[New criteria to assess the risk of acute angle closure]

To compare anterior segment and ocular biometric parameters of unaffected fellow eyes of patients with a previous attack of acute angle closure [AAC], primary angle closure suspect [PACS] eyes, and normal eyes; and to assess the risk of developing AAC in PACS. In this prospective comparative observational case series, 16 unaffected fellow eyes of patients with a previous attack of AAC [group I], 40 PACS eyes [group II] and 32 normal eyes [group III] were evaluated. Pentacam and A-scan echography were performed in all cases. Anterior chamber angle [ACA], anterior chamber volume [ACV], anterior chamber depth [ACD], central corneal thickness [CCT], keratometry [KR], lens thickness [LT] and axial length [AL] were measured in all eyes as main outcome measures. Age, CCT and LT were comparable among the study groups [all P values>0.05]. Mean ACA was 24.8, 22.9 and 35.4 in groups I, II, and III respectively [P<0.001]. Corresponding values for ACV were 72, 76 and 172 microl, respectively [P<0.001]. Central ACD measured from the endothelium was 1.80, 1.91, and 3.09 mm in groups I, II, and III respectively [P<0.001]. Using receiver operating characteristic [ROC] curves, ACV

[Mitomycin-C drops versus subconjunctival 5-fluorouracil for management of early bleb failure]

To compare the efficacy and safety of topical Mitomycin-C [MMC] drops versus subconjunctival 5-Fluourouracil [5-FU] injections for management of early bleb failure after trabeculectomy or combined phacoemulsification and trabeculectomy with posterior chamber intraocular lens implantation [PT+PCIOL]. In a comparative study, 37 eyes of 37 patients with impending early bleb failure were randomly allocated to MMC 0.02% eye drops [19 eyes] or subconjunctival 5-FU injections [5mg each dose] [18 eyes] for 2 to 4 weeks or. Main outcome measures included intraocular pressure [IOP], and bleb morphology according to the Indiana Bleb Appearance Grading Scale. Other outcome measures included success rate, number of glaucoma medications, best corrected visual acuity [BCVA] and complications. Complete success was defined as 5

[Intraocular pressure measurements after penetrating keratoplasty using the ocular response analyzer versus goldmann applanation tonometer]

To compare intraocular pressure [IOP] readings measured by the Ocular Response Analyzer [ORA] with those measured by the Goldmann applanation tonometer [GAT] in keratoconic eyes following penetrating keratoplasty [PKP] and to evaluate the influence of anatomical and biomechanical properties of the grafts on IOP measurements. This cross-sectional study was conducted on 45 keratoconic eyes undergoing PKP. IOP was measured using the GAT [IOP GAT]; corneal hysteresis [CH], corneal resistance factor [CRF], Goldmannrelated IOP [IOPg], and cornea-compensated IOP [IOPcc] were obtained using the ORA; central graft thickness [CGT] was measured by ultrasonic pachymetry. Bland-Altman and mountain plots were used to evaluate agreement between the tonometers. The correlation of graft curvature and astigmatism; central graft thickness [CGT]; and corneal biomechanical properties with IOP readings was investigated using multivariate regression analysis. Mean patient age was 29.8 +/- 6.1 years and mean follow up was 91.2 +/- 35.4 months. Mean CH, CRF, and CGT were 10.2 +/- 2.1 mmHg, 10.1 +/- 2.2 mmHg, and 565.4 +/- 37.7 mm, respectively. Mean IOP GAT, IOPg, and IOPcc were 12.2 +/- 2.4, 15.1 +/- 3.5, and 15.8 +/- 3.3 mmHg, respectively [P<0.001]. The 95% limit of agreement between IOP GAT and IOPg ranged from -3.6 to 9.3 mmHg. CH and CRF, but not CGT or keratometric astigmatism were significantly associated with IOP GAT, IOPg, and IOPcc. Graft biomechanics had more influence on IOP values as compared to anatomical features. In comparison to GAT, the ORA seem to overestimate IOP in post-PKP eyes

[Early drainage of delayed suprachoroidal hemorrhage following glaucoma surgery]

