experienced a symblepharon. Eyes with burns of grade II to III shows more visual imporvement (7.3 + 3 lines) than those with burns of grade IV (2.3 + 3.0 lines : P < 0.05, unpaired t test). In the group with grade II or III burns, none had limbal stem cell deficiency. All eyes in the group with grade IV burns did experience limbal stem cell deficiency.

                    Conclusions: Amniotic membrane transplantation is effective in promoting re-epithelialization and reducing inflammation, thus preventing scarring sequelae in the late stage. In mild to moderate burns AMT alone rapidly restores both corneal and conjunctival surfaces. In severe burns, however, it restores the conjunctival ocular surface without debilitating symblepharon and reduces limbal stromal inflammation, but does not prevent limbal stem cell deficiency, which requires further limbal stem cell transplantation. These results underscore the importance of immediate intervention in the acute stage of eyes with severely damaged ocular surface. Further prospective randomized studies including a control group are required to determine the effectiveness of AMT in acute chemical and thermal burns of the eye.

(Ophthalmology 2000; 107: 980-990. 2000 by the Amercian Academy of Ophthalmology.)

  COMPARATIVE STUDY OF EDROPHONIUM TEST AND NEOSTIGMINE TEST
  IN OCULAR MYASTHENIA GRAVIS (NO. 309)

                    To compare the sensitivity of edrophonium test and neostigmine test in ocular myasthenia.

                    Materials and methods: The edrophonium and neostigmine tests in 57 consecutive patients who presented with symptoms of ptosis and/or binocular upon exertion were studied prospectively in Neuroophthalmologic Unit, Siriraj Hospital. The palpebral fissure, marginal reflex distance (MRD), levator palpebrae superioris muscle function and angle of deviation by Prism and cover test were measured before and after performing the tests for evaluation of positive result of the edrophonium and neostigmine tests. All patients were treated with pyridostigmine for one week. The patients who responsed to the treatment were diagnosed as ocular myasthenia gravis. Statistical analysis was carried out by the Chi-square test.

                    Result: Forty five patients were diagnosed as ocular myasthenia gravis and 12 patients were nonmyasthenic group. The edrophonium test was positive in 44 patients (97.8%) and the neostigmine test was positive in 38 patients (84.4%) in myasthenic group. In nonmyasthenic group, 12 patients (100%) were found negative in both tests. Edrophonium produced more severe side effects than neostigmine.

                    Conclusion: The neostigment test displayed similar positive result compared with the edrophonium test but is safer and easier to perform.

Siriraj Hosp Gaz 2000;52(5):281-7.

  TOPICAL CIPROFLOXACIN FOR BACTERIAL CORNEAL ULCER (NO. 310)

Key words: Bacterial Corneal Ulcer, Topical Ciprofloxacin

                    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 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.

(J Med Assoc Thai 2000;83:776-82)

  EFFECT OF NARCOTICS ON PUPIL SIZE AND INTRAOCULAR PREAAURE
  DURING VITREORETINAL SURGERY (NO. 311)

Key words: pupil size, intraocular pressure, vitreoretinal surgery, intraocular surgery, narcotics, opioids, general anesthesia

                    This randomized controlled trial study was performed to evaluate the effect of narcotics and general anesthesia on pupil size and intraocular pressure (IOP) during vitreoretinal surgery. We studied in 80 patients. 52 males and 28 females, ASA I or II aged between 17-65 years, who underwent vitreoretinal surgery. The affected eye was dilated before surgery. The patients were divided into 4