BINA
Year:2009 | Volume:15 | Issue:1 (58)|Papers Count:17

Purpose: To compare ophthalmic artery velocity in eyes with nonarteritic anterior ischemic optic neuropathy (NAION) with that of normal fellow eyes.Methods: In this case-control study, 20 patients with unilateral NAION and disease onset less than 8 weeks were enrolled. Using color Doppler imaging, mean, maximum systolic and end diastolic ophthalmic artery I velocities were evaluated. The results were compared between the fellow eyes. Results: Twelve men and 8 women with a mean age of 54.6±11.8 years were included. Mean interval I between disease onset and velocity measurements was 27.5±12.8 days. Mean (18.5±0.8 vs 19.9±2.8), I maximum systolic (37.9±4.09 vs 39.7±3.1) and end diastolic (10.3±2.1vs 12.3±2.5) ophthalmic artery velocities in NAION eyes were significantly less than that of the normal fellow eyes (P=0.01, P=0.001 and P<0.001, respectively). No significant difference was found in subgroup analysis of patients with and without diabetes, and with and without systemic hypertension. Conclusion: NAION seems to be associated with changes in ophthalmic artery velocity.

Purpose: To detennine the effect of intravitreal triamcinolone (NT) injection on visual acuity in patients with ischemic central retinal occlusion (CRVO).Methods: This randomized clinical trial was perfonned on patients with ischemic CRVO referred to the retina clinic at Feiz Hospital in 2007-2008. Inclusion criteria were: duration of CRVO less than one month, normal IOP, no sign of diabetic retinopathy or hypertensive retinopathy, no history of laser therapy and ocular surgery and vascular diseases. Patients were randomly allocated to two groups: intervention group (injection of 0.1cc IVT) and control group (no injection). Follow up examinations for all patients were scheduled 1, 2, 3 and 6 months after injection. The results were analyzed by SPSS13 and t-test. Results: Overall, 52 patients (22 male and 30 female) entered the study. Mean age was 60.5±9.7 (range: 30- 80) years. Duration of signs was 21±5.5 days in the control group and 19±6 days in the NT group (P= 0.66). All patients had signs of ischemic CRVO. Mean baseline visual acuity was 1.75±0.20 logMAR in the NT group and 1.91±0.08 logMAR in the control group (P= 0.1). VA improvement in the IVT group was greater in comparison with the control group at one month (P= 0.019) however this difference was not significant at other follow-up examinations. In addition, the difference in lOP between before and after the injection was not significant (P= 0.802).Conclusion: This study showed that in patients with CRVO, intravitreal injection of triamcinolone, has no significant long-tenn effect on visual acuity.

Purpose: Retinopathy of prematurity (ROP) adversely affects normal ocular vascularization in premature infants. It can be mild with no visual consequences, or may become aggressive with new vessel formation and even progress to retinal detachment and bJjndness. ModeflJ treatment can prevent blindness due to neovascularization but uncorrected refractive errors may lead to amblyopia. Methods: In this retrospective case series/ we evaluated data of 796premature wants (gestational age 25 to 34 weeks and birth weight 600 to 1800 grams) who were at risk of ROP. Patients with progressive ROP underwent laser therapy and were followed for at least one year to detect any degree of refractive errors. Results: ROP was observed in 134 infants (16.8%), of whom 70 patients (52.6%) cured spontaneously while 56 patients (111 eyes, 41.4%) with progressive disease underwent laser therapy. Overall 47 patients (92 eyes) were followed for at least one year. Out of 92 eyes, 45 eyes (49.4%) developed myopia, 33 eyes (36.2%) had mild hyperopia, 10 eyes (10.8%) showed higher degrees of hyperopia, and 3 eyes were emmetropic. Conclusion: An important challenge in ROP after laser therapy is some follow up to prevent amblyopia due to refractive errors especially myopia.

