فهرست مطالب
Journal of Current Ophthalmology
Volume:30 Issue: 3, Sep 2018
- تاریخ انتشار: 1397/06/01
- تعداد عناوین: 17
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Pages 194-201PurposeThe aim of this study was to determine the prevalence of amblyopia in the population of Iran.MethodsThis article is a systematic review. A comprehensive search was conducted in PubMed, Scopus, Science Direct, Ovid, Web of Science, SID, Magiran, with appropriate terms. Information related to the sample size and the prevalence of amblyopia was extracted and summarized in tables. Analysis was performed using STATA software.ResultsFrom 551 articles that were originally extracted from the databases, 31 articles met the criteria for entering the review. These studies were conducted in different regions of Iran. The prevalence of amblyopia in different regions varied between 0.19 and 3.69%. Study results were heterogeneous (I2 = 99.7%), and therefore, a meta-analysis was not done.ConclusionsThe prevalence of amblyopia in Iran is very different. In addition to conducting national screenings, it is necessary to report the incidence of amblyopia and its related factors in different parts of the country.Keywords: Amblyopia, Systematic review, Iran, Prevalence
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Pages 202-210PurposeTo summarize available literature on physiologic and pathologic ocular changes during pregnancy.MethodsNarrative review of literature.ResultsOcular changes occur commonly during pregnancy. Although most of these are benign physiologic responses to the metabolic, hormonal, and immunologic modifications to adopt the gestational product, there is some serious pathology that may develop, exacerbate, or even resolve over the course of pregnancy which requires prompt diagnosis and management. The pathological eye conditions can be classified into preexisting pathologies and emerging ocular diseases. Regardless of the different mechanisms by which these ocular changes occur, the key point is the establishment of an effective perinatal screening program to monitor the new development or successive progression of these ocular abnormalities. Irrespective of the visual health status of the pregnant women, regular perinatal eye examination should be scheduled in order to assure continuous surveillance of healthy eyes. Treatment of pathologic ocular conditions or functionally disturbing benign changes relies on an appropriate patient selection.ConclusionsDiscriminating pathological eye disease from physiologic ocular changes is important in order to establish an individualized treatment or preventive plan and constitutes the mainstay of obstetric ophthalmology. This individualized approach should always weigh the ocular benefits of treatment to the mother against the potential harms to the fetus.Keywords: Eye, Gestation, Ophthalmic change, Pregnancy, Visual change, Visual system
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Pages 211-216PurposeThe purposes of this study were to validate the Persian translation of the Glaucoma Quality of Life-15 (GQL-15) questionnaire, evaluate its psychometric properties, and identify new composite items and item numbers.MethodsThis cross-sectional study was conducted from August to November 2016, at the Glaucoma Clinic of the Ophthalmology Department at Shiraz University of Medical Sciences, Iran. One hundred ninety patients with glaucoma were enrolled. Habitual-corrected visual acuity (HCVA), intraocular pressure (IOP), slit-lamp biomicroscopy, fundus exam, and mean deviation (MD) of the visual field were recorded in the course of clinical examination by glaucoma professional. Psychometric properties, i.e. testretest reliability, internal consistency, content validity, and construct validity were evaluated with factor analysis. Based on the Disc Damage Likelihood Scale (DDLS), patients were stratified to mild, moderate, and severe disc damage. The association between the GQL-15 scores and disease severity (mild, moderate and severe) were evaluated by the analysis of variance (ANOVA).ResultsOf 190 eligible glaucoma patients, reliable clinical data were available for 140 participants. Mean age [standard deviation (SD)] of the patients was 58.7 (13.3) years. Cronbach's α coefficient ranged from 0.74 to 0.91, and the correlation coefficient for total score was 0.53. The content validity ratio (CVR) was 0.91 based on evaluations in expert panel. Exploratory factor analysis (EFA) based on eigenvalue higher than one identified two factors after varimax rotation for the GQL-15 which explained 66.5% of the total variance. Discriminant validity analysis disclosed statistically significant differences in mean quality of life scores between levels of disease severity.ConclusionThe Persian version of the GQL-15 is a reliable and valid questionnaire for use in glaucoma clinics as a complementary tool for evidence-based decision-making.Keywords: Glaucoma, Linguistic validation, Persian, Psychometric properties, Quality of life
