Vertical strabismus cases and their surgical outcome in Yazd, Islamic Republic of Iran

Early diagnosis and management of strabismus is needed to avoid complications such as amblyopia. In this retrospective cohort study we reviewed the profile and surgical outcome of vertical strabismus patients attending a clinic in Yazd city in the Islamic Republic of Iran. From the medical files of 265 patients, 19.2% were found to have pure vertical deviation and 80.8% had combined horizontal and vertical strabismus. Congenital causes were recorded for 83.0% of cases and 24.9% had a family history of strabismus. Hypertropia [91.7%] was more common than hypotropia [8.3%]. There was a statistically significant relationship between age at onset and vertical strabismus. Female patients had a higher rate of congenital vertical strabismus than did male patients. There was no significant association between surgery outcomes and sex or age of onset of strabismus. Early diagnosis and management in affected families and screening of patients with strabismus family history is needed

[Assessment of color matching ability among the student of Yazd faculty of dentistry]

One of the most challenging procedures in restorative dentistry is fitting the color of the restoration to the tooth. The main purpose of this study was to determine the ability rate of color matching among the students of Yard faculty of dentistry in December 2004. In this descriptive study, 127 dental clinical students of Yard faculty were participated. Age, gender, wearing eyeglasses or lens and the year of starting the dental faculty were assessed as variable. Heliomolar composite with 16 colors was used to make the shade guide and 6 colors of the same composite were used as test group. The students were matched the shade guide with the test group in similar conditions. The data was analyzed by t, ANOVA and LSD test. Mean truth definition of all colors in 20-29 years old students were 3.86 and in 30-40 years old group were 3.38 and there was no significant differences between them. Mean truth definition in male group was 3.57 and was 3.91 in females. There was no significant differences between them. Mean truth definition in all of the colors by students without eyeglasses or contact lens were 3.98 and the other group was 3.55 which was significantly differences [P=0.023]. The difference between the entrance year for mean truth definition of all colors was significant [P=0.016]. In this study, the students whom specially wear photochoromic eyeglasses or contact lenses were lower truth color definition, but age and gender had no effect on truth color definition

[Evaluation of diurnal variations of intraocular pressure in a normal Iranian population]

To evaluate diurnal variations in intraocular pressure [IOP] in normal adult residents of Yazd city. This cross-sectional study was performed on 800 eyes of 400 subjects aged between 20-80 years selected by cluster random sampling from residents of Yazd city during 2004-2005. IOP was measured by Goldman applanation tonometer in the morning [8-9 AM] and evening [8-9 PM]. The difference between the two measurements was considered as diurnal variation of IOP. Mean IOP was 14.80 +/- 1.83 mmHg in the morning and 11.58 +/- 2.0 mmHg in the evening in right eyes and 14.79 +/- 1.89 mmHg in the morning and 11.33 +/- 2.0 mmHg in the evening in left eyes [P< 0.001]. Mean diurnal variation of IOP was 3.23 +/- 1.23 mmHg in females, 3.46 +/- 1.23 mmHg in males and 3.34 +/- 1.05 mmHg, overall [P< 0.001]. Morning IOP was higher in 84%, the same in 13.6% and lower in 2.4% compared to evening values. IOP increased with aging. There was no significant difference in mean IOP between males and females. This study revealed that IOP is usually higher in the morning in both eyes and increases with ageing in both sexes

[Aspergillus fumigatus keratitis after laser in situ keratomileusis]

To report a case of unilateral Aspergillus fumigatus interface keratitis after laser in situ keratomileusis [LASIK]. A 22-year-old woman developed corneal infiltrates located at the flap- stroma interface in her left eye 48 hours after myopic LASIK. The infiltration progressed despite administration of topical fortified antibiotics therefore, the flap was lifted and irrigated with antibiotic solution. Six days after LASIK, visual acuity was counting fingers at 30 cm and a large full-thickness corneal infiltrate was located at the flap-stroma interface. On scanning confocal microscopy, fungal hyphae were observed as high-contrast filaments. The LASIK flap was amputated. Corneal scraping revealed fungal filaments in smears and culture. The fungus was identified as Aspergillus fumigatus. Fortified antibiotic drops were discontinued and intensive topical natamycin and systemic ketoconazole were initiated which controlled the keratitis. Two months after surgery the eye was quiet and vision improved to 20/200. Interface fungal infection after LASIK is a potentially vision-threatening complication. Early lifting of the flap, fungal culture and aggressive antifungal treatment are required to treat this complication. Confocal microscopy may be a fast and safe diagnostic tool in determining the presence of fungal hyphae in vivo within the human cornea

