Journal of Current Ophthalmology
Volume:25 Issue: 3, Sep 2013

To determine add power (AP) and amplitude of accommodation (AA) in a sample of Iranian population and its relationship with refractive errors This cross-sectional study enrolled people of 35-70 years old by simple random sampling. Exclusion criteria were myopia or hyperopia over 6 diopter (D) and astigmatism more than 0.75 D. Those with a history of eye disorders and taking certain medicines that affect on vision were excluded. After correcting refractive errors, distance and near visual acuity (VA) and APs were determined considering subject’s age and AA at a distance of 33 cm. The AA was measured using a Royal Air Force (RAF) rule with push up method. Of 422 participants, 205 (48.6%) were males with a mean age of 50.2±8.8 years old, mean AP of 1.57±0.82 D, and average AA of 3.48±2.5 D. For each year of age, AP raised 0.1 D and AA decreased to 0.23 D (p<0.001). The need for AP occurs when AA was less than 6 D. The results of this study showed the distributions of AP and AA in a sample of Iranian population. The AA in this study was mid-range in comparison with other studies. It was found that females became presbyopic earlier than males and hyperopes became presbyopic earlier than emmetropes and myopes. These results pointed out that decreasing in AA less than 6 D requires AP.

To evaluate the effect of tenotomy on visual function and eye movement records in patients with infantile nystagmus syndrome (INS) without abnormal head posture (AHP) and strabismus A prospective interventional case-series of patients with INS with no AHP or strabismus. Patients underwent 4-horizontal muscle tenotomy. Best corrected visual acuity (BCVA) and eye movement recordings were compared pre and postoperatively. Eight patients were recruited in this study with 3 to 15.5 months of follow-up. Patients showed significant improvement in their visual function. Overall nystagmus amplitude and velocity was decreased 30.7% and 19.8%, respectively. Improvements were more marked at right and left gazes. Tenotomy improves both visual function and eye movement records in INS with no strabismus and eccentric null point. The procedure has more effect on lateral gazes with worse waveforms, thus can broaden area with better visual function. We recommend this surgery in patients with INS but no associated AHP or strabismus.

We describe our experience on safety and effectiveness of phacoemulsification in cataract and congenital iris coloboma and point out some specific surgical recommendations aimed to minimize its complications. A prospective case series study was conducted on nineteen consecutive patients with cataract and congenital iris coloboma referred to the Farabi Eye Hospital in Tehran. After primary preoperative evaluations, cataract surgery was performed for each patient. All patients were followed-up for at least six months to determine surgical mid-term outcome. Mean preoperative best corrected visual acuity (BCVA) in the participants was 1.99±0.70 logMAR which was improved to 0.82±0.61 logMAR postoperatively (p<0.001). Mean cell area was increased from 419.0±103.9 µm2 to 656.8±281.6 µm2 after surgery (p=0.001), while endothelial cell density was decreased from 2313.6±474.2 cell/mm2 before surgery to 1361.2±448.2 cell/mm2 after the operation (p<0.001). None of the patients developed corneal decompensation within the follow-up period. Regarding postprocedure complications, vitreous loss was observed in three patients, followed by penetration of dye to vitreous and remnant of the posterior capsule. None of the patients also experienced glare or photophobia and all of them were satisfied with the cosmetic result of their pupils. Based on our experience phacoemulsification with cosmetic repair of the coloboma can be a useful and safe procedure in patients with cataract and congenital iris coloboma.

To report clinical aspects of choroidal metastasis at a referral ocular oncology center We reviewed the records of all patients with choroidal metastasis referred to an ocular oncology referral center over a 10-year period retrospectively. The study was performed to identify and analyze clinical presentations and features of patients with choroidal metastasis. A total of 113 choroidal metastases were diagnosed in 60 eyes of 48 consecutive patients. There were 17 male (35.4%) and 31 female (64.6%) patients with a mean age of 54.5 years (median: 42; range, 29- 82 years) at the time of choroidal metastasis diagnosis. The median and mean numbers of choroidal metastasis were one and three tumors in each eye respectively. The primary cancer location was found to be the breast in 18 patients (37.5%), lung in 11 (22.9%), lymphoproliferative system in three (6.3%), thyroid in three (6.3%), gastrointestinal tract in three (6.3%), prostate in two (4.2%), brain in one (2.1%) and unknown primary in seven (14.5%). The most common primary cancer was the breast in females and lung in males. The main ocular symptoms of choroidal metastasis at diagnosis were blurred vision in 42 patients followed by pain in five patients. The choroidal metastasis was unilateral in 36 patients (75%) and bilateral in 12 patients (25%). The clinical features and primary sites of choroidal metastasis in Iranian patients were similar to those of published reports in this regard. One out of every seven patient had no known primary cancer at the time of choroidal metastasis presentation.

