BINA
Year:2006 | Volume:11 | Issue:4 (45)|Papers Count:30

Purpose: To determine the prevalence of ocular involvement in patients with tuberculosis (TB) infection.Methods: All patients with a new diagnosis of TB who were referred to Zahedan Tuberculosis Center underwent a complete ophthalmic examination. Any cases of known ophthalmic disease or previous ocular involvement were excluded from the study. Prevalence of ocular involvement with 95% confidence interval (95% CI) was calculated.Results: Out of 444 eyes of 222 TB patients, 19 eyes (4.3%, 95% CI: 2.6-6.6%) of 17 patients (7.7%, 95% CI: 4.5-12.0%) had some ophthalmic lesions ascribable to TB. The most frequent ophthalmic lesions were choroidal tubercles in 4 eyes (21.1%); interstitial keratitis and acute iritis each in 3 eyes (15.8%); chorioretinitis, peripapillary nodule and lid lupus vulgaris each in 2 eyes (10.5%); and retinal vasculitis, vitritis and lateral rectus paresis each in one eye (5.3%).The ocular Involvement was unilateral in 88.2%. Multiple logistic regression analysis revealed that only the duration of TB before treatment had direct correlation with ocular involvement (odds ratio=5.22, 95% CI: 1.57-17.35).Conclusion: The frequency of ocular involvement in TB in the study population is at least 3 times greater than other countries. Early treatment of TB can reduce ocular involvement and prevent other complications of the disease.

Purpose: To evaluate four southern provinces of Iran for trachoma by rapid assessment of trachoma (RAT) during 2004.Methods: This descriptive study was performed in rural areas of four probable contaminated provinces in south of Iran including Bushehre, Kerman, Hormozgan, and Sistan and Baluchestan. By multistage sampling, 5328 subjects including 4782 children aged 1-9 years and 546 adults were selected and examined based on the World Health Organization (WHO) protocol. Children were evaluated for presence of follicular and intense trachoma and adults were examined for presence of trachomatous trichiasis. Prevalence of these types of trachoma was determined and compared with acceptable WHO limits.Results: Only in Sistan and Baluchestan province, 7 cases of active follicular trachoma were observed equal to a local prevalence of 0.5% and a total prevalence of 0.15%. No case of severe trachoma was observed. Trichiasis was seen in 0.03% of adult subjects including 0.17% in Bushehr province and 0.03% in Kerman province. No trichiasis was detected in Hormozganor Sistan and Baluchestan provinces.Conclusion: The prevalence of active follicular trachoma and Trichiasis is less than the accepted level of WHO. There seems to be no need for nationwide intervention in this regard.

Purpose: To evaluate the visual and refractive outcomes of automated lamellar therapeutic keratoplasty (ALTK) in patients with keratoconus.Methods: In this prospective noncomparative clinical trial, ALTK was performed in 14 eyes of 14 patients with moderate to severe keratoconus. All patients were spectacle and contact lens intolerant.Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), spherical equivalent refraction (SE), and refractive, keratometirc and topographic astigmatism were evaluated preoperatively and at one, three, and six months postoperatively and also at least 2 months after complete suture removal. Minimum duration of follow up was 8 months.Results: The study included 9 male and 5 female subjects with mean age of 26.2±5.5 years (18-36 years). Mean UCVA was 1.2±0.16 LogMAR (20/300) preoperatively and 0.55±0.2 LogMAR (20170) at the last visit. (P<0.001) Mean BCVA was 0.8±0.2 LogMAR (20/120) preoperatively and reached 0.34±0.15 LogMAR (20/40) at the last visit. (P<0.001) Mean SE was -6.0±2.4 diopter preoperatively and -2.6±2.0 diopter at last visit. (P<0.001) BCVA2³20/40 was achieved in 64.3% of the cases and refractive astigmatism was within 4 diopter in 57% of the subjects at last visit.Conclusion: Although ALTK can be used for lamellar keratoplasty in patients with keratoconus, high post-op astigmatism is the major drawback.

