Purpose: To evaluate visual function in patients with different types of light-filtering intraocular lenses (IOLs) Methods: In this prospective comparative clinical study Cataract patients with different types of IOLs in Khatam-al-Anbia Eye Hospital, Mashhad were enrolled and followed for three months postoperatively. Corrected distance visual acuity (CDVA), color discrimination under photopic (1000 lux) and mesopic (40 lux) conditions were evaluated with Roth 28 hue test. Contrast sensitivity testing was then performed with 1000E contrast sensitivity unit (CSV-1000E, vector vision) with a constant test luminance level of 85 cd/m. Results: In this study, 47 patients were evaluated with different IOLs (16 clear, 17 yellow, 14 photochromic). There were no significant differences between the three IOLs in CDVA, contrast sensitivity and mesopic and photopic color vision (p<.05). Conclusion: Contrast sensitivity as well as the mesopic and photopic color vision are not different in clear, yellow and photochromic IOLs.
Purpose: To determine the prevalence and determinants of age-related macular degeneration (AMD) in a 40-64 year old Iranian population Methods: In a cross-sectional study, 6,311 people were randomly selected from Shahroud. For all participants, visual acuity, refraction, slit-lamp examination and fundus photography were conducted under pupil dilation. Results: Results of this study are based on analysis of 4,387 high quality photographs. The prevalence of AMD in this study was 4.7% (95% confidence interval (CI): 4.1-5.4). Multiple logistic regression analysis revealed that only older age [odds ratio (OR)=1.07] and hyperopia (OR=1.12) significantly correlated with AMD. Associations with biometric components and spherical equivalent were studied in another model and older age (OR=1.08), male sex (OR=1.54), and ocular axial length (OR=0.66) significantly correlated with AMD. Conclusion: AMD prevalence in this population was lower compared to Western countries and higher in comparison to East Asian countries. In agreement with other studies, age strongly correlated with AMD. Regarding the correlation between AMD and ocular axial length; the incidence is more likely to occur in people with short axial lengths.
Purpose: Uncorrected visual acuity is the only variable measured in vision screening programs in many countries worldwide. The aim of this study was to calculate the sensitivity, specificity, and predictive value of the uncorrected visual acuity in the screening programs for the diagnosis of refractive errors. Methods: In this cross-sectional study, of 4,157 students in the first year of primary school who were selected from seven cities of Iran through multistage cluster sampling, 3,675 students participated in the study. In each school, measurement of corrected and uncorrected visual acuity, cycloplegic and non-cycloplegic refraction, and cover test were performed for all students by an optometrist. Refractive errors obtained by cycloplegic refraction were considered gold standard and the validity of uncorrected visual acuity measured in the screening program for the diagnosis of refractive error was calculated. Results: In students with visual acuity of 20/20, the prevalence of myopia, hyperopia and astigmatism was 1.14%, 8.07% and 11.11%, respectively. The sensitivity of uncorrected visual acuity in the screening program for the diagnosis of myopia, hyperopia, astigmatism, and ametropia was 25.33%, 12.81%, 14.34%, and 12.64%. The area under the ROC curve of uncorrected visual acuity by optometrist and the screening program only showed a significant difference in myopia (p=0.013). Conclusion: The measurement of visual acuity in screening programs is not useful per se in the diagnosis of refractive errors and has a high percentage of false negative results. Adding refractive error examinations to the protocol of screening programs can increase their efficacy.
