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Ophthalmic and Vision Research - Volume:11 Issue: 4, Oct-Dec 2016

Journal of Ophthalmic and Vision Research
Volume:11 Issue: 4, Oct-Dec 2016

  • تاریخ انتشار: 1395/09/22
  • تعداد عناوین: 22
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  • Alfonso Vasquez Perez, Mehran Zarei-Ghanavati, Christopher Liu Page 343
  • Hesam Hashemian, Mirgholamreza Mahbod, Fahimeh A. Amoli, Mohammad Y. Kiarudi, Mahmoud Jabbarvand, Ahmad Kheirkhah* Page 345
    Purpose
    To evaluate the histopathologic changes in the conjunctiva of patients with conjunctivochalasis (CCh) compared to age‑matched controls.
    Methods
    This cross‑sectional, controlled study included 27 eyes of 27 patients with CCh and 16 eyes of 16 age‑matched controls. A biopsy of the bulbar conjunctiva was performed along the temporal lower lid margin before cataract surgery in both groups. Histopathologic evaluation of the specimens was done with light microscopy using staining with hematoxylin/eosin, periodic acid Schiff, and van Gieson elastic stain. Various histopathologic features of the conjunctival epithelium and stroma were compared between the two groups.
    Results
    The mean age of patients was 62.4 ± 6.9 years in the CCh group and 65.1 ± 6.3 years in the control group (P = 0.54). No significant differences were noted between the two groups in terms of conjunctival epithelial changes including papillomatosis, epithelial clefts, epithelial goblet cells, or infiltration of inflammatory cells. Mean thickness of the conjunctival stroma was 0.21 ± 0.08 mm in the CCh group and 0.26 ± 0.21 mm in the control group (P = 0.10). For the conjunctival stroma, there were no significant differences between the two groups in terms of elastosis, fibrosis, lymphangiectasia, or infiltration of inflammatory cells.
    Conclusion
    No noticeable differences were found in the histopathologic features by light microscopy between eyes with CCh and those of age‑matched controls. Therefore, the primary pathology of CCh may not be within the conjunctiva itself. Instead, loose attachment of the conjunctiva to the underlying tissue may be the reason for the redundant folds in the bulbar conjunctiva.
    Keywords: Conjunctiva, Conjuctivochalsis, Histopathology, Tenon's Capsule
  • Seyed Hamid Reza Jahadi Hosseini, Seyed Mohammad Bagher Abtahi, Mohammad Reza Khalili * Page 350
    Purpose
    To evaluate the changes and predictability of higher order aberrations (HOAs) after personalized laser in situ keratomileusis (LASIK) and personalized photorefractive keratectomy (PRK) for simple myopia and compound myopic astigmatism.
    Methods
    In this prospective cross‑sectional study, 100 eyes were included. A total of 50 eyes underwent personalized LASIK and 50 eyes underwent personalized PRK. Preoperative and postoperative wavefront data were compared between the two groups. The influential factors and predictability of HOAs were also assessed.
    Result
    Total HOA increased in the amount of 0.01 ± 0.14 μm for the 5 mm pupil (P = 0.55) and 0.08 ± 0.22 μm for the 6 mm pupil (P = 0.02) after PRK; however after LASIK the corresponding values for the 5 and 6 mm pupil sizes were 0.05 ± 0.12 and 0.15 ± 0.18 μm, respectively (P
    Conclusion
    For the 6mm pupil size, the total HOA increased following both personalized PRK and LASIK with no significant difference between the two groups. Change of the total HOA RMS was influenced by the preoperative values. The known influencing factors could predict nearly 50% of the changes in total HOA.
    Keywords: Wavefront?guided, High Order Aberration, Spherical Aberration, Laser in situ keratomileusis, Photorefractive Keratectomy, Personalized
  • Mostafa Naderi, Khosrow Jadidi, Seyed Aliasghar Mosavi, Seyed Aref Daneshi Page 358
    Purpose
    To compare the effectiveness, safety and stability of the results of transepithelial photorefractive keratectomy (tPRK) with conventional photorefractive keratectomy (PRK) for low to moderate myopia.
