Journal of Current Ophthalmology
Volume:22 Issue: 2, Jun 2010

It has been stated that near work can cause myopia progression1-3 and carpet weaving is included in that frame of work. Carpet weaving is a meticulous and very fine handwork which is performed from a very near distance for hours and hours each day and for many years in life-time. A precise visual attention and concentration is needed in this job. In this current issue of Iranian Journal of Ophthalmology, Yekta et al4 have investigated five workshops of carpet weaving, 269 carpet weavers in Mashhad, north-east of Iran and they claim that myopia is much more frequent among carpet weavers compared with the general population of Iran. In those five centers 67% of the carpet weavers had myopic eyes versus 3% of hyperopia. In an investigation performed in Mashhad the prevalence of myopia in high school students was reported to be 24.1%.5 In a report concerning the elderly population in the same town the incidence of myopia was shown to be 27.2%.6 This very high percentage of myopia reported in this issue of the IrJO among carpet weavers (67% versus 24.1% of high school students and 24.1% of the elderly population at the same geographical area) raises two questions: 1. Is the near work as much determinant in changing the anatomy of the eye and developing such a high percentage of myopia among carpet weavers? 2. Are the carpet weavers initially have been selected among the myopic persons for this very fine handicraft? They must be able to see these very fine and thin fibers of cotton, wool, silk and to create such a fine and uniform knots, and this for hours and hours. The answer can be found by a large-scale prospective study in which all the carpet weavers to have an ocular examination and refraction before being employed and during the years to come. So further studies are required for a more reliable conclusion.

It has been estimated that each year 50,000 newborns born prematurely and underweight; and are candidates to have retinopathy of prematurity (ROP). 1 In the developing countries where we see most of the blind children, ROP is accused to be one of the essential causes of blindness.2 ROP and its consequences (impaired vision and blindness) could be prevented in most cases by an early ocular examination (before 9 weeks of infantile age) and prompt therapy by laser or cryopexy before the disease progresses to advanced stages (Stages 4 or 5), where therapy could be hardly successful. In this issue of Iranian Journal of Ophthalmology (IrJO) three important articles concerning ROP are presented. Since new steps in detection, treatment, and education of physicians and parents are being taken in our country, focusing on such subject seems essential. In the article “Screening for Retinopathy of Prematurity: The Role of Educating the Parents”3 Mousavi et al (pages: 13-18) have presented 605 newborns, suspected to have ROP. The mean gestational age (GA) and birth weight (BW) in these infants were 31.4 (SD 2.3) weeks and 1,562 (SD 443) g, respectively. 443 (73.2%) parents had received simple recommendation concerning early ophthalmic examination (group A) and 162 (26.8%) parents had been given written and also had been informed orally about the outcomes of the disease in case of late consultation (group B). 81.2% of the infants in group A were examined before 9 weeks of infantile age vs. 95.5% of group B. They have indicated that the incidence of stage 4 and 5 of ROP was significantly higher in group A. The authors particularly emphasize on the importance of informing and educating the parents about the undesired consequences of late consultation and its sight threatening results. In another presentation in this issue of the journal, Mousavi et al4 (pages: 19-24) have reviewed the “Characteristics of Advanced Stages of Retinopathy of Prematurity in Iran”. The investigation has been done during the years 2003-2007 at the same referral center (Farabi Eye Hospital, Tehran). During those years 1,053 premature infants suspected to have ROP were examined and 380 infants (36.1%) had ROP and 91 of them (8.6%) presented with advanced ROP. Forty patients had bilateral stage-5 ROP. 74.7% of infants with advanced ROP had been examined after 9 weeks of post-natal age. In this investigation; low GA was considered the only significant risk factor for development of advanced ROP (P≤0.001). Roohipoor et al5 from the Farabi Eye Hospital (Pediatric Vitreoretinal Section) (pages: 25-31) report “Anatomical Outcome of 25-gauge Vitrectomy Associated with Scleral Buckling in Stage 5 Retinopathy of Prematurity: A Case Series Study”. Twenty-one eyes with stage-5 ROP were vitrectomized with 25 gauge probe and had scleral buckling. The end anatomical success rate (complete reattachment) is reported to be only 38%. They have not used internal tamponades explaining that a complete removal of the tractions and membranes with a fine 25 gauge probes would allow them to remove all the posterior tractions and the anterior buckling would reduce the remaining peripheral tractions and protect the retina to be attached. The technique is open to many discussions. These three presentations emphasize the importance of early detection and treatment of ROP and as it was indicated late examination of the newborns (after 9 weeks) and late treatments would result in undesired outcomes. It is now evident that ROP can be detected and treated successfully in most cases, and this is being done in the developed countries, in most cases. In a report from New Zealand6 only one out of 85 premature newborns developed stage-4 ROP who was examined at eleventh weeks of birth. Fortunately, during the recent few years, thanks to our colleagues, neonatologists, pediatric vitreoretinal ophthalmologists this burden of blind infants caused by ROP has been reduced to its minimum and most of our ophthalmic centers under the guidance of the ministry of Health and Education are consciously taking care of these infants. But, still in Iran and other developing countries more extensive programs are needed to overcome the social and economic burden of this disease.

