BINA
Year:2016 | Volume:21 | Issue:4 (85)|Papers Count:13

Purpose: To determine the maximum safe dose for intravitreal injection of anti-CTGF (IVAC) in rat eyes in order to decrease gene and protein expression of connective tissue growth factor (CTGF) for the treatment of ocular fibrotic disorders.Methods: Forty-five Lister hooded pigmented rats were divided into one of the five groups of 9 rats; 4 out of these 5 groups received different doses of IVAC (2l); 10mg/ml in group B, 20mg/ml in group C, 50 mg/ml in group D, and 100mg/ml in group E. The sham group (group A) received 2l of normal saline. Full field electroretinography (ERG) was performed at baseline and on days 7 and 28 after the IVAC injection. At end of the study, the animals were euthanized and the injected eyes were subjected to routine histopathology, immunohistochemistry for glial fibrillaryacidic protein (GFAP), and terminal transferase dUTP nick endlabeling (TUNEL) assay.Results: In group E, Baseline scotopic rod b-wave amplitude and maximal combined b-wave amplitude were 111.89±71.2 v and 178.57±55.58 v, respectively, which significantly reduced to 79.31±52.59 v and 128.73±41.61 v, respectively, after 28 days (P<0.05). There was no significant reduction in the amplitudes of ERG in other groups that received lower doses of anti-CTGF antibody and in the sham group. Reduction in oscillatory potentials was also noticed after 7 and 28 days in group E (46.24±18.05 v at baseline, 30.03±15.95 v on day 7, P<0.05 and 29.79±12.20 v on day 28, P<0.001) but not in other groups. Photopic ERG responses did not show any significant change in any groups. Image J software cell counter indicated that retinal ganglion cells were significantly decreased in group E as compared to other groups. GFAP immune reactivity was not significant in any of the groups. TUNEL test showed inner retinal neural cell apoptosis only in group E.Conclusion: ERG, histopathologic, and apoptotic assays revealed no toxic effects of 10 to 50mg/ml of IVAC in the rat eyes. The injection of 100mg/ml IVAC, however, caused significant deleterious effects on both retinal function and structure as demonstrated by functional tests, and histopathologic and TUNEL findings.

Purpose: Primary acquired nasolacrimal duct obstruction (PANDO) is an acquired disease characterized by persistent symptoms such as tearing, mucus secretion, recurrent conjunctivitis and eye irritations. Different etiologies such as conjunctival infections, and nasal and sinus diseases have been proposed. Pathological studies have revealed inflammation, vascular congestion and edema in the early stages, and fibrosis with nasolacrimal duct obstruction in the latter stages. The mechanism of cytokine increase in tear film, although not exactly clear, can be delayed clearance because of the lacrimal system obstruction. The aim of this study was to compare the concentration of IL-1 in the tear film between cases with primary acquired nasolacrimal duct obstruction (PANDO) and cases without nasolacrimal duct obstruction.Methods: Twenty-eight patients with PANDO (unilateral in 26 patients and bilateral in two patients) and 26 age and sex- matched patients with cataract but without nasolacrimal duct obstruction were divided into one of the three groups: eyes with PANDO (n=30), the normal fellow eyes of the patients with PANDO (n=26), and control eyes (n=26). In each eye, 20 L of tear were taken and diluted 10 times before sending to the laboratory for centrifuging and measuring IL-1 concentration.Results: The mean participant was 48.85 (20-72) years and 53.46 (36-68) years in the PANDO group and control group, respectively. In the PANDO group, 7 patients (25%) were male and 21 (755) were female.These figures were 5 (19.25%) 21 (80.8%) in the control group, respectively. There was no significant difference in IL-1 concentration between control eyes and the normal fellow eyes of patients with PANDO (P=0.122). However, IL-1 concentration was significantly higher in eyes with PANDO as compared to the normal fellow eyes of patients with PANDO (P=0.001).Conclusion: Our results suggest that the increase in IL-1 concentration was due to stasis and obstruction in tear drainage and was not a primary event. This results cannot be generalized to other cytokines that may increase prior to the obstruction.