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Pages 217-222PurposeThis study evaluates the correlation between horizontal white-to-white (WTW) distance using Caliper and Orbscan IIz with the ciliary sulcus diameter measured by high frequency ultrasound biomicroscopy (UBM) and presents an adjustment formula to improve the correlation.MethodsWe measured horizontal sulcus-to-sulcus (STS) dimension of 273 right eyes of 273 high myopic patients with 35 MHz UBM and horizontal WTW using Orbscan IIz and Caliper. Mean WTW diameter, differences, and the correlation of measurement methods were evaluated.ResultsThe mean spherical equivalent was −8.79 ± 4.87 diopters. Mean horizontal STS dimension with UBM was 12.13 ± 0.45 mm (range, 10.8113.42 mm). Mean WTW diameter in the Caliper method was 11.70 ± 0.40 mm (range, 10.612.8 mm) and 11.70 ± 0.40 mm (range, 10.513.1 mm) in the Orbscan method. Mean difference of UBM STS and WTW with Caliper was 0.48 ± 0.28 mm (range, −0.19 to 1.37 mm). Mean difference of UBM STS diameter and Orbscan WTW was 0.38 ± 0.31 mm (range, −0.64 to 1.29 mm). The Pearson correlations of WTW diameter measured by Caliper and Orbscan with UBM's STS diameter were 0.778 and 0.773, respectively. This difference diminished after adjustment. The 95% limit of agreement was almost the same in Caliper and Orbscan (−0.07 to 1.03 compared with −0.23 to 0.99).ConclusionThere is a significant difference in measurements between STS diameter using UBM and WTW diameter utilizing Caliper and Orbscan. This difference diminished after our recommended adjustment.Keywords: Ultrasound biomicroscopy, Sulcus-to-sulcus diameter, White-to-white diameter, Phakic IOL, WTW adjustment formula
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Pages 223-227PurposeTo determine the changes in the depth of the demarcation line in the central to peripheral cornea following accelerated compared to standard corneal cross-linking (CXL).MethodsIn this prospective, non-randomized study, 60 eyes with progressive keratoconus underwent accelerated or standard CXL (30 in each group). Anterior segment optical coherence tomography (AS-OCT) was done one month later by two independent masked examiners to measure the depth of the demarcation line in the central cornea and on peripheral rings.ResultsThe inter-examiner agreement (intra-class correlation coefficient) was >0.75 for all measured points, and average measurements were used in the analysis. The depth of the visualized demarcation line in the center was 223.4 ± 67.4 μm and 354.9 ± 79.0 μm in the accelerated and standard groups, respectively (PConclusionsThe depth of the demarcation line with accelerated CXL is less than the standard protocol and decreases from the center towards the periphery. Demarcation lines are more homogenized with standard CXL. In cases with an inferior cone, demarcation line depth varies throughout the cornea.Keywords: Accelerated cross-linking, Standard cross-linking, Demarcation line, Peripheral cornea, Cone position
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Pages 228-233PurposeThe aim of this study was to analyze and compare corneal endothelial cell morphology and characteristics in bilateral keratoconus (KCN) patients with unilateral Vogt's striae.MethodsFifty patients aged 2038 years were recruited in this cross-sectional contralateral eye study. In this study, corneal endothelial cell parameters were evaluated in patients with bilateral KCN and unilateral Vogt's striae using the Topcon SP2000P specular microscope (Topcon, Tokyo, Japan).ResultsIn the current study, there were no significant differences in corneal endothelial cell parameters including endothelial cell density (ECD), hexagonal cell ratio (HEX), and coefficient of variance of cell size (CV) between the KCN groups with and without Vogt's striae, [(2968.34 ± 276.65 vs. 2980.05 ± 253.30, P = 0.618), (51.88 ± 13.57 vs. 53.24 ± 9.31, P = 0.658), and (32.50 ± 5.40 vs. 32.97 ± 4.07, P = 0.467), respectively]. Also, among study groups with and without Vogt's striae, ECD did not correlate with anterior chamber depth (ACD) [(P = 0.564, r = 0.09), (P = 0.219, r = −0.18), respectively], maximum keratometry (Kmax) [(P = 0.215, r = 0.18), (P = 0.898, r = 0.02), respectively], and central corneal thickness (CCT) [(P = 0.989, r = −0.02), (P = 0.643, r = −0.07), respectively].
