BINA
Year:2018 | Volume:24 | Issue:1 |Papers Count:11

Purpose: To determine the prevalence of demodex infestation in patients with chronic blepharitis versus normal subjects in Iranian population. Methods: In this case-control study, 203 consecutive patients in Torfeh and Labbafinejad Hospitals in Tehran in 2017 were enrolled and the prevalence of demodex infestation in patients with chronic blepharitis (n=102 patients) versus normal population (n=101 subjects) was determined. Demographic data, Clinical signs and symptoms was documented for every subject. Lash sampling was performed by epilating the lashes. Every eyelash has cylindrical dandruff was chosen to epilate. totally four lashes were collected from each patient, two lashes from superior eyelid and two from inferior eyelid. Then the collected lashes were inspected for Demodex based on morphology using a light microscope at the magnification 40 and 100. The time interval between sampling and observation was less than 12 h in all cases. The main outcome measure was the prevalence of demodex infestation in each study group Results: The prevalence of Demodex in total study group is 26. 1% and the prevalence in blepharitis group is 26. 5% and in control group is 25. 7% without statistically significant difference (P > 0. 05). Demodex presence was related to older age, cylindrical, and some clinical symptoms such as ocular burning, and itching (P>0. 05). Conclusion: Totally, according to the obtained results it may be concluded that demodex infestation may not related to chronic blepharitis significantly. Prevalence of demodex infestation was increased by aging and it has negative association with oily scales.

Purpose: Comparison of serum vitamin D levels in patients with dry eye syndrome and control group in patients referring to ophthalmology clinic Al-Zahra of Hospital in 2016. Methods: This case-control study was conducted in 2016 on 80 patients with a dry eye syndrome referring to ophthalmology clinic Al-Zahra of Hospital. The data were collected, using information forms and analyzed, using SPSS v. 22. Results: In this study, 80 patients were evaluated. 60% of the patients were male and the mean age of the patients was 44. 5± 11. 28 years. Mean vitamin D level was 20. 86± 10. 88 ng/dl, which was not statistically different between the case and control groups. There was not a significant relationship between age and gender of the patients with vitamin D level. Vitamin D level had a significant inverse relationship with OSDI (Ocular Surface Disease Index) (r=-0. 48, P=0. 002). Conclusion: In this study, the severity of eye dryness based on the OSDI test was inversely related to the serum vitamin D level. Low serum vitamin D level may play a role in pathogenesis of dry eye.

Purpose: To evaluate the effect of orbital steroid injection in patients with active thyroid ophthalmopathy resistant to or dependent on systemic steroids, or with complications related to systemic steroids. Methods: This prospective study was conducted on 31 eyes of 17 patients affected with active thyroid ophthalmopathy and clinical activity score of 3 or more without compressive optic neuropathy or overt exposure keratopathy. All subjects had a history of previous systemic steroid use with steroid resistance or dependence, or had developed complications related to steroids. A combination of steroids including triamcinolone 20 mg and dexamethasone 4 mg was injected in the upper and lower retroseptal orbital spaces 3 or 4 times at 1 month intervals. The patients were examined periodically after the injections and at least 3 months after the last injection; if the disease became quiescent, surgical procedures would be performed as needed. Results: Mean preinjection clinical activity score (CAS) was 5. 2± 1. 3, which was reduced to 1. 6± 1. 2 after the 4th injection (p<0. 001). Upper and lower lid retraction improved in 100% and 68. 2% of affected eyes for 1 mm or more; lagophthalmos improved significantly in 64. 3% of the cases, and strabismus completely resolved in 1 of 5 affected patients and the most significant improvement was observed in supraduction. Mean improvement in proptosis was 1. 2± 1. 1 mm. Visual acuity did not significantly change after the injections. Eyelid ecchymosis and/or subconjunctival hemorrhage was seen in 6. 5% of eyes and intraocular pressure rise occurred in 8. 8% of eyes, which responded to topical medications. Conclusion: Orbital steroid injections can be used for treatment of active thyroid ophthalmopathy when the patient is resistant to or dependent on systemic steroids, or has developed complications of systemic steroids. CAS, lid retraction, lagophthalmos, ocular movements, and proptosis improved after treatment, but visual acuity was unaffected.

