BINA
Year:2013 | Volume:19 | Issue:1 (74)|Papers Count:13

Purpose: To describe the prophylactic patterns for endophthalmitis after cataract surgery in Iran.Methods: In this cross-sectional study, 486 ophthalmologists, members of Iranian Society of Ophthalmology, who participated in the 20th Annual Meeting of Ophthalmology in December 2010, Tehran-Iran, filled a self-administered questionnaire. A wide range of ophthalmologists, from all around the country, working in private and academic medical centers, entered the study. Pre-, intra- and postoperative prophylactic measures and self-reported rate of endophthalmitis were assessed.Results: Preoperatively, 75.5% of surgeons used povidone-iodine in the conjunctival sac and only 28.6% of them used oral antibiotics. Intraoperative measures used by 61.9% of ophthalmologist included intracameral or subconjunctival injection of antibiotics. Only 7.8% used intracameral cephalosporins. Postoperative antibiotics [mostly chloramphenicol (57%) and ciprofloxacin (28%)] were used by 94.2% of the surgeons. Ten years of practice were required to observe one case of endophthalmitis.Conclusions: Prophylaxis regimens vary among Iranian ophthalmologist, which need to be updated according to recent guidelines.

Purpose: To measure corneal power using different methods to assess agreement between these methods among patients who underwent photorefractive keratotomy.Methods: In this prospective comparative study, keratometry was measured in 66 eyes of 33 refractive surgery candidates using manual keratometry (kr), conventional topography average central corneal power (ACCP), Galilei total corneal power (TCP), Orbscan II and Eye sys (EffRP). Corneal power was also calculated using clinical history method (CHM) and two corneal power formula (adjusted ACCP and adjusted EffRP).The readings by these instruments and methods were compared using t-test. Agreement among the measurements by three devices was assessed using Pearson (R) and intraclass correlation coefficients (ICC). Linear regression analysis was used to quantify this correlation.Results: The values for CHM were correlated with all keratometric methods and corneal power formulas.However, postoperative kr, ACCP, Orbscan II and EffRP were higher than CHM. (-0.58±0.63, -0.55±0.66, -0.51±0.62, -0.36±0.62, respectively, P<0.001). CHM demonstrated the least mean difference with TCP, Adjusted ACCP and adjusted EffRP (0.17±0.77, -0.14±0.63, 0.07±0.63, respectively). CHM had narrowest limit of agreement with adjusted EffRP and adjusted ACCP (-1.16 to 1.3, -1.37 to 1.09, respectively).Conclusion: CHM has the least mean difference with TCP, Adjusted ACCP and adjusted EffRP. However, the narrowest limits of agreement were between CHM and adjusted EffRP, and CHM and adjusted ACCP.

Purpose: To report the outcomes of pediatric penetrating keratoplasty (PK) performed in Labafinejad medical center, a tertiary referral ophthalmology center, between 2001 and 2012.Methods: In this retrospective interventional case series, medical records of all pediatric patients (age12 years) who underwent primary PK were reviewed. Age at the time of surgery, indications for keratoplasty, postoperative uncorrected visual acuity (UCVA) and best spectacle-corrected visual acuity (BSCVA), postoperative refractive error, graft rejection episodes, graft clarity at the final follow-up, cause of graft failure and secondary intervention were reported. Cumulative graft survival was calculated using Kaplan-Meier method.Results: The study was conducted on 54 eyes of 45 children (27 males) including unilateral PK in 36 cases and sequential bilateral PK in 9 patients. Surgical indications were congenital hereditary endothelial dystrophy (CHED, n=17, 31.5%), trauma (n=6, 11.1 %), keratoconus (n=9, 16.7%), anterior segment dysgenesis (n=8, 14.8%), corneal perforation (n=8, 14.8%), corneal scars (n=4, 7.4%) and aphakic bullous keratopathy (n=2, 3.7%). Cumulative graft survival for 6 months, 1, 2 and 3 years were 74%, 68%, 65% and 62%, respectively. This rate was 61% at mean follow-up of 59 months. The graft survival was highest in old corneal scar and keratoconus (100% clear at month 60) followed by CHED (82.3% at month 61). The worst outcome was observed in traumatic cases (16.6% at month 9) Conclusion: Pediatric PK yielded the best results when the indications were keratoconus and old corneal scar followed by CHED. The worst prognosis was observed in eyes with a history of trauma having led to vitreoretinal surgery and anterior segment dysgenesis.

