BINA
Year:2011 | Volume:17 | Issue:1 (66)|Papers Count:15

Purpose: To assess the short-term effect of Mitomycin-C (MMC) 0.02% on endothelial cell density and morphology after photorefractive keratectomy (PRK) in patients with moderate myopia.Methods: Forty-two eyes of 21 participants with moderate myopia (range, -4.0 to -8.0 D) underwent PRK with MMC 0.02% for 40 seconds. Specular microscopy was performed preoperatively and repeated 6 months after surgery to determine any change in central endothelial cell density (ECD), mean cell area (MCA), and coefficient of variation in cell size (CV).Results: Mean patient age was 26.2±6.3. Mean preoperative spherical equivalent refractive error was -5.2±1.2 D which was reduced to -0.4±0.5 D postoperatively (P<0.001). Mean ECD was reduced insignificantly from2920±363 cells/mm2 preoperatively to 2802±339 cells/mm2 postoperatively (P=0.59). Similarly, there was no significant change in MCA (P=0.76) or CV (P=0.52) at six months.Conclusion: Intraoperative MMC 0.02% applied for 40 seconds during PRK for moderate myopia did not significantly change central corneal endothelial cell density and morphology after 6 months.

Purpose: To compare the success rate of mitomycin-C Versus bevacizumab for prevention of bleb failure following phacotrabeculectomy.Method: In this study 74 eyes of 69 patients with uncontrolled IOP, progressive visual field loss and cataract were randomized in two groups. In the first group, after conjunctival peritomy at the sclera flap site, sponge pats soaked in mitomycin C with concentration of 0.25 mg/ml were applied for 3 minutes. In the second group, bevacizumab with concentration of 1.25 mg/0.5 ml was injected adjacent to the bleb at the end of surgery.Result: Seventy four eyes of 69 patients including 41 men and 28 women with mean age of 66.92±9.8 years months after surgery were analyzed. Mean intraocular pressure in the bevacizumab group was significantly higher than the MMC group (15.91±4.9 mmHg vs 12.76±3.1 mmHg, P=0.001) at 6 months and (15.76±3.26 mmHg vs 13±2.4 mmHg, P=0.003) at the end of 12 months. Bleb characteristics including extension, elevation and vascularity showed no significant difference between two groups. (P values 0.94, 0.93, 0.41 after 6 months, and 0.56, 0.58, 0.89 after 1 year of follow up respectively).One eye in the second group underwent trabeculectomy because of uncontrolled IOP despite using 3 antiglaucoma medications. One eye in each group underwent bleb revision due to failing bleb. No sides effects related to the medications were noted in any of the two groups.Conclusion: Mitomycin C is more effective than bevacizumab for IOP control after phacotrabeculectomy; however, there is no difference between the two agents in terms of bleb characteristics and side effects.

Purpose: To compare the efficacy and safety of topical Mitomycin-C (MMC) drops versus subconjunctival 5- Fluourouracil (5-FU) injections for management of early bleb failure after trabeculectomy or combined phacoemulsification and trabeculectomy with posterior chamber intraocular lens implantation (PT+PCIOL).Methods: In a comparative study, 37 eyes of 37 patients with impending early bleb failure were randomly allocated to MMC 0.02% eye drops (19 eyes) or subconjunctival 5-FU injections (5 mg each dose) (18 eyes) for 2 to 4 weeks or. Main outcome measures included intraocular pressure (IOP), and bleb morphology according to the Indiana Bleb Appearance Grading Scale. Other outcome measures included success rate, number of glaucoma medications, best corrected visual acuity (BCVA) and complications. Complete success was defined as 5<IOP£18 mmHg without medications and qualified success was defined as the same with one or two topicalglaucoma medications.Results: Baseline characteristic including age, sex, type of glaucoma, and number of previous surgeries were comparable in the study groups. However, there were more instances of combined PT+PCIOL in the MMC group as compared to the 5 FU group [11 (57.9%) eyes versus 3 (16.7%) eyes, P=0.01]. Patients were followed for a mean period of 11.5±8.0 (median=8.0) versus 10.9±5.4 (median=11) months in the MMC and 5-FU groups respectively (P=0.58). Mean preoperative IOP was 20.6±8.8mmHg in the MMC group and 25.8±11.4 mmHg in the 5-FU group (P=0.12), which decreased to 13.2±6.1 and 10.6±4.8mmHg respectively after 12 months (P=0.15). There was no significant difference in bleb extent (P=0.30), height (P=0.157) and vascularity (P=0.26) between the study groups. At the end of the study, complete success was achieved in 13 eyes (68.4%) in the MMC group and 14 eyes (77.8%) in the 5-FU group (P=0.71); qualified success was achieved in 1 eye (5.3%) in the MMC group and no eyes in the 5-FU group. Kaplan-Meier analysis revealed that survival of success at 8 months (median follow-up) was 89.5% vs 86.5% in the MMC and 5FU groups, respectively. Similarly, the number of glaucoma medications (P=0.71) and BCVA (P=0.55) were comparable between the study groups. The most common complication related to MMC was punctate epithelial keratopathy observed in 6 eyes (31.5%). The most common complication of 5-FU injections was filamentary keratitis in 7 eyes (38.9%); complication rates were comparable between the study groups (P=0.14).Conclusion: For management of early bleb failure, postoperative application of topical MMC 0.02% drops is comparable to subconjunctival injection of 5FU in terms of efficacy and safety. Topical MMC 0.02% drops are more convenient and can be initiated first; 5-FU injections can be reserved for eyes with insufficient response to topical MMC.

