Epidemiologic features of retinoblastoma in Shiraz, southern Iran

Retinoblastoma [RB] is the most common primary intraocular cancer of childhood. There is no published report on this affliction at our center as a referral center in southern Iran. This study aimed to perform a 15 years epidemiological assessment of RB, in Fars Province, Southern Iran. We retrospectively analyzed medical records of all patients with RB diagnosed in Khalili Hospital affiliated to Shiraz University of Medical Sciences in Shiraz, Southern Iran. All available pathologic slides were reviewed and staging of tumors were revised using the TNM classification of 2008. Sixty-seven patients were enrolled in this study [46.3% females and 53.7% males]. Among the cases, 71.6% had unilateral and 28.8% bilateral RB. The mean age of symptom presentation and diagnosis were 20.5 +/- 16.5 and 26.3 +/- 20.1 months, respectively, which were significantly lower in bilateral cases. Leukocoria was the most common presenting symptom [56.7%], followed by strabismus [10.4%]. The result of histopathological review showed that RB in 70% of patients was at T1, T2 and T3 stage, but 30% were at T4 stage. Demographic and clinical variables of RB under the present study are comparable with published reports but our patients were diagnosed at the later stage, leading to poorer prognosis. It is necessary to expand the existing organizations into a comprehensive population-based registry system to obtain a clearer picture of the epidemiology of RB in our region

Effect of dexamethasone in combination with acetylcysteine at different times on corneal wound healing in dogs

The purpose of this study was to evaluate the effects of different time combinations of dexamethasone and acetylcysteine on experimentally induced corneal ulcers in dogs. Experimental corneal wounds were created surgically to the anterior one third of the cornea in the center of all eyes of 15 mixed breed dogs. The eyes were divided into five groups according to planned post-operative medications: group 1, one drop of N- acetylcysteine 3% and one drop of dexamethasone 0.1% immediately after surgery; group 2, two drops o N. acetylcysteine 3% from day 1, one drop of N-acetylcysteine 3% and one drop of dexamethasone 0.1% from day 15; group 3, two drops of N-acetylcysteine 3%; group 4, two drops of dexamethasone 0.1%; group 5 [control], two drops of normal saline. When applied immediately after corneal ulceration, dexamethasone 0.1% [group 4] decreased corneal haze significantly and did not delay corneal wound healing. Addition of dexamethasone 0.1% to N-acetylcysteine 3% from day 15 [group 2] significantly suppressed opacity at two months after the beginning of the study, but when dexamethasone 0.1% associated to N-acetylcysteine 3% immediately after corneal ulceration [group 1], significant delay in corneal wound healing was induced. It is concluded that combination of dexamethasone 0.1% and NAC 3% immediately after surgery may delay corneal wound healing, also use of these drugs individually, has no obvious clinical effect on corneal haze. On the other hand, use of these drugs in combination with each other may reduce the corneal haze in later months after discontinuation of drugs. However, further studies using larger groups of animals are needed to demonstrate the effectiveness of these pharmacological modulators following experimentally induced corneal wounds in dogs

Amniotic membrane transplantation for the treatment of pseudomonas keratitis in experimental rabbits

Amniotic membrane transplantation [AMT] has been considered in combination with medical treatment in progressive infective keratitis. The purpose of this study was to evaluate the efficacy of AMT as an adjunctive treatment in the management of experimental pseudomonas keratitis. Cryopreserved AMT was performed on 12 pseudomonas rabbit corneal ulcers. After one week in one group amniotic membrane transplantation combined Poostchi Eye Research Center with topical medical treatment was done [AMT group]. At the end of the second week, the clinical and pathological findings were compared with those obtained from eight corneal ulcers in another group which had only been treated with topical medication [control group]. There was not any significant difference in clinical signs between the two groups at the end of the second week. Corneal perforation was found in three cases of the control group but in none of the cases in the AMT group. Amniotic membranes were melted in four eyes, retracted in three eyes and intact in five eyes. Pathologic examination showed no significant difference in cellular infiltration or density of organism between the two groups. AMT is effective in preventing corneal perforation in the early stage of experimental pseudomonas keratitis

Histopathologic changes of extraocular muscle fibers after injection of botulinum toxin

