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Here we describe shifting bubble sign in manual dissection of deep anterior lamellar keratoplasty (DALK). This sign can be noticed in more than 99% of patients. It is very useful in phakic keratoconic eyes, the leading indication for DALK. We believe that our small modification can help surgeons early in learning curve to avoid inadvertent anterior chamber penetration during the final stages of DALK.
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AIM: To study the frequency of amblyogenic factors in patients with congenital ptosis.congenital ptosis more than 1 year old were included. Amblyopia was defined as best-corrected visual acuity (BCVA) less than 10/10 or a difference between the two eyes of at least 2/10. In patients too young to be measured by the linear Snellen E test, fixation behavior was observed. Different types of amblyopia were assessed for each patient as: 1) anisometropic amblyopia: astigmatic anisometropia≥ 1dpt, hyperopic spherical anisometropia≥ 1dpt, myopic spherical anisometropia≥ -3dpt (with cycloplegia);2) strabismic amblyopia, and 3) stimulus deprivation amblyopia (SDA). Then the total incidence of amblyopia and each type of it were obtained. Patients with uni-and bi-lateral ptosis were also compared. Each specific cause was refractive amblyopia in 29.8%, SDA in 10.5%, strabismic amblyopia in 4.3%. Amblyopia was more frequent in severe ptosis, 76% in patients with covered optical axes (OA), compared to non-covered OA (22.5%). In unilateral ptosis with covered OA, astigmatic anisometropic amblyopia was more frequent, and in bilateral ptosis with at least one eye covered OA, spherical anisometropic amblyopia was more frequent. In both unilateral and bilateral ptosis, SDA was more common if the OA was covered. Paying attention to all causes of amblyopia may be important in preventing amblyopia in a child with a ptotic eye.
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AIM: To determine the frequency of HIV-related ocular involvement and to describe the characteristics of involvement in a special clinic in Tehran.METHODS: In this cross sectional study, 141 patients (125 male and 16 female, 282 eyes) of HIV-infected patients with various stages of HIV infection that were referred to Center of behavioral diseases were evaluated during a period of 7 months. Every patient had a complete profile including demographic data, method of HIV transmission, recent CD4 T cell lymphocyte count, serological studies for common sexual or blood-born viruses and toxoplasmosis, history of antiretroviral therapy, and associated systemic disease. RESULTS: A total of 141 patients were evaluated. HIV-related ocular involvement was detected in 15 patients (10.6%), including 3 mycobacterium tuberculosis-related choroiditis, 2 cytomegalovirus retinitis, 2 retinal toxoplasmosis, 2 herpes simplex virus-related lesions, 1 HIV-associated retinopathy, 1 herpes zoster ophthalmicus, 1 undetermined vitritis, and 3 cases of cranial nerve involvement including 2 cases of gaze palsy and 1 case of papilitis. In our study, mean CD4 T cell lymphocyte count was fewer in patients with ocular involvement than in patients without ocular involvement (204.7±123.8 vs 403.7±339.7, P=0.029), but there was no difference in other possible associated factors between two groups.lesions are the most common HIV-related ocular involvements in Tehran that is different from those of recent publications in developed countries.
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AIM:To report a rare case of medullary thyroid carcinoma (MTC) with iridocorneal angle metastasis.METHODS:A 28-year-old woman,a known case of sporadic MTC was referred to our hospital due to left eye mass involving iridiocorneal angle.Several months' later retinal evaluation revealed retinal involvement with some patches.RESULTS:After palliative laser photocoagulation ablation of the choroidal and angle lesions no signs of recurrence or any new lesion was detected.CONCLUSION:As we know this is the first report of MTC with iridocorneal angle metastasis in the literature.
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·Color blindness is a common disorder in human. Congenital color blindness is a trait of X-linked recessive inheritance. In our study, one thousand and six hundred female students were selected by randomized group sampling and tested by "Ishihara pseudoisochromatic plates".Among this(0.63%) showed color vision deficiency; among these cases six girls (0.38%) had deuteranomaly and 4 girls (0.25%) had protanomaly.
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AIM: To evaluate the clinical success of living related conjunctival limbal and amniotic membrane transplantation for treatment of chemical injury induced limbal stem cell deficiency.METHODS: From July 2005 to December 2007, 10 eyes of 9 male patients with chemical injury induced limbal stem cell deficiency were included in the study. All subjects underwent living related conjunctival limbal and amniotic membrane transplantation. Blepharorrhaphy was performed in two cases. Systemic immunosuppression with cyclosporine and prednisolone was initiated.RESULTS: Complete corneal epithelialization was observed in 3 eyes (30%). In one of the patients immunologic rejection and corneal melting led to perforation 1.5 months after surgery. The increasing dose of systemic immunosuppression was used to control it. Three eyes were described as primary failure because graft could not re-epithelialize the corneal surface. The remained four eyes showed partial re-epithelialization, but failed to cover the entire corneal surface with epithelium. Best corrected visual acuity ranged from hand movement to counting finger at 1 meter before the surgery and after the surgery was light perception to 20/80. Five eyes had visual improvement without any additional procedure. Dry eye and persistent inflammation were known as main causes of failure.CONCLUSION: Living related conjunctival limbal allograft and amniotic membrane transplantation can be a good option in the management of limbal stem cell deficiency in selected cases in which tear production and control of ocular inflammation are adequate.
