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Current Ophthalmology - Volume:30 Issue: 1, Mar 2018

Journal of Current Ophthalmology
Volume:30 Issue: 1, Mar 2018

  • تاریخ انتشار: 1396/12/27
  • تعداد عناوین: 16
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  • Hassan Hashemi, Akbar Fotouhi, Abbasali Yekta, Reza Pakzad, Mehdi Khabazkhoob* Pages 3-22
    Purpose The aim of the study was a systematic review of refractive errors across the world according to the WHO regions.
    Methods To extract articles on the prevalence of refractive errors for this meta-analysis, international databases were searched from 1990 to 2016. The results of the retrieved studies were merged using a random effect model and reported as estimated pool prevalence (EPP) with 95% confidence interval (CI).
    Results In children, the EPP of myopia, hyperopia, and astigmatism was 11.7% (95% CI: 10.5–13.0), 4.6% (95% CI: 3.9–5.2), and 14.9% (95% CI: 12.7–17.1), respectively. The EPP of myopia ranged from 4.9% (95% CI: 1.6–8.1) in South–East Asia to 18.2% (95% CI: 10.9–25.5) in the Western Pacific region, the EPP of hyperopia ranged from 2.2% (95% CI: 1.2–3.3) in South-East Asia to 14.3% (95% CI: 13.4–15.2) in the Americas, and the EPP of astigmatism ranged from 9.8% in South-East Asia to 27.2% in the Americas. In adults, the EPP of myopia, hyperopia, and astigmatism was 26.5% (95% CI: 23.4–29.6), 30.9% (95% CI: 26.2–35.6), and 40.4% (95% CI: 34.3–46.6), respectively. The EPP of myopia ranged from 16.2% (95% CI: 15.6–16.8) in the Americas to 32.9% (95% CI: 25.1–40.7) in South-East Asia, the EPP of hyperopia ranged from 23.1% (95% CI: 6.1%–40.2%) in Europe to 38.6% (95% CI: 22.4–54.8) in Africa and 37.2% (95% CI: 25.3–49) in the Americas, and the EPP of astigmatism ranged from 11.4% (95% CI: 2.1–20.7) in Africa to 45.6% (95% CI: 44.1–47.1) in the Americas and 44.8% (95% CI: 36.6–53.1) in South-East Asia. The results of meta-regression showed that the prevalence of myopia increased from 1993 (10.4%) to 2016 (34.2%) (P = 0.097).
    Conclusion This report showed that astigmatism was the most common refractive errors in children and adults followed by hyperopia and myopia. The highest prevalence of myopia and astigmatism was seen in South-East Asian adults. The highest prevalence of hyperopia in children and adults was seen in the Americas.
    Keywords: Myopia, Hyperopia, Astigmatism, Meta, analysis
  • Mohammad-Ali Abtahi, Alireza Zandi, Hassan Razmjoo, Sara Ghaffari, Seyed-Hossein Abtahi, Hamidreza Jahanbani-Ardakani * Pages 23-34
    Purpose Ameloblastoma is a non-encapsulated and slow-growing tumor with high recurrence rate. Orbital involvement by this neoplasm is an extremely rare entity. In this study, we present a systematic review on this situation along with clinical and paraclinical features of a case.
    Methods An electronic search was conducted on major medical sources. Data of the cases in the literature in addition to our own case were extracted, summarized, and statistically analyzed.
    Results A total of 36 other cases from 20 relevant studies were also reviewed. Review topics included epidemiology, clinical presentation, pathologic features, differential diagnosis, imaging, treatment, and prognosis. We provided a five-year history of a 50-year-old man with orbital/skull base invasion of plexiform maxillary ameloblastoma.
    Conclusions Maxillary ameloblastoma is a locally aggressive neoplasm, and physicians must be alert to the biologic behavior of this tumor to detect any invasion to critical structures such as orbit and cranium. Orbital ameloblastoma causes significant morbidity and mortality. We advocate meticulous patient follow-up with regular clinical examinations and paraclinical work-up for timely detection of any invasion or recurrence. The best must be done to avoid extensions by aggressive removal of maxillary ameloblastoma.