To evaluate the effect of early drainage of delayed suprachoroidal hemorrhage [SCH] after glaucoma surgery. These study reports seven cases of delayed supra-choroidal hemorrhage following glaucoma surgery managed with early drainage. In this series instead of waiting for 7 to 14 days for clot lysis, the SCH was drained from the suprachoroidal space immediately after diagnosis. Seven eyes of 7 patients with delayed SCH including 4 men and 3 women were enrolled in the study. Median age was 42.57 +/- 29.61 years and mean follow up duration was 21.43 +/- 13.35 months. Immediately after diagnosis, choroidal tap and anterior chamber reformation were performed for all the patients. Intraocular pressure [IOP] decreased significantly after intervention. At final follow up, mean visual acuity was 1.08 +/- 0.31 LogMAR. Immediate surgical drainage of suprachoroidal hemorrhage seems to be an effective and safe method for treatment of delayed SCH; and it may decrease the inflammation from the entrapped blood in suprachoroidal space and reduce complications and additional procedures. Larger trials are recommended for further evaluation

[Superior versus inferior Ahmed glaucoma valve implantation]

To compare the efficacy and safety of Ahmed Glaucoma Valve [AGV] implantation in the superior versus inferior quadrants. This prospective parallel cohort study was performed on 106 eyes of 106 patients with refractory glaucoma. Main outcome measures included intraocular pressure [IOP] and rate of complications. Other outcome measures included best-corrected visual acuity [BCVA], number of glaucoma medications and success rate [defined as at least 30% IOP reduction and 5

[Diagnosis, treatment and prognosis of optic neuritis]

Optic neuritis occurs in young patients, most often females, and presents as subacute monocular visual loss. Periocular pain, particularly with eye movement occurs in the majority of cases. The retrobulbar form occurs in 65% of cases and is associated with normal optic disc appearance at onset. The central visual field is usually affected and an RAPD and dyschromatopsia are present. Brain magnetic resonance imaging [MRI] is recommended in all cases of optic neuritis. Evaluation for periventricular white matter lesions is the single best test for assessing the risk of future multiple sclerosis [MS]. Typical idiopathic neuritis begins to show improvement within one month, the use of intravenous methylprednisolone 250 mg every 6 hours for 3 days, followed by oral prednisolone 1 mg/kg/ day for 11 days speeds recovery by 1 to 2 weeks. Oral prednisolone alone has shown no benefit, has been associated with an increased risk of recurrence and its use is not recommended

[Frequency of obsessive-compulsive disorder in schizophrenic patients according to structural clinical interview [SCID]]

The life time prevalence of schizophrenia is estimated about 1%-1.5% in United States and various studies have shown that between 7.8-46.6% of these patients suffer from OCD. The differences in these statistics are partly due to the assessment and treatment methods. The purpose of this study was to measure the frequency of OCD in hospitalized schizophrenic patients. The study was cross-sectional. 96 inpatients [56 men and 40 women] with DSM-IV schizophrenia diagnostic criteria were selected from Iran Psychiatry Hospital by simple non-random sampling. The age range of the patients were 17-73 with a mean age of 35 +/- 12.6. The majority of patients [88.5%] suffered from paranoid schizophrenia. 47 patients [49%] were diagnosed to have obsessive-compulsive symptoms on interview. The mean age of schizophrenia onset was 24.7 +/- 8.8 and the mean age of OCD onset in schizophrenic patients was 20.2 +/- 6.7. In 8 [17%], the two disorders were began simultaneously and in 20 [20.8%], schizophrenia was started earlier. Obsessive-compulsive symptoms are completely prevalent in schizophrenia. The co morbidity of these two clinical entities has both etiological and therapeutic importance

[Hypotonous maculopathy following ocular blunt trauma]

To report a case of hypotonous maculopathy after blunt trauma and its treatment. A 34-year-old woman presented with decreased visual acuity in her left eye following blunt trauma. Right eye examination was unremarkable, but visual acuity of left eye was counting fingers. Slit lamp biomicroscopy of the left eye was within normal limits, but on funduscopy, papillomacular chorioretinal wrinkling was present. Intraocular pressure [IOP] of left eye was 4 mmHg. On gonioscopy, a cyclodialysis cleft was seen from 11 to 1 o'clock. Argon laser therapy to cyclodialysis cleft was performed. Two months later, best spectacle corrected visual acuity of left eye was 20/20 and chorioretinal wrinklings disappeared and IOP was 15 mmHg with timolol 0.5% twice daily. Blunt ocular trauma may result in cyclodialysis cleft which can lead to hypotony and maculopathy, consequently. Argon laser photocoagulation to the cyclodialysis cleft might be an effective way to relieve hypotony and improve vision