Purpose: To study the prevalence and characteristics of accommodative esotropia (AET).Methods: In a descriptive analytic study records of all patients referred from 1383 to 1388 to the strabismus clinic at Nikookari Eye Center were reviewed and demographic data such as age, gender, refractive error, type of AET, mean deviation and amblyopia were analyzed.Results: A total of 2, 146 patients were referred during this period. AET comprised 142 (11.55%) patients. 35.9% of these patients were male and 64.1 % were female. Mean age at presentation was 5.85±4.4 years. The frequency of refractive accommodative ET (RAET), non-refractive accommodative ET (NRAET), partially accommodative ET (PAET) were 82 (57.7%), 7 (4.9%) and 53 (37.3%), respectively. Overall, 69 (48.6%) patients were amblyopic and spherical equivalent refractive error was +4.22±1.82 D. Inferior oblique overaction (IOOA) and dissociated vertical deviation (DVD) were seen in 5 (3.5%) and 2 (1.4%) of patients respectively.Conclusion: RAET is the most common and NRAET is the least common form of AET. Amblyopia is common in AET. The prevalence of associated findings such as DVD and IOOA is low.

Purpose: To compare corneal endothelial cell features after cataract surgery performed using fixed torsional or conventional (Pulse) ultrasound mode.Methods: In this randomized comparative study, 60 eyes were randomly and equally divided into two groups of torsional or longitudinal mode phacoemulsification. All surgeries were performed by an experienced surgeon, and the outcomes were evaluated by a masked examiner. Preoperatively visual acuity (VA), age and mean nuclear grade (LOCS III) were recorded; besides automated confocal microscopy was used to measure ECD, polymegathism and pleomorphism at the Centre of the cornea. All patients underwent clear cornea phacoemulsification in a similar manner. Intraoperative outcome measures were ultrasound time (UST), cumulative dissipated energy (CDE), and total fluid use. Best corrected VA and confocal measurements were repeated after 1 month.Results: Mean preoperative ECD in conventional and torsional phaco mode groups were 2761.61±403.36 and 2690.36±490.92 cells/mm2. Postoperative ECD was 2494.30±358.63 and 2436.56±468.39 cells/mm2, respectively. The decrease in ECD, and increase in pleomorphism and polymegatism were statistically significant within both study groups (P<.001), but there were no statistically significant differences in preoperative and postoperative measurements between the 2 groups (P>.01). No relevant clinical differences or operative complications were seen in either group. There was no statistically significant difference between intraoperative measures in both groups (P>.01).Conclusion: Both phaco methods provide effective lens removal with no significant difference.

Purpose: To compare Rose-K and conventional RGP contact lenses in terms of visual acuity, visual function and comfort in keratoconus patients.Method: Fifty-four patients with keratoconus were randomly fitted with Rose-K and conventional RGP contact lens (Wohlk contact lens), by one experienced ophthalmologist using a standard (three touch point) approach. General and demographic information, KR values, far and near visual acuity without and with contact lenses, daily contact lens wearing time, daily need for lens removal, patient comfort with contact lens, and visual function score(based on VFQ-25 questionnaire) at initial and follow up visits were measured and compared.Results: Both Rose-K and conventional RGP (Wohlk) lenses improved far and near visual acuity in all patients and there was no statistically significant difference between the two groups (P=0.88).Daily contact lens wearing time and patients comfort with lenses was greater in the Rose-K group (P<0.001). Daily need for lens removal was almost equal in the two groups (mean=1.4 hr, P=0.83). There was significant improvement in visual function in all patients with use of contact lenses, but there was no significant difference between the two groups (p=0.45).Conclusion: Both lenses improve visual acuity and function in patients with keratoconus, but Rose-K lenses are a good therapeutic alternative for rehabilitation of keratoconus patients; they offer more comfort in comparison to conventional RGP contact lenses.

