BINA
Year:2003 | Volume:8 | Issue:3 (31)|Papers Count:14

Purpose: To evaluate contrast sensitivity, color vision, visual field, and stereopsis in 30 patients with isolated optic neuritis. Methods: Contrast sensitivity test, color vision testing, stereo acuity test, and perimetry was done for 30 patients with proven optic neuritis before and one week after treatment.Results: In this study, 30 patients including 17 (56.7%) female and 13 (43.3%) male were evaluated. Mean contrast sensitivity of affected eyes was 50 cycle/degree and mean stereo acuity was 310 seconds of arc. On color vision testing, mild deutan defect was found in 60% of the patients. On visual field testing, 21 cases (65.2%) had central scotoma, 2 cases (8.7%) had paracentral scotoma, 1 case (4.3%) had nasal constriction, and 1 case (4.3%) had enlargement of the blind spot. After treatment, mean contrast sensitivity reached 209 cycle/degree, stereo acuity reached 60 seconds of arc, and blind spot size returned to relatively normal value (P<0.0001).Conclusion: Contrast sensitivity, color vision, visual field, and stereo acuity were significantly reduced in optic neuritis; after treatment these tests returned to a relatively normal level. Since the possibility of spontaneous recovery is high, evaluation of real treatment effect needs clinical trials.

Purpose: To evaluate the efficacy of contact diode laser cyclophotocoagulation (CDLCPC) in treating different types of refractory glaucoma. Methods: In this before-after clinical trial, 30 eyes of 29 patients with refractory glaucoma unresponsive to usual medical and surgical management were treated by CDLCPC using Oculight  SLX system. All patients were treated by one surgeon. Success was defined as IOP reduction to 6- 22 mmHg with or without anti-glaucoma medications.Results: Patients' age ranged from 13-18 years (mean 50±22). Postoperative follow up ranged from 2-16 months (mean 7.9±3.9 months). IOP was significantly reduced from a preoperative level of 30.7±9.6 mmHg to a post operative level of 19.3±10 mmHg (P<0.0001). The success rate was 50% by the above-mentioned criteria; 10 eyes without any anti-glaucoma medication and 5 eyes with anti glaucoma medications had an IOP of6-22 mmHg. Complications included 4 cases of hyphema (13%),4 cases of vitreous hemorrhage (13%),6 cases of choroidal effusion (20%), and two cases of phthisis bulbi (6.7%).Conclusion: CDLCPC is a useful and cost-effective procedure for eyes with refractory glaucoma but serious complications such as phthisis bulbi may occur after this treatment modality.

Purpose: To evaluate the long-term outcome and complications of initial ciliary ablation with trans-scleral diode laser cyclophotocoagulation in the management of severe refractory glaucoma's.Methods: We used diode laser to perform trans-scleral contact cyclophotocoagulationin 50 patients with medically and surgically uncontrollable glaucoma's and no previous ciliary ablation. Pre and postoperative information was registered and patients were followed for 6 months. We delivered laser energy through a 600 µm diameter quartz fiber probe especially designed for ciliary ablation (G-probe). About 17 to 19circumlimballaser applications (power 1500 -2000 m W, duration 2 sec) over 270o were given. Results: The patients inclded 56% male and 44% females with a mean age of 49 years (12-94 years). Causes of refractory glaucoma in these patients were aphakic glaucoma (32%), absolute glaucoma (14%), post corneal graft (14%), congenital glaucoma (12%), neovascular glaucoma (8%), post corneoscleral laceration repair (8%), post deep vitrectomy (8%), ghost cell glaucoma (2%), and microphthalmia (2%). Twenty-eight percent had previous filtering surgery, 66% were aphakic, and 65% had ocular surgery other than glaucoma or cataract surgery. The mean preoperative IOP was 34.72± 6.48mmHg,andmean IOP six months after TSCPC was 20.80+12.79 mmHg, which shows 40% reduction (p= 0.001). The mean number of glaucoma medications decreased from 2.72 preoperatively to 1.27post operatively which showed 46% reduction (p= 0.001). Conclusion: The results suggested that trans-scleral diode laser cyclophotocoagulation may be a useful procedure to reduce IOP and the number of medications needed in refractory glaucomas.

