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Ophthalmic and Vision Research - Volume:6 Issue: 3, Jul-Sep 2011

Journal of Ophthalmic and Vision Research
Volume:6 Issue: 3, Jul-Sep 2011

  • تاریخ انتشار: 1390/06/15
  • تعداد عناوین: 15
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  • Petrina Tan, Jodhbir S. Mehta Pages 153-154
  • Akbar Derakhshan, Javad Heravian Shandiz, Masumeh Ahadi, Ramin Daneshvar, Habibollah Esmaily Pages 155-159
    Purpose
    To assess the efficacy of collagen crosslinking with riboflavin and ultraviolet A (UVA) radiation for treatment of early keratoconus.
    Methods
    Thirty-one eyes of 22 patients with early keratoconus were included in this study. All patients underwent slit lamp examination and assessment of uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), intraocular pressure, corneal topography and pachymetry. Collagen crosslinking was performed without epithelial removal. Riboflavin was applied to the cornea every 3 minutes 30 minutes before UVA irradiation and every 5 minutes thereafter. Patients were re-assessed 1, 3, and 6 months after treatment.
    Results
    Postoperatively, UCVA increased by 2 Snellen lines and BSCVA was improved by 1.7 Snellen lines (P < 0.001). Spherical equivalent refractive error was reduced by 0.55 D, and maximum and mean K values were decreased by 0.65 D and 0.51 D respectively (P < 0.05 for all comparisons). Evidence of regression was present in 71% of treated eyes.
    Conclusion
    Collagen crosslinking demonstrated significant improvement in vision with reduction in corneal power and spherical equivalent refractive error in eyes with early keratoconus.
  • Hasan Razmju, Leila Rezaei, Kobra Nasrollahi, Hamid Fesharaki, Hossein Attarzadeh, Farhad Janbaz Footami Pages 160-165
    Purpose
    To compare keratometric measurements using a Javal type manual keratometer with IOLMaster in eyes undergoing photorefractive keratectomy (PRK) for myopia.
    Methods
    In this comparative case series, we studied patients aged 21 to 27 years scheduled for myopic PRK. Keratometry was performed preoperatively and three months after the procedure using a Javal type manual keratometer and the IOLMaster. We compared postoperative measurements obtained by both instruments with the clinical history method (CHM).
    Results
    Seventy eyes of 35 patients with mean age of 23.45±1.55 years were studied. Mean preoperative spherical equivalent was -4.53±1.3 D. Average preoperative IOLMaster and manual keratometric readings were 45.95±1.23 D and 46.32±1.18 D, respectively. Postoperatively, mean IOLMaster measurements was 38.03±0.68 D and that of manual keratometry was 43.15±1.1 D. Compared to CHM measurements, the 95% limits of agreement were -5.95 to -0.85 for the IOLMaster and -1.44 to 4.04 for manual keratometry.
    Conclusion
    Keratometric measurements with the IOLMaster and a Javal type manual device are comparable after PRK; both are largely deviant from the CHM and can yield misleading results.
  • Gholam A. Peyman, Michael Tsipursky, Nariman Nassiri, Mandi Conway Pages 166-176
    Purpose
    To report the preliminary results of oscillatory photodynamic therapy (OPDT) for choroidal neovascularization (CNV) and central serous retinopathy (CSR).
    Methods
    This study included 7 eyes of 6 patients with CSR (2 eyes), idiopathic CNV (2 eyes), CNV due to age-related macular degeneration (AMD) (2 eyes), and peripapillary CNV secondary to presumed ocular histoplasmosis syndrome (1 eye). Intravenous verteporfin (6 mg/m2 body surface area) was infused over 10 minutes followed by oscillating laser (wavelength 689 nm) covering slightly beyond the entire lesion. An Area Centralis lens was applied and laser was delivered (600 mW/cm2 fluence rate and 50 J/cm2 dose). Intravitreal bevacizumab and dexamethasone combination therapy was used with OPDT in 4 eyes with CNV; intravitreal dexamethasone and triamcinolone acetonide were injected in the other eye with CNV. Clinical examination, funduscopy, fluorescein angiography, and optical coherence tomography (OCT) were performed at baseline and after treatment.
