Journal of Ophthalmic and Vision Research
Volume:14 Issue: 4, Oct Dec 2019

This study investigates the effects of 0.05% topical tacrolimus as an adjunct therapy for patients with non-necrotizing herpetic stromal keratitis (HSK).

Patients with non-necrotizing HSK, referred to the Cornea Clinic at Hospital in Rasht, Iran, between September 2016 and February 2018, were randomly assigned to two groups. The case group (N = 25) and the control group (N = 25) received conventional treatment with systemic acyclovir and topical prednisolone. The case group (N = 25) additionally received 0.05% tacrolimus eye drops four times a day for one month. Complete ocular examinations, including best-corrected visual acuity (BCVA) assessment, intraocular pressure (IOP) measurement, slit lamp biomicroscopy, and photo slit lamp imaging, were performed before treatment, and 3, 7, 14, 21, and 28 days after the intervention.

The mean age of the patients was 46.2 ± 12.9 years, and 70% of the patients were male. There was no difference between the groups in terms of age, sex, and baseline ocular measurements (P > 0.05). The case group had a lower mean logarithm of the minimum angle of resolution (LogMAR) for BCVA, lower grading scores, and steeper decreasing trends for corneal haziness, edema, neovascularization, and epitheliopathy compared to the control group after the second week (P < 0.05), while IOP remained unchanged between groups (P > 0.05).

The addition of 0.05% topical tacrolimus enhances visual acuity and reduces corneal inflammation, neovascularization, and scarring; thus, it can used as an appropriate adjunct treatment for patients with HSK.

To evaluate the efficacy, safety, and steroid-sparing effect of topical cyclosporine A (Cs A) 0.05% in patients with moderate to severe steroid dependent vernal keratoconjunctivitis (VKC).

A prospective, comparative, placebo controlled study was carried out on 68 VKC patients, with 34 patients treated with topical Cs A 0.05% and the remaining 34 with topical carboxymethyl cellulose 0.5% (placebo). Both groups also received topical loteprednol etabonate 0.5%. Symptom (itching, photophobia, tearing, and discharge) score, sign (tarsal and limbal papillae, corneal involvement, and conjunctival hyperemia) score, and drug score (steroid drop usage/day/eye) were recorded at baseline and each followup visit. The intraocular pressure (IOP) measurement and evaluation of any ocular side effects were carried out.

Significant reduction in symptom score and sign score was seen in both groups. Cs A group significantly showed more reduction in symptom (P < 0.0001 in all follow-up visits) and sign (P < 0.0001 in all follow-up visits) scores compared to the placebo group. At day 7, mean steroid usage reduced from 4 to 3.44 ± 0.5 and 3.79 ± 0.4 in Cs A and placebo groups, respectively (P < 0.0001). Steroid drops completely stopped in 21 patients at day 60 in the Cs A group compared to none in the placebo group. No significant rise in IOP or any side effects were noted in either group.

Topical Cs A 0.05% is effective and safe in patients with moderate to severe VKC with good steroid-sparing effect.

To evaluate ocular surface alterations in two populations at different exposure levels to particulate matter (PM) in their living and work environments.

A cross-sectional study was conducted, including 78 volunteers from Argentina who lived and worked under different pollution levels in an urban (U; n = 44) or industrial zone (I; n = 34). Mean exposure level to PM was evaluated. Responses to the Ocular Symptom Disease Index and McMonnies questionnaire were obtained from all subjects. Subsequently, an assessment through the Schirmer I test (ST), slit lamp microscopy, vital staining, and tear breakup time was conducted. Statistical analyses with Chi-square and Bartlett’s tests, as well as Student’s t-tests and principal component analysis (PCA), were performed.

Particles of size < 2.5 μm (PM2.5) level was significantly higher in the I group than the U group (P = 0.04). Ocular surface parameters including bulbar redness, eyelid redness, and the degree of vital staining with fluorescein (SF) and lissamine green (SLG) exhibited difference between the groups. With regards to the tear film, statistically significant differences in the ST value and meibomian gland dysfunction between the groups were detected (P = 0.003 and P = 0.02, respectively). Conjunctival SF and SLG, and ST values were identified as factors which could distinguish groups exposed to different PM levels.

Subjects exposed to higher levels of PM in the outdoor air presented greater ocular surface alterations. Thus, ST, SF, and SLG values could be used as convenient indicators of adverse health effects due to exposure to air pollution.

To evaluate the effect of MyoRing implantation on corneal asphericity in moderate and severe keratoconus (KCN).

