BINA
Year:2020 | Volume:25 | Issue:3|Papers Count:31

Purpose: A case report of a patient with endogenous endophthalmitis following acute cholecystitis. Case Report: a 64-year-old woman without medical history underwent uncomplicated cataract surgery due to a mature cataract and was discharged with essential recommendations. A few hours later, she was admitted to the hospital because of acute abdominal pain, and with the diagnosis of acute cholecystitis, cholecystectomy was done and intravenous antibiotic therapy was started. On a postop day, 1 frequent prophylactic topical antibiotic and steroid was started but 3 days later, the patient’ s eye was visited at the clinic with the signs of fulminant acute endophthalmitis and total corneal melting. Intravenous, intravitreal, and topical antibiotic therapies started for the patient after admission as endogenous endophthalmitis, but unfortunately, the infection was unresponsive to treatment and the eye was lost. A week later, evisceration was done for the patient. Conclusion: Endogenous endophthalmitis is an uncommon type of endophthalmitis and the early diagnosis and treatment are important for the patient both visually and vitally.

Purpose: To evaluate the facial characteristics in patients with unilateral esotropic Duane retraction syndrome (DRS) with head turn and compare with orthotropic participants. Methods: This cross-sectional descriptive-analytical study was performed on 42 esotropic DRS patients with head turn and 42 orthotropic participants. Four photos of each patient were taken from 40 cm and the pictures were analyzed with Corel Draw X7 software. "Facial angle" (the angle between the line connecting the two outer canthi with the line connecting the corners of lips) and "relative face size" (the ratio of the distance between the outer canthus and lip corner of both face sides) were measured. Qualitative variables of facial asymmetry (columella deviation, one-side compression of the face, nostrils, and cheek) were also recorded. Results: The mean age of patients and controls was 15 ± 9 and 17 ± 10 years, respectively (P = 0. 268). In the DRS group, 35 patients (83. 3%) had facial asymmetry, and only 7 patients (16. 7%) had symmetrical faces (P <0. 001), while in the control group, facial asymmetry was found in 21 participants (50%). The mean relative face size in the DRS group (1. 018 ± 0. 013) was significantly higher than orthotropic participants (1. 010 ± 0. 008) (P=. 0030). Although the mean facial angle in the DRS group (1. 06 ° ± 0. 96 ° ) was higher than orthotropic participants (0. 80 ° ± 0. 64 ° ), no significant relationship was observed between them (P = 0. 119). The frequency of presence of facial asymmetry, columella deviation, one-side compression of the face, nostrils, and cheek in DRS patients was significantly higher than orthotropic participants (all, P<0. 001). Conclusion: Facial asymmetry in esotropic DRS patients with head turn is significantly higher than in orthotropic participants.

Purpose: Quantitative and qualitative evaluation of facial asymmetry in patients with unilateral exotropia Duane retraction syndrome (DRS) with head turn in comparison with normal subjects. Methods: The present cross-sectional study was performed on 22 samples, including 11 patients with unilateral exotropia DRS with a head turn and 11 normal subjects without torticollis as a control group. To evaluate the appearance of the face, from a distance of 40 cm, four photos of each sample were captured and analyzed, using Corel Draw X7 software. The presence of qualitative facial asymmetry parameters, including one-side compression of the nostrils, cheek and face, and columella deviation were recorded. Quantitative facial asymmetry parameters, including "relative face size" and "facial angle" were also measured. Results: The mean age of patients and normal subjects was 17± 10 and 18± 10, respectively. Two groups were matched by gender and age (P=0. 885, P>0. 99, respectively). All 11 (100%) exotropia DRS patients had facial asymmetry, but in the control group, facial asymmetry was observed in 6 (54. 5%) subjects, and 5 (45. 5%) subjects had perfectly symmetrical faces (P = 0. 736). The mean facial angle in the patient group (1. 7° ± 0. 016° ) was significantly higher than the control group (0. 8° ± 0. 8° ) (P= 0. 012). Also, the mean relative face size in the patient group (1. 022± 0. 016) was significantly higher than the control group (1. 008± 1. 006) (P = 0. 019). The frequency of all qualitative facial asymmetry parameters (one-side compression of the nostrils, cheek and face, and columella deviation) in the patient group was significantly higher than the normal control group (all, P <0. 001). Conclusion: All facial asymmetry parameters in exotropia DRS patients with head turns were significantly higher than the normal control group.

