[Management of a complex strabismus secondary to complicated endoscopic dacryocystorhinostomy]

To report a patient with exotropia due to medial rectus muscle entrapment as a complication of endoscopic dacryocystorhinostomy [EDCR]. A 34-year-old female was referred with left exotropia 18 days after EDCR for treatment of primary nasolacrimal duct obstruction. She had a large angle left exotropia in primary position as well as complete limitation of adduction and partial limitation of abduction in the left eye. Forced duction test was positive in adduction and abduction, and force generation test revealed total paralysis of the left medial rectus. CT scan showed a large fracture of the medial orbital wall in which the medial rectus muscle was entrapped. She underwent the first operation through a medial canthal incision for releasing the entrapped muscle as well as repair of the medial orbital wall defect. After two additional surgeries including medial transposition of vertical rectus muscles and left lateral rectus muscle disinsertion she had 10 PD exotropia and her diplopia disappeared in primary position. In addition the patient had developed optic atrophy and superior arcuate visual field defect in her left eye probably because of intraoperative trauma to the optic nerve after EDCR. To the best of our knowledge, this is the first report of medial rectus entrapment following EDCR. This complication should be kept in mind in the approach to a patient with strabismus following endoscopic sinus and nasal surgeries in order to select appropriate diagnostic and therapeutic measures

[Pyogenic granuloma of the lacrimal sac]

To report a case of free floating pyogenic granuloma within the lacrimal sac. A 13 month old infant with unresolving dacryocystitis and history of two times failed probing and once failed turbinate fracture was scheduled for dacryocystorhinostomy [DCR]. A free floating red mass was removed from the sac. Histopathologic examination confirmed a diagnosis of pyogenic granuloma. Eight months after the operation the patient was asymptomatic. When probing of the lacrimal duct fails to improve its obstruction, in addition to nasal lesions, lacrimal sac masses including pyogenic granuloma must be considered

[Causes of visual impairment among patients referred to rehabilitation clinics of Shahid Beheshti medical university]

To describe causes of low vision and blindness in patients referred for low vision aids to rehabilitation clinics at Shahid Beheshti Medical University during 2005. Visual acuity was classified to five groups based on best-corrected visual acuity [BCVA] in the better eye according to World Health Organization [WHO] criteria and by using standard Snellen chart which included mild, moderate, severe and profound low vision and blindness. The causes of blindness and low vision were determined using the 10[th] version of International Classification of Diseases [ICD-10] based on the main cause in both eyes. The study was performed on 432 patients including 275 [65%] male and 148 [35%] female subjects with mean age of 43.6 +/- 25.5 [range 3-92] years. Mild to moderate and severe low vision and blindness were present in 28.8%, 46.4% and 24.8% of cases, respectively. The main causes of visual impairment were diseases of the retina and choroid [74.5%], optic nerve and optic tract diseases [9.8%], vitreous and globe disorders [3.5%], congenital cataract [3.1%] and glaucoma [2.6%]. The pattern of distribution of the causes was almost similar in all age subgroups. Diseases of the retina and choroid are the main cause of visual impairment among patients referred to eye rehabilitation clinics

[Assessing Iranian ophthalmologists' perception of english language presentations in scientific congresses]

To assess the English language competence of Iranian ophthalmologists and their points of view regarding the need for and importance of holding ophthalmologic congresses in English. A descriptive-analytic, cross sectional study was conducted during the 17th Iranian Ophthalmology Congress, Tehran. Data collection was performed via a standard self administered questionnaire. Five-hundred question forms were distributed among ophthalmologists and answers were graded using an ordinal five-level score. The response rate of this study was 94.6%. The English competence of 200 [42.3%] of the responders was good or perfect. Overall, about 90% of the responders agreed on holding ophthalmologic congresses in English; 72 [15.2%] individuals proposed holding speeches in English at all sessions, 189 [40.0%] preferred holding the main hall speeches in English and 162 [34.2%] said that the best way is to have only foreign guests' speeches in English. Most ophthalmologists implied that holding ophthalmic congresses in English and inviting foreign lecturers is of great importance and the best form of performance is holding all lectures in the main hall in English. It seems that improving the English abilities of ophthalmologist together with holding English congresses and inviting foreign lecturers may help improve international communications and update their knowledge

