مجله چشم پزشکی بینا
سال دوازدهم شماره 3 (بهار 1386)

To compare the frequency of Helicobacter pylori (H. pylori) infection in subjects with primary open angle glaucoma (POAG) vs controls. In a case-control study, 44 patients with primary open angle glaucoma and 79 patients with senile cataract (control group) were investigated for serum level of anti-H. pylori antibody using the enzyme-linked immunosorbant assay (ELISA) method. The study included 26 male and 18 female subjects with mean age of 60.8±20.6 years in the case group and 44 male and 35 female subjects with mean age of 66.0±19.8 years in the control group. Seropositivity was higher in patients with glaucoma (70.5%) compared to controls (40.5%) with an odds ratio of 3.51 (95% confidence interval, 2.89-4.11; P= 0.001). H. pylori infection is much more prevalent in patients with primary open angle glaucoma. Further investigations are required to evaluate the possible causative role of H. pylori infection in primary open angle glaucoma.

To evaluate the preschool vision screening program coverage and to assess its validity indices including specificity, negative predictive value (NPV), sensitivity and positive predictive value (PPV) and the frequency of treatment for visual impairment. A sample of 906 six-year-old children signed up for primary school registration in the Shahrood district (Semnan, Iran) were randomly selected and invited for optometric examination. Mentally retarded and blind subjects due to organic disorders were excluded. All children were examined by optometrists for ocular alignment, visual acuity, cover test, stereoacuity and retinoscopy under cycloplegia. Screening history and the results were detected by available documents. Treatment history was obtained from the family. Of 906 invited children, 827 (91.3%) participated in the study, of which 815 (98.6%) were eligible and cooperative. Fifty-two children (6.4%) had amblyogenic visual impairment. Screening coverage rate was 85.3% (95% confidence interval [CI], 82.9-87.7) which was unrelated to gender, residence in urban or rural area or parents’ education but was greater in families with higher-than-average economic status (87.7% vs 81.9%, P<0.05). The specificity and NPV of the screening exam were 95.4% (95%CI, 94.1-96.7) and 96.7% (95%CI, 95.3-98.1), respectively. Only 47.5% of children with amblyogenic factors were suspected on screening examination (sensitivity). Of those with suspected exams, 38.8% had impairments in optometric examination (PPV). All of those with a correct diagnosis of amblyogenic visual impairment on screening had been treated. A significant proportion of six-year-old children have amblyogenic vision impairment. Inadequate coverage and validity of the current screening program has prevented timely diagnosis and treatment of many of them.

To evaluate cases of post-traumatic endophthalmitis in terms of risk factors. This chart review was performed on 67 eyes of 67 patients who were admitted to Shiraz Khalili Hospital with a clinical impression of post-traumatic endophthalmitis following penetrating eye trauma from 2002 to 2004 serving as the case group. Sixty-five patients with penetrating eye trauma but not endophthalmitis were selected as controls. The case group included 52 (78%) male and 15 (22%) female subjects with mean age of 26.0±9.3 years, of which 33 (49%) were rural residents. The control group included 47 (72%) male and 18 (28%) female subjects with mean age of 24.0±11.2 years, of which 14 (21.5%) were from rural areas. Delayed repair (later than 24 hours) was seen in 44 (66%) of cases and 7 (11%) of controls (P= 0.0005). Intraocular foreign body was found in 9 cases (13%) and 10 controls (15%) (P= 0.46). Lens rupture was found in 38 cases (57%) and 3 controls (5%) (P= 0.0005). The cornea was only involved in 30 cases (45%) and 45 controls (69%). Scleral involvement was seen in 37 cases (55%) vs 20 controls (31%) (P=0.012). Lens rupture, delayed primary repair and rural area as well as limbal and scleral involvement were associated with a higher rate of endophthalmitis. However, intraocular foreign body, age and sex had no role in predisposing to endophthalmitis.

