​Journal of Current Ophthalmology
Year:2005 | Volume:18 | Issue:2|Papers Count:16

Purpose: To evaluate the response of patients with high risk characteristic PDR (Proliferative Diabetic Retinopathy) to panretinal photocoagulation and the effects of systemic factors on it.Materials & Methods: The study was performed as a case-control study on 73 patients (100 eyes) with high risk PDR refering to Farabi Eye hospital between 1998 to 2000. Laboratory exams such as Hgb A1C, serum lipid profile, creatinin and proteinuria were assessed before performing PRP (panretinal photocoagulation). Meanwhile body mass index and history of cardiovascular diseases were evaluated in all patients. The main outcome was the rate of response of PDR to PRP after four weeks and also at the end of follow up. Systemic factors have been compared between good response group with poor response eyes analyzed statistically.Results: One hundred eyes (belonging to 73 patients) were followed for 7.7 months (with the range of 4.5 to 11 months). There was a complete response in 55% and relative response in 24% of eyes after 4 weeks. 75% of cases who had a good response after 4 weeks, kept the same situation throughout the study. In type II diabetics the rate of good response to PRP was significantly higher than type I or mixed type diabetics (P<0.05). Good response to PRP was seen in 89.4% of women and 72.5% of men which was significantly different (P<0.05). Also there was less number of cases with good response in groups with ages younger than 20 years. We couldn't find a significant difference in the number of cases with good response to PRP with respect to other above mentioned factors.Conclusion: Although the severity of PDR seems to be the most important factor in determining the response to PRP but some other factors such as the type of diabetes, age, sex and good diabetic control should be considered in HRC PDR patients. Studies with more cases should be performed to evaluate the effects of other factors such as proteinuria or hyperlipidemia in these patients.

Purpose: To quantitate the visual field abnormalities associated with amblyopia.Materials & Methods: In a prospective study, 33 amblyopic patients (17 anisometropic, 10 combined, 6 strabismic) performed automated perimetry in each eye using the Humphrey C-30-2 SITA Standard program. Primary outcome were abnormalities seen in probability plots, foveaI threshold, mean deviation, average threshold and average threshold in 10, 20 and 30 degree of eccentricity.Results: When the probability plots were examined, 22 visual fields in amblyopic eye were abnormal; 19 had generalized depression, 3 had paracentral scotoma. Average of foveal threshold, mean deviation, average threshold and average threshold in 10, 20 and 30 degree of eccentricity, were decreased in amblyopic eye in compare with fellow eye, and this was statistically significant in all variables.Conclusion: Visual field of amblyopic eye has a mild & generalized depression, compared to fellow eye and is not associated with any focal field abnormalities; but Software of SITA program translates this mild & generalized depression into abnormal points in Total deviation plot centered around fixation point that typically not been seen in Pattern deviation plot. This pattern of abnormality in visual field of amblyopia, in the absence of other signs of disease needs not any further investigation.

Purpose: To determine the frequency of exposure to Helicobacter pylori infection in primary open angle glaucoma patients and in cataract patients as control group.Design: Prospective case-control study.Patients & Methods: 34 patients with primary open angle glaucoma (POAG) and 34 age and sex-matched cataract patients as control group were studied. Serum was analyzed for the presence of H. pylori - specific IgG antibodies by enzyme – linked immunosorbent assay (ELlSA).Results: Seropositivity for H. pylori was confirmed in %73.5 of POAG patients that was higher than control patients (%58.8) but this did not achieve statistical significance.(P=0.20). Also, the mean serum level (±SD) of anti- H. pylori - specific IgG antibodies was 1.44±0.44 ISR (Immune status ratio) in glaucoma patients and 1.3±0.47 ISR in control participants that was not significant (P=0.20).Conclusion: This study suggests that exposure to H. pylori infection is not associated with open angle glaucoma.

