epidemiology of orbital exentration in Southern Iran

Exentration is performed as an infrequent procedure for the treatment of locally invasive or potentially life threatening orbital neoplasm, when less invasive management are inadequate. This study was performed to report the epidemiological features of diseases treated by orbital exentration as well as surgical techniques used in south of Iran. In a retrospective study, records of all patients' undergone exentration of the orbit between years 1986 and 2006, at the Khalili Teaching Eye Hospital were reviewed. Correspondingly, records of pathology were also searched for the same cases to confirm the pre-operation diagnosis in the charts. There were 28 men and 20 women with a mean age of 50 +/- 23.9 years. Basal cell carcinoma [31%], squamous cell carcinoma [18%] and malignant melanoma [14%] were found to be the frequent ones. Consequently, eyelid was reported as the anatomic site for origin of tumors in 41.6% of patients. The exenterated cavity was left to heal by granulation tissue and epithelialization in 32 cases [66%], skin graft was placed in 13 cases [27%] and tissue flap were prepared for reconstruction in the remaining three cases. Basal cell carcinoma with secondary orbital involvement was the most common cause of orbital exenteration and healing by the granulation tissue was the main rout of reconstruction in our cases

[Specular microscopy evaluation of corneal endothelial cells after intravitreal and subconjuctival injection of avastin]

To evaluate corneal endothelial cell changes after intravitreal and subconjunctival injection of avastin [bevacizumab] based on specular microscopic findings. This prospective interventional study was performed on 82 eyes of 82 patients. Forty-two cases with ptrygia received a subconjunctival injection of bevacizumab [2.5mg/0.2ml] and 40 diabetic subjects with retinal neovascularization or macular edema received an intravitreal injection of bevacizumab [1.25mg/0.1ml]. Specular microscopy, including corneal endothelial cell count, size and shape, was performed in all patients for the injected eye before, and one and three month after injection and the results were compared and analyzed. There was no change in the corneal endothelial cells count after one month but there was mild reduction of endothelial cells after 3 months which was not statistically significant.[P=0.75 and 0.29, respectively]. Subconjunctival and intravitreal injection of bevacizumab [up to 1.25 mg/0.1 ml and 2.5 mg/0.2 ml, respectively] entails no harmful effect on human corneal endothelial cells up to three months following the injection

effect of nutririon and supplements on ocular health

Nutrition is a subject of interest in many fields of medicine. So ophthalmologists have also attempted to find possible ways to preserve vision through diet and supplements. Ocular disorders such as cataracts, age-related macular degeneration and glaucoma are the leading causes of visual impairment and blindness in the world, so most of the studies have focused on these major disorders and nutritions containing antioxidant such as vitamin C and E. Zexanthin/luteins and omega 3 have been the main substances studied in this relation. Although benefits of the regimens with high amounts of antioxidants were observed in reducing progression of cataract, agerelated macular degeneration and so on, as many of these studies have been observational, the cause and effect relationship cannot be definitely concluded and multiple cohort prospective studies will be desired to evaluate the exact role of nutrition. Somehow, a healthy diet which means the diet which increases our health can be achieved in regimens with low saturated fatty acids and rich in fresh fruits, vegetables and fish. On the whole, even though they may not affect disease progression, they are generally good for overall health

healing effect of vitreous body on repair of cartilage defects of knee joint in dog as an animal model

To investigate the healing effects of vitreous body in repair of cartilage defects of the knee joint in dog as an animal model. Ten mature cross-bred female dogs weighing 20-35 kg entered our study. The right and left knees underwent a medial parapatellar incision arthrotomy. A cartilage defect was created by a six mm drill to subchondral bone in the right knee and the two borders of the fascia were fixed to the space of the joint defect. The vitreous was provided through a clear corneal incision to completely fill the joint defect. In the left knee, the cartilage defect was left untreated. The dogs were sacrificed after 3 months post-operation and the samples were studied for any sign of repair. The defects of the right knee showed more signs of repair compared to the left knee after 12 weeks. Fibrous and hyaline tissues, new bone and blood vessels formation were significantly more visible in the right knee. Modified histological scoring scale in the right and left knees were 5.8 and 11, respectively. The results imply the promising effect of vitreous body implantation in the healing of a cartilage defect in the knee joint