Purpose: To determine the safety of LASIK according to decreased BSCVA in myopia and myopic astigmatism.Methods: In this pre and post non-randomized clinical trial, 736 eyes from 369 patient who had LASIK surgery for myopia and myopic astigmatism were evaluated. Mean pre and postoperation visual acuity were measured based on Snellen and Log MAR systems. Results: This study included 62.6% female and 37.4% male patients with a mean age of 30±8 years. Follow up period was 9 months. Preoperative spherical equivalent was -5.2±2.6 diopters. Nine months after surgery this value decreased to -0.28±0.62 diopters. Nine months after operation, 83.7% of the eyes were within ±0.50 diopter of emmetropia. Uncorrected visual acuity was 20/20 or more in 55.8% and 20/40 or more in 97.8% of the eyes. Mean BSCVA before operation was 0.052±0.095and 9 months after operation increased to 0.034±0.069 (P<0.001). Nine months after operation, BSCVA decreased 2 lines in two eyes, 3 lines in one eye, and 4 lines in another eye. Overall the incidence of decreased BSCVA was 0.5%. Conclusion: Regarding decreased BSCVA, LASIK is a safe procedure for myopia and myopic astigmatism.

Purpose: To determine the efficacy of botulinum-A toxin in the treatment of spastic entropion. Methods: In this uncontrolled interventional case series, 20 eyes of 17 patients were evaluated for 14 months. Each case received 15-20 (average 18)units of botulinum-A toxin injection under the eyelid margin at 3-4 points. Effects on ocular symptoms and anatomic results were determined. Results: From 17 patients, 7 were male and 10were female. The range of age was 55-90 years. Lower lid entropion was unilateral in 14 patients (8 right and 6 left eyes) and bilateral in 3 patients. Six eyes (30%) had only one injection, 11 eyes (55%) had a second injection after an average of2.5 months, and 3 eyes (15%) had a third injection after an average of2.6 months. There was previous entropion surgery in 4 eyes (23.5%). Other ocular surgeries including cataract, filtering, and pterygium surgery in 15 eyes (88%). Overall good results were achieved in 75% and relative success was obtained in 25%.Conclusion: Regarding to effectiveness, ease, cost effectiveness, non-invasiveness, and lack of serious complications; we can use this procedure especially for patients who are not suitable candidates for surgery.

Purpose: To identify the clinical features of eyes affected with intraretinal foreign bodies (IRFBs) and to evaluate the results of surgical management in these cases.Methods: The records of 29 patients (30 eyes) with IRFBs were reviewed. All eyes underwent vitrectomy. The IRFBs were removed with intraocular forceps and magnetic extraction either through pars plana sclerotomy or through limbal.Results: All patients were male with a mean age of 28.3 years. Average follow up period was 21.5 months. Of 30 injuries, 6 (20%) were war injuries and 24 (80%) were penetrating trauma (missile) injuries. The IRFBs were ferromagnetic in 25 (83.3%) eyes. IRFB extraction was performed by means of an external magnet in 12 eyes (40%) and intraocular forceps in 18 eyes (60%). Laser photocoagulation was performed around the IRFB before surgery in 7 eyes. Macular puker and scar were present in 7 eyes (23.3%) and retinal break formation posterior to the sclerotomy occurred in 9 eyes (30%). In these 30 eyes, final visual acuity was 20/40 or better in 12 eyes (40%) and 20/200 or better in 22 eyes (73.3%). The retina was attached at the final follow-up examination in all the eyes. There were no significant relation between final visual acuity of 20/200 or better and site, size, or type of IRFBs, and time between trauma and surgery. Conclusion: The surgical management of IRFBs is a complicated procedure. The appropriate route of removal may be determined by the type, size, and site of the embedded IRFB. The results of vitreous surgery are remarkably good. The data from this study suggest no preference of external magnet over intraocular forceps for extraction of magnetic IRFBs.

Purpose: To evaluate the visual outcomes and complications of trans-sclerally sutured posterior chamber lenses (TS-PCIOL) in aphakic patients without capsular supports.Methods: We reviewed the hospital records of 69 eyes of 69 patients who underwent TS-PCIOL since 1996 to 2001 in H. Rasoul Hospital with at least 6 months of follow up. Follow up examinations measured visual acuity, intraocular pressure, IOL decentration, and posterior segment complications. Results: Mean follow up was 10.5±1.7 months and mean age of the patients was 39±4 years. BCVA was 1/10 or more in 84% of the eyes pre-operatively and in 90% postoperatively (P>0.05). All eyes had successful fixation of their PCIOLs immediately after surgery. Six eyes (9%) had microscopic vitreous hemorrhage and 4 eyes (6%) had increased IOP in first week after surgery. Eight eyes (12%) showed evidence of suture erosion from the scleral flap. Posterior segment complications included CME in 3 eyes (4.5%) and retinal detachment in one eye (1.5%).Conclusion: Trans-scleral fixation is a safe and effective means of implanting a posterior chamber lens in eyes without capsular support. Prospective studies should be performed for long term complications of TS-PCIOL.

