مجله چشم پزشکی بینا
سال شانزدهم شماره 2 (زمستان 1389)

Blepharitis is the most common ocular disease encountered by an ophthalmologist constituting 37% of all ophthalmology clinics out patient visits. Blepharitis is categorized into anterior and posterior, each classified as infectious or noninfectious. Anterior blepharitis is mainly infectious and caused by Staphylococcus sp., Propyonibacterium acne, Corynebacterium sp., Moraxella catarrhalis, herpes simplex virus, Phitirus pubis and Mites. Possible mechanisms working in anterior blepharitis are colonization of lid margins by microorganisms, an imbalance between pathogenic and non-pathogenic microorganisms, and inflammatory mediators released by microorganisms or immune cells. Another form of anterior blepharitis is Seborrheic which is characterized by greasy scales on the anterior lid margin. Posterior blepharitis is mainly non-infectious and caused by alterations in the composition of meibomian secretions including an increase in free fatty acids and fatty wax leading to tear film instability, tear hyperosmolarity and evaporative dry eye. Tear hyperosmolarity is an important reason for ocular inflammation and irritation leading to epitheliopathy. In all forms of blepharitis, subjective complaints are burning and discomfort which is typically worst in the morning and improving toward the end of the day, discomfort while working on a computer, discharge, and redness. Additionally, patients may complain of contact lens intolerance or recurrent episodes of chalazia. Clinical findings vary depending on the type of blepharitis and include collarets around eyelashes, hyperemia and thickening of the lid margins, madarosis, poliosis, trichiasis, telangectasia, lid margin irregularities, and pouting and plugging of meibomian gland orifices. These abnormalities may be complicated by corneal marginal ulceration, and conjunctival or corneal phlyctenulosis. Treatment of blepharitis is aimed to reduce patient discomfort decrease, bacterial colonies and inflammation, as well as help meibomian glands release their secretions. These goals are achieved through different measures including hot, moist compresses and application of anti-bacterial and anti-inflammatory agents.

Retinoblastoma is the most common primary intraocular malignancy of childhood. Current treatments for retinoblastoma have led to a survival rate exceeding 95% and only occasional long-term morbidity. Locally delivered chemotherapy could carry the benefits of chemoreductive effects and conceivably spare patients from the toxicity and mutagenicity associated with systemic chemotherapy. Mainstays of local chemotherapy are improving drug delivery to the tumor site in the eye and molecular target treatment of the tumor while sparing intact organs. In this review, chemotherapeutic drug delivery as peribulbar, intraophthalmic artery and/or intravitreal injections and finally gene therapy and use of vectors for local delivery of drugs and genes are presented. Despite many pre-clinical advanced improvements in local chemotherapeutic control of the tumors, using these methods in the clinic requires many delicate and well controlled preclinical and clinical studies.

To present a patient with localized corneal edema due to a small retained fragment of nucleus in the anterior chamber after uncomplicated phacoemulsification.Case Report: A 74-year-old female subject with history of phacoemulsification in her right eye about 1.5 years ago complained of foreign body sensation, pain and decreased vision in the same eye. Visual acuity of that eye had decreased from 20/25 after the operation to 20/50 at the time of presentation. Slitlamp examination revealed localized stromal edema in the inferior part of the cornea accompanied with iridocorneal adhesion and a 3 mm retained fragment of lens nucleus in the anterior chamber. The fragment was removed through a clear corneal incision which resulted in improvement of the ocular pain and corneal edema. Retained nuclear fragments are a complication of phacoemulsification cataract surgery which can present early or late postoperatively. One should consider this complication in the approach to a patient with postoperative localized corneal edema or intraocular inflammation even if the fragment is not visible itself.

To present a case of orbital granular cell tumor, a rare orbital tumor.Case Report: A 55-year-old woman presented with binocular diplopia and right ocular displacement. The problem had initiated 3 years ago. A firm nontender mass at the region of the right lower lid was visible. Orbital CT-scan disclosed a well-defined mass in the inferior right orbit with involvement of the inferior muscles. Subtotal excision of the mass, and histopathological and immunohistochemical studies revealed granular cell tumor. Postoperatively, there was improvement in patient's signs and symptoms. Because of residual tumor, she was referred for radiotherapy. Immunohistochemical and histopathological studies are beneficial in diagnosis of rare orbital tumors.

To report a typical case of HLA-A29 positive birdshot choroidipathy as the first report in Iran.Case Report: A 43-year-old male subject without any systemic disease resented complainting of decreased visual acuity in both eyes for 5 years. Visual acuity was 20/30 in his right eye and CF at 2 meters in the left eye. Intraocular pressure was within normal limits bilaterally. Corneas and lenses were clear and no inflammation or cellular reaction was noted in the anterior chamber on slitlamp examination. The vitreous body, however showed cellular reactions. Color fundus photograph, fluorescein angiography and indocyanin green were in favor of choroidopathy. In FA multiple hyperfluorescent lesions and in ICG multiple hypofluorescent lesions were seen. He had been under treatment with oral prednisolone, cyclosporine and azathioprine during the past 5 years. Despite initial response, the disease progressed and visual loss were progressive. Regarding the course of uveitis and the fundus pattern as well as positive HLA-A29, he was diagnosed with typical birdshot choroidopathy. To our knowledge, this is the first report of a typical HLA-A29 positive birdshot choroidopathy in Iran. The strong association of this disease with HLA-A29 confirms the diagnosis.