مجله چشم پزشکی بینا
سال بیست و چهارم شماره 4 (تابستان 1398)

To determine the etiologic factors on rejection and failure rates and ocular surface changes after corneal transplantation by either DALK or PKP, in cases of keratoconus (KCN).

In this cross-sectional study, considering the existing data, patients with keratoconus referring to Labbafinejad Medical Center from 2006 to 2016, who underwent corneal transplantation, were enrolled and recalled in this study. The diagnosis of Keratoconus was based on Slit lamp clinical findings, topographic, and tomographic findings, for which keratoplasty was indicated. All surgical procedures for corneal transplantation, as well as postoperative follow-up protocol, were identical. During the postoperative follow-up, a careful examination was performed on the complications and symptoms of corneal graft rejection and underlying causes.

In this study, 108 patients in each group (N= 216) were examined for at least 6 months after the removal of all sutures. The rate of graft rejection was 13% and 34.3% in the DALK and PKP groups, respectively (P<0.001). The failure rate was 7.4% and 2.8% in the DALK and PKP groups, respectively (P = 0.12). Generally, 60.5% of all cases of corneal vascularization developed rejection (23 out of 38) (P<0.001). The rate of graft opacity was 30.6% in the DALK group while it was 14.8% in the PKP group (P = 0.006). Patients with dry eye, graft ulcer, and stitch abscess were more likely to develop rejection (P<0.001). Gender, age of host and donor, method of Donor preservation, duration of surgery, duration of follow-up, postop duration of topical corticosteroid administration, the season of graft rejection, Infiltration, history of previous rejection, time suture removal, history of VKC, and history of corneal transplantation in the other eye were not correlated to rejection.

Ocular surface changes and dry eye is more prevalent in DALK in relation to PKP. Corneal vascularization, which is an important factor in graft rejection, occurs more frequent in PKP than DALK. Opacification of graft interface, which occurs in DALK, is an important factor in graft failure.

To evaluate the histopathological changes of the cornea in rabbit corneas after accelerated collagen cross-linking.

Right eyes of 7 adult New Zealand albino rabbits weighing 1.5 to 2.0 kg were studied. Right eyes of all animals were in the treatment group and left eyes were in the control group. The epithelium of all right eyes was removed and was crossed-linked with riboflavin 0.1% solution (10 mg riboflavin-5-phosphate in 10ml 20% dextran-T-500) applied every 3 minutes for 30 minutes, and exposed to UVA (360 nm, 3 mW/cm2) for 10 minutes. All rabbits were humanely euthanized and examined histologically. Apoptosis was evaluated using TUNEL staining.

There was a significant difference in the mean percent of apoptotic cells in the treated and control groups. In both keratocyte and endothelial cells of the treated cornea, the number of apoptotic cells was significantly higher than the control group. In the evaluation of cornea totally (endothelial and keratocyte), the mean percent and standard deviation of apoptotic cells were 18.29 ± 3.2 in right eyes and 6.29 ± 1.7 in left eyes. In the evaluation of apoptosis in keratocytes separately, the mean percent and SD in right eyes were 15.29±2.56 that was significantly higher in comparison with the left eyes 5.71±1.5. The mean and SD of apoptotic endothelial cells in right and left eyes were 2.86±1.07, 0.53±0.43, respectively, that were statically significant (P= 0.026).

Although CXL is a safe procedure to arrest progression in keratoconus disease, due to endothelial cell damage in our study and others, there are some risks for endothelial cell damage and related complications; so, it needs for more studies.

To determine the incidence of macular edema in patients with MS treated with 0.5 mg Fingolimod.

In this prospective descriptive-analytic study a total of 115 patients were enrolled. Patients underwent an ophthalmologic examination before starting the treatment. In the fourth month after starting the treatment for each patient, regardless of whether or not being marked, the ophthalmologic examination and OCT were repeated. The results were analyzed, using SPSS version 19 software.

The mean ± SD age of the patients was 32.68 ± 7. 57 years. The result of the preliminary examination of direct and indirect ophthalmoscopy of the right and left eyes before the onset of treatment in all cases for macular lesions was normal. The average of the secondary ocular examination during the treatment was 4.05±3.18 months. The result of the secondary examination of direct and indirect ophthalmoscopy of the right and left eyes during the treatment in all cases for macular lesions was normal. There was no macular edema in the right or left eye of none of the patients during the treatment.

Based on the results of the present study, Iranian Fingolimod can be used for the treatment of patients with MS with minimal ophthalmic complications and macular edema with considering regular ophthalmologic examinations.

To investigate the postoperative surgical outcome of all patients undergoing strabismus surgery and its effect on palpebral fissure alteration.

In this cross-sectional study, 58 patients, who underwent strabismus surgery at Amir-al-Momenin Hospital, Rasht, Iran from March 2018 to 2019, were investigated for the changes in eye deviation and palpebral fissure height (PFH) 1 and 3 month(s) after surgery compared to the pre-surgical status. Also, their corneal light reflexes of the upper (margin to reflex distance [MRD1]) and lower eyelid (MRD2) were clinically evaluated.

