Journal of Ophthalmic and Vision Research
Volume:10 Issue: 3, Jul-Sep 2015

To investigate the association between ocular biometrics such as axial length (AL), anterior chamber depth (ACD), lens thickness (LT), vitreous chamber depth (VCD) and corneal power (CP) with different refractive errors. In a cross‑sectional study on the 40 to 64‑year‑old population of Shahroud, random cluster sampling was performed. Ocular biometrics were measured using the Allegro Biograph (WaveLight AG, Erlangen, Germany) for all participants. Refractive errors were determined using cycloplegic refraction. In the first model, the strongest correlations were found between spherical equivalent with axial length and corneal power. Spherical equivalent was strongly correlated with axial length in high myopic and high hyperopic cases, and with corneal power in high hyperopic cases; 69.5% of variability in spherical equivalent was attributed to changes in these variables. In the second model, the correlations between vitreous chamber depth and corneal power with spherical equivalent were stronger in myopes than hyperopes, while the correlations between lens thickness and anterior chamber depth with spherical equivalent were stronger in hyperopic cases than myopic ones. In the third model, anterior chamber depth + lens thickness correlated with spherical equivalent only in moderate and severe cases of hyperopia, and this index was not correlated with spherical equivalent in moderate to severe myopia. In individuals aged 40‑64 years, corneal power and axial length make the greatest contribution to spherical equivalent in high hyperopia and high myopia. Anterior segment biometric components have a more important role in hyperopia than myopia.

To determine the accuracy of photorefraction and autorefraction as compared to cycloautorefraction and to detect the repeatability of photorefraction. This diagnostic study included the right eyes of 86 children aged 7‑12 years. Refractive status was measured using photorefraction (PlusoptiX SO4, GmbH, Nürnberg, Germany) and autorefraction (Topcon RM800, USA) with and without cycloplegia. Photorefraction for each eye was performed three times to assess repeatability. The overall agreement between photorefraction and cycloautorefraction was over 81% for all refractive errors. Photorefractometry had acceptable sensitivity and specificity for myopia and astigmatism. There was no statistically significant difference considering myopia and astigmatism in all comparisons, while the difference was significant for hyperopia using both amblyogenic (P = 0.006) and nonamblyogenic criteria (P = 0.001). A myopic shift of 1.21 diopter (D) and 1.58 D occurred with photorefraction in nonamblyogenic and amblyogenic hyperopia, respectively. Using revised cut‑off points of + 1.12 D and + 2.6 D instead of + 2.00 D and + 3.50 D improved the sensitivity of photorefractometry to 84.62% and 69.23%, respectively. The repeatability of photorefraction for measurement of myopia, astigmatism and hyperopia was acceptable (intra‑cluster correlation [ICC]: 0.98, 0.94 and 0.77, respectively). Autorefraction results were significantly different from cycloautorefraction in hyperopia (P < 0.0001), but comparable in myopia and astigmatism. Also, noncycloglegic autorefraction results were similar to photorefraction in this study. Although photorefraction was accurate for measurement of myopia and astigmatism, its sensitivity for hyperopia was low which could be improved by considering revised cut‑off points. Considering cut‑off points, photorefraction can be used as a screening method.