Purpose: To determine the effect of intravitreal injection of bevacizumab (IVB), which is the standard treatment for diabetic macular edema, along with vitamin D supplementation, on diabetic macular edema in patients with vitamin D deficiency. Methods: Generally, 83 eyes of 83 patients with diabetes mellitus (DM) type 2 and diabetic macular edema (DME) were studied. The patients were divided into 3 groups: normal vitamin D levels + IVB administration (Group 1, n=29), vitamin D insufficient/deficient + IVB administration (Group 2, n=26), and vitamin D insufficient/deficient + IVB administration+ oral vitamin D supplementation (Group 3, n=28). All groups received 3 monthly IVB injections and group 3 received oral vitamin D supplementation simultaneously. The patients were followed up 1, 3, and 6 months after the third baseline IVB with clinical examination, CDVA, and CMT measurements. Results: The mean baseline CDVA (LogMAR) in groups 1, 2, and 3 was 0. 68 ± 0. 16, 0. 72 ± 0. 14, and 0. 71 ± 0. 1, respectively. In months 1, 3, and 6, after the basic triple IVB injection, visual acuity improved in all groups, but the increase in visual acuity in month 6 was statistically significant in the group treated with vitamin D supplement (group 3) and the group with normal vitamin D levels (group 1) compared to the vitamin D deficiency untreated group (group 2) (P<0. 001). Mean CMT decreased in all groups following IVB injections (466. 83 ± 57, 527. 46 ± 42. 3, and 500. 61 ± 56. 01 microns in groups 1, 2, and 3, respectively), but similar to visual acuity, only in month 6, these changes were significantly different in groups 1 and 3 compared to group 2 (P<0. 001). Conclusion: The correction of vitamin D deficiency in DME patients with type 2 diabetes and vitamin D deficiency, in addition to IVB injections, may play a role in improving CDVA and CMT.

Purpose: To measure the retinal nerve fiber layer thickness (RNFLT) in patients with -thalassemia major and to compare with healthy controls. Methods: A total of 20 patients with B-thalassemia major and 20 healthy controls were included. Each subject underwent a standard ophthalmological examination. RNFLT measurements were, performed using optical coherence tomography. Results: The mean age of the patient group and healthy controls were 17. 85± 7. 5 and 24. 75± 9. 9 years, respectively. Mean peripapillary RNFL thickness was 88. 9± 4. 67 μ m in the patient group, and 94. 25± 4. 15 μ m in the control group (P<0. 001). In patients, there was no significant relationship between the mean of RNFL and blood ferritin level, differential using, and blood transfusion volume and hemoglobin level (P> 0. 05). Conclusion: In this study, we observed RNFL was thinner in patients with -thalassemia major. Thinning of RNFL did not correlate with hemoglobin, blood transfusion volume, or ferritin levels, and deferral using.

Purpose: To report the frequency of different orbital tumors from Labafi Nejad Hospital, Iran. Methods: This retrospective consecutive case series includes all records coded with a diagnosis of “ orbital tumor” along with a definite histopathologic diagnosis from April 2008 to March 2019. All Patients with definite histopathologic diagnosis (327 cases) were included in the study and the other cases were excluded. Results: A total of 327 orbital space-occupying lesions (SOLs) with definite histopathologic diagnoses were identified during the 11 years of the study. Affected subjects comprised 183 (56%) female and 144 (44%) male patients with a mean age of 30± 21. 6 years. Overall, 276 (84. 4%) of the SOLs were benign, whereas 51 (15. 6%) were malignant; 236 (72. 2%) of the lesions were extraconal, while 91 (27. 8%) were intraconal; 306 (93. 6%) of them were primary, 18 (5. 5%) were secondary, and only 3 (0. 9%) were metastatic. The most common types of lesions in decreasing frequency were cystic, vascular, inflammatory, and lymphoproliferative, mesenchymal, neurogenic, secondary and metastatic, and epithelial lacrimal gland tumors. Dermoid cysts were the most frequent orbital SOL with 109 cases (33. 3%) and also the most common benign lesion. Malignant lymphoma with 12 cases (3. 7%) was the most prevalent malignant orbital SOL. Dermoid cysts and malignant lymphoma were the most prevalent benign and malignant orbital SOLs, respectively. The ratio of malignant to benign lesions was 0. 46 in children (􀀀 18 years), 0. 84 in middle-aged patients (19-59 years), and 5. 2 in older (􀀀 60 years) cases. Rhabdomyosarcoma was the most common malignancy in children; lymphoma was the most frequent malignancy in middle-aged subjects and invasive basal cell carcinoma from the eyelids was the most common malignancy in the old age group. The superotemporal quadrant was the most frequent site of involvement and proptosis was the most common presenting symptom. Conclusion: Benign, extraconal, and primary orbital SOLs were more frequent than malignant, intraconal, and secondary lesions in this report. The ratio of malignant lesions increased with age in our cohort.

