BINA
Year:2006 | Volume:12 | Issue:1 (46)|Papers Count:23

Purpose: To evaluate the anatomic and visual results and complications of vitrectomy in eyes with diffuse refractory diabetic macular edema associated with a taut posterior hyaloid.Methods: This prospective interventional case series was conducted on 25 eyes of 22 patients with diffuse clinically significant diabetic macular edema, macular thickness greater than 250 microns on optic coherence tomography (OCT) and thickened posterior hyaloid. Best-corrected visual acuity (BCVA) and macular thickness measured by OCT were evaluated preoperatively and 3 and 6 months postoperatively. Macular perfusion was evaluated by fluoresce in angiography, preoperatively.Results: Mean BCVA was 1.14±0.51 Log MAR, preoperatively and 0.89±0.53 Log MAR6 months postoperatively (P=0.005). Mean preoperative macular thickness was 506±121.9 μm which decreased to 318±90.5 μm, postoperatively (P=0.001).Conclusion: Vitrectomy with removal of the posterior hyaloid membrane appears to be beneficial in some cases of diffuse persistent diabetic macular edema with a taut premacular posterior hyaloid unresponsive to laser therapy. Careful selection of eyes with favorable preoperative clinical characteristics may improve surgical outcomes.

Purpose: To evaluate the visual and anatomical outcomes and complications of vitrectomy with or without removal of internal limiting membrane (ILM) in idiopathic macular hole (IMH) at Labbafinejad Medical Center, Tehran-Iran, 1993-2003.Methods: Hospital records of patients who had undergone vitrectomy for IMH and completed6 months of follow up were reviewed for demographic data and outcomes of surgery.Results: The study was conducted on 30 eyes (46.7%right eyes) of 29 patients (69%female) with mean age of 65.2±5.6 years. Mean duration of symptoms was 3.2±3.7 months (66.7%less than 6 months). Preoperatively macular holes were in stages 2, 3, and 4 in 3.0%, 36.7%, and 33.3%, respectively. ILM removal was performed in 21 eyes (70%). Mean visual acuity was 0.99±0.6 LogMAR preoperatively which reached to 0.87±0.39 LogMAR postoperatively (P=0.05). Single operation anatomical success rate was 80% (24eyes) and final success rate was 86.7% (26 eyes). Retinal breaks developed in 3 eyes (10%) intraoperatively. ILM removal had no effect on increasing the rate of macular hole closure.Conclusion: ILM removal has no significant role on closure of IMH with less than 6 months of duration.

Purpose: To evaluate the efficacy of silicone oil injection after deep vitrectomy in infectious endophthalmitis regarding visual acuity.Methods: This single-blind randomized clinical trial was performed on 50 cases of infectious endophthalmitis undergoing deep vitrectomy. Patients were randomly assigned to two groups: in one group silicone oil was injected into the eye at the end of the operation (silicone group) and in the second group the eye was formed with balanced salt solution (non-silicone group). All patients were followed for more than six months.Results: The underlying cause of endophthalmitis was cataract surgery in 23 patients (46%), trauma in 20 patients (40%), bleb-associated endophthalmitis in 3 patients (6%), corneal graft in 2 patients (4%) and endogenous in 2 patients (4%). Mean visual acuity was 2.1 LogMAR in the silicone group and 4.0 LogMAR in the non-silicone group (p<0.0001).Conclusion: Silicone oil injection may be beneficial in terms of visual outcomes in deep vitrectomy for infectious endophthalmitis.

Purpose: To evaluate the effect of age, sex, type of surgery, extent of retinal detachment (RD), vitreous incarceration in wound, and myopic degeneration on the rate of retinal reenactment following RD surgery using eternal Weibull regression analysis.Methods: We performed a survival analysis on a multi-center randomized controlled trial conducted on patients with pseudophakic or aphakic RD to compare the anatomic outcome of scleral buckling vs primary vitrectomy alone. Patients were examined one week and then 1, 2, 4 and 6 months after the operations. We applied modification to the survival, density and hazard function and considered the two-parameter Weibull distribution for survival times. Herein we evaluated the appropriateness of the modified model vs unmodified model with and without the effects of covariates.Results: The mean survival time for the unmodified model was 2920 days confirming the eternal nature of the survivor function whereas the mean survival time for the modified model was 43.06 days. In the absence of covariates, the eternal proportion in the modified model was estimated to be 0.73. Taking the effects of covariates into account, the modified model revealed that the risk of reenactment is 76% higher among males than females and is almost 4 times greater in eyes with myopic degeneration, while this risk was 2.6 times for males and 2.7 times for those with myopia in the unmodified model. Moreover, vitreous incarceration in the wound played a significant role in the unmodified model whereas it had been set aside in the modified model. Comparing the two final models showed the superiority of modified model: -2 log Ĺm-(-2 log ĹUM)= 46.274 (P<0.001).Conclusion: This study strongly suggests the benefit of using the modified over the unmodified model of eternal Weibull regression analysis in situations such as the present study in which some cases will have the event of interest whereas others will never have the event, given enough time.

