[ outbreak of nocardia keratitis following photorefractive keratectomy]

To report 3 cases of nocardia keratitis following photorefractive keratectomy [PRK]. Report of Outbreak: Four eyes of 3 patients [2 female and one male] who had undergone PRK by a single surgeon at a single center developed nocardia keartitis 3 to 6 weeks postoperatively. Mean age was 25 [range 23-28] years and mean onset of corneal manifestations was 29 [range 21-40] days after PRK. Corneal smear and culture and confocal scan were performed in all eyes. Two eyes from the first two patients required lamellar keratectomy to debulk the involved stroma and to obtain specimens for microbiologic and histopathologic evaluation. Light microscopic examination disclosed gram-positive and acid-fast filaments of nocardia which were confirmed by the microbiologic results. Diagnosis of nocardia keratitis in the third case was not as challenging as the first two cases because of a high index of suspicion. Confocal scan in all cases disclosed hyperreflective and slender fibril-like structures in the corneal stroma. All eyes responded favourably to topical amikacin and the infection resolved without recurrence. Nocardia is a rare cause of keratitis following PRK. Clinical suspicion along with microbiologic, histopathologic and confocal scanning help to establish the correct diagnosis. The most probable cause of the outbreak was inadequate attention to sterility during surgery

[Evaluation of diurnal variations of intraocular pressure in a normal Iranian population]

To evaluate diurnal variations in intraocular pressure [IOP] in normal adult residents of Yazd city. This cross-sectional study was performed on 800 eyes of 400 subjects aged between 20-80 years selected by cluster random sampling from residents of Yazd city during 2004-2005. IOP was measured by Goldman applanation tonometer in the morning [8-9 AM] and evening [8-9 PM]. The difference between the two measurements was considered as diurnal variation of IOP. Mean IOP was 14.80 +/- 1.83 mmHg in the morning and 11.58 +/- 2.0 mmHg in the evening in right eyes and 14.79 +/- 1.89 mmHg in the morning and 11.33 +/- 2.0 mmHg in the evening in left eyes [P< 0.001]. Mean diurnal variation of IOP was 3.23 +/- 1.23 mmHg in females, 3.46 +/- 1.23 mmHg in males and 3.34 +/- 1.05 mmHg, overall [P< 0.001]. Morning IOP was higher in 84%, the same in 13.6% and lower in 2.4% compared to evening values. IOP increased with aging. There was no significant difference in mean IOP between males and females. This study revealed that IOP is usually higher in the morning in both eyes and increases with ageing in both sexes

[Prevalence and causes of low vision and blindness in the blind population supported by the Yazd Welfare Organization]

In 1995, the World Health Organization [WHO] estimated that there were 37.1 million blind people worldwide. It has subsequently been reported that 110 million people have severely impaired vision, hence are at great risk of becoming blind. Watkins predicted an annual increase of about two million blind worldwide. This study was designed to investigate the causes of blindness and low vision in the blind population supported by the welfare organization of Yazd, Iran. This clinical descriptive cross-sectional study was done from January to September, 2003. In total, 109 blind patients supported by the welfare organization were included in this study. All data was collected by standard methods using questionnaire, interview and specific examination. The data included; demographic characteristics, clinical states, ophthalmic examination, family history and the available prenatal information. The data were analyzed by SPSS software and chi square test. of total patients, 73 cases were male [67%] and 36 were female [33%]. The median age was 24.6 years [range one month to 60 years]. More than half of the cases [53.2%] could be diagnosed in children less than one year of age. In total, 79 patients [88.1%] were legally blind of which 23 cases [29.1%] had no light perception [NLP]. The most common causes of blindness were retinitis pigmentosa [32.1%] followed by ocular dysgenesis [16.5%]. Our data showed that more than half of the blindness cases occur during the first year of life. The most common cause of blindness was retinitis pigmentosa followed by ocular dysgenesis, cataract and glaucoma, respectively