Purpose: To investigate the efficacy of temporal artery biopsy (TAB) for the diagnosis of giant cell arteritis (GCA) and to evaluate the clinical and laboratory characteristics of patients. Methods: In this retrospective study, the medical records of suspected GCA patients, who underwent TAB in a tertiary center in Iran between 2008 and 2017, were evaluated. The 2016 American College of Rheumatology (ACR) criteria for early diagnosis of giant cell (temporal) arteritis were considered for each patient for inclusion in this study. Results: A total of 114 patients were included in this study. The mean age was 65. 54± 10. 17 years. The mean overall score based on the 2016 American College of Rheumatology criteria was 4. 17± 1. 39, with 5. 82± 1. 28 for positive biopsies and 3. 88± 1. 19 for negative biopsies (P<0. 001) and 17 patients (14. 9%) were biopsy-positive. The mean length of the specimen in the biopsy-positive group (18. 35 ± 6. 9 mm) was higher than the biopsynegative group (15. 62 8 8. 4 mm), but the difference was not statistically significant (P=0. 21). There was no statistically significant difference between the two groups in terms of sex, serum hemoglobin level, platelet count, and erythrocyte sedimentation rate. There was a statistically significant difference between biopsynegative and biopsy-positive groups in terms of patients’ age and the level of C-reactive protein (P<001 and P=0. 012, respectively). Conclusion: According to a large number of negative TAB results, avoiding unnecessary biopsies could lower the workload and improve medical services. It is recommended that GCA be diagnosed based on clinical suspicion and laboratory results.

Purpose: To compare the perfusion pressure of the eye among people having primary open-angle glaucoma with healthy people. Methods: This case-control study was performed on 97 patients with glaucoma referring to the Eye Ward of Valiasr Hospital affiliated to the Birjand University of Medical Sciences, Birjand, Iran, in 2017. The samples were selected among patients with open-angle glaucoma and their companions without a history of glaucoma and hypertension for the case and control groups (n=50 each), respectively. All subjects in both groups were examined regarding ocular pressure control and blood pressure using gonioscopy, and their ocular perfusion pressure was calculated. The statistical analysis of these variables was performed, using an independent t-test and Chi-square. Results: In this study, 47 (48. 5%) and 50 (51. 5%) of the participants were males and females, respectively. Their mean age was 56. 88 11. 61 years, which was 57. 58 years in the case and 55. 51 years in the control groups. The mean scores of ocular pressure were 17. 30 5. 01 and 14. 83 2. 08 mm Hg, respectively, in the case and control groups. Based on the results, systolic blood pressure scores in the case and control groups were 133 and 123. 72 mm Hg, respectively. Moreover, diastolic blood pressure scores were reported to be 82. 50 12. 13 and 79. 36 12. 58 mm Hg in the case and control groups, respectively. It was also found that the mean scores of ocular perfusion pressure in the case and control groups were 48. 65 8. 27 and 46. 71 8. 72 mm Hg, which was not significant (P=0. 26). Conclusion: No significant difference was revealed in ocular perfusion pressure between the case and control groups.

