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Ophthalmic and Vision Research - Volume:12 Issue: 3, Jul-Sep 2017

Journal of Ophthalmic and Vision Research
Volume:12 Issue: 3, Jul-Sep 2017

  • تاریخ انتشار: 1396/05/18
  • تعداد عناوین: 23
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  • Mehran Zarei-Ghanavati, Christopher Liu Page 249
  • Alireza Baradaran-Rafii, Sahba Fekri, Mohammad Rezaie, Shahram Salehi-Rad, Ali Moradi, Tahmineh Motevasseli, Masumeh Kalantarion Page 254
    Purpose
    To compare the corneal power measurements obtained using different topographic instruments after myopic photorefractive keratectomy (PRK).
    Methods
    Patients with myopia who were candidates for corneal refractive surgery were sequentially included. Pre-PRK and six months post-PRK corneal powers were measured using Javal manual keratometer, Orbscan II, Galilei, Tomey TMS4, and EyeSys 2000 topographers. Measured values were compared with those obtained using the clinical history method (cHM).
    Results
    This study included 66 eyes of 33 patients. The lowest keratometric measurements were obtained using the Galilei topographer (42.98 ± 1.69 diopters, D) and the highest measurements were obtained using the Javal manual keratometer (43.96 ± 1.54 D) preoperatively. The same order was observed postoperatively. Effective refractive power (EffRP) measured using EyeSys was most similar to the values obtained using cHM (Icc, intraclass correlation coefficient = 0.951), followed by the total corneal power measured using the Galilei system (Icc = 0.943). The values obtained using the adjusted EffRP formula (EffRP – 0.015*Δ Refraction – 0.05) were more consistent with the values obtained using cHM (Icc = 0.954) compared to those obtained with the adjusted average central corneal power formula measured using the Tomey system (Icc = 0.919).
    Conclusion
    Post-PRK corneal powers measured using the adjusted EffRP formula were the most similar to values obtained using cHM.
  • Siamak Zarei-Ghanavati, Hamid Khakshour, Mohammadreza Vejdani, Haleh Ghooshkhanei, Amirhosein Vejdani Page 260
    Purpose
    To assess and compare preoperative refractive, aberrometric, topographic, and contrast sensitivity (CS) measurements with postoperative values after corneal collagen cross-linking (CXL) in patients with progressive keratoconus.
    Methods
    Twenty-two eyes of 11 patients with keratoconus were enrolled in this prospective study. Uncorrected distance visual acuity (UDVA), best spectacle corrected visual acuity (BSCVA), CS, and higher order aberrations (HOAs) were evaluated at baseline and 1, 3, 6, and 8 months after surgery.
    Results
    The mean total HOAs of the included patients were 2.24, 2.34, 2.28, 2.17, and 2.03 μm before and 1, 3, 6, and 8 months after CXL, respectively. A significant reduction in corneal HOAs including vertical coma, vertical and horizontal trefoil and spherical aberration was observed 6 and 8 months after CXL.UDVA and BSCVA improved significantly in all patients who completed the follow-up period (P = 0.001). Although mean cS declined significantly 1 month postoperatively, it improved significantly after 3, 6, and 8 months (P
    Conclusions
    CXL seems to improve UCVA, BSCVA, and CS and reduce most corneal HOAs in progressive forms of keratoconus.
    Keywords: Collagen Cross‑linking, Contrast Sensitivity, Corneal Aberration, Keratoconus
  • Farid Karimian, Vahid Ownagh, Mohammad Aghazadeh Amiri, Seyed Mehdi Tabatabaee, Nooshin Dadbin Page 265
    Purpose
    To determine changes in stereoacuity in anisometropic myopic eyes after photorefractive keratectomy (PRK).
    Methods
    Myopic patients with at least 1 diopter (D) of anisometropia in sphere, astigmatism, or spherical equivalent who were referred to our hospital for excimer refractive surgery were enrolled as a prospective sequential interventional case series. All patients underwent wavefront-guided photorefractive keratectomy (WFG-PRK) using the Technolas Perfect Vision (217z) Excimer laser machine. changes in binocular stereoacuity were evaluated using the TNO and Butterfly stereoacuity tests before and at 2 weeks, 1 month, and 3 months after the operation.
