BINA
Year:2002 | Volume:7 | Issue:2|Papers Count:18

Purpose: To identify the distribution and characteristics of new referrals with uveitis to a tertiary eye care center in Tehran.Method: A 2 year prospective study was carried out, getting information from a survey applied to patients who had been referred with uveitis by other ophthalmologists. Results: Five hundred forty-four patients were referred (mean age 32.3 years). The most common forms of uveitis were anterior uveitis versus other anatomical forms, chronic vs acute, nongranulomatous vs granulomatous, noninfectious vs infectious. Of the cases, 45.5% were idiopathic, 19.9% had specific ocular disease, and 37.3% had systemic disease associations. Behcets disease was the most common noninfectious condition and toxoplasmosis was the most common infectious entity. The most prevalent causes were: in anterior uveitis; idiopathic and Fuchs heterochromic iridocyclitis, in posterior uveitis; toxoplasmosis, Eales, and toxocariasis, in intermediate uveitis; idiopathic, sarcoidosis, and multiple sclerosis, and in panuveitis; Behcet, idiopathic, and Vogt Koyanagi Harada syndrome. The most frequent cause under 16 years was pars planitis. Half of the patients had intermediate socioeconomic status. Uveitis seriously affected daily activity of 57.3% of patients. Conclusion: Referral pattern of uveitis may be influenced by geographical, environmental, genetic, and ethnic factors as well as use of advanced diagnostic techniques and employed diagnostic criteria. This study disclosed entities such as cytomegalovirus retinitis and bird shot chorioretinopathy are extremely rare; HLA-B27 associated iridocyclitis is less common. In contrast, Behcets disease, Fuchs heterochromic iridocyclitis, Eales disease, and toxocariasis were more prevalent entities.

Purpose: To compare central corneal thickness (CCT) in patients with ocular hypertension (OHT), primary open-angle glaucoma (POAG), low-tension glaucoma (LTG), and a control group.Materials and methods: All consecutive patients affected by OHT, POAG, or LTG examined at Farabi Eye Center, glaucoma clinic (Isfahan, Iran) who met the eligibility criteria were recruited. A control group consisting of hospital staff and patients examined at the general eye clinic who had a normal eye examination were also included. Exclusion criteria were: (1) history of previous corneal or intraocular surgery, (2) history of previous eye trauma or presence of significant corneal pathology, (3) contact lens wear, (4) myopia or hyperopia greater than 5 diopters or astigmatism exceeding 2.5 diopters, and (5) use of acetazolamide or dorzolamide within the previous month. Central corneal thickness was measured by an ultrasound pachymeter 3 times in each eye and the lowest measurement was chosen as the final value. Only measurements from the right eye of each binocular individual were included for further analysis.Results: A total of 125 eyes were examined consisting of 42 ocular hypertensives, 37 POAG cases, 6 cases with LTG and 40 normal eyes (control group). Mean (SD) central corneal thickness was 562.9 (30.8), 528.4 (31.2), 502.8 (47.3), and 525.6 (26.0) microns in the OHT, POAG, LTG, and control groups, respectively. A statistically significant difference was detected between the OHT group and POAG and control groups (P= 0.000 for both comparisons). No statistically significant comparison was found for the LTG group because of the low number of cases. A CCT of 580 microns or more was present in 2.5%, 5.4% and 33.3% of the control, POAG, and OHT eyes, respectively (P= 0.000 for both comparisons).Conclusion: Some eyes with OHT have an abnormally thick cornea that may lead to overestimation of the intraocular pressure and probably undue treatment. Measuring CCT in all eyes with OHT is indicated.

Purpose: To evaluate success rate of initial probing for congenital nasolacrimal duct obstruction and influencing factors in children less than 5 years.Materials and methods: From November 1998 to June 2000, 207 eyes from 161 patients underwent nasolacrimal duct probing and irrigation.Results: Overall success rate was 83.9% varing from 50 to 100%, depending on the age of the patient, type of the nasolacrimal obstruction, and canaliculus status.Conclusion: Success rate of initial probing is excellent in patients less than one year, whilst it is fare in patients between 1-5 years old.