Purpose: To compare intraocular pressure (IOP) measurements with Goldmann applanation tonometry (GAT) after penetrating keratoplasty (PK) versus deep anterior lamellar keratoplasty (DALK) in keratoconus eyes. Methods: This retrospective study included 356 PK eyes (group 1) and 684 DALK eyes (group 2). IOP was measured in all eyes during postoperative follow-up. The study groups were compared in the rate of high IOP encountered postoperatively. Results: The follow-up period was 59. 4± 44. 1 and 62. 4± 38. 9 months in groups 1 and 2, respectively (P=0. 70). Postoperative best spectacle-corrected visual acuity was 0. 24± 0. 18 and 0. 29± 0. 19 logMAR, respectively (P=0. 13). Graft rejection occurred in 34. 6% and 25. 8% of eyes in groups 1 and 2, respectively (P=0. 30). IOP >21 mmHg was observed in 42 eyes (11. 8%) in group 1 and 18 eyes (2. 6%) in group 2 during the follow-up period (P=0. 03). IOP was controlled medically in all of these eyes. Conclusion: High IOP was more frequently encountered in the PK group as compared to the DALK group. IOP was controlled medically in all of these eyes and no patients required surgical intervention.

Purpose: To investigate the effect of smartphones on vision performance among students of Iranshahr University of Medical Sciences in 2018. Methods: This study was performed among the 18 to 30-year-old students of Iranshahr University of Medical Sciences, who were healthy and without any eye or systemic diseases. All subjects were studied for 3 hours with 3 different smartphone sizes, for one hour under the same precise eye work. An examiner performed the tests and evaluated the samples to ensure a constant distance between the user and the mobile. If the refraction was more than ± 0. 5 diopters, an optical correction would be placed over the eye. To create eye fatigue, the person was asked to perform an exact and identical eye work on all three mobile phones. An eye work consisted of 6 precise tasks that one had to focus on the mobile screen. That was, chasing moving targets at low speed, finding large and small targets that are found and hiding, and reading moving sentences to find answers; all the targets moved from left to right and vice versa so that one does not only look at the center of the mobile screen but also the perimeter of the screen during the examination. Results: Out of 20 participants (8 males and 12 females), 11 were right eye dominated and the rest were left eye dominated. NPA was 3. 3 ± 9. 5 cm (mean: 10. 5 diopters) before the test, and 12. 1± 5. 8 diopters had a mean of 8. 3 diopters after the use of a 5. 5-inch phone. No major change was observed before and after using Mobile 5. 5. PRA was 9. 8 ± 2. 6 cm (mean: 10. 2 diopters) before and after ophthalmology 4. 2 ± 10. 0 (mean: 10. 0 diopters), indicating minimal changes between the three smartphones (P = 0. 20). The NPC rate before glare was 7. 7 ± 2. 2, 7. 5 ± 2. 3, and 8. 1 ± 2. 6 for 5. 8, 5. 5, and 5. 1 5. 1. The NPC rate after glare was 8. 0 ± 2. 4, 8. 2 ± 2. 7, 8. 4 ± 2. 8. The highest increase was for the 5. 5 mobile phone, but no significant difference was observed between the three types of phones. Conclusion: In summary, there was no significant difference between the adaptive response in all cases and the version of the stimulus between the three types of phones. This condition may be due to the youthfulness of the samples and the normalization of their adaptive range in proportion to their age.

Purpose: Content and citation analysis of articles published in Bina Journal Ophthalmology. Methods: The qualitative approach is considered for this research and the method of this research is quantitative content analysis. The data collection tool was a researcher-made checklist. The statistical population included 834 published articles of Bina Ophthalmology Journal between 2004 and 2017. We used Excel software to analyze the data. Results: The largest publication of the article is in 2004 (96 articles) and the smallest is in 2017 (34 articles). In terms of scientific rank, Assistant Professors (17. 45), Associate Professors (16. 76), and Professors (15. 57) were ranked first to third. In terms of organizational affiliation, Shahid Beheshti University of Medical Sciences (54. 8), Tehran University of Medical Sciences (10. 47), and Iran University of Medical Sciences (6. 39) ranked first to third. Conclusion: It seems that the publication of the article has decreased since 2011 so that in the first 7 years, 478 articles (57. 3%) and in the second 7 years, 356 articles (42. 6%) have been published. Probably the decrease in the number of articles is related to the authors' desire to publish their articles in other prestigious journals. Another reason is that professors show less desire to publish articles after receiving the last academic degree, and the educational and research system should be such that it allows more use of professors' experiences and the publication of their articles in domestic journals.

