JOURNAL OF CURRENT OPHTHALMOLOGY
Year:2004 | Volume:17 | Issue:4|Papers Count:21

Purpose: To compare central corneal thickness (GGT) readings measured by Orbscan II and Nidek Ultrasound Pachymeter (UP-1000) in healthy eyes and to evaluate the reliability coefficient of Orbscan II pachymetry.Methods: In 88 eyes of 44 subjects GGT was measured twice by Orbscan II and then by ultrasound. Sample rings of different diameters in the range of 0 mm to 3 mm were assigned to Orbscan II and measurements were recorded. before and after applying the manufacturer's suggested acoustic factor. A correction equation was calculated through regression analysis with which data were reanalyzed. To evaluate the relationship between the two devices, corneal thickness was compared using the 95% limits of agreement (LoA), The reliability coefficient of Orbscan II was assessed to determine the reproducibility of GGT measurements.Results: Mean CCT measured by Orbscan II and ultrasound was 578 (range, 527-656) and 560 (range, 507-630) microns (m m) with standard deviations of 29 and 31, respectively. Mean difference between the two series of measurements was 18.7±15.5 mm and the 95% LoA was -11.7 to 49.2 mm. After applying the calculated correction equation, the mean difference changed to 0.38±15.4 mm (95% LoA: -29.9 to +30.7 mm).The reliability coefficients of Orbscan II in different diameters assigned were consistently high and was 0.978 (P<0.001) for the 2-mm-diameter ring.Conclusion: The two devices should not be used interchangeably before a precise correction equation is achieved through studies with samples of greater numbers and ranges of GGT. Orbscan II can be the single non-contact device used in follow-up of patients with intact corneas regarding its reliability.

Purpose: To introduce an inexpensive and simple method to inject botulin toxin into extraocular muscles.Method: Ten muscles of 7 patients were injected with botulin toxin using the new method. With no use of electromyogram, 10 IU botulin toxin A (Dysport) was injected directly into the muscle. Topical tetracaine was used for cooperative patients. Patients with poor cooperation underwent light general anesthesia.Results: After 48 hours, temporary paresis was observed in all patients. There were no complications such as retrobulbar hemorrhage or perforation of the globe.Conclusion: Direct botulin toxin injection into extraocular muscles without use of electromyogram, can cause a temporary paresis without any complications.

Background: There is controversy as to the efficacy of subconjunctival injections of antibiotics and corticosteroids. We performed this study to assess the effectiveness of prophylactic antibiotics and corticosteroid after phacoemulcification cataract surgery.Materials and Methods: In this randomized clinical trial 397 patients were included, between September 2002 and August 2003. Phacoemulcification cataract surgery, under local anesthesia and insertion of Acrylic foldable lens was performed in all these patients.After comprehensive physical examination, patients were randomly divided into injected and non injected groups and followed for 11 (2-20) months. The results of this study were assessed based on the amount of anterior chamber reaction, presence of cell and flare, fibrin formation and occurrence of endophthalmitis and as well as patient satisfaction.Results: Average age for the injected group (206 patients) was 67+/-5.5 years (45-80), while this figure for non-injected group was 69+/-6.2 (64-78). Equal number of males and females were recruited in both groups. No case of endophthalmitis was seen in either group, over the study period. However, two cases of noninfectious endophthalmitis were seen in both study groups. The amount of anterior chamber reaction was considerable from statistical point of view (P>0.005). In patients who received antibiotic and corticosteroid injection of 68% complained from pain during injection. Besides, subconjunctival hemorrhage and swelling were seen in 41.3% and 21.1% of patients, respectively. On the other hand, none of these complications were observed in non-injected group (P<0.0001).Conclusion: Our study showed that in uncomplicated phacoemulsification cataract surgery for senile cataracts, no significant difference exists in patients with or without subconjunctival antibiotic and steroid injection in terms of postoperative inflammation and endophthalmitis. Moreover, some complications such as hemorrhage and swelling of counjunctiva will not be observed among those operated without injection. In conclusion it is recommended that subconjunctival injection not be prescribed in phaco cataract surgeries.

