BINA
Year:2013 | Volume:18 | Issue:3 (72)|Papers Count:17

Purpose: To define the demographic and clinical features of eyelid masses at a referral hospital over a 10-year period. Methods: This is a retrospective record-based study on patients with eyelid masses during the abovementioned period. Data on epidemiologic and clinical features and therapeutic approaches were collected and analyzed.Results: 551 patients were included in the study from which 369 cases (67%) were inflammatory lesions (Chalazia), 82 cases (14.8%) were benign and 100 cases (18.2%)were malignant neoplasms. Melanocytic nevi (40%), papillomas (16%)and cysts (10%) were the most common benign lesions. Basal cell carcinoma (BCC) (83%) squamous cell carcinoma (SCC) (8%) and sebaceous gland carcinoma (SGC) (6%) were the most frequent malignant tumors. The lower lid was the most common location for malignant lesions followed by the upper lid. Recurrence of BCC was recorded in 16 cases which was most common in the lower lid.Conclusion: Inflammatory lesions including chalazia were the most common type of eyelid mass in lesions our survey. Melanocytic nevi and BCC were the most frequent benign and malignant lesions respectively. Recurrence of BCC was common especially in the lower lid.

Purpose: To evaluate the results of augmented vertical rectus muscle transposition with intraoperative botulinum toxin for complete and chronic sixth nerve palsy.Methods: During a 10 years period (1381-1390) all patients with chronic and complete sixth nerve palsy, and contracted medial rectus (MR) underwent augmented vertical rectus muscle transposition with botulimum toxin injection into the MR. Demographics such as age, gender and etiology, and pre- and postoperative data including deviation, limitation of abduction, success rate and complications were analyzed.Results: 29 patients (5 bilateral) were enrolled into this study. Trauma (48%) and congenital or unknown causes (31%) were the most common etiology. 14 (49.3%) cases were female and 15 (51.7%) were male. Mean age at enrollment was 26.5±19.8 years. Preoperative deviation was 45±17.5 PD which was improved to -3.1±13.2 after the operation (P<0.00 1). Mean correction effect was 48. 1±17.7 PD. Mean preoperative and postoperative abduction limitation was -4.4±1.1 and -1.8±0.9 respectively (P<0.001). Success rate was 76% (deviation within 10 PE of orthotropia). 4 patients (13.7%) had hypotropia. In 19 patients with preoperative deviation £45 PD, four patients had consecutive exotropia. Anterior segment ischemia was not seen. Conclusion: Intraoperative botulinum toxin injection with augmented vertical rectus transposition is an effective procedure. In deviation £45 there is a risk of over correction.

Purpose: To determine the effect of induced myopia and hyperopia using soft contact lenses on optic disc parameters measured by Fourier domain optical coherence tomography (FD-OCT) in emmetropic persons.Methods: In a quasi-experimental self controlled study, 57 normal emmetropic participants 18-42 years of age were studied. Each subject underwent a complete ophthalmic examinations including measurement of best corrected visual acuity, intraocular pressure, dry and cycloplegic refractions and axial length. OCT scans to measure optic disc parameters were repeated in 114 cycloplegic eyes of 57 participants, while different refraction powers were induced in each eye by wearing soft contact lenses of five different powers (-10.00, - 5.00, plano, +5.00, +10.00).Results: Mean age of participants was 25.8±6.5 years. Average RNFL thickness was 123.29±10.56 m 123.17±11.61 m, 122.77±11.61 m, 123.37±11.15 m, 123.42±11.45 m in high-induced-myopia, mild-induced-myopia, emmetropia (Contact Lens:plano), mild-induced-hyperopia, and high-induced-hyperopia groups, respectively. Corresponding values for average cup area were0.65±0.53 mm2, 0.63±0.53 mm2, 0.63±0.52 mm2, 0.64±0.56 mm2, and0.64±0.54 mm2 respectively Also in these groups neither disc area nor rim area measurements were statistically different.Conclusion: Using Fourier domain OCT, inducing myopia and hyperopia by soft contact lens has no significant effect on RNFL thickness, disc area, cup area and rim area.

