Journal of Current Ophthalmology
Volume:24 Issue: 4, 2012 Dec

To determine the prevalence of amblyopia and strabismus in the schoolchildren of the city of Bojnourd, Iran In 2010, randomized stratified cluster sampling was employed in a cross-sectional study on primary and junior high schoolchildren. All the examinations were performed in schools. All students received refraction, vision and subjective refraction tests. The cover test was used to determine tropia. Amblyopia was defined as best corrected visual acuity (BCVA) 20/30 or less or a 2-line interocular optotype acuity difference with no pathology. Of 2,020 selected students, 1,551 participated in the study (response rate: 76.7%). The prevalence of amblyopia was 2.3% (95% CI: 1.6-3.1); 2% of the male students and 2.5% of the female students had amblyopia (P=0.508). Amblyopia decreased significantly with age (P=0.032). The most common type of amblyopia was anisometropic followed by isometropic amblyopia. Hyperopia and astigmatism were the most common refractive errors in individuals with amblyopia. The prevalence of strabismus in the students was 2% (95% CI: 1.3-2.7). Of female and male students, 2.4% and 1.4% had strabismus, respectively (P=0.160). Of the students with strabismus, 67.7%, 25.8% and 6% had exotropia, esotropia and vertical deviations, respectively. The prevalence of amblyopia and strabismus in the current study was intermediate. However, correction of refractive errors at young ages can largely prevent amblyopia and strabismus in children.

To review ocular surface abnormalities caused by exposure to mustard gas and current approaches to manage its delayed-onset complications A total of 198 medical articles related to mustard gas were reviewed using known international medical databases, 114 articles were more relevant to the main aim were selected. Mustard gas-related ocular injuries can be divided into immediate and late phases. Acute manifestations of varying degrees include eyelid erythema and edema, chemosis, subconjunctival hemorrhage, and epithelial edema, punctate erosions, and corneal epithelial defects. Late complications can cause progressive and permanent reduction in visual acuity (VA) and even blindness and occur in approximately 0.5% of those initially severely wounded. These complications consist of chronic blepharitis, decreased tear meniscus, conjunctival vessel tortuosity, limbal stem cell deficiency, corneal scarring and thinning, and lipid/amyloid deposits. Management of the late complications varies from symptomatic treatment to surgical interventions for dry eye, corneal epithelial instability, limbal stem cell deficiency, and corneal opacity. Mustard gas-related ocular complications are progressive and some sort of surgical interventions may be ultimately required. A long-term and meticulous follow-up for these patients is warranted.

To examine the safety and efficacy of simultaneous Ahmed glaucoma valve (AGV) implantation with intravitreal and intracameral injection of bevacizumab (IVB and ICB) in patients with refractory acute neovascular glaucoma (NVG) with very high intraocular pressure (IOP) and active neovascularization of the iris (NVI) and/or the angle (NVA) In a prospective interventional study, patients presenting with acute NVG with uncontrolled IOP despite maximally tolerated medical treatment and with no prior history of interventions for their ischemic retinal condition underwent AGV implantation and IVB and ICB injection. Their baseline clinical data including the etiology of NVG, visual acuity (VA), IOP and the number of anti-glaucoma medications were recorded. Postoperatively, VA, IOP and number of anti-glaucoma medications and any complications were recorded. The main outcome measure was IOP control with and without medical therapy. Six eyes of 6 patients were recruited in the study. All of them had diabetic NVG. The mean age of the patients was 62.6±7.8 years. Mean IOP and number of medications were 61.5±9.9 mmHg and 4.1±.4, respectively. Three months after the surgery, the mean IOP and the number of medications were 19.5±4.5 mmHg and 2±1.26, respectively. The most frequent complication was hyphema (occurring in all eyes) that resolved spontaneously during the first postoperative week in 5 eyes and necessitated anterior chamber (AC) washout in 1 eye. Postoperatively, two eyes developed choroidal effusions and shallow ACs which resolved without any intervention during the first postoperative month. In patients with acute NVG with no prior treatment whose IOP was very high despite maximal medical therapy, AGV implantation with simultaneous IVB and ICB injection effectively reduced IOP and medications use in short term. The most frequent complication was development of hyphema (in all eyes) which spontaneously resolved in most eyes.

