فهرست مطالب

Current Ophthalmology - Volume:32 Issue: 1, Jan-Mar 2020

Journal of Current Ophthalmology
Volume:32 Issue: 1, Jan-Mar 2020

  • تاریخ انتشار: 1399/04/11
  • تعداد عناوین: 13
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  • MohammadReza Akbari, Arash Mirmohammadsadeghi, Raziyeh Mahmoudzadeh, Amirreza Veisi* Pages 1-13
    Purpose

    To review various treatment methods in thyroid eye disease (TED) related strabismus.

    Methods

    We searched in PubMed and Google Scholar and Ovid MEDLINE for keywords including TED-related strabismus, strabismus in thyroid-associated ophthalmopathy, Graves’ ophthalmopathy related strabismus or squint, and restrictive strabismus. Two expert strabismus specialists selected and evaluated the English articles that were related to our paper and had been published since 2000. Some articles were added based upon the references of the initial articles.

    Results

    One hundred fifteen articles were found, 98 of which were mostly related to the topic of this review. Management of TED‑related strabismus was reviewed and categorized in non-surgical and surgical. Botulinum toxin A (BTA) is a useful non-surgical management of strabismus in an active TED and residual deviation after strabismus surgery. Postoperative under-correction is relatively more common in TED-related esotropia. Lateral rectus resection and BTA are the options to manage the problem. Muscle rectus muscle resection should be performed after maximum recession of restricted muscles. It should be avoided on a restricted or enlarged muscle. Management of TED-related vertical deviation is challenging. In these cases, the surgical treatment selected depends on forced duction test (FDT) (pre and intraoperative), orbital imaging (which muscle is enlarged), and the amount of vertical deviation (in both down-gaze and primary position).

    Conclusions

    TED‑related strabismus needs careful evaluation and management to achieve optimal outcome. Different surgical and non‑surgical options are available for intervention in TED-related strabismus.

    Keywords: Graves’ ophthalmopathy, Strabismus, Thyroid eye disease
  • Suneeta Dubey, Harleen Bedi, Manveen Bedi, Preeti Matah, Jigyasa Sahu*, Saptarshi Mukherjee, Lokesh Chauhan Pages 14-18
    Purpose

    To investigate the impact of glaucoma-associated vision loss on quality of life and social functioning in Indians.

    Methods

    A cross-sectional study with prospective enrollment was conducted. Participants were divided as: mild, moderate, and severe. Severity of glaucoma was stratified by the degree of binocular visual field loss in accordance with the Nelson Glaucoma Severity Scale (NGSS). The Glaucoma Quality of Life‑15 (GQL‑15) and a self‑developed social function scale (SFS) were utilized to assess patients’ wellbeing.

    Results

    A total of 260 patients (mean ± SD age = 58.1 ± 12.01 years; 106 females) participated in the study. Univariate analyses revealed a significant relationship between final quality of life score and number of anti‑glaucoma medications (P = 0.01), previous surgeries (P = 0.00), patients age (P = 0.00), patients education level (P = 0.02), and severity of glaucoma (P = 0.00). Previous surgeries (P = 0.04) and severity of glaucoma (P = 0.00) were significant predictors of GQL‑15 summary score. With increasing glaucoma severity, patients noted greater difficulty with peripheral vision, glare and dark adaptation, and outdoor tasks (P < 0.0001). Severe glaucoma also impacted patients’ functional performance—a significant decline was observed in sense of personal (P < 0.0001) and social wellbeing (P < 0.0001).

    Conclusions

    Patients with advanced glaucoma report significant decline in functioning, their ability to interact in community, take care of self, and do leisure activities. Glaucoma imposes greater social burden on the elderly by impacting their sense of personal safety. Targeted visual and social rehabilitative programs are necessary to improve their wellbeing and independent functioning.

    Keywords: Functional disability, Glaucoma, Indian patients, Quality of life
  • Alireza Peyman, Awat Feizi, Mazdak Ganjalikhani Hakemi, Fahimeh Hosseini Nasab, Mohsen Pourazizi* Pages 19-25
    Purpose

    To evaluate the multiple pretreatment characteristics and topographic factors of keratoconus (KC) patients and their relationship to clinical outcomes of corneal collagen cross-linking (CXL).

    Methods

    In this prospective study, 61 patients (106 eyes) with KC as candidates for CXL were included. Demographic data including age, sex, place of birth and residence, atopic constitution, family history, rubbing history, sleep apnea, and blood group were collected via a structured checklist. Complete ophthalmologic examination and tear collection to assess tear interleukin 6 (IL‑6) and tumor necrosis factor alpha (TNF‑α) level were performed. Topometric parameters were evaluated using a rotating Scheimpflug topography device. Changes in best corrected visual acuity (BCVA) and maximum keratometry (K-max) were considered the main predicted variables. Predictive variables were analyzed by univariate and multivariate regression.