This cross-sectional observational study comprised 32 eyes of 28 patients with KCN, who had femtosecond-assisted MyoRing corneal implantation. The primary outcome measures were preoperative and six-month postoperative corneal asphericity in 6-, 7-, 8-, 9-, and 10-mm optical zones in the superior, inferior, nasal, temporal, and central areas. The secondary outcome measures included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, thinnest location value, and keratometry readings.

A significant improvement in the UDVA and CDVA was observed six months after the surgery (P < 0.001) with a significant reduction in the spherical (4.67 diopters (D)) and cylindrical (2.19 D) refractive errors. A significant reduction in the corneal asphericity in all the optical zones and in the superior, inferior, nasal, temporal, and central areas was noted (P < 0.001). The mean thickness at the thinnest location of the cornea decreased from 437.15 ± 30.69 to 422.81 ± 36.91 μm. A significant corneal flattening was seen. The K1, K2, and Km changes were 5.32 D, 7 D, and 6.17 D, respectively (P < 0.001).

MyoRing implantation is effective for improving corneal asphericity in patients with KCN. It allows successful corneal remodeling and provides a significant improvement in UDVA, CDVA, and refractive errors.

The purpose of this study was to evaluate the risk of recurrence of optic neuritis after corneal refractive surgery in patients with a history of optic neuritis and to examine the safety and efficacy of the procedure in this population.

This was a retrospective chart review of patients with a history of optic neuritis who underwent laser-assisted in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) at a single tertiary center from June 1996 to December 2014. Fifteen eyes of 14 patients were included in this study. Visual acuity before and after the surgery was recorded. Patients were followed-up for over five years postoperatively for the recurrence of optic neuritis.

The average LogMAR best corrected visual acuity (BCVA) preoperatively was 0.12 ± 0.19 (–0.10 to 0.60) and postoperatively was 0.06 ± 0.10 (–0.10 to 0.30). No eyes lost lines of BCVA. The average LogMAR uncorrected distance visual acuity (UDVA) after surgery was 0.12 ± 0.13 (0.00 to 0.48). Twenty-eight percent of patients reached a UDVA of 20/20 or better after refractive surgery. Optic neuritis recurred in 3/15 (20%) eyes and 3/14 patients (21%).

While corneal refractive procedures appear safe in patients with a history of optic neuritis, our data suggest that their efficacy may be reduced.

To assess the quantitative changes of macula in diabetic and non-diabetic eyes after uncomplicated cataract surgery.

In this prospective interventional study being performed in a tertiary healthcare hospital, a total of 660 eyes were divided into two groups. Group 1 included 330 eyes from healthy subjects and group 2 included 330 eyes from well-controlled diabetic subjects with no diabetic retinopathy planned for phacoemulsification with foldable IOL implantation by the same surgeon under similar settings. Optical Coherence Tomography (Heidelberg Spectralis SD-OCT) was used to assess preoperative and postoperative central macular thickness (CMT) at weeks 1 and 6.

The mean CMT in group 1 preoperatively, at postoperative week 1, and at post-operative week 6 was 257.03 ± 20.904, 262.82 ± 17.010, and 265.15 ± 20.078 µm, respectively. The corresponding values in group 2 were 255.36 ± 17.852, 259.15 ± 16.644, and 266.09 ± 18.844 µm, respectively. There was no significant difference in the mean CMT values between the two groups on any of the three occasions when the CMT was measured (P = 0.374 and P = 0.313 at weeks 1 and 6, respectively).

There was no statistically significant difference in CMT between normal subjects and diabetic subjects without diabetic retinopathy preoperatively and in early postoperative period after uncomplicated phacoemulsification surgery.

To investigate the potential neuroprotective effect of glycine supplementation on the retinal ultrastructure of streptozocin (STZ)-induced diabetic rats.

Adult male Wistar rats weighing 200–250 g (n = 40) were randomly divided into four groups of 10 each: normal group (C), glycine + normal group (G), STZ group (D), and glycine + STZ group (DG). The G and DG groups received glycine (130 mM and 1% w/v) freely in their drinking water seven days after the induction of diabetes for up to 16 weeks. Retinal samples for histopathology were examined using light and electron microscopy.

Diabetes-induced histological changes were attenuated in the retinas of rats in the DG group. The ultrastructural alterations produced by experimental diabetes in the inner nuclear layer, outer nuclear layer, and ganglion cell layer were significantly ameliorated by glycine supplementation.

Our findings suggest that glycine supplementation effectively attenuates retinal neuronal damage in experimental diabetic rats, and thus may be a potential candidate to protect retinal ultrastructure against diabetes.