Clinical survey of ocular findings in patients with grave's disease

Grave's disease is an autoimmune process manifested by three hallmarks: hyper-thyroidism with diffuse goiter, ophthalmopathy and dermopathy. This disease usually occurs with hyper thyroidism; although the may be euthyroidism. To evaluate the ophthalmic lesion in patients with grave's disease according to sex, age, and the duration of the illness as well as the treatment. Ninety five patients [62% females and 38% males] with grave's disease were included in this study. The subjects underwent a complete ophthalmic examination and the results were recorded. The elevation of IOP and chemosis were significantly higher in males than in females. The prevalence of ophthalmopathy was 60%, and most common ophthalmic signs were proptosis and lid retraction. Eyes lesions were more frequent among 50-70 years old patients. In addition, chemosis, periorbital edema, corneal sensitivity secondary to dry eye, convergence insufficiency, diplopia and proptosis were positively correlated with age. Initially, ophthalmic complains were only given by 15% of the subjects. Lid retraction was decreased with prolonged duration of disease whereas chemosis, conjunctival congestion, and extra-ocular muscle enlargements were increased. Grave's ophthalmopathy was found mostly in males and proptosis with lid retractions were the most important signs of the disease.

Indications and outcome of penetrating keratoplasy in Yazd

Penetrating keratoplasty [PK] is the most common tissue transplant. The indications for penetrating keratoplasty [PK] vary in different regions of the world. To determine the indications for PK and visual outcome in a primary referral center for a period of 8 years. This was a retrospective chart review of all patients who underwent penetrating keratoplasty at Shaheed Sadoughi University Eye Hospital from March 20, 1997 to April 20, 2005. From 286 procedures performed in this period, 255 records were available for evaluation. The data were analyzed regarding sex, age indication, visual outcome and rejection. The study group included 255 patients from which 141 [55.3%] were males and 114 [44.7%] females. The mean age of the patients was 59.2+19 [with a range of 5-82] years. The frequencies of leading indications for penetrating keratoplasty were as follows: keratoconus [32.9%], pseudophakic and aphakic bullous keratopathy [21.7%], corneal scar [14.1%], corneal dystrophy [11%], regrafts [10.2%] and corneal ulcer/perforation [4.7%].Other indications represented only 5.4% of the cases. Gender difference [M/F] ratio was significant for keratoconus. The average age of keratoconus group was significantly low [23.5+1.7] compared with other diagnostic group [P=0.00]. Grafts carried out for keratoconus group were indicative of better visual outcome than grafts performed for other corneal pathologies. A large number of keratoconus patients [71.4%] achieved BCVA of 20/40 or higher at final follow up. Keratoconus remains the leading indication for corneal transplantation in our institution followed by PBK/ ABK

Regression after LASIK in high myopic patients

Regression is one of the complications, which may occur following LASIK eye surgery in high myopic patients. To determine the degree of regression after LASIK in high myopic eyes. This interventional longitudinal study was performed on 34 eyes in 20 patients who underwent LASIK. The range of preoperative refraction errors was -6.12 to -22.00 Diopter. LASIK was performed using Moria microkeratome to create a 9 mm diameter, 160 microns thick flap. Preoperative and four consecutive cycloplegic refractions were carried out using recommended standards. The maximum follow up was after 6 months. Considering all patients, mean preoperative refraction was -10.58 D which decreased to -0.51 +/- 1.33 D a week following surgery. Mean cycloplegic refraction was - 0.98 +/- 1.33 D, -1.21 +/- 1.81 D and -1.42 +/- 1.87 D, respectively, which was recorded at 1,3 and 6 months postoperatively. Maximum regression occurred 6 months after the surgery [0.9 +/- 0.8 D [8.5%]]. Factors associated with regression included preoperative keratometry [P=0.013] and correction rate [P<0.001]. The degree of regression after LASIK in high myopia was related to preoperative keratometry and correction rate

