JOURNAL OF CURRENT OPHTHALMOLOGY
Year:2002 | Volume:14 | Issue:1|Papers Count:13

Purpose: To evaluate the efficacy, predictability, stability and safety of laser in situ keratomileusis (LASIK) to correct residual astigmatism after cataract surgery. Methods: LASIK was performed on 20 eyes of 20 patients with refractive myopic or mixed astigmatism of 3.00 to 6.00 diopters (D) after extracapsular cataract extraction with posterior chamber intraocular lens implantation without complication. Each eye underwent bitoric LASIK one year or more after cataract surgery. All cases were followed for 6 months. All eyes were treated with the Nidek EC-5000 excimer laser and the automated corneal shaper microkeratome. Results: At 6 months after LASIK the mean refractive astigmatism decreased from 4.64±0.63D (range, 3.50 to 6.00 D) to 0.44±0.24D (range, 0.00 to 1.00D) (P<0.001).The mean percent reduction of astigmatism was 90.4±5.0% (range, 80 to 100%). The mean refractive spherical equivalent decreased from -2.19±0.88D (range, -3.88 to -1.00 D) to -0.32±0.34D (range, +0.38 to -1.25 D) (P<0.001). Vector analysis showed that the mean amount of axis deviation was 0.7±1.2° (range, 0.0° to 4.3°) and the mean percent correction of preoperativeastigmatismwas92.1±5.9% (range,85.6to 108%). Eighty-five percent of all eyes had a mean spherical equivalent and mean cylinder within ±0.50D of emmetropia. Changes of spherical equivalent and cylinder between 2 weeks and 6 months was less than or equal ±0.5 D in 90%, and 95% of all eyes, respectively. Spectacle-corrected visual acuity was not reduced in any eye, and improved one line in 6 eyes (30%) after LASIK. There were no intraoperative complications. Diffuse lamellar keratitis occurred in three eyes (15%) after LASIK and was treated medically without sequelae. Conclusion: LASIK was an effective, predictable, stable and safe procedure for correction of residual myopic or mixed astigmatism of 3.00 to 6.00 D with a low spherical component after cataract surgery.

Purpose: To study the effect of pterygium surgery on induced topographic changes. Method: In 30 patients undergoing pterygium surgery, visual acuilty, corneal topography, Keratometric readings and manifest refraction were recorded before and 1 month after surgery. Patients with pterygium size>3 mm were selected. Results: Successful pterygium surgery was associated with statistically significant improvement in topographic status, visual acuity, keratometry and manifest refraction. Conclusion: Surgery may eliminate all factors which induce topographic and refractive cylinder and brings about steepening in the meridian of the pterygium.

Purpose: Congenital esotropia is the most common deviation in infancy. The aim of this study is to determine the relationship between age of surgery and motor results at Emam Hossein Medical center during 1999-2001. Patients & Methods: This cohort study was performed on 40 patients with congenital esotropia who were less than 2 years old. Their deviations were measured by the krimsky method. The age at surgery in controls was between 1 and 2 years and in cases it was between 6 months and 1 years. All operations were bimedial recession. Recessions were performed according to Park's table. Follow up period was at feast 2 months. If post op. Deviation was less than 8 PO, it would be considered successful. The results were analysed by Chi2, Fisher and T-tests. Results: In this study 47.5% of the patients were male and 52.5%were female. Amblyopia was noted in 30% of patients. The preoperative esotropia was 43.8+9.0 PO in controls and 40.8 + 6.1 PO in cases. Success rate was 75% in the control group and 85% in the case group (N.N). Conclusion: Because there was no difference between groups, it is hopeful that surgery under 2 years of age will be successful. In addition it is expected that patients get good peripheral fusion in future.

Purpose: To evaluate the sensory and functionaloutcomes of strabismus surgery.Materials & Methods: Fifty-three patients (33 with exotropia and 20 with esotropia) were included in the study. All patients were over age 8. No patient had visual acuity worse than 20/60 in the weak eye. Binocular vision was assesed with the Worth four dot test and random dot stereogram.Results: Pre-operatively no esotropic patient demonostrated fusion or any degree of stereoacuity but 17 exotropic patients (32% of total and 52% of exotropic patients) had fusion at far and 21 of them (37% of total and 64% of exotropic potients) had fusion at near. Also 6 exotropic patients (11 % of total and 18 % of exotropic patients) had stereoacuity of 60 to 240 seconds of arc. Post operatively 10 (50%) patients with esotropia had fusion and achieved stereoacuity 60 to 240 seconds of arc. 29 (88%) exotropic patients had neaJ:fusion and 28 (85%) had far fusion. Also 25 (72%) of them had near stereoacuity 30 to 240 seconds of arc. Overall, after operation 39 patients (74%) had near fusion, 38 (72%) had distance fusion and 35 (66%) achieved stereoacuity from 30 to 240 seconds of arc. Improvement of fusion and stereoacuity were significant (p value<0.002).Conclusion: Successful surgical alignment of strabismic patients can effectively improve fusion and near stereoacuity. Further study to evaluate outcome of distance stereoacuity is recommended.