    Results

    The use of multivariate analysis changes in K‑max was significantly associated with rubbing frequency (coefficient = 0.94, P = 0.02), blood group (coefficient = 4.52, P = 0.005), pretreatment corneal asphericity (coefficient = −3.99, P ≤ 0.001), and pretreatment central keratoconus index (CKI) (coefficient = −55.38, P = 0.001). Regarding the changes in BCVA, the multivariate analysis showed a significant association with place of birth (coefficient = −0.08, P = 0.03), pretreatment BCVA (coefficient = −0.67, P < 0.001), pretreatment central corneal thickness (CCT) (coefficient = −0.005, P = 0.04), and pretreatment keratoconus index (KI) (coefficient = 0.53, P = 0.04). Other parameters assessed in the multivariable analysis did not appear to have an individual effect on treatment outcomes.

    Conclusion

    Our results demonstrated that blood group, rubbing of eye, place of birth, corneal asphericity, pretreatment BCVA, CKI, KI, and CCT were statistically associated with the outcome of KC following CXL.

    Keywords: Cornea, Corneal topography, Cross-linking reagents, Interleukin 6, Keratoconus, Treatment outcome, Tumor necrosis factor alpha
  • Siamak Zarei Ghanavati, Bahareh Yahaghi*, Samira Hassanzadeh, Majid Ghayour Mobarhan, HamidReza Hakimi, Pardis Eghbali Pages 26-31
    Purpose

    To assess the possible association between keratoconus (KC) and serum levels of 25-hydroxyvitamin D (25OHD), Selenium (Se), Zinc (Zn), and Copper (Cu) and to compare it with age-matched healthy subjects.

    Methods

    One hundred patients with KC and 100 normal subjects were included. The two groups were compared for serum 25OHD and serum levels of three trace elements: Se, Zn, and Cu. These factors were also compared between groups with different KC stages.

    Results

    Serum levels of vitamin D, Zn, Cu, and Se were significantly different between the KC and normal groups (P = 0.006, P = 0.015, P = 0.004, and P = 0.038, respectively). Although a lower level of 25OHD was found in severe stages of KC, it was not significantly different among different KC groups (P = 0.441). KC stage groups were not significantly different for mean serum Zn, Cu, and Se (P = 0.130, P = 0.98, P = 0.113, respectively). Although the Cu/Zn ratio was higher in cases than in controls, there was no significant difference between the two groups and between KC stages (P = 0.168, P = 0.143, respectively).

    Conclusion

    Lower serum 25OHD, Cu, Zn, and Se were found in the KC group compared to the control group. The results of this study suggest that a lower antioxidative activity may be involved in the possible etiology of KC.

    Keywords: Cu, Keratoconus, Se, Serum 25-hydroxyvitamin D, Zn
  • María Camila Aguilar Sierra, Rosa Alvarado Villacorta, Claudia Palacio Pastrana* Pages 32-37
    Purpose

    To evaluate the effect of preoperative 0.09% bromfenac ophthalmic solution for the reduction of intraoperative miosis and pain in patients who have undergone femtosecond laser-assisted cataract surgery.

    Methods

    This prospective randomized clinical study included 65 patients with senile cataracts in the absence of significant ocular comorbidity. The patients received 0.09% bromfenac ophthalmic solution or control placebo twice a day for 3 days before surgery. Pupil diameter was measured at the initiation and finalization of femtosecond laser‑assisted cataract surgery, and pain quantification was assessed by an analogous pain scale after one day of follow-up.

    Results

    A total of 65 patients were randomly divided into two groups. Five patients were excluded due to defective coupling with the laser interface. Each of the 60 patients was randomized to receive preoperative topical treatment with either 0.09% bromfenac or 0.1% sodium hyaluronate. Baseline characteristics were similar between groups for age and gender. The mean change in horizontal and vertical pupil diameter from the preoperative to post‑femtosecond laser measurements were significantly less in the bromfenac group than in the placebo group (0.43 ± 0.6 vs. 1.71 ± 0.9, P < 0.001 and 0.40 ± 0.6 vs. 1.78 ± 0.9, P < 0.001, respectively). Compared with untreated patients, the quantification of pain one day after the procedure was significantly lower in the 0.09% bromfenac group (46.7% with a score of 3 vs. 50% with a score of 1, P < 0.001, respectively).

    Conclusions

    The maintenance of pupil dilation and the prevention of miosis were more effective in the 0.09% bromfenac group than in the control group. Likewise, the greater control of postoperative pain represented an additional significant benefit.