Purpose: To evaluate bacterial and fungal contamination of donor corneas before and after Decontamination at Eye Bank of I.R. of Iran based on cultures.Methods: This descriptive study was performed on 131 donor eyes (whole globe or cut cornea) used for corneal transplantation at Labbafinejad hospital during 6-month period. Microbiologic culture was performed at three stages: before enucleation at the forensic medicine unit, after decontamination process at the eye bank and before transplantation in the at operation room. Prevalence of contamination with 95% confidence interval (95% CI) at each stage of the study was calculated.Results: Donor tissue included 60 (45.8%) whole globes and 71 (54.2%) preserved cut corneas. Cultures were positive in 92.2% (CI 95%; 89.8-98%) of specimens before enucleation, 7.6% (CI 95%, 2.1-12.1) after decontamination, and only in 3.1% (CI 95%; 0.1-6%) before transplantation. There was no case of postkeratoplasty endophthalmitis. Staphylococcus epidermidis was the most frequent organism found before enucleation (32.1%) and after decontamination (3.05%).There was no correlation between frequency of contamination and cause of death, preservation time, and death to enucleation time. Fungal contamination was found only in one specimen.Conclusions: The decontamination process of the eye bank of the I.R. of Iran seems to be effective. Endophthalmitis following penetrating keratoplastyis rare under standard operating room and eye bank methods. Staphylococcus epidermidis is the most frequent organism, cultured from eye bank specimens.

Purpose: To compare the efficacy and safety of topical mitomycin-C 0.01% versus dexamethazone phosphate 0.1% in patients with refractory vernal keratoconjunctivitis (VKC).Methods: In this double blind randomized clinical trial, patients with refractory VKC were randomly assigned to treatment with topical mitomycin-C 0.01% eye drops (N=27) or dexamethazone phosphate 0.1% (N=27), four times daily for 20 days. Symptoms including foreign body sensation, tearing, itching, mucous discharge and signs including conjunctival hyperemia, conjunctival giant papillae, limbal hypertrophy, and Trantas dots, were compared before after treatments between the two groups.Results: There was a statistically significant decrease in signs and symptoms in the mitomycin-C group at the end of 20 days of treatment such that two cases (7.4%) of the mitomycin group and 26 cases (96%) of the dexamethazone group required another medication. (P=0.000).Conclusion: Short-term low dose topical mitomycin-C may be considered for acute exacerbations of severe VKC.

Purpose: To evaluate the efficacy of sub-tenon block (preemptive analgesia) following general anesthesia and before the beginning of scleral buckling and cryopexy in retinal detachment (RD) surgery on decreasing intra-and post-operative complications.Methods: Sixty eight patients scheduled for RD surgical repair with ASA (American Society of Anesthesiologists) class I or II were enrolled in this clinical trial. The patients were randomly divided into two groups. Both groups underwent general anesthesia (GA), but one group received sub-tenon block as preemptive analgesia following induction of general anesthesia (treatment group). Intra-and post-operative (up to 24 hours) incidence of oculocardiac reflex (OCR), mean blood pressure (BP), heart rate (HR), post-operative ischemic heart disease (IHD) changes, nausea and vomiting (PONV), delirium, total analgesic consumption, severity of ocular pain, frequency of analgesic requirement, and duration of hospitalization were compared between the two groups.Results: There was no statistically significant difference between the two groups regarding age, sex, and preoperative blood pressure (BP) and heart rate. Mean BP of patients in the treatment group and the control group was 126.6/74.8 and 126.4/74.4 mmHg, preoperatively (P>0.2) and 126.4/76.4 and 134.6/74.4 mmHg, postoperatively (P=0.01). Pain complaint of any degree was more frequent in the control group such that 38% in the recovery room and 25% 6 hours after surgery complained of severe pain compared to none in the treatment group. (P=0.001) Incidence of delirium in the recovery room was 3.7% in the treatment group vs 24.1% in the control group. (P=0.001) Mean duration of hospitalization after surgery was 26.6±1.5 hr in the treatment group and 34.0±1.5 hr in the control group. (P<0.01)Conclusion: Sub-tenon block following induction of GA for RD surgery reduces intra- and postoperative complications effectively, therefore it is recommended for routine ophthalmologic procedures.