    Methods
    In this prospective non-randomized case-control study, patients with low to moderate myopia were assigned to the tPRK group (cases) or the PRK group (controls). In the tPRK group, eyes were treated using the Amaris excimer laser (SCHWIND eye‑tech‑solutions GmbH and Co. KG, Germany). Outcome measures included postoperative pain using McGill Pain Questionnaire, epithelial healing time, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), manifest refraction, and safety and efficacy indexes which were compared between the study groups.
    Results
    Three hundred forty eyes of 170 patients were enrolled in this study. Each study group comprised of 170 eyes of 85 patients. There was a significant difference between the two groups regarding the postoperative pain scores in favor of the tPRK group (P = 0.04). The tPRK group had a shorter epithelial healing time than the conventional PRK group postoperatively (P = 0.01). Mean UCVA was significantly better in the case group than in the control group at the postoperative month 2 (P = 0.01). Regarding the safety and efficacy indexes, the tPRK group had better results than the conventional PRK group (P
    Conclusion
    Transepithelial PRK seems to be superior to conventional PRK for treatment of low to moderate myopia in terms of postoperative pain, epithelial healing time, visual recovery and safety and efficacy indexes.
    Keywords: Conventional Photorefractive Keratectomy, Transepithelial Photorefractive Keratectomy, Myopia
  • Chittur Y. Ranjini *, Vishnu V. Waddepally Page 363
    Purpose
    To identify the prevalence and microbial profile of infectious keratitis in a tertiary eye care hospital, and to test for the in vitro antimicrobial resistance of the bacterial isolates.
    Methods
    A total of 312 patients presenting to a tertiary eye care hospital with infected corneal ulcer were enrolled in this study. Their socio-demographic data and risk factors were recorded. Corneal scrapings collected from the edge of the ulcer were processed for direct gram stain and KOH mount. Culture was recovered on blood agar, chocolate agar, MacConkey agar and Sabouraud's dextrose (SDA) agar in multiple C shaped streaks. After overnight incubation, bacterial culture was followed by standard biochemical tests and antimicrobial sensitivity according to the clinical and laboratory standards institute (CLSI) guidelines. Inoculated SDA was inspected daily for up to 10 days and the growth was identified by its colony morphology, pigment production and lacto-phenol cotton blue mount examination.
    Results
    Of 312 patients, a microbial etiology was established in 117 cases (37.5%). Of these, 72 (61.5%) were male. The age range of 41-60 years was the most affected group. Of 117 positive cases, 52 (44.5%) were bacterial, 58 (49.5%) were fungal and 7 (6%) patients showed mixed bacterial and fungal infection. The most common isolated fungus was Fusarium which was detected in 36 (31%) cases, followed by Aspergillus spp in 13 (11%) subjects. Staphylococcus aureus was the most common isolated bacteria. All Gram positive cocci were susceptible to vancomycin followed by gatifloxacin, whereas all Gram negative bacilli were susceptible to gatifloxacin.
    Conclusion
    Routine microbiological examination of patients with corneal ulcer is necessary in order to analyze and compare the changing trends of the etiology and their susceptibility patterns.
    Keywords: Keratitis, Corneal Ulcer, Fungal, Bacterial, Antibiotic Susceptibility
  • Vipul Bhandari, Jagdeesh K. Reddy, Prateek Chougale Page 368
    Purpose
    To evaluate visual outcomes, endothelial cell density and complications following Descemet’s membrane endothelial keratoplasty (DMEK).
    Methods
    This study included 40 consecutive eyes that underwent DMEK for various pathologies involving the corneal endothelium. Best corrected visual acuity (BCVA) and endothelial cell density (ECD) were measured and compared before and 6 months after surgery.
    Results
    Out of 40 eyes, 34 eyes (85%) had BCVA ranging from 0.5 to 0.7 LogMAR 6 months postoperatively. Mean donor ECD was 2367.96 ± 47.87 (range, 2314.0–2472.0) cells/mm2 preoperatively, which was reduced to 1798.42 ± 45.79 (range, 1736.0–1902.0) cells/mm2 6 months after DMEK surgery, indicating a mean reduction of 569.54 cells/mm2 (24%) in ECD.