    Results
    After mean follow-up of 7.1±5.1 months, visual acuity improved from 0.87±0.69 logMAR (20/160) to 0.60±0.65 logMAR (20/80) (P = 0.027); central foveal thickness decreased from 322±62.1 to 240.7±34.8 microns as measured by OCT (P = 0.018). Fluorescein angiography and OCT demonstrated cessation of vascular leakage, and resolution of hemorrhage and subretinal fluid in all eyes. No adverse events or recurrence were noted.
    Conclusion
    OPDT was effective in treating CNV lesions and CSR. OPDT may be an improvement on standard PDT due to reduced side effects, thermal damage and scarring.
  • Alireza Dehghani, Kamran Montazeri, Amin Masjedi, Najmeh Karbasi, Leila Ashrafi, Behrooz Saeedian Pages 177-182
    Purpose
    To evaluate the effect of local lidocaine application on the incidence of the oculocardiac reflex (OCR) during scleral buckling (SB) for rhegmatogenous retinal detachment (RRD) under general anesthesia.
    Methods
    In a randomized clinical trial, eyes with RRD scheduled for SB under general anesthesia were randomized to adjunctive local application of 1 ml lidocaine 2% versus normal saline to the muscles after conjunctival opening. Surgical stimulation was initiated 5 minutes afterwards. Additionally, 100 mg of lidocaine 2% was added to 50 ml of normal saline in the treatment group which was used for irrigation during surgery; control eyes were irrigated with normal saline. The incidence of the OCR, rate of postoperative nausea/vomiting (PONV), total intravenous (IV) analgesic dose, duration of surgery, and period of hospitalization were compared between the study groups.
    Results
    Thirty eyes of 30 patients including 22 (73.3%) male and 8 (26.7%) subjects with mean age of 49.4±16.3 years were operated. OCR and PONV occurred less frequently, and total intravenous analgesic dose was significantly lower in the lidocaine group (P < 0.05 for all comparisons). However, no significant difference was noted between the study groups in terms of duration of surgery and period of hospitalization.
    Conclusion
    Adjunctive local application of lidocaine during SB under GA for RRD decreases the rate of OCR and PONV, reduces the intravenous analgesic dose, but does not affect the duration of surgery or hospitalization.
  • Mohsen Azarmina, Masoud Soheilian, Hossein Azarmina Pages 183-186
    Purpose
    To evaluate the latency of visual evoked potentials (VEPs) in healthy women during and after menstruation.
    Methods
    Pattern and flash VEPs were performed in 15 healthy women aged 18 to 25 years on the maximum bleeding day (luteal phase) and 7 days after the menstrual cycle (follicular phase).
    Results
    Mean latency was 119.6 msec on the maximum bleeding day and 100.8 msec one week after menstruation on pattern VEP (P < 0.001). Corresponding values for flash VEP were 124.5 msec and 112.7 msec, respectively (P < 0.001).
    Conclusion
    Prolonged VEP latency on the maximum bleeding day indicates that high progesterone levels may have an inhibitory effect on optic nerve conduction velocity.
  • Renu Dhasmana, Ramesh C. Nagpal, Rahul Sharma, Krishan K. Bansal, Harsh Bahadur Pages 187-191
    Purpose
    To evaluate visual field changes in patients with pituitary adenomas following trans-sphenoidal surgery.
    Methods
    Eighteen patients with pituitary adenomas underwent a complete ophthalmic assessment and visual field analysis using the Humphrey Field Analyzer 30-2 program before and after trans-sphenoidal surgical resection at the Himalayan Institute of Medical Sciences over a one year period. Visual acuity, duration of symptoms, optic nerve head changes, pattern of visual field defects, and variables such as mean deviation and visual field index were compared.
    Results
    Thirty-six eyes of 18 patients including 10 male and 8 female subjects with mean age of 35.1±9.9 years and histologically proven pituitary adenoma were included. Mean visual acuity at presentation was 0.29 logMAR which improved to 0.21 logMAR postoperatively (P = 0.305). Of 36 eyes, 24 (66.7%) had visual field defects including temporal defects in 12 eyes (33.3%), non-specific defects in 10 eyes (27.8%), and peripheral field constriction in 2 eyes (5.6%). Mean deviation of visual fields at presentation was -14.28 dB which improved to -11.32 dB postoperatively. The visual field index improved from 63.5% to 75% postoperatively. Favorable visual field outcomes were correlated with shorter duration of symptoms and absence of optic nerve head changes at presentation.