Purpose: To report the clinical and histopathologic features of a patient with basal cell carcinoma of the medial canthus.Design: Interventional Case Report.Participants: One pathologically proven case of basal cell carcinoma.Method: Findings of the ophthalmic evaluation, intraoperative examination and light microscopy of the specimens were analysed.Results: Histopathology demonstrated numerous malignant cells with basal cell origin, infiltrating the epidermis and involving the basement membrane into the dermis, confirming the clinical diagnosis of basal cell carcinoma.Conclusion: Although basal cell carcinoma is often seen in middle-aged or old patients, it should be considered in any lid or canthal tumor at any age.

Purpose: To compare the effectiveness, safety and patient satisfaction following laser epithelial keratomileusis (LASEK) and photo refractive keratectomy (PRK) for low to moderate myopia.Methods: Eighty-four eyes of 42 myopic patients were enrolled in this prospective, randomized, paired clinical study. Each patient received LASEK on one eye and PRK on the other eye; procedure assignment to each eye, and the sequence of operations for each patient was randomized. Before surgery, mean spherical equivalent of refractive error (SE) was-3.57 diopters (D) ±1.25 (SD)(range,-1.50 to -6.50 D) in the LASEK eyes and -3.44 D ±1.13 (SD) (range, -1.60 to -6.00 D) in the PRK eyes. Patients were visited on the first 7 days, and 1 and 3 months after surgery. Patient satisfaction and quality of vision were assessed using a subjective questionnaire.Results: In the first 7 days and at 1 month after surgery, all patients (100%) and at 3 months, 32 patients (76%) came for follow-up. At 3 months, 32 (100%) of LASEK eyes and 31 (97%) of PRK eyes had an uncorrected visual acuity of 20/40 or better; 25 (79%) of LASEK eyes and 26 (82%) of PRK eyes had uncorrected visual acuity of 20/20 or better (P=0.959), mean spherical equivalent refraction was 0.08 D ±0.53 (SD) in LASEK eyes and 0.12 D± 0.50 (SD) in PRK eyes (P=0.652), 26 (81%) of LASEK eyes and 23 (72%) of PRK eyes had a SE within± 0.50 D and 29 (91%) of LASEK eyes and 30 (94%) of PRK eyes had a SE within± 1.00 D. The epithelial healing time was 3.97 days± 1.27 (SD) in LASEK group and 3 69 days ± 1.03 (SD) in PRK group (P=0.078). Mean subjective pain score in the scale of 0 to 3 (3 for severe) was 1.07±0.75 (SD) in LASEK eyes and 0.85±0.73 (SD)in PRK eyes on the first day after operation (P=0.183). At 1 month and 3 months after surgery, the grade of haze was not statistically different in the two groups. Patients were similarly satisfied with both techniques.Conclusions: In this study, LASEK and PRK were found to have similar effectiveness, safety, and predictability for treatment of low to moderate myopia. LASEK, as a modified PRK, was not found to have any advantage to PRK considering postoperative pain, epithelial healing and corneal haze.

Purpose: To report the clinical and histopathologic features of a patient with basal cell carcinoma of the medial canthus.Design: Interventional Case Report.Participants: One pathologically proven case of basal cell carcinoma.Method: Findings of the ophthalmic evaluation, intraoperative examination and light microscopy of the specimens were analysed.Results: Histopathology demonstrated numerous malignant cells with basal cell origin, infiltrating the epidermis and involving the basement membrane into the dermis, confirming the clinical diagnosis of basal cell carcinoma.Conclusion: Although basal cell carcinoma is often seen in middle-aged or old patients, it should be considered in any lid or canthal tumor at any age.

Purpose: To evaluate the visual outcome and complications of phacoemulsification and posterior chamber intraocular lens implantation (PE+PC-IOL) in patients with Fuchs heterochromic iridocyclitis (FHIC).Setting: A private clinic and a university hospital. Tehran, Iran. Methods: In this non - comparative interventional case series, 26 eyes of 25 consecutive patients clinically diagnosed as having FHIC and cataract, were retrospectively studied. Scleral-tunnel phacoemulsification and in - the - bag IOL implantation was performed in all cases. Preoperative and postoperative visual acuity (VA), intraoperative and complications were evaluated.Results: There were 15 males and 10 females ranging in age from 12 to 70 years (mean 35±12). Follow up duration was 14±10months. Preoperatively, best corrected visual acuity (BCVA) was less than 20/40 in all patients, which improved to 20/40 or better in all postoperatively. Sixteen eyes (61.5%) achieved BCVA of 20/20 (P<0.0001). The major cause of postoperative VA<20/20 was vitreous haze. There were no major intraoperative complications. Postoperatively, a mild anterior chamber fibrin reaction occurred in 4 patients. IOL deposits occurred in 7 eyes (26.9%) and decentration was observed in one. During follow up, 3 patients developed posterior capsule opacity (PCO) requiring YAG laser capsulotomy. There was one case of clinical cystoid macular edema which resolved with medication. There were no instances of posterior synechiae (PS) nor any postoperative glaucoma or retinal detachment.Conclusion: PE and PC-IOL implantationis a safe procedureand the preferredtechniquefor cataractsurgeryin FHIC.

