Journal of Current Ophthalmology
Volume:24 Issue: 3, Sep 2012

To investigate and compare the causes of blindness in ocular Behçet’s disease (BD) in men and women In a retrospective, descriptive investigation from 1976 to 2008, 6,021 BD cases were registered in our BD Unit of Shariati Hospital of Tehran University of Medical Sciences (TUMS). At the last visit, 187 patients (124 men and 63 women) were blind (vision=1/10 or less) at least in one eye and with at least 3 years of follow-up in our clinic. All patients received conventional treatments for BD following the diagnosis. 187 unilateral or bilateral blind cases of BD, 124 males (244 eyes) and 63 females (124 eyes) were included in our study. They were blind (VA=1/10 or less) at the last visit. The mean age of men was 31.74±8.6 years, the mean age of women was 33.13±10.26 years at presentation, t=0.97, P=0.3. At presentation 229 eyes (62.23%) had severely impaired vision (VA≤1/10), 144 eyes (59.02%) of men and 85 eyes (68.55%) of women, χ2 =0.403, P=0.5. The mean duration of diagnosis up to 2008 was 13.85±6.42 years in men and 15.65±6.41 years in women, t=1.8, P=0.05. The end-blinding outcome was registered in 77.99% (N=287) eyes, 78.28% (N=191) eyes in men and 77.42% (N=96) eyes in women. χ2 =0.05, P=0.8. The most common cause for blindness was end-stage disease (retinal vascular necrosis or fibrosis, chorioretinal and optic atrophy) which was observed in 39.67% (N=146) eyes, 40.98% (N=100) eyes of men and 37.09% (N=46) eyes of women, χ2 -0.163, P=0.7. BD can have a very severe and blinding outcome, but the end blinding result does not seem to be different in two genders.

To compare the intraocular pressure (IOP) lowering effect and side effects of Xalatan with generic Latanoprost (Xalabiost) in adults with open-angle glaucoma or ocular hypertension This was a two-center prospective randomized, crossover clinical trial. Eligible patients with open-angle glaucoma or ocular hypertension were sequentially randomized to two parallel study groups receiving Xalatan and Xalabiost in two periods. The primary efficacy outcome was change in the mean of IOP between baseline and end of each treatment period, and secondary outcomes included differences between treatment groups in mean percent change in IOP from baseline and in proportions of patients reaching specified target mean IOP levels. Nineteen patients in BX group (receiving Xalabiost in first and passing to Xalatan in second treatment period) and 22 patients in XB group (receiving Xalatan in first period and Xalabiost in second treatment period) completed both treatment periods. The mean baseline IOP was 24.9 mmHg in group XB and 25.4 mmHg in group BX (P=0.57). At the end of Xalatan treatment periods, patients experienced a 7.5±1.3 mmHg (29.8±3.6 percent) reduction in IOP compared to baseline IOP. Xalabiost treated patients had a 7.3±1.2 mmHg (29.2±3.3 percent) decrease in IOP compared to baseline IOP (P=0.084). Adverse ocular events were mild in both treatment groups. Both Xalatan and generic Latanoprost (Xalabiost) reduced IOP effectively after 1 month of treatment in patients with primary open-angle glaucoma or ocular hypertension, with no significant difference in efficacy and tolerability between them.

To compare intraocular pressure (IOP) readings measured by the Ocular Response Analyzer (ORA) with those measured by the Goldmann applanation tonometer (GAT) in keratoconic eyes following penetrating keratoplasty (PKP) and evaluate the influence of anatomical and biomechanical properties of the grafts on the IOP measurements In this cross-sectional study conducted on 45 keratoconic eyes of 36 patients (24 men and 12 women) undergoing PKP, IOP using the GAT (IOP GAT) and corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-related IOP (IOPg), and cornea-compensated IOP (IOPcc) using the ORA and central graft thickness (CGT) were measured. Bland-Altman and mountain plots were used to evaluate agreement between the tonometers. The correlation of graft curvature and astigmatism; CGT; and corneal biomechanical properties with IOP readings was investigated using multivariate regression analysis. The mean age of patients was 29.8±6.1 years and they were followed up for 91.2±35.4 months postoperatively. Mean CH, CRF, and CGT were 10.2±2.1 mmHg, 10.1±2.2 mmHg, and 567.5±38.8 μm, respectively. Mean IOP GAT, IOPg, and IOPcc were 12.2±2.4, 15.1±3.5, and 15.8±3.3 mmHg, respectively (P<0.001). The 95% limit of agreement between IOP GAT and IOPg ranged from -3.6 to 9.3 mmHg. CH and CRF, but not CGT or keratometric astigmatism were significantly associated with IOP GAT, IOPg, and IOPcc. Following PKP in keratoconus, graft biomechanics had more influence on IOP values than anatomical features. In comparison to the GAT, the ORA yielded higher IOP values.

