Journal of Current Ophthalmology
Volume:23 Issue: 2, Jun 2011

Evaluating the effects of memantine on visual function after scleral buckling for rhegmatogenous retinal detachment (RRD) In a Double blind prospective randomized clinical trial, 61 patients with clinical diagnosis of less than 4 weeks macula-off RRD who had successful scleral buckle surgery had been selected and divided into two randomized groups. Thirty of them received 5 mg/day memantine orally for first week and 10 mg/day for two weeks, while the others (31 patients) received placebo. Best corrected visual acuity (BCVA), macular thickness measured by optical coherence tomography (OCT) and contrast sensitivity test, were measured for all patients at one and three months. Multifocal electroretinography (ERG) was performed for all patients who returned to us at third month postoperatively. Mean BCVA was 0.74±0.27 logMAR in memantine group versus 0.77±0.21 logMAR in placebo group at one month, and improved respectively to 0.64±0.25 logMAR versus 0.69±0.26 logMAR in memantine and placebo groups. There wasnt significant difference in first month and third month BCVA between two groups. Mean central macular thickness in memantine group was significantly lower than placebo group 215±41 μm versus 262±101 μm at first month, respectively and this difference was also significant after three months 204±39 μm versus 249±57 μm. Nineteen of 61 patients (31.4%) had persistent subretinal fluid (SRF) at first month (12 of them were in placebo group). P1 wave amplitude of multifocal ERG in 10-15º and >15º of central fovea in memantine group were significantly higher than placebo group. Memantine using as an adjuvant to reattachment surgery may have neuroprotective effects which can rehabilitate the function of macula in RRD patients.

To evaluate orbital blood flow velocities and optic nerve diameter with Doppler and gray-scale sonography in patients with acute unilateral optic neuritis (ON) Orbital Doppler and gray-scale sonography was performed in 46 eyes of 23 patients aged 19-47 with acute unilateral ON. ON was diagnosed by an ophthalmologist on the basis of clinical presentation, presence of decreased visual acuity (VA) and assessment of visual evoked potentials (VEP). The peak systolic (PSV) and end-diastolic (EDV) blood flow velocities and resistance and pulsatile indices (RI, PI) of the ophthalmic artery (OA), central retinal and posterior ciliary arteries (CRA, PCAs) and optic nerve diameter were measured in both eyes. We compared results from affected and unaffected eyes using the paired T-test. The area under the receiver-operating characteristic (ROC) curves was used to assess diagnosis of ON on the basis of measured blood flow parameters of the OA, CRA and PCAs and optic nerve diameter. Optic nerve diameter in eyes with ON was significantly higher than that of the control eyes (P<0.001). The mean (SD) optic nerve diameter was 4.1 (0.8) mm in affected eyes and 3.0 (0.4) mm in unaffected eyes (P<0.001). There were no differences in average PSV, EDV, RI and PI of OA and CRA between affected and unaffected eyes (P>0.05). The mean RI in the PCAs (P<0.05) was slightly lower in the eyes with ON than in the contralateral eyes. The area under the ROC curves was 0.928 for optic nerve diameter. Optic nerve diameter was related to ON, but orbital blood flow parameters were not.

To investigate the impact of socioeconomic factors on presenting severity of glaucoma In a cross-sectional study at Farabi Eye Hospital, and during 12 months study period, 258 patients with newly diagnosed glaucoma were enrolled and socioeconomic status of the patients were evaluated. Lower socioeconomic score was associated with higher intraocular pressure (r=-0.307, P<0.0001), poorer best corrected visual acuity (BCVA) (r=-0.280, P≤0.0001), and higher cup/disc ratio (r=-0.351, P≤0.0001). Expressed income was also negatively correlated with cup/disc ratio (r=-0.258, P<0.0001). Advanced glaucoma at presentation is directly related to the low socioeconomic status of patients.