Purpose: To determine the visual and anatomical outcomes and complications of vitrectomy for non-traumatic non-diabetic vitreous hemorrhage (NDVH) and to report the causes of the condition among patients at Labbafinejad Medical Center, Tehran-Iran, from 1993 to 2003.Method: Records of patients who underwent vitrectomy for non-traumatic NDVH with 6 months follow-up were reviewed for demographic characteristics, causes of NDVH and results of surgery. Results: Fifty eyes (54.2%right eyes) of 49 patients (51% male) with mean age of 62.7±10.3 years Were enrolled in the study. Mean visual acuity (VA) was 2.36±0.52 LogMAR and relative afferent Papillary defect (RAPD) was positive in 91.7% of the eyes, preoperatively. Causes of non-traumatic NDVH detected intraoperatively were: branch retinal vein occlusion (56%), central retinal vein occlusion (16%), choroidal neovascularization (12%), and posterior vitreous detachment with break, Eales disease, familial exudative vitreoretinopathy, and Terson syndrome (eachin 4%). Mean VA increased significantly at 6th month (1.38±0.72 logMAR) compared to preoperative value. (P<0.0001) The most common causes of decreased VA were: macular pigmentary derangement (26%), optic atrophy (16%), severe lens opacity (12%), and epiretinal membrane (8%). Conclusion: Despite the statistically significant increase in mean VA following vitrectomy, underlying macular pathology limits significant improvement of central VA in most cases of non-traumatic NDVH.

Purpose: To determine the correlation between body mass index (BMI) and exudative age-related macular degeneration (ARMD).Methods: This case-control study was conducted on 60 patients with exudative ARMD and 60 controls, both aged over 50. Age, sex, cigarette smoking and blood pressure were evaluated beside BMI Data analysis was performed by SPSS software, version 9.0 using Pearson Chi square and t tests. Odds ratio (OR) with 95% confidence interval (95%CI) was calculate for over-weight (BMI > 25 kg/m2) and smoking.Results: Subjects were male in 66.7% of the case group and 43.3% of the control group. (P<0.01) Mean age was 71.0 and 71.4 years in the case and control groups, respectively. Mean BMI was 26.77 and 25.32 kg/m2 in the case and control groups, respectively. (P>0.05) There were 5% lean (BMI<20 kg/m2), 35% normal-weight (20£BMI£25kg/m2), and 60% over-weight subjects in the case group and 15% lean, 38.3% normal-weight, and 46.7% over-weight subjects in the control group. (P>0.05) Being over-weight did not predispose to exudative ARMD before (OR=1.71, 95% CI: 0.81-3.57) and after (OR=1.65, 95% CI: 0.73-2.6) omitting the smoking factor. Cigarette smoking was a significant risk factor for exudative ARMD (OR=10.54, 95% CI: 2.33-49.47).Conclusion: This study showed no significant relation between BMI and exudative ARMD.

Purpose: To evaluate the clinical manifestations and results of lensectomy in patients with hereditary lens subluxation at Labbafinejad Medical Center, Tehran-Iran from 1996 t 2003.Method: In an interventional case series, records of patients with hereditary lens subluxation who Had undergone lensectomy were reviewed. Patients with at least 6 months of follow up were included. Background disease, best corrected visual acuity (BCVA) before and after surgery, intraocular pressure (IOP), and post-operative refraction and complications were evaluated.Results: The study was performed on 87 eyes of 49 patients including 27 male and 22 female subjects. Mean follow up was 20±18 months. Background diseases included: Marfan syndrome (79.5%), Weill-Marchesani syndrome (8.2%), simple ectopia lentis (8.2%), and homocystinuria (4.1%). The most common indication for surgery was non-correctable refractive error (92.1%). Mean BCVA was 1.13 LogMAR preoperatively which improved to 0.26 LogMAR post-operatively (P<0.001). BCVA better than 20/40 was achieved in 82.8% of cases after surgery. Angle-supported anterior chamber intraocular lens (AC10L) was implanted in 85.1% of the eyes. Prophylactic band was applied in 63 eyes (72.4%). Retinal detachment developed in four eyes, which was successfully treated.Conclusions: Lensectomy with implantation of angle-supported AC IOL in patients with hereditary subluxated lens will improve vision significantly without significant complications.