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We present here a case of central retinal artery occlusion (CRAO) occurring after blunt ocular trauma. This is a rare occurrence and has not been frequently reported in literature. It is important to consider this uncommon but visually catastrophic condition in the differential diagnosis of acute post-traumatic visual deterioration.
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AIM:To determine the clinical characteristics of a prospective study of patients with Graves' ophthalmopathy.METHODS:We reviewed clinical manifestations,and medical records of 103 patients in whom Graves' ophthalmopathy WaS diagnosed between 2003 and 2005.RESULTS:Among 103 patients with Graves' ophthalmopathy,48(46.6%)male and 55(53.3%)female(F:M=1.1),with mean age of 45 (range;18-73) years,95 (92.2%)patients had Graves' hyperthyroidism,3(2.9%) had primary hypothyroidism,and 5 (4.8%) were euthyroid.The mean duration of ocular symptoms was 13.2 (range 2-95) months) while the mean duration of dysthyroid symptoms was 39.4(range 6-180) months.Unilaterality was occurred in 12 patients.Eyelid retraction was present in 90 patients (87%),whereas the approximate frequency of exophthalmos was 77.6%(80 patients);restrictive extraocular myopathy.29% (30 patients);evidence of extraocular enlargement on CT-scan in 52 patients of 70 patients (74%) that was evaluated,and optic nerve dysfunction,5.8%(6 patients).22(21%)patients hadglaucoma associated with Graves' ophthalmopathy that 7 (6.7%)of them were normal-tension glaucoma.CONCLUSION:Eyelid retraction Was the most common clinical sign of Graves' ophthalmopathy in our patients.Larger prospective studies are suggested to evaluate both the prevalenoe and possible racial difference in its dinical presentation in Iranian population.
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AIM: To investigate the efficacy of recombinant tissue plasminogen activator (TPA) for treatment of fibrinous membranes following cataract surgery.METHODS: 25μg of TPA was injected into the anterior chamber of 15 pseudophakic eyes with moderate to severe fibrinous membranes that developed after cataract surgery.Simultaneously, topical corticosteroid and cycloplegic therapy was continued. Routine follow-up included slit lamp examination and intraocular pressure measurement.RESULTS: Injection of the solution of tissue plasminogen activator into anterior chamber of 15 eyes resulted in complete dissolution of the fibrinous membranes in 9 (60.0%)eyes after 2 hours, and 11 (73.3%) eyes within 1 day. In 3eyes, within a few days after injection, fibrinous membrane recurred. Increased anterior chamber reaction (P=0.54) and corneal edema (P =0.083) were seen after 24hours. No evidence of toxicity was observed as measured by slit-lamp biomicroscopy and intraocular pressure. Finally, expectable stable result was obtained in all of the eyes.CONCLUSION: Safety and high efficacy of TPA in the treatment of fibrinous membranes after cataract surgery are confirmed.
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· AIM: To evaluate contrast sensitivity in patients who had undergone uncomplicated excimer laser photorefractive keratectomy (PRK) for myopia.· METHODS: Monocular contrast sensitivity function was measured with the CSV-I000E chart in 41 patients who had received PRK by the Nidek EC-5000 excimer laser system.Mean preoperative refractive error was -2.62±1.33 D (range,-0.75 to -4.00 D). Contrast sensitivity function was measured preoperatively, 1week, 1, 3 and 6months after surgery through the CSV-1000E contrast sensitivity unit (VectorVision).· RESULTS: Logarithmic values of contrast sensitivity at each spatial frequency were used for statistical analysis and normalized values were used for graphical representation.Contrast sensitivity decreased 1 week and 1 month postoperatively. Starting from the first month, there was rapid recovery of contrast sensitivity especially at low spatial frequencies, and at the third month, only at 6 and 12 cycles per degree (cpd) statistically significant decrease was seen.Six months after surgery, there was an increase in contrast sensitivity values at ail spatial frequencies.· CONCLUSION: Photorefractive keratectomy can induce significant reductions in contrast sensitivity in the first month after surgery; these values returned to the preopereative values at 6 months after surgery.
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True neoplasm of retinal pigmented epithelium (RPE) is rare, but because of important differential diagnosis including malignant melanoma (which is more common than adenocarcinoma of RPE), both in clinical and pathological characteristics, we are interested in reporting this case. A 60-year-old man underwent right eye enucleation because of progressive loss of vision and ophthalmologic diagnosis of malignant melanoma. Pathological findings revealed a lesion in posterior segment near the optic nerve. The mass was solid and well circumscribed. In histological evaluation, the tumor was composed of cells having large, pleomorphic and hyperchromatic nuclei, prominent nucleoli and occasional pigmentation. Tumor cells were mostly arranged in papillary pattern. For differentiation of melanoma, immunohistochemistry was done. Epithelial membrane antigen (EMA)was strongly positive and HMB45 was negative; consistent with the diagnosis of adenocarcinoma of RPE. Systemic evaluation ruled out any metastasis. In conclusion, although adenocarcinoma of RPE is rare, but must be kept in mind in differential diagnosis of malignant melanoma of choroids.