Anterior segment study with the Pentacam Scheimpflug camera in refractive surgery candidates.

PURPOSE: The purpose of this study was to evaluate the anterior segment measurements according to refractive status in a sample of the Iranian population. SETTING: Rassoul Akram Hospital, Tehran University of Medical Sciences. MATERIAL AND METHODS: IN THIS STUDY, REFRACTIVE SURGERY CANDIDATES WERE ASSIGNED ACCORDING TO THE REFRACTIVE ERROR TO ONE OF THREE GROUPS : emmetropia, myopia, and hyperopia. Myopic eyes were further divided to four subgroups : simple myopic group, simple myopic astigmatism group, high myopic group, and high myopia with astigmatism group. Anterior segment measurements with the Pentacam Scheimpflug system were performed in the right eye of all subjects. RESULTS: The study sample was comprised of 283 subjects with a mean age of 29.1 ± 7.5 (standard deviation) years. Mean keratometry reading, Anterior chamber depth (ACD) and volume measurements were significantly higher in the myopic group and mean keratometry reading and anterior chamber angle measurements were significantly lower in the hyperopic group (P < 0.05, all comparisons). Maximum anterior elevation (AEmax) and maximum posterior elevation (PEmax), Q value, progression index, minimum corneal thickness, and corneal volume measurements were similar for all groups (P > 0.05, all comparisons). In the myopic subgroups, AEmax and PEmax and maximum keratometry (Kmax) were significantly higher, and ACD was lower in the astigmatic groups (P < 0.05, all comparisons). The Q value was less negative in low myopia (P < 0.05). CONCLUSIONS: Myopic eyes had steeper corneas than hyperopic eyes and anterior chamber measurements were significantly higher in the myopic eyes. In myopic eyes, AEmax and PEmax and Kmax measurements were higher, and ACD measurements were lower in the astigmatic groups.

Pathogenesis of primary acquired nasolacrimal duct obstruction.

PURPOSE: To assess the factors assumed to be contributed in pathogenesis of primary acquired nasolacrimal duct obstruction (PANDO). METHODS: In a prospective, controlled, interventional case series, 87 patients with symptomatic PANDO (case), 7 with traumatic nasolacrimal duct obstruction (NLDO) (control), 2 with congenital NLDO (control), and 70 asymptomatic females (control) were enrolled. Frequency of putting eye make-up (PANDO versus normal females), level of sexual hormones consisting of follicular stimulating hormone (FSH), luteal hormone (LH), estradiol, progesterone and testosterone (standard laboratory level), lacrimal sac biopsy for inflammation and fibrosis and immunohistochemistry for herpes simplex virus (HSV) type 1 and 2, and human papilloma virus were recorded. RESULTS: Severity of inflammation and fibrosis were not significantly different between case and control groups (P = 0.69), and between smokers and nonsmokers with PANDO (P = 0.15). Patients with severe preoperative symptoms showed significantly more lacrimal sac fibrosis (P = 0.018). No lacrimal sac pathology was found. Frequency of putting eye make-up was not significantly different between case and control group (0.596). Immunohistochemistry was negative for the viruses in all cases. There was no abnormal sexual hormone level in any case in this series. CONCLUSION: This study did not find any evidence in favor of the role of viral infection (HSV1, HSV2, HPV), eye make-up, and sex hormones in pathogenesis of PANDO. No abnormal pathology was found in lacrimal sac biopsy of patients with PANDO.

A modified Schirmer test in dry eye and normal subjects: open versus closed eye and 1-minute versus 5-minute tests.

OBJECTIVE: To assess the results of 1-minute and 5-minute Schirmer test (ST) when eyes are open (STo) and closed (STc) in normal subjects and patients with dry eye disease. METHODS: In a comparative, observational case series study, 34 normal volunteers (group 1) and 34 patients with dry eye disease (DED) associated with Sjogren syndrome (group 2) were included in the study. STo and STc for 1 minute and 5 minutes were performed separately for all subjects with an interval of at least 24 hours using Whatman No. 41 (5 × 60 mm) with bended end of the paper inserted into the lateral side of the lower conjunctival fornix. RESULTS: In group 1, there were 19 females and 15 males with a mean age of 20.8 years (range 18 to 23 years). In group 2, there were 29 females and 5 males with a mean age of 53.7 years (range 35 to 75 years). Mean value of STc was significantly less than STo in both 1 minute and 5 minutes in both groups. One-minute STo and STc showed significantly less wetting than the 5-minute test in both healthy and patients with DED. Normal distribution was observed for all the values. A significant correlation between 1-minute and 5-minute tests in both STo and STc were found in the two groups. Therefore, two equations were proposed to calculate the 5-minute from 1-minute ST in each group. Statistical analysis did not provide a reliable equation for calculating the standard ST (5-minute STo) from the most comfortable state (1-minute STc). CONCLUSION: Faster and more comfortable ST (1-minute) is a reliable test to calculate the 5-minute ST in both open and closed eyes, using the provided equations. The 1-minute STc is not a reliable test to calculate the 5-minute STo.

Botulinum toxin injection with and without electromyographic assistance for treatment of abducens nerve palsy: a pilot study.

PURPOSE: To compare the effects and complications of botulinum toxin injection into the medial rectus muscle with and without electromyographic (EMG) assistance for treatment of abducens nerve palsy. METHODS: In a prospective, comparative, interventional case series, botulinum toxin was injected into the medial rectus muscle of 23 patients with esotropia secondary to abducens nerve palsy within 3 months of onset. Patients were randomly assigned to two groups. The injection was given with EMG assistance in the first (EMG group) and without EMG in the second group (no-EMG group). Success was defined as a distance esotropia of no more than 10(Delta) in the primary position. Angle of deviation was recorded preoperatively and at 1 week, 3 months, and 6 months; any postoperative complications and side effects were noted. RESULTS: There were 11 patients in the EMG and 12 patients in the no-EMG group. The ocular deviations were significantly improved in both groups with an overall 6 month success rate of 52.2% (p = 0.008 in the EMG group, p = 0.006 in the no-EMG group). Success rates and mean changes of the angle of deviation were not statistically different between the two groups. Postinjection blepharoptosis was found to be significantly more in the EMG group (p = 0.009). CONCLUSIONS: The effectiveness of botulinum toxin injection is the same with or without EMG assistance into the medial rectus muscle for treatment of abducens nerve palsy. EMG assistance is associated with more blepharoptosis.