BINA
Year:2016 | Volume:21 | Issue:2 (83)|Papers Count:13

Purpose: To determine the effect of using rigid gas permeable (RGP) contact lenses in improvement of involuntary eye movements and visual functions in hyperopic astigmatism patients with congenital nystagmus.Methods: This prospective interventional case series study was conducted on patients with congenital nystagmus and hyperopia equal or more than +0.5 D and Astigmatism more than -1 D, who were referred to our clinic over a period of 2 years. All ophthalmological exams including visual acuity, contrast sensitivity and video nystagmography were performed for all of the patients before and after contact lens fitting and were compared with each other.Results: In this study 32 eyes of 16 patients were entered with mean age of 18.6±4.9 years. In these cases, mean sphere was 2.45±2.44 (range +0.5 to +7.5), spherical equivalent of refraction was+1.5±2.35 (range -1 to +6.25) and mean astigmatism was -1.90±0.83 (range -1 to -4). The level of visual acuity changes in Log Mar improved monocularly from 0.56±0.23 to 0.51±0.23 and binocularly from 0.54±0.25 to 0.48±0.24 which was statistically significant (P=0.007). Improvement of contrast sensitivity were statistically significant in low (P=0.02) and intermediate (P<0.001) frequencies but not in high frequencies (P=0.7). Frequency, amplitude and intensity of nystagmus were decreased significantly after contact lens usage (p<0.001).Conclusion: Using RGP contact lenses in patients with congenital nystagmus increase monoocular and binocular vision. Also contrast sensitivity and motor indices of nystagmus (frequency, amplitude and intensity) were significantly improved after contact using lens.

Purpose: To compare clinical and confocal scan outcomes after Descemet stripping automated endothelial keratoplasty (DSAEK) performed for Fuchs' endothelial dystrophy versus pseudophakic bullous keratopathy.Methods: In this retrospective comparative study, 47 consecutive eyes of 39 patients with the diagnosis of Fuchs’ endothelial dystrophy (n=29, group 1) or pseudophakic bullous keratopathy (n=18, group 2) that underwent DSAEK were enrolled. Postoperatively, confocal microscopy was used to measure central corneal and graft thickness and endothelial cell density and morphology. Postoperative visual acuity, refractive outcomes, graft endothelial cell count, central corneal and graft thickness, and postoperative complications were compared between the study groups.Results: Mean age at the time of surgery were 65.2±11.8 and 69.4±12.5 years in groups 1 and 2, respectively (P=0.27). Follow-up period were 23.6±14.0 months in group 1 and 25.6±15.7 months in group 2 (P=0.79). Postoperative best spectacle-corrected visual acuity was significantly better in group 1 than in group 2 in 6 months after surgery. Afterwards, the two study groups were comparable in this regard. Postoperative spherical equivalent refractive error was +0.39±1.46 D in group 1 and +0.80±1.47 D in group 2 (P=0.45). Postoperative refractive astigmatism was 1.02±0.83 D and 2.36±0.67 D, respectively (P<0.001). Mean central graft thickness was 98.0±33.3 mm in group 1 and 107.6±28.0 mm in group 2 (P=0.45). No significant statistically difference was observed between two groups in postoperative endothelial cell density.Conclusion: Outcomes of DSAEK surgery were comparable between Fuchs' endothelial dystrophy and pseudophakic bullous keratopathy. All grafts were clear despite lower than normal endothelial cell counts.

Purpose: To compare corneal biomechanical properties and intraocular pressure (IOP) in eyes with pseudophakic bullous keratopathy (PBK) before and after Descemet stripping automated endothelial keratoplasty (DSAEK).Methods: This prospective non-randomized intra subject comparative study was conducted on 44 eyes of 22 patients with the diagnosis of PBK who underwent DSAEK in one eye. Intraocular pressure was measured by Goldmannapplanation tonometer (IOP GAT), and central corneal thickness (CCT) was measured by ultrasound pachymetry. The ocular response analyser (ORA) was used to measure corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-related intraocular pressure (IOPg), and cornea-compensated intraocular pressure (IOPcc). The same measurements were performed in the normal fellow eyes which served as controls. All measurements were performed preoperatively and six months postoperatively.Results: Mean patient agewas 67±14 years. Mean preoperative CH and CRFvalues in the DSAEK group were 5.77±2.94 and 6.39±2.72 mm Hg, respectively, which were significantly lower than those measured in the control group (8.2±2.47 and 8.43±2.49 mm Hg, respectively, P=0.001 for both comparisons). Postoperatively, CH and CRF demonstrated a significant increase (7.09±3.68 mm Hg, P=0.05 and 8.21±3.84 mm Hg, P=0.03, respectively) in operated eyes approaching the normal values measured in the control eyes.Conclusion: Corneal biomechanicalparameters were significantly lower in PBK eyes as compared to the normal fellow eyes. These metrics significantly increased after DSAEK and reached values measured in the normalfellow eyes.

