Efficacy of diclofenac versus dexamethasone for treatment after strabismus surgery

OBJECTIVE: To compare the efficacy of topical diclofenac sodium 0.1% versus dexamethasone 0.1% on the conjunctival healing process and on intraocular pressure (IOP) after strabismus surgery. DESIGN: A randomized clinical trial. PARTICIPANTS: Forty consecutive pediatric patients who underwent strabismus surgery. INTERVENTION: The patients were assigned before surgery to receive topical diclofenac 0.1% (study group, 20 patients) or dexamethasone 0.1% (control group, 20 patients) from immediately after surgery to up to 4 weeks after surgery (both combined with chloramphenicol 0.2%, polymyxin B sulfate 2500 U). MAIN OUTCOME MEASURES: Between-group comparison of five parameters: patient discomfort, conjunctival chemosis, inflammation, gap, and intraocular pressure (IOP) at 1, 2, and 4 weeks after surgery. RESULTS: At postoperative week 2, the diclofenac-treated group showed significantly less patient discomfort and less conjunctival inflammation, edema, and gap than the dexamethasone group (P: = 0.003, P: = 0.04, P: = 0.02, P: = 0. 001, respectively). At week 4, the study patients continued to show less discomfort and conjunctival gap (P: = 0.02). The dexamethasone group showed a significant change in IOP between the preoperative and the fourth postoperative week (P: = 0.001 in the right eye, P: = 0.0005 in the left eye) and an increased prevalence of higher IOP during the fourth postoperative week (P: = 0.01 in the right eye, P: = 0.02 in the left eye). Thirty-eight percent of the dexamethasone group showed an increase in IOP to more than 21 mmHg during the four postoperative weeks. No increase in IOP was noted in the diclofenac group. CONCLUSIONS: Topical diclofenac is superior to dexamethasone for each of the five postoperative parameters examined. Its maximal effect occurred at 2 weeks after surgery, without an increase in IOP or in local subconjunctival hemorrhage.     

Effect of laser in situ keratomileusis on tear stability

OBJECTIVE: Patients frequently experience dry eye symptoms after laser in situ keratomileusis (LASIK). The mechanisms that lead to these changes are not well understood. The purpose of this study was to investigate the effect of LASIK on tear function. DESIGN: Prospective, comparative, nonrandomized interventional trial. PARTICIPANTS: Fifty-eight consecutive patients (96 eyes) who underwent myopic LASIK treatment. METHODS: The prospective study involved 58 consecutive patients (96 eyes) who underwent sequential or bilateral LASIK for the correction of myopia. Dry eye symptoms, standardized Schirmer test values, basal tear secretion test, and tear break-up time were measured before surgery and 1 day, 1 week, and 1 month after surgery. MAIN OUTCOME MEASURES: Schirmer test value, basal tear secretion value, and tear break-up time. RESULTS: Before surgery, 15.6% of patients (15/96) had dry eye symptoms. After surgery, 94.8% of patients (91/96), 85.4% of patients (82/96), and 59.4% of patients (57/96) experienced dry eye symptoms at 1 day, 1 week, and 1 month, respectively. Schirmer test value (13.32 +/- 10. 67 mm) increased at 1 day (14.48 +/- 10.57 mm; P = 0.25) and subsequently decreased at 1 week (11.18 +/- 9.81 mm; P = 0.05) and at 1 month (10.83 +/- 10.02 mm; P = 0.03). Basal tear secretion test value (8.49 +/- 8.48 mm) decreased at 1 day (6.80 +/- 6.48 mm; P = 0.05), at 1 week (5.97 +/- 6.88 mm; P = 0.005), and at 1 month (5.89 +/- 6.24 mm; P = 0.007). Tear break-up time (5.32 +/- 2.35 seconds) decreased 1 day (4.14 +/- 1.90 seconds; P < 0.001) and 1 week (4.49 +/- 1.70 seconds; P = 0.004) after surgery and recovered by 1 month after surgery (5.09 +/- 3.03 seconds; P = 0.52). Poor preoperative tear functions with a Schirmer test value less than 10 mm was a significant risk factor (72% vs. 46%; relative risk, 1.58 [1.10-2.26]) for experiencing dry eye symptoms at 1 month after surgery. CONCLUSIONS: Dry eye symptoms are common after myopic LASIK surgery. Laser in situ keratomileusis significantly altered the tear break-up time, Schirmer test values, and basal tear secretion. Patients with preexisting tear flow abnormality as demonstrated by Schirmer test values less than 10 mm are especially at risk of experiencing dry eye symptoms.     

