Journal of Current Ophthalmology
Volume:25 Issue: 1, Mar 2013

Gholam Ali Peyman, MD was recognized for his great achievement on February 2013 when he was awarded with the honor of being named as one of the most distinguished in the list of 12 top researcher recipients of the National Medal of Technology and Innovations in the United States. There were twelve highly accomplished inventors in the list of National Medal of Technology and Innovation. Scientists, engineers and inventors have great esteem for this medal along with other National Medal of Science designations. In 1980; the National Medal of Technology and Innovation was established by the United States congress. Individuals who create viable solutions to improve the quality of life as well as technological abilities of workers are usually nominated for this distinguished award. A well-known independent group consisting of private sectors and public firms make up the nomination evaluation committee.1

Round-the-clock on-demand availability and corneal cloudiness are the two major problems with animal eyes for surgical practice. The purpose of this investigation is to assess the usability of long-term deep freezing for the preservation of enucleated sheep eyes and the adjunctive role of intracameral cryoprotective agent on corneal clarity. Thirty-two enucleated fresh sheep eyes were obtained from the slaughterhouse. With an insulin syringe, 0.5 mL of aqueous was tapped from the 16 right globes; it was replaced by an equivalent intracameral cryoprotection solution. Treated eyes were kept in receptacles filled with 1 cc of the same cryoprotectant and stored in a deep freezer (-80˚C). Left eyes were served as controls (untreated globes) and stored in the same condition. Six months later, globes were defrosted and corneal clarity was compared in a paired and masked fashion. All treated globes had clearer corneas as compared with untreated globes and they were all successfully applied for anterior segment surgical practice. Long-term deep freezing with adjuvant intracameral cryoprotectant is effective for the preservation of corneal clarity of animal whole globe. This allows round-the-clock on-demand availability of animal eyes with clear corneas for surgical practice in ophthalmology skill labs.

To evaluate the efficacy, safety, predictability and stability of Implantable Collamer Lens (ICL) and toric ICL for the treat­ment of high myopia and high myopic astigmatism In this prospective nonrandomized clinical trial, 95 eyes of 51 patients who underwent ICL (31 eyes) and toric ICL (64 eyes) implantations were participate in Eye Research Center, Department of Ophthalmology, Rasoul Akram Hospital, Tehran University of Medical Sciences and Negah Eye Hospital, Tehran, Iran. Uncorrected visual accuity (UCVA), best spectacle corrected visual acuity (BSCVA), manifest refraction, adverse events and com­plications were evaluated at 5th day and 2, 6 and 12 months postoperation. The mean preoperative manifest refractive spherical equivalents (MRSE) were -11.75±4.63 D (diopter) (-5.0 to -22.0) in ICL group and -11.67±3.99 D (-3.0 to -21.0) in toric ICL group. Mean residual refractive spherical equivalent were -0.68±1.07 D at 5th day, -0.86±1.07 D at 2 months, -0.65±0.72 D at 6 months, -0.71±0.78 D at one year in ICL group and -0.69±1.03 D, -0.59±0.84 D, -0.71±0.76 D and -0.89±0.68 D in toric ICL group, respectively. Preoperative cylinder in toric ICL group was -3.25±1.29 D (-2.0 to -6.0) and after operation was -0.81±0.63 D, -0.75±0.67 D, -0.93±0.70 D, -0.94±0.61 D, respectively. At 2 months after operation, the UCVA was 20/40 or better in 74.3% in ICL group and 74.6 % in toric ICL group (efficacy=1.092 and 1.154, respectively). 71.0% and 68.2% were within ±0.5 D and 77.5% and 85.7% were within ±1.0 D of emmetropia, respectively. 58.1% and 63.6% gained one or more lines (safety=1.18 and 1.24) two months after operation. At 2 months after operation, 81%, of eyes in toric ICL group had <1.0 D and 95.3% <1.5 D cylinder. No operative and postoperative complications or adverse events were observed. One eye (1.05%) developed asymptomatic (trace) anterior subcapsular opacities. ICL and toric ICL implantations were effec­tive, predictable, and safe procedures for the treatment of high myopia and high myopic astigmatism.

