Journal of Current Ophthalmology
Volume:19 Issue: 4, 2007 Dec

To investigate the efficacy of limbal-conjunctival autografting technique in patients with primary pterygium

Fifteen eyes of 15 patients with primary pterygium underwent surgery for the removal of pterygium with limbal-conjunctival autograft. After the pterygium excision, the limbal portion of the graft was oriented and sutured to the limbus at the recipient bed with the epithelial surface upside. Recurrence was defined as fibrovascular tissue extension of more than one mm onto the cornea in the area of previously excised pterygium.

With a mean follow-up period of 8 months, no recurrences or serious complications were recorded among our patients.

Pterygium excision followed by limbal-conjunctival autograft is a safe and very effective way of treating primary pterygium.

To study the effect of phototherapeutic keratectomy (PTK) in the treatment of various superficial corneal pathologies.

We performed a nonrandomized, prospective study on patients who presented with superficial corneal disease and/or poor vision. Fifty eyes were included; recurrent corneal erosion (RCE): 25 eyes, Salzmann’s nodular degeneration: 9 eyes, spheroidal degeneration: 4 eyes, trachoma keratitis scar: 5 eyes, traumatic scar and pseudophakic bullous keratopathy: each one 2 eyes, macular dystrophy, herpetic corneal scar, and band keratopathy each of them 1 eye. All patients were treated with Nidek EC-5000 excimer laser. A central 4- 8 mm ablation zone was determined by opacity diameter. Follow up ranged from 90 days to 20 months; mean 304±165 days for RCE group and 395±197 days for others.

Uncorrected visual acuity (UCVA) improved from mean of 20/50 (logMAR=0.44) and 20/400 (logMAR=1.1) preoperatively to 20/30 (logMAR=0.2) and 20/120 (logMAR=0.78) postoperatively in RCE and opacity groups respectively. Best corrected visual acuity (BCVA) improved from mean of 20/30 (LogMAR=0.22) and 20/200 (logMAR=0.96) preoperatively to 20/25 (logMAR=0.07) and 20/100 (logMAR=0.65) postoperatively in RCE and opacity groups respectively. Recurrent erosion dramatically reduces in RCE group.

PTK can improve UCVA and BCVA in various superficial corneal pathologies and reduce spontaneous corneal erosions but proper case selection is crucial.

To evaluate the efficacy of pars plana vitrectomy (PPV) in treating patients with rhegmatogenous retinal detachment (RRD)

In a retrospective study, we reviewed hospital records of patients with RRD operated by PPV at Farabi Eye Hospital between [DU1] 2002 and 2004. The indications for PPV were proliferative vitreoretinopathy (PVR) grade B or C, holes posterior to the equator and holes greater than 90 degrees.

Two hundred and thirty patients were included in this study. The mean visual acuity improved from 2.6±0.61 logMAR to 2.1±0.77 logMAR after surgery (P=0.0001). The failure and redetachment rates after the first operation were 14.8% and 23.5%, respectively. In 202 of 230 eyes (87.8%), the retina was ultimately reattached with subsequent operations. The mean follow-up period was 9±7.2 (range: 3–48) months.

Our outcomes are comparable with those of the previous studies and show that PPV is an effective procedure for most of the RRDs complicated by PVR.

To assess the efficacy of intraoperative mitomycin C (MMC) during silicone intubation (SI) as a substitute for dacryocystorhinostomy (DCR) in nasolacrimal duct (NLD) obstruction.

In a prospective, randomized, double-blind study, 88 candidates of DCR for NLD obstruction were randomly assigned into two groups of SI with application of either MMC (0.2 mg/ml for 2 minutes) or placebo.

After a mean follow-up interval of 8 months, 25 of the 43 eyes in the MMC group and 21 of the 44 eyes in the placebo group had a successful outcome and were free of tearing and discharge (P=0.331). In patients with simple epiphora and less than 6 months of duration of symptoms, SI alone was effective in 83% of patients; MMC application during SI did not show additional benefit over SI alone in this group of patients. But in patients with simple epiphora and more than 6 months duration, the application of MMC during SI resulted in better efficacy compared to SI alone. The overall success rates in the patients with chronic dacryocystitis was lower (23%) compared to patients with epiphora only (63.7%).

SI alone could effectively substitute for a more extensive procedure such as DCR in patients with simple epiphora particularly in whom their symptoms has been newly developed. In cases with longer duration of symptoms of epiphora, application of MMC would increase the success rate significantly.

To quantify the intraobserver reproducibility of retinal nerve fiber layer (RNFL) measurements using scanning laser polarimetry with variable corneal compensation in glaucoma suspect patients.

Twenty-six eyes of 26 glaucoma suspect patients were included. Complete ophthalmologic examination and standard automated perimetry were performed for all of them. RNFL measurements were done using GDx-VCC (Laser Diagnostic Technologies, San Diego, CA) by an experienced operator. The test repeated immediately by the same operator.

Patients were 24 to 70 years old (55.9±11.5 years). Twenty patients were female and 6 patients were male. Eighteen patients were ocular hypertensive and 8 patients had large cup to disk ratios. None of them had glaucomatous field defect in standard perimetry. The mean coefficient of variation for measurements of TSNIT average (Avg), superior Avg, inferior Avg, TSNIT-SD and nerve fiber indicator (NFI) were 0.77, 0.95, 0.91, 0.81, and 0.98 respectively. The mean coefficient of variation of GDx-VCC was 88.4 for the 5 main parameters (TSNIT Avg, superior Avg, inferior Avg, TSNIT-SD, and NFI).

