To compare recurrence rates and complications of 2 surgical methods for primary pterygium excision: subconjunctival injection of mitomycin C (MMC) 1 month before bare scleral excision and conjunctival rotational flap with intraoperative MMC application. Eighty-two eyes of 82 patients participated in the study and were allocated randomly into two groups. Group A received subconjunctival injection of MMC 1 month before bare scleral excision, and group B underwent conjunctival rotational flap with intraoperative MMC application for 2 minutes. Exclusion criteria consisted of pregnancy and lactation, history of ocular surgery,glaucoma, herpetic keratitis, trachoma and any autoimmune disease. The main outcome measure was recurrence and complications rate in each group. Mean age of the patients was 48.48± 13.67 years and 51.1% of cases were female. Follow up visits were performed at 1,3,6,9 and 12 months after the operation. Two cases of clinical recurrence occurred in group B (4.3%). However there was no statistically significant difference between groups in terms of recurrence rate (P=0.31). Subconjunctival injection of MMC 1 month before bare scleral excision is a quick, easy, and safe surgical procedure for pterygium excision and is at least as effective as conjunctival rotational flap with intraoperative MMC application.

This study is done to examin the role of smears, cultures, and sntibiotic sensitivity testing in the treatment of infectious keratitis. A prospective study was performed for 100 patients in Rasool Akram hospital ophthalmology department. After routine examination by slit lamp, evaluation of corneal epithlium, stromal edema and infiltration, AC reaction or hypopyon, all underwent corneal scrapings for staining and cultures. Patients were treated with fortified cefazolin and fortified gentamicin. 50 patients (50%) improved without requiring a modification, but in 4 patients (4%) required a chang in treatment base on cultures and antibiotic sensitivity testing. In 43 patients (43%) corneal surgery was perform due to poor response to medication (conj flap in 36 patients and corneal graft in 7 patients). 7 patients (7%) underwent eviseration due to perforated glob and NLP vision at the time of admition. Based on result of this study most bacterial corneal ulcers resolved with broad spectrum emperical antibiotics and sensitivity testing that might be considerd includemore sever or suspected non-bacterial ulcers.

To evaluate and compare the results of different surgical methods for post-trabeculectomy bleb revision at Labbafinejad Medical Center, Tehran-Iran, from 1999 to 2003. This study was conducted on all patients who underwent post-trabeculectomy bleb revision due to hypotony [intraocular pressure (IOP) less than 6 mmHg] or bleb leakage. Surgical methods were: conjunctival advancement, rotational conjunctival flap and free conjunctival graft. Bleb revision was performed in the cases of bleb leakage if the bleb hole was greater than 1 mm or leakage could not be controlled within 1 to 2 weeks of conservative treatment. Bleb revision was performed in eyes with hypotony in cases with cataract development or progression or hypotony maculopathy or iridocorneal adhesion. Surgical success was defined as IOP between 6-21 mmHg with a maximum of 2 topical antiglaucoma medications and discontinuation of leakage. Twenty-seven eyes of 27 patients (17 male, 10 female) with mean age of 37.8±15.2 years (9-37 years) were studied. Indication for surgery was bleb leakage in 22 cases (81.5%) and hypotonous maculopathy in 5 cases (18.5%). Mean IOP was 4.4±1.04 mmHg preoperatively and 13.00±1.29 mmHg postoperatively. (P< 0.001) Mean visual acuity was 0.9 LogMAR (20/160) before surgery and reached 0.6 LogMAR (20/80) after bleb revision. (P<0.002) Mean cup/disc ratio was 0.7 preoperatively which remained unchanged postoperatively. Conjunctival advancement was performed in 18 cases (success rate = 72.2%), rotational conjunctival flap in 6 cases (success rate= 66.7%) and free conjunctival graft in 3 cases (success rate= 66.7%). (P=0.73) Bleb revision was repeated in 2 cases due to continuous leakage. Mitomycin-C (MMC) and 5-fluorouracil had been used during primary trabeculectomy in 62% and 7.6% of cases, respectively. In 19.6% of cases surgery was done without using antimetabolites and usage of antimetabolites was unknown in 11%. The average time between primary trabeculectomy and bleb leakage or hypotonia was 17 months in cases with prior use of MMC and 52 months in the cases with no antimetabolite usage. (P<0.05) Post-trabeculectomy bleb revision using conjunctiva seems to be a successful method for control of leakage and prevention of complications of hypotony.