Descemet membrane endothelial keratoplasty (DMEK) is lamellar corneal transplantation that involves the removal of endothelium and Descemet membrane of the recipient and subsequent transplantation of endothelium and Descemet membrane from a donor. To date, DMEK revealed promising outcomes, including the fast visual recovery, the better final visual acuity, and the lower risk of allograft rejection. In the present review article, firstly, an introduction to endothelial keratoplasty is explained with the focus on similarities and differences between DMEK and Descemet membrane automated endothelial keratoplasty (DSAEK). Then, the method of performing DMEK preferred in authors’ experience is reviewed in a stepwise fashion. The steps include preparation of the donor tissue, corneal incisions, removal of the recipient’ s tissue, insertion of the graft, and conclusion of the surgery. Finally, the postoperative care of the patients is briefly mentioned.

Nowadays, Phosphodiesterase inhibitors (such as Sildenafil, Tadalafil, Vardenafil, and Avanafil) are used to treat erectile dysfunction in men and pulmonary arterial hypertension. There have been numerous reported ocular side effects of these drugs including anterior ischemic neuropathy, central serous chorioretinopathy, retinal hemorrhage, retinal vein occlusion, and retinal artery occlusion. Also, after taking phosphodiesterase inhibitors, various subjective vision complaints, such as Cyanopsia, blurred vision, diplopia, and photopsia are expressed by patients. We extensively searched phosphodiesterase inhibitors ocular side effects in the literature, using PubMed and Medline. In this review article, we classified the ocular side effects of these drugs and the controversies in the reports, the mechanism of action, paraclinical findings, as well as animal studies in this field.

Congenital nasolacrimal obstruction is a common disease that leads to tearing and mucoid discharge. Congenital nasolacrimal obstruction occurs in about 20% of children under one year of age. Most of these cases improve spontaneously, but sometimes the obstruction persists. Spontaneous improvement in the first year is high. Treatments include conservative therapy, probing and irrigation, inferior turbinate fracture, balloon dacryocystoplasty, endoscopic, or external dacryocystorhinostomy. The purpose of this article is to review the literature on the treatment of congenital nasolacrimal obstruction.

Corneal Collagen Cross-linking (CCL) was introduced and applied to ophthalmology during the past two decades. It has been a major advance in the management of progressive keratoconus and ectasia after laser vision corneal refractive surgery. CCL has successful and significant results in halting the progression of ectasia. The more the prevalence of keratoconus in our region, the more the number of performing this procedure is increasing day by day. There have been many published studies revealing the effect of CCL on corneal steepness, keratometry, pachymetry, visual acuity, biomechanical, and albeit progression of Keratoconus. In this article, many studies related to different aspects and effects of CCL are classified, reviewed, and summarized for concluding this field.

Accommodation anomalies are the spectrum of disorders, which affect monocular and binocular clear vision, particularly at a near distance. Accommodation anomalies can be classified into three major categories: accommodation deficit, accommodation excess, and failure to alter accommodation. In this article, we will review categories of clinical characteristics, etiology, and treatment options.

Purpose: To report a case of spontaneous closure of macular lamellar hole, and to discuss its probable mechanisms. Case Report: A 70-year-old woman with a diagnosis of SLE and chronic usage of hydroxychloroquine, presented to our clinic for routine retinal examinations. Her best corrected visual acuity was 7. 10 in both eyes, with a senile lens opacity and no sign of retinal HCQ toxicity. On examination and macular OCT of her left eye, a thick epiretinal membrane with the adjacent lamellar hole was detected. As there were no indications for surgical intervention, she was followed without any treatment. On 1-year follow-up examination, the ERM was seen but the hole was closed, and macular OCT of the left eye approved spontaneous closure of the hole. Conclusion: Herein we report a case of spontaneous resolution of the macular lamellar hole, an event not reported in the literature, in addition to presenting a brief review on pathophysiology and treatment of ERM and lamellar holes. Although the resolution of retinal edema or change in ERM can alter tractional features of a macular hole resembling spontaneous whole closure, in our case there was no retinal edema, and the epiretinal membrane showed no change on follow-up examinations.