The aim of this study was to compare the rate and location of intraoperatively induced retinal breaks between two techniques of standard 20-gauge vitrectomy and transconjunctival 23-gauge using trocar/cannula In this prospective comparative case series patients having attached retina before surgery who were operated for different vitreoretinal or macular conditions by standard 20-gauge trans-pars plana vitrectomy (20G) were compared with another group of patients who were operated by 23-gauge using trocar/cannula system. The peripheral retina was examined before surgery and by the end of surgery using indirect ophthalmoscope and scleral depression. The rate of iatrogenic break formation, number and type of breaks and location of breaks were compared between the two groups. A total of 115 vitrectomies were studied. Fifty five vitrectomies were done by transconjunctival micro-incision vitrectomy systems (MIVS) and 60 were performed by standard 20G system. The overall rate of iatrogenic break formation was two (3.6%) and seven (11.7%) for 23-gauge and 20-gauge system, respectively. Eleven breaks in 20G group were either dialysis behind or tears within one clock hour from the sclerotomy site, while the two patients in 23-gauge group had tears away from the sclerotomy site (P<0.05). No patient in the 23-gauge group showed iatrogenic dialysis. Twenty-three gauge vitrectomy may have the potential benefit of lower complication in terms of sclerotomy related breaks and retinal dialysis formation. This benefit should be weighed against the limitations and other potential complications of this technique. Further studies are required to assess their safety and other complications of these systems.

Studies show that phenytoin is effective in improvement of different chronic ulcers such as venous stasis ulcers, and diabetic ulcers. The exact mechanism is yet not clear; investigators thought that phenytoin might help to heal intractable corneal ulcers by reducing inflammation, differentiating limbal fibroblasts, and promoting the invasion of the cornea with new blood vessels as shown in animal and in vitro studies. Given the importance of healing process of corneal alkali burns which are common and always problematic, the need for finding strategies that can help improve this process is always felt. This study investigated the effect of topical phenytoin 1% in corneal epithelial defects healing in rabbit model. A chemical corneal epithelial defect was created in one eye of albino rabbits in animal house of Al-Zahra eye center. Rabbits were randomly assigned into two groups of ten. The case group was treated using soluble phenytoin 1% eye drop and the control group received normal saline eye drop. Clinical assessment and epithelial defect size were evaluated daily for 14 days using slit-lamp biomicroscopy. Data were analyzed using Independent t-test and ANOVA on repeated observations. The difference between the first and the last day of follow-up in each group was significant (P<0.05). Topical phenytoin 1% induced a significantly faster epithelial healing in comparison with the control group (P<0.05). Topical phenytoin 1% can help in improvement of epithelial defect caused by alkali burns as a supplement treatment.

Vitreoretinal surgery can be difficult or impossible in patients with corneal opacity. One solution for this problem is use of temporary keratoprosthesis (TKP). We report anatomical and visual outcomes of this combined surgery in our institution. We retrospectively reviewed charts of patients in whom a TKP was used between 2006 and 2010 with follow-up of at least six months. Several variables such as indications for surgery, pre and postoperative visual acuity (VA), postoperative intraocular pressure (IOP), graft status, retinal status and postoperative complications were evaluated. Successful surgical outcome was defined as maintenance of clear graft, anatomic reattachment of retina, and controlled IOP. A TKP was used in 58 eyes, 43 (74.1%) of them were traumatic. Posterior segment comorbidity were retinal detachment in 39 (67.2%) eyes, vitreous hemorrhage in 19 eyes (32.8%) and endophthalmitis in 13 eyes (22.4%). All patients had corneal opacity due to scar, edema or blood staining. Postoperative VA was improved in 16 eyes (27.6%) of patients, and was unchanged in 31 eyes (53.5%) and was decreased in 11 eyes (18.9%) at the final visit. Postoperative VA was statistically better than preoperative VA (P<0.001) whether patients had retinal detachment or had not. Poor visual outcome (BSCVA≤hand motion) was seen in 49 eyes (84.5%). Only 9 patients (15.5%) achieved ambulatory vision in involved eye (BSCVA≥counting finger or 20/200-20/800). Corneal grafts remained clear in 19 eyes (32.7%). 11(18.9%) eyes had successful surgical outcome. 4 eyes (12.1%) out of 33 eyes that had not become phthisic were at risk for phthisis bulbi. Our results of simultaneous vitreoretinal surgery and penetrating keratoplasty (PKP) using TKP showed that in most patients, vision did not improved and in many patients eye cosmesis was not preserved, probably because our patients had more severe retinal and optic nerve dysfunction.