Purpose: To evaluate the effect of suture removal on refraction and keratometry measurements after deep anterior lamellar keratoplasty (DALK) performed in patients with keratoconus. Methods: This retrospective study was conducted on 54 keratoconus-affected eyes that underwent DALK. A combined suturing technique consisting of a 16-bite single running and 8-bite interrupted 10-0 nylon sutures was used at the time of keratoplasty. Selective interrupted suture removal was performed before complete suture removal in a subgroup of patients to reduce post-keratoplasty astigmatism. In another subgroup, all sutures were removed at a single session. The stitching of Running sutures did not occur in any patient. The effect of suture removal on refraction and keratometry readings was investigated in the entire study group, and the two subgroups were compared. Results: The mean patient age was 26. 6± 6. 7 years at the time of keratoplasty. The mean interval from surgery to complete suture removal was 17. 4± 5. 9 months. Compared to the pre-suture removal values, there was a significant increase in the magnitudes of spherical equivalent refraction (-1. 12± 1. 73 D; P=0. 001), refractive astigmatism (-0. 89± 2. 47 D, P=0. 04), mean keratometry (1. 39± 1. 64 D, P=0. 001), and keratometric astigmatism (2. 61± 2. 43 D, P<0. 001) after complete suture removal. Subgroup analysis revealed that postkeratoplasty astigmatism could not be decreased effectively by the selective removal of interrupted sutures. Conclusion: Complete suture removal was followed by an unpredictable and significant increase in post-DALK refraction and keratometry readings. Corneal graft astigmatism could not be decreased significantly with selective removal of interrupted sutures when the tension of the running suture was not adjusted.

Purpose: To compare maintaining corneal asphericity and high-order aberration changes in optimized PRK for myopic astigmatism patients, using Allegretto EX500 (WaveLight Allegretto Wave Eye-Q laser devices; Alcon Laboratories, Inc., Fort Worth, TX) and Technolas Teneo 317 (Bausch & Lomb, Rochester, NY). Methods: The patients with myopic astigmatism, whose range of myopic was between 1 and 8 diopters, and maximum astigmatism of 2. 5 diopters, were selected based on inclusion and exclusion criteria and, then, randomly operated with one of the Allegretto EX500 and Technolas Teneo 317 devices. Before the operation, a complete visual examination (visual acuity, refraction, Slit lamp, and Fundoscopy) and imaging including orbscan, zywave, and topolyzer were performed. The examinations were repeated 6 months after surgery. The results were compared before surgery and between the two devices. Results: This clinical trial study was performed on 97 eyes of 49 patients with mean age of 28± 5 years. Six months after surgery, visual acuity with the best correction was similar between the two groups (P=0. 152). The mean spherical equivalent before surgery was-3. 43± 1. 29 and-2. 91± 1. 29 (P=0. 047) and 6 months after surgery,-0. 14± 0. 19 and-0. 08± 0. 23 (P=0. 173) in the Allegretto and Teneo groups, respectively. There was no significant difference between the two groups before and after the surgery (P>0. 05) between the third and fourth order corneal aberrations. The ocular higher order aberration increased from 0. 3± 0. 1 and 0. 31± 0. 12 (P=0. 639) to 0. 43± 0. 2 and 0. 180± . 42, (P=0. 828) in the Allegretto and Teneo, respectively. Corneal asphericity was at 30° before operation-0. 3± 0. 12 and-0. 38± 0. 51 (P=0. 25) and after operation, 0. 28± 0. 26 and 0. 28± 0. 25 (P=0. 858) in the Allegretto and Teneo groups. This increase was higher per a diopter of spherical equivalent in Teneo group (P= 0. 628). Conclusion: The results of the treatment of the two Allegretto and Teneo devices were the same in correction of myopic astigmatism, although the Allegretto device induces less changes in asphericity, and the Teneo device induces less higher-order aberrations.

