​Journal of Current Ophthalmology
Year:2004 | Volume:17 | Issue:1|Papers Count:18

Purpose: We implanted the Thinlens TM as an ultrathin intraocular lens (IOL) and evaluated its safety and refractive outcomes.Patients and Methods: Twenty one patients with cataract who were visited at Noor Vision Correction Center (NVCC) from March to July 2002, were chosen. These patients underwent the same phacoemulsification procedure as other cataract patients. One hundred and five eyes, which had cataract surgery and a foldable IOL insertion during the same period, were chosen as the control group.Results: At the 12th month follow up, mean uncorrected visual acuity (UCVA) in the ThinlensTM group was 0.67:t0.17 logMar in comparison to 0.66±0.14 logMar in the control group (P=0.789). Mean best-corrected visual acuity (BCVA) in these groups was 0.25±0.12 and 0.31±0.07 logMar, respectively (P=0.118). There was no statistically significant difference in major complications after surgery between the groups. In the ThinlensTM group, the rate of posterior capsule opacity (PCO) seems to be higher than newer IOL generations.Discussion: The ThinlensTM seems to be an easy lens to handle, the refractive outcome, and safety appear to be comparable to other modern IOLs. The effect of excessive intracapsular space on the development of PCO must be further studied.

Purpose: To evaluate the efficacy of intraocular Gentamicin and Clindamycin in prevention of acute posttraumatic bacterial endophthlamitis following penetrating ocular injuries.Desigin: Randomized Clinical Trial (Double-masked) Methods: 177 eyes of 177 patients with penetrating ocular injuries were enrolled. Following primary repair, the eyes were randomized in two groups; eyes in the antibiotic injection group were given intracameral or intravitreal injection of 0.1 mL antibiotic (40µg Gentamicin and 45 µg Clindamycin). Eyes in the control group were given no intraocular injections. All patients received standard prophylactic antibiotic therapy (systemic, subconjunctival, and topical). Results: The overall incidence of endophthalmitis was 2.3% (4 of 177 eyes). All endophthalmitis cases occurred in the control group (P=0.029). The incidence of endophthalmitis was higher in those who had intraocular foreign bodies (P<0.001), in those with posterior lens capsule rupture (P=0.002), and in eyes with vitreous penetration (P=0.02). Conclusion: Intraocular injection of Gentamicin and Clindamycin seems to be an effective procedure in prevention of acute posttraumatic endophthalmitis.

Purpose: To evaluate the efficacyand safety of aniridiaposterior chamber IOL in traumatic aniridia in vitrectomized eye. Materials and Methods: Participants were three patients who had undergone secondary implantation of an aniridia PCIOL; two patients were men and one woman with mean age of 40 years. There was previous ocular trauma followed by pars plana deep vitrectomy due to vitreous hemorrhage or retinal detachment resulting in aniridia. Minimum follow-up was 7 month.Results: Best corrected visual acuity improved in two patients and was unchanged in one case. All eyes achieved the desired anatomic results. Glare was subjectively reduced in all patients. Contrast sensitivity and visual function improved dramatically in two patients. One case developed secondary glaucoma requiring cyclophotocoagolation. No patients developed chronic uveitis or redetachment.Conclusion: The aniridia PCIOL can overcome aphakia reduce glare, increase visual function and contrast sensitivity in vitrectomized eyes with traumatic aniridia. Although this lens appears safe, some disadvantages are secondary glaucoma and reduced visibility of the peripheral fundus. Caution should be used in its implantation until more patients with longer follow-up are studied.

Background: Pterygium is a common cause of asymmetric and low vision. It is more common in patients who are more exposed to ultraviolet sunlight.Purpose: To describe risk factors for development of pterygium and to assess the quantitative relation between pterygium size and induced corneal astigmatism.Methods: In a survey of 4200 patient who were visited in university and private clinics of Yazd, 221 patients had pterygium. Pterygia were graded for severity, (T1-T3 by visibility of episclerals vessels), basal and apical extent; refraction was performed by ophthalmologists. Risk factors and grade 3 pterygium were evaluated with logistic regression models.Results: A total of 4200 pepople participated. They ranged in age from 17 to 82 years. Pterygium was present on clinical examination in 221 (5.2%). Mean age was 46.7 years and 89.5% were male. The size of pterygium extended from 0.50 mm to 8.1 mm, induced corneal astigmatism ranged from 0.50 to 14.2 diopter. Independent risk factUi6 for pterygium were found to be age, male sex, rural residence and life time ocular sun exposure. Primarily pterygium induced with the rule astigmatism. Pterygium extending 18% of the corneal radius induced astigmatism of more than 1.0 diopter. There were a significant correlation between the extension of pterygium onto the cornea and the amount of induced astigmatism (p<0.001).Conclusion: Pterygium is significant public health problem in rural areas, primarily as a result of ocular sun exposure. Independent associations with increasing age, male sex and past out door activity suggest a multifactorial cause of this condition.

