BINA
Year:2001 | Volume:6 | Issue:3|Papers Count:22

Purpose: To compare the results of standard and augmented surgical treament of patients with partial accommodative esotropia.Patients and methods: In this sequential matched randomized double blind clinical trial, 50 patients (100 eyes) with partial accomodative esotropia were studied at strabismus clinic in Farabi eye hospital, from 1999-2000. Age varied from 13 to 144 months. Patients were grouped according to age, degree of hyperopia and AC/A (accomodative convergenceaccomodation) ratio into standard and augmented subgroups (25 patients in each group). All patients were followed for at least 6 months after standard or augmented bimedial recession with or without inferior oblique weakening procedure. Post operative visual acuity, hyperopia, eye deviation, stereopsis, fusion and AC/A ratio were compared between the groups.Results: Post operative acceptable deviation was observed in 36% and 84% at first week (P<0.001), in 64% and 84% at sixth week (P<0.05) and in 88% and 92% at sixth month of follow up (NS) in patients of standard and augmented groups, respectively. Other findings in standard and augmented groups were as follows. Improvement of visual acuity (at least one line) in 8% and 20%, fusion in 8 of 13 patients (61.5%) and in 9 of 14 patients (64.3%), stereopsis in 2 of 13 patients (15.4%) and in 3 of 13 patients (23%), and reduction of AC/A ratio in all patients with high AC/A ratio, in both groups, which were not statistically significant.Conclusion: This study showed that augmented surgery improves longterm aligment, visual acuity, streopsis, and fusion greater than standard group, but statistically insignificant, which might be due to short duration of follow up and the small number of cases in each group.

Purpose: To determine the clinical findings associated with ocular hypertension or glaucoma in eyes with pseudoexfoliation syndrome.Methods: Phakic pseudoexfoliative eyes with no previous history of laser or incisional surgery and no other significant ocular pathology were selected by convenience sampling. Presence and severity of exfoliative deposits and pigmentary signs were carefully evaluated. The eyes were categorized as either ocular hypertensive/glaucomatous or nonglaucomatous based on use of medications, intraocular pressure and optic disc appearance. Logistic regression was used to determine clinical findings predictive of ocular hypertension or glaucoma.Results: One hundered-fifty eyes (104 patients, 72 men and 32 women) were included. Mean (±SD) age was 68.4 (± 6.3) years. Seventy-seven and 73 eyes were classified as hypertensive/glaucomatous and nonglacomatous, respectively. Of 15 clinical paremeters evaluated, only 2 were found to be significantly associated with OHT or glaucoma: inferior angle pigmentation (P=0/0000) and male gender (P=0.01).Conclusion: This study confirms the strong association of angle pigmentation with presence of ocular hypertension or glaucoma in pseudoexfoliation syndrome. Male seem to be at higher risk of developing ocular hypertension or glaucoma in association with pseudoexfoliation syndrome in this population. Further research on this subject would be warranted.

Purpose: To determine the results of trabeculecomy surgeries in Labbafinejad hospital during 1998-2000.Material and methods: This study is a descriptive non-comparative study on consecutive series of glaucoma patients for whom standard (coventional) trabeculectomy was performed and followed up for one year. The effects of age, type of glaucoma, history of previous ocular surgery and their frequency were evaluated on final surgical outcome and prognosis.Results: One hundred and thirty two patients were operated on. Twelve patients due to combination of surgery with cataract extraction and 53 due to inadequate follow up were excluded, so 67 eyes of 62 patients were evaluated. Age of the patients ranged from 3 to 74 years (38.93 ±25.4). There were different types of glaucoma, those not controlled by medical therapy were scheduled for trabeculectomy. Preoperative intraocular pressure was 28.9 ±10.3 mmHg with full medication, which decreased to 12.6 ±4.3 mmHg after one year post-operatively. Intraocular pressure was less than 21 mmHg in 83.6% of cases (success rate) with or without use of antiglaucoma medications. Major early complications were hypotony (59.7%) followed by choroidal effusion, shallow anterior chamber, hyphema and bleb leakage. Late complications were rise in intraocular pressure, bleb encapsulation, progression of cataract and hypotony maculopathy.Conclusion: The results of this study confirm that intraocular pressure can be controlled by trabeculectomy with low complication rate.

