Journal of Current Ophthalmology
Volume:26 Issue: 1, Mar 2014

In the retrospective investigation titled “Risk factors evaluation of threshold retinopathy of prematurity” at a tertiary ophthalmic center in Tehran, Iran, the authors have studied 859 premature neonates during one year (2008-2009). 791 eyes have had retinopathy of prematurity (ROP) and 7.4% of them presented threshold retinopathy (TROP). The investigators aim has been to present and compare the risk factors of ROP and TROP and also to emphasize that the proposed criteria1 for investigation of ROP and TROP are not very precise and valuable for the developing countries. For example they remark that 33% of their TROP had birth weight of more than 1,500 grams. In this investigation the most important risk factors for TROP have been delay in initial examination, low weight, low gestation age, and duration of oxygen therapy.

To compare Orbscan II and Pentacam keratometry readings in terms of their agreement with a manual Javal type keratometer In this retrospective study, records of patients who had refractive surgery were reviewed. We extracted data of 765 eyes which had keratometry with the Javal keratometer; of these, 577 had Orbscan II and 200 eyes had Pentacam acquisitions. Minimum (min-K) and maximum (max-K) keratometry readings and keratometric astigmatism with the latter two devices were compared with Javal. Correlation coefficients for Javal and Orbscan II in measuring min-K and max-K were r=0.916 and r=0.913, respectively (p<0.001). The 95% limits of agreement (LoA) between Javal and Orbscan II was 1.17-1.20 D for min-K and 1.22-1.24 D for max-K. The coefficients for Pentacam and Javal min-K and max-K readings were very high (r=0.943 and r=0.962). The 95% LoA between Pentacam and Javal in measuring min-K and max-K were 0.51-0.99D and 0.72-0.99D, respectively. The correlation between Pentacam and Javal measurements of keratometric astigmatism was stronger than that for Orbscan II and Javal (r=0.973 and r=0.800); the 95% LoA was 0.55-0.76D for Pentacam and Javal, and 1.14-1.19D for Orbscan II and Javal. According to this research, Orbscan II and Pentacam had high correlation and agreement with Javal-keratometer in determining keratometric values. Nevertheless, the results obtained from Pentacam showed better agreement and stronger correlation with Javal as compared with Orbscan II. It seems that Pentacam is a suitable substitute for Javal to perform keratometry in normal eyes.

To determine the incidence and risk factors associated with glaucoma following congenital cataract surgery (CCS) in children under age of 15 This prospective cohort (since 2006) consisted of children less than 15 years of age who underwent cataract surgery with or without intraocular lens (IOL) implantation. The role of the following factors on the development of glaucoma after CCS including age at surgery, gender, laterality of the cataract, IOL implantation, congenital ocular anomalies, intra- and postoperative complications, length of follow-up, central corneal thickness (CCT) as well as the effect of the age of onset, time to development of glaucoma, and response to treatment were evaluated. Overall, 161 eyes of 96 patients were included in this study of which 28 eyes developed glaucoma. Incidence of glaucoma was 17.4%. Mean±SD age at surgery was 9.3±6.9 (range, 1-24) months in glaucomatous and 40.4±41.1 (range, 1 m-13.6 year) months in non-glaucomatous group (p<0.001). All glaucoma patients had the operation under two years of age. In group 1, 9 (60%) and in group 2, 24 (30%) patients were female (p=0.001). In group 1, 17 eyes (60.7%) and in the group 2, 41 eyes (30.8%) were aphakic (p=0.001). Mean time to diagnosis of glaucoma was 111.2 days (range 30-1200 days). Mean follow-up time was 3.1 years (range, 1-6 years). In 22 (78.6%) eyes glaucoma was diagnosed within six months after surgery. Glaucoma was controlled with medications in 23 eyes (82%) and with surgery in five eyes. In this study the incidence of glaucoma after CCS was 17.4% over a follow-up period of six years. Younger age at the time of lensectomy increases the risk of secondary glaucoma. IOL implantation may protect against glaucoma. Female gender was affected more than male.

