فهرست مطالب mohammad reza razeghinejad

To report a case of uveitis-glaucoma-hyphema syndrome (UGHS) secondary to a large capsulorhexis with an intracaspular intraocular lens (IOL) managed with IOL exchange and gonioscopy assisted transluminal trabeculotomy (GATT).  A 73-year-old male patient presented with UGHS of the right eye in the setting of an intracapsular single-piece acrylic IOL with circumferential optic and partial haptics exposure due to a large capsulorhexis. In lieu of the patient's uncomplicated surgical history, subtle symptoms, and clinical findings, the diagnosis and referral was delayed until intraocular pressure reached a peak of 50 mmHg with recurrent anterior chamber cells. The patient underwent combined IOL exchange with placement of a 3-piece sulcus IOL and GATT, which finally resolved the UGHS. With respect to the increasing prevalence of intracapsular single-piece IOL implantation, it is important to recognize UGHS and thus fashion proper sized capsulorhexis to prevent this vision threatening complication. GATT may be considered to be one of the glaucoma surgeries combined with the IOL surgical procedures in UGHS.

The correct estimation of Intraocular Pressure (IOP) is the most important factor in the management of various types of glaucoma. Primary congenital glaucoma is a type of glaucoma that can cause blindness in the absence of control of the IOP. In this retrospective observational study, 95 eyes, including 48 healthy eyes and 47 eyes with Primary Congenital Glaucomatous (PCG) were studied. Two groups were matched for age, gender, and Goldman Applanation Tonometry (GIOP). Corneal Hysteresis (CH), Corneal Resistance Factor (CRF), and Goldman intraocular pressure were measured by ORA (IOPg), and corneal compensated Intraocular Pressure (IOPcc) was measured for each patient using the Ocular Response Analyzer (ORA). Central Corneal Thickness (CCT) was measured by ultrasonic pachymetry. For each patient, one eye was selected randomly. Student’s t-test and analytical regression were used for statistical analysis. The two groups were matched for age (P = 0.34), gender (P = 0.47), and GIOP (P = 0.17). Corneal hysteresis and CRF were significantly lower in PCG than in normal eyes (P < 0.0001), yet CCT was significantly thicker in PCG than normal eyes (P < 0.0001). The regression equation on the effect of CH, CRF, and CCT on GIOP in the PCG group showed that CH and CRF (P-value = 0.001 and P-value<0.0001) also had a significant effect yet CCT did not (P-value = 0.691). A significant decrease in CH and CRF was found in the PCG group compared to the normal controls. In the PCG group, the CCT was greater than normal. These results showed the usefulness of biomechanical properties (CH, CRF) in order to interpret IOP measurements. Furthermore, GIOP measurement may not be confined to consideration of CCT alone. A low CH and CRF value could be responsible for under-estimation of GIOP in the PCG group, in comparison to the normal controls.

The 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.
This 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. test–retest 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).
Of 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.
The 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.

To study the effects of filtration surgeries (tube and trabeculectomy) on changes in intraocular pressure after a water‑drinking test.
In this prospective, non‑randomized, comparative clinical study, 30 patients who had tube surgery and 30 age‑ and sex‑matched trabeculectomy patients underwent a water‑drinking test. Only one eye of each patient was included. The baseline intraocular pressure was ≤21 mmHg in all enrolled eyes with or without adjunctive topical medications. After the water‑drinking test, the intraocular pressure was measured and recorded at 15, 30, 45, and 60 minutes and the results were compared between the two groups.
In both groups, intraocular pressure significantly increased from baseline at all measured time‑points (P  Intraocular pressure significantly increased after the water‑drinking test in both the groups. Intraocular pressure started to decline 30 minutes after the water‑drinking test in the trabeculectomy group, while it continued to increase up to 60 minutes in the Tube group. This finding may have implications regarding the efficacy or safety of the procedures in advanced glaucoma patients.