Purpose: To assess the agreement of ultrasonic pachymetry, the Galilei dual Scheimpflug analyzer and Orbscan II in measuring central corneal thickness (CCT) in normal and keratoconic eyes.Methods: In this prospective comparative study, CCT was measured in 88 refractive surgery candidates and 76 (39 right) eyes of 45 keratoconic patients using ultrasonic pachymetry, Galilei and OrbscanII. Readings by the three instruments were compared using one-way analysis of normal variance. Agreement between the three devices was assessed using Pearson (R) and intraclass correlation (ICC) coefficients, mountain plots, and Bland-Altman plots.Results: In the normal group, mean CCT was 551.0±39.4, 566.9±33.5, and 565.5±40.9mm measured by ultrasonic pachymetry, Galilei and Orbscan II, respectively (P<0.00 1). Corresponding figures in the keratoconus group were 488.4±61.5, 504.1±42.0, and 473.8±58.5mm, respectively (P<0.001). CCT measurements by the three instruments were significantly correlated in both groups. The association was strongest in the normal group and between the Galilei and OrbscanII (R=0.91, ICC=0.90), where 95% limits of agreement (LOA) were narrowest (-35 to 32mm). The correlation was weakest in the keratoconus group and between ultrasonic pachymetry and Galilei (R=0.67, ICC=0.61).Conclusion: To measure CCT, Galilei and Orbscan can be used interchangeably in normal eyes but not in keratoconic eyes. Agreement between the two optical devices and ultrasonic pachymetry is low and therefore they cannot replace ultrasonic pachymetry in measuring CCT in normal or keratoconic corneas.

Purpose: To evaluate the role of active uveitis on refractive errors changes.Methods: A Cohort single group study was conducted on patients with acute or recurrent uveitis. Cyclorefraction was performed in both phases of active and quiescent. Sphere, cylinder and sphere equivalent power were compared in active and quiescent phases and analyzed statistically.Results: Sixty-six patients (eighty-eight eyes) were enrolled in this study. Mean age was 34 ± 14 years (range 6 to 65). 61.7% of the patients were women (54 out of 88). Among the 46 cases of anterior uveitis 25 eyes (54%) were in acute and 21 eyes (46%) were in recurrent phase. Spherical power changes were statistically significant in anterior non-granolumatous uveitis (P=0.039) and intermediate uveitis (P=0.00 2). Spherical equivalent power changes were statistically significant different in intermediate uveitis (P=0.005) and panuveitis (P=0.096) groups. Cylinder power did not show any significant changes in none of the above mentioned groups. This study showed that, in anterior non-granolumatous uveitis and panuveitis, spherical and spherical equivalent power changes were shifted toward myopia during active uveitis and just spherical power changes were shifted toward hyperopia in intermediate uveitis. Regression analysis disclosed that only activity of uveitis and age had a statistically significant effect on the spherical power changes after adjustment (P<0.001 and P=0.0 36, respectively). Evaluating spherical equivalent power changes, regression analysis showed that activity of uveitis and anatomic location of uveitis had a statistically significant effect (P=0.00 3 and P=0.00 1, respectively).Conclusion: Active uveitis plays an effective role on changing the refractive powers. The shift of these changes depends on the inflammated anatomical area; in anterior uveitis it is toward myopia and in intermediate uveitis it is toward hyperopia.

Purpose: To identify the profile of cataract surgery in an Iranian population.Methods: This population-based survey was conducted on adults aged 50 years and over in 2009 at Varamin district. Cataract surgical coverage (CSC) was defined as the proportion of operable cataractous eyes (bestcorrected visual acuity [BCVA] <6.18 due to cataracts) that had been operated. Poor outcome was defined as BCVA < 6.60 in the operated eye.Results: From 3,000 eligible subjects, 2,819 (94%) participated in the study. Among 5,836 examined eyes, 526 eyes (9.0 %) had history of cataract surgery including 5.8% first eyes and 3.16% second eyes. Intraocular lenses were used in 92.8% of surgeries. Good outcomes was associated with using intraocular lenses (IOLs) during cataract surgery (82.0% vs. 31.6%, P<0.001). CSC was 66.4% and poor outcome rate was 13.2%. In non-operated subjects who needed cataract surgery (BCVA<6.60 or 1.0 LogMar), the main barrier was unawareness of treatment which accounted for 44.3% of reasons.Conclusion: The coverage and outcome of cataract surgery in operable eyes should be improved. Overall, cataract services in the studied population were acceptable, although the need for improving public awareness and health services is still felt.

