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Aim: To assess the incidence and associated signs and symptoms of patients with keratoconus in Asir Province, Saudi Arabia. Methods: 125 new keratoconus patients (51 male, 74 female; mean age 18.5 (SD 3.8) years; range 8-28 years) were recruited from referrals to the department of ophthalmology, Asir Central Hospital, over a 1 year period. Age, visual acuity, and keratometry were recorded along with clinical signs and symptoms.

Homologous blood transfusions have been associated in both animals and humans with an increased risk of acute postoperative infectious complications. Eighty-four patients who underwent hip replacement surgery and were transfused with 2 or 3 units of blood were analyzed to determine whether those receiving homologous transfusions had different outcomes than those receiving autologous blood only. Only patients free of other risks for postoperative infection were studied. Those receiving homologous blood had a 32 percent (16/50) rate of proven or suspected infections, which was significantly higher than the 3 percent (1/34) rate in patients receiving autologous blood (p = 0.0029). Wound infections accounted for only a minority (6/17) of the proven or suspected infections, which suggests that nonsurgical factors contributed to these complications. The patients identified as being infected required significantly more antibiotic therapy (mean, 7.6 days) and lengthier hospital stays (mean, 15.5 days) than the patients who remained free of evidence of infection (means: 2.3 days of antibiotics and 12.3 days in the hospital) (p = 0.0001 for each variable). Other potential risk factors for infection, such as duration of surgical procedure, advanced patient age, amount of blood loss, type of anesthesia, surgeon performing the operation, use of a cemented versus porous-coat prosthesis, leukocytopenia, anemia, and underlying medical diagnosis, did not account for the differences in infection rates seen in those receiving homologous and autologous transfusions. These results confirm previous reports of an increased risk of postoperative infection in patients receiving homologous transfusions. Homologous transfusion may contribute to an increased risk of infection by immunologic modulation of the recipient.(ABSTRACT TRUNCATED AT 250 WORDS)

Sodium hyaluronate of 0.1% and 0.3% reduces symptoms of ocular irritation and lengthens NIBUT in subjects with moderate dry eye more effectively than saline, in terms of peak effect and duration of action.

Contact lens wearers with dryness symptoms exhibit significantly more LWE and LIPCOF, but not increased corneal staining, bulbar hyperaemia or decreased PLBUT. LWE and LIPCOF are significantly correlated: this may reflect their common frictional origin. LIPCOF Sum severity scores appear to be most predictive for symptoms.

28 29Purpose: This paper reports on the development of a new tear ferning (TF) subjective 30 grading scale, and compares it with the Rolando scale. 31Method: TF patterns obtained from tear film samples collected from normal and dry eye 32 subjects in previous studies were collated into a large image library. From this library, 60 33 images were selected, to represent the full range of possible TF patterns, and a further sub-34 set of 15 images was chosen for analysis. Twenty-five optometrists were asked to rank the 35 images in increasing order between extreme anchors on a scale of TF patterns. Interim 36 statistical analysis of this ranking found 7 homogeneous sub-sets, where the image rankings 37 overlapped for a group of images. A representative image (typically the mean) from each 38 group was then adopted as the grade standard. Using this new 7-point grading scale, 25 39 optometrists were asked to grade the entire 60 image library at two sessions: once using the 40 4-point Rolando scale and once using the new 7-point scale, applying 0.25 grade unit 41 interpolation. 42Results: Statistical analysis found that, for the larger image set, the Rolando scale produced 43 3 homogeneous sub-sets, and the 7-point scale produced 5 homogeneous sub-sets. With this 44 refinement, a new 5-point TF scale (Grades 0−4) was obtained. 45 Conclusions:The Rolando grading scale lacks discrimination between its Type I and II 46 grades, reducing its reliability. The new 5-point grading scale is able to differentiate between 47 TF patterns, and may provide additional support for the use of TF for both researcher and 48 clinician. 49 50

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Values of TBUT are dependent on the volume of fluorescein solution instilled before measurement; thus, attempts should be made to standardize this variable. Accurate estimation of TBUT requires more recordings to be averaged than are normally taken, unless breakup time is very short.