Evaluation of keratoconus by videokeratography in subjects with vernal keratoconjunctivitis [VKC]

To assess demographic variables and the incidence of keratoconus in patients with VKC and to evaluate the characteristics of Vernal Keratoconjunctivitis [VKC] associated with keratoconus. One hundred and fifty patients with VKC were studied at Ophthalmology Department of Shaheed Sadoughi medical center between October 2004 and June 2005. Both eyes of VKC patients were evaluated by Orbscan topography for the diagnosis of keratoconus. Corneal topography maps were examined with modified Robinowitz-McDonnell test. The characteristics of VKC were recorded in keratoconus patients. The study included 93 male and 57 female subjects. The patients mean age was 13.07 ' 4.71 [range 8-24] years. The clinical forms of VKC were as follows: 45.2% mixed, 38% palpebral and 16.7% limbal types. Fifty four [36%] of 150 subjects with VKC had complications of pseudogerontoxon, punctate keratitis and shield ulcer. Eightyfour eyes [42 subjects] of 150 patients with VKC were detected as having keratoconus by videokeratography maps [28%]. There were 27 males and 15 females in keratoconus group. 16.7% of the eyes had mild, 33.3% had moderate and 50% had severe keratoconus. Eyes with severe keratoconus presented at younger age [12.7 +/- 3.35 years] than moderate keratoconus [18.3 +/- 2.15 years]. Keratoconus was more common in male gender, long-standing disease, mixed and palpebral VKC. Screening of keratoconus subjects with corneal topography allows early detection and management of keratoconus. The higher incidence of keratoconus in our study is due to videokeratography study of early keratoconus

[Ocular injuries occurring in motor vehicular accident victims, Yazd province]

Motor vehicular accidents are one of the leading causes of death in young men and severe complications in all age groups. This study was carried out to evaluate eye injuries secondary to motor vehicular accidents that have a high rate of occurrence in Yazd province. This descriptive, cross- sectional study was conducted through case series method. Simple sampling, i.e. census from the under study population was performed to complete the sample number. The study was carried out in 1383 on 126 motorcycle accident cases with eye injuries referred to the Kalantari Emergency Department. Data collected from questionnaires was analyzed by SPSS software using chi-square, Fisher and Variance analysis statistical tests. Of the 126 cases, 124 [98.4%] were male and 2 [1.6%] were female. The mean age of the patients was 27.4 [SD=13.7] ranging between 5 months and 81 years. The highest rate of accidents was between cars and motor cycles; 83 cases [65.9%] and most of them [76.2%] were in the city. The most frequent eye injury was sub conjunctival hemorrhage in 112 cases [44.4%] followed by eyelids injury [Right side 64 cases [50.8%] and left side in 55 cases [43.6%]], orbital injury in 57 cases [22.6%] of which 39 cases [68.4%] had periorbital hematoma and 18 cases [31.6%] had an orbital fracture, 20 cases [7.9%] had ocular movement limitation and lacrimal drainage system injury was seen in 13 cases [5.2%]. Those with helmets had more mandibular fractures [p=0.0001]. The victims of motor vehicular accidents in our study were young men. The most frequent eye injuries were sub conjunctival hemorrhage, eyelid, orbital and lacrimal system injuries

[Three cases of Acanthamoeba keratitis [AK] in Yazd]