    Results
    Between January and November 2015, a total of 98 eyes of 49 patients (71.4% men) with a mean age of 28 ± 5.5 years, mean myopia of −3.32 ± 1.74 D, and mean astigmatism of 1.3 ± 1.3 D were enrolled in this study. Preoperative mean stereoacuity values were 102 ± 103.44 and 56.8 ± 41 seconds of arc (s/arc)as measured by the TNO and Butterfly stereoacuity tests. Mean stereoacuity improved to 90 ± 110.52 s/arc (P = 0.009) and 56.5 ± 41.3 s/arc (P = 0.80), respectively, 6 months after WFG-PRK. Overall improvement in stereoacuity was 10.2% and 6.12% according to the TNO and Butterfly stereoacuity tests, respectively.
    Conclusion
    Stereoacuity improves after WFG-PRK for treatment of anisometropic myopia. This improvement is more accurately detectable by the TNO than the Butterfly stereoacuity test.
    Keywords: Anisometropia, Photorefractice Keratectomy, Stereoacuity, Wavefront‑guided
  • Parviz Malekifar, Hamed Esfandiari, Nazanin Behnaz, Fatemeh Javadi, Sima Azish, Mohammad Ali Javadi, Masumeh Kalantarion Page 270
    Purpose
    To evaluate the risk factors for pterygium in the dry, high altitude province of Ilam, Iran.
    Methods
    The study included patients who presented to ophthalmology clinic. The patients were divided into two groups: 210 diagnosed with pterygium or pinguecula (unilateral or bilateral), and 210 healthy controls. Demographic variables, living environment, disease type, disease laterality, family history of pterygium as well as history of smoking, working outdoors, baking, welding, ocular conditions (trachoma keratopathy, glaucoma, refractive error, and dry eye), use of glasses, ultraviolet light exposure, and systemic conditions were collected from both groups and compared for risk assessment.
    Results
    Univariate analysis revealed that age (P = 0.001), sex (P = 0.001), family history of pterygium (P = 0.001), positive history of smoking (P
    Conclusion
    This study tested more risk factors related to the prevalence of pterygium compared to previous studies. It also confirmed previously established risk factors. Family history of pterygium and blepharitis were risk factors that have not been reported in previous studies and were found to be significantly associated with the development of pterygium in this study.
    Keywords: Prevalence, Pterygium, Risk Factors
  • Outcome of single-piece intraocular lens sulcus implantation following posterior capsular rupture during phacoemulsification
    Masomeh Mohebbi, Seyed Ali Bashiri, Seyed Farzad Mohammadi, Behnaz Samet, Fariba Ghassemi, Elham Ashrafi, Fatemeh Bazvand Page 275
    Purpose
    To assess the safety and outcome of single-piece posterior chamber intraocular lens (PC-IOL) implantation in the ciliary sulcus following posterior capsular rupture during cataract surgery.
    Methods
    Patients with posterior capsular rupture during cataract surgery with a single-piece acrylic IOL implanted into the ciliary sulcus were studied. complete ocular examinations were performed after 6 months postoperatively.
    Results
    Twenty-four eyes were included. Mean follow-up duration was 8.33 ± 2.33 months. There was no significant difference between preoperative and postoperative keratometric cylinder or intraocular pressure. Visual acuity of 87.50% of patients was ≥20/40 after surgery. complications included foveopathy (10 eyes), iris transillumination defect (4 eyes), iris chafing (2 eyes), pigmented keratic precipitate (KP) (4 eyes), clinical IOL tilt (6 eyes), endothelial pigment dusting (14 eyes), IOL pigment dusting (17 eyes), iris bowing (6 eyes), IOL decentration (4 eyes), and IOL tilt detected with ultrasonography biomicroscopy (UBM) (4 eyes). IOL pigment dusting was significantly higher in eyes with short axial lengths, high IOL power, small sulcus-to-sulcus (STS) diameter, large STS IOL diameter mismatch, and small anterior chamber depth and angle. Significant relationships were observed between pigmented KP with small STS diameter and large STS IOL diameter mismatch, UBM and clinical IOL tilt with large anterior chamber depth and between iris transillumination defect and STS IOL diameter mismatch.
    Conclusion
    This implantation is associated with higher incidence of complications. Single-piece acrylic IOLs are not designed for sulcus implantation. However, they may be used in eyes with longer axial length if the 3-piece IOL is not available.
    Keywords: Cataract Surgery, Single‑piece Intraocular Lens, Ciliary Sulcus Implantation
  • Khalil Ghasemi Falavarjani, Anahita Amirsardari, Abbas Habibi, Acieh Eshaghi, Shohreh Bakhti, Kaveh Abri Aghdam Page 281
    Purpose
    To evaluate the effect of spironolactone on chronic central serous chorioretinopathy (CSC).