To compare visual outcome of aspheric and spheric intraocular lenses (IOLs) implantation in patients with age-related cataract in terms of visual acuity (VA), contrast sensitivity (CS) and spherical aberration In this prospective randomized interventional study, 59 consecutive cases of senile cataract who had been admitted for cataract surgery to Farabi Eye Hospital, Tehran, Iran between June 2008 and July 2010 were recruited. Patients were randomly assigned to two treatment groups using computerized software; eyes were implanted with either a aspheric or spheric IOLs (Acrylic, Lens Tec Co, Tehran, Iran). Pre and postoperatively, patients underwent complete ocular examination and their uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were measured. Three months after the operation patients were visited to measure spherical aberration and CS. Fifty-two patients with the mean age of 55.7±5.9 years (range, 45-73 years) remained for surgical interventions. Postoperative UCVA and BCVA did not show a significant difference between our two study groups (P=0.124 and 0.400, respectively). Spherical aberration after cataract surgery in pseudophakic situation and pupil diameter of 5 mm was significantly lower in eyes with aspheric IOLs compared to spherical ones (0.22±0.10 vs. 0.30±0.12 µ, respectively, P=0.03). CS in all frequencies was better in aspheric IOLs compared to the spheric ones and except to the frequency of 20 cpd this difference was statistically significant (P<0.05). Although both aspheric and spheric IOLs resulted into a favorable VA, aspheric IOLs lead to better visual performance through a lower spherical aberration and better CS and quality of vision. However intraindividualization of asphericity by individual IOL surface design may be the best future option.

To describe a distinctive pattern of induced higher order aberration (HOA) after LASIK for mixed astigmatism Case reports: Wavefront-guided LASIK with iris recognition and eye tracking (Excimer laser: Technolas 217z; APT protocol; Microkeratome: Moria CB) was performed in six eyes with moderate to high mixed astigmatism for a nominal optical zone of 6.3 mm. The patients were re-examined beyond 9 months postoperatively. Postoperative uncorrected distance visual acuities (UDVA) equaled preoperative corrected distance visual acuities (CDVA). The cycloplegic cylinder increased an average of about 2.50 D compared with dry retinoscopy. Significant increases in HOAs were detected with pupils dilated, specially in the amounts of secondary astigmatism (mean change=0.41 µm) and horizontal coma (HC) (mean change=0.29 µm). Large kappa angles were detected in all of the eyes studied (mean=7.45̊). The bitoric ablation profile of mixed astigmatism LASIK may induce significant secondary astigmatism which causes a remarkable disparity between dry and wet refraction and manifests as an unusual skiascopic reflex during wet retinoscopy. A large kappa angle may cause tilted ablation and induce HC.

