Journal of Current Ophthalmology
Volume:27 Issue: 1, Mar–Jun 2015

Torticollis can arise from nonocular (usually musculoskeletal) and ocular conditions. Some facial asymmetries are correlated with a history of early onset ocular torticollis supported by the presence of torticollis on reviewing childhood photographs. When present in an adult, this type of facial asymmetry with an origin of ocular torticollis should help to confirm the chronicity of the defect and prevent unnecessary neurologic evaluation in patients with an uncertain history. Assessment of facial asymmetry consists of a patient history, physical examination, and medical imaging. Medical imaging and facial morphometry are helpful for objective diagnosis and measurement of the facial asymmetry, as well as for treatment planning. The facial asymmetry in congenital superior oblique palsy is typically manifested by midfacial hemihypoplasia on the side opposite the palsied muscle, with deviation of the nose and mouth toward the hypoplastic side. Correcting torticollis through strabismus surgery before a critical developmental age may prevent the development of irreversible facial asymmetry. Mild facial asymmetry associated with congenital torticollis has been reported to resolve with continued growth after early surgery, but if asymmetry is severe or is not treated in the appropriate time, it might remain even with continued growth after surgery.

To evaluate the effect of phacoemulsification on intraocular pressure (IOP) in pseudoexfoliation (PEX) syndrome and its diurnal variation. In this prospective, non-comparative, interventional case series, phacoemulsification was done for patients with PEX and concomitant visually significant cataract. Follow-up examinations including IOP measurement were done at postoperative day 1, week 1, month 1, month 3, and month 6. All IOP measurements were performed twice daily: once in the morning between 8 and 10 AM and the other in the evening between 6 and 8 PM. The minimum and maximum IOP and the mean IOP were recorded. IOP variation was defined as the difference between maximum and minimum pressures. Sixty-eight eyes of 68 patients were analyzed. The mean IOP dropped from 17.45 ± 3.32 mm Hg to 12.57 ± 1.58 mm Hg at 6 months. The minimum and maximum IOP dropped from 14.97 ± 3.46 mm Hg and 20.03 ± 3.39 to 11.53 ± 1.79 mm Hg and 13.01 ± 1.81 after 6 months, respectively. Diurnal IOP variation dropped from 5.06 ± 1.85 mm Hg (range 2–10) at baseline to 1.49 ± 0.93 mm Hg (range 0–4) at postoperative month 6 (p < 0.001 for all). This drop was not correlated with age and CCT, but was strongly correlated with baseline IOP variation (r = 0.847, p < 0.001). Phacoemulsification without any additional intervention can be an attractive choice in managing the IOP and its diurnal variations in pseudoexfoliation patients, even with elevated IOP, who do not have advanced optic nerve damage.

The aim of this study was to assess the cost-effectiveness of confocal scan laser ophthalmoscopy (HRT II) and compare it with scanning laser polarimetry (GDx) for diagnosing glaucoma. A cost-effectiveness analysis was performed at two eye hospitals in Iran. The outcome was measured as the proportion of correctly diagnosed patients based on systematic review and Meta analysis. Costs were estimated at two hospitals that used the HRT II (Noor Hospital) and current diagnostic testing technology GDx (Farabi Hospital) from the perspective of the healthcare provider. The incremental cost-effectiveness ratio (ICER) was estimated on the base scenario. Annual average costs were estimated as 12.70 USD and 13.59 USD per HRT II and GDx test in 2012, respectively. It was assumed that 80% of the maximum feasible annual tests in a work shift would be performed using HRT II and GDx and that the glaucoma-positive (Gl+) proportion would be 56% in the referred eyes; the estimated diagnostic accuracies were 0.753 and 0.737 for GDx and HRT II, respectively. The incremental cost-effectiveness ratio (ICER) was estimated at USD44.18 per additional test accuracy. In a base sensitivity sampling analysis, we considered different proportions of Gl+ patients (30%–85%), one or two work shifts, and efficiency rate (60%–100%), and found that the ICER ranged from USD29.45to USD480.26, the lower and upper values in all scenarios. Based on ICER, HRT II as newer diagnostic technology is cost-effective according to the World Health Organization threshold of <1 Gross Domestic Product (GDP) per capita in Iran in 2012 (USD7228). Although GDx is more accurate and costly, the average cost-effectiveness ratio shows that HRT II provided diagnostic accuracy at a lower cost than GDx.

