BINA
Year:2002 | Volume:7 | Issue:4|Papers Count:17

Purpose: To determine the association of mitral valve prolapse and keratoconus.Patients and Methods: In this case-control study, 62 patients with definite keratoconus and 167, age and sex matched controls were selected. All participants underwent complete ophthalmic examination and corneal topography. In addition, a comprehensive cardiac exam including M-mode, two-dimensional, and doppler echocardiography was performed. Definite cases of MVP were determined according to Perloffs criteria. Comparisons were made using t-test, Chi-square test, Mantel Haenzel test, and Fishers exact test.Results: Overall, mean age (SD) was 29.8 (12.3) years and the two groups were similar regarding age and sex. In the keratoconus group, 14 patients (22.6%) and in the control group, 11 patients (6.6%) had definite MVP (P=0.009). The odds for having MVP was 4.2 for patients versus controls (95% confidence interval: 1.9-11.3). The odds ratio increased in the third decade and slightly decreased in the fourth decade.Conclusion: This study revealed an association between keratoconus and MVP, therefore it seems prudent to refer patients with keratoconus to cardiologists for work-up and consider bacterial endocarditis prophylaxis when appropriate.

Purpose: To report 14 cases of gelatinous drop-like corneal dystrophy (GDCD) for the first time in Iran.Material and methods: This is a case series of 14 patients who were diagnosed based on clinical characteristics and pathologic documentation.Results: Of 14 cases, 11 were female and 3 were male. Average age was 28.6 years. According to family trees, the predominant mode of inheritance was autosomal recessive, however 1 case was sporadic and 3 cases in a single family showed autosomal dominant inheritance pattern. Ten cases underwent surgery including superficial keratectomy (SK), lamellar keratoplasty (LK), and penetrating keratoplasty (PK). Cases were followed for 5-15 years (mean 8). Recurrence was the rule; one case underwent 4 PKs in one eye.Conclusion: GDCD is a rare autosomal recessive corneal dystrophy which causes early and severe visual loss in young adults. Recurrences complicate SK, LK, and PK. Surgical interventions (especially PK) should better be postponed as much as possible.

Purpose: To evaluate the efficacy and safety of topical mitomycin-C 0.02% in patients with resistant vernal keratoconjunctivitis.Materials and method: This placebo-controled double-masked clinical trial was done in resistant cases of VKC. After ceasing previous medications if any, for one week, symptoms and signs of patients were recorded on the first day of the new treatment. Topical mitomycin-C 0.02% was prepared and used in one eye and placebo in the other eye four times per day for ten days. The changes in symptoms and signs were compared at the end of treatment and one month later.Results: Seventeen patients including 11men and 6 women with a mean age of 15 years were studied. Mean duration of involvement was 4.65 years. There was not any significant difference between the two groups in terms of improvement in symptoms and signs. No patient was excluded because of mitomycin-C side effects.Conclusion: Topical mitomycin-C 0.02% four times per day for ten days is not an effective treatment for severe VKC.

Purpose: To evaluate the efficacy and safety of low-dose topical mitomycin-C in patients with severe vernal keratoconjunctvitis.Materials and methods: In this placebo-controlled randomized clinical trial, patients with severe keratoconjunctivitis were randomly assigned to treatment with topical mitomycin-C 0.01% eye drops (N= 31) or placebo (N= 27), three times daily for 2 weeks. Symptoms including, itching, photophobia, tearing, mucous discharge, foreign body sensation; and signs including conjunctival hyperemia, epithelial conjunctival giant papillae of the patients were recorded on the day of enrollment and at the end of the treatment period.Results: There was a statistically significant decrease in the signs and symptoms in the mitomycin-C treated group at the end of 2 weeks of treatment. One of the treated patients (3.2%) and 26 of the placebo group (96%), required medication during the 4-week post-treatment follow up period.Conclusions: Short term, low-dose topical mitomycin-C may be considered in the acute exacerbations of severe vernal keratoconjunctivitis.