    Methods
    In this prospective interventional case series, patients with chronic cSc were treated with spironolactone (25 mg daily) for at least 6 weeks. If the subretinal fluid (SRF) had not completely resolved by this time, treatment was continued, and the dosage was increased to 25 mg twice daily. Primary outcome measure was the change in maximum SRF height at the final follow-up visit, as detected by optical coherence tomography. Secondary outcome measures were changes in best corrected visual acuity (BCVA) and central macular thickness (CMT).
    Results
    Sixteen eyes of 14 patients with chronic cSc were enrolled. Mean follow-up time was 6.4 ± 4.3 months. Baseline BcVA was 0.54 ± 0.44 logarithm of the minimum angle of resolution (log MAR), which improved to 0.42 ± 0.43 log MAR at the final visit (P = 0.04). Mean cMT decreased from 282.69 ± 103.23 μm at baseline to 236.75 ± 90.10 μm at final visit (P = 0.11), and the mean of maximum SRF height decreased from 155.63 ± 95.27 μm at baseline to 77.19 ± 95.68 μm at the final visit (P = 0.04). SRF resolved completely in seven eyes (43.75%).
    Conclusion
    In eyes with persistent SRF due to CSC, spironolactone therapy was associated with a statistically significant decrease in maximum SRF height, as well as an improvement in BCVA.
    Keywords: Central Serous Chorioretinopathy, Optical Coherence Tomography, Spironolactone, Subretinal Fluid
  • Rajesh Subhash Joshi, Ajay Sharad Deshpande Page 290
    Purpose
    To determine the success rate of conventional dacryocystorhinostomy (DCR) and endoscopic DCR performed in patients with acute dacryocystitis.
    Methods
    Records of patients with acute dacryocystitis and operated during 2007–2008 were reviewed. Patients who completed a follow-up of 60 months were included in our study. Demographic characteristics, surgery types, success rate, and follow-up periods were recorded. Success was defined as the elimination of epiphora, absence of dacryocystitis, and negative syringing test result (i.e., unrestricted flow of irrigated saline to the nose).
    Results
    A total of 67 patients were operated during the period. Fifty-seven patients completed the follow-up of 60 months. The mean age in the conventional and endoscopic groups was 39.5 ± 8.5 and 39.5 ± 8.4 years, respectively. The participants included 33 female and 24 male patients. Endoscopic DCR was performed in 28 (endoscopic group) and conventional DCR (conventional group) in 29 patients. conventional DCR was performed after subsidence of the acute attack, which took an average of 10 days (range, 9–19 days). After a period of 60 months, patency on syringing and resolution of epiphora was documented in 26 patients in the conventional group (success rate, 89.7%) and 23 patients in the endonasal group (success rate, 82.1%) (P = 0.654).
    Conclusion
    The success rates of conventional and endonasal DCR during a follow-up period of five years in patients with acute dacryocystitis are almost similar.
    Keywords: Acute Dacryocystitis, Conventional Dacryocystorhinostomy, Endonasal Dacryocystorhinostomy
  • Mohammad Reza Talebnejad, Saeed Khademi, Milad Ghani, Mohammad Reza Khalili, Mohammad Hossein Nowroozzadeh Page 296
    Purpose
    Oculocardiac reflex (OCR), defined as bradycardia induced by manipulation of extraocular muscles, is a serious complication during strabismus surgery for which prevention and proper management is required. In the present study, we investigated the efficacy of sub‑Tenon injection of bupivacaine for prevention of OCR and postoperative pain.
    Methods
    A prospective randomized controlled clinical trial was conducted. Fifty patients who were candidates for strabismus surgery were randomized into case (sub‑Tenon’s bupivacaine injection) or control (normal saline injection) groups. Standard strabismus surgery was performed for all cases. Occurrence and severity of OCR (primary outcome) and postoperative pain (using the Visual Analog Scale) were compared between the two groups.
    Results
    Both incidence (32% vs. 100%; P = 0.002) and severity of OCR (mean heart rate decrease, 10.1 vs. 38.7 beats/minute; P
    Conclusions
    Sub‑Tenon injection of bupivacaine as a local anesthetic can significantly prevent OCR and decrease the severity of bradycardia. This technique can also diminish postoperative pain in patients who underwent strabismus surgery.
    Keywords: Bupivacaine, Oculocardiac Reflex, Pain, Strabismus
  • Farzad Pakdel, Mahmood Reza Gohari, Anis Sadat Jazayeri, Afsaneh Amani, Niloofar Pirmarzdashti, Hossein Aghaee Page 301
    Purpose
    To develop and validate a Farsi version of Ocular Surface Disease Index (OSDI) for the Iranian population.
