BINA
Year:2017 | Volume:23 | Issue:1 |Papers Count:17

Purpose: To evaluate visual field changes after trabeculectomy in patients with glaucoma.Methods: In this retrospective study, 166 eyes of 166 patients with glaucoma (mean age 53.3±17.9), who underwent mitomycin C augmented trabeculectomy, were examined. The patients needed to have at least 3 reliable visual field before the surgery and 2 after the surgery. The data of biomicroscopic examination, intraocular pressure, visual field, best corrected visual acuity, and spherical correction of refractive error were extracted from their electronic data record. The results of this study showed changes in visual filed mean deviation as the main outcome measure. Secondary outcome measure was intraocular pressure, visual acuity, visual field pattern standard deviation, and visual field index.Results: The mean post-operative IOP (13±5 mmHg) significantly decreased from the baseline values (19±6 mmHg) (P<0.001). Best corrected visual acuity significantly decreased from 0.1±0.25 at baseline to 0.23±0.36 LogMAR post-operatively (P<0.001). The mean of visual field mean deviation and pattern standard deviation increased from -6.68±7.36 to -9.14±7.96 dB and 5.19±3.50 to 6.11±3.74, respectively. The mean of visual field index was 82.62±21.88 preoperatively and decreased to 76.46±24.53 post-operatively.Conclusion: Glaucoma is a progressive optic neuropathy that even persists after significant intraocular pressure reduction. This underlines the importance of examining the optic nerve and the field of vision after surgery.

Purpose: To compare the short-term outcomes of intratenon injection of mitomycin C (MMC) with the conventional application of MMC soaked sponges in trabeculectomy.Methods: In this randomized clinical trial, 80 open angle glaucoma cases were randomly divided into 2 groups; group 1 received an intratenon injection of 0.1 mL of 0.01% MMC, while group 2 received 0.02% MMC soaked sponges. Intraocular pressure (IOP), endothelial cell count (ECC) changes and bleb morphology, according to the Indiana bleb appearance grading scale (IBAGS), were evaluated at 1, 3, and 6 months after surgery and compared between 2 groups. Complete and qualified success was defined as IOP within 6-15 mmHg without and with medications at month 6, respectively.Results: The mean preoperative IOP was 21.8±5.1 in group 1, which reduced to 10.3±3.7 mmHg at the final visit (P<0.001). Corresponding values for group 2 were 21.8±5 and 10.8±3.5 mmHg, respectively (P<0.001).Complete success was 82.5% and 87.5% in groups 1 and 2, respectively (P=0.526). The blebs tended to be more diffuse, shallower, and less vascularized in group 1, at month 6 (P=0.45, 0.001, and <0.001, respectively). Endothelial cell counts did not change significantly at the final visit (P=0.813).Conclusion: Intratenon injection of MMC is a safe and effective method and produces more favorable bleb morphology after trabeculectomy.

Purpose: To study the effects of filtration surgeries (tube and trabeculectomy) on changes in intraocular pressure after a water drinking test.Methods: In this prospective, non‑randomized, comparative clinical study, 30 patients, who underwent tube surgery, and 30 patients, who underwent trabeculectomy, were investigated; the patient were matched in terms of gender and age. Only one eye of each patient was included. The baseline intraocular pressure was 21 mmHg in all enrolled eyes with or without adjunctive topical medications. After the water drinking test, the intraocular pressure was measured and recorded at 15, 30, 45, and 60 minutes and the results were compared between the two groups.Results: In both groups, intraocular pressure significantly increased from baseline at all measured time‑points (P<0.001). In the trabeculectomy group, the average intraocular pressure increased from 14.8±2.9 to 18.8±4.7 mmHg at 30 minutes, but decreased at 60 minutes (18.0±5.2 mmHg). In the tube group, intraocular pressure incrementally increased until the last measurement (14.2±3.9, 18.8±5.6, and 19.7±6.0 mmHg at baseline, 30, and 60 minutes, respectively). The end‑pressure difference (intraocular pressure at 60 minutes vs. baseline) was significantly greater in the tube group (5.6±3.6 mmHg; 41% change) than in the trabeculectomy group (3.2±4.7; 23% change; P=0.03).Conclusion: Intraocular pressure significantly increased after the water drinking test in both groups. Intraocular pressure started to decline 30 minutes after the water drinking test in the trabeculectomy group, while it continued to increase up to 60 minutes in the tube group. This finding may have implications regarding the efficacy or safety of the procedures in patients with advanced glaucoma.

