BINA
Year:2012 | Volume:17 | Issue:4 (69)|Papers Count:18

Purpose: To evaluate corneal hysteresis and corneal resistance factor in penetrating keratoplasty grafts in a group of keratoconic eyes using the ocular response analyzer (ORA) and to evaluate the relationship between donor size, donor-recipient disparity and central graft thickness (CGT), and ORA parameters.Methods: This cross-sectional study was conducted on 34 eyes of 34 keratoconus patients who had undergone PKP. Corneal hysteresis (CH), corneal resistance factor (CRF), and cornea-compensated intraocular pressure were measured at least 6 months after complete suture removal. Two groups of donorrecipient disparity (0.25 vs. 0.50 mm) were compared using the independent t test. Multivariate regression analysis was used to investigate the correlation of donor trephine size and CGT with ORA parameters. Factors influencing intraocular pressure measured with the Goldmann applanation tonometer (IOP GAT) after PKP were determined using multiple regression analysis.Results: Mean patient age and follow-up period were 29.6±6.2 years and 82.4±59.6 months, respectively. Mean CGT, CH, and CRF were 567.5±38.8 mm, 10.2±2.1 mm Hg, and 10.1±2.2 mm Hg, respectively. CH and CRF had a significant positive correlation with donor trephine size and CGT. Significantly greater values of CH and CRF were observed in the 0.5-mm disparity group compared with the 0.25-mm disparity group. Among the studied parameters, only CH, CRF, and cornea-compensated intraocular pressure had a significant positive correlation with IOP GAT.Conclusion: Graft biomechanics seem to be closer to normal values with larger grafts and greater donorrecipient disparity. These metrics had a significant correlation with IOP GAT after PKP.

Purpose: To compare the corneal thickness progression (CTP) and progression index (PI) in keratoconus (KCN), keratoconus suspected (KS) and normal corneas, using Scheimpflug photography (Pentacam).Methods: Three-hundred eyes were evaluated using rotating Scheimpflug photography (Pentacam). On the basis of anterior sagital curvature, maximum posterior elevation (MPE) and thinnest point of pachimetry (TP) the eyes were divided into three equal groups. The normal group had normal anterior topography, pachimetry 500 m or more and MPE less than 20 m, KS group had a suspected topography and KCN group had definit topographic findings. The eyes were evaluated by "pachimetric map", "Corneal thickness spatial profile" and "percentage of corneal thickness" and mean of "progression Index" calculated for each eye and data analysis was performed with SPSS software.Results: Mean MPE was 13.20±3.95 m in the normal group, 19.80±6.75 m in the KS group and 40.93±16.21 in the KCN group. Mean TP was 541.53±27.92 m in the normal group, 504.15±31 m in the KS group and 461.09±46.84 m in the KCN group. Mean PI was 0.91±0.15 in the normal group, 1.11±0.20 in the KS group and 2.00±0.73 in the KCN group. This study demonstrated that, all of three parameters (MPE, TP and PI) had statistically significant difference between three groups (P<0.001). A statistically significant but week correlation was found between PI and the severity of keratoconus.Conclusion: In addition to topography, central corneal thickness, posterior and anterior elevation, PI and CTP can be used to distinglish normal corneas from KS and KCN ones.

Purpose: To evaluate the prevalence and risk factors of dry eye in the patients referred to an eye clinic in Birjand, Iran.Methods: This cross sectional descriptive-analytical study consisted of 600 patients who were referred to the eye clinic of Birjand, Iran between September 2010 and September 2011. They were given a simple questionnaire about the risk factors of dry eye including the demographic information, cigarette smoking, and menopause, climate conditions, underlying disease, eye diseases, drug history and previous eye surgery. The Schirmer 1 test was done for all of participants and statistical analyses were performed using software SPSS 16.Results: The total prevalence of DES was 59% and its prevalence increased with age from 31.6% in patients<20 years to 81.8% among patients>80 years. After adjusting for age, other risk factors were the history of cigarette smoking (OR=1.89 , P=0.021), menopause (OR=3.26, P<0.001), season (P<0.001), systemic hypertension (OR=2.09, P=0.012), diabetes (OR=1.89, P=0.006), glibenclamide usage (OR=2.28, P=0.008), the presence of cataract (OR=2.08, P=0.001) and cataract surgery (OR=2.16, P=0.005). There was no statistically significant association between DES and patients gender.Conclusion: Dry eye is very common in Birjand with aride climate condition. It’s prevalence increases with aging, cigarette smoking, menopause, history of hypertension, diabetes, glibenclamide taking, the presence of cataract and cataract surgery.

