​Journal of Current Ophthalmology
Year:2005 | Volume:18 | Issue:4|Papers Count:19

Purpose: To evaluate anterior chamber depth (ACO) measurement validity by Orbscan II and IOL Master in comparison to A-scan as a standard and to determine ACO measurement repeatability with Orbscan II.Materials & Methods: Forty-four myopic patients (88 eyes), scheduled for refractive surgery, were enrolled in this prospective study. In all eyes, the ACO was measured with A-Scan (EchoScan US-3300, Nidek), Orbscan II (Orbtek), and IOL Master (Carl Zeiss) by three independent technicians. The mean (±SO) age and spherical equivalent were 30.2±8.5 years and -4.98±2.67 0 (range, -1.00 to -15.00), respectively. The female percentage was 56.8%. To evaluate the validity, Orbscan II and IOLMaster readings were compared with those of A-scan as a standard. To evaluate Orbscan II reliability, each eye was examined twice consecutively and the reliability coefficient was calculated.Results: The mean difference between Orbscan II and A-scan ACO measurements was -0.025±0.12mm, with 95% limits of agreement from -0.25 to +0.20 mm. Corresponding figures for IOL Master and A-scan measurements were +0.093±0.14mm with 95% limits of agreement from -0.18 to +0.36mm. Based on these results, Orbscan II readings were lower and those of IOLMaster were higher than A-scan readings on average. Both Orbscan II and IOLMaster had acceptable agreement with A-Scan in measuring ACO, although the agreement between IOL Master and A-Scan was lower.The Pearson coefficient of Orbscan measuring ACO was 0.994 (P<0.001), which shows quite good reliability.Conclusion: Orbscan II ACO measurements in myopic patients showed better agreement with ultrasonic values than IOL Master. Both Orbscan II and IOL Master provide advantages of a non-contact method and their ACO measurements seem valid enough to consider them suitable devices for measuring the ACO.

Purpose: To study the knowledge of first degree relatives of patients with Primary Open Angle Glaucoma (POAG) about Glaucoma.Materials & Methods: In these study first degree relatives of patients with POAG, who came to Glaucoma clinic of Nikookari Eye hospital, consecutively entered the study & were asked to respond to the questionnaire.Results: 110 first degree relatives of patients with POAG took part in this study. Mean age of volunteers was 38.7±6.9 Yr & 69.1% were male. 41% of responders had history of previous ophthalmologic examination. Only 16.4% of responders had an lOP check before. 60.9% of responders suggested regular ophthalmic examination as a prevention for glaucoma. Only 18.3% believed glaucoma as a familial disease & only 16% introduced having first degree relatives with POAG as a risk factor for glaucoma.Conclusion: The knowledge about high risk groups & risk factors of glaucoma is low. Only few of these high risk populations had undergone ophthalmologic examination before. These finding indicate that improving the level of general knowledge about glaucomais necessary.

Purpose: OCT is able to determine the optic disc margin automatically. The aim of this study was to evaluate of the automatic OCT Optic nerve head measurements and compared it with manual tracing results.Materials & Methods: This was a cross-sectional, retrospective study. 31 patients evaluated with OCT for analysis of optic nerve head. 19 eyes having glaucoma, 9 eyes with glaucoma suspect, 3 normal eyes were entered to study. The standard test for glaucoma was clinical examination and visual field evaluation. The optic nerve head analysis was done with OCT-2 and optic nerve head parameter compared with automatic and manual disc margin detection.Results: Significant differences were found between most OCT optic nerve head automated and manual disc assessment parameters, however, good agreement was found between the two methods for all parameters (Intraclass Correlation, 0.71 to 0.94).Areas under receiver operator characteristic curves for clinical examination and visual field analysis were similar for all parameters with both methods in glaucomatous and nonglaucomatous groups.Conclusion: Automated OCT optic nerve head analysis may be used in glaucoma and other clinical optic nerve head abnormalities.In manual disc margin detection, significant differences were detected in the mean measurements between observers but, they demonstrated good inter observer agreement (ICC=0.86 to 0.97).Therefore, the automatic optic nerve head measurements are in agreement with the result obtained by manual detection of the disc margin, but the actual measures are not interchangeable.In ROC curve analysis, manual determination of the disc margin did not improve the ability to distinguish between groups for either the clinical assessment or the visual field analysis.Thus, the automatic optic nerve head analysis can be used in the clinical setting but the normal range of optic disc parameters in different age group was not determined and should be evaluated with caution when compared with population study results.

