BINA
Year:2006 | Volume:11 | Issue:3 (44)|Papers Count:31

Purpose: To report the early results of transplantation of autologous limbal stem cell cultivated on amniotic membrane in total limbal stem cell deficiency.Methods: Four eye of 4 patients with total unilateral stem cell deficiency secondary to severe chemical or thermal burn were included. Stem cell deficiency was confirmed with impression cytology in all cases. Under topical anesthesia, a small limbal sector (1×1mm) was removed from the sound eye and cultivated on amniotic membrane. Cell expansions were transplanted to the affected eye 2 weeks later. Patients were regularly followed up. At each follow-upvisit, a complete eye examination with special attention to recurrence or regression of vascularization, corneal opacification, and healing of epithelial defect was performed. Digital imaging was performed at each follow-up visit. Impression cytology was repeated in all cases after surgery.Results: The patients were followed for 5-13 months. Decrease in corneal opacification and vascularization was obvious in 3 cases, in which the surface of the cornea was covered with corneal epithelium. Sectoral conjunctivalization was evident in these 3 cases, but their corneas were ready for corneal transplantation. The procedure failed in one case with total corneal conjunctivalization. Visual acuity improved in all cases.Conclusion: Autologous cultivated stem cell transplantation on amniotic membrane seems to be an effective way for stem cell transplantation. More definite judgment needs longer follow-up together with long-term results of corneal transplantation in these patients.

Purpose: To describe the association between optic disc traction and non-arteritic anterior ischemic optic neuropathy (NAION).Methods: Eighty three eyes of 83 patients with NAION were evaluated by optical coherence tomography (OCT) for detecting vitreous adhesion to the optic nerve head with separation from adjacent retina (partial posterior vitreous detachment).Those who were negative for such adhesion underwent ultrasonography to detect complete PVD.Results: Fifty male and 33 female subjects with mean age of 51.9±10 yr were studied. Partial PVD with optic nerve head adhesion was found in 54 patients (65.1%) using OCT. Ultrasonography found complete PVD in all eyes with optically empty spaces in OCT.Conclusion: Vitreous traction on optic nerve head from PVD mayplay a causative role in some cases of NAION. This traction may impair vascular supply and axoplasmic flow leading to signs and symptoms of NAION.

Purpose: To compare the effect of high dose intravenous corticosteroid therapy with placebo in the treatment of recent traumatic optic neuropathy (TON).Methods: In a double masked-placebo controlled clinical trial, 31 eyes of 31 patients were randomly assigned into two groups. Only patients with history of ophthalmic or head trauma within the past 7 days were included. Unconscious patients, those with penetrating ocular injury, and candidates for decompression surgery were excluded. The treatment group (16 eyes) received 1 gr methylprednisolone intravenously for 3 days followed by 1 mg/kg prednisolone orally for 11 days. The placebo group (15 eyes) received 50 ml normal saline intravenously every 6 hours for 3 days. Visual improvement was defined as increase of at least 0.3 Log MAR visual acuity after 3 months.Results: Visual improvement was achieved in 68.8% of the treatment group and 53.3% of the placebo group (P=0.1). Visual improvement in the first 48 hours was correlated with final visual acuity (P=0.03) but final visual acuity was not significantly correlated with age (P=0.06), interval from trauma to treatment (P=0.5), and initial visual acuity (p=0.06).Conclusion: In patients with recent TON, high-dose intravenous corticosteroids and placebo are comparable in terms of improvement in visual acuity.

