JOURNAL OF CURRENT OPHTHALMOLOGY
Year:2006 | Volume:19 | Issue:1|Papers Count:18

The history of medicine and ophthalmology in Iran and Middle-East dates back to 6000 years ago. In the religious book of Zaroastrians many chapters concerning medicine and health have been discussed and at the school of Mazdayasna and Ekbatan these facts have been well indicated.In the kingdom of Achemenides (550-330 BC) many physicians and ophthalmologists from Egypt, Greece, India were invited to Iran and participated in the progress of science in this region. Universities at Perspolis, Ray and Ekbatana, were scientific centers and educated many physicians and ophthalmologists.During the rule of Sassanides (224-641 AD) the famous university of Jondi-Shapour was founded and scientists from abroad and Iran were welcomed to this center and example is the Bakhtishou family, physicians and ophthalmologists who worked at Jondi-Shapour and Baghdad for 250 years.At that periods other scientific centers were very active in this country and trained physicians and ophthalmologists such as Tabari (192 Hijri), Razi (251-313 H), Ahwazi (318-348 H), Avicenna (370-427 H), Jorjani (434-528 H) and Zarrindast.After the attacks of Alexander, Arabs and Mongols to Iran most of the books and cultural centers were destroyed and due to the instability of the region many scientists emigrated to European countries and many scientific centers were created abroad.At the epoque of Qajar dynasty the prime minister (Amir Kabir) constructed the university of Dar-al-Fonoun (1850 AD) and many European Scientists participated in the education of Iranians and many students went to Europe to be educated.After the foundation of Tehran University (1934 AD) and many other educational centers in Iran, medicine and ophthalmology regained its high value in this country.

Purpose: The dynamic contour tonometer (DCT) is a novel tonometer designed to measure lOP independent of corneal properties. The purpose of this study is a comparisonof lOP measured with the DCT and the Goldmann applanation tonometry (GAT), before and after keratorefractive surgery.Materials & Methods: In a cross-sectional study of 154 myopic and myopic astigmatism eyes, central corneal thickness (CCT) was measured ultrasonically and lOP measured before and 1 month after LASIK and PRK with DCT and GAT. The correlation between these two methods with each other and eachone with CCT analyzed with linear regression and Pearson Correlation.Results: Mean lOP before surgery with GAT was 17.85±2.64mmHg and after surgery was 13.56±2.64mmHg. Mean lOP before surgery with DCT was 18.79±3.5mmHg and after surgery was 17.39±3.5mm Hg. Corneal ablation of 90.4±5 Micron, reduced lOP readings by GAT and DCT, but this Reduction was significant in GAT in comparison with DCT (P<0.0001).Conclusion: CCT and corneal rigidity causes an error in tonometery. DCT can measure real lOP reading and independent from corneal properties. This study revealed that the lOP measurement with DCT has no Correlation with CCT. (Pearson correlation r=-0.4 and p=0.5).

Purpose: To evaluate the effect of recipient-donor disparity on spherical equivalent refractive error and corneal curvature in penetrating keratoplasty (PKP) for keratoconus.Materials &Methods: A prospective randomized clinical trial was conducted between April 2000 and April 2004 in Yazd. Forty keratoconus patients were randomly assigned to two groups. In group I (n=20) the patients were operated with 0.25mm oversized donor and in group II (n=20) with 0.5mm disparity.VA, Spherical Equivalent and keratometry were compared between the two groups. Patients were followed for a mean period of 22.4 months. Both groups were operated on by the same surgeon and with the same technique.Results: Mean spherical equivalent was -3.10 in the first group and -4.25 in the second group (P=0.023).We found a better final visual acuity in group I when compared with group II. More myopic shift was observed with greater disparity (group II).Best corrected visual acuity (BCVA) at final follow-up was better in group I when compared with group II. Fourteen eyes (70%) achieved BCVA of 20/40 or better in group I whereas, ten eyes (50%) achieved this vision in group II.The mean astigmatic refractive error was minimally different between the two groups. This difference was statistically insignificant.Mean keratometry were 43.3+1.6 and 45.3+1.80 in group I and II respectively.There was a mean difference of 1.50 between the two groups (P=0.01).Conclusion: It seems that minimizing the size difference between donor and recipient or using same - size trephines will diminish final spherical equivalent. Post PKP myopia in keratoconus can be decreased by reducing recipient – donor trephine disparity.