Purpose: To report three patients with central serous chorioretinopathy (CSR)who had undergone kidney transplantation and corticosteroid therapy. Patients and Findings: First case: A 34 year-old woman presented with decreased vision in the left eye. She was under systemic corticosteroid therapy for 30 months due to kidney transplantation. Second case: A 29 year-old woman presented with decreased vision in her left eye. She was under systemic corticosteroid therapy for 9 years due to kidney transplantation. Third case: A 23 year-old man presented with decreased vision in his right eye. He was under corticosteroid therapy for 2 years due to kidney transplantation.In all three cases, in ophthalmoscopy and fluorescein angiography detected serous neurosensory detachment with leakage in the macula.Conclusion: Corticosteroids and organ transplantation are risk factors for CSR. Thus in patients with CSR due to corticosteroid therapy, we should discontinue or reduce corticosteroid dosage.

Back Ground and Purpose: Some Acanthamoeba species can cause a chronic, progressive ulcerative keratitis, not responsive to antimicrobial therapy and frequently mistaken as stromal herpetic keratitis. In Acanthamoeba keratrtis (AK) many patients are initially treated with inappropriate drug therapies, hence, early detection of Acanthamoeba infection is critical. Contrary to molecular methods, use of parasite culturing as a diagnostic method may take several weeks. In the present work, PCR was used for diagnosing AK. Materials and Methods: Corneal scraping specimens were collected from 70 patients referred to Farabi hospital as well as private clinics in Tehran. The specimens were cultured in ECNNA then the growing parasites were harvested. Phenol-chloroform method was applied for DNA extraction directly on corneal scraping specimens. Polymerase Chain Reaction was done for 18s rDNA amplification of the parasite using JDP1 and JDP2 as specific primers.Results and Conclusion: Following PCR amplification of 18s rDNA of 70 specimens, 21 detected positive and a single band (458 bp) appeared on gel agarose and only 21 of the specimens (the same samples) grew in ECNNA culture after a long time. Therefore, PCR is fast and highly efficient in the diagnosis of Acanthamoeba keratitis.

Purpose: To evaluate the effect of atracurium added to local anesthetics on akinesia in peribulbar block. Methods: In a double blind randomized clinical trial, 60 patients undergoing cataract surgery were allocated to 2 groups and received either 8ml of lidocain-bupivacain plus 0/5 ml nacl 0/9% (group I) or 8ml of the same mixture plus 0/5ml (5 mg) atracurium (group 11).The level of akinesia was graded by an ophthalmologist unaware of group assignment 5, 10, 15 and 20th minutes after block. Data were analized by Student-T Test and Two Sample T-Test; P<0.05 was considered significant.Results: Onset of akinesia was shorter in group 11(5.6 min) (P=0.000). 6% of group I (n=6) and 90% of group 11 (n=27) had complete akinesia ten minutes after block. 73% of group I (n=22) and 83% of group 11 (n=25) had complete akinesia 15 minutes after block. None of the eyes in group 11required supplementary block, while 2 patients in groupl received additional injection for inadequate akinesia. Duration of akinesia was not statistically different between two groups (P=0.434).Conclusion: Atracurium (5 mg) added to lidocain-bupivacainmixture for peribulbar block decreases the onset and increase the quality of akinesia without obvious side effects but has no effect on duration of akinesia.

Purpose: To investigate the indications and rejection rate of corneal transplantation in the ophthalmology clinic of Rasool Akram hospital between 1993 and 2002. Materials and Methods: We retrospectively reviewed 305 corneal transplantations performed in Rasool Akram hospital between August 1993 and August 2002. Medical records were reviewed and variables including age, sex, clinical indication for corneal transplantation, rejection and graft clarity were studied.Results: The indications for corneal transplantation in 305 studied eyes were corneal scarring 82 (26.9%), Keratoconus 59 (19.3%), Corneal perforation 34 (11.1%), aphakic bullous keratopathy 33 (10.8%), Pseudophakic bullous keratopathy 32 (10.5%), Corneal dystrophies 24 (7.9%), regraft 14 (4.6%), corneal ulcer 13 (4.3%), congenital central corneal opacity and sclerocornea 5 (1.6%), chemical injuries 5 (1.6%,) Band keratopathy 3 (1.0%) and ICE syndrome 1 (0.3%).Conclusion: The major indication of corneal transplantation in our series was corneal scarring. This is in contrast to the findings of some other studies in more developed countries which show the predominance of pseudophakic bullous keratopathy and keratoconus as the main indications for corneal transplantation. Although the majority of corneal scarrings in our study were of unknown etiology, we believe that the major cause is infectious involvement of the external structures of the eye.

