[Ocular trauma in subjects older than 60 years]

To evaluate the demographic data, mechanisms of injury and complications of ocular trauma in patients over 60 year of age. We retrospectively reviewed the medical records of 91 patients older than 60 who were admitted and treated in the Ophthalmology Department of Khalili Hospital, between September 2002 and November 2008, due to ocular trauma. Data were retrieved from admission charts including demographic information, mechanisms of injury, site of penetrating or perforating trauma, associated injuries such as endophthalmitis and intraocular foreign bodies, complications of trauma, the time interval between trauma and referral to our center and the initial visual acuities. X2 analysis were performed using SPSS 11.5 program to analyze the data. Patient age ranged from 60 to 87 years with mean [ +/- SD] of 69.6 [ +/- 7.8] years. 11 patients [21.1%] were monocular. 61 patients [67%] belonged to rural and 30 patients [33%] were from urban areas. Mean [ +/- SD] time interval from trauma to referral was 102 [ +/- 130] hours [range: 1 to 480 hours]. The most common mechanisms of trauma were trauma with tree spines [24.2%], sharp trauma with wood [22%], blunt trauma with wood [11%], blunt trauma with hand [11%] and falling down [9.9%]. Three patients had intraocular foreign bodies and 14 eyes [15.4%] were complicated by endophthalmitis. The most common complications of trauma were corneal ulcer [27.5%], surgical wound dehiscence [22%] and corneal laceration [22%]. There was significant correlation between corneal ulcer and also surgical wound dehiscence and profound visual loss. There was also significant correlation between referral later than 48 hours and profound visual loss. The results of this study provide some information about elderly eye trauma. These results may be valuable in planning, education, prevention programs and surveillance of this susceptible population of the community

[Advanced retinopathy of prematurity at poostchi ROP clinic, Shiraz]

To evaluate patients with advanced retinopathy of prematurity [ROP] among neonates referred to Poostchi ROP clinic in Shiraz from March 2006 to February 2008. Among referred infants to Poostchi clinic for screening and management of ROP, medical records of patients with advanced ROP [stage 5] at initial examination or during disease progression were evaluated. Information regarding gestational age, time of diagnosis, follow-up programs and causes of delayed screening were recorded. Overall, 20 patients [11 male, 9 female] out of 1024 reffered neonates had advanced ROP which was unilateral in 3 [15%] and bilateral in 17 [85%] patients. Advanced ROP was due to late diagnosis and treatment in 17 [85%] patients and treatment failure in 3 [15%] patients. Main causes of delayed diagnosis were uninformed parents in 10 [50%] patients, misdiagnosis by an ophthalmologist in 3 [15%] patients, socioeconomic problems and parental ignorance in 3 [15%] patients and poor systemic condition of the neonate in 1 [5%] patient. The main cause of visual loss due to advanced ROP is uninformed parents and health care providers as well as absence of an organized screening program

Headache as the main presenting symptom of iritis

Headache is one of the most common outpatient pain conditions encountered in both the private practice and emergency departments. Recognition of serious causes of headache requires a standardized diagnostic approach to history and examination. We will report a patient with iritis associated with elevated intraocular pressure [IOP] that presented with severe sudden onset headache mimicking intracranial hemorrhage. A 60-year old man, a known case of non-insulin dependent diabetes mellitus, referred to the emergency room due to severe, sudden onset of headache associated with nausea without any complaint of ocular problem except mild redness of the left eye. Considering subarachnoid hemorrhage subsequent work ups including brain CT scan and lumbar puncture were performed which proved to be inconclusive. The intraocular pressure [IOP] of the left eye was 50 mmHg and there was significant cell and flare in the anterior chamber. IOP was controlled by administration of intravenous manitol, topical antiglaucoma medications and steroid eye drops. The symptoms were relieved within a few days. This manuscript propounds the importance of the awareness of the possibility of serious headache as the presentation of ocular problems

