Journal of Current Ophthalmology
Volume:20 Issue: 4, 2008 Dec

In July 2008, the Iranian Journal of Ophthalmology (IrJO) was selected by the Institute of Scientific Information (ISI) for inclusion in its Science Citation Index Expanded. This is a focal point in the history of the journal, and congratulations go to the Iranian ophthalmic society! Research is defined as any objective replicable enquiry the product of which is Science.1 But this formal systematic observation does not occur in isolation; we formulate the question, design the protocol, and report the findings within the current paradigms and available scientific literature. The essence of contributing to science is conducting a quality research, preparing a polished report, and having it published in an indexed journal to facilitate discovery and allow citation. In concrete terms, unless cited, no work can be a piece in the knowledge puzzle or a knot in the science web. Among the numerous international databases for scientific knowledge and biomedical sciences, ISI, Medline/PubMed, EMBASE, and Scopus are the most popular. These databases are ranked based on their coverage, perceived quality of covered literature, their popularity, and their identity in the information world (analytical and processing tasks, and their services and features). We are now being indexed in the most prestigious scientific database of the world. The IrJO was founded by the late Professor Mohammad-Gholi Chams in 1968, who apart from having an outstanding role in ophthalmic care and academic ophthalmology (education and research), was a key figure in ophthalmology leadership in the country and made lasting contributions to ophthalmology profession in this part of the world. Later, the journal was entertained by the vivid vision of Professor Ahmad Javadian and fueled by his well-known sense of urgency. It was published half in English and half in Farsi for a number of issues, and anglicized completely in 2006. The IrJO has now been published on a quarterly basis for forty years. Our editorial board members and scientific reviewers are renowned national ophthalmology academicians, however, the last element to be added to this elixir was technical input by our motivated editorial office members, some of our young peers from within the ophthalmic community, and our sharp collaborators at Farzan Institute for Research and Technology. Finally our dreams were realized in July 2008. We are now indexed in the ISI Web of Knowledge, and also in the process of achieving indexing in other mentioned databases. ISI selects scientific periodicals for inclusion according to formal criteria: quality of scientific content, regularity of publication, editorship processes, and perceived representation of human knowledge (geographically and thematically).2 We have met those criteria, but we are still far from the state of the art standards of scientific publication in the world. ISI reviews maintenance of standards and our status is subject to exclusion.3 The world is competitive, i.e. our inclusion in the ISI is deterrent to other (regional) journals, and they are our potential replacements in the ISI database. In the editorial board, we are to adopt more sophisticated approaches in journal structure and invite participation by authorities with excellent research track and employ motivated, interested young colleagues with technical expertise in the field of scientific editorship. We plan to apply flexible schemes for publication i.e. being versatile in manuscript types4 and publish special issues and supplements. The editorship processes should be transmuted to the digital format for a more efficient and objective process, which is a mandate for state of the art international journals. Our mission now goes beyond our borders and we have a regional duty to facilitate dissemination of the best research from Persia/Central Asia to the World. We should seek collaborations with our regional counterparts and potential international partners, not only for more manuscript submission but also for participation in the editorship. We have to exploit this unprecedented opportunity for visibility in the scientific community; not only is it instrumental in reporting current research but it also motivates us to embark on more extensive studies.

To present conductive keratoplasty (CK) as a new procedure to correct residual hyperopia and astigmatism after phacoemulsification surgery and to evaluate its predictability, safety and stability

Fifteen eyes of 13 patients with preoperative hyperopia +0.75 to +3.00 D and or astigmatism -0.75 to -3.00 D were enrolled into the study and underwent CK treatment. At the 1st and 3rd month follow-ups, near and far uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA), refraction, and in 6th month contrast sensitivity was also considered.

In six months follow-up uncorrected visual acuity far (UCVAF) 20/40 or better increased from 10 eyes preoperatively to 12 eyes postoperatively. Uncorrected visual acuity near (UCVAN) 20/40 or better increased significantly from no case to 8 eyes postoperatively. Mean manifest sphere (MS) preoperatively was 1.5 D (±0.75) which decreased to 0.05 D (±0.7) postoperatively. Mean manifest cylinder (MC) preoperatively was -1D (±0.8) which was decreased slightly to -0.8 D (±0.5). Manifest refractive spherical equivalent (MRSE) preoperatively was 1 D (±1) which decreased to -0.3 D (±0.83) postoperatively. There was one eye with loss of more than 2 lines of best corrected visual acuity far (BCVAF) and we had no case of 2 lines loss of best corrected visual acuity near (BCVAN) during six months follow-up. No significant change occurred during 3rd to 6th months follow-up.

