مجله چشم پزشکی بینا
سال بیست و پنجم شماره 1 (پاییز 1398)

To evaluate the long-term results of Keratolimbal allograft (KLAL) in the management of Delayed-onset Mustard Gas Keratopathy (MGK).

This cross-sectional descriptive study considers those patients with documented MGK, who underwent KLAL between 2002 and 2016 in the Department of ophthalmology, Labbafinejad Medical Center. After obtaining consent, the patients were followed closely and finally recalled for complete ophthalmic examination. The, the data were statistically analyzed. The cumulative survival rate of the KLAL’s was the main measured outcome.

A total of 108 eyes of 68 cases of MGK underwent KLAL. All the patients were men with an average age of 54±6 years. The average follow-up duration was 81.9±38.4 months. KLAL types were: Segmental in 62, with Lamellar Keratoplasty (LKP) in 40 and with Penetrating Keratoplasty (PKP) in 6 eyes. Of these eyes, 88.1% underwent only one operation for stabilizing the ocular surface. Average BCVA did not change after KLAL except improving in those cases accompanied by LKP. After this follow-up, 75% of KLAL survived, with the best results in those with LKP. Infectious keratitis occurred in 6 (5.5%) eyes. No case of adverse effect secondary to systemic immunosuppression was reported.

KLAL techniques alone or with LKP are effective, durable, and visually acceptable in the replacement of damaged stem-cells and opacified cornea in cases of MGK.

To examine the visual and refractive results of cataract surgery by phacoemulsification method in patients with keratoconus.

In this retrospective study, the files of patients with keratoconus, who underwent phacoemulsification between 2008 and 2017, were evaluated. The intraocular lens power calculation formula was SRK/T. Post-operative visual and refractive results were analyzed.

A total of 36 eyes of 24 patients with the mean age of 61.2±8.7 (range: 42-73) were included. The mean post-operative spherical equivalent of refractive error significantly reduced (p<0.001). The mean pre- and post-operative cylinders showed no statistical significant difference (P=0.096). The mean corrected distance visual acuity (CDVA) significantly improved (P<0.001). The mean pre-operative keratometry obtained from biometry or topography showed no statistical significant difference (P=0.506).

Cataract surgery in patients with keratoconus and cataract, and intraocular lens power calculation, using SRK/T formula, have optimal results.

To investigate the prevalence of age-related cataracts in people older than 40 years, urban and rural regions covered by Iranshahr University of Medical Sciences in 2016.

This is a cross-sectional study (descriptive and analytic), in which all urban and rural population were screened by Iranshahr University of Medical Sciences. The primary screening examination in the health centers included a visual acuity test, a red reflex, a retinoscopy, and an assessment of anterior chamber with a flashlight and an ophthalmoscope were performed by an optometrist. Those with visual impairment or impaired red reflex were referred to an ophthalmologist. Lens opacity after pupil dilatation and biomicroscope examination were classified according to the Lens Opacity Classification System III (LOCS III) standard protocol. Information on gender, occupation, and education was recorded.

In the primary screening، 4352 patients were screened, of whom 230 (5.31%) patients had cataract and entered the study. A total of 125 women (54.34%) and 105 men (45.66%) over 40 years of age with abnormalities were studied. The age range of the participants in this study was at least 40 and at most 81 years and the mean age of the subjects was 61.2 ± 7.7 years. The overall incidence of cataracts was about 7.3% concerning the number of surgeries. However, the prevalence of abnormal membranes was 40.28% and the highest frequency was 68 (59.3%) in the age group of 60-69 years. The prevalence of age-related cataracts in rural areas was higher than in urban areas. In terms of occupation، 50 (49.7%) were workers and farmers. In terms of education، 102 (44.34%) were illiterate. Less than half of the patients (41.59%) had information about the causes of illness. Most patients (97.9%) agreed that they should undergo surgery, but most (64.72%) avoided doing it because of financial difficulties.

Several factors have been associated with age-related cataract. In our study, the role of occupation, age, place of residence،, and education level was more effective than other factors. The prevalence of this disorder was relatively lower in people with higher education and income، while better diagnosis and treatment were done earlier.