Purpose: To evaluate and compare the results of contact diod laser cyclophotocoagulation (DCPC) versus cyclocryotheraphy (CCT) in treatment of refractory glaucoma.Materials and Methods: This randomized clinical trial was performed on 73 eyes of 73 patients with refractory glaucoma. The patients were randomly categorized into two groups for undergoing one of the procedures. All of the patients were examined before intervention and the findings were recorded. After intervention patients were examined at determined intervals and the findings such as intraocular pressure, best corrected visual acuity, number of antiglaucoma medications, as well as complications secondary to the intervention were recorded and statistically analyzed.Results: Seventy-one patients including 36 in first group (DCPC) and 35 in second groups (CCT) completed the follow up. Intraocular pressure was 35.7±8.7 mmHg in the first group and 36±7.1 mmHg in the second group before the intervention that reduced to 18.7±6.7 mmHg and 18.3 ±6.6 mmHg respectively at the end of third month of follow up. Success rate in controlling intraocular pressure between 6-21 mmHg at the end of third month of follow up was 66.7% for the first group and 74.3% for the second. Most of the complications secondary to intervention were more prevalent in the second group.Conclusions: Short-term results of DCPC and CCT in the treatment of refractory glaucoma were comparable to each other but complications of DCPC were less frequent.

Purpose: To determine early intraocular pressure (IOP) changes after pars plana vitrectomy and evaluate the related factors.Patients and methods: In a clinical trial, the study was performed on 105 eyes of 105 patients who underwent pars plana vitrectomy. The patients were divided into four major groups: silicone oil-injected (63 patients), simple vitrectomy (16 patients), sulfur hexafluoride-injected (13 patients), and air-injected (13 patients). Preoperative and six consecutive post operative IOP measurements were done with applanation tonometer.Results: Considering all patients, mean preoperative IOP was 11.53 mmHg which increased by 8.85 after surgery, and maximum elevation occured 16 hours after the surgery. In the four study groups, mean IOP elevation was 11.94, 3.26, 6.64 and 2.58 mmHg, respectively and maximum IOP was recorded at 2-4, 6-8, 16, 24, 36, and 48 hours postoperatively. Post operative IOP increased to 21 mmHg or more in 66.7% of the patients. Factors associated with post vitrectomy IOP elevation included intraoperative silicone oil injection, SF6 injection, scleral buckling and development of fibrin in the anterior chamber postoperatively. Conclusion: IOP elevation is very commonly seen after pars plana vitrectomy, especially in silicone oil and SF6-injected patients. The optimal time for detecting the pressure rise differs with the type of substitutes injected at the conclusion of operation. Measuring the IOP in the above conditions is compulsory.

Purpose: To evaluate visual outcomes and Complications of Nd: Yag Laser Capsulotomy in Rasool-Akram hospital from 1998 to 1999.Methods: A descriptive study was done on 48 eyes of 45 patients who underwent Nd: YAG Laser posterior capsulotomy for posterior capsule opacification. The patients had complete ocular examination and fluorescein angiography or angioscopy before capsulotomy, and repeated if required.Results: Of 45 patients; 24 men and 21 women, ranging in age from 6 to 85 years (57±20 years), were followed for 6.5±2 (4-12) months. Visual acuity greater than 8/10 increased from 2.1% before to 58.3% after capsulotomy. The IOP before was 12.08± 2 mmHg which increased to 16.13 ±5 mmHg 4 hours after the procedure. Intraocular lens crack was seen in one eye and pits were observed in the majority of the cases. Severe complications were not seen after Capsulotomy.Concusion: The efficacy of Nd: YAG Laser capsulotomy in improving visual acuity was comfirmed. Complications were minimal.