Purpose: Brown syndrome is characterized by limitation of the elevation when the eye is in adduction. Both congenital and acquired cases, as well as constant or intermittent have been reported; it is bilateral in 10% of cases. Bilateral cases may occur simultaneously in most cases or sequentially in rare cases. Herein, we report a patient with a bilateral brown syndrome, who was diagnosed to be congenital in one eye and sequentially presented in the other eye. Case Report: A 4-year-old patient presented to Labbafinejad medical center with head tilt and strabismus since his childhood. In his examination, he had 30 PD hypotropia in the primary position and the same amount of esotropia accompanied by limitation of elevation in adduction in the left eye. The patient underwent two surgeries with a 3-year interval, including adhesion band release in superior oblique muscle and SO elongation and recession and resection of both horizontal recti. Nine months later, the patient presented with the complaint of strabismus in the fellow eye. In the ocular examination, the right eye had a limitation of elevation in the adduction. While the right eye was the fixator eye, hypertropia of the left eye in the primary position was evident at this stage. The patient was diagnosed to have acquired brown syndrome of the right eye. He underwent systemic work-ups, including rheumatologic consult and orbital and paranasal CT scan for sinusitis. All work-ups revealed negative results. After 5 months, the patient underwent two sequential surgeries on SO tendon for the correction of severe hypotropia including SO elongation and tenotomy, which resulted in acceptable residual hypertropia and esotropia in the left eye with no limitation in any direction. Conlusion: In this s tudy, we reported a rare case of Brown syndrome with the congenital presentation in the first eye and idiopathic acquired type in the second eye after an 8-year delay. This bilateral sequential type has been reported rarely and we assume it may be the result of an anatomical anomaly in SO tendon and trochlea.

Purpose: To report the result of strabismus surgery in a case of near-reflex substitution for horizontal gaze palsy. Case Report: The patient was a 9-year-old girl with esotropia of 35 PD, right face turn, and right side facial palsy. Ocular motility examination was remarkable for right side gaze palsy and on attempting right gaze, all components of near reflex, including a convergence movement as well as bilateral pupillary miosis and myopic shift, were manifested. Her deviation was manifested after the first episode of intraventricular hemorrhage at the age of one month. Clinical and imaging findings were consistent with right side facial colliculus syndrome with near reflex substitution. We performed a right medial rectus muscle recession and a half-tendon transposition of the superior and inferior recti muscles to the right lateral rectus muscle insertion, which resulted in orthophoria in primary position, improvement of the right face turn, and substantial decrement of convergence movement. Conclusion: Near reflex substitution for the horizontal gaze palsy in a patient with other features of the facial colliculus syndrome has rarely been reported. Eye muscle surgery did reduce the paradoxical convergence movement but did not significantly improve the other components of the substituted near reflex.

Purpose: To report a case of Joubert’ s syndrome with alternating skew deviation and lateral skew deviation. Case report: A 18-year-old girl was referred with the chief complaint of abnormal eye movements since infancy. Some degree of oculomotor apraxia was revealed as the girl had difficulties in initiating horizontal saccades and subsequent head thrust. Periodic alternating vertical misalignment of eyes was also evident, known as alternating skew deviation. After 3 to 5 seconds, the vertical divergence of the eyes reversed direction. Gaze to either side also resulted in hypertropia of abducting eye, known as lateral skew deviation. MRI demonstrated hypoplasia of superior cerebellar vermis along molar tooth signs associated with Joubert syndrome. Conclusion: This report shows that alternating skew deviation and lateral skew deviation can be manifestations of Joubert’ s syndrome.

Purpose: To Report a case of bilateral choroidal neovascularization (CNV) and angioid streaks in a patient with  thalassemia. Case Report: A 41-year-old male, a known case of -thalassemia, presented with the gradual decrease of vision from 3 months ago. The best corrected visual acuity was 8/10 in right and 3/10 in the left eye and Marcus Gunn was negative. In slit lamp examination, the anterior segment of both eyes was normal and in the posterior segment of both eyes, dark brown to red irregular bands radiating a few millimeters from a peripapillary ring was visible. There was an active CNV in the right eye and a CNV scar in the left eye. Intravitreal injection of bevacizumab was performed for the right eye. Conclusion: Angioid Streaks can occur in patients with 􀀀 thalassemia and one of the complications of angioid streaks is choroidal neovascularization, which can decrease vision.