Purpose: To determine the effect of macular laser photocoagulation on clinically significant macular edema in diabetic patients with low vision (range of 20/200 to 20/80 of Snellen chart).Materials and method: This is a before and after clinical trial. After 4 months of treatment by a retinal specialist, complete eye exams, blood lipid profile, and urinalysis were evaluated. Main outcome measures were visual acuity and macular edema.Results: Thirty-three eyes from 22 patients were evaluated. Ninteen eyes (57.5%) had macular edema improvement and 17 eyes (51.5%) had visual acuity improvement. The difference between visual acuity before (19/100) and after (23/100) treatment was statistically significant (P=0.02). Twelve eyes (36.3%) had both improvement of visual acuity and resolution of macular edema. The only significant risk factor against improvement of visual acuity was hypertriglyceridemia (P= 0.03).Conclusion: The effect of macular laser photocoagulation in this range of vision is at least as effective as in better ranges of vision.

Purpose: To provide relevant data regarding the clinical aspects of spontaneous vitreous hemorrhage and the surgical results.Materials and methods: During 3.5 years, 44 eyes of 44 nondiabetic patients with spontaneous vitreous hemorrhage underwent standard pars plana deep vitrectomy and were followed for 3-6 months (4.4± 1.1). Demographic characteristics, surgical results, functional results, and postoperative complications were recorded.Results: Half of the patients were female and mean age ± SD of the patients was 56.1±11.3 (Range 28-75 years). The causes of vitreous hemorrhage were retinal vein occlusion (63.7%), choroidal neovascularization (11.4%), presumed posterior vitreous detachment (9%), retinal tears without (6.8%) or with (4.5%) retinal detachment, and ocular tumors (4.5%).Conclusion: The frequency of causative factors is different from previous studies performed in other countries.

Purpose: To compare measured intraocular pressure (IOP) at different times after halothane inhalation in patients with congenital glaucoma.Materials and methods: Fourty-seven eyes of 27 infants and children with a clinical diagnosis of congenital glaucoma who underwent examination under anesthesia (EUA) during the year 2000 were enrolled. After installation of tetracaine 0.5% in both eyes, the patients were given halothane 3% by mask for a minute or less. If the eyes were in the primary position and there was no movement or resistance by the patients, measurements were carried out using the tonopen. Then the patients were given halothane again until a total of five minutes and the measurements were repeated using the same device.Results: Mean IOP measured by tonopen was 22.6±8.5 mmHg after one minute or less of, and 21.5 ±7.4 mmHg after a total of 5 minutes of halothane inhalation (P=0.018). The difference was not clinically important (mean paried difference: 1.1 mmHg). Conclusion: The decrease in mean measured IOP after five minutes of halothane inhalation compared with one minute or less of halothane inhalation (1.1 mmHg) does not seem to be clinically important.

Purpose: To compare complications associated with hydroxyapatite implant (HAI) in enucleation, evisceration, and secondary implantation.Methods: Analysis of data collected on 141 consecutive HAI cases performed by one surgeon.Results: Major complications associated with enucleation or evisceration with primary HIA and secondary HAI were ptosis (4.8% in enucleation cases, 6.8% in evisceration cases, and 5.3% in secondary cases); granuloma formation (7.3% in enucleation cases, 4.5% in evisceration cases, and 14% in secondary cases); small exposure (7% in enucleation cases, 4.5% in evisceration cases, and 5.3% in secondary cases); large exposure (8.9% only in secondary cases); and lower lid sagging (7.3% only in enucleation cases).Conclusion: No statistically significant difference was noted among complications associated with enucleation or evisceration with primary HAI and secondary HAI.