Our results showed significant differences in corrected and uncorrected distance visual acuity (UDVA), cycloplegic refractive error components (calculated by vectorial analysis), CCT, and Kmax between two study groups (all PConclusionsWe were not able to find the statistically significant differences in ECD, HEX, and CV between KCN eyes with and without Vogt's striae. Despite clinical and tomographic results, it seems that Vogt's striae cannot cause deterioration in the corneal endothelial morphology.Keywords: Keratoconus, Corneal endothelial cell, Vogt's striae, Endothelial cell density, Contralateral eye study -
Pages 234-238PurposeThe aim of this study was to detect the genetic defects in a large pedigree of affected individuals with various phenotypes of ocular anomalies including partial aniridia, congenital cataract, and nystagmus.MethodsThe entire coding region of paired box gene 6 (PAX6) was amplified by polymerase chain reaction (PCR), sequenced, and compared with a GenBank database.ResultsA novel mutation (c.1170 C > T; p.Gln297X) was found in the proband and all affected members. This nonsense mutation leads to PAX6 protein truncation.ConclusionsOur findings suggest that this novel mutation is most likely responsible for the pathogenesis of the congenital aniridia, cataract, and nystagmus in this pedigree. To the best of our knowledge, this is the first report of this mutation of PAX6 gene in a kindred pedigree with various ocular abnormalities.Keywords: PAX6 nonsense mutation, Polymerase chain reaction, Congenital aniridia, Cataract, Nystagmus
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Pages 239-244PurposeTo report the demographic data, treatment methods, and outcomes among patients with pellet gun eye injuries.MethodsThis study was a retrospective review of all pellet gun eye injuries coming to Farabi Eye Hospital, a referral ocular trauma center in Iran, from February 2009 to November 2013. Patient's demographics, type of injury, choice of management, complications, and post-treatment visual acuity were recorded.ResultsOne hundred eleven patients with a mean age of 25.7 ± 15.6 years entered the study. The most common age group was younger adults (1645 years old) (61.3%). The mean uncorrected visual acuity after treatment was 2.05 (20/2240) ±1.5 logMAR. The most prevalent ocular zone was zone III (38.7%), and an intraocular foreign body was present in 97 patients (87.4%). Lid laceration and periocular tissue damage were present in 27 patients (24.3%). Lensectomy and vitrectomy were the most common treatment (31.5%). In most patients (87.4%), the injury was non-deliberate, and the most common time of hospitalization was the same day (45.0%). The only statistically significant indicator of post-treatment visual acuity was ocular trauma score (OTS) at admission (PConclusionPellet gun injuries were more common among young male patients, and the only statistically significant indicator of post-treatment visual acuity was OTS at admission.Keywords: Demographic, Eye, Injury, Pellet gun, Outcome
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Pages 245-249PurposeTo evaluate the role of combined phacoemulsification and intravitreal injection of bevacizumab in prevention of postoperative diabetic macular edema (DME) in patients with no diabetic retinopathy or non-proliferative diabetic retinopathy (NPDR) and without macular edema.MethodsIn a prospective randomized clinical trial, 71 eyes from 71 diabetic patients with no diabetic retinopathy or mild NPDR and with central macular thickness (CMT) of less than 300 μm were enrolled and were randomized into two groups: combined phacoemulsification and intravitreal bevacizumab injection group and only phacoemulsification group. Our primary outcome measures included best corrected visual acuity (BCVA), CMT, and total macular volume (TMV) before and after (1 month and 3 months) the cataract surgery.ResultsThe two groups did not show any significant difference in terms of baseline BCVA, age, CMT, stage of diabetic retinopathy. While the bevacizumab group showed lower CMT one month after the surgery compared to control group (267.3 ± 31.8 and 293.6 ± 53.7, respectively, P = 0.019), this difference did not remain significant 3 months after surgery (264.5 ± 21.9 and 291.4 ± 79.8, P = 0.089). The TMV and BCVA in the two groups showed no significant difference one month or 3 months after surgery. Considering our definition of post-cataract surgery diabetic macular edema (PME) in this study [CMT >300 μm using spectral domain optical coherence tomography (SD-OCT)], there was no significant difference between the incidence of PME at 1 month and at 3 months after surgery.ConclusionsAlthough the intravitreal injection of bevacizumab during phacoemulsification would result in decreased macular thickness in patients with no diabetic retinopathy or NPDR and without macular edema in the early postoperative period, this effect would no longer persistent at 3 months. In addition, the BCVA and TMV showed no significant difference between the two groups at any time during follow-up period.Keywords: Intravitreal bevacizumab, Phacoemulsification, Postoperative macular edema
