Visual and Anatomical Outcomes of Pars Plana Vitrectomy for Dropped Nucleus after Phacoemulsification.

PURPOSE: To determine the prognostic factors and visual and anatomic outcomes of pars plana vitrectomy (PPV) in patients with dropped nucleus following complicated phacoemulsification (PE). METHODS: The records of patients with complicated PE who underwent PPV to remove posteriorly dislocated nucleus fragments from January 2011 to December 2014 were retrospectively reviewed. RESULTS: Of 43 patients, 36 patients (36 eyes) were included with mean age of 73 ± 9.5 years and mean follow-up duration of 23.8 ± 15.3 (range 4-53) months. The mean interval between cataract surgery and PPV was 11.5 ± 9.6 (range 1-45) days. The pre-PPV mean best-corrected visual acuity (VA) was 1.04 ± 0.24 logMAR, which improved to 0.46 ± 0.18 logMAR (P < 0.001). Pre-PPV VA ≥20/200 was significantly associated with good final VA ≥20/40 (P = 0.002). Implantation of intraocular lens (IOL) at the time of complicated PE and complicated course after PPV were significantly associated with poor visual outcome of <20/40 (P = 0.041 and P < 0.001, respectively). However, the timing of PPV, route of nucleus removal, and final IOL status were not significantly associated with the visual outcome. The most frequent causes of poor visual outcome were optic atrophy, cystoid and/or diabetic macular edema, history of rhegmatogenous retinal detachment, and pre-existing eye disease (age-related macular degeneration). CONCLUSION: PPV for dropped nucleus was associated with improved VA. Better pre-PPV VA was associated with good visual outcome, while inserting IOL at the time of complicated PE, and complicated course after PPV were associated with poor visual outcome.

Identification of A Novel Missense Mutation in The Norrie Disease Gene: The First Molecular Genetic Analysis and Prenatal Diagnosis of Norrie Disease in An Iranian Family.

Norrie disease (ND) is a rare X-linked recessive disorder, which is characterized by congenital blindness and, in several cases, accompanied with mental retardation and deafness. ND is caused by mutations in NDP, located on the proximal short arm of the X chromosome (Xp11.3). The disease has been observed in many ethnic groups worldwide, however, no such case has been reported from Iran. In this study, we present the molecular analysis of two patients with ND and the subsequent prenatal diagnosis. Screening of NDP identified a hemizygous missense mutation (p.Ser133Cys) in the affected male siblings of the family. The mother was the carrier for the mutation (p.Ser133Cys). In a subsequent chorionic amniotic pregnancy, we carried out prenatal diagnosis by sequencing NDP in the chorionic villi sample at 11 weeks of gestation. The fetus was carrying the mutation and thus unaffected. This is the first mutation report and prenatal diagnosis of an Iranian family with ND, and highlights the importance of prenatal diagnostic screening of this congenital disorder and relevant genetic counseling.

The Incidence of Reoperation and Related Risk Factors Among Patients With Infantile Exotropia.

PURPOSE: To determine the incidence and related risk factors of reoperation among patients with infantile exotropia who were operated on at Imam Hossein Medical Center, Tehran, Iran, from 2001 to 2015. METHODS: In this study, 82 children (55 girls and 27 boys) with infantile exotropia were divided into two groups 3 months after their first operation: children with horizontal deviation of 10 prism diopters (PD) or less (n = 64; success group) and those with horizontal deviation greater than 10 PD (n = 18; failure group). Patients with deviation of 20 PD or greater were indicated for reoperation. Factors including age at the first operation, preoperative angle of deviation, inferior oblique muscle overaction, dissociated vertical deviation, and A- or V-pattern in relation to reoperation were studied. Sensory status of children older than 5 years was also evaluated using Worth 4-dot and Titmus tests. RESULTS: Reoperation was indicated in 18.3% (n = 15) of patients after 11.5 ± 19 months of follow-up. Preoperative angle of deviation (P < .001) and surgical approach (P = .017) were statistically different between the failure and success groups. The majority of patients (71%) achieved fusion and gross stereopsis (< 3,000 seconds of arc) after surgery. CONCLUSIONS: According to the results, 18.3% of patients with infantile exotropia, especially those with more preoperative exotropia, needed reoperation to achieve good alignment. Although the recession-resection method had better motor results, the authors could not recommend it as a first operation for all patients with infantile exotropia because it was only performed on patients with amblyopia. Gross stereopsis and binocular fusion were seen in the majority of patients. [J Pediatr Ophthalmol Strabismus. 2017;54(1):22-30.].