    Keywords: Ameloblastoma, Eye, Vision, Orbit, Review
  • Hassan Hashemi, Mehdi Khabazkhoob, Payam Nabovati, Negareh Yazdani, Abbasali Yekta * Pages 35-41
    Purpose To determine the normal range of intraocular pressure (IOP) in the young and its association with certain corneal parameters using a non-contact device.
    Methods Subjects were selected from students of Mashhad University of Medical Sciences through stratified sampling. All participants had visual acuity testing, corneal imaging, a comprehensive slit-lamp examination by an ophthalmologist, and IOP measurement using a non-contact air-puff tonometer.
    Results Of the 1280 invitees, 1073 (83.8%) participated, and 1027 were eligible. Mean IOP was 16.38 mmHg [95% confidence interval (CI): 16.22–16.53] in the total sample, 16.14 mmHg (95% CI: 15.84–16.45) in men, and 16.48 mmHg (95% CI: 16.31–16.66) in women. There was a significant IOP difference between myopes and emmetropes (P = 0.031). Based on the multiple linear regression model, IOP associated directly with age and central corneal thickness (CCT), and inversely with corneal diameter, spherical equivalent (SE), and keratoconus. Based on standardized coefficients of the regression model, CCT and SE had the strongest association with IOP.
    Conclusions In the present study, we demonstrated the IOP distribution in a young population using a non-contact method. CCT and SE were strongly associated with IOP.
    Keywords: Intraocular pressure, Cross, sectional study, Distribution, Air, puff tonometer
  • Mohammad Reza Sedaghat, Hadi Ostadi-Moghadam, Mahmoud Jabbarvand, Farshad Askarizadeh, Foroozan Narooie-Noori * Pages 42-47
    Purpose To evaluate and compare corneal hysteresis (CH) and corneal resistance factor (CRF) in pellucid marginal degeneration (PMD), keratoconus (KCN), and normal eyes using the Ocular Response Analyzer (ORA).
    Methods In this retrospective study, corneal biomechanical parameters were measured in patients with PMD (n = 102) and KCN (n = 202) and normal subjects (n = 208) using the ORA.
    Data, including full patient history as well as the results of refraction, slit-lamp biomicroscopy, Pentacam HR (Oculus), and ORA (Reichert; Buffalo, New York, USA), were collected from medical records. Also, the data of only one eye per individual were selected for the analysis. The inclusion criteria for PMD and KCN groups were a reliable diagnosis of these ectatic disorders based on the clinical and corneal tomographic findings. CH, CRF, CH–CRF, intraocular pressure (IOP) measurements were assessed for each subject. Data were analyzed with SPSS and MedCalc using the ANOVA, Pearson Correlation, and receiver operating characteristic (ROC) curve analysis.
    Results The mean CH was 8.91 mmHg ± 1.05 [standard deviation (SD)], 8.43 ± 0.78, and 10.89 ± 1.08 in the PMD, KCN, and normal group, respectively. Also, the mean CRF was 8.21 ± 1.35, 7.19 ± 1.11, and 10.69 ± 1.41 in the PMD, KCN, and normal group, respectively. ANOVA showed differences in the mean CH, CRF, and CH–CRF between three groups (P 1.3 mmHg for CH, CRF, and CH–CRF in the PMD group, respectively. For biomechanical parameters in PMD eyes, CRF had the highest sensitivity (75.49%) while the greatest area under the ROC curve (AUC) was seen for CH (0.903). Moreover, central corneal thickness (CCT) showed no correlation with CH (P = 0.30, r = −0.104) or CRF (P = 0.75, r = 0.033) in the PMD group.
    Conclusions This study presented the values of corneal biomechanics for PMD using the ORA. The results of the ORA were markedly different between PMD, KCN, and normal eyes.
    Keywords: Pellucid marginal degeneration, Corneal biomechanics, Corneal hysteresis, Corneal resistance factor, Keratoconus
  • Mohammad Miraftab, Hassan Hashemi, Soheila Asgari * Pages 48-53
    Purpose To compare two-year results of femtosecond laser assisted LASIK (femto-LASIK) and photorefractive keratectomy (PRK) in terms of astigmatism correction in patients with less than 2.0 diopters (D) of spherical error and more than 2.0 D of cylinder error.