Evaluation of keratoconus by videokeratography in subjects with vernal keratoconjunctivitis [VKC]

To assess demographic variables and the incidence of keratoconus in patients with VKC and to evaluate the characteristics of Vernal Keratoconjunctivitis [VKC] associated with keratoconus. One hundred and fifty patients with VKC were studied at Ophthalmology Department of Shaheed Sadoughi medical center between October 2004 and June 2005. Both eyes of VKC patients were evaluated by Orbscan topography for the diagnosis of keratoconus. Corneal topography maps were examined with modified Robinowitz-McDonnell test. The characteristics of VKC were recorded in keratoconus patients. The study included 93 male and 57 female subjects. The patients mean age was 13.07 ' 4.71 [range 8-24] years. The clinical forms of VKC were as follows: 45.2% mixed, 38% palpebral and 16.7% limbal types. Fifty four [36%] of 150 subjects with VKC had complications of pseudogerontoxon, punctate keratitis and shield ulcer. Eightyfour eyes [42 subjects] of 150 patients with VKC were detected as having keratoconus by videokeratography maps [28%]. There were 27 males and 15 females in keratoconus group. 16.7% of the eyes had mild, 33.3% had moderate and 50% had severe keratoconus. Eyes with severe keratoconus presented at younger age [12.7 +/- 3.35 years] than moderate keratoconus [18.3 +/- 2.15 years]. Keratoconus was more common in male gender, long-standing disease, mixed and palpebral VKC. Screening of keratoconus subjects with corneal topography allows early detection and management of keratoconus. The higher incidence of keratoconus in our study is due to videokeratography study of early keratoconus

[Status of inheritance pattern of blindness in blind people supported by yazd province's welfare organization]

It is estimated that 148 million people worldwide, the vast majority of them in developing countries, are suffering from blindness or severe visual disorders. Understanding of the different kinds of blindness epidemiology and its inheritance pattern, genetic counseling and prenatal diagnosis are important factors in prevention and treatment of blindness. This survey was designed based on the above facts. This cross-sectional study was done on 109 blind people. The individuals were interviewed based on standard genetic counseling procedure. Blood samples were collected from the cases with inheritance pattern and then stored in a DNA bank. The data were analyzed by using SPSS software and ?2 test. From the total of 109 individuals, 73 were male [67%] and 36 were female [33%]. More than half of them [53.2%] were detectable in patients aged less than one year old. The most common cause of blindness and low vision was retinitis pigmentosa in 35 cases [32.1%] followed by globe dysgenesis in 18 cases [16.5%]. Consanguinity in different degrees and a positive familial history of blindness were detected in 76 and 66 patients respectively. There was no genetic pattern in ten pedigrees. In the rest, the genetic patterns were as follows 6.4% autosomal dominant, 33.9% autosomal recessive, and 11.1% X-linked recessive. In total the inheritance pattern was detected in 56 familial pedigrees which suggested single gene disorder with the relative frequency of 51.4% in the studied population. This study may help physicians and genetic counselors to understand the importance of genetic inheritance in blindness and low vision. In addition, we believe our findings will possibly shed a new light on the future plans involving diagnosis and prevention of visual blindness

[Ocular injuries occurring in motor vehicular accident victims, Yazd province]