GDx-VCC showed a good test-retest correlation and acceptable intraobserver reproducibility. NFI may be the most reproducible major GDx-VCC parameter in glaucoma suspect patients.

To assess the effect of EMLA® cream application without occlusive dressing on pain on needling (PN) and pain on injection (PI) felt during multiple botulinum toxin type A (BTA) injections for correction of hyperkinetic upper facial lines

A Prospective, randomized, double-blind, placebo-controlled clinical trial was conducted on 44 subjects seeking upper facial wrinkles correction. Either EMLA® or placebo cream without occlusive dressing was applied on each side of the upper face at least for 60 minutes prior to injections of BTA. PN and PI scores were measured with Visual Analog Scale (VAS).

Patients age ranged from 27 to 57 (mean=40.95) years. Mean PN score (3.46) was less than PI score (3.61) (non significant); the two scores were highly correlated (r: 0.63, P=0.000). While both PN and PI scores were less in the EMLA® (3.02 and 3.34, respectively) than those of placebo group (3.90 and 3.89, respectively), the difference was statistically significant only for PN score (P=0.000 for PN and P=0.06 for PI). Male subjects had less PN and PI scores than females which was not statistically significant (P=0.66 for PN and 0.63 for PI). Time intervals between the cream application and BTA injections (60 to 110 minutes; mean=73.02, SD=10.15) did not have significant effect on the pain scores.

EMLA® cream application without occlusive dressing significantly reduces PN associated with multiple BTA injections. Reduction of PI was not significant. Longer duration of EMLA® cream application (up to 110 minutes) did not show lower pain score in either type of the pain.

To study the effects of adding intravitreal bevacizumab (Avastin) to conventional LASER treatment on regression of retinal neovascularization in threshold ROP.

Intravitreal injection of bevacizumab (1.25 mg) in one eye of each of three newborns with threshold ROP was performed in addition to laser treatment. The other eye of each patient was treated with laser alone. Changes in retinal neovascularization, its regression and unfavorable anatomical outcome were assessed on fundus photographs by Retcam and frequent funduscopy. ERG was performed four months after injection.

ROP regressed in both eyes at the same time. There were no differences in normal retinal vascularization. We had no adverse effects due to injection including cataract, endophthalmitis or vitreous hemorrhage. We didn’t observe any differences in ERG between two eyes.

Intravitreal injection of bevacizumab seems to have no adverse effect in newborns with threshold ROP. There were no differences in regression of neovascularization between two eyes. It is recommended to perform more studies in order to assess its effect.

We report an unusual case of trabecular carcinoid of the ovary with orbital involvement.

We encountered a 49-year-old woman with a complaint of bilateral proptosis. Ocular examination revealed severe bilateral proptosis and signs of corneal exposure. Orbital CT scan showed massive enlargement of extraocular muscles and optic nerve compression. The patient medical history showed that she have had an ovarian mass for which she was underwent right oophorectomy followed by left oophorectomy and total abdominal hysterectomy.

Histological examination showed trabecular carcinoid in both ovaries. Fine needle aspiration from extraocular muscles showed trabecular carcinoid tumor compatible with the primary tumor of the ovary.

Ocular metastases from carcinoid tumors are considered rare. They can be the primary presentation of a carcinoid tumor or develop during the course of the disease. The extent of distant metastases from carcinoid tumors correlates with poor prognosis and survival; early detection of metastasis may change the overall management.

True neoplasm (adenocarcinoma) of retinal pigment epithelium (RPE) is very rare; since it can be misdiagnosed as intraocular malignant melanoma it is of importance to know the clinical and pathologic aspects of this neoplasm. Here, we report a case of adenocarcinoma of RPE.

Case report.

A 60-year-old man with progressive loss of the vision of the right eye was enucleated with a clinical diagnosis of malignant melanoma. Grossly, a solid well-circumscribed mass occupying the posterior section of the globe near the optic disc was observed. In histological evaluation, the tumor was composed of cells having large, pleomorphic, and hyperchromatic nuclei and prominent nucleoli with occasional pigmentation. Tumor cells were mostly arranged in a papillary pattern. To differentiate it from melanoma, immunohistochemistry was performed. Epithelial membrane antigen (EMA) was strongly positive and HMB45 was negative; this is consistent with the diagnosis of adenocarcinoma of RPE. On systemic evaluation no metastases was found.

Adenocarcinoma of RPE is very rare but it should be considered in the differential diagnosis of malignant melanoma of the eye.

To report a case of Candida glabrata endophthalmitis after deep anterior lamellar keratoplasty

Interventional case report

A young male patient presented with asymptomatic white to cream-colored interface deposits two months after deep anterior lamellar keratoplasty. After a while, severe anterior chamber reaction together with decreased visual acuity developed. Because of the progression of the lesions, irrigation of the interface was considered and finally, penetrating keratoplasty was performed due to a rupture in the Descemet’s membrane. The microbiological evaluation of the irrigation fluid demonstrated Candida glabrata. After regrafting, scattered endothelial plaques together with hypopyon formation and anterior vitreous inflammation developed, that improved with intensive antifungal therapy. The patient remained asymptomatic with a clear graft in the 6-month follow up.

Yeast-induced keratitis may rarely occur after corneal transplantation and it should be considered and treated aggressively in all cases of interface deposits due to fungi after lamellar corneal graft.