To determine the normal conjunctival flora in neonates and infants. Conjunctival specimens were obtained from both eyes of 43 newborns delivered by cesarean section (C/S) and 53 newborns delivered by normal vaginal delivery (NVD) as well as 54 healthy infants in two maternity and pediatric hospitals. The specimens were cultured aerobically, anaerobically and for fungi. Among C/S delivered newborns 51% were culture positive for Staphylococcus epidermidis as the most common isolate (72.4%) followed by corynebacterium species. (10.3%). Among NVD newborns 73.5% were culture positive. The most common isolates were S. epidermidis (26.5%) and Streptococcus viridans (17%). Significantly greater isolates of anaerobic bacteria were observed in NVD newborns compared to C/S delivered newborns as follows: Lactobacillus (9.5%), Propionibacterium acnes (7.8%) and Fusobacterium (1.5%). Among healthy infants 48% were culture positive. The most common isolates were S. epidermidis (55%) and P. acnes (10.5%). There were no significant differences in normal conjunctival flora between healthy infants and C/S newborns, but significant differences were observed between infants and C/S newborns versus NVD newborns in certain vaginal tract related isolates such as Lactobacillus and Streptococcus species. Due to the higher incidence of anaerobic bacteria in NVD newborns, these organisms may be considered as presumptive causes in ophthalmia neonatarum.

To evaluate the role of amniotic membrane transplantation (AMT) in acute ocular chemical burns.

Patients with grade II-IV (GII-GIV) ocular chemical burns (Roper-Hall classification) of less than two weeks’ duration underwent AMT in addition to medical therapy. Patients were followed for at least 6 months and evaluated for ocular pain, visual acuity, epithelial defect healing, symbelpharon formation, and corneal opacity and neovascularization.

Twelve eyes of 8 patients (6 male, 2 female) with mean age of 28.75±11.8 (range 12-44) years were operated. Mean duration between chemical burn and surgery was 2.5±3.3 days (range, 2 hours to 10 days). Mean follow up period was 11.5±1.5 (range 10-13) months. The chemical agent was acidic in six eyes and alkaline in the other six. Ocular burns were GII in one eye, GIII in four eyes and GIV in seven eyes. Pain and discomfort decreased in all patients. Visual acuity improved completely in the eye with GII burn. It also improved in three eyes and remained unchanged in one eye with GIII burn. In eyes with GIV burn, two underwent tectonic corneal grafts due to perforation and two were phthisical, however visual acuity decreased in two and increased in one of the remaining eyes. The epithelial defect healed within 6 days in the eye with GII burn. Mean time for healing was 53.75±5.2 days in eyes with GIII burn. Keratolimbal allograft surgery was performed in one eye with persistent epithelial defect and severe corneal thinning. In the other two eyes, the epithelium healed in 70 and 75 days. Corneal neovascularization was seen in two eyes with GIII and all eyes with GIV burns. Corneal opacity developed in all eyes with GIII and GIV burns. Only mild symblepharon was seen in four eyes with GIV burn.

AMT seems to be effective in pain reduction and prevention of symblepharon formation. It seems ineffective in preventing corneal opacification and neovascularization. The role of AMT in accelerating epithelial healing and improving visual acuity in patients with GII and GIII ocular burns needs to be evaluated in a clinical trial. It seems that prevention of symblepharon formation is the only role of AMT in eyes with GIV chemical burns.

To investigate the penetration of cefixime, cephalexin and ciprofloxacin into the human eye based on microbial inhibition by human aqueous samples after oral administration. Sixty patients aged 40 to 75 years who were scheduled for cataract surgery were divided into three equal groups. One group received 500 mg oral ciprofloxacin 24, 12 and 2 hours preoperatively; another group received 500 mg oral cephalexin 24, 18, 12, 6 and 2 hours before the operation and the third group received 400 mg oral cefixime 24, 12 and 2 hours prior to surgery. Immediately before opening the anterior chamber, 0.1 ml of aqueous was taped with an insulin syringe. A 4 ml sample of the patient’s blood was obtained simultaneously. Aqueous and serum specimens as well as a standard antibiotic disc were placed on the culture media of a known bacterium which was completely sensitive to the respective antibiotic. After 48 hours microbial inhibition zone of each sample was compared to the standard antibiotic disc. No microbial inhibition zone was seen by aqueous samples, however very large zones of inhibition were seen by discs of serum samples and antibiotics. It seems that oral cefixime, cephalexin and ciprofloxacin do not achieve effective concentrations in human aqueous for microbial inhibition.

