JOURNAL OF CURRENT OPHTHALMOLOGY
Year:2005 | Volume:18 | Issue:1|Papers Count:15

Purpose: To compare the efficacy of diclofenac sodium 0.1% and betamethasone 0.1% and combination therapy with both drugs in controlling postcataract surgery inflammation. Methods: In this randomized-clinical trial, 78 patients who had undergone ECCE-PCIOL surgery were randomized to receive diclofenac sodium 0.1% eye drop, betamethasone 0.1% eye drop and combination therapy with both drugs. The patients were examined on days 3,7 and 28 postoperatively. Severity of anterior chamber reaction (A/C reaction) and conjunctival injection were evaluated and compared. Results: Severity of A/C reaction and conjuctival injection were not statistically different among the three groups. No significant complication was observed in either groups. Also no significant change in intraocular pressure occurred in any group. Conclusion: Diclofenac sodium 0.1% eye drop is as effective as betamethasone 0.1% eye drop in controlling post cataract surgery inflammation. Although combination therapy with both drops is more effective than monotherapy with either drop but this difference is not statistically significant.    

Purpose: To investigate the efficacy & safety of low dose adjunctive MMC 0.2mg/ml in the probing for adults with partial nasolacrimal duct obstruction (PANLDO). Materials & Methods: In this intrerventional case series, 58 eyes from 56 adult patients with partial NLDO were included. All patients had chronic epiphora and were scheduled for DCR. Lacrimal duct was probed then irrigated with 1cc/2mg/ml MMC solution. Patients were followed for 8 months & were visted at least 4 times. Results: The nasolacrimal duct was patent in 30 patients (51.7%) by irrigulation test at final follow up, 23 patients (39.7%) had partial obstruction and 5(8.9%) had complete obstruction of the duct. In subjective assessment, 35(60.3%) reported no epiphora. 17(29.3%) had decreased epipora and 6 (10.3%) had no improvement in symptoms. There was no complication related to the use of MMC in our series. Conclusion: Probing and irrigation with MMC 0.2mg/ml appears to be a safe and effective method in treating patients with partial NLD obstruction in our series (further randomized clinical trial is recommended).      

Purpose: To assess the demographic, clinical and therapeutic characteristics of Eales' disease and detection of mycobactrium tuberculosis genome in vitreous samples of patients who had undergone pars plana vitrectomy. Materials & Methods: In this prospective study, ophthalmic examination (visual acuity, slit exam and funduscopy) was performed in 15 patients with Eales' disease and their demographic data was recorded. PPD test was performed for all patients. According to stage of disease (inflammatory, ischemic or proliferative), patients underwent steroid therapy, laser therapy or parsplana vitrectomy. Vitrous samples in patients that had undergone pars plana vitrectomy, were tested for detection of mycobactrium tuberculosis genome. Results: Mean age was 27.5±6.9SD and 87% of patients were male. 40% of patients were Afghan. 60% of patients had bilateral involvement. Mean induration in PPD test was 18.4±6.9. two eyes (with inflammatory stage) were treated with steroid therapy. 23 eyes were in proliferative stage of which 12 underwent laser therapy and 11 underwent vitrectomy. Mycobactrium tuberculosis genome was detected in one of 9 vitreous sample tested with PCR. Visual acuity, only in the subgroup treated with laser therapy significantly improved. On follow up, 3 eyes. undergone reoperation (due to redetachment) and 4 eyes undergone cataract surgery (due to significant cataract formation). No NVI or NVD was observed in any patient. Conclusion: It seems that Demographic pattern of Eales' disease in Iran is similar to other countries. Most patients were in fairly advanced stages and visual prognosis is poor especially in vitrectomized eye. Early diagnosis and treatment and periodic follow up have significant role in improvement of prognosis.    