Evaluation of stereo tests for screening of amblyopia

One of the most dramatic sensory ocular anomalies is the low visual acuity of one eye known as amblyopia. The goal of preschool vision screening is to detect children with amblyopia. Stereopsis is an important indicator of the state of binocularity. Previous studies showed a disagreement on the reliability of stereo tests as screening tools for amblyopia. This study was performed to compare visual acuity testing with the ability of TNO, Titmus and Randot stereo tests for detection of amblyopia. A total of 1000 pupils, aged 6-12 years were examined in a field study in Shiraz. In addition to the 3 stereo tests of TNO, Titmus and Randot, the examination included visual acuity, cover testing and inspection of red reflex. According to definite fail pass criteria, abnormal cases were referred to pediatric eye clinic for complete eye physical examination. Similar to the first part, in the second part of the study, 100 amblyopic students aged 6-12 years, were referred to pediatric eye clinic for complete physical examination. Sensitivity and specificity of each stereo test for detection of amblyopia was calculated. In screening situation, the sensitivity of stereo tests was 55.5% for TNO with a cutoff point of 240", 48.8% for Titmus with a cutoff point of 70" and 44.4% for Randot stereo test with cutoff point of 100". Specificity of these tests in screening situation was 86.9%, 94.4%, and 98.4% respectively. The respective sensitivity of these stereo tests in clinical situation was 74%, 68%, and 62%. Considering these fail-pass criteria, none of the TNO, Titmus, and Randot stereo tests can be recommended as a screening method for detection of amblyopia in children

Fine needle aspiration cytology of intraocular, orbital and eyelid lesions

Fine-Needle Aspiration Cytology [FNAC] is used for diagnosis of intraocular, orbital and eyelid lesions. In this study we evaluated the outcome and the accuracy of using this technique in diagnosis of benign or malignant behavior of lesions. FNAC was performed on 26 specimens obtained from 25 patients with intraocular, orbital and eyelid tumors and the results were compared with the histopathologic findings in a prospective double-blind observational study. In 22 specimens [85%] a concordant definitive diagnosis was established that comprised five retinoblastoma, four basal cell carcinomas, four inflammations and two dermoid cysts. All specimens were diagnosed as benign or malignant with reasonable concordance. Definitive cytologic diagnosis was also made in two rare, if ever reported, conditions namely orbital fibrous histiocytoma and eyelid leishmaniasis. FNAC seems to be a simple, rapid, relatively safe and cost-effective technique with considerable diagnostic value in the assessment of selected ophthalmic lesions, especially when sampling and interpretation are performed by experienced personnel

LASIK after Sclera! buckling surgery

To compare the safety, efficacy, and visual results of laser in situ keratomileusis [LASIK] in eyes with and without previous scleral buckling surgery in the same individuals.In a prospective clinical trial, 14 eyes of 7 patients with myopic refractive error and history of sclera] buckling in one eye, underwent LASIK surgery in both eyes according to a standard surgical protocol. Uncorrected visual acuity [UCVA], best corrected visual acuity [BCVA], refraction, Orbscan topography, and pachymetry were recorded 1, 3, 6, and 12 months after LASIK. Eyes with previous scleral buckling were named RD group and the fellow eyes without any previous ocular surgery were named non-RD group. LASIK was performed without any complication. No patient developed a new RD or significant vitreoretinal changes during one year of follow-up. There was no decrease in BCVA in any of the eyes. In the RD group, mean spherical equivalent [MSE] before LASIK was -7.67 D and '.4.-as reduced to -0.17, -0.87, -1.37, and -1.89 D at 1, 3, 6, and 12 months after LASIK, respectively. In the non-RD group, MSE before LASIK was -5.25 D which was reduced to +0.05, -0_17. -0_37. and -0.57 D - at 1. 3, 6, and 12 months after LASIK, respectively. Differences between the two eroups were statistically significant at 3, 6, and, 12 months after operation. Myopic regression between 1 and 12 months after LASIK in the RD group [-1.71 D] was greater than the non-RD group [-0.62 D]. [P=0.019] Mean increase in central corneal thickness during this period had no significant difference between the two groups. Corneal power increase in the RD group [2.44 D] was more than the non-RD group [1.01 D]. [P=0.00I] LASIK may be considered for treatment of myopia in eyes with previous RD surgery. Although it seems to be safe in these eyes, it is not as effective as LASIK in eyes without previous RD surgery. Myopic regression seems to be more pronounced in these eyes