    Methods In this retrospective study, data were extracted from 100 patient charts. The two study groups were matched by age, gender, and baseline uncorrected distance visual acuity (UDVA) and refractive astigmatism (RA). Preoperative astigmatism was categorized as mild: 2.00 to Results Mean RA in the femto-LASIK and PRK groups was respectively −3.15 ± 0.94 D (−7.00 to −2.00 D) and −3.29 ± 0.95 D (−6.25 to −2.00 D) at baseline (P = 0.284), and −0.61 ± 0.40 D and −0.62 ± 0.60 D one year after surgery (P = 0.674), but significantly lower in the femto-LASIK group (−0.61 ± 0.39 vs. −0.83 ± 0.56 D, P = 0.021) at 2 years when the rate of residual astigmatism more than 1.0 D was 6.3% in the femto-LASIK and 19.6% in the PRK group (P = 0.046). Mean UDVA in the femto-LASIK group (0.02 ± 0.05 logMAR) was better than the PRK group (0.06 ± 0.10 logMAR) (P = 0.025). Mean corrected distance visual acuity (CDVA) was not significantly different between groups (0.01 ± 0.03 vs. 0.01 ± 0.04 logMAR, P = 0.714). Both groups had 1–4 Snellen lines CDVA improvement. The three subgroups of baseline astigmatism did not differ significantly in terms of residual astigmatism (all P > 0.05). However, in subgroups with ≥4.00 D cylinder, there was less astigmatic regression at 1 year in the femto-LASIK group (0.28 ± 0.43 D) than the PRK group (0.54 ± 0.68 D) (P = 0.007).
    Conclusions Our results pointed to better two-year results with femto-LASIK in the treatment of different degrees of astigmatism. UDVA improvement was superior with femto-LASIK, but the two methods did not significantly differ in terms of CDVA improvement.
    Keywords: Femtosecond assisted LASIK, PRK, MMC, High astigmatism
  • Jeyanth Suresh Rose *, Juliet Eldrina, Aarwin Joshua, S. Amalan, Sanita Korah Pages 54-57
    Purpose To quantify normal corneal transparency by anterior segment optical coherence tomography (AS-OCT) by measuring the average pixel intensity. To analyze the variation in the average pixel intensity in mild and severe grades of corneal opacities.
    Methods This is an observational, cross-sectional study of 38 eyes from 19 patients with mild or severe grades of corneal opacities greater than 3 mm and a normal contralateral cornea. AS-OCT was performed centered on the opacity with a 3 mm cruciate protocol. A similar image is taken of the contralateral clear cornea in the same quadrant. The average pixel intensity was calculated in a standardized manner using MATLAB software.
    Result The average pixel intensity of the normal cornea was 99.6 ± 10.9 [standard deviation (SD)]. The average pixel intensity of the mild and severe corneal opacities was 115.5 ± 9.1 and 141.1 ± 10.3, respectively. The differences were statistically significant.
    Conclusions AS-OCT images can be used to quantify corneal transparency. Average pixel intensity is a measure that varies significantly with varying corneal opacification.
    Keywords: Corneal transparency, Anterior segment optical coherence tomography, Mild, severe grades of corneal opacities, Pixel intensity
  • Soheila Asgari, Hassan Hashemi * Pages 58-62
    Purpose To determine topographic and aberrometric changes after accelerated cross-linking (ACXL; 18 mW/cm2 for 5 min) as measured with OPD Scan III (Nidek Inc., Tokyo, Japan) and their repeatability in patients with mild and moderate keratoconus (KCN).
    Methods In this prospective study, 25 eyes with mild KCN [Ksteep = 47.24 ± 3.11 diopter (D)] and 20 moderate cases (Ksteep = 52.86 ± 4.39 D) were examined under mesopic conditions (20 lux) twice, 30–45 min apart, at baseline and 6 and 12 months afterwards. Extracted indices were Ksteep, Kflat, ocular and corneal irregularity, ocular and corneal total higher order aberrations (HOAs), coma, trefoil, and spherical aberration (SA). Repeatability index (RI) and intraclass correlation coefficients (ICCs) were determined.
