JOURNAL OF CURRENT OPHTHALMOLOGY
Year:2004 | Volume:16 | Issue:2|Papers Count:15

Aims: To determine the prevalence and causes of visual impairment in Tehran through a population-based study. Methods: Through a population-based, cross-sectional study, a total of 6497 citizens of Tehran were sampled from 160 clusters using a stratified, random, cluster sampling strategy. Eligible individuals were enumerated through a door-to-door household survey in the selected clusters and were invited. All participants were transferred to a clinic for an extensive eye examination and interview. Visual impairment was determined using presenting and best-corrected visual acuity (low vision: visual acuity of less than 6/18 to 3/60 in the better eye; blindness: visual acuity of less than 3/60 in the better eye). Results: Of those sampled, 4565 (70.3%) people participated in the study. Age – and gender - standardized prevalence of visual impairment on the basis of best-corrected and presenting visual acuity were 1.39% (95% confidence interval [CI], 1.07 to 1.71) and 2.52% (95% CI, 2.07 to 2.97),  respectively. Fifteen people (0.28%; 95% CI, 0.14 to 0.42) were blind with corrected vision while 22 people (0.39%; 95% CI, 0.23 to 0.56) were blind with presenting vision. Using corrected and presenting vision, the prevalence of low vision was 1.11% (95% CI, 0.84 to 1.39) and 2.13% (95% CI, 1.71 to 2.55), respectively. Causes of visual impairment according to best-corrected vision were cataract (36.0%), macular degeneration (20.0%), and amblyopia (10.7%). However, according to presenting vision, uncorrected refractive errors were the most frequent primary cause (33.6%) and cataract (25.4%), macular degeneration (12.7%) and amblyopia (8.2%) were the other main causes of visual impairment in the study sample. The prevalence of visual impairment was associated with advancing age and lower education. Conclusion: The results indicate that the burden of visual impairment is important and although easily preventable, uncorrected refractive errors and cataract have a major role as causes of visual impairment in this population. Results also highlight the need for visual impairment prevention programs, with emphasis on treatment of refractive errors and cataract.  

Background and Purpose: Glaucoma after congenital cataract surgery is one of the challenging problems in pediatric ophthalmology. The incidence of glaucoma after congenital cataract surgery has been reported from 5% to 41%. The aim of this study was epidemiological evaluation of glaucoma after congenital cataract surgery at Imam Hossein hospital from 1990 to 2000. Methods and Materials: This study was performed as an existing data in the first part and as non-comparative case series in the second. Records of all patients that had undergone congenital cataract surgery at Imam Hossein hospital between 1990-2000 were reviewed and patients were invited for complete eye reexamination. Glaucoma was considered if IOP was more than 21 mmHg with or without increased optic nerve cupping. Follow up was at least 2 years for every patient. Results: 151 eyes of 92 patients were evaluated. Mean age was 11.46±5.32 years. 53.3% were female and 46.7% were male. Mean age at the time of surgery was 4.68±3.24 years. The most common type of cataract was complete (31.1%). Mean follow up duration was 52.2±23 months. 25 of 151 eyes were glaucomatous (16.55%). Mean time between cataract surgery and glaucoma detection was 45.04±13 months. The most common type of surgery was anterior lensectomy + anterior vitrectomy + primary posterior capsulotomy. Posterior capsule opacity was seen in 30.5% of cases. Conclusion: Glaucoma after congenital cataract surgery is one of the most serious and resistant complications in pediatric patients. Children do not cooperate for eye examination and intraocular pressure measurement, so glaucoma diagnosis can be easily missed. Long term follows up and repeated eye examinations especially in patients with microcornea are recommended for detection of glaucoma as soon as possible. Knowledge of physicians and parents about possibility of glaucoma after congenital cataract surgery can help early diagnosis and treatment, in order to prevent irreversible visual impairment.  

