مجله چشم پزشکی بینا
سال بیستم شماره 3 (بهار 1394)

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, one year prospective study. In this prospective nonrandomized clinical trial, 95 eyes of 51 patients that had ICL (31 eyes) and toric ICL (64 eyes) were participate in Eye Research Center, Department of Ophthalmology, Rasoul Akram Hospital, Iran 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 preoperative mean manifest refractive spherical equivalent (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±0.63D, -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. Asymptomatic (trace) anterior sub capsular opacities were seen in one eye (1.05%). ICL and toric ICL were effective, predictable, and safe procedures for the treatment of high myopia and high myopic astigmatism.

To investigate the effect of CCL2C-2512T polymorphism on age-related macular degeneration (AMD). This study enrolled 48 patients originating from Northeast of Iran who suffered from dry type AMD. The association of C-2518T in the promoter region of CCL2 gene was investigated using polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). Control group consisted of 69 healthy people and were matched for age, sex and ethnicity. Statistical analysis showed a significant association of TT genotype in this polymorphism with susceptibility to AMD (P=0.008). This genotype was more frequent in patients compared to the controls (60.41% vs 43.48%). TT genotype of C-2518T gene polymorphism is associated with dry age related macular degeneration in patients from Northeast of Iran.

To compare the clinical outcomes following deep anterior lamellar keratoplasty (DALK) for keratoconic patients with vernal keratoconjunctivitis (VKC) and without VKC. In this retrospective comparative study, the records for 262 eyes with keratoconus only (group 1) and 28 keratoconic eyes with VKC (group 2) that underwent DALK were complied. The parameters reviewed included the length of follow-up, best-corrected visual acuity (BCVA), refractive error, complications and cumulative graft survival. The mean length of follow-up was 38.6±20.2 months in group 1 and 34.4±20.9 months in group 2 (P=0.21). The mean postoperative BCVA was 0.19±0.11 logMAR and 0.20±0.15 logMAR (P=0.79), with a BSCVA  20/40 achieved in 91.6% and 88.5% of these eyes, respectively (P=0.48). Epithelial problems were encountered in 31.3% and 42.9% of the eyes, respectively (P=0.16). Vascularization of suture tracts and stitch abscesses were encountered more frequently in the eyes with VKC (P=0.01 and <0.001, respectively.) At the 33-month followup examination, the rejection-free graft survival rates were 56.0% in group 1 and 33.3% in group 2, with mean durations of 41.0 and 32.1 months, respectively (P=0.15). The graft survival rates were 98.1% in group 1 and 95.0% in group 2, with mean durations of 88.6 and 88.4 months, respectively (P= 0.47). The clinical outcomes of DALK for the eyes with keratoconus and VKC were comparable to those for the eyes with keratoconus alone. However, because complications such as suture tract vascularization and stitch abscesses were more common when VKC coexisted, closer monitoring is necessary in these cases.

To compare axial length (AL) changes after trabeculectomy with mitomycin C (MMC) measured using two methods, contact and non-contact biometry. Thirty-four eyes of 31 glaucoma patients who were candidates for primary trabeculectomy were enrolled. AL was measured using A scan ultrasound biometry (UD-6000 Ultrasonic A/B scanner biometer, TOMEY) and non-contact optical biometry device (LenStar LS 900,Haag Stereit) preoperatively and 3 and 6 months postoperatively. Postoperative values, measured at 3 and 6 months, were compared with the preoperative values. After trabeculectomy, AL decreased by 0.21±0.16 mm and 0.14±0.13 mm at month 3 and 0.19±0.15 and by 0.14±0.15 mm at month 6 after surgery using A scan and LenStar, respectively (P 0.001 for all comparisons). The mean reduction in AL was significantly lower with LenStar compared with A scan with a mean difference of 0.07±0.15 mm (P=0.011) at month 3 and 0.04±0.09 mm (P=0.02) at month 6. LenStar can provide more accurate AL measurements than A scan which is attributable to the elimination of false AL reduction caused by the effect of contact biometry probe on softened eyes after trabeculectomy.

To describe a novel surgical technique for in vivo limbal stem cell cultivation for reconstruction of corneal epithelium in total limbal stem cell deficiency (LSCD). Patients suffering from chronic total unilateral LSCD due to a chemical injury were sequentially included. One small limbal block (2x1 mm) harvested from contralateral healthy eye sutured over the amniotic membrane (AM) to the superior limbal area of the injured eye. Amniotic membrane extract eye drop (AMEED) at the concentration of 0.1 mg/ml was regularly used until total corneal epithelialization was achieved. All eyes underwent sequential penetrating keratoplasty (PKP) for optical indication and the corneal button was sent for histopathologic examinations and molecular analysis for the detection of limbal stem cell markers. Five eyes of 5 patients with a mean age of 32 years were operated. Mean follow up period was 12 months. Total epithelialization of the corneal surface was achieved in 2 weeks in all eyes. Corneal conjunctivalization and vascularization regressed dramatically after 3 to 4 weeks. Transplanted corneas were clear at the last follow-up examination. No complication developed in donor and recipient eyes. Laboratory examinations showed limbal stem cell markers over the corneal buttons. In vivo cultivation of limbal stem cells over the AM using AMEED is an effective procedure for ocular surface reconstruction in patients with unilateral total LSCD. However, its long term results should be confirmed in studies with a longer follow-up period.