Purpose: To determine whether angiotensin II levels in aqueous humor is related to diabetes mellitus and to evaluate the effect of captopril.Methods: In a case-control study, aqueous humor samples were obtained during cataract surgery from 58 eyes of 58 patients, of which 37 were diabetic. From these latter subjects, 16 had taken captopril (captopril group) and 21 had not taken any angiotensin converting enzyme (ACE) inhibitor (non-captopril group). Angiotensin level was assessed by radioimmunoassay. Severity of macular edema was evaluated by clinical examination after surgery. Mann Whitney U test was used to assess the statistical difference of mean angiotensin ii and HbA1C levels between the groups and Spearman's rank-order correlation coefficient was used to evaluate the correlation between aqueous levels of angiotensin II and severity of macular edema.Results: The aqueous level of angiotensin II was significantly higher in diabetic patients (31.0±7.3 pg/ml) compared to non-diabetics (6.28±2.8pg/ml). (P<0.0001) Aqueous concentration of angiotensin II in the captopril group (16.3±6.5mg/ml) was significantly lower than in the noncaptopril group (75.73±9.36). (P<0.0003) Severity of macular edema was significantly lower in the captopril group as compared to the non-captopril group such that 68.75% of the captopril group vs 33.3% of the non-captopril group had no macular edema (P<0.005).Conclusion: These findings suggest that the aqueous level of angiotens in II is significantly correlated with the severity of macular edema and may have a role in pathogenesis of macular edema in diabetic patients. It seems that modulation of the renin-angiotens in system may become e very important target for medical treatment in patients with diabetic macular edema.

Purpose: To compare the effects of short-term and long-term systemic corticosteroids in the treatment of confirmed ocular toxoplasmosis.Methods: This randomized comparative clinical trial was performed on 69 patients with confirmed active ocular toxoplasmosis with typical clinical manifestations. The subjects were randomly assigned to receive either 10 days (group A, 33 cases) or 4-6 weeks (group B, 36 cases) of systemic corticosteroids in addition to classic antibiotic therapy. All patients were visited and followed weekly until complete improvement of vision. Mean visual acuity, inflammatory cell countin the vitreous, lesion size and severity of the condition were compared between the two groups.Results: There was no statistically significant difference between the two group, regarding mean values of visual acuity in Log MAR (before; group A: 0.24±0.6, group B: 0.280±0.07, P=0.43 and after; group A: 0.11±0.08, group B: 0.06±0.07, P=0.09), vitreal inflammatory cell count (before; group A: 1.8±0.56, group B: 1.9±0.60, P=0.45 and after; group A: 1.5±0.65, group B: 1.5±0.5, p=0.94), and size of the lesions in disc diameter (before; group A: 0.94±0.37, group B: 1.03±0.37, P=0.49 and after; group A: 0.94±0.44, group B: 1.12±0.38, P=0.4).Conclusion: The study revealed that there is no significant difference between the effects of short term and long-term systemic corticosteroid therapy in the treatment of ocular toxoplasmosis. It is reasonable to perform an equivalence trial study on this issue.

Purpose: To evaluate the role of anxiety in idiopathic acute anterior uveitis.Methods: In this case-control study, three groups including 30 patients with uveitis, 30 patients with conjunctivitis, and 30 healthy controls were enrolled for estimating the anxiety level by employing Zung anxiety assessment and a structured clinical interview. T test and Chi square test were used for statistical analysis.Results: Mean anxiety level was 37.5, 33.5, and 33.5 in the anterior uveits, conjunctivitis, and control groups, respectively. (P<0.001) Severe anxiety was present in 23%, 7% and 17% of the uveitis, conjunctivitis and the control groups, respectively. The individuals were malein 60%, 53%, and 57% and were married in 77%, 70%, and 83% of the uveitis, conjunctivitis and control groups, respectively. Mean age in uveitis, conjunctivitis, and control groups was 42.6 yr, 33.6yr, and 31.1 yr, respectively. (P<0.01, F=3.09).Conclusion: The present findings have verified that anxiety may be effective in idiopathic acute anterior uveitis.

Purpose: To compare the results of two different methods of frontalis suspension using fascia lata in congenital ptosis.Methods: In a randomized clinical trial, double triangle sling was compared with single triangle sling using fascia lata. Eight patients with unilateral and 11 patients with bilateral congenital ptosis were randomly assigned for each procedure.Results: There was no statistically significant difference between the two groups in terms of age and sex. Mean increase in interpalpebral fissure was 4.35±2.32 mm in the double triangle group and 4.36±1.89 mm in the single triangle group. Increase in palpebral fissure was statistically significant in both groups (P=0.00) but there was no difference between the two groups regarding functional (lid fissure height) and cosmetic (lid margin contour) results and early or late complications during follow up.Conclusion: Single triangle sling method using fascia lata is safe, easy, and fast with acceptable results and can be used instead of conventional double triangle fascia lata sling for treatment of low function ptosis.