To compare the prevalence of ocular symptoms and signs in professional video-display users (VDU) and non-users. This cross-sectional case-control study was performed on bank staff who used computer for their task as the VDU group and staff who did not work with computer as controls. Ocular symptoms were evaluated based on a questionnaire and signs were detected according to complete ocular examination. The VDU group included 34 male and 23 female subjects with mean age of 30.7±6.8 years and controls included 25 male and 31 female subjects with mean age of 27.6±7.2 years. There was no statistically significant difference between the two groups regarding age and sex. Ocular symptoms included burning and tearing in 79% vs 45% (P=0.037), dry eye sensation in 66% vs 32% (P= 0.022) and asthenopia in 64.8% vs 40% (P=0.044) of the VDU group vs controls, respectively. Dry eye based on Schirmer test of less than 10 mm after 5 minutes was found in 40.3% vs 10.7% in the VDU group and controls, respectively (P=0.012). Tear break up time of less than 10 seconds was seen in 43.8% of the VDU group and 8.9% of the control group (P=0.044). Heterophoria was present in 33.2% of the VDU group vs 5.3% of controls (P=0.032). There was no difference between the two groups regarding myopia (54.3% in the VDU group vs 39.2% in controls). Ocular complaints such as burning and tearing, dry eye sensation and asthenopia were more prevalent in video-display users.

To evaluate the outcomes and complications of phacoemulsification and posterior chamber intraocular lens implantation (PE+PCIOL) in patients with congenital iris coloboma. In a prospective noncomparative interventional case series, 13 eyes of 9 patients (six female and three male) with congenital iris coloboma and cataract underwent PE+PCIOL using clear corneal incision and in-the-bag foldable hydrophilic acrylic IOL implantation by one surgeon. Best corrected visual acuity (BCVA) and complications were evaluated six months postoperatively. Mean age was 46.5±5.7 years. BCVA was counting finger in six eyes and between 20/200-20/100 in seven eyes, preoperatively which increased to 20/50-20/20 in 11 eyes, postoperatively (P<0.001). No serious complications occurred intraoperatively. Two eyes had concomitant ocular pathology causing no improvement in their visual acuity after surgery. Two patients developed postoperative monocular dioplopia. No case of retinal detachment occurred during the follow up period. PE+PCIOL seems to be safe and effective in terms of visual improvement in patients with typical congenital iris coloboma and cataract.

To evaluate the visual outcomes and complications of lensectomy, posterior capsulotomy, anterior vitrectomy and Acrylic hydrophobic posterior chamber intraocular lens (PCIOL) implantation for congenital or developmental cataract in children 6-9 years of age. In a prospective interventional case series, 13 eyes of 10 children with congenital or developmental cataract underwent the above-mentioned surgery. Patients were followed for at least six months postoperatively. Pre- and postoperative visual acuity as well as intra- and postoperative complications were evaluated. Mean age was 7.8±1.2 (range 6-9) years. Patients were followed for a mean period of 13.3±7 months after surgery. Mean preoperative visual acuity was 1±0.1 LogMAR which reached 0.1±0.1 LogMAR at final follow up (P<0.0001). No intraoperative complication occurred. All cases had clear visual axis at the last visit. Lensectomy, posterior capsulotomy, anterior vitrectomy and PCIOL implantation in 6-9 years old children with congenital or developmental cataract is a safe procedure and effective in terms of visual improvement.

To evaluate the efficacy of pretreatment with diclofenac sodium 1% eye drop for prevention of post-cataract surgery ocular inflammation.

A double blind clinical trial was performed on 111 patients who were scheduled for phacoemulsification and intraocular lens implantation (PE+IOL) at Feiz Hospital, Isfahan-Iran. Cases with traumatic cataract and complicated surgery were excluded. Patients were randomly assigned to three groups: (1) controls; (2) treatment with one drop of diclofenac sodium 1% QID one day before surgery; and (3) treatment with one drop of diclofenac sodium 1% QID for three days preoperatively. All eyes received topical steroid and antibiotic, postoperatively. Postoperative anterior chamber (AC) reaction, ocular pain, burning, red eye, atonic mydriasis and intraocular pressure were evaluated on days 1, 3, 14 and 30.

