BINA
Year:2005 | Volume:10 | Issue:3|Papers Count:14

Purpose: To evaluate the etiologic and epidemiologic findings in central retinal artery occlusion (CRAO) patients in a tertiary eye center in Tehran, Iran.Methods: All patients with CRAO referred to the emergency department of Farabi Hospital during 2001-2002 were enrolled in the study. All patients received routine treatment and were followed for 3 months. Cardiology consult was done for all patients.Results: From 36 patients, 6 patients had cilioretinal artery sparing. Age of patients ranged from 18 to 80 years (56.3±15.7). Interval from onset of symptoms to admission was between 4-48 (20±8) hours. Prevalence of NVI, hypertension, and diabetes mellitus was 6.6%,36.7%, and 16.7%, respectively.Conclusion: The lower mean age in our patients compared to other studies is probably due to longer duration of life in western countries or decreasing atherosclerosis age in our country. The low prevalence of hyperterision and diabetes mellitus in our patients require further evaluation in great scale studies. The low prevalence of NVI in our study may be due to earlier presentation of our patients or special characteristics of this disease in our country.

Purpose: To evaluate the effect of intravitreal triamcinolone acetonide (IVT) on clinical, angiographic, and optical coherence tomographic parameters in refractory diabetic macular edema (DME).Methods: In a double-masked placebo-controlled randomized clinical trial, 88 eyes of 61 patients with DME refractory to previous laser therapy or not suitable for such treatment were included in the study. Eligible eyes were randomly assigned into two groups. The treatment group (45 eyes) received 4 mg IVT and the placebo group (43 eyes) received subconjunctival injection of placebo. Complete ophthalmologic examination, fluorescein angiography, and optical coherence tomography (OCT) were performed before intervention and repeated after 2 and 4 months. Quantitative measurement of variables on angiograms including hard exudates (HE), size of foveal avascular zone, and leakage severity was performed using Photoshop software.Results: Two months after intervention, visual acuity (VA) improved in the treatment group (-0.13 LogMAR, P=0.01) but slightly deteriorated in the placebo group (0.02 LogMAR, P=0.63). The difference of the above changes (0.15 LogMAR) was statistically significant at 2 months (P=0.02) but reduced to 0.11 LogMAR (P=0.08) after 4 months. Mean (standard deviation) of central macular thickness (CMT) by OCT before and 2 and 4 months after injection was 393 (151), 293 (109), and 362 (119) microns in the treatment group and 393 (166), 404 (134), and 405 (160) microns in the placebo group, respectively. The second month difference was statistically significant (P=0.01).Reduction of the amount of HE (51%, P=0.004) and petaloid pattern (P=0.012) was significant in the treatment group as compared with the placebo group. There were no significant IVT-related side effects except for transient ocular hypertension in 32.6% of patients after 2 months.Conclusion: The greatest therapeutic effect of IVT on DME according to CMT and VA occurs at 2 months and decreases up to the fourth month. However, concerning cyctoid macular edema and hard exudates, the effect is maintained up to 4 months.

Purpose: To evaluate the agreement between a new method for quantitative analysis of fundus or angiographic images using Photoshop software and clinical judgment.Methods: Four hundred eighteen fundus and angiographic images of diabetic patients were evaluated, by three retina specialists and then by computer using Photoshop 7.0 software. Four variables were selected for comparison: amount of hard exudates (HE) on color pictures, amount of HE on red-free pictures, severity of leakage, and size of foveal avascular zone. Available programs in the software such as color selection, luminosity channel, and histogram and tools such as magnetic lasso and magic wand were used for measurement. Coefficients of agreement and kappa measurements were calculated.Results: Agreement (kappa) between the two methods in the amount of HE on color and red-free photographs were 85% (0.69) and 79% (0.59), respectively. This agreement for severity of leakage was 72% (0.46). In the evaluation of the foveal avascular zone size with two methods of quantification using the magic and lasso software tools the agreement was 54% (0.09) and 89% (0.77), respectively.Conclusion: Quantitative measurement of fundus and angiographic image variables such as HE, leakage, and foveal avascular zone can be performed precisely using Photoshop software.