To evaluate the effect of Lamium album extract on human corneal epithelial cells (10.014 pRSV‑T cell line) cultured in vitro. Normal human corneal epithelial cells were incubated with ethanol, ethyl acetate and heptane extracts from Lamium album. Their effect on cells was evaluated by neutral red (NR) uptake and MTT assays for cytotoxicity, ELISA for immunomodulation, Griess method for nitric oxide levels, DPPH assay for free radicals scavenging activity. A blank control consisted only of culture medium. In NR and MTT assays, Lamium album extracts did not affect cell viability (80% at 125 µg/ml concentration). Ethanol was the least toxic extract (cell viability over 88%) and expressed the most potent reactive oxygen species (ROS) scavenging action. It was 19.88 ± 0.87% higher than controls representing a reduction corresponding to 7.136 µg/ml of trolox. Heptane extract revealed no ROS scavenging activity. All extracts decreased NO production by cells. The most active extract was ethanol (8 µg/ml) which reduced NO level to 0.242 µM (75% decrease compared to control). Extracts influenced pro‑inflammatory (IL‑1, IL‑6, TNF‑α) and anti‑inflammatory (IL‑10) cytokines levels reducing all of them in general. The strongest reduction in tested cytokines level was observed by the heptane extract. On the other hand, the ethanol extract induced mainly TNF‑α level in a concentration dependent manner. Selected Lamium album extracts influence human corneal epithelial cells. Generally, while not toxic, they modulate pro‑inflammatory and anti‑inflammatory cytokines levels, and decrease NO release by cells; moreover, ethanol and ethyl acetate extracts reduce ROS levels.

To compare corneal biomechanical properties following three different transplantation techniques, including Descemet stripping automated endothelial keratoplasty (DSAEK), deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) in comparison to normal eyes. This cross‑sectional comparative study included 118 eyes: 17 eyes of 17 patients received DSAEK, 23 eyes of 21 patients underwent DALK using Anwar’s big bubble technique, and 45 eyes of 36 patients had PK; 33 right eyes of 33 normal subjects served as the control group. Using the ocular response analyzer (ORA, Reichert Ophthalmic Instruments, Buffalo, New York, USA), corneal hysteresis (CH) and corneal resistance factor (CRF) were measured and compared among the study groups at least 3 months after all sutures were removed. Mean patient age was 26.9 ± 5.0 years in the control group, 28.8 ± 4.2 in the PK group, 27.2 ± 6.5 in the DALK group, and 62.5 ± 16.8 in the DSAEK group (P < 0.001). Central corneal thickness (CCT) was 539.0 ± 24.8, 567.5 ± 38.8, 547.0 ± 42.6 and 631.1 ± 84.8 µm, respectively (P < 0.001). CH and CRF were significantly lower in the DSAEK group (7.79 ± 2.0 and 7.88 ± 1.74 mmHg, respectively) as compared to the PK (10.23 ± 2.07 and 10.13 ± 2.22 mmHg, respectively) and DALK (9.64 ± 2.07 and 9.36 ± 2.09 mmHg, respectively) groups. The two latter groups demonstrated biomechanical parameters comparable to normal subjects (9.84 ± 1.59 and 9.89 ± 1.73 mmHg, respectively). Graft biomechanical parameters after DSAEK are lower than those following PK and DALK. After PK and DALK in keratoconic eyes, these metrics are increased to normal values. These differences may have implications for interpreting intraocular pressure or planning graft refractive surgery after keratoplasty.

To evaluate risk factors associated with nuclear and cortical cataracts among a hospital based sample of subjects in Southern India. In this hospital‑based study, 3,549 subjects including 2,090 male and 1,459 female individuals aged 45 years and over were randomly screened for nuclear and cortical cataracts. Lens opacity was graded and classified after pupil dilation using the lens opacities classification system (LOCS) III at the slit lamp. Furthermore, participants were interviewed for lifestyle variables and dietary intake of carotenoids using a structured food frequency questionnaire. Demographic risk factors for cataracts included older age and lower socioeconomic status. Nuclear cataracts were associated with diabetes (OR = 6.34; 95% CI: 2.34‑8.92%), tobacco chewing (moderate, OR = 3.04; heavy, OR = 4.62), cigarette smoking (moderate, OR = 1.58; heavy, OR = 1.87) and hypertension (OR = 1.56; 95% CI: 1.25‑2.78%). Cortical cataracts were associated with diabetes (OR = 15.03; 95% CI: 7.72‑29.2%), tobacco chewing (moderate, OR = 2.16; heavy, OR = 2.32) and cigarette smoking (moderate, OR = 2.20; heavy, OR = 2.97). Higher dietary intake of lutein/zeaxanthin (L/Z) and β‑carotene was associated (P < 0.001) with a lower risk of nuclear and cortical cataracts. Higher dietary intake of carotenoids is associated with a lower risk of cataracts. Nuclear and cortical cataracts are associated with various risk factors such as diabetes, hypertension, cigarette smoking and tobacco, similar to studies conducted in other Asian and European populations, irrespective of ethnic origin.