Purpose: To evaluate the effect of Levodopa-Carbidopa on visual acuity in nonarteritic anterior ischemic optic neuropathy.Design: Randomized double blind placebo controlled clinical trial.Patients and Methods: Thirty-seven eyes of 35 patients with nonarteritic anterior ischemic optic neuropathy were randomized to receive Levodopa-Carbidopa 125/12.5 mg daily (18 eyes) or placebo (19 eyes) for 3 weeks. Change in visual acuity in Log MAR was the main outcome measure. The minimum followup was 6 months.Results: Despite apparently greater improvement in the treatment group (-0.35 Log MAR vs -0.22 Log MAR), this difference was not statistically significant (P= 0.37). Even after stratifying changes in visual acuity and exclusion of patients with initial visual acuity better than 20/40 ( 0.3 Log MAR), the difference still did not reach statistical significance (P= 0.63). Of interest, visual acuity improvement was positively correlated with optic nerve head hemorrhage (P= 0.01).Conclusion: Levodopa-Carbidopa 125/12.5 mg daily failed to show statistically significant greater improvement in visual acuity compared to placebo for patients with nonarteritic anterior ischemic optic neuropathy.

Purpose: To evaluate the different types of low vision and effectiveness of low vision aids on patients referred to Noor eye clinic from September 1999 to February 2001.Patients and Methods: This study was performed in two phases. Phase one was a descriptive study, while phase two was a before-after type clinical trial. Ability to read normal print, large print and to recognize faces was evaluated before and after using low vision aids. Results were analyzed by McNemars test. Correlation with etiology of low vision was also assessed.Results: Durring the study, 131 patients (67.93% male) in age of 54.5 ±29.6 years were evaluated. After using low vision aids, distance visual acuity better than 20/200 achieve in 67.8%; near visual acuity better than 20/200 occurred in 96.4%; and the ability to read normal print and large print changed from 8.6% to 94.8% and from 55.2% to 97.4%, respectively. Face recognition improved from 16.8% to 63.3% (p< 0.0001). Cases affected with Stargardts disease had the greatest improvement in reading ability. The rate of purchase and usage of different low vision devices was different, and the highest rate was 89.74% for recommended near telescopes.Conclusions: This study confirmed the effectiveness of low vision aids in increasing distance and near vision in low vision patients, however a high percentage of our patients refrained from using low vision aids. Analysis of socioeconomic and cultural factors is recommended.

Purpose: To determine the effect of preserved human amniotic membrane transplant in patients with persistent corneal epithelial defects.Methods: Glycerin preserved amniotic membrane used for 10 eyes of 10 patients with corneal epithelial defect and associated sterile ulceration due to different causes. Epithelial defects had persisted for a mean of 5.3 weeks (range 3-8 weeks).Results: In 7 eyes (70%), total epithelial healing occurred within a mean period of 14 days (range 11-21 days) with no recurrence after a mean follow up of 6 weeks (range 3-8 weeks). One eye had partial healing within 7 days but had been lost to follow up. Two eyes (20%) failed to heal after a follow up of 3 weeks.Conclusion: Amniotic membrane transplantation may be considered as a useful alternative method for treatment of persistent corneal epithelial defects associated with sterile ulceration which is refractory to conventional treatment.

Purpose: To determine the differential effect of Betadine 2.5% eye drops as a prophylactic agent in ophthalmia neonatorum.Materials and methods: This study was performed as a clinical trial including 466 neonates. The neonates were randomly divided into four groups. Three groups received 1-3 drops of Betadine 2.5%, 1-3 drops of sulfacetamide 10%, and tetracyline ointment 1% in both eyes within 30 minutes after birth, respectively; and the fourth group received no eyedrops or ointment (control group). All of the neonates were examined in the 3rd and 7th day after birth, and whenever during the first 28 days after birth the mother reported any kind of red eye or red eye discharge, reexamination was done.Results: Of the total 466 neonates, 105 cases showed conjunctivitis during the course of study. The occurance rate of ophthalmia neonatorum was 22.7% in the control group, 16.8% in the tetracycline group, 27.5% in the sulfacetamide group, and 23.3% in the Betadine group. These differences were statistically significant among the groups, but regarding the sex or age no significant differences were observed.Conclusion: According to similar drug effects, due to easy availability, lower cost, lower hypersensitivity rates in the newborns eyes, and the fewer reports of resistance; Betadine 2.5% eye drops can be used as a suitable substitute in prophylaxis of neonatal conjunctivitis.