Purpose: To compare Orbscan II and Pentacam keratometry readings in terms of their agreement with a manual Javal type keratometer Methods: In this retrospective study, records of patients who had refractive surgery were reviewed. We extracted data of 765 eyes which had keratometry with the Javal keratometer; of these, 577 had Orbscan II and 200 eyes had Pentacam acquisitions. Minimum (min-K) and maximum (max-K) keratometry readings and keratometric astigmatism with the latter two devices were compared with Javal. Results: Correlation coefficients for Javal and Orbscan II in measuring min-K and max-K were r=0.916 and r=0.913, respectively (p<0.001). The 95% limits of agreement (LoA) between Javal and Orbscan II was 1.17-1.20 D for min-K and 1.22-1.24 D for max-K. The coefficients for Pentacam and Javal min-K and max-K readings were very high (r=0.943 and r=0.962). The 95% LoA between Pentacam and Javal in measuring min-K and max-K were 0.51-0.99D and 0.720.99D, respectively. The correlation between Pentacam and Javal measurements of keratometric astigmatism was stronger than that for Orbscan II and Javal (r=0.973 and r=0.800); the 95% LoA was 0.55-0.76D for Pentacam and Javal, and 1.14-1.19D for Orbscan II and Javal. Conclusion: According to this research, Orbscan II and Pentacam had high correlation and agreement with Javal-keratometer in determining keratometric values. Nevertheless, the results obtained from Pentacam showed better agreement and stronger correlation with Javal as compared with Orbscan II. It seems that Pentacam is a suitable substitute for Javal to perform keratometry in normal eyes.
Purpose: Comparing the optical coherence tomography (OCT) pachymetry patterns in keratoconus suspect and normal people Methods: Thirty-two keratoconus suspects and 36 healthy eyes were selected within the age range of 20-30 yrs. Their pachymetry pattern was obtained through OCT Visante in the minimum thickness spot, upper and lower corneal difference (I-S), lower temporal, and upper nasal thickness (IT-SN), withdrawal or non-withdrawal of the minimum thickness area of cornea from 0-2 central zone using the output map. Results: In all measured parameters a significant difference was observed between the two groups (p<0.0001). The Keratoconus suspects had a thinner cornea and showed more changes in corneal thickness than the normal group. Conclusion: It seems that an OCT system of anterior segment can be utilized to assess patients prior to refractive surgery or Keratoconus screening, along with equipments such as Pentacam, and Orbscan.
Purpose: To identify the postoperative surgical outcomes and the changes in deviation in patients treated by bilateral medial rectus (BMR) recession for small to large angle esotropia with a minimum follow-up of two years Methods: In this retrospective and consecutive case series, we reviewed medical records of 130 patients who had recession surgery for correction of esotropia between 2001-2011 in a tertiary center in Tehran. Patients were excluded if neurological abnormalities or developmental delays were documented and if structural eye abnormalities were present. Results: One month after operation (n=109), there were 85 successful cases (orthophoria or deviation less than 10 prism diopter), 18 cases of undercorrection, and six cases of overcorrection. The success rate at two years after surgery (n=82) was 78.2% with 13.3.% undercorrection and 8.5% over correction. The preoperative angle of esodeviation and patients’ age are found to significantly influence the response to the surgery. Conclusion: Surgery was effective because of high success rate and acceptable alignment after two years follow-up. Dose response increased in patients with larger angle of preoperative deviation, and was lower for patients who were older at the time of the surgery.
Purpose: To describe the clinical findings, preoperative radiologic findings and results of surgery in a patient with congenital bilateral hypoplasia of medial rectus muscle Case report: A 50-year-old man presented with large angle incomitant horizontal deviation with marked deficit of adduction of both eyes. MRI finding defined very thin medial rectus muscle. Intraoperatively medial rectus muscles were not found. Lateral rectus recess combined with partial vertical rectus muscle tendon transposition was carried out on both eyes. The patient had orthotropia in primary position and adduction improved in final follow-up. Conclusion: This case is the first case report of the Iranian population who had congenital hypoplasia of medial rectus muscle. MRI allowed effective surgical planning to correct congenital abnormality.