External ocular manifestation of Wolfram syndrome

Wolfram syndrome is a neurodegenerative disorder usually diagnosed in childhood. The ocular manifestation of wolfram syndrome is mainly characterized by bilateral optic atrophy; however, pigmentary retinopathy has been reported in some cases. We present a case with new external ocular manifestation of wolfram syndrome not previously reported in the literature. A 22-year-old retarded man clinically diagnosed as having wolfram syndrome presented with ocular discomfort in his both eyes for a 4-year period, being aggravated recently. On examination, he was emmetrope with best corrected visual acuity of about two meter count finger in each eye. Pupillary response was sluggish but equal in both eyes. Ocular motility was normal and there was no considerable sign of nystagmus; however, there were disturbed blinking reflex, lagophthalmus, and poor bell's phenomenon. Slit lamp examination showed bilateral symmetrical saucer-like depression of the corneal surface adjacent to the limbos that is known to be deled formation. The result of Schemer test was out of the normal limit, in favor of dry eye. So, dry eye due to blinking disturbances in patients with wolfram syndrome as a neurodegenerative disorder may lead to external ocular manifestations, requiring conservative treatments

[Thyroid function tests in patients with chalazia]

To evaluate the prevalence of clinical and subclinical thyroid disorders using thyroid function tests in patients with single and multiple chalazia. A complete ophthalmologic examination and thyroid function tests including thyroid stimulating hormone [TSH], thyroxine [T4] and triiodothyronine [T3] were performed in 60 patients with single chalazia and 50 patients with multiple chalazia, consecutively referred to Poostchi Eye Clinic, Shiraz, Iran and compared with 60 age- and gender-matched control subjects. Mean TSH values were higher in patients with single [3.89 Mu/l] and multiple [4.80 Mu/l] chalazia as compared to controls [3.02 Mu/l] [P= 0.23]. No significant difference was detected for T4 levels between patients with single or multiple chalazia as compared to controls. The prevalence of blepharitis was 18% in patients with single chalazia, 34% in patients with multiple chalazia, both of which were higher than controls [5%] [P<0.001]. The difference between patients with single and multiple chalazia in terms of the prevalence of blepharitis was also significant [P<0.05]. There was no significant difference between patients with single and multiple chalazia in comparison with controls regarding thyroid function tests; however the prevalence of blepharitis in patients with multiple chalazia was higher than patients with single chalazia and both figures were higher than controls

Local injection of bevacizumab as an alternative method for management of recurrent pterygium

Surgery has so far been used for primary treatment of pterygium; however, one of the major limitations is its high recurrence rate. This study was performed to determine the effect of bevacizumab in recurrent pterygium. Patients with recurrent pterygium were divided into two groups, receiving bevacizumab [Group 1] or normal saline [Group 2]. They were evaluated for photophobia and any conjunctival congestion and were scored from 0 to 4 prior to any injection. The size of pterygium was assessed in relation to extension of pterygium on the cornea over the limbus. All patients were followed in regular 48 hour intervals weekly up to one month and then monthly up to 6 months after the injection. There were 50 patients in group 1 and 48 in group 2 and the mean age of the patients was 40.94 +/- 13.82 and 47.10 +/- 5.9 years, respectively with a male to female ratio of 1 2. The mean size of ptrygium was 52.84 in group 1 and 46.02 in group 2. In group 1, photophobia and conjunctival congestion were 59.53 and 61.27, respectively while in group 2, they were 39.16, and 37.24, respectively. In the first 48 hours, conjunctival congestion and photophobia were higher in group 1 but there was no significant difference regarding the size of pterygium. After one week, the scores were significantly lower in group 1 while the mean rank for the size of pterygium was 52.84 in group 1, and 46.02 in group 2. After 1 and 6 months, the scores were lower in group 1. Subconjunctival injection of bevacizumab can be considered as an effective temporary treatment in the management of recurrent pterygium in those who are not a candidate for secondary operation. It can decrease conjunctival congestion and photophobia and prevent further progression even in the long term