To compare the psychosocial status before and after successful strabismus surgery on Iranian strabismic patients One hundred twenty-four strabismic patients, older than 15 years were evaluated between 2009 and 2010. They were asked to complete a questionnaire about their psychosocial experiences, before and three months after successful strabismus surgery. Effects of strabismus on self-esteem, self-confidence, and self-assessment of intelligence, employment and interpersonal relationships were compared. Fifty-six percent of patients had problems in adjusting to society, and 71% had developed a mannerism to camouflage their misalignment before surgery. The preoperative scores of self-esteem, self-confidence, and interpersonal relationship were 4.33±2.07, 4.23±2.53 and 6.06±2.33 which changed to 8.33±3.02, 7.29±2.89 and 6.72±3.17 after surgery, respectively (p<0.001 for all of values). More esotropic patients reported to be discriminated against compared to exotropic patients. Postoperatively, 79% of patients reported improvements in their ability to meet new people, and 82% in interpersonal relationships. Scores of self-confidence and self-esteem increased up to three and four units, respectively (p<0.001 for both values). Patients with strabismus have psychosocial problems and successful strabismus surgery improves their psychosocial status.

Design and establishment of Persian near reading card for clinical use and practice At first, card dimension, word and character size and specifications were calculated. Then, English near reading card, Richmond Product INC, was considered as a template. Context and syntax contribute to reading accuracy and efficacy of the Richmond card was considered for designed Persian card. Near reading acuity of 50 Persian native languages, that could read conventional English texts, was compared with three near reading card (two designed Persian cards and Richmond card). These cards randomly presented to the subjects. Visual acuity (VA) was randomly measured with and without a cylindrical lens (+2.00 x 90) for all participants. VA results and reading time were compared in three cards. Correlation coefficient of first and second Persian reading card were 0.824 and 0.817 (p<0.001) respectively. Plus cylindrical lens would change the reading time and VA in all reading cards. Kappa index of agreement in these three cards was acceptable (61.1%). Comparison of Persian cards and English card showed high sensitivity (97.5%). Specificity for 1.25 MAR cut point for these charts was 55.6%. Reading time for Persian card was less than English card. These finding implies that Persian near reading card may be used for near reading acuity. It may be very useful for evaluation of visual function of Iranian and other Persian language persons at near distance.

The evaluation of the presence of Herpes Simplex Virus (HSV) in corneal scars by real-time polymerase chain reaction (PCR) and comparison of the results with histopathologic findings and clinical diagnoses Eighty-seven corneal scar samples obtained after penetrating keratoplasty (PK), were selected after reviewing the records from 2006 to 2010. Nucleic acid was extracted from paraffin embedded corneal samples and PCR-amplified for HSV DNA. Among 87 samples, four samples were excluded because internal controls were negative. HSV infection was established in 9.6% (8/83) of all patients. The prevalence of HSV infection in patients with no clinical suspicion of herpetic keratitis was 7.3%. Histopathologic evaluation revealed that among samples with positive PCR results, 100% had evidence of inflammation, 62.5% had giant cells, 37% had necrosis, 62.5% had vascularization, 62.5 % had ulcer and all of them had inclusion bodies. Because some of the patients with no clinical suspicion of herpes infection were found positive, we suggest that HSV keratitis to be considered as one of the underlying etiologies in any patient with corneal scar. Therefore, performing further diagnostic methods, including PCR and histopathology, are mandatory to rule out the infection.