    Keywords: Bromfenac, Cataract, Femtosecond laser, NSAID, Pupil
  • Shreya Thatte*, Ankita B. Dube, Trupti Dubey, Malvika Krishnan Pages 38-45
    Purpose

    To assess the achievement of anatomical integrity after primary tectonic sclerokeratoplasty procedure and outcome after subsequent secondary procedures to manage devastating corneoscleral infection threatening the structural integrity of the eyeball.

    Methods

    This prospective interventional study comprised 60 patients with severe devastating corneoscleral pathology of infective origin with varying degrees of scleral involvement who underwent tectonic sclerokeratoplasty. They were grouped into three groups according to the involvement of scleral quadrants, i.e., Group A with only one quadrant, Group B with two quadrants, and Group C with more than two quadrants. The demographics, clinical features, microbiological status, postoperative complications, need for secondary procedures, and tectonic outcome in terms of anatomical success were analyzed in all three groups during follow-up between 2 and 5 years.

    Results

    The donor graft size in Groups A, B, and C was 9.5–10.5, 11–12, and 12.5–14 mm, respectively. Globe integrity after primary procedure was noted in all patients of Group A, 76% of Group B, and 38% of Group C. Reinfection was observed in 19 cases of Groups B and C, from which 5 Group C patients were eviscerated and 14 underwent regrafting. Postoperative complications (suture related, rejection, graft failure, and secondary glaucoma) were encountered more frequently in Group C patients. Secondary procedures (cataract/posterior segment surgery, secondary intraocular lens, and trabeculectomy) were required more in Groups B and C. After regrafting, 7 eyes were salvaged and 7 (3 in Group B and 4 in Group C) resulted in phthisis bulbi. Thus, tectonic outcome was achieved in 80% of cases.

    Conclusions

    Sclerokeratoplasty is an effective tectonic treatment for restoring the globe anatomy in severe corneoscleral infection. Outcome depends on involvement of scleral quadrants, graft size, and severity of disease. Subsequent regrafting procedures are required to overcome reinfection of the primary graft.

    Keywords: Corneoscleral, Infective sclerokeratitis, Reinfection, Scleral quadrant, Sclerokeratoplasty, Tectonic
  • Hassan Hashemi, AbbasAli Yekta, Negareh Yazdani*, Hadi Ostadimoghaddam, Mehdi Khabazkhoob Pages 94-98
    Purpose

    To review the published data about changes in the anterior chamber depth (ACD) in keratoconus patients.

    Methods

    In this systematic review and meta-analysis of observational studies, we reviewed the available and relevant literature on anterior segment changes in keratoconic eyes, with a special focus on the ACD, an effective factor in many surgical methods. Articles published up to December 2017 were identified in the following data sources: PubMed, Scopus, Ovid, ISI, ScienceDirect, and Google Scholar. Databases were comprehensively searched using the key words “Anterior Chamber Depth AND Anterior segment AND Keratoconus”.

    Results

    A total of 496 studies including these key words were detected. Four hundred fifty‑three studies were excluded, and overall 16 studies which precisely described the change in ACD were included in the literature review. The results show that with respect to the applied device, there was a statistically significant difference in ACD between keratoconic eyes and normal eyes except for Galilei analyzer.

    Conclusion

    Summarizing the results of studies, this review revealed that ACD is significantly deeper in keratoconic eyes as compared with normal eyes, which could be explained by the steeper corneal curvature.

    Keywords: Anterior chamber depth, Anterior segment, Keratoconus
  • Helen Chung*, Emi Sanders, Guillermo Rocha, Jamie Bhamra Pages 99-106
    Purpose

    To explore the opinions of Canadian ophthalmologists on refractive and presbyopia-correcting surgeries.

    Methods

    We distributed an online survey to the Canadian Ophthalmological Society members, covering laser refractive surgery (LRS), femtosecond laser-assisted cataract surgery (FLACS), lenticular refractive surgery (lenRS) that includes cataract refractive surgery (CRS) with premium intraocular lens (IOL) implantation, and presbyopia correction.

    Results

    There were 68 (7.6%) total respondents. Most respondents would not consider LRS (62.5%) nor FLACS (73.9%) for themselves. Male sex and performance of LRS or FLACS was significantly associated with consideration of these procedures for self. Most respondents (59.3%) would consider lenRS for themselves. The top method of personal presbyopia correction was spectacles, chosen by 52.5%.

    Conclusions

    When surveying the wide body of Canadian ophthalmologists, most respondents preferred spectacle correction of presbyopia and would consider lenRS, but not LRS or FLACS for themselves. Surgeons performing these procedures were more likely to consider them for self.