Purpose: To evaluate and compare the results of different surgical methods for post-trabeculectomy bleb revision at Labbafinejad Medical Center, Tehran-Iran, from 1999 to 2003.Methods: This study was conducted on all patients who underwent post-trabeculectomy bleb revision due to hypotony [intraocular pressure (IOP) less than 6 mmHg] or bleb leakage. Surgical methods were: conjunctiva advancement. rotational conjunctiva flap and free conjunctiva graft. Bleb revision was performed in the cases of bleb leakageif the bleb hole was greater than 1mm or leakage could not be controlled within 1 to 2 weeks of conservative treatment. Bleb revision was performed in eyes with hypotony in cases with cataract development or progression or hypotony maculopathy or iridocomeal adhesion. Surgical success was defined as IOP between 6-21mmHg with a maximum of 2 topical antiglaucoma medications and discontinuation of leakage.Results: Twenty-seven eyes of 27 patients (17male, 10 female) with meanage of 37.8±15.2 years (9-37 years) were studied. Indication for surgery was bleb leakage in 22 cases (81.5%) and hypotonous maculopathy in 5 cases (18.5%). Mean IOP was 4.4±1.04mmHg preoperatively and 13.00±1.29mm Hg postoperatively. (P<0.001) Mean visual acuity was 0.9 LogMAR (20/160) before surgery and reached 0.6 LogMAR (20/80) after bleb revision. (P<0.002) Mean cup/disc ratio was 0.7 preoperatively which remained unchanged postoperatively. Conjunctival advancement was performed in 18 cases (success rate=72.2%). rotational conjunctival flap in 6 cases (success rate=66.7%) and free conjunctiva graft in 3 cases (success rate=66.7%). (P=0.73) Bleb revision was repeated in 2 cases due to continuous leakage. Mitomycin-C (MMC) and 5-fluorouracilhad been used during primary trabeculectomy in 62% and 7.6% of cases. respectively. In 19.6% of cases surgery was done without using ant metabolites and usage of ant metabolites was unknown in 11%.The average time between primary trabeculectomy and bleb leakageor hypotonia was 17 monthsin cases with prior use of MMC and 52 months in the cases with no antimetabolite usage (P<0.05).Conclusion: Post-trabeculectomy bleb revision using conjunctiva seems to be a successful method for control of leakage and prevention of complications of hypotony.

Purpose: To compare the outcomes and complications of mitomycin-C (MMC)trabeculectomy and Ahmed glaucoma implant (ACI) for treatment of aphakic glaucoma following congenital cataract surgery in children £16 years of age.Methods: In a randomized clinical trial, eligible children were randomly assigned to MMC trabeculectomy or ACI. Aphakia was due to previous anterior lensectomy and vitrectomy. Cases were excluded if cataract was due to persistent hyperplastic primary vitreous or intrauterine infections or if the patient had previous ocular surgery other than anterior lensectomy and vitrectomy. Fifteen eyes of 13 children with mean age of 9.1±4.1 year underwent MMC trabeculectomy and 15 eyes of 15 children with mean age of 10.9±5.1 year were treated with ACI. Results of surgery were classified as complete success (5<IOP£ 21 mmHg without any antiglaucoma medication) and partial success (IOP£21 mmHg with a maximum of two topical antiglaucoma agents) in the absence of any sight-threatening complication or further glaucoma surgery, stable cup/disc ratio and vision loss not greater than two Snellen lines; otherwise the surgery was considered as failed. The sum of complete and partial success was considered as overall success. Data was analyzed by SPSS software version 13 using T-test, Pearson Chi-square, and paired T-test.Results: Mean follow-up period was 14.8±11 months in the MMC trabeculectomy group and 13.1± 9.7 months in the ACI group. Complete, partial and overall success rates were 33.3%, 40%, and 73.3% in the MMC trabeculectomy group and 20%, 66.7%, and 86.7% in the ACI group, respectively. (P=0.361) Complication rates were 40% in the MMC trabeculectomy group and 26.7% in the ACI group. (P=0.439) The most frequent complication was choroidal effusion in both groups. The most common cause of failure was flat vascularized nonfunctional bleb in the trabeculectomy group and suprachoroidal hemorrhage in the ACI group.Conclusion: This study revealed that MMC trabeculectomy and ACI achieve comparable results in terms of success and complications in pediatric aphakic glaucoma with no previous glaucoma procedure.Selection between these two surgical procedures depends on surgeon's experience in addition to conjunctival quality and mobility.

