BINA
Year:2001 | Volume:6 | Issue:2|Papers Count:14

Purpose: To evaluate the role of intravitreal injection of carboplatin in the management of intraocular retinoblastoma in patients referring to Farabi Eye Hospital during 1999-2000. Patients and methods: This is a randomized double-blind matched clinical trial. Definite diagnosis of intraocular retinoblastoma was made based on clinical examination, ultrasonography or orbital CT-scanning tomography. A comprehensive ophthalmic examination was performed with the patient under general anesthesia. Anterior chamber, iris, lens, vitreous, retina and intraocular tumors were assessed carefully. The greatest basal diameter and the thickness of each tumor were estimated through indirect ophthalmoloscopy according to disc diameter. After ruling out the exteraocular or systemic metastasis, the eyes were divided into 10 blocks according to Reese-Ellswrth classification and then the eyes in each block were divided randomly into two groups; the control group and the case group. The control group only received systemic chemotherapy including vincristine, etoposide, and carboplatin (VEC) at least for 6 sessions. The case group received the same chemotherapy plus intravitreal carboplatin. The intravitreal carboplatin administered as 2 injection of 5 mcg with 2 weeks interval. All patients were reexamined under general anesthesia monthly and the greatest basal diameter and the thickness of each tumor and the vitreous status were reassessed each time and when the volume of tumor reduced, laser therapy was performed. All examinations were done by a single physician. The results were compared and analyzed with Chi-square, Fisher exact test, and T-test. Results: This study was conducted on 45 tumors in 19 eyes of 13 patients. In the control group there were 20 tumors in 8 eyes and in the case group there were 25 tumors in 11 eyes. There was 1.8±l.8 disc diameter or 81% decrease in tumor thickness in the case group (P<0.001)that was two times greater than in control group (P<0.09). There was 56% decrease in the greatest basal diameter of the tumors in the case group. About 91% of the eyes in the case group and 75% of the eyes in the control group saved from enucleation. In the control group 6 eyes had advanced stages of tumor (Reese-Ellsworth group IV, V) which two of them were enucleated and in the case group from 6 eyes which had advanced stages of tumor just one eye was enucleated. Conclusion: Intravitreal carboplatin plus systemic chemotherapy using VEC inhibited the tumor growth more effectively in comparison with systemic chemotherapy alone.

Purpose: To evaluate the visual outcome and complications of phacoemulsification and posterior chamber intraocular lens implantation in patients with Fuchs' heterochromic iridocyclitis. Methods: In a case series, 12 eyes of 12 patients, clinically diagnosed as Fuch's heterochromic iridocyclitis with cataract, which were operated on by one surgeon were studied. Phacoemulsification with scleral tunnel incision and in-the-bag PMMA intraocular lens implantation was performed. Preoperative and postoperative visual acuity, and intraoperative and postoperative complications were evaluated. Results: There were 7 males and 5 females ranging in age from 18to 65 years. Follow up duration was 25.2±6.4 months. Preoperatively, best corrected visual acuity was 20/40 or worse, which increased in an patients postoperatively to 20/40 or better and to 20/20 in 50% of them (P<0.0001). There were no intraoperative complications, postoperative glaucoma, or posterior synechiae. Two patients developed posterior capsule opacity requiring YAG Laser capsulotomy. Conclusion: Phacoemulsification and posterior chamber intraocular lens implantation is a safe procedure in Fuch' s heterochromic iridocyclitis. Intraocular lenses with large optics are recommended.

Purpose: To determine visual and anatomical outcome, complications and prognostic factors of pars plana vitrectomy for removal of intraocular foreign bodies in patients referring to Rasool Akram hospital during 1993-99. Material and methods: We retrospectively studied patients with intraocular foreign bodies who underwent pars plana vitrectomy in order to removing intraocular foreign bodies and had at least 3 months square test. Results: We studied the records of 60 patients including 58 (96.7%) young men, a bout 38% of them were in their third decade of life. The antecedent event was hammeringin 40% of the patients, the site of penetrance was in the cornea in 48.3% and 58% of the cases had a single foreign body. In 77.2% of the patients the nature of the foreign body was iron. Mean size of fo reign bodies was 3.6 mm. The foreign body was located in vitreous in 51.7% and in the retina, between the equator and the vascular arcades in 31.7%. Vitreous hemorrhage was seen in 53.3% of the cases. In 51 (81.7%) patients, vitrectomy was performed within 3 months after penetration. In 13 (21.7%) cases primary intraocular lens was implanted. The most common intraoperative complication was iatrogenic break (23.3%) and the most common postoperative complications were retinal detachment associated with PVR (20%), and cataract (15%). Primary visual acuity was significantly associated with final acuity (p< 0.05). Retinal detachment associated with PVR and presence of relative afferent pupillary defect were predictors of poor final visual acuity (P<0.05). Primary intraocular lens implantation significantly improved final acuity (P<0.05). Conclusion: Consideration of prognostic factors can help the surgeon to predict the final visual acuity. The most important prognostic factors were primary visual acuity, presence of relative afferent pupillary defect, and retinal detachment associated with PVR. PIimary intraocular lens implantation, whenever indicated may improve visual rehabilitation.