[Sensorineural hearing loss in pseudoexfoliation syndrome]

To determine hearing thresholds at sound frequencies important for speech comprehension in subjects with ocular pseudoexfoliation [PXF] and to compare them with that of controls without PXF. Eighty-three subjects with ocular PXF and 83 age and sex matched controls without PXF were enrolled in this case-control study. Pure tone audiometry [bone conduction] was performed at 1, 2 and 3 kilohertz [KHz] in all subjects. Thresholds were compared to an age and sex stratified standard [ISO7029] and between study groups. Hearing loss was defined as sum of tested hearing thresholds [HTL-1, 2, 3] lower than the ISO7029 standard median. The study included 60 male and 23 female subjects in each group. Hearing loss was present in 147 of 166 [88.6%] examined ears in the case group vs 89 of 166 [53.6%] ears in the control group [P<0.001; odds ratio [OR] = 6.69; 95% confidence interval [CI], 3.49-11.79]. Overall 78 subjects [94.0%] in the case group vs 58 subjects [69.9%] in the control group had hearing loss in one or both ears [P< 0.001; OR=6.72; 95%CI, 2.42-18.62]. Hearing thresholds at each of the examined frequencies and the HTL-1, 2, 3 were also significantly higher in individuals with PXF. Although glaucoma was significantly more common in subjects with PXF [51.8% vs 22.9%, P<0.001], it was not associated with hearing loss in any of the study groups. Hearing thresholds at frequencies which are important for speech comprehension are significantly worse in individuals with ocular PXF as compared to matched controls. This finding may support the multi-organ nature of PXF syndrome

[ case of anterior ischemic optic neuropathy after use of tadalafil]

To report a case of anterior ischemic optic neuropathy [AION] after ingestion of Tadalafil [a drug for management of erectile dysfunction]. A healthy 26-year-old male was referred due to loss of vision and visual field defect in his left eye a few days after using Tadalafil. Visual loss was progressive during the following days. Examination revealed disc swelling which consequently led to optic atrophy. His visual acuity remained low during 12 months of follow up. Tadalafil may predispose to AION even in young men with no vascular risk factors

Results of post-trabeculectomy bleb revision using conjunctiva

To evaluate and compare the results of different surgical methods for post-trabeculectomy bleb revision at Labbafinejad Medical Center, Tehran-Iran, from 1999 to 2003. This study was conducted on all patients who underwent post-trabeculectomy bleb revision due to hypotony [intraocular pressure [IOP] less than 6 mmHg] or bleb leakage. Surgical methods were: conjunctival advancement, rotational conjunctival flap and free conjunctival graft. Bleb revision was performed in the cases of bleb leakage if the bleb hole was greater than 1 mm or leakage could not be controlled within 1 to 2 weeks of conservative treatment. Bleb revision was performed in eyes with hypotony in cases with cataract development or progression or hypotony maculopathy or iridocorneal adhesion. Surgical success was defined as IOP between 6-21 mmHg with a maximum of 2 topical antiglaucoma medications and discontinuation of leakage. Twenty-seven eyes of 27 patients [17 male, 10 female] with mean age of 37.8 +/- 15.2 years [9-37 years] were studied. Indication for surgery was bleb leakage in 22 cases [81.5%] and hypotonous maculopathy in 5 cases [18.5%]. Mean IOP was 4.4 +/- 1.04 mmHg preoperatively and 13.00 +/- 1.29 mmHg postoperatively. [P< 0.001] Mean visual acuity was 0.9 LogMAR [20/160] before surgery and reached 0.6 LogMAR [20/80] after bleb revision. [P<0.002] Mean cup/disc ratio was 0.7 preoperatively which remained unchanged postoperatively. Conjunctival advancement was performed in 18 cases [success rate = 72.2%], rotational conjunctival flap in 6 cases [success rate= 66.7%] and free conjunctival graft in 3 cases [success rate= 66.7%]. [P=0.73] Bleb revision was repeated in 2 cases due to continuous leakage. Mitomycin-C [MMC] and 5-fluorouracil had been used during primary trabeculectomy in 62% and 7.6% of cases, respectively. In 19.6% of cases surgery was done without using antimetabolites and usage of antimetabolites was unknown in 11%. The average time between primary trabeculectomy and bleb leakage or hypotonia was 17 months in cases with prior use of MMC and 52 months in the cases with no antimetabolite usage. [P<0.05] Post-trabeculectomy bleb revision using conjunctiva seems to be a successful method for control of leakage and prevention of complications of hypotony