To determine features of eye trauma associated with self-trauma by pens and pencils among children.

Thirty-six children suffering from self-inflicted eye trauma with pens or pencils were included in this prospective cross-sectional study.

The age range of the participants was 2-14 years with an average of 5.6 years and a standard deviation of 2.7, with a male: female ratio of 1.76. The superomedial (55.5%) and inferomedial (30.6%) quadrants were the most common sites of injury. The leading culprit was colored pencils (44.4%). During surgical exploration, no foreign body (FB) was found in 25 (69%) patients while an FB was found in 11 (30%) patients. Brain injury was present in two patients (5.6%) and only in superomedial quadrant injuries. Zone 1 was the most common site for ocular trauma associated with penetrating injury. The mean ocular trauma score (OTS) in penetrating injuries was 3.8±1.2. The best-corrected visual acuity (BCVA) was 0.34±0.61 upon admittance and 0.08±0.21 after one year. The final BCVA was significantly correlated with the entrance site, better final BCVA was found in nasal entrance site.

The ophthalmologists should keep a high index of suspicion to rule out penetrating eye injuries related to writing instruments in a young uncooperative child. Brain injury is a life-threatening event that should be ruled out by appropriate imaging. Medial canthal area as the most common site needs especial attention in writing instrument injuries.

To investigate the frequency of depression and quality of life in patients with glaucoma.

This cross-sectional study included 204 patients (102 males and 102 females) with a mean age of 58.9±11.96 and a range of 40 to 85 years old. Achromatic perimetry was performed, using the HFA SITA-standard 24-2. Severity was stratified according to the Nelson Glaucoma Severity Scale (based on the degree of binocular visual field loss). Participants answered the Persian version of the NEI VFQ-25 and the depression part of the Persian version of the DASS-21. The mean score of each patient's response to depression and quality of life questionnaire were assessed and the frequency of depression among glaucoma subjects and mean the quality of life score in three groups of glaucoma were determined. In this study, patients with depression, who were under the supervision of a psychiatrist and using anti-depression drugs, patients with chronic physical conditions such as MS and Parkinson's or chronic eye diseases such as advanced cataracts, diabetic retinopathy, and Macular Degeneration were excluded from the study population.

The frequency of depression was 40.2% and the mean score of quality of life in these patients was 79.83 ± 19.77. The prevalence of depression in women with glaucoma was higher. People with severe glaucoma showed a lower quality of life and higher levels of depression.

Depression is common among patients. With increasing the severity of disease, their quality of life decreases and their depression increases. This is more likely in women with glaucoma.

To investigate the effect of smoking on corneal parameters, including Endothelial Cell Density, Central Corneal Thickness, Percent of Hexogonality, and Coefficient of Variation.

This study was a systematic review and meta-analysis of published articles until the end of February 2019. To do this, the first search was done for creditable medical databases such as PubMed, and ISI (Web of Science), using an article search strategy and keywords derived from MeSH, including cigarette, smoking, tobacco, and their derivatives and relevance. They were conducted with the keywords pachymetry and corneal thickness. All English and Persian related articles were extracted by two independent researchers and by a thorough review of the articles; the articles that met the inclusion criteria for the present meta-analysis were selected for analysis.

Initial search of 351 articles found that information of 8 studies was selected and entered into the present meta-analysis. The total number of participants was 588 in the cigarette smoking group and 602in the non-cigarette smoking group. The mean age of the two groups was 38.9 and 40.4 years, respectively, and 21% of the participants were female. Of the studies included in the present meta-analysis, all studies reported the information needed to analyze the CCT index. For CV, ECD, HEX, and AXIAL LENGTH indices 4, 4, 4, and 5 studies reported the information required for performing the meta-analysis, respectively. The results of the meta-analysis showed that smoking had no significant effect on any of the corneal parameters, including CCT, ECD, CV, AXIAL LENGTH, HEX (P=0.543, P=0.591, P=542, P= 0.231, P=0.584, respectively).

Smoking does not affect different parameters of the cornea. Due to the limited number of articles in this field, it is recommended to investigate the effect of cigarette smoking in more samples to compare the effect of cigarette smoking on high daily volume of corn.