To assess the safety, efficacy and predictability of photorefractive keratectomy (PRK) [Tissue-saving (TS) versus Plano-scan (PS) ablation algorithms] of Technolas 217z excimer laser for correction of myopic astigmatism In this retrospective study one hundred and seventy eyes of 85 patients (107 eyes (62.9%) with PS and 63 eyes (37.1%) with TS algorithm) were included. TS algorithm was applied for those with central corneal thickness less than 500 µm or estimated residual stromal thickness less than 420 µm. Mitomycin C (MMC) was applied for 120 eyes (70.6%); in case of an ablation depth more than 60 μm and/or astigmatic correction more than one diopter (D). Mean sphere, cylinder, spherical equivalent (SE) refraction, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) were measured preoperatively, and 4 weeks,12 weeks and 24 weeks postoperatively. One, three and six months postoperatively, 60%, 92.9%, 97.5% of eyes had UCVA of 20/20 or better, respectively. Mean preoperative and 1, 3, 6 months postoperative SE were -3.48±1.28 D (-1.00 to -8.75), -0.08±0.62D, -0.02±0.57 and -0.004± 0.29, respectively. And also, 87.6%, 94.1% and 100% were within ±1.0 D of emmetropia and 68.2, 75.3, 95% were within ±0.5 of emmetropia. The safety and efficacy indices were 0.99 and 0.99 at 12 weeks and 1.009 and 0.99 at 24 weeks, respectively. There was no clinically or statistically significant differences between the outcomes of PS or TS algorithms or between those with or without MMC in either group in terms of safety, efficacy, predictability or stability. Dividing the eyes with subjective SE≤4 D and SE ≥4 D postoperatively, there was no significant difference between the predictability of the two groups. There was no intra- or postoperative complication. Outcomes of PRK for correction of myopic astigmatism showed great promise with both PS and TS algorithms.

To report clinical and pathological features of three cases of opacification with hydrophilic acrylic intraocular lenses (IOLs) Case reports: In this interventional case report, we introduce the surgical and laboratory information about three hydrophilic acrylic IOLs which calcified after implantation for these patients with cataract. These lenses were explanted and analyzed with optical microscopy and pathological evaluation. Microscopic analyses showed granular deposits and pathological evaluation revealed deposition of calcium crystals. Pathologic analyses of explanted IOLs revealed that late opacification of hydrophilic acrylic IOLs are the result of calcification. Patient related factors might have been responsible for this complication.

To report a rare case of a patient with hypoparathyroidism presenting with bilateral disc swelling and near mature cataract as her first clinical manifestation Case report: A 23-year-old woman presented with complaint of worsening vision since one year ago and a history of refractory seizures and headache for several years, being under treatment with Lamotrigine 50 mg/daily. Slit-lamp examination revealed significant cataracts on both sides. Red reflex was dull in the right eye and absent in the left side. The intraocular pressure (IOP) measurement was normal in both eyes (16 mmHg). Her fundus examination revealed disc swelling in her right eye and hazy media that obscured fundus examination due to dense cataract in the left eye. The combination of bilateral disc swelling and dense cataracts raised suspicion to hypoparathyroidism. Subsequently, neuroimaging and intracranial pressure (ICP) monitoring was requested along with neuro-ophthalmalogy consultation. The diagnosis was Psedotumor Cerebri. Due to increased ICP, she underwent multiple lumber punctures. Computed tomography (CT) scan showed abnormal signal density in basal ganglia suggestive for presence of calcium depositions, making the diagnosis of hypoparathyroidism more probable. Ensuing laboratory result made the definite diagnosis of hypoparathyroidism. Meanwhile the cataract progressed and the visual acuity (VA) decreased to HM in her both eyes. She underwent cataract extraction and PCIOL implantation. Papilledema resolved and the vision restored to 20/20. Ocular complaints happens very rare in the course of hypoparathyroidism but still it seems rational that this occasionally fatal condition be ruled out by hormonal evaluation for cases of unexplained cataracts, particularly if it is accompanied by disc swelling.

Although there are ample evidences for the effects (mostly decrease) of intraocular pressure (IOP) after the administration of atracurium and cisatracurium during general anesthesia in ophthalmic operations, no study has yet been done to compare their effects on both IOP and pupillary diameter (PD) simultaneously. The aim of this study was to determine whether there is any difference between the effects of atracurium and cisatracurium on IOP and PD. Sixty patients with American Society of Anesthesiologists class I-II without history of previous eye surgery were studied in two randomly divided, double-blind groups. Following induction of anesthesia, atracurium (0.6 mg/kg) and cisatracurium (0.15 mg/kg) were administered to each group. IOP was measured by applanation tonometry (TONO – PEN ® XL) and PD (COLVARD pupillometer) at six sequential occasions, before induction of anesthesia, 2 and 5 minutes after induction and 2, 5 and 10 minutes after intubation prior to initiation of operation. Then they were compared to each other. Trend of recorded IOP and PD values showed that there were no statistically significant differences between atracurium and cisatracurium according to their effect on IOP (p=0.125) and PD (p>0.137) during the course of study. It seems that both atracurium and cisatracurium have similar effects on IOP and PD before and up to ten minutes after tracheal intubation prior to surgical intervention.