Purpose: To compare visual outcomes after deep anterior lamellar keratoplasty (DALK) between eyes with and without successful big-bubble formation.Methods: In this retrospective comparative study, a total of 290 consecutive eyes from 257 keratoconus-affected patients underwent DALK with the big-bubble technique were enrolled. In cases where the big bubble could not be accomplished, manual stromal dissection down to DM was progressively performed using a crescent knife. The rate of successful big-bubble formation was determined. Visual acuity and refractive outcomes were compared between the bare Descemet membrane (DM) group (group 1) and manual dissection group (group 2).Results: The surgery was completed as DALK in 289 of 290 eyes and a bare DM was successfully achieved in 229 (79.2%) eyes. The study groups were comparable in terms of age (27.8±7.9 years in group 1 versus 27.5±8.5 years in group 2, P=0.79), preoperative best-spectacle corrected visual acuity (BSCVA) (1.28±0.49 versus 1.31±0.51 logMAR, respectively, P=0.15), and postoperative follow-up (38.4±20.4 versus 37.4±19.9 months, respectively, P=0.73). Postoperative BSCVA was significantly better in group 1 than in group 2 throughout the follow-up period (P<0.05). At final follow-up examination, a BCVA 0.30 logMAR was achieved in 82.1% of group 1 and 54.5% of group 2 (P<0.001). Groups 1 and 2 were comparable in terms of postoperative spherical equivalent refractive error (-4.24±3.35 versus -4.49±3.25 D, respectively, P=0.61) and keratometric astigmatism (3.62±1.92 versus 3.38±1.71 D, respectively, P=0.39).Conclusion: Retention of posterior corneal stroma resulted in a lower visual acuity as compared to the bare DM group.

Purpose: To compare the safety, efficacy, predictability, stability and complications of wavefront-guided laser-assisted subepithelial keratectomy (LASEK) in low myopia, myopic astigmatism and high myopia correction.Methods: In his retrospective study, 416 eyes were divided to 3 groups: 159 eyes with low myopia (LM) and mean refractive spherical equivalent (MRSE) of -3.68±1.33 (SD) diopter (D); 161 eyes with myopic astigmatism (MA) and MRSE of -5.99±2.24 D and mean cylinder of 2.41±1.07 D; and 96 eyes with high myopia (HM) and MRSE of -7.41±0.80 D. After an epithelial flap creation, a Wavefront-based excimer laser ablation was performed. Safety, efficacy, predictability, and stability were evaluated at day 10, months 2, 6 and 12 postoperatively.Results: The MRSE were -0.36±0.31 D in LM group, 0.15±0.41 D in MA group and 0.58±0.68 D in HM group. The uncorrected visual acuity (UCVA) were 20.20 in 90.60% of patients in LM group, 78.90% in MA group and 67% in HM group. Efficacy indices were 0.98, 1.04 and 0.92 in LM, MA and HM groups, respectively. Safety indices were 1.00, 1.07 and 1.05 in LM, MA and HM respectively. Five eyes (3.1%) in the LM group improved 1 line. Forty-four eyes (27.3%) in MA gained 1-3 lines and 19.2 % of HM group gained 1-2 lines of BSCVA. Only 2 eyes in LM group developed corneal haze. There were not significant statistically differences in efficacy and safety indices between three groups.Conclusion: Wavefront-guided LASEK is an effective and safe procedure for the treatment of LM, MA, and HM. Although predictability, efficacy and safety indices improved in myopic astigmatism.