The study included 70 male and 41 female subjects with mean age of 61.03+8.35 years. Ocular pain was significantly more prevalent and severe in controls compared to other groups on postoperative days 1, 3 and 14. AC reaction was also more prevalent and severe in controls than the other two groups only on the first postoperative day. The prevalence and severity of red eye on days 1, 14 and 30 postoperatively were higher in controls compared to the two other groups without any difference by the third postoperative day. Eye burning was more prevalent in the control group than the other two groups only on days 1 and 3. The active treatment groups had no difference in terms of the above-mentioned characteristics at any stage; except for AC reaction on the first postoperative day which was more severe in the one-day treatment group compared to the three-day group. There was no significant difference between the three groups regarding relative miosis intraoperatively. Postoperative changes in intraocular pressure were within normal limits in all groups.

Pretreatment with diclofenac sodium 1% can reduces the incidence and severity of post-cataract surgery AC reaction, eye burning, red eye and ocular pain, particularly during the first postoperative week.

To evaluate the visual outcomes and complications of deep lamellar endothelial keratoplasty (DLEK) for management of corneal endothelial disorders. From 2003 to 2005, nine eyes of nine patients with severe bullous keratopathy due to endothelial dysfunction underwent DLEK. Uncorrected (UCVA) and best-corrected (BCVA) visual acuity were evaluated pre- and one week, 1, 3 and 6 months postoperatively. The sutures were removed 3-4 months postoperatively in all eyes. Five female and four male subjects with mean age of 66.3±10.9 years underwent DLEK. Preoperative diagnoses included aphakic bullous keratopathy (ABK, 2 cases), pseudophakic bullous keratopathy (PBK, 4 cases) and Fuchs’ endothelial dystrophy (FED, 3 cases). Mean BCVA was 1.7±0.5 LogMAR (~20/1000) preoperatively which improved to 1.4±0.1 LogMAR one month (P=0.02), 1.4±0.2 LogMAR three months (P=0.04) and 1.2±0.4 LogMAR six months (P=0.01) postoperatively. Mean corneal astigmatism was 7.43±5.02 diopters one month after DLEK which decreased to 4.06±3.58 at final follow up. All eyes had clear graft and cornea after 6 months. Postoperative complications included transient leakage (two eyes), lenticule displacement, graft wrinkling, double chamber formation, mild interface hemorrhage and filamentary keratitis (each in one case). Cystoid macular edema was present in four eyes. DLEK has acceptable results for replacement of the endothelium in patients with ABK, PBK and FED. The most important drawback of this technique is the complexity of the equipment and the procedure. DSAEK (Descemet stripping automated endothelial keratoplasty) seems to be replacing DLEK due to less dependence on instruments and being a more simple procedure.

To determine the frequency of congenital nasolacrimal duct obstruction (CNLDO) in premature newborns and its correlation with gestational age (GA), sex, family history and chronological age. This study was performed on infants who were referred for retinopathy of prematurity from 2002 to 2003. Cases of CNLDO were visited again three and six months later. This study was conducted on 60 preterm infants (26 male, 34 female) with gestational age of 33.2±1.3 weeks (range 25-36) and age of 3.8±0.9 months (range 1.5-6) at first presentation, of which 13 had CNLDO (9 unilateral and 4 bilateral). Overall, 17 out of 120 ducts (14.1%) were obstructed. There was no correlation between CNLDO and sex, family history or gestational age. Three months later 58.4% of the obstructions were cleared and at the 6 month visit, 25% of residual obstructions were cleared, such that the total remission rate at 6 months was 83.4%. In premature newborns with CNLDO, the rate of spontaneous clearing of the obstruction is greater than 80% during the first 6 months.

To determine the efficacy and safety of subconjuctival injection of mitomycin C versus daunorubicin for treatment of pterygium.

