BINA
Year:2010 | Volume:15 | Issue:4 (61)|Papers Count:13

Purpose: To evaluate the outcomes of ptosis surgery in patients with weak levator function using orbicularis oculi and frontalis muscles.Methods: This prospective interventional case series study was conducted over 3 years on patients with ptosis and weak levator function (less than 4mm). In all cases, orbicularis oculi and frontalis muscles were used directly to correct the ptosis. Success was defined as upper lid margin to central corneal reflex distance (MRD1) equal or higher than 3 mm in bilateral cases and less than 1 mm difference between the two eyes in unilateral types.Results: The study included 26 eyes of 22 patients with mean age of 15.4±9.4 years; 12 patients (54.5%) had a history of previous unsuccessful ptosis surgery. Mean follow up was 13.5±8.4 months. The most common cause of ptosis was congenital which was present in 15 patients (68.2%). The operation was successful in 19 patients (86.4%). Age and history of previous surgery was not correlated with success rate but the amount of levator function was directly correlated with success (P=0.02).Conclusion: Direct use of orbicularis and frontalis muscles to correct ptosis in patients with weak levator function can be a good substitute for other methods of surgery.

Purpose: To report the demographics and clinical profile, and outcomes of canalicular laceration repaired with Mini Monoka monocanalicular stent.Method: All patients who had undergone canalicular laceration repair over 4 years (2004-2008) at Imam Khomeini Hospital, Ahwaz, were retrospectively reviewed. Demographics, the cause of eyelid injury, associated ocular damage, time interval between injury and surgery, and surgical management with Mini Monoka stent were analyzed. Patients were observed for complications (especially for epiphora) and premature extrusion. Afterwards, probing and irrigation test were done under topical anesthesia.Results: Eighty-eight out of 97 referred patients with eyelid laceration including 70 men (79.5%) and 18 women (20.5%) had monocanalicular injury and underwent Mini Monoka stent implantation. Mean age at presentation was 25.4 (range: 12 months to 75) years. The main cause of laceration was motor vehicle accidents. Lower and upper canalicular injuries were present in 79 (89.8%) and 9 patients (10.2%), respectively. Simultaneous ocular injury was noted in 32 patients (36.3%). Probing and irrigation test was done in 56 patients which was normal in 49 patients; therefore, anatomical success rate was considered 87.5%. There was no epiphora in any patient (functional success rate defined as 100%). Premature stent loss was the main post operative complication in 5 patients (9%). Mean duration of the stent remaining in its place was 8 months (range: 1 to 28).Conclusion: The MiniMonoka monocanalicular stent is a safe, effective and uncomplicated surgical technique. Unlike bicanalicular procedures, this procedure does not threaten unaffected parts of the lacrimal drainage system.

Purpose: To determine the surgical results of partially accommodative esotropia (PAET).Methods: Thirty-eight patients with PAET scheduled for surgery from 2002 to 2008 were enrolled in a descriptive, analytic retrospective study. Patient characteristics including age, gender, refractive error, visual acuity, pre and post operative deviation, technique of surgery and follow up duration were recorded and analyzed.Results: PAET accounted for 38.29% of accommodative esotropia. Mean age and refractive error (spherical equivalent) were 6.32±3.38 years and +4.1±1.98 diopters, respectively. The prevalence of amblyopia was 54.04% and patients were followed up for 18.76±13.58 months. Mean pre and post operative deviation were 30.87±10.3 and 2.05±5.7 PD, respectively (P<0.001). Mean amount of bilateral medial rectus recession was 5.48±0.66 mm. In 78.9% of patients, postoperative deviation was within 10PD of orthotropia. Residual esotropia and consecutive exotropia were seen in 18.4% and 2.6% of patients, respectively.Conclusion: Pre-operative deviation, refractive error and amblyopia had no significant effect on outcomes of surgery.

Purpose: To evaluate residual refractive errors after cataract surgery and its determinant factors at Farabi Eye Hospital, Tehran.Methods: Simple random sampling was done among cataract surgery scheduled patients over a 4 year period (2003-2006). Exclusion criteria were uveitis, previous intraocular surgery and ocular trauma. After applying the exclusion criteria, 423 patients were studied. Lens calculation was performed using the SRK-II formula. Unexpected refractive errors were defined as the difference between postoperative refractive errors with target refraction. Mean and percentage of this variable were reported based on 0.5, 1 and 2 D of ametropia.Results: Of 558 studied patients, 78.1% had biometric data before and refractive data after surgery. Mean absolute unpredictable refractive error was 0.84±0.89 D. Eyes with normal axial length (AL) had the least (0.76±0.84) and those with long AL had the most unpredictable refractive errors (P<0.001).45.9%, 73.9%, and 91.7% of the study cases had refractive errors within 0.5, 1 and 2 D of emmetropia, respectively. Eyes with short AL had positive refraction and those with long AL had negative refraction after surgery. The majority of keratometric astigmatism followed extra-capsular surgery while the least measures were associated with phacoemulsification (P<0.001).Conclusion: Axial length was one of the important factors influencing residual refractive errors after cataract surgery. Unpredictable refractive errors were more common in eyes with long and short AL than those with normal AL.