To determine the normal distribution of corneal diameter in a 40- to 64-year-old population and its association with other biometric components. In a cross-sectional population-based study, subjects were selected through multistage cluster sampling from the 40- to 64-year-old citizens of Shahroud in northern Iran. After obtaining informed consents, optometry tests including refraction and visual acuity and ophthalmic exams including slit lamp exams and retinoscopy were done for all participants. Biometric components and white-to-white (WTW) corneal diameter were measured with the LENSTAR/BioGraph. Of the 6311 invitees, 5190 (82.2%) participated in the study. After applying exclusion criteria, analysis was done on data from 4787 people. Mean WTW corneal diameter in this study was 11.80 mm (confidence interval: 11.78–11.81), and based on two standard deviations from the mean, the normal range for this index was from 10.8 to 12.8 mm. WTW corneal diameter strongly correlated with corneal radius of curvature (r = 0.422) and axial length (r = 0.384). According to multiple linear regression, lower age, thinner cornea, longer AL, thicker lens, and flatter cornea were significantly related to higher WTW corneal diameter. Spherical equivalent significantly increased at higher corneal diameters (hyperopic shift). The average and normal range of corneal diameter, as measured with the BioGraph, was studied in an Iranian population for the first time. The corneal diameter strongly correlates with AL and radius of curvature. WTW is larger at younger ages.

To report the results of intrastromal corneal ring segment (KeraRing; Mediphcose, Belo Horizonte, Brazil) implantation relative to depth of insertion in keratoconic patients. In this retrospective, observational study, we evaluated 29 eyes of 27 patients with keratoconus who underwent implantation of KeraRing SI-5 with mechanical tunnel creation. In the mean follow-up of 8.8 months, all eyes underwent scheimpfluge image of pentacam (Oculus, Germany) to determine insertion depth. Based on the measured implantation depth, cases were categorized into: 40–59% thickness group, 60–79% thickness group, and ≥80% thickness group. Visual, refractive, and shape outcomes were evaluated relative to implantation depth. The mean insertion depth was 61.7%.We had 41.4% of cases were in the 40–59% thickness group, 51.7% in the 60–79% group, and 6.9% in the >80% group. Results were similar in 40–59% and 60–79% thickness groups: uncorrected visual acuity (UCVA) and best spectacle corrected VA (BSCVA) improved 3 and 2 lines, respectively, maximum keratometry (Kmax) decreased 2.6 D, refractive cylinder improved 2.04 D, and Q value 8 mm anterior changed by 0.35. In the ≥80% thickness group, UCVA and BSCVA improved less than 1 lines, Kmax change was less than 0.5 D, and RC decreased less than 0.25 D. Implantation of KeraRing with mechanical tunnel creation in 40–80% of stromal thickness despite the variable insertion depth is effective.

The present study aims at investigating and comparing the vision-related quality of life of myopic persons who wear spectacles or contact lenses with those who have undergone refractive surgery. It also compares the vision-related quality of life of these two groups with that of emmetropes. In this study, the questionnaire of evaluation instrument of refractive error in quality of life (NEI/RQL-42) was used to compare the quality of life between 154 myopic patients with spectacles and contact lenses, and 32 patients who have undergone refractive surgery. The two groups were also compared with 54 emmetropes. The questionnaire included 13 different subgroups (score 0–100) related to vision. Data was analyzed using SPSS software. The overall score of quality of life in emmetropes (95.11 ± 4.23) was more than that in persons who had undergone refractive surgery (86.98 ± 4.73), and it was the least in the group wearing spectacles or contact lenses (78.30 ± 9.21), (P < 0/001). Furthermore, except for a glare variable, the studied groups indicated a statistically significant difference in all the thirteen subgroups of vision-related quality of life. Quality of life for people with myopia who had the refractive surgery was better than people with myopia who wore spectacles or contact lenses. Although quality of life in people with myopia who had the refractive surgery was less than emmetropia, it seems that refractive surgery improves quality of life of myopic patients.

