BINA
Year:2009 | Volume:14 | Issue:4 (57)|Papers Count:16

Purpose: To evaluate intelligence quotient (IQ) in patients with congenital strabismus scheduled for surgery at Labbafinejad Medical Center. Methods: All patients with congenital strabismus scheduled for surgery were enrolled consecutively over a one year period in a cross sectional study and were evaluated for verbal, performance and total IQ, and compared with normal population whose mean IQ is 100±15. Results: During the study period, 109 patients with a mean age of 18.4±10.5 years (range: 4-63 years) were included. Educational status in most patients (%80) was less than high-school diploma. Most patients (%79.8) lived in urban areas, 46 patients (%42.2) had some degrees of unilateral or bilateral amblyopia. Mean verbal IQ was 87.2±19.6 (range 45-127), performance IQ was 81±15.5 (range 44-111) and total IQ was 83.5±18.3(range 40-120).Total IQ was lower in comparison with normal population (P<0.01) and was significantly higher in urban residents as compared to rural residents (85.1±19.5 versus 77.3±10.8, P=0.016). Patients with non educated parents and with coexisting amblyopia had lower IQ levels. Total IQ was higher in myopes than emmetropes and both had better IQ levels than hyperopes. IQ was betters with vertical deviations and was higher in ETs than XTs, however, these comparisons were not statistically significant (All Ps> 0.05). Conclusion: Patients with congenital strabisumus assessed in this study had lower mean IQ than normal. The reason may be genetic background or acquired causes secondary to strabismus.

Purpose: Superior oblique palsy is a common cause of paralytic strabismus. This disorder causes diplopia, head posture and facial asymmetry. This retrospective study reviews patient with superior oblique (SO) palsy operated at Labbafinejad Medical Center from 1997 to 2007. Methods: In this descriptive study, records of patients with SO palsy scheduled for surgery were reviewed. Forced duction test (FDT) and tendon laxity was checked in each patient. Patients were divided into congenital and acquired subgroups. Results: During the study period, 83 patients were referred for surgery. Of these 73 patients with complete records (45 males, 28 females) were enrolled into our study, with age ranging from 1.5 to 62 (mean 19.7±11.7) years. SO palsy was congenital in 56 patients (76%) and acquired in 17 patients (24%). Most patients (47.9%) had left side and 13.7% had both eyes involvement. The most common chief complaint was ocular deviation (52.1%). The following abnormalities were noted: positive FDT 7 patients (9.7%), tendon laxity 2 patients (2.7%), amblyopia 14 patients (19.2%), facial asymmetry 5 patients (6.8%), head tilt 10 patients (13.7%), and chin down position 3 patients (4.1%). Mean preoperative vertical deviation was 16.2±8.3 which was reduced to 1.9±4 prism diopters after surgical intervention (P<0.05). Mean exotropia and esotropia were 15±9.5and 13.9±11.5 prism diopters before operation, respectively and both were reduced to mean horizontal deviation of 1.5±4.8 prism diopters after operation (P<0.05). The most common Knapp classification of disease was type 3 (42.5%). The most common muscle operated was the inferior oblique (83.6%) and the most common type of operation was the inferior oblique myectomy. Conclusion: The most common form of superior oblique palsy leading to operation is the congenital form which occurs most commonly in young men. The most popular surgical intervention at this center was inferior oblique myectomy.

Purpose: Evaluate the effect of relaxing incision and adjustment sutures to correct astigmatism after deep anterior lamellar keratoplasty (DALK) in patients with keratoconus. Materials and Methods: This interventional case series included keratoconic eyes undergoing graft refractive surgery (GRS) for intolerable post-DALK astigmatism. The technique of graft refractive surgery for the 5 initial cases consisted of relaxing incisions at the steep meridian in the graft-host interface down to Descemet's membrane. The main outcomes were uncorrected and best-corrected visual acuity, and change in refractive and keratometric astigmatism using subtraction and vector analysis methods. Results: Fourteen eyes of 14 keratoconic patients (12 male subjects) with history of DALK underwent GRS. Mean age of the patients was 29.36±6.2 years and mean follow-up period was 12.0±7.4 months after initial GRS. Mean preoperative BCVA was 0.29±0.1 logMAR which improved to 0.22±0.1 logMAR after the operation (P=0.007). Average keratometric astigmatism was reduced by 3.8 D and 5.5 D as measured by subtraction and vector analysis methods, respectively. Conclusion: Relaxing incisions and suturing at the steep meridian followed by selective suture removal can effectively and predictably reduce post-DALK astigmatism in patients with keratoconus.