To review the effectiveness and safety of perioperative injection of bevacizumab in vitrectomy for proliferative diabetic retinopathy (PDR) A literature search of all English articles from the Medline and Scopus databases was performed. Original articles، case reports and letters were included. Nineteen، 3 and 5 studies reported preoperative، intraoperative and postoperative intravitreal injection of bevacizumab، respectively. There is good evidence that preoperative injection of bevacizumab induces the regression of new vessels، facilitates the surgery and may reduce the incidence of postoperative vitreous hemorrhage in selected eyes. Also، it may decrease the vitreous clear up time for postoperative vitreous hemorrhage. However، the risk of development or progression of tractional retinal detachment (TRD) should be considered. Postoperative complications like the neovascular glaucoma and nonclearing vitreous hemorrhage may be properly managed by intraocular bevacizumab injection. Preoperative intravitreal bevacizumab (IVB) is probably effective and relatively safe for surgical facility with variable effects on postoperative hemorrhage. Postoperative intravitreal injection may be effective for the treatment of postoperative complications.

Childhood blindness due to retinopathy of prematurity (ROP) is an important concern, but this blindness or severe visual impairment may be prevented if at risk infants are screened before occurrence of advanced stages. In this study, we tried to find the role of parental education about ROP in parents’ compliance for on-time attendance for ROP screening. Demographic factors and clinical information of all the consecutive infants screened for ROP in Farabi Eye Hospital during 2003-2007 were recorded and analyzed using independent sample T-test, chi-square and multiple logistic regressions. Among 605 eligible infants, parents of 443 (73.2%) were given a simple written recommendation for their infant’s eye examination (group A), while 26.8% were given written information about the consequences of late examination (possibly blindness) and information about the date and place of a free of charge previously made appointment (group B). Mean age at first eye exam in group A was 51.9 days versus 41.8 in group B (P<0.001). The incidence of stage 4 and/or 5 was significantly lower in infants examined before 9 weeks (P<0.001). In group A, 81.2% of the infants were examined before 9 weeks of infantile age versus 95.5% in group B (P<0.001). Gender, being the first child and single or multiple births did not contribute to the time of first eye exam significantly. Logistic regression methods showed that after controlling for gestational age (GA), recommendation type had a significant effect on on-time attendance rate (P< 0.001). Giving sufficient information about ROP to parents and educating them about this potentially blinding condition, along with making appointments for them and presence of facilities for free ROP screening exams, can increase the chance of on-time screening

To evaluate the incidence and risk factors of severe visual impairment and retinopathy of prematurity (ROP)-related blindness in a tertiary eye hospital in Iran In a cross-sectional study, clinical data of premature infants screened for ROP in Farabi Eye Hospital during 2003-2007 were reviewed. Characteristics of advanced stages of ROP (stage 4 or 5) were determined and compared to other stages of ROP. Among 1053 infants, 380 (36.1%) had ROP, 91 infants (8.6%) had advanced stages of ROP in at least one eye (none of them had a history of previous ROP screening); 40 of them had bilateral stage 5. The mean gestational age (GA) and birth weight (BW) in infants with advanced ROP were 28.3±2.3 (24-35) weeks and 1267±398 (450-2600) g, respectively. 74.7% of infants with advanced ROP had been examined after 9 weeks of infantile age. Only 23.1% (21/91) had recommendation for eye examination by their neonatologists. Lower GA was the independent risk factor of developing advanced ROP (P< 0.001). We observed a high incidence of advanced ROP (stage 4 and or 5) in our settings; most of them were not referred for screening examination during the first few weeks and had delayed eye examination. Among the possible risk factors, GA was the only factor related with development of advanced ROP