Purpose: To demonstrate optical (visual) and refractive results and complications of microkeratome-assisted lamellar keratoplasty in patients with anterior corneal opacities. Materials & Methods: A noncomparative case series of ten patients who had automated lamellar keratoplasty for treating anterior corneal opacities with ALTK system. Refraction, visual outcome, pachymetry, specular microscopy, confocal microscopy were evaluated in all patients.Results: Surgery was uneventful in 9 patients, however in one case microperforation of the stromal bed occurred. In 70% of patients postoperative best corrected visual acuity was 20/40 or better. Mean spherical equivalent was -2.8 diopterat 3 months after surgery.Corneal thickness was more than expected. Endothelial cell count did not show significant change after surgery.Conclusion: Automated lamellar therapeutic keratoplasty is a useful technique for managing anterior corneal opacities by harvesting intact corneal layers.

Purpose: To evaluate the visual outcomes and surgical results of pars plana vitrectomy for diabetic macular edema unresponsive to laser therapy using optical coherence tomography (OCT).Materials & Methods: Standard pars plana vitrectomy with separation of posterior hyaloid was performed in 19 eyes of 17 patients with diabetic macular edema unresponsive to laser therapy (after 4 months). The macular thickness was evaluated before and after surgery with OCT. Slit lamp examination and visual acuity measurement were performed periodically.Results: After follow up of 3 months, visual acuity improved in 13 cases, decreased in 2 cases and was unchanged in four patients. The postoperative foveal thickness (374.7±114.9) was thinner than the preoperative foveal thickness (512.5±162) that was statistically significant (p=0.002). Postoperative complications included cataract formation (4 cases) and vitreous hemorrhage in one case. Conclusion: In eyes with persistent macular edema unresponsive to laser therapy, vitrectomy appears to be beneficial in decreasing macular thickness and improving visual acuity.

Purpose: To evaluate the success of direct internal eye lash extirpation with radiofrequency in the management of congenital distichiasis.Patients &Methods: This procedure was performed on the 16 eyelids of 4 patients.Results: Overall success rate for the lash ablating procedure was 91.3%. The follow up period was 12 months. No serious complication developed in this series.Conclusion: Direct internal eye lash bulb extirpation is a safe and effective procedure for the treatment of congenital distichiasis.

Purpose: To investigate the current ocular status of Iranian veterans with a past history of penetrating eye injury 17-25 years ago.Materials &Methods: In this descriptive study 800 veterans (1010 eyes), with history of penetrating ocular injuries were examined 17-25 years following the trauma sustained during the Iran and Iraq war. Age, gender, injured eye, involved ocular components, number of injuries, surgeries performed, and final visual acuity were recorded.Comprehensive eye examinations were performed by an ophthalmologist.Results: Of 800 subjects 99% were male, 1% female, 77.9% were in the age range of less than thirty, 92.7% in the age range of less than forty. The left eye was involved in 39.4%, the right eye in 34.4%, and both eyes in 26.2%. The cornea was involved most commonly in 23.4% of the cases and optic nerve the least in 1%.The injuries were divided into 11 categories and in total 1586 injuries existed. A total of 2149 ocular surgeries were performed; an average of 2.7 surgeries per veteran with a minimum of none to maximum of twelve surgeries.The results showed 45.1% obtained modest improvement and 33.5% were enucleated. In terms of visual acuity 49.7% were blind, 36.6% had higher than 0.1 and 11.7% had lower than 0.1 and 5.1% had 1.0.Conclusion: Ocular penetrating injuries can lead to devastating visual outcomes such as blindness and enucleation. Prompt management of these injuries with adequately trained surgeons can lead to better outcomes. As a preventative measure the use of eye protection is highly recommended.

Purpose: Pleomorphic adenoma (benign mixed tumor) is the most common epithelial tumor of the lacrimal gland, which grows very slowly and usually is painless. Here we report a case of pleomorphic adenoma of the lacrimal gland in a woman with a long standing history.Case Rerort: A 60-year-old woman presented with a gradually growing mass in the super temporal quadrant of the right orbit which was present since 25 years ago. The right eye underwent diagnostic total excisional biopsy with en bloc removal of the tumor through the superotemporal aspect of the right orbit. Histopathologic examination revealed a pleomorphic adenoma of the lacrimal gland with no evidence of malignancy.Conclusion: Because of the potential for malignant transformation and the pressure effect of the slowly growing mass on globe, early diagnosis and complete removal of these tumors is very important for prevention of the recurrence and complications of the pleomorphic adenoma.

We report a 29-month-old boy with a congenital nasal dermoid cyst who presented with an intracranial abscess. Clinically the only evidence of a dermoid cyst was a small pit on the dorsum of the nose from which very fine hair protruded. The presence of the same lesion in the mother and great-grandmother is emphasized.