Purpose: To report pathologic findings in patients presenting with optic atrophy of unknown cause.Patients & Methods: A cross sectional study of 62 patients presenting with unilateral or bilateral optic atrophy was undertaken at Farabi Eye Hospital, Iran from March 1997 to November 1999. Brain CT or MRI was obtained in all patients.Results: A total of 62 patients, 32 men (51.5%) and 30 women (48.5%) with the mean age of 43.5 years (range 8-78 years) were included. 24% of patients were younger than 20 years. 25% of patients presented with unilateral optic atrophy and 75% with bilateral optic atrophy. 30% of patients presented with headache, 13% with vertigo, 5% with nausea or vomiting and 16% with ataxia. Visual acuity in the involved eye was in the range of finger count. 12 patients (19.5%) had pathologic brain findings. There was no difference in the prevalence of pathologic brain findings regarding age, sex, visual acuity and neurologic symptoms (headache, nausea, vomiting, vertigo and ataxia).Conclusion: There was a significant correlation between optic disc atrophy/pallor and pathologic brain findings. Brain CT or MRI is recommended for all patients with optic atrophy of unknown cause.

Over the past decade, chemotherapy combined with focal therapy is being used increasingly as primary management for patients with retinoblastoma (Rb). There has been a trend away from EBRT toward conservative treatments.Since EBRT has not been widely used as primary treatment for Rb for the past several years, a proposed new international intraocular retinoblastoma classification (IIRC) is being presented in different meetings and articles.This article discusses different aspects of intraocular retinoblastoma based on more recent published data emphasizing on the new group classification of Rb (IIRe).

Purpose: To evaluate 10 cases of corneal epithelial defect who were treated with cyanoacrylate glue temporary tarsorrhaphy.Materials & Methods: We used cyanoacrylate glue (razi supper glue) tarsocilliorraphy for the management of patients with corneal persistent epithelial defects (PED) with several etiologies who did not respond to other commercial treatments such as lubricants, artificial tears and patching. The cyanoacrylate glue was placed on the lateral one third of anterior lamella of lid margin and base of the cilia after preparastion with povidone iodine 5%, patients underwent a 14 days follow up for epithelial defect and tarsocilliorraphy prospectively.Results: 10 patients (8 males, 2 females) aged 52.1 (range: 12-81) years were evaluated prospectively after cyanoacrylate glue tarsocilliorraphy. Tarsocilliorraphy maintained 12.1 (range: 4-20) days and the mean period of epithelial defect healing was 11.2 (range: 3-20) days.Conclusion: We concluded the cyanoacrylate glue tarsocilliorraphy is an effective and safe method for the treatment of corneal persistent epithelial defect (PED) due to neurotrophic ulcer, exposure keratopathy and any epithelial defects not responded to commercial treatment.

Purpose: Color blindness is a condition in which certain colors can not be distinguished; it is divided in two types, 1- hereditary, 2- acquired. In the hereditary type red-green colorblindness is most common. No research has previously been performed in this field in Zanjan. This study was performed among male students in guidance schools of Zanjan-2002.Materials & Methods: Using random sampling 3000 male students were selected. To estimate their color vision, Ishihara booklet with 38 cards has been used.Results: Among 3000 guidance school boys, 242 cases (8.07%) of color blindness were found. 181 (74.8%) of them were Deutan and 61 (25.2%) cases were Protan.In other words, in this population (6.035%) were Deutan and 2.035% were Protan. The most common type of color blindness was Deutanomalia (141 cases or 4.7%).There was not any case of total color blindness. In this study, only 10 cases (4.1%) had previous awareness about their color blindness. Only 3 cases (1.2%) were aware of a person with color blindness in their family.Conclusion: There are different statistical information, about color blindness prevalence in Iran and the world, so other 'studies especially with advanced tests are recommended. We can detect cases of color blindness in schools and give them necessary information about job selection and living facilities.