Purpose: To evaluate the clinical findings and surgical management of patients with congenital unilateral double elevator palsy (DEP) or monocular elevation deficiency (MED) Methods: In a non-comparative interventional case series, 27 consecutive cases of DEP were studied. Hypotropia, elevation deficiency, and pseudoptosis were corrected by Knapp or Callahan procedure with or without inferior rectus recess. Ptosis was corrected by anterior levator resection (ALR) and brow suspension. Levator excision and brow suspension was performed for correction of accompanying jaw winking ptosis. Horizontal strabismus repair, blepharoplasty, and double Z-plasty for epicanthal folds were done in some cases.Results: This series included 15 female and 12 male subjects with mean age of 13±10 years. All patients except two were sporadic cases. Definite congenital DEP was present in two members of a consanguineous family. In most cases, the presenting complaint was ipsilateral ptosis (74%).Hypotropia with various degrees of severity was found in 20 cases (74%). Six patients (22%) had jaw winking ptosis of the ipsilateral eye. Knapp procedure was performed in 6 and Callahan procedure was performed in 4 cases. True ptosis was corrected by anterior levator resection in 9 and brow suspension in 8 eyes. Levator excision and brow suspension was performed in 3 patients with accompanying jaw winking ptosis. In one case with mild jaw winking, levator resection was done.Hypotropia was corrected in 80% after surgery and eye elevation increased by 25±15 PD. Ptosis correction procedures successfully improved chin up position and cosmetic appearance in addition to opening the visual axis. Anterior segment ischemia was not found in any cases after one year of follow up.Conclusion: Blepharoptosis and hypotropia are the chief clinical features and presenting complaints in this condition. Knapp and Callahan procedure with or without inferior rectus recess are effective and should be consider prior to considering surgical intervention for the ptosis.

Purpose: To evaluate the use of amniotic membrane transplantation (AMT) for management of congenital distichiasis. Methods: This interventional case series was performed on 16 eyelids of 5 patients with congenital distichiasis treated with posterior lamella resection and AMT.Results: All patients were men aged 2 to 42 years. Mean follow up was 17 months (6-29 months).Post-operative symptoms of dry eye were controlled by medical treatment in all patients. Misdirected eyelashes recurred in 3 eyelids (18.8%) outside the AMT area and in 2 eyelids within the AMT area which were treated by gentle laser epilation.Conclusion: AMT is a useful option in management of distichiasis with a low rate of complications and acceptable eyelid contour.

Purpose: To assess the etiology, demography, surgical management and postoperative complications of ptosis in a referral ophthalmologic center.Methods: We reviewed records of 233 ptosis patients managed at Labbafi nejad Hospital during 1998-2003. Etiology, age, sex, laterality, family history, amblyopia, past medical history, margin reflex distance and levat or function, type of surgery, and postoperative complications were evaluated.Results: The study included 117 female and 116 male subjects with mean age of 18.7±12.8 years. There was past ocular surgery in 85%, family history of ptosis in 3.4%, amblyopiain 19.2% and strabismus in 6.9%. Ptosis was unilateral in 85% and bilateral in 15% and was congenital in 79%. Conclusion: The most prevalent type of ptosis is congenital therefore early detection and referral of affected children is necessary to prevent amblyopia.