Purpose: Oculocardiac reflex (OCR) is a frequent event during strabismus surgery. The aim of this study is to compare the preventive effect of intravenous lidocaine and hyoscine on OCR. Methods: This prospective, randomized clinical trial was performed on 75 patients (5-63 years old) underwent strabismus surgery. Patients divided randomly into three groups. Intravenous hyoscine (0.2 mg/kg), lidocaine (1.5 mg/kg) and distilled water were injected before induction with propofol for each group respectively under standard monitoring. Heart rate, blood pressure and/or cardiac dysrrythmia were recorded immediately before/after injection and muscle hooking. Decrease of heart rate more than 20%, hypotension (decrease more than 20% in systolic or diastolic pressure) or any cardiac dysrrythmia were defined as OCR. Results: One hundred and thirty-six muscles were hooked during strabismus surgery. OCR was observed in 44 hooked muscles (32.3%). Reflex was observed in hyoscine (34.2%), lidocaine (24.9%) and control (40.9%) groups (p=0.12). The most stretched muscles which caused OCR were medial rectus (56.8%) and lateral rectus (36.3%) muscles. OCR was greater in patients with age between 5-10 years (56%). Conclusion: Intravenous lidocaine and N-buthylbromide hyoscine both could reduce OCR occurrence but the difference was not statistically significant compared to the control group. OCR was seen greater in young patients (5-10 years old). Some patients (specially children) need intervention to restore normal condition.
Purpose: To assess the efficacy of polyhexamethylene biguanide (PHMB) in treating Acanthamoeba keratitis (AK) and also to identify related factors affecting final visual outcome in AK patients treated with PHMB Methods: In these interventional case series study, 27 eyes of 25 patients with AK received PHMB 0.02% and divided into two groups according to the final visual acuity (VA); VA equal to or greater than 20 /25 and VA less than 20 /25. Two groups were evaluated for the effectiveness of PHMB in treatment of AK. Results: Before treatment, more than 85% of the eyes had VA of less than 20 /25 whilst after treatment final VA was 20 /25 or better in 66.7% of eyes. VA regressed in 14.8% of the eyes during follow-up and improved or remained the same in more than 85% of eyes. Patients with deep stromal keratitis or a ring infiltrate had more than a 28-fold increase in the odds of a visual outcome worse than 20/ 25 [odd ratio (OR), 28.0; 95% CI, 3.3-240.8, p=0.001]. Patients with Initial VA 0.05). Five eyes (18.5%) finally required keratoplasty. Conclusion: Initial stage of corneal involvement at presentation was the most predictive factor for final visual outcome in AK. Although PHMB, even as monotherapy, is effective in treatment of AK, a remarkable proportion of patients still suffer a final grim visual outcome which requires aggressive treatments.
Purpose: To present an extraocular muscle disinsertion in a pterygium surgery Case report: A 61-year-old woman presenting an acute diplophia after a nasal pterygium surgery. The medical rectus muscle was cut during the primary surgery which was immediately reported and the muscle was reinserted to its original site and recovery was more or less obtained. Conclusion: Anatomical consideration meticolous pterygium surgery and prompt reoperation of muscle are recommended.
Purpose: To assess the stability of visual and refractive outcomes that was compared between three and 12 months after MyoRing implantation in moderate and severe keratoconus Methods: This study included 54 eyes of 50 patients (27 males and 23 females) with stage II and III keratoconus who underwent MyoRing (Dioptex GmbH) implantation. Clinical outcomes including uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, spherical equivalent (SE) and mean keratometry (k)- readings were compared preoperatively and postoperatively (follow-up times were at 1, 3, 6 and 12 months postoperation). Results: The mean age was 28.48±6.3. The mean UDVA (logMAR) and the mean CDVA (logMAR) improved significantly from 1.20±0.24 to 0.20±0.09 and from 0.58±0.22 to 0.14±0.06, respectively (p<0.001). Both SE and the maximum keratometry (k)-reading decreased significantly by six diopters (p<0.001). There was no significant difference in visual and refractive outcomes between three and 12 months postoperatively. Twelve months after MyoRig implantation the predictability was 47 eyes (87%) within ±1.00 D and 31 eyes (57%) within ±0.50 D of emmetropia. Conclusion: MyoRing implantation in keratoconic patients improves SE, UDVA and CDVA significantly. Additionally, the improvement in UDVA was remarkable (approximately 10 lines). The procedure was safe and effective in treatment of patients with moderate and severe keratoconus. The visual and refractive outcomes remained stable between three and 12 months postoperatively.