Purpose: Trabeculectomy is one of the most common operations performed in glaucomatous eyes. The purpose of this study is to compare the results & complications of Limbal-based & Fornix-based trabeculectomy.Patients and Methods: This prospective study was performed on 51 glaucomatous eyes (46 patients) at Farabi eye hospital. None of the patients had history of ocular surgery and all were under medical treatment for lOP control. After dividing patients in two groups randomly, each group was operated by one method without antimetabolite usage. Then findings were analysed by Mann-whitney, Wilcoxon signed ranks test, Chisquare, Fisher's exact test in SPSS version 10 program.Results: The two groups of patients were similar in age, sex and operated eye (P>0.05). lOP decreased from 32.82±9.71 mmHg with 2.2±0.49 drugs before operation to 16±6.3 mmHg with 0.65±0.81 drugs after operation in the Fornix-based group and from 31.09±8.85 mmHg with 2.22±0.52 drugs to 13.95±3.61 mmHg with 0.68±0.94 drugs in the Limbal-based group (P>0.05).61.5% of patients in Fornix-basep group and 59.1% in Limbal-based group had lOP less than 21 mmHg without any medication during the follow-up period (9.93±3.5 months in Fornix-based group and 9.77±5.9 months in Limbal-based group). Bleb leakage and shallow AC (grade 3) were seen in one patient from Fornix-based group but none of the patients in the other group (P=0.57). Tenon cyst formation occurred in 4 Fornix-based & 5 Limbal-based cases (P=0.48).Conclusion: Regarding the feasibility and reduced operation time in the Fornix-based method and also the lack of significant difference in outcomes & complications between these two methods, the Fornix-based approach seems to be more suitable for patients without previous ocular surgery.

Background: Helicobacter pylori infection is the major pathogenic factor for peptic ulcer disease. Its epidemiology is not fully known; few data are available in patients with glaucoma.Aims: To investigate the prevalence of glaucoma in a series of patients with Helicobacter Pylori infection.Methods: In a cross-sectional study, a total of 56 consecutive patients with Helicobacter Pylori infection and 56 controls (health examinees) were included. The presence of Helicobacter Pylori was assessed by histological findings and antibodies using a commercial ELlSA kit. Visual acuity, lOP, C/D ratio, angle and visual field were evaluated.Results: This study included 56 patients with Helicobacter Pylori infection, consisting of 24 female (42.86%) and 31 male (55.36%) with mean age of 51 years (40-75 years), without any previous known disease, over a 20 month period.The range of lOP was 6-19 mmHg (mean 13.82 mm/Hg) in the right and 10-18 mmHg (mean 13.94 mm/Hg) ill left eye. CD ratio was 0.3-0.45 in the right eye and 0.30-0.40 in left eye.The angle was classified as open in 50 cases (89.28%) and grade 2-3 in the other 6 cases (10.76%).Conclusion: This study suggests that exposure to Helicobacter Pylori infection is not associated with glaucoma. Although we have failed to show a possible causal link between Helicobacter Pylori and glaucoma, a much larger study is probably required.

Background and Purpose: Fibro-inflamatory changes in the nasolacrimal duct (NLD) lead to lower success rate after simple probing in children older than 2 years. This study evaluates the outcomes of silicone intubation for congenital nasolacrimal duct obstruction (NLDO).Patients and Methods: In this interventional case series, 23 children (>2 years old) underwent silicone intubation of the nasolacrimal duct. All patients had history of epiphora and discharge. There was history of lacrimal massage and antibiotic use. All children except 5 cases had history of nasolacrimal duct probing. Patients were followed for at least 6 months.Results: Twenty-three children with mean age of 62 months (62±8) were included (57% male and 43% female). In 16 cases (70%) symptoms started in the neonatal period, in others the mean age of onset of epiphora was 2.8 months. In 12 cases (52%) there was soft obstruction of distal NLD and.9 cases (40%) had hard distal NLDO. In the other cases stenosis in the proximal lacrimal system was present in spite of distal NLDO. In 5 patients silicone tube was removed earlier than 6 months. In 2 cases traction on the punctum and slit punctum developed. Tearing or discharge persisted only in 2 patients (8%) one of whom underwent dacryocystorhinostomy (DCR). Overall success rate was 92% in our cases.Conclusion: Silicone intubation is a safe and effective method for the management of nasolacrimal duct obstruction in children older than 2 years with or without history of probing.