To evaluate the intraocular pressure (IOP) rising effect of anterior versus posterior subtenon injection of triamcinolone in eyes with retinal vein occlusion This prospective nonrandomized study was performed on 57 eyes of 57 patients with macular edema due to retinal vein occlusion. 26 eyes received posterior subtenon injection of 40 mg triamcinolone acetonide [PSTT] and 31 eyes received anterior subtenon injection of 40 mg triamcinolone acetonide [ASTT]. IOP measurement was performed before the injection, and after the injection at one week, two weeks, one month and every month up to six months after the injection. IOP rise was treated accordingly by drops and filtering surgery. IOP rise was found in 8% of the PSTT, and 67% of the ASTT injected eyes (P=0.001). All eyes with IOP rise in the PSTT group were controlled medically. Only 50% of eyes with IOP rise in the ASTT group could be controlled medically and filtering surgery was necessary for 33% of patients in the ASTT group. Visual acuity (VA) improvement was the same for both groups. More patients may have IOP rise after ASTT injection compared to PSTT injections.

To compare the visual and refractive outcomes of laser in situ keratomileusis (LASIK) versus laser assisted subepithelial keratectomy (LASEK) in the treatment of low to moderate myopia and astigmatism A retrospective comparative case series study comprised 2,474 eyes of patients with manifest refraction spherical component lower than -5.00 diopters (D) and cylinder components lower than -3.00 D were assigned to 2 groups: 1,238 eyes were treated with LASIK and 1,236 eyes with LASEK. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), remaining refractive error, and complications were evaluated at 1 week, 2, 6, 12, and 36 months postoperation. Preoperatively the mean refractive spherical equivalent (MRSE) was -3.42 D±1.01 (SD) in LASIK group and -3.36 D±1.01 (SD) in LASEK group, at 2 months it was -0.12 D±0.279 and -0.37 D±0.341, at 36 months postoperation in LASIK group it was -0.06 D±0.25 and in LASEK group it was -0.14±0.28 D, respectively. At 2 and 36 months, UCVA was 20/20 in 91.5% and 77.8% in LASIK group and, 94.7% and 90.9% in LASEK group, respectively. At 2 and 36 months, 95.4% and 78.7% in LASIK, 97.3% and 94.2% in LASEK group respectively were within ±0.5 D of emmetropia. Diffuse lamellar keratitis (DLK) in 5.9% and corneal ectasia in 1.05% of eyes (N=13) in the LASIK group and corneal haze in 10.6% (N=131) eyes in the LASEK group were seen. Both LASIK and LASEK were safe and effectively treated eyes with low to moderate myopia and astigmatism. LASEK provided superior results in visual outcomes.

To demonstrate an approach to the problems of cataract surgery in extensive iridoschisis Four eyes of 2 patients with extensive iridoschisis had cataract surgery by the same surgeon using the techniques that resembled techniques for phacoemulsification in intraoperative floppy iris syndrome (IFIS). We used low flow parameters on phacoemulsification, used super-cohesive ophthalmic viscosurgical devices (OVDs), avoided iris stretching, inserted iris hooks, administrated topical atropine preoperatively, and injected intracameral epinephrine. Iris fibrils remained immobile during the procedure, and despite the severity of iridoschisis, there was no iris attachment to phaco tip, iris billowing, or iris prolapse during phacoemulsification. None of the eyes developed posterior capsule rupture. In severe iridoschisis patients, there are risks of aspiration of iris fibers and iris prolapse during cataract surgery. These might be prevented by combination of using super-cohesive OVDs, avoidance of iris stretching, insertion of iris hooks, preoperative administration of topical atropine, and intracameral epinephrine.

The goal of this study was evaluation of the incidence rate of posttraumatic endophthalmitis, its clinical features and probable risk factors in repaired open globe injuries. In this retrospective case series, surgical and medical records of 600 patients with open globe injury were reviewed. Patients who underwent primary repair (as soon as possible) in Khatam-al-Anbia Eye Hospital, Mashhad, Iran, were included. Traumatic eye injuries were evaluated with respect to place of occurrence, age of patients, time interval between trauma and repair, damaged tissues, incidence of endophthalmitis, and its probable risk factors. Endophthalmitis occurred in 25 patients (4.2%). The mean age of the patients was 23.5 year (SD=20.006). 76% of patients (456 cases) were males and 24% were females. 69.9% of injuries occurred in urban places (419 cases) and 181 cases were occurred in rural areas. Mean interval time between trauma and repair was 30.85 hour (SD=72.187), median was 9.5 hour, and 80.9% of cases repaired within first 24 hours. 32.3% of patients (193 cases) had traumatic cataract, vitreous prolapse occurred in 23.1% (139 cases), and 6.5% of cases (39 patients) had intraocular foreign body (IOFB). Sharp offending object and trauma in right eye were associated with significantly increased risk of endophthalmitis (P=0.009 and P=0.004 respectively), but age (P=0.336), gender (P=0.632), location in which trauma occurred [rural area (P=0.268)], vitreous prolapse (P=0.751) and IOFB (P=0.169) were not associated with statistically significantly increased risk of endophthalmitis. Intravitreous antibiotic had not been injected routinely. Endophthalmitis was more frequent in those who received intravitreal antibiotics, P=0.000. Incidence of endophthalmitis was 4.2%, which is comparable with previous studies. Trauma with sharp objects and right eye were associated with increased risk of endophthalmitis. Despite previous studies IOFB and rural areas did not increase the risk of endophthalmitis, possibly due to vitrectomy in these cases. Probably, because of short time interval between trauma and primary repair in most cases, lag to repair was not a risk factor for development of endophthalmitis. Intravitreous antibiotic was injected only in severely damaged eyes, therefore its prophylactic effect against endophthalmitis could not be evaluated in this study.