Postoperative deposition of calcium on the surfaces of a hydrogel intraocular lens

OBJECTIVE: To report clinical, pathological and histochemical features of 5 Hydroview intraocular lenses (IOLs) explanted from five patients who had visual disturbances caused by postoperative deposits on the lens surfaces. DESIGN: Noncomparative small case series with clinicopathologic and histochemical correlations. PARTICIPANTS: Five hydrophilic IOLs explanted from five different patients. All patients presented with decreased visual acuity and glare circa 12 months after uneventful phacoemulsification and IOL implantation, associated with a red-brown granularity on the optical surfaces of the IOLs. METHODS: The lenses were explanted, fixed in buffered formaldehyde and examined by gross and light microscopy. MAIN OUTCOME MEASURES: Staining of the IOLs with 1% alizarin red and with the von Kossa method (both stains for calcium). Two additional IOLs were also stained and included as controls. RESULTS: The optical surfaces of all five IOLs were covered by a layer of irregular granular deposits, composed of multiple fine, translucent spherical-ovoid granules. The deposits stained positive for calcium in all cases. No deposit or positive staining was observed on the IOLs haptics. Staining of the control IOLs was also negative. CONCLUSION: This is the first histopathological report of calcified deposits on the surfaces of this hydrogel IOL model. Further studies on other similar cases with this lens should be done to determine the incidence and possible mechanisms of this phenomenon.     

穗、深两地眼科医务人员生存质量现况调查

目的了解广州和深圳两地的眼科医务工作者的生存质量现况。方法采用目的抽样的方法,以世界卫生组织生存质量评定量表简表对广州和深圳的311名眼科医务工作者进行调查。结果35岁以下者在生理领域(F=5.265,P<0.01)和心理领域(F=3.191,P<0.01)的得分高于36岁以上者;工龄10 a以下者在生理领域的得分高于11 a以上工龄者(F=4.093,P<0.01)。高级职称和具有博士学历者在环境领域的得分较高。结论年龄、工龄、职称和学历都与眼科医务工作者的生存质量有关。     

Form deprivation without light deprivation produces the visual deprivation syndrome in Macaca mulatta.

The previously reported arrest of cell growth in the lateral geniculate nucleus (LGN) following unilateral lid suture during visual immaturity in cats, dogs and monkeys could be caused by deprivation of light or form vision, binocular interaction or a combination of these factors. The lens was surgically removed from one eye of 3 macaques during the first month of life. Quantitative histologic comparison between LGN laminae connected with the phakic and aphakic eye revealed reductions of cell sizes in the monocular and binocular LGN segments receiving input from the aphakic eye of a magnitude comparable to that obtained by the lid suture technique. Since the amount of light stimulating the retina through an aphakic pupil is not reduced, we conclude that light deprivation can be excluded as a cause for arrest of cell growth in the LGN.     

Indications, complications and results with silicone stents

Fifty-two patients with complicated lacrimal problems were treated with silicone stents. Our overall success rate, judging from a minimum 6-month follow-up, was 40% in these complicated cases, accepting only positive dye tests as our criteria for success. We divided these cases into six groups with successes ranging from 0--68%. Twenty-nine percent of patients had complications related to their stents. While silicone stents are probably the most important recent advance in lacrimal surgery, one must be aware of their indications, limitations and complications.