Purpose: To evaluate the effect of corneal flap hinge position on dry eye after Laser in Situ Keratomileusis (LASIK). Setting: Aban Eye Clinic, Isfahan, Iran.Methods: In a prospective double masked randomized controlled clinical trial, 212 consecutive eyes of 106 myopic patients underwent LASIK; in each patient one eye was randomly assigned for superior hinge and the other eye for nasal hinge. Patients were examined preoperatively, 1 week, 1 month, 3 months and 6 months after surgery for: visual acuity, fluorescein tear film break up time, and Schirmer's baseline tear secretion test; Subjective evaluation of dry eye symptoms accomplished through Ocular Surface Disease Index (OSDI®) questionnaire at 1 month, 3 month, and 6 month postoperative visits.Results: Tear-film break up time was not significantly different with nasal or superior hinge flap techniques at pre-op, 1 week, 1 month, 3 month and 6 month post operative visits. No significant difference between two groups was found for amount of Schirmer's baseline tear secretion test at pre and post-op visits (P>0.05 for all comparisons between two groups, β: 0.2). Subjective evaluation of symptoms also showed no significant difference in 1 month, 3 month and 6 month postoperative visits. Conclusion: Our results show that nasal and superior hinge flap making methods do not affect signs and symptoms of dry eye after LASIK. We recommend that selecting hinge position should be done with the surgeons' preference and ease.

Purpose: To evaluate whether laser in situ keratomileusis (LASIK) is a safe and effective treatment for myopia, hyperopia and astigmatism after penetrating keratoplasty (PK).Setting: Medical University of Mashad; Toos LASIK clinic.Patients and Methods: Twelve eyes of 9 patients who had LASIK after PKP were reviewed (interventional case series). The interval between LASIK and PKP was at least 1 year, and mean follow-up after LASIK was 8 months. The Nidek EC 5000® excimer laser was used.Results: Nine patients (12 eyes) underwent LASIK following PK between 2000 and March 2002. Mean age of patients at the time of LASIK was 30.1 years (range, 22-37). Keratoconus was the indication for PK in the majority of the eyes (91.6%). Anisometropia was the indication for LASIK following PK. No intraoperative complications occurred. Six months after LASIK, mean best spectacle-corrected visual acuity (BSCVA) was 9/10 (in decimal scale) with no statistic difference from preoperative BSCVA (9/10) Mean spherical equivalent was reduced from -6.68 D to -0.38 D (95%) one day and to -1.34 D (80%) one year after LASIK. Mean refractive astigmatism was reduced from 6.5 D (mean attempted correction was 5.2 D) to 2.9 D one day 75% reduction (relative to attempted correction) and to 3.42 D one year 67% reduction (relative to attempted correction) after LASIK. Uncorrected visual acuity was 5/10 or better in all eyes after LASIK.Conclusion: LASIK is safe and effective in the treatment of myopia, hyperopia and astigmatism following PK.

Oculodermal melanocytosis is a congenital melanoblastic hamartoma affecting ocular tissues and facial skin. Malignant degeneration once believed to be rare in this syndrome, occurs in 4.6% of all reported case, and is more frequent in whites. A review of the literature in this disease is discussed as well as a new case of orbital malignant melanoma associated with it. A 49-year-old woman with evidence of congenital oculodermal melanocytosis presented with a sub brow mass. After imaging, incisional biopsy was performed from the orbital mass, pigmented conjunctiva, pigmented periocular skin and palate mucosa. Histhopathologic studies documented primary orbital malignant melanoma.

Purpose: To report an intractable inflammatory orbital apex pseudotumor in a 52- year-old man with Crohn's disease- (CD). Design: Interventional case report.Methods: Clinicopathologic case report and literature review.Results: A patient with left orbitalapex inflammatory pseudotumor presented 5 years after diagnosis of CD. He presented with orbital pain, decreased vision, and severe limitation of extra ocular movements of the left eye. Computerized tomographicscan, magneticresonance imaging, laboratory studies, and histology confirmed the diagnosis.Different treatments including corticosteroids, radiotherapy, and a cytotoxicagent could not completely control the disease.Conclusion: This is the first clinicopathologic report of an orbitalapex pseudotumor in CD. The patient presented clinically as a sclero sing-type of orbital pseudotumor.

Palpebral tumors are essentially rare tumors. One of the extremely rare tumors of this region is pleomorphic adenoma, which is also known as chondroid syringoma. In most published data, the pleomorphic adenoma has an incidence between 0.5-1 % of all palpebral tumors. In addition to its rare occurrence, our case is also of interest because of its strange huge size.