Purpose: To compare the clinical and paraclinical outcomes following deep anterior lamellar keratoplasty (DALK) using frozen versus fresh corneas in patients with keratoconus.Methods: In this prospective, comparative interventional study, 16 frozen and 19 fresh corneas were used during DALK in keratoconus patients. Big bubble technique was used in all patients. The two groups were compared at 3 and 6 months after surgery in terms of best spectacle-corrected visual acuity (BSCVA), graft clarity, the rate of epithelial defect improvement, graft rejection and pachymetry. Confocal scan was performed to measure and compare basal epithelial cell density, keratocyte density at anterior, middle and posterior stroma, interface haziness and endothelial cell density.Results: The study included 22 female and 13 male subjects with mean age of 27±5 (21-32) years. There was no statistically significant difference between the two groups regarding mean value of BSCVA, central corneal thickness, basal epithelial cell density and endothelial cell density. Graft epithelial defects improved by 7 days postoperatively in both groups. The rejection-free graft survival rate was 100% in both groups. Three months postoperatively, TWO grafts belonging to the frozen cornea group were not clear. Of which, one became clear after 6 months. There was a significant difference between anterior, middle and posterior keratocyte density with mean keratocyte density of zero at both 3 and 6 months postoperatively in the frozen corneas. Confocal scan demonstrated significantly higher interface haziness after 3 months, in frozen corneas after 6 months (P<0.05).Conclusion: DALK using frozen corneas seems to yield clinical and paraclinical results comparable to DALK using fresh corneas.

Purpose: To evaluate the etiologies of excessive blinking in children and teenagers less than 18 years of age in Hamedan, Iran.Methods: This study was performed during 2009-2010 as a cross-sectional study on 50 children and teenagers less than 18 years old who were referred to Sheikh-al-Reis and Farshchian clinics in Hamedan for abnormal and excessive blinking. Ophthalmic and neurologic examinations were performed and recorded for each patient. Pediatric psychologist and pediatrician if seen necessary also examined the patients.Results: Mean age of the patients was 10.5 years and mean duration of blinking was 3.8 weeks. Chief complaints included increased blinking rate in 45 cases, increased blinking force in 17 patients and both of them in 12 subjects. Blinking increased with light exposure in 11 patients. Signs and symptoms of eye diseases such as visual loss, pain, red eye, photophobia, strabismus and corneal involvement were present in 25 patients. Etiologies of excessive blinking were eye-related in 25 patients (50%), neurological in 21 cases (42%) and psychological in 4 patients (8%).Conclusion: The most prevalent etiology of excessive blinking in this study was related to diseases, followed by psychological and neurologic causes. Therefore, we recommend eye examination in all of these patients.If necessary, psychological and neurological examinations were recommended as well.

Purpose: To evaluate changes in tear condition following unilateral ptosis surgery.Methods: In this case series all patients with unilateral ptosis who underwent ptosis surgery over a Two-year period were studied. The patients did not have history of previous eye surgery or other eye problems. Eyelid and lacrimal evaluation included Schirmer's test with and without anesthesia and tear break up time (TBUT), which were performed before, and 1, 3, and 6 months after surgery. Ptosis surgery included levator resection and sling. Subjective symptoms related to dry eye were also evaluated before and after surgery.Results: Overall, 83 patients with mean age of 26.2±16.2 years including 46 (55.4%) male patients were studied. The most common cause of ptosis was congenital in 77 (92.8%) patients. Surgical procedure was levator resection in 56 (675%) cases and sling in 27 (32.5%) cases. The result of surgery was good in 47 (56.6%) patients but we noted under-correction in 32 (39.8%) and over-correction in 3 (3.6%) patients. The changes in the Schirmer's test with and without anesthesia and in TBUT after the surgery were in favor of decrease in tear quantity and quality after operation with time. Patients who had complaints of dryness had only shorter TBUT among the objective signs. Above-mentioned indices were not significantly different based different types & results of surgery.Conclusion: Ptosis surgery can potentially decrease the quantity and quality of tear in operated eyes and may lead to overt signs and symptoms of dry eye. Considering that some of these patients may need other ocular surgeries in future such as refractive or cataract surgeries, evaluation of the tear condition before surgery is prudent.