[Medication error following intraocular surgery at a tertiary eye care center]

To evaluate the incidence of medication error in patients who underwent intraocular surgery based on different methods of drug instruction [hand-written versus orally explained] at Labbafinejad Medical Center. During a 6-month period, we evaluated 204 postoperative patients who underwent cataract or glaucoma surgery. Patients were randomly assigned to two groups; in group I, patients and their attendants received oral and written instruction in addition to the prescription, while the patients and their attendants in group II only received oral instruction besides the prescription. One to 3 days after the operation, the overall incidence of medication errors was determined and compared between the groups using Fisher's exact test. Overall 204 patients including 114 [55.9%] male and 90 [44.1%] female subjects were studied. Mean age of the patients and their attendants was 53.5+22.1 [range 1-90] years and 39.1+12.2 [range 19-79] years, respectively. Actual medication errors occurred in 7 patients including 3 [3%] in the group with written instruction and 4 [3.9%] in the group with oral instruction [P=0.511]. Dispensing errors were the cause in 5 [71.4%] patients including 3 in group I and 2 in group II [P=0.491] but the 2 [28.6%] other cases were due to misconsumption [all in group II]. Overall, 3 medication errors were detected and corrected [intercepted errors] by the patients or their attendants [all in group I] thus; nonintercepted errors were 4 [all in group II]. Cases of actual medication errors were female in 6 [85.7%] and illiterates in 4 [57.1%]. It seems that using a written instruction in addition to the prescription may reduce the incidence of medication errors following ocular surgery

[Early results of autologous cultivated limbal stem cell transplantaion in total limbal stem cell deficiency]

To report the early results of transplantation of autologous limbal stem cell cultivated on amniotic membrane in total limbal stem cell deficiency. Four eye of 4 patients with total unilateral stem cell deficiency secondary to severe chemical or thermal burn included. Stem cell deficiency was confirmed with impression cytology in all cases. Under topical anesthesia, a small limbal sector [1x1 mm] was removed from the sound eye and cultivated on amniotic membrane. Cell expansions were transplanted to the affected eye 2 weeks later. Patients were regularly followed up. At each follow-up visit, corneal eye examination with special attention recurrence or regression of vascularization, corneal pacification, and healing of epithelial defect was performed. Digital imaging was performed at each follow-up visit. Impression cytology was repeated in all cases after surgery. The patients were followed for 5-13 months. Decrease in corneal opacification and vascularization was obvious in 3 cases, in which the surface of the cornea was covered with corneal epithelium. Sectoral conjunctivalization was evident in these 3 cases, but their corneas were ready for corneal transplantation. The procedure failed in one case with total corneal conjunctivalization. Visual acuity improved in all cases. Autologous cultivated stem cell transplantation on amniotic membrane seems to be an effective way for stem cell transplantation. More definite judgment needs longer follow-up together with long-term results of corneal transplantation in these patients

Prevalence and causes of blindness and low vision in Tehran Provisam methodology and implementation program

To describe the methodology and implementation of the investigation for prevakaice causes of visual impairment in Tehran province.This population-based cross-sectional study was conducted on all urban and rural residents of Tehran province in 2003. A stratified cluster random sampling with probability proportional procedure was used. First, best pinhole-corrected visual acuity [BPCVA] was determined habitual visual acuity [VA] by an optometrist. Cases of BPCVA 20/60 in either eye 'awe ophthalmologist for detection of best spectacle-corrected visual acuity [BSCVA] and mail visual impairment [VA< /- 0/60] including low vision [VA< 20/60-20/400] and blindness [VA< according to BPCVA and BSCVA. Epidemiologic aspects and response rates in each phase of the study are presented.Of 13 24% invited subjects, 1 l 975 persons participated in the first step of the stay primary response rate: 90.4%]. Of these, 760 cases [6.3%] with BPCVA /- 50 years. [P<0.001] No children below the age 4 years were referred. The referral rate was not different between male [6.8%] and female [6.0%] subjects. Secondary participation rate was greater in male [85.8%] than female [64.4%] subjects [P<0.001], but there was no difference between rural and urban residents or between the age groups in this aspect. Despite good primary participation rate, the age and sex distribution of the study population was different from the reference population which highlights the need for planning an effective sampling procedure. The prevalence rates should be standardized for age and sex

