BINA
Year:2000 | Volume:5 | Issue:3|Papers Count:11

Purpose: To determine the incidence of abnormal ocular findings in patients with sickle cell disease. Material and methods: 30 patients with sickle cell disease were randomly selected. Diagnosis of sickle cell disease was based on complete blood count and morphologic examination of a peripheral blood sample and hemoglobin electrophoresis. Age and sex of the patients were recorded and a complete ocular examination including visual acuity, tonometry and funduscopy was done. The specific type of sickle cell disease any associated diseases and any medication used, were also recorded.Results: 60 eyes of 30 patients with a mean age of 14 years (5-46 years) were studied. 17 patients were female and 13 were male. 14 patients had sickle thalassemia, 11 patients had sickle cell anemia (SS) and 5 patients had sickle cell trail (AS). 8 patients had comma-shaped conjuctival vessels (1 sickle cell trait and 2 sickle cell anemia). A notable finding was the presence of small iris nodules in 11 patients with sickle thalassemia. Iris atrophy was not seen in any case. Ophthalmoscopy did not reveal any retinal neovascularization, macular hole, retinal detachment or angioid streaks. The only funduscopic findings were the presence of venous tortusity in 2 patients and optic nerve atrophy in 1 patient; all 3 of these patients had sickle cell anemia (SS).Conclusion: Patients with sickle cell disease, especially sickle cell anemia (SS), should receive regular ophthalmic examinations. Any decrease in visual acuity of these patients mandates the performance of a complete eye examination.

Purpose: To evaluate the visual outcome and complications of cataract extraction in vitrectomized eyes. Methods: The study was a retrospective, noncomparative case series.Results: Twenty one eyes of 21 patients were operated. 71.4% of the patients were male, the age range was 18-75 years (the average: 52.2 years). The principle causes of vitrectomy were proliferative diabetic retinopathy (57%), non diabetic vitreous hemorrhage (19.2%) and ARN (9.5%). The interval between vitrectomy and cataract extraction were: More than 2 years (28.6%), 1-2 years (42.8%) and less than 1 year (28.6%). YAG capsulotomy was carried out in 52.4% of cases. The complications were noticed in 2 eyes (9.5%). Improvement of visual acuity occurred in 90.4% of the eyes after cataract surgery. Before surgery, 81% of the eyes had the visual acuity of less than 20/200. After the operation, only 28.6% of the eyes had such a vision. Macular lesions were observed in 62% and optic neuropathy in 57.2% of the eyes.Conclusion: This study shows a significant visual improvement in vitrectomized eyes undergoing cataract extraction and intraocular lens implantation. The complications are rare. The result of this study is comparable to the previous reports.

Purpose: To evaluate the effect of prophylactic treatment in fellow eyes of patients who underwent scleral buckling surgery in Labbafinejad Medical Center.Material and Method: Between 1997-1999, 376 patients had undergone scleral buckling for treatment of their retinal detachment in Labbafinejad Medical Center, chart review of these patients performed to determine any detected peripheral retinal lesion in their fellow eyes.Results: Out of 376 patients, 72 patients were excluded from the study, 33 patients were one eyed and 15 patients had bilateral retinal detachment. Of the remaining 256 patients, in 201 the periphery of the other eyes was within normal limit and only for 53 eyes (21%) prophylactic treatment was applied. Of the 53 treated eyes 11 eyes (4%) finally developed retinal detachment.Conclusion: Despite prophylactic treatment in fellow eyes of patients who had undergone scleral buckling, risk of retinal detachment in these eyes is still high. Periodic examination of peripheral retina should be considered for all high risk patients and decision about prophylactic treatment of the predisposing lesions for retinal detachment should be individualized for each patients. These patients should be under close observation with periodic examination.

Purpose: To study the results of cataract extraction combined with intra-operative indirect laser PRP (Panretinal photocoagulation) in patients with active proliferative eye disease.Patients & Methods: 14eyes of 14 diabetic patients with active retinal or Iris neovascularisation in which the presence of lens opacities prevented adequate preoperative PRP underwent cataract surgery combined with indirect laser PRP after lens material aspiration and before intraocular lens implantation.Results: Regression of neovascularization with this combined procedure was achieved in 9 eyes; 2 eyes developed neovascular glaucoma and 3 eyes responded to further PRP. Visual acuity improved in all eyes, 7 achieving VA of 5/10 or more. Seven eyes developed post operative uveitis, and one eye developed clinically significant macular edema.Conclusion: Intra-operative PRP appears to improve the outcome of cataract surgery in eyes with active proliferative diabetic retinopathy and may be advantageous to PRP attempted in the immediate post-operative period when it may be less effective or even impossible to perform.

Purpose: This study was conducted to define any association between peripheral retinal degenerations and the risk of retinal detachment in the fellow eye.Material & Methods: 200 eyes were studied in a case-control study (100 cases and 100 controls). The groups were matched regarding to age, sex, myopia, posterior vitreous detachment, aphakia and family history of retinal detachment.Each underwent evaluation by fundoscopy. The results were analyzed via chi-square and fishers exact test.Results: The presence of lattice degeneration was more common in cases than in controls (P<0.01). The same result was encountered in patients with phakic RD (P<0.05). Multiple lattice degeneration was more frequent in cases (P<0.005). This finding was also more frequently seen in cases with phakic RD (P<0.005). In patients with phakic RD the superior temporal lattice was more frequent in cases than in controls (P<0.04).Conclusion: The presence of lattice degeneration, presence of multiple lattice degenerations and their superotemporal location is associated with the risk of retinal detachment in the fellow eye of patients with phakic retinal detachment.