To evaluate the health-related quality of life (HRQOL) among strabismus patient. One hundred and twenty-two strabismic patients  14 years who scheduled for surgery were selected non-randomly. The patients completed the adult strabismus 20 (AS-20) and SF 36 questionnaires. Measurements were performed preoperatively and 3 and 6 months postoperatively. Changes in psychosocial and function scores were evaluated as a difference in scores between pre- and postoperative. All operated eyes were successfully aligned 3 and 6 months postoperatively. Success was defined based on clinical criteria (residual deviation less than 8 prism diopter). The results showed an improvement in the psychosocial score from 50.9 preoperatively to 80.8 postoperatively (p<0.001) and in the function scores from 56 preoperatively to 81.8 postoperatively (p<0.001). The high educational level and having a job significantly improved the scores of quality of life. No significant correlation was found between indices of quality of life and type or severity of strabismus. Strabismus surgery in adult led to a significant improvement in both psychosocial and function scores, indicating that improvement in HRQOL. Evaluation of HRQOL should be considered when reporting strabismus surgery outcomes in clinical trials, and may prove helpful in assessing outcomes in clinical practice.

To compare anterior segment indices measured by two Scheimpflug camera; Galilei and Pentacam. In this observational case series, myopic patients scheduled for refractive surgery underwent corneal and anterior segment analyses using Pentacam (single Scheimpflug camera) and Galilei (dual Scheimpflug camera). Analyzed parameters included anterior and posterior best-fit spheres (BFS), axial curvature, true corneal power, central corneal thickness (CCT), anterior chamber (AC) depth, AC volume, AC angle and pupil diameter. Statistical analysis was performed using paired t- test and Bland-Altman plots. The study comprised 176 eyes of 88 patients. The mean radius of the anterior BFS was 7.79 ± 0.34 mm measured with Pentacam and 7.75 ± 0.39 mm measured with Galilei (r=0.877,p 0.001), and the mean radius of posterior BFS was 6.42 ± 0.32 mm and 6.47 ± 0.38 mm, respectively, (r=. ,p<0.001). Anterior axial curvature was 43.8 ± 1.9 D with Pentacam and 43.8± 2.4 D with Galilei (r=0.905,p 0.003). Posterior axial curvature was 6.3 ± 0.3 D and 6.3 ± 0.4 D, respectively (r=0.873, p<0.001). True Corneal power was 43.9 ± 1.9 D with Pentacam and 43.5± 2.3 D with Galilei (r=0.909,p<0.001). CCT was 537±44 μm with Pentacam and 553±51 μm with Galilei (r=0.796,p<0.001). Anterior chamber depth was 3.29±0.4 mm and 3.3±0.38 mm (r=0.85, p<0.001), anterior chamber volume was 207±50 mm³ and 129±39 mm³ (p=0.004), anterior chamber angle was 39.7±9.2 degree and 54.2±5.2 degree (p=0.051), respectively. Average pupil diameter was 3.91±1.77 mm with Pentacam and 3.34±0.89 mm with Galilei (p=0.007). There was a significant correlation between all measured parameters except for CCT, AC volume, AC angle, and pupil diameter. There is a significant agreement between Galilei and Pentacam Scheimpflug analyzers in most of the measured indices. However, the correlation can be low in some parameters. Therefore, these two devices cannot be used interchangeably.

Anti malaria agents including chloroquine and hydroxichloroquine are commonly used for rheumatic diseases e.g. systemic erythematous lupus or rheumatoid arthritis. One of the most important systemic side effects of these agents is ocular side effects (chloroquine toxicity retinopathy). Regarding to importance of early detection of this toxicity, the patients who take these drugs should be evaluated regularly. This article presents the latest recommendations on screening for chloroquine and hydroxychloroquine-induced retinopathy.

To present a case of unilateral epibulbar dermoid cyst in a girl with VACTERL syndrome.Case Report: A 4-year-old girl was referred with a white, soft and painless mass in the inferotemporal limbus of the left eye having presented since birth. The patient was healthy with normal growth. Other ocular examinations were normal. Systematic review revealed a group of abnormalities including vertebral scoliosis, imperforate anus, rectovaginal fistula, atrial septal defect, horseshoe kidneys, bladder diverticulitis, and a neurogenic bladder. Accordingly, she had been diagnosed with the VATERL association at birth. Defects of any organ system have been reported to be associated with VACTERL. Orbital dermoid is a rare non-VACTERL type defect in patients with VACTERL spectrum. However, there is one report in the literature indicating the association between the VACTERL syndrome and epibulbar dermoid cysts. The presence of an ipsilateral epibulbar dermoid cyst should lead to thorough investigation for other syndromes like VACTERL spectrum.

To report a case of cluster headache associated with secondary blepharospasm and its management. Case Report: A 37-year-old lady was referred because of unilateral severe blepharospasm. She had a history of severe headache in the same side of blepharospasm with features compatible with cluster headache. Blepharospasm was treated with botulinum toxin but treatment of headache was challenging and finally responded to beta blockers and anti-psychotic medications. In secondary blepharospasm, it is necessary to treat the underlying disease in addition to blepharospasm.