To report the outcomes of cataract surgery at a large referral eye hospital and to identify factors associated with less than excellent visual outcomes. Hospital records of patients, who had undergone age‑related cataract extraction (1,285 procedures) within a two‑year period were sampled randomly for 353 patients (405 eyes) and baseline characteristics were recorded. Up to three causes of visual loss (contributory reasons) were considered and the principal cause of “less than excellent outcome,” i.e., best spectacle corrected visual acuity (BSCVA) <20/25 was defined as the primary reason. Mean age of the participants was 68.6 years, and 50.7% of enrolled subjects were female. Phacoemulsification had been performed in 92.1% of cases. Out of 405 eyes, 54%, 78%, and 97% achieved BSCVA of ≥20/25, ≥20/40, and ≥20/200, respectively. Poor visual outcomes were significantly associated with older age (OR: 4.55 for age >70 years), female gender (OR: 4.64), ocular comorbidities (OR: 7.68), surgically challenging eyes (OR: 7.33), long and short eyes (versus eyes with normal axial length, OR: 3.24), and being operated on by a novice surgeon (OR: 2.41). The leading contributory reasons for unfavorable outcome, in descending order were maculopathy (17%), posterior capsule opacification (PCO, 11.8%), corneal opacity (5.7%), and degenerative myopia (5.4%). Maculopathy, PCO, corneal opacity, degenerative myopia and ARMD may contribute to unfavorable outcomes in cataract surgery.

To evaluate the effect of mitomycin‑C (MMC) on corneal endothelial cell density (ECD) and morphology after trabeculectomy. In this prospective comparative case series, 31 eyes with glaucoma underwent trabeculectomy with (group I), or without (group II) MMC. Specular microscopy was performed pre‑, and postoperatively at months 1 and 3. Outcome measures included central corneal endothelial cell count and coefficient of variation (CV) of cell size. Overall, mean preoperative ECD was 2,135.8 ± 397.6 cells/mm2; corresponding values at postoperative months 1 and 3 were 2,019.6 ± 447.2 cells/mm2, and 1,991.4 ± 425.5 cells/mm2, respectively (P > 0.05). Cell loss from month 1 to 3 was 1.3 % (P > 0.05). Subgroup analysis showed significant differences in endothelial cell loss at month 1 (P = 0.048) and month 3 (P = 0.014) between the MMC and control groups with no significant difference between the two groups in terms of cell loss from months 1 to 3, postoperatively (P = 0.968). Overall, mean pre‑and postoperative CVs at months 1 and 3 were 27.38 ± 4.55, 27.96 ± 4.26, and 28.35 ± 4.47, respectively, with no significant difference between the two groups (P > 0.05). There was no correlation between preoperative central endothelial cell density (CECD) and MMC related cell loss. MMC application in trabeculectomy seems to cause a small but significant corneal endothelial loss. Most of the damage occurs intraoperatively, or in the early postoperative period, however progressive endothelial cell loss is not a major concern.