    Conclusion
    Visual field defects were present in two thirds of patients at presentation. An overall improvement in vision and visual fields was noted after surgical resection. An inverse correlation was found between the duration of symptoms and postoperative visual field recovery, signifying the importance of early surgical intervention.
  • Mohammad-Ali Javadi, Sepehr Feizi Pages 192-198
    Our understanding of keratoconjunctivitis sicca (KCS), also known as dry eye syndrome, has been changed over recent years. Until lately, the condition was thought to be merely due to aqueous tear insufficiency. Today, it is understood that KCS is a multifactorial disorder due to inflammation of the ocular surface and lacrimal gland, neurotrophic deficiency and meibomian gland dysfunction. This change in paradigm has led to the development of new and more effective medications.
  • Gholamreza Khataminia, Roja Aghajanzadeh, Babak Vazirianzadeh, Mahmoud Rahdar Pages 199-203
    Purpose
    To present a case of massive orbital myiasis. CASE REPORT: An 87-year-old debilitated woman suffering from left ocular pain of four day's duration presented with a severely necrotized left orbit and several attached live larvae. The upper and lower eyelids and the eyeball were completely destroyed. She had history of eyelid surgery in the same eye due to a skin lesion, apparently some type of skin cancer, 15 years before. The larvae were identified as Chrysomya bezziana (Diptera: Calliphoridae) or old world screwworm fly.
    Conclusion
    Infestation of ocular and orbital tissues by fly larvae (ophthalmomyiasis) progresses rapidly and can completely destroy orbital tissues within days, especially in patients with poor general health. Treatment consists of removal of the larvae and surgical debridement.
  • Kumudini Sharma, Vikas Kanaujia, Anu Jain, Sukhdeep Bains, Suvarna Suman Pages 204-207
    Purpose
    To report an unusual presentation of tuberculosis. CASE REPORT: A six-year old boy presented with left upper lid swelling of 15 day's duration and an asymptomatic midline neck mass from 2 months ago. Imaging studies, and microbiologic tests which demonstrated acid-fast bacilli in the fine needle aspirate of the thyroid mass, both confirmed a diagnosis of cold tuberculous thyroid abscess with presumed hematogenous spread to the orbit. The patient demonstrated marked improvement of both lesions with antitubercular drugs.
    Conclusion
    This case illustrates a very rare association of orbital and thyroid tuberculosis.
  • Mohammad Pakravan Pages 208-214
  • Maryam Aletaha, Mehdi Tavakoli, Mozhgan Rezaei Kanavi, Ali Hashemlou, Shiva Roghaei - Pages 215-218
  • Ohammad Etezad Razavi, Morteza Noorollahian, Alireza Eslampoor Pages 219-224
    To circumvent the disadvantages of endoscopic dacryocystorhinostomy such as small rhinostomy size, high failure rate and expensive equipment, we hereby introduce a modified technique of non-endoscopic mechanical endonasal dacryocystorhinostomy (NE-MEDCR). Surgery is performed under general anesthesia with local decongestion of the nasal mucosa. A 20-gauge vitrectomy light probe is introduced through the upper canaliculus until it touches the bony medial wall of the lacrimal sac. While directly viewing the transilluminated target area, a nasal speculum with a fiber optic light carrier is inserted. An incision is made vertically or in a curvilinear fashion on the nasal mucosa in the lacrimal sac down to the bone using a Freer periosteum elevator. Approximately 1 to 1.5 cm of nasal mucosa is removed with Blakesley forceps. Using a lacrimal punch, the thick bone of the frontal process of the maxilla is removed and the inferior half of the sac is uncovered. The lacrimal sac is tented into the surgical site with the light probe and its medial wall is incised using a 3.2 mm keratome and then excised using the Blakesley forceps. The procedure is completed by silicone intubation. The NE-MEDCR technique does not require expensive instrumentation and is feasible in any standard ophthalmic surgical setting.
  • Marzieh Katibeh, Hamid-Reza Moein, Mohammad-Ali Javadi Pages 225-226
  • Pages 227-228