Use of botulinum toxin is becoming a popular way in treatment of some forms of strabismus. To evaluate the morphological changes in the orbital surface layer muscles of the rabbit eye following a single injection of botulinum toxin. 10 white Dutch rabbits weighing 2-3 kg received either 10 units [group 1; n=5] or 20 units [group 2; n=5] of botulinum toxin into the superior rectus muscle of right eye. The superior rectus muscle of the left eye in each rabbit was considered as control. The diameter of at least 20 muscle fibers of the orbital layer of the superior rectus muscle was measured with an ocular micrometer on histological sections after extirpation 2 and 1 0 days, and 4, 8 and 1 2 weeks after the injection. Marked decrease in size of muscle fibers was observed, especially on 2 and 10 days post-injection. It was more sever in animals which received 20 units of the toxin. In both groups, between 4 and 12 weeks after injection, the size of some fibers returned back to normal; rarely, the fibers became hypertrophic while atrophic changes were still present. Hypertrophy of neuro-muscular end-plate was seen accompanied with atrophic changes. Fibrosis around the muscle fibers was rarely seen. Injection of botulinum toxin into extraocular muscles causes atrophic changes which seems to be more severe with higher doses. The effect of botulinum toxin has been persisted up to 8 weeks

[Cataract etiology in children less than 3 years of age at Khalili hospital, Shiraz-Iran]

To evaluate the etiology of cataracts in children less than 3 years of age particularly the association of rubella virus infection and galactosuria with congenital cataracts at Khalili Hospital, Shiraz-Iran from 2003 to 2006. This prospective study included 46 patients less than 3 years undergoing lensectomy for the management of significant cataracts. Lens aspirate specimens were obtained from some cases. Serum samples for detection of anti-rubella IgM and IgG antibodies and urine samples for detection of galactose were also obtained. Out of 46 patients, 78.3% had congenital cataracts and 21.7% had traumatic cataracts. Patients with congenital cataracts were male in 45% and female in 55% with mean age of 5.12 +/- 5.23 months at the time of diagnosis. In the congenital cataract group, 2.8% had history of failure to thrive and 16.7% had low birth weight; 80.6% had bilateral and 19.4% had unilateral cataracts; 77.8% had isolated cataracts, 16.7% were associated with other ocular disorders and 5.6% were associated with systemic diseases; 11.1% had family history of congenital cataracts and 10.5% had galactosuria. Rubella virus was isolated from one [5.3%] of 19 cultured lens aspirates. No cases had anti-rubella IgM antibody. Congenital cataract is the most common type of cataracts in children under age 3 years in our area and most of them are idiopathic. The prevalence of rubella induced cataract in our country is less than developing countries but more than developed countries

Asyptomatic fungal cyst of conjunctiva caused by bipolaris spicifera

An asymptomatic fungal cyst of a conjunctival infection was found and removed by biopsy in a young shepherdess. Histopathologic evaluations of the excised tissue specimen from the lesion of the conjunctiva demonstrated an epithelium lined cavity containing a tangled mycelial mass that was surrounded by inflammatory cells and the fungus was identified as Bipolaris spicifera. It is concluded that asymptomatic conjunctival infections by fungi may occur without a having previous history of trauma or having any signs of inflammation

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

Papilledema as a presentation of spinal cord tumor: a case report

To report a case of spinal cord tumor with visual symptoms and papilledema due to increased intracranial pressure.A 24-year-old woman was referred because of recent blurred vision in both eyes. Visual acuity was 20/25 and 20/20 in the right and left eyes, respectively. Fundoscopy revealed bilateral papilledema. Other ophthalmic examinations were normal. Visual fields showed blind spot enlargement and brain ET scan revealed dilated ventricles. Ventriculoperitoneal shunt was inserted for the patient with a diagnosis of hydrocephalus. Ten weeks later, she returned with low back pain and lower extremity weakness. Lumbosacral MRI revealed a tumor in the region of LI-L4. The patient underwent surgical removal of the tumor and histopathologic study showed mixopapillary ependymoma.Increased intracranial pressure and papilledema without evidence of a space occupying intracranial lesion may be the presenting sign of spinal cord tumors

[Correlation of hand dominancy and eye dominancy with vidual acuity and refractive errors]

To determine the correlation between hand dominancy and eye dominancy with visual acuity and refraction in subjects with refractive errors. This cross-sectional study includes 620 patients undergoing LASIK. Their refractive error [dry and cycloplegic], hand dominancy, eye dominancy [by hole-in-the-hand method] and visual acuity were determined. Exclusion criteria were monocularity, patient's inability to perform hole-in-the-hand test, and amblyopia. Overall, 585 patients met the inclusion criteria for this study. Age range was 21-43 years [mean- 33.7 years], 58% were female and 42% were male. The right hand was dominant in 90.9% and the right eye was dominant in 77.9% of the subjects. Right eye dominancy was observed in 79.1% of right handed individuals and in 66.1% of left handed patients. Cross eye-hand dominancy was observed in 38.3% and uncrossed eye-hand dominancy in 61.7%. Visual acuity was better in dominant eyes in 68.2% [P=0.03, t=0.89]. The non dominant eyes had higher refractive errors than dominant eyes [P=0.01, t=0.88]. In both groups of right handed and left handed individuals, the right eye was more often dominant and uncrossed dominancy was more prevalent than crossed dominancy. Better visual acuity or smaller refractive error may influence eye dominancy

[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