Journal of Current Ophthalmology
Volume:24 Issue: 1, Mar 2012

To compare the cosmetic and functional results of frontalis sling procedure using silicone rod with polytetrafluoroethylene (Ptose-up) in congenital ptosis with poor levator function (LF) In a prospective randomized study, 90 eyes of 66 patients with congenital ptosis that underwent frontalis suspension surgery [31 patients (18 unilateral, 13 bilateral cases) using a silicone rod and 35 patients (24 unilateral, 11 bilateral cases) using Ptose-up] were included. Follow-up time was 6 months. The preoperative and postoperative medical records and photographs of patients and also their satisfaction were evaluated. The functional success rate was not significantly different between the two groups (P>0.05), but silicone material extrusion and infection was more frequent (although statistically nonsignificant) in silicone rods group. The mean margin reflex distance (MRD1) at 1, 3, and 6 months was 3.07 mm, 2.90 mm, and 2.61 mm in the silicone rods group, compared to 2.54 mm, 2.37 mm, and 2.37 mm in Ptose-up group. The results were significantly different between the two groups at one and 3 months (P=0.018, 0.012, respectively), but at 6 months the difference was not significant. The patients’ satisfaction with the operation was significantly better in Ptose-up group compared to silicone rods group [42%: good, 45%: moderate, 13% poor; and 71%: good, 14%: moderate, and 14%: poor, respectively (P=0.017)]. Ptose-up is an excellent alternative to the silicone rod for the sling procedure, with a good success rate and acceptable complication rates compared to the silicone rod, and better subjective satisfaction of the patients.

To investigate the correlation between corneal biomechanical properties and tomographic parameters of Pentacam Corneal biomechanical properties and tomographic results of 36 normal subjects were measured by Ocular Response Analyzer (ORA) and Pentacam and the correlation between these two measurements were analyzed with Pearson correlation test with SPSS version16. Significant correlation was found between corneal hysteresis (CH) and central corneal thickness (CCT), depth and angle of the anterior chamber, corneal shape factor and corneal volume (P<0.05). Strong association between corneal resistance factor (CRF) and CCT was also found (P<0.05). Goldmann correlated intraocular pressure (IOPg) had significant positive relation with CCT and negatively correlated with corneal power in different areas (P<0.05). Corneal compensated intraocular pressure (IOPcc) had no significant correlation with CCT (P>0.05). Corneal thickness had an effective role in determining biomechanical properties of this tissue. In addition, significant correlation between CH and corneal volume was also found. Since corneal volume is a three dimensional parameter, it can play a more effective role than corneal thickness, the two dimensional parameter, in determining biomechanical properties of cornea.

To compare the serum homocysteine (Hcy) level in healthy control individuals and in patient with primary open angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEXG) In this cross sectional study, 79 subjects including 36 patients with PEXG, 23 patients with POAG, and 20 matched healthy control individuals were recruited. Those who used alcohol and mediations affecting Hcy levels were excluded. The level of serum Hcy was measured by Enzyme Immunoassay (EIA) method. Analysis of variance (ANOVA) was used to compare Hcy levels among PEXG, POAG and control groups. The mean ages were 68.9, 63.3, and 64.7 years in PEXG, POAG, and control groups, respectively (P=0.053); and 64%, 52%, and 60% were male in three study groups, respectively (P=0.67). The mean Hcy levels in PEXG, POAG and control groups were 12.21±4.93, 10.20±5.25, and 11.59±3.87 µmol/l, respectively (P=0.293; ANOVA). There was not a significant correlation between Hcy levels and diabetes, hyperlipidemia (HLP), hypertension (HTN), and cigarette smoking among diagnostic groups. No significant difference was found in Hcy levels among PEXG, POAG, and normal control group.