To evaluate the effect of topical diclofenac sodium 0.1% on the corneal epithelial healing after photorefractive keratectomy (PRK) In this prospective randomized double blind clinical trial, PRK was performed on 82 patients. Thirty-three cases of them receiving topical diclofenac four times per day after surgical procedure and 45 patients did not receive this medication as a control group. Patients were compared for corneal epithelial healing after treatment. Statistically significant delayed epithelial healing has been found in the treatment group 24 hours after PRK but corneal reepithelialization has been completed in all patients four days after surgery. Postoperative topical diclofenac used following PRK may delay the epithelial healing.

To investigate the association of primary open angle glaucoma (POAG) and systemic hypertension in patients referred to Farabi Eye Hospital In this case-control study in Farabi Eye Hospital. One hundred patients were selected randomly from POAG patients of glaucoma clinic, Farabi Eye Hospital. Control group consists of 100 patients, candidates for cataract surgery. History of any anti-hypertensive agent consumption was recorded for all participants. A complete set of systemic and ophthalmologic examinations, including several blood pressure measurements, was performed for each subject. Systolic blood pressure above 140 mmHg, diastolic blood pressure above 90 mmHg and/or any history of anti-hypertensive usage in each group were considered as hypertensive status. Diastolic blood pressure was significantly higher in POAG patients than control group (P=0.003). Systolic blood pressure was also higher in POAG patients than control group; however, the difference was only marginally significant (P=0.07). No association between POAG and hypertension was found. POAG was found to have a strong positive association with diastolic blood pressure in our patients.

To evaluate the correlations between visual field (VF) defects with retinal nerve fiber layer (RNFL) thickness in nonarteritic anterior ischemic optic neuropathy (NAION) eyes, compare different GDx parameters with the other healthy contralateral eyes, and calculate receiver operating characteristic (ROC) curve for the GDx parameters Eighteen patients with unilateral NAION from at least 3 months before were enrolled. Patient's healthy eyes were considered as control. Peripapillary RNFL thickness was measured by GDx using variable corneal compensator (GDx VCC) and VF was tested using a central 24-2 program. The GDx measurements and VF test points were divided into 4 sectors and correlations of measured parameters for each nearly corresponding sector were evaluated. The two groups were compared in terms of RNFL thickness and VF sensitivity. Correlation of RNFL thickness and VF was calculated for each sector and ROC curve and sensitivities at specificity of >90% were calculated for each GDx parameter. All global and most sectoral GDx parameters were significantly different in affected and normal eyes. Temporal-nasal-superior-inferior-temporal (TSNIT) average, TSNIT standard deviation (SD) and nerve fiber indicator (NFI) were significantly correlated to mean deviation (MD) in NAION group (r=0.463, 0.597, -0.713; P=0.05, <0.01, 0.001 respectively). Most of the superior GDx parameters correlated well with the inferior field MD. Superior maximum had the highest sensitivity at ≥90% specificity at best cut-off point of 0.001 (100%). Most of GDx parameters were correlated with corresponding VF MD in eyes with NAION. Superior maximum was the most powerful discriminator between NAION and normal eyes.

To evaluate indications, risk factors and outcome of repeat penetrating keratoplasty (PKP) at a tertiary referral eye care center In this retrospective study, medical chart of patients who underwent repeat PKP at Labbafinejad Medical Center between January 2004 and December 2009 were reviewed. A total of 1,859 corneal transplantations were performed on 1,624 eyes during study period. Of these, 82 cases were repeat PKP which performed on 72 eyes (6.2% of the total number of primary PKP). Seventy-two eyes had two grafts; 10 eyes had three grafts. Among major indications, keratoconus was the least common initial indication for regraft and bullous keratopathies were the most common initial indication. The percentage of graft/regraft ratio ranged from a high of 9.6% for eyes with pseudophakic bullous keratopathy (PBK) / aphakic bullous keratopathy (ABK) to a low of 1.4% for eyes with keratoconus. Eyes with PBK/ABK were significantly overrepresented as a relative contributing factor to repeat PKP compared to initial PKP (29.2% vs. 11.7%, P=0.001), while those with keratoconus were significantly under-represented (13.9% vs. 38.4%, P=0.001). Bullous keratopathies are the leading indication for repeat PKP in our center. It has the highest relative risk for repeat PKP in comparison to other conditions whereas, keratoconus has the least.