Our purpose is to determine the structural outcome of 25-gauge vitrectomy in addition to scleral buckling in stage 5 retinopathy of prematurity (ROP). In a prospective interventional case series, 21 eyes with stage 5 ROP underwent 25-gauge vitrectomy and scleral buckling. Demographic data, disease activity (having plus disease or neovascularization) and the procedure manner were recorded. They were followed 12±2 (range 8-18) months. Anatomical outcomes were assessed during the follow-ups. Success rate was defined as totally reattached retina. In case of vascularly active disease, some eyes received laser therapy or intravitreal bevacizumab before progression to stage 5 ROP. Twenty one eyes of 16 patients with stage 5 ROP with mean gestational age (GA) of 28±2 weeks and birth weight (BW) of 1190± 314 g were included. Lensectomy was done in 81% of eyes. Total reattachment was achieved in 52.3% (success rate) and partial reattachment in 23.8% of the eyes. Reattachments were usually obtained during the first 2-4 weeks. Redetachment occurred in three eyes. Two of them redetached at month 10 and the other one at month 14. Final total reattachment was achieved in 38% of the eyes. Vascularly active disease was seen in 42.8% of the eyes before operation. Success rate was inversely related to disease activity (P=0.044) and directly related to presurgery treatments (P=0.024) [Laser therapy or intravitreal bevacizumab]. The structural outcome of 25-gauge vitrectomy in addition to scleral buckling in stage 5 ROP is promising and vascularly active disease will lower the outcome.

To determine and evaluate the visual acuity (VA) and refracion of correcting compound severe myopic astigmatism with the Artisan toric intraocular lenses (IOLs) In this noncontrolled clinical trial, 15 patients with severe astigmatism and at least 2.0 diopters (D) of astigmatism were enrolled. All patients met the inclusion criteria. Artisan toric IOL implantation was recommended to them, while the procedure and its possible complications were discussed. Preoperative examinations included refraction, uncorrected visual acuity (UCVA), and best corrected visual acuity (BCVA) tests, endothelial cell count (ECC), and anterior chamber depth (ACD) measurement. Mean UCVA was 1.57 logMAR preoperatively, and increased to 0.21 logMAR 18 months after surgery (P<0.001). Mean sphere was -7.84 ±3.1D (range, -3 to -15) preoperatively, and changed to 0.04±0.47 D (range, 0.75 to -1.5) 18 months after surgery (P<0.001). Cylinder error showed a statistically significant change from -3.53±1.32 D (range, -1.5 to -6.5) to -0.90±0.90 D (range, 0 to -4.5) during the same period (P<0.001). Mean ECC was 3257.8 cell/mm2 before surgery, and 2761.7 cell/mm2 18 months later (P<0.001). Mean ACD showed reduced from 3.7± 0.23 mm preoperatively to 2.9± 0.23 mm after surgery (P<0.001). When laser refractive surgery is not an option, correcting severe myopia and astigmatism with the Artisan toric IOL has acceptable results, but it’s possible complications must be kept in mind.

Cataract is one of the most common diseases of older ages and, at present, the leading cause of avoidable blindness in the world. Along with the population growth, the rate of cataract surgeries is increasing in most countries worldwide. The number of cataract operations per million population per year is known as the cataract surgery rate (CSR) and is one of the indicators introduced by Vision 2020 initiative. This index is a useful indicator of the level of eye care services. The main purpose of the ICSS was to determine the CSR from 2000 to 2005 in Iran and use results to develop improved strategies towards the elimination of cataract. In a descriptive, retrospective, cross-sectional survey, the Iranian population which has undergone cataract surgery is targeted. First, all major and minor cataract surgery services are identified and the required sample is randomly selected. Data from 8000 cases of cataract surgery is collected and studied. The Iranian cataract surgery survey (ICSS) determines the CSR over a five year period and provides valuable information in terms of cataract surgery methods and intraocular lens (IOL) implantation. The results will definitely be useful in developing strategies to eliminate cataract from the causes of avoidable blindness and improve eye care services.

To determine the relationship between refractive errors and ocular components values in carpet weavers Refractive errors and ocular components values were investigated on carpet weavers at Mashhad city in Iran. After selection of samples, the individuals who had ophthalmic and systemic disease effective on the refractive errors were excluded from the study. Refractive errors and ocular components were measured by autorefractometry, A-Scan ultrasonography and, keratometery, respectively. 269 carpet weavers including 191 male (71.9%) and 78 female cases (28.1%) with the mean age of 41.30±6.5 years and range of 21 to 60 years were investigated in this study. The average of spherical equivalent (SE) refraction of the subjects was -1.7±1.8 diopters (D). SE has a significant relation to axial length (AL) (r=-0.564), anterior chamber depth (ACD) (r=-0.301), vitreous chamber depth (VCD) (r=-0.557), lens thickness (LT) (r=0.170), and corneal curvature (CR) (r=0.170). AL and VCD had the most relationship to myopia. The average values of the AL, ACD, VCD, and LT of the subjects were 23.6, 3.2, 16.6 and 3.9 millimeters respectively. The average of CR was 7.6 millimeters. Except LT, other optical components were significantly different in both genders. ACD, VCD, and CR had an inverse relation to age and LT had a direct relation to age. SE refraction in carpet weavers had a significant relation to the ocular components and variation in SE refraction may be due to the changes of these elements.