Purpose: To compare donor lenticule thickness reported by the eye bank with lenticule thickness measured at 6 months after Descemet stripping automated endothelial keratoplasty (DSAEK). Methods: This prospective, interventional case series enrolled 30 eyes of 30 patients, who underwent DSAEK, using precut eye bank tissue. Preoperative thickness measurements of the donor lenticules were taken centrally and at pericentral and peripheral graft areas using an anterior segment optical coherence tomography system. The same measurements were repeated 6 months postoperatively. The preoperative and postoperative values were compared, and the relationships between these measurements were investigated, using Pearson correlation coefficients. Results: The mean donor age was 47. 7± 10. 7 years old. The mean preoperative endothelial cell density was 3016. 8± 361. 4 cells/mm2, which decreased to 1644. 9± 482. 0 cells/mm2 postoperatively (P<0. 001). The graft thickness of the precut tissue, as reported by the eye bank, was 136. 8± 24. 9 􀀀 m at the center, 149. 4± 27. 3 􀀀 m at the pericentral area, and 198. 4± 32. 8 􀀀 m at the periphery. The corresponding postoperative values were 119. 2± 29. 8 􀀀 m (P=0. 004), 124. 5± 34. 6 􀀀 m (P=0. 002), and 156. 3± 45. 4 􀀀 m (P<0. 001), respectively. The graft thickness measured by the eye bank was significantly associated with that measured in vivo at 6 months at the central (r=0. 63; P=0. 001) and pericentral (r=0. 5; P=0. 009) graft area. However, the correlation between preoperative and postoperative peripheral graft thickness was insignificant (P= 0. 14). Conclusion: Compared to preoperative values, central, pericentral, and peripheral graft thicknesses were reduced by 10. 4%, 14. 2%, and 18. 4%, respectively, 6 months after DSAEK. Postoperative graft thinning was greater at the periphery compared with the central and pericentral area.

Retinopathy of prematurity (ROP) is the main reason of preventable blindness in pediatric age group. In this disease, incomplete development of retinal vessels in a premature neonate cause retinal ischemia and formation of retinal new vessel, which can result in retinal detachment and vision loss. Early diagnosis and intervention can prevent blindness; therefore, timely screening should be highlighted in these infants. The most important risk factors for developing ROP in a premature infant are low birth weight and low gestational age. Other possible predisposing elements are genetic, supplementary oxygen and variations in blood oxygen level, blood transfusion, sepsis و and blood glucose level. In developed countries, chances of ROP causing blindness is less than 10%, whereas this proportion is up to 40% in developing countries due to limitations in resources, neonatal care and NICU facilities, and availability of retinal exam. Therefore, it is recommended that screening guidelines be customized in each country. Based on a research conducted at Farabi eye Hospital in Tehran, 2016, screening guidelines in Iran has been defined as gestational age  32 weeks and gestational weight  2000 gram. Following this guideline, infants need treatment can be identified with a sensitivity of about 100%, while unnecessary exams will be at its lowest rate. Using screening recommendations of American Academy of Pediatrics would miss 8. 4% ROP requiring treatment in this cohort. The first retinal examination of premature infants with gestational age of  27 weeks should be at 31st week of postmenstrual age. This time for neonates with gestational age of 28-32 weeks is at 4-6 weeks after birth or postmenstrual age of 31-33 weeks (whichever is later). An international committee of ROP classified retina (with the centration of optic nerve) into 3 zones (I-III) and categorized severity of ROP into 5 stages (1-5). Plus disease, which is defined as vascular dilation and tortuosity in posterior pole, shows severity of disease and it is an indication for treatment. Guidelines for examination follow up and treatment is based on this international classification. 90% of ROP spontaneously regress in stage 1 and 2. Of those with aggressive posterior ROP, approximately 17% progress to retinal detachment. The gold standard of treatment of ROP is laser, which ablates avascular retina and helps control the activity of disease and regression of new vessels. Intravitreal injections of anti VEGF (Bevacizumab) has been recently considered the treatment of choice for treatment of zone I ROP. Although the regression time is shorter in the injection group, these babies require a longer follow-up time for the retina to become fully vascularized and should be monitored for the possible complications may occur in avascular retina. Recurrence showed to be more common in posterior zone II cases. Fluorescein angiography can be helpful in suspicious cases of recurrence due to its potential in differentiating new vessels from shunt vessels. Scleral buckling and vitrectomy are treatment options when there is a retinal detachment. Overall, children with ROP need a long life follow-up for managing the possible complications, of which the most devastating are retinal detachment and glaucoma.

Purpose: To report a case of superficial orbital rim osteoma. Case Report: A 29--year-old woman presented with two small and firm subcutaneous nodule in anterior aspect of the left inferonasal orbital rim. Orbital CT scan showed small well circumscribed exophytic bone density masses on frontal process of maxillary bone. The patient did not undergo surgery at the time of the first referral. After 5 years, she was treated with clinical examination and CT scan according to the growth of the lesion. Complete surgical excision was performed through modified Linch incision. Histopathology evaluation was consistent with ivory type osteoma. Conclusion: Although the orbital rim osteoma often originates from paranasal sinuses and appears as a mass in the orbit with or without superficial components, it may present as subcutaneous nodules on orbital rim.