BINA
Year:2005 | Volume:10 | Issue:2 (38)|Papers Count:17

Purpose: To analyze the clinical patterns and etiologic diagnosis of uveitis in Isfahan Methods: The records of 329 patients with uveitis referred to Farabi tertiary eye care center in lsfahan during 1999-2002 were classified and analyzed.Results: Mean age of onset of uveitis was 33.2 years. The female to male ratio was 1.19:1. Anterior uveitis was the most common type (29.2%) followed by panuveitis (26.7%), posterior uveitis (23.7%), and intermediate uveitis (20.4). The most prevalent causes were: idiopathic and Fuch's heterochromia iridiocyclitis (FHI) in anterior uveitis, toxoplasmosis in posterior uveitis, idiopathic in intermediate uveitis; and Bchcet's disease and idiopathic in panuveitis. Overall, 35.5% were idiopathic, 12.1% had specific ocular disease, and 52.3% had systemic disease associations. The most common known etiologies were toxoplasmosis (22.2%), Behcet's disease (18.6%), and FHI (9.4%). Chronic (67.2%), nongranulomatous (90.9%), and noninfectious uveitis (73.3%) were the most frequent types. The most frequent cause under 16 years of age was pars planitis. Conclusion: Significant differences were seen in the clinical and etiologic pattern of uveitis in lsfahan; for example the higher frequency of uveitis due to toxoplasmosis, Behcet's disease and FHI. Environmental, genetic, and geographical factors may contribute to this difference.

Purpose: To evaluate the effect of levodopa- carbidopa on improvement of visual acuity, color vision, and visual field in patients with nonarteritic anterior ischemic optic neuropathy (NAION) with onset less than 6 wks. Methods: In this double-blind randomized controlled trial, 13 patients were treated with levodopa carbidopa and 12 patients were treated with placebo for 3 weeks. After 6 months, visual acuity (evaluated by Snellen chart), color vision (evaluated by Ishihara pseudoisochromatic plate), and visual field (evaluated by Humphrey automated perimetry central 30-2) were evaluated. Results: Mean visual acuity in the treatment group was 1.007 Log MAR (1/10) at beginning of  study and 0.75 Log MAR (4/10) at the end. Improvement of visual acuity in this group was 3 lines of Snellen chart (P=0.001). In the placebo group, mean visual acuity was 0.85 Log MAR (3/10) at the beginning of study and 0.75 Log MAR (4/10) at the end. Improvement of visual acuity in this group was 1 line of Snellen chart (P=0.013). Mean color vision in treated eyes was 4/14 at beginning of study and 5.76/14 at the end. In the placebo group this value was 4.3/14 at ending. There was no statistically significant difference in color vision between two groups both at beginning and at the end of treatment. Visual field improvement did not show any difference between the two groups (P=0.93).Conclusion: Although levodopa- carbidopa significantly improved visual acuity, other aspects of visual function did not show significant changes. Other therapeutic modalities should be tried.

Purpose: To evaluate the prevalence of concomitant systemic and ocular diseases in patients scheduled for phacoemulsification and intraocular lens implantation (PE+PC IOL) and post surgical visual outcomes and complications in 1253 cases.Methods: Medical records of all patients of a private clinic who underwent PE+PCIOLfrom1999 to 2003 were reviewed. All operations were performed by a single surgeon (MAJ).Results: Among 1253operated eyes, 95.9%had senile cataracts. Mean age was 61 years and mean follow up was 20±12.5 months. Incidence of systemic hypertension, diabetes mellitus (DM), ischemic heart disease, pseudo exfoliation syndrome (PXF), and glaucoma were 16%, 11.5%,7.7%, 3.1%, and 2.7%, respectively. After the operation 71.9% and 90.4% of the eyes gained UCVA and BCVA of 20/40 or better, respectively. The most important intraoperative and postoperative complications were sterile uveitis (4.R%), vitreous loss (0.23%), endophthalmitis, CME, RD and, corneal decompensation each in one eye (0.08%). Significant posterior capsule opacity requiring Nd: YAG capsulotomy occurred in 5.8% of the eyes.Conclusion: PE+PC IOL is a safe and effective procedure in patients with cataract. Systemic hypertension and DM are important concomitant systemic disorders in this group of patients.