Purpose: To determine the clinical characteristics in a prospective study of patients with Graves' ophthalmopathy.Patients & Methods: We reviewed the clinical manifestations and medical records of 103 patients with Graves' ophthalmopathy from 2003 to 2005.Results: Out of 103 patients with Graves' ophthalmopathy, 48 (46.6%) male and 55 (53.3%) female (F: M=1.1), with mean age of 45 years (range; 18-73 years), 95 (92.2%) patients had Graves' hyperthyroidism, 3 (2.9%) had primary hypothyroidism, and 5 (4.8%) were euthyroid. Mean duration of ocular symptoms was 13.2 months (range 2-95 months) while mean duration of dysthyroid symptoms was 39.4 months (range 6-180 mpnths). Unilaterality occurred in 12 patients. Eyelid retraction was present in 90 patients (87%), whereas the approximate frequency of exophthalmos was 77.6% (80 patients); restrictive extraocular myopathy, 29% (30 patients); evidence of extraocular enlargement on CT-scan in 52 patients of 70 patients (74%) that was evaluated, and optic nerve dysfunction, 5.8% (6 patients). 22 (21%) patients had glaucoma associated with Graves' ophthalmopathy and 7 (6.7%) of them were normal-tension glaucoma. Conclusion: Eyelid retraction was the most common clinical sign of Graves' ophthalmopathy in our patients. Larger prospective studies are suggested to evaluate both the prevalence and possible racial difference in its clinical presentation in Iranian population.

Purpose: To compare the efficacy and complications of limbal stem cell autograft transplantation (LSCAT) and amniotic membrane transplantation (AMT) versus intraoperative mitomycin C (MMC) and AMT for treatment of recurrent pterygium.Materials & Methods: Methods: 40 eyes of 40 patients with recurrent pterygium underwent LSCAT and AMT (20 eyes) or intraoperative MMC (0.02%, 3 min) and AMT (20 eyes). 3 eyes in each group (15%) had symblepharon prior to surgery.Results: No major postoperative complication occurred during 6-19 months of follow up. In the LSCAT/AMT group, no pterygium recurrence was observed. Recurrence occurred in 4 eyes (20%) in MMC/AMT group after 3 and 4 months (P value= 0.035, Chi square test). No recurrence of pterygium or symblepharon was seen in 6 eyes with recurrent pterygium and symblepharon (3 eyes in each group).Conclusion: LSCAT with AMT seems to be more effective than intraoperative MMC with AMT for treatment of recurrent pterygium.

Purpose: This study was designed to evaluate the efficacy of Botulinum toxin injection to the medial rectus muscles for management of essential infantile esotropia without electromyographic control.Patients & Methods: Twenty four consecutive neurologically normal children from 8 to 38 months of age entered a case series with a mean deviation angle of 40 prism diopters. Simultaneous injection of 10 units Botulinum toxin A (Dysport) were made into the medial rectus muscles under halotane in halation anesthesia. Post operative controls were performed 3 days, 3 weeks, 3 months and 6 months after the injection.Results: At 6 months, residual deviation was an average of 7.08 prism diopters of esotropia (25 prism diopters of esotropia to 10 prism diopters of exotropia).Conclusion: Transconjuctival Botulinum toxin injection even without electromyographic assistance is an effective method in control of essential infantile esotropia in children.

