BINA
Year:2004 | Volume:9 | Issue:2 (34)|Papers Count:12

Purpose: To determine the long-term visual and mortality outcomes of endoresection for treatment of malignant posterior choroidal melanoma.Methods: This before and after clinical trial included 20 eyes of 20 patients with a diagnosis of posterior choroidal melanoma confirmed by indirect ophthalmoscopy and A and B ultrasonography. All tumors were medium sized according to measures of Collaborated Ocular Melanoma Study and no one had extra ocular metastases. After obtaining informed consent, the eyes underwent vitrectomy and endoresection of the tumors. Characteristics of the patients and tumors, visual acuity before and after surgery, intraoperative and postoperative complications, and enucleation rates were recorded. Patients were followed for 22 to 108 months (mean: 67.4±36.1). Results: Of 20 patients, 13 (65%) were male. Mean age was 47.1±16 years. Overall, 5 (25%) eyes were enucleatedincluding 2 eyes (10%) due to severe intraoperative bleeding, 1 eye (5%) due to recurrence of intraocular melanoma, 1 eye (5%) because of a new focus of the tumor, and 1 eye (5%) secondary to intolerable pain. Final visual acuity of 15saved eyes was 20/200 in one eye (6.7%), counting fingers in 8 eyes (52.3%), hand motion in 3 eyes (20%), and no light perception in 3 eyes (15%).Conclusion: Endresection of posterior choroidal melanoma is a reasonable globe saving treatment modality. Distant metastasis of choroidal melanoma is an infrequent result of this procedure.

Purpose: To determine normal values of Hertel exophthalmometryin children, teenagers, and adults in Tehran.Methods: In a population-based epidemiological study, ocular protrusion was measured in 1063 randomly selected (stratified sampling method) normal subjects of Tehran. Hertel exophthalmometry was performed in all by a singe oculoplastic surgeon. Subjects were divided into 3 age groups: children (6-12 years), teenagers (13-19 years), and adults (20-70 years). Data were analysed using two-tailed paired t-test, independent sampled-test and linear regression test.Results: The age range was 6 to 70 years (mean: 20.3±10.9) and 601 (56.5%) were male. Mean absolute exophthalmic value was 14.2±1.8 mm in children, 15.2±1.9 mm in teenagers, and 4.7±2.3 mm in adults. Increase in age had a statistically significant effect on the exophthalmic value (r = +0.32 for children,+0.01 for teenagers, and-0.30 for adults; P<0.01). Relative exophthalmic value was less than 2 mm in all subjects. Conclusion: The normal exophthalmic value had positive correlation with increase in age up to 20 years old and negative correlation thereafter. There was a positive correlation between the base and increase in age of all age groups.

Purpose: To comparethe intraocularlens (IOL) power, keratometricvalues, and axial length of both eyes.Methods: In a case series, 100 patients were selected by simple randomized sampling. Keratometry was performed by Goldman keratometer, axial length was measured with contact method, and PC IOL power was calculated with A constant 118.5 by SRK II formula in both eyes of all patients.Inclusion criteria were axial length of 22-26mm, anisometropia≤0.50 diopter, age 2≥15 years, and good patient cooperation. The values of both eyes were compared and statistically analysed.Results: Keratometry, axial length, and intraocular lens power of fellow eyes had no clinically significant differences. Axial length of eyes in men was significantly longer than women. Mean keratometric values of women's eyes was significantly more than men. There was no significant difference in intraocular lens power between men and women. The IOL power difference was≤1 diaper in 89% of cases and≤2 diapers in 99%. The IOL power difference was 0.61±0.65 diopter in women and 0.45±0.53 diaper in men which was not statistically significant.Conclusion: There are usually acceptable results of IOL power calculation by using fellow eye criteria. This can be used in medium sized eyes with less than 0.5 diaper anisometropia. Sometimes there is a surprise result, which may be related to precision of used formula or experience of exammer.

Purpose: To evaluate the therapeutic effect of propranolol in central serous retinopathy (CSR).Methods: In a double-blind clinical trial, 60 patients with CSR were randomly divided into two groups: 1) propranolol (treatment) group which received propranolol 20 mg bid and 2) placebo (control) group. Main outcome me asures were the time for full clinical resolution, final visual acuity, and rate of final visual acuity of 10/10, which were compared between the two groups with student's t test and X2 test.Results: Mean clinical resolution time was shorter in the treatment group than the control group (62±29 days vs 89±44 days, P<0.05). Final visual acuity and rates of final visual acuity of 10/10 were not statistically different between the two groups.Conclusion: Propranolol reduced the clinical resolution time of CSR but had no effect on final visual acuity.

Purpose: To determine the success rate of scleral buckling without retinopexy in patients with primary retinal detachment.Methods: In a before-after clinical trial, 24 patients who had primary retinal detachment with PVR grade A or B underwent scleral buckling surgery with encircling band without retinopexy.Results: Sixteen (66.7%) patients were male and 8 (33.3%) were female. Mean age of the patients was 43.5 years (range, 22-73). Seventeen (70.8%) were phakic and 7 (29.2%) were pseudophakic or aphakic. Anatomical success rate was 100% intraoperatively. However, within 1-14 weeks redetachment occurred in 11.8% of phakic and 43% of pseudophakic or aphakic eyes. Reattachment was achieved in 4 patients by SF6 injection and laser application. Overall final success rate was 95.8%, but in phakic eyes it was 100%. Only 1 pseudophakic eye required pars plana deep vitrectomy, endolaser, and SF6 injection. All cases who underwent reoperation had attached retina up to end of the study with mean follow up of 53 months.Conclusion: Encircling scleral buckling surgery without retinopexy in phakic patients with primary retinal detachment and PVR grade A or B is safe with acceptable results but the results are guarded in pseudophakic or aphakic patients and needs more investigation.

