Journal of Current Ophthalmology
Volume:19 Issue: 3, Sep 2007

To introduce the importance and world prevalence of ocular leishmaniasis (OL), its clinical manifestations, and diagnostic and management features with more emphasis on Iranian cases.

We reviewed all available articles published about OL during recent 50 years.

OL is an ocular protozoal infection which is widespread in the world but is more common in developing countries. All forms of leishmaniasis (cutaneous, mucocutaneous, and visceral) can involve the eye, but ocular lesions are usually seen in cutaneous form. Clinical manifestations of OL include: lid skin ulcer, conjunctivitis, episcleritis, cataract, glaucoma, keratitis, uveitis, and finally eye destruction. Clinical diagnosis of this disease is difficult and any delay in diagnosis and management can cause irreversible damage to the eye and adnexae. From 1950 to 2005 there were limited reports of OL in the literature from: USA, Brazil, Germany, Spain, Turkey, India, Sudan, and Iran. In Iran, four cases were reported, two of whom ended in blindness, because the treatment procedures were not effective. Treatment with combined stibogluconate and allupurinol in early stages of the disease usually leads to complete healing of the lesions and disappearing of parasites from the ocular samples

Although OL is a relatively rare disease in the world, it is potentially dangerous and affected patients must be followed up closely, especially immunodeficient ones. Early diagnosis of OL and rigorous treatment may prevent blindness. Pentavalent antimonial compounds (combined stibogluconate with allopurinol) can be effective in treatment.

To evaluate the effect of phacoemulsification and posterior chamber intraocular lens (PCIOL) implantation on intraocular pressure (IOP) in eyes with chronic angle-closure glaucoma.

Twenty-two patients with chronic angle-closure glaucoma (CACG) and visually significant cataract were included in our study. All were underwent phacoemulsification and PCIOL implantation. IOP, depth of angle, visual acuity, and the number of antiglaucoma medications were recorded preoperatively and one day, one week, one month, two months, and six months postoperatively.

The mean age was 71.04±6.55 years and there were 8 males (36.4%) and 14 females (63.6%). The mean IOP was 19.54±1.49 mm Hg preoperatively and 16.04±1.49 mm Hg six months postoperatively. The mean number of antiglaucoma medications was 2 preoperatively and 0.18±0.50 at final follow-up. The mean preoperative LogMAR visual acuity was 1.00 and 0.3 at final follow-up (P <0.005).

When chronic angle-closure glaucoma is associated with visually significant cataract, phacoemulsification and PCIOL implantation alone can significantly reduce intraocular pressure.

To investigate etiological factors of endophthalmitis in Farabi Eye Hospital.

In a retrospective study, the clinical records of 223 patients admitted to the hospital with final diagnosis of endophthalmitis between March 2002 and March 2004 were reviewed. Analyzed factors included: age, sex, clinical presentation, clinical course, microbiological data, treatment modality, visual outcome, and surgical complications.

Two hundred twenty three patients with final diagnosis of endophthalmitis were evaluated. One hundred and fifty patients (67%) were male and 73 (33%) were female. 50.2% of the patients were older than 40 years, 14.3% fall in the range of 17-40 years and 30.5% in the range of 2-16 years, and 4.9% were younger than 2 years of age. 57% of endophthalmitis cases were postoperative, 40.5% were posttraumatic, and 2.5% were endogenous. Overall 15.9% of the cases had positive culture. Wound leakage was noted in 39% and vitreous loss in 22% of postoperative patients. During 3.5–6.5 months (mean 4.5 months) visual acuity was 20/400 or better in 69.5% of posttraumatic cases and in 44.5% of postoperative patients. Finally 92.8% of patients required at least one vitrectomy procedure as a part of their management. Evisceration or enucleation was performed in 8.1% as a primary operation or in the course of their treatment.

The incidence of postoperative endophthalmitis in this study is similar to other studies. Posttraumatic endophthalmitis incidence is less than the mean incidence of other reports. The rate of positive culture was also less than other studies.

To evaluate the prevalence and severity of ophthalmic manifestations of Graves’ disease in the Mashhad University of Medical Sciences endocrine clinics.

