مجله چشم پزشکی بینا
سال بیست و دوم شماره 2 (زمستان 1395)

To determine the prevalence of different types of strabismus among patients presenting to Farabi hospital strabismus clinic from 2008 to 2014.
This retrospective cross-sectional study was conducted using the records of patients with strabismus. The data compiled included the type of strabismus, associated abnormalities, the type of amblyopia, and other ocular pathologic findings.
In this study, 1,174 strabismic patients were enrolled. Overall, 63.03% of all patients had esodeviation and exodeviation was encountered in 24.53% of patients. Accommodative esotropia was the most prevalent type of strabismus accounting for 25.04% of all strabismic patients. This type of strabismus was followed by intermittent exotropia, non-accommodative esotropia, and partially accommodative esotropia which were encountered in 12.09%, 11.24% and 10.39% of patients, respectively. Two hundred and thirty-six patients (20.1%) had other ocular pathologic findings in addition to strabismus which were inferior oblique overaction in the majority of cases (11.07%), followed by nystagmus (88 patients). Of the patients, 45% had no amblyopia, whereas 37% had combined type of amblyopia which was the most common type of amblyopia observed in this study.
Esotropia was two and half times more prevalent than exotropia and almost half of the strabismic patients suffered from amblyopia. The results of this study suggest that strabismus screening of children could be useful in the early detection and hence appropriate management of strabismus.

To compare the accommodation facility response changes between three-dimensional and two-dimensional television viewers watching a similar visual stimulus for 90 minutes.
The study enrolled 66 students, aged between 18 and 25 years. The participants were randomly divided into one of the two groups; 3D viewers and 2D viewers. In each group, 3D or 2D movies was shown on 42” display for 90 minutes. Monocular and binocular accommodation facility, visual acuity and fixation disparity were measured before and after the movies and changes in the accommodation facility response were compared between the two groups. Statistical analyzes were performed using the SPSS statistical software, version 18.0.
The mean participant age was 20.70±1.20 and 21.20±1.20 in the 3D and 2D groups, respectively. In the 3D group, the mean accommodation facility for right eye, left eye and both eyes was 12.15 ± 1.73, 12.42 ± 2.03 and 10.75 ± 1.90, respectively, before intervention, and 11.33 ± 1.77, 11.51 ± 2.07 and 9.96 ± 2.06, respectively, after intervention. The mean fixation disparity was 0 ± 0 before and after intervention. The mean visual acuity was 10/10 before and after intervention. There was a statistically significant change (p Watching 3D televitions can decrease the facility of accommodation immediately after watching the movies but, it is not clinically considerable.

To investigate­ the possible association of polymorphisms of rs4151667(L9H) B gene with age-related macular degeneration (AMD) in a population from the North West of Iran.
In this study, 56 patients with AMD and 144 age-, sex-, and ethnic-matched controls were recruited. Both patients and controls were selected from the North West of Iran. The association of polymorphisms of rs4151667(L9H) CFB gene with AMD was investigated using polymerase chain reaction (PCR) and digested fragment length polymorphism technique (RFLP).
­ A significant association was found between the polymorphism of rs4151667(L9H) CFB gene and AMD disease. (P=0.01 for TT genotype and P=0.02 for AT genotype)
­ The TT genotype increases the likelihood of AMD by 2.6 times as compared to genotypes other than TT, whereas the AT genotype has a protective effect against the disease.

