[Clinical evaluation of drug induced acute angle closure glaucoma]

To evaluate all cases of drug induced angle closure glaucoma cases who presented to Feiz Hospital, Isfahan during 2008-2010. In this retrospective case series, we present 7 cases of drug induced angle closure glaucoma after administration of Topiramate. All patients were female. The average age of patients was 33.28 years old [ranging from 19 to 44]. With sufficient corneal clarity, mean BCVA was 20/400 and mean refractive error was -6.50 [rang -3.00 to-12.00] diopters. Mean intraocular pressure was 44.71 [rang 34 to 60] mmHg. Mean time normalization of intraocular pressure was 12.30 [rang 8 to 23] hours. Acute myopia and acute angle closure glaucoma are serious adverse effects of Topiramate, both of which are reversible with immediate discontinuation of the drug. So, taking a complete drug history and thinking about culprit drugs is critical in the evaluation of such cases

[Outcomes of photorefractive keratectomy for post penetrating keratoplasty myopia and astigmatism]

To report the results of photorefractive keratectomy [PRK] with mitomycin-C [MMC] to correct myopia and astigmatism in patients who had previously undergone penetrating keratoplasty [PKP]. Thirty-eight eyes of 32 patients underwent PRK with MMC to correct astigmatism and myopia following PKP. Mean spherical equivalent [SE] was -5.2 +/- 4.7 D [diopter] and mean astigmatism was -2.4 +/- 3 D preoperatively which reached -3.1 +/- 3.1 D and -1.2 +/- 2.8 D 3 months after the operation respectively. The cornea was clear in 55.3%, had trace haze in 21.1%, moderate haze in 15.8% and severe haze in 7.9% of cases. PRK with MMC after PKP is a relatively safe and effective procedure. It reduces both the spherical error and the cylindrical component of the ametropia. Corneal haze is the major complication

[Comparison of aberrations after photorefractive keratectomy using tissue saving and personalized techniques]

To compare the effects of standard tissue saving method and personalized techniques of photorefractive keratectomy [PRK] on aberration changes in fellow eyes. This randomized controlled trial was performed on patients who were referred to Isfahan Parsian Clinic during 2007. After a comprehensive ophthalmologic examination, PRK was randomly performed using tissue saving [TS] technique in one eye and personalized [P] technique in the fellow eye. Aberrometry was performed pre- and 6 months postoperatively. This study included 296 eyes of 148 [67 male and 81 female] patients with mean age of 29.1 +/- 7.0 years. The two groups had no significant difference in terms of laterality, pupil size and level of myopia preoperatively [P=0.65]. Uncorrected visual acuity was 20/25 or more in 88.9% of the TS group and 92.6% of the P group [P=0.83]. Mean refractive error 6 months postoperatively was -0.50 +/- 0.36 diopter [D] in the TS group and 0.31 +/- 0.43 D in the P group [P=0.95]. Mean root-mean-square [RMS] value was -0.41 +/- 0.17 preoperatively and 0.86 +/- 0.43 postoperatively in the group TS [P<0.01]. Corresponding figures were 0.47 +/- 0.39 and 0.77 +/- 0.43 in the P group [P<0.01]. The two groups did not differ regarding pre- and postoperative RMS. Postoperative aberrations may be increased with both tissues saving and personalized techniques of PRK with no significant difference between them in this regard

[Comparison of intraocular pressure measurement with the noncontact pulsair 3000 tonometer and goldmann applanation tonometer]

To compare intraocular pressure [IOP] measurement with Pulsair non-contact tonometer and Goldmann applanation tonometer [GAT]. In this cross-sectional study, during a complete ophthalmologic examination, each patient underwent Pulsair tonometry three times at 5 minutes intervals and then Goldmann tonometry at the same intervals. Mean IOP values were measured and analyzed. We evaluated 458 eyes of 250 patients [138 males and 112 female subjects]. Mean IOP was 19.45 +/- 9.04 mmHg with GAT and 20.11 +/- 8.42 mmHg with Pulsair [P=0.075]. Correlation coefficient between the two methods was 0.96 [P= 0.004] and the mean difference [Pulsair-GAT] was 0.65 +/- 1.52 [confidence interval 95%, +3.5 to -2.29]. With IOPs between 10-25mmHg, mean difference between the two methods was 0.49 +/- 1.23 [P= 0.32] mmHg, however it was -1.75 +/- 1.91 [P= 0.06] at IOPs over than 25 mm Hg. Pulsair tonometry has acceptable accuracy in comparison with GAT, especially in IOP ranging from 10 to 25 mmHg

[Vitrectomy for complications of branch retinal vein occlusion]

To evaluate the outcomes of vitrectomy for complications of branch retinal vein occlusion [BRVO]. This retrospective study, included patients who underwent vitrectomy surgery due to the complications of BRVO over an 11-year period. Visual acuity and retinal condition were evaluated before and after surgery. The study included 30 eyes of 30 patients with mean age of 64.7 +/- 10.92 [range 41-85] years. Vitrectomy was performed for vitreous hemorrhage in 23 eyes [76.6%], for tractional macular detachment in 5 eyes [16.6%] and for combined tractional macular detachment and vitreous hemorrhage in 2 eyes [6.6%].The patients were followed for a mean of 15.43 +/- 12.5 months [range 6-60 months]. Visual acuity improved from 2.6 +/- 0.66 to 0.92 +/- 0.75 LogMAR after operation [P<0.001]. Visual improvement was significant in vitreous hemorrhage group [P<0.001], however, it was not significant in the other two groups [both Ps= 0.1]. Visual acuity remained unchanged in 2 patients and decreased in two other patients. The most common cause of vitrectomy for complications of BRVO was vitreous hemorrhage. Patients with tractional macular detachment with or without vitreous hemorrhage had less improvement in visual acuity in comparison to patients with vitreous hemorrhage alone

