JOURNAL OF CURRENT OPHTHALMOLOGY
Year:2002 | Volume:15 | Issue:2|Papers Count:12

Purpose: To evaluate intraocular pressure changes in the early postoperative period after small incision cataract surgery.Setting: Farabi Eye Hospital, Tehran University of Medical Science.Methods: This prospective study includes 82 eyes of 82 patients with age-related cataract that underwent small incision extracapsular cataract extraction by phacoemulsification or phacosection (manual phaco) surgical techniques.Intraocular pressure was measured by goldman tonometry in all patients preoperatively and then at 6 hours, one day and one week postoperatively. No topical or systemic antiglaucoma medications, were given during the study period.Results: Six hours following surgery mean IOP rise was 8.2±9.4 mmHg in the phacoemulsification group (P<0.001) and 4.1± 7.6 mmHg in the phacosection group (P=0.002). IOP rise was also significantly different between two groups. (P=0.034).One day postoperatively the mean change was +2.8± 6.1 mmHg in the phacoemulsification group (P= 0.004) and +2.1±5.2 mmHg in the phacosection group. (P=0.02). At one week there was a mean decrease of -0.5±2.6 mmHg in the phacoemulsification group (P= 0.07) and -2.3±3.7 mmHg in the phacosection group (P<0.05). The drop in IOP in phacosection group was greater in comparison to the phacosection group (P=0.014).Conclusion: Consistent with previous studies, there is a significant IOP rise during the first 24 hours following cataract surgery. Our findings suggest a higer rise for phacoemulsification in comparison to phacosection technique at one week. IOPs tend to drop to levels less than preoperative values in both groups but the decrease in IOP was significantly greater in the phacosection group.

Objective: Evaluation of Intraocular pressure rising after Nd:YAG laser posterior capsulotomy and Timolol 0.5% eye drop effect in prevention of lOP rising in patients who referred to Farabi Eye Hospital (Tehran) between January 2001 and September 2001 for laser capsulotomy.Material & Methods: 96 eyes of 96 patients with posterior capsule opacity who need Nd:YAG Laser capsulotomy. Study was prospective randomized double masked clinical trial.Intervention: Patients randomly distributed in two groups and randomly received (with double masking) timolol 0.5%. IOP measured with applanation tonometer (goldmann) in one hour before and one, four, twenty-four hours after YAG laser post capsulotomy. Written informed consent was obtained from all patients (both groups).Results: Mean ages of patients in group 2 were 57.6± 20.35 year old and timolol group 60.6± 19.92 years old which were not statistically different. (P=0.474). The most prevalent systemic disease in both group were Hypertension and Diabetes Mellitus. Types of surgical procedures in 90 patients were extra capsular cataract extraction with posterior chamber intra ocular lens, in majority of in patients (93.8%) and 6 patients have extracapsular cataract extraction without IOL Implantation, in 74 patients IOL Implanted in the capsular bag (77.1%) and in 16 patients in the sulcus, (16.7%). Mean IOP before cataract surgery was 14.2± 3mmHg. Mean IOP rising in timolol group were zero and in control group 10mm Hg.Mean improvement of acuity was 4.5± 2.9 lines of snellen chart (Range: 1 line through 10 lines). Meantime between surgery and the YAG laser capsulotomy in groups were 39.5:t31.5 months and timolol group 34.6± 31.1 months. There were no significant correlation association between laser energy and IOP rise in two groups (P= 0.896, P=0.330, P=0.717 respectively for 1,4,24 hours after laser therapy). There were no statistically significant correlation between Axial lengths (mm) and IOP rising (P1=0.274, P4=0.545, P24=0.884).Significant IOP rising (>10 mmHg) after YAG laser capsulotomy only were seen in groups (20.8% of patients) and in timolol group there were not any significant IOP rising. (P= 0.00834).Conclusion: Timolol 0.5% eye drop is effective in prevention of significant IOP rising (>10 mmHg) in non glaucomatous patients.