Purpose: To evaluate patients with advanced retinopathy of prematurity (ROP) among neonates referred to Poostchi ROP clinic in Shiraz from March 2006 to February 2008.Methods: Among referred infants to Poostchi clinic for screening and management of ROP, medical records of patients with advanced ROP (stage 5) at initial examination or during disease progression were evaluated. Information regarding gestational age, time of diagnosis, follow-up programs and causes of delayed screening were recorded.Findings: Overall, 20 patients (11 male, 9 female) out of 1024 reffered neonates had advanced ROP which was unilateral in 3 (15%) and bilateral in 17 (85%) patients. Advanced ROP was due to late diagnosis and treatment in 17 (85%) patients and treatment failure in 3 (15%) patients. Main causes of delayed diagnosis were uninformed parents in 10 (50%) patients, misdiagnosis by an ophthalmologist in 3 (15%) patients, socioeconomic problems and parental ignorance in 3 (15%). patients and poor systemic condition of the neonate in 1 (5%) patient.Conclusion: The main cause of visual loss due to advanced ROP is uninformed parents and health care providers as well as absence of an organized screening program.

Purpose: Compaison of excyclotorsion induced by horizontal transposition of vertical rectus muscles versus vertical transposition of horizontal rectus muscles in rabbit eyes.Methods: In this exprimental study, group 1 underwent full tendon nasal transposition of the superior rectus and full tendon temporal transposition of the inferior rectus (10 adult rabbits); group 2 underwent superior transposition of the lateral rectus and inferior tranposition of the medical rectus (10 adult rabbits). External limbal marking was used to estimate the magnitude of excyclotorsion resulting from muscle surgery.Results: The mean angle of excyclotorsion in group 1 was 31±1.8 degree, ranging from 28-35 degree. The mean angle of excyclotorsion in group 2 was 12.85±1.6 degree, ranging from 10-16 degree. Excyclotorsion induced by horizontal transposition of vertical rectus muscles was significantly larger than that induced by vertical transposition of horizontal rectus muscles (P<0.001). The amount of excyclotorsion after LR displacement (1.1±0.8 degree) was significantly smaller than the amount of excyclotorsion after MR displacement (12.6±1.7 degree) (P<0.001).Conclusion: Althaugh the mean angle of excyclotorsion induced by horizontal transposition of vertical rectus muscles was larger than that of vertical transposition of horizontal rectus muscles; superior displacement of the LR muscle induced no significant change in globe torsion. The torsional effect of horizontal transposition of vertical rectus muscles can be changed varying amounts of globe torsion.

Purpose: To evaluate visual outcomes after deep anterior lamellar keratoplasty (DALK) in patients with keratoconus.Methods: In this interventional case series, patients with moderate to advanced keratoconus underwent DALK. Inclusion criteria consisted of contact lens intolerance or poor spectacle-corrected visual acuity. DALK was performed using the big-bubble technique introduced by Anwar and Teichmann. Outcome measures included visual acuity, refractive status, effect of different methods of suturing on visual outcomes and intraoperative and postoperative complications.Results: One-hundred and twenty-six consecutive eyes of 121 patients were included. At the time of surgery, mean patient age and mean follow-up period were 26.08±7.6 years and 21.62±9.0 months, respectively. Mean preoperative uncorrected and best corrected visual acuity were 20/500 and 20/400, increasing to 20/80 and 20/32 after the operation, respectively (P<0.001). Postoperatively mean spherical refractive error and refractive and keratometric astigmatism were -3.41±3.1D, 3.04±2.3D, and 3.67±2.1D, respectively. Bared DM was achieved in 100 (81.3%) eyes, however, in 23 (18.7%) eyes a few layers of the stroma remained.Conclusion: DALK using the big-bubble technique appears to be an effective procedure for patients with keratoconus. In the case of extensive intraoperative DM perforation or postoperative complications, PK could be done without any limitation.

Purpose: To compare the outcomes of deep anterior lamellar keratoplasty (DALK) using the big-bubble technique with that of penetrating keratoplasty (PK) in patients with keratoconus.Methods: This double-blind clinical trial included patients with moderate to advanced keratoconus and poor spectacle-corrected visual acuity or contact lens intolerance. Refractive errors, best corrected visual acuity (BCYA), contrast sensitivity function (CSF) and higher order aberrations (HOAs) were compared between the study groups.Results: Forty-two eyes underwent DALK while 35 eyes received PK. Mean patient age was 26.91±7.9 versus 30.89±10.3 years in the DALK and PK groups, respectively (P=0.06). Mean follow-up period was 19.0±7.9 months in the DALK and 24.6±3.5 months in the PK group (P=0.32). Mean postoperative spherical equivalent refractive error was -3.23±3.4 D in the DALK group versus -2.22±4.6 D in the PK group (P=0.28) and mean postoperative BCYA was O.18±0.08 logMAR and O.15±0.10 logMAR, respectively (P=0.12). There was no significant difference between the study groups in terms of CSF, total aberrations and HOAs. Conclusions: DALK may be considered as an effective alternative to PK in patients with keratoconus.