Purpose: To evaluate the effects of laser therapy in patients with choroidal neovasculatization refering to Labbafinejad medical center during 1994-99. Materials and methods: This descriptive study was based on existing data. By review of patients records, the following information were extracted: age, sex, job, corrected visual acuity before and after laser therapy (in the last follow up), the status of fundus appearance, some of known risk factors, and angiographic findings. The patients were divided into 3 groups; subfoveal, extrafoveal, and juxtafoveal based on location of choroidal neovascularization. Statistical analysis of data performed using computer data base. Results: Most of the patients were male, mean follow up was 9.25 months (9.25± 12.97), mean age of patients was 55/6 (14-79) years. Overall in all 3 groups after macular photocoagulation, final visual acuity increased, but the difference was not statistically significant(p< 0.29). The mean visual acuity increased from 198/1000 to 257/1000 after a mean follow up of 9.25 months. In 9 eyes (34.6%) with subfoveal involvement the mean visual acuity raised trom 53/1000 to 57/1000 during a mean follow up of 14 (14±19) months (p< 0.54), in 10 eyes (38.4%) with extrafoveal involvement the mean visual acuity raised from 373/1000 to 402/1000 after a mean follow up 7 (7±6.4) months (p< 0.70), and in 7 eyes (27%) with juxtafoveal involvement, the mean visual acuity raised from 137/1000 to 310/1000 during a mean follow up of 6 (6±5.9) months (p< 0.37). The most frequent risk factor was age-related macular degeneration. Conclusion: Although the results of macular photocoagulation for choroidal neovascularization are still disappointing, it may prevent further decrease in visual acuity in some selected patients.

Objectives: To describe the success rate of laser-induction of chorioretinal venous anastomosis and its effect on visual outcome in patients with retinal vein occlusion associated with progressive macular edema or visual loss. Patients and Method: Ten patients with non-ischemic central retinal vein occlusion, one patient with hemi-CRVO, and 2 patients with branch retinal vein occlusion underwent chorioretinal venous anastomosis by argon blue laser and/or Nd: YAG laser. Visual acuity, fundus findings, and fluorescein angiography before and after laser therapy were evaluated and recorded. Results: Patients were followed for a mean of 9 months (2-19). In 6 cases (46%) successful anastomosis was created and in 4 patients (30.7%) final visual acuity increased. In 7 patients (54%) laser-induction of chorioretinal anastomosis was unsuccessful. In 2 patients (15.4%) nonischemic central retinal vein occlusion progressed to ischemictype. In 4 patients (30.7%) final visual acuity decreased and in 5 patients (38.5%) final visual acuity did not change. One patients with active anastomosis developed choroidal neovascularization and vitreous hemorrhageand final visual acuity decreased. In another patient final visual acuity decreased due to fibrosis and macular traction. Conclusion: Creation of chorioretinal anastomosis by Argon Blue and/or Nd: YAG lasers is not always successful and may be associated with vision-threatening complication. Even with active and patent shunt formation, final visual acuity may not improve. Outcome of this type of surgery needs to be evaluated in a prospective study with larger sample size.

Objective: To compare therapeutic effects and complications oftbe two surgical methods; clear cornea incision and inferior approach cataract surgery in eyes with functional filtering bleb. Materials and Methods: In this study 38 eyes from 31 patients were categorized into two groups each containing 19 eyes. We assessed age, sex, type of glaucoma, interval between the two operations, duration of follow up , usage of antifibrotic agent, the number of medications, visual acuity, posterior synechia formation, astigmatism, cup/disc ratio, bleb condition before and after surgery, and also intraoperative and postoperative complications. Student T-test was used to compare the results between the two groups. Results: After 22.21±14 months of follow up in the clear cornea group and 19.17±15 months of follow up in the inferior approach group, we found that intraocur arpressure raised from10.9±5.3 to 14.9±5.6mmHg in clear cornea group and from 11.9+3.4 to 14.7+3.3mmHg in inferior approach group (p< 0.02). The number of medications raised from 0.4±0.8 to 1.1±1.1 in clear cornea group (P<0.003) and from 0.3 ±0.7 to 1.0±0.9 in inferior approach group (P<0.005). Duration of the follow up, interval between the two groups, and amount of astigmatism, were not significantly different between the two groups. Conclusion: There was no significant difference between two methods of cataract surgery regarding intraocular pressure control, number of used medications, and induced astigmatism.