Motor vehicular accidents are one of the leading causes of death in young men and severe complications in all age groups. This study was carried out to evaluate eye injuries secondary to motor vehicular accidents that have a high rate of occurrence in Yazd province. This descriptive, cross- sectional study was conducted through case series method. Simple sampling, i.e. census from the under study population was performed to complete the sample number. The study was carried out in 1383 on 126 motorcycle accident cases with eye injuries referred to the Kalantari Emergency Department. Data collected from questionnaires was analyzed by SPSS software using chi-square, Fisher and Variance analysis statistical tests. Of the 126 cases, 124 [98.4%] were male and 2 [1.6%] were female. The mean age of the patients was 27.4 [SD=13.7] ranging between 5 months and 81 years. The highest rate of accidents was between cars and motor cycles; 83 cases [65.9%] and most of them [76.2%] were in the city. The most frequent eye injury was sub conjunctival hemorrhage in 112 cases [44.4%] followed by eyelids injury [Right side 64 cases [50.8%] and left side in 55 cases [43.6%]], orbital injury in 57 cases [22.6%] of which 39 cases [68.4%] had periorbital hematoma and 18 cases [31.6%] had an orbital fracture, 20 cases [7.9%] had ocular movement limitation and lacrimal drainage system injury was seen in 13 cases [5.2%]. Those with helmets had more mandibular fractures [p=0.0001]. The victims of motor vehicular accidents in our study were young men. The most frequent eye injuries were sub conjunctival hemorrhage, eyelid, orbital and lacrimal system injuries

[Prevalence and causes of low vision and blindness in the blind population supported by the Yazd Welfare Organization]

In 1995, the World Health Organization [WHO] estimated that there were 37.1 million blind people worldwide. It has subsequently been reported that 110 million people have severely impaired vision, hence are at great risk of becoming blind. Watkins predicted an annual increase of about two million blind worldwide. This study was designed to investigate the causes of blindness and low vision in the blind population supported by the welfare organization of Yazd, Iran. This clinical descriptive cross-sectional study was done from January to September, 2003. In total, 109 blind patients supported by the welfare organization were included in this study. All data was collected by standard methods using questionnaire, interview and specific examination. The data included; demographic characteristics, clinical states, ophthalmic examination, family history and the available prenatal information. The data were analyzed by SPSS software and chi square test. of total patients, 73 cases were male [67%] and 36 were female [33%]. The median age was 24.6 years [range one month to 60 years]. More than half of the cases [53.2%] could be diagnosed in children less than one year of age. In total, 79 patients [88.1%] were legally blind of which 23 cases [29.1%] had no light perception [NLP]. The most common causes of blindness were retinitis pigmentosa [32.1%] followed by ocular dysgenesis [16.5%]. Our data showed that more than half of the blindness cases occur during the first year of life. The most common cause of blindness was retinitis pigmentosa followed by ocular dysgenesis, cataract and glaucoma, respectively

Clinical survey of ocular findings in patients with grave's disease

Grave's disease is an autoimmune process manifested by three hallmarks: hyper-thyroidism with diffuse goiter, ophthalmopathy and dermopathy. This disease usually occurs with hyper thyroidism; although the may be euthyroidism. To evaluate the ophthalmic lesion in patients with grave's disease according to sex, age, and the duration of the illness as well as the treatment. Ninety five patients [62% females and 38% males] with grave's disease were included in this study. The subjects underwent a complete ophthalmic examination and the results were recorded. The elevation of IOP and chemosis were significantly higher in males than in females. The prevalence of ophthalmopathy was 60%, and most common ophthalmic signs were proptosis and lid retraction. Eyes lesions were more frequent among 50-70 years old patients. In addition, chemosis, periorbital edema, corneal sensitivity secondary to dry eye, convergence insufficiency, diplopia and proptosis were positively correlated with age. Initially, ophthalmic complains were only given by 15% of the subjects. Lid retraction was decreased with prolonged duration of disease whereas chemosis, conjunctival congestion, and extra-ocular muscle enlargements were increased. Grave's ophthalmopathy was found mostly in males and proptosis with lid retractions were the most important signs of the disease.