This randomized double blind placebo-controlled clinical trial included 54 eyes of 36 patients with pterygium who were referred to Al-Zahra Hospital, Zahedan-Iran in 2004. Eyes were randomly assigned to three groups including mitomycin C, daunorubicin or placebo. The injection was performed subconjuctivally at limbus under the pterygium. Patients were examined before and one month after injection. Change in symptoms and size reduction of pterygia and complications were compared among the three groups.

There was no statistically significant difference between the three groups in terms of age and primary pterygium size. Post-injection reduction in symptoms and pterygium size had no significant difference among the three groups. Post-njection complication rates were 72.2%, 93.3% and 40% in the mitomycin, daunorubicin and placebo groups, respectively. Serious complications were not seen in any group.

Subconjuctival injection of mitomycin C and daunorubicin for treatment of pterygium is relatively safe, but has little effect in reducing symptoms and pterygium size.

To evaluate anophthalmic socket complications and the incidence of sympathetic ophthalmia among individuals who had undergone primary enucleation or severe ocular trauma during the war between Iran and Iraq. All monocular veterans of the mentioned war in Khorasan province, Iran were recalled during a 7-month period. Preliminary data including age at the time of injury, occupation, previous operations and ocular symptoms were evaluated and all participants underwent a complete ophthalmologic examination particularly regarding the anophthalmic socket, orbital implant and prosthesis condition. Overall, 135 male individuals participated in this study. Mean age was 42±7 years and 86% were 30-50 years. Patients had undergone complete enucleation in 39 (28.9%), partial enucleation in 21 (15.6%) and evisceration in 6 (4.4%) cases. In 34 cases (25.2%) pthisis bulbi had occurred after trauma and the type of surgery was not identifiable in the remaining 35 cases (25.9%). The most common symptom in injured eyes was mucoid or mucopurulent discharge (71%). Common complications in 101 subjects with previous operations were superior sulcus deformity (72.3%) and socket contracture (44.5%). Socket motility was satisfactory only in 18%. All signs of the anophthalmic syndrome are more severe and more prevalent among enucleated cases secondary to war injuries. Due to the rarity of sympathetic ophthalmia, we suggest enucleation and orbital implantation in an elective setting.

To compare total plasma homocysteine (tHcy) levels in cataract patients with and without pseudoexfoliation syndrome (PXS). In this case-control study 29 (15 female and 14 male) cataract patients with PXS and 29 (16 female and 13 male) cataract patients without PXS were enrolled. Fasting tHcy level was measured using high-performance liquid chromatography and compared between the two groups. Mean age was 68.9±13.9 years in the PXS group and 63.1±12.6 in patients without PXS (P=0.69). Mean plasma tHcy level was 21.08±11.72 mol/l in patients with PXS Vs 13.20±4.23 mol/l in patient without PXS (P=0.001). Hyperhomocysteinemia was seen in 17 cases (56.6%) of PXS vs 4 cases (13.8%) of non-PXS subjects (P=0.001). This study supports the association of hyperhomocysteinemia with pseudoexfoliation syndrome.

In spite of rapid advances in keratorefractive surgery in recent decades, the most common method for refractive error correction throughout the world is glasses, the discovery of which is attributed to the Persians. Other advantages include protection of the eye against trauma and radiations, correction of phorias and tropias and cosmetic reasons. The purpose of this article is to describe and review different components of glasses (frame, temple and lens), sunglasses, photochromic and polarizing glasses, antireflective and mirror coats, progressive additional lenses and also recommendations about frame selection.

To report a case of cloverleaf skull syndrome with cleft palate.

We report a 20-day-old boy with cloverleaf-shaped skull deformity, very constricted cranium and prominent temporal bones associated with severe proptosis, maked lid retraction, conjunctival chemosis, exposure keratitis, corneal opacity and cleft palate. CT-scan dislosed fusion of the coronal, sagittal and lambdoidal skull sutures with shallow orbits. To control the exposure keratitis, bilateral tarsorrhaphy was performed temporarily and the patient was referred to the neurosurgery service.

To the best of our knowledge this is the first report on the association of cleft palate with cloverleaf skull syndrome. After performing preliminary measures for preservation of the cornea, patients should be referred to neurosurgeons or plastic surgeons.