Purpose: To evaluate the outcomes of limbal stem cell transplantation in patients with chronic and delayed mustard gas keratitis.Patients and Methods: This interventional case series was performed on 22 eyes of 18 patients with delayed or chronic onset mustard gas keratitis from 2000 to 2003 at Labbafinejad Medical Center.Living related transplantation was performed transferring 120 to 240° to the recipient limbus. Systemic immunosuppresion in addition to topical steroid was used 9 to 18 months after the procedure.Results: 22 eyes of 18 patients with mean age of 36 years (all males) underwent limbal stem cell transplantation. 14 cases had unilateral and 4 cases underwent bilateral surgeries. After the operation both subjective and objective sings and symptoms markedly improved. The uncorrected visual acuity (UCVA) increased in 18 cases and was unchanged in 4 cases (P<0.05). Mean UCVA (Log MAR) was 1.4 preoperatively that increased to 0.64 postoperatively (P<0.05).6 eyes showed the signs of graft rejection that responded well to increased steroid dosage. In one case, the persistent epithelial defect resulted in corneal ulcer and ultimately penetrating keratoplasty (PKP) was performed. Histopathologic findings revealed perilimbal conjunctival ischemia, telangectasia, vasculitis, subconjunctival hemorrhage and decreased conjunctival goblet cells.Conclusion: Living related allograft stem cell transplantation is an effective method in short period for the treatment of mnustard gas keratitis.

Purpose: To find a method of calculating intraocular lens (IOL) power that may be independent of preoperative data in eyes that have previously undergone Laser in Situ Keratomileusis (LASIK).Methods: In 148 eyes of 75 patients, IOL power was calculated with SRK/T formula utilizing the spherical equivalent as the desired target refraction before and 6 month after LASIK. Assuming that LASIK does not alter the crystalline lens refractive properties, IOL error was estimated with this formula: C = [pre-LASIK IOL power]/[post-LASIK IOL power]. Then we used postoperative biometry and Orbscan II corneal topography data in multiple regression models to find the best formula to predict the "C". Predicted amount of error (C) calculated independent of preoperative data could be used to correct the post-LASIK calculated IOL:Corrected IOL power= C x Calculated IOL powerResults: A regression model with these predictors was found: axial length in millimeters (L), radius of posterior corneal surface best fitted sphere in millimeters (Post BFS), difference between corneal central 5 and 3 millimeter mean power in diopters (Mean5mm - Mean3mm), and calculated IOL power. The model R Square was 0.886.Conclusion: There is correlation between post-LASIK biometry values and IOL power correction factor. This study presents a new model for further investigation.

Purpose: To evaluate quantitative topographic parameters of the cornea and to define topographic cone patterns and pachymetry in a series of keratoconus patients.Methods: We prospectively evaluated topographic findings of 130 eyes of 73 patients using Orbscan corneal topography system. The location, anterior and posterior surface elevation, curvature, amount of astigmatism and pachymetry were analyzed with special reference to the central point of corneal, the apex and the thinnest point.Results: The mean age of patients was 27/31 years ± 9.30 (SD). Fifty seven patients (67.6%) had bilaterial and sixteen (12.3%) had unilateral keratoconus.Most cones (64.6%) were located in the inferior temporal quadrant. 32.3% of cones were restricted to the central cornea and 4 were above horizontal meridian. Maximum apex elevation was 68.9D. The mean elevation of the apex was (0.195±0.055) mm. The mean distance between the apex and central point was (0.697±327) mm.The mean thickest of thinnest point of cornea was 398pm (range 143-551pm).Conclusion: Orbscan can provide accurate and subtle information about the shape and thickness of keratoconus which can help for early diagnosis of this disease.Orbscan topography system may be helpful in identifying patients who are potentially at risk for developing ectasia after lasik.