Background: Digoxin remains a common prescribed cardiac glycoside used in the treatment of supraventricular dysarhythmias and congestive cardiac failure. Disturbances of vision-for example, blurring, central scotomas, glare effects, and altered colour perception, are a less common but more specific presenting complaint. Aim: The aims of the present study were to use screening test for red-green colour defect to investigate the incidence of acquired colour deficiency in hospitalized, elderly patients receiving maintenance digoxin therapy, and furthermore, to assess the relation between serum digoxin concentration and colour vision impairment. Materials &Methods: This study assigned 200 patients into two groups. Case group (n=100) included outpatients or admitted patients (age 50-84) who were receiving oral digoxin therapy at least for 2 weeks. Control group (n=100) was selected from non-cardiac patients and were matched with the characteristic of patients in case group. 100 patients receiving digoxin at least for two weeks, were tested using a colour vision test (lshihara).The test used and their scoring criteria were measured. Venous blood samples were obtained from two groups (case and control) for evaluation of digoxin and potassium serum levels. Results: Colour vision impairment was found in 15% of digoxin, and 2% of control group. There was a significant difference between two groups (P-value=0.001). There was correlation between colour vision impairment and male in both groups (P-value=0.007). There was no correlation between colour vision impairment and female in both groups. (P-value=0.117). Mean serum concentration of digoxin in persons with color vision defect was 1.06±0.29ng/ml and in person without that was 1.27±0.98ng/ml. Conclusion: These findings suggest that patients using digoxin showed a high incidence of colour deficiency.This defect increases in elderly patients. Routine colour vision testing in elderly patients receiving digoxin would have value for the detection of drug toxicity.    

Purpose: To find the results and complication of cyclodialysis in refractory glaucomatous patients candidated for cyclocryotherapy. Method: 10 patients (10 eyes) were enrolled in this clinical trial study between 2002 and 2003 after complete eye exam, standard cyclodialysis procedure under local or general anesthesia were performed for them. Results: 7- male and 3 female age between 20-70 years (x =56.7), follow up period 3-16 months (X=8.6). The lOP 28-60 mmHg (X=39.6) before operation with pain and 0- 32 mmHg (X =18.6) after operation with and without medication was controlled. One of the patients became phthisis, one of the 2 patients with high lOP had painful eye. Conclusion: In refractory glaucomatous patients who were candidate for cyclocryotherapy, cyclodialysis is suggested procedure for control pain and lOP and prevention of phthisis.    

Objective: To determine the efficacy and safety of optic nerve fenestration in patient with pseudotumor cerebri with visual loss despite medical treatment. Design: Prospective; interventional case series. Patients &Methods: 13 eyes of 13 patients with PTC and visual field loss resistant to medical treatment underwent optic nerve fenestration. Visual acuity, visual field, headache, intracranial pressures were checked before and after surgery. We defined visual field stability within 2db from mean deviation. Optic nerve fenestration was performed with the patient under general anesthesia. A standard transconjunctival approach was used in all cases. Results: After optic nerve fenestration visual field stabilized or improved in %85. Of 7 patients with acute papilledema, 6 patients improved, one patient worsened. Of 6 patients with chronic papilledema, 4 patients stabilized, one patient improved, one patient worsened. No significant difference was detected in MD (mean deviation) between operated eye from non operated eye after 1 week, 3 weeks, 2 months. The greatest improvement in visual field MD was detected between the first weeks to 3rd week after operation. Conclusion: Optic nerve fenestration effectively stabilizes or improves visual function in the majority of patient with pseudotumor cerebri and visual loss.    

Purpose: To compare the results of lateral rectus resection and medial rectus rerecession on the patients with residual esotropia at Emam Hossein Medical Center, since2004 to 2005. Patients &Methods: This double blind controlled clinical trial study was performed on 25 patients with residual esotropia by consecutive selection. After signing of consent form by the patients or their parents, cyclorefraction, best corrected visual acuity, deviation, near point of convergence, medial rectus function were measured by our orthoptist. On table of operation, if FDT was positive, MR ReRec. and if it was negative, both methods were done by random selection. 12 patients were operated with rerecession of medial rectus (cases) and 13 patients were operated with lateral rectus resection (controls). Patients were re-examined-after 1.5 months follow up by the same orthoptist who did not know the type of operation. The results were analysed by T, Fisher exact and X2 tests. Results: 15 (60%) of patients were female and 10 (40%) were male. The patients were matched as their spherical equivalent; best corrected visual acuity, degree of deviation and near point of convergence. The success rate of the case and control groups were 67% and 54% respectively, but the difference was not statistically significant. Each millimeter of MR ReRec. has corrected 7.5 pd and each millimeter of LR Res. Has corrected 2.5 pd of residual esotropia. Medial rectus mild underaction were seen in 50% of cases, but only 17.5% of them showed increased near point of convergence. There were no muscle slippage or lost, exotropia and scleral perforation. Conclusion: Considering the results of this study, lateral rectus resection can be substituted with medial rectus rerecession in special situations. Medial rectus underaction was relatively mild and would not produce cosmetic problem.    

