Journal of Current Ophthalmology
Volume:23 Issue: 1, Mar 2011

Peoples of Persian culture celebrate the last Wednesday of the year on its eve, the Tuesday night, according to the Persian calendar. Named Chaharshanbe-Soori, literally ‘red Wednesday', the festivity is held on a day from 12 to 19 of March. The event precedes Nowruz (the Persian New Year) and comprises several traditions of which setting up bonfires and jumping over them is an integral part. Red refers to fire, itself symbolizing brightness, purity, life, and health in ancient Persia.1 The origin of the festivity goes back to a Zoroastrian tradition circa 1725 BC. Fireworks are used in many celebrations around the world: the Fourth of July (the United States’ Independence Day), the New Year in China, Halloween and Guy Fawkes Night in the UK, Diwali in India, Hari Raya Festival in Malaysia, and Prophet Mohammad’s Birthday in Libya.2-7

To determine the incidence and determinants of intraoperative complications of cataract surgeries performed in Iran during 2000 to 2005 The Iranian Cataract Surgery Survey (ICSS) is a retrospective study in which random sampling was done from selected centers. One week per season between 2000 and 2005 was assigned to each center and records of cataract surgeries performed during these weeks were studied to determine the type of surgery, the type of cataract, and intraoperative complications. A total of 13,409 records of cataract surgery were reviewed. The rate of intraoperative complications was 3.03% [95% confidence interval (CI): 2.5-3.5%]. Intraoperative complications were not significantly correlated with age or gender. The most common complication was posterior capsule rupture (PCR) with a rate of 2.82% (95% CI: 2.2-3.4%) followed by vitreous loss (2.76%; 95% CI: 2.2-3.32%). Subconjunctival hemorrhage and nucleus drop into the vitreous occurred in 0.21% and 0.01% of surgeries, respectively. The risk of intraoperative complications was highest with intracapsular cataract surgery (36.17%) and lowest with phacoemulsification (2.29%). In terms of type of cataract, intraoperative complications were highest with traumatic cataract (12.55%) and lowest with senile cataract (2.77%). Risk of intraoperative complications is lowest with phacoemulsification compared to other methods of cataract surgery. Cataract surgery in Iran, compared to developed countries, does not suffer much from complications such as PCR and vitreous loss.

To evaluate the effects of memantine on improving visual function in patients with acute nonarteritic anterior ischemic optic neuropathy (NAION) This was a prospective, double masked, randomized, clinical trial. The study involved 47 subjects with unilateral NAION of less than 8 weeks duration. Eligible patients were randomly allocated to take either memantine tablets (5 mg daily during the first week and then 10 mg daily for the next two weeks, 25 subjects) or placebo tablets (22 subjects). Baseline visual acuity (VA) tests, pattern visual evoked potential (VEP) and automated perimetry (SITA-standard 24-2) were performed. VA tests were repeated 3 weeks, 3 months and 6 months after initial visit. VEP and automated perimetry were repeated 3 months after initial visit. At baseline there was no significant difference between the two groups in terms of clinical and laboratory characteristics. After 3 weeks, 3 months and 6 months of treatment, best corrected visual acuity (BCVA) improved by -0.31±0.39, -0.49±0.47 and -0.53±0.48 logMAR in the memantine group respectively and -0.02±0.41, -0.09±0.60 and -0.05±0.67 logMAR in the placebo group respectively (P=0.024, P=0.025 and P=0.017). VEP results demonstrated a reduction of implicit time of -8.32±17.18 mS in the memantine group after 3 months, whereas in the placebo group it increased +5.7±21.60 mS (P=0.043). The change in VEP amplitude was not significantly different between the memantine and placebo groups (P=0.083). The effect of the memantine on mean deviation (MD) and pattern standard deviation (PSD) changes was not significantly different from that of the placebo (P=0.428 and 0.863 respectively). Treatment of patients who experience acute NAION with memantine may result in significant improvement in BCVA compared with no treatment. The VEP changes seen at 3 months may indicate improved transmission of impulses through the optic nerve.

To determine the association between retinal vascular diameter and its branching angles with diabetic retinopathy (DR) stages in diabetic patients A descriptive analytic cross-sectional study was conducted in 62 diabetic patients (120 eyes) referred to Farabi Eye Hospital between June 2008 and December 2009. Digital fundus photography pictures were imported into Photoshop software and diameters of arterioles and venules at their second branches from the disc were calculated. Meanwhile branching angles were measured in the same arterioles and venules. DR was graded by retinal specialists according to Airlie House classification of DR. Retinal vascular diameters and their branching angles were compared in different DR stages. There was a significant difference between retinal vascular diameters in different retinopathy stages. The diameter was significantly more in proliferative stage compared with mild nonproliferative stage (P<0.05). After multivariate analysis, age or hypertension has had no effect on the results. However, there was no significant difference between vascular angles in different retinopathy stages (P>0.05). Retinal vascular diameter, but not retinal vascular angle, seems to be related with retinopathy stage regardless of age and hypertention in these patients.