Purpose: To assess the clinical course, determine the efficacy and safety of oral methotrexate in the control of intraocular inflammation and evaluate the outcomes of lensectomy-vitrectomy and goniosynechiolysis in pediatric VKH-associated panuveitis.Methods: In this retrospective non-comparative interventional case series, 10 patients (20 eyes) with pediatric VKH-associated panuveitis (onset of disease at age 14 years or younger) were studied. All patients underwent stepwise medical treatment consisting of oral prednisolone (0.5-1mg/kg), supplemented by oral methotrexate (5-7.5 mg/wk) in refractory cases. Surgical intervention was performed for complications such as visually significant cataracts and secondary glaucoma and included pars plana lensectomy-vitrectomy and peripheral anterior synechiolysis in a one-stage procedure. Control of inflammation, corticosteroid requirement, visual acuity, and intraocular pressure (IOP) were the main outcome measures. Results: Ten consecutive patients with minimum follow up of six months were analyzed. All patients were initially treated with oral corticosteroids; methotrexate was additionally required in six subjects. In all eyes, inflammation decreased and vision was preserved or improved. Side effects of methotrexate were mild and transient. Nine eyes of five patients underwent combined lensectomy and vitrectomy. The procedure was successful in all eyes without any exacerbation of inflammation. Eight eyes had elevated IOP, six of which underwent peripheral anterior synechiolysis at the time of lensectomy-vitrectomy. IOP was controlled after the procedure in all eyes with timolol only. Overall, final visual acuity was³20/40 in 30% of the eyes and <20/200 in only 20%.Conclusion: Pediatric VKH-associated panuveitis seems to follow an aggressive course; the rate of cataracts and secondary glaucoma seems to be high. Oral methotrexate is a safe and effective adjunct and displays steroid-sparing properties in the control of inflammation. Surgical interventions including peripheral anterior synechiolysis in addition to pars plana lensectomy and vitrectomy may be effective in controlling IOP in eyes with cataract and glaucoma.

Purpose: To determine the distribution of oculomotor, abducens, and trochlear nerve palsies in diabetic patients with ocular nerve palsy.Methods: This study was performed on all diabetic patients who referred to ophthalmology and neurology clinics at Yazd Medical Science University because of ocular palsy from March 2004 to October 2005. Signs and symptoms of the disorder were evaluated.Results: Palsies included oculomotorpalsy in 51/2%, trochlear palsy in 24.4%, abducens palsy in 19.5%, and simultaneous palsies in 4.9%. The most common symptoms were diplopia (85.4%), abnormal head posture (63.4%), blurred or disturbed vision (9.8%) and other problems 12.2%). The mostcommonsigns were exotropia (36.6%), hypertropia (24.4%), esotropia (19.5%) and mixed typedeviations (19.5%).Conclusion: The study revealed that more than half of diabetic ocular palsies are due to coulometer palsy and the main symptom in these patients is diplopia.

Purpose: To evaluate the ocular side effects of desferal in b-thalassemia major patients.Method: This cross-sectional study was conducted on 100 b-thalassemia major subjects. All patients under went complete ophthalmic examination, color vision test, and visual field evaluation.Electroretinography (ERG) was performed for 50 patients.Results: Mean patient age was 14.4 years, Only 9 patients complained from ocular problems Including nyctalopia (8 subjects) and permanent visual loss (one case), but eye examination revealed Abnormalities in 74 subjects including cataract in 43, fundus abnormality in 9; abnormal visual field in 71 with the most common abnormality being paracentral scotoma (64%), and abnormal color vision in 35 with the most common abnormality being tritanopia (81%). All patients had abnormal ERG with abnormal amplitude of "a" and "b" waves in scotopic phase. There was no significant Correlation between age, duration of desferal usage or serum ferritin with ocular findings. All Patients who received more than 40 mg/kg/day of desferal had ocular abnormalities.Conclusion: The main risk factor for ocular finding in desferal users is the dosage. ERG and perimetry are useful for early detection of ocular problems in these patients.