Aim of the present study was to detect the expression of P-glycoprotein (P-gp) and multi drug resistance associated protein 1 (MRP1) in retinoblastoma tumors, and analyze the relationship between its expression, the clinicopathological features and recurrence. P-gp and MRP1 expression in formalin-fixed paraffin-embedded tissue sections from 26 patients were studied by immunohistochemistry assay, and the results were analyzed in correlation with clinicopathological parameters. Patients were classified into two groups according to their treatment: with (n=16) and without preoperative chemotherapy (n=10). Six (23%) and 12 (46%) tumors were P-gp and MRP1 positive respectively. Three out of five tumors that presented P-gp had tumor invasion while MRP1 was positive in four tumors with invasion. Seven patients showed recurrence during follow-up time that P-gp and MRP1 were expressed in three and four of them, respectively. There was no correlation between protein expression and clinical outcomes as recurrence in this study. MRP1 and multi drug resistance 1 (MDR1) were intrinsically expressed in our studied population. However, the results did not demonstrate significant association between P-gp and/or MRP1 positive expression and unresponsiveness to chemotherapy in Iranian retinoblastoma patients.

To report visual outcomes of pars plana vitrectomy in severely traumatized eyes with no light perception (NLP) and flat electroretinography (ERG) We performed a prospective interventional study on 22 severely traumatized eyes with no light perception, 4+ relative afferent pupillary defect (RAPD) and flat ERG. One year after pars plana virectomy, 15 patients (68.18%) had no light perception, six patients (27.27%) had light perception and one patient (4.54%) could count fingers at 70 cm. There was a significant improvement in final visual acuity (VA) (p=0.02). There was no significant association between mechanism of trauma, type or site of laceration, age, sex, ocular comorbidities, type of the surgery or mean number of vitrectomies and final VA. If the anatomical status of the eye permits (such as lack of optic nerve avulsion), and also in the presence of specific situations (as in one eyed patients), vitreoretinal surgery could be thought for the preserving at least some vision and also to conserve the appearance of the globe and to help the psychological state of the patient.

The main purpose of this study was to evaluate the prevalence of herpes simplex virus 1 and 2, Varicella-Zoster virus and Adenovirus associated with conjunctivitis in swab samples of patients who referred to Eye Specialist Hospitals in Tehran. In this cross-sectional study, swab samples from patients with acute conjunctivitis during the first sixth months of 2012, in two ophthalmic departments of Tehran were collected. After DNA extraction, multiplex Real-Time PCR was carried out in two separate reactions for each sample. A total of 150 swap samples were collected from acute conjunctivitis patients. Among them, 22 (14.6%) and 5 (3.3%) were positive for Adenovirus and HSV-1 DNA, respectively. There were no patients with positive results for HSV-2, VZV. Statistical analysis showed insignificant P-value (0.845) between gender and conjunctivitis; however, there was close correlation (P-value < 0.05) with age. Moreover, 63.6% of Adenoviral conjunctivitis occurs in the summer compared to spring (36.4), whereas no significant seasonal variation was observed for HSV-1. This prevalence pattern indicates that adenovirus has major role in viral conjunctivitis rather than HSV-1. Further research is needed to identify other viral pathogens associated with ocular infection.

To identify the postoperative surgical outcomes and the changes in deviation in patients treated by bilateral medial rectus (BMR) recession for small to large angle esotropia with a minimum follow-up of two years In this retrospective and consecutive case series, we reviewed medical records of 130 patients who had recession surgery for correction of esotropia between 2001-2011 in a tertiary center in Tehran. Patients were excluded if neurological abnormalities or developmental delays were documented and if structural eye abnormalities were present. One month after operation (n=109), there were 85 successful cases (orthophoria or deviation less than 10 prism diopter), 18 cases of undercorrection, and six cases of overcorrection. The success rate at two years after surgery (n=82) was 78.2% with 13.3.% undercorrection and 8.5% over correction. The preoperative angle of esodeviation and patients’ age are found to significantly influence the response to the surgery. Surgery was effective because of high success rate and acceptable alignment after two years follow-up. Dose response increased in patients with larger angle of preoperative deviation, and was lower for patients who were older at the time of the surgery.