Background: Cycloplegic refraction is an important test in strabismus patients and any patient with decreased vision.The most commonly used drugs for this test are Atropine and Cyclopentolate. The drug which was more popular in the past was Atropine, which is still the standard against which other cycloplegic agents are compared. Nowadays Cyclopentolate is the drug of choice because it has many advantages as compared to atropine, including faster onset, shorter duration, reduced toxicity and ease of use.This is now an open question as to what is an appropriate regimen of cyclopentenlote. In different references and among specialists, different opinions exist. Some believe that a single drop of cyclopentolate produces the adequate cycloplegia and some believe in two or even three drops to be adequate.Purpose: In this research we tried to define how many drops of cyclopentolate can produce adequate cycloplegia without producing unwanted side effects.Materials & Methods: We used data obtained from the 3 to 20 year old patients referring to strabismus clinic during one year (2003-2004). We divided the patients randomly into three groups and compared the results between one and two drops, one and three drops and two and three drops.We also considered the factors that could be potential confounders, including age, sex, color and darkness of iris, type and amount of strabismus and the kind and amount of refractive error.Results: 96 patients (192 eyes) were studied including 32 patients in group 1 and 33 patients is group 2 and 31 patients in group 3. They included 40 males (41.7%) and 56 females (58.3%) with mean age 11±5.7 years. 50 patients (52%) did not have strabismus but 46 patients (48%) had strabismus including 26 patients( 27.1%) with ET and 18 patients (18.8%) with XT. Two patinas (2.1%) had only hypertropia. 142 eyes (74%) were hyprope an 30 eyes (15.6%) were myope and 20 eyes (10.4%) were between a little hyperopia and myopia in two stages of the study. The effect of all factors including age, sex, iris color and darkness, presence of strabismus and its magnitude and type of refractive error and its magnitude and spherical equivalent were evaluated and were not significant in different groups. The study also showed that side effects were more prevalent using more frequent drops.Conclusion: The study showed that considering all these factors that could have been potential confounders, the adequate dose of cyclopentolate is one drop, meaning that in any patient who is candidate for doing cycloplegic refraction, using a single drop of cyclopentolate 1% suffices. We also reached the conclusion that there are less side effects using one drop of cyclopentolate, compared to two or three drops.

Purpose: To evaluate the success rate of initial probing combined with inferior turbinate fracture in comparison to simple probing in the treatment of congenital nasolacrimal duct obstruction in children.Method: In a prospective interventional case-control study 86 eyes from 61 children older than 6 months with congenital nasolacrimal duct obstruction underwent surgical intervention.42 eyes of 33 patients underwent probing combined with infracturing of the inferior turbinate and 44 eyes of 28 patients underwent simple probing. Out come evaluation included a standard ophthalmologic examination plus a dye disappearance test at two months after surgical intervention.Results: In case group (probing + Infracture of the inferior turbinate) results were good in 22 (66.7%) patients, fair in 8 (24.2%) and poor in 3 (9.1%). In control group (simple probing) results were good in 20 (71.4%) patients, fair in 3 (10.7%) and poor in 5 (17.9%) (P=0.9).Success rates were 91% and 82% in case and control groups respectively (P=0.4).Conclusion: Based on the results of this study infracturing of the inferior turbinate doesn't increase the success rate of the simple probing.

Purpose: To measure the endotoxin concentration (EC) in viscoelastic materials used in IRAN.Setting: Noor Vision Correction Center, Tehran, Iran.Materials & Methods: The Limulus amebocyte lysate (LAL) test was used to measure the EC. In prescence of positive and negative controles, a dilution series of samples and lysate were mixed in a ratio of 1:1 and then incubated at 37°c for 60 minutes. The results were evaluated according to gel formation.Results: Concidering the dilution series of samples (1/20, 1/200, 1/400) and lysate sensitivity (0.06 Eu/ml), which was confirmed with the lysate sensitivity test, EC was measured semi quantitatively in the range of 1.2-24 Eu/ml.The EC in all evaluated viscoelastic materials were lower than 1.2 Eu/ml. Conclusion: By measuring the EC in viscoelastic materials and avoiding those with a higher EC, viscoelastic related inflamatory reactions after intraocular surgeries, can be reduced.

Purpose: Evaluation of characteristic and surgical outcome of patients with rhegmatogenous retinal detachment and identify the factors influencing anatomic and visual results.Materials &Methods: In a retrospective, non comparative, interventional case series, 360 eyes from 360 patients with a clinical diagnosis of rhegmatogenous retinal detachment were examined and demographic data and surgical outcome of them were analyzed.Success referred to attachment of retina by single procedure and failure was referred to need for more than one procedure.Visually success was referred to improvement of post operative visual acuity. Results: 360 eyes from 360 patients included 201 males and 159 females with a mean age 43.24±19.58 years were analysed. The anatomical success was achieved in 76% of cases. The patients were followed from 2 to 29 months. Extent of detachment, no break finding, aphakia & pseudophakia, complications, choroidal effusion and site of detachment were identified as influencing factors by Chi-square test for failure of surgery. The role of extent of detachment (P=0.001), pseudophakia or aphakia (P=0.014) and complications (P=0.025) were confirmed by stepwise logistic regression test. Postoperative visual acuity was directly related to preoperative vision (P=0.001) and to preoperative macular condition also (P=0.01).Conclusion: Many factors such as extent of retinal detachment, aphakia & pseudophakia and complications, preoperative visual acuity and preoperative macular condition influence post operative anatomical and visual outcome.

