Journal of Current Ophthalmology
Volume:27 Issue: 3, Sep–Dec 2015

To compare long term efficacy of phacoemulsification in the early management of acute primary angle closure (APAC) after aborting an acute attack and performing laser peripheral iridotomy (LPI).
In this nonrandomized comparative prospective study, we included 35 subjects presenting with APAC who had responded to medical treatment and LPI with intraocular pressure (IOP) less than 25 mmHg. Twenty patients with visually significant cataract with visual acuity of IOP, number of medications, gonioscopy grading, and amount of synechiae were not significantly different at baseline between the two groups. Acute attack did not recur in any patient. There was more significant failure in the LPI Only group compared with the Phaco/LPI group (40% vs. 5%; p ¼ 0.02). There was a significant difference in final IOP between the two study groups (13.90 ± 2.17 vs. 17.8 ± 4.16 in the Phaco/ LPI and LPI Only groups, respectively; p ¼ 0.001). Patients in the Phaco-LPI group needed less medication than the other group at final followup. No serious complications have arisen from the immediate LPI or phacoemulsification.
Phacoemulsification is a safe procedure for preventing IOP rise after aborting acute primary angle closure if performed within a few weeks of the attack.

To evaluate the visual outcome and intraocular pressure changes after Visian Implantable Collamer Lens (ICL) implantation V4b and V4c (with central hole) for correction of high myopia.
A prospective, consecutive, interventional comparative case series of V4b and 4c ICL implantation was done in high myopic patients who were unsuitable for laser vision. The main outcome measures studied were uncorrected and corrected distant visual acuity (UDVA, CDVA), ICL vault, intraocular pressure (IOP), endothelial cell count (ECC), and development of subcapsular lens opacities. The patients were evaluated at postoperative 1,3,6, and 9 months.
A total of 62 eyes of 32 patients (24.56 ± 4.8 years) underwent V4b ICL implantation (21 non-toric, 41 toric ICL-TICL) with intraoperative peripheral iridectomy (PI), and 10 eyes of 5 patients (26.13 ± 3.8 years) had implantation of V4c ICL (4 non-toric, 6 TICL). The mean preoperative manifest spherical equivalent (MSE) was
9.98 ± 2.8 D and
9.14 ± 2.4 D in the V4b and V4c groups, respectively, which reduced to postoperative values of
0.24 ± 1.3 D and
0.2 ± 1.18 D, respectively. At the end of 9 months follow-up, mean ECC loss was 6.4% and 6.1%, mean vault was 573.13 ± 241.13 m, and 612 ± 251.14 m, respectively, in the V4b and V4c groups. Anterior subcapsular opacities were present in 6.9% and 3.14% of eyes with V4b and V4c groups, respectively. Four eyes from V4b (9.75%) and 1 eye from V4c (16.66%) had rotation of more than 30 and required realignment surgery, which was done successfully. Two eyes (3.22%) with V4b ICL implantation had high postoperative IOP (>35 mm Hg) due to blocked PI and required Nd:Yag laser iridotomy, which was done with successful control of IOP. The safety indices were 1.11 and 1.14, and efficacy indices were 1.4 and 1.5 in the V4b and V4c groups, respectively, at the end of 9 months.
ICL implantation is a safe and effective surgery for correction of high myopia. Implantation of ICL with a central hole showed negligible postoperative IOP fluctuations without a peripheral iridectomy.

To investigate the efficacy of Technolas 217Z eye tracking system (torsional component) in corneal surface irregularity and high order aberrations (HOAs) after photorefractive keratectomy
Patients with compound myopic astigmatism among persons demanding refractive surgery in Khatam-al-Anbia Eye Hospital with the mean age of 29 years were enrolled in this double-blind randomized interventional study. The mean spherical equivalent (SE) of refractive error was
4.75 diopters(D) (range:
1.5 to
7.0), and the mean astigmatism was 3 D (range:1.0 4). Many studies were performed for each patient including: A complete eye examination, visual acuity and Monocular contrast sensitivity evaluation, and refraction. Corneal topography, Orbscan II, and wavefront aberrometry were conducted. One eye was randomly assigned for aspheric treatment and applying eye tracking system. The other eye was treated without torsional eye tracking system. The outcome measures were uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), contrast sensitivity, corneal irregularity index in 3 mm and 5 mm optical zones in Orbscan II, and mean total HOAs at the 6-monthvisit.
Fifty eyes of 25 patients were enrolled. Mean UCVA was improved significantly in both the study and control groups in the 6-month post-operative follow-up. There was no significant difference between the 2 groups in UCVA and BCVA (P ¼ 0.185 and P ¼ 0.176, respectively). Total HOAs increased in both groups after PRK. However, they were lower in eyes treated with the eye tracking system (P Our study findings suggest that applying ‘Technolas 217z’ eye tracker system (Bausch and Lomb Advanced) results in a more regular anterior surface of cornea. Therefore, we recommend it for surface laser refractive surgery.

