[Histopathologic evaluation of trabeculectomy specimens and surgical results in patients with chronic primary glaucoma]

To evaluate the histopathologic features of trabeculectomy specimens and the results of trabeculectomy in relation with these features in patients with chronic primary glaucoma. This interventional case series included 30 eyes of 28 patients with primary chronic glaucoma who underwent trabeculectomy between 2004 and 2006. Each case was followed for 6 months postoperatively. Histopathologic features and results of surgery were evaluated. The surgery considered as successful when resulted in intraocular pressure [IOP] <21 mmHg without antigiancoma medication and as failed when resulted in IOP of > 21 mmHg and need to anti-glaucoma agent. Mean age of patients was 59 [range 20 to 90] years and 18 patients [64.3%] were male. Seventeen patients had chronic primary open angle glaucoma and 11 had primary chronic closed angle glaucoma. The operation was performed as fornix-based method in 16 eyes and limbal-based in 14. The surgery was successful in 26 [86.7%] and failed in 4 [13.3%]. The content of trabeculectomy specimens in the successful cases included trabecular meshwork in 15 [57.7%], only scleral in 6 [23.1%] and only corneal tissue in 5 [19.2%] cases. Out of 15 cases with content of trabecular meshwork, 7 cases [26.9% of successful cases] had all three portions of cornea, trabecular meshwork and sclera. This figure was not observed in any failed cases. The content of trabeculectomy specimens in failed cases included trabecular meshwork in 3 cases and only sclera in one case. The size and position of the site of trabeculectomy is variable and seems to have significant effects on the success rate of the surgery such that surgical resection anterior to the scleral spur increases the chance of surgical success

Automated lamellar therapeutic keratoplasty for surgical treatment of keratoconus

To evaluate the visual and refractive outcomes of automated lamellar therapeutic keratoplasty [ALTK] in patients with keratoconus. In this prospective noncomparative clinical trial, ALTK was performed in 14 eyes of 14 patients with moderate to severe keratoconus. All patients were spectacle and contact lens intolerant. Uncorrected visual acuity [UCVA]. best corrected visual acuity [BCVA], spherical equivalent refraction [SE], and refractive, keratometirc and topographic astigmatism were evaluated preoperatively and at one, three, and six months postoperatively and also at least 2 months after complete suture removal. Minimum duration of follow up was 8 months. The study included 9 male and 5 female subjects with mean age of 26.2 +/- 5.5 years [18-36 years]. Mean UCVA was 1.2 +/- 0.16 LogMAR [20/300] preoperatively and 0.55 +/- 0.2 LogMAR [20/70] at the last visit. [P<0.001] Mean BCVA was 0.8 +/- 0.2 LogMAR [20/120] preoperatively and reached 0.34 +/- 0.15 LogMAR [20/40] at the last visit. [P<0.001] Mean SE was -6.0 +/- 2.4 diopter preoperatively and -2.6+2.0 diopter at last visit. [P<0.001] BCVA >/= 20/40 was achieved in 64.3% of the cases and refractive astigmatism was within 4 diopter in 57% of the subjects at last visit. Although ALTK can be used for lamellar keratoplasty in patients with keratoconus, high post-op astigmatism is the major drawback

Outcomes of Phacoemulsification in Eyes with and without Pseudoexfoliation

To evaluate the incidence of pseudoexfoliation syndrome [XFS] in patients with senile cataract who were scheduled for phacoemulsification and intraocular lens implantation [PE + IOL] and to compare the outcomes of PE+IOL between eyes with and without XFS. We retrospectively reviewed 2200 eyes with cataract undergoing PE + IOL. All procedures were performed by a single surgeon [M.A.J] at a private clinic. Patients with XFS were considered as the case group and age and sex matched patients without XFS were selected as controls. The incidence of XFS was 4.1% [90 eyes]. Mean age was 71.8 +/- 7.1 and 70.7 +/- 6.7 years in the case and control groups, respectively. XFS was unilateral in 60% of the cases. The prevalence of hypertension, diabetes mellitus [DM] and diabetic retinopathy [DR] was 31.1%, 6.7% and 0% in the XFS group vs 42.9%, 26.6% and 5.2% in the control group, respectively [P< 0.05]. Glaucoma was present in 25.6% of the XFS group and 6.5% of the control group [P<0.0001]. Vitreous loss occurred in one eye in each group; only one eye had zonular dehiscence in the XFS group. Iris stretching was performed during surgery in 11.1% in the XFS group and 1.9% in the control group [P<0.0001]. Anterior capsule contraction occurred in 9.1% of the XFS group vs 0% in the control group [P=0.007]. PE + IOL in patients with XFS is as safe and effective as pure senile cataract. The incidence of DM and DR is significantly lower in XFS