Purpose: To evaluate the early and intermediate outcomes of Ahmed glaucoma valve implantation in pediatric glaucoma at Labbafinejad Medical Center.Methods: This was a retrospective chart review of 101 eyes of 80 consecutive patients with pediatric glaucoma who underwent Ahmed glaucoma valve implantation. Success was defined as an intraocular pressure less than 21 mmHg with or without medication. Subgroup analysis was performed in three groups. Group 1 included phakic eyes with primary congenital glaucoma (60.4%); group 2 consisted of eyes with glaucoma that developed after congenital cataract surgery (31.7%); and group 3 included eyes with glaucoma caused by other etiologies (7.9%).Results: Mean age at the time Ahmad glaucoma valve implantation was 94.7±77.8 months. The cumulative probabilities of success measured by the Kaplan-Meier analysis at 12, 24, 36, 48 and 60 months was, respectively, 79%, 69.4%, 62.5%, 56.8% and 52.4% in group 1 and 79.9%, 75.9%, 71.5%, 71.5% and 71.5% in group 2. Kaplan-Meier survival analysis failed to reveal any difference in survival profiles related to specific diagnosis of glaucoma. Severe surgical complication occurred in 19.8% of cases. Tube-related complications were the most common complication but difference was not significant statistically among the subgroups. Reoperation was necessary in 21 eyes (20.8%).Conclusion: Ahmed glaucoma implantation is an option for the management of pediatric glaucoma.However, reoperation was commonly required for the tube-related complications and uncontrolled intraocular pressure.

Purpose: To assess the frequency and type of associated malformations and chromosomal anomalies among patients with anophthalmia, microphthalmia, and coloboma in Sistan and Baluchestan province.Methods: Patients with a clinical diagnosis of anophthalmia, microphthalmia, or coloboma were examined to find any anomaly in craniofacial, muscle-skeletal, cardiac, neurologic and urogenital systems. Also, karyotyping was performed to diagnose any chromosomal anomalies.Results: Different kinds of systemic anomalies were detected in six of 26 patients (23.1%). None of the patients had any kind of chromosomal anomalies. Neurologic disorders were the most frequent systemic anomalies among the patients (19.2%), followed by craniofacial anomalies (11.2%). All of the systemic anomalies were found in anophthalmic and microphthalmic cases but not in cases with coloboma.Conclusion: Due to the likelihood of systemic disorders in patients with anophthalmia and microphthalmia, regular and systemic examinations seems necessary in these patients.

Purpose: To evaluate the efficacy and safety of primary aphakic Artisan–Verysise intraocular lens (IOL) implantation during complicated cataract surgery.Methods: The study is a retrospective analysis of 49 eyes that underwent primary aphakic Artisan IOL implantation for complicated cataract surgery. Compiled data included demographic information, visual outcomes and complications. Pre- and post-operative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA) and spherical equivalents (SE) were compared.Results: The mean patient age was 68±12.8 years; and the mean follow-up time was 30.714.8 months. The mean preoperative UCVA was 1.40±0.64 which increased to 0.82±0.48 logMAR postoperatively (P<0.001). The mean BCVA improved significantly from 0.58±0.4 logMAR at baseline to 0.44±0.41 logMAR postoperatively (P=0.008). The spherical equivalent changed insignificantly from -0.13±1.55 D preoperatively to -0.6±1.88 D at the last visit (P=0.724). IOL position was acceptable in all eyes. Postoperative complications were transient pigmented precipitates in 5 eyes and raised intraocular pressure in one eye.Conclusion: Primary aphakic Artisan–Verysise IOL implantation during complicated cataract surgery is safe and effective. Given acceptable clinical outcomes and low complication rates, Aphakic Artisan IOL is an appropriate alternative in complicated cataract surgery when there is no sufficient capsular bag support.

Purpose: To assess the relative frequencies of etiologies leading to eye removal in patients who referred to Feiz hospital, Isfahan, between 2011 and 2014.Methods: This retrospective study was conducted on patients who underwent eye removal at Feiz hospital. Age, sex, eye laterality, underlying etiology, visual acuity, and surgical technique (enucleation, evisceration, or exenteration) were recorded and analyzed.Results: This study consists of 204 patients with a mean age of 52.18±24.04 (range 2-92 years). Of whom, 150 subjects (73.5%) were male and 54 subjects (26.5%) were female. The most common cause was trauma (n=84, 41.2%), followed by corneal ulcer (n=35, 17.2%), blind painful eye (n=41, 20.1%; of which, 11 (5.4%) had glaucoma), orbital tumor (n=24, 11.8%), and endophthalmitis (n=20, 9.8%; of which, 2 (1%) had fungal infection), in descending order. One hundred and fifteen patients (56.4%) lived in urban areas, and 89 (43.6%) in rural areas.Conclusion: This study showed that the majority of causes for enucleation (trauma and corneal ulcer) are preventable. To reduce devastating consequences, it is imperative to raise public awareness about eye protection at work and immediate referral to an ophthalmologist in the case of corneal ulcer.