Purpose: To investigate the proportion and time trend of second-eye senile cataract surgery (SECS) in a highturnover academic center in Iran.Methods: In this cross-sectional study, Samples were selected among all records of senile cataract surgery based on the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) during four consecutive years (2006-2009). Utilizing hospital's computer-based records, 15% of records were included by systematic random selection. Patient’s demographics as well as surgical data were assessed. The proportion of annual SECS was considered as the main outcome measurement and the time trend was calculated through linear regression model.Results: Of total senile cataract surgeries (N=10517) performed over a 4-year period (between 2006 and 2009), 1585 (15%) were retrieved randomly. Among these, 1139 records [71.8%: 95% confidence interval (CI): 69.5-74.1] were related to the first eye operation and 446 (28.2%; 95% CI: 25.9-30.35) were related to the second eye. The proportion of SECS was increased from 24.6 % in 2006 to 33.4% in 2009 (p=0.01), with a linear increase in the trend of SECS (b=0.031, P=0.003). Overall, median (inter quartiles range) of time interval between two cataract surgeries was 9 (4-24) months which remained unchanged during the study period. SECS rate and time interval were independent of age, sex, and the type of insurance during the study period. SECS was 10.4% higher (P=0.01) and time interval was 13 months lower (P=0.007) in patients who underwent Phacoemulcification in the first eye as compared to those who had extra capsular cataract extraction in their first eyes, (29.9% vs. 19.5%, P= 0.01).Conclusion: Recently, there has been an increase in the number of senile cataract surgery and SECS which contributed one-third of total cataract surgeries.

Purpose: To investigate tear function in Acne Vulgaris patients who were treated with Isotretinoin (Accutane).Methods: In this prospective clinical study, patients who were scheduled for isotretinoin (Accutane) therapy for two months underwent complete eye examination. The best corrected visual acuity measurement, careful slit lamp examination of anterior segment, evaluation of break-up-time and Schirmer test were performed. All examinations were repeated two months after treatment complation.Results: Thirty-nine patients entered the study. There were 5 patients complaining of eye strain, which rose to 19 patients after isotretinoin therapy (P<0.001). The tear break up time was 13±1 seconds which decreased to 9±1 (P<0.001) after therapy and the Schirmer test was 22±2 mm which was reduced to 18±5 mm (P<0.001).There were 4 patients with blepharitis before the treatment which rose to 19 patients after the end of isotretinoin treatment (P<0.001).Conclusion: The most frequently observed side-effects were decreased tear break up time and alterations of the lid margin. Isotretinoin causes dry eye by reducing the tear.

Purpose: To assess the effect and long-term results of oral propranolol in pediatric capillary hemangiomas.Methods: Four children aged 3 months to 5 years with periocular and orbital hemangioma of infancy (HOI) were treated with propranolol, 2 milligram per kilogram per day divided in 2 doses. Propranolol was continued in all cases until the end of the first year of life and tapered over 2-3 weeks.Results: Significant improvement was noted in all patients in the first 2 months of treatment and continued slowly during the follow-up. No serious complications were observed during the follow-up period.Conclusion: Oral propranolol can be used as the first line treatment in children with capillary hemangioma.

Purpose: To present the success of novel method for management of conjunctival orbital inclusion cysts following enucleation after using trichloroacetic acid injection technique.Methods: A 20% TCA solution was injected to treat 6 cases of orbital conjuctival cyst in anophthalmic socket.Results: All the patients were treated successfully. The follow-up interval was 1-7 years. No recurrence or other complications developed.Conclusion: Intralesional TCA injection is successful in resolving the problematic cyst without surgical intervention in an anophthalmic orbit. It is a safe procedure and recommended for treatment of orbital conjuctival cyst.

Purpose: To evaluate malpractice complaints against ophthalmologist referred to the IRI.Methods: This cross-sectional study was performed on medical council during years 2003 to 2008. SPSS software was used for analysis.Results: During this period from 1869 cases of malpractice 115 (%6.1) have been related to the field of ophthalmology but in order to some problems we can’t analysis 24 files. Out of 91 cases, 10.1% of them have been related to university centers, 58.3% related to non- university centers and 30.7% related to private centers, however malpractice rate in these centers have been 20%, 28.3% and 35.8%. The highest rate of filed complains was related to the cataract surgery (46.1%) follow by refractive error (16.4%) and eye trauma (10.1%).Conclusion: Ensure that patients fully understand the specific risks associated with the procedure, good communication and behavior with patients and their companions and performing adequate physical examination have significant effect on the decreasing of malpractice complaints against ophthalmologist.

