جمال فلاحتی

Nasolacrimal duct obstruction as a common problem causes bothersome social and physical symptoms such as euphoria، acute and chronic dacryocystitis attacks، pain، pruritus and erythm of eye. Although، there is no consensus about available therapeutic methods. So the aim of this study is to investigate and compare the effect and complications of endoscopic dacryocystorhinstomy and patients'' preferences in two common surgical methods for settling nasolacrimal duct obstruction. In this clinical trial study، 220 patients with nasolacrimal duct obstruction were randomly divided into two groups and underwent external and endoscopic dacryocystorhinostomy surgery. Finally، patients were compared with a view to echymosis and tearing after operation and the time of surgery and bleeding during operation. The patients data were analysed by Chi-square test and using SPSS 16 software. Our results show significant difference between two groups in post-operative echymosis، post-operative bleeding and the time of surgery (p=0. 000). There was no significant difference in post-operative tearing between two groups (p=0. 418). According to the results of our study، the use of endoscopic dacryocystorhinostomy is remarkably better than external dacryocystorhinostomy Therefore، with regard to the most of patients'' tendency to endoscopic surgery، surgeons should achieve more experience in this method.

Glaucoma is the second most common cause of blindness and it is one of the main causes of irreversible blindness. Multi-drug regimens usually recommended in reducing intraocular pressure (IOP) in patients with glaucoma. This study was aimed to compare the effect of combination therapy with Timolol and Latanoprost vs. Timolol and Dorzolamide in reducing IOP in patients with open-angle glaucoma. In this blind randomized clinical trial study, 60 eyes with glaucoma were randomly assigned to two treatment groups including Timolol and Latanoprost vs. Timolol and Dorzolamide. Required variables were measured before and 6 weeks after the intervention. The data was analyzed by running the Stata software (version 12) at a significance level of 0.05. The mean age in groups of Timolol-Latanoprost and Timolol and Dorzolamide was 72.6 and 67.6 years old, respectively. Analysis of the data revealed that there was no significant difference between groups in terms of intraocular pressure (IOP), visual acuity and cup to disc ratio. According to our findings, there were no statistical significant differences in the IOP lowering effect between both treatments in open angle glaucoma patients.

According to the toxoplasmic retinochoroiditis leading to loss of central vision، corneal opacity، tearing، photophobia، and is، therefore early treatment is very important. This study aimed to evaluate the efficacy of intravitreal injection of toxoplasmic retinochoroditis clindamycin in comparison with conventional therapy (oral drug) was performed. In this clinical trial، target population was all patients with the toxoplasmic retinochoroiditis referred to clinics in ophthalmology Arak city، that stratified randomly into two groups، interventional group “A” was received treatment with intravitreal injection clindamaycin «and control group “B” was received standard oral treatment (Pyrimethamine and sulfadiazine and clindamaycin). Tool for data gathering was questionnaires and medical records of patients in which visual acuity based on the Senllene Chart and retinal thickness with use tomography layers of the retina (OCT). Results of measurement were recorded by specialist retina before and after intervention (weekly and monthly until complete resolution of lesions in retina) during one year. The data entered into the SPSS 16 software and after matching age &sex of patients، was final analysis the using descriptive and inferential tests such as t-test was performed. Of the 26 patients with toxoplasmic retinochoroditis، 16 (61/5%)، urban and number 10 (38/5%) were rural. The average improvement in visual acuity between the two groups in mean time to lesion healing (A) and (B) was different. The visual acuity in before and after treatment (separation of treatment) was significant difference in both groups (P<0/05). Also central macular thickness (in patients with toxoplasmic retinochoroditis) between before and after treatment in each group was different (P= 0/001)، but the changes mean central macular thickness (in cases of toxoplasmic retinochoroditis) There was no significant difference between treatments (P= 0/452). Although any two methods of treatment are effective، but intravitreal injection clindamaycin method due to shorter lesion healing time and increase higher visual acuity، is better than the alternative similar way.

Endophthalmitis is the most important complication after cataract surgery which its incidence can lead to severe loss of vision or even loss of vision; therefore, methods of prevention are very important. This study investigated the influence of vancomycin consumption during cataract surgery on prevention of endophthalmitis.

