مجله چشم پزشکی بینا
سال دهم شماره 4 (تابستان 1384)

To evaluate the properties of cultured limbal stem cells for corneal surface reconstruction. Specimens of limbal explants were prepared from the Eye Bank of I.R. Iran. The explants were cultured and expanded on acellular amniotic membrane for 21 days. The cultured cells were evaluated for expression of Connexin 43 and keratinine K3 by immunocytochemistry and expression of K12 keratinine and P63 by RT-PCR. After 2 to 3 weeks, the limbal epithelial cells grew to form a sheet approximately 2×2 cm2 in size on the amniotic membrane. On histological examination the epithelial sheet was composed of 4 to 5 cell layers at the margin of the sheet and from 1 to 4 cell layers in the area between the margin and the original explant tissue. Immunocytochemistry analysis showed Keratinine K3 and Connexin 43 were expressed in normal cornea. The markers were expressed weakly in cultured limbal cells. Also, RT-PCR analysis revealed that P63 and K12 were expressed in cultured and normal limbal cells. The normal cornea expressed K3 and K12 but not P63. These data support the notion that expansion of limbal stem cells on amniotic membrane can be used of tranplantation to patients with limbal stem cell deficiency.

To evaluate the outcomes of surgery for cicatricial ectropion in Labbafinejad hospital, Tehran, Iran. This existing data study was conducted on the hospital records of 84 patients who underwent eyelid surgery because of cicatricial ectropion. Z-plasty was the most frequent method among 9 techniques. Of 92 eyelids, 60 (65%) were completely corrected. The most frequent procedure leading to correction was lateral tarsal strip + skin graft. The results of operations for cicatricial ectropion with skin graft are better than those without skin graft.

To determine the success rate and complications of blepharotomy and tarsotomy in moderately severe upper eyelid cicatritial entropion. This randomized clinical trial was conducted on patients with moderately severe cicatritial entropion. The patients were followed for six months and the results and complications were evaluated. Success was defined as uncontacted eyelid margin and cilia to cornea. Sixty upper eyelids of 37 patients (10 male and 27 female) underwent blepharotomy in 30 eyelids and tarsotomy in 30 other eyelids. Mean age was 68.77.0 years in the blepharotomy group and 61.214 in the tarsotomy group. (P=0.3) Trachoma was the undelying cause in all cases. Success rate was 93.3% in the blepharotomy group and 96.7% in the tarsotomy group. (P=0.5) There was no significant difference between the two groups regarding complications of the procedures at the end of follow up except for eyelid notching which was significantly greater in the blepharotomy group. (16.7% vs 0, P=0.02) Blepharotomy and tarsotomy are successful operations in moderately severe cicatritial entropion. Tarsotomy is easier and doesnt need a skin incision. We suggest tarsotomy as a better technique in patients with moderately severe trachomatic cicatritial entropion of the upper eyelids.

To evaluate exposure rate following wrapping hydroxyapatite implant in mersilene mesh and donor sclera. In a prospective comparative interventional case-series 60 consecutive patients underwent primary hydroxyapatite orbital implant wrapped in mersilene mesh or donor sclera. Thirty patients (21 male and 10 female) underwent implantation with mersilene mesh and 30 patients (20 males and 10 females) with donor sclera. Average age at the time of surgery was 36.4 years (range, 10-77) in the mersilene mesh group and 28.5 years (range, 8-85) in the sclera group. The most frequent cause of enucleation in both groups was trauma (53.3% in mersilene mesh and %56.6 in scleral group, respectively). After 10.4 months (range, 6-18) follow up there was no exposure in the mersilene mesh group; however after 9.4 months (range, 6-15) follow up in the sclera group one exposure was observed. There was no significant diference in exposure rate between the two groups. Mersilene mesh should be considered as an alternative for donor sclera. It is readily available and avoids risk of disease transmission.