To evaluate the efficacy and safety of subconjunctival oculusgen implantation when used during trabeculectomy In this prospective, nonrandomized, interventional case series, 10 eyes of 10 patients with medically uncontrolled open angle glaucoma were enrolled. Conventional fornix based trabeculectomy with implantation of subconjunctival biodegradable collagen implant (oculusgen) was performed in all patients. The preoperative best corrected visual acuity (BCVA), intraocular pressure (IOP) measurement and numbers of antiglaucoma medication were recorded. There were 7 postoperative follow-up visits within 6 months after surgery. After 6 months, follow-up visits were continued every 2-3 months. At each visit, the examination included measurements of BCVA and IOP, slit-lamp biomicroscopy, assessment of cell and flare, bleb evaluation and funduscopy. Any complications were recorded at the end of each examination. Data analysis was performed using SPSS software version 15. Mean duration of follow-up was 11.9 months (range 6-26 months). Mean preoperative IOP was 19.3 mmHg (range 12-25 mmHg) with 2.9 number of IOP lowering medications (range 2-4) and mean postoperative IOP was 15.3 mmHg (range 10-24) at month 6 (P=0.028) and 14.7 (range 10-20) at last visit (P=0.016). Mean IOP lowering medications and IOP reduction after 180 days were 0.4 (range 0-3) (P=0.000) and 4.2 mmHg respectively. Mean IOP lowering medications and IOP reduction at last visit were 0.7 (range 0-3) (P=0.000) and 4.8 mmHg. Overall success at last follow-up was 80%. None of the patients experienced systemic or ocular complication related to oculusgen. Trabeculectomy with implantation of oculusgen is a safe and effective surgical method in patients with open angle glaucoma, but longer duration of follow-up in larger number of patients is needed.

To identify any factors that may predict successful levator resection in blepharoptosis correction The hospital records of 52 consecutive patients undergoing anterior levator resection for unilateral congenital blepharoptosis were reviewed. Successful result was defined a lid level within 1 mm of the fellow eye 1 year after surgery. We studied the effect of levator function, the amount of ptosis and the kind of anesthesia on the surgical outcome. Twenty-eight patients were treated with a levator resection under local anesthesia (group 1) and 24 patients (46.2%) were treated with a levator resection under general anesthesia (group 2). The mean age was 16.37 ± 9.3 (range 4-40) years. The overall success rate was 76.9% two months after surgery and 61.5% one year after surgery. The most common complication after one year was undercorrection (38.5%). Sever ptosis (P=0.002) and decreasing preoperative levator function (P=0.007) were associated with decreasing chance of success. The kind of anesthesia was not a predictor factor for surgical success (P=0.312). The preoperative levator function and the amount of ptosis were found to be the most significant predictors of surgical outcome. The surgery under local anesthesia was not associated with a higher success rate.

Our aim was to isolate mesenchymal stem cells (MSCs) from mouse umbilical cord and culture them with vitreous body to investigate their capacity to differentiate into lens fiber cells, crystallins are expressed. Wharton''s jelly is the appropriate source of MSCs. After isolation, the cells were cultured and alkaline phosphatase detection kit was used for staining undifferentiated umbilical cord-MSCs. In the experimental groups, MSCs were plated in the maintenance medium supplemented with bovine vitreous body (1:1, 3:1 v/v) for induction up to 10 days. Light microscopy and immunostaining methods used to assess differentiation of the cells. Mouse umbilical cord-MSCs have alkaline phosphatase activity and vitreous body can induce them to differentiate into the lens fiber cells. Lens fiber cells can be produced by umbilical cord-MSCs derived from mouse. MSCs have the potential to be useful source for stem cell researchers

Cutaneous anthrax of the eyelid is a rare condition in clinical practice, but should be considered in the differential diagnosis of preseptal and orbital cellulitis. Here we report a case of palpebral anthrax. Case report: A 5-year-old girl with anthrax infection of the right upper eyelid is presented. Her eyelid showed an edematous, necrotic, and partially bullous lesion. Following complete healing of the eyelid lesion, mild cicatricial ectropion resulted. Anthrax is a rare disease that is not well known by ophthalmologists. Clinicians should be aware of the complications and the management of palpebral anthrax.

To report a patient with sphenoid sinus mucocele (SSM) Case report: The patient is a 19-year-old man who was referred to Khatam-al-Anbia eye center as retrobulbar optic neuritis. Brain and orbital CT scan and MRI revealed SSM. The patient underwent endoscopic sinus surgery and visual acuity (VA) improved from no light perception (NLP) to 2 meter counting fingers. SSM may have unique presenting symptoms. Even it may be considered as a differential diagnosis of optic neuritis and VA may be reversible after surgery.