Mohammad Faghihi et al have investigated “The Prevalence of Refractive Errors, Strabismus and Amblyopia in Schoolboys of Varamin, Iran, in 2010”, a random cluster sampling has been applied in this small town of less than half a million population which is located near the capital. They have found the prevalence of myopia ≥ 0.5 diopters, hyperopia of ≥ 0.5 and ≥ 0.1 to be 33.2%, 17.5% and 6.1%, respectively. Astigmatism and anisometropia of ≥ 0.75 D and ≥ 1.0 D were detected in 10.5% and 3.8% in that population of 14 to 18-year-old. The prevalence of strabismus was found to be 1.5% which contained 0.9% of exotropia. The prevalence of amblyopia was reported to be 2.1%, anisometropia was the cause in 54.2% of the cases. In 15.4% of the students the refractive error was uncorrected.
Purpose: To evaluate the rate of optical coherence tomography (OCT) grid decentration in a routine practice and its effect on thickness measurements Methods: Topcon spectral domain OCT scans from various macular diseases including age related macular degeneration, diabetic macular edema, macular pucker and central serous chorioretinopathy (CSCR) were studied in all patients visited during seven consecutive days. In each scan, the macular EDTRS grid was evaluated for decentration. After grid adjustment, the changes in central subfield thickness (CST) measurements were recorded. Differences >1 µm and >8.5 µm between automatically determined and manually adjusted CST measurements were recorded as grid decentration and significant grid decentration. Results: Ninety-three OCT scans of 93 eyes were evaluated. Thirty-three scans were unreliable for grid adjustment. In the remaining 60 eyes, grid decentration was found in 32 eyes (53.3%). The mean change in CST after grid adjustment was 41.1±55.01 (3-251) microns. Clinically significant CST changes were found in 24 eyes (40%). No significant relationship was found between underlying disease and corrected CST, and grid decentration. Conclusion: Abnormal retinal thickness map was found in a significant number of scans. Topcon OCT scans should be evaluated routinely for grid decentration.
Purpose: The goal of this study was to compare differences in the mean heterophoria and fusional amplitudes before and after photorefractive keratectomy (PRK) for myopia. Methods: In a prospective controlled study, myopic patients were treated with aspheric and wavefront-guided (personalized) PRK. The manifest refraction, visual acuity, fusional amplitudes and heterophoria were evaluated preoperatively and at three and six months postoperatively. Fusional amplitudes were measured at far (six meters) and near (40 centimeters) by rotary prism and heterophoria was evaluated at nearby Maddox wing. Results: A total of 48 cases (96 eyes, 68.75% female) were treated, with a mean age of 26.70±4.89 years (18-34 years). In the fusional reserves, comparisons between preoperative and six months postoperative means showed that far and near convergence reserves (or base out recovery points) and near divergence (or base in recovery point) were decreased significantly (p-values were 0.013, 0.002 and 0.008, respectively). In heterophoria measurements, contrary to the rest of the deviations, exophoria was increased, but not significantly (p=0.063). Conclusion: Findings of this study imply that far and near convergence amplitude (or base out reserves) were decreased significantly after keratorefractive surgery (KRS). The other fusional reserves were similarly decreased at three months postoperatively and returned to the preoperative values at six months.
Purpose: To determine the prevalence of intraocular injuries in patients with blow-out fracture and also to evaluate the etiologic mechanism of orbital blow-out fractures Methods: This study is a consecutive case series analysis of 116 patients with orbital blow-out fractures. The patients were visited by an ophthalmologist within 24 hours of trauma. Results: Ninety-one men and twenty-five women with mean age of 29.1±13.9 years were included for this study. Fist trauma and assault (54%) was the most common cause of orbital blow-out fractures. Inferior wall was involved more commonly (49%) than medial wall and combined form. Significant enophthalmos (>2 mm) was present in 26 cases. Orbital reconstruction surgery was performed in 34% of cases. Intraocular injuries were detected in 25% of patients. Hyphema (65%) and commotio retina (39%) were the most frequent detectable intraocular injuries. Intraocular damages were significantly less common in patients with large fractures (synchronous medial and inferior wall fractures or fracture size equal or more than 1 /2 of orbital wall) in contrast to small size fractures (p=0.02). Conclusion: Ocular injuries are relatively common in blow out fractures and ophthalmic examination is mandatory. In our study ocular injuries were less frequent in large fractures than small size fractures that may indicate protective role of orbital integrity or other factors caused by fractures.