Correlation of central corneal thickness with optic disc area in patients with primary open angle glaucoma

To evaluate the relationship between central corneal thickness [CCT] and optic disc area in patients with primary open angle glaucoma [POAG]. The study was performed on patients with POAG who were being followed at Johns Hopkins Hospital. All patients underwent thorough eye examination, optic disc imaging with the Heidelberg Retina Tomograph II [HRT II], and ultrasound corneal pachymetry. Exclusion criteria were prior ocular surgery and low-quality HRT II images [HRT standard deviation> 50]. SAS version 8.1 was used to generate Pearson correlation coefficients [r]. Of 199 eyes of 152 participants, 57 eyes met the inclusion and exclusion criteria of the study. Mean CCT was 530.7 +/- 35.5 microns. Black subjects had thinner corneas [blacks= 520 microns, whites= 546, others= 550, p < 0.05]. White subjects had smaller discs [Whites' mean disc area= 1.84 mm2, blacks= 2.44, others= 2.38 P= 0.0003]. Univariate analysis revealed that CCT is inversely correlated with optic disc area [r = -0.215, P= 0.12, n= 53]. After including all HRT images with standard deviation < 100, a statistically significant correlation was observed among white subjects [r = -0.282, P= 0.02, n=60]. Our findings demonstrate that optic nerve size might have some correlation with central corneal thickness. It may be that the protective effect of thicker corneas is not solely due to mis-measurement of IOP, but may also be an indication of more robust optic nerve head tissue

[Intravitreal triamcinolone for refractory diabetic macular edema: a randomized climical trial]

To evaluate the effect of intravitreal triamcinolone acetonide [IVT] on clinical, angiographic, and optical coherence tomographic parameters in refractory diabetic macular edema [DME]. In a double-masked placebo-controlled randomized clinical trial, 88 eyes of 61 patients with DME refractory to previous laser therapy or not suitable for such treatment were included in the study. Eligible eyes were randomly assigned into two groups. The treatment group [45 eyes] received 4 mg IVT and the placebo group [43 eyes] received subconjunctival injection of placebo. Complete ophthalmologic examination, fluorescein angiography, and optical coherence tomography [OCT] were performed before intervention and repeated after 2 and 4 months. Quantitative measurement of variables on angiograms including hard exudates [HE], size of foveal avascular zone, and leakage severity was performed using Photoshop software. Two months after intervention, visual acuity [VA] improved in the treatment group [-0.13 Log MAR, P=0.01] but slightly deteriorated in the placebo group [0.02 Log MAR, P=0.63]. The difference of the above changes [0.15 Log MAR] was statistically significant at 2 months [P=0.02] but reduced to 0.11 Log MAR [P=0.08] after 4 months. Mean [standard deviation] of central macular thickness [CMT] by OCT before and 2 and 4 months after injection was 393 [15 I], 293 [109], and 362 [119] microns in the treatment group and 393 [166], 404 [134], and 405 [160] microns in the placebo group, respectively. The second month difference was statistically significant [P=0.01]. Reduction of the amount of HE [51%, P=0.004] and petaloid pattern [P=0.012] was significant in the treatment group as compared with the placebo group. There were no significant IVT-related side effects except for transient ocular hypertension in 32.6% of patients after 2 months. The greatest therapeutic effect of IVT on DME according to CMT and VA occurs at 2 months and decreases up to the fourth month. However, concerning cyctoid macular edema and hard exudates, the effect is maintained up to 4 months

[Outcomes of keratorefractive surgery for management of postkeratoplasty astigmatism in keratoconus]

To evaluate the outcomes of keratorefractive surgery for correction of postkeratoplasty astigmatism in keratoconus. In this retrospective study, surgical records of 45 eyes of 45 patients that underwent relaxing incisions with or without compressive sutures were evaluated. The minimum interval between complete suture removal and operation was 1 month. Location and extent of incisions were determined by topography. Intraoperative keratoscopy was performed to determine if compressive sutures were needed. Mean age at the time of corneal graft surgery was 29.6 +/- 9.1 years. Mean interval between keratoplasty and keratorefi-active surgery was 18.4 +/- 8.8 months. Follow up period was 17.2 +/- 12.3 months. Preoperative refractive astigmatism was 7.25 +/- 1.59 D and keratometric astigmatism was 8.33 +/- 2.37 D. After surgery, these values reached 4.14 +/- 1.67 D and 4.42 +/- 1.88 D, respectively [P<0.0001]. Moderately 0.34 D myopic shift occurred. BSCVA was 2 20140 in 76.5% of the eyes before and 93.3% after surgery. Mean BSCVA in Log MAR was 0.28]20140] before and 0.17 [20130] after surgery [one Snellen line increase of vision], P<0.0001. Keratorefractive surgery by relaxing incisions with or without compressive sutures is a safe and effective procedure to reduce postkeratoplasty astigmatism in keratoconus