CK appears to be safe, effective and stable for correcting low to moderate hyperopic after cataract surgery, but more predictable nomogram is needed to correct postoperative astigmatism.

To compare results of different methods for true corneal power determination and intraocular lens (IOL) power calculation formulas in 10 eyes of 7 patients with previous radial keratotomy (RK) with or without astigmatic keratotomy

In this case series study, we determined the corneal power of 10 eyes of 7 patients who had undergone RK with or without astigmatic keratotomy with two

the contact lens method (CLM) and the mean keratometry of the 3 mm zone in topography. In the next step, the IOL power for these eyes was calculated with the 3 formulas of SRK II, SRK T, and Holladay II; the latter was used for the IOL selection. Refractive results were determined 3 month after surgery. According to the rule that 1.5 diopter (D) change in IOL power results in 1.0 D change in a patient’s refraction at the spectacle plane, we estimated the manifest refraction of these eyes with other formulas and compared them with the results achieved by Holladay II formula.

Using the CLM and Holladay II formula, the postoperative manifest refraction spherical equivalent in 8 eyes ranged from -3.00 to +2.00 D. Both CLM and the mean keratometry of the 3 mm zone in topography lead to a greater degree of hyperopia after cataract surgery with SRK II formula than SRK T, and with SRK T than Holladay II. The mean spherical equivalent with mean keratometry of the 3 mm zone in topography and Holladay II formula was 0.08 D, and with CLM and Holladay II formula was -0.05 D.

In this study, it seemed that after RK, the mean keratometry of the 3 mm zone in topography gives a better estimate of true corneal power compared with CLM, and that the Holladay II formula brings results closer to emetropia compared with SRK II and SRK T formulas.

To evaluate the accuracy of ocular sonography in measurement of size of intraocular foreign bodies (IOFB)

In a case series study, 58 consecutive patients with intraocular foreign body were included. Ocular sonography was performed to detect intraocular foreign body and the results were compared with the same intraoperative findings.

Metallic material was found to be the most prevalent one (71%) followed by glasses (12%), stone (8%) and wood (6%). Ultrasound localized the foreign body lodged in the lens in 10.3%, in the angle in 3.4% and in the vitreous or vitreoretinal region in the rest of them (86.3%). The mean size measured by ocular sonography was 3.5×4.5 mm and that was reported by the surgeon was 2.9×4 mm. While the reports of sonography in detection and localization of IOFB was completely comparable with surgical findings, size measurements were considerably different from true measurements after intraocular surgery.

Ocular sonography showed mostly overestimation in measuring intraocular foreign bodies. Although ocular sonography was one of the best methods for assessment of IOFB, it doesn''t have high accuracy in estimation of size of IOFB.

To determine the anatomical site and underlying causes of blindness and severe visual impairment (BL/SVI), in schools for the blind in East Azerbaijan state with determining potentially preventable and treatable causes.

Between October 2003 and November 2004 a total of 124 students attending three schools for the blind in East Azerbaijan state were examined clinically and data reported using the WHO/PBL childhood blindness assessment form.

Most of the students (91.9%) were blind. The major causes of BL/SVI in our study were: Retinal dystrophy (mainly early onset retinitis pigmentosa) in 34.7% of participents; cataract and aphakia in l4.5%; corneal scar/haze in 15.4% and microphthalmus in 13.7%. The retina was the major anatomical site of visual loss (41.1%) followed by the whole globe (23.4%), lens (14.5%), cornea (15.3%) and optic nerve (5.6%).

A relatively high proportion of childhood blindness in East Azerbaijan state has avoidable causes. Most cases of corneal scars and phthisis can be prevented, and cataract is potentially treatable condition.

The aim of this study was to determine indications of keratoplasty during 7 years (1999–2006) in Emam-Rreza and Vali-Asr teaching hospitals of Birjand University of medical sciences.

Medical records of all patients who underwent penetrating keratoplasty (PK) in teaching hospitals of Birjand University of Medical Sciences from 1999 to 2006 were investigated retrospectively. The recorded data covered sex, age, indication, job and place of life of the patient. This data were analyzed regarding statistical significance was determined using X2 analysis.

During a 7-year period, total number of 120 patients were operated. The most common indication for PK was corneal opacity (62%), followed by keratoconus 20% and other 18% (Bolus keratopathy plus corneal dystrophia). The major job group for keratoplasty was farmer and the keratoplasty in patients that live in village (56%) was more than the city (44%).

Corneal opacity was the leading indication for PK. The major cause of corneal scarring was trauma with Thorn barberry and corneal infection in our study.