To compare the postoperative results of Epi-LASIK and photorefractive keratectomy-mitomycin (PRK-mitomycin) in patients with moderate to high myopia For this double-blind clinical trial, samples were randomly selected among those subjects above 20 years of age who were visited for myopia correction and had a spherical equivalent between -4 to -8 D. We randomly performed PRK-mitomycin in one eye and Epi-LASIK in the other eye of the patients. Refraction examinations, visual acuity (VA) measurements, contrast sensitivity testing, and corneal examination were performed at 1, 3, and 6 months after surgery. In the current study, analysis was performed on 3- and 6-month data. Thirty - six eyes were studied. Six months after surgery, the mean spherical equivalent in PRK-mitomycin and Epi-LASIK groups was 0 and -0.1 D, respectively (p=0.994). Six months after surgery, 13 eyes had a spherical equivalent of 0±0.5 D in each group while one diopter of ametropia was seen in 16 and 15 eyes in the PRK-mitomycin and Epi-LASIK groups, respectively. Six months after surgery, one eye in the PRK-mitomycin group and two eyes in the Epi-LASIK group lost 1 line of best corrected visual acuity (BCVA). Six months after surgery, 12 eyes in the PRK-mitomycin group and nine eyes in the Epi-LASIK group had an uncorrected visual acuity (UCVA) of 10/10. The safety index in the PRK-mitomycin and Epi-LASIK group was calculated to be 1.25 and 1.19, respectively (p=0.480). No haze was seen in the PRK-mitomycin group 6 months after surgery while 2 cases in the Epi-LASIK group had haze grade 0.5. There was no significant difference in contrast sensitivity between the two groups (p>0.05). The two methods were similar in postoperative VA and refractive results. Since the chance of haze formation in Epi-LASIK surgery without the application of mitomycin-C (MMC) is similar to PRK with mitomycin, Epi-LASIK can be considered as an alternative to PRK with MMC for the treatment of moderate to high myopia.

To evaluate the correlation between inner segment/outer segment (IS/OS) line and external limiting membrane (ELM) layer integrity at foveal center and visual outcome and to investigate the prognostic factors in optical coherence tomography (OCT) that related to final visual acuity (VA) and recovery time in acute central serous chorioretinopathy (CSC) We prospectively studied 108 consecutive patients (114 eyes) with acute CSC. The status of IS/OS line and ELM layer in the foveal center were assessed using OCT at initial and follow-up observation. OCT parameters including subretinal fluid (SRF) height (h), SRF width (w), central retinal thickness (r), total central foveal thickness (f), macular volume, and SRF surface were measured. Ninety-four eyes (49 OD and 45 OS) from 88 patients (70 men and 18 women) were enrolled. No correlation was found between the total central foveal thickness at the center of the fovea and the final best corrected visual acuity (BCVA) levels (p=0.51). Final BCVA in patient with intact IS/OS junction and intact ELM at the fovea was significantly greater compared with absent or interrupted groups. We found significant correlation between the BCVA at the first visit and the final levels (p≤0.0001; r=0.69). Also there was significant correlation between final BCVA and recovery period (p≤0.0001; r=0.47). Although, there was no correlation between the recovery period and subretinal fluid volume, SRF height, SRF width, and SRF surface area, but there was correlation between the recovery period with SRF height to width ratio (p=0.0052; r=0.26). We reported that absence or interruption of foveal IS/OS junction and ELM layer, poor VA at initial visit, systemic diseases, use of certain drugs, and SRF height to width ratio in OCT is associated with poor final VA or longer duration of recovery time which in turn causes poor final VA in acute CSC.

To investigate the sensations experienced by Chinese patients during refractive surgery including the laser in situ keratomileusis (LASIK), Epi-Lasik, and Sub-Bowman keratomileusis (SBK) techniques. A prospective, randomized, and self-matched clinical study was conducted. The participants included 44 men and 58 women aged 16 to 47 years old (mean 24.3±0.6 years) who underwent bilateral refractive surgery. Data were collected by using a standardized questionnaire regarding intraoperative experiences including light perception, perception of the green fixation light, pain, fear, and so on. A higher proportion of patients experienced temporary loss of light perception in the LASIK group compared with the Epi-Lasik and SBK groups (97% vs. 92% vs. 73%; χ2 =0.0072, p<0.05). Moreover, 71 patients were frightened by their intraoperative experiences [20 Epi-Lasik patients (71%); 23 LASIK patients (68%); 28 SBK patients (70%)]. These patients were mostly younger, aged ≤ 20 years (χ2 =0.0182, p<0.05). Moreover, the younger age group was significantly associated with the higher level of fear (χ2 =0.0011, p<0.05). Patients included in the group who felt pain with a mean duration of surgery ranging from five to 10 minutes (8.471±1.566) were significantly less in number compared with those who did not feel pain (7.100±1.820) (χ2 =0.0154, p<0.05). Patients also saw colors and movement, but the differences were not significant among the techniques. Patients experienced various visual sensations. Younger age and relatively longer surgical durations were found to be the risk factors for the visual sensations of fear and pain during surgery. Preoperative counseling is an important factor in preparing patients for such visual experiences.