Glaucoma management in pregnant patients is a real challenge, especially when the glaucoma is not controlled with medications. We report the results of 6 incisional glaucoma surgeries for the management of medically uncontrolled glaucoma patients during pregnancy. This retrospective, case series was conducted on the 6 eyes of 3pregnant patients with uncontrolled glaucoma using maximum tolerable medications. Details of the glaucoma surgical management of these patients as well as their postoperative care and pregnancy and clinical outcomes on longitudinal follow-up are discussed. All 3 patients had juvenile open-angle glaucoma and were on various anti-glaucoma medications, including oral acetazolamide. The first case described underwent trabeculectomy without antimetabolites in both eyes because of uncontrolled intraocular pressure with topical medications. The surgery was done with topical lidocaine jelly and subconjunctival lidocaine during the second and third trimesters. The second patient had an Ahmed valve implantation in both eyes during the second and third trimesters because of uncontrolled IOP with topical medications and no response to selective laser trabeculoplasty. Surgery was done with topical tetracaine and subconjunctival and sub-Tenon’s lidocaine. The third case had a Baerveldt valve implantation under general anesthesia in the second trimester. In selected pregnant glaucoma patients with medically uncontrolled intraocular pressure threatening vision, incisional surgery may lead to good outcomes for the patient with no risk for the fetus.

To determine the agreement between intraocular pressure (IOP) measurements using an automated non‑contact tonometer (NCT), Goldmann applanation tonometer (GAT), and the ocular response analyzer (ORA) in subjects with primary congenital glaucoma (PCG). Twenty‑nine eyes of 17 PCG patients underwent IOP measurements using NCT, GAT and ORA. Variables obtained by the ORA were corneal‑compensated IOP (IOPcc), Goldmann‑correlated IOP (IOPg), corneal hysteresis (CH), and corneal resistance factor (CRF). A difference more than 1.5 mmHg for IOP was considered as clinically relevant. Mean age of the patients was 12 years. Mean IOP (±standard deviation, SD) was 15.3 ± 2.8 mmHg (GAT), 15.5 ± 6.0 (NCT), 19.2 ± 7.0 (IOPg), and 21.1 ± 7.9 (IOPcc); (P = 0.001). Except for NCT vs. GAT (P = 1.0), the average IOP difference between each pair of measurements was clinically relevant. The 95% limits of agreements were − 10.2 to 10.3 mmHg (NCT vs. GAT), −7. to 15.3 (IOPg vs. GAT), and − 8.1 to 19.0 (IOPcc vs. GAT). The differences in IOP measurements increased significantly with higher average IOP values (r = 0.715, P = 0.001, for NCT vs. GAT; r = 0.802, P < 0.00, for IOPg vs. GAT; and r = 0.806, P < 0.001, for IOPcc vs. GAT). CH showed a significant association with differences in IOP measurements only for IOPcc vs. GAT (r = 0.830, P < 0.001). Mean IOP obtained by NCT was not significantly different from that of GAT, but ORA measured IOPs were significantly higher than both other devices.

To evaluate the local safety of bevacizumab and its effect on recurrence of primary pterygium excision. This randomized, placebo-controlled clinical trial was conducted on 44 eyes of 44 patients randomized to Group 1 (bevacizumab) and Group 2 (balanced salt solution). Group 1 underwent pterygium excision with a rotational conjunctival flap and received a total of 7.5 mg subconjunctival bevacizumab (5 mg / 0.2 mL on the day of surgery and 2.5 mg / 0.1 mL on the fourth day after surgery). Group 2 received balanced salt solution in the same manner. Recurrence, defined as any fibrovascular tissue crossing the limbus, and the number of patients with > 1.5 mm fibrovascular overgrowth on the cornea were compared between the study groups. There was no statistically significant difference between the study groups in terms of demographics, pterygium size, daily sun exposure, preoperative visual acuity, keratomeric readings, corneal astigmatism, or IOP (P > 0.05). Three and four patients in each group at the three- and six-month visits, respectively, had more than 1.5 mm fibrovascular tissue overgrowth on the cornea (P = 1 and 0.62, respectively). At the three-month visit, 3 patients in Group 1 versus 7 patients in Group 2 (P = 0.13), and at the six-month visit 4 patients in Group 1 versus 8 patients in Group 2 (P = 0.17) had fibrovascular tissue crossing the limbus. Patients in Group 1 experienced a statistically significant rise in IOP at the one-week visit (P = 0.007). Bevacizumab had no significant effect on the recurrence rate of pterygium. Although the frequency of fibrovascular tissue crossing the limbus in the bevacizumab group was half that of the BSS group, the difference failed to reach a statistically significant level.