Purpose: To study the potential systemic effects of intraocular epinephrine during cataract surgery. Methods: This clinical trial was performed on consecutive patients who underwent cataract surgery. The patients were randomized to surgery with or without injection of diluted intraocular epinephrine. Surgery was performed with similar technique and materials (except epinephrine) in all patients. Blood pressure and pulse rate of all patients were monitored before operation, after injection of retrobulbar anesthetics and 1 and 10 minutes after intraocular injection of 1/50000 diluted epinephrine or placebo solution. Results: Overall 121 eyes of the subjects of the study included 59 eyes (49%) that received epinephrine injection and 60 eyes (61%) were in control group. There was no statistically significant difference between mean blood pressure or pulse rate changes at 1 and 10 minutes after intraocular injection of 1:50000 diluted epinephrine between the two groups (P>0.1, paired T-test). Conclusion: Intraocular injection of 1:50000 diluted acid tartrate epinephrine to facilitate cataract surgery in patients undergoing surgery with local anesthesia had no systemic adverse effects and may probably be safe in patients with controlled hypertension.

Purpose: To evaluate the results of strabismus surgery in cases who previously underwent scleral buckling procedures. Patients and methods: A series of 17patients with longstanding constant significant ocular deviation(more than 10 PD and longer than 6 months of duration) who underwent strabismus surgery after scleral buckling procedures were studied. Various preoperative and postoperative factors as well as results of strabismus surgery were evaluated. Results: The types of ocular deviation after scleral buckling procedures were esotropia in 7 cases (41.2%) with mean deviation of 43.57±5.56 PD, exotropia in 9 cases (52.9%) with mean deviation of 37.44±17.85 PD and associated vertical deviation in 9 cases (52.9%) with mean deviation of 15.22±8.94 PD. Superior oblique paresis in four cases and superior rectus paresis in one case were detected. The surgical procedures included horizontal recess-resect in 94.1%, displacement of horizontal recti in 53.3%, and inferior oblique myectomy in 23.5%. In two cases reoperation were needed. After mean 9 months of follow up, orthotropia achieved in 76.5% of cases and in 94.1% of the cases the results of strabismus surgery were acceptable (with in 10PD ortho). Conclusion: Because of higher risk of redetachment of retina with removal of explant, strabismus surgery can be performed with desirable results in cases with postoperative scleral buckling ocular deviations.

Purpose: To review methods of diagnosis and treatment of cystoid macular edema after cataract surgery. Materials and Methods: We searched all papers up to 2000 regarding the key words: cystoid macular edema, diagnosis, and treatment at the Medline. We reviewed the relevant articles and compared the results and discussed about them according our own experiences. Results and discussion: Cystoid macular edema should be considered in the evaluation of loss of vision after cataract surgery in any patient. There are several methods for diagnosing the cystoid macular edema, but the most important one is funduscopy. Although new techniques like optical cohererce tomography and infrared scanning laser ophthalmoscopy can exactly determine the thickness of retina, they are not widely used and they are very expensive instruments. Therefor the best way for diagnosis of cystoid macular edema is physical examination and fluorescein angiography. The most controversies are around treatment of cystoid macular edema. The first step is treating the existing complications during the surgery, especially vitreous or iris adhesion to the wound. Postoperative inflammation should be treated by administration of corticosteroids and /or cyclooxygenase inhibitors. Even in the absence of inflammation and in the chronic cases, administration of cyclooxygenase inhibitors improves cystoid macular edema, but recurrences are frequent. Cyclooxygenase inhibitors are also widely used for prevention of cystoid macular edema. In the chronic nonresponsive cases with considerable loss of vision, vitrectomy is indicated. Conclusion: The major known cause of cystoid macular edema is prostaglandin production and so tbe most effective way for prevention is breaking this process by using cyclooxygenase inbibitors. In the presence of complication, corticosteroids should be administered. In the chronic nonresponsive cases, even in the absence of other complications, vitrectomy is highly recommended.

Purpose: To introduce leiomyoma as a rare benign tumor of the orbit that must be differentiated from the malignant tumors like melanoma or rhabdomyosarcoma. Patient and findings: A 20 years old girl with exotropia of 35 PD, limitation of lateral gaze and positive forced duction test was referred at 1998. She reported that she had an intraocular mass with clinical and radiological diagnosis of melanoma, but she had not accepted enucleation and she went to England for further evaluation. After fine needle biopsy, the diagnosis of benign leiomyoma was established and the mass was excised. Six months later she underwent cataract surgery and after a few months, strabismus was corrected with surgical intervention. Finally she was orthotropic with a visual acuity of 9/10 in that eye. Conclusion: For making an accurate diagnosis, especially in young adults we suggest fine needle biopsy of anterior segment tumors, before any invasive surgeries.

Purpose: To report a type of strabismus surgery by applying adjustable sutures in a case of strabismus after scleral buckling. Patient and findings: A 57-year-old highly myopic woman with history of scleral buckling at 20 years ago developed esotropia of her left eye. She underwent strabismus surgery in which medial rectus and lateral rectus muscles were isolated and dissected behind the buckle without any manipulation of capsule of the buckle and the muscle over it. The medial rectus was recessed with a hang back adjustable non-absorbable suture and the lateral rectus was advanced with the same method. Residual deviation was adjusted the day after the surgery. Conclusion: This surgical technique is a safe and effective method without any manipulation of the capsule of buckle and its potential complications, therefor can be recommended in strabismus surgery after scleral backling.