Purpose: To define the causes of enucleation during the years 1988-98 in Labbafinejad hospital and to define the complications after the surgery.Materials and methods: This was a study of existing data that was performed on medical records of the patients who had enucleation.Results: of 169 patients, 73.4% were male and 26.6% were female. Median age of patients was 22.6 year (range 0.25 to 83). In 55.6%, the right eye and in 44.4%, the left eye were enucleated. The most common cause of enucleation was trauma (70.4%), and the most common tumor which led to enucleation was retinoblastoma (13%). The most common implant during 1988-93 was sphere ball (81.9%), but during 1993-98 was hydroxy apatite (66.6%). In 21.8% of patients a postoperative complication was present. Conclusion: Trauma is the most common cause of enucleation especially in young males, and protection from it is recommended, and retinoblastoma is the most common cause of enucleation in children, and the early diagnosis is recommended.

Purpose: To have an up-to-data review on the changes in retinal disorder induced by pregnancy.Material and methods: All existing relevant articles in Medline from the year 1978 to July 2000 with titles or subtitles of retinopathy, pregnancy, eclampsia, and pre-eclampsia were completely reviewed and classified.Findings: During normal pregnancy; definite hormonal, metabolic and heamatologic changes occur, which have a definite impact on all different parts of the body, in particular the eyes. Since the retina is the main part of the eye, it is not exempted from these changes. Some retinal diseases such as central serous chorioretinopathy and uveal melanoma are more commonly seen during pregnancy. The aggravation of their disorder like diabetic retinopathy is more commonly noticed as well. Other retinal diseases secondary to underlying systemic disorders like pre-eclampsia, eclampsia, or disseminated intravascular coagulation are more prominent during pregnancy or normal parturition.Conclusion: The development and aggravation of many retinal diseases and other abnormal conditions are more prominent during pregnancy. Pregnant women with underlying systemic disorders like hypertension and diabetes mellitus should have regular occular examinations and take specific ocular and medical management if needed.

Background and purpose: Cyclic strabismus is a type of strabismus occurring spontaneously or secondary to some other processes like ocular surgery. The cause is unknown and it can be treated with different methods like glasses, medications, or surgeries. The number of reported cases with this disease is limited. We report a rare case with complaint of diplopia who was referred to Labbafinejad hospital in 1997.Patients and findings: A 56-year-old woman with high myopia after cataract surgery and scleral buckling of right eye, and cataract surgery and prophylactic band of left eye, became diplopic with 24-hour intermittency in the form of esotropia and hypertropia. She improved after surgery while she had experienced the attacks for 7 years.Conclusion: It seems that these persons have a background of strabismus and have perodic improvement in alignment and binocular function. The surgery is very successful in these cases.

Purpose: To report a rare case of sphenoidal sinus mucocele in a young man presenting as retrobulbar optic neuritis.Patient and findings: A 28 year old man referred with a sudden loss of vision in his left eye since 2 weaks age. He complained of ocular pain during eye movements. Visual acuity was 20/20 in his right eye, and 1m CF in the left eye. There was a relative afferent pupillary defect and nearly complete loss of color perception in the left eye. Other ocular examinations were within normal limits. Fundoscopic examination showed a normal optic nerve. A diagnosis of retrobulbar optic neuritis was considered for the left eye, IV methylprednisolon, 1 gr daily (250 mg QID) was started. Visual acuity improved the next day. Brain and orbital MRI showed a homogenous mass in the left sphenoidal sinus, which confirmed by CT scan. After sinus surgery, visual acuity in the left eye improved to 20/20, and color perception became normal.Conclusion: Mucoceles arising from sphenoidal sinus are rare and may mimic signs of retrobulbar optic neuritis. In patients with retrobulbar optic neuritis, sphenoidal sinus mucocele should be considered.

Purpose: To report a case presenting with dacryoadenitis as the earliest manifestation of systemic Wegeners granulomatosis (WG). Patient and findings: We examined a 41 year old woman who initially presented the symptoms of bilateral dacryoadenitis. Upper and lower respiratory tract involvement, scleritis and keratitis evolved subsequently. Cytoplasmic antineutrophil cytroplasmic antibody titer was found positive. The lacrimal gland and lung biopsy were consistent with WG. The patient responded well to treatment with cyclophosphamide and prednisolone.Conclusion: Dacryoadenitis may be the earliest presenting manifestation of WG and by early administration of immunosuppressive chemotherapy, the disease may be controlled thus preventing the limited disease from progressing to a complete from and decreasing its morbidity and mortality.