[Association between acute corneal hydrops in patients with keratoconus and mitral valve prolapse]

To investigate the association between acute corneal hydrops in patients with keratoconus [KCN] and mitral valve prolapse [MVP]. This case-control study included KCN patients with corneal hydrops who were referred to Labbafinejad Medical Center or a collaborating private clinic from March 2006 to March 2008 as the case group. The control group included age- and sex-matched individuals who were selected from patients without any ophthalmic diseases among clients of the same medical centers. Patients with history of eye trauma, corneal degenerative diseases, rheumatic fever, Marfan syndrome, rheumatoid arthritis, and systemic lupus erythematous were excluded. The size of the control group was four times that of the case group to increase the power of the study. All subjects were referred for cardiac examination and underwent two-dimensional M-mode and color Doppler echocardiography. Proloff's criteria were used for diagnosis of MVP. Fisher exact test and logistic regression were used to compare these two groups. Overall, 160 patients [32 cases and 128 controls] with mean age of 31.0 +/- 13.2 were studied. Prevalence of MVP was 65.6% in the case group and 9% in controls [P<0.001]. Patients with hydrops had an odds ratio of 26.7 for having MVP [95% confidence interval, 9.5-75.2]. Age- and sex-adjusted analysis revealed a higher correlation between the two conditions in the case group. There seems to be a correlation between corneal hydrops secondary to KCN and MVP suggesting the need for cardiovascular evaluation in these patients to assess mitral valve status

[Causes of visual impairment among patients referred to rehabilitation clinics of Shahid Beheshti medical university]

To describe causes of low vision and blindness in patients referred for low vision aids to rehabilitation clinics at Shahid Beheshti Medical University during 2005. Visual acuity was classified to five groups based on best-corrected visual acuity [BCVA] in the better eye according to World Health Organization [WHO] criteria and by using standard Snellen chart which included mild, moderate, severe and profound low vision and blindness. The causes of blindness and low vision were determined using the 10[th] version of International Classification of Diseases [ICD-10] based on the main cause in both eyes. The study was performed on 432 patients including 275 [65%] male and 148 [35%] female subjects with mean age of 43.6 +/- 25.5 [range 3-92] years. Mild to moderate and severe low vision and blindness were present in 28.8%, 46.4% and 24.8% of cases, respectively. The main causes of visual impairment were diseases of the retina and choroid [74.5%], optic nerve and optic tract diseases [9.8%], vitreous and globe disorders [3.5%], congenital cataract [3.1%] and glaucoma [2.6%]. The pattern of distribution of the causes was almost similar in all age subgroups. Diseases of the retina and choroid are the main cause of visual impairment among patients referred to eye rehabilitation clinics

[Patient satisfaction with outpatient/inpatient ophthalmologic services at labbafinejad medical center]

To assess patient satisfaction with ophthalmologic services at Labbafinejad Medical Center. The present study was a cross-sectional study conducted during the summer of 2008. Patients with ophthalmic problems were selected by systematic random sampling according to the admission list. A trained investigator interviewed patients in the hospital or clinic. The data collection tool was based on a standard PSQ-18 questionnaire. Primary outcomes were measured as the level of satisfaction domains on a 5-point scale [1 = lowest satisfaction, 5 = greatest]. Of 539 patients [98% response rate] with mean age of 44.7 +/- 23 years age, 167 patients [31.2%] were completely satisfied, 215 [39.9%] were satisfied, 95 [17.5%] were partially satisfied, 29 [5.2%] were unsatisfied, and 33 [6.2%] were completely unsatisfied. The mean score and standard deviation of general satisfaction was 4.05 +/- 1.1. Mean score in different domains of satisfaction were as follows respectively, interpersonal manner [doctor-patient] 4.6 +/- 0.77, financial aspects 4.5 +/- 1.1, communication 4.3 +/- 0.96, time spent for patient 4.3 +/- 0.97, technical quality and professionalism 4.1 +/- 0.99, accessibility 3.8 +/- 1.1, and convenience 2.6 +/- 1.2. The patients were relatively highly satisfied with the ophthalmologic services overall; however, certain aspects such as accessibility and convenience should be improved

[Intravitreal injection of bevacizumab versus triamcinolone acetonide in patients with refractory CME]

To compare intravitreal bevacizumab [IVB] with intravitreal triamcinolone acetonide [IVT] for treatment of refractory uveitic cystoid macular edema [CME]. In this randomized clinical trial, 31 eyes with uveitic CME were allocated into 2 groups: the IVB group, received one to three injections of 1.25 mg bevacizumab [15 eyes]; the IVT group received one to three injections of 2mg triamcinolone [16 eyes]. The primary outcome measure was change in best-corrected visual acuity [BCVA] at 36 weeks. Visual acuity improvement as compared to baseline values was meaningful in the IVB group at 12, 24, and 36 weeks and in the IVT group at 24 and 36 weeks. A significant reduction in central macular thickness [CMT] was observed only in the IVT group at week 36 [74.6?108.0 microm [P=0.049]]. Intergroup analysis however, disclosed no significant difference in any of the outcome measures. By removing the effect of cataracts, IVT had a better improving effect on VA [P=0.007]. No significant systemic side effect was observed during the study period. IVB was as effective as IVT in refractory uveitic CME regarding VA improvement. Irrespective of triamcinolone-induced cataract, the effect of IVT may be superior to IVB

