مجله چشم پزشکی بینا
سال بیست و سوم شماره 4 (تابستان 1397)

To evaluate the effects of combined intravitreal tissue plasminogen activator (TPA) and bevacizumab on retinal vascular diseases. In this prospective, interventional case series, a total of 19 eyes from 19 patients with retinal vascular diseases, including diabetic macular edema (DME), diabetic vitreous hemorrhage (VH), central retinal vein occlusion (CRVO), and neovascular age related macular degeneration (AMD) received combined intravitreal TPA (50 μg) and bevacizumab (1.25 mg). The measurement of best corrected visual acuity, B-scan, and OCT was performed at the baseline and 1 month after injections. The mean age of the patients was 56.8 years. Eight patients (42.1%) were male and 11 patients (57.9%) were female. Seventeen eyes (89.4%) were phakic and 2 eyes (10.6%) were pseudophakic. The incidence of posterior vitreous detachment (PVD) was 57.8% (11 of 19). One month after intravitreal injections, best corrected visual acuity (BCVA) improved (P=0.005) and central macular thickness (CMT) decreased (P=0.013) significantly. Decrement of CMT was significantly greater in PVD positive eyes compared with PVD negative eyes (P=0.014). Combined intravitreal injection of bevacizumab and TPA was significantly related with increase in BCVA and decrease in CMT and PVD.

To evaluate the efficacy of intravitreal bevacizumab for the treatment of type 1 retinopathy of prematurity (ROP) in zone I.

Preterm infants with type 1 ROP in zone I (zone I ROP, any stage with plus disease or zone I ROP, stage 3 without plus disease) were enrolled in this prospective study. Intravitreal bevacizumab (0.625 mg/0.025 ml) was injected under topical anesthesia. The patients were followed-up weekly for 4 weeks and, then, biweekly till 90 weeks gestational age.

Seventy eyes of 35 patients with type 1 ROP in zone I were enrolled. At a gestational age of 90 weeks, ROP regressed with complete or near‑complete peripheral retinal vascularization, in 82.9% of eyes after a single injection and in 92.9% of eyes after up to two injections. In 5 eyes (7.1%), ROP progressed to stage 4B or 5, so that surgical management was required. There were no major complications such as endophthalmitis, cataract, or vitreous hemorrhage after injection.

Intravitreal bevacizumab injection is an effective method for the management of patients with Zone I ROP requiring treatment; however, some cases may progress to more advanced stages and require surgical management. Close monitoring for recurrence or progression is necessary. Eyes with persistent zone I ROP may progress to advanced stages when treated with intravitreal bevacizumab injection and re‑treatment may be needed.  

To evaluate the long-term stability of subjective refraction after deep anterior lamellar keratoplasty (DALK) performed in keratoconus-affected eyes. This retrospective case series analyzed the data of 73 eyes in 69 patients with keratoconus, who underwent DALK. Only patients with clear grafts, who had all sutures removed for at least 12 months, were enrolled. The corrected distance visual acuity (CDVA), spherical equivalent refraction, refractive astigmatism, and vector components of refractive astigmatism (J0 and J45) were recorded and compared at different time points after all sutures were removed. The mean age of the patients was 28.3±8.3 years at the time of keratoplasty. No significant changes in the CDVA were observed during the follow-up. Spherical equivalent refraction was measured at 1 month (23.18±3.41) and 3 months (4.29±4.26) after complete suture removal differed significantly from that measured at the last examination (4.70±3.75, respectively). These measured values were stabilized from 6 months after complete suture removal onward. Refractive astigmatism and its vector components (J0 and J45) did not change over time after complete suture removal. Refraction is stabilized 6 months after complete DALK suture removal. Therefore, postponing refractive surgery until this time is advisable to manage post-DALK refractive errors.