Purpose: To evaluate the ocular findings of patients with chronic renal failure (CRF) undergoing hemodialysis (HO) at Emam Hossein and Taleghani Medical Centers from 1999 to 2001.Patients & Methods: This case series was performed on 96 patients with CRF and HO by consecutive selection. All patients underwent complete eye examinations (BCVA, lOP, anterior segment, lens, posterior segment). The results were analysed by percent, means, standard deviation and confidence interval.Results: There were 57.3% male and 42.7% female patients with mean age and duration of HO of 47.1+7.5 and 4.4+3.6 years respectively. The etiologic factors of CRF were hypertension (57.3%) and diabetes (14.6%). The anterior and posterior segment ocular findings were conjuctival depositions (66%), cataract (57%), retinal vascular pathology (69%), macular changes (43.8%) and optic nerve anomalies (33%). The median of visual acuity of the patients was 7/10 with a range of NLP to 10/10.Conclusion: Based on the results of this study, we suggest careful examination of these patients eyes at short intervals. In addition, early diagnosis and control of hypertension and diabetes can prevent or reduce CRF, HO and ocular complications.

Introduction & Purpose: Control of inflammation after intra-ocular surgery is essential for success of surgery. Topical steroids are the most popular drugs used for this purpose. In this study, which was performed as a clinical trial, the effectiveness of prednisolone acetate 1% and dexamethasone phosphate 0.1 % eye drops for control of intraocular inflammation after ECCE+PCIOL was compared. Two Iranian pharmaceutical companies manufactured both drugs.Material & Method: Anterior chamber (AC) cell and flare, injection and pain were used to evaluate inflammation in this study. All patients had senile cataract. Above parameters were evaluated on the 3rd, 7th and 14th daysafter surgery. The course of study was 16 months.Resuts: Eighty patients were studied (forty in each group). On the basis of the above-mentioned methods, there was no statistically difference in pain between two groups. (P value=0.351) There was statistically difference in eye injection between two groups (P value=0.054). However on the 7th day mean injection in the dexamethasone group was 0.775 and in the prednisolone group was 0.450 whose difference was meaningful. (P value 0.012) There was not any statistically significant difference in AC cell between two groups. (P value 0.421) In the case of AC flare there wasn't any statistically difference between two groups. Although AC flare on the 3rd day was different in two groups: mean AC flare was 1.525 in dexamethasone group and 1.225 prednisolone group whose difference was statistically meaningful (P value=0.02).Conclusions: In general the two eye drops, prednisolone acetate 1% and dexamethasone phosphate 0.1%, manufactured in Iran, had more or less similar effects on control of inflammation after ECCE+PCIOL.

Purpose: Evaluation of the effect of trans-scleral cyclophotocoagulation (TSCPC) with Diode Laser in IOP control, after vitreoretinal surgeries with silicone oil injection. Methods: This study is a Non-Comparative Clinical Trial. In this study 22 eyes of 22 patients who had resistant glaucoma after silicone oil injection, treated with diode laser contact cycloablation. These patients had no history of glaucoma, and filtering or shunt operation and there was no evidence of pupillary block in the affected eye. Results: After 35.6±6.4 weeks follow up, IOP before TSCPC was 37.2±6.7 mmHg., and by the end of the follow up period it was 18.3±3.8 mmHg. The number of drugs in this period changed from 1.95±0.38to 0.55±0.73. Visual Acuity did not change in all but one case, whose vision changed from Hand Motion (HM) to Light Perception (LP). By the end of the follow up period, the retinal exams remained unchanged and there was no Hypotonia or Phthisis Bulbi. Conclusion: Contact Diode Laser CPC is relatively effective and safe method for IOP Control and preservation of Visual Acuity after Vitreoretinal Surgeries with Silicone Oil Injection.

Purpose: The prognosis for patients with ophthalmomyiasis interna posterior is variable. In many patients the larva remains in the eye for years without inducing inflammationor loss of vision. Sometimes, the migratinglarva involvesthe macula or optic nerve and results in permanent visual loss or blindness.Methods: Our patient was referred secondary to decreased visual acuity in her left eye because of recurrent uveitis resistent to anti-inflammatory drugs. We found panuveitis with a subluxated lens. Pars plana deep vitrectomyand lensectomy was done and the larva was removed. Two days laterwe found localized inferior peripheral retipal detachment with multiple holes. Repeat vitrectomy, scleral buckling and endolaser photocoagulation was done.Results: Clinical examination 6 weeks later revealed visual acuity of 2/10 in the left eye.Conclusion: We suggest early removal of larva to prevent damage and visual loss in cases of ophthalmomyiasis interna posterior.