Purpose: Dormant corneal ulcers do not respond to common treatments. Today, several therapies are used to treat epithelial corneal ulcers, including artificial tear, ocular droplets derived from platelet-rich plasma, amniotic membrane transplantation, and limbal stem cell transplantation. The aim of this study was to evaluate the effect of platelet growth factors on the recovery of amniotic membrane epithelial cells and limbal stem cells grown on amniotic membrane.Methods: In this experimental study, 5 amniotic membranes were prepared and after freezing and treatment with platelet lysate, the viability of the cells was evaluated. The limbal stem cells obtained from the human cornea were immune characterized for P63 and vimentin markers. The limbal stem cells seeded on the surface of amniotic membrane and after treatment with platelet lysates, the viability of the cells was evaluated.Results: The viability rate was significantly increased at 24 hours, 72 hours, and 1 week intervals in the amniotic membrane treated with platelet lysate after the freezing process. The results of viability in Limbal stem cells indicated a significant increase at 24 hours and 72 hours after culture on the amniotic membrane fortified by platelet lysate. However, this increase was not significant during one week.Conclusion: The results of this study showed that platelet lysates could increase the viability amniotic membrane cells and limbal stem cells; thus, using the cultured limbal cell on amniotic membrane fortified by platelet lysates will be helpful to limbal cell defects cases.

Purpose: To evaluate result of Corneal graft (PKP) after cultivated oral mucosal epithelial transplantation (COMET) in patients with chemical burn.Methods: In this prospective interventional nonrandomized case series, optical PKP was performed after successful COMET for visual rehabilitation in patients with severe stromal opacity. Main outcome measures were clarity of the corneal graft, visual acuity improvement, and corneal graft survival.Results: Fourteen eyes of 14 patients with successful COMET were included. Overall, PKP was performed 7.6±1.3 months (6-9 months) after COMET. The mean follow-up period was 28.2±8 months (14-40 months, median 30 months). The time for complete epithelial healing was 7 days in all eyes. There was no epithelial defect in 13 eyes at the final examination. The corneal surface had been covered by a transparent epithelium without significant neovascularization. Bacterial keratitis developed in 1 eye due to persistent epithelial defect, which was healed with vascularization. Best-corrected visual acuity increased from 2.67±0.08 LogMAR preoperatively to 0.64±0.27 LogMAR after PKP (P<0.001). Four patients had Endothelial rejection that successfully managed by systemic and topical steroids. Overall and rejection-free graft survival rates were 92.9 and 69.2%, respectively.Conclusion: PKP is a good choice for visual rehabilitation in chemical burn with bilateral total LSCD and severe stromal opacity that underwent successful COMET.

Purpose: To evaluate the magnitudes and axis orientation of anterior corneal astigmatism (ACA) and posterior corneal astigmatism (PCA), the ratio of ACA to PCA, and the correlation between ACA and PCA in the different stages of keratoconus (KCN).Methods: This retrospective study comprised 161 eyes of 161 patients with KCN (104 men, 57 women; mean age, 22.35±6.10 years). The participants were divided into 4 subgroups according to the Amsler‑rumeich classification. A Scheimpflug imaging system was used to measure the magnitude and axis orientation of ACA and PCA. The posterior‑nterior corneal astigmatism ratio was also calculated. The results were compared among different subgroups.Results: The average amounts of anterior, posterior, and total corneal astigmatism were 4.08±2.21 diopters (D), 0.86±0.46 D, and 3.50±1.94 D, respectively. With‑he‑ule, against‑he‑ule, and oblique astigmatisms of the posterior surface of the cornea were found in 61 eyes (37.9%), 67 eyes (41.6%), and 33 eyes (20.5%), respectively; corresponding figures in the anterior corneal surface were 55 eyes (32.4%), 56 eyes (34.8%), and 50 eyes (31.1%), respectively. A strong correlation was found between ACA and PCA in the different stages of KCN (P 0.001, r= 0.839); the correlation was weaker in eyes with grade 3 (P 0.001, r=0.711) and grade 4 (P 0.001, r=0.717) KCN. The maximum posterior‑anterior corneal astigmatism ratio (PCA/ACA, 0.246) was found in patients with stage 1 KCN.Conclusion: Corneal astigmatism in anterior surface was more affected than posterior surface by increasing in the KCN severity, although PCA was more affected than ACA in an early stage of KCN.