[Effect of intravitreal triamcinolone [IVT] injection on visual acuity in patients with ischemic CRVO]

To determine the effect of intravitreal triamcinolone [IVT] injection on visual acuity in patients with ischemic central retinal occlusion [CRVO]. This randomized clinical trial was performed on patients with ischemic CRVO referred to the retina clinic at Feiz Hospital in 2007-2008. Inclusion criteria were: duration of CRVO less than one month, normal IOP, no sign of diabetic retinopathy or hypertensive retinopathy, no history of laser therapy and ocular surgery and vascular diseases. Patients were randomly allocated to two groups: intervention group [injection of 0.1cc IVT] and control group [no injection]. Follow up examinations for all patients were scheduled 1, 2, 3 and 6 months after injection. The results were analyzed by SPSS13 and t-test. Overall, 52 patients [22 male and 30 female] entered the study. Mean age was 60.5 +/- 9.7 [range: 30-80] years. Duration of signs was 21 +/- 5.5 days in the control group and 19 +/- 6 days in the IVT group [P= 0.66]. All patients had signs of ischemic CRVO. Mean baseline visual acuity was 1.75 +/- 0.20 logMAR in the IVT group and 1.91 +/- 0.08 logMAR in the control group [P= 0.1]. VA improvement in the IVT group was greater in comparison with the control group at one month [P= 0.019] however this difference was not significant at other follow-up examinations. In addition, the difference in IOP between before and after the injection was not significant [P= 0.802]. This study showed that in patients with CRVO, intravitreal injection of triamcinolone, has no significant long-term effect on visual acuity

[Evaluation of ophthalmologists' sitting position]

To evaluate ophthalmologists' sitting position during ocular examination and surgery and to evaluate any correlation between musculoskeletal disorders and mean work time. This cross-sectional study was performed on ophthalmologists in Isfahan, Iran in different occupational positions including the office, during slitlamp examination and in the operating room. The evaluation included neck angle, lumbar lordosis, pelvic angle and the position of lower leg and foot. Ophthalmologists were asked about spinal and shoulder pains and mean work time in the office and operating room. Among 73 studied ophthalmologists [including 60 male and 13 female subjects], there were malpositions in neck angle in 43 [58.9%], lumbar lordosis in 36 [49.3%], hip angle in 9 [12.3%], lower leg in 49 [67.1%] and foot in 31 [42.4%] cases. Among 62 ophthalmologists who performed surgery there were malpositions in neck angle in 38 [61.3%], lumbar lordosis in 38 [61.3%], hip angle in 2 [37.1%], knee angle in 43 [69.4%] and foot in 44 [71.0%] cases. There was a significant correlation between spinal pains and mean work time in the office [P=0.02] and operating room [P=0.01]. According to the correlation between spinal pains and work time, it is necessary to educate ophthalmologists for correct sitting position during work

[Effect of Ramadan fasting on physiologic myopia]

Simple myopia is one of the most common ocular abnormalities. Diet is amongst the factors that affect on myopia. Therefore, this study was aimed to evaluate the effect of Ramadan fasting on physiologic myopia. This descriptive-analytical study was conducted on a total of 61 individuals [122 eyes]. The subjects were male myopic with simple myopia ranged 0.50 to -8D, aged 22-50 years. The refraction of their eyes was examined before and after Ramadan [3-4 days after Ramadan] using cycloplegic refraction. At the end of fasting month, the same examination was administrated and the findings obtained were compared using t test. The mean age of the patients was 31.20 +/- 11.24 [ranged 22-50 years]. Visual intensity of the patients was 20.20. The mean of refraction deficiency of the individuals before and after the fasting was -3.21 +/- 2.80 and -3.16 +/- 3.00 D [P>0.05]. Fasting has no effect on myopia in the male individuals aged above 23 years

[Dry eye following keratorefractive surgery]

To compare tear secretion values following LASIK [laser in situ keratomileusis] and photorefractive keratectomy [PRK]. Patients referred to Aban Eye Clinic [Isfahan, Iran] for refractive surgery were randomly assigned to LASIK or PRK. Exclusion criteria were contraindications for refractive surgery, usage of topical ocular drugs, dry eye and reoperation. Schirmer test was performed pre- and 1, 3 and 6 months postoperatively. The study included 176 eyes of 88 patients [30 male and 58 female] with mean age of 24.7 +/- 3.5 [range 19-34] years. Each group included 44 patients without any statistically significant difference regarding age, sex, mean spherical equivalent and corneal thickness. Mean values of Schirmer test were 13.5 +/- 5.3 mm in the PRK group and 14.5 +/- 7.1 mm in the LASIK group [P=0.08] preoperatively which reached 11.7 +/- 4.2, 12 +/- 4.1 and 12.7 +/- 5 mm in the PRK group and 13.5 +/- 3.6, 14.3 +/- 5 and 14.2 +/- 5.1 mm in the LASIK group at 1, 3 and 6 months postoperatively, respectively [P=0.07, P=0.09 and P=0.17, respectively]. There were 4 cases [4.5%] of dry eye 6 months postoperatively in the LASIK group vs nill in the PRK group [P= 0.04]. Tear secretion decreases following both PRK and LASIK, however it seems to be more severe after LASIK