To evaluate the outocmes and complications of dacryocystorhinostomy (DCR) in the ophthalmic centers of Yazd Medical Sciences University, Yazd, Iran. The outcomes of external DCR (EX-DCR) operation on 187 patients were evaluated. Patients were selected consecutively. Overall success rate was 90.4% (CI 95%; 86.3 - 94.5%). Success rate was 90.9% in females and 89.1% in males (P= 0.543). Regarding DCR method, success rate was 96.3% with silastic intubation and 88% without it (P= 0.08). The more frequent and important complications of DCR were failure of treatment and recurrence of epiphora and purulent discharge (9.6%), unusual scar (8.6%), and infection (5.3%). No major complications occurred during operation. External DCR is a relatively easy technique with a success rate of more than 90% with few complications. The procedure can be done in most ophthalmic centers.

To compare body mass index (BMI) in patients with exfoliation syndrome (XFS) and a matched control group. In a cross-sectional study, 84 patients with XFS (XFS group) and 84 persons without XFS (control group) were matched for sex and age and selected sequentially. BMI was compared in the two groups. Patients with XFS with or without glaucoma and other complications were included. Mean age of patients was 62.89.1 (47-84) years. Unilateral involvement was observed in 78% of women and 54% of men. BMI was 20.523.94 in the XFS group and 22.844.55 in the control group (P= 0.005). Patients with XFS have lower BMI than patients without this syndrome. Factors such as malnutrition, malabsorption, or other systemic disorders may play a role in the etiology of pseudoexfoliation.

To compare long-term results of excimer laser sub-epithelial keratectomy (LASEK) and laser in situ keratomileusis (LASIK) for low to moderate myopia. In a comparative case series, visual outcomes in 415 LASIK-treated eyes (212 patients) and 359 LASEK-treated eyes (194 patients) with myopia ranging from -1.5 to -5 diopters (D) and astigmatism up to -2.75 D using a flying spot excimer laser (Technolas 217) by a single surgeon were analyzed. Patients were divided into mild and moderate myopia. Uncorrected and corrected visual acuity, manifest refraction, and complications were evaluated. Patient's age ranged from 19 to 47 years. Uncorrected visual acuity was 20/20 or better in 89.3% of LASEK treated eyes and 90.7% of LASIK treated eyes at about 2 years follow-up (P>0.05). Spherical equivalent within 0.5 D of emmetropia was achieved in 83.3% of eyes in the LASEK group and 84.7% of eyes in the LASIK group (P>0.05). None of the eyes lost 2 or more lines of BCVA. LASEK is a safe and effective procedure that provides excellent refractive and visual results with no serious complications. It can be considered as an alternative refractive surgery for correction of low to moderate myopia.

To compare the safety, efficacy, and visual results of laser in situ keratomileusis (LASIK) in eyes with and without previous scleral buckling surgery in the same individuals. In a prospective clinical trial, 14 eyes of 7 patients with myopic refractive error and history of scleral buckling in one eye, underwent LASIK surgery in both eyes according to a standard surgical protocol. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refraction, Orbscan topography, and pachymetry were recorded 1, 3, 6, and 12 months after LASIK. Eyes with previous scleral buckling were named RD group and the fellow eyes without any previous ocular surgery were named non-RD group. LASIK was performed without any complication. No patient developed a new RD or significant vitreoretinal changes during one year of follow-up. There was no decrease in BCVA in any of the eyes. In the RD group, mean spherical equivalent (MSE) before LASIK was -7.67 D and was reduced to -0.17, -0.87, -1.37, and -1.89 D at 1, 3, 6, and 12 months after LASIK, respectively. In the non-RD group, MSE before LASIK was -5.25 D which was reduced to +0.05, -0.17, -0.37, and -0.57 D - at 1, 3, 6, and 12 months after LASIK, respectively. Differences between the two groups were statistically significant at 3, 6, and, 12 months after operation. Myopic regression between 1 and 12 months after LASIK in the RD group (-1.71 D) was greater than the non-RD group (-0.62 D). (P=0.019) Mean increase in central corneal thickness during this period had no significant difference between the two groups. Corneal power increase in the RD group (2.44 D) was more than the non-RD group (1.01 D). (P=0.001) LASIK may be considered for treatment of myopia in eyes with previous RD surgery. Although it seems to be safe in these eyes, it is not as effective as LASIK in eyes without previous RD surgery. Myopic regression seems to be more pronounced in these eyes.