Purpose: To compare the sensitivity, specificity and validity of SITAfast (SiF) strategy with the standard full thershold (SFT) algorithm in the Humphrey field analyzer. Materials &Methods: As an observational case series, twenty glaucoma patients (37 eyes) who were referred to Emam Reza & Ghaem eye clinic, central field testing was performed with the central 30-2 program using SFT and SiF strategies. Both tests were carried out on four different days in a span of two weeks. Sensitivity, specificity, validity, time saved, and the extent of defect in SITA fast strategies were compared with those of SFT. Results: The sensitivity of SFT & SiF was 93.3%. Specificity of SFT & SiF was 71.4% & 57.4% respectively. The validity of SFT & SiF was 89.2% & 86.5% respectively. The mean time in SFT, SiF were 14.6 min & 5.45 min, respectively. Defects in gray scale was shallower in SiF (significant at P<1%, P<0.5%) but defects in the pattern deviation plots tended to be more in SITA fast strategy but there was no significant difference in statistics. Conclusion: SITA fast strategy has good sensitivity and is significantly faster as compared with the SFT algorithm. Test time is much shorter so common use of SiF is suggested. In children, old age patients and patients who has difficulty in concentration, SiF is superior to SFT.          

Purpose: To evaluate the efficacy of topical anesthesia for clear corneal phacoemulsification in Iranian patients at Farabi Hospital. Setting: Department of Ophthalmology, University of Tehran, Tehran, Iran. Methods: An interventional case series was performed on 58 consecutive patients that underwent clear cornea phacoemulsification under topical anesthesia. Information about intra-operative & postoperative pain (score 1=without pain to score 3= severe pain), visual outcome, cooperation between patient and the surgeon, patient satisfaction from surgery, mean surgical time, intraoperative and postoperative complications were reordered in specific code sheets and were analyzed by SPSS 10 computer software. Topical anesthesia was achieved with tetracaine drop 0.5% and injection of preservative free lidocaine 1% in the AC, without any additional anesthesia or sedation. Surgery was performed through a 3.2mm temporal corneal tunnel with in the bag (intercapsular) phacoemulsification. Results: From 58 patients (29 female, 29 male) with mean age of 58.5 yr and mean preoperative UCVA=1/10 (1/100-3/10), 86% had BCVA≥5.10 one month after surgery and 43% had BCVA≥10/10 and mean BCVA was 8/10 and mean improvement in visual acuity was 6.7 snellen lines. Mean surgical time was 28/8' (18'-50'), complications were: 2 cases of vitreous loss, 1 case of iris touch to phaco probe, 1 case of severe postsurgical uveitis and 1 case of severe corneal edema: Overall mean pain score was 1.4, 62,1% of patients have Grade 1, 32/8% Grade 2, 5/1% Grade 3 pain. 75.9% of the patients had good to excellent cooperation with surgeon, 19% medium and 5.2% poor cooperation. 74.1% of patient was very satisfied from this surgical method. Conclusion: Topical anesthesia was an effective and easy procedure for phacoemulsification, providing good perioperative pain tolerance by patients and is simple with minimal complications for phaco surgeons.  

Purpose: To evaluate the success rate of canalicular laceration repair with silicone intubation. Participants: 65 consecutive patients with canalicular lacerations were included. Design: Interventional case series. Methods: In this prospective study patients underwent repair of the lacerated canaliculi with re-approximation of the overlying orbicularis and anastomosis of cut ends of canaliculi in conjunction with monocanalicular or bicanalicular silicone intubation. All patients were operated under general anesthesia. Stents were left in place for at least 3 months if tolerated and not complicated. Probing across the lacerated portion of canaliculus was carried out at the time of stent removal to check the patency and repeated 1.5 to 3 months later. Results: 65 patients completed follow up. Probing showed canalicular patency in 52 patients (success rate: 80%). 4 patients out of 13 failed repaired cases didn't have any symptoms (probably due to adequacy of the other canaliculus). We were not able to prove a significant correlation between outcome and sex, site of involvement, severity of primary injury, intervention type & time intervals of trauma-referral, referral-surgery and surgery-tube removal. Conclusion: Repair of canalicular laceration with silicone intubation seems to be a successful procedure and would prevent post operative canalicular stenosis with low complication rate. It also appears to be the best method of soft tissue reconstruction of the medial canthal region. We also noticed problems related to design of the Iranian made crawford tubes including shape of the probe head, its consistency & weak connection between probe and silicone tubes that would influence outcome. We recommend a comparative clinical trial with larger sample size in order to compare Iranian made crawford tubes with foreign made ones.        