To evaluate the outcomes of botulinum toxin injection into the inferior oblique (IO) muscle for management of unilateral acute traumatic superior oblique (SO) palsy. In this prospective case series, 10‑20 units of botulinum toxin A (Dysport, Ipsen, Biopharm Ltd., Wrexham, UK) was injected into the ipsilateral IO muscle of 13 consecutive patients with unilateral acute traumatic SO palsy. All patients received injections within four weeks of the incident. Mean age was 29 ± 15 years and 12 (92%) subjects were male. Mean amount of hypertropia (in primary position) was decreased from 10.0 ± 3.9∆ at baseline to 4.6 ± 8.9∆, one month after the injection, and to 1.5 ± 2.7∆ at final follow‑up (P = 0.001). IO overaction improved from 2.7 ± 0.6 to 1.0 ± 1.2 and 0.6 ± 0.9 (P ≤ 0.001), and subjective torsion from 5.3 ± 3.9 to 3.2 ± 3.4 and 1.6 ± 2.5 degrees (P ≤ 0.001), at the same time intervals respectively. One month after the injection as well as at final follow‑up, 10 (77%) patients were diplopia‑free in primary and reading positions. Subgroup analysis showed that patients who recovered had less baseline hypertropia as compared to those who failed (8.3∆ vs. 15.7∆, respectively; P = 0.01). All patients with a favorable outcome had baseline hypertropia of 10∆ or less. A single injection of BTA into the IO muscle can rapidly and safely resolve symptomatic diplopia in patients with acute traumatic SO palsy, while waiting for spontaneous recovery.

To evaluate cortical activity using pattern visual evoked potentials (PVEPs) in patients with mild and moderate amblyopia (esotropic and anisometropic). PVEP was recorded in 43 unilateral amblyopic patients, including 15 esotropic (ET) and 28 anisometropic (AM) patients, selected from three different medical centers in the city of Shiraz, Iran and compared to that obtained from 15 age and sex matched normal subjects who served as controls. Visual acuity (VA) in amblyopic eyes was equal to or less than 0.7 LogMAR. The latency of P100 was recorded monocularly using two check sizes of 15 and 60 min of arcs at two different levels of contrasts (30% and 100%). P100 latency in amblyopic eyes was significantly increased compared to the normal group (P < 0.001). There was a significant difference (P < 0.001) in P100 latency in anisometropic and esotropic amblyopic eyes as compared to normal subjects, using high spatial frequency and with both levels of contrast. A significant difference was observed with large check sizes and high contrast between anisometropic amblyopic and normal eyes (P = 0.03). However, there was no significant difference between these two groups and the control group with other stimuli. The neural response based on p100 latency in PVEP was different between amblyopic groups and normal subjects. PVEP may be valuable for diagnosis, prognosis and treatment of amblyopia.

Presence of neurophysiological abnormalities in dyslexia has been a conflicting issue. This study was performed to evaluate the role of sensory visual deficits in the pathogenesis of dyslexia. Pattern visual evoked potentials (PVEP) were recorded in 72 children including 36 children with dyslexia and 36 children without dyslexia (controls) who were matched for age, sex and intelligence. Two check sizes of 15 and 60 min of arc were used with temporal frequencies of 1.5 Hz for transient and 6 Hz for steady‑state methods. Mean latency and amplitude values for 15 min arc and 60 min arc check sizes using steady state and transient methods showed no significant difference between the two study groups (P values: 0.139/0.481/0.356/0.062). Furthermore, no significant difference was observed between two methods of PVEPs in dyslexic and normal children using 60 min arc with high contrast (P values: 0.116, 0.402, 0.343 and 0.106). The sensitivity of PVEP has high validity to detect visual deficits in children with dyslexic problem. However, no significant difference was found between dyslexia and normal children using high contrast stimuli.