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Pages 250-254PurposeTo determine the prevalence of hyperopia and myopia and their associations with age and gender in 5- to 15-year-old children in underserved rural areas in Iran.MethodsIn this cross-sectional study, sampling was done using a multistage cluster sampling method from two underprivileged rural regions in Iran, and 3851 persons over 1 year old of age were invited to the study. After inviting the selected participants, examinations were conducted at a designated site in the selected villages. All participants underwent measurements of uncorrected and corrected visual acuity, manifest refraction, and a slit-lamp examination. Cycloplegic refraction was done by instilling cyclopentolate 1% eye drops in under 15-year-old participants.ResultsOf the 3851 selected persons, 3314 subjects participated (86.5%), and of these, 602 were in the 515 year age group. The prevalence of myopia and hyperopia in the studied children was 2.60% [95% confidence interval (CI): 1.104.10] and 4.00% (95% CI: 1.846.15), respectively. The prevalence of myopia in male and female children was 2.65% and 2.55%, respectively (P = 0.951). The prevalence of hyperopia in male and female children was 2.83% and 5.25%, respectively (P = 0.130). The prevalence of myopia in the villages of southwest and north was 2.42% and 3.09%, respectively (P = 0.618), and the prevalence of hyperopia was 4.71% and 2.10%, respectively (P = 0.0056).ConclusionThe present report is a brief description of the status of refractive errors in children residing in underprivileged villages of two rural districts in Iran. As presented, the prevalence of myopia is not high, although the prevalence of hyperopia is in the mid-range compared to previous studies.Keywords: Myopia, Hyperopia, Cross-sectional study, Rural population, Children
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Pages 255-262PurposeTo assess the awareness and knowledge on eye donation among students of Allied Health Sciences (AHS), medical, and nursing.MethodsA cross-sectional descriptive study was conducted using a standard predesigned and pretested closed-ended structured questionnaire based on eye donation to obtain information about awareness and knowledge from AHS, medical, and nursing students of Goa.ResultsThree hundred and forty participants participated in the study. The majority of the participants [97.9% (95% CI: 95.899.2)] were aware of the existence of eye donation. Mass media (62.9%) was the foremost source of information. However, only 145 [42.6% (95% CI: 37.348.1)] participants were willing to donate their eyes. AHS, medical, and nursing students stood apart significantly in their awareness and knowledge. Only 60 [17.6% (95% CI: 13.722.1)] participants were aware that the whole eye can be removed from the donor while 215 [63.2% (95% CI: 57.968.4)] were wrongly aware that the cornea can be removed separately. Awareness about eye donation was not associated with willingness to donate eyes.ConclusionsAlthough awareness regarding eye donation was satisfactory, there was lack of willingness to donate eyes. There is a need to bridge the gap between eye bank and donors.Keywords: Eye donation, Awareness, Knowledge, Corneal transplantation, Allied Health Science, Medical
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Pages 263-267PurposeTo evaluate the ultrawide field fundus fluorescein angiography (UWFA) characteristics of rhegmatogenous retinal detachments (RRDs) and compare the findings with an early treatment diabetic retinopathy study (ETDRS) 7 field (ETDRS7F) overlay.MethodsUWFA (Optos, PLC, Dunfermline, UK) was performed in 10 eyes with macula-off RRDs in 9 patients. The findings of UWFA were compared with that of an overlay of standard ETDRS7F.ResultsVascular dilation, tortuosity of vessels, and blockage of choroidal fluorescence were noted in all eyes in both UWFA and ETDRS7F overlay. Other findings in UWFA and ETDRS7F included peripheral perivascular