In a multicenter prospective-descriptive study, patients with Graves'' disease that were being followed in Mashhad University of Medical Sciences endocrine clinics were recruited for the study, from December 2002 to September 2005. A comprehensive ophthalmic assessment including visual acuity, external eye examination, ocular motility examination, exophthalmometry, tear status evaluation, intraocular pressure (IOP) measurement, slit lamp examination, and funduscopy were performed. We also evaluated the recent thyroid disease status and the treatment regimen of all patients. The classification of ophthalmopathy was based on the classification by the American Thyroid Association.

Sixty-eight patients (24 men and 44 women) were studied. The mean age of the patients was 37.98±14 (range 15 to 71) years. The mean duration of systemic thyroid disease was 2.46±2.36 years (range 6 months to 11 years). The majority of patients had hyperthyroidism at the time of visit (86.2%) and only 3% of the patients were hypothyroid. The most common complaints of patients were foreign body sensation (54%) and puffy eyelids (48.4%). Mean Snellen visual acuity was 0.9±0.17. The most prevalent sign was increased IOP in upgaze (88.2%). Increased IOP in upgaze had a statistically significant association with limitation of extraocular movements (4.57 mm Hg vs. 2.56 mm Hg in the presence and absence of gaze limitation, respectively; P=0.03). The most common clinically evident abnormality was lid retraction, which was noticed in 64.2% of patients. Lid retraction was bilateral in 95.3% of the cases. Exophthalmos was present in 53%. Injection over the insertion of horizontal recti was noticed in 48.5% and ocular motility limitation in 19.1%. Tear breakup time was abnormal (less than 10 seconds) in 55.9% of the patients; with a mean of 17.76±6.18 mm (range 4-30 mm); the Schirmer’s test was abnormal in 10.3% of patients too. The patients had a mean modified Werner’s NOSPECS classification score of 3 with an SD of 1.46. The score was significantly affected by sex, and was higher in males (3.58 vs. 2.63 in females; P<0.01). The score was positively correlated with the age of the patients (r=0.298, P=0.016).

Our study of a relatively large number of patients replicated the known epidemiological facts regarding Graves ’ ophthalmopathy in Mashhad with slight epidemiologic variations.

To compare the effect of tissue plasminogen activator (TPA) and aspirin in patients with central retinal vein occlusion.

A prospective interventional study was conducted on patients with central retinal vein occlusion of less than 28 days'' duration. Patients in the TPA group received 100 μg intravitreal tissue plasminogen activator and the patients who declined intravitreal injection were considered as Aspirin group. Patients were followed up for 6 months.

sixty five patients were enrolled, 19 in the TPA group and 46 in the Aspirin group. The mean 6-month change in visual acuity for TPA-treated patients was -0.29±0.42 (range: -1.4 to +0.5) while in the Aspirin group, it was 0.28±0.79 with a range of -1 to +2.5. TPA group had a significantly better visual improvement in comparison to Aspirin group (P< 0.0005).

Intravitreal tissue plasminogen activator can be injected safely and easily. Patients treated with intravitreal tissue plasminogen activator within 28 days of the onset of central retinal vein occlusion are more likely to improve visual acuity.

To investigate aqueous humor nitric oxide (NO) levels in patients with branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO) and to compare these with age-matched controls.

Eight consecutive patients with BRVO and 16 patients with CRVO were included in this study. Aqueous humor specimens were obtained within 21 days of diagnosis. Samples of aqueous humor were also collected from 20 control patients undergoing cataract surgery. For each sample after reduction of nitrate to nitrite with vanadium chloride (VCL3), we used spectrophotometric method for simultaneous detection of nitrate and nitrite.

Mean level of aqueous humor nitrite and nitrate were 84.08±21.29 μmol/l in BRVO group, 65.40±22.23 μmol/l in CRVO group, and 55.68±11.02 μmol/l in control group. The difference between aqueous humor nitrite and nitrate levels of BRVO group and that of control group was statistically significant (P<0.0001) but not for the difference between those of CRVO and control groups (P=0.10).

The results may support involvement of nitric oxide in the pathogenesis of BRVO.

To evaluate the effect of botulinum toxin-A as an alternate to surgery in acute complete sixth nerve palsy and to shorten the recovery period.