Purpose: Neuromyelitis opitca (NMO) is an autoimmune disease that relates to deposition of antiAquaporin-4 (AQP4) IgG in the central nervous system (CNS). However, called seronegative NMO when patients are negative for AQP4 antibody. Nevertheless, NMO is most probably an antibody mediated disease. The aim of this study was to assess the association between seronegative NMO disease and variations in the AQP4 gene region. Methods: A total of 24 seronegative NMO patients were enrolled in the study in 12 months. The frequency of neucleotide variations in 5’ untranslated region (5’-UTR), coding, noncoding, and 3’ untranslated region (3’-UTR) regions were found and compared with the corresponding rates reported previously. Results: The frequencies of the studied variations showed no statistical difference with the rates reported previously. However, a variation was found in 7% of the alleles in the intronic region between exons 1 and 2 which has not been reported so far. Conclusion: Nucleotide variation in different regions of AQP4 gene can affect antigenicity of AQP4 in different ways one of which is making a change in AQP4 isoform (M1/M23) expression ratio. While the variation found in this study in the intronic region of the gene can affect isoform expression ratio, further investigation is needed to determine its role.
Purpose: To determine the incidence and risk factors associated with glaucoma following congenital cataract surgery (CCS) in children under age of 15 Methods: This prospective cohort (since 2006) consisted of children less than 15 years of age who underwent cataract surgery with or without intraocular lens (IOL) implantation. The role of the following factors on the development of glaucoma after CCS including age at surgery, gender, laterality of the cataract, IOL implantation, congenital ocular anomalies, intra- and postoperative complications, length of follow-up, central corneal thickness (CCT) as well as the effect of the age of onset, time to development of glaucoma, and response to treatment were evaluated. Results: Overall, 161 eyes of 96 patients were included in this study of which 28 eyes developed glaucoma. Incidence of glaucoma was 17.4%. Mean±SD age at surgery was 9.3±6.9 (range, 1-24) months in glaucomatous and 40.4±41.1 (range, 1 m-13.6 year) months in non-glaucomatous group (p<0.001). All glaucoma patients had the operation under two years of age. In group 1, 9 (60%) and in group 2, 24 (30%) patients were female (p=0.001). In group 1, 17 eyes (60.7%) and in the group 2, 41 eyes (30.8%) were aphakic (p=0.001). Mean time to diagnosis of glaucoma was 111.2 days (range 30-1200 days). Mean follow-up time was 3.1 years (range, 1-6 years). In 22 (78.6%) eyes glaucoma was diagnosed within six months after surgery. Glaucoma was controlled with medications in 23 eyes (82%) and with surgery in five eyes. Conclusion: In this study the incidence of glaucoma after CCS was 17.4% over a follow-up period of six years. Younger age at the time of lensectomy increases the risk of secondary glaucoma. IOL implantation may protect against glaucoma. Female gender was affected more than male.