To evaluate the effect of amniotic membrane transplantation in trabeculectomy. The study was conducted on 25 eyes of 25 patients with advanced and medically uncontrolled glaucoma. All patients underwent trabeculectomy with a fornix based conjunctival flap, amniotic membrane was then placed under the scleral flap and fixed using 10-0 nylon suture. Amniotic membrane was retrieved from healthy pregnant women during elective cesarian section. Preoperative intraocular pressure was 33.5±5.0 mmHg (26-50 mmHg) with full medication, which decreased to 12.4±1.8 mmHg (9-15 mmHg) post-operatively (P= 0.0001). Intraocular pressure was less than 21 mmHg after surgery in all eyes, with (8%) or without (92%) use of antiglaucoma medications after six months. The use of amniotic membrane in trabeculectomy can increase the chance of success in terms of maintenance of a functional bleb and prevention of failure. This method may be superior to antimetabolites due to lack of complications.

A sural artery flap is a fasciocutaneous one based on the reverse blood flow and the anastomosis between the superficial sural artery and the perforators of peroneal artery. This flap is used in order to reconstruct the soft tissue defects of the distal leg, ankle and heel and also to cover the vessels, tendons and bones. It is possible to cover the defects in size 10*12 cm with this flap, classically; as well, the design of the flap is being done by the limited shapes such as L and T-shaped. The purpose of this article is to introduce the new design of this flap to creating the most level of consistency with the shape of the defect.
The patient was a twelve year old girl who faced a large defect and the separation of the soft tissue of the heel and ankle of the right foot by an accident with a motorcycle about three weeks prior to her referral as her medial malleolus and Achilles tendon were exposed. Then, after the first reconstruction in the orthopedically services, she faced severe necrosis of tissue and exposition of the heel's bone and Achilles tendon. There was not a clear sensory disorder in her fingers and the movement of her ankle and toes were intact. During the first surgical operation, debridement of the necrotic tissue was occurred and preparation of the fields for the pediculate flap was done. Then bandage, dressing and splint–making were completed. The second operational surgery was done for designing a flap and during this operation, the sural flap was designed in a boot – shaped way due to the impossibility of covering the defect using the classic method and the obvious need for longer pedicle. In the end, the basis of flap was cut during the third operational surgery and the final reconstruction of the damage was done. Moreover, the soft tissue defect of the donor flap was reconstructed by the cutaneous graft from the medial surface of the thigh of the same foot. Then, the patient was followed for three months.
Findings: The final result of designing the sural flap in a boot – shaped way for this area of lower limbs was remarkable because there were no side effects such as venous congestion, superficial necrosis and the bleeding from the flap's edge and finally, the patient could properly walk. The effects of removing the flap in the donor site and the sensory disorder resulted from removing the flap were trivial and negligible and also, the patient returned to her daily life in almost no time.
A boot-shaped sural flap is one of the best choices for covering the defects of soft tissue of the heel and ankle. In the classic term, it is formed in a rectangular or oval shape but this flap was a versatile flap and can be designed in other shapes for increasing the efficiency of the flap and decreasing the side effects in terms of the shape and size of the defects.

Backgroun and In acute extensive injuries of soft tissues of hand leading to exposure of vital elements such as nerves, vessels, tendons, bones and joints; locoregional or distant flaps are required to cover the injured areas. The aim of the study is to introduce a new flap with better cosmetic and functional quality for the coverage of defects of the soft tissues of hand. This is a randomized clinical trial. In Hazrat Fatemeh Hospital, 20 patients with extensive soft tissue injury of hands due to various crushing trauma leading to avulsion of soft tissues were entered into this study. The subjects were divided randomly into two groups, each group consisted of 10 patients. In the case group, coverage of the defects of hands were performed with distally based radial artery perforators flaps. In the control group, other routine and known flaps such as Chinese flap (6 cases) and groin flap (4 cases) were used to cover the defects. The flap repair in the case group was nearly successful in all of the cases. Only 2 cases developed partial necrosis of the flaps, one of them managed conservatively and the other one was repaired by minor surgical procedures. After 6 months the flaps were soft and pliable. Grafts were required for the repair of all of the donor sites. In the control group 60% of the cases were operated in one stage, 20% in two stages and 20% in three stages. Total necrosis of flap occurred only in one case. After 6 months 60% of flaps were pliable and 40% were bulky requiring another additional debulking procedure in 50% of the bulky flaps. Skin grafts were required in 40% of the cases to repair the donor sites. According to this study distal radial perforators based pedicle forearm flap is a safe one-stage operation in which radial artery is preserved and offers good results in the treatment of extensive soft tissue injury of hands and can be substituted for other routine flaps.