Purpose: To determine the efficacy, safety, and stability of these techniques and some factors affecting refractive and visual outcomes in treated patients.Methods: 236 LASIK-treated eyes (122 patients) and 218 PRK-treated eyes (112 patients) with myopia and myopic-astigmatism between -1.25 and -4 diapers (D) underwent refractive surgery overran 11monthperiod by a single surgeon. Patients were compared between and within groups retrospectively. Refractive surgery was performed with the flying spot Technolas excimer laser. Preoperative and postoperative evaluation included uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and cycloplegic refraction. Results: Patients were between 18-47 years of age and female outnumbered males by a factor of two. There was no significant difference in the baseline refractive and visual values. In final examination 94.7% of LASIK cases and 93.3% of PRK cases had uncorrected visual acuity of  20/25 or better. Refractions within :to.5 D represented 91.1% of LASIK eyes and 90.6% of PRK eyes over 3years of follow up, indicating slightly better results in LASIK-treated eyes but the difference between two groups was not statistically significant (P>0.05 for all comparison). Conclusion: PRK and LASIK are found to be similarly effective and predictive of correction myopia. In eyes with mild myopia, there was little insignificant difference in refractive and visual outcomes between flap-based and PRK-based procedure.

Purpose: To evaluate and compare tear secretion and tear film instability following laser in situ Keratomileusis (LASIK) and laser assisted subepithelial keratectomy (LASEK). Methods: In a randomized clinical trial, 30 eyes of 15 patients underwent LASIK and 30 eyes of 15 Patients underwent LASEK to correct myopia, Tear secretion and tear film instability were tested Ireoperatively,2 and 6 weeks, and 6 month postoperatively, using TBUT (tear break-up time) and Schirmer I and II tests. Results: Six month after surgery, TBUT, Schirmer I, II tests decreased significantly in LASIK group compared with LASEK group. There was no significant difference between LASIK and LASEK groups preoperatively.Conclusion: The decrease in tear secretion was greater after LASIK than LASEK at 6 months follow up. Proper treatment of dry eye is required after LASIK and LASEK, particularly after LASIK surgery.

Purpose: To report complications involving the posterior segment after laser assisted in situ keratomileusis (LASIK) in 5 myopic patients ranging in age from 26 to 38 years.Patients and findings: Case one developed bilateral cilioretinal artery obstruction in association With ischemic optic neuropathy. Case two presented with nonsimultaneous bilateral delayed-onset optic neuropathy. In case three, aggravation of the symptoms and signs of Stargardt's maculopathy was noticed. Case four showed rapid progression and worsening of diabetic retinopathy in both her eyes. In case five, early onset unilateral macular hemorrhage was observed.Conclusion: The increased intraocular pressure during LASIK surgery may disturb blood flow in posterior ciliary's arteries and choroids. The deleterious effect of LASIK on ocular circulation may Result in sight threatening complications in predisposed patients.

Purpose: To evaluate the success rate of vitrectomy in giant retinal tears (GTR) and factors Influencing it.Methods: In an interventional case series, hospital records of 68 eyes of 63 patients operated for GRT were reviewed. Standard three port vitrectomy plus placement of an encircling band, retinopexy, and internal tamponade was performed for all eyes. Possible influencing factors including age, sex, visual acuity, afferent papillary defect, grade of PVR, size and location of GRT, macular status, extent of RD, interval from onset of symptoms to operation, co-existing eye diseases, surgical technique, post operative complications, and results after silicone oil removal were evaluated. Anatomic success was classified as complete success, relative success, and failure. Results: Mean age of the patients was 31.2±17.2 and 50 patients (79.3%) were male. Underlying Ocular disease existed in 39 eyes, of which high myopia was the most prevalent (33.8%). The eyes Were operated after a mean of 30 days from beginning of symptoms. Silicone oil was used for Internal tamponade in 64 eyes and was removed from 36 eyes. Patients were followed from 1 to 54.5 Months (median 10 months). Anatomic success rate was 73.7%. Preoperative stage of  PVR was the only factor found to be associated with worse anatomic results. Conclusion: Anatomic success rate was comparable to that of other centers and significantly better Than results of a previous report from our center. Early operation of eyes with GRT before development of PVR results in better anatomic success.