Evaluation of 97 eyes of 58 patients (47 left and 50 right eyes; 73.8% women; mean age of 19.8±13.8 years) undergoing strabismus surgery showed significant changes in deviation, PFH, and MRD2 1 and 3 month(s) after surgery compared to the pre-surgical status with significant differences based on the type of surgery. Correction of deviation had a significant effect on PFH change (3 months after surgery compared to baseline) in medial and lateral rectus recession techniques (P<0.001).

The results of this study showed a significant effect of medial and lateral rectus recession on PFH, MRD1, and MRD2, which emphasizes the need to inform patients about the possibility of these changes after surgery and search for intraoperative strategies to reduce these changes.

To report the effect of fascia temporalis sling of lower lid combined with lateral canthus Y-V plasty and tarsorrhaphy on paralytic ectropion.

Eight patients with lower lid paralytic ectropion were treated with lower lid fascia temporalis sling and lateral canthus Y-V plasty in addition to lateral tarsorrhaphy in one step surgery. A band of approximately 4 cm in length and 1 cm in width was made from deep fascia temporalis. Y-shape skin incision was made at lateral canthus and releasing of lateral canthal tendon was performed, deep temporalis fascia harvested and sutured to periosteum at medial canthus area then passed through lower lid, using wright needle to lateral area and sutured to periosteum of lateral orbital rim; lateral canthal tendon was fixed to lateral orbital periosteum in a more lateral and superior position and conventional lateral tarsorrhaphy were also added. All patients were evaluated for appearance and beauty and eyelid function before and after at least 6 months follow-up.

The mean age of 8 enrolled patients was 66.6± 10.7 years. The mean MRD1 and MRD2 changed from 2.6±2 and 8.7±2.7 mm to 1.7±1.2 and 5.1±1.1 mm (P= 0.01), respectively; the mean of pre-operative lagophthalmos was 10±5.2 mm, which improved to 3.6±1.4 mm after the operation (P= 0.01). Two patients underwent medial tarsorrhaphy because of medial ectropion. The medial and lateral flare was also decreased. Most of the patients were satisfied with cosmetic results and reported improvement of ocular pain and discomfort and required fewer lubrications. At follow-up, on average, 12 ± 8.5 (3-36), no ectropion recurrence was observed in any of the patients.

Triple surgery effectively improves paralytic ectropion, reduces corneal exposure symptoms, and improves the beauty and greatly modifies lagophthalmos.

According to military documents, the incidence of ocular injuries significantly increases. Intraocular foreign body (IOFB) is one of the ocular damages that seriously threats vision. Many ocular injuries occurred in a war between Iran and Iraq from 1980 to 1988. The aim of the present study was to review ocular damages made by IOFB in this war, different methods of treatment and their prognosis.

To report a case of the congenital primitive neuroectodermal tumor (PNET) of the orbit.

 The patient was a 2-week-old neonate referred to the oculoplastic clinic with right eye proptosis from birth. The neonate was a full term with a history of difficult vaginal delivery. At an initial examination, the ecchymosis of the medial right upper lid was noted. At an initial CT scan, an isodense intraconal infiltrative mass without distinct margins and without bone erosion or calcification was present. With an initial diagnosis of retrobulbar hemorrhage due to a difficult delivery, the patient was followed. With regard to the progressive course of proptosis in the follow-up period, orbitotomy and incisional biopsy were performed and after histologic evaluation, the primitive neuroectodermal tumor was diagnosed. The patient was treated with combination adjuvant chemotherapy regimen. After 5 cycles of chemotherapy, proptosis significantly improved. One year after disease diagnosis, there was no symptom or sign of recurrence.

In congenital masses or proptoses, the possibility of PNET should be considered, although it is not common.

To report a rare presentation of ophthalmic tuberculosis.

 A 19-year-old man was referred to the glaucoma clinic due to multiple attacks of increased intraocular pressure (IOP) in his right eye. IOP of the right eye was 50 mmHg, and glaucomatous damage of the optic nerve was present. In gonioscopy, an oval-black lesion was present in the ciliary body band on the temporal side, which looked like a granuloma in ultrasound biomicroscopy (UBM). After rejecting immunological diseases due to the 20mm tuberculin test, the diagnosis of ciliary body tuberculosis was made. The patient was treated with a multi-drug regimen for 9 months. After 4 weeks, IOP was normalized, and at the end of 9 months, the ciliary body granuloma disappeared.

Ciliary body tuberculosis can cause multiple attacks of acute IOP rise (possibly due to the release of pigment and necrotic debris). Systemic causes of glaucoma such as tuberculosis should be kept in mind, especially in unilateral cases, and performing a thorough gonioscopy is useful in this regard.

To introduce the case of unilateral periorbital edema secondary to sarcoid parotiditis.

A 26-year-old female was referred to Labbafinejad Medical Center because of right hemifacial and periorbital edema for last month. The result of a skin biopsy (1 month ago) from her arm showed an unspecified granulomatous inflammation. In addition, she had a new annular lesion on her left arm when she was referred. PPD test was positive with 29 mm induration. After a biopsy of the parotid, gland sarcoidosis was confirmed and she responded brilliantly to oral prednisone in 2 days and all symptoms and signs disappeared in a month.

Sarcoidosis can present itself as periorbital edema.