Purpose: To determine the normal values of bony inter- and intra-orbital distances in an Iranian adult population by orbital CT scan.Methods: The study was conducted on all adults who were referred to Farabi Eye Hospital from March 2003 to June 2005 for CT scan ordered for complaints unrelated to craniofacial or orbital abnormalities. Patients were excluded in the presence of any pathology of craniofacial bones, globes and orbits.Results: Four hundred CT scans (134 females, 266 males; mean age 36.9±16.7 years) were studied. Mean intertribal distance at the level of the posterior border of the frontal process of the maxilla was 2.30cm (1.8 to 3.5cm) in men and 2.17cm (1.5 to 3.2cm) in women. (p<0.01) This value at the level of orbital equator was 2.65cm (2-3.4cm) in men and 2.46cm (1.7-3.2cm) in women. (p<0.01)Conclusion: Normal values of orbital measurements in Iranian adults seem to be smaller than published standards. This fact should be considered for interpreting CT scans of the orbit.

The past decade has witnessed the revival of amniotic membrane transplantation (AMT) in ophthalmology. The importance of AMT is due to its ability to reduce scarring and inflammation and to enhance wound healing and epithelialization, and also its anti-microbial properties. Amniotic membrane has recently been used as a substrate for culturing limbal stem cells for transplantation. It has been used extensively in corneal disorders such as neurotrophic ulcers, persistent epithelial defects, shield ulcers, microbial keratitis, band keratopathy, bullous keratopathy, following photorefractive keratectomy, and chemical injury. It has also been used for ocular surface reconstruction in conjunctiva pathologies such as following surgery for ocular surface squamous neoplasia, pterygium, and symblepharon. The purpose of this review article is to describebasic structure and features of amniotic membrane, the preparation process it for transplantation, and its clinical applications in ophthalmology.

Purpose: To present two patients with acute corneal hydrops, superimposed with infectious keratitis using topical steroids.Patients and Findings: The first case was a 44-year-old man with acute corneal hydrops in his left eye which was on topical steroids for one week. Visual acuity was hand motion at presentation and there was a large epithelial defect with stromal infiltration and corneal edema on slit lamp examination. Corneal smear and culture were negative and the patient did not respond to aggressive antibiotic therapy. He underwent emergency tectonic corneal graft due to perforation and the eye was preserved. The second case was a 28-year-oldwoman, a known case of keratoconus with acute hydrops. She was using topical steroids and NaCl 5% for 4 days. Culture was positive for Gram-positive cocci. She underwent tectonic corneal graft, but endophthalmitis occurred which lead to phthisis.Conclusion: Acute corneal hydrops makes the eye more susceptible to superimposed infections. Topical steroids may aggravate this condition.

Purpose: To report a case of posterior ischemic optic neuropathy (PION) following percutaneous nephrolithotomy (PCNL).Patient and Findings: A 57-year-oldmalewho under went PCNL because of renal stone was referred due to painless bilateral visual loss to the level of light perception immediately after the operation. The patient had history of diabetes mellitus, hyperlipidemia, and mild anemia.Ophthalmic examinations were unremarkable and optic discs were pink and without any sign of swelling. Visual fields were severely affected, but neuro-imaging was normal. Within three months, visual acuity and visual fields improved dramatically and optic discs became mildly pale. The clinical course was typical for PION.Conclusion: PION is a rare cause of severe visual loss following surgery. Severe blood loss, hypotension, anemia, and position of the patient during surgery are the most important risk factors.This is the first report of PION following PCNL. Urologists, ophthalmologists and anesthesiologist should be aware of this entity, and rare possibility should be discussed with the patient before surgery. Preventive measures against PION should also be taken.

Purpose: To report a case of delayed corneal perforation secondary to topical diclofenac usage after myopic LASEK and review of literature.Patients and Findings: A 25-year-oldfemale with history of myopic LASEK 2 months before referred to her surgeon with epithelial defect, stromal thinning and infiltration. She was treated with antimicrobial medications for infectious keratitis for one week. She was then referred to Labbafi nejad Medical Center because of lack of response and progressive stromal thinning. Two days after admission, corneal perforation was occurred. Smear and culture of the cornea were negative. She had used topical diclofenac for 6 weeks. After discontinuing the topical medications and conservative measures (oral acetazolamide, patching, simple eye ointment) the perforation started healing.Conclusions: Prolonged use of topical non-steroidal anti-inflammatory drugs after surface ablation may lead to stromal melting and corneal perforation; therefore, such medications should be used cautiously in these patients especially in high risk groups such as rheumatoid arthritis, dry eye syndrome, ocular surface disorders and neurotrophic keratopathy.