Purpose: To evaluate the incidence of pseudo exfoliation syndrome (XFS) in patients with senile cataract who were scheduled for phacoemulsification and intraocular lens implantation (PE+ IOL) and to compare the outcomes of PE+IOL between eyes with and without XFS.Method: We retrospectively reviewed 2200 eyes with cataract undergoing PE+IOL. All procedures were performed by a single surgeon (M.A.J) at a private clinic. Patients with XFS were considered as the case group and age and sex matched patients without XFS were selected as controls.Results: The incidence of XFS was 4.1% (90 eyes). Mean age was 71.8±7.1 and 70.7±6.7 yearsin the case and control groups, respectively. XFS was unilateral in 60% of the cases. The prevalence of hypertension, diabetes mellitus (DM) and diabetic retinopathy (DR) was 31.1%, 6.7% and 0% in the XFS group vs 42.9%, 26.6% and 5.2% in the control group, respectively (p< 0.05). Glaucoma was present in 25.6% of the XFS group and 6.5% of the control group (P<0.001). Vitreous loss occurred in one eye in each group; only one eye had zonular dehiscence in the XFS group. Iris stretching was performed during surgery in 11.1% in the XFS group and 1.9% in the control group (P<0.0001).Anterior capsule contraction occurred in 9.1% of the XFS group vs 0% in the control group (P= 0.007).Conclusion: PE + IOL in patients with XFS is as safe and effective as pure senile cataract. The incidence of DM and DR is significantly lower in XFS.

Purpose: To evaluate the efficacy and safety of Ferrara intra-stromalcorneal ring (FISCR) segments for keratoconus.Methods: The study was performed on 57 eyes of 44 patients with keratoconus and clear cornea who were contact lens intolerant. Subjects underwent complete ophthalmic examination before surgery. Objective and subjective refraction achieving the best visual acuity was used to determine the refractive error and Orbscan II corneal topography system provided the corneal data on pre- and post-operative visits. FISCR segments were implanted according to the manufacturer's monograms and standard surgical method.Results: Mean patients age was 26.7±6.8 years. Patients were followed for 2-14 months (mean,9 months). At last follow-up visit, mean±standard deviation improvement in main outcome measures were as follows: 5.4±3.65 D for spherical equivalent (P<0.001), 1.89±2.25D for magnitude of cylindrical error (P<0.001), 0.61±0.46 LogMAR for best corrected visual acuity (P<0.001), and 0.18±0.36 LogMAR for uncorrected visual acuity (P=0.002) The rings were removed and reimplanted in 3 cases due to inadequate depth and in one case because of suspected infectious keratitis.Conclusion: Implantation of FISCR segments is a safe and reversible procedure, particularly in contact-lens-intolerant patients with keratoconus whose only option is corneal transplantation.

Propose: To evaluate patients with renal transplantation for abnormal ocular findings and to determine the association of these findings with pretreatment dialysis duration, immunosuppressive regimen and underlying disease causing renal failure.Methods: This cross-sectional study was performed on 150 patients who had undergone kidney transplantation for at least three months and with serum creatinin < 3 mg/dl. All patients underwent ophthalmologic examination including visual acuity, slit lamp biomicroscopy and dilated funduscopy.Results: This study included 91 male and 59 female subjects with mean age of 39 years. No abnormal ocular findings was found in 10.7%; there was at least one ocular disorder in 89.3% including visual acuity ≤ 20/25 (48.6%), conjunctival degeneration in the palpebral fissure (36.6%), posterior subcapsular cataracts (24%), pinguecula (17.3%), pigmentary retinal epitheliopthy (14%), arteriovenous crossing changes (8.6%), proliferative diabetic retinopathy (6%), central serous chorioretinopathy and retinal vein occlusion (each in 3.3%) and non-proliferative diabetic retinopathy, optic nerve atrophy and significant macular edema due to diabetes (each in 2.7%).Abnormal ocular findings had no correlation with underlying disease and cyclosporine or prednisolone usage but significantly increased with increase in transplant duration, pre-transplantation dialysis duration and azathioprine or mycophenolate mofetil consumption.Conclusion: Ophthalmic disorders are frequent in renal transplant patients, therefore periodic ophthalmic evaluation is strongly recommended.