Purpose: To determine the prevalence of open-angle glaucoma (OAG), glaucoma suspects (GS), and ocular hypertension (OHT) in patients with Thyroid-Related Immune Orbitopathy (TRIO) and compare it with a control group.Patients & Methods: In this cross-sectional analytic study, 233 eyes of 117 patients with TRIO (case group) and 240 eyes of 120 normal age and sex-matched individuals (control group) underwent complete ocular examinations.Grave's orbitopathy was diagnosed by clinical examinations with the help of an endocrinologist and paraclinical tests. Controls were selected among apparently healthy individuals with no history of previous orbitopathy or thyroid diseases.Results: Prevalence of OAG, and OHT was 2.5% and 8.5% in the case group, respectively. In contrast, OAG was detected in only 2 eyes (0.8%) of the control group and there were no instances of GS or OHT in the control group. Although the prevalence of OAG and GS were higher in cases than controls, this difference was not statistically significant. However, OHT was more common in cases (P<0.01). Ten eyes in the case group (4.3%) developed compressive optic neuropathy (CON); high intraocular pressure (lOP) was detected in 5 of them (2.1%). All cases of OAG and GS in the case group were classified as stage 3 or higher of NOSPECS (No symptoms or signs, Only signs no symptoms, Soft tissue, Proptosis, Extraocular muscle, Cornea, Sight loss). Active Grave's orbitopathy was only more prevalent in patients with OHT (P<0.001).Conclusion: The prevalence of OHT was higher in cases with Grave's orbitopathy than age and sex matched controls. Ophthalmologic examinations including lOP measurement (and if needed automated visual fields) should be regularly performed in patients with Graves orbitopathy particularly in higher stages and those with active disease.

Purpose: To compare the anatomical and functional results of deep vitrectomy with and without ILM peeling for full thickness macular hole.Materials & Methods: 37 eyes of 37 patients with full thickness macular hole (FTMH), confirmed by clinical examination and optical coherence tomography (OCT), enrolled in this clinical trial. Based on the stage of FTMH (stage 2, 3, 4) as described by Gass and the techniques of surgery (with or without ILM peeling) the patients were randomized into two different groups. All patients underwent preoperative Act and at least one OCT image was obtained during the postoperative follow up.After obtaining informed consent, deep vitrectomy and 20% SF6 injection was performed. The patients were unaware of their allocation status. Patients data & surgical outcome were collected and statistically analyzed. Anatomical success was defined as hole closure at postoperative OCT and functional success was referred to any improvement in visual acuity. Macular hole index (MHI) was defined as a ratio of the greatest height to the base diameter of the hole on cross-sectional OCT images.Results: 37 eyes of 37 patients (15 men & 22 women) were enrolled. The mean age of the patients was 56.4±21.94 years and FTMH were traumatic in 13 cases (35%) and Idiopathic in 24 (65%) cases. Twenty cases underwent deep vitrectomy with ILM peeling (ILM group) and the remaining cases underwent vitrectomy without ILM peeling (no ILM group).The mean preoperative 10gMAR visual acuity was 1.38±1 in the ILM group and 1.22±0.13 in the no ILM group, these improved to 0.95±1 and 0.77±0.31 postoperatively in the ILM and no ILM group, respectively (P=0.871). The overall anatomical success rate was 64%. The hole was closed in 70% of ILM peeling and 47% in the no ILM group (Chi-square test, P=0.15). In anatomically successful cases the mean of postoperative VA was significantly improved (P=0.001).In traumatic subgroup, ILM peeling seems did not affect the anatomical (P=0.2) and visual Success rates (P=0.5). There was no significant differences in hole closure rates between the traumatic and idiopathic FTMH (P=0.968). Visual acuity significantly improved after operation In MHI ³ 0.5 group compared with the MHk 0.5 group. The stage of the hole did not affect the anatomical success rate (P=0.52) or visual acuity improvement (P=0.741). Macular hole index ³ 0.5 had a prognostic value for postoperative visual acuity improvement. The hole duration was not related to anatomical success rate but there is an inverse relation between duration of the symptoms and improvement in VA.Conclusion: Deep vitrectomy and SF6 injection was a safe & effective surgical technique for full thickness macular hole and peeling of the ILM seems did not affect the anatomical or functional success rates. The hole duration, stage and origin of the hole (traumatic or idiopathic) does not related to the anatomical success or visual acuity improvement. MHI  ³ 0.5 seems to be a prognostic factor for postoperative visual improvement but not for closure rate.