To report a case of traumatic sclopetaria and to present a review on the mechanism of traum, disease prognosis, and treatment methods.

A 18-year-old male was assaulted with an air gun from a 3-meter distance. The projectile had entered the left orbit without rupturing the globe. He presented to the emergency room with BCVA of hand motion OS and 20/20 OD. He had a left rAPD. He had a 4-millimeter superonasal palpebral laceration. On funduscopic examination, there was Berlin’s edema in the posterior pole in addition to a sectoral chorioretinal rupture. The intact sclera was seen beyond the site of rupture. Orbital imaging revealed a 4-millimeter projectile captured in the orbital cavity, situated near the site of chorioretinal damage outside the globe. The patient was diagnosed with traumatic sclopetaria, and after the vitreoretinal specialist consult, he was planned to be observed. On follow-up examination, the ruptured structures were replaced by the pigmented scar, and BCVA was improved to finger counting.

Concomitant necrosis of the retina and choroid can be caused by penetrating orbit damage by high-velocity objects that stop without damading the globe in the orbit, and usually heals with extensive scarring at the site of necrosis and rupture. The patient's vision depends on the site of the trauma and the side effects of corticosteroids. There is no consensus on the treatment of this penetrating trauma and the decision is made based on the patient's condition. The main consensus in the management of these patients is their observation.

To Report a case of blindness due to hyaluronic acid filler injection.

 A 28-year-old female patient was referred to our clinic with complaints of vision loss in the left eye, which occurred one hour after hyaluronic acid filler injection for correction of detachment trough hollowness. In the ophthalmologic examination, relative afferent pupillary defect (RAPD) was positive in the left eye. Dilated fundus examination of the left eye revealed retinal edema and whitening in the inferotemporal macula consistent with a branch retinal artery occlusion. Cherry red spot was noticed in the central macula, along with scattered intraretinal hemorrhages. Fluorescein angiography demonstrated the blockage of the inferior branches of retinal circulation in the left eye and areas of patchy choroidal non-perfusion were revealed. Fluorescein angiography also demonstrated delayed filling in some of the proximal arteries in the left eye, but the pattern of filling was patchy. The Optical Coherence Tomography of the left eye demonstrated retinal inner layers edema starting just below the fovea. The patient underwent anterior chamber tap and ocular massage in primary hours of symptoms and, then, treatment with aspirin, systemic corticosteroid, acetazolamide, and nitroglycerin for one month. The visual acuity of the eye was No Light Perception (NLP) without any improvement after 3 days and even after 6 months after the treatment.

It is necessary to describe this complication, as well as its treatment process for patients, who undergo filler injection for cosmetic purposes. Additionally, the patients should be trained for an appropriate and prompt arrival with the least visual impairment.

To report a case of retained subretinal perfluorocarbon liquid (PFCL) after vitrectomy and to discuss the diagnosis and management of subretinal PFCL based on literature review.

A 57-year-old female patient underwent 3-port 23-gauge vitrectomy for advanced proliferative diabetic retinopathy and combined tractional and rhegmatogenous retinal detachment. During the surgery, PFCL and Silicon Oil injections were used to attach and stabilize the retina in the vitreous space with an endolaser. After the surgery and the follo-up, a small subretinal droplet at the macula outside the fovea was seen. Optical coherence tomography (OCT) revealed retained subfoveal PFCL, based on which the clinical and paraclinical characteristics suggested Retained Subretinal PFCL for the patient. The patient was successfully followed without complication because the volume of PFCL was low and the location of PFCL was outside the fovea. Reviewing the literature sheds light on the use of PFCL in retinal retinopexy and the retained PFCL characteristics in the subretinal space, differential diagnoses, and methods of dealing with Retained Subretinal PFCL.

Reviewing the literature over the past few decades introduces the various dimensions of this issue and the suitable approaches to deal with it. Based on the findings of OCT, retained PFCL can be distinguished from other similar cases and, according to the site of the retained fluid and the complications, decisions can be made concerning the appropriate treatment, including follow-up or surgery.