To evaluate the effect of induced esophoria and exophoria on distance stereoacuity at 6 meters Fifty subjects with distance corrected or uncorrected visual acuity of 6/6 and orthophoria without history of amblyopia, strabismus or any ocular pathology were recruited and distance stereoacuity was measured by Howard-dolman test before and after introducing 2, 4, 6 and 8Δ base in and base out to induce esophoria and exophoria, respectively. Although the decrease in stereoacuity was not significant by introducing 2Δ base in prism (P=0.062), but it was significant statistically by introducing 4 and 6Δ base in (P=0.002, P=0.026, respectively) and 2, 4, 6, 8Δ base out (P=0.042, P<0.001, P<0.001, P<0.001, respectively) prisms compared with orthophoric position. There was no significant difference between stereoacuity in 2Δ and 4Δ induced esophoria with 2Δ and 4Δ induced exophoria (P=0.696, P=0.677, respectively), but 6Δ induced esophoria decreased stereoacuity more than induced exophoria of the same amount (P=0.007). Induced heterophoria at distance of 6 meters reduced stereoacuity measured by modified Howard-Dolman test. Greater than 4Δ of induced esophoria had statically and clinically adverse effect on distance stereoacuity.

Retinoblastoma (RB) is a relatively common childhood tumor. In this report we discuss the clinical characteristics, treatments and outcome of the treated RB patients from a referral center in Iran in order to understand this medical problem in our society. A retrospective study was carried out on RB cases treated in Farabi Eye Hospital since 1979 to 2007. The variables analyzed were age, sex, affected eyes, time of the diagnosis, treatment modalities, pathological findings and the survival rate. We analyzed 557 cases with a mean age of 32.2 months [standard Deviation (SD)= 22]. There was a male predominance (60%). There were 380 unilateral cases (68.6%). Enucleation was performed in 65.6% of the patients. Nearly 82% of the eyes were in group Va and Vb Reese-Ellsworth or in a very advanced condition. Of the enucleated cases, 43.2% of the eyes have had undifferentiated types of tumors. Disease free survival was 68.5% in this study (by a mean follow-up of 61.9 months). Considering the advanced stages of disease in the majority of patients at the time of diagnosis, the enucleation ratio of our RB patients was higher than other countries.

To analyze the correlation of ocular higher-order aberrations (HOAs) and mesopic pupil size (MPS) with age and gender in myopic patients screened for refractive surgery Ocular HOAs and MPS were examined in 1,641 females eyes and 749 males eyes with myopia and also in two different age groups, under 30-year-old (1,675 eyes) and over 30-year-old (715 eyes), using the Zywave aberrometer (Busch & Lomb) wavefront aberrometer. Root-mean-square (RMS) values of HOA and MPS were analyzed. All patients had correctable refractive error without history of refractive surgery or underlying diseases. Pupil size measurement was performed under mesopic condition and ocular HOAs were examined across a ≥6.0 mm pupil. The mean value of HOAs in 18-30-year-old group was 0.354±0.137 μm (range, 0.10 to 0.97 μm) and in over 30-year-old group was 0.417±0.158 μm (range, 0.10 to 0.99 μm) (P<0.001). The difference of HOAs between males and females was not significant. The mean value of MPS in 18-30-year-old group was 6.36±0.90 mm (range, 3.1 to 8.9 mm) and in over 30-year-old group was 5.60±0.99 mm (range, 2.8 to 8.5 mm) (P<0.001). The mean value of MPS in females group was 6.10±0.98 mm (range, 2.8 to 8.7 mm) and in males group was 6.20±1.01 mm (range, 2.8 to 8.9 mm) (P=0.010). Significant levels of HOAs were found in our population. The mean value of HOAs in older subjects had statistically significant greater levels, while there was no difference between males and females. Young men had the highest value of MPS.