Purpose: To determine tear secretion changes after prescribing cyclosporine as an Immunosuppressive agent in patients receiving allograft kidney transplantation.Methods: Patients with end stage renal failure who underwent kidney transplantation at Namazi Hospital, Shiraz, from September 2000 to January 2001 were included in the study. Shirmer II test (4 minutes) using local anesthesia was performed in both eyes before and 3 times after receiving cyclosporine.Results: Fifteen patients (8 males and 7 females) with mean age of 32.2±2.96 years were evaluated.Tear secretion increased from 18.83±0.953 mm/4min (measured 1-7 days before prescribing cyclosporine) to 28.433±1.564 28.633±1.267 and 28.467±1.369 mm/4min at 1, 3, and 5 months after prescribing cyclosporine, respectively (P<0.001).Conclusion: There was a statistically significant increase in tear secretion of patients receiving kidney transplantation and systemic cyclosporine's an immunosuppressive agent. Increased tear secretion continued during 6 months follow-up and can be considered as a favorable side effect of cyclosporine. The increased tear secretion was also observed in patients with normal levels of tear secretion.

Purpose: To evaluate the effect of simultaneous surgical and medical treatment on cases with late filtering bleb leakage.Methods: The study was a comparative clinical trial including patients who had late filtering bleb leakage unresponsive to medical treatment after glaucoma filtering surgery with blurred vision and tearing. They underwent surgical bleb revision by conjunctiva advancement or free antilogous conjunctiva graft in association with nonsurgical therapy including pressure patching and systemic acetazolamide 250 mg/6 hrs for five days. Patients were followed up for at least three months and measures of success were controlled leakage and increase of intraocular pressure to more than 6 mmHg. Complications such as bleb infection, endophthalmitis, etc. were recorded.Results: The study was performed on 12 patients including 7 males and 5 females with a mean age of 51.5±10.7 years, and mean follow up of 9±5.4 months.Postoperatively, leakage ceased perfectly in all patients after a mean duration of 1.7±1 days. Preoperative intraocular pressure was less than 6 mmHg (2.7±2.1 mmHg) in all patients which rised to more than 6 mmHg (17±6.4 mmHg) in all 14 (P<0.0001). Postoperative intraocular pressure was under control without any medication in 8 cases, with 1 drug in 1 patient, and with 2 drugs in 1 patient, but was not controlled in 2 patients even with 3 drugs. Complications such as bleb infection, endophthalmitis, peripheral anterior synechia, cataract, maculopathy, and permanent hypotonia were not seen during the follow up period.Conclusion: It seems that simultaneous surgical and medical therapy of late filtering bleb leakage is more effective than each alone.

Purpose: To evaluate the late concurrent ophthalmic and respiratory complications of mustard gas exposure in warfare patients in the department of medical consultations of Bonyade Janbazan of Iran.Methods: In this descriptive study, we evaluated 500 males patients aged 30 to 50 whose mustard gas injury period was more than 10 years. The complications were classified as mild, moderate, and severe.Results: Out of 500 patients, 48% were aged 30-35, 27.2% lived in a humid climate. Mustard gas exposure occurred once in 82.2%, twice in 12.2%, three times in 1.8%, and more than 3 times in 3.8% of the cases. They used ophthalmic, respiratory, and dermal medications in 77.2% and 99.2% had dermal complications. The degree of ophthalmic complications was mild in 80%, moderate in 13.2%, and severe in 6.8% and the degree of respiratory complications was mild in 69.2%, moderate in 19.8%, and severe in 11.6%. Late respiratory complications were significantly more than ophthalmic ones.Conclusion: Late moderate and severe respiratory complications were more than common ophthalmic lesions, but mild late ophthalmic complications were more common than respiratory ones.

Cataract is a major cause of blindness worldwide. Although preventive measures have been inadequate, its management and treatment have undergone great refinements over the past few decades so that 20/20 distance and near vision on the first postoperative day is not surprising nowadays. Cataract surgery is greatly dependent on instruments and technique. What we consider as modern and updated today may seem primitive and obsolete in the future. The present article reviews changes in cataract surgery over the past 20 years. We should bear in mind that technological advances should be proven of their superiority and practical efficacy prior to becoming popularized.

Purpose: To report a case of primary orbital liposarcoma presenting with a conjunctiva mass. Patient and findings: A 45-year-old female peresented with a mass in left caruncle. She underwent incisional biopsy of the caruncle and orbit. Pathologic examination of the specimen revealed liposarcoma. One year later she presented with expansion and progression of the tumor and exenteration was performed. Conclusion: Although rare, liposarcoma should be considered in the differential diagnosis of conjunctiva land orbital masses.

Purpose: To report a case of giant osteoma of the frontal sinus with involvement of the orbit, intracranial cavity, and frontal bone.Patient and findings: A 23-year-oldman presented with downward and lateral displacement of the left globe, upper lid fullness, frontal disfiguration, and diplopia. Clinical examination and CT-scan revealed giant osteoma with involvement of the frontal sinus, orbit, intracranial cavity, and frontal bone. Osteoma of the orbital and frontal bone was removed by two separate operations. Visual and cosmetic signs improved.Conclusion: Good cosmetic and visual results can be obtained with surgical removal of giant osteomas of the orbit.