Background & Purpose: Salt and pepper change is the retinal change that occurs in human retina and its cause is not entirely known. In the present study, the retina of patients infected with Giardia lamblia living in Tehran was examined for presence of "salt and pepper" retinal change. Methods& Patients: 50 girdiasis patients were selected as study group and 50 healthy individuals as control group. The retina of two groups was tested by ophthalmologist. White blood cells and eosinophila percentage were counted in haematology lab. For measurements of IgA and IgG Levels, SRID technique, and for IgE level, ELISA technique was applied. Results & Conclusion: The results indicated, six patients of study group showed "salt and pepper" retinal change in their eyes. When the patients treated with metronidazole, the ocular change disappeared in three of them. In addition, eosinophila percentage, IgA, IgE and IgG levels in the infected patients were found increased significantly in comparison with control group. Meanwhile, among patients with ocular change and without ocular change the differences of eosinophila percentage and IgE levels were found significant, According to IgA and IgG levels, no significant difference between two groups were observed.    

Purpose: To report the clinical features and management of a patient with valsalva retinopathy after sexual activity. Methods: After complete ophthalmic examination YAG: Laser hyaloidotomy was performed and the patient was followed for a months. Results: With YAG: Laser hyaloidotomy, rapid recovery of visual acuity was occurred without any complication. Conclusion: YAG-Laser hyaloidotomy is an efficient method of treatment in the management of subhyoloid hemorrhage and prevention of complications of premacular hemorrhage.      

Rhino-orbital mucormycosis is an acute and fulminant infection that generally occurs in mmunocompromised patients. We report a 25 year-old female patient that presented with aute onset proptosis, total ophtalmoplegia and visual loss while receiving immunosupressive drugs 6 month after kidney transplantation. With the rhino-orbital mucurmycosis diagnosis immediate treatment was begun. Despite agressive surgical debridment and full course amphotericine B therapy, she lost her left eye vision completely. In immunocompromised patients such as diabetics or renal failure who present with orbital cellulitis, sudden onset onhtalmoplegia and orbital apex syndrome, rhino-orbital mucormycosis must be considered as a possible cause. Immediate diagnosis and treatment may reduce the morbidity and mortality of this disease.      

Purpose: To report visual and anatomical outcome of flap loss after LASIK surgery for correction of high myopia. Materials & Methods: Retrospective evaluation of flap loss in two eyes of two patients, a rare complication of LASIK Surgery. Case No. 1: 27 y/o woman with Ref. OD -9.75; 2.75*177 VA. CC: 20/60 KR OD: 41.86*77 39.86 * 168 & partial amblyopia due to anisometropia. Case No. 2: 38 y/o woman with Ref OD. -9.50 1.0*177 VA CC: 20/30 KR OD: 42.06*77 40.99 * 167. Results: In both patients during LASIK surgery free cap complication occurred and after Laser therapy free cap positioned over the stromal bed, but the next day after operation flaps were lost. For case NO.1only medical management performed and after 4.5 years F/U cornea has 2° central haziness. For case NO.2 another corneal flap from donor globe cut and sutured with Nylon 10/0 and after 18 months F/U cornea is clear. Conclusion: In patients with flat keratometry less than 41.0 Diopter rate of free cap are high and after laser therapy for high myopia the keratometry became more flat. If surgeon doesn't suture flap the rate of flap loss increase so for prevent of corneal haziness and corneal ectazia this evaluation suppose to perform donor corneal flap graft.      

Purpose: Anterior transposition of the inferior oblique muscle was reported to be an effective treatment for dissociated vertical deviation (DVD), Our aim is to evaluate the efficacy of this surgical procedure in a series of patients with DVD alone and DVD with concurrent overactive inferior oblique muscle and to compare the results. Method: Nineteen eyes with DVD only (group one) and fifteen eyes with DVD and concurrent inferior oblique overaction (group two) underwent IOAT. The amount of DVD and inferior oblique overaction (IOOA) before and after the operation was registered and statistically analyzed. Results: The mean follow up time for the first and the second groups were 9.4 and 9 months respectively. Overall in five of seven eyes with DVD of more than 15PD, the residual DVD following the operation were more than five PD .Whereas in the 27 patients with DVD less than or equal to 15 PD the residual deviation were below 5PD (P value=0.014). Conclusion: IOAT is an effective method for correcting DVD with and without IOOA especially in deviations under 15 PD. In DVD> 15 PD it seems that IOAT alone is unable to correct or reduce DVD satisfactorily.