Purpose: To determine the prevalence of blue-yellow color vision defects among diabetics at Farabi and Shariati Hospitals during 2001.Methods: This cross-sectional study was conducted on diabetics referred to us. We excluded patients whom were affected by cataract, age-related macular degeneration, optic neuritis, optic atrophy, glaucoma, or vitreous hemorrhage or other retinal disease; and also whom had undergone laser therapy. Color vision was examined by Farans worth D-15 and Lanthony D-15. Role of age, sex, visual acuity, duration of diabetes mellitus, stage of retinopathy, and macular edema were assessed.Results: Of 120 diabetics, 33.5% were male and 64.4% were female. Mean age (SD) was 48.5 (15.1) years. There was 22.4% and 47.6% color vision defects according to Farans worth D-15  and Lanthony D-15 tests, respectively. There was a positive association between age, duration of diabetes mellitus, visual acuity, stage of retinopathy, and macular edema with the color vision defect, but the defect had no association with sex.Conclusion: Blue-yellow color vision defect has a significant prevalence among diabetics.

Media opacification following pediatric cataract surgery has always been a problematic issue. Despite advances in microsurgical techniques, unique aspects of the anatomy, physiology, and the post-operative inflammatory response in children predispose them to rapid opacification of the visual axis after successful cataract surgery. Considering the importance of media clarity as a prerequisite for proper optical correction and amblyopia therapy, many methods have been proposed for the prevention or treatment of opacification. The choice of a particular surgical technique in a given patient should be made individually. Factors that may influence such a decision include age, cataract type, associated ocular or systemic conditions, follow-up issues, and socioeconomic status. In young children, the method of choice with good long-term results and low complication rate is lensectomy, primary posterior capsulotomy, and anterior vitrectomy. This review article covers media opacification after pediatric cataract surgery in detail.

Purpose: Presentation of one case with keratoconus and granular corneal dystrophy. Patient and findings: This report is the third histopathological report of keratoconus associated with granular corneal dystrophy in the world and the first one from Iran. In this patient there were both clinical and histopathology findings of keratoconus and granular corneal dystrophy. Due to severe visual loss, corneal transplantation was performed in left eye.Conclusion: Coexistence of granular corneal dystrophy and keratoconus may affect the management of the patients, so it should be considered.

Purpose: To report a case of retinal toxocity after accidental intravitreal injection of methyl prednisolone.Patient and findings: A 53-year-oldwoman presented with decreased vision in her left eye since 1 week before. She had corneal graft about 8 month before. Ophthalmic examination revealed visual acuity of 1.5m counting finger, 3+ corneal edema, and diffuse KPs. She was treated for endothelial graft rejection using local administration of methyl prednisolone (1 ml, 40 mg) by trans-septal injection superiorly. The patient had pain and immediate loss of vision. She was admitted immediately after the accident. Prone-positioning and intravenous mannitol was administered and pars plana vitrectomy was performed. At 1 month, ophthalmic examination showed a clear corneal graft, complete retinal attachment, extensive macular ischemia, and macular pucker. Visual acuity was no light perception (NLP). Conclusion: Perforation of the globe with intraocular injection of depot-steroids is a rare and dangerous complication of periocular steroid therapy. It produces severe visual loss as a result of retinal toxicity. Ophthalmologists should be aware of the risks of periocular injections and accidental injection into the vitreous cavity should be considered as an emergency.

Purpose: To report a case of central retinal artery occlusion in a patient with lupus anticoagulant (LAC) positive SLE.Patient and findings: A 33-years-oldwoman with a diagnosis of SLE and positive lupus anticoagulant titer was admitted in the rheumatology ward. The patient was referred to the ophthalmology clinic for decreased visual acuity since previous day. During 48 hours, her vision was completely lost. In funduscopy, we found central retinal artery occlusion. Conclusion: Patients with SLE and a high titer of lupus anticoagulant, should be considered at high risk for thrombotic events.