    Keywords: Femtosecond laser-assisted cataract surgery, Intraocular lens, Presbyopia, Refractive surgery
  • Elias Khalili Pour, Fatemeh Bazvand, MohammadReza Mehrabi Bahar, Mahmood Davood Abadi, Hooshang Faghihi* Pages 103-106
    Purpose

    To report a case of chronic myelogenous leukemia (CML) treatment with imatinib mesylate in the remission phase who developed unilateral macular choroidal neovascularization (CNV).

    Methods

    A 45-year-old male marketer with a 5-year history of CML treated with imatinib mesylate presented with 2 months history of progressive vision loss and metamorphopsia in the right eye.

    Results

    Fundus examination of the right eye revealed grey-white elevated retinal lesion with indistinct borders in the macula and retinal telangiectasia in the temporal macula. Fluorescein angiography (FA) and optical coherence tomography angiography (OCTA) confirmed the presence of CNV in the right eye. After treatment with anti-vascular endothelial growth factor (anti-VEGF), macular CNV regressed significantly.

    Conclusion

    Macular CNV must be kept in mind as a rare ophthalmic manifestation of patients with CML under treatment with imatinib even in the remission phase.

    Keywords: Bevacizumab, Choroidal neovascularization, Chronic myelogenous leukemia, Imatinib mesylate, Pachychoroid neovasculopathy
  • Argyrios Tzamalis*, Asterios Diafas, Paraskevi Riga, Iordanis Konstantinidis, Nikolaos Ziakas Pages 107-113
    Purpose

    To present a rare case report of Onodi cell-associated optic neuropathy, conducting a review of the literature.

    Methods

    A 36-year-old male presented with an 18-h history of acute deterioration of vision in his left eye (LE). Ophthalmic examination and Magnetic Resonance Imaging (MRI) were consistent with an Onodi cell-associated compressive optic neuropathy.

    Results

    Despite immediate, successful surgical decompression, severe optic nerve atrophy and permanent visual loss occurred during early postoperative period. The reported case gives rise to different hypotheses regarding pathophysiology that may lead to irreversible blindness. A systematic review of the respective literature is provided attempting to compare different approaches in the management of Onodi cell‑associated compressive optic neuropathy and assess their efficacy in the final visual outcome. Poor initial visual acuity (VA) may represent a bad prognostic factor. Moreover, age and gender do not seem to significantly influence the outcome.

    Conclusion

    This report and associated literature review highlight the importance of the radiologic characteristics and early diagnosis in the final visual outcome of the Onodi cell‑associated optic neuropathy. High level of suspicion is crucial for early diagnosis of mucoceles, which must be treated promptly by surgical and medical means to enhance visual recovery.

    Keywords: Acute visual loss, Compressive optic neuropathy, Mucocele, Onodi cell
  • AhmadReza Salehi Chaleshtori, Masoud Garshasbi, Ali Salehi, Mehrdad Noruzinia* Pages 114-118
    Purpose

    To investigate the presence of a probable genetic defect(s) that may cause primary congenital glaucoma (PCG) in a seven-year-old female patient.

    Methods

    A seven-year-old female patient and her family received genetic counseling and underwent full clinical examinations by an expert ophthalmologist. The patient’s genomic DNA was subjected to the targeted gene capture and next‑generation sequencing (NGS) along with Sanger sequencing method. The 3D structure prediction and stereochemistry analysis were performed for both mutant and wild-type forms of the CYP1B1 protein.

    Results

    The clinical examinations indicated that the diagnosis of PCG was correctly made. We identified a novel homozygous deletion in which a “C” nucleotide was deleted from the final exon of the Cytochrome P450 Family 1 Subfamily B Member 1 (CYP1B1) gene. The 3D molecular modeling of the CYP1B1 protein predicted significant structural changes could occur in this protein as a result of the mutation mentioned earlier. The stereochemistry analysis revealed mutant features of the protein, as well as significant misfolding and possible malfunctions in the mutant form of the CYP1B1 protein.

    Conclusions

    This mutation might cause a frameshift in the translation process, leading to the malfunction of the CYP1B1 protein and development of glaucoma. This newly‑identified mutation could be regarded as potential deletion mutation in genetic counseling and molecular examination for the detection of PCG disease in Iran.

    Keywords: Cytochrome P450 family 1 subfamily B member 1_CYP1B1_Deletion mutation_Iran_Primary congenital glaucoma
  • Mladen Bušić, Mirjana Bjeloš*, Biljana Kuzmanović Elabjer, Ana Križanović Page 119
  • Ai Hong Chen*, Nurul Farhana Abu Bakar, Patricia Arthur Pages 120-121