Purpose: To report confocal scan features of keratic precipitates (KPs) in Fuchs' heterochromic iridocyclitis (FHIC). Methods: In this descriptive study, corneal confocal scan was performed to characterize KPs in patients with FHIC referred to Labbafinejad Medical Center from November 2005 to March 2007. Polymerase chain reaction (PCR) for Herpes Simplex virus, Herpes Zoster virus, Toxoplasma gondii, Cytomegalovirus and Rubella virus was performed on aqueous humor samples taken in 4 patients who underwent phacoemulsification. Results: Confocal scan was performed in 40 eyes of 34 patients including 18 male and 16 female subjects with mean age of 30.7±10.5 (range 18-57) years. FHIC was bilateral in 6 and unilateral in 28 patients. The distribution of KPs was diffuse in 31 eyes and limited to the inferior cornea in 9 eyes. The morphology of KPs included: globular, 34 eyes (85%); infiltrating, 31 eyes (77.5%); dendritiform, 31 eyes (77.5%); stippled, 27 eyes (67.5%); and cruciform, 25 eyes (62.5%). None of the cases demonstrated smooth-rounded KPs. PCR of aqueous specimens was negative for the above-mentioned infectious agents in 4 eyes who had infiltrating and dendritiform KPs on confocal scan. Conclusion: Confocal features of KPs in FHIC are diverse and include globular, infiltrating and dendritiform, stippled and cruciform. Presence of infiltrating and dendritfrom KPs in FHIC may be suggestive of a possible infectious etiology, however the results of PCR were negative in the limited numbers of such patients in our series.

Purpose: To compare intraocular pressure (IOP) measurement with Pulsair non-contact tonometer and Goldmann applanation tonometer (GAT). Methods: In this cross-sectional study, during a complete ophthalmologic examination, each patient underwent Pulsair tonometry three times at 5 minutes intervals and then Goldmann tonometry at the same intervals. Mean IOP values were measured and analyzed. Results: We evaluated 458 eyes of 250 patients (138 males and 112 female subjects). Mean IOP was 19.45±9.04 mmHg with GAT and 20.11±8.42 mmHg with Pulsair (P=0.075). Correlation coefficient between the two methods was 0.96 (P= 0.004) and the mean difference (Pulsair-GAT) was 0.65±1.52 (confidence interval 95%, +3.5 to -2.29). With IOPs between 10-25mmHg, mean difference between the two methods was 0.49±1.23 (P= 0.32) mmHg, however it was -1.75±1.91 (P= 0.06) at IOPs over than 25 mm Hg. Conclusion: Pulsair tonometry has acceptable accuracy in comparison with GAT, especially in IOP ranging from 10 to 25 mmHg.

Purpose: To evaluate the outcomes of vitrectomy for complications of branch retinal vein occlusion (BRVO). Methods: This retrospective study, included patients who underwent vitrectomy surgery due to the complications of BRVO over an 11-year period. Visual acuity and retinal condition were evaluated before and after surgery. Results: The study included 30 eyes of 30 patients with mean age of 64.7±10.92 (range 41-85) years. Vitrectomy was performed for vitreous hemorrhage in 23 eyes (76.6%), for tractional macular detachment in 5 eyes (16.6%) and for combined tractional macular detachment and vitreous hemorrhage in 2 eyes (6.6%).The patients were followed for a mean of 15.43±12.5 months (range 6-60 months). Visual acuity improved from 2.6±0.66 to 0.92±0.75 LogMAR after operation (P<0.001). Visual improvement was significant in vitreous hemorrhage group (P<0.001), however, it was not significant in the other two groups (both Ps= 0.1). Visual acuity remained unchanged in 2 patients and decreased in two other patients. Conclusion: The most common cause of vitrectomy for complications of BRVO was vitreous hemorrhage.Patients with tractional macular detachment with or without vitreous hemorrhage had less improvement in visual acuity in comparison to patients with vitreous hemorrhage alone.