In this experimental study, the study population included patients of cataract surgery that were admitted to Amir Kabir Hospital. The patients were randomly assigned to two groups: with and without receiveing vancomycin in serum. Demographic characteristics of the patients before surgery and incidence of endophthalmitis with the examination until two weeks after surgery were recorded. To compare the frequency (incidence) of infection, endophthalmitis in two groups, Fisher's exact test and X2 test were used.

Of the 1281 patients, 539 were administered vancomycin in serum. The examination after two weeks indicated that 3 (0.23%) patients developed endophthalmitis. Of these, 2 (0.16%) patients belonged to the group without vancomycin and 1(0.07%) patient belonged to the group receiving vancomycin. Fisher's exact test did not show any significant differences between the groups receiving vancomycin and the control group in the prevalence of endophthalmitis.

Although the relative frequency of endophthalmitis in patients without receiving vancomycin was further than control group, the difference was not statistically significant. Thus, adding a drop of vancomycine was not effective in prevention of endophthalmitis and the causes should be sought in other cases.

Diabetes is the sixth main cause of mortality in the world, and its both types are accompanied with eye complications in a way that the risk of blindness in diabetic patients is 25 times more than normal people. Hence, this study was conducted to determine diabetic patients’ awareness of the eye complications associated with this disease. In a cross-sectional study, 200 diabetic patients referring to the eye clinic of Amir Kabir Hospital of Arak in 2008 were evaluated. Data collection was done through questionnaire and referral interviews. Then some of the factors affecting patients’ awareness of eye complications associated with diabetes were analyzed. The level of awareness of eye complications associated with diabetes in 40% of the patients was average. Also, significant relationships were observed between the level of awareness and age, job, education, type of retinopathy, type of treatment, and the history of referring to ophthalmologist (p<0.001), whereas no significant relationships were observed between the level of awareness and gender, familial history of diabetes, and controlling the diet (p>0.05). This study showed that a higher level of awareness in diabetic patients does not necessitate that they observe a proper diet, but it can lead to patients’ greater care in preventing the development of diabetes

Two of the most common complaints of patients who refer red to ophthalmology clinic are headache and asthenopia which are induced or intensified by exodeviation. This study was conducted to determine the relationship between exodeviation and headache or asthenopia. In this cross-sectional study, the sampling method, was screening of patients who referred to ophthalmology clinic with headache and asthenopia in 2006. Inclusion criteria were age above three, rejection of other causes of headache and asthenopia. Also, patients with organic headaches such as tumor were eliminated from the study. A questionnaire was provided for the patients and Cover-uncover test was also conducted for determining the existence of exotropia. Of 206 patients, participating in this study, 90.77% had exotropia and the majority of them were female. The most common symptom in these patients was headache. A direct relationship was observed between both headache and asthenopia with exodeviation. Exodeviation also had a direct relationship with gender. Noticing the direct relationship between headache and asthenopia with exodeviation in patients referring with such complaints, exodeviation examinations must be done in order to prescribe surgical or non surgical treatments asneeded.

Myopia is the most common refractive defect and degenerative myopia is one of the five causes of blindness in the world. The aim of this study is to examine degenerative myopia and its related risk factors. In this cross-sectional study, the data was collected through a questionnaire along with the auto-refraction apparatus, which was utilized for determining the myopic degree. The inclusion criteria for this study were the age above the 10, myopia or astigmatic myopia, apparent media (in fonduscopic examination), and the absence of age related retinal defect. A total 65 patients participated in this study 51% of whom had degenerative myopia. Choroid neovascularization was observed in 17.65% of the subjects. There was a significant difference in the relationship between hypertension(r=28%), diabetes mellitus (r =22%) and glaucoma, and degenerative myopia; however, this difference was not observed between cataract and myopia. The correlation coefficients between hypertension and diabetes mellitus, and degenerative myopia were 28% and 22%, respectively. This correlation was very low in the case of glaucoma. The greatest correlation existed between the myopic crescent and hypertension (r=0.295%). In all of the cases, the correlation coefficient between diabetes mellitus and all the myopic complications was positive but below 40%. The majority of the patients had degenerative myopia. Hypertension and diabetes mellitus were the most common co-existing diseases. Noticing the correlation coefficient existing between hypertension and myopia, the need for controlling hypertension and diabetes mellitus for preventing retinal complications is emphasized. Also, for preventing the adverse effects of degenerative myopia in retinal defects, controlling glaucoma is suggested.