Purpose: To evaluate the relationship between central corneal thickness (CCT) and optic disc area inpatients with primary open angle glaucoma (POAG).Methods: The study was performed on patients with POAG who were being followed at Johns Hopkins Hospital. All patients underwent thorough eye examination, optic disc imaging with the Heidelberg Retina Tomograph II (HRTII), and ultrasound corneal pachymetry. Exclusion criteria were prior ocular surgery and low-quality HRT II images (HRT standard deviation> 50). SAS version 8.1 was used to generate Pearson correlation coefficients (r).Results: Of 199 eyes of 152 participants, 57 eyes met the inclusion and exclusion criteria of the study. Mean CCT was 530.7 +/- 35.5 microns. Black subjects had thinner corneas (blacks=520 microns, whites= 546, others= 550, p < 0.05). White subjects had smaller discs (Whites' mean disc area=1.84mm2, blacks=2.44, others=2.38P=0.0003). Univariate analysis revealed that CCT is inversely correlated with optic disc area (r = -0.215,P= 0.12, n= 53). After including all HRT images with standard deviation< 100, a statistically significant correlation was observed among white subjects (r= -0.282,P= 0.02, n= 60).Conclusion: Our findings demonstrate that optic nerve size might have some correlation with central corneal thickness. It may be that the protective effect of thicker corneas is not solely due to mis-measurement of IOP, but may also be an indication of more robust optic nerve head tissue.

Purpose: To evaluate the effect of oral tranexamic acid, oral prednisolone and placebo on prevention of recurrent hemorrhage in traumatic hyphema.Methods: This randomized placebo-controlled double-blind clinical trial was performed on 182 subjects affected by hyphema after blunt trauma. The patients were hospitalized for at least 5 days and were randomly assigned for receiving oral tranexamicacid (75mg/kg/day; 3 divided doses), oralprednisolone (0.8mg/kg/day; 2 divided doses) and oral placebo (3 times a day). Recurrent hemorrhage was measured during the course of hospitalization.Results: Rebleeding was significantly more frequent in the placebo group (26.7%) versus the prednisolone (15.0%) and tranexamic acid (13.3%) groups (P=0.0032%), but there was no statistically significant difference between the two latter groups.Conclusion: There is no significant difference between oral prednisolone and tranexamic acid in reducing the rate of rebreeding in traumatic hyphema.

Purpose: To determine the efficacy of primary placement of a titanium sleeve and peg on hydroxyapatite (HA) orbital implants.Methods: This retrospective non-comparative interventional case series was performed on 34 patients undergoing nucleation. A standard enucleation technique with primary HA implantation was performed, in which titanium sleeve and peg were placed primarily during the initial surgery.The patients were visited one, three and six months after placement of the prosthesis for evaluating complications and prosthesis movement.Results: Twelve patients (35.3%) had one or more complications including discharge (26.4%), peg drilled off center (23.5%), conjunctiva overgrowth (11.8%), implant and peg exposure (each in 8.8%) sleeve extrusion, conjunctiva thinning, peg on an angle and conjunctiva cyst (each in 5.9%) and sleeve obstruction (2.9%). Movement of the prosthesis (2-3+) was achieved in 97% of the cases in supraduction, introduction, abduction and adduction.Conclusion: Primary peg placement at the time of enucleation with the HA implant is a promising technique with relatively minor complications.

Purpose: To compare the range of motion of hydroxyapatite (HA)and porous polyethylene (Medpor) ocular implants in enucleated eyes.Methods: This comparative study was performed on records of 34 patients who underwent Unilateral nucleation and implantation of hydroxyapatite (13 cases) or Medpor (21 cases). The two groups were compared regarding age, gender, cause of enucleation, laterality, and movement.Results: Patients were male in 55.9%. Mean age of patients was 29.7 year (1-61 years). The most common cause of enucleation was trauma (55.9%) and the most common complication was mucopurulent discharge (14.7%).There was no case of extrusion, migration or exposure. Moderate to good motility was achieved in 89.3% of patients in the Medpor group and 86.6% in the HA group. There was no statistically difference between the two group regarding upward movement (P=0.68), downward movement (P=0.62), adduction (P=0.17) and abduction (P=0.65).Conclusion: Medpor and hydroxyapatite ocular implants are comparable regarding range of motion.