Acanthamoeba keratitis is a vision- threatening infection and the most important risk factors are contact lenses Characteristic symptoms include disproportionately severe ocular pain, epithelial ulcer, ring stromal infiltrate and resistance to antimicrobial treatment. The aim is to report the first cases of Acanthamoeba keratitis in Yazd in a retrospective study confirmed on histopathological and confocal microscopy. All of our patients used soft contact lenses and were women. The age range was between 20-29 years. One eye was`misdiagnosed as herpes simplex keratitis and two were misdiagnosed as bacterial keratitis. A delayed visit as well as a late diagnosis led to the advanced stage of eye disease. Improvement in visual acuity following medical therapy was seen in two patients and one patient needed urgent keratoplasty for corneal necrosis A prompt clinical and laboratory diagnosis along with treatment with propamidine- isentionate resulted in significant improvement of eye condition Failure to disinfect contact lenses and introduction of tap water rinsing of storage cases were associated with increased risk of Acanthamoeba infection. Penetrating keratoplasty is an effective treatment for medically unresponsive acanthamoeba keratitis. Confocal microscopy is the most effective and a fast diagnostic tool because it ensures the detection of acanthamebic cysts and trophozoids in corneal stroma

[ case report of unilateral severe visual loss along with bilateral optic disc cupping secondary to metastatic brain tumor]

To report a case of unilateral severe visual loss and bilateral optic disc cupping secondary to brain metastasis of bronchogenic carcinoma. A 48 year-old woman presented with severe visual loss of left eye without redness or pain or any systemic findings .Clinical findings included decreased visual acuity of left eye to 4 m CF and [+3] positive Marcus-Gunn reflex .There was asymmetric optic disc cupping associated with visual field defect in left eye The neurologic investigations showed a secondary metastatic tumor in the brain from bronchogenic carcinoma. Before making a diagnosis of normal -tension glaucoma in asymmetric optic disc cupping and normal intraocular pressure, ophthalmologists should rule out neurologic defects and brain tumors

Outcomes of external Dacryocystorhinostomy

To evaluate the outocmes and complications of dacryocystorhinostomy [DCR] in the ophthalmic centers of Yazd Medical Sciences University, Yazd, Iran. The outcomes of external DCR [EX-DCR] operation on 187 patients were evaluated. Patients were selected consecutively.Overall success rate was 90.4% [CI 95%; 86.3 - 94.5%]. Success rate was 90.9% in females and 89.1% in males [P= 0.543]. Regarding DCR method, success rate was 96.3% with silastic intubation and 88% without it [P= 0.08]. The more frequent and important complications of DCR were failure of treatment and recurrence of epiphora and purulent discharge [9.6%], unusual scar [8.6%], and infection [5.3%]. No major complications occurred during operation.External DCR is a relatively easy technique with a success rate of more than 90% with few complications. The procedure can be done in most ophthalmic centers

Double masked randomized clinical trial comparing Latanoprost with Timolol in open angle glaucoma

To Compare the efficacy and safety of latanoprost once a day with timolol administered twice a day in patients with open angle glaucoma. In this six month double masked randomized clinical trial, 80 patients with primary open angle glaucoma were divided randomly for treatment to either 0.005% latanoprost once a day [n = 40] or 0.5% timolol twice a day [n = 40]. Intraocular pressure was measured, and efficacy was based on intraocular pressure reduction from baseline. Through the day the mean IOP was significantly lower with latanoprost than with timolol. Diurnal IOP [10:00 AM, 4:00 PM, 8:00PM] was reduced from 26.2 to 16.9 mmHg with latanoprost and from 25.8 to 17.4 mmHg with timolol at the end of the 6-month treatment period. Mean IOP reduction ranged from 7.8 to 8.2 mmHg in 35.2% of the latanoprost group and from 6.3 to 6.8 mmHg in 33.9% of the timolol group. Significantly higher percentage of patients had low IOP levels with latanoprost than timolol [P < 0.001]. The decrease from baseline lOP was up to 8.2 mmHg in latanoprost group compared to 6.2 mmHg in timolol group. Latanoprost caused more conjunctival hyperemia than timolol. Timolol caused more systemic side effects than latanoprost. There were greater mean and peak TOP reductions achieved with 0.005% latanoprost QD compared with 0.5% timolol. BID. Latanoprost must be considered a new first-line drug for glaucoma