Purpose: To evaluate the success rate and complications of single-plate Molteno tube implantation inpatients with intractable glaucoma.Methods: This study was conducted on records of patients who underwent Molteno tube implantation from 1995 to 2000 and had at least 18 months of follow-up.Results: Thirty six eyes of 35 patients including 20 male and 15 female subjects with mean age of 29.7±25.3 yr (range 3-77 yr) were enrolled in the study. Intraocu1ar pressure (IOP) was 34.48±10.39 mmHg with use of 2.3±0.8 drugs which decreased to 17.97±7.63 mmHg with 1.9±1.2 drugs after 32.8±16.14 months of follow-up. (p<0.0001) Complete success (IOP£21 mmHg without medication), qualified success (IOP£21 mmHg with medication), and total success rates (summation of complete and qualified success rates) were 19.5%, 55.6%, and 75%, respectively. At final follow-up, visual acuity was improved³1 line in 10 (27.8%), decreased³1 line in 8 (22.2%) and remained unchanged in 18 (50%) eyes. Postoperative complications occurred in 20 eyes (55.6%) including encapsulated bleb in 10 (27.8%), tube-iris touch in 4 (11%), flat anterior chamber in 3 (8.4%), tube-corneal touch in 2 (5.6%), and retinal detachment, tube-lens touch, and tube blockage each in 1 (2.8%). Intraocular pressure dropped to zero in one eye and vision was lost.Conclusion: In eyes at high risk for trabeculectomy failure, implantation of the Molteno tube can be considered as a procedure with high success for controlling intraocular pressure and preservation of vision. Long term follow up is recommended to ensure adequate management of the frequent complications of this procedure.

Purpose: To evaluate the ability to predict visual outcome after penetrating keratoplasty (PKP) in patients with pseudophakic or aphakic corneal edema (PCE or ACE).Methods: Medical records of 34 patients (34 eyes) who under went PKP for PCE or ACE during 1994-2004in Ahvaz were retrospectively analyzed for variables in the history and ocular examination before PKP and visual outcome after PKP. The predictive value of each preoperative variable including age, gender, method of intraocular lens (IOL) implantation, vitreous loss during cataract surgery, time between cataract and PKP surgery, and history of glaucomaor increased intraocular pressure (IOP) before PKP surgery on post-PKP visual outcome was assessed using logistic regression analysis. Odds ratio (OR) with 95% confidence interval (95% CI) was calculated for predictive factors.Results: Mean follow-up was 23.6 months. Best corrected visual acuity (BCVA) of 20/200 or better was achieved in 17patients (50%).The strongest predictors of this outcome were time between cataract surgery and PKP (P=0.008, OR=3.50, 95% CI; 0.48-31.18), aphakia (P=0.027, OR=4.29, 95% CI; 0.36-114.8) and no history of glaucomaor increased IOP before PKP (P=0.020, OR=3.75, 95%CI; 0.71-21.41).Conclusion: In patients with PCE and ACE who are candidates for PKP, time between cataract and PKP less than 20 months, no history of glaucoma or increased IOP before PKP, aphakia versus presence of IOL are associated with a better visual outcome.

Purpose: To evaluate the diagnostic signs, intraoperative complications and postoperative outcomes in children with Congenital cataract and pre-existing posterior capsule defect (PPCD).Methods: This interventional case series was conducted on 14 eyes of 7 patients who underwent lensectomy-anterior vitrectomy for congenital cataract with PPCD. All children had bilateral cataract. Preoperative diagnostic signs of PPCD detected under maximum pupil dilation in patients without a mature cataract included a well-demarcated horizontaloval defect with white margin and/ scattered white dots around the defect. The greatest lens opacity was over the defect itself. In patients with mature cataract, PPCD was diagnosed during operation. Bimanual irrigation/aspiration and 2-port anterior vitrectomy was performed in all cases.Results: The patients included in 2 girlsand5 boys with manage of 11.4±4.1 months. PPCD was diagnosed preoperatively in 5 patients (10 eyes) and intraoperatively in 2 patients (4 eyes).Intraocular lens was implanted in 2 eyes of one patient and 12 eyes were left aphakic. Except for nucleus dislocation into the anterior vitreous in our first case which was successfully removed, no other intraoperative complication occurred. During a mean follow up of 21.1±7.1 months (18-36 months) the visual axis remained clear in all the eyes.Conclusion: Establishing the diagnosis of PPCD preoperatively with fully dilated pupil and careful surgical planning prevents intraoperative complications and produces satisfactory technical results.