Purpose: To determine long-term outcomes of probing in adult patients with nasolacrimal duct (NLD) obstruction.Methods: Patients older than 20 years admitted in Labaffinejad hospital with complete nasolacrimal duct obstruction were studied. The selected patients underwent probing under local anesthesia and cases with successful NLD probing enrolled the study. Patients were examined during the first week, 1, 6 and 12 months after probing.Results: 65 patients with complete nasolacrimal duct obstruction underwent probing.41 patients with successful probing enrolled. The overall success rate (complete and partial success) was reported in 28 patients (68.3%) in the first week. Success rates were 51.2% and 43.9% in 6 and 12 months after probing. Most of the decline in success rates were between 1 and 6 months after probing (p=0.016).Conclusion: Probing of nasolacrimal duct for treatment of adult patients with complete obstruction has a significant success rate and probing can be considered in cases that are not suitable for general anesthesia or doing dacryocystorhinostomy.

Purpose: To determine the accuracy of photorefraction and autorefraction as compared to cycloautorefraction and to detect the repeatability of photorefraction.Methods: This diagnostic study included the right eyes of 86 children aged 7-12 years. Refractive status was measured using photorefraction (PlusoptiX SO4, GmbH, Nurnberg, Germany) and autorefraction (Topcon RM800, USA) with and without cycloplegia. Photorefraction for each eye was performed three times to assess repeatability.Results: The overall agreement between photorefraction and cycloautorefraction was over 81% for all refractive errors. Photorefractometry had acceptable sensitivity and specificity for myopia and astigmatism. There was no statistically significant difference considering myopia and astigmatism in all comparisons, while the difference was significant for hyperopia using both amblyogenic (P=0.006) and nonamblyogenic criteria (P=0.001). A myopic shift of 1.21 diopter (D) and 1.58 D occurred with photorefraction in nonamblyogenic and amblyogenic hyperopia, respectively. Using revised cut-off points of+1.12 D and+2.6 D instead of+2.00 D and+3.50 D improved the sensitivity of photorefractometry to 84.62% and 69.23%, respectively. The repeatability of photorefraction for measurement of myopia, astigmatism and hyperopia was acceptable (intra-cluster correlation [ICC]: 0.98, 0.94 and 0.77, respectively). Autorefraction results were significantly different from cycloautorefraction in hyperopia (P<0.0001), but comparable in myopia and astigmatism. Also, noncycloglegic autorefraction results were similar to photorefraction in this study.Conclusion: Although photorefraction was accurate for measurement of myopia and astigmatism, its sensitivity for hyperopia was low which could be improved by considering revised cut-off points.Considering cut-off points, photorefraction can be used as a screening method.

Purpose: To determine the prevalence of various types of conjunctival lesions, at a tertiary ophthalmic center in Fars Province, South of Iran.Methods: Histopathologic slides and medical records of conjunctival lesions submitted to the pathology department of Khalili Hospital, Shiraz, Iran was reviewed from April, 2009 to July, 2013. The histopathologic diagnoses were categorized into benign, pre-malignant, and malignant lesions. The prevalence of various types of conjunctival lesions was calculated.Results: Histologic sections of 631 conjunctival lesions were reviewed. Benign lesions were most prevalent (81.8%), followed by premalignant (10.8%) and malignant (7.4%) lesions. Pterygia were the most common benign lesions (69.2%), intraepithelial dysplasia constituted most cases of premalignant lesions (94.1%), and squamous cell carcinoma was the most frequent malignant lesion (93.6%). Benign lesions were the most common type of lesions in all age groups; however the prevalence of malignant lesions increased significantly with age (P<0.001).Conclusion: Benign lesions were the most common conjunctival lesions with pterygia on top of the list, while intraepithelial neoplasia and squamous cell carcinoma were the most common premalignant and malignant lesions, respectively. Conjunctival malignant lesions were more prevalent with older age.

Purpose: To report two cases of granulomatosis with polyangiitis (GPA) presented ocular manifestations.Cases report: We report two cases of scleritis with red eye, one of them was a 30 years old female patient with saddle nose and positive C-ANCA and the other one was a 56 year-old female patient with lung cavitation and positive C-ANCA. Both cases undergone corticosteroid and immunosuppressive agents and they had a significant improvement following this treatment.Conclusion: Ophthalmologists may be the first clinician encountering patients with GPA. Hence, they play an important role in accurate diagnosis and early treatment of these patients.