Journal of Current Ophthalmology
Volume:22 Issue: 1, Jun 2010

To determine the prevalence of ptosis and its correlation with vision-related variables in Tehran population Through a stratified cluster random sampling, 160 clusters were selected proportional to the population of each municipal district of the city. All consented participants were transferred to the clinic and underwent thorough eye examination. Here we report the prevalence of ptosis with 95% confidence intervals (CI), and its associations with age, gender, amblyopia, astigmatism and previous cataract surgery. The prevalence of ptosis in the studied population was 0.90% (95% CI: 0.58 to 1.21). The prevalence rates of bilateral and unilateral ptosis were 0.46% (95% CI: 0.23 to 0.69) and 0.44% (0.95% CI: 0.21 to 0.66), respectively. The prevalence of ptosis was higher in men (P=0.008) and showed a significant increase with age (P=0.023). The odds of amblyopia was 3.24 times higher among cases of ptosis than those free of the condition (P=0.048). The mean cylinder error in ptotic patients was significantly higher (P=0.006). The prevalence was more in those with previous history of eye surgery (P<0.001). In this study, we found that the prevalence of ptosis in Tehran’s population was low, and is more common in men than women. Age was associated with its prevalence. Also, in accordance with some other studies, amblyopia was shown to be the most serious visual disorder in these cases.

To determine the distribution of iris colors in the population of Tehran and to assess possible associations between iris color and Ocular disorder Through a stratified random cluster sampling approach, 160 clusters were selected in different municipality districts of Tehran, and the approached households were invited to a clinic. After the initial interview, all participants had complete eye examinations and their iris color was categorized as grey/blue, yellow/green, light brown, medium brown, and dark. Distributions were determined in percentages and possible correlations with race, refractive errors, visual impairment, cataracts, age-related macular degeneration (AMD). Intraocular pressure (IOP) was also examined. Out of 4230 participants aged 7 years or more, the iris color was determined in 4200 people; in 54.09% [95% confidence interval (CI) 51.74% to 56.44%] the iris color was medium brown as the most prevalent color, and in 1.96% (95% CI: 1.43% to 2.48%) the color was grey/blue as the least prevalent color. The inter-gender difference in iris color was not statistically significant (P=0.288). AMD showed the highest prevalence in light brown iris colors (P<0.001). Nuclear cataract and posterior subcapsular cataract (PSC) was significantly correlated with iris color, with higher risks of cataract among medium brown, light brown and yellow/green iris colors (P<0.001). The most prevalent iris color in the population of Tehran was medium brown. In light of the observed correlation between the iris color and certain conditions such as cataract and AMD with lighter eye colors, further studies are recommended to investigate the probable associations.

To evaluate the safety and efficacy of limbal relaxing incisions (LRIs) for corneal astigmatism correction during phacoemulsification 24 eyes of 24 patients with the mean age of 65.71 years (range: 55 to 83 years) with senile cataracts and mean corneal astigmatism of 1.9±0.83 diopters (D) (range: 1.5 to 3.5 D) were included in this study. All LRIs were performed during phacoemulsification by one surgeon. Topography indices were recorded preoperatively and postoperatively in months 2 and 6. A statistically significant reduction in the mean corneal astigmatism was seen from 1.9±0.83 D preoperatively to 1.4±0.84 D and 1.4±0.92, 2 months and 6 months postoperatively (P<0.001). Surgical induced astigmatism (SIA) (the amount and axis of astigmatism change induced by the surgery) was 0.90±0.48 at 2 months and 0.96±0.59 at 6 months. Correction index (CI) (calculated by determining the ratio SIA/ target induced astigmatism (TIA) was 0.55±0.41 and 0.57±0.32 at 2 and 6 months, respectively. Index of success (IOS) (ratio of topographic residual astigmatism and TIA) was measured 0.44±0.41 and 0.47±0.32 at months 2 and 6 correspondingly. Combined LRI and phacoemulsification appears to be safe and fairly effective to correct mild to moderate corneal astigmatism. However, under correction is a common limitation that may be further managed by modified nomograms in future studies.