We report a sixteen day-old male patient that presented with an opaque corneoconjunctival mass extending from the supratemporal conjuctiva to two- thirds of the corneal surface in his right eye in examination under general anesthesia.The mass was completely excised and the patient underwent lamellar keratoplasty. Also posterior scleral choristoma and right temporal lobe atrophy were detected according to the imaging which was taken. The Patient was considered as a limited form of organoid nevus syndrome. Conclusion: Epibulbar complex choristoma in association with posterior scleral choristoma and temporal lobe atrophy in a newborn without skin findings is a limited or atypical form of organoid nevus syndrome.    

Purpose: To compare endothelial cell changes induced by different phacoemulsification incision sites using specular microscopy Setting: Department of ophthalmology, Farabi eye hospital, Tehran University of medical sciences, Iran. Design: Randomized controlled trial. Materials & Methods: Sixty-three eyes planned for phacoemulsification were randomly assigned in 2 groups of 32 and 31 eyes each: 3.5mm temporal clear corneal incision and 3.5mm superior scleral tunnel with acrylic foldable IOL implantation. Non-contact specular microscopy was performed in the center and 3mm superior and temporal to the central zone preoperatively as well as 1 and 3 months postoperatively. Endothelial cell density, mean cell area and cell size coefficient of variation were compared. Results: Progressive endothelial cell loss and increase in mean cell area occurred in both groups during the follow up. The cell loss percentage in temporal clear corneal (TCC) group was significantly greater than superior scleral tunnel group in temporal site postoperatively (P-value was 0.059 at 1 month postop. period and 0.004 at 3 months postop. period). Cell loss percentage relative to the center of cornea was similar in both groups 3 months after operation but slightly although not significantly greater in TCC group within 1 month postoperation. Conclusion: The temporal clear corneal incision incurs more postoperative endothelial damage than scleral tunnel incision specifically at the temporal site. This is probably because the scleral tunnel incision is placed more posteriorly and therefore induces less direct and indirect endothelial surgical trauma.      

Purpose: To report the characteristics and incidence of rhegmatogenous retinal detachment (RRD) in myopic eyes after laser in situ keratomileusis (LASIK). Design: Retrospective, interventional case series. Methods: Medical records of 49 patients with RRD after 59,424 LASIK procedures were reviewed. The incidence of post-LASIK RRD was determined and potential risk factors were evaluated. Results: LASIK was performed on eyes with spherical equivalents (SE) ranging from -0.75 to -26.50 Diopters (D) (mean -6.10±3.5 D). Forty-nine eyes developed RRD between 1.5 and 76 months (mean 27.3±21.7 mo.) after LASIK. The mean pre-operative refractive error in these eyes was -8.6±3.9 D. These patients were on average 38.2±11.2 years old. Thirty five patients (71.4%) were male. The cumulative incidence of RRD was 0.082% (95% Cl: 0.061-0.109), and the yearly incidence was 0.032% (95% Cl: 0.023-0.042) after LASIK. The most frequent location of the breaks was superior temporal quadrant (22.7%). The male sex, higher age and higher pre-operative myopia were significantly related with the incidence of RRD after LASIK (p<0.001). Conclusion: Based on the results of this study, following the treatment of high risk peripheral retinal lesions, LASIK did not appear to be an additional risk factor for the development of RRD after LASIK in our patients, but the patients should be informed of the possibility of RRD as a consequence of myopia. Male patients and those with higher age and pre-operative myopia may be at increased risk.        

Purpose: To assess the multifocal electroretinography (mfERG) responses in patients with branch retinal vein occlusion (BRVO). Methods: mfERG responses were recorded at 61 discrete retinal locations from 13 eyes of 12 patients diagnosed with superior temporal branch retinal vein occlusion within 3 weeks of onset. The latencies and amplitudes of average responses at 5 regions including the center and 4 quadrants; and temporal, nasal, superior and inferior hemispheres were compared with values obtained from 17 normal fellow eyes of patients with BRVO. Results: The mfERG responses obtained from eyes with BRVO were significantly different from those derived from the fellow eyes, especially when the hemispheres were compared. Conclusion: As a new non-invasive investigative tool for assessing retinal function, mfERG could be a useful electrophysiologic test in clinical evaluation and determination of the severity of underlying ischemia in patients with branch retinal vein occlusion. Further studies are needed to evaluate its role as a prognostic tool to determine eyes prone to serious complications.