To evaluate the agreement in intraocular pressure (IOP) measurements by Ocular Response Analyzer (ORA) and Tono-Pen XL (TXL) with the Goldmann Applanation Tonometer (GAT) and to examine corneal biomechanical properties in aphakic glaucoma patients with a central corneal thickness (CCT) >600 µ. Thirty-six eyes of aphakic glaucoma patients (group 1) and 40 eyes of normal children (group 2) were studied. The mean ORA and TXL IOP values were compared with the GAT-IOP values. Regression analyses were used to evaluate the associations between IOP and CCT, corneal hysteresis (CH), and corneal resistance factor (CRF). Bland-Altman plots were used to evaluate the agreement between the tonometers. The mean±standard deviations of the age and male/female ratio were 16.58±5.44 and 15.75±5.04 years and 14/22 and 18/22 in group 1 and group 2, respectively. CCT in group 1 was 651.1±42 and in group 2 was 567.3±32.4. In group 1, the mean TXL (22.4, P=0.004), IOPcc (corneal compensated) (27.8, P=0.005), and IOPg (Goldmann correlated) values (28.1, P<0.0001) were greater than GAT-IOP (20.6). In group 2, only IOPg value (16.4) was higher than GAT-IOP (14.8, P=0.04). IOP reading of all the tonometers were positively and negatively associated with CRF and CH in the multiple regression analysis, respectively. The TXL had a greater agreement with the GAT, and the ORA overestimated IOP in aphakic glaucoma patients. The ORA and TXL seemed to be affected by CH and CRF.

To compare ocular biometric parameters in primary angle closure suspects (PACS), primary angle closure glaucoma (PACG) and acute primary angle closure (APAC). This cross-sectional study was performed on 113 patients including 33 cases of PACS, 45 patients with PACG and 35 subjects with APAC. Central corneal thickness (CCT), axial length (AL), anterior chamber depth (ACD) and lens thickness (LT) were measured with an ultrasonic biometer. Lens-axial length factor (LAF), relative lens position, corrected ACD (CACD) and corrected lens position were calculated. The parameters were measured bilaterally but only data from the right eyes were compared. In the APAC group, biometric parameters were also compared between affected and unaffected fellow eyes. Logistic regression analysis was performed to identify risk factors. No statistically significant difference was observed in biometric parameters between PACS and PACG eyes, or between affected and fellow eyes in the APAC group (P>0.05 for all comparisons). However, eyes with APAC had thicker cornea (P=0.001), thicker lens (P

To present a case of missed intraorbital wooden foreign body presented as soft tissue massCase report: We introduce a case of intraorbital wooden foreign body which presented with orbital soft tissue mass two years after trauma. A plain CT was requested which revealed a foreign body in the right orbit. It is frequently difficult to identify and localize organic intraorbital foreign bodies despite modern day high-resolution imaging studies.