Visual outcomes of LASIK in Myopic eyes

To evaluate the visual outcomes of LASIK in myopic eyes. This interventional case series was performed on records of 345 eyes of 179 patients for correcting myopia with astigmatism < 3.00 diopter [D]. All patients were operated by one surgeon [H.N.] with the NIDEK EC 5000 excimer laser. All patients had at least one year follow up. Based on preoperative refraction, patients were divided into four groups: low [-1.00 to -4.00 D], moderate [-4.00 to -7.00 D], high [-7.00 to -13.00 D], and extremely high myopia [> -13.00 D]. Data including pre- and postoperative refraction, UCVA one year after surgery, pre- and postoperative BCVA, and range of emmetropia were analyzed in each group. Mean preoperative spherical equivalent [SE] was -2.84 +/- 0.73 D in low myopia group, 5.12 +/- 0.84 D in moderate myopia group, -9.53 +/- 1.8 I D in high myopia group, and -16.26 +/- 2.23 D in extremely high myopia group. The value decreased to -0.0845 +/- 0.16 D, -0.143 +/- 0.216 D, 0.467 +/- 0.34 D, and -2.385 +/- 1.49D, respectively at one year. The percentage of eyes according to range of ametropia were as follow: 94%, 83%, 40%, and 0% of eyes were within +/- 0.25 D of emmetropia; 100%, 100%, 73%, and 15% of eyes were within +/- 0.5 D of emmetropoia; and 100%, 100%, 95.5%, and 23% of eyes were within +/- 1.0 D of emmerropia in each group, respectively. Postoperative UCVA of 20/40 or better was achieved in 100%, 100%, 98.4%, and 30.8% of eyes and UCVA of 20/20 or better was obtained in 78.9%, 73.1%, 31%, and 0% of eyes in the four groups, respectively. One year after LASIK, 2.1%, 0%, 6.7%, and 0% of the eyes lost two or more lines of BCVA in each group but 2.1%, 1.4%, 4.4%, and 7.7% of eyes gained more than one line of BCVA. LASIK is an effective and predictable procedure for correcting myopia. The predictability of LASIK decreases with increase in preoperative refractive error

Radial Optic Neurotomy with and without Intravitreal Triamcinolone Injection in Central Retinal Vein Occlusion

To evaluate the efficacy of radial optic neurotomy [RON] combined with or without intravitreal triamcinolone acetonid [IVTA] injection in the management of central retinal vein occlusion [CRVO].This non-randomized clinical trial was conducted on 23 patients with CRVO, who underwent RON with or without IVTA injection. Preoperative and postoperative best corrected visual acuity were converted to LogMAR and time to plateau of best corrected visual acuity were evaluated over a 12 months period. The patients included 16 male and 7 female subjects with mean age of 56 +/- 16.8 year [25-72 years]. Mean visual acuity was 1.42 +/- 0.43 LogMAR [20/600] preoperatively, which improved to 1.1 +/- 0.14 LogMAR [20/250] postoperatively. [P< 0.05] At one year, mean visual acuity was 1.56 +/- 0.63 LogMAR in the non-IVTA group and 1.09 +/- 0.37 LogMAR in the IVTA group [P= 0.04]. Vision improved by 3 or more lines in 14 eyes [60.9%]. Overall eyes with combined RON and IVTA injection had better postoperative visual acuity, although it was not statistically significant. Time to plateau of best-corrected visual acuity in eyes that underwent RON combined with 1VTA injection was significantly shorter. The combination of RON and IVTA injection may enhance therapeutic success and cause faster visual rehabilitation than RON alone