Purpose: To compare the anatomical results of scleral buckling surgery with and without retinopexy in the management of phakic rhegmatogenous retinal detachment (RD).Methods: In this retrospective, nonrandomized, interventional, comparative case series, data of 71 phakic eyes of 71 patients with rhegmatogenous RD that had undergone scleral buckling were evaluated. The procedure in 41 consecutive eyes was accompanied by retinopexy using intraoperative transscleral cryotherapy (6 cases) or postoperative laser photocoagulation (35 cases).The next 30 eyes did not receive retinopexy.The primary outcome measure was retinal redetachment rate.The secondary outcomes measures were final visual acuity and the occurrence of cystoid macular edema and macular pucker.Results: The two groups were matched regarding age, sex, history of trauma or high myopia, and duration of RD before the surgery as well as the characteristics of the breaks and RD except for RD externt which was more in the non-retinopexy group. Retinal redetachment occurred in 4 patients (13.3%) in the nonretinopexy group and in 6 patients (14.6%) in the retinopexy group. The difference was not statistically significant (P>0.999).Neither was the difference between the groups significant in terms of final visual acuity and the occurrence of cystoid macular edema and macular pucker.Conclusion: Retinopexy does not seem to offer additional benefit to scleral buckling surgery for phakic rhegmatogenous RD in terms of anatomical and functional success. However, thses findings have to be confirmed in a randomized clinical trial.

Purpose: To report the characteristics of children referred to the emergency department of Feiz Medical Center with penetrating eye injuries.Methods: In a cross-sectional study, children with penetrating eye trauma were evaluated. Age, sex, parents’ educational level, time, location, and cause of trauma recorded and compared.Results: Overall, 100 patients with mean age of 7±3.8 (range 2 to 16 years) including 69 male and 31 female were assessed. 57 eye injuries occurred at home, time of trauma was in the morning in 47% of patients. The most common cause of injury was knife (26%) and wood was the second common cause (17%). Overall, 29 child were alone at the time of injury. The most common type of injury was corneal laceration (71%). All traumatic cases were unilateral.Conclusion: Most children were injured in the early morning, therefore education of parents and other child care givers for more attention to children and improvement of health education about eye trauma may prevent pediatric eye injuries.

Purpose: Dry eye syndrome is a multifactorial disorder of the tear film and ocular surface that results in eye discomfort, visual disturbance, and often ocular surface damage. Studies suggest that the prevalence of clinically diagnosed dry eye syndrome (DES) is 0.4%. to 0.5%, which is highest among women and the elderly. The burden of DES can be substantial, affecting visual function, daily activities, social and physical functioning, work place productivity and quality of life. This article discusses the normal anatomy and physiology of the lacrimal functional unit and tear film; pathophysiology of DES; DES etiology;classifications and risk factors; and DES diagnosis and management.

Purpose: To report a case of isolated corneal squamous cell intraepithelial neoplasia in a patient with unilateral dry eye symptoms.Case report: A 48 year old man presented with history of thermal corneal injury in his left eye two years ago, with decreased visual acuity and dry eye symptoms a short time thereafter. He was treated for dry eye with no improvement in symptoms. Upon presentation, slit lamp examination revealed near total hypertrophy of the corneal epithelium with distinct and scalloped border, without limbal or conjunctival involvement. The patient underwent excisional biopsy (debridement) of the corneal epithelium. Histopathology revealed severe corneal dysplasia (carcinoma in situ). After excision, the patient was treated with fluorouracil drops 50 mg/dl QID and there was no sign of recurrence up to 1.5 months after surgery. At final follow-up, visual acuity was 9/10 and dry eye symptoms had completely disappeared.Conclusion: In patients with unilateral chronic dry eye refractory to treatment and signs of corneal epithelial involvement, isolated corneal neoplasia should be considered even without limbal or conjunctival involvement.

Purpose: To report a case of endogenous Klebsiella endophthalmitis associated with liver abscess in Iran.Case report: A 79 year old man was referred with chief complaint of left eye pain and visual loss. The patient had conjunctival hyperemia, corneal edema, hypopyon and severe vitreous cellular reaction in the left eye and yellowish conjunctival discoloration which was apparent in the right eye. Abdominal CT scan revealed a right liver lobe abscess that underwent percutaneous liver biopsy under sonography guide. Blood, vitreous and liver mass cultures revealed Klebsiella Pneumonia growth. The patient was diagnosed as a case of endogenous Klebsiella endophthalmitis secondary to bacteremia associated with liver abscess.Conclusion: This report suggests that rather than being confined to Far East, endogenous endophthalmitis secondary to liver abscess due to Klebsiella pneumonia may be a global problem.

Purpose: To report a case of pseudoexfoliation syndrome in young keratoconus patient following penetrating keratoplasty.Case report: A 37 year old man who underwent penetrating keratoplasty 13 years ago in his left eye due to keratoconus developed pseudoexfoliation (PEX) syndrome in the operated eye. Apart from PEX material deposition on the crystalline lens ophthalmic exam was within normal limit. The donor was 40 year old man who died because of car accident.Conclusion: Occurrence of PEX following ocular surgery can be accidental or related to the surgery. Occurrence of PEX syndrome following intraocular surgery can be explained by triggering effect of surgery on susceptible patient.