Purpose: To compare intravitreal bevacizumab (IVB) with intravitreal triamcinolone acetonide (IVT) for treatment of refractory uveitic cystoid macular edema (CME). Methods: In this randomized clinical trial, 31 eyes with uveitic CME were allocated into 2 groups: the IVB group, received one to three injections of 1.25 mg bevacizumab (15 eyes); the IVT group received one to three injections of 2mg triamcinolone (16 eyes). The primary outcome measure was change in best-corrected visual acuity (BCVA) at 36 weeks. Results: Visual acuity improvement as compared to baseline values was meaningful in the IVB group at 12, 24, and 36 weeks and in the IVT group at 24 and 36 weeks. A significant reduction in central macular thickness (CMT) was observed only in the IVT group at week 36 (74.6±108.0pm [P=0.049]). Intergroup analysis however, disclosed no significant difference in any of the outcome measures. By removing the effect of cataracts, IVT had a better improving effect on VA (P=0.007). No significant systemic side effect was observed during the study period. Conclusion: IVB was as effective as IVT in refractory uveitic CME regarding VA improvement. Irrespective of triamcinolone-induced cataract, the effect of IVT may be superior to IVB.

Purpose: To report and evaluate the characteristics of patients referred to the emergency department of Labbafinejad Medical Center with work-related eye injuries during 2005. Methods: In this descriptive study, an available sample of patients with work-related eye injuries were assessed. Demographic characteristics, causes of ocular trauma, and use of work safety devices were main evaluated variables. Results: Overall, 99 subjects (96% male) with mean age of 31.76±10.55 years were enrolled. Mean time interval between the accident and referral to eye emergency was 2.46±4.46 days (0-30 days). Of these, 66.6% came to the emergency ward on the first day after the incident and 37.1% underwent an eye examination at this center for the first time. The most unsafe activities were grinding (21.4%), welding (204%), hammering work (14.3%) and manual work (10.2%). Metal industrial (50%), constructional (17.3%) and mechanical (8.2%) workers had the highest risk for eye injury among different occupations. The major consequence of eye injuries was corneal foreign bodies (72.7%). Of injured patients, only 14 persons (14.1%) had passed job safety educational courses and 93 persons (93.9%) had not used any eye protection device. Conclusion: Most injured patients were young men workers using no safety devices; therefore it seems that occupational safety efforts including eye protection education and training programs in this context is insufficient.

Purpose: To evaluate the demographic data, mechanisms of injury and complications of ocular trauma in patients over 60 year of age. Methods: We retrospectively reviewed the medical records of 91 patients older than 60 who were admitted and treated in the Ophthalmology Department of Khalili Hospital, between September 2002 and November 2008, due to ocular trauma. Data were retrieved from admission charts including demographic information, mechanisms of injury, site of penetrating or perforating trauma, associated injuries such as endophthalmitis and intraocular foreign bodies, complications of trauma, the time interval between trauma and referral to our center and the initial visual acuities. X2analysis were performed using SPSS 11.5 program to analyze the data. Results: Patient age ranged from 60 to 87 years with mean (±SD) of 69.6 (±7.8) years. 11 patients (21.1%) were monocular. 61 patients (67%) belonged to rural and 30 patients (33%) were from urban areas. Mean (±SD) time interval from trauma to referral was 102 (±130) hours (range: 1 to 480 hours). The most common mechanisms of trauma were trauma with tree spines (24.2%), sharp trauma with wood (22%), blunt trauma with wood (11%), blunt trauma with hand (11%) and falling down (9.9%). Three patients had intraocular foreign bodies and 14 eyes (15.4%) were complicated by endophthalmitis. The most common complications of trauma were corneal ulcer (27.5%), surgical wound dehiscence (22%) and corneal laceration (22%). There was significant correlation between corneal ulcer and also surgical wound dehiscence and profound visual loss. There was also significant correlation between referral later than 48 hours and profound visual loss. Conclusion: The results of this study provide some information about elderly eye trauma. These results may be valuable in planning, education, prevention programs and surveillance of this susceptible population of the community.