Purpose: To investigate the effect of prophylactic subthreshold macular grid laser photocoagulation on drusen area, and to evaluate visual outcome and incidence of new CNV formation in patients with bilateral soft drusen maculopathy.Desigin: Non-randomized, non-masked clinical trial.Methods: Fourteen patients (28 eyes) with bilateral soft drusen maculopathy were enrolled in this prospective pilot study. In each patient, one eye was treated with 48 subthreshold (invisible end point) applications of KTP-laser (532nm) in a macular grid pattern and the fellow eye was observed.Soft drusen area and chorioretinal atrophy surface area were calculated at baseline and follow-up (3,6,12 months) and compared between two groups. BCVA was also compared in observation and laser- treated eyes.Main Outcome Measures: Reduction of drusen area, change in visual acuity, and rate of new choroidal neovascularization (CNV) formation.Results: At baseline, there was no significant difference in mean drusen surface area between two groups (P=0.90). Mean surface area of soft drusen in treated eyes was 6.54mm2 after one year and 7.56mm2 (P=0.50) in control eyes. There was a trend towards reduction of mean soft drusen area after one year from baseline in treated eyes.(6.54 versus 7.03mm2).In treated eyes, there was no statistically significant difference between mean BCVA at baseline (0.29 logMAR) and after 12 months (0.32 logMAR) (P=0.40).Conclusion: In our study, subthreshold KTP-laser (532nm) macular grid photocoagulation in bilateral soft drusen did not seem to reduce drusen surface area significantly and did not improve BCVA after one year. No exudative lesion developed in laser-treated eyes. A large, multicenter, prospective, randomized clinical trial with longer follow-up is needed to determine the efficacy of treatment in reducing soft drusen area and the rate of CNV formation.

Purpose: To report a case of primary squamous cell carcinoma (SCC) that originated from corneal epithelim and was limited to the cornea.Stinting: Farabi Eye Hospital, Tehran Medical University, tehran, Iran.Patients & Methods: A 50-year-old farmer man had a fleshy, vascular and diffuse sessile mass on his right cornea, which he claimed to have it since childhood. His medical history was significant for a velvety gelatinous lesion on the right cornea since childhood that resulted in decreased visual acuity, isotropia and amblyopia in the right eye. The patients's visual acuities were LPP and 20/30 for the right and left eyes, respectively. A conjunctival map biopsy performed for diagnosis of conjunctival involvement in four quadrants about 5-6 mm from the limbus which revealed normal conjunctival tissue. In October 2000 a diagnostic and therapeutic penetrating keratoplasty was recommended. He underwent allograft limbal and corneoscleral grafting one month later.Results: The histopathologic examination of the specimen showed hyperplastic changes of corneal epithelium and dysplastic tralisformation in all areas of the involved corneal epithelium confined to the epithelium without any invasion to the underlying Bowman's layer. The conjunctival epithelium was spared.Conclusion: We suggest that SCC can originate primarily from corneal epithelium and corneoscleral grafting is a useful technique for treatment of primary squamous cell carcinoma of the cornea.

The patient was an Iranian 40 years old woman who complained of loss of vision in both eyes from two weeks before. She had signs of anterior segment inflammation along with small white lesions at choroidal level, disc swelling, periphlebitis, intraretinal and preretinal hemorrhage and Roth spots. Serum angiotensin converting enzyme titer was high. Tuberculosis evaluation test (PPD) was negative. Lung tissue and conjunctival biopsy were positive for noncaseating granuloma. According to her findings, ocular sarcoidosis was labeled and treatment with topical corticosteroid and cycloplegics and systemic prednisolone was initiated. All the uveitis, choroiditis and vasculitis signs were regressed after one month and her visual acuity was improved from 20/800 to 20/200 and from 20/200 to 20/30 in right eye and left eye, respectively.

Purpose: Cavernous hemangioma is the most common benign neoplasm of the orbit in adults and may occur almost anywhere in the orbit. Here in we present a 41 year old man with ten intraconal orbital cavernous hemangiomas. To the best of our knowledge these are the greatest number of cavernous hemangiomas removed from the orbit.Design: Interventional case report.Methods: A 41-year man presented to the oculoplastic clinic with a 7-year history of gradually increasing right proptosis and a 2-year history of associated decreased vision and limitation of eye movements. Multiple courses of steroid therapy had been taken with the impression of thyroid ophthalmopathy before referral. Proptosis (11 mm), third and sixth nerve paresis and visual impairment (color vision defect, visual field defect and mild decrease in visual acuity) implied orbital apex compression. A lateral orbitotomy was performed and ten separate hemangiomas were removed.Results: Histological examination was consistant with cavernous hemangioma in all removed tumors. Proptosis disappeared post operatively. Visual acuity remained the same as preoperation 20/25). Whereas, there was a significant improvement of the eye movement at the last follow-up 4 months post operatively. Conclusion: Unilateral proptosis should be investigated with a proper imaging study. Multiple cavernous hemangiomas should be considered in the differential diagnosis of a patient presenting with proptosis land orbital apex syndrome.