Purpose: To determine correlation between horizontal and vertical size and staging of pterygium, and corneal spherical power and corneal astigmatism by refraction, keratometry and corneal topography.Material & Methods: 59 eyes of 44 patients were selected simply and nonrandom, in a cross sectional study. VA, staging, horizontal and vertical size of pterygium were determined and refraction, keratometry and corneal topography were done. Correlation between pterygium horizontal and vertical size and staging and corneal spherical power and astigmatism and VA were evaluated by Bivariate correlation tests with pearson and spearman.Results: 59 eyes of 44 patients with mean age of 49.71 years were studied. 28 patients were male and 16 patients were female. Mean of vertical size was 5.16 mm and mean of horizontal size was 3.19 mm. Correlation between horizontal and vertical size and VA (p=0.001), refraction spherical equivalent (p<0.01), average sim k (p<0.05), cu index (p<0.001), Pc acuity (p<0.001) was significant. Also significant correlation between horizontal and vertical pterygium size and refraction cyl. (p<0.00) keratometric delta k (p=0.001 and p=0.01 respectively), total astigmatism (p<0.001), delta k (p<0.001) and regular astigmatism (p<0.001)was present. No significant correlation was between staging of pterygium and refraction, keratometry and topographic parameters.Refraction astigmatism (-2.63 D), Keratometric Delta k (D) and topographic Delta k (2.20 D) was less than Total astigmatism (5.06 D) and regular astigmatism (D) on corneal topography. In greater than two thirds of patients, the axis of astigmatism was with the rule.Conclusion: The greater pterygium csize, the greater effects on corneal spherical power astigmatism of refraction, keratometry and topography is seen and therefore decrease in VA is greater. For decision to excise the pterygium, corneal refractive changes and astigmatism is better seen by topography than keratometry and refraction.

Purpose: To evaluate the efficacy of microkeratome-assisted lamellar keratoplasty. Methods: In this prospective interventional study, 17 eyes of 14 patients (11 male and 3 female) ranging in age from 16-71 years underwent lamellar keratoplasty (LKP) using a microkeratome. Eyes with lesions limited to the anterior two thirds of the cornea with minimal central corneal thickness of 340 μm, normal endothelial cell function, and normal adnexa were included. Lamellar dissection in both donor and recipient corneas was performed using a microkeratome (ACS-Chiron Vision).Results: Mean follow up was 8.6 months (range 6-14 months). Mean preoperative spectacle corrected visual acuity was less than <20/200, which improved to 20/30 postoperatively. Mean postoperative astigmatism was 50. On the last examination, all grafts were clear and no immune reaction or epithelial in growth was observed in any of the patients.Conclusion: In superficial corneal disorders, microkeratome-assisted LKP is a reasonable alternative to conventional LKP due to superior visual results in addition to faster and easier technique.

Purpose: To evaluate the clinical findings, histopathologic features and the precise anatomic origin of primary ocular malignant melanoma.Design: Retrospective, noncomparative case series.Participants: The participants included 95 consecutive patients with microscopically confirmed ocular malignant melanoma managed at Farabi Eye Hospital between 1988 and 1998.Main Outcome Measures: Patient features at initial examination such as age and gender, the presenting symptoms and signs, tumor cell types based on the modified Calendar classification for uveal melanomas and anatomic origin of the primary ocular malignant melanoma.Patients & Methods: The clinical records of all patients with pathologically proven ocular malinant melanoma were reviewed and the relevant clinical data were gathered regarding features of the patient, clinical manifestations and anatomic origin of the primary tumor, as well as cell type.Results: Over the 10-year period of this study, there were 95 patients with microscopically confirmed ocular melanoma at the pathology department of Farabi Eye Hospital. Mean age at initial diagnosis was 49 years (range, 6-83 years). There were 58 (61.1%) men and 37 (38.9%) women. The most common histologic type in uveal melanoma was mixed cell type and painless visual loss was the most frequent presenting complaint.Conclusions: Many melanoma patients have asymptomatic tumors discovered on routine ophthalmic examination. This fact emphasizes the importance of routine, periodic, dilated ocular examinations.