To evaluate distance and near contrast sensitivity (CS) under photopic and mesopic conditions before and after refractive lens exchange (RLE) and implantation of the aspheric AcrySof ReSTOR (SN6AD3 model) intraocular lens (IOL) Sixty eyes of 30 consecutive patients after RLE underwent bilateral implantation with the aspheric AcrySof ReSTOR IOL. The patients sample was divided into myopic [n=15, mean spherical equivalent (SE) -6.87± 2.03 diopters (D)] and hyperopic (n=15, mean SE +4.52±1.14 D) groups. Monocular uncorrected visual acuity at distance and near (UCVA and UCNVA, respectively) and monocular best corrected visual acuity at distance and near (BCVA and BCNVA, respectively) were measured before and 6 months postoperatively. Monocular CS function was measured with the Stereo Optical FACT CS chart at distance and near, at three different luminance levels (85, 5 and 2.5 cd/m2) before and after RLE. Postimplantation results at 6 months were compared with those found before surgery. Our results revealed that patients in both groups obtained good UCVA and BCVA after RLE at distance and near vision in relation to presurgery values. The safety and efficacy indexes were 1.06 and 0.87 for the myopic group and 1.02 and 0.86 for the hyperopic group at distance vision. At near vision, the safety and efficacy indexes were 1.24 and 1.16 for the myopic group and 1.15 and 1.13 for the hyperopic group. No statistically significant differences were found between the values of CS pre and post-RLE at distance and near, at any lighting condition and spatial frequency (P>0.002). RLE with aspheric AcrySof ReSTOR IOL in myopic and hyperopic population provided good visual function and yield good distance and near CS under photopic and mesopic conditions. Although mesopic CS is reduced at distance and near in relation to photopic CS, the performance is comparable to that obtained prior to surgery with the natural lens and better than published results of the spherical AcrySof ReSTOR model.

To report the complications and acute and chronic managements of a case of corneal bee sting injury and to report the outcome of visual performance Case report : A 28-year-old Caucasian man who was stung by insect and was complaining of ocular pain and decreased vision in the left eye, presented to the emergency room. A sting was found and completely removed. Corneal edema, bullous keratopathy, corneal epithelial defect, cataract and transitory rise of intraocular pressure (IOP) were identified. The corneal edema not improved despite topical and systemic corticosteroids were given during the follow-up period. IOP returned to normal with anti-glaucoma drugs. Penetrating Keratoplasty (PK) and extracapsular cataract extraction (ECCE) and IOL insertion was done 10 months after trauma. Graft resuturing and amniotic membrane transplant (AMT) was done 3 months after PK for loose sutures and persistent graft epithelial defect. Later perilimbal subconjunctival injection of 0.1 ml bevacizumab was done. The cornea was vascularized and scarified and patient was placed on the waiting list for rePK. Bee sting can lead to serious visual impairment despite adequate medical and surgical approaches.

To report an unusual case of bilateral Candida keratitis in a young drug abuser Case report : A 19-year-old man sought medical care for his left eye redness, pain and photophobia. On slit-lamp examination a well-defined paracentral exudative corneal ulcer was observed. Smear from the corneal ulcers contained pseudohyphae and accordingly a routine regime of antifungal therapy (topical drop of Amphotericin-B 0.15% q1h beside out-patient daily follow-up) was commenced. Although the signs and symptoms improved initially, the corneal ulcer grew even larger in the third day of treatment and the contralateral cornea also began to show preliminary signs of fungal infection. Further work-ups revealed that his bilateral Candida keratitis had happened in association with an unusual route of drug abuse (transconjunctival heroin abuse). Clinical response was achieved by additional topical Voriconazol (1% q1h) and systemic Fluconazol (200 mg bid). Candida Keratitis in the context of previous drug abuse and the presence of bilateral keratoconjunctivitis beside kissing conjunctival lesions may serve as diagnostic clues for this very rare condition.

Cataract has a long history and was known about 2500 BC in Egypt. In the medieval times, physicians and surgeons used surgical approaches to ease cataract (āb morvārid). Albucasis, as a Great Spanish Muslim surgeon (936-1013 AD) has a detailed and accurate description of cataract surgery procedure and patient care in his manuscript, Al Tasreef. His description can show surgical development to ease cataract in medieval time.

We are describing a new surgical approach in the management of advanced ocular surface cicatrization through a single procedure conjunctival-limbal-corneal allograft in which the external eye is resurfaced; it involves a lamellar corneolimbal keratoplasty, 360° limbal stem cell transfer (on a “bipedicle” conjunctival-corneal carrier), and conjunctival tissue transplantation - all in a single continuous sheet but with two edges for suturing: donor corneal-limbal edge to recipient’s scleral-limbal edge (avoiding overlying stem cell element of the donor tissue) and donor’s and recipient’s conjunctival edges; fornices would be reconstructed if needed.