MAIN OUTCOME MEASURES

The primary outcomes were the success rate and duration of the healing of the ulcer after treatment in each group.

RESULTS

Forty-one patients were enrolled. Twelve (70.6%) of 17 patients in the ciprofloxacin group were therapeutically successful while 15 (62.5%) of 24 patients in the control group showed similar outcome without a statistically significant difference. However, the mean duration for healing after treatment was not significantly different being 14.6 days in the control group and 15.6 days in the ciprofloxacin group. Visual improvement in the success cases of the control and ciprofloxacin groups was 46.7 per cent, and 66.7 per cent, respectively.

CONCLUSION

Treatment with topical ciprofloxacin in suspected bacterial corneal ulcer should be considered as an alternative to standard therapy.

Treatment of acanthamoeba keratitis with chlorhexidine

OBJECTIVE

To evaluate the efficacy of chlorhexidine solution in the treatment of patients with Acanthamoeba keratitis.

DESIGN

Prospective nonrandomized study.

PARTICIPANTS

Five patients infected with culture-proven Acanthamoeba keratitis.

INTERVENTION

Chlorhexidine solution was used hourly on six eyes and gradually reduced to four times a day after 1 month. Follow-up ranged from 1 to 10 months (mean, 4 months).

MAIN OUTCOME MEASURES

Severity of symptoms and signs, time for healing, and final visual acuity.

RESULTS

Clinical results in four patients showed improved visual acuity, with a rapid recovery within 1 week. No adverse drug reaction was encountered, but one patient with a perforated ulcer developed glaucoma. Eighty-three percent of 6 eyes were medically cured with chlorhexidine and recovered visual acuity 6/18 or better. Four of five patients improved within 3 weeks, with resolution of infiltration and healing of epithelial defects. By 2 to 3 weeks, visual acuity 6/18 or better had improved in four (66.7%) of six eyes and recovered 6/6 in two eyes (33.3%). Bacterial coinfection occurred in one eye.

CONCLUSION

Chlorhexidine dramatically hastened clinical improvement in all eyes and is a successful medical therapy that has excellent results in patients who are diagnosed early.

Corneal endothelial changes after divide and conquer versus chip and flip phacoemulsification

PURPOSE

To evaluate changes in central corneal endothelial cells and corneal thickness after divide and conquer phacoemulsification and chip and flip phacoemulsification.

SETTING

Houston Eye Clinic, Houston, Texas, USA.

METHODS

Forty-four eyes were randomly assigned to one of two groups to have divide and conquer (D/C Group) or chip and flip (C/F Group) phacoemulsification with implantation of a posterior chamber, foldable, silicone intraocular lens performed by one surgeon. Of these, 41 eyes of 37 patients (22 D/C Group, 19 C/F Group) met the inclusion criteria. All surgeries were uneventful. A complete eye examination including specular microscopy and pachymetry was performed preoperatively and 1 week and 1 and 3 months postoperatively.

RESULTS

There were no significant between-group differences in any of the following means: sex; age; time at 70% phaco power; total phacoemulsification time. No correlation was found between ultrasound time and increased corneal thickness except for a significant increase in percentage of hexagonal cells in the C/F Group at 1 month. The only statistically significant between-group differences were greater endothelial cell loss in the C/F Group at 1 month and the percentage change in hexagonal cells at 1 week (1.1% increase, D/C Group; 10.7% decrease, C/F Group).

CONCLUSION

The divide and conquer technique led to less endothelial loss and hexagonal cell change than the chip and flip technique, although at 3 months the differences were not significant.

Topical piroxicam and conjunctivitis

The study of comparison of the clinical responses of acute hemorrhagic conjunctivitis to antibiotic eye drops alone and combined with topical piroxicam was analyzed. Seventy-five patients (146 eyes) with viral conjunctivitis were randomly assigned to receive topical antibiotic (35 cases) or antibiotic combined with piroxicam eye drops (40 cases). The patients were examined under slit lamp biomicroscope every other day for the first week, then twice a week until recovery. There was no statistically significant difference between groups in mean age, sex, bilaterality, history of contact, systemic involvement, mean incubation period, mean onset and mean follow-up time. Mean recovery time in the piroxicam group (4.9 days) was less than for the control group (P = 0.003). Foreign body sensation, pain and tearing in the piroxicam group recovered significantly faster than in the control group. Complete recovery of all symptoms and signs in piroxicam treated eyes (61%) was significantly more common than with antibiotic only (29%) in spite of more drug induced burning. Piroxicam eye drops may have beneficial effects for acute hemorrhagic conjunctivitis to relieve discomfort, pain, and accelerate recovery.

Acute hemorrhagic conjunctivitis outbreak in Thailand, 1992

The 260 cases of acute hemorrhagic conjunctivitis seen at Siriraj Hospital during October to December, 1992 were studied. Evidence of coxsackie virus A24 variant (CA24v) infections was demonstrated in 76.8% of 95 cases. The isolation rates from conjunctival swabs and throat swabs were 68.2% and 32.8%, respectively. A four-fold rising titer of neutralizing antibody was shown in 59.5% of 42 cases. The disease was characterized by a short incubation period, sudden onset, a mild and self-limited course within 5 days without ocular sequelae. Lacrimation, swelling lida, itching, foreign body sensation and periorbital pain were common features with bilateral involvement in the majority of cases. Approximately 48% of eyes had a mucopurulent discharge. Preauricular lymphadenopathy, keratitis and subconjunctival hemorrhage were observed in 16.2%, 12.6%, and 10.1% of affected eyes, respectively. Respiratory disturbances accompanied the eye signs in some cases. Only one case developed neurological complications: facial palsy was observed for three months without recovery.

Causes of diplopia

A prospective study of 96 diplopia patients was analyzed concerning the common types and causes in order to develop early and proper management. Two-thirds (62) of the patients were male (64.6%). The average age was 34.5 +/- 15.7 years (+/- SD). The result revealed that the common types of diplopia were horizontal, vertical and torsional diplopia, respectively. The common causes of diplopia were head trauma (38.5%), systemic diseases from diabetes mellitus, hypertension (20.8%), undetermined group (15.6%), eye diseases (9.4%), and etc. Sixth cranial nerve paralysis was frequently found among the third, fourth and sixth cranial nerves. There were 13 cases of spontaneous fusion in the primary position. Only 7 of 12 surgical cases eventually achieved satisfactory alignment and fusion.