    Results In mild cases, Ksteep and corneal irregularity had lower RI, but Kflat and ocular irregularity had higher RI (all P > 0.050) at 1 year. The RI for ocular total HOAs, coma, and SA decreased and showed no significant change for trefoil (all P > 0.050). Moderate cases showed non-significant increases in RI for Ksteep, Kflat, ocular and corneal irregularity (all P > 0.050), and all aberrometry indices, and significant increases in RI for ocular coma (P = 0.046) and corneal trefoil (P = 0.037). At 1 year, ICC was >0.75 for all indices except ocular and corneal trefoil (ICC = 0.613 and 0.390) in moderate cases.
    Conclusions At one year after ACXL, OPD Scan III showed acceptable repeatability in mild cases. In moderate cases, topographic indices had acceptable repeatability but poorer compared to the mild group. Overall, ocular HOAs showed better repeatability than corneal ones. These changes should be considered in the interpretation of measurements.
    Keywords: Repeatability, OPD Scan III, Accelerated cross, linking, Mesopic condition, Repeatability index
  • Mohammad Ghoreyshi, Ahmadreza Khalilian *, Mohammadreza Peyman, Mohaddeseh Mohammadinia, Alireza Peyman Pages 63-67
    Purpose To compare the performance of OKULIX ray-tracing software with SRK-T and Hoffer Q formula in intraocular lens (IOL) power calculation in patients presenting with cataract.
    Methods In this prospective study, 104 eyes of 104 patients with cataract who underwent phacoemulsification and IOL implantation were recruited. Three IOL brands were used and for all eyes, IOL power calculation was performed using SRK-T, Hoffer Q formula and also OKULIX ray-tracing software. For all patients, axial length and keratometry data was obtained with IOLMaster 500 device and IOL power was determined using Hoffer Q and SRK-T formula. The IOL powers were also calculated using the OKULIX ray-tracing software combined with CASIA AS-OCT and IOLMaster 500 device. Optically measured axial length of eyes were inserted to OKULIX software from IOLMaster 500 device, and anterior and posterior tomographic and corneal pachymetry data was imported from CASIA AS-OCT into the OKULIX.
    The performance of each calculation methods was measured by subtracting the predicted postoperative refraction from the postoperative manifest refraction spherical equivalent (MRSE). For each of the 3 methods, the mean absolute prediction error was determined, too.
    Results The mean value absolute prediction error by OKULIX, SRK-T and Hoffer Q formulas, respectively, were 0.42 (±0.03), 0.36 (±0.02) and 0.37 (±0.02). The mean absolute prediction error by OKULIX had no significant difference between three IOL groups (P = 0.96), and it was confirmed that there was no meaningful statistically difference in mean absolute prediction error between the OKULIX, SRK-T and Hoffer Q formula. (P = 0.25). Also in each group of implanted IOLs, all three formulas worked with the same accuracy. The prediction error using OKULIX were within ±0.50 diopter in 63.5% of eyes and within ±1.00 diopter in 94.2% of eyes.
    Conclusion OKULIX ray-tracing IOL power measurements provides reliable and satisfactory postoperative results, which are comparable to other 3rd generation formulas of SRK-T and Hoffer Q.
    Keywords: Ray, tracing, IOL power calculation, OKULIX
  • Walid Abdallah, Wen Li, James Weiland, Mark Humayun, Hossein Ameri * Pages 68-73
    Purpose Epiretinal and subretinal prosthesis have been shown to be a valid way to provide some vision to patients with advanced outer retinal degeneration and profound vision loss. However, the field of vision for these patients is markedly limited by the area occupied by the electrode array. In this study, we aimed to evaluate the feasibility of implantation of multiple suprachoroidal electrode arrays in a single eye in order to increase the field of vision in patients implanted with retinal prosthesis.
    Methods The right eye of seventeen Dutch rabbits (age range, 5–6 months) was used for the study. Multiple inactive custom-made electrode arrays were inserted into the suprachoroidal space (SCS) and animals were followed up for up to 6 months using fundus photography, optical coherence tomography (OCT), and fluorescein angiography (FA).