Purpose: Rifampin which is an anti-tuberculosis (TB) drug, can increase metabolism and thus reduce endogenous steroid. So it is mentioned as a probable drug for acute central serous chorioretinopathy (CSCR) treatment. Therefore we have decided to evaluate its beneficial effects in CSCR treatment. Methods: A non-randomized clinical trial involving 39 patients with acute CSCR (less than two weeks) were studied. Initially, complete visual examinations including determination of spectacle best corrected visual acuity (SBCVA) using Snellen chart, anterior and posterior segment examinations were performed on all patients. Fundus fluorescein angiography (FA) and ocular coherence tomography (OCT) were performed to confirm the diagnosis. Twenty-three patients were treated with 600 mg rifampin per day up to maximum 4 to 6 weeks (treatment group) and 17 patients did not receive any treatment (control group). In the treatment group, one of the patients suffered from severe headache a few days after using the drug. So the drug was discontinued and the patient was excluded from the study. The patients were examined once in two weeks and totally up to fourth or sixth weeks. In each time of examination, the best clear visual acuity determination and funduscopy were done, and if necessary (cases of obvious macular edema) OCT was performed at the end of 4 th to 6 th week. Primary gain was reduction in macular thickness (MT) and secondary gain was the SBCVA during the study. Results: The mean age of patients was 38.5±6.7 years. The mean age of the treatment group (37.7±6.2 years) was not significantly different from control group (39.7±7.3). Gender distribution shows that 76.9% of samples were male. In the treatment group, the average MT changed from 339.9±44.36 µm at the beginning of treatment to 297.4±29.09 µm at the end of treatment and this reduction in MT was equal to 12.58% (p<0.001) and in the control group, the initial and final thickness were 310.06±20.31 and 296.71±17.22, µm respectively. The reduction was equals to 4.3% (p<0.003). In the treatment group MT reduction was significantly more than the control group (p<0.018). In the treatment group, average of SBCVA before and after treatment was 0.2±0.18 and 0.6±0.34 Snellen visual acuity (SV), respectively (p<0.0001) and in the control group, this average was 0.2±0.1 before and 0.37±0.35 SV after treatment (p<0.024). The difference in SBCVA between two groups was more or less important (p=0.055). At the end of study, macula in 45.5% of the treatment group and 29.4% of control group had dried out Odd's Ratio (OR)=2 (0.52-7.6, CI: 95%) (p<0.307). Conclusion: Rifampin has beneficial effects in the treatment of acute CSCR. These early findings suggest a novel treatment of CSCR and warranted further study.
Purpose: The main purpose of this study was to evaluate the prevalence of herpes simplex virus 1 and 2 (HSV-1 and HSV-2), Varicella-Zoster virus and Adenovirus associated with conjunctivitis in swab samples of patients who referred to Eye Specialist Hospitals in Tehran. Methods: In this cross-sectional study, swab samples from patients with acute conjunctivitis during the first sixth months of 2012, in two ophthalmic departments of Tehran were collected. After DNA extraction, multiplex Real-Time PCR was carried out in two separate reactions for each sample. Results: A total of 150 swap samples were collected from acute conjunctivitis patients. Among them, 22 (14.6%) and 5 (3.3%) were positive for Adenovirus and HSV-1 DNA, respectively. There were no patients with positive results for HSV-2, VZV. Statistical analysis showed insignificant P-value (0.845) between gender and conjunctivitis; however, there was close correlation (P-value 0.05) with age. Moreover, 63.6% of Adenoviral conjunctivitis occurs in the summer compared to spring (36.4), whereas no significant seasonal variation was observed for HSV-1. Conclusion: This prevalence pattern indicates that adenovirus has major role in viral conjunctivitis rather than HSV-1. Further research is needed to identify other viral pathogens associated with ocular infection.
Purpose: To present a case of orbital cellulitis secondary to dacryocystitis Case report: A 48-year-old postmenopausal lady was referred with a prominent proptosis of the right eye in addition to external ophthalmoplegia. She had one year history of lacrimation. Orbital Computed Tomography (CT) revealed an extraconal infiltration near the medial and inferior orbital wall consistent with orbital cellulitis. Treatment included intravenous antibiotics, followed by dacryocystorhinostomy (DCR) one month after discharge. Within five days after antibiotic treatment, inflammatory signs improved dramatically. Conclusion: Acute dacryocystitis should be considered as an emergency in ophthalmology; as it can cause orbital cellulitis with potential vision-threatening side effects, if left untreated.