[Assessing Iranian ophthalmologists' perception of english language presentations in scientific congresses]

To assess the English language competence of Iranian ophthalmologists and their points of view regarding the need for and importance of holding ophthalmologic congresses in English. A descriptive-analytic, cross sectional study was conducted during the 17th Iranian Ophthalmology Congress, Tehran. Data collection was performed via a standard self administered questionnaire. Five-hundred question forms were distributed among ophthalmologists and answers were graded using an ordinal five-level score. The response rate of this study was 94.6%. The English competence of 200 [42.3%] of the responders was good or perfect. Overall, about 90% of the responders agreed on holding ophthalmologic congresses in English; 72 [15.2%] individuals proposed holding speeches in English at all sessions, 189 [40.0%] preferred holding the main hall speeches in English and 162 [34.2%] said that the best way is to have only foreign guests' speeches in English. Most ophthalmologists implied that holding ophthalmic congresses in English and inviting foreign lecturers is of great importance and the best form of performance is holding all lectures in the main hall in English. It seems that improving the English abilities of ophthalmologist together with holding English congresses and inviting foreign lecturers may help improve international communications and update their knowledge

[Outcomes of lensectomy, posterior capsulotomy, anterior vitrectomy and posterior chamber intraocular lens implantation in pediatric cataracts]

To evaluate the visual outcomes and complications of lensectomy, posterior capsulotomy, anterior vitrectomy and Acrylic hydrophobic posterior chamber intraocular lens [PCIOL] implantation for congenital or developmental cataract in children 6-9 years of age. In a prospective interventional case series, 13 eyes of 10 children with congenital or developmental cataract underwent the above-mentioned surgery. Patients were followed for at least six months postoperatively. Pre- and postoperative visual acuity as well as intra- and postoperative complications were evaluated. Mean age was 7.8 +/- 1.2 [range 6-9] years. Patients were followed for a mean period of 13.3 +/- 7 months after surgery. Mean preoperative visual acuity was 1 +/- 0.1 LogMAR which reached 0.1 +/- 0.1 LogMAR at final follow up [P<0.0001]. No intraoperative complication occurred. All cases had clear visual axis at the last visit. Lensectomy, posterior capsulotomy, anterior vitrectomy and PCIOL implantation in 6-9 years old children with congenital or developmental cataract is a safe procedure and effective in terms of visual improvement

[Effect of religious fasting on basal tear secretion, tear break up time and intraocular pressure]

To compare the effect of religious fasting on basal tear secretion [BTS], tear break up time [TBT] and intraocular pressure [IOP] in Ramadan 2005. One-hundred fifty-six healthy male volunteers less than 40 years of age from Tehran, Zahedan, Ahvaz, Mashhad and Tabriz with no ocular and systemic disease participated in this study. Weight, urine specific gravity, BTS, TBT and IOP were measured at 8:00 AM one week before as well as at 8:00 AM and 5.00 PM in the third week of Ramadan. Mean age of participants was 30 +/- 5.9 years. Duration of fasting was 12-13 hours. Mean TBT, BTS and IOP decreased by 1.8 second [P<0.0001], 2.1 mm [P<0.0001] and 0.5 mmHg [P<0.0001], respectively at 5:00 PM in the third week of Ramadan compared to 8:00 AM one week before Ramadan. IOP reduction was not clinically significant. Significant decrease in BTS and TBT was seen after three weeks of religions fasting

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

Botulinum Toxin injection into inferior Oblique Muscle for treatment of acquired superior Oblique Palsy

To evaluate the effect of Botulinum toxin-A [BTA] injection into the inferior oblique [10] muscle in releaving the symptoms of superior oblique [SO] palsy.The study was conducted on patients who were referred for acquired SO palsy with less than 2 years of duration. About 10-20 unit of BTA was injected into the belly of the inferior oblique muscle through the inferotemporal quadrant of the involved eye without opening the conjunctiva. Results: Eighteen eyes from 16 patients were injected. Mean age was 33.7 years and mean duration of paresis was 6 months. Trauma was the cause of paresis in 81.2%. Six months after the injection, mean deviation decreased from 6.4 A to 1.9A; mean I0 over-activity decreased from +6.4 to +1.9; mean SO upper-activity decreased from -1.7 to -0.6; mean subjective torsion decreased from 9.3° to 0.4°; and mean head tilt decreased from 8.4° to 1.1°.Botulinum toxin-A injection into the 10 muscle can decrease the symptoms of patients with SO palsy and cause faster rehabilitation of these patients before stabilization of signs for final decision

