JOURNAL OF CURRENT OPHTHALMOLOGY
Year:2011 | Volume:23 | Issue:3|Papers Count:14

Although in Iran we have a well developed examination system to evaluate the residents which is applied each year during the four years of training and there is a trial board examination at the end of the residency to obtain the certificate from The Ministry of Health and Education and also the continuous medical education is mandatory in Iran, at The Ministry of Health and Education they encourage the young physicians to improve constantly their medical knowledge and the best way to evaluate their learning is to participate in the international evaluation systems such as International Council of Ophthalmology (ICO) exams.

Purpose: This study was performed in order to characterize the psychometric properties of the National Eye Institute visual functioning questionnaire in Iranians.Methods: After forward and backward translation, examination of the translation quality and a pilot test, 80 patients with various chronic ophthalmic diseases and 30 healthy individuals completed the questionnaire. Internal consistency (IC) was measured using Cronbach's alpha coefficient and reproducibility was evaluated using the intraclass correlation coefficient (ICC) obtained through test-retests. Regarding construct validity, convergent, discriminant and known group comparison validities were evaluated. The standardized response mean index was used to assess responsiveness and sensitivity of the instrument to changes.Results: Cronbach’s alpha was above 0.7 for all of the subscales except for that of "driving", which had a value of 0.68. The ICC in all subscales was above 0.7. All items had correlations higher than 0.4 with their original subscales. About 70% of the items were correlated with their own subscale more than other subscales. Known group comparison showed that the healthy group scored significantly higher than the patients in all subscales and the composite score (P<0.001). Standardized response means ranged from 0.61 to 2.42, and was 1.19 in general health (GH), indicating the sensitivity of the instrument to changes.Conclusion: The Persian version of the National Eye Institute visual functioning questionnaire 25 was valid, reliable, responsive to changes and could evaluate the results of therapeutic ophthalmic interventions and quality of life (QoL) of the Iranian patients.

Purpose: To evaluate central corneal thickness (CCT) in patients with juvenile glaucoma and compare it with that of normal individualsMethods: A prospective, case-control study was performed on 80 eyes with juvenile glaucoma who attended glaucoma clinic in Farabi eye hospital, Tehran, Iran and 107 clinically normal healthy eyes. Standard automated perimetry (SAP) was performed for all the participants. CCT was measured using ultrasonic pachymetry. Mean CCT and its correlations with juvenile glaucoma diagnosis, mean deviation (MD) in SAP, age and usage of topical carbonic anhydrase inhibitors (CAIs) was calculated.Results: Mean CCT was 561.6±49.9 mm (range, 463-650 mm) and 531.5±29 mm (range 457-606 mm) in eyes with juvenile glaucoma and normal healthy eyes, respectively. The differences of mean CCT between the groups were highly significant (P<0.001). CCT did not correlate with age, MD and usage of topical CAIs.Conclusion: CCT measurements in eyes with juvenile glaucoma were greater than those in normal healthy eyes. There might be no correlation between CCT and severity of the disease in juvenile glaucoma.

Purpose: To determine the optical coherence tomography (OCT) findings in eyes with idiopathic perifoveal retinal telangiectasis (IPT)Methods: This study is a retrospective review of patient charts, OCT, fundus photography, related to 16 eyes (11 patients).Results: The most consistent finding of idiopathic perifoveal telangiectasia seen in 93.7% of eyes (15 eyes) on OCT was the presence of hyporeflective intraretinal spaces (cysts) in the absence of retinal thickening. Other findings identified in IPT were: loss and disruption of the photoreceptor layer in 87.5% (14 cases), internal limiting membrane draping across the foveola related to an underlying loss of tissue in 25% (4 cases), an abnormal outward disfiguring of outer retinal layers which may be related to outer retinal atrophy in 37.5% (6 cases).Conclusion: The OCT findings in idiopathic perifoveal telangiectasia were characteristic and are helpful for better understanding its pathogenesis and visual function abnormalities.

Purpose: The objective of this study was to investigate the total antioxidant status (TAS) and DNA damage markers of serum and aqueous humor in patients with pseudoexfoliation (PEX) syndrome.Methods: Twenty-seven cataract patients with PEX and twenty-seven without PEX syndrome were included in the study and groups were matched for age and gender. Patients had no elevated intraocular pressure (IOP) or glaucoma. Aqueous humor and serum samples were taken at the time of surgery and TAS and 8-hydroxy-2’-deoxyguanosine (8OHdG) levels of all samples were determined by spectrophotometric and enzyme-linked immunosorbent assay (ELISA) methods, respectively.Results: Mean 8OHdG concentration in the PEX aqueous (3.34±1.93 ng/ml) and serum (17.63±6.78 ng/ml) samples were significantly higher than that measured in the control aqueous (1.98±0.70 ng/ml) and serum (13.63±3.54 ng/ml) samples, respectively (P=0.002, P=0.010). TAS of serum (0.60±0.15 vs.0.70±0.14 mmol/lit, P=0.022) and aqueous humor (0.33±0.13 vs. 0.34±0.15 mmol/lit, P=0.003) in PEX patients were lower than that of the control group.Conclusion: The increased 8OHdG levels in the aqueous humor and serum of PEX patients suggests that oxidative DNA damage may play a role in the pathophysiology of PEX.