This manuscript has discussed interesting points regarding ablation profiles and induced aberrations. Although the size of samples is low, the constant findings in the majority of cases make the findings valid. I think the bias in this study is that there were not control groups to compare the findings and validate the conclusions. Are the induced low and high order aberrations in this group of cases due to specific algorithm (bitoric as mentioned)? Or these may happen with other ablation profiles too. We looked at several case of ours in 2 groups, one group the same as this study, i.e. mixed astigmatism and other group of compound myopic astigmatism with cylinder in the range of this study. Interestingly there were similar findings between our cases and cases reviewed in this study, and more interesting finding was that the same pattern of induced aberrations happened in both compound and mixed group. Most eyes in both groups had induced horizontal coma, secondary astigmatism and increase in hyperopia and minus cylinder at exam diameter, so our conclusion is that induction of these aberrations is due to high cylinder correction per se and not the pattern of ablation. Since the ablation is concentrated on the peripheral horizontal cornea in all cases, astigmatism may be induced in this area. Although radial energy loss and lack of radial compensation may play a role, it is more commonly associated with spherical aberration. Blurred vision, glare and hallows are common subjective complaints after refractive surgery, even if it was customized or other techniques, so, correlation of specific aberrations with visual symptoms has to be documented with more evidence, as well as the clinical value of secondary astigmatism that increases with increasing pupil diameter. The issues of angle Kappa and centration of ablation on the pupil center, corneal vertex or visual axis are so complex that need extensive evaluation. Another issue in this study is that most cases had undercorrection of hyperopia or indeed induction of hyperopia (hypropic shift). This is due to coupling effect of cylinder, that occurs more frequently in APT algorithm. It can also be due to aberration interaction. In our experience the advanced nomogram in APT algorithm underestimates these effects and operator should add more hyperopia or subtract more myopic sphere when correcting these conditions, specially when the cylinder is very high and the amount of higher order aberration (HOA) is also high.

To report a patient with orbital pseudotumor masquerading as orbital cellulitis Case report: A 42-year-old woman was referred to orbit and oculoplastic clinic with 6 days history of left orbital pain, proptosis, lid edema and fever. Clinical finding included severe lid edema, chemosis, conjunctival injection and severe restriction in extraocular motility. She was diagnosed as orbital cellulitis and hospitalized for treatment with intravenous antibiotics. Because of no improvement, on the fifth day after admission, systemic corticosteroid, was prescribed. Diagnosis of orbital pseudotumor was made after significant response to systemic corticosteroids. Antibiotics were discontinued and systemic corticosteroid was tapered slowly during the 4 months. Orbital pseudotumor is an ophthalmologic condition that may mimic a variety of pathologic processes. Despite complete physical examination and appropriate imaging, sometimes correct diagnosis of the disease would be difficult.

To report a patient with branch retinal vein occlusion (BRVO) and serologic evidence of primary Cytomegalovirus (CMV) infection Case report: We have reported a 27-year-old male with a complaint of sudden decrease in right eye vision starting a few days before. Immunoglobulin G (IgG) seroconversion indicated primary CMV infection. Involvement and obstruction of small retinal veins may occur in association with primary CMV infection and should be considered in the differential diagnosis of BRVO in healthy young adults. An appropriate assay for CMV infection should be done for young patients with retinal vascular occlusion to rule out the diagnosis.

To report a rare case of spontaneous resorption of a membranous congenital cataract in an adult woman with no systemic disease, with complete absorption of the central lens material, anterior and posterior capsules of the right eye, and partial absorption of the lens material with intact anterior capsule in the left eye. Case report: A 23-year-old woman was referred to our clinic suffering from decreased vision from childhood. Her visual acuity (VA) was 1/10 in the right eye (OD) and FC (40 cm) in the left eye (OS) after correction with +10.25 spherical Diopter in both eyes (OU). Her ocular history revealed profound low vision and nystagmus from childhood, with no prior intervention in either eye. The slit examination of the right eye revealed white opaque membranes at the periphery of the lens which were presumably remnants of the lens capsule. The central lens material was completely absorbed as well as anterior and posterior capsules, mimicking a surgical anterior and posterior capsulorrhexis. The left eye examination showed membranous cataract presenting as a piece of dense white fibrotic membrane and small amount of residual cortex at the peripheral part. The chalky-white lens material was partially absorbed with intact anterior capsule. As complete spontaneous resorption of membraneous congenital cataracts leading to high refractive hyperopia and amblyopia may happen in children with congenital cataracts, careful ocular examinations seems to be essential to avoid neglecting comorbid pathologies specially in children with high refractive errors and/or amblyopia. Surgical management of membranous cataracts need special considerations.

In this report a patient with concomitant Axenfeld-Rieger syndrome and glaucoma is presented. New symptoms of a recent traumatic subdural hematoma were being attributed to his previously diagnosed conditions for several months. Appropriate imaging saved the patient from more dangerous complications.