Blepharotomy versus Tarsotomy in Upper Eyelid Cicatricial Entropion

To determine the success rate and complications of blepharotomy and tarsotomy in moderately severe upper eyelid cicatritial cntropion.This randomized clinical trial was conducted on patients with moderately severe cicatritial cntropion. The patients were followed for six months and the results and complications were evaluated. Success was defined as uncontacted eyelid margin and cilia to cornea. Sixty upper eyelids of 37 patients [10 male and 27 female] underwent blepharotomy in 30 eyelids and tarsotomy in 30 other eyelids. Mean age was 68.7 +/- 7.0 years in the blepharotomy group and 61.2 +/- 14 in the tarsotomy group. [P=0.3] Trachoma was the undelying cause in all eases. Success rate was 93.3% in the blepharotomy group and 96.7% in the tarsotomy group. [P=0.5] There was no significant difference between the two groups regarding complications of the procedures at the end of follow up except for eyelid notching which was significantly greater in the blepharotomy group. [16.7% vs 0, P=0.02] Blepharotomy and tarsotomy are successful operations in moderately severe cicatritial entropion. Tarsotomy is easier and doesn't need a skin incision. We suggest tarsotomy as a better technique in patients with moderately severe trachomatic cicatritial entropion of the upper eyelids

[Effect of levodopa-carbidopa on visual function in patients with recent nonarteritic anterior ischemic optic neuropathy]

To evaluate the effect of levodopa-carbidopa on improvement of visual acuity, color vision, and visual field in patients with nonarteritic anterior ischemic optic neuropathy [NAION] with onset less than 6 wks. In this double-blind randomized controlled trial, 13 patients were treated with levodopa-carbidopa and 12 patients were treated with placebo for 3 weeks. After 6 months, visual acuity [evaluated by Snellen chart], color vision [evaluated by Ishihara pseudoisochromatic plate], and visual field [evaluated by Humphrey automated perimetry central 30-2] were evaluated. Mean visual acuity in the treatment group was 1.007 LogMAR [1/10] at beginning of study and 0.75 LogMAR [4/10] at the end. Improvement of visual acuity in this group was 3 lines of Snellen chart [P=0.001]. In the placebo group, mean visual acuity was 0.85 LogMAR [3/10] at the beginning of study and 0.75 LogMAR[4/10] at the end. Improvement of visual acuity in this group was 1 line of Snellen chart [P=0.013]. Mean color vision in treated eyes was 4/14 at beginning of study and 5.76/14 at the end. In the placebo group this value was 4.3/14 at ending. There was no statistically significant difference in color vision between two groups both at beginning and at the end of treatment. Visual field improvement did not show any difference between the two groups [P=0.93]. Although levodopa-carbidopa significantly improved visual acuity, other aspects of visual function did not show significant changes. Other therapeutic modalities should be tired

[Epidemiologic and etiologic characteristics of patients with paralytic strabismus]

Purpose: to evaluate the epidemiologic and etiologic characteristics of patients with paralytic strabismus at Labbafinejad Hospital during the years 2000-2001, Tehran-Iran

Method: as a descriptive study, consecutive cases with extraocular muscles paralysis [according to signs of cranial nerves 3,4, or 6 involvement and negative forced duction test] were enrolled in the study. Age, gender, duration of involvement, past medical history, intensity of muscle paralysis, deviometry, head posture, and etiology were evaluated

Results: of 119 patients [75 male and 44 female] with mean age of 30.58 +/- 22 years, 111 cases [%93.3] had unilateral involvement and 8 cases [%6.7] had bilateral involvement; 103 [%86.6] cases had isolated nerve involvement including sixth nerve paralysis [%33.6], fourth nerve paralysis [%32.7], and third nerve paralysis [%20.2]. The etiology was congenital in 32 patients [%26.9], vascular in 30 patients [%25.2], and traumatic in 27 patients [%22.7]. Mean age was 13.8 +/- 10.3, 56.4 +/- 122, and 27.4 +/- 15.6 in these subgroups, respectively. Other etiologies like unknown, infective, myasthenia gravis, migraine, multiple sclerosis, and tumoral followed in frequency. Over 60% of cases with 4th nerve palsy were operated, of which the most successful method was inferior oblique myectomy. Half of cases with 6th or 3rd nerve palsies were operated and the most common method was R and R

Conclusion: the most common nerve involvement was the 6th nerve. Fourth nerve involvement was the most common etiology in congenital disorders and 6th nerve involvement was the most common in traumatic and vascular disorders

[Results of penetrating keratoplasty in macular corneal dystrophy]

Purpose: to evaluate the outcomes of penetrating keratoplasty [PIS] in macular corneal dystrophy [MCD] at Labbafinejad Medical Center, Tehran-Iran [1986-2002]