Objective: To determine the sensivity and specify of ocular ultrasonography in detecting Vitreoretinal lesion prior to deep vitrectomy in patients with opaque media.Method: The hospital records of patients undergoing deep vitrectomy in a defined period at Shiraz Khalili hospital were reviewed. Sonographic reports given by a sinologist and operation reports Given by a vitreoretinal fellowship were compared regarding significant clinical problems in five groups: intraocular foreign bodies, retinal detachment, choroidal detachment, posterior globe rupture and significant vitreous opacities. Results: From 42 sonographic reports, sensitivity of sonography was 100% for detection of vitreous Opacity, posterior globe rupture, and intraocular foreign bodies; 90% for retinal detachment; and 71.4%for choroidal detachment. The specificity of sonography for all of the above mentioned Pathologies was over 80% except for determination of significant vitreous opacities that was 71.4%. Conclusion: In this five group of vitreoretinal lesions, sonographic reports were accurate and were reliable for surgical planning and decision making in our setting.

Purpose: To ascertain whether the use of nested-PCR (nested polymerase chain reaction) technique leads to more rapid and accurate diagnosis of bacterial endophthalmitis.Methods: The aqueous humor and vitreous samples of 24 eyes of 24 patients with bacterial endophthalmitis were evaluated by microscopy, diagnostic aerobic culture, and Nested- PCR to detect the infectious agent.Results: Aerobic cultures of the aqueous humor and the vitreous were positive in 1 eye (4%) and6 eyes (25%), respectively. Using Nested-PCR, an infectious agent was detected in the aqueous hurnor of 14 eyes (58%) and in the vitreous of 17 eyes (70%). Nested-PCR for eubacterial genome showed 100% correlation with bacteriologically positive specimens. Eubacterial genome was detected in 11 of 18 bacteriologically negative cultures of the vitreous.Conclusions: Nested-PCR on aqueous humor and vitreous samples is a powerful and reliable tool for the diagnosis of bacterial endophthalmitis particularly in smear and culture negative specimens.

Purpose: To evaluate the results of Jensen procedure in correction of ocular deviation in patients With complete sixth nerve palsy.Methods: Hospital records of patients with complete sixth nerve palsy who underwent Jensen procedure at Khalili Hospital of Shiraz during 1993-2002 were studied and results of the operation were evaluated.Results: Of 18 patients including 14 male and 4 females, 19 eyes were operated on. Cause of the condition was head trauma in 83.5% of the patients. Average horizontal deviation in primary position was 48 prism diopter esotropia before and 2.6 prism diopter esotropia after the operation. After the procedure, 78% of the patients had ≤ 8prism diopter horizontal deviation in primary position 11% of the patients developed 5 prism diopter vertical deviation; and 17% of the patients developed face turn. Thirty-three percent of the patients suffered from diplopia before operation which completely resolved after the operation. None of the patients developed anterior segment ischemia. Conclusion: Jensen procedure is a suitable method for correcting deviation due to complete sixth nerve palsy. The results of this procedure are comparable to other surgical methods.

Purpose: To determine the safety and efficacy of mitomycin-C injection into the lacrimal duct for treatment of partial nasolacrimal duct obstruction in adults. Method: This is a before-after clinical trial performed on 20 patients with partial primary acquired nasolacrimal duct obstruction. We injected 1.5 ml of mitomycin-C 0.2 mg/ml into the lacrimal duct and repeated it with concentration of 0.3 mg/ml for inadequate response.Results: After 9 months of follow up, epiphora decreased in 80% of the patients, while the amount of obstruction decreased to 50% In patients with low grade anatomical obstruction the improvement was 100% and with increasing degrees of obstruction, the success rate of this intervention decreased. Ophthalmic complications did not occur and nasal mucosal pallor was observed only in one patient. Conclusion: Intraductal mitomycin injection can reduce epiphora in adults with partial primary acquired nasolacrimal duct obstruction and is a safe method.