Purpose: To report a case of periocular xanthogranuloma with adult-onset asthma in Hodgkin Lymphoma association with intermediate uveitis. Case Report: A 51-year-old man presented with the complaint of blurred vision in both eyes and bilateral periocular masses. He had a history of Hodgkin lymphoma treated by chemotherapy 10 years ago with no recurrence. Respiratory problems with small periocular nodules occurred 3 years after completion of chemotherapy. Multiple incisional biopsies were all negative for recurrence of lymphoma. Anti-asthma therapy was started for the patient with close follow-up. During past years, periocular and upper eyelid nodules enlarged very slowly leading to severe mechanical ptosis and bilateral intermediate uveitis and uveitic macular edema emerged. Excisional biopsy was done and the diagnosis of xanthogranuloma was confirmed by pathology exam. No recurrence was seen after 6 months. Conclusion: History of Hodgkin lymphoma and chemotherapy may predispose the patient to future inflammatory disorders like Periocular xanthogranuloma with adult-onset asthma and intermediate uveitis.

Purpose: To report a case of hypertensive chorioretinopathy. Case Repost: A 31-year-old man was referred with the complaint of blurred vision and severe headache 1 month ago. Bilateral disc swelling and exudative retinal detachment, as well as scattered yellow lesions, were evident below the retina. Multiple lumbar punctures with the suspicion of idiopathic intracranial hypertension (IIH) and methyl prednisolone pulse therapy with the diagnosis of Vogt-Koyanagi-Harada (VKH) disease had been performed for him during the last month. A very high blood pressure (BP) was detected for the patient and his visual acuity and headache improved after urgent and intensive BP control. Conclusion: Hypertensive chorioretinopathy may be misdiagnosed as IIH, ocular inflammation, or other disorders because of the overlap between the presenting signs, but it should be thought of as the first differential diagnosis due to its life-threatening nature.

Purpose: To report medical and surgical management of a 5 months old infant with multiple orbital abscesses secondary to untreated dacryocystitis. Case Report: A 5-month-old boy presented with proptosis, swelling, and redness of the right eye, which was more prominent around the medial canthus and lower lid. Symptoms started 3 months ago, and he was treated with multiple courses of systemic antibiotics. Orbital MRI revealed dilated lacrimal sac and multiple orbital abscesses. He was admitted and treated with broad-spectrum intravenous antibiotics for 2 days; then, abscess drainage and nasolacrimal duct probing were performed at the same session. After these procedures, his sign and symptoms improved. There was no recurrence in a 3-months follow-up. Conclusion: Untreated dacryocystitis secondary to congenital nasolacrimal duct obstruction may progress to orbital abscesses. In this condition, after systemic antibiotics coverage, orbital abscess drainage, and nasolacrimal duct probing are essential for treatment.

Purpose: To report a rare case of autosomal dominant optic atrophy plus syndrome in a patient with decreased visual acuity. Case Report: A 27-year-old man with decreased visual acuity since many years ago and his visual acuities were 20/500 OD and 20/400 OS. He also had several other neurologic findings, including bilateral optic atrophy, sensorineural hearing loss, and sensorimotor polyneuropathy. He was under anti-glaucoma medication due to abnormal optic disc appearance. After clinical evaluation, autosomal dominant optic atrophy plus syndrome was diagnosed. Conclusion: Autosomal dominant optic atrophy (ADOA) is the most common hereditary optic neuropathy. With central nervous system symptoms such as hearing loss, this syndrome is called ADOA plus Syndrome. Clinicians should consider that “ plus” symptoms may appear years after vision decrement in some patients with autosomal dominant optic atrophy.