Methods: in a descriptive study, records of patients with MCD who had undergone PK were reviewed. All cases were recalled for a complete ocular examination. Patients who participated in the recall examination with at least 6 months follow up were enrolled in the study

Results: sixty-two eyes of 39 patients were included. The age of patients at first examination [before keratoplasty] was 30 +/- 12 [12-58] and at the time of keratoplasty was 34 +/- 10.3 [13-58] years. Duration of follow up after PK was 52 +/- 47.3[6-190] months. Best corrected vision before surgery in LogMAR notation was 1.4 +/- 0.4 [4/100]. After PK, uncorrected visual acuity improved to 0.6 +/- 0.44 LogMAR [20/28] [P<0.0001] and best spectacle corrected visual acuity [BSCVA] at the end of follow up was 0.2 +/- 0.32 LogMAR [20/32]. Spherical equivalent refractive error after surgery was -2.28 +/- 3.24 diopters and refractive astigmatism was 3.32 +/- 2.05 diopters. Suturing technique had no effect on final astigmatism after PK [P=0.9]. BSCVA in 36 eyes who were operated before 35 years of age was 0.16 +/- 0.37 LogMAR and in 26 eyes operated at or after age 35 was 0.26 +/- 0.25 [P=0.005]. Immunologic graft rejection occurred in 12 eyes [1 9.4%] during the follow up period. The first rejection occurred at 6.1 +/- 3.5 [2-14] months after PK. Graft opacification and failure occurred only in one eye following ocular trauma and wound dehiscence. The rest of the grafts [98.4%] were clear at the end of follow up

Conclusion: PK in patients with MCD improves vision significantly with excellent graft survival rates. In this study, patients who underwent PK before 35 years of age had better final visual acuity

[Post operative uveitis and viscoelastics: coatel versus healon]

Purpose: to compare two viscoelastics, hydroxypropylmethylcellulose [Coatel] and sodium hynluronate] [Healon] as causative factors for postoperative uveitis [POU] following cataract surgery

Methods: in this clinical trial, 81 eyes from 80 patients underwent phacoemulsification and IOL implantation [PMMA AGENA 550 Opsia]. Patients with uveitis, diabetes, and pseudoexfoliation syndrome were excluded. In 39 eyes [48%] Coatel and in 42 eyes [52%] Healon was used randomly. Patients were followed three months for appearance of POU

Results: the incidence of POU in the Coatel and Healon groups was 20.5% and 2.4%, respectively

Conclusion: use of Healon in comparison to Coatel decreases the incidence of POU in cataract surgery. Thus, it is better to use Healon in patients at high risk for POU

[Prophylactic topical steroids prior to Lasik for prevention of diffuse lamellar keratitis [DLK]]

Purpose: to evaluate the role of prophylactic topical steroids in the prevention of DLK after LASIK

Methods: in a randomized double blind clinical trial, 101 LASIK candidates aged 18 to 55 years were enrolled. Myopia ranged from -2 to -12 diopters and was stable for at least one year. No patient had any ocular or systemic contraindication for LASIK. From one day before surgery, topical betamethasone 0.1% was randomly applied for one eye every 4 hours while the other eye received placebo. One hour before surgery the dosage was increased to every 5 minutes for at least six times. All operations were performed by one surgeon [F.K]. Both eyes were operated in one setting. Six hours after surgery, all the eyes were put on topical betamethasone every 2 hours and dosage was tapered depending on the response and according to the grade of DLK if present. Severity of DLK was graded according to the Linebarger-Lindstorm classification. Patients were regularly examined in the first week and if the postoperative course was uneventful they were re-examined one and three months after surgery. Vision [BCVA], refraction [cyclorefraction], and severity of DLK were documented by a third examiner at each visit

Results: one hundred eyes were in the treatment and 98 eyes were in the control group. In both groups, pre and post LASIK refraction and VA were comparable [P> 0.05]. There were no significant complications in both groups during or after LASIK except for DLK. DLK was seen in 55 eyes [55%] of the treatment group including 44 eyes [44%] with grade I and 11 eyes [11%] with grade II. In the control group DLK was seen in 36 eyes [36.7%] of which 29 eyes [29.5%] were grade I, and 7 eyes [7.2%] were grade II. There was no statistically significant difference between the incidence of DLK in the two groups [P= 0.81]. More severe grades of DLK [III and IV] were not seen in any group

Conclusion: although steroids [topical and systemic] play a key role in the treatment of DLK, they seem to have no inhibitory role on DLK