To evaluate the efficacy of pattern visual evoked potentials (PVEP), standard automated perimetry (SAP), short-wavelength automated perimetry (SWAP), contrast sensitivity (CS), stereoacuity testing in detecting subclinical visual impairment in visually asymptomatic patients with multiple sclerosis (MS) and no history of optic neuritis Twenty-seven eyes of 27 patients (7 males, 20 females, average age 33.81 ± 9.33 years) with confirmed diagnosis of MS, underwent PVEP with 60-minute arc and 15-minute arc check sizes, SAP (Humphrey 750-II, program central 30-2, SITA standard strategy), SWAP (Humphrey 750-II, program central 30-2 full-threshold strategy), CS with CSV1000E chart, Stereoacuity by the Randot stereoacuity (RSA) test. They were age and sex matched with twenty seven healthy volunteers as a control group. Stereoacuity score was significantly reduced in MS group compared with controls (p=0.007). P100 latency time for both 60-minute arc and 15-minute arc was significantly prolonged in MS group compared with controls (p=0.005, p=0.002 respectively). P100 amplitude for both check sizes significantly reduced in MS group compared with controls (p<0.001). When comparing MS patients with the control group significant differences were found for SAP mean deviation (MD), SWAP MD, SAP pattern standard deviation (PSD), SWAP PSD (p<0.001). By considering predefined criteria, asymptomatic MS patients have shown abnormal stereoacuity in 22.2%, abnormal VEP in 40.7%, abnormal CS in 37%, abnormal SAP in 44% and abnormal SWAP in 37% of patients. Our results showed the probable presence of subclinical visual impairment among MS patients without optic neuritis history and no visual symptoms. This emphasizes the importance of the follow-up programs, even in asymptomatic patients with MS. Comparison of multiple tests could help in better understanding of silent visual impairment. However, performing VEP and perimetry test together are useful choices in the regular assessment of these patients.

To evaluate the efficacy of autologous plasmin in pediatric vitrectomy and to report the anatomic outcomes of autologous plasmin assisted pediatric vitrectomy In an interventional prospective study, Thirty-four pediatric patients with vitreoretinal disorders who needed vitrectomy during 2008 to 2010, included in the study. The patients were divided into two groups: the retinopathy of prematurity (ROP) and the other vitreoretinal disorders (non-ROP) groups. The patients underwent plasmin assisted vitrectomy. The anatomic outcome was studied among patients with ROP and rhegmatogenous retinal detachment (RRD). Grading of the induced posterior vitreous detachment (PVD) and intraoperative complications were reported by the surgeon. Follow-up examinations revealed anatomic outcomes and complications. The PVD was graded as 0-4 or questionable and anatomic outcomes was reported as total attachment, partial attachment, and detachment. The mean age of patients was 21.82±31.94 months. Forty-four percent were male. Among the ROP group 82.3% had questionable PVD, 5.9% grade 2, 5.9% grade 3, and 5.9% grade 4; and among the non-ROP group: 12%, 12%, 23%, and 53% had grade 1, 2, 3, and 4 PVD, respectively (p<0.001). After 6 months follow-up, in ROP cases, 29.5% had total attachment, 47% partial attachment, and 23.5% detachment. Among RRD cases 100% had total attachment. No complications were seen during surgery. Intravitreal plasmin injection may facilitate the complete PVD induction with few complications and acceptable anatomic outcomes in pediatric vitreoretinal disorders.