To investigate the histomorphpmetrical changes in the rabbit retina exposed to continuous versus intermittent ultraviolet irradiation.
In this experimental study, 15 New Zealand white male rabbits were divided into one of the three groups: control group (N=5), the experimental group that was exposed to continuous ultraviolet irradiation with 253.7 nm intensity for 4 weeks (N=5), and the experimental group that was exposed to intermittent ultraviolet irradiation with 253.7 nm intensity for 6hr/6hr, dark/irradiation cycles for 4 weeks (N=5).
There was a decrease in the mean thickness of the different part of the photoreceptor layer under the effect of intermittent and continuous ultraviolet irradiation. The mean thickness of the outer segment layer, inner segment layer, outer nuclear layer, and outer plexiform layer was 13.27±4.27, 10.41±3.7, 33.59±8.19,7.19±1.02 micrometers, respectively, in the continuous ultraviolet irradiation group, 12.5±0.98, 9.38±0.92, 32.99±2.43, 7.38±0.86 micrometers, respectively, in the intermittent ultraviolet irradiation group, and 19.5±3.04, 14.92±2.4, 42.78±4.67, 7.48±0.96 micrometers, respectively, in the control group. The histological study revealed vacuoles in the inner and outer plexiform layers in the experimental groups. Additional findings were condensed and dark nuclei observed in the continuous ultraviolet irradiation group and pyknotic and karyolitic nuclei observed in the intermittent ultraviolet irradiation group.
Intermittent ultraviolet irradiation can cause more damage the photoreceptor layer compared with continuous ultraviolet irradiation.

To develop clinical practice guidelines (CPGs) for preventing, diagnosing, treating and follow-up of acute and delayed-onset ocular injuries due to mustard gas.

The related clinical questions were developed by the guideline technical committee for each categories, prevention, diagnosis and treatment. Related websites and databases such as National Institute for Clinical Excellence, PubMed, Cochrane, and National Guidelines Clearinghouse were searched to find the available CPGs and answer the clinical questions consequently. No relevant CPGs were published in the literature, therefore related articles in English and Persian languages were extracted, critically appraised and summarized. The recommendations were developed and revised based on their clinical benefits, costs and customization criteria. These recommendations with their evidence were sent to the experts in this area in Iran and request them to score the recommendations from 1 to 9. The agreement on each recommendation was determined through assessing the given scores.

All experts were agreed on the recommendations. Eventually, 98 recommendations were developed under three four categories including prevention of injury, diagnosis and management of the acute and late‑onset mustard gas ocular injuries.

The recommendations of these CPGs would be useful to prevent the ocular complications of mustard gas and standardize and promote the eye care services for the affected persons.

To compare the surgical outcomes and recurrence rate after pterygium removal surgery using free conjunctival autograft (CAT) versus amniotic membrane transplantation (AMT).
In this prospective study, 60 patients with primary pterygium were randomly assigned to the CAT group or AMT group and were compared in terms of recurrence rate, mean healing time of epithelial defects, mean level of inflammation in the site of surgery, and complications.
The mean patient age was 48.98±9.8 years (range: 27-71 years). Of patients, 73.3% were men and 26.7% were women. The groups did not differ with respect to demographic characteristics (P>0.05). Patients were followed for an average of 12.6±1.3 months. The recurrence rates were 6.7% and 3.3% in the AMT and CAT groups, respectively (P>0.05). Mean inflammation score was higher in the AMT group in the first, third, and sixth postoperative months (P No significant complications were observed during or after both surgical methods. No statistically significant difference was seen in recurrence rate and epithelial healing time between the CAT and AMT groups. Therefore, both procedures can be considered appropriate choices for pterygium removal surgery.

To compare the effect of adiponectin versus bevacizumab on reducing corneal neovascularization
This study was performed on 40 eyes of 20 New Zealand Albino male rabbits. Corneal neovascularization was induced by a 7-0 silk suture 2mm long and 1 mm away from the limbus. Rabbits were randomly divided into two groups of ten. In the first group, adiponectin eye drop and artificial tears were administered in the right and left eyes, respectively. In the second group, adiponectin eye drop was applied in the right eye and bevacizumab eye drop was used in the left eye for 14 days. The rabbits were examined regularly. Imaging was performed at each visit. The area of corneal vascularization and the length of vessels were measured and compared.
At the end of 14 days, the average length of vessels in the rabbits treated with adiponectin decreased from 2.12 ± 0.32 mm to 0.89 ± 0.46 mm, (57.68 ± 19.98% decrease ;1.24 ± 0.51mm) (P The results of this study suggest that adiponectin can potentially decrease youn corneal neovascularization. Its effect seems to be at least comparable to bevacizumab.