To compare the 6-months anatomic and best corrected visual acuity (BCVA) responses after primary intravitreal bevacizumab (IVB; intravitreal AVASTIN) and IVB plus macular photocoagulation (MPC) in diabetics with clinically significant macular edema (CSME) In this interventional Randomized Clinical Trial (RCT) 40 diabetics (80 eyes) with bilateral CSME and non-proliferative diabetic retinopathy (NPDR) or early proliferative diabetic retinopathy (PDR) underwent IVB in one eye (group A) and IVB plus MPC in the other eye (group A+MPC). The patients had a complete eye exam (including BCVA, OCT and fluorescein angiography (F/A)) at baseline and were re-examined every two months for 6 months BCVA and OCT indices and number of IVB injections were recorded. Main outcome measures were number of IVB injections and changes in BCVA and OCT. In both groups, the mean BCVA [(group A: 0.326±0.279 logMAR±SD before treatment and 0.188±0.245 logMAR±SD at 6 months), (group A+ MPC 0.409±0.332 logMAR±SD baseline and 0.230±0.273 logMAR±SD at 6 months)] and OCT indices [(group A: 261±115 µ before treatment and 221±87 µ Mean±SD at 6 months), (group A+ MPC: 270±93 µ baseline and 225±80 µ Mean±SD at 6 months)] improved at the final follow-up and these changes were statistically significant; however there was no significant difference between the two groups at baseline and the final visit at 6 months follow-up. There was also no statistically significant difference in number of IVB injections between the two groups (group A: 2.3±1.24 and group A± MPC: 2.49±1.09). IVB injection is an effective modality of treatment in CSME, but MPC appears to have no additive effect on it, at least in the first 6 months of treatment.

To evaluate efficacy، complications، and patient satisfaction using local anesthesia (LA)، in comparison to with general anesthesia (GA) in external dacryocystorhinostomy (DCR) In this prospective study، 149 patients with complete nasolacrimal duct (NLD) obstruction who were candidates for external DCR were randomized in 2 groups: GA; 73 patients، and LA; 76 patients. Intraoperative bleeding، duration of surgery، postoperative complications and patient''s satisfaction were recorded. Mean intraoperative bleeding was 50. 5±42. 6 cc in the LA group and 62. 6±59. 9 cc in the GA group (P=0. 157). In terms of operation time، postoperative complications، and patient’s satisfaction no significant differences were noted between the 2 groups. Our success rate was 100% at the third month follow up visit. LA in DCR is safe، comfortable، and high level of patient acceptance. Intraoperative bleeding is less with LA than GA although it was not statistically significant in our study.

To evaluate the effectiveness of chemoreduction (CRD) for globe saving in patients with intraocular retinoblastoma In this interventional case series all patients with intraocular retinoblastoma were included and classified according to the international classification of retinoblastoma (ICRB) from group A to E. Six cycles of intravenous Vincristine, Etoposide and Carboplatin (VEC) were used for all groups, except for unilateral group A and E. After reduction of tumor volume adjuvant therapy was applied in all cases. Main outcome measure was CRD success, defined as globe salvage by avoidance of external beam radiotherapy or enucleation (EBRT). Forty-three eyes from 31 patients were enrolled, 12 patients had bilateral involvement. 5 eyes were in group A, 7 in group B, 6 in group C, 8 in group D and 15 in group E. Thirty-one eyes were treated with VEC protocol and aggressive focal consolidation. Successful response was observed in 24 patients, de-novo recurrences occurred in 6 eyes that treated with additional VEC and neoadjuvant therapy. Success rate was 100% for groups A, B and C and 55% for group D during 6-18 months (mean=11.4 months) follow-up. Overall 19 eyes were enucleated (group E=15 and group D=4). CRD is an effective treatment modality for globe salvage in patients with intraocular retinoblastoma with a high success rate in groups B and C, and an acceptable success in group D.

To investigate the application of mitomycin-C 0.02% (MMC) in the photorefractive keratectomy (PRK) procedure in correcting regressed myopia Eighteen eyes of 11 patients with a spherical equivalent (SE) of less than -5 diopters (D) who had undergone laser in situ keratomileusis (LASIK) more than 2 years before were operated on. At the end of the PRK procedure, MMC was applied on the ablated stroma for 1 minute using a surgical sponge and then irrigated with 30 ml of cold sterile balanced salt solution. Patients had follow-up visits everyday until complete reepithelialization and then at 1st and 2nd weeks, and at 2nd, 3rd, and 6th months postoperatively. The mean preoperative sphere and cylinder were -1.23 D and -1.29 D, respectively, which improved to -0.08 D and -0.30 D, six months after surgery. Mean uncorrected and best corrected visual acuity (UCVA and BCVA) before reoperation were 0.41 and 0.06 logMAR that postoperatively changed to 0.13 and 0.04 logMAR, respectively. At 6 months after surgery, there was no sign of haze formation in any eye. The safety and efficacy indices were 1.13 and 1.06 at this time, respectively. The application of MMC in PRK for the treatment of low to moderate regressed myopia after LASIK is a safe and effective option. The risk of postoperative haze formation can be reduced using this method.