Purpose: Evaluation of funduscopic findings in patients with ischemic heart disease (IHD) that hospitalized in coronary care unit (CCU) of Feiz & Khorshid hospitals in Isfahan in 1376- 1378.Materials and methods: In 268 patients with IHD hospitalized in CCU were examined for eight funduscopic findings, including hard exudate, cotton wool spots, vascular sheating, retinal hemorrhage, retinal vein occlusion, retinal artery occlusion, abnormal A-V crossing changes, and vascular tortuosity. The patients were classified into 4 groups: 1) patients with systemic hypertension (46 patients, 17.2%), 2) patients with diabetes mellitus (32 patients, 11.9%), 3) patients with both hypertension and diabetes (18 patients, 6.7%) and 4) patients with none of them (172 patients, 64.2%). Results: 32 diabetic patients (56.3%), funduscopic findings were seen in 35% of hypertensive patients, and 44.5% of patients with both diabetes and hypertension, only 19% of patients with neither diabetes nor hypertension had funduscopic findings.Conclusion: Funduscopic findings are not common in patients with IHD but without diabetes and / or hypertension.

Purpose: To evaluate the epidemiologic and clinical characteristics and therapeutic results in paralytic strabismic patients who were referred to Labbafinejad Hospital from 1374 to 1378.Materials & Method: During 4 years, all the patients with paresis of 3rd & 4th & 5th cranial nerves were followed and surgery was performed if necessary.Result: This study included 53 patients with 36 male (68%) & 17 female (32%) with mean age 18.4 (ranging 3 months old to 60 years) and they followed 45- 1020 days. Manifest tropia in 45 case (86.8%), Diplopia in 3 case (7.5%) ptosis in one case (1.9%) and visual loss secondary to concurrent optic nerve damage in 2 case (38%) were the main cause to seek medical advice.Twenty six cases (49%) had fourth nerve palsy, 19 cases (36%) third nerve palsy & 8 cases had sixth nerve palsy. In 61% left eye, in 28% right eye, in 11% both eyes were involved. The most common cause in patients with 4th nerve palsy was congenital and in the 3rd and 6th nerve palsy was trauma. Among the patients operated, 72.3% of patients improved in one step, 23.4% of patients in two steps and 43% in three steps.Conclusion: Surgical outcome in all 3 groups for partial form was better and more stable than with complete palsies.

Background: Dosage of adjunctive antimetabolites applied in trabeculectomies with high risk for failure remains controversial.Purpose: To compare two techniques of adjunctive antimetabolit application in cases of trabeculectomy with high risk for failure.Material and Methods: In a clinical trial, adjunctive antimetabolite trabeculectomies were performed for 24 eyes of 29 patients in which glaucomas were poor controlled with tolerable medications. This cases had one of the risk factors for failure: aphakia or pseudophakia, failed previous trabeculectomy (ies), neovascular glaucoma, uveitic glaucoma, age of less than 40 years. Trabeculectomies were randomized in two groups. In control group, intraoperative 0.027% MMC for 3 minutes and in experimental group intraoperative 0.01% MMC for 3 minutes plus 5 daily postop subconjuctival injections of 5-flurouracil were used.Results: Fifteen eyes in control group were compared with 14 eyes in experimental group. Age, sex, type of glaucoma, intraocular pressure, preop number of used medications in both group were comparable. Patients had at least 6 months of follow up. Mean intraocular pressures of 2 groups in all follow up intervals had no statistically difference. There was no case of bleb or wound leakage, suprachoroidal hemorrhage, scleritis or hypotonia maculopathy in both groups. Shallowing of anterior chamber occurred in 33 percent of control group but none in experimental group (P<0.02). Serous choroidal detachment and hypotonia were not statistically different in two groups.Conclusion: Both techniques of adjunctive antimetabolite trabeculectomies had equal effect with comparable side effects. Other studies with more cases and longer follow up time is recommended.

Objectives: Evaluation of the effectiveness and safety of sublingual timolol 0.5% and dorzolamide 2%. Methods: A randomized, double-masked, placebo controlled study of 120 normal human subjects was carried out in Ghaem Hospital - Mashhad. Volunteers were randomized to receive a single drop of either timolol, dorzolamide or placebo sublingually and IOP measurement were obtained before, 1 hour, and 2 hours after instillation of the drug.Results: The IOP was reduced by a mean of 3.97± 2.07mmHg (21.34%) 2 hours after sublingual timolol instillation (P<0.001). Sublingual dorzolamide and placebo had no ocular hypotensive effect. Conclusion: Sublingual timolol is an effective agent in lowering IOP and maybe an alternative to topical medication in glaucoma. This method of administration in glaucoma needs further study.

Purpose: To identify clinical factors that predicts ocular survival and final VA after open globe injury. Methods: A two year prospective study of 79 consecutively admitted patients who presented with open globe injury at Ra.ahan Eye Hospital between March 1997 to March 1999 was performed.Results: This study included 79 eye injuries. Fifty nine (74.7%) occurred in males and 20 (25.3%) in females. Mean age was 17.08 years. Left eye was more commonly involved (57%). Initial VA was an important predictor of final VA. Good initial VA>20/200 lead to final VA of 20/200 or better in 24% of patients. 40.6% of trauma occurred in first decade of life. Injuries less than 10mm and related to zone I, II predicted a good visual outcome. In our study endophthalmitis (5.1%) was much less likely to develop in eyes with primary repair within 24 hours of the injury (1.5%) than in eyes with more than 24 hours (21.4%, P=0.016).Conclusion: Significant predictive factors of final VA after open globe injury include: initial VA, wound length and location, mechanism of injury, APD and time of primary repair. Public education on the use of safety eye protector is necessary and may reduce the incidence of globe injury.