ABSTRACT
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
ABSTRACT
To evaluate changes in indications of corneal transplantation at Labbafinejad Medical Center during 2001-2003. Records of 563 from 684 patients who had undergone corneal transplantation from Oct. 200 1 to Oct. 2003 were evaluated. All the procedures were performed by corneal surgeons and fellows. There were 292 male [51.9%] and 217 female [48.1%] subjects ranging in age from 2 months to 97 years. Keratoconus [KCN] was the most common cause [27.3%] of corneal grafting, and other causes were as follows: herpes simplex keratitis [11.7%], regraft [11.5%], bacterial keratitis [6.5%], trachoma keratopathy [5.5%], macular corneal dystrophy [5.5%], corneal opacity of unknown cause [4%], trauina [2%], congentital hereditary endothelial dystrophy [2%], fuch's endothelial dystrophy [1.9%], fungal keratitis [1.9%], and other causes [7.2%]. As in our previous report, KCN is the leading cause of corneal graft at Labbafinejad Medical Center. Infectious keratitis is the second and fuch's endothelial dystrophy is the least common indication. Herpes simplex keratitis has decreased which may be due to better medical management of the disorder. The rate of regraft has not changed
ABSTRACT
To report a case who had undergone LASIK in his right eye and PRK in the fellow eye for correction of equivalent myopia but developed progressive post-operative keratectasia only in the right eye. A 30-year-old man had undergone LASIK in right eye 3 years ago for correction of refractive error of - 1.75 - 1.50@48[degree] and PRJS in left eye 2 years ago for correction of refractive error of -1.00 - 1.75@ 100[degree]. Preoperative pachymetry was 447 [micro]m in the right eye and 446 pm in left eye. However, post-operative pachymetry decreased to 341 [micro]m in the right and 384 [micro]m in the left eye, but only the right eye revealed progressive corneal ectasia that led to severe visual loss [20/400]. PRJS may be a better choice for surgical correction of low amounts of myopia due to lack of flap creation; a factor that may weaken the anterior corneal structure and subsequently lead to progressive keratectasia. However, it is prudent to avoid any refractive surgery in eyes with central corneal thickness less than 500 [micro]m
ABSTRACT
Cataract is a major cause of blindness worldwide. Although preventive measures have been inadequate, its management and treatment have undergone great refinements over the past few decades so that 20120 distance and near vision on the first postoperative day is not surprising nowadays. Cataract surgery is greatly dependent on instruments and technique. What we consider as modern and updated today may seem primitive and obsolete in the future. The present article reviews changes in cataract surgery over the past 20 years. We should bear in mind that technological advances should be proven of their superiority and practical efficacy prior to becoming popularized
ABSTRACT
Purpose: to report the clinical features of 93 eyes with chronic and delayed onset mustard gas keratitis in 48 patients
Methods: forty-eight Iranian survivors of Iraqi chemical warfare with chronic or delayed onset mustard gas keratitis were enrolled. We reviewed the symptoms, signs, clinical course, and treatment of our patients. In 5 cases, histopathologic features of corneal and conjunctival specimens are presented
Results: of 48 patients, 3 1 [64.6%] had chronic symptomatology whereas 17 [3 5.4%] experienced delayed onset lesions. Visual acuity at referral ranged from hand motions to 20120. Ocular surface changes included chronic blepharitis and decreased tear meniscus in all, limbal ischemia [81.3%] and conjunctival vascular abnormalities [50%]. Corneal signs in order of frequency were: scar/opacity [87.5%], neovascularization [70.8%], thinning [58.3%], lipoid deposits [52. I%], amyloid deposits [43.8%], and epithelial defects and irregularity [3 1.3%]. Twenty patients received conservative treatment; others underwent allograft stem cell transplantation [20 eyes of 17 patients], penetrating keratoplasty [12 eyes of 12 patients], and lamellar keratoplasty [4 eyes of 3 patients]. Conjunctival specimens were evaluated by light microscopy. Decreased goblet cell density, attenuated or thickened epithelium, scarring in the substantia propria associated with plasmacytic and lymphocytic infiltration, and dilated lymphatic vessels were noted. Excised corneal buttons disclosed absence of epithelium and Bowman's layer, firbrovascular pannus, stromal scarring, and vascularization
Conclusion: mustard gas may cause chronic and delayed destructive lesions in the ocular surface and cornea leading to progressive visual deterioration and ocular irritation. The pathophysiology of these changes is not clearly identified. Excised conjunctival and corneal specimens revealed a mixed inflammatory response without any specific features. Based on the clinical appearance of the lesions and histopathologic findings, an immune-mediated component seems possible
ABSTRACT
Purpose: to report a case of corned epithelial cyst and its treatment
Patient and findings: a 14-year-old girl with history of strabismus surgery 9 years ago, was referred due to a white lesion in her right cornea. The lesion has been detected first in the nasal limbus 3 years ago and enlarged gradually. Because of progression toward the corneal center and threatening of the visual axis, surgery was done. The lesion was removed and at the same time, ethylic alcohol 96% was injected and applied. No recurrence was seen until 11 months after surgery
Conclusion: corneal epithelial cysts are benign lesions the removal of which is necessary if center of the cornea is threatened. With timely removal of the lesion, vision will be preserved and with meticulous surgery, no recurrence will occur
ABSTRACT
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
ABSTRACT
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
ABSTRACT
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
ABSTRACT