This study aimed to compare the effects of short-term administration of levodopa plus occlusion therapy versus occlusion therapy alone in preschool children with hyperopic anisometropic amblyopia.

This comparative interventional study included 40 eligible preschool children aged 6 to 7 years with hyperopic anisometropic amblyopia. The primary outcome measure was the logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity recorded at baseline, 3 weeks after the treatment initiation and 12 weeks after the treatment termination. The results were compared between the two groups.

No statistically significant intergroup difference was observed in baseline logMAR visual acuities (P = 0.92). The mean logMAR visual acuities of the amblyopic eyes were significantly better in both groups three weeks after the treatment initiation than the baseline (P < 0.01 in both groups). At 12 weeks after treatment termination, the logMAR visual acuities of the amblyopic eyes were significantly better than the baseline values (P < 0.001 in the placebo group and P = 0.09 in the levodopa group). Intergroup comparisons revealed no statistically significant difference in visual acuities 3 weeks after the treatment initiation (P = 0.11) and 12 weeks after the treatment termination (P=0.10). Twelve weeks after the treatment termination, visual acuities regressed 0.037 logMAR in the placebo group and 0.042 logMAR in the levodopa group. These regression rates were not significantly different (P = 0.89).

The results of this study provide evidence that adding short-term administration of levodopa to occlusion therapy in hyperopic anisometropic amblyopia offers no additional benefit in visual outcomes and provides no advantage in terms of the regression rate.

To compare the surgical outcomes of slanted versus augmented recession in patients with horizontal strabismus.

In this randomized clinical trial, a total of 100 esotropic (ET) and exotropic (XT) patients with a high AC/A ratio which was defined as a difference of ≥ 10 prism diopters (pd) between the distance and near deviations were included if the patients had a distance deviation ≥ 15 pd. Patients were randomly assigned into the slanted (n = 26 in ET and n = 24 in XT group) and augmented recession groups (n = 25 in ET and n = 25 in XT group). In the slanted group, recession was performed on the superior and inferior poles of the muscle based on the distance and near deviations, respectively, while in the augmented recession group, the muscles were recessed 1.00 or 1.50 mm more than the standard amount according to the distance and near difference between 10 and 20 pd or > 20 pd, respectively.

The mean age was 9.8 ± 9.6 years and 63% were female. There was a significant postoperative reduction of difference in convergence excess in ET cases compared to patients who underwent the augmented recession procedure (12.65 ± 6.16 vs 8.64 ± 6.1 pd, P = 0.014). Among our XT groups, there was no significant difference in postoperative reduction in the XT angle in the slanted group compared with the augmented group (P > 0.05).

Slanted recession is recommended in convergence excess ET patients. In XT patients, either slanted or augmented recession may be chosen according to the priority and experience of the surgeon.

To determine the prevalence of asthenopia and its associated factors in a sample of university students in Iran.

In this cross-sectional study, participants were selected using multistage cluster sampling. Presence of at least one of the 10 symptoms—foreign body sensation, diplopia, blurred vision, eye swelling, dry eye, eye pain, difficulty in sustaining visual operations, decreased visual acuity, tearing, and photophobia—was considered as asthenopia. Ocular examinations, including uncorrected/corrected visual acuity measurement, objective/subjective refraction, cover test, amplitude of accommodation (AA), and near point of convergence (NPC) were performed.

Of the 1,462 students (mean age: 22.8 ± 3.1 years), 73% were women. The age- and genderstandardized prevalence was 70.9% (95% confidence interval [CI]: 68.3–73.5), 39.8% (95% CI: 36.4–43.1), and 19.7% (95% CI: 16.0–23.3) based on the presence of at least one, two, and three symptoms, respectively. The prevalence was significantly higher in females (P = 0.048), hyperopic students (P < 0.001), and astigmatic participants (P < 0.001). The mean AA and NPC were 9.7 ± 2.6 D and 10.2 ± 4.2 D (P = 0.008) and 7.0 ± 2.1 cm and 7.7 ± 3.9 cm (P < 0.001) in participants with and without asthenopia, respectively. Multiple regression model revealed age (28–29 years), astigmatism, and NPC as independent associated factors (odds ratios: 3.51, 1.61, and 0.91, respectively).

This study shows relatively high prevalence of asthenopia in university students. Demographic factors and visual system disorders are important risk factors and timely correction of conditions may lead to decreased asthenopia.

This study was performed to assess the learning styles of a sample of Iranian residents through Kolb’s and VARK questionnaires.