The aim of this study is to present a novel surgical technique in the management of severe blepharoptosis with poor levator function.

Four patients (five eyes) were included in this study. Mean age of the patients was 15.3 years (range, 3-28 years). Preoperative levator function averaged 3.4± 0.9 mm. All of the patients underwent combined maximum levator resection and septal sling in the ptotic eye.

The follow-up ranged from 4 to 10 months (mean, 8 months). Preoperative palpebral apertures averaged 4.4± 0.7 mm and postoperative apertures averaged 8.5± 0.4 mm (P<0.001). There was marked improvement in the aperture (4.1 mm). The mean of margin reflex distance-1 (MRD-1) was increased from 0±1 preoperatively to 4.1±0.4 postoperatively (P<0.001). All the patients demonstrated symmetry of the upper eyelid position (less than 1 mm), good lid crease position, and acceptable cosmetic outcome. All of the patients revealed some degree of lid lag and lagophthalmus. One patient developed exposure keratopathy associated with lagophthalmus which was treated successfully with lubrication.

This preliminary study shows that this new technique may be a useful alternative in the management of severe blepharoptosis associated with poor levator function.

To compare the protection of eyes against visible light (VL) and ultraviolet radiation (UVR) by sunglasses available through the Iranian optician trade union (IOTU) shops and those provided by miscellaneous vendors.

Totally، 353 pairs of sunglasses، including 188 pairs from IOTU shops and 165 pairs from miscellaneous vendors were selected based on systematic random sampling. The amount of UVA، UVB and VL transmission of the samples were examined by spectrophotometer. American national standard institute (ANSI) standards were the reference for measuring the UV transmission.

All of the sunglasses from IOTU shops met ANSI standards in transmission of UVA، UVB، while these percentages in miscellaneous vendors were 92. 1% for UVB and 95. 8% for UVA transmission (P<0. 05). Mean of UVB transmission was 0. 78% in IOTU shops and 1. 8% in miscellaneous vendors. These percentages for UVA transmission was 0. 92% and 7. 1% respectively (P≤0. 001). All of the nonstandard sunglasses regarding UVA transmission had graduated tints. 8. 7% of graduated tints and 1. 45% of smoky tints regarding UVB transmission did not meet the ANSI standards.

Although a number of sunglasses presented by miscellaneous vendors were not standard، but in cases that it is not possible to buy expensive sunglasses، it is advisable to use inexpensive ones with non-graduated tints for eye protection against UVR for daily and non-industrial use.

To present a patient with radiation chiasma neuropathy, secondary to radiotherapy of paranasal sinus lymphoma who was referred for evaluation of gradual decrease of vision in both eyes Case report: The patient was a 38-year-old male, with history of right maxillary sinus lymphoma, who underwent surgery, chemotherapy and radiation therapy. One year after radiotherapy, he noticed gradual decrease in his right eye vision. He referred to our center 6 months after onset of visual symptoms (1.5 years after radiotherapy). On his first examination, visual acuity (VA) of right eye was no light perception (NLP), and right optic disc was severely atrophic. Other examinations of right eye were unremarkable. The VA of left eye was 10/10 with correction, color vision was normal, slit lamp exam and tonometry was normal as well, but bow tie atrophy of left optic disc was detected. Visual field of left eye revealed temporal hemianopia. MRI showed thickening and enhancement of optic chiasm, especially in right side. In follow-up the enhanced lesion enlarged posteriorly and involved both optic tracts and optic radiations. In spite of treatment with high dose corticosteroid and hyperbaric oxygen, within two years following radiotherapy, vision of left eye gradually decreased to NLP too.

Radiation-induced optic neuropathy is an important differential diagnosis of decreased vision in a case with history of head and neck radiotherapy. Since this complication is very important with ominous consequence, ophthalmologists and radiotherapists should be aware of that; and decrease the chance of its occurrence by lowering the dosage, daily fractionation, stereotactic methods, and precise aiming of radiation beam.

To report a case with history of penetrating keratoplasty (PK) for keratoconus that developed acute hydrops in the recipient and donor cornea

A 46-year-old man, with history of bilateral keratoconus, who had undergone corneal transplantation in his left eye, presented with complaints of sudden visual reduction, photophobia, redness and pain of the left eye.

Review of his clinical course, slit-lamp biomicroscopy, laboratory evaluations including confocal microscopy and ultrasound biomicroscopy revealed acute hydrops in the graft. Second corneal transplantation was done for his left eye and pathologic examination confirmed the diagnosis.

Acute hydrops can occur after PK in patients with keratoconus. Although this condition is not common, it should be considered as a differential diagnosis of graft rejection.