Purpose: to evaluate the prevalence of contat lens wear among highschool girls and their general knowledge about contact lenses and also to evaluate the specific knowledge of contact lens wearers about the lens
Methods: in a cross-sectional study, 1664 students of 22 randomly selected girl highschools were enrolled. A questionaire including questions about wearing contact lens, age of first use, cause of lens wear, type of lens, source of providing, way of wearing, and medical and hygienic care was filled out by the participants. Contact lens wearers were classified in two groups according to the main cause of lens wear: cosmetic and therapeutic
Results: the prevalence of contact lens wear was 16.5% including 81.8% for cosmetic purposes and 18.2% for therapeutic reasons. The age of starting lens wear was before 14 in 36%. About 50% of contact lens wearers had at least once worn the lens of another person. General knowledge was often weak or little and the knowledge about serious complications of contact lens wear was good only in 43% of the students. There was no significant differences between weares and nonwearers regarding these issues. The source of providing of lens among the therapeutic group was physicians in 90% and boutiques in 2% corresponding figures were 9.8% and 32% respectively in the cosmetic group. The most common type of lens was soft [98%] and colored [84.3%]. Lens handling was bad or inappropriate in 73.1 %; however appropriate handling was greater in the therapeutic group [42%] than the cosmetic group [23.6%]. Medical care was appropriate in 30.9% [68% in the therapeutic group and 22.7% in the cosmetic group]. Hygienic care of lens was appropriate in 53.8% [62% in the therapeutic group and 52% in the cosmetic group]. Hygienic care of lens container was appropriate in 16.4% [24% in the therapeutic group vs 4.7% in the cosmetic group]. Specific knowledge of lens wearers was appropriate in 46.6% [58% in the therapeutic group vs 44% in the cosmetic group]
Conclusion: the prevalence of contact lens wear among highschool girls in Tehran is considerable especially for cosmetic purposes. Furthermore, general and specific knowledge about contact lens use was inadequate in the majority of lens wearers
ABSTRACT
Purpose: to compare the refractive results of penetrating keratoplasty [PK] in two groups of patients with keratoconus undergoing corneal grafting with different amounts of donor-recipient disparity [0.25 and 0.5 mm]
Methods: as a randomized clinical trial and after performing a complete ocular examination and vitreous length measurement, 30 patients with keratoconus were randomly assigned in two groups: 15 patients underwent PK with 0.25 mm graft-recipient disparity and the other 15 patients underwent the operation with 0.5 mm disparity. One surgeon performed all the operations using a single running suture technique. Best corrected visual acuity and refractive errors were evaluated 1 year after PK and also two months after suture removal
Results: one year after PK and also 2 months after suture removal there was no statistically significant difference in BCVA between the two groups. Mean spherical and mean spherical equivalent refractive error was better in the 0.25 mm group, however this difference was not statistically significant [P> 0.05]. In vitreous length range of 16.2-17.7 mm [20 patients] mean spherical equivalent refractive error was -1.6 and -3.6 D in the 0.25 mm and 0.50 mm disparity groups, respectively [P= 0.03]. Mean spherical error was also better in the 0.25 mm group as compared with the 0.5 mm group [-0.8 versus -2.6 D, P= 0.05]. Mean astigmatic refractive error was minimally different between the two groups
Conclusion: less donor-recipient disparity [0.25 mm Vs 0.50 mm] seems to lead to better refractive outcomes in penetrating keratoplasty for eyes with keratoconus and vitreous length of 16.2- 17.7 mm
ABSTRACT
Corneal transplantation is the most common and successful form of solid organ transplantation with; a 2-year survival rate of over 90% in low risk cases. This high success rate may be due to the immune privileged status of the cornea, ACAID [anterior chamber associated immune deviation]: induction phenomena and secretion of inhibitory molecules by corneal cells such as IL1 -ra, IL-la and Fas ligand. However, immunological rejection is the leading cause of corneal graft failure. This process is primarily mediated by CD+ T cells of the Th1 phenotype. The mainstay of corneal graft rejection treatment is topical and systemic steroid. Recently topical and systemic cyclosporine A have also yielded promising results. This article reviews the molecular mechanisms of immunity in corneal graft rejection in addition to its prevention and treatment. Correct preoperative case selection is vital in preventing graft rejection
ABSTRACT
Purpose: to present 2 cases of acanthamoeba keratitis diagnosed by confocal scanning before positive results of smear and culture, and their successful treatment with combined medical therapy and corneal epithelial debridment
Patients and Windings: confocal scan was carried out in 2 contact lens wearers with a clinical diagnosis of acanthamoeba keratitis followed by corneal epithelial debridment for debulking of the corneal lesion and preparing specimens for smear and culture. Medical therapy was initiated subsequently. Wet mount preparations of the contact lens preservative fluid were also evaluated under dark field microscopy. Confocal scan in both patients revealed reflective round to oval-shaped structures 15 to 25 micro in diameter in the sub-epithelial and anterior stromal areas. Smear and culture results were positive for acanthamoeba and the motility of the trophozoites was easily observed using wet mount preparations. Both cases were treated successfully by combined medical therapy and debulking of the lesion
Conclusion: confocal scan is a very helpful, non-invasive procedure in the early diagnosis of acanthamoeba keratitis before positive results of smear and culture. Corneal epithelial debulking in the early stages of acanthamoeba keratitis is of diagnostic value and has high therapeutic importance when combined with anti-acanthamoeba medical therapy