Purpose: To evaluate the effectiveness of pars plana vitrectomy and posterior hyaloid stripping in decreasing macular thickness and improving vision in diabetic macular edema.Methods: This prospective interventional case series includes 30 eyes of25 diabetic patients with diabetic macular edema with macular thickness exceeding 170 microns and thickened posterior hyaloid. BCVA and macular thickness measured by OCT were evaluated preoperatively and 4-6 months postoperatively. Macular perfusion was evaluated by means of fluorescein angiography preoperatively. Treatment consisted of pars plana vitrectomyand stripping of posterior hyaloid. Results: Mean preoperative macular thickness was 531.97±126.52 µm which decreased to 365.2±103.2, postoperatively (p<0.001). Mean preoperative BCVA (Log MAR) was 0.82±0.39 which improved to 0.65±0.34 postoperatively (P=0.006). According to Pearson correlation coefficient, macular perfusion and presurgical BCVA≤20/200 had statistically significant correlation with post surgical BCVA.Conclusion: Pars plana vitrectomy and posterior hyaloid stripping lead to decrease in macular thickness and improvement of vision in patients with diabetic macular edema. All patients are legible to be exposed to the risks of surgery and it is rvandatory to select patients for this modality according to be exposed to the and after documenting the role of vitreousin the pathogenesis of the edema with OCT.

Purpose: To compare the complications of pegging between the polycarbonate peg system and the titanium peg system.Method: Complications associated with pegging (polycarbonate: Bio-Eye or titanium: Dr-Perry new P-K) were reviewed from the hospital records of 153 patients over 5 years.Results: Out of 153 cases, 96 (62.3%) were male and 57 (37.7%) were female. Mean age was 27.7 yr (6-59 yr). In 88 cases, the peg was poly carbonate with sleeve system and in 65 cases, a titannium peg was used. There was at least one complication in 41 (46.6%) cases with polycarbonate and 18 (27.7%) cases with titanium (P= 0.018). The rates of the most common complications including granulation tissue, discharge, conjunctival over growth, and peg falling out were 35%, 23%, 13%, and 8%, respectively in the polycarbonate peg group and 15%, 5%, 1.5%, and 0 in the titanium peg group. The rate of the last 3 complications in the titanium peg group was statistically lower than the polycarbonate group. Twenty-five (28.4%) cases with polycarbonate peg and 5 (7.5%) cases with titanium peg had two or more complications (P= 0.03). Peg removal for treatment of complications was required in 11 out of 41 complicated cases (28.8%) of the polycarbonate group but in 2 out of 18 complicated cases (11.1%) of the titanium group (P= 0.03).Conclusion: Both pegging systems incurred complications which were less severe and less prevalent with the titanium peg system. Surgical intervention for treatment of complications in the titanium peg system was required less than the poly carbonate peg. It may be concluded that the titanium peg is a good substitute to the polycarbonate peg system.

Purpose: To report clinical features, types, and results of surgery for Duane's retraction syndrome (DRS). Methods: This is an existing data study on the records of patients with DRS. The study was conducted on the hospital records of patients who were referred for DRS to a tertiacy eye center in Tehran, Iran during 8 years. The follow-up period after the surgery was at least 6 months.Results: Data of 42 cases was studied. Mean age was 11.7 years (14 months to 25 years). Twenty-seven cases (64%) were female and 15 cases (36%) were male. The involved eye was left in 24 (57%), right in 13 (31%), and both eyes in 5 cases (12%). Ocular alignment in primary position was esotropia in 20 (47.5%), exotropia in 14 (33.5%), and orthotropia in 8 cases (19%). The most common type of DRS was type I (57%) followed by type II (31%) and type III (9%). There was one case (3%) of synergistic divergence. Shooting phenomen was present in 17 (41%) patients. Ocular abnormalities were present in 16% and systemic abnormalities in 7%. Thirty-three cases (78.5%) underwent operation. Indications of surgery were ocular deviation (79%), abnormal head posture (51.5%), palpebral fissure changes and retraction (51.5%), and shooting (27%). The operation was performed on one or two horizontal rectus muscles in 63% and on three or four muscles in 39%. Type of surgery was bimedial rectus recession and bilateral rectus recession in 63%, vertical muscles transposition in 27%, and splitting of the lateral rectus in 24%. In 61% of patients the affected eye improved with one operation. Abnormal head posture was improved in 76%. Cases with residual deviation, abnormal head posture, vertical deviation, or shooting phenomena were reoperated.Conclusion: DRS can be diagnosed clinically most of the times; signs and symptoms can be significantly improved with appropriately tailored operation on extraocular muscles.