    Conclusion
    DMEK is an emerging and a more advanced alternative to penetrating keratoplasty (PKP) and Descemet’s stripping endothelial keratoplasty (DSEK) for corneal pathologies involving the corneal endothelium. Compared to PK and DSEK, however, DMEK has a longer learning curve, and its safety and efficacy need to be confirmed through more experience on a large volume of cases.
    Keywords: Descemet's Membrane, Corneal Endothelium, Descemet's Membrane Endothelial Keratoplasty
  • Mohammad Ali Javadi, Sepehr Feizi *, Roya Jafari, Firooz Mirbabaee, Vahid Ownagh Page 372
    Purpose
    To compare clinical and confocal scan outcomes after Descemet stripping automated endothelial keratoplasty (DSAEK) performed for Fuchs’ endothelial dystrophy (FED) versus pseudophakic bullous keratopathy (PBK).
    Methods
    This retrospective comparative study included 47 consecutive eyes of 39 patients with the diagnosis of FED (n = 29, group 1) or PBK (n = 18, group 2) that underwent DSAEK. Clinical outcomes were compared between the study groups. At the final follow-up examination, confocal microscopy was used to measure and compare central corneal and graft thickness as well as endothelial cell density and morphology between the two groups.
    Results
    Mean age at the time of surgery was 65.2 ± 11.8 and 69.4 ± 12.5 years in groups 1 and 2, respectively (P = 0.27). Follow‑up period was 23.6 ± 14.0 months in group 1 and 25.6 ± 15.7 months in group 2 (P = 0.79). Postoperative best spectacle-corrected visual acuity was significantly better in group 1 than in group 2 until postoperative month 6. Afterwards, the two study groups were comparable in this regard. At the final follow-up examination, spherical equivalent refractive error was 0.39 ± 1.46 diopters (D) in group 1 and 0.80 ± 1.47 D in group 2 (P = 0.45). Postoperative keratometric astigmatism was 1.02 ± 0.83 D and 2.36 ± 0.67 D, respectively (P
    Conclusion
    The outcomes of DSAEK surgery were comparable between FED and PBK. All grafts were clear despite the lower than normal endothelial cell counts.
    Keywords: Confocal Scan, Descemet Stripping Automated Endothelial Keratoplasty, Fuch's Endothelial Dystrophy, Outcomes, Pseudophakic Bullous Keratopathy
  • Narges Fazili, Sahar Balagholi, Yashar Amizadeh, Seyed Bagher Hosseini, Mozhgan Rezaei Kanavi * Page 379
    Purpose
    To investigate the correlation between floating versus adherent growth pattern of cultivated retinoblastoma (RB) cells from three patients with RB and their histopathologic features.
    Methods
    RB cells from three Iranian patients (MM, NR, and MS) were cultivated in Dulbecco’s modified eagle medium (DMEM) supplemented with 15% fetal bovine serum (FBS) for four weeks in each passage. Fresh medium was added on a weekly basis and immunocytochemistry for Synaptophysin was performed. All experiments were performed in duplicate. Growth pattern of the cultivated RB cells was studied during the three consecutive passages and compared among three cases in the light of histopathologic data.
    Results
    Cultivated RB cells from MM and NR demonstrated an adherent growth pattern in the 2nd week and the pattern was enhanced by the 4th week. The RB tumorspheres adhered to the bottom of the flask while surrounded by fibroblasts. Histopathologic diagnosis in MM and NR was a well-differentiated RB without optic nerve involvement. Such an adherent growth was not observed in cultivated RB cells from MS, in which the histopathologic analysis revealed a poorly‑differentiated RB with optic nerve intrusion and prominent choroidal invasion.
    Conclusion
    The adherent growth pattern of cultivated RB cells might be associated with tumor differentiation and the lack of optic nerve involvement in histopathology.