Purpose: To determine the efficacy of probing in treatment of congenital nasolacrimal duct obstruction (CNLDO) in children attending Imam Hossien Hospital, Tehran, Iran (1996-99).Methods: This descriptive study was conducted on 104 eyes from 83 patients. The variations of gender, symptom severity, presence of mucous discharge, time of probing, infracture of turbinate, and duration of follow up were recorded.Results: From 83 subjects (104 eyes), 49 were male (59%) and 34 were female (41%). The mean age at probing was 27.2 months. The obstruction was bilateral in 21 patients (25%) and unilateral in 62 (75%). Six cases were eligible for infracture of the turbinate. The failure rate was 17% and 83% of them had perfect recovery. Mean age in patients who failed was 36 months and in those with recovery 25.5 months.Conclusion: Probing is not recommended during the first year of life, except in cases with copious purulent discharge. Probing for CNLDO beyond 2 years of age is highly successful.

Purpose: To describe the vitreoretinal abnormalities in 24 patients with anterior megalophthalmos (AM).Patients and methods: Funduscopy was performed in patients examined in Labbafinejad medical center with the diagnosis of anterior megalophthalmos (megalocornea with visible iris diameter of 13 mm or more, iris hypoplasia, lens subluxation, cataract formation at an early age, and absence of congenital glaucoma). Their hospital records were reviewed for past history.Results: Twenty four patients (12 males, 12 females) with an age range of 4 months to 64 years were found to have AM. Eight patients did not have follow up visits. Others were followed from 1 to 16 years. Vitreous degeneration was the most common abnormal finding present in 34 eyes (73.9%). Nine eyes (19.5%) had optically empty vitreous with strands. Lattice degeneration was seen in 5 eyes (10.8%). Spontaneous vitreous hemorrhage occurred in 3 eyes and peripheral retinal neovascularization was detected in 2. Retinal detachment had occurred in 15 eyes (31.2%) leading to loss of the eye in 4 cases. Retinal break was found in 6 of the eyes including giant retinal break (1 eye) and atrophic hole (1 eye). Spontaneous retinal reattachment occurred in 1 eye. Ten eyes underwent a total of 15 surgeries with successful results in 9.Conclusion: Anterior megalophthalmic eyes seem to have a kind of vitreoretinopathy predisposing them to retinal detachment (in 31.2% of current series). Conventional scleral buckling and vitrectomy techniques yield good results in these eyes.

Purpose: To evaluate visual outcome of post traumatic endophthalmitis managed in Rasoul Akram hospital during 1989-1997.Materials and Methods: Hospital records of 147 cases of post-traumatic endophthalmitis were evaluated retrospectively. The cases had progressive anterior segment inflammation and vitritis after penetrating globe injuries. Effect of initial visual acuity (VA), red reflex (RR), relative afferent pupillary defect (RAPD), and positive culture on final VA were determined.Results: The cases included 111 males and 36 females. Mean (SD) age was 18.4 (16.9) years. Initial VA of 92.5% of patients was below 20/200 and 7.5% of them had a VA more than 20/200 that increased to 33.6% after 2 months (P<0.0005). Relationship between initial VA and RAPD was significant (P<0.0001). Relationship between RR and culture with final VA was not significant.Conclusion: The visual prognosis of patients with post-traumatic endophthalmitis is guarded. It seems that RAPD and initial VA are important prognostic factors on visual outcome. Case-control studies are recommended to increase treatment success.

