Hamed Ghassemi

Evaluation of conjunctival graft thickness after pterygium surgery by anterior segment optical coherence tomography.

Background: To evaluate changes in thickness of the conjunctival graft after pterygium surgery by anterior segment optical coherence tomography (AS-OCT). Materials and Methods: Eleven eyes of 11 patients with primary nasal pterygium underwent excision followed by free conjunctival autograft. Imaging with AS-OCT was performed at 1 week, 1 month and 3 months after surgery to measure thickness of the conjunctival graft at 1, 2 and 3 mm posterior to the scleral spur. As the control, thickness of the normal bulbar conjunctival epithelium in the temporal area was also measured at the same locations. Results: Average thickness of the graft decreased from 458 ± 171 µm at 1 week after surgery to 306 ± 64 µm at 1 month (p < 0.0001). Although the graft thickness decreased to 291 ± 124 µm at 3 months postoperatively, the difference between 1-month and 3-month values was not statistically significant (p = 0.94). Average thickness of the normal conjunctival epithelium was 58 ± 13 µm, 60 ± 19 µm and 61 ± 12 µm at 1 week, 1 month and 3 months after surgery, respectively, with no statistically significant difference. Graft thickness was significantly greater than thickness of the normal conjunctival epithelium at various time points (p < 0.05). Conclusion: Evaluation by AS-OCT showed that there was significant thickening of the conjunctival graft at 1 week after pterygium surgery which continued to decrease up to 3 months. Quantitative data by AS-OCT allows accurate evaluation of the conjunctival changes over time.

Tacrolimus Eye Drops as Adjunct Therapy in Severe Corneal Endothelial Rejection Refractory to Corticosteroids

Purpose: To evaluate the safety and efficacy of tacrolimus eye drops as adjunctive therapy in the treatment of severe corneal endothelial rejection after penetrating keratoplasty refractory to corticosteroids. Methods: In this prospective interventional case series, 11 eyes of 11 patients assessed for severe corneal endothelial rejection, with an inadequate response to topical, local, and systemic corticosteroids, were treated with either 0.01% or 0.05% tacrolimus eye drops 4 times daily. Improvement in signs of rejection, visual function, and development of complications were monitored. Results: The duration of steroid treatment before intervention was 8.1 ± 1.4 days (range = 7–11). Patients were subsequently administered topical tacrolimus 0.01% or 0.05% qid. The time to clinical improvement was 10.3 ± 3.4 days (range = 3–17). The time to rejection reversal was 27.8 ± 16.3 days (range = 7–52). After 3 months, 10 patients (90.8%) demonstrated clinical improvement, and complete restoration of graft clarity was achieved in 5 patients (45.4%). In responsive cases, steroid therapy was successfully tapered off after 60.2 ± 19.7 days (range = 36–93). The best spectacle-corrected visual acuity improved from 1.7 ± 0.9 to 0.8 ± 0.5 logMAR (P = 0.0016). Reported side effects included stinging on drop instillation and punctate epithelial keratopathy. Conclusions: Tacrolimus eye drops may be able to play an adjunctive therapeutic role in patients with severe corneal endothelial rejection refractory to conventional steroid treatment. Controlled studies are needed to further investigate the role of tacrolimus in this setting.

Fuchs’ Uveitis in Iranian Patients: A Review of 89 Eyes

ABSTRACT Purpose: To describe clinical and imaging features of Fuchs’ Uveitis (FU) and investigate the rate of misdiagnosis in Iranian patients. Methods: Records of 82 FU patients (89 eyes) were reviewed retrospectively. Results: Remarkable findings included iris heterochromia in 14 (17.1%) patients and Fuchs’ keratic precipitates in 97.8%, vitritis in 89.7% and cataract in 69.7% eyes. FU discovered as an incidental finding in 7 patients (10.0%). Imaging revealed disc hyperfluorescence, mild vascular leakage and epiretinal membrane in 72.7%, 32.5% and 19.4% of eyes, respectively. The rate of misdiagnosis was 19.5% (16 patients) with intermediate uveitis being as the most common erroneous diagnosis (10 patients). Patients with the wrong diagnosis were significantly younger (p = 0.045) and more likely to have bilateral involvement (p = 0.004) or no anterior chamber cells (p = 0.039). Conclusions: Heterochromia is an infrequent clinical feature in Iranian FU patients, however, vitreous involvement is common. Intermediate uveitis is a usual misdiagnosis.