    Keywords: Adherent Growth, Choroidal Invasion, Histopathology, Optic Nerve Intrusion, Retinoblastoma
  • M. Fernanda Estrago, Franco, M. Tarek Moustafa, Mohammad Riazi, Esfahani, Ashish U. Sapkal, Rhina Piche, Lopez, A. Jayaprakash Patil, Ashish Sharma, Payam Falatoonzadeh, Marilyn Chwa, Georgia Luczy, Bachman, Baruch D. Kuppermann, M. Cristina Kenney* Page 385
    Purpose
    To identify inhibitors that could effectively lower reactive oxygen/nitrogen species (ROS/RNS), complement and inflammatory cytokine levels induced by Benzo(e)pyrene [B(e)p], an element of cigarette smoke, in human retinal pigment epithelial cells (ARPE‑19) in vitro.
    Methods
    ARPE‑19 cells were treated for 24 hours with 200 μM, 100 μM, and 50 μM B(e)p or DMSO (dimethyl sulfoxide)‑equivalent concentrations. Some cultures were pre‑treated with ROS/RNS inhibitors (NG nitro‑L‑arginine, inhibits nitric oxide synthase; Apocynin, inhibits NADPH oxidase; Rotenone, inhibits mitochondrial complex I; Antimycin A, inhibits mitochondria complex III) and ROS/RNS levels were measured with a fluorescent H2DCFDA assay. Multiplex bead arrays were used to measure levels of Interleukin‑6 (IL‑6), Interleukin‑8 (IL‑8), Granulocyte‑Macrophage Colony Stimulating Factor (GM‑CSF), Transforming Growth Factor alpha (TGF‑α) and Vascular Endothelial Growth Factor (VEGF). IL‑6 levels were also measured by an enzyme-linked immunosorbent assay. Real-time qPCR analyses were performed with primers for C3 (component 3), CFH (inhibits complement activation), CD59 (inhibitor of the complement membrane attack complex (MAC)) and CD55/DAF (accelerates decay of target complement target proteins).
    Results
    The ARPE‑19 cultures treated with B(e) p showed significantly increased ROS/RNS levels (P
    Conclusion
    The cytotoxic effects of B(e)p include elevated ROS/RNS levels along with pro-inflammatory IL‑6 and GM‑CSF proteins. Blocking the Qi site of cytochrome c reductase (complex III) with Antimycin A led to partial reduction in B(e)p induced ROS production. Our findings suggest that inhibitors for multiple pathways would be necessary to protect the retinal cells from B(e)p induced toxicity.
    Keywords: Benzo(e)pyrene, Cytokines, Retinal Pigment Epithelium
  • Zhale Rajavi, Sare Safi *, Mohammad Ali Javadi, Mohsen Azarmina, Siamak Moradian, Morteza Entezari, Ramin Nourinia, Hamid Ahmadieh, Armin Shirvani, Saeid Shahraz, Alireza Ramezani Page 394
    Purpose
    To customize clinical practice guidelines (CPGs) for management of diabetic retinopathy (DR) in the Iranian population.
    Methods
    Three DR CPGs (The Royal College of Ophthalmologists 2013, American Academy of Ophthalmology [Preferred Practice Pattern 2012], and Australian Diabetes Society 2008) were selected from the literature using the AGREE tool. Clinical questions were designed and summarized into four tables by the customization team. The components of the clinical questions along with pertinent recommendations extracted from the above‑mentioned CPGs; details of the supporting articles and their levels of evidence; clinical recommendations considering clinical benefits, cost and side effects; and revised recommendations based on customization capability (applicability, acceptability, external validity) were recorded in 4 tables, respectively. Customized recommendations were sent to the faculty members of all universities across the country to score the recommendations from 1 to 9.
    Results
    Agreed recommendations were accepted as the final recommendations while the non-agreed ones were approved after revision. Eventually, 29 customized recommendations under three major categories consisting of screening, diagnosis and treatment of DR were developed along with their sources and levels of evidence.
    Conclusion
    This customized CPGs for management of DR can be used to standardize the referral pathway, diagnosis and treatment of patients with diabetic retinopathy.