Purpose: To compare the ability of three diagnostic methods (clinical examination, serum retinol, and conjunctival cytology) with relative dose response (RDR) method as the gold standard.Patients & methods: In this descriptive and diagnostic study, 70 children aged from 6 to 72 months were evaluated sequentially from 1998 to 2000. First their epidemiologic characteristics were obtained and then eye examinations (conjunctiva, cornea, fundus) were performed. Samples for cytology were taken from the temporal bulbar conjunctiva. Serum retinol concentrations were determined by 2 ml of blood sample. Then the children were given a drop of vitamin A (1500 IU) and after 5 hours another 2cc of blood sample was examined for RDR. Statistical tests were Chi square and Fisher exact tests.Results: Sensitivity, specificity, positive predictive value and negative predictive value of cytology and serum retinol and eye examination compared with RDR were 69,98,97;91 and 41,96,78;83 and 12,82,18;74 percent, respectively.Conclusion: This study showed that clinical examiantion, serum retinol concentration and cytology alone are not able to determine vitamin A status in children. It seems that conjunctival cytology is better than others comparing with RDR.

Purpose: To describe view points and methods of Iranian ophthalmologist in the management of patients with cataract.Material and methods: The study was conducted on Iranian ophthalmologists who participated in the tenth annual congress of ophthalmology in the year 2000. A standardized questionnaire was distributed among the participants and they were asked to answer and return it. The received questionnaire data were analyzed through SPSS & EPI-6 soft ware and compared with the similar data of the year 1998.Results: From 800 ophthalmologists, 307 returned the answered questionnaire. Most of them (54%) were working out of cities with medical school. All of them performed cataract surgery routinely. There was improvement in preoprative management, operative equipment and medications facilities, in comparison to 1998. Seventy percent of them used local anesthesia while 40% were using general anesthesia at 1998. There was a decrease in intraoperative and postoperative complication rate. Sixty four percent of them did refractive surgery; 48% of them used laser (P= 0.000).Conclusion: Comparing 1998 & 2000 shows a significant improvement in facilities and techniques for modern cataract surgery which follows the trend in developed countries

Purpose: To update ophthalmologists on the latest results and indications of transpupillary thermotherapy (TTT) for some posterior segment disorders.Method: All reported studies on this technique until 2001 in the medline were retrieved through queries: transpupillary thermotherapy, choroidal melanoma, age related macular degeneration (AMD), and circumscribed choroidal hemangioma. The relevant studies were reviewed and discussed.Results and Conclusion: We found 25 relevant articles. It is suggested that TTT is an acceptable therapeutic option for choroidal melanoma, CNV due to AMD, and circumscribed choroidal hemangioma. Definitive statements regarding the role of TTT in the management of these posterior segment diseases requires controlled randomized clinical trials.

Purpose: To report the successful treatment of a case with extensive lateral rectus muscle rupture and defect due to sharp trauma.Patient and findings: A 16 years old boy came to hospital because of diplopia after sharp trauma with glasses. He had left esotropia and complete absence of abduction of the left eye. Ocular CT-scan revealed complete rupture of the left lateral rectus muscle. During surgical exploration, an extensive defect was found in the lateral rectus muscle that was repaired. Diplopia and esotropia completely improved from the day after surgery.Conclusion: When the patient has good fusion even a large resection of extraocular muscle can not disrupt fusion and cause eye deviation.

Purpose: To report a case of staphylococcal keratitis under LASIK flap.Patient and findings: A 28- year-old man underwent simultaneous bilateral LASIK for high myopia about one year ago. He noted tearing and photophobia in his left eye 9 days after LASIK. He had a central stromal infiltration under the left corneal flap. The patient was taken to the operating room, the flap was lifted and corneal scraping was performed. The stromal bed was irrigated with betadine 5% and chloramphenicol drops and the flap was replaced. Staphylococcus aureus was identified as the infecting organism which was treated with fortified vancomycin and gentamicin. After 3 weeks the infiltrated bed resolved, but a central stromal scar developed and didn't resolve. Penetrating keratoplasty was performed in the left eye 9 months after keratitis. At the last visit, BCVA was 20/30 and the graft was clear.Conclusion: We would like to suggest that infection under the flap is a serious complication of LASIK. Early diagnosis and treatment with ophthalmic fortified drops is important, and sequential surgery is preferred.