To investigate the changes in aberrations induced by implantation of Implantable Collamer Lenses (ICL and Toric ICL; STAAR Surgical, Nidau, Switzerland) in eyes with high myopia .and high myopic astigmatism We investigated thirty-three eyes of 18 consecutive patients, with spherical equivalent errors of - 6.00 to -21.09 diopters (D) and cylindrical errors of -0.5 to -4.75 D, who underwent ICL and toric ICL implantation. Before and 5 days, 2 and 6 months after surgery, the uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), defocus and adverse events of the surgery were assessed. Ocular higher order aberrations also were evaluated by Hartmann-Shack aberrometry ((Technolas PV, Rochester, New York, USA) before and 6 months after surgery. 6.0 month after surgery, the uncorrected and best corrected visual acuity respectively in 40% and 66.7% of eyes were 20/20. Six month post-operation, mean defocus refraction and astigmatism reduced to - 0.66 and 0.65 D from -12.79 and 2.18 at baseline respectively. For a 6-mm pupil, higher order aberrations were not significantly changed, merely from 0.417±0.162μ before surgery to 0.393±0.119μ after surgery (P = 0.45). Spherical aberration (Z400) increased significantly (P= 0.00). Surgical induced astigmatism was lower than 0.25 D and there were no changes in trefoils and coma aberration. No vision-threatening complications occurred during the observation period. This study shows, the ICL and toric ICL performed well in correcting high myopic astigmatism without significant changes in HOAs during a 6.0 months observation period, although the spherical aberration (Z400) increased significantly.

To investigate the rate and agents of contamination in bandage soft contact lenses fitted for the management of persistent corneal epithelial defects and to evaluate potential variables that could influence contamination risk. This prospective comparative case series enrolled 57 consecutive eyes fitted with bandage contact lenses for the treatment of persistent corneal epithelial defects. The lenses were collected at the time of epithelial closure or when it was necessary to exchange contact lenses and were immediately placed in sterile tubes containing an enriched thioglycolate liquid medium. When contamination of the contact lens was detected, the microorganism was cultured in different media and identified based on various tests. All isolates were tested for susceptibility to various antibiotics. Univariate analyses were used to evaluate the influence of different variables on bandage contact lens contamination. Seventeen of the contact lenses (29.8%) were contaminated. The most commonly isolated pathogen was Staphylococcus epidermidis (n=10), followed by Enterobacter cloacae (n=3), Staphylococcus aureus (n=1), Streptococcus viridans (n=1), and Alcaligenes spp. (n=1). One contact lens yielded a mixed infection with Enterobacter cloacae and Candida spp. Infectious keratitis was not observed in any eyes. Correlations between contact lens contamination and investigated variables were statistically non-significant. A significant number of bandage contact lenses used for the management of persistent corneal epithelial defects yielded positive cultures for aerobic bacteria. However, no cases of infectious keratitis were observed. Contamination was independent of different investigated variables, including the duration of contact lens use.

To determine the pathology type of pterygium in surgeries performed in Shafa Hospital of Kerman. This descriptive-analytical study was performed on all patients (111) that were under surgeries since March 2011 till August 2012 in Shafa Hospital of Kerman. Background information including age and gender, clinical findings including the side of the eye involved with pterygium and the pingecula in the other eye, the location of pterygium, the degree of progression of the pterygium to the center of the cornea and the extent of the lesion in the Limbus area, the pupillary diameter, the type of pathology, the grading of the disease, the surgery technique, and pathological findings of the samples were included in the checklist. Finally, the data were analyzed by of SPSS 20 software. Right eye was involved in 54% of the patients. In this study 50% of patients’ other eye had pterygium and 40% of the patient had pingecula. The most common complaint of patients was vision loss (79%). In 94% of the patient, pterygium was in nasal area. The mean enhancement of lesion, extent of the lesion, and corneal diameter were 3.9, 6.1, and 11.00 mm, respectively. In 6 patients, SCC, carcinoma insitu, and CIN was seen. A total of 64% of the patients were older than 50 years and 53% were female, but there was no significant difference in age and gender. In patient with grade 1, there were no pathology. In grade 2, the most common pathology was carcinoma insitu, and in grade 3, it was SCC. Generally, 60% of the patients were treated with the conj flap method and 40% of the patients underwent pterygium surgery, using the Bare Sclera method. With respect to observation of many of malignant cases such as SCC, carcinoma insitu in patients with clinical diagnosis of pterygium, it is useful to remove all ptertgium samples to refer to pathology experiments.

Optical Coherence Tomography Angiography (OCTA) is a new imaging technique that allows imaging of the retina and optic nerve. It is noninvasive and provides high resolution and rapid image. It is reproducible and has several applications in evaluation of retinal and optic nerve diseases. In this review, principle of imaging technique and application of OCTA in glaucoma detection will be discussed.

Persistent conjunctival chemosis after upper lid blepharoplasty is an uncommmon complication of, and the treatment of chronic and resistant cases is challenging. The authors report a case of chronic chemosis after cosmetic upper lid blepharoplasty in the right eye of a young female and present and successful and innovative method of treatment with hand-held cautery with fine tip.