    Methods
    This study was a translation and cross‑cultural adaptation and validation of Farsi version of OSDI. Four bilingual (English‑Persian) individual including three physicians and one native English teacher were asked to translate the original English OSDI questionnaire in Farsi. Following back and forth translation, integration and pilot check, the translation team came to consensus on translation. Consecutive patients visited in ophthalmology clinic, underwent comprehensive general ophthalmology exam and specific assessments for dry eye including non‑anesthetic Schirmer’s test, fluorescein tear break‑up time, Fluorescein and Rose Bengal staining and Farsi OSDI (F‑OSDI). F‑OSDI was again rechecked within 2‑7 days after the examination.
    Results
    Forty‑four participants were enrolled into study. Thirty‑two (72.7%) were male and 12 (27.3%) female. Mean age of participants was 45.5 (SD = ±15.97, range = 18‑80) years. Twenty five percent were less than 31 years old and 10% percent older than 65. The cronbach’s alpha for the questionnaire was 0.807. Questions number 7, 8 showed excellent, and question12 showed good internal consistency, respectively. There was a significant correlation between all pre measures and post assessments.
    Conclusion
    The obtained F‑OSDI showed acceptable internal consistency and test‑retest reliability. This F‑OSDI could be used for assessment of dry eye, ocular surface discomfort and quality of life in Iranian and Farsi speaking populations.
    Keywords: Ocular Surface Disease Index, Dry Eye Disease, Dysfunctional Tear Syndrome, Transcultural Farsi Translation
  • Hasan Bashir, John T. Seykora, Vivian Lee Page 305
    The ocular surface is comprised of the cornea and conjunctiva, which are structures that not only protect the eye but also enable vision. The corneal epithelium is the most superficial layer of the cornea, and therefore first line of defense against external assaults. Damage to this highly specialized structure could lead to vision loss, making it an important structure to investigate and understand. Here, we conducted a search of the current literature on the mechanisms the corneal epithelium has adapted against three frequent insults: UV‑radiation, pathogens, and environmental assaults. This review systematically examines the corneal epithelium’s response to each assault in order to maintain its role as an invisible shield. The goal of this review is to provide insight into some of the critical functions the corneal epithelium performs that may be valuable to current regenerative studies.
    Keywords: Apoptosis, Barrier, Cornea, Epithelium, Inflammation, Neurosensory, Ocular Surface, Pathogen, Sensory, UV‑radiation
  • Joel R. Palko, Owen Qi, Arsham Sheybani Page 312
    A systematic literature review was performed evaluating articles examining the effects of pseudoexfoliation syndrome (PEX) and glaucoma (PEXG) on the cornea with a focus on the corneal endothelium. We searched for articles relevant to pseudoexfoliation syndrome, pseudoexfoliation glaucoma and corneal endothelial cell counts using Pubmed, Google Scholar Database, Web of Science and Cochrane Library databases published prior to September of 2016. We then screened the references of these retrieved papers and performed a Web of Science cited reference search. Corneal characteristics analyzed included central corneal thickness (CCT), corneal nerve density, endothelial cell density (ECD), polymegathism, and pleomorphism. These parameters were compared in the following populations: control, PEX, PEXG, and primary open angle glaucoma (POAG). Over 30 observational studies were reviewed. Most studies showed a statistically significant lower ECD in PEX and PEXG populations compared to controls. Overall, PEX eyes had a non‑statistically significant trend of lower ECDs compared to PEXG eyes. No consistent trends were found when analyzing differences in CCT amongst control, PEX and PEXG groups. For the few studies that looked at corneal nerve characteristics, the control groups were found to have statistically significantly greater nerve densities than PEX eyes, which had significantly greater densities than PEXG eyes. ECD and corneal nerve densities may be potential metrics for risk‑stratifying patients with PEX and PEXG. Our literature review provided further evidence of the significant negative influence PEX has on the cornea, worsening as patients convert to PEXG.
    Keywords: Pseudoexfoliation Syndrome, Pseudoexfoliation Glaucoma, Endothelial Cell Density, Corneal Nerve Density
  • Ramin Daneshvar, Kouros Nouri-Mahdavi Page 325
    Optical coherence tomography angiography (OCTA) is a new modality in ocular imaging which provides high resolution view of the vascular structures in the retina and optic nerve head. This technology has the advantages of being noninvasive, rapid and reproducible. OCTA is becoming a valuable tool for evaluating many retinal and optic nerve diseases. This article provides a brief introduction to the technology and its application in the field of glaucoma diagnostics.