Prevalence of Keratoconus in patients with Mitral Valve Prolapse

To determine the prevalence of keratoconus [KCN] in patients with mitral valve prolapse [MVP]. This descriptive study was conducted on patients with MVP at Shahid Rajaei Hospital during 2003-2004. Corneal topography was performed in 392 subjects with absolute mitral valve prolapse based on Perloff's major criteria. Orbscan was carried out in suspected KCN cases. Results: Patient consisted of 247 men [63%] and 145 women [37%] with mean age of 37.27 +/- 11.29 years. The diagnosis of two topographically KCN suspect patients was not confirmed with Orbscan. Positive family history of keratoconus in first-degree relatives was found in three patients. No cases of keratoconus were found. This study suggests that the prevalence of KCN in patient's with MVP could be less than previously reported. A large multicenter study is needed to detect the association of these disorders. Genetic studies are suggested

Effect of religious fasting on intraocular pressure in healthy individuals

To evaluate the effects of diurnal fasting during Ramadan on intraocular pressure OOP] in healthy subjects.The study was conducted on healthy male volunteer less than 40 years of age without ocular or systemic diseases who were on religious fasting during Ramadan, 2004. Intraocular pressure were measured at 9 AM and 1, 5, and 7 PM in 2nd and 4th weeks of Ramadan and also one month after Ramadan, except for the 7 PM measurement.Twenty-eight eyes of 14 men were evaluated. Duration of fasting was between i 2-13hours. Mean age was 3 1.9 +/- 4.4 years. Mean weight in the 4th week decreased about 1 kg in comparison to the 2nd week of fasting [P=0.05] and increased about 1.5 kg one month after Ramadan in comparison to the 4th week of fasting [13--- 0.008]. Mean IOP at 9 AM and 1 PM significantly decreased in the 4th week compared to the 2nd week [1.1 and 1.5 mmHg, respectively]. Mean 10P significantly increased one month after Ramadan compared to the 4th week of Ramadan [1.4 and 2.1 mmHg, respectively]. Mean LOP at 5 PM one month after Ramadan had a significant increase of 1.6 and 1.8 mmHg compared to the 2nd and 4th weeks of Ramadan, respectively. Mean IOP at 7 PM [after breaking the fast] decreased 0.5 and 0.6 mmHg in comparison to 5 PM [before the time of breaking the fast] in the 2nd and 4th weeks of Ramadan, respectively.intraocular pressures changes due to fasting in healthy person are not considerable. Evaluating intraocular pressure changes in cases with glaucoma with enough sample size is recommended

[Topographic evaluation in relatives of patients with keratoconus]

To evaluate topographic corneal changes in relatives of patients with keratoconus [KCN]. This study was performed on 300 eyes on 150 relatives of 45 KCN patients. Complete slit lamp examination, refraction, and corneal topography was performed on all eyes. The topographic indices for diagnosis of keratoconus was based on Rabinowitz criteria. The study included 84 [56%] female and 66 [44%] male subjects. Mean age was 32.4 +/- 15 years [range, 16-83]. KCN was detected in 14% of the subjects and 7.3% were diagnosed as KCN suspect. The overall prevalence of astigmatism was 58% including in 42.1% in the KCN group, 66.7% in the KCN suspect group, and 49.6% in the normal group. Thirty one eyes had high regular astigmatism [>1.5 diopters] including, 17 [54.8%] in the KCN group and 14 [45.2%] in the normal group. Oblique astigmatism was seen in 33 eyes [11%] including 34.2% in the KCN group, 47.6% in the KCN suspect group, and 4.6% in the normal group. Relatives of KCN patients have a high prevalence of undiagnosed KCN. Corneal topography is very important for the diagnosis of KCN and KCN suspects in family members of KCN patients. Therefore, keratorefractive surgery should be considered cautiously in these individuals