Purpose: Wolfram syndrome or DIDMOAD is a rare autosomal recessive neurological disorder characterized by clinical symptoms of diabetes insipidus, diabetes mellitus, hearing loss, and optic nerve atrophy. Due to the rarity of the disease, the rare prevalence of this disease, and the importance of identifying and patient recognition, this study aimed at introducing a patient with Wolfram syndrome, who was a candidate for vitrectomy with the diagnosis of retinal tachycardia. Case Report: A 19-year-old girl with Wolfram with symptoms of diabetes mellitus, optic nerve and hearing atrophy, advanced Proliferative Diabetic Retinopathy, and Tractional Retinal Detachment was referred to Imam Khomeini Hospital for Vitrectomy. Conclusion: Since optic nerve atrophy in the reported patient appears earlier than other symptoms, the referral of young diabetic patients for ophthalmologic examinations to early diagnosis is suggested. According to the results of this study, children with parents who have a family relationship and a family history of diabetes are more likely to develop Wolfram syndrome. So, it is necessary to pay attention to this issue in premarital counseling. Also, it is recommended that authorities make appropriate arrangements for screening susceptible patients for this syndrome.

Purpose: To report a rare case of solitary myofibroma involving the sclera in an elderly person. Case Report: The patient was a 93-year-old man complaining of a mass lesion in the lateral sclerolimbal area of his left eye; the lesion had enlarged suddenly since 20 days ago. Other examinations (including skin, heart, and ext) and lab data (CBC, Lipid profile, liver, and kidney function) were normal. The only medical history was laryngeal cancer with a history of radiotherapy 15 years ago. The tumor was excised completely. Histopathology reported solitary myofibroma. During two months of follow-up, no sign of recurrence was found. Conclusion: Solitary myofibroma of the sclera may be a differential diagnosis of epi-bulbar masses, including squamous cell and peduncular squamous cell carcinomas, especially in patients with a history of cancer and radiation therapy.

Purpose: To report a case of bilateral neuroretinitis as the first sign of underlying pheochromocytoma. Case report: A 14-year-old girl was referred to our clinic with the complaint of progressive visual loss in her left eye 2 weeks ago. She was under systemic steroid therapy and one injection of periocular triamcinolone was done for her. Dilated funduscopy revealed bilateral disc swelling, cotton-wool spots, arterial narrowing, venous dilation and engorgement, macular exudates in star-shaped formation; all symptoms were more prominent in the left eye with no significant finding in the anterior segment examination. Examination of the anterior segment was not particularly significant. By impression of bilateral neuroretinitis, blood pressure was checked urgently و which was 200/120 mmHg. Finally, pheochromocytoma was diagnosed for her during a complete systemic workup. Conclusion: Bilateral neuroretinitis mandates thorough systemic workup, including blood pressure control as this ocular finding, may be the first sign of an underlying life-threatening disorder.

Purpose: To report the result of strabismus surgery in a case of inferior rectus aplasia with a relatively small amount of hypertropia. Case Report: A 22-year-old man was referred to the strabismus clinic for evaluation of an abnormal head posture and right eye deviation. Eyes exam revealed a best-corrected visual acuity of 10/10 in both eyes; the patient had a right head tilt along with a right hypertropia and exotropia. The hypertropia measured 14 PD in the primary gaze position and increased during the right gaze and left head tilt. The exotropia had an Apattern. Ocular motility revealed downgaze limitation of the right eye in the abduction; however, in straight downgaze, the right eye passed the midline with a moderate overaction of the left superior oblique muscle. Based on the initial clinical findings, a diagnosis of right inferior rectus palsy was made. Intraoperatively, a positive force duction test indicating superior rectus restriction was noted; therefore, we planned to perform a right superior rectus recession along with a right inferior rectus resection. However, after recessing the right superior rectus, we were surprised to find that the IR muscle was not present, and there were only a few strands of fibrovascular tissue in that region. We changed our surgical plan and performed transposition of inferior oblique muscle to the expected site of insertion of aplastic IR muscle 6. 5 mm from the limbus after a 6 mm resection. After surgery, the absence of IR muscle was confirmed by an orbital CT scan (Figure 2). Post-operatively, the patient’ s eyes were orthophoric in the primary position, and his abnormal head posture was significantly improved. The exam findings remained stable until his last visit at the sixth postoperative month. Conclusion: Inferior rectus aplasia should be kept in mind as a differential diagnosis of congenital inferior rectus muscle paresis/palsy. This condition may manifest with a modest amount of hypertropia in the primary position, and the ipsilateral superior oblique muscle may be over-active, thus generating enough force to move the eye downward past the midline. Orbital imaging is the only way to arrive at a definitive diagnosis preoperatively.