Human scleral tissue has been widely used in the management of various ophthalmic disorders. Some applications include the coverage of post-enucleation orbital implants, scleral grafts in cases with scleral melting, filtering bleb reconstructions, and coating filtering drainage devices. In this study, we performed a systematic review on the use of donated scleral tissue in ophthalmology and, for the first time, reported the results of the procured and distributed donated scleral tissues over the last 6 years in the Central Eye Bank of Iran.

To report an acute endophthalmitis that developed after keratoprosthesis implantation in a patient with Stevens-Johnson syndrome.
Case Report: A 61 year-old man had corneal keratinization and dry eye due to Stevens-Johnson disease. Visual acuity was light perception in both eyes. Since keratoplasty was not applicable, Pintucci type keratoprosthesis was considered for his right eye. The patient underwent a two-stage operation including surface reconstruction with mucous membrane graft and keratoprosthesis implantation. One day postoperatively, visual acuity was hand motion and the mucous membrane graft was inflammatous and sings of necrotic tissue were seen around the optical cylinder of the keratoprosthesis. Ten days postoperatively, the visual acuity was reduced to no light perception and the eye had discharge, pain and acute inflammation and the necrotic tissue was developed around the optical cylinder of keratoprosthesis. Based on the clinical findings and vitreous involvements documented by B-scan, the diagnosis of acute endophthalmitis was made and the right eye was eviscerated.
Regarding to mucous membrane graft necrosis and endophthalmitis after the keratoprosthesis implantation in this case, the risk of the complications should always be considered in patients with Stevens-Johnson syndrome.

To report a case of limbal mass that was the initial manifestation of metastasis from an undifferentiated carcinoma of parotid gland.
Case Report: A 56-year-old man without known systemic disease developed simultaneously a limbal and parotid mass in his left side. He underwent excisional biopsy of the limbal mass and subtotal parotidectomy in the same session and underwent systemic evaluations. Histopathologic evaluations and immunohistochemistry staining of both limbal and parotidal masses disclosed an undifferentiated carcinoma of both sites. Further evaluations revealed no other sites of involvement or metastasis. The patient underwent systemic chemotherapy and local radiotherapy.
This is the first report of limbal mass that was the initial manifestation of metastasis from an undifferentiated carcinoma of parotid gland. It should be considered in the differential diagnosis of limbal masses.

Facial asymmetry is a condition in which the two sides of the face are not completely alike and similar. There are different causes for facial asymmetry including abnormal head posture (AHP), trauma, facial muscle palsy, facial macrosomia, craniosynostosis, phakomatosis, and progressive facial atrophy. AHP can arise from nonocular (usually musculoskeletal) and ocular conditions. Congenital muscular AHP is the most common cause of AHP in children and has effects on the development and progression of facial asymmetry in children very similar to ocular AHP. Assessment of facial asymmetry consists of a patient history¡ physical examination¡ and medical imaging. Medical imaging and facial morphometry are helpful for objective diagnosis and measurement of the facial asymmetry¡ as well as for planning an appropriate treatment. It has been well-documented that patients with congenital superior oblique palsy tilt their head to prevent diplopia. Therefore¡ there is a chance of developing facial asymmetry such as midfacial hemihypoplasia on the side opposite the palsied muscle¡ with deviation of the nose and mouth toward the hypoplastic side in a long term AHP. Such facial asymmetries do not develop in the acquired type of AHP. Therefore, facial asymmetry should help to confirm chronicity and prevent unnecessary neurologic evaluation in patients with an uncertain history. Correcting the torticollis through strabismus surgery or other non-surgical methods before critical developmental age may prevent the development of irreversible facial asymmetry.
The purpose of this study is to review the effect of abnormal head posture on facial asymmetry. In this review¡ articles or books that were published from January 1970 to January 2015 were searched, assessed and appraised. Additionally¡ quantitative and qualitative evidences with regard to inclusion and exclusion criteria were gathered¡ summarized¡ discussed and concluded.