To introduce a novel classification system for the extent of choroid invasion and to analyze the incidence of histopathologic risk factors (HRFs) in the patients with retinoblastoma in China The clinical data of 104 enucleated eyes diagnosed with retinoblastoma were retrospectively reviewed, and the pathological re-examination of the enucleated eyes was conducted. Overall, the HRFs were present in 53% of the 104 eyes. For choroid infiltration, type 1 was observed in 38 eyes as isolated, sporadic tumor cells, or suspected tumor cells with no obvious choroid thickening; type 2 in 26 eyes, as localized nest-like or nidulant tumor cells without obvious choroid thickening; and type 3 in 25 eyes, as lumpish, massive or dense invasion with or without obvious choroid thickening. The mean follow-up period was 27.6 months (median, 24.9; range, 8.3-65.7). During the course of the study, four patients died of recurrence or metastasis. Statistically significant differences between the proportional mortality ratios were observed in choroidal infiltration of Type 3 (P=0.003), invasion of postlamina (P=0.033), sclera (P=0.003), and optic nerve resection line (P=0.005) cases. Based on univariate and multivariate analysis, leukocoria was negatively correlated with HRFs (P=0.001, OR=0.21; P=0.010, OR=0.25). Clinically, the novel classification system for the extent of choroid invasion could function as a practical definition for choroid infiltration, and the HRFs are present in a significant proportion of patients enucleated for retinoblastoma in China.

To describe a case of successful laser in situ keratomileusis (LASIK) retreatment over a previous LASIK surgery after 11 yearsCase report: The patient had his first LASIK for the correction of -2.25 -1.75×90° and -2.25 -1.00×90° in the right and left eye, respectively. Eleven years later, the refraction in the right eye was plano -3.25×80° and he was scheduled for an enhancement procedure by relifting the old LASIK flap. Ablation was made with the Allegretto Concerto excimer laser. Three months postoperatively, the right eye uncorrected visual acuity (UCVA) was 20/20, the refraction was plano -0.50×160°, the flap was intact, and the cornea was clear. One year after retreatment the refraction was stable and there was no sign of epithelial ingrowth. LASIK retreatment can be safely performed by lifting the original flap even more than one decade after primary operation provided that the residual stromal bed is adequate.

To present a case of missed intraorbital wooden foreign body presented as soft tissue massCase report: We introduce a case of intraorbital wooden foreign body which presented with orbital soft tissue mass two years after trauma. A plain CT was requested which revealed a foreign body in the right orbit. It is frequently difficult to identify and localize organic intraorbital foreign bodies despite modern day high-resolution imaging studies.

report a case of total blindness a few hours after orbital blowout fracture repair; the visual acuity (VA) returned to normal after immediate reoperation.Case report: A 21-year-old man with obvious enophthalmos in the left side, 2 weeks after car accident, was candidate for orbital floor reconstruction surgery. Anterior orbitotomy from subcilliary incision was done and at the end of the surgery, titanium medpore inserted in orbital floor. Three hours after surgery patient complained of severe pain and a significant proptosis was noticed. VA was no light perception (NLP) and relative afferent pupillary defect (RAPD) was positive. The patient reoperated and medpore plate was removed. There was significant blood in orbital cavity that was totally removed. Three hours after reoperation proptosis disappeared and VA improved to 3M count finger. One week after the surgery the VA was raised to 20/20. Acute severe pain in the early postoperative period, may be a sign of the orbital hemorrhage. Awareness of the potential severity of this complication and execution of appropriate treatment with minimal delay, may result in rapid and complete visual recovery.