prevalence of hypertensive retinopathy in referral patients to hospitals of Yazd

With Hypertension this clinical situation is the target organs including eye complications. The hypertensive vasculopathy can be directly identified on the retinal vessels by ophthalmoscopy. To determine the prevalence rate of hypertensive retinopathy in high blood pressure patients. 213 patients with hypertension were examined to determine the ophthalmologic stages of their retinopathy. In this study 213 hypertensive patients [95 males and 118 females] in age range of 25-85 years old [mean age: 64.47 +/- 10.26 years], mean duration of diagnosed hypertension 7.82 +/- 6.26 years and mean duration of medical treatment 7.32 +/- 5.46 years were evaluated. 39.9% of patients had hypertensive retinopathy which was more common in women [45.8%] than in men [33%]. 47.8% of patients with positive family history and 31% with negative family history of hypertension showed hypertensive retinopathy. 25.3% of patients with mild hypertension [HTN], 34.5% with moderate HTN and 84.6% with severe HTN suffered from hypertensive retinopathy. 42.36% of patients with hypertensive retinopathy were classified as grade I, 35.29% as grade II, 20% as grade III and 2.35% as grade IV. The most common ophthalmoscopic findings in hypertensive retinopathy were: arteriole narrowing [35.13%], AV nicking [17.12%] and cotton wool patch [9%]. Early diagnosis and control of high blood pressure prevents ocular and other target organ hypertension complications. Positive family history of hypertension and also hypertensive complications of target organs especially cerebrovascular are risk factors for hypertensive retinopathy

Use of inhaled corticosteroids and risk of cataracts: a case-control study

Exposure to systemic corticosteroids is known to be associated with a risk of cataract. This study was undertaken to determine the risk of cataract associated with the use of inhaled corticosteroids in old age. A case-control study consisting of 160 people with cataract [case] and 160 controls matched for age and sex was conducted at Shaheed Sadoughi and Shaheed Rahnemoon hospitals of Yazd. Data gathered via a questionnaire and interview and analyzed by SPSS, Chi Square and ANOVA tests. There was no difference in age and sex between the two groups of case and control. In case group, 22 [13.8%] and in control group 11 [6.9%] persons [total of 33 patients] used inhaled corticosteroids that was statistically significant [P-Value=0.042]. The odds ratio for the association between inhaled corticosteroids and cataract was 2.16 [95% CI 1.01 to 4.61]. After adjustment for systemic corticosteroid exposure, the Odds ratio rose to 4.73 [95% CI 1.51 to 14.82]. The association was stronger with increase in duration of use. This case-control study showed an association between use of inhaled corticosteroids and increased risk of cataract, especially the posterior sub capsular type. But, in order to confirm these findings, other studies including experimental ones and similar groups in respect to other risk factors of cataract are needed

Comparison of efficacy and safety of topical Ketotifen [Zaditen] with cromolyn sodium in the treatment of vernal keratoconjunctivitis

This study compared the efficacy of Ketotifen fumarate.025% [Zaditen] with Cromolyn sodium 4% [Opticrom] eye drops in prevention of itching, tearing, and redness in Vernal Keratoconjunctivitis [VKC]. This double blind randomized single center clinical trial conducted between April and August 2004 in Yazd. One hundred eligible patients with clinical diagnosis of moderate VKC were randomly prescribed Zaditen [group A: n=50] and Cromolyn sodium [group B: n=50] eye drops for a 4 weeks period. Itching, lacrimation, redness, and hotophobia were scored on a 4-points severity scale. After 7 days of treatment, the response rates based on subjects assessment of global efficacy was significantly greater in Ketotifen group [61.5%] than in Cromolyn group[53%].A clear response to treatment occurred in 94.4 of Zaditen and 81.2% of Sodium Cromoglycate treated patients. The investigator,s assessment of response rates also showed that Ketotifen was superior to Cromolyn sodium [P=0.001]. Ketotifen produced a significantly better outcome than Cromolyn for relief of signs and symptoms of VKC [P<0.05]. Ketotifen fumarate treatment significantly reduced the total signs and symptoms score for each patients, in compare with day 0. Ketotifen had a faster onset of action and provided better symptom relief than Cromolyn. The rapid onset of action and symptom control, make Zaditen a valuable treatment for VKC

