فهرست مطالب homayoon nikkhah

A 35-year-old lady presented with a history of decreased vision in her right eye from one week before her referral. She did not report any significant systemic disease. Ocular findings were compatible with the diagnosis of central retinal vein occlusion. Systemic laboratory tests were all within normal limits except for Mantoux test (PPD) which was positive, 18 mm induration and 2+ redness. Chest radiography was negative for lung tuberculosis. Fluorescein angiography confirmed the presence of retinal vasculitis. With a probable diagnosis of papillophlebitis secondary to tuberculosis, the patient received a course of anti-tuberculosis medications. The inflammation subsided and vision improved within a 6-months therapy. This was a rare case of presumed ocular tuberculosis with no evidence of systemic infection presenting first as a papillophlebitis.

To evaluate the demographic and clinical features of childhood pars planitis, and to determine the therapeutic and visual outcomes of the disease. Medical records of pediatric patients (less than 16 years of age at diagnosis) with pars planitis and at least 6 months of follow-up who were referred to Labbafinejad Medical Center, Tehran, Iran over a 22 year period were reviewed. Overall, 117 eyes of 61 patients including 51 (83.6%) male subjects were included. Mean age at the time of diagnosis was 7.8±3.2 (range, 3-16) years. Mean best corrected visual acuity (BCVA) was 0.88±0.76 logMAR at presentation which improved to 0.39±0.51 logMAR at final visit (P < 0.001). Endotheliitis was present in 23 (19.6%) eyes and was significantly more prevalent in subjects younger than 9 years (P=0.025). Cataract formation (41.9%) and cystoid macular edema (19.7%) were the most prevalent complications. Univariate regression analysis showed that better baseline visual acuity (OR=0.38, 95%CI 0.21-0.70, P=0.002), age older than 5 years at disease onset (OR=0.36, 95%CI 0.14-0.9, P=0.029), absence of endotheliitis (OR=0.39, 95%CI 0.15-0.99, P=0.047) and female gender (OR=3.77, 95%CI 1.03-13.93, P=0.046) were significantly associated with final BCVA of 20/40 or better. Childhood pars planitis was much more common among male subjects. Endotheliitis may be a sign of inflammation spillover and is more prevalent in younger patients. Visual prognosis is favorable in most patients with appropriate treatment.

To compare the visual outcomes and complications of phacoemulsification surgery in patients with and without vitreous loss (VL). A historical cohort study was performed on patients attending Labbafinejad Hospital who had underwent phacoemulsification surgery and was complicated by VL from April 2006 to March 2007. A control group was selected randomly from patients with uncomplicated phacoemulsification surgery during the same period. Best corrected visual acuity (BCVA) and posterior segment complications of phacoemulsification surgery were compared between these two groups using SPSS 15. The VL group included 70 cases; among them, BCVA was 20/40 or better in 39 (56%) cases. Seventy nine patients entered the control group; of whom, BCVA was 20/40 or better in 62 (78%) cases (P<0.001). In the VL group, 4 patients developed cystoid macular edema (CME) and 6 patients developed clinically significant macular edema (CSME) while in the control group only 2 patients developed CME (P<0.05). Furthermore, 4 patients developed rhegmatogenous retinal detachment (RRD) in the VL group while there were no cases of RRD in the control group (P<0.05). Vitreous loss during phacoemulsification surgery reduced postoperative BCVA significantly. The rate of postoperative CME and RRD was also significantly higher with this condition.

To compare the outcomes and complications of mitomycin-C trabeculectomy (MMC-T) versus the Ahmed glaucoma implant (AGI) for treatment of pediatric aphakic glaucoma. In a randomized clinical trial, 30 eyes of 28 children < 16 years of age who had undergone anterior lensectomy-vitrectomy for congenital cataract were assigned to MMC-T (15 eyes of 13 children) or AGI (15 eyes of 15 children). Surgical success was classified as complete (IOP 6-21 mmHg without any antiglaucoma medication) and partial (IOP 6-21 mmHg with < 2 topical antiglaucoma agents) in the absence of any sight-threatening complication or need for further glaucoma surgery, stable cup/disc ratios and visual loss < 2 Snellen lines. Overall success was defined as the sum of complete and partial success. Mean patient age was 9.1±4.1 and 10.9±5.1 years in the MMC-T and AGI groups, respectively (P=0.29). After a mean follow up of 14.8±11 and 13.1±9.7 months; complete, partial and overall success rates were 33.3%, 40% and 73.3% in the MMC-T vs 20%, 66.7% and 86.7% in the AGI groups, respectively (P= 0.361). Complication and failure rates were 40% and 26.7% in the MMC-T group vs 26.7% and 13.3% in the AGI group, respectively (P= 0.439). MMC-T and AGI seem to be comparable in terms of success and complications as the initial surgical procedure in pediatric aphakic glaucoma. Choice of either technique depends on surgeon''s experience and conjunctival quality and mobility.