Purpose: To evaluate whether adjunctive subconjunctival mitomycin C before pterygium excision was a safe and effective treatment. Setting: Medical University of Mashhad; Khatam-Al-Anbia eye hospital.Design: Interventional non-comparative case-series.Patients & Methods: 42 eyes of 38 patients with pterygium received 0.1 ml of 0.2 mg/ml mitomycin C subconjunctivally injected into the body of the pterygium 1 month before bare sclera surgical excision.Main outcome measure: Complication and rate of recurrence in adjunctive subconjunctival mitomycin C injection before pterygium excision.Results: Mean follow up was 8 months. Pterygium recurred to a in two eye (4.7%) of a patient with pterygium. The only complication after subconjunctival mitomycin C injection is mild chemosis and redness in the site of injection for few days that were seen in six patient. There were no intraoperative complications. In follow up visit no toxicity of mitomycin C were found.Conclusion: Adjunctive subconjunctival mitomycin C before pterygium excision safe and effective treatment and reduce mitomycin C toxicity. It is also reduce rate of recurrence.

Purpose: To determine effects of single injections of botulinum toxin in bilateral medial rectus for the correction of infantile esotropia.Patients & Methods: Eighteen neurologically normal children (6-15 months) with mean esotropic angle of 45.8 prism diopters were entered consecutively into the study.Simultaneous bilateral injections of 10 units of Botulinum toxin (Dysport) were made into the medial rectus muscles under general anesthesia. The patients' angles of deviation were measure at 1 week and 1, 3, 6, and 12 months later.Results: 12 months after injection of the toxin reduced the esotropic angle from 45.8±8.4 PD to 1.8±1.2 PD.Conclusion: Single bilateral injections of botulinum toxin into medial rectus muscles were effective for the correction of infantile esotropia, producing binocular alignment of the visual axes.

Objective: To evaluate the clinical features as well as the visual and anatomical outcome in eyes with posterior segment intraocular foreign bodies (IOFBs), to identify prognostic factors that predict find poor vision.Materials & Methods: In this retrospective analytical (historical cohort) study, the clinical records of 236 patients admitted to the hospital with posterior segment IOFBs (Intraocular foreign bodies) between March 1992 and March 2001 were reviewed and patients were followed in the out patient after discharge from the hospital. Factors analyzed included: age, sex, foreign body characteristics, entrance site, entrance site size, location of foreign body, RAPD, complications, time between injury to operation and initial visual acuity. The relation between these factors and poor vision was evaluated and analyzed using univariate and multivariate logistic regression analysis.Results: After a mean follow up of 8.1 months 53 eyes (22.21%) achieved VA of HM or less. On univariate analysis, final poor vision (HM or less) was influenced by poor initial visual acuity (P-value<0.001), presence of RAPD (P-value<0.001), endophthalmitis (P-value<0.001) size of foreign body larger than 3mm (P-value<0.001), entrance site size larger than 4mm (P-value<0.001) and shape of foreign body (P-value=0.027). Multivariate analysis identified poor initial VA, presence of RAPD, endophthalmitis and entrance site size larger than 4mm to be the factors significantly associated with poor visual outcome.Conclusion: Most of the posterior segment IOFBs is found in young males as a consequence of work accidents. Most patients require vitrectomy to remove the foreign body. On multivariate analysis significant prognostic factors for final poor vision of HM or less were initial poor vision, presence of endophthalmitis, RAPD and entrance site size larger than 4mm.

Purpose: To report a patient who developed severe panuveitis and dermal vasculitis after MMR vaccination in the otherwise healthy woman.Design: Case report study.Case report: A 17-year-old girl, developed panuveitis seven days after having the combined vaccination for measles, mumps and rubella (MMR). No other definite cause of uveitis was detected from history or from laboratory work up. Both patients responded to traditional regimens of uveitis therapy. However, she required a treatment period of several months.Conclusion: Panuveitis and dermal vasculitis may occur following MMR vaccination. Uveitis should be consider as a MMR vaccination side effect and it may lead to permanent ocular complications and visual loss. Cases of vaccination thus require ophthalmic awareness if visual symptoms or a painful red eye develop.