To compare the effect of Homatropine and Diclofenac eye drops for reducing pain after photorefractive keratectomy (PRK).
This randomized, double-masked, interventional study included 32 patients (64 eyes) who underwent bilateral PRK. After operation, patients received Homatropine eye drops in one eye and Diclofenac eye drops in the fellow eye for 48 h. The level of pain was evaluated using visual analogue scale (VAS), verbal rating scale (VRS), and pain rating index (PRI) at 0.5, 24, and 48 h after operation.
The level of pain was statistically similar between the two eyes half an hour after operation; however, Diclofenac eyes had significantly less pain 24 h after operation (1.7 ± 1.4 vs 5.8 ± 2.1, P The effect of Homatropine seems to be lower compared to Diclofenac for reducing pain after photorefractive keratectomy.

To determine the corneal elevation values and keratoconus indices in the 40- to 64-year-old population and their changes with aging.
The 6311 invitees of this study were selected through random cluster sampling, and 5190 of them participated in the study (response rate ¼ 82.2%). Here, we analyzed results of Pentacam acquisitions in 4148 respondents. Cases of keratoconus and forme fruste keratoconus (FFKC) were determined using topography and clinical data. Studied variables included keratoconus indices, central corneal thickness readings, maximum elevations on the anterior and posterior surfaces, and elevation values at the thinnest point, anterior steepest point, and posterior steepest point in healthy, FFKC, and keratoconus groups.
In all subjects, the mean maximum elevations were 6.80 ± 5.0 mm and 16.60 ± 7.7 mm on the anterior and posterior corneal surfaces, respectively. Maximum elevation values on the anterior and posterior corneal surfaces showed significant correlations in the keratoconus, FFKC, and healthy groups (P Anterior elevation values slightly increase with age, and keratoconus indices change as well. Elevation readings and keratoconus indices in the keratoconus group and FFKC cases are higher than the healthy corneas although their values could be compared with other studies on younger participants.

To investigate the medical profiles of patients referred to Iran Lens Clinic with myopic/myope-astigmatic refractive errors.
Medical records of 182 patients (364 eyes) with myopic/myope-astigmatic refractive errors that underwent orthokeratology contact lens wear and fulfilled a 6-month period of follow-up were recruited. Efficacy and safety of these contact lenses in improving the visual acuity and correction of the refractive errors were investigated. Time needed to achieve final targeted visual acuity and association of various factors in this time course and level of acuity were investigated. Complications related to these lenses that were recorded in the medical profiles were studied.
In manifest refraction, the amount of spherical equivalent and myopia decreased significantly after orthokeratology contact lens wear (P 0.1).
Patients with myopic refractive error lower than
5.0 Diopters achieved higher final visual acuities rather than patients with higher amounts of myopic refractive errors.

To assess the long-term visual acuity (VA) outcome after congenital cataract surgery at Imam Hossein Medical Center (Tertiary Referral Center) (2004e2014).
In this descriptive study, records of 120 patients with a history of congenital cataract surgery were studied. Those with traumatic, metabolic cataract, aged In this study, 20 males and 22 females with a mean age of 11.80 ± 6 years at their last visit were studied. Bilateral and unilateral cataract was seen in 69% and 31% of cases, respectively. Posterior and anterior subcapsular opacity was the most common (53.70%) and rarest (1.90%) type of congenital cataract, respectively. The mean age at the time of operation and surgical interval was 65 ± 66.6 (range: 1e200) and 12.9 ± 23.5 (range: 0e96) months, respectively. The most common method of refractive error correction was pseudophakia plus glasses (56.3%) with the mean best corrected visual acuity (BCVA) of 0.29 ± 0.28 LogMAR., The mean BCVA was 0.7 ± 0.53 LogMAR for aphakic patients correcting by glasses. In our study, amblyopia (56%), glaucoma (23.90%), and posterior capsular opacity (16.40%) were observed during their follow-ups on an average of 76 ± 65 months (median: 60, range: 6e240). Unilateral cataract, aphakia, nystagmus, female gender, and strabismus were risk factors of VA loss.
Based on our results, 56% of cases showed amblyopia. It could be due to late operation (especially in unilateral cases), longer surgical interval between two eyes, and no compliance of amblyopia therapy. Early detection through screening may reduce the rate of amblyopia. Refractive errors, visual acuity, amblyopia, glaucoma, posterior capsular opacity, and compliance of amblyopia therapy should be checked regularly at follow-up visits.