To evaluate the effects of topical sesame oil in the treatment of severe corneal alkali injury in rabbits In a double-blind experiment, 30 healthy white rabbits were randomized into a sesame oil treatment group (n=15) and a control group (n=15). Under general anesthesia, severe corneal alkali injuries were induced by application of 1 N sodium hydroxide for 40 seconds to the right eye of each rabbit. The sesame oil group was treated with sesame oil drops 4 times daily for 1 month. Both groups received chloramphenicol eye drops, 4 times daily. Daily examination with fluorescein staining and photography were performed, and details of corneal erosion and ulceration were recorded. The main outcome measure was descemetocele and perforation of the cornea. The animals were euthanized at the end of the study or earlier if corneal perforation had occurred, and the corneas were excised and fixed in 10% neutral-buffered formalin for histologic examination. Mean time to perforation in sesame oil group was longer than control group (29.6 versus 25.5 days, respectively; P=0.01). Four eyes in sesame oil group and 8 eyes in control group developed descemetocele and perforation (P=0.13). Extent of corneal vascularization was 66.6% in sesame oil group and 49.3% in control group (P= 0.065). Topical sesame oil seems to have beneficial effects on alkali-injured corneas. It delays corneal perforation in rabbits compared to control group.

To report a case of simultaneous bilateral Fleischer and Kayser-Fleischer rings two years prior to appearance of any sign, symptom or laboratory data of the Wilson''s disease Case report: In this observational case report the examination and laboratory information of a 17-year-old Iranian female with blurred and decreased vision is introduced in a 2 years follow-up period. Complete ophthalmic examination, corneal topography, Orbscan corneal topography, laboratory tests [complete blood count (CBC), serum ceruloplasmin level, urine ceruloplasmin level, serum copper level, urine copper level] were done. In slit-lamp examination Kayser-Fleischer (KF) and Fleischer rings along with a corneal inferior cone was revealed. The topography and Orbscan imagings confirmed the diagnosis of keratoconus (KCN). Patient did not suffer from any systemic sign or symptoms. Her systemic physical examination was normal. All laboratory tests (liver function tests, serum and 24 hours urine copper level, serum ceruloplasmin level) were within normal limits. After two years of follow-up, fine hand tremors started, so she was referred for more investigations to neurologists. They confirmed that the signs might be due to Wilson''s disease central nervous system involvement. In her latest laboratory examinations, her serum ceruloplasmin level was reported beneath the normal limits. In our literature review there was no other resembling case in literature of coincidence of Wilson''s disease and KCN. Hence we prefer to name it the first «double corneal ring» patient.

To report a rare case of isolated orbital mucocele after trauma Case report: A 45-year-old man presented with swelling in the left orbital region. The only significant event in his medical history was trauma which occurred 25 years previously during the Iran-Iraq war. Computed tomography revealed a left medial intraorbital cystic mass lesion. The cystic mass was completely removed through the transcaruncular approach. The cystic mass was isolated in the orbital cavity. Histological examination confirmed the diagnosis of mucocele. Generally, mucocele is within the sinus cavities or its origin is from sinus cavity, but in the present case, the old trauma was the most likely cause of the mucocele that had caused sinus epithelium take access to the orbital cavity and grow there.

To report two cases of retinoblastomas detected by “white pupillary reflex” end-gaze leukocoria via flash photographs reported by parents Case reports: Retinoblastoma, a malignant ocular tumor, can be manifested by leukocoria. Herein, we report two cases, a 4-year-old boy and a 5-year-old girl, presented with the parents'' chief complaint of end-gaze leukocoria. In further evaluations retinoblastoma was detected and treated. Leukocoria is an alarming sign specially in pediatrics age group which should be detected and treated promptly. It may be detected solely in end-gaze by the child''s parents or in photographs in the early stages of retinoblastoma.