Purpose: To evaluate the efficacy of amniotic membrane (AM) grafting in surgery for severe upper lid cicatricial entropion. Methods: This randomized clinical trial was performed on both upper eyelids of 22 patients with severe cicatricial entropion. On one side the anterior and posterior lamellae were split and the anterior lamella was recessed. On the other side, the same procedure was done but bare tarsus was covered with AM. Patients were evaluated one day, one and two weeks, and one and three months after surgery. The mean follow-up period was 9.89 ±6.17 (range 4-21) months. Results: Overall, 22 patients (13 women and 9 men) aged 55 to 84 years (mean age, 71.54±8.58) entered the study. The cause of cicatricial entropion was old trachoma in 18 (81.8%) and idiopathic in 4 (18.2%) subjects. In second week, eyelids with AM stained less with fluorescein than the control group (P= 0.016). At the end of the first month, all lids were epithelialized. There was no significant difference between the two groups in the number of lids with recurrent trichiasis but the number of lashes in contact with the globe in the AM group was significantly lower than the controls (P= 0.042). There was no significant difference in tarsal shrinkage and normalization of bare tarsus between the study groups. Subgraft hemorrhage occurred in 3 cases in the first week which completely resolved by one month. Conclusion: AM is a useful tissue which can enhance reepithelialization of bare tarsus and may be considered as an adjunct in lid split entropion surgery.

Purpose: To compare the efficacy of granisetron, metoclopramide and dexamethasone in prevention of post operative nausea and vomiting (PONV) after cataract surgery. Methods: Sixty patients scheduled for cataract surgery with age between 45 to 80 years and with ASA class I & II were enrolled in this clinical trial. The patients were randomly allocated to three 20- person groups. The induction of anesthesia in all groups was similar using the same drugs. Granisetron 1 mg IV was administered to patients in the first group and metoclopramide 0.2 mg/kg/IV (Max: 10 mg) was administered to the second group at the end of the surgery. In the third group dexamethasone 0.15 mg/kg/IV (Max: 8 mg) was used before surgery. Patients in all three groups were observed for PONV at defined intervals for 24 hours. Results: Incidence of PONV during first 6 hours after surgery was 5% in granisetron group, 35% in metoclopramide group and 15% in dexamethasone group. Only the difference between granisetron and metoclopramide groups was statistically significant (P= 0.01). Incidence of late PONV (6-24 h) was 5% in granisetron group, 30% in metoclopramide group and zero in dexamethasone group. This difference was statistically significant (P<0.01). Conclusion: Granisetron is more effective than metoclopramide in prevention of PONV after cataract surgery. Granisetron and dexamethasone are more effective than metoclopramide in prevention of late PONV after cataract surgery.

A 53 year-old woman presented with corneal edema 25 years after uneventful penetrating keratoplasty or keratoconus. She was initially misdiagnosed with acute endothelial rejection; however by observation of Descemet's membrane detachment, a diagnosis of late onset corneal hydrops following corneal transplantation was made. This is a rare complication which may occur many years after penetrating keratoplasty and may be due to recurrence of keratoconus within the grafted cornea. Therefore, patients with long standing corneal grafts who present with acute corneal edema should be carefully examined for signs of corneal hydrops.

Purpose: To describe the variability of ocular and systemic findings in two brothers with Gaucher's disease. Case report: Ophthalmic, general clinical evaluation and enzymatic studies were performed in two brothers, 14 and 7 years old with Gaucher's disease. Mental retardation, occipital meningomyelocele and Gaucher cells in bone marrow in addition to high myopia and various fundus abnormalities consisting of granular white lesions in the fundus periphery were noted. In the older brother, splenomegaly and anemia, macular coloboma -like anomaly in the right eye and night blindness were additional findings. Conclusion: There are various ocular findings including fundus changes and high myopia in Gaucher's disease.