A number of ocular biometric parameters, iris hiotologic and anatomic characters have been suggested as inciting factors for converting patients with narrow angle to angle-closure glaucoma. This study was conducted to determine if there was any goniscopic difference between patients with acute angle-closure glaucoma (AACG) and chronic angle-closure glaucoma (CACG). The study is a retrospective analysis of the charts of 97 patients with asymmetric CACG and 15 patients with unilateral AACG. The age, sex, type of glaucoma, gonioscopic findings and optic nerve head cup/disc ratio were recorded for all patients. Dynamic gonioscopy and Spaeth’s convention were used to grade the drainage angle. The eyes with AACG or more optic nerve damage in CACG groups were considered as involved eye, and the contralateral eyes in the AACG and CACG groups were considered as noninvolved and less-involved, respectively. There was no significant difference between patients with AACG and CACG in terms of age, gender, refraction, and laterality of the involved eyes. In intragroup analysis, no significant difference was observed for distribution of iris attachment, irido-corneal angle, iris configuration, or trabecular pigmentation. In intergroup analysis, the superior iris was attached more anterior in the involved eyes of AACG compared to that in CACG (P=0.007). Moreover, the iris root attachment was also more anterior in both the superior (P=0.001) and inferior (P=0.002) angles of the noninvolved eyes of AACG vs. than those in the less-involved eyes of CACG group. The findings of the study indicate that there is no significant difference between the eyes with AACG or CACG in terms of goniscopic findings. However, the superior iris attachment was located more anterior in eyes with AACG compared to that in eyes with CACG.

To report a case of spontaneous direct carotid-cavernous fistula causing abrupt loss of vision. CASE REPORT: A 50-year-old woman with systemic hypertension but no history of ocular disease developed sudden proptosis, frozen eye, subconjunctival hemorrhage and loss of vision in her left eye over 2 hours. Imaging studies revealed a direct carotid-cavernous fistula. Management for high intraocular pressure was promptly initiated and the patient was referred to a neurosurgery service, but she refused any surgical intervention. Ultimately, she accepted to undergo manual carotid artery compression which resulted in significant reduction in the proptosis, but she lost all vision permanently. Direct carotid-cavernous fistula can occur spontaneously and should be taken into account in patients with signs suggestive of direct carotid-cavernous sinus fistula even without history of trauma or connective tissue disorder.

To report a case of non-Hodgkin’s lymphoma (NHL) presenting as an ocular adnexal and forehead mass. CASE REPORT: An elderly male patient was referred by a neurosurgeon to the eye clinic with a six-month history of a massive tumor measuring 12x16x8 cm involving the right side of the forehead, eyebrow and upper eyelid. Neurological examination had been normal and computed tomography revealed no intracranial extension. The patient was referred to an otorhinolaryngologist who performed an incisional biopsy which revealed the mass to be NHL. He received chemotherapy with CHOP regimen (cyclophosphamide, adriamycin, vincristine and prednisolone) resulting in reduction in lesion size leaving a phthysical eyeball and a ptotic lid. Non-Hodgkin’s lymphoma may occur in almost any part of the body and should be considered in the differential diagnosis of extralymphoid tumors.

Glaucoma is a progressive optic neuropathy and is one of the leadingcauses of blindness worldwide. Different factors have been contributed in the pathogenesis of glaucoma including H. pylori infection. To determine the levels of anti-H. pylori IgG antibody in the aqueous humor of patients with pseudoexfoliation and primary open angle glaucoma، in comparison with age and sex matched cataract patients. This study was conducted on 41 cases of glaucoma (21 with pseudoexfoliation and 20 with primary open angle glaucoma) and 39 cases of cataract as control group. Aqueous humor was aspirated at the beginning of glaucoma or phacoemulsification cataract surgery in glaucoma and cataract patients، respectively. Anti-H. pylori IgG concentration was measured by means of an enzyme- linked immunosorbent assay. The aqueous levels of anti-H. pylori IgG in primary open angle glaucoma (0. 44±0. 64 U/ml) had no significant difference with cataract (0. 24±0. 52U/ml) and pseudoexfoliation glaucoma group (0. 63±0. 71U/ml) (P=0. 18 and 0. 44، respectively). However، the concentration of this antibody was higher in the aqueous humor of pseudoexfoliation glaucoma patients compared to the control group (p=0. 03). The results of this study did not support a relation between H. pylori infection and primary open angle glaucoma. The elevated concentration of anti-H. pylori IgG in pseudoexfoliation glaucoma compared to cataract patients may be due to the breakdown of blood-aqueous-barrier.