    Keywords: Clinical Practice Guidelines, Diabetic Retinopathy, Iran
  • Jacob W. Reynolds, Margaret L. Pfeiffer, Omar Ozgur, Bita Esmaeli Page 415
    Ocular surface squamous neoplasia (OSSN) is a common ocular surface tumor with an increased incidence in African countries (3.4 and 3.0 cases/year/100,000). Despite its potential for vision loss and death, OSSN remains largely neglected by both eye and HIV care programs in Africa. The purpose of this review is to identify the barriers to timely diagnosis and early interventions for OSSN in Africa. PubMed searches were conducted targeting previous use of topical chemotherapy (interferon alpha 2b, Mitomycin-C, 5-Fluorouracil) and Human papillomavirus (HPV) vaccination in Africa. We found that OSSN is a significant vision and life-threatening health problem in Africa leading to significant loss of vision, as well as facial disfigurement and social stigma. We did not find any reports on the use of topical interferon, Mitomycin-C or HPV vaccination for OSSN in Africa. One report on the use of topical 5-FU for OSSN in Africa was found. Common barriers to early detection and management of OSSN in Africa include lack of sufficient laboratory infrastructure, lack of trained healthcare personnel, lack of compliance with follow-up visits, cost of topical chemotherapies, and cultural preferences for traditional medicines. In conclusion, OSSN is a significant vision and life-threatening health problem in Africa. There is not much literature on prevention or treatment options for early stages of OSSN in Africa. The use of topical chemotherapy as early interventions and judicious use of smart phone Apps to help with remote diagnosis of early OSSN should be further explored.
    Keywords: Africa, HIV, Ocular Surface Squamous Neoplasia, Topical Chemotherapy
  • Roberto Pineda *, Tulika Chauhan Page 422
    Phakic intraocular lenses revolutionize refractive surgery and continue to serve as an excellent option for vision correction in patients who are not ideal candidates for laser vision correction. This article will review special indications of phakic intraocular lenses in the clinical practice.
    Keywords: Anterior Chamber, Intraocular Lens, Phakic, Posterior Chamber, Special Indications
  • Ali Tavallali *, Lawrence A. Yannuzzi Page 429
    Idiopathic multifocal choroiditis (MFC) and/or punctate inner choroidopathy (PIC) describe a chronic progressive bilateral inflammatory chorioretinopathy that predominantly affect healthy myopic white women with no known associated systemic or ocular diseases. The principal sites of involvement are the retinal pigment epithelium (RPE) and outer retinal spaces; the choroid is not affected during the active phase of the disease. Idiopathic MFC with atrophy is a recently described variant. Although there is no generally accepted standard treatment, anti-inflammatory and anti-VEGF (vascular endothelial growth factor) agents are necessary in the acute stage to control the inflammation and choroidal neovascularization (CNV).
    Keywords: Idiopathic Multifocal Choroiditis, Panuveitis, Punctate Inner Choroidopathy
  • Tayyab Afghani, Furqan Ahmed Khan, Hassan Mansoor* Page 433
    Purpose
    To report a case of conjuctival leiomyoma.
    Case Report: An 18‑year‑old female patient presented with a conjunctival growth in the left eye for a 2-year-period with no change in size. She merely presented for cosmetic reasons. Visual acuity was 20/20 in each eye. The lesion had prominent vessels and was not adherent to the sclera. The growth resembled a benign lesion of the conjunctiva. The tough and vascular tissue was excised and sent for histopathology. The defect was covered by an end to end conjunctival suturing. Histopathology showed the lesion to be conjunctival leiomyoma. Trichome was used to highlight the spindle shaped cells and immuno‑histochemistry using anti-smooth muscle actin antibody and Vimentin was applied to confirm the diagnosis.
    Conclusion
    This case adds to the total number of cases of conjuctival leiomyoma reported in the literature to date. An ophthalmologist needs to think beyond a common mass when encountering a conjunctival growth extending onto the cornea.
    Keywords: Benign, Conjuctival, Leiomyoma, Pterygium
  • Mohammad Hossein Jabbarpoor Bonyadi * Page 436
    Purpose
    To report high resolution spectral domain optical coherence tomography (SD-OCT) findings in a case with bilateral photic maculopathy and resultant central scotoma following pterygium excision.
    Case Report: A 38‑year‑old man with a history of pterygium excision complained of visual disturbance and annoying central scotoma in both eyes. Although he had subtle funduscopic and angiographic changes, SD‑OCT precisely showed disruption of the photoreceptors inner segment/outer segment in the foveal center.