Methylenetetrahydrofolate reductase gene polymorphism and homocysteine level in patients with pseudoexfoliation and pseudoexfoliation glaucoma in southern Iran

Pseudoexfoliation [PEX] syndrome leads to elevated intraocular pressure and consequent glaucomatous damage of the optic nerve. This study was performed to investigate the frequency of MTHFR, 677 C-T polymorphism and homocysteine [Hcy] levels in Iranian patients with PEX and PEX glaucoma were compared to that in normal population. Thirty four patients with PEX, 27 with PEX and glaucoma, and 32 control subjects were enrolled. Pregnant patients with any systemic disorder such as hypertension and diabetes mellitus, usage of vitamin supplements or any condition affecting homocysteine level were excluded. Fasting total homocysteine [tHCT] levels of all the participants were determined, using an ELISA method and values exceeding 14 micromole /L were considered as an elevation. MTHFR genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism [PCR-RFLP]. Genotyping of polymorphism was done with polymerase chain reaction. The patients' mean age was 67 years [range 50-90 years] in all three groups and the male to female ratio was 2:1. The mean plasma homocysteine level was 13.95 +/- 8.7 in the PEX, 16.37 +/- 8.2 and 14.22 +/- 11.32 in the PEX glaucoma and the control group, respectively. The rate of C677T polymorphism was 44% in the PEX, 52% in the PEX glaucoma, and 40% in the control group. The result of this study implies that neither C677T polymorphism nor hyperhomocysteinemia can be considered as major risk factors for PEX or PEX glaucoma in Iranian population

[Local injection of bevacizumab for treatment of primary active pterygium]

To report subconjunctival injection of bevacizumab [Avastin] for treatment of primary active pterygium. Patients with primary active pterygia without other ocular disease, pregnancy or diabetes mellitus were enrolled. Patients were randomly allocated into two groups to receive injection of Avastin or placebo. Patients were evaluated for changes in photophobia, conjunctival congestion and size of the pterygium. In the first 48 hours, conjunctival congestion was greater in the treatment group as compared to the placebo group [125.76 vs 73.98, P<0.001]. The same was observed for photophobia [139.01 vs 69.18, P<0.001], but there was no difference in the size of pterygium between the two groups [105.86 vs 94.08, P= 0.130]. After one week, conjunctival congestion [90.98 vs 108.20, P= 0.01] and photophobia [85.08 vs 114.36 P<0.001] were less marked in the treatment group; however, mean pterygium size did not differ between the two groups [105.89 vs 94.06, P= 0.120]. This trend continued up to 6 months after the injection, the time at which the results regressed to become similar to those observed 48 hours after injection. Local injection of bevacizumab may be effective in treatment of pterygium; however, repeat injections should be considered

Headache as the main presenting symptom of iritis

Headache is one of the most common outpatient pain conditions encountered in both the private practice and emergency departments. Recognition of serious causes of headache requires a standardized diagnostic approach to history and examination. We will report a patient with iritis associated with elevated intraocular pressure [IOP] that presented with severe sudden onset headache mimicking intracranial hemorrhage. A 60-year old man, a known case of non-insulin dependent diabetes mellitus, referred to the emergency room due to severe, sudden onset of headache associated with nausea without any complaint of ocular problem except mild redness of the left eye. Considering subarachnoid hemorrhage subsequent work ups including brain CT scan and lumbar puncture were performed which proved to be inconclusive. The intraocular pressure [IOP] of the left eye was 50 mmHg and there was significant cell and flare in the anterior chamber. IOP was controlled by administration of intravenous manitol, topical antiglaucoma medications and steroid eye drops. The symptoms were relieved within a few days. This manuscript propounds the importance of the awareness of the possibility of serious headache as the presentation of ocular problems