Purpose: To translate and test the reliability and validity of the Refractive Status and Vision Profile (RSVP), a vision related Quality of Life Questionnaire in Iran.Patients & Methods: Forward-backward translation method, committee review and pilot testing were performed to report a final Iranian version of the RSVP. Seventy-three consecutive patients with refractive error before or after refractive surgery at the LASIK ward of Farabi Eye Hospital completed the questionnaire. A convenience sample of 14 patients completed the questionnaire twice within one week. Reliability was measured by: test-retest method and internal consistency (Cronbach's a). Validity was evaluated by correlation between the different RSVP subscales, known groups comparison analysis and correlation between the subscales versus global items and traditional clinical measures.Results: Internal consistency was high (Cronbach's α: 0.71-0.92, except for the subscale expectation, a: 0.6). Test-retest reliabilities of subscales and overall scores were high except for optical problems and glare. Prior to surgery patients had significantly higher concern, physical/social functioning and overall scores than the post-op patients. Almost all subscales showed desirable inter-scale correlations.Conclusion: The Iranian version of the RSVP is a reliable and valid measure of vision related quality of life in patients with refractive errors.

Purpose: Duane's retraction syndrome (DRS) has been extensively studied in Western populations, but few comprehensive reports from other countries are available. So, we report the prevalence and clinical features of DRS in a series of strabismus cases from a single institute in Iran.Materials & Methods: In this retrospective study, 7,349 cases of strabismus seen during 2000-2003 were evaluated. Data regarding the age at onset, type, posture, primary position deviation, palpebral fissure, Leash phenomenon, refractive error, amblyopia, and history of surgery were collected and analyzed using appropriate statistical methods.Results: One hundred and twenty-five DRS cases were diagnosed (prevalence: 1.7%). The onset was at birth in 35.6%, during infancy in 25.4%, and during childhood in 39% of the cases. The age at referral ranged from 3.5 months to 65 years (median: 10 years). The female to male and left to right eye involvement ratios were 3:2 and 3.5:1 respectively. The most common form of the syndrome was type I (109 patients, 87%). Type II and III were present in 6.5% and 5.7% of the patients respectively. 7.2% had bilateral DRS. Horizontal deviations (median: 20 PD) was resent in 76% and vertical deviations (median: 8.2 PD) in 12.8% of subjects. Leash phenomenon was detected in 37.6% of cases. 26.8% were amblyopic. Head turn, primary position deviation without posture), and orthophoria were observed in 71.2%, 13.6%, and 15.2% of cases respectively. Surgery had been performed in 71.2% of cases. Vertical deviations and Leash phenomenon were more common in types II and III, and hypermetropia was more common in type I (P values: 0.036, < 0.004 and 0.025).Conclusion: Basic features of our DRS series seem to be comparable with previous reports. The incidences of bilateral involvement and type III DRS were lower. The proportion of cases with posturing and the indications for surgery were higher.

Objective: To evaluate the efficacy of chemoreduction and adjuvant treatment for retinoblastoma (Rb) and its effects on complete retinal tumor control, ocular prognosis and metastasis.Design: Prospective, nonrandomized clinical trial.Participants: 30 eyes of 22 consecutive patients with 91 intraocular retinoblastoma tumors were enrolled and studied prospectively. Main Outcome Measures: The 3 main outcome measures included ocular prognosis, tumor prognosis and life prognosis. Mean follow-up was 14 months.Results: 30 eyes of 22 consecutive patients (10 males and 12 females) were treated. Mean patient age was 28.4 months. 16 eyes had Reese-Els worth (RE) group I-IV tumors, and 14 had RE group V tumors at diagnosis. 14 patients completed at least 6 cycles (range: 6-24 cycles) of chemotherapy with vincristin, etoposide and carboplatin.Of those eyes classified as RE group I-IV, external beam radiation therapy (EBRT) and enucleation were necessary in 3 (18.75%) and 1 eyes (6.25%) respectively; versus 4 (28.57%) and 7 eyes (50%) in those in group V. Kaplan-Meier analysis for globe survival showed 24 months survival of 55.0%. Subgroup comparison of globe survival demonstrated survival rate of 25.4% globes in eyes with RE stage V and 88.8% in eyes with stage IV b or less (Log Rank, P= 0.024). No patient developed retinoblastoma metastasis, pineoblastoma, or second malignant neoplasms during follow-up.Conclusion: Chemoreduction combined with focal treatment provides satisfactory retinoblastoma control for RE group I-IV. More effective modalities are required for advanced cases, particularly for RE group V tumors.