Purpose: To evaluate the beneficial effects of rifampin for the treatment of central serous chorioretinopathy (CSCR).Methods: In this non-randomized clinical trial, 39 patients with acute CSCR (<2 weeks) were enrolled.Initially, complete visual examinations including determination of best spectacle-corrected visual acuity (BSCVA) using Snellen chart, anterior and posterior segment examination was performed. Fundus fluorescein angiography (FFA) and ocular coherence tomography (OCT) were also performed to confirm the diagnosis. Twenty-three patients were treated with 600 mg rifampin per day for a maximum of 4-6 weeks (treatment group) and 17 patients did not receive any treatment (control group). The patients were examined post treatment at weeks 2, 4 & 6. At each follow-up examination BCVA and fundoscopy were performed. If no macular edema was observed in fundOscopy, OCT was performed, otherwise OCT was performed at the end of 4th-6th week. Primary objective was reduction in macular thickness (MT) and secondary objective was the BSCVA.Results: Mean age of patients was 38.5±6.7 years, 37.7±6.2 years in the treatment group and 39.7±7.3 years in the control group (P>0.05).76.9% of patients were male. Mean MT reduced from 339.9±44.36mm at the beginning of treatment to 297.4±29.09mm at the final visit (12.58% reduction, P<0.001). In the control group, the figures were 310.06±20.31 and 296.71±17.22mm, respectively (4.3% reduction, (P<0.003). The treatment group demonstrated more reduction in MT (P<0.018). Mean BSCVA was 0.2±0.18 and 0.6±0.34 SV before and after treatment respectively (P<0.0001) in the treatment group and 0.2±0.1 and 0.37±0.35 SV, respectively (P<0.024) in the control group. The difference in BSCVA between the two groups was significant (P=0.055). Macula was dry in 45.5% of the treatment group and 29.4% of the control group at the end of study (OR=2 CI95%, 0.52-7.6, P=0.307). All the patients with dry macula at the end of study in the treatment group were followed for 9 months and no recurrence of the lesion was found.Conclusion: Rifampin has beneficial effects in the treatment of acute CSCR. These early findings suggest a novel treatment of CSCR and warranted further study.

Cystoid macular edema (CME) is a painless disease with different etiologies, which manifests as multiple cyst like (cystoid) spaces in the macula. CME is a common cause of vision loss following cataract surgery. Some risk factors for post-cataract surgery CME include intraoperative complications specially incarceration of vitreous in the surgical wound, history of diabetes, uveitis and postoperative inflammation and infection. Clinical examination, fluorescein angiography and OCT are beneficial in the diagnosis of this disease. Since, it is a self-limiting disease, no standard therapy has been developed despite topical NSAIDs, periocular and intravitreal steroid injection and oral carbonic anhydrase inhibitors are used in chronic cases.

Studying the prominent Iranian-Islamic scientific texts of Middle Ages in the field of ophthalmology may play a role in recognizing the science of traditional ophthalmology and its crucial diagnostic and therapeutic points. The most important and reliable resources in the context of ophthalmology belong to Iranian scientists. This study collects these references and provides their relative equivalent conceptions confirmed with modern ophthalmology.

Purpose: To report a case of anterior segment eye deposits in a patient on long-term chlorpromazine therapy.Case Report: A 34 years old man had been on chlorpromazine therapy for 5 years with a total dose of 1, 100 gram. Since one year ago, He presented with gradual onset of decreased visual acuity in both eyes. Slit-lamp examination revealed multiple fine yellow-brown deposits on the corneal endothelium, especially in the interpalpebral portion, and stellate opacity on the anterior crystalline lens capsule in both eyes. In vivo confocal microscopy identified multiple hyperreflective irregular dot-shaped deposits, varying in size, with a peak density at the level of pre-Descemet's membrane.Conclusions: Long-term chlorpromazine therapy induced irreversible deposits in the corneal endothelium and crystalline lens, which can lead to visual loss. Therefore, periodic ophthalmologic examinations are useful in patients who take chlorpromazine for long-term duration.