To evaluate conjunctival epithelial neoplastic lesions in a 7-year period. The data of all primary cases of conjunctival neoplasia diagnosed in the Pathology Department of Farabi Eye Hospital were analyzed. The patient group consisted of 179 (65.3%) males and 95 (34.6%) females, with an age range of 14–90 years and a mean age of 57.9 years. The most common primary conjunctival epithelial neoplastic lesion was invasive squamous cell carcinoma (SCC) (40.8%), followed by dysplasia (17%), papilloma (16.4%), In situ SCC (16%), actinic keratosis (7.3%), basal cell carcinoma (0.7%), xeroderma pigmentosum (0.7%), and mucoepidermoid carcinoma (0.3%). Of 274 lesions, 47 (17.1%) were benign, 159 (58%) were malignant, and 68 (24.8%) were precancerous. Compared to the results of a previous study of this center (1990–2004), the incidence of precancerous lesions has slightly increased whereas the incidence of SCC has decreased (22.1% vs. 24.8% and 59% vs. 40.8%, respectively). SCC is the most common conjunctival epithelial neoplasm in this study, and its prevalence in males is nearly two times higher than in females. The high percentage of squamous cell carcinoma can likely be attributed to elevated sun exposure and ultraviolet light in Iran.

The aim of this study was to investigate the rate of monosomy 3 by CISH technique in Iranian patients with uveal melanoma (UM) and its correlation with clinical and histopathological features. Archival formalin fixed, paraffin-embedded material from 50 patients who had undergone enucleation for large uveal melanomas was obtained. Monosomy of chromosome 3 alteration by chromogenic in situ hybridization (CISH) was investigated. Clinical and histopathological features of tumors were collected. The patients had a mean age of 56.6±7.6 years. Mean basal diameter and thickness of tumors were 14.1 mm and 10.2 mm, respectively. Four patients (8%) were identified to harbor monosomy of chromosome 3. In the mean follow-up of 5.3 years (range, 3.2–9.5 y), only one case with monosomy 3 died of UM metastasis. The most common type of cellularity was mixed cell (86%).There was not any statistically significant correlation between monosomy of chromosome 3 and type of cellularity, ciliary body involvement, and largest basal diameter. The low rate of monosomy chromosome 3 and the consequent low rate of mortality may be indicative of good prognosis in Iranian patients with uveal melanoma.

To evaluate the fluorescein angiography and infrared autofluorescence finding in patients with confirmed Behcet׳s disease (BD) but without clinical ocular signs. In this prospective, non-interventional case series, montage fluorescein angiography (MFA) and infrared autofluorescence imaging were performed for all patients with confirmed BD but without ocular signs in clinical examination. Fifty BD patients (100 eyes) without clinical ocular manifestations were investigated. In MFA, we found fluorescein angiography (FA) leakage in 22 cases (44%) in both eyes, mostly at the periphery of retina. In infrared autofluorescence, profound changes were found in 43 patients, 86 eyes (86%). Twenty-five patients, 50 eyes (50%), presented retinal vascular branching modifications, straightening, tortuosity, and shunt. MFA of retina may be useful in patients with presumed BD for early diagnosis, early treatment, and follow-up of patients.