To measure peripapillary retinal nerve fiber layer (RNFL) thickness in normal human eyes by optical coherence tomography (OCT). Eighty-one eyes of 45 normal participants were studied. Each person underwent a complete ophthalmic examinations, including measurement of visual aquity and intraocular pressure and evaluation of the anterior segment, optic disc, and retinal nerve fiber layer. None of the participants had any evidence of ocular hypertension (IOP > 21 mmHg), glaucoma or other ocular diseases. Three to six peripapapillary circular scans with a diameter of 3.4 mm were performed on both eyes of participants by optical coherence tomography (model 2000, Carl-Zeiss Med Tec). Subjects ranged in age from 18 to 52 years and refractive error ranged from -5.00 to +1.75 diopters. Average peripapillary RNFL thickness 1.74 mm from the center of the disc was 137.56 ± 16.79 µm. Average RNFL thickness in the four quadrants were: superior 161.67 ± 21.17 µm, nasal 118.38 ± 21.97 µm, inferior 163.67 ± 29.93 µm, and temporal 109.23 ± 26.35 µm. There were no statistically significant correlation between RNFL thickness and age, gender or refractive error. RNFL thickness in right and left eyes had significant correlation, especially in the inferior quadrant. (r=0.67, P=0.000) RNFL thickness of both eyes of each person are nearly the same.

To report five cases of Wolfram syndrome, an autosomal recessive neurodegenerative disease with ِDiabetes Insipidus, Diabetes Mellitus, Optic Atrophy, and Deafness (DIDMOAD syndrome). Patients and All of the five patients had diabetes mellitus and optic atrophy. Four patients had hearing loss. In spite of persistence of polyuria and polydipsia, diabetes insipidus had been previously detected in only one patient and its presence was discovered after the diagnosis of the syndrome in the other three. Two brothers had open angle glaucoma. Although Wolfram syndrome is rare, it should be considered in all insulin-dependent diabetics in whom polyuria and polydipsia persists despite adequate control of blood sugar. It should also be considered in familial cases of diabetes mellitus type I. Presence of optic atrophy is a helpful sign for diagnosis. Fundoscopy is crucial for early diagnosis. With early management of diabetes insipidus, late urologic complications may be prevented. Quality of life may be improved with visual and hearing aids.

To evaluate the effects of diurnal fasting during Ramadan on intraocular pressure (IOP) in healthy subjects. The study was conducted on healthy male volunteer less than 40 years of age without ocular or systemic diseases who were on religious fasting during Ramadan, 2004. Intraocular pressure were measured at 9 AM and 1, 5, and 7 PM in 2nd and 4th weeks of Ramadan and also one month after Ramadan, except for the 7 PM measurement. Twenty-eight eyes of 14 men were evaluated. Duration of fasting was between 12-13 hours. Mean age was 31.94.4 years. Mean weight in the 4th week decreased about 1 kg in comparison to the 2nd week of fasting (P=0.05) and increased about 1.5 kg one month after Ramadan in comparison to the 4th week of fasting (P= 0.008). Mean IOP at 9 AM and 1 PM significantly decreased in the 4th week compared to the 2nd week (1.1 and 1.5 mmHg, respectively). Mean IOP significantly increased one month after Ramadan compared to the 4th week of Ramadan (1.4 and 2.1 mmHg, respectively). Mean IOP at 5 PM one month after Ramadan had a significant increase of 1.6 and 1.8 mmHg compared to the 2nd and 4th weeks of Ramadan, respectively. Mean IOP at 7 PM (after breaking the fast) decreased 0.5 and 0.6 mmHg in comparison to 5 PM (before the time of breaking the fast) in the 2nd and 4th weeks of Ramadan, respectively. Intraocular pressures changes due to fasting in healthy person are not considerable. Evaluating intraocular pressure changes in cases with glaucoma with enough sample size is recommended.