Cataract is a type of tarnish observable opacity in different layers constituting the lens and will cause light occlusion or scattering. Necessity for treatment of Cataract via surgery and its close relation with corneal astigmatism, when we applied a new method in cutting and type of cataract surgery, led us to measure the post-operation corneal astigmatism changes in frown incision Phacosection. This interventional study has been done on 73 eyes(58 patients). These patients were gone under Cataract surgery via no stitch frown incision scleral tunnel phacosection method. In this study we have 7mm external scleral incision with no suture. They were Keratometerized in four separate periods including pre-operation, one week, one month and three months post- operation. Data was analyzed using independent and paired t-tests. Age, sex and left or right eye had no influence on astigmatism. Mean pre- operation astigmatism was 0.84 ± 0.87D, mean astigmatism 1 week post- operation was 0.27 ± 0.88 D, 1 month post- operation 0.06 ± 0.82 D, and three months post-operation was -0.03 ± 0.85 D (P= 0.0001). Before operation, 80% of the patients did have an astigmatism rate less than 1D that increased to 94.5% in three months period after operation and in 89% of the cases, the ultimate change in astigmatism has been found lower than 1D. The obtained information revealed that there is a meaningful difference between pre-operation astigmatism and the same after one week, one month and three months post-operation(P= 0.0001). Independent sample t and paired t-test were used to analyse data. Our study indicated that the no stitch frown incision scleral tunnel phacosection surgery can reduce pre-op corneal astigmatism, and because of induction of the slight controlled astigmatism we can apply this technique for all cataractic patients

Cataract is one of the most important and a major disease in human. The prevalence of cataract in age 65-74 get to 50%, and over 75 it arrives to 70%. Absolute cure for cataract is surgery that can be done by different techniques such as intracapsular, extracapsular, and phacoemulsification. Cataract surgery has different side effects such as hemorrhage, Glaucoma, posterior capsular opacification and astigmatism. This study decides to compare astigmatism after two techniques of cataract surgery phaco and extracapsular. This study is a double blind randomized clinical trial, which has been experienced on 112 patients. Patients were divided in two groups (A and B). In group A surgery was done by phaco technique which has a small incision of 3.2 mm and does not need suture. But in group B, (extracapsular group) the incision is bigger about 10 mm and needs suture. Then keratometry was done for each patient before surgery, one week and 2 months after surgery for determining astigmatism. Data was analyzed by independent and paired sample T tests. p< 0.05 was considered meaningful. From 112 patients that had been studied, 56 patients underwent phaco technique and 56 patients underwent extracapsular technique. Mean of astigmatism before surgery in group phaco was 0.79±0.71 D and in extracapsular was 0.90.55 D (p>0.05). Mean of astigmatism 1 week after surgery in phaco group was 1.110.72 D and in extracapsular group was 3.991.46 D (p<0.05) and mean of astigmatism two months after surgery in phaco group was 1.00.71 D and in extracapsular group was 3.281.29 D (p<0.05). Induced astigmatism in phaco group was 0.21 D and in extracapsular was 2.38 D, that has meningful difference. Other criteria such as age, lens number, sex and left or right eye do not have any effect on induced astigmatism.

Cataract is one of the important diseases in childhood that can be classified in two main groups: Congenital & Acquired. There hasn’t been any exact idea about the prevalence of this disease in childhood yet. On the other hand it has been very important to diagnose the disease before the age 6 years old. So that preventing from the adverse effects. We tried to perform our plan in the students of the primary schools in the city of Arak. The study was descriptive observational and cross-sectional. Total numbers of the students of the primary schools in Arak were 58557. We selected 7668 students (3972 boys & 3696 girls). 10 students (7 boys & 3 girls) had cataract. As a result the total prevalence of the cataract among the students of the primary schools in the city of Arak in spring (1376) was 0.13%.