Purpose: To compare the short and long-term efficacy and complications of releasable suture vs conventional interrupted suture for scleral flap in trabeculectomy.Methods: in a prospective randomized clinical trial, 42 eyes of 42 consecutive patients requiring trabeculectomy for uncontrolled primary glaucoma underwent conventional trabeculectomy (group A) and trabeculectomy with releasable sutures (group B); 21 eyes of 21 patients for each group. Short-term hypotony related complications and long-term intraocular pressure were measured and compared.Results: The mean follow up was 11.7±6.5 months in group A and 9.4±6.4 months in group B. The mean ± SD final intraocular pressure at the end of follow up period was 13.95±4 mmHg in group A and 14.57± 3 mmHg in group B (P=0.58). Mean reduction in intraocular pressure at the end of follow up was 54.5% in group A and 56% in group B. Final intraocular pressure was controlled (lOP≤20mmHg) without medications in 15 patients in group A giving a success rate of 71-4% and in 14 patients in group B giving a success rate of 66.7%. Flat anterior chamber (grade III) was observed in 2 eyes in group A but in no eyes with releasable suture. At the end of follow up, the two groups were similar regarding intraocular pressure and need for ocular hypotensive medication.Conclusion: Releasable scleral flap sutures reduce the incidence of hypotony and related complication without any effects on long-term control of intraocular pressure and is an effective way with no extra cost or instrument.

Purpose: To determine the effect of trabeculectomy (Tx) on cataract formation or progression in glaucoma patients.Methods: This controlled clinical trial was performed on 82 eyes of 41 consecutive patients older than 50 years with glaucoma. Trabeculectomy was indicated only in one of their eyes and lOP in the other eye was controlled with medication. The operated eyes were considered as treatment and the fellow eyes were considered as control. The effect of Tx on lens opacity was evaluated with 2 criteria: decreased visual acuity (VA) and cataract formation or progression based on the LOCS III score on slitlamp photography. Results: Overall, 53.7% of patients were male and 46.3% were female. Mean age was 62.5±9.3 years. Cataract progression in the treatment group was statistically significant when compared with their preoperative condition according to VA, and LOCS III photography (P<0.05) and scores (P=0.01). Cataract progression in the treatment group was statistically significant compared the fellow eye according to LOCS III scores (P<0.05), but was not significant according to LOCS III photography (p=0.07).Conclusion: Trabeculetctomy can induce cataract progression based on visual loss and LOCS III photography, Mean VA seems to be decreased, however not all lens opacities necessarily cause visual loss.

Purpose: To evaluate the outcomes of keratorefractive surgery for correction of postkeratoplasty astigmatism in keratoconus.Methods: In this retrospective study, surgical records of 45 eyes of 45 patients that underwent relaxing incisions with or without compressive sutures were evaluated. The minimum interval between complete suture removal and operation was 1 month. Location and extent of incisions were determined by topography. Intraoperative keratoscopy was performed to determine if compressive sutures were needed.Results: Mean age at the time of corneal graft surgery was 29.6±9.1 years. Mean interval between keratoplasty and keratorefractive surgery was 18.4 ± 8.8 months. Follow up period was 17.2±12.3 months. Preoperative refractive astigmatism was 7.25 ±1.59 D and keratometric astigmatism was 8.33 ± 2.37 D. After surgery, these values reached 4.14±1.67 D and 4.42±1.88 D, respectively (P<0.0001). Moderately 0.34 D myopic shift occurred. BSCVA was ≥20/40 in 76.5% of the eyes before and 93.3% after surgery. Mean BSCVA in LogMAR was 0.28 (20/40) before and 0.17 (20/30) after surgery (one Snellen line increase of vision), P<0.0001Conclusion: Keratorefractive surgery by relaxing incisions with or without compressive sutures is a safe and effective procedure to reduce postkeratoplasty astigmatism in keratoconus.

