JOURNAL OF CURRENT OPHTHALMOLOGY
Year:2005 | Volume:18 | Issue:3|Papers Count:20

Purpose: To compare the effect of Timolol 0.5% and Trusopt 2% eye drops on corneal thickness in patients with primary open angle glaucoma.Materials &Methods: This randomized clinical trial (RCT) was conducted on 70 eyes of 41 patients with primary open angle glaucoma in which 34 eyes received Timolol and 36 eyes received Trusopt. Corneal thickness was measured using ultrasonic pachymetry before treatment and 1 week, 4 weeks and 3 months after treatment. Patients with previous ophthalmic surgery or those using systemic and topical medications to control ocular pressure and patients having corneal problems were excluded.Results: In the timolol group, mean patient age (±SD) was 62.41±7.2 years and 58.8%, the mean corneal thickness (±SD) prior to treatment was 524.9±23.7 microns, were male. In the trusopt group mean patient age (±SD) was 61.22±5.8 years and 44.4%, the mean corneal thickness (±SD) prior to treatment was 538.5±30.1 microns, were male.Conclusion: There is no significant difference in corneal thickness change in patients with primary open angle glaucoma after consumption of topical drops of timolol and trusopt.

Background & Objectives: Using phacolaser in Micro Incision Cataract Surgery (MICS) for obtaining astigmatic neutrality and providing the best visual acuity in sh0rt time after sugary with less laser energy.Materials & Methods: In a Semiexperimental Clinical Traial study (2003) phacolaser cataract surgery was performed on 100 eyes of 98 patients (52 male and 46 female) with Oodick ARC photolysis System. Superior clearcorneal incision (1.75mm) was made with microsurgery knife (1.50*1.75mm) and Thinoptx PCIOL implanted in the capsular bag.Keratometry before and 5 days after surgery recorded and against the wound astigmatism analysed statistically with "t" test and wilcoxon methods.UCVA (uncorrected visual acuity) and total energy per cataract also recorded after surgery.Results: MICS was performed with "photolysis & thinoptx PCIOL" implantation in 100 eyes. Mean age of patients was 56±14 years.The average cylinder in vertical meridian (90°±20°) before and after surgery was -0.620 and -0.820 respectively. Average SIA (Surgically Induced Astigmatism) and average spherrical equivalent 5 days after surgery was 0.20 and -0.640 respectively. UCVA in 68% of eyes was 0.1 LogMar (20/25) or better and mean total energy percataract was 1400mj. Conclusion: MICS with photolysis & Thinoptx implantation in posterior subcapsular cataract and soft nucleuses results in astigmatic neutrality and the best was obtained VA in 5 days after surgery by using less laser energy.

Purpose: To evaluate the outcomes of penetrating keratoplasty (PKP), cataract extraction and interaocular lens (IOL) implantation in patients with keratoconus or other corneal disorders and visually significant cataract.Materials & Methods: Records of 35 patients who were operated on by one surgeon in a private clinic from 1997 to 2003 were reviewed.Results: There were 20 male and 15 female patients with an average age of 62.8±13.04 (range 25 to 87 years). Nine patients had keratoconus and 26 (74%) had other corneal disorders mainly Fuch's endothelial dystrophy (11 patients) together with visually significant cataract. Mean follow-up was 22.5±15.5 months (range 5 to 60 months); 94% of the patients had clear graft at the end of follow-up. Mean pre-operative BCVA was 20/800 which increased to 20/60 postoperatively and was 20/40 or better in 34% of cases. Mean postoperative spherical equivalent, refractive astigmatism, and keratometric astigmatism were -1.2±3.04, 3.41±2.14 and 3.9±1.90 respectively. Mean postoperative keratometry was 44.2±2.3 D and there was no significant difference between patients with keratoconus and other corneal disorders.Conclusion: Penetrating keratoplasty, cataract extraction and IOL implantation is a safe and effective procedure in patients with keratoconus and other corneal disorders with visually significant cataract.

Purpose: To determine the results of penetrating keratoplasty (PK) in patients with perforated corneal ulcers.Methods: In a retrospective study, we reviewed the medical records of 42 patients who underwent PK for perforated corneal ulcers at Nikookari Hospital during a four year period (2000-2004).Results: Out of 42 patients, 28 (66.5%) were male and 14 (33.5%) were female with mean age of 62 years (range 18-96 year). 35 patients suffered from bacterial keratitis (83.5%) and 7 patients had herpetic ulcer (16.5%). PK eradicated the infection in 22/35 of patients with bacterial and 6/7 of patients with herpetic ulcer. 19/35 of grafts for bacterial and 5/7 for herpetic ulcer remained clear. Anatomical success was achieved in 33 cases (93%) of bacterial and all cases of herpetic ulcers. Two eyes with secondary endophthalmits due to bacterial infection, had to be enucleated.Conclusion: PK is relatively valuable in the management of perforated corneal ulcers.