    Results It was possible to surgically implant up to 8 electrode arrays in a single eye. None of the rabbits showed any major complications. The electrodes were well tolerated and remained in position in all rabbits. There was no evidence of retinal damage on follow-up exams and FA throughout the study.
    Conclusion Multiple suprachoroidal electrode array implantation is feasible and may provide a novel approach to increase the field of vision in subjects implanted with retinal prosthesis.
    Keywords: Suprachoroidal, Electrodes, Array, Retinal prosthesis, Retinal implant
  • Mohammad R. Talebnejad, Ali Sadeghi-Sarvestani, M. Hossein Nowroozzadeh, Seyed Mohammad J. Mortazavi, Mohammad R. Khalili * Pages 74-79
    Purpose Mobile cell phones are used extensively these days, and their microwave (MW) radiation has been shown to affect the eye. The purpose of the present study was to evaluate the effects of MW radiation on rabbit retina.
    Methods This experimental study (concluded in 2015) was conducted on 40 adult white New Zealand rabbits. A Global System for Mobile Communications (GSM) cell phone simulator was used for MW irradiation. The rabbits were randomized into five groups (8 in each) and treated as follows: Group 1: no irradiation (sham); Group 2: irradiation at 10 cm for 1 day; Group 3: irradiation at 30 cm for 1 day; Group 4: irradiation at 10 cm for 3 days; and Group 5: irradiation at 30 cm for 3 days. Scotopic and photopic electroretinography (ERG) responses were obtained at baseline and 7 days after the last exposure. Then all the rabbits were euthanized, and their eyes were enucleated and sent for pathology examination. Kruskal–Wallis and Chi-Square tests were used to evaluate intergroup differences in ERG parameters and histological findings, respectively.
    Results ERG responses obtained 7 days after irradiation did not show any statistically significant difference between the groups (P > 0.1, for all tested parameters). There were statistically non-significant trends toward greater changes in the MW irradiated eyes. In pathological examination, retina was normal with no sign of degeneration or infiltration. Ciliary body congestion was observed in greater fraction of those who received higher MW doses. (P = 0.005).
    Conclusions Histopathologically, cell phone simulated MW irradiation had no significant detrimental effect on the retina. However, ciliary body congestion was observed in greater fraction of those who received higher MW doses. Although there was no significant difference between post-treatment mean ERG values, there were statistically non-significant trends toward greater changes in the MW irradiated eyes.
    Keywords: Ciliary body, Electroretinography, Irradiation, Microwave, Retina
  • Caner Kara *, Emre Hekimolu, kbal Seza PetriCli, Handan Akil Pages 80-84
    Purpose To evaluate the efficacy of intravitreal bevacizumab (IVB) in case of treatment failure with laser photocoagulation in retinopathy of prematurity (ROP).
    Methods A retrospective review of infants treated with IVB injection due to treatment failure with laser photocoagulation was performed. The anatomical results and complications were evaluated after treatment.
    Results 9 eyes of 6 premature infants with a mean gestational age of 26.8 ± 3.0 weeks (range, 23–32 w) and mean birth weight of 958 ± 319 g (range, 600–1400 g) were identified. Six of the eyes had zone 1 disease, and all of these eyes were classified as aggressive posterior ROP (APROP). Three of the eyes had zone 2 disease, and one of these eyes was classified as APROP, and the other two eyes were classified as high-risk pre-threshold disease. All of the eyes showed regression of the disease except one patient, both eyes of whom progressed to stage 4A. None of the patients developed ocular and systemic complications at the end of the six-month follow-up period.
    Conclusion IVB could be an option in patients with ROP in whom laser photocoagulation failed.
    Keywords: Bevacizumab, Retinopathy of prematurity, Photocoagulation, Rescue therapy, Treatment failure
  • Mohammadali Hassani, Ebrahim Jafarzadehpur *, Ali Mirzajani, Abbasali Yekta, Mehdi Khabazkhoob Pages 85-86
    Purpose To compare the visual acuity outcome of the ClearKone SynergEyes™ hybrid contact lens and Boston XO rigid gas permeable (RGP) contact lens in patients with keratoconus.