Purpose: To compare postoperative astigmatism-results of suture less 3.2 mm clear corneal (SSC) and 5.5 mm scleral (SSS) incision in phacoemulsification cataract surgery.Methods: This semiexperimental study was performed on 100 eyes of97 patients.Phacoemulsifcation cataract surgery was performed with foldable acrylic lens implantation with 3.2 mm clear corneal incision (70 cases) and small optic P.M.M.A lens implantation with 5.5 mm scleral incision (30 cases). Both incisions were made in superior vertical meridian and keratometric alterations were recorded preoperatively, and 5 days and 3 months after surgery. Comparisons were made with T test and simple subtraction and polar-value methods.Results: In the SSC group, mean astigmatism increased from 0.81 D (dioptre) preoperatively to 1.44 D at 5 days and 1.06 D at 3 months after surgery. It equals to 0.25 D increase in astigmatism 3 months after surgery. In the SSS group, mean astigmatism increased from 1.09 D to 1.12 D at 5 days after surgery and reduced to 1.02 D at 3 months after operation. In other words, there was 0.07 D reduction in mean corneal astigmatism 3 months after surgery. The number of eyes with W.T.R astigmatism decreased from 46 cases before surgery to 15 cases after that and the number of eyes with A.T.R astigmatism increased from 29 cases before surgery to 60 cases after the operation.Conclusion: No significant difference was observed between SSC and SSS incisions regardingsurgically induced astigmatism and the amount of surgically induced astigmatism was very low in both groups. Thus we recommend SSC incision fur easy phaco cataract surgery.

Purpose: To report two cases of bilateral bacterial keratitis as a sight-threatening complication following photorefractive keratectomy (PRK)Patients and findings: The first case was a 45-year-old man referred due to bilateral ocular pain and purulent discharge two days after bilateral PRK. Based on his clinical picture, smear and cultures from both corneal ulcers were taken with a diagnosis of bacterial keratitis. Frequent topical fortified antibiotic treatment was started. Smear showed many PMN cells but the culture was negative. Corneal ulcers were controlled with medical treatment. The second case was a 24-year-old man who presented with bilateral severe pain and discharge. He was diagnosed as bilateral corneal ulcers 2 days after PRK and topical antibiotics were started for him, but because of poor response he was referred to our center. Culture result was positive for staphylococcus aureus. He had severe bilateral blepharitis. Frequent fortified antibiotics were started which controlled his condition.Conclusion: Infectious keratitis after PRK is a rare, but potentially devasting complication. The predisposing risk factors are breakdown of the barrier function of the corneal epithelium, active blepharitis, use of bandage contact lens on an extended wear basis and use of topical steroids to control wound healing. It is recommended not to operate bilateral eyes simultaneously in those at risk.

Patient and findings: A 31-year-oldman presented with decreased vision without redness or pain or any systemic finding. Clinical findings included decreased visual acuity to 3 m CF and trace cell and flare in the anterior chamber and anterior vitreous. There were findings compatible with multifocal choroiditis that progressed to subretinal fibrosis in the macula in 3-4 months resulting in further decrease in visual acuity.Conclusion: In spite of many previous reports of SFU in women, it may occur in men. The patient should be followed carefully to detect early findings of subretinal fibrosis and to initiate appropriate treatment.

Purpose: To present a case of chorioretinitis sclopetaria with attached retina in spite of performing deep vitrectomy without retinopexy.Patient and findings: A 10-year-old boy was referred due to air-gun injury to the left eye. Right eye had visual acuity of 20/16, MG-, and normal slit lamp examination and fundoscopy. In the left eye, visual acuity was count fingers at 50 cm, MG+++, anterior segment examination revealed massive subconjunctival hemorrhage and chemosis. On B-Scan echography there was a suspicious retinal detachment. We performed standard pars plana deep vitrectomy with prophylactic band without endolaser retinopexy. The retina was attached until last follow up at 14 month.Conclusion: In spite of severe defects in the retina and choroid in chorioretinitis sclopetaria, retinal detachment does not usually occur due to spontaneous retinopexy and scar formation.