    Keywords: Angiography, Glaucoma, Optic Nerve, Optical Coherence Tomography Angiography
  • Khosrow Jadidi, Hossein Hasanpour Page 333
    Purpose
    In this case report, we describe the surgical procedure of corneal inlay preparation and corneal pocket creation using a femtosecond laser system.
    Case Report: A 7‑year‑old girl who presented with unilateral paracentral corneal thinning underwent the surgical procedure of corneal inlay. Preoperatively, the refraction was .00‑6.00 × 170. One month after the procedure, astigmatism and hyperopia were decreased and the refraction was .00‑1.25 × 110.
    Conclusion
    Femtosecond laser–assisted pocket creation for the implantation of corneal inlays offers accuracy of pocket parameters, enhancing predictability, resulting in better final outcomes, and improving the safety of the procedure.
    Keywords: Femtosecond Laser, Keratectasia, Intrastromalcornea Graft
  • Ramin Nourinia, Mohammad Hossein Dehghan, Sahba Fekri Page 338
    Purpose
    To describe a 42‑year‑old man, a known case of Bietti crystalline dystrophy who underwent surgery for unilateral full thickness macular hole.
    Case Report: Clinical features, color fundus photographs, and optical coherence tomography, electroretinography, and electrooculography findings of the patient are reported. His visual acuity improved from counting fingers to 20/50 after pars plana deep vitrectomy with internal limiting membrane (ILM) peeling and gas injection.
    Conclusion
    Macular hole can occur in Bietti crystalline dystrophy and the post‑surgical outcome is good.
    Keywords: Bietti Crystalline Dystrophy, Crystalline Retinopathy, Macular Hole
  • Douglas P. Dworak, Shyam A. Patel, Lisa S. Thompson Page 342
    Purpose
    To describe a rare case of blepharochalasis that progressed from unilateral to bilateral involvement at five years after disease onset.
    Case Report: A previously healthy five‑year‑old white boy presented to our hospital for a screening visual examination. He was found to have a 2‑mm right eyelid ptosis with crepe‑like skin and subcutaneous telangiectatic vessels. His mother noted that since the age of three, the child has been having two to seven day‑long episodes of right upper eyelid swelling and edema with tenderness. The episodes eventually progressed to involving the left eyelid as well. Oral steroid taper was found to effectively resolve these exacerbations, and a diagnosis of blepharochalasis was made.
    Conclusion
    Blepharochalasis should be in the differential diagnosis for young children presenting with unilateral or bilateral ptosis with periorbital skin abnormalities.
    Keywords: Bilateral Ptosis, Blepharochalasis, Oculoplastics, Orbital Inflammation, Unilateral Ptosis
  • Thankappan Lekha, Leelakrishnan Venkatakrishnan, Karuppannasamy Divya, Lavanya Perumal Page 345
    Purpose
    To report a rare case of periorbital emphysema concurrent with cervicofacial and mediastinal emphysema in an elderly woman who underwent upper gastrointestinal endoscopy for chronic liver disease.
    Case Report: An elderly woman with decompensated chronic liver disease presented with features of periorbital, facial, and mediastinal emphysema, characterized with crepitant swelling over the right periorbital area, face, neck, and mediastinum after undergoing upper gastrointestinal endoscopy. There was no history of trauma or Valsalva maneuver. Ocular findings were stable with no evidence of orbital compartmental syndrome. Urgent computed tomography scans of the orbit and chest were performed, and emergency systemic treatment with nasogastric decompression and antibiotics was initiated. However, she suddenly collapsed and succumbed despite all resuscitative efforts.
    Conclusion
    Our case demonstrates that periorbital emphysema can occur following procedures such as upper gastrointestinal endoscopy, in the eyes without history of local trauma. This complication should be suspected especially if there is associated cervicofacial and mediastinal emphysema. Subcutaneous emphysema is usually self‑resolving; however, extension of air into deeper planes can cause dangerous complications such as blindness due to orbital emphysema or mortality due to mediastinal emphysema. Hence, prompt diagnosis and urgent intervention are crucial to avoid vision and life threatening complications.
    Keywords: Mediastinal Emphysema, Periorbital Emphysema, Upper Gastrointestinal Endoscopy
  • Mahmood Dhahir Al-Mendalawi Page 353
  • Hossein Jamali, Reza Gharebaghi Page 356