To determine the prevalence and causes of blindness and visual impairment (VI) in Yazd, central Iran. This population‑based, cross‑sectional study was performed on adults aged 40–80 years, residing in Yazd district, in 2010–2011. Eligible subjects were selected using cluster random sampling. Each participant underwent an interview and complete ophthalmologic examination. Blindness and VI were defined as best‑corrected visual acuity (VA) <3/60 and < 6/18 in the better eye, respectively. Out of 2,320 eligible individuals, 2,098 participated in the study (90.4% response rate), of whom, 2,023 subjects completed all evaluations. The standardized prevalence of blindness and VI were 0.7% (95% confidence interval [CI], 0.3–1.0%) and 4.4% (95% CI, 3.3–5.4%), respectively which was significantly associated with older age (odd ratio [OR] = 3.2, 95% CI: 1.9–5.2 and OR = 3.1, 95% CI: 2.3–4.2, respectively) and female sex (OR = 3.6, 95% CI: 1.1–12.3 and OR = 1.7, 95% CI: 1.2–2.5, respectively). The proportion of avoidable causes of blindness and VI were 92.9% (95% CI: 80.0‑100.0%) and 76.6% (95% CI: 69.2‑85.0%), respectively. Major causes of blindness were diabetic retinopathy (50.0%), glaucoma (21.4%) and cataracts (14.3%) whereas main causes of VI were cataracts (41.5%), diabetic retinopathy (17.0%) and age‑related macular degeneration (13.8%). Diabetic retinopathy, glaucoma, cataract and age‑related macular degeneration were the leading causes of blindness and VI in Yazd, most of which are avoidable. Planning for prevention of blindness is highly recommended to decrease the proportion of avoidable blindness.

A cell line spontaneously derived from human retinal pigment epithelium (hRPE) was cultured on alginate film gelatinized with different concentrations of neurobasal cell culture medium (NCCM) to assess its growth and morphological behavior on this naturally occurring polysaccharide. Neonatal human globes were used to isolate hRPE cells. They were cultured in Dulbecco’s modified Eagle’s‑medium‑and‑Ham’s‑F12‑medium‑(DMEM/F12) supplemented with 10% fetal bovine serum (FBS). Cultures were continuously studied using phase contrast microscopy. After the nineth passage, cells were characterized through immunocytochemical analysis for Oct4, Chx10, and Pax6 and Ki67 markers. In each well of a 6‑well microplate, 1 and 2% weight/volume (w/v) alginate in deionized water was added and gelatinized using 1× and 10× NCCM. hRPE cells were cultured at a density of 2 × 105 cells/well in alginate‑coated microplates. After 5 days, hRPE colonies were harvested and re‑plated on polystyrene substrates. Morphology and growth of hRPE cultures were determined during the next 2 weeks. The first few passages of the cultures were purely hRPE cells that revealed typical morphological features of the pigmented epithelium. They made spaces, devoid of cells, between hRPE cell monolayer and fill in the unoccupied spaces. They grew faster than native RPE cells and rapidly overgrew. Immunocytochemical test revealed that the founded cells expressed Chx10, Pax6, Ki67 and Oct4. The hRPE cells survived unlimitedly on alginate film and formed giant adjoining colonies. After re‑plating, hRPE colonies adhered quickly on polystyrene and displayed native hRPE morphological features. Alginate film can support the survival and growth of hRPE cells and induce the cells to re‑organize in tissue‑like structures.

A two‑phase preclinical study was designed to determine the safe dose of intravitreal topotecan and its inhibitory effect on experimental choroidal neovascularization (CNV) in a rat model. In phase I, 42 rats were categorized into 6 groups, 5 of which received intravitreal topotecan injections of 0.125 µg, 0.25 µg, 0.5 µg, 0.75 µg, and 1.0 µg/5 µl, respectively; the control group received an injection of normal saline. Ophthalmic examination and electroretinography (ERG) were performed on days 7 and 28, and enucleated globes were processed for histopathology and immunostaining for glial fibrillary acidic protein. In phase II, CNV was induced via laser burns in 20 rats and the animals were divided into 2 groups. One group received topotecan and the other received normal saline intravitreally. Four weeks later, mean scores of fluorescein leakage on fluorescein angiography as well as mean CNV areas on histology sections were compared. In phase I, clinical, ERG and histopathologic results were unremarkable in terms of retinal toxicity in all groups. Based on the results of phase I, a dose of 1 µg/5 µl topotecan was chosen for phase II. Leakage scores obtained from late‑phase fluorescein angiography were significantly lower in topotecan‑treated than control eyes (P < 0.01) four weeks after induction of CNV. Compared to control eyes, topotecan‑treated eyes showed a significantly lower incidence of fibrovascular proliferation (8.7% vs. 96.2%) and significantly smaller areas of CNV (P < 0.01). Intravitreal injection of topotecan at a dose of 1 µg/5 µl is safe and may be a promising treatment for CNV.