Purpose: This study was planned to evaluate the efficacy, safety and complication of photorefractive keratectomy (PRK) as a retreatment of residual myopia after previous laser in situ keratomileusis (LASIK).Methods: In this descriptive study in ophthalmology ward, Feiz Hospital, Isfahan University of Medical Sciences, Iran, with the consideration of inclusion and exclusion criteria, 170 eyes of the 92 patients were selected and underwent PRK with mitomycin C. One hundred-twenty seven eyes were in the first group (myopia≤-2 diopter [D]) and 43 eyes were in the second group (myopia>-2 D).Results: This study was performed on 170 eyes of 92 patients with an average age of 35 years old (56 women and 36 men). The average interval between procedures was 17.5±3.2 months. After 1 year, 94.7% of the eyes had uncorrected visual acuity (UCVA) (20/40 or better) and 65.8% of eyes had UCVA (20/20 or better).135 eyes (79.4%) were within ±0.5 D and 168 eyes (98.8%) were within ±1.00 D of target refraction. Two eyes lost one line of best corrected visual acuity (BCVA) and 14 eyes had BCVA gain. In this study 20 eyes presented with corneal haze after one year after PRK (11.8%). Five eyes (3.9%) in first group (myopia £-2.0 D) developed corneal opacity from the patients in second group (myopia >-2.0 D) 15 cases (34.9%) encountered corneal opacity. Before and after PRK, spherical equivalents of eyes were -1.84±0.6 and -0.15±0.2 D respectively (P<0.001), mean UCVA was 0.34±0.23 and 0.92±0.14 of lines (P<0.001), mean BCVA was 0.94±0.4 and 0.98±0.5 of lines (P=0.84) and the mean corneal thickness was 428±20 and 407±12 microns respectively (P=0.032).Conclusion: PRK is an effective and safe procedure as a retreatment of post LASIK residual myopia. The treatment of higher grade of residual myopia has higher rate of postoperative complication.

Purpose: To assess the rate of microbial contamination of the fornix and suture needle during strabismus surgeryMethods: In a prospective study in Khatam-al-Anbia Eye Hospital, fornix samples and suture needles were cultured in 28 eyes of 28 patients. Fornix sampling was performed before and after preparation of the eyes and the needles and remained string were transferred to culture media directly at the end of operation. All samples were cultured in aerobic and anaerobic media. Findings were analyzed statistically.Results: Twenty-four cases (85.7%) of pre-preparation samples were positive for staphylococcus (coagulase positive and negative, 67.85%), peptostreptococcus (3.57%) and gram positive bacillus (14.28%). After preparation, 16 cases (57.1%) of infected samples changed to sterile (P=0.002). Only 15 cases (53.57%) of needles culture were sterile. There was no evidence of cellulitis or significant conjunctivitis postoperatively in patients.Conclusion: Because of close relationship between the organisms cultured from pre-preparation fornix’s samples and needles culture, we concluded that the most probable source of contamination is the normal flora of the fornices. Also because of high possibility of needle contamination (46.43%) during strabismus surgery, care must be taken to avoid globe penetration and if it happened, prophylaxis for endophthalmitis seems to be reasonable.

Purpose: To study the age and gender specific history of ocular trauma in the population of TehranMethods: Using a stratified cluster sampling approach, 6, 497 residents of Tehran were selected. Participants were transferred to an eye clinic to have complete eye examinations. During the interview, participants were asked about any history of ocular trauma, and any treatment or hospitalization due to such trauma. Data are presented in detail according to age and gender, along with their 95% confidence intervals (CI).Results: A total of 4, 565 people participated in the study (response rate: 70.3%); their mean age was 30.05±18.78 years, and 58.2% were female. A history of ocular trauma was recorded in 13.3% (95% CI: 12.0-14.5%); the rate was significantly higher in men (17.1% vs.9.2%, P<0.001). The trauma was blunt, sharp or chemical in 6.1% (95% CI: 5.2-7.1%), 4.1% (95% CI: 3.5-4.7%), and 1.5% (95% CI: 1.1-1.9%), respectively. A history of medical treatment and hospitalization due to eye trauma was stated by 2.2% and 2.4% of the participants.Conclusion: Our results indicated that ocular trauma was more frequent among men and younger age groups. The rates of ocular trauma are neither too high nor very low compared to reports from other countries, yet it is important to consider educational programs to prevent ocular injury, specially occupational eye trauma.