Early results and short term complications of lasik surgery

Today, Lasik surgery is one of the most common and effective procedures for correction of refractive errors. Less than 1% of patients undergoing Lasik operation suffer from serious and 3-5% suffers from mild complications. Also, results of lasik in most centers are promising. With the recent inauguration of the Lasik center of Yazd, it was decided to evaluate the results and complications of this surgery. In this descriptive outcome study, cases were selected randomly and data from files of 230 operated eyes was filled in a specially formatted questionnaire. Data of patients who had been operated upon between March 2003 and March 2004 was gathered and evaluated using SPSS software program with Chi square and Fisher statistical tests. Patients were followed up for 3 months. Residual refractive error in the range of +/- 0.5 was considered as complete treatment and more than +/- 0.5 considered as relative. From the total of 230 eyes, 122 eyes were of women and 108 eyes belonged to men. 24 cases [10.4%] were myopic, 188 cases [81.8%] myopic-astigmatism, 5 cases [2.2%] hyperopic and 13 cases [5.6%] hyperopic-astigmatism. 204 eyes were in the age group of less than 40 years and 26 eyes were in the age group of more than 40 years. Based on visual acuity well-being, 225 eyes [97.8%] were treated completely and 5 eyes [2.2%] were treated relatively. Complete eradication of refractive error, 3 months after surgery in myopias was 96%, myopic astigmatisms 88%, hyperopias 60% and hyperopic astigmatisms 62%. At 3 months of follow up, 224 cases [97.4%] were without any complications and the rest had few minor side effects. Lasik operation is a safe and effective procedure for correcting refractive errors with limited complications. Results are comparable with similar studies

Vitamin C concentration of Aqueous humor in senile cataract

Oxidative agents like ultraviolet are one of the important cause of cataract and vitamin C is an important water soluble antioxidant agent in the aqueous humor. This study aimed to evaluate the concentration of vitamin C in the aqueous and plasma of patients with senile cataract. In a descriptive cross- sectional study on 85 patients [41 men and 44 women] admitted for cataract surgery, aqueous [0.2 ml] and blood [5ml] were sampled just before operation under general anesthesia from anterior chamber and vein, respectively. Spectrophotometer measured the concentration of vitamin C in both samples. The mean age was 64.3 +/- 11.1 years. Aqueous and plasma concentration of vitamin C was 4.29 +/- 1.11 mg/dl and 0.77 +/- 0.0332 mg/dl, respectively. The differences were statistical significant [P almost equal to 0]. Vitamin C of aqueous were equal in both sexes, but vitamin C of plasma in women were higher than men [P= 0.043]. The concentration of vitamin C showed no relation to the type of cataract. Vitamin C of aqueous and plasma in senile cataract are lower than normal. More study is recommended for evaluating preventive effect of high vitamin C diets or supplements

Evaluation of vitamin C concentration of aqueous humor in senile cataract

Senile cataract is one of the most important preventable causes of blindness. Oxidative agents like ultraviolet [UV] are one of the most important causes of cataract. Vitamin C is an important water soluble antioxidant agent in the aqueous humor. In a cross-sectional study, 85 patients admitted to Rah-Ahan Eye Hospital for cataract surgery were evaluated. The mean age of the patients was 64.3 +/- 1.2 yr of the 85 patients, 41 were men and 44 were women. Under general anesthesia 0.2 cc of aqueous humor from anterior chamber and 5 cc of peripheral blood were taken just before operation. Concentration of vitamin C was measured in these samples and the data was analyzed by SPSS statistical program. Mean concentration of vitamin C was 4.29 +/- 0.12 mg/dl [mean +/- SE] in the aqueous and 0.77 +/- 0.036 mg/dL in the plasma. The differences were statistically significant when compared with normal values. P 0.000 in both conditions. Vitamin C concentrations of aqueous humor were equal in both sexes, but vitamin C concentrations of plasma in women were higher than men [p=0.043]. The concentration of vitamin C was not related to the type of cataract or job of patients. Since vitamin C concentration of aqueous humor and plasma in senile cataract are lower than normal, it is better to advise fresh vegetables and fruits or other supplements to patients who are at risk of senile cataract