Purpose: To evaluate the clinical manifestations and surgical results in patients with double elevator palsy operated at Labbafinejad Eye Center from 1993 to 2004.Methods: The study was conduct on hospital records of 20 patients with double elevator palsy. Patients were classified in three groups including primary elevator muscle palsy (9 subjects), primary supranuclear palsy with secondary inferior rectus restriction (4 subjects) and pure inferior rectus restriction (7 subjects) according to results of forced duction test (FDT), force generation test (FGT) and Bell's reflex. Patients in the first group underwent Knapp procedure, the second group underwent Knapp procedure and inferior rectus muscle recession simultaneously and the third group underwent vertical recess-resect or mere inferior rectus recess operation. Success was defined as deviation≤5 PD for correction of deviation and ≥25% improvement in muscle restriction after all strabismus operations.Results: The patients included 10 male and 10 female subjects with mean age of 12.6yr (1.5-32yr).Mean follow up period was 22±20 months. Mean pre- and post-operative deviations were 32±8 PD and 3.8±8 PD (P<0.0001) and mean muscle restrictions before and after operation were -3.5±0.7 and -2.3±1.2 (P<0.0001) respectively. Overall success rate was 77% for correction of deviation and 80% for improvement in muscle restriction.Conclusion: Appropriate surgery must be individualized in patients with double elevator palsy.FDT, and FGT and Bell's reflex evaluation are useful to determine the underlying pathology and determine the optimal surgical procedure in each case.  

Purpose: To determine the nature and types of household eye injuries.Methods: We prospectively analyzed data from 100 consecutive patients with household eye injuries (104 eyes) referred to emergency room of Farabi Eye Hospital during October 2003.Standardized international classification of ocular trauma (Birmingham Eye Trauma Terminology) was used for classification.Results: Household ocular trauma represented 4.85% of all ocular emergencies (2061 patients) referred to the emergency room during that period. Male to female ratio was 1.13 and mean age was 26±18 years (range, 1-73). The cornea was involved in 50.0% and the sclera, lens, and retina each was involved in 4.8%. There was severe visual loss (best-corrected distance visual acuity< 20/200 due to trauma) in 4% of the patients. The most frequent household ocular injury was globe injury (93.7%) including mechanical (72.1% closed and 4.8% open), chemical (14.4%) and thermal (1.9%) injures.Conclusion: Closed mechanical injuries were the most common type of household ocular injury in our series. Considering the high rate of household eye trauma, more effective preventive measures should be taken at home.

Purpose: To report a patient with pretarsal dermoid cyst.Patient and findings: A 2.5-year-oldgirl presented with a pretarsal upper lid mass and underwent excisional biopsy A 1.0×1.0cm cystic mass attached to upper lid tarsus was completely excised.Pathologic study of the specimen revealed a dermoid cyst.Conclusion: Although pretarsal dermoid cyst is rare; it should be considered in all cases with mass lesion in the pretrial lid.

Purpose: To report a case of butterfly-shaped macular dystrophy.Patient and Findings: A 34-year-old woman presented with metamorphopsia in both eyes from 2 years ago. Visual acuity was 9/10 in right eye and 10/10 in left eye. There was no pathologic finding on slit lamp biomicroscopy and funduscopy other than mild macular retinal pigment epithelium mottling. Visual fields and electroretinogram were normal but electrooculogram showed sub-normal results. Fluoresce in angiography showed black, non-fluorescent butterfly-shaped macular structures.Conclusion: Butterfly-shaped macular dystrophy occurs in middle aged subjects and presents with mild visual loss and metamorphopsia. It is slowly progressive and leads to marked visual acuity reduction in older ages. Considering the paucity of clinical findings, fluoresce in angiography and/or electrophysiological tests are recommended for making a correct diagnosis.

Purposes: To report a case of primary graft failure (PGF) and systemic manifestations of herpes simplex virus (HSV) infection following transplantation of an HSV-contaminated donor cornea.Patient and Findings: A 28-year-oldmale with history of penetrating keratoplasty 12 days before, developed intraocular inflammation with marked anterior chamber reaction, graft edema and elevated intraocular pressure (IOP) together with systemic manifestations such as fever and unilateral cervical adenopathy. Systemic manifestations resolved after a few days but the graft edema was persistent. Regraft was performed after 3 months and the previous donor tissue was evaluated by PCR for cytomegalovirus (CMV) and HSV and was positive for HSV.Conclusion: HSV may be a cause of PGF, which can be transmitted by a contaminated donor cornea to the recipient. This condition may also lead to systemic symptoms.