مجله چشم پزشکی بینا
سال بیست و چهارم شماره 2 (زمستان 1397)

To compare the effects and complications of lidocaine/adrenaline with Ropivacaine in candidates for upper-lid blepharoplasty. This study was conducted as a clinical trial. Forty patients with superior upper-lid blepharoplasty following local anesthesia were randomly divided into two groups. In the first group (intervention), ropivacaine and in the second group (control) lidocaine/adrenaline with the same volume as the local anesthetic were used. Then, the pain was measured, using VAS scale and bleeding and edema criteria with a clinical examination. The mean concentration of the required anesthetic drug in the intervention and control groups was 4.7 ± 0.4 ml and 4.8 ± 0.4 ml (P=0.445), respectively. In the anesthesia scale analysis, in all time intervals and in both intervention and control groups, the mean VAS of the patients was less than 3 and there was no significant difference between the two groups (P=0.374). Concerning postoperative edema in the intervention group, there was a significant decrease in swelling around the eyes as compared to the control group (P=0.015). As a local anesthetic agent in upper-lid blepharoplasty, Ropivacaine reduces pain and the incidence of postoperative edema and does not require the use of adrenaline to control the bleeding time of the surgery. Therefore, it can be used in high-risk surgical patients, for whom the adrenaline is not applicable.

To evaluate the association of osteoporosis and pseudoexfoliation syndrome. This case-control observational study was conducted on patients admitted to Baghaee Poor eye clinic of Shahid Sadoughi Hospital, Yazd, in 2015. The case group included 35 patients diagnosed with pseudoexfoliation syndrome and the control group included 35 patients with no evidence of pseudoexfoliation syndrome. Patients in both groups underwent bone densitometry. All questionnaires were completed by a physician. Finally, the results of the two groups were analyzed. There was a statistically significant difference between the mean lumbar spine bone mineral density in both groups (P=0.002; 95% CI: -0.82- -0.02), so that the mean for spinal bone density was -2.57±0.36 in the case group, and -1.48±0.02 in control group and difference between groups was -1.09±0.028. Moreover, the results showed no significant relationship between age and sex with incidence of osteoporosis in patients with pseudoexfoliation syndrome (P>0.05). The patients with pseudoexfoliation syndrome, compared with controls who did not have the syndrome, were under higher risk for developing osteoporosis. So, doing regular examinations in patients with pseudoexfoliation syndrome and in cases of high suspicion measurement of bone density could prevent developing osteoporosis among those patients.

To compare the central corneal thickness measured through Pentacam, OCTCasia2, and Orbscan IIz in normal individuals. In this cross sectional comparative study, the researcher investigated the eyes of 70 normal candidates (140 eyes) with the mean age of 31.42 ± 7.70, referring to Dr. Sedaghat eye clinic for refractive surgery. For each person, Central Corneal Thickness (CCT) was measured, using 3 devices including Pentacam, OCTCasia2 and Orbscan. The data were collected and analyzed. The Pearson Correlation Coefficient was employed to assess correlation of 3 devices with each other. Bland-Altman plot was also used to evaluate the agreement between devices. The mean CCT measured through Orbscan, Pentacam, and OCTCasia2 was reported to be 535.06±35.11 µm, 525.21±31.60 µm, and 511.06±30.87 µm, respectively. The Pearson Correlation Coefficient between Pentacam-OCTCasia2, OCTCasia2-Orbscan, Pentacam-Orbscan were r=0.955; P<0.001, r=0.913; P<0.001, r=0.941; P<0.001, respectively. There was a very good correlation and agreement between devices, but none of the devices had the ability to replace each other.

To evaluate study of corneal the frequency of re-graft during 5 years at Khalili hospital, Shiraz. In this retrospective observational study, all corneal re-grafts during 5 years (2009-2014) were assessed at Khalili Hospital, Shiraz. Demographic data of 76 cases, out of total of 1 190 transplants, were retrieved, including age, area of residence, primary disease, type of graft, cause of re-graft, and associated eye systemic diseases; then, the data were analyzed. The number of re-grafts during 5 years was 76 cases (6.38%). The most common procedure was penetrating keratoplasty and the most successful ones were deep anterior lamellar keratoplasty. The shortest interval to the next procedure was observed in cases of fungal infections and, then, in failed endothelial keratoplasties. The main causes of graft failure were endothelial dysfunction, infection, immunologic rejection, and recurrence of primary disease (14 cases). Male gender, type of primary disease, and associated ocular surface abnormalities were among risk factors. Considering high and fast rate of re occurrence of infection in grafts and the importance of controlling inflammation, treatment of surface abnormalities and infections as well as assessment of donor tissue before proceeding to surgery seem crucial.