Purpose: To evaluate the results of keratoprosthesis (KPS) at Labbafi nejad Medical Center. Method: In this case-series 29 eyes of 27 patients who underwent KPS between 1995-2002 were evaluated for results and complications.Results: Patients included 22 male and five female subjects. Diagnoses included chemical burn (17 cases), Stevens-Johnson syndrome (three cases), ocular cicatricial pemphigoid (seven cases), corneal retransplantation (one case) and old corneal scar (one case). Preoperative visual acuity was hand motion or lighpt perception (no light perception, hand motion, or light perception in the fellow eyes). Prostheses were Girard in 20 cases, tibiakeratoprosthesis in 3 cases, and Dohlman type 1, Dohlman type 2 and Pintucci, each in two cases. Postoperative visual acuity improved in 21 patients (72.4%) of which 66.7% experienced major complications including bacterial endophthalmitis (42.9%), retinal detachment (28.6%), uncontrolled glaucoma (21.4%), and spontaneous extrusion (7.1%).Conclusion: Although KPS is hopeful in the short term with acceptable initial results, the long-term complication rate is high and the prognosis is poor. So it is better that KPS be preceded with safer procedures such as keratolimbal graft especially in young patients.

Allergic disorders affect 15%of human beings world wide. The eyes are involved in most allergic conditions, which varies in severity from mild allergic conjunctivitis to severe and chronic inflammation of the conjunctiva and cornea with loss of vision. In this review article, we discuss the allergic keratoconjunctivites with emphasis on pathophysiology and treatment modalities We searched the Medline database by queries: "allergic conjunctivitis", "atopic conjunctivitis", "vernal conjunctivitis", and "giant papilla". Relevant English language articles from 1965 to 2006 were retrieved and studied. Regarding the chronic nature of the condition and the adverse effects of long term usage of certain medications, it is very important to explain the nature of the condition to the patients. Conservative management and administration of safe drugs such as mast cell stabilizer are the first option. Surgical interventions in these eyes like penetrating keratoplasty should be perform during remission of the inflammation.

Purpose: To report a case of lacrimal sac lymphoma presenting with nasolacrimal obstruction.Patient and Findings: A 35-year-oldwoman presented with epiphoria and swelling of the left lacrimal sac area and cervical lymphadenopathy. She had undergone dacryocystorhinostomy (DCR) 6 months before. Computed tomography demonstrated a lacrimal sac mass involving the nasal cavity. Histopathologic examination revealed diffuse large cell lymphoma. According to immunohistologic staining, the tumor was B-cell type. The patient was treated with irradiation and chemotherapy.Conclusions: Lacrimal sac tumors may present with epiphoria and dacryocystitis masquerading as nasolacrimal canal obstruction.

Purpose: To present 3 rare cases of benign flecked retina syndrome.Patients and Finding: A 19-year-oldfemale patient presented with fundus albipunctatus appearance in fundoscopy without night blindness and normal dark adaptation time on electeroretinography (ERG). After 9 years of follow up, no change in visual acuity, ERG, or other ophthalmologic examinations was seen. Two members of her family had the same condition.Conclusion: Benign flecked retina syndrome presents with fundus abnormalities similar to fundus albipunctatus but without night blindness and normal dark adaptation time and without any changes in vision or ERG.

Purpose: To report two cases of oil-drop cataract and the description of this entity.Patients and Findings: Two women (one 46 and the other 56 years-old) presented with gradual visual loss. Previous studies including CT scan, MRI, VEP and ERG were normal. With the use of simple diagnostic tests including a multiple pinhole occlude and use of visuscope, a diagnosis of oil-drop cataract was made in both cases.Conclusion: In cases with progressive visual acuity loss without definite etiology, negative RAPD and normal color vision, oil-drop cataract should be considered as a possibility. Visuscope and multiple pinholes are effective methods for confirming the diagnosis