Purpose: To determine the indications for and surgical techniques of corneal transplantation at Labbafinejad Medical Center (LMC) from 2004 to 2007.Methods: In this descriptive study, records of 756 patients who had undergone corneal transplantation from October 2004 to October 2007 were reviewed.Results: Overall, 504 male (64.9%) and 272 female (35.1%) subjects with mean age of 41.29±21.25 (range: 10 days to 89 years) were operated. Keratoconous (40.8%) was the leadingindication for keratoplasty, followed by bullous keratopathy (11.7%), non herpetic corneal scar & opacity (8%), regrafts (7.8%), corneal ulcers (bacterial, fungal, acanthamoeba) (7.8%), herpetic corneal ulcer & scar (4.9%), corneal dystrophies (3.6%) and trachoma keratopathy (3.4%). The most cornmon type of corneal transplantation was penetrating keratoplasty (PKP) (67.6%), other types included: deep anterior lamellar keratoplasty (DALK) (13.9%), tectonic PK (10.3%), lamellar keratoplasty (LK) and automated lamellar therapeutic keratoplasty (ALTK) (6.7%), descemet's stripping automated endothelial keratoplasty (DSAEK) (0.9%) and keratolimbal allograft (KLAL) (0.5%).Conclusion: Keratoconus remains the leading indication for corneal transplantation PK at LMC accounting for 40.9% of all grafts. But in comparison with previous studies, bullous keratopathy has increased. In our study the rate of lamellar keratoplasty, especially DALK, has also increased significantly. DSAEK which was begun in 2007 at LMC is rapidly becoming the preferred treatment for corneal endothelial dysfunction at this center.

Purpose: To present our experience with cyanoacrylate tissue adhesive in eyes with exposed hydroxyapatite orbital implants.Methods: Cyanoacrylate tissue adhesive was used in 3 patients with hydroxyapatite orbital implant exposure defects. Results: Cyanoacrylate glue was applied on the defective area of 3 patients presenting with small exposure (<4mm). The patients were followed for 33 months (range: 20-58 months), no complication developed and the defect size was stable. In one patient after 12 months, the glue was removed and a mucous membrane graft was performed without any complications over a 9 month period.Conclusion: Cyanoacrylate tissue adhesive application is safe and easy to use; it can be used for treatment of exposed hydroxyapatite orbital implant in selected cases.

Purpose: To compare the value of conventional laboratory methods and polymerase chain reaction (PCR)in the diagnosis of fungal keratitis.Methods: This cross sectional study was conducted at Khalili Hospital, Shiraz, Iran. Samples were taken from thirty-eight patients with findings suspicious for fungal keratitis. Corneal scrapings were used for Gram, Giemsa and KOH stains, culture and PCR analysis.Results: Of 38 enrolled eyes, 25 eyes (68.5%) were judged to have fungal infection based on positive cultures, staining, PCR or response to antifungal treatment. PCR detected fungi DNA in 17 of 25 samples (68% sensitivity). Staining (Gram, Giemsa and KOH) and culture yielded a positive result in 40% and 24% of samples respectively. Twenty one (84%) of 25 patients showed fungal elements in at least one laboratory work up and 4 patients were diagnosed as fungal keratitis only based on response to antifungal drugs. Conclusion: Compared to conventional laboratory methods, PCR based methods offer higher sensitivity and a faster diagnosis in fungal keratitis.

Purpose: To report the clinical, radiological, pathological and therapeutic features of a case of recurrent cavernous hemangioma.Case report: A 32 year old lady with progressive decrease of vision in her right eye associated with blepharoptosis was diagnosed to have orbital cavernous hemangioma which was excised. 10 years later she presented with recurrent proptosis and progressive eye deviation. Imaging showed the same pathology in the same orbit and repeat excision confirmed a cavernous hemangioma. Evaluation of old CT scans showed that the recurrent lesion was a twin tumor and we had only excised one of them in the first operation. Conclusion: Recurrent cavernous hemangioma may be the result of a small residual tumor which grows gradually and becomes clinically evident after some years. When the mass is large or seems multilobulated, after excision of the main mass a thorough search to find small residual masses seems mandatory.