Purpose: To evaluate the maximum clinical affect of augmented hummelsheim procedure with medial rectus recession in patients with type I Duane's syndrome.Materials & Methods: Five patients with type I Duane's syndrome was included in the study. They underwent 5mm medial rectus recession (except one with 4.5mm recession) and transposition of the temporal half of the vertical recti to the sides of lateral rectus and augmentation by myoscleropexy 8mm posterior to lateral rectus insertion.Results: Four patients showed significant improvement in clinical signs including: esotropia (ET), face turn, up shoot, down shoot and palpebral fissure narrowing.Consecutive XT occurred in only one patient, which was corrected by secondary lateral rectus recession.Conclusion: This surgical approach is very effective in improving clinical findings in patients with type I DRS.

Purpose: To determine the prevalence of refractive errors among schoolchildren in urban and rural areas of Dezful County, Iran.Methods: In a cross-sectional study, using random cluster sampling, 5721 Dezful schoolchildren were selected from 39 clusters. The participants in the study totaled 5544; 3673 elementary and middle school students and 1871 high school students. For the former group, cycloplegic refraction and for the latter, non-cycloplegic refraction was tested. In all participants, uncorrected visual acuity and best corrected visual acuity were determined, and those with a visual acuity of 20/40 or worse underwent a complete ophthalmic examination to determine the cause of visual impairment. A spherical equivalent of -0.5 diopter (D) or worse was defined as myopia, +2.0 D or more was defined as hyperopia, and a cylinder refraction greater than 0.75 D was considered astig matism.Results: The uncorrected visual acuity was 20/40 or worse in the better eye of 224 schoolchildren (3.8% of participants). This figure (percentage) was 14 (0.03%) based on their best corrected visual acuity and 96 (1.7%) with their presenting vision. According to results of cycloplegic refraction, 3.4% (95% confidence interval [CI, 2.5 to 4.4) of the primary and middle school students were myopic and 16.6% (95% CI, 13.6 to 19.7) were hyperopic. For high school students, these rates were 2.1% (95% CI, 0.7 to 3.5) and 33.0% (95% CI, 24.9 to 41.1), respectively, with non-cycloplegic refraction. In the multivariate logistic regression for primary and middle school students, myopia was correlated with age (p=0.030), and hyperopia was correlated with age (p<0.001) and area of residence (p=0.007). In high school students, hyperopia again showed a correlation with their area of residence (p=0.029).Conclusion: The present study reveals the considerable prevalence rates of refractive errors among schoolchildren in Dezful County and the high rate of an unmet need for their correction. Although myopia is not very prevalent, the high rate of hyperopia in the studied population emphasizes its need for attention.

Purpose: To assess demographic variables, age at diagnosis and clinical characteristics of keratoconus patients.Materials & Methods: This prospective descriptive study was performed on 285 eyes of 150 patients with kercetoconus, at The Ophthalmology Department of Yazd between March 2004 and August 2005. The main outcome measures were demographic variables, age at diagnosis, disease severity on biomicroscopic signs and topography.Results: The study included 89 (59.3%) male and 51 (40.7%) female subjects. One hundred-thirty five subjects (94.7%) had bilateral keratoconus. Mean age at presentation was 17.43±3.71 years. Positive family history was seen in 9.3% of the cases. Based on topography and keratometry values 7.7% of eyes had mild, 49.1% had moderate and 43.2% had severe keratoconus. Eyes with severe keratoconus presented at younger age (15.8±4.32 years) than moderate keratoconus (19.25±3.85 years). Uncorrected visual acuity less than 20/40 was seen in 82.8% of the eyes. Six eyes (1.4%) presented with corneal hydrops and this early occurrence of hydrops indicates coexisting vernal keratoconjunctivitis. Fourty two patients (84 eyes, 28%) had associated vernal keratoconjunctivitis.Conclusion: The majority of keatoconic eyes in Yazd patients demonstrate severe stages of the disease by the second decade.

Purpose: To describe the clinical course and treatment of corneal ring infiltration associated with topical Tetracaine abuse.Case Report: A 23-year-old male patient with blurred vision and irritated left eye was reffered to our hospital. His problem started one week ago following metal hammering and for pain relief he used topical Tetracaine frequently. Slit-lamp examination revealed a corneal ring infiltration with epithelial defect and stromal thining in the inferior part of the ring. He was admitted and cultures of the cornea and conjunctiva was performed.Topical Tetracaine drop was discontinued and prophylactic antibiotic, cycloplegic and lubricant applied. After one week, the epithelial defect was healed and stromal infiltration was decreased but the stromal opacity persists.Conclusion: Frequent and long-term use of topical Tetracaine may cause corneal ring infiltration. History is an important key in diagnosis; however, infections agents must be ruled out. In chronic cases psychologic consult may be necessary.