To compare changes in posterior corneal elevation, anterior chamber depth (ACD), anterior chamber volume (ACV) and corneal volume (CV) after laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) for low to moderate myopia by pentacam imaging In this prospective comparative case series, 105 consecutive myopic eyes randomly scheduled for LASIK (n=59) or PRK (n=46) in Farabi Eye Hospital, underwent pentacam imaging. Posterior corneal elevation, ACD, ACV and CV changes before and 6 months after operation were evaluated. Mean posterior displacement was 4.55±4.12 µm (range: -4 to +18 µm) and 3.9±4.5 µm (-4 to +21 µm) in LASIK and PRK treated eyes, respectively (P>0.05). The ACV, ACD and CV were decreased in both groups but the reduction of these parameters pre and postoperatively in each group and between two groups was not statistically significant (P>0.05). There was no significant difference in posterior corneal displacement, ACD, ACV and CV between LASIK and PRK treated eyes.

Cataract surgery is the most common ocular surgery worldwide and in modern era of phacoemulsification with posterior chamber intraocular lens (PC IOL) implantation, refractive aspects of surgery is as important as the surgery itself. After the IOL implantation, the anterior chamber depth (ACD) is increased and the iridiocorneal angle is widened. These changes should be considered for accurate IOL selection. In this study we evaluated the actual ACD following implantation of Morcher foldable PC IOL and compared it with the predicted depth. In a cross-sectional analytic study, ninety four cataractous eyes were operated with standard phacoemulsification and a foldable PC IOL (Morcher Bio Com Fold Type 93 IOL) was implanted. ACD, axial length (AL), refraction, and visual acuity were checked before and 3 months after the surgery. ACD after the surgery was significantly increased, but it was smaller than the predicted depth (5.61 mm). Best corrected visual acuity (BCVA) after the surgery was significantly improved. There was a myopic trend in postoperative refraction. ACD after cataract surgery combined with Morcher BioComFold type 93 lens was different from the predicted depth and this made most patients myopic.

To evaluate the efficiency and safety of using autologous fibrin glue for attachment of a conjunctival autograft in primary pterygium surgery In this prospective interventional case series, 15 eyes from 13 patients with primary nasal pterygium were included for conjunctival autograft surgery. On the operation day, thrombin and fibrinogen were prepared from the patient’s own blood in two separate sealed tubes in the blood transfusion center. Autologous fibrin glue was applied over the bare sclera for attachment of the free conjunctival autograft to the surrounding conjunctiva and sclera. The anatomic outcomes of flap, surgical time, recurrence rate, and other complications were evaluated on days 1, 3, and 7 and at months 1, 6, and 9 and 3 year after operation. A patient’s pain was evaluated using a 5-point scale from Lim-Bon-Siong et al grading at all visits. Of the 13 patients, 76.9% were male. The mean age of the patients was 37.26±12.61 (SD) years (range 23-60). The mean follow-up period was 34.67±2.96 months (range 25-36). Three eyes (20%) developed autograft retraction that resolved completely with continued eye patching. Two eyes (13.33%) developed total graft dehiscence, and sutures were used for reattachment of the graft in its correct position. Two eyes (13.33%) developed recurrence of pterygium, one of them had already a total graft dehiscence. In 13 eyes (86.66%), the conjunctival grafts were appropriately adhered to the bed and surrounding conjunctiva without suturing in the final visit. In the first postoperative day, ocular pain was recorded as grade 1 in 11 eyes (73.3%), grade 2 in 3 eyes (20%), and grade 3 in 1 eye (6.6%). In all patients, ocular pain disappeared during the 5 days after operation, except for two patients who needed suturing for graft reattachment, in whom ocular pain continued for 2 weeks. No other complications were found during follow-up. This case series suggests that autologous fibrin glue is a safe and useful alternative method for graft fixation in pterygium surgery.