In this descriptive-analytical study, 45 ophthalmology residents of Mashhad University of Medical Sciences were enrolled. Kolb’s and VARK questionnaires were provided, and residents were oriented and guided on how to complete them.

Forty-three out of the forty-five ophthalmology residents completed the questionnaire (95.5% response rate). The preferred learning style among ophthalmology residents was assimilative (51.2%), followed by convergent (37.2%), accommodative (7.7%), and divergent (4.7%), based on Kolb’s questionnaire. According to the results of the VARK questionnaire, most ophthalmology residents were auditory learners (34.9%), followed by multimodal learners (30.2%). In addition, there was no significant relation between genders, stage of residency, and Kolb’s and VARK learning styles (P > 0.05 for all).

The most preferred learning styles of ophthalmology residents were assimilative and auditory. Considering the dominant learning styles of learners and incorporating various teaching methods are recommended to enhance the learning among residents.

Tau is a microtubule-associated protein, which is highly expressed in the central nervous system as well as ocular neurons and stabilizes microtubule structure. It is a phospho-protein being moderately phosphorylated under physiological conditions but its abnormal hyperphosphorylation or some postphosphorylation modifications would result in a pathogenic condition, microtubule dissociation, and aggregation. The aggregates can induce neuroinflammation and trigger some pathogenic cascades, leading to neurodegeneration. Taking these together, targeting pathogenic tau employing tau immunotherapy may be a promising therapeutic strategy in fighting with cerebral and ocular neurodegenerative disorders.

To report the clinical characteristics, laboratory findings, and treatment of a rare case of keratitis caused by pigmented fungi Bipolaris hawaiiensis.

Case Report: 

A 55-year-old man presented with a history of trauma with vegetative matter in his left eye. Slit lamp biomicroscopic examination revealed the presence of a brownish-black pigmented plaque with surrounding infiltrates. Corneal scrapings revealed multiple septate hyphae. Culture revealed growth of the Bipolaris species. The patient was treated with topical natamycin 5%, topical voriconazole 1%, and oral itraconazole followed by intracameral amphotericin B (5 μg/mL). The patient responded well to the treatment.

Brown pigmented infiltrates are an important clinical feature of dematiaceous fungi. B. hawaiiensis is a rare cause of corneal phaeohyphomycosis. Our patient responded well to intracameral amphotericin B, which obviated the need for penetrating keratoplasty.

To highlight the importance of histopathological evaluation of a lid mass to prognosticate the disease. We report a case of ulcerative squamous cell papilloma with clinical features suggesting malignancy.

Case report:

 A 65-year-old man presented with a rapidly enlarging mass in the left upper eyelid, with clinical features suggesting a squamous cell carcinoma. However, a repeat histopathological examination showed no malignant cells. The patient was diagnosed with squamous cell papilloma. He was followed-up for 30 months and no recurrence was observed. No such case has previously been reported in the literature.

This report highlights the need for histopathological examination of all eyelid lesions to enable surgeons to prognosticate the disease.

Heavy metals, such as lead can cause optic neuropathy. Optic disc neuropathy due to lead intoxication has previously been reported. We report a rare case of lead toxicity-induced optic neuropathy presenting with bilateral hemorrhagic optic disc swelling. Case Report: The patient was a 42-year-old man with a history of chronic oral opium use, who had a gradually progressing blurred vision in both eyes over 40 days, with ataxia, paresthesia, and a toxic level of serum lead. He had been treated with lead chelators for lead poisoning. His color vision was impaired in both eyes. Humphrey’s visual field test revealed double arcuate scotoma with enlargement of the blind spot. Funduscopy revealed bilateral optic disc swelling, which was confirmed on optical coherence tomography and fluorescein angiography.

In cases of optic disc edema, a comprehensive history should be taken to detect the cause. Further, in cases of chronic oral opium use, lead toxicity should be considered.

We report a rare case of CRB1gene mutation in two siblings (sisters) affected with the exact same genetic mutation on both CRB1genes resulting in varying phenotypes.

Case Report: 

CRB1gene mutation in this case has resulted in causing varying degrees of Leber congenital amaurosis (LCA) in both sisters with a more severe phenotype in the older sibling causing LCA-8 with retinitis pigmentosa spectrum in both eyes and a milder phenotype causing LCA-8 with less severe rod cone dystrophy in the younger sister.

In summary, the mechanisms of varying phenotypes resulting from CRB1 genetic mutation are still not well understood. We concluded that the presence of different phenotypes associated with identical genotypic mutation of a single gene in siblings or in a family is important especially when dealing with retinal dystrophies.