To determine the proportion of patients with central serous chorioretinopathy (CSCR) mistaken for posterior uveitis and to identify the deleterious consequences. Charts of 1,657 patients admitted in the section of inflammatory eye diseases at the Center for Ophthalmic Specialized Care (COS) in Lausanne, Switzerland from 1995 to 2013 were reviewed. CSCR cases misdiagnosed as posterior uveitis or those with superimposed disease due to steroid therapy for uveitis were studied. Delay in diagnosis, specific erroneous uveitis diagnosis and evolution of the disease were also evaluated. Retrospectively, the most useful means for a correct diagnosis of CSCR were the original fluorescein angiography (FA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT) when available. Out of a total of 1,657 patients, 15 (0.9%) cases with CSCR were identified. These included 12 subjects misdiagnosed as posterior uveitis and 3 uveitis subjects with superimposed CSCR following corticosteroid therapy for uveitis. The presentation of the disease was largely influenced by improper and continued use of corticosteroids. CSCR is a rare but not negligible misdiagnosis in posterior uveitis representing approximately 1% of subjects from a collective series of uveitis cases at a referral center. Investigative measures such as FA, ICGA and OCT are crucial for reaching a correct diagnosis and avoiding disease aggravation due to corticosteroid therapy.

To report the use of intraoperative spectral domain optical coherence tomography (SD‑OCT) for detecting anatomical changes during macular surgery. In a consecutive case series, 32 eyes of 32 patients undergoing concurrent pars plana vitrectomy and intraoperative SD‑OCT for macular hole (MH), epiretinal membrane (ERM) and vitreomacular traction (VMT) were enrolled. Intraoperative changes in retinal thickness and dimensions of the macular hole were measured in patients with ERM and VMT following surgical manipulation using a hand‑held SD‑OCT device (iVue, Optovue Inc., Fremont, CA, USA). SD‑OCT images of sixteen eyes with macular hole were subjected to quantitative and qualitative analysis. All MH dimensions remained stable during consecutive stages of surgery except for MH apex diameter, which showed a significant decrease after internal limiting membrane (ILM) peeling (P=0.025). Quantitative analysis of ten patients with ERM showed a significant decrease in retinal thickness after membrane removal (P=0.018) which did not remain significant until the end of the procedure (P=0.8). In three cases, subretinal fluid was formed after ILM peeling. Quantitative analysis of five patients with VMT showed a decrease in retinal thickness during consecutive steps of the surgery, although these changes were not significant. In two cases, subretinal fluid was formed after ILM peeling. Intraoperative SD‑OCT is a useful imaging technique which provides vitreoretinal surgeons with rapid awareness of changes in macular anatomy during surgery and may therefore result in better anatomical and visual outcomes.

To determine the types and frequency of ocular conditions simulating retinoblastoma (pseudo‑retinoblastoma) at Farabi Eye Hospital, Tehran, Iran. We reviewed data of patients who were referred with a diagnosis of retinoblastoma to Farabi Eye Hospital oncology clinic, from January 2009 to July 2013. Examination under general anesthesia was performed for all patients. Other investigations, such as ultrasonography, were performed as required. Of a total of 331 patients (aged 1‑60 months), 138 (42%) were found to be suffering from a benign disorder. Among these pseudo‑retinoblastoma cases, Coats’ disease was the most prevalent codition (n = 36, 26%); persistent hyperplastic primary vitreous (PHPV) and familial exudative vitreo‑retinopathy (FEVR) were the next two common pseudo‑retinoblastoma cases in our series. The rate of misdiagnosis upon referral to our center was close to 40%. The most common pseudo‑retinoblastomas entities include Coats’ disease, PHPV and FEVR. An accurate diagnosis is essential for management of pseudo‑retinoblastoma cases.