The study compared ocular biometry values using applanation and immersion techniques to determine the most applicable method for our tertiary training centre where personnel with different levels of experience and expertise in biometry take measurements used in calculation of required intraocular lens before cataract surgery.
The study was a prospective cross-sectional comparative study of different techniques of ocular biometry from diagnostic equipment (biometry probe 10 MHz Sonomed® A-scan (PACSCAN 300A, USA). Measurement variables were obtained among children and adults undergoing cataract surgery. Scleral (Prager) shell was used for the immersion technique followed by the contact technique by the same examiner.
The biometry values of 92 eyes of 92 adult were taken. Their ages ranged from 18 to 95 years with a mean of 64.7 (SD ± 12.9) years. There were 55 (59.8%) males and 37 (40.2%) females, with a male to female ratio of 1.5:1. Average axial length (22.0e24.4 mm) eyes were the most common eyes measured in 75 (81.5%) of the cases. The means of the axial lengths biometry values with immersion and contact technique were 23.66(±1.36) and 23.46 mm (±1.46); the axial length differences was 0.2 ± 0.26 mm (range 0.0e0.94 mm) and statistically significant (95% CI of the Difference 0.15 to 0.26, p ¼ 0.000). The Standard deviation SD (mm) of Individual Eye Axial Length showed a mean of 0.03 ± 0.04 (0.0e0.3) mm for immersion and for contact technique 0.14 ± 0.12(0.0e0.6)mm.
There was a significant difference in ocular biometry measurement with the contact and immersion ultrasound techniques. The immersion technique had better repeatability, thus it is ideal in a training hospital setting in a typical in sub-Saharan Africa who have limited resources to employ a dedicated person to do biometry; and where the different operators of A-scan machines have different levels of experience and expertise.

To determine the distribution of Zernike coefficients and higher order aberrations in a normal population and its relationship with age, gender, biometric components, and spherical equivalent.
During the first phase of the Shahroud cohort study, 6311 people of the 40-64 year-old population of Shahroud city were selected through random cluster sampling. A subsample of participants was examined with Zywave aberrometer (The Bausch & Lomb, Rochester, NY) to measure aberrations. Measurements of aberrations were done before cycloplegic refraction, and values generated from a minimum pupil diameter of 5 mm were reported in this analysis.
After applying exclusion criteria, 904 eyes of 577 people were analyzed in this study and mean age in this study was 49.5 ± 5.7 years and 62.9% were female. Mean root-mean-square (RMS) of the third
, fourth
, and fifth order aberrations was 0.194 mm (95%CI: 0.183 to 0.204), 0.115 mm (95%CI: 0.109 to 0.121), and 0.041 mm (95%CI: 0.039 to 0.043), respectively. Total RMS coma (Z3
1, Z3 1 , Z5
1, Z5 1 ), Total RMS trefoil (Z3
3, Z3 3 , Z5
3, Z5 3 ), and spherical aberration (Z4 0 ) in the studied population was 0.137 mm (95% CI:0.129e0.145), 0.132 mm (95% CI: 0.123e0.140), and
0.161 mm (95%CI:
0.174 to
0.147), respectively. Mean higher-order Zernike RMS in this study was 0.306 (95% CI: 0.295e0.318) micrometer, and in the multiple model, it significantly correlated with older age and short axial length. The highest amounts of higher-order RMS were observed in hyperopes, and the smallest in emmetropes. Increased nuclear opacity was associated with a significant increase in HO RMS ( p This report is the first to describe the distribution of higher-order aberrations in an Iranian population. Higher-order aberrations in this study were on average higher that those reported in previous studies.

To evaluate the macular thickness changes in diabetic macular edema after meal.
In this prospective case series, macular thicknesses of diabetic patients with clinically significant macular edema (CSME) were measured after 7 h of fasting and repeated 2 h after breakfast.
Thirty six eyes of 20 diabetic patients were evaluated. The mean central subfield thickness (CST) and maximum retinal thickness (MRT) significantly decreased after meal (mean change of
10.3 ± 14.3 mm and
13.1 ± 12.7 mm, respectively, both P Retinal thickness measurements may change after meal. So, fasting state of diabetic patient should be considered in measurement of macular thickness of patients with CSME.

We describe a case of transient visual loss following cataract surgery with unpreserved intracameral lidocaine.
A 50-year-old man with posterior polar cataract underwent phacoemulsification. Following capsulorhexis and hydrodelineation with 0.5 cc of unpreserved lidocaine 1%, a portion of fluid reached behind the crystalline lens and caused the posterior capsule rupture. Cataract extraction and anterior vitrectomy were performed. Anesthetic administration was repeated to relieve the discomfort felt by the patient. A threepiece hydrophobic acrylic intraocular lens was implanted in the ciliary sulcus.
On the first postoperative morning, the patient's vision was recorded as having no light perception. The relative afferent pupillary defect (RAPD) was found to be 4þ. The retina and optic nerve head appeared normal. In the afternoon, the visual acuity (VA) was improved to 3-m count-finger. On the second postoperative morning, the patient's VA was improved to 4/10. On the third postoperative day, his VA returned to normal at 20/20 without RAPD.
In the event of posterior capsular rupture, to reduce retinal toxicity risks, intracameral lidocaine should not be repeated.

To report a case of Wolfram syndrome (WS) characterized by diabetes mellitus, diabetes insipidus, progressive optic atrophy, and deafness.
Case report: A 19-year-old female patient, a known case of diabetes mellitus type I from six years before, presented with progressive vision loss since four years earlier. On fundoscopic examination, she had bilateral optic atrophy without diabetic retinopathy. The patient also had diabetes insipidus, neurosensory deafness, and neurogenic bladder.
WS should be considered a differential diagnosis in patients with diabetes mellitus who present with optic atrophy, and it is necessary to perform a hearing test as well as collecting 24-h urine output.