staining (10 versus 4 eyes), peripheral capillary nonperfusion (CNP) (9 eyes compared to none), vascular loop formation (7 eyes versus none), optic disc hyperfluorescence (5 eyes in both), petaloid leak at macula (2 eyes in both), and neovascularization elsewhere (3 eyes versus none).ConclusionsPeripheral perivascular staining and leak, CNP, and vascular tortuosity are common UWFA features of RRDs. Standard ETDRS7F missed peripheral CNP, peripheral vascular loops, and peripheral retinal new vessels in all eyes compared to UWFA in the current study.Keywords: Capillary nonperfusion, Perivascular leak, Vascular loop, Arteriovenous shunt, Retinal neovascularization, Neovascularization of iris
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Pages 268-272PurposeTo report a case of prolonged conjunctivitis as the manifestation of Granulomatosis with polyangiitis (GPA).MethodsA 37-year-old man presented with prolonged conjunctivitis which had persisted for one month. He was taking medication for his conjunctivitis without any response. A slit-lamp examination revealed conjunctivitis and scleritis in the right eye. Conjunctivitis, 360-degree peripheral corneal thinning, corneal perforation, and scleritis were seen in the left eye.ResultsEmergency penetrating keratoplasty was performed to treat the patient's corneal perforation. After a consultation with the Internal Medicine Department, the patient was suspected of having GPA with positive cytoplasmic anti-neutrophil cytoplasmic antibodies (C-ANCA). Functional endoscopic sinus surgery was performed to treat right maxillary sinusitis, and a biopsy of the maxillary sinus mucosa was obtained. The pathology report showed granuloma and vasculitis with severe acute and chronic inflammation and few eosinophils; thus, the diagnosis was confirmed.ConclusionBecause prolonged conjunctivitis occurs only rarely in association with systemic disease, ophthalmologists should be aware of this potential, particularly in patients with GPA.Keywords: Granulomatosis with polyangiitis, Prolonged conjunctivitis, Scleritis, Keratitis
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Pages 273-275PurposeTo report a case of intraoperative rupture of inferior rectus muscle, which was retrieved and later successfully transposed for management of sixth nerve palsy.ResultsA 36-year-old woman presented with traumatic right sixth nerve palsy and esotropia following a car accident five years earlier. During the originally planned vertical transposition surgery, the inferior rectus muscle snapped, but was retrieved and resutured to the sclera 3 mm posterior to the original insertion. After a few months, the second attempt of transposition of vertical recti (including the previously snapped and reattached inferior rectus) was successful, and the patient achieved satisfactory postoperative alignment.ConclusionsIntraoperative rupture of an extraocular muscles is a rare and serious complication encountered during strabismus surgery. However, if successfully retrieved, this muscle has still the chance of future re-operation.Keywords: Sixth nerve palsy, Snapped muscle, Vertical transposition
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Pages 276-279PurposeTo demonstrate the effect of intravitreal bevacizumab (IVB) on the size and vascularity of the fibro-vascular complex with the optical coherence tomography angiography (OCTA) before pars plana vitrectomy (PPV).MethodsObservational case series of three eyes with active diabetic fibro-vascular complex and tractional retinal detachment (TRD) who underwent IVB (1.25 mg/0.05 ml) two days before proceeding to PPV. OCTA was carried out prior to IVB, two days after IVB and six weeks after PPV.ResultsOCTA showed a reduction in the size and calibre of the diabetic fibro-vascular complex two days after IVB in all the cases. Consequently, there was less traumatic dissection of the fibro-vascular membranes during PPV and thus reduced chances of intraoperative and postoperative vitreous cavity bleeding. One case showed mild hemorrhage in the posterior vitreous on the second day post-injection which implies the increased traction caused by IVB.ConclusionsIn this case series, we have used OCTA to demonstrate how IVB is highly effective in reducing the vascularity of diabetic fibro-vascular membranes. This finding also suggests that the use of IVB before PPV in the management of diabetic TRD could also be much shorter than the advocated standard practice of one week in most institutions.Keywords: Bevacizumab, Diabetic tractional retinal detachment, OCTA, Vitreous hemorrhage