Mitomycin-C Trabeculectomy versus Ahmed Glaucoma Implant for treatment Pediatric Aphakic Glaucoma

To compare the outcomes and complications of mitomycin-C [MMC] trabeculectomy and Ahmed glaucoma implant [AGI] for treatment of aphakic glaucoma following congenital cataract surgery in children

Posterior lschemic optic neuropathy following percutaneous nephrolithotomy

To report a case of posterior ischemic optic neuropathy [PION] following percutaneous nephrolithotomy [PCNL]. A 57-year-old male who underwent PCNL because of renal stone was referred due to painless bilateral visual loss to the level of light perception immediately after the operation. The patient had history of diabetes mellitus, hyperlipidemia, and mild anemia. Ophthalmic examinations were unremarkable and optic discs were pink and without any sign of swelling. Visual fields were severely affected, but neuro-imaging was normal. Within three months, visual acuity and visual fields improved dramatically and optic discs became mildly pale. The clinical course was typical for PION. PION is a rare cause of severe visual loss following surgery. Severe blood loss, hypotension, anemia, and position of the patient during surgery are the most important risk factors. This is the first report of PION following PCNL. Urologists, ophthalmologists and anesthesiologist should be aware of this entity, and rare possibility should be discussed with the patient before surgery. Preventive measures against PION should also be taken

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

[Posterior segment complications following laser assisted in situ keratomileusis [LASIK]: a report of 5 cases]

To report complications involving the posterior segment after laser assisted in situ keratomileusis [LASIK] in 5 myopic patients ranging in age from 26 to 38 years. Case on developed bilateral cilioretinal artery obstruction in association with ischemic optic neuropathy. Case two presented with nonsimultaneous bilateral delayed-onset optic neuropathy. In case three, aggravation of the symptoms and signs of Stargardt's maculopathy was noticed. Case four showed rapid progression and worsening of diabetic retinopathy in both her eyes. In case five, early onset unilateral macular hemorrhage was observed. The increased intraocular pressure LASIK surgery may disturb blood flow in posterior ciliary arteries and choroid. The deleterious effect of LASIK on ocular circulation may result in sight threatening complications in predisposed patients

[Prevalence of cataract in Tehran]

Purpose: to evaluate the prevalence of cataract, lens opacity, and other conditions of the lens among residents of Tehran aged 40 or above, Tehran-Iran

Methods: this study was performed as a part of the population based study on the prevalence of glaucoma among citizens older than 40 in Tehran. A total of 2 160 participants joined the study [50% response rate]. After performing a medical history interview, all participants were examined according to a standard protocol including refraction, visual acuity testing, and slit-lamp biomicroscopy of the anterior segment. Cataract was diagnosed as any lens opacity with visual acuity of 20140 or less in the absence of other causes of visual loss

Results: the prevalence of lens opacity among right eyes, left eyes, and overall was 29.4%, 30.6%, and 32.4%, respectively. Prevalence of cataract was 8.1% in right and 9.1% in left eyes, respectively. The overall prevalence of cataract was 12%. The rate of pseudophakia or aphakia was 3.9% in right or left eyes and 5.2% overall. The prevalence of cataract in male and female subjects was 14.3% and 10.6%, respectively. The prevalence of cataract among adults older than 50 [17.1%] was 9 times that of the 40-49 age group [1.9%]. The prevalence of lens opacity among males and females was 39.1% and 28.3%, respectively. The prevalence of lens opacity among adults older than 50 [45.7%] was more than 7 times that of the 40-49 age group [6.3%]. The prevalence of grade II lens opacification or over was 33.4%. The most frequent type of lens opacity was nuclear sclerosis followed by cortical and posterior subcapsular opacities

Conclusion: the prevalence of cataract and lens opacity in residents of Tehran aged 40 or over is significant especially among elderly indivisuals and it may be estimated that 240,000 persons in Tehran population have cataract and 648,000 have lens opacity, which is a matter of concern for our health system