Ophthalmoplegia makes many physicians to refer the patients to neurologists and/or ophthalmologists for neuro-ophthalmic evaluation. Ophthalmoplegia has different etiologies some of which may be very harmful and need urgent intervention. Prevalence of the disease is not obvious. This study is designed to evaluate the various etiologies and their prevalence in this disorder. This descriptive case series study was conducted on 226 patients with ophthalmoplegia referred to adult neurology clinic between the years 2005 to 2009. An informed consent was taken, considering inclusion and exclusion criteria. All patients had a complete neurologic and ophthalmologic examination. Case based laboratory and imaging techniques were used to determine the etiology of the ophthalmoplegia. Data were analyzed by χ2 test. P<0.05 was considered significant. Totally 226 patients were enrolled, including 121 (53.5%) males and 105 (46.5%) female s (P>0.05). The age range was between 19-72 years (mean 56.2±11.2). Symptoms were unilateral in 215 (95%) patients. Most common etiologies were diabetes mellitus (16.8%), infectious disorders (14.6%), intracranial tumors (13.2%) and head trauma (11.1%). Other common etiologies were orbital tumors (7.1%), posterior communicating artery (PCA) aneurysm (5.3%), and orbital pseudo tumors (4.0%). The etiologic factors were not identified in 4% of cases. Ophthalmoplegia has many different etiologies some of which such as aneurysms can be potentially very dangerous and need careful and urgent management, while some others can be easily treated. Management is very important and warrants the cooperation and intervention of ophthalmologists and neurologists simultaneously.

Fluoroquinolones are widely used antibiotic for prophylaxis of intra and postoperative infections in individuals undergoing cataract surgery. This study was designed to assess the penetration of ciprofloxacin into the ocular aqueous humor (topical only versus topical and oral administration). Studied population (n=47) consisted of two groups: group one (n=26) and group two (n=21). Group one received eye drop (one drop every six hours for three days before surgery and on the day of surgery topical medication was administered every 30 minutes with the last drop instillation maximum 4 hours before start of surgery). Group two received a combination of ciprofloxacin comprising of eye drop therapy as describe above plus oral dose (500 mg/twice a day starting three days before operation). Samples of aqueous humor were taken at the start of surgery. Ciprofloxcacin concentration was determined by high performance liquid chromatography (HPLC) with fluorescence detector. Aqueous humor concentrations of ciprofloxacin in the patients who received combinations of eye drops and oral administration doses (mean 0.95 µg/ml) were significantly higher than patients receiving only eye drops (mean 0.23 µg/ml, P<0.001). The results for first group were below the minimum inhibitory concentration (MIC) values of Staphylococcus epidermidis, S. aureus, Streptococcus pneumoniae, Pseudomonas aeroginosa, Escherichia coli and Haemophilus influenzae. These results for the second group were over the MIC values of S. epidermidis, S. aureus, Streptococcus pneumoniae and Escherichia coli and below the MIC values of Pseudomonas aeroginosa and Haemophilus influenzae. These results demonstrate that topical ciprofloxacin can penetrate into the aqueous humor but it alone dose not seems to be prophylactically effective against most of the ocular pathogens. In most cases, combining the oral therapy with topical therapy increases the aqueous humor drug level and also is effective significantly against most of the ocular pathogens. This proposal is applicable for drug monitoring in patients undergoing prophylactic antibiotic therapy prior to surgery.

To report for the first time, a presumable case of pediculus capitis corneal pseudo-infestation Case report : Our patient was a 35-year-old farmer presenting with symptoms and signs of ocular discomfort and inflammation. Clinical examination suggested a retained corneal foreign body; pathology of the lesion suggested a female pediculus humanus capitis (head louse). Arthropod (pseudo-) infestation can be considered in the differential diagnosis of corneal foreign bodies.

To describe a case of bilateral squamous cell carcinoma in right nasal and left temporal conjunctiva, simulating bilateral pterygium Case report : A reddish fibrovascular pterygium-like lesion was observed in the nasal side of bulbar conjunctiva on the right eye and temporal conjunctiva of the left eye. Medical examination not revealed any coexistent malignancy elsewhere excisional biopsy showed squamous cell carcinoma (SCC) insitu. Topical mitomycin-C (0.02%) one drop 4 times daily for two weeks postoperation had an excellent outcome. Bilateral pterygium-like lesion especially in area of conjunctiva that are exposed to sunlight radiation may be a malignant lesion; so early excisional biopsy with supplement of mitomycin-C result in long time relief without systemic association or recurrence.

To report a case of bilateral dense ring-shaped marginal keratitis after photorefractive Keratectomy (PRK) Case report : A 44-year-old man developed bilateral dense ring-shaped marginal keratitis after PRK. The patient had moderate to severe meibomian gland dysfunction preoperatively that was treated incompletely. He was treated with mild topical antibiotics, topical and systemic steroids and systemic doxycycline. The condition was controlled with faint peripheral scarring. This case suggests the role of blepharitis and meibomian gland dysfunction in producing marginal keratitis after excimer laser for which complete preoperative treatment is recommended.