BINA
Year:2018 | Volume:23 | Issue:3 |Papers Count:12

Purpose: To evaluate the visual and anatomical outcomes of pars plana vitrectomy (PPV) in patients with dropped intraocular lens (IOL) following complicated phacoemulsification (PE) and to determine the prognostic factors. Methods: The present retrospective study was conducted on the patients, who were referred after complicated PE and underwent PPV. Patients’ demographic characteristics, the interval between complicated PE and PPV, pre-and post-PPV visual acuity (VA), the final intraocular lens (IOL) status, and complications were recorded. Results: Twenty-three patients (23 eyes) with a mean age of 67. 7 years and mean follow-up of 28. 3 months were evaluated. Mean interval between cataract surgery and PPV was 14. 1 days. Pre-PPV mean best corrected visual acuity (BCVA) was 1. 03± 0. 24 LogMAR, which was improved to 0. 45± 0. 17 logMAR at final visit (P<0. 001). Pre-PPV VA of 20/200 or better was significantly associated with good final VA of 20/50 or better (P=0. 001). Complicated course after PPV was significantly associated with poor visual outcome (P<0. 001). However, timing of PPV (the interval between complicated PE and PPV) and final IOL status were not significantly associated with visual outcome. Conclusion: PPV for dropped IOL was associated with VA improvement. Better pre-PPV VA is associated with good visual outcome, while complicated course after PPV is associated with poor visual outcome.

Purpose: To assess the results of brachytherapy with ruthenium-106 in patients with recurrent ocular surface squamous neoplasia. Methods: In this retrospective study, 3 eyes of 3 patients with recurrent ocular surface squamous neoplasia underwent brachytherapy of one eye with ruthenium-106 (RU-106) plaques. Results: The mean age of patients was 66 years. The maximum diameter of the tumor was 11 mm and the median thickness was 2 mm, the follow-up period was an average of 14 months. In all four eyes, recurrent neoplasia of the squamous cell or cornea completely receded. None of the patients showed clinical and paraclinical evidence of tumor invasion of the eye. Distant metastases were not observed in any of the patients. Conclusion: Brachytherapy with RU-106 plaque is an alternative method for treatment of selected patients with recurrent ocular surface squamous neoplasia.

Purpose: To compare the effectiveness, safety, and stability of the results of transepithelial photorefractive keratectomy (tPRK) with conventional photorefractive keratectomy (PRK) for low to moderate myopia. Methods: In this prospective non􀀀 randomized case􀀀 control study, patients with low to moderate myopia were assigned to the tPRK group (cases) and the PRK group (controls). Outcome measures included postoperative pain using McGill Pain Questionnaire, epithelial healing time, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and manifest refraction. Results: A total of 340 eyes of 170 patients were enrolled in this study. Each study group comprised of 170 eyes of 85 patients. There was a significant difference between the two groups regarding the postoperative pain scores in favor of the tPRK group (P = 0. 04). The tPRK group had a shorter epithelial healing time than the conventional PRK group postoperatively (P = 0. 01). Mean UCVA was significantly better in the case group than in the control group at the postoperative month 2 (P = 0. 01). Conclusion: Transepithelial PRK seems to be superior to conventional PRK for treatment of low to moderate myopia in terms of postoperative pain, epithelial healing time, and visual recovery.

Purpose: Pentacam indices affecting elevation difference of cornea in patients with mild and moderate keratoconus. Methods: A total of 115 eyes were enrolled in different clinical stages. Elevation difference of anterior and posterior of cornea from Belin Ambrosio enhance system achieved. K max, K mean, corneal astigmatism, thinnest corneal thickness, horizontal and vertical distances of thinnest point to apex and asphericity (all measured by pentacam) were correlated with anterior and posterior elevation differences of cornea (measured with Belin/Ambrosio Enhanced Ectesia Display of Pentacam). All measured parameters were classified according to Amsler krumeich classification. Results: Anterior elevation difference of the cornea had a direct and positive correlation with keratometric maximum (K max) (r = 0. 88), mean keratometry (r = 0. 83), corneal astigmatism (r = 0. 361), and vertical point of thinnest point corneal apex (r= 0. 83) and an inverse and positive correlation with with the Thinnest point (r =-0. 673) and Asphericity (r=-0. 594) (P <0. 001) (For all indicators). Correlation between elevation difference posterior with K max (r = 0. 849), K mean (r= 0. 827), astigmatism (r= 0. 26), and vertical point of Thinnest point to corneal apex (r = 0. 413) was direct, significant, and positive (P <0. 001 for all indices) and correlation between Thinnest point and elevation difference posterior was negative and inverse (r=-0. 598; P<0. 001). After performing linear step wise regression test, K max (P<0. 001), astigmatism (P= 0. 005), and K mean (P= 0. 007) were the most important Pentacam indices associated with Elevation Anterior, and among the measured Pentacam indices, K mean (P= 0. 003), K max (P <0. 0001), and astigmatism (P <0. 0001) were the strongest indices measured values related to elevation difference posterior, respectively. The best diagnostic points for K max at grade I, grade II, and grade III were 48. 4, 51. 65, and 74. 2, respectively. Conclusion: K max, K mean, and corneal astigmatism are pentacam indices mostly correlated with anterior and posterior elevation differences of cornea.