To determine the prevalence of the uncorrected refractive errors in Bojnourd students In a cross-sectional study, the samples were selected proportionate to the population of the schools using stratified randomized cluster sampling. The target population was the primary and junior high school students of the city of Bojnourd. Visual acuity (VA) (Snellen chart) and cycloplegic, non-cycloplegic and subjective refraction were measured in all students. Uncorrected visual acuity (UCVA) was defined as improvement in corrected vision for at least 2 lines as compared to the presenting vision. Of 2,020 selected students, 1,551 were included in the study (response rate 76.7%). The prevalence of uncorrected refractive errors was 6.2% (95% CI: 5-7.4) in at least one eye and 2.8% of the students had uncorrected refractive errors in both eyes. The prevalence of the uncorrected refractive errors was marginally higher in girls (p=0.068). Age, education level of the father and employment of the mother did not correlate with uncorrected refractive error. Myopic individuals followed by astigmatic students had the highest uncorrected refractive error. The presenting vision did not differ with the corrected vision in 83.3% of the participants. In 2.5% and 0.8% of the study population, vision improved by at least 3 and 4 lines after correcting vision, respectively. In individuals with glasses, the vision improved by at least 2, 3 and 4 lines in 21.1%, 9.5% and 3.2% respectively as compared to their present glasses. The prevalence of the uncorrected refractive errors in students was not low in this study. Girls, myopes, and cases of astigmatism showed high rates of uncorrected refractive errors, and it is important that they receive attention. Correcting these errors can help prevent visual impairment at young ages. Identifying uncorrected refractive errors should be among priorities of the health system, specially for students.

This study was performed to compare complications and clinical course of microscopic and macroscopic hyphema resulting from blunt ocular trauma In a prospective observational case series during the period 21 March 2010 to 20 March 2011 all referred patient with traumatic hyphema to ophthalmic emergency ward of Ahvaz, main city of southwest of IRAN that met inclusion criteria were included in the study and followed for at least one year. Of 197 patients with traumatic hyphema 37 patients were excluded by exclusion criteria. 160 patients who completed examinations and follow-up protocol were enrolled in the study, 99 patients (61.9%) had microscopic and 61 patients (38.1%) had macroscopic hyphema. In microscopic group 89 patients were male and in macroscopic group 46 patients were female. Clearing the anterior chamber was longer in macroscopic type (p=0.0001). Intraocular pressure (IOP) was significantly higher in macroscopic hyphema (p=0.007). Four (6/5%) cases of macroscopic hyphema required surgery, but no patient needed surgery in microscopic hyphema (p=0.02). Concomitant injuries to ocular structures like commotio retina, vitreous hemorrhage, retinal hemorrhage, macular hole and corneal epithelium defects were significantly less in macroscopic group than microscopic group (p=0.006). Despite a higher incidence of microscopic hyphema due to blunt ocular trauma, its secondary complications are rare. Microscopic hyphema do not require hospitalization and short intervals of follow-up examination but require attention to concomitant ocular injury.

To present the conjunctival aphthous ulceration in Behçet’s disease (BD) Case report: A 36-year-old woman with a known history of BD presenting an isolated, monosymptomatic conjunctival bulbar aphthosis. The eye was photophobic and painful. The lesion appeared four days prior to the consultation and measured 3.5 to 1.5 mm, which was totally excised and underwent pathological investigations. The patient was treated with topical chloramphenicol and oral colchicine. Histological examination revealed conjunctival ulceration with mono and polynuclear infiltration in subepithelial stroma of conjunctiva, and invasion of polymorphonuclear cells in blood vessel walls. Ocular aphthosis, although very rare, but very typical can be helpful in the diagnosis of BD.

To report a patient with orbital tuberculosis (TB) without any history of systemic involvement Case report: A 41-year-old Afghani man who presented with progressive painless swelling in lateral side of the left upper eyelid and diplopia. He did not have history of fever or pulmonary disease. Histopathology revealed a granulomatous inflammation with caseation necrosis. Microbiological studies for finding Acid-fast bacilli and Polymerase chain reaction (PCR) results were negative. The patient completely responded to a course of anti-tuberculous treatment. Although tuberculous dacryoadenitis is a very rare manifestation of TB, it is still important to recognize this presentation, specially when patient originating from endemic area.

To report an unusual presentation of chandler syndrome Case report: A 22-year-old female came to our clinic with complaint of progressive visual loss in her left eye since three days ago. She had a history of trauma with finger-nail to her left eye eight days ago and had been managed with topical antibiotic. In her examination, the left eye had visual acuity (VA) of counting finger at three meters, with intraocular pressure (IOP) of 14 mmHg, and there was a 3+ corneal stromal edema without epithelial defect. After medical management when edema decreased, specular biomicroscopy revealed decreased endothelial cell count and increased average cell size, pleomorphism and polymegathism, and epithelial transformation in the left eye and normal indices in the right eye. After one month, edema was completely resolved and VA improved to 20/25 but specular biomicroscopy remained abnormal. Chandler variant of iridocorneal endothelial syndrome (ICE) was diagnosed. Although corneal edema after blunt trauma is a usual manifestation, in long lasting edema after trauma, we should consider other possible endothelial causes of stromal edema including toxic insult, inflammatory processes, and endothelial dystrophies.