Purpose: To determine the efficacy of simultaneous peripheral crescentic lamellar keratoplasty (LK) and central penetrating keratoplasty (PK) for advanced pellucid marginal degeneration (PMD). and compare it with the efficacy of Crescentic Wedge Resection (CWR).Methods: Simultaneous peripheral crescentic lamellar keratoplasty (LK) and central penetrating keratoplasty (PK) was done in the right eye and CWR in the left eye of a patient with advanced PMD., and the results of the two methods was compared.Results: Post-operatively flat anterior chamber (AC) and significant astigmatism which was not correctable with spectacles and hard lenses developed in the left eye. Visual acuity results were 5/10 (with piggyback lens) in the left eye and 4/10 (Uncorrected) in the right eye which increased to 6/10 with correction. No any other complication was seen in either eye.Conclusions: The short-term results with simultaneous peripheral crescentic lamellar keratoplasty (LK) and central penetrating keratoplasty (PK) were better than Crescentic Wedge Resection in our patient; and provided early and stable visual rehabilitation.

Objective & Background: Retinopathy of prematurity (ROP) is a potentially blinding condition that afflicts preterm infants. This study is aimed to evaluate clinical factors associated with ROP.Material & Methods: All premature infants with severe visual problems who were referred to Farabi Eye Hospital between January, 1999 and April 2002 were included in the study. Estimated gestational age (EGA), birth weight (BW), age when the eyes were initially examined, parents" awareness of the ocular consequences in permature infants neonatalogist recommendation for time of eye exam, duration of supplemental oxgen therapy, visual acuity assessment, according centering, steady maintain (CSM) were recorded, a complete eye exam with dilated pupil was performed, ophthalmoscopic findings, and associatiated systemic and ocular disorders were noted.Results: A total of 25 infants (50 eyes) were included in the study, Diagnosis was based on low GA, low SW, and retinal findings by indirect ophthalmoscopy. Ocular involvement were bilateral in all cases, 33 of 50 eyes (66%) were in stage V of the disease, stage IV in 5 eyes (10%), dragged macula was observed in 8 (16%) and regressed ROP in 4(8%). All recorded GAs were 32 weeks or less (mean 27.6±2), 81.2% of recorded BWs were 1500 gram or less. There was a neonatalogist recommendation for eye examination in 36% of the cases and no recomendation in 48%. Mean age of infants at first examination ophthalmologist was 25.1±13.8 .weeks.Seven of nine (77%) infants who had been advised by neonatalogist to visit an ophthalmologist had delayed eye examination at 25.3±12.8 weeks after birth. The parents of all 7 infants were not aware of any relation between prematurity and eye disease. Visual acuity estimated NCNSNM in 38 eyes (76%) CNSNM in 8 (16%) and CSM in 4 (8%) of the eyes. 56% of the infants were totally blind and 28%llad severe visual impairment.Conclusion: GA<32 week and SW±1500 gram are two main associated factors of the disease. Delayed eye examination of the premature neonates leads to severe visual impairment and blindness. This delay is due to lack of knowledge of some of our neonatologists about ROP and lack of public awareness of the disease.

Purpose: The most common cause of failure during the first trimester after trabeculectomy is bleb encapsulation and needling bleb revision is a less invasive method in the management of refractory cases. The purpose of this study is to determine the efficacy and safety of Mitomycin-C (MMC) augmented bleb revision in failed filtration surgery.Methods: This study is a before-after (paired) observation. Thirty-three patients with failed trabeculectomy because of bleb encapsulation, whose IOP (IntraOcular Pressure) was not reduced under 21 mmHg despite use of medications and digital massage for about two weeks, underwent needling bleb revision and subconjunctival injection of 0.01 ml MMC (0.4 mg/ml). Statistical analysis of the data included paired two-tailed Student's t test for preoperative and postoperative IOP and number of medications.Results: 36 needling procedures (mean, 1.09± 0.21 revisions per eye) were performed on 33 eyes. Patients were 10-80 years old (mean, 45.67±22.41 years) and mean follow-up was 9.24± 5.27 months. IOP decreased from 29.06± 5.03 mmHg to 18.21±6.76 mmHg at the last follow-up (p=0.000). Antiglaucoma medications decreased from 2.18±0.58 to 1.36±0.29at the last follow-up (p=0.000).Overall,6 (18.2%) of 33 cases achieved a complete success and 20 (60.6%) cases achieved qualified success. The complications of this procedure were subconjunctival hemorrhage (17 cases), hyphema (5 cases) and conjunctival button hole (2 cases).Conclusion: Needling bleb revision with Mitomycin-C appears to be an effective and relatively safe way to revive failed filtration surgery.