[Ocular ultrasonography in prediction of deep vitrectomy findings]

To determine the sensivity and specifity of ocular ultrasonography in detecting vitreoretinal lesion prior to deep vitrectomy in patients with opaque media. The hospital records of patients undergoing deep vitrectomy in a defined period at Shiraz Khalili hospital were reviewed. Sonographic reports given by a sinologist and operation reports given by a vitreoretinal fellowship were compared regarding significant clinical problems in five groups: intraocular foreign bodies, retinal detachment, choroidal detachment, posterior globe rupture, and significant vitreous opacities. From 42 sonographic reports, sensitivity of sonography was 100% for detection of vitreous opacity, posterior globe rupture, and intraocular foreign bodies; 90% for retinal detachment; and 71.4% for choroidal detachment. The specificity of sonography for all of the above mentioned pathologies was over 80% except for determination of significant vitreous opacities that was 71.4%. In this five group of vitreoretinal lesions, sonographic reports were accurate and were reliable for surgical planning and decision making in our setting

[Evaluation of Jensen procedure in patients with complete sixth nerve palsy]

To evaluate the results of Jensen procedure in correction of ocular deviation in patients with complete sixth nerve palsy. Hospital records of patients with complete sixth nerve palsy who underwent Jensen procedure at Khalili Hospital of Shiraz during 1993-2002 were studied and results of the operation were evaluated. Of 18 patients including 14 male and 4 females, 19 eyes were operated on. Cause of the condition was head trauma in 83.5% of the patients. Average horizontal deviation in primary position was 48 prism diopter esotropia before and 2.6 esotropia after the operation. After the procedure, 78% of the patients had

Nd: YAG laser treatment for premacular hemorrhage

To investigate the effects of drainage of premacular subhyaloid hemorrhage into the vitreous with Nd: YAG laser in 13 eyes of 12 patients in a 3 months followup period. This study was conducted from January 2001 to December 2001. Thirteen eyes of 12 patients had a circumscribed premacular hemorrhage and were treated with Nd: YAG laser to drain the blood into the vitreous cavity. The hemorrhage originated from diabetic retinopathy [8 eyes], retinal macroaneurysm [2 eyes], AML [2 eyes] and branch retinal vein occlusion [1 eye]. The size of the hemorrhage was expressed in disc diameters. Success of laser application was defined as clearing of premacular hemorrhage within 3 months. By this definition drainage of premacular subhyaloid hemorrhage into the vitreous with Nd: YAG laser succeeded within three months is eleven, out of thirteen eyes treated without requiring further membranotomy. One eye had persistent, dense nonclearing vitreous opacity for at least 3 months. One clotted hemorrhage did not drain into the vitreous. Overall visual improvement was best in eyes with AML and macroaneurysm. During the follow-up, neither macular epiretinal membranes nor tractional retinal detachments occurred in any eye. Drainage of premacular subhyaloid hemorrhage into the vitreous with Nd: YAG laser is a viable alternative treatment alternative for eyes with recent bleeding. However, to establish Nd: YAG laser treatment as a routine procedure, the risk and benefits have to be weighed in randomized trials and compared with those deferral of treatment or primary vitrectomy

[Tear secretion before and after cyclosporine administration in kidney transplantation recipients]

Purpose: to determine tear secretion changes after prescribing cyclosporine as an immunosuppressive agent in patients receiving allograft kidney transplantation