Purpose: To describe a new surgical technique for treatment of total third nerve palsy. Methods: This study was conducted in the form of interventional and prospective. Patients with chronic third nerve palsy were included. In this procedure, lateral rectus muscle (LR) was splitted as posteriorly as possible; then, superior and inferior halves disinserted and passed between the sclera and superior and inferior rectus muscles respectively, medial rectus muscle (MR) was sutured as posterior as possible from insertion and cut, then residual distal stump of MR was splitted into two halves and sutured to superior and inferior halves of LR, and proximal portion of MR was sutured back to its insertion. When there were hypotropia and functional superior oblique muscle (SO), tenectomy was also added. For the first day after operation, globe was fixated in adduction position with traction suture. Horizontal and vertical deviation changes were evaluated before and at least 3 months after surgery. The success was defined as postoperative horizontal deviation 􀀀 10 PD and vertical deviation􀀀 5 PD. After at least 3 months of follow-up, if the Bell's reflex was acceptable, ptosis surgery was also performed, otherwise crutch glasses was prescribed. Results: Ten patients were operated by this method. The mean age of the patients was 32. 4 ± 18. 4 years (range 759) years. Two of them had history of previous horizontal recession-resection surgery and one of them had a history of surgery on the upper right muscle of the same eye. Mean preoperative exotropia was 84± 14. 9 (45 to 100) PD that reduced to 6± 8. 4 (0 to 20) PD (P<0. 001) at 3months and 6. 5± 8. 2 (0 to 20) PD (P<0. 001) at the last examination. The mean vertical deviation was 16. 5± 10 (0 to 30) PD that reduced to 3± 4. 8 (0 to 15) PD (p=0. 001) at 3months and 2. 5± 3. 5 (0 to 10) PD (p=0. 001) at the last examination. Mean follow-up duration was 13. 2± 7. 9 (5. 1 to 29. 6) months; success rate was 70 % and 90 % for horizontal and vertical deviation, respectively. Two cases (20%) required additional strabismus surgery. Conclusion: Lateral rectus-medial rectus union technique is an effective and long-lasting procedure to overcome large angle exotropia of total third nerve palsy. This method can also be used as a reoperation surgery.

Purpose: Retina regeneration through reprogramming process is an interesting topic for the retinal disorders and regeneration study. This phenomenon naturally happens in a few of amphibians even if the neural retina is completely removed by surgery. Studies show the critical role of FGF2 factor and RVM microenvironment in retinal regeneration. Thus, this study pays particular attention to regeneration potential of human RPE cell under the influence of the fibrin glue 3D structure as FGF2 reservoir and RVM like space. Methods: hRPE cells were isolated from donor eyes of two adult humans. The cells were encapsulated with three concentrations of fibrin glue (FG1: 42mg/dl, FG2: 84mg/dl, FG3: 126mg/dl) and FBS treated with 20% concentration was considered as control. Gene expressions of PAX6, MMP2, RPE65, ACTA2, CRX, Thy-1, NogoA, and Integrin-B1 were analyzed, using real-time PCR. Results: Gene expression of Integrin B1 and Thy-1 were significantly higher in FG1-treated cells compared to controls. Also, PAX6 gene expression in FG1 concentration compared to control and FG3 showed a significant increase, while expression of MMP2 gene expression at FG1 concentration showed a higher expression level than other concentrations, but only significant compared to FG3. RPE65 expression in FG1, FG2 concentrations shows a significant increase compared to control; ACTA2 gene expression was lower than 3 concentrations compared to control, but it was not significant. Also, expression of NogoA gene showed a significant decrease in FG1 concentration compared to control and FG3. In addition, the expression of the CRX gene was negative in all treatments and control. The immunocytochemistry results indicate that PAX6 protein is not expressed in incubated specimens and controls in adult RPE cells, but these cells express specific proteins such as RPE65, cytokeratin8. 18 in both control and incubated specimens are positive. Conclusion: Adult RPE cells at the concentration of FG1 (42 mg/dl) maintain certain adult characteristics, but exhibited signs of multipotency, which could indicate the potential of these cells for retinal tissue regeneration. This effect appears to be due to the presence of adhesion molecules such as Fibronectin and Laminin in fibrin glue that simulates the RVM like space, as well as the creation of an FGF2 reservoir and its localization, which leads to an increase of the PAX6 gene expression.

Mucous membrane pemphigoid (MMP) is a systemic autoimmune blistering disease that mostly affects skin and mucosal membranes. When the finding is primarily seen in eyes and conjunctiva, it is called ocular cicatricial pemphigoid (OCP). OCP is characterized by linear deposits of IgA, IgG, or c3 in the epithelial basement membrane zone (BMZ). Ocular involvement is devasting as progressive cicatrization can lead to blindness. In this review article, we discuss pathogenesis, ocular findings, grading, and diagnosis and treatment modalities for OCP.

Report a rare case of orbital cavernous hemangioma with bone erosion and its management with review of literature. Cavernous Hemanioma is the most common vascular benign tumor of the orbit in adults. In this article, a case of Orbital Cavernous Hemanioma is introduced in a 28-year-old man. Because corrosion and bone destruction are the hallmark of malignant or metastatic tumors, it should be considered in benign cases such as Orbital Cavernous Hemanioma.