Purpose: To evaluate the results and complications of subconjunctival botulinum toxin injections in the management of thyroid associated upper and lower lid retraction at Khatam-Al-Anbia eye hospital, Medical University of Mashhad.Patients & Methods: In this Prospective, non-comparative interventional case-series, 14 patients with lid retraction associated with thyroid eye disease were treated with one or more injections of Botulinum toxin into the proximal margin of the upper and lower tarsal plate, via a conjunctival approach. The goals of study were to reduce superior scleral show to less than 1 mm and decrease lower lid retraction. Main outcome measures were upper and lower lid response after Botulinum toxin injection, number of injections for controlling retraction during follow up and complications.Results: Of 28 upper lids treated, 24 lids required only one treatment with achievement of less than 1mm scleral show during follow up visits. Two lids required additional injection (in one patient for initially inadequate response and in on other for recurrence during follow up).Totally, we observed treatment failure (more than 1mm scleral show after 3 upper lid injections) in two patients. Among twelve responsive patients, upper lid retraction was successfully controlled during follow up (Mean follow up was 7.6 months). No patient with initial satisfactory response became unresponsive during the study.There was variability in the degree of reduction in lid retraction and duration of effect. It was also difficult to predict the time interval needed for re-treatment. The amount of lid lowering effect of injections varied among patients and lasted between 1 and more than 14 months (mean effect of each upper lid injection lasted 7.02 months). Mean reduction of palpebral fissure, levator function, superior scleral show and lower scleral show, were 3.28±1.80mm, 1.78±1.34mm, 2.46±1.07mm and 1.50±0.80±mm at the last visit respectively.The procedure was well tolerated. No patient had diplopia or developed new motility problems, in particular hypotropia or superior rectus underaction in follow up visits. Two patients (3 eyes) experienced visually significant ptosis or chin up position lasting after 2 and 4 weeks. We experienced increasing corneal exposure and lagophthalmos in 16 of 21 eyes with lower lid treatment. In one of these patients, corneal ulcer developed.Conclusion: Subconjunctival Botulinum A toxin injection provides an effective treatment for upper eyelid retraction associated with thyroid eye disease even in patient with long standing lid retraction. The treatment safely relieved symptoms and improved eye appearance as a temporary solution. Treatment of lower lid retraction was associated with high rate of lagophthalmos that led to corneal ulcer in one our patient. By our experience, lower lid treatment is not recommended as routine in the case of lower lid retraction.

Purpose: To determine the efficacy and safety of topical autologous serum as an alternative treatment of Persistent corneal Epithelial Defect (PED) and non-healing corneal ulcer.Patients & Methods: We prospectively evaluated 21 eyes based on clinical evidence of PED which failed to heal with conventional treatment. All patients underwent an interview to establish age, sex, the cause of PED, duration of PED, previous treatments, past medical and ocular history, as well as a slit lamp ocular examination including size and location of PED and also the status of associated inflammation and/or neovascularization, dry eye and corneal sensation. Treatment consisted of 20% preservative-contained autologous serum.Results: Out of the 20 eyes with PED, fourteen healed at a mean of 15.78 days whereas the mean duration of PED before the use of serum drops was 52.2 days. PED was early-healed (healing lasted S;2 weeks) in 8 eyes (40%), late-healed (healing lasted S;4 weeks) in 6 eyes (30%) and non-healed (healig needed >4 weeks) in 6 eyes (30%). All patients reported subjective improvement (100%). In 14 eyes, PED completely healed with mean rate of 240 micrometers per day. No major ocular or systemic side effects were observed during this trial. All 8 cases with corneal anesthesia healed successfully with aoutologous serum. Healing was more rapid in PEDs with a diameter of £2.5 mm. Eyes with post-operative PED healed more rapidly. All 3 eyes with underlying thermal burn did not respond to autologous serum. Long term follow-up of 10 patients disclosed ocular surface stability in all these eyes.Conclusion: Topical administration of preservative-contained autologous serum was found to be an effective therapy for PED objectively as well as subjectively and can be used as an alternative to more aggressive surgical management.

Purpose: Retinal artery occlusion involving the macular area, is a true ophthalmologic emergency; nevertheless, with no effective treatment exists for this condition. In comparison to minimally invasive modalities of treatment, which are not practically proven to be effective, other treatment modalities may show more promising results.Materials & Methods: This is a case report on a young woman with a hemi-retinal arterial occlusion lasting for 30 hours. Regarding the long period of arterial occlusion and low efficiency of traditional treatments, transluminal Nd: YAG laser embolysis was attempted. The beam of Nd: YAG laser was focused on the lodged clot for dissolving the embolic occlusion.Results: Shutting with three pulses of the laser, the clot in the inferior retinal arteries' bifurcation disappeared and the artery became opened with minimal hemorrhage. Distal blood flow was obvious on angiography. Clinical condition improved dramatically following the procedure.Conclusion: Laser assisted embolysis, may be a new chance for the patient suffering the catastrophic occlusion of retinal arteries.