Thirty patients with acute complete sixth nerve palsy received 1-10 units of botulinum toxin-A (Dysport) injection in the medial rectus muscle within one month from the onset of palsy. Toxin was injected directly into the muscle belly under local (25 cases) or general (5 cases) anesthesia. At the 1st, 7th, 30th, 90th, and 180th day followup, binocular field of vision, abduction and any residual deviation were measured.

Patients aged between 9mo to 70yrs. 24 (80%) patients had significant improvement in abduction after 3 months and 6 (20%) had <10° abduction. Among treatment failures, 2 were traumatic and 2 were tumoral. Binocular diplopia free field was >75° in 22 (73%). 22 (73%) had no residual esotropia and other 8 patients (27%) had 10-50° residual esotropia which required surgery. No cases of exotropia or globe perforation were encountered.

Injection of botulinum toxin-A is a simple and safe way of treating acute complete sixth nerve palsy eliminating the need for invasive surgical manipulation in majority of cases. It can eliminate diplopia during acute stage of palsy in the cases of spontaneous recovery.

To evaluate the effect of preoperative eyelash trimming on periocular bacterial flora.

One hundred patients divided into two groups. Fifty cases (group 1) had eyelash trimming prior to phacoemulsification and other fifty patients (group 2) did not. None of the study participants had been diagnosed as having an active ocular infection prior to surgery. Patients taking topical and systemic medications were excluded from the study. Eyelid and inferior conjunctiva cultures were obtained during the preoperative visit. Phacoemulsification was done through a temporal clear corneal incision. At the end of operation, cultures were retaken.

The culture results showed that Staphylococcus epidermis was the most commonly isolated bacterial species from eyelids and fornix prior and following the operation. There were no statistically significant differences for eyelid cultures testing positive for any of isolated organisms between eyelash trimmed and not trimmed before and after surgery. There were also no statistical differences in the proportion of conjunctiva cultures testing positive for any of isolated organisms in before-after surgery as well as cultures of anterior chamber specimen.

In this study, it is shown that eyelash trimming - as a common preoperative technique for endophthalmitis prophylaxis in patients undergoing cataract surgery – may not be effective.

To report an Iranian patient with diagnosis of Oguchi disease associated with diabetic retinopathy.

A 50-year-old diabetic woman with night blindness was referred to our clinic. Complete ophthalmic examination including ophthalmoscopy after dark adaptation and paraclinic evaluations such as fluorescein angiography and electroretinography were performed.

In the both eyes, retinal neovascuarizaion and preretinal hemorrhages compatible with high-risk characteristic proliferative diabetic retinopathy were observed. In addition, a golden yellowish discoloration of posterior pole was noted in her both eyes. The diagnosis of Oguchi disease was made when this discoloration disappeared after dark adaptation for 3 hours. Electroretinograms also confirmed the diagnosis by showing a slow negative wave followed by a slow positive wave in the photopic condition and absent a- and b-waves in the scotopic state.

Proliferative diabetic retinopathy may occur in a patient with Oguchi disease. This report represents this association in an Iranian patient for the first time.

To report an unusual case of orbitocranial meningioma presenting in a neonate.

Case report

A 1-day-old neonate was presented with severe proptosis of the left eye. CT scan and MRI showed an extensive mass with involvement of left orbit and brain. Discrete calcification could be seen on CT scan. The patient did not have any signs of neurofibromatosis and family history was negative. Histopathologic evaluation of orbital biopsy was compatible with meningioma.

This is an unusual presentation of meningioma in a neonate and to our knowledge this is the second report of such a case in the literature.

Congenital corneal leukoma is rare with an incidence of 6/100000 and is one of the most important causes of amblyopia. Here we report an unusual case of bilateral congenital elevated corneal leukoma.

We encountered a 13-day-old full term male newborn. Ocular examination of both eyes revealed central elevated corneal leukomas with a narrow normal lucid interval to limbus. Corneal diameter of both eyes was 10.5 mm.

After performing penetrating keratoplasty, histological examination reported that corneal thickness was about 2 mm and had central circular defect in Descemet’s membrane, endothelium, and some part of Bowman’s layer compatible with Peters’ anomaly.

Peters’ anomaly should be considered in the differential diagnosis of bilateral congenital bulged corneal leukoma with severe edema.