Purpose: To compare single pass technique for preparation of donor endothelial keratoplasty lenticules from fresh whole eyes using 400mm versus 350mm microkeratome head in three different time intervals.Methods: Precut corneas were prepared for Descemet stripping automated endothelial keratoplasty according to the standard protocol of the Central Eye Bank of Iran and by using either 400 m or 350 m microkeratome heads. The preparation was performed in three different time intervals: less than 30 seconds, 30-50 seconds, and more than 50 seconds. Expected thickness of endothelial keratoplasty lenticules (full thickness of central cornea minus the size of microkeratome head) was measured by ultrasound pachymetry. Final thickness of endothelial keratoplasty lenticules and depth of cut were measured by Visante-Optical Coherence Tomography. ANOVA and Bonferroni tests were used to analyze the results considering the size of microkeratome head and duration of the lenticule preparation.Results: The study enrolled 316 precut corneas that were prepared between October 2015 and December 2015. Mean depth of cut using the 350 m microkeratome was not significantly different among 3 time intervals (P=0.405); however, the depth of cut with the 400 m microkeratome was significantly different among the different time interval groups and was significantly increased with pass time lasting more than 50 sec (P=0.014).Conclusion: Single slow pass technique using 400 m microkeratome head is an effective method for preparation of thin donor endothelial keratoplasty lenticules from fresh whole globes.

Purpose: To adapt the Iranian clinical practice guidelines (CPGs) for diabetic retinopathy (DR).Methods: Three DR CPGs (Royal College 2013; American Academy 2012 and Australian Diabetes Society 2008) were chosen from the extracted CPGs in the related databases and websites. Clinical questions about the DR were developed by the customization team. Four tables were used to analyze and summarize the clinical questions. Each clinical question along with its answers and comments was entered in table 1 from the selected CPGs. The evidences of each answer were extracted and recorded in table 2. The recommendations were developed by customization team and evaluated them in terms of clinical benefits, cost and side effects in table 3. In table 4, recommendations have been revised based on its customizing capability (applicability, acceptability, and external validity). Recommendations were sent to the faculty members of Iran medical universities to score the recommendations from 1 to 9.Results: Customization team were analyzed the scores. The agreed recommendations were served as the final recommendations. Non-agreed ones were modified and totally, 29 customized recommendations were developed.Conclusion: The Iranian customized CPG for DR might be effective in standardization of referral, diagnosis and treatment of the diabetic patients.

Purpose: To report the results of anti-VEGF therapy in choroidal neovascularization associated with angioid streaks in a patient with pseudoxanthoma elasticum.Case Report: A 53-year-old woman presented to Labbafinejad Medical Center with a complaint of decreased visual acuity in the left eye that started 3 months before her presentation. Her past medical history revealed that she was diagnosed with pseudoxanthoma elasticum. Best-corrected visual acuity was counting finger at 4 meters in the right eye and 1.10 the left eye. Funduscopy revealed brown to grey bands emanating from the optic disc in both eyes, suggestive of bilateral angioid streaks. Fluorescein angiography disclosed choroidal neovascularization (CNV) in the left eye. She received three consecutive injections of intravitreal bevacizumab (1.25 mg) with one month interval between injections. BCVA was increased by one line 6 months after the last injection.Conclusion: Despite various treatments, anti-VEGF therapy has become the treatment of choice for CNV associated with angioid streaks. In our patient, visual acuity improved by 1 line of Snellen chart after 6 months of follow-up.

Purpose: To report clinical outcomes after the implantation of an indigenous version of Pintucci keratoprosthesis in a patient suffering from severe ocular surface chemical burn.Case Report: A 41 year-old man had bilateral severe acid burn 5 years before his recent presentation. He underwent penetrating keratoplasty and keratolimbal allografts OU which failed. Upon the presentation, visual acuity was light perception in both eyes. Slitlamp examination revealed severe dry eye, corneal opacities and conjunctivalization indicating total limbal stem cell deficiency OU. The left eye was considered for keratoprosthesis. The keratoprosthesis which was an indigenous version of Pintucci keratoprosthesis was manufactured in the Ophthalmic Research Center, affiliated with Shahid Beheshti University of Medical sciences, Tehran, Iran. In the first stage, ocular surface was reconstructed with oral mucus membrane graft, and keratoprosthsis was placed under the skin and orbicularis oculi muscle. Three months later, keratoprosthsis was removed and implanted in the left eye. Three months postoperatively, best corrected visual acuity was 2.10 and anatomical position was acceptable. No complications were encountered during the follow up.Conclusion: The results of the first case implanted with the locally manufactured keratoprosthesis are acceptable and encourage us to implant this type of keratoprosthesis in patients with severe dry eye and total limbal stem cell deficiency.