To assess the efficacy of polyhexamethylene biguanide (PHMB) in treating Acanthamoeba keratitis (AK) and also to identify related factors affecting final visual outcome in AK patients treated with PHMB In these interventional case series study, 27 eyes of 25 patients with AK received PHMB 0.02% and divided into two groups according to the final visual acuity (VA); VA equal to or greater than 20/25 and VA less than 20/25. Two groups were evaluated for the effectiveness of PHMB in treatment of AK. Before treatment, more than 85% of eyes had VA of less than 20/25 whilst after treatment final VA was 20/25 or better in 66.7% of eyes. VA regressed in 14.8% of eyes during follow-up and improved or remained the same in more than 85% of eyes. Patients with deep stromal keratitis or a ring infiltrate had more than a 28-fold increase in the odds of a visual outcome worse than 20/25 (OR, 28.0; 95% CI, 3.3-240.8, p=0.001). Patients with Initial VA<20/40 had a 9-fold increase in the odds of a visual outcome worse than 20/25 (OR, 8.6; 95% CI, 1.2-59.8, p=0.003). Longer duration of symptoms (≥ 3 weeks) or the medication used prior the first visit were not associated with poorer final VA (p>0.05). Five eyes (18.5%) finally required keratoplasty. Initial stage of corneal involvement at presentation was the most predictive factors for final visual outcome in AK. Although PHMB, even as monotherapy, is effective in treatment of AK, a remarkable proportion of patients still suffer a final grim visual outcome which require aggressive treatments.

This study aimed at the evaluation of risk factors associated with threshold retinopathy of prematurity (ROP) in infants stricken with ROP referred to Farabi Eye Hospital during years 2008-2009. Since blindness and adverse impairments will occur in a high percentage of infants stricken with threshold retinopathy, we did intend to examine relation between demographic factors with threshold retinopathy in Farabi Eye Hospital, which, as a tertiary center, represents an appropriate sample of Iran’s population. In this retrospective case-control study, sample consisted of infants less than 36 weeks and birth weight under 2,500 grams that were referred to Farabi Eye Hospital in order to screen threshold retinopathy of prematurity. They were checked up and a questionnaire was filled out for each infant. Based on the gathered data, the relation between risk factors and threshold ROP was examined. Out of 1,718 eyes participated in this study, 791 eyes had retinopathy. The incidence of threshold retinopathy in this study was 7.4% percent. Using independent sample t-test between two groups (infants with threshold retinopathy and infants without it) showed significant relationships between gestational age, birth weight, oxygen supplementation, duration of ventilation, blood transfusion, respiratory distress syndrome (RDS), post-conceptual age and chronic respiratory disease with threshold ROP. Cross-tab test revealed a significant relation between threshold retinopathy and sepsis (P=0.006), oxygen supplementation (P=0.000), blood transfusion (P=0.004), RDS (P=0.000), weight (P=0.000) age at first examination (P=0.000), and duration of ventilation. Logistic regression showed that sepsis and the age more than 40 weeks at the time of examination are the predicting factors of threshold retinopathy. Threshold ROP was seen in patients with birth weight more than 1,500 gram so screening criteria in developing country is not appropriate for us. The most important risk factors of threshold ROP are low gestational age, low birth weight and the delayed initial examination and the duration of oxygen therapy.

To report a case of bilateral acanthamoeba keratitis with recurrence after keratoplasties Case report: Here we report a case with bilateral acanthamoeba keratitis who initially responds to medical treatment, after discontinuation of treatment the disease flared up and not responded to medical therapy so superficial keratectomy was done and medical treatment continued and the ulcer improved. Eleven months later only central corneal scar remained. For restoration of vision conventional lamellar keratoplasty (LK) and deep anterior lamellar keratoplasty (DALK) accomplished for left and right eye respectively. The left eye had uncomplicated post operative course, but in the right eye three weeks after DALK recurrence of acanthamoeba keratitis occurred, the keratitis not responded to medical treatment and therefore therapeutic penetrating keratoplasty (PK) was done. In last visit the graft was clear and the patient had uncomplicated postoperative course. PK and postoperative antiamoeba treatments are appropriate treatments for restoration of vision in acanthamoeba keratitis. It is recommended that for prevention of recurrence antiamoeba agent to be continued for at least two months.