To determine the prevalence of refractive errors, among 6- to 15-year-old schoolchildren in the city of Dezful in western Iran. In this cross-sectional study, 1375 Dezful schoolchildren were selected through multistage cluster sampling. After obtaining written consent, participants had uncorrected and corrected visual acuity tests and cycloplegic refraction at the school site. Refractive errors were defined as myopia [spherical equivalent (SE) −0.5 diopter (D)], hyperopia (SE ≥ 2.0D), and astigmatism (cylinder error > 0.5D). 1151 (83.7%) schoolchildren participated in the study. Of these, 1130 completed their examinations. 21 individuals were excluded because of poor cooperation and contraindication for cycloplegic refraction. Prevalence of myopia, hyperopia, and astigmatism were 14.9% (95% confidence interval (CI): 10.1–19.6), 12.9% (95% CI: 7.2–18.6), and 45.3% (95% CI: 40.3–50.3), respectively. Multiple logistic regression analysis showed an age-related increase in myopia prevalence (p << 0.001) and a decrease in hyperopia prevalence (p << 0.001). There was a higher prevalence of myopia in boys (p<<0.001) and hyperopia in girls (p = 0.007). This study showed a considerably high prevalence of refractive errors among the Iranian population of schoolchildren in Dezful in the west of Iran. The prevalence of myopia is considerably high compared to previous studies in Iran and increases with age.

To compare the prevalence of refractive errors, amblyopia, and strabismus between hearing-impaired and normal children (7–22 years old) in Mashhad. In this cross-sectional study, cases were selected from hearing-impaired children in Mashhad. The control group consisted of children with no hearing problem. The sampling was done utilizing the cluster sampling method. All of the samples underwent refraction, cover test, and visual examinations. 254 children in the hearing-impaired group (case) and 506 children in the control group were assessed. The mean spherical equivalent was 1.7 ± 1.9 D in the case group, which was significantly different from the control group (0.2 ± 1.5) (P < 0.001). The prevalence of hyperopia was 57.15% and 21.5% in deaf and normal children, respectively, but myopia was mostly seen in the control group (5.5% versus 11.9%, P = 0.007). The mean cylinder was 0.65 ± 1.3 D and 0.43 ± 0.62 D in deaf and normal subjects, respectively (P = 0.002). 12.2% of deaf subjects and 1.2% of normal subjects were amblyopic (P < 0.001), and the prevalence of strabismus was 3.1% in the case group and 2.6% in the control group (P = 0.645). In a comparison of children of the same ages, hearing-impaired children have significantly more eye problems; therefore, a possible relation between deafness and eye problems must exist. Paying attention to eye health assessment in hearing-impaired children may help prevent adding eye problems to hearing difficulties.

To report a case of perfluorocarbon liquid (PFCL) migration into the subarachnoid space at the time of vitreoretinal surgery in a patient with morning glory syndrome associated retinal detachment.Case report: A 9-year-old girl underwent pars plana vitrectomy and silicone oil injection for retinal detachment associated with morning glory syndrome. PFCL was used for retinal stabilization before endolaser photocoagulation. The retina detached, and repeated vitrectomy and silicone oil injection was performed. Postoperative magnetic resonance imaging revealed PFCL in the subarachnoid space. The migration of perfluorocarbon into the subarachnoid space is a rare complication of vitrectomy in patients with morning glory syndrome.

To report a case of Idiopathic retinal vasculitis, arteriolar macroaneurysms, and neuroretinitis (IRVAN). syndrome in a young female.Case report: A 21-year-old woman presented with unilateral visual acuity (VA) loss. Ophthalmological examination disclosed unilateral optic disc swelling, star-shaped macular exudation, multiple aneurysms surrounded by perivascular exudation, retinal vasculitis, and mild vitreous reaction. The left eye examination was entirely normal. Clinical and paraclinical findings were compatible with IRVAN syndrome criteria. The patient was treated with a short course of oral steroid, a trans-septal triamcinolone acetonide injection, selective laser photocoagulation in peripheral non-perfusion areas, and intravitreal bevacizumab. In spite of primary good response, after each treatment cessation, VA dropped with increasing central macular thickness (CMT), but response to intravitreal triamcinolone (4 mg/0.1 cc) was permanent and good. IRVAN syndrome can have unilateral presentation. All treatment options were temporary except intravitreal steroid injection in our case. The effect of steroid in IRVAN will need further evaluation.