Purpose: To evaluate the therapeutic effect of posterior sub-tenon methyl prednisolone in anterior ischemic optic neuropathy, No class 1 study has shown any conclusive medical or surgical treatment for non-arteritic anterior ischemic optic neuropathy (NAION). Efficacy of systemic or intravitreal steroids was suggested by some studies. This study was performed to evaluate the efficacy and safety of posterior sub-tenon injection of methyl prednisolone in eyes with acute NAION.Methods: In a double blind randomized clinical trial, forty patients with a recent onset NAION were randomly assigned into case and control groups. The case group received a single posterior sub-tenon injection of 40 mg methyl prednisolone; the control group received a sham injection. The patients had complete eye examination including visual field measurement and fluorescein angiography and systemic evaluation at the beginning. Eye examination was repeated at 2, 4, 6 and 8 week steps of the follow-up. Visual field was rechecked at the end of the follow-up. Statistical analysis used: SPSS 11.5 system, paired sample t-test; independent sample t-test, X2, and ANOVA.Results: Visual acuity (VA) improved 0.3 logMAR (three lines of Snellen chart) in the case group (P<0.030), no visual improvement was observed in the control group (P<0.589). Comparison between the two groups showed improvement in VA (P=0.021 at two weeks, and P=0.053 at 8 weeks), visual field pattern standard deviation (PSD), (P=0.034) and optic disc edema, (P=0.000) in the treatment group. No case of globe perforation or severe intraocular pressure (IOP) rise was detected.Conclusion: Posterior sub-tenon injection of methyl prednisolone was preferred to observation in acute NAION.

Purpose: To report an unusual case of dermoid cyst of the frontal boneCase report: We report a case of 28-year-old man with a history of painless progressive proptosis of the left eye. CT-Scan was showed a hypodense lesion that mainly located within the frontal bone with only a small intraorbital involvement. Excisional biopsy was performed and histopathologic examination was compatible with dermoid cyst. Dermoid cysts are the most common orbital cystic lesions in childhood which commonly present as a painless palpable mass in the superotemporal aspect of the orbit. Typically, orbital dermoids involved the orbital cavity and may compress the nearby structures or erode the orbital walls. Here we report an unusual case of dermoid cyst that mainly involved a bony orbital wall with only a small intraorbital extension.Conclusion: Appropriate diagnosis of unusual cases of dermoid cysts can lead to proper therapeutic approaches and prevention of complications.

Purpose: To report two cases of orbitofrontal cholesterol granuloma, which is a rare progressive destructive diseaseCase reports: We report two patients with orbitofrontal cholesterol granuloma; a 50-year-old man and a 20-year-old woman; both with progressive proptosis due to a cystic lesion in the superior part of the orbit with frontal bone erosion and intracranial extension. The second case had a previous incomplete surgery 5 years before and presented with recurrent orbital tumor. We performed orbitotomy and cyst evacuation for both cases, which resulted in complete resolution without any complications. At last follow-up (2 and 6 years after operations respectively), no recurrence was observed.Conclusion: We presented the clinical and para-clinical manifestations and surgical results. Complete resolution of symptoms without any recurrence was observed after surgery.

Purpose: We describe clinical and radiologic findings and surgical outcome of an orbital dermoid cyst located in the superior oblique muscle tendon. This unusual location for dermoid tumors has not been reported previously.Case report: A 15-year-old girl referred to us with an orbital mass in superonasal quadrant of the left orbit reportedly to be present from birth. Computed tomography revealed a cystic mass in the superonasal quadrant of the left orbit. Surgical excision through an incision at the medial of the upper lid crease showed two well-circumscribed masses surrounded by superior oblique muscle tendon. Results of histopathologic evaluation showed a dermoid cyst. Postoperatively, the patient did well with no change in her clinical finding.Conclusion: The findings in this patient demonstrate an unusual presentation for dermoid cysts; such pathologies could be included in the differential diagnosis of an enlarged extraocular muscle (EOM).

Purpose: To report a patient with retained broken probe tip in the false passage site after nasolacrimal duct (NLD) probingCase report: A 18-month-baby with epiphora and a nontender mass in the site of lacrimal sac was visited in clinic. She had a history of probing six months ago by another ophthalmologist. The probing was repeated successfully but the mass size didn’t change. The mass was dissected and small size whitish color mass was completely removed. In pathologist report, there was a metallic foreign body (5 mm × 0.3 mm) in the center of the mass. The foreign body was due to probe breaking and its tip being retained in the false passage site.Conclusion: This case report shows the importance of gentle probing and notification to integrity of the probe before and after the procedure.

Dear Editor: Sir, the present public health problem to be concerned is the E. coli outbreak in Europe. This problem started in Germany and extended widely. The main presentation of E. coli infection is diarrhea. However, the other non-diarrhea symptoms are also mentioned.