Purpose: To determine and introduce the best ways of diagnosis, management and prevention of PCT.Methods: All existing relevant articles in medline from 1963 to 2001 were searched with the following key words: cataract surgery, complications of phacoemulsification, posterior capsule, and posterior capsule tears. We reviewed and classified the relevant articles and discussed them.Results and conclusion: Intraoperative PCT is the most common type of PCT and can occur during any stage of cataract surgery. Conventional management consists of prevention of mixture of cortical matter with vitreous, dry aspiration, and anterior vitrectomy, if required. If PCT is detected soon after its occurrence, by using dry technique or posterior continuous curvilinear capsulorrhexis (PCCC), if possible, visual results are similar to that of patients without this complication. If a PCT occurs during phacoemulsification, low flow rate, high vaccum, and low ultrasound are advocated. Dislocated nucleus or nuclear fragments required vitrectomy and the use of perfluorocarbon liquids by a trained vitreoretinal surgeon. In the presence of a PCT, the intraocular lens (IOL) can be placed in the sulcus, if the capsular rim is available; or in the bag, if the tear is small. Scleral fixated PCIOL and ACIOL can be implanted when the PCT is large. Faced with this complication, it is best for a surgeon to approach and manage systematically. Early recognition and correct management including PCCC if possible, careful vitrectomy, removal of nucleus and cortical fragments with preservation of the capsule as much as possible. A dry technique, appropriate IOL selection and insertion will provide the best visual outcome for these patients.

Purpose: To report a case of choroidal hemorrhage four days after cataract surgery due to warfarin usage.Patient and findings: An 81-year-old man with cardiac disease and history of warfarin usage for 10 years was operated on with phacoemulsification technique and PCIOL implantation without any complication. Warfarin had been discontinued 7 days before surgery and was re-initiated 4 days after surgery. Choroidal hemorrhage occurred 10 hours after the use of warfarin.Conclusion: In patients with anticoagulant usage, choroidal hemorrhage should be considered after cataract surgery.

Purpose: To report a case of bilateral acquired Browns syndrome following juvenile rheumatoid arthritis. Patients and findings: A 15 year-old girl with poorly controlled systemic juvenile rheumatoid arthritis presented with painless vertical diplopia and was found to have an acquired Browns syndrome of the left eye. Injection of long-acting steroid near the trochlea made her free of signs and symptoms. Later in the course of disease, she developed vertical diplopia for the second time and was diagnosed to have an acquired Browns syndrome of the right eye. Again, her problem disappeared with injection of steroid near the trochlea. Conclusion: Acquired Browns syndrome following juvenile rheumatoid arthritis is a rare complication and has been reported previously in a few cases.

Purpose: To report a case of malignant melanoma in a patient with bilateral nevus of Ota and emphasize the importance of early diagnosis and treatment in these cases.Patients and findings: A 57 year-old caucasian female with bilateral nevus of Ota was referred to Labbafinejad Medical Center in Tehran with a prior 8-month history of severe pain in her left eye. Vision in her left eye was NLP, applanation tonometry was 50 mmHg, and black pigmented nodules were observed on the scleral surface. In an orbital computerized tomography scan there was a mass behind the left globe with optic nerve involvement. The left eye was exentrated. According to the pathologic report there was a malignant melanoma in the ophthalmic tissues and a disorganized globe was seen. However the eyelids were tumor free. Four years prior to exentration, she had been admitted due to loss of vision in the left eye, an exudative retinal detachment and a choroidal lesion which was seen on echography suggesting a choroidal malignant melanoma, but she refused treatment.Conclusion: Early diagnosis and treatment of such patients will deter lesion progression and so periodic examination of nevus of Ota is recommended to provide early diagnosis of malignant transformation.

Purpose: To report two cases of spontaneously regressed retinoblastoma.Patients and findings: Two patients presented with a chief complaint of decreased vision. In fundoscopy of both cases, a grayish white, translucent nodular retinal mass, with calcified areas was seen. In CT-scan of both cases, typical calcification in the retina was visible.Conclusion: Spontaneous regression is a rare phenomenon which occurs in 1-2 % of cases with retinoblastoma. Due to the probability of malignant changes and appearance of retinoblastoma in offsprings, meticulous follow up of patients and counselling is recommended.