Purpose: To evaluate the effect of nicotinic acid (as a possible vasodilator) in treatment of retinal vein occlusions (CRVO or BRVO).Setting: Mashad University of Medical Science (MUMS); Khatam-Al-Anbia eye hospital.Desigin: Prospective non-randomized pilot studyPatients & Methods: Twenty two eyes of 21 patients with CRVO or BRVO, participated to receive incremental doses of niacin starting from 300 mg/day up to 3g/day for 3 months.Main outcome measures: Changes in visual acuity, visual fields, amount of vascular congestion, hemorrhage and macular edema in fundus photographs, and systemic complications of nicotinic acid.Results: Mean follow up was 8.6±2.7months. Mean BCVA was 0.11±0.14 before treatment, 0.12±0.11 (P=0.30) at 1 month and 0.27±0.22 (P=0.009) at 3 months after treatment. At last follow up visit, mean BCVA was 0.26±0.23 (P=0.02). All patients had resolution of hemorrhages, cotton wool spots, macular edema, disc edema, venous tortuosity and dilation on basis of fundus photographs, 3 months after treatment. MD index or automated primetry improved from -29±9 before treatment to -24±7 (P=0.007) at three months and -28±9 (P=0.01) in the last follow up. Four patients were lost to follow up before 3 months and two other patients were excluded due to hypersensitivity to nicotinic acid and severe hyperglycemia. The only other notable side effect of nicotinic acid was flushing which was well tolerated by all patients. Conclusion: Nicotinic acid treatment for 3 months led to significant clinical improvement in CRVO and BRVO. Niacin, by induction of vasodilatation, may possibly provide enough time for collateral vessels to develop. Niacin is well tolerated and is associated with mild systemic side effects.

Purpose: To assess the outcomes of Ferrara intracorneal ring segments for keratoconus.Setting: Private practice and university hospital, Khatam-Al-Anbia hospital, Iran. Design: Retrospective noncomparative interventional case series.Patients & Methods: Twenty-seven eyes of 27 patients with keratoconus that had Ferrara intracorneal ring segment implantation was reviewed. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), central corneal curvature, corneal astigmatism and complications were analyzed.Results: At a mean follow-up of 3.0 months, BSCVA and UCVA improved in 100% of eyes. Mean spherical equivalent (SE) was reduced from -8.3 diopters (D) to -1 D and the mean refractive astigmatism, from - 5.4D to -5D. The mean central corneal curvature was reduced from 51.2D to 45.3D. Penetrating keratoplasty was avoided in 100% eyes during the follow-up. Intracorneal ring segment decentration occurred in 4 eyes (14.8%), segment extrusion occurred in 2 eyes (7.4 %).Conclusion: Implantation of Ferrara intracorneal ring segments in patients with keratoconus is a safe and reversible procedure that improves vision and leads to stable results. This modality may avoid or delay PKP in many cases.

Purpose: Silicone tube and knots may be removed through the upper system.Among the complications associated with this method is trauma to the lacrimal drainage system and silicone tube breakage, leaving the knots in the sac or canaliculi. The purpose of this study is report of a rare case with canaliculitis due to Actinomyces and dacryoliths as a result of retained silicone tube knots secondary to incorrect removal.Case Report: In a 53-year-old woman, incorrect silicone tube removal through the canthus led to retained silicone tubing causing canaliculitis and dacryolith formation.Conclusion: Silicone tube removal through the canthus is a traumatic procedure. If loop retraction occurs and the end of silicone tube is not visible in the nasal cavity, it should be viewed and retrieved after adequate shrinkage by a nasal endoscope.

We encountered a 3-year-old boy with epiphora, a striking mass on the nasal bridge and ipsilateral nasal hypoplasia. CT-Scan imaging showed multiple calcified areas within the tumor in addition to linear defect in frontal bone, hypoplastic left ethmoidal sinus and left nasal cavity, and absence of left nasal concha. The patient had no history of seizure, no neurologic deficit, and ocular developmental examS were normal. After performing excisional biopsy of the tumor, histopathologic analysis revealed complex choristoma composed of cartilage and bone. The most appropriate name for this malformation, which we have not found described in the literature, seems to be, "nasal hypoplasia with complex choristoma and nasolacrimal duct obstruction".

A 19-year-old girl was seen symptoms of intermittent tearing and bloody discharge from the left eye. She had a history of probing 15-years ago due to nasolacrimal duct obstruction. On medial canthus palpation she had indurations and tenderness. Orbital radiography revealed a metallic foreign body which seemed to be the tip of a lacrimal probe. After dacryocystorinostomy and foreign body removal she showed relief of symptoms and no recurrence of epiphora.