To assess the results of intracorneal ring (ICR) segments for treatment of patients with pellucid marginal degeneration (PMD) In this prospective interventional case series study, eight eyes of 5 patients with PMD who were contact lens intolerant received one or two Intacs (Intacs, Addition Technology) segments. Preoperative and postoperative evaluations included slit-lamp examination, uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) and keratometry by Pentacam scheimpflug camera (oculas opticigerate GmbH). Patients were followed for 3 months and all parameters were reviewed at the end of follow-up time. Three months postoperatively, UCVA significantly improved from preoperative values after Intacs implantation (mean 1.07±0.27 [SD] and 0.5±0.27 respectively). The BCVA also improved from preoperative state compared to 3 months after surgery (Mean 0.40 ± 31 and 0.18 ± 0.17 respectively). The BCVA was 5/10 or more in all 8 eyes. Spherical equivalent (SE) and refractive cylinder decreased significantly compared to preoperative values (Mean -9.40 ± 4.98 to -6.53 ± 5.00 and mean -6.93 ± 3.79 to -3.06 ± 2.07 respectively). Topographic cylinder decreased postoperatively, but this decrement was not statistically significant (mean -5.42 ± 3.47 [SD] to -5.08 ± 3.20). In our series of patients, ICR implantation proved to be a safe and effective method for correction of PMD and improving the vision in these patients.

Primary localized amyloidosis of eyelid is a localized type of amyloidosis without evidence of systemic involvement, which is a quite rare clinical condition. Here we report a case of primary localized amyloidosis of eyelid. Case report : A 40-year-old woman presented with a four-month history of swelling of the left upper eyelid resulting in a mechanical ptosis. The mass had a firm bony consistency. Ocular examination revealed a firm mass in upper lid connected to the tarsus. She had no sign or history of ocular inflammation. Homogenous eosinophilic deposits with extensive foci of calcification and ossification were visible In pathologic assessment, which was consistent with amyloidosis. All evaluations were negative for systemic amyloidosis. Primary localized amyloidosis may appear as a calcified and ossified tumoral mass.

Granular cell tumors (GCT) are benign unusual neoplasms which have been proven to have a Schwann cell phenotype. They rarely occur in the eye region. Case reports : We report three cases of GCT in the ocular adnexa including palpebra, subconjuctiva and orbit which rarely occur. Patients are, a young girl with the lesion in orbit and presentation of proptosis, a middle aged man with the lesion in nasal limbus and erythema presentation and as well as an old age woman with the lesion in eyelid and protrusion. Morphologic examination of above cases show similar histology composed of polygonal cells which contained PAS positive eosinophilic granules. The S-100 protein and CD68 tests were positive in immunohistochemical stainngs. GCT occurs in different sites and ages, so they should be considered in the differential diagnosis of eye tumors in children and adults.

Fine needle aspiration (FNA) cytologic findings of Langerhans cell histiocytosis (LCH) have been well described, but using this method in the diagnosis of orbital lesions is a recent experience. We hereby report two cases of orbital bone LCH diagnosed by FNA that later was confirmed by routine H&E histopathology and immunohistochemistry (IHC) methods. Case reports: The first case was a one-year-old boy with a left upper lid mass. Radiologic findings were suspicious for malignancy. The other case was a three-year-old boy with right lower lid edema. Radiographic study revealed a mass with peripheral condensation and orbital bone defect. FNA of lesions in both patients showed a mixed cell population of eosinophils, neutrophils and lymphocytes admixed with neoplastic histiocytes with folded nuclei. Consequently, the cytological diagnosis was “Langerhans cell histiocytosis” that was confirmed by the routine histopathologic examination. In both cases staining for CD1a by IHC method was also performed that showed positive reaction. LCH should be considered in differential diagnosis of primary orbital bone lesions specially in childhood. FNA method may be useful in the diagnosis of orbital lesions suspicious for LCH.