Purpose: To report and compare outcomes and intra- and postoperative complications of senile cataract surgery using phacoemulsification in patients with and without pseudoexfoliation syndrome.Methods: Consecutive patients with pseudoexfoliation syndrome who underwent phacoemulsification in one or both eyes for senile cataracts between October 2009 and October 2010 were enrolled in the study. If both eyes of each participant were operated on, data relevant to the right eye were considered. The control group was selected among patients with senile cataracts who did not have pseudoexfoliation syndrome. Other ocular pathologies including a history of trauma or previous ocular surgeries led to patient exclusion from the study. The two study groups were compared with respect to pre- and postoperative uncorrected and best corrected visual acuity and intraocular pressure, as well as intra- and postoperative complications.Results: This study was conducted on 371 (174 right) eyes of 371 patients, 327 eyes belonged to the control group and 44 eyes to the pseudoexfoliation group. Mean patient age was 68±11 years and 73±7 years in the control and case group, respectively. Preoperative best corrected visual acuity was 0.65±0.48 logMAR and0.91±0.67 logMAR respectively. Preoperative mean intraocular pressure was 15.0 ±8.0 mmHg in the control group and 15.0± 2.0 mmHg in the case group. The difference did not reach a significant level. At the last follow-up examination, best corrected visual acuity was increased to.22±0.18 logMAR in the control group and 0.22±0.12 logMAR in the case group. With respect to preoperative values, the increase was statistically significant in both groups (P<0.001 and P=0.0 3, respectively). However, there was no significant difference between the study groups in terms of postoperative best corrected visual acuity. Postoperative spherical equivalent refraction was significantly higher in the control group (-0.42±0.65 D) than that in the case group (-0.16±0.45 D). Intraocular pressure readings measured at all postoperative follow-up examinations were significantly lower than preoperative values in both groups. No significant difference was observed in these measurements between the groups postoperatively. Intraoperative complications included vitreous loss (n=2; 0.5%) and zonular dehiscence (n=1; 0.3%) in the control group. These complcations were not observed in the case group.Conclusion: Outcomes of phacoemulsification in patients with pseudoexfoliation syndrome can be expect ed to be similar to patients without this syndrome provided that a thorough preoperative evaluation such as examination of zonules as well as appropriate intraoperative approach for the management of small pupil and weak zonules are performed.

Purpose: To investigate the incidence, mechanisms, characteristics, and visual outcomes of traumatic wound dehiscence following keratoplasty.Methods: Medical records of 32 consecutive patients with traumatic globe rupture following keratoplasty who had been treated at our center from 2001 to 2009 were retrospectively reviewed.Results: The study population consisted of 32 eyes of 32 patients including 25 men and 7 women with history of corneal transplantation who had sustained eye trauma leading to globe rupture. Mean patient age was 38.1 (range, 8 to 87) years and mean interval between keratoplasty and the traumatic event was 44.1 (1- 350) months. Associated anterior segment findings included iris prolapse in 71.9%, lens extrusion in 34.4% and hyphema in 40.6% of eyes. Posterior segment complications included vitreous prolapse (56%), vitreous hemorrhage (28%) and retinal detachment (18%). Eyes which had undergone deep anterior lamellar keratoplasty (DALK, 5 cases, 15.6%) tended to have less severe presentation and better final visual acuity. There was no correlation between the time interval from keratoplasty to the traumatic event and final visual outcomes.Conclusion: The host-graft interface demonstrates decreased stability long after surgery and the visual prognosis of traumatic wound dehiscence is poor in many cases. An intact descemet’s membrane in DALK may mitigate the severity of ocular injuries, but even in these cases, the visual outcomes of globe rupture is not good and prevention of ocular trauma should be emphasized to all patients undergoing any kind of keratoplasty.