Purpose: To evaluate the effect of topical phenytoin 1 % on corneal epithelial defects healing in a rabbit model.Methods: One eye of 20 albino rabbits in the animal house of Al-Zahra Ophthalmology Hospital was studied. A single corneal epithelial defect was created. The rabbits were randomly assigned into two groups (Ten animals in each group). After creating a chemical burn in rabbits, one group was treated by soluble phenytoin 1% eye drops and the other group with normal saline eye drops. Daily examination was performed to determine the maximum diameter of corneal epithelial defects during 14 days. Data was analyzed using statistical tests including independent T Test and ANOVA on repeated observations.Results: The difference between the first and the last day of follow up in each group was significant (P<0.05). Topical phenytoin 1%, as compared with the control group, significantly improved epithelial defect healing (P<0.05).Conclusion: Topical phenytoin 1% as a supplement treatment can help in the improvement of epithelial defect caused by alkaline burns.

Stem cells located at the limbus , are the ultimate source for regeneration of the corneal epithelium in the normal and traumatized states. When limbal stem cells are dysfunctional or deficient, limbal stem cell deficiency (LSCD) develops. Its surgical management depends on laterality and severity of corneal-limbal involvement. Conventional methods of stem cell transplantation are conjunctival-limbal autograft (CLAU); conjunctival-limbal allograft (CLAL) and kerato-limbal allograft (KLAL) surgeries. Cultivated limbal epithelial transplantation (CLET) and cultivated oral mucosal epithelial transplantation (COMET) on a carrier such as amniotic membrane are current surgical alternatives.These new surgical procedures are effective in stabilizing the ocular surface. The theoretical advantage of ex vivo expansions over conventional methods is that only a small limbal or mucosal biopsy is needed, thus minimizing the risk to the donor eye; and has a lower risk of rejection. They can be used in cases with unilateral or bilateral total stem cell deficiency. In the unilateral cases, the source for CLET is healthy fellow eye and in bilateral cases, the source can be living-related or cadaveric eyes.The oral explants do not have limbal stem cells, but they seem to be a source of limbal stem cell equivalents that are able to generate cornea-like epithelium under the proper culture conditions. The main advantage of COMET is that patients with bilateral LSCD, can be treated with grafts derived from their own autologous oral mucosal cells. The long-term outcomes of COMET have to be elucidated.

Purpose: To present a case of traumatic bilateral eyelid lymphedema.Case Report: An 18-year old male presented with severe bilateral eye lid lymphedema with a history of severe craniofacial trauma three month ago and neurosurgical procedure. He had lost vision in his left eye because of sever globe injury. His lymphedema was attributed to wide surgical incision scar. The patient underwent manual lymphatic drainage (MLD) and his condition was improved significantly.Conclusion: Traumatic eyelid lymphedema is a rare condition with significant morbidity and manual lymphatic drainage is of great value in its management.

Purpose: To report a case of Idiopathic Retinal Vasculitis, Aneurysm, and Retinitis [IRVAN] with angiographic and optical coherence tomography (OCT) findings.Case Report: A 15-year-old girl with a 2 -month history of decreased visual acuity in both eyes and bestcorrected visual acuity of 20/70 in both eyes was referred to the retina clinic. Mild inflammation was present in anterior chamber and vitreous cavity. There was severe exudative maculopathy, optic disc swelling, multiple tied knot-like aneurysmal dilations of retinal arterioles, and retinal vasculitis bilaterally. Systemic and laboratory work-up were negative. OCT illustrated severe retinal edema, cystic spaces in nerve fiber layer (NFL), and excrescences on the retinal surface around posterior pole.Conclusion: In this report, we present OCT findings in a case of IRVAN syndrome about which few reports are available. The findings show that reduced axonal conduction and schisis-like cavities in NFL may be present.

Purpose: To report a patient with an intraocular lymphoma with history of treated brain lymphoma.Case Report: A 45-year-old female was referred with moderate chronic intermediate uveitis of both eyes that was unresponsive to medications. She had history of treated brain lymphoma with chemotherapy and radiotherapy 6 years before presentation. Systemic workup, laboratory evaluation, brain and orbital MRI was normal. 25-G pars plana vitrectomy with 400 intravitreal injection of methotrexate was done in both eyes. Intraocular lymphoma was reported by cytopathologic evaluation of vitreous fluid.Conclusion: Intraocular lymphoma should be kept in mind in a patient with persistant chronic and diffuse uveitis and vitritis specially when beginning over fifties, in order to select appropriate diagnostic and therapeutic measures.