Vitamin C concentration of Aqueous humor in senile cataract

Oxidative agents like ultraviolet are one of the important cause of cataract and vitamin C is an important water soluble antioxidant agent in the aqueous humor. This study aimed to evaluate the concentration of vitamin C in the aqueous and plasma of patients with senile cataract. In a descriptive cross- sectional study on 85 patients [41 men and 44 women] admitted for cataract surgery, aqueous [0.2 ml] and blood [5ml] were sampled just before operation under general anesthesia from anterior chamber and vein, respectively. Spectrophotometer measured the concentration of vitamin C in both samples. The mean age was 64.3 +/- 11.1 years. Aqueous and plasma concentration of vitamin C was 4.29 +/- 1.11 mg/dl and 0.77 +/- 0.0332 mg/dl, respectively. The differences were statistical significant [P almost equal to 0]. Vitamin C of aqueous were equal in both sexes, but vitamin C of plasma in women were higher than men [P= 0.043]. The concentration of vitamin C showed no relation to the type of cataract. Vitamin C of aqueous and plasma in senile cataract are lower than normal. More study is recommended for evaluating preventive effect of high vitamin C diets or supplements

Outcome of corneal scleral laceration in Yazd

The aim of this study is to define the epidemiologic characteristics and clinical profile and evaluation of final visual outcome of corneal scleral laceration. A prospective survey was conducted over a two year period from March 2000 to March 2002 on 79 consecutively admitted patients who underwent corneal scleral repairment at Yazd Eye Hospitals. This study included 79 eye injuries. Fifty nine of cases [74.7%] occurred in males and 20 cases [25.3%] in females. Mean age was 17.08 years. Left eye was more commonly involved [57%]. Initial VA was an important predictor of final VA. Good initial VA > 20/200 leading to excellent final VA. 40.6% of traumas occurred in the first decade of life. Injuries less than 10 mm and related to zone I and II predicted a good visual outcome. In this study endophthalmitis [5.1%] was much less likely to develop in eyes with primary repairment within 24 hours from the injury [1.5%] than in eyes being repaired after 24 hours [21.4%] and the difference was significant [P==0.016]. Significant predictive factors for final VA after corneal scleral injury include: initial VA, wound length, wound and location,, and the time of primary repair

Evaluation of vitamin C concentration of aqueous humor in senile cataract

Senile cataract is one of the most important preventable causes of blindness. Oxidative agents like ultraviolet [UV] are one of the most important causes of cataract. Vitamin C is an important water soluble antioxidant agent in the aqueous humor. In a cross-sectional study, 85 patients admitted to Rah-Ahan Eye Hospital for cataract surgery were evaluated. The mean age of the patients was 64.3 +/- 1.2 yr of the 85 patients, 41 were men and 44 were women. Under general anesthesia 0.2 cc of aqueous humor from anterior chamber and 5 cc of peripheral blood were taken just before operation. Concentration of vitamin C was measured in these samples and the data was analyzed by SPSS statistical program. Mean concentration of vitamin C was 4.29 +/- 0.12 mg/dl [mean +/- SE] in the aqueous and 0.77 +/- 0.036 mg/dL in the plasma. The differences were statistically significant when compared with normal values. P 0.000 in both conditions. Vitamin C concentrations of aqueous humor were equal in both sexes, but vitamin C concentrations of plasma in women were higher than men [p=0.043]. The concentration of vitamin C was not related to the type of cataract or job of patients. Since vitamin C concentration of aqueous humor and plasma in senile cataract are lower than normal, it is better to advise fresh vegetables and fruits or other supplements to patients who are at risk of senile cataract