Methods: patients with end stage renal failure who underwent kidney transplantation at Namazi Hospital, Shiraz, from September 2000 to January 2001were included in the study. Shirmer II test [4 minutes] using local anesthesia was performed in both eyes before and 3 times after receiving cyclosporine

Results: fifteen patients [8 males and 7 females] with mean age of 32.2k2.96 years were evaluated. Tear secretion increased from 18.8350.953 md4 min [measured 1-7 days before prescribing cyclosporine] to 28.433 +/- 1.564,28.633 +/- 1.267, and 28.467 +/- 1.369 mm/4min at 1, 3, and 5 months after prescribing cyclosporine, respectively [P<0.001]

Conclusion: there was a statistically significant increase in tear secretion of patients receiving kidney transplantation and systemic cyclosporine as an immunosuppressive agent. Increased tear secretion continued during 6 months follow up and can be considered as a favorable side effect of cyclosporine. The increased tear secretion was also observed in patients with normal levels of tear secretion

[Correlation between refractive error and stereoacuity]

Purpose: to assess the correlation between refractive error and stereoacuity in school children

Methods: in this correlational study, 202 children with normal visual acuity and 104 children with refractive error and without amblyopia [90 myopic, 4 hyperopic, 4 astigmatic, and 4 anisometropes] were included. All children were in 7-12 years age group and sex distribution was equal in two groups. Stereoacuity was measured for each child with the Titmus test at 40 cm distance. In children with refractive error, stereoacuity measurement was repeated after correction of the refractive error with spectacles

Results: mean stereoacuity in the control group and in children with refractive errors before and after correction with spectacle were 43, 96, and 45 seconds of arc, respectively. Mean stereoacuity in children with refractive error before correction with spectacle was less than the control group [P<0.0001]. After correction of the refractive error with spectacle the difference was not statistically significant. Correction of refractive error with spectacle resulted in improved stereoacuity to normal values in all types of refractive errors except anisometropia. There was no significant linear relationship between visual acuity of the worse eye and stereoacuity in children with refractive errors [r= -0.12, P= 0.23]

Conclusion: uncorrected refractive errors especially anisometropia can significantly decrease stereoacuity in children. Stereoacuity tests may be used for screening of refractive errors in children

[Scleral buckling with and without retinopexy for rhegmatogenous retinal detachment]

Purpose: to compare the anatomical results of scleral buckling with or without retinopexy and to assess the effect of retinopexy on outcomes of the operation

Methods: this interventional case series was performed on 22 patients undergoing scleral buckling [segmental or encircling] with or without subretinal fluid drainage and without any type of retinopexy and 33 patients who received transscleral retinal cryopexy around retinal break[s] in addition to above procedure. The two groups were matched regarding age, sex, myopia, aphakia, and number, size, and location of the break[s] and also stage of proliferative vitreoretinopathy [PVR]

Results: in the non-retinopexy group, 19 patients [86.4%] had complete and 1 patient had partial retinal attachment after 10-24 months of follow up. The cause of failure in two cases was missed breaks out of the buckle area in one and PVR in the other patient. Overall success rate was 90.9% [20 of 22] in this group. In the retinal cryopexy group, 26 patients [78.9%] had complete and 2 had partial attachment after 11-32 months of follow up. Attachment was not achieved in 3 patients and 2 patients developed redetachment 1 and 3 months later because of PVR. Overall success rate was 84.8% [28 of 33]. The anatomical results in this two groups were comparable statistically [P=0.9]

Conclusion: with permanent scleral buckling technique, retinal cryopexy does not seem to increase success rate defined as short term anatomical retinal reattachment

Primary malignant melanoma of eye in a 17 - ytear - old girl with acute lymphoblastic leukemia

Herein we describe a case of intraocular melanoma in a17-year old leukemic patient. The history, histological findings of the enucleated eye, blood and bone marrow of the patient were investigated. The enucleated eye contained epitheloid cell type melanoma instead of leukemic cell infiltration. We conclude that intraocular malignant melanoma can occur in acute lymphoblastic leukemia