Purpose: To report the results of a wrapping technique for hydroxyapatite orbital implants by using mersilen mesh.Methods: This study is prospective interventional case series conducted on records of 55 Consecutive patients who received a mersilen mesh-wrapped HA orbital implant after enucleation or as a secondary procedure. We recorded results and potential problem before and after pegging due to mersilen mesh. Results: Twenty nine males (52.7%) and 26 females (47.3%) underwent the procedure. Mean age was27.6±13.7 (33 months to 71 years). Average follow up was 19.1±8.1 (1 month to 68 months). There were28 (51%) primary enucleations and 27 (49%) secondary orbital implants. Thirty eight patients (65.5%) underwent peg placement. Average duration to pegging was 6.5±11.27 months (5 months to 39 months). Before pegging, 2 patients (5.2%) had implant exposure; one after a primary implant and another following a secondary implant. One exposure resolved spontaneously and one case required a mucous membrane graft. None of the patients had socket inflammation after pegging. One case had exposure, 4 cases had granulation tissue, and 3 patients had discharge. Conclusion: Mersilen mesh is an alternative option to sclera as a wrapping material for porous orbital implants. It is simple to use, readily available, and low-cost

Purpose: To evaluate the range of accommodation lag and it's signs and symptoms in 20-25 year old female students at Zahedan Medical School, Iran. Methods: Three-hundred female students were enrolled for assessment of accommodation. After Exclusion of individuals with individuals with accommodation disorders in 3 steps including amplitude of accommodation, accommodative facility, and relative accommodation; 216 students Remained and were assessed for accommodative response and lag. Results: Of 216 eligible persons, 28 (13%) had no accommodation lag. Accommodation lag of Other degrees were as follow: +0.25 in 42 (19.4%), +0.50 in 40 (18.5%), +0.75 in 39 (18.1%), +1.00 in 51 (23.6%), +1.25 in 4 (1.9%), +1.5 in 10 (4.6%), and +1.75 in 2 (0.9%). None of the 149 participants with accommodation lag of 0.00 to + 0.75 had any problem. From 51 persons with +1 accommodation lag, 6 (11.8% or 2.8% of total) had eye strain and 4 (2.8% or 1.9% of total) had both burning and eye strain. Overall, 4.2% had burning eye strain. Conclusion: Accommodation Jag assessment is a necessary exam for complaints of eye strain and burning.

Purpose: To report two patients with keratoconus who underwent redrafting to correct anisometropia and high astigmatism after penetrating keratoplasty. Patients and findings: The first case is a 34-year-old man with keratoconus who had undergone penetrating keratoplasty. The sutures were removed 6 months postoperatively that led to high hyperopia. Redraft was performed considering vitreous length (14.57 mm) and the high refractive error was corrected by changing donor-recipient disparity. The second case was a 21-year-oldman with keratoconus who had history of corneal transplantation. The patient suffered from high myopia and astigmatism after suture removal. He underwent redraft considering vitreous length (17.32 mm) and the refractive error was corrected by changing donor-recipient disparity. Conclusion: In patients with keratoconus, vitreous length should be taken into account for selection of appropriate donor-recipient disparity.

Purpose: To report a case of partial agenesis of the inferior rectus muscle in a child who was presented because of ocular misalignment and a deficient depression of the right eye. Patient and findings: The patient was a 4-year-old girl. Preoperative CT scans confirmed the clinical diagnosis of inferior rectus agenesis. The patient underwent augmented transposition of Horizontal recti muscles with good post-operative results.  Conclusion: Congenital absence of the inferior rectus muscle is a possible cause of inferior rectus muscle palsy. Although rare, agenesis deserves attention in the absence of another identifiable causes for inferior rectus palsy. Muscle transposition procedures in conjunction with intramuscular botulinium toxin injection or other weakening procedures of the superior rectus muscle have had appreciable functional and cosmetic results in these patients.

Purpose: To report a case of Proteus syndrome with new ophthalmic findings not reported elsewhere. Patient and findings: The patient is an 18-year-old girl with red lesions on hand and foot from birth and disproportionate growth of right upper and lower limbs from the first year of life. On examination, the patient has enlargement of the right upper and lower limb, macrodactyly, vascular malformations on limbs, epidermal nevus on trunk, and kyphoscoliosis. On ophthalmic examination, the patient has posterior subcapsular cataract, dilation of inferior and nasal retinal veins, narrowing of the superior and temporal retinal veins, and macular hypoplasia in both eyes.Conclusion: The patient had general criteria, and two group B and one group C criteria of proteus syndrome. From ophthalmic presentation, only cataract has previously been reported in proteus syndrome and others are new.