To report a 3-decade eye bank data and activity of the Central Eye Bank of Iran (CEBI). All the eye bank records in terms of procured eyes, utilized tissues, corneal transplants per capita, and indications for keratoplasty over the last 3 decades were analyzed. During the last 27 years, 115 743 whole eyes were donated, among which 114 169 eyes were donated between 1994 and 2017. Out of 114 169 donated eyes, 95 314 eyes were sent for corneal graft and 95 057 corneas were finally transplanted. The mean rate of corneal transplants per capita per year was 55×10−6±27×10−6. Penetrating keratoplasty (PKP) was the most leading surgical technique between 2006 and 2017 (70%); however, unlike an increasing trend of Descemet stripping automated endothelial keratoplasty (DSAEK; P<0.001), it revealed a decreasing trend (P=0.048). Keratoconus (KCN; 39.7%), bullous keratopathies (BK; 18.5%), corneal scar and opacities (CSO; 15.7%), and graft failure (GF, 7.5%) were the 4 leading indications for keratoplasty in Iran; demonstrating an increasing trend for BK, GF, and KCN. 83.7% of the scleral tissues was used for protecting the orbital implants. Over the past 12 years, adverse reactions were reported in 0.088%. Over the last 3 decades, an increasing trend was observed for the procured eyes in the Central Eye Bank of Iran. KCN and BK were the most leading indications for keratoplasty. There was an increasing trend over the past 12 years for DSAEK, while PKP was the most common procedure for corneal transplantation. Considering the small amount of reported adverse reactions after corneal transplantations, it can be concluded that there is a high safety of corneal transplantation system from the eye bank to the recipients.

Normal level of eye protrusion is different in various populations and many factors such as age, sex, race, refractive error, and anthropometric characteristics affect it. There are limited studies in Iran about the normal amount of eye protrusion in healthy population and normal exophthalmometric values. In this meta-analysis, taking into account the results of the 4 studies, we decided to obtain a reference number in the normal Iranian population. The results of meta-analysis in 3 696 normal Iranian people showed that the average eye protrusion was 16.5 mm in men and 16.26 mm in women and there was no significant difference between two sexes (P=0.5). Also, in left and right eyes, this was 16.33 and 16.44 mm, respectively, which was not significant between two eyes (P=0.3). The mean exophthalmometric value was 17.10 in the Iranian population aged 13 to 19 and 16.32 in the population over 20 years, and the upper limit of exophthalmometry in the Iranian population was 20.15 mm, which is lower than in the western studies. It is essential to begin further evaluation of imaging and endocrine tests in the Iranian population when eye protrusion is over these standard values.

To report a case of bilateral congenital Ectropion and its management. A newborn with bilateral congenital upper eyelid Ectropion and sign of exposure keratopathy associated with bilateral cleft lip and palate was referred and underwent full thickness skin graft of both upper eyelids. Ectropion was corrected and sign of exposure keratopathy improved. Congenital upper eyelid Ectropion may be associated with cleft lip and palate and full thickness skin graft can be used for its correction.

Pregnancy leads to significant changes in the body, which potentially affect the retina. Pregnancy can induce disease such as that seen in hypertensive retinopathy and choroidopathy. It can cause exudative retinal detachments in the HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets), disseminated intravascular coagulation (DIC), and thrombotic thrombocytopenic purpura (TTP), and provoke arterial and venous retinal occlusive disease. Pregnancy may also exacerbate pre‑existing retinal disease, such as idiopathic central serous chorioretinopathy (ICSC) and diabetic retinopathy. Special consideration needs to be exercised when treating pregnant patients in choosing medications, as well as in selecting diagnostic modalities and surgical methods.