Circumscribed choroidal hemangiomas are benign vascular hamartomas without systemic associations. Generally, they are orange‑red elevated masses, which are found posterior to the equator. Lesions are usually solitary and unilateral. Overlying subretinal fluid, serous retinal detachment and cystoid macular edema are common findings. Intravenous fluorescein angiography, indocyanine green angiography, ultrasonography, optical coherence tomography and enhanced depth imaging are helpful ancillary tests for diagnosis of circumscribed choroidal hemangiomas. Asymptomatic circumscribed choroidal hemangiomas do not require treatment. For symptomatic lesions with exudative retinal detachment or cystoid macular edema, photodynamic therapy has emerged as the treatment of choice with high rates of tumor regression, subretinal fluid resorption and minimal complications. Lens‑sparing external beam radiotherapy, plaque brachytherapy, proton beam therapy, stereotactic radiosurgery, transpupillary thermotherapy, laser photocoagulation and anti‑VEGF injections are other treatment modalities.

While genetic networks and other intrinsic mechanisms regulate much of retinal development, interactions with the extracellular environment shape these networks and modify their output. The present review has focused on the role of one family of extracellular matrix molecules and their signaling pathways in retinal development. In addition to their effects on the developing retina, laminins play a role in maintaining Müller cell polarity and compartmentalization, thereby contributing to retinal homeostasis. This article which is intended for the clinical audience, reviews the fundamentals of retinal development, extracellular matrix organization and the role of laminins in retinal development. The role of laminin in cortical development is also briefly discussed.

Glaucoma surgery is ripe for innovation. In the last few years, there has been a substantial increase in the number of devices approaching commercialization. While not all that is new is necessarily good, the role of these devices in changing glaucoma surgery is equally important in terms of both success and failure. Trabeculectomy, the most commonly performed incisional filtration surgery for glaucoma, is subjective by nature and certainly has risks. As devices aim to standardize glaucoma surgery, specifically subconjunctival filtration surgery, predictability and in turn safety should theoretically improve. This may allow the glaucoma surgeon to intervene earlier in the disease process, prevent more advanced vision loss and potentially decrease the burden of medications.

To report the clinicopathologic features of a case of conjunctival synthetic fiber granuloma. Case Report: A 6‑year‑old girl presented with a slow‑growing red nodule in the right inferior conjunctival sac with no history of surgery or trauma. Histopathological examination revealed foreign body type granulomatous inflammation around birefringent fibers of variable colors consistent with synthetic fiber granuloma. This is the first case report of synthetic fiber (teddy bear) conjunctival granuloma from Iran. Despite its scarcity, ophthalmologists should consider this type of granuloma in the differential diagnoses of childhood conjunctival lesions especially when the lesion is unilateral and inferior.

To report a case of late iatrogenic bleb formation and hypotony maculopathy after pterygium surgery applying Mitomycin C (MMC). Case Report: A 66‑year‑old man presented with an elevated, bleb‑like, fluid‑filled, cystic lesion on the nasal sclera of the right eye. The patient had undergone pterygium surgery with a combination of conjunctival autograft and adjuvant intraoperative MMC 0.02% four years before. The sclera seemed fistulized at the site of surgery and a thin layer of conjunctiva completely covered the lesion. A scleral patch graft was secured over the fistula with sutures, followed by excision of the thinned, avascular conjunctiva and advancement of the healthy adjacent conjunctiva to cover the patch graft. One month later, a small bleb re‑appeared adjacent to the scleral patch graft and IOP was 2 mmHg. Argon‑laser treatment of the bleb was tried to induce scarring and reduction of bleb size, and was highly effective. After one week, IOP was increased to 8 mmHg. The clinical features remained stable four months after initial presentation. Pterygium surgery using adjuvant MMC may result in late iatrogenic bleb formation and hypotony maculopathy. This complication can be successfully corrected surgically using a scleral patch graft combined with argon laser treatment over the inadvertent bleb.