Purpose: To determine the prevalence of refractive error and binocular vision abnormalities in deaf individuals.Methods: In this cross sectional study, a team of optometrists and social worker visited 158 deaf students at their schools and those who needed more detailed evaluation were referred to the Farabi Eye Hospital's strabismus clinic. These students in the selected schools underwent detailed visual acuity testing, refraction, binocular examination, color vision, and fundoscopy.Results: The percentage of ocular abnormalities in the deaf boys included in this study was 52.8%. The frequency of refractive errors in the present study was 39.9%. Astigmatism was the leading refractive anomaly (31%). Hypermetropia was found in 13.2% of the children and myopia was found in 12.6%. Anisometropia was detected in 30 children (19%) and amblyopia was found in 22 children (13.9%). A disturbance of ocular motility was present in 18 cases (11.3%). In 44 (28%) cases, stereopsis was reduced, and in 6 (3.8%) cases, it was absent. The majority of the students (89.9%) had congenital hearing loss and 6.3% of the children had color vision deficiency. Seventy-four deaf boys (46.8%) had a normal eye examination, while 84 (53.2%) cases had ocular problems, and 20 (12.65%) of them had more than one problem. The prevalence of refractive error, amblyopia, and strabismus was found to be significantly increased compared to the general population. In addition, the prevalence of ocular abnormalities generally increased with the severity of the hearing loss.Conclusion: We recommended that screening for ocular abnormalities should be made mandatory in hearingimpaired children and parents must be aware of the high prevalence of ocular abnormalities in deaf children, as they need appropriate visual sense to compensate their poor auditory sense.

Glaucoma is the leading cause of irreversible blindness and vision loss in the world. Although intraocular pressure (IOP) is no longer considered the only risk factor for glaucoma, it is still the most important one. In most cases, high IOP is secondary to trabecular meshwork dysfunction. High IOP leads to the compaction of the lamina cribrosa and subsequent damage to retinal ganglion cell axons. Damage to the optic nerve head is evident on funduscopy as posterior bowing of the lamina cribrosa and increased cupping. Currently, the only documented method to slow or halt the progression of this disease is to decrease the IOP; hence, accurate IOP measurement is crucial not only for diagnosis, but also for the management. Due to the dynamic nature and fluctuation of the IOP, a single clinical measurement is not a reliable indicator of diurnal IOP; it requires 24‑hour monitoring methods. Technological advances in microelectro mechanical systems and microfluidics provide a promising solution for the effective measurement of IOP. This paper provides a broad overview of the upcoming technologies to be used for continuous IOP monitoring.

Purpose: Report a case of iatrogenic medial rectus loss in exotropia surgery and its management with review literature.Case Report: A 14-year-old female with a history of cerebral palsy and left exotropia underwent strabismus surgery in another center when she was 7 years old. As her surgeon reported, after 8 mm medial rectus resection, it was lost and he could not retrieve it; so, to balance the forces of adduction and abduction, the surgeon disinserted left lateral rectus, but 2 months later, because of large angle exotropia and severe limitation in adduction, she was referred to this center. We explored the area and could not find the lost medial rectus; so, half tendon transposition of superior rectus and inferior rectus to the previous insertion site of medial rectus was performed and left lateral rectus was fixated to the lateral orbital periosteum. Two months after the operation, she was orthotropic and ocular movements were significantly balanced.Conclusion: Half tendon transposition of vertical recti to the site of lost medial rectus associated with periosteal fixation of lateral rectus can improve the strabismus of lost medial rectus muscle.

Purpose: To report a case of bilateral acute angle closure glaucoma after one dose of 75 mg oseltamivir.Case Report: A 37-year-old man with a history of influenza developed high intraocular pressure and uniformly shallow anterior chamber in both eyes 5 hours after receiving the first dose of 75 mg oseltamivir. The condition was successfully managed with topical cycloplegic and systemic/topical antiglaucoma medications.Conclusion: Since a presumed idiosyncratic reaction developed right after receiving the first dose of the medication, it challenges the common concept of adaptive immune system involvement in this type of reaction in medication-related ciliochoroidal effusion.