Purpose: To evaluate corneal endothelial cell changes after intravitreal and subconjunctival injection of avastin (bevacizumab) based on specular microscopic findings.Methods: This prospective interventional study was performed on 82 eyes of 82 patients. Forty-two cases with ptrygia received a subconjunctival injection of bevacizumab (2.5mg/0.2ml) and 40 diabetic subjects with retinal neovascularization or macular edema received an intravitreal injection of bevacizumab (1.25mg/0.1ml). Specular microscopy, including corneal endothelial cell count, size and shape, was performed in all patients for the injected eye before, and one and three month after injection and the results were compared and analyzed.Results: There was no change in the corneal endothelial cells count after one month but there was mild reduction of endothelial cells after 3 months which was not statistically significant. (P=0.75 and 0.29, respectively).Conclusion: Subconjunctival and intravitreal injection of bevacizumab (up to 1.25 mg/0.1 ml and 2.5 mg/0.2 ml, respectively) entails no harmful effect on human corneal endothelial cells up to three months following the injection.

Purpose: To evaluate the effects of intravitreal and intracameral injection of bevacizumab in patients with neovascular glaucoma (NVG).Methods: This interventional case series was conducted on 40 eyes of 40 patients with neovascular glaucoma. Data included the extent of iris (NVI) and angle neovascularization (NVA), peripheral anterior synechia (PAS), and intraocular pressure (IOP). Following standard NVG treatment, 1.5 and 1 mg of Bevacizumab were injected intravitreally and intracamerally, respectively. Six weeks after injection, the same procedure was repeated.Results: Intraocular pressure decreased significantly from 40.15±18.33 to 29.27±15.07 mmHg (P<0.001). NVI and NVA were eliminated in 97.5% and 100% of patients, respectively. No significant change was seen in best corrected visual acuity (BCVA). After the injection, hyphema occurred only in one eye.Conclusion: Intravitreal and intracameral injection of bevacizumab is an effective complementary treatment for reducing NVI and NVA and hence IOP in NVG.

Purpose: To compare post-operative pain with cooling photorefractive keratectomy (PRK) versus conventional PRK.Methods: A prospective clinical trial was performed on 94 eyes from 47 patients scheduled for PRK. Patients were randomly assigned to either cooling or conventional PRK. Pain was evaluated 6, 12, 24 and 48 hours post-operation using a visual analogue scale (VAS). Corneal haze, conjunctival and palpebral edema, and complications were also assessed.Results: Mean age of the patients was 24.8±4.5 (range: 18-36 years) and mean refractive error was 3.6±1.6 diopters. Median pain score in the cooling group at 6 and 12 hours was 15 and 10, respectively and zero at 24 and 48 hours. Median pain score in the conventional group at 6 and 12 hours was 30 and 15 and was zero at 24 and 48 hours. There was no adverse effect in either of the groups.Conclusion: Cooling PRK effectively reduces post-operative pain after PRK without any additional adverse effect.

Purpose: To evaluate the effect of trans-scleral cyclophotocoagulation (TSCPC) in reducing intraocular pressure in eyes with history of pars plana vitrectomy with or without intraocular silicone oil and refractory to medical treatment.Methods: Medical records of 35 eyes of 35 patients who underwent TSCPC for medically uncontrolled glaucoma after pars plana vitrectomy for retinal pathology were reviewed retrospectively. Diode laser contact TSCPC was performed at a power of 1-3 watt, for a duration of 2 seconds and with 15-30 applications. Intraocular pressure, visual acuity, number of previous operations, number of medications, number of treatment sessions per eye. Laser parameters and complications were evaluated.Results: After a mean follow-up period of 13.31±4 (range 6-60) months, mean IOP was decreased from 33.46±9.80 (12-38) mmHg before surgery to 16.57±8.21 (2-46) mmHg after TSCPC (P<0.001). The number of anti-glaucoma medications was reduced from 2.60±1.09 preoperatively to 1.31±0.99 at final follow up (P<0.001). Qualified success and complete success were achieved in 29 (83%) and 9 eyes (20%), respectively.Conclusion: Patients with medically uncontrolled intraocular pressure following to pars plana vitrectomy with or without intravitreal silicone oil can be treated successfully with TSCPC.

Purpose: To evaluate the effect of early drainage of delayed suprachoroidal hemorrhage (SCH) after glaucoma surgery.Methods: These study reports seven cases of delayed supra-choroidal hemorrhage following glaucoma surgery managed with early drainage. In this series instead of waiting for 7 to 14 days for clot lysis, the SCH was drained from the suprachoroidal space immediately after diagnosis.Results: Seven eyes of 7 patients with delayed SCH including 4 men and 3 women were enrolled in the study. Median age was 42.57±29.61 years and mean follow up duration was 21.43±13.35 months. Immediately after diagnosis, choroidal tap and anterior chamber reformation were performed for all the patients. Intraocular pressure (IOP) decreased significantly after intervention. At final follow up, mean visual acuity was 1.08±0.31 LogMAR.Conclusion: Immediate surgical drainage of suprachoroidal hemorrhage seems to be an effective and safe method for treatment of delayed SCH; and it may decrease the inflammation from the entrapped blood in suprachoroidal space and reduce complications and additional procedures. Larger trials are recommended for further evaluation.

Purpose: To describe a complicated case of traumatic carotid-cavernous fistula (CCF) and our management strategy.Case report: A 13-year-old patient was referred one month following a car accident and facial trauma with severe proptosis, chemosis and limitation of ocular movement. Presence of murmur and an enlarged superior ophthalmic vein on orbital imaging suggested an arteriovenous fistula. The patient underwent transarterial fistula ballooning which resulted in alleviation of the fistula and improvement of signs and symptoms.Conclusion: Orbital signs and symptoms following trauma may indicate an arteriovenous fistula.