    Conclusion
    Phototoxic macular damage following ocular surgeries may be diagnosed with difficulty due to subtle funduscopic findings. SD-OCT is a precise imaging in revealing characteristic retinal alterations in different foveal injuries. Ophthalmologists should be aware of the possibility of photic maculopathy following various ophthalmic operations including pterygium surgery.
    Keywords: Microscope?induced Retinopathy, Pterygium Excision, Spectral Domain Optical Coherence Tomography
  • Renata T. Rothwell, Sofia B. Campelos, Sandra Prazeres Page 439
    Purpose
    To describe the clinical presentation and treatment of a patient with a cutaneous pleomorphic adenoma of the eyelid.
    Case Report: A 73-year-old male patient presented with a nodular mass on the lateral third of his right upper eyelid, which had slowly enlarged over 10 years. Radiologic features were of an extra-conical mass, with no invasion of adjacent structures. An excisional biopsy of the lesion was performed. The histopathological examination revealed a biphasic tumor, composed of tubules with a double layer of epithelial cells arranged in a chondromyxoid stroma. The inner epithelial cells were positive for pancytokeratins AE1/AE3 and carcinoembryonic antigen. The outer epithelial cells and stromal component expressed vimentin and S100 protein. These pathologic findings were consistent with a palpebral pleomorphic adenoma, with an apocrine gland origin.
    Conclusion
    Pleomorphic adenomas of the skin are rare tumors, and even less frequent as tumors of the ocular adnexa. These lesions should be considered in the differential diagnosis of palpebral nodular masses, and complete excision should be attempted due to the possibility of malignant transformation.
    Keywords: Pleomorphic Adenoma, Apocrine Gland Tumor, Ocular Adnexal Tumor
  • Giuseppe Giannaccare *, Corrado Gizzi, Michela Fresina Page 442
    Purpose
    To report the clinical and pharmacological findings of a patient with iatrogenic Horner syndrome (HS) which occurred after thyroid surgery.
    Case Report: A 29‑year‑old man was referred to our emergency ward due to anisocoria and unilateral eyelid ptosis reported by the patient immediately after a recent thyroidectomy for a papillary carcinoma. Ophthalmologic examination revealed 3 mm ptosis of the right eyelid. In dim illumination, the right and left pupil size was measured 3 and 6 mm, respectively. In bright illumination, the amount of anisocoria decreased; the near pupillary reaction was intact. Brain and neck magnetic resonance imaging and chest radiography were normal. Pharmacological tests with 10% cocaine, 1% hydroxyamphetamine and 1% phenylephrine localized the interruption of the oculosympathetic pathway with postganglionic third‑order neuron involvement. After 6 months of follow‑up, no sign of recovery was recorded.
    Conclusion
    Despite HS could appear to be a rare complication of thyroid surgery, it is of importance for the neck surgeons to be aware that oculosympathetic pathway (OSP) is a potentially vulnerable structure with close anatomical relationship with the thyroid gland, and for the ophthalmologists that HS may occur secondary to neck surgery and taking an accurate history is mandatory.
    Keywords: Horner syndrome, Miosis, Ptosis, Thyroid Surgery
  • Aditya Verma, Chetan Rao, Muna Bhende Page 445
  • Tanuj Dada, Dewang Angmo *, Neha Midha, Talvir Sidhu Page 452
    Two patients with history of trabeculectomy presented with uncontrolled intraocular pressure (IOP) postoperatively. The first patient had a flat and vasularized bleb 10 weeks after the surgery, and the second subject developed encapsulated bleb 3 months postoperatively. Both patients were taken to the operating room and intraoperative optical coherence tomography (OCT) guided bleb needling was performed to restore aqueous egress into the subconjunctival space. Postoperatively, IOP of the operated eyes ranged 14‑18 mmHg at week 6 and month 3. None of the eyes had any intraoperative or postoperative complications. This novel application of the intraoperative OCT for bleb needling facilitates precision surgery under direct visualization and reduces the risk of complications.
    Keywords: Bleb Needling, Optical Coherence Tomography, Encysted Bleb
  • Brijesh Takkar, Shorya Azad* Page 455