    Methods Twenty-eight eyes with keratoconus participated in this study. The visual acuity was examined once with the RGP lens and once with the ClearKone SynergEyes™ hybrid contact lens.
    Results The mean corneal keratometry, the mean lens back optic zone radius, and the mean vault was 7.23 ± 0.62 mm, 7.67 ± 0.44 mm, and 277.94 ± 104.5 μm, respectively. Visual acuity was significantly better with the ClearKone SynergEyes™ hybrid lens (P = 0.004). The mean best corrected visual acuity (logMAR) was 0.022 ± 0.03 and 0.057 ± 0.09 for the ClearKone and RGP lens, respectively. The Clearkone lens yields an average improvement of one line of the Snellen chart in comparison with the RGP lens.
    Conclusion The ClearKone hybrid contact lens and the RGP lens may improve visual acuity in corneal irregularities. But patients who are able to afford hybrid lens wearing may show better visual acuity.
    Keywords: ClearKone hybrid contact lens, Rigid gas permeable, Keratoconus, Irregular cornea
  • Manpreet Singh *, Natasha Gautam, Aniruddha Agarwal, Manpreet Kaur Pages 87-90
    Purpose Primary lacrimal canaliculitis (PLC) is a unique disorder which often gets misdiagnosed by the general as well as speciality-trained ophthalmologists. Elderly patients with history of chronic or recurrent epiphora with discharge, often get mislead towards chronic dacryocystitis. The aim of our report is to discuss the misleading diseases in our PLC patients and to revisit this hidden disease.
    Methods The patients of PLC who were previously misdiagnosed were studied. The clinical history, presenting clinical features, misdiagnosis, and final management of the patients is described.
    Results There were 5 misdiagnosed female patients. A history of chronic redness, watering, discharge, and medial canthal region edema lead to the misdiagnosis of chronic dacryocystitis in 3 (60%) and medial marginal chalazion in 2 (40%) cases. Slit-lamp examination revealed localized hyperemia (n = 5), classical pouting of lacrimal punctum (n = 3), and expressible purulent discharge (n = 3). Two patients without punctum pouting had an explicit yellowish hue/discoloration of the canalicular region. Our patients had a mean 4 visits before an accurate diagnosis. Three-snip punctoplasty with canalicular curettage was performed in three while two were managed conservatively. At last follow-up, all patients were symptom-free with punctum and canalicular scarring in three, who underwent surgery.
    Conclusion PLC is a frequently misdiagnosed clinical entity which delays the initiation of appropriate treatment. A succinct magnified examination of punctum and canalicular region can provide sufficient clues pivotal for accurate diagnosis.
    Keywords: Primary lacrimal canaliculitis, Misdiagnosis, Lacrimal canaliculus, Lacrimal punctum, Chronic dacryocystitis
  • Seyed Ali Tabatabaei, Mehdi Tabatabaei, Mohammad Soleimani *, Zahra Fallah Tafti Pages 91-96
    Purpose To report two rare cases of filamentous fungal keratitis.
    Methods Two non-consecutive patients presented with suspicious fungal keratitis. After performing the smear and culture, medical therapy was started for them. They underwent slit photography and in vivo confocal microscopy (IVCM) in their follow-up visits.
    Results The patients were 33-year-old and 56-year-old farmer men. They both mentioned a history of ocular trauma by plants. During their follow-up visits, corneal infiltration density and fungal hyphae density decreased in slit-lamp biomicroscopy and IVCM, respectively. The corresponding organisms were Pseudallescheria boydii (P. boydii) and Colletotrichum coccodes.
    Conclusions It is important to be aware of these rare organisms and their antibiotic susceptibility. There was not any specific confocal feature for the presented fungal keratitis that was different from other filamentous fungal hyphae; however, confocal scan is a good choice to follow the response to the treatment.
    Keywords: Fungal keratitis, Pseudallescheria boydii, Colletotrichum coccodes
  • Maddalena De Bernardo *, Nicola Rosa Page 97