Blepharotomy versus Tarsotomy in Upper Eyelid Cicatricial Entropion

To determine the success rate and complications of blepharotomy and tarsotomy in moderately severe upper eyelid cicatritial cntropion.This randomized clinical trial was conducted on patients with moderately severe cicatritial cntropion. The patients were followed for six months and the results and complications were evaluated. Success was defined as uncontacted eyelid margin and cilia to cornea. Sixty upper eyelids of 37 patients [10 male and 27 female] underwent blepharotomy in 30 eyelids and tarsotomy in 30 other eyelids. Mean age was 68.7 +/- 7.0 years in the blepharotomy group and 61.2 +/- 14 in the tarsotomy group. [P=0.3] Trachoma was the undelying cause in all eases. Success rate was 93.3% in the blepharotomy group and 96.7% in the tarsotomy group. [P=0.5] There was no significant difference between the two groups regarding complications of the procedures at the end of follow up except for eyelid notching which was significantly greater in the blepharotomy group. [16.7% vs 0, P=0.02] Blepharotomy and tarsotomy are successful operations in moderately severe cicatritial entropion. Tarsotomy is easier and doesn't need a skin incision. We suggest tarsotomy as a better technique in patients with moderately severe trachomatic cicatritial entropion of the upper eyelids

Effect of religious fasting on intraocular pressure in healthy individuals

To evaluate the effects of diurnal fasting during Ramadan on intraocular pressure OOP] in healthy subjects.The study was conducted on healthy male volunteer less than 40 years of age without ocular or systemic diseases who were on religious fasting during Ramadan, 2004. Intraocular pressure were measured at 9 AM and 1, 5, and 7 PM in 2nd and 4th weeks of Ramadan and also one month after Ramadan, except for the 7 PM measurement.Twenty-eight eyes of 14 men were evaluated. Duration of fasting was between i 2-13hours. Mean age was 3 1.9 +/- 4.4 years. Mean weight in the 4th week decreased about 1 kg in comparison to the 2nd week of fasting [P=0.05] and increased about 1.5 kg one month after Ramadan in comparison to the 4th week of fasting [13--- 0.008]. Mean IOP at 9 AM and 1 PM significantly decreased in the 4th week compared to the 2nd week [1.1 and 1.5 mmHg, respectively]. Mean 10P significantly increased one month after Ramadan compared to the 4th week of Ramadan [1.4 and 2.1 mmHg, respectively]. Mean LOP at 5 PM one month after Ramadan had a significant increase of 1.6 and 1.8 mmHg compared to the 2nd and 4th weeks of Ramadan, respectively. Mean IOP at 7 PM [after breaking the fast] decreased 0.5 and 0.6 mmHg in comparison to 5 PM [before the time of breaking the fast] in the 2nd and 4th weeks of Ramadan, respectively.intraocular pressures changes due to fasting in healthy person are not considerable. Evaluating intraocular pressure changes in cases with glaucoma with enough sample size is recommended

[Effect of levodopa-carbidopa on visual function in patients with recent nonarteritic anterior ischemic optic neuropathy]

To evaluate the effect of levodopa-carbidopa on improvement of visual acuity, color vision, and visual field in patients with nonarteritic anterior ischemic optic neuropathy [NAION] with onset less than 6 wks. In this double-blind randomized controlled trial, 13 patients were treated with levodopa-carbidopa and 12 patients were treated with placebo for 3 weeks. After 6 months, visual acuity [evaluated by Snellen chart], color vision [evaluated by Ishihara pseudoisochromatic plate], and visual field [evaluated by Humphrey automated perimetry central 30-2] were evaluated. Mean visual acuity in the treatment group was 1.007 LogMAR [1/10] at beginning of study and 0.75 LogMAR [4/10] at the end. Improvement of visual acuity in this group was 3 lines of Snellen chart [P=0.001]. In the placebo group, mean visual acuity was 0.85 LogMAR [3/10] at the beginning of study and 0.75 LogMAR[4/10] at the end. Improvement of visual acuity in this group was 1 line of Snellen chart [P=0.013]. Mean color vision in treated eyes was 4/14 at beginning of study and 5.76/14 at the end. In the placebo group this value was 4.3/14 at ending. There was no statistically significant difference in color vision between two groups both at beginning and at the end of treatment. Visual field improvement did not show any difference between the two groups [P=0.93]. Although levodopa-carbidopa significantly improved visual acuity, other aspects of visual function did not show significant changes. Other therapeutic modalities should be tired

[Post operative uveitis and viscoelastics: coatel versus healon]

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

[ prevalence and knowledge of contact lens wear among highschool girls in Tehran]

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