Abnormal head posture (AHP) is an important clinical sign which may be due to non-ocular or ocular causes. Because of disperse data in the literature, this review of articles was performed. Data base search with the keywords "abnormal head posture" was performed from 1975 to 2004. The main etiologies of AHP, case reports with specific causes, therapeutic interventions, and any significant points regarding AHP were gathered. An AHP should alert the examiner to search for various conditions and its proper interpretation is an important step in diagnosis and therapy. Ocular causes should be ruled out in any case of AHP. AHP due to ocular causes can be observed in conditions related to extraocular motility or may occur to increase quality of visual acuity or visual field. Comitant and incomitant deviations, supranuclear palsies, A and V patterns, nystagmus, and central nervous system disorders are causes of ocular torticolis. Facial asymmetry can be a feature of a long-standing congenital or acquired AHP.

To report a case of recurrent keratoconus after penetrating keratoplasty (PK).Patient and A 31-year-old male patient who had undergone PK in his right eye for keratoconus 10 years ago presented with gradually decreased vision in the right eye. Clinical, topographic, and histopathologic features of the cornea including irregular myopic astigmatism, central and paracentral corneal thinning, and foci of break and fragmentation in Bowman's layer were in keeping with the diagnosis of keratoconus. Slow recurrence of keratoconus characteristics in the corneal graft after PK may result from graft repopulation by recipient’s keratocytes, graft aging or both and may occur along with the process of cellular invasion from the recipient and renewal of resident cells.

To report a case of Duane's retraction syndrome with dry eye. Patient and An 18-year-old girl presented with chief complaint of limited abduction in her right eye. Best corrected visual acuity was OD: 8/10 and OS: 9/10. Ocular motility examination revealed severe abduction limitation (-4), mild adduction limitation (-1), and moderate upshoot and mild downshoot in the right eye on adduction. The patient stated absence of lacrimation during crying in the right eye. Schirmer and basic tear secretion tests revealed dry eye. The same teratogenic factor that induced Duane's syndrome could cause impaired lacrimal gland secretion and dry eye symptoms.

To report the first case of concomitant optic nerve transection and chorioretinitis SclopetariaPatient and A 12-year-old boy with history of BB gun injury to his right eye was referred for loss of vision 8 months after the accident. Visual acuity in the right eye was counting fingers at one meter with 3+ RAPD. On slit lamp examination, right eye seemed normal except 1+ anterior vitreous reaction. Fundus exam of right eye revealed a pale disc with superior retinal scar and diffuse submacular fibrosis compatible with chorioretinitis sclopetaria and advanced optic atrophy. Orbital CT-scan showed transection of the optic nerve by the BB gun pellet at the orbital apex. BB gun injury may cause concomitant optic nerve transection and chorioretinitis sclopetaria.

To report a case of spinal cord tumor with visual symptoms and papilledema due to increased intracranial pressure.Patient and A 24-year-old woman was referred because of recent blurred vision in both eyes. Visual acuity was 20/25 and 20/20 in the right and left eyes, respectively. Fundoscopy revealed bilateral papilledema. Other ophthalmic examinations were normal. Visual fields showed blind spot enlargement and brain CT scan revealed dilated ventricles. Ventriculoperitoneal shunt was inserted for the patient with a diagnosis of hydrocephalus. Ten weeks later, she returned with low back pain and lower extremity weakness. Lumbosacral MRI revealed a tumor in the region of L1-L4. The patient underwent surgical removal of the tumor and histopathologic study showed mixopapillary ependymoma. Increased intracranial pressure and papilledema without evidence of a space occupying intracranial lesion may be the presenting sign of spinal cord tumors.