Photorefractive keratectomy is a preprogrammed surface corneal refractive ablation which is aimed to reduce or eliminate myopia, hyperopia or astigmatism through the removal of the corneal surface epithelium and basement membrane and the application of excimer laser photoablation to Bowman membrane and anterior stroma. The epithelium then begins to cover the wound, in direct contact with the anterior stroma instead of bowman membrane. Since approval of the use of the excimer laser to reshape the cornea, significant developments in the correction of refractive errors have been achieved. Despite these advances, certain limitations and complications do exist. So it is time well spent for the practitioners to ensure that the patient has realistic expectations and a thorough knowledge of the complications. The surgeon should not get involved in special cases without previous experience. This article relies on published literature to describe the basic knowledge, indications, surgical issues, patient selection, mitomycin use, and prevention of the complicating.

Cataract is an important ophthalmologic disorder that can result in blindness. Its treatment is just by surgery. Cataracts have been identified and treated from ancient times. Persian and Islamic physicians recognized this disease and called it “nozul-al-mae” or “ab avardan e cheshm”. Rabben Tabari, Rhazes and Avicenna are famous medical practitioners of the 9-11th century AD. They described cataracts in their manuscripts, including pathology, sign and symptoms and management strategies. Management and treatment strategies were divided into 3 main categories: nutrition and life style, medications and surgery. Ancients medications are not used currently and may be good candidates for further studies for application. It also can clarify a part of the history of ophthalmology in Iran and the world.

Purpose: To report a case of xerophthalmia after bariatric surgery.Case Report: A 24- year -old man presented to the eye clinic with a 4 -month history of irritable gritty eyes. He complained from night blindness, too. He was being treated for dry eye with artificial tears and ophthalmic ointments during the last month without any significant improvement. His vision was 20/20 unaided in both eyes. On examination, he had subtle corneal epithelial changes with areas of punctuate staining. The bulbar conjunctive showed a triangular gray foamy appearance with keratinization typical of Bitot spot. The patient had undergone bariatric surgery to treat obesity 2 years ago. He had lost 90 kilograms weight after surgery. Systemic review revealed fatigue and chronic diarrhea. On systemic examination he had pale conjunctiva and skin, dry skin and brittle nales. Subsequent testing confirmed vitamin A and other vitamin deficiencies. Ocular symptoms and signs improved after vitamin A supplementation. Other vitamin deficiencies was addressed, too.Conclusion: Bariatric surgery has become an accepted treatment option for obesity and could lead to malabsorpsion. In case of dry eye and ocular surface keratinization in these patients, vitamin A deficiency should be considered.

Purpose: To report two cases of conversion disorder with unilateral psychogenic pseudoptosis.Case reports: The first case was 21 years old man who developed sudden ptosis of his left eye, since 2 weeks ago. The patient had episodes of upper lid drooping during the last 7 months; the second case was a 10 years old girl with history of ptosis since 6 months, after viral conjunctivitis. All neurological and paraclinical evaluations were normal in both cases. Symptoms which in both patients differentiated psychogenic pseudo ptosis from true ptosis included: ipsilateral brow ptosis with orbicularis oculi muscle spasm, reveres ptosis of the lower lid of the affected eye and involuntary Bells or reverse Bells phenomena in the ptotic eye. Also psychological stressors (legal, financial and family stress) before the onset of symptoms must be considered. After diagnosing psychogenic pseudoptosis the patients should be referred to psychologists, and after successful treatment complete recovery was happened.Conclusions: Psychogenic pseudoptosis must be considered in the differential diagnosis of ptosis. Early diagnosis and treatment is essential not only for good outcome, but also it prevents extra clinical and Para clinical evaluation and even intervention.