The Association of Central Corneal Thickness with Ocular and General Parameters in a Community Setting: The Yazd Eye Study.

PURPOSE: To assess central corneal thickness (CCT) and its associations in an adult Iranian population. METHODS: This was a population-based cross-sectional study of adults aged 40-80 years. Eyes with corneal disorders, previous ocular surgery, or trauma were excluded. All subjects underwent complete ophthalmic examination, general health assessment, laboratory tests, and a detailed interview. CCT was measured with an ultrasonic pachymeter. Intraocular pressure (IOP) was measured with Goldmann applanation tonometry. Except for the report on interocular differences in CCT, only one eye of each subject was used for the rest of statistical analyses. RESULTS: The mean age (±SD) of the 1203 participants, who had CCT measurements and met inclusion criteria, was 51.8 ± 8.5 years. The mean CCT was 544 ± 35, 564 ± 28, and 544 ± 36 µm in the eyes of the normal, ocular hypertension, and glaucoma groups, respectively (P = 0.025). In participants without glaucoma, the mean interocular difference in CCT was 9 ± 12 µm. CCT was not significantly associated with age, sex, or some select systemic factors (body mass index, diabetes, hypertension, and renal failure). While controlling for age and sex, CCT was greater in individuals with higher IOPs (P < 0.001), larger vertical or horizontal cup-to-disc ratios (P = 0.044, and P = 0.025, respectively), and hyperopia (P = 0.009). CONCLUSION: In this adult Iranian population, CCT was significantly associated with IOP, cup-to-disc ratio, and the refractive status of eye. CCT outside the normal range of 475-613 µm or with interocular asymmetry greater than 33 µm (6%) should prompt evaluation for potential ocular disorders.

Intraocular pressure measurement by three different tonometers in primary congenital glaucoma.

PURPOSE: To determine the agreement between intraocular pressure (IOP) measurements using an automated non-contact tonometer (NCT), Goldmann applanation tonometer (GAT), and the ocular response analyzer (ORA) in subjects with primary congenital glaucoma (PCG). METHODS: Twenty-nine eyes of 17 PCG patients underwent IOP measurements using NCT, GAT and ORA. Variables obtained by the ORA were corneal-compensated IOP (IOPcc), Goldmann-correlated IOP (IOPg), corneal hysteresis (CH), and corneal resistance factor (CRF). A difference more than 1.5 mmHg for IOP was considered as clinically relevant. RESULTS: Mean age of the patients was 12 years. Mean IOP (±standard deviation, SD) was 15.3 ± 2.8 mmHg (GAT), 15.5 ± 6.0 (NCT), 19.2 ± 7.0 (IOPg), and 21.1 ± 7.9 (IOPcc); (P = 0.001). Except for NCT vs. GAT (P = 1.0), the average IOP difference between each pair of measurements was clinically relevant. The 95% limits of agreements were - 10.2 to 10.3 mmHg (NCT vs. GAT), -7.8 to 15.3 (IOPg vs. GAT), and - 8.1 to 19.0 (IOPcc vs. GAT). The differences in IOP measurements increased significantly with higher average IOP values (r = 0.715, P = 0.001, for NCT vs. GAT; r = 0.802, P < 0.001, for IOPg vs. GAT; and r = 0.806, P < 0.001, for IOPcc vs. GAT). CH showed a significant association with differences in IOP measurements only for IOPcc vs. GAT (r = 0.830, P < 0.001). CONCLUSION: Mean IOP obtained by NCT was not significantly different from that of GAT, but ORA measured IOPs were significantly higher than both other devices.

Outcome of endophthalmitis treatment in a tertiary referral center in southern iran.

PURPOSE: The purpose of this study was to investigate the causative organisms, the clinical characteristics, visual outcomes, and the incidence of acute endophthalmitis after cataract surgery. MATERIALS AND METHODS: In this retrospective study, a chart review was performed for patients treated in a tertiary referral center for acute endophthalmitis after cataract surgery from January 2005 to December 2009. During the study period, 62 additional patients with acute postoperative endophthalmitis were referred to and treated in this center. Therefore the cohort comprised 70 patients (8 of whom underwent cataract surgery at our center, and 62 who were referred). Demographic, clinical, and laboratory data were analyzed. The primary outcome measure was final visual acuity. P<0.05 indicated statistical significance RESULTS: During the study period, 7737 cataract surgeries were performed in this center. Eight (0.10%) of 7737 eyes developed acute postoperative endophthalmitis. Subgroup analysis indicated that extracapsular cataract extraction was associated with a fourfold higher risk of endophthalmitis compared with phacoemulsification. We found better initial visual acuity (VA) (≥ hand motion) (P<0.001) and negative cultures (P=0.021) were independently associated with a more favorable visual outcome. Patients with relative afferent papillary defect (RAPD) were associated with lower initial VA (P<0.001) and worse visual outcome (P=0.001). Positive microbial cultures were found for 33 (42.9%) cases. Staphylococcus aureus was the most common organism isolated. Positive cultures were more frequently found in patients with RAPD. The "gram-positive coagulase-negative" and "no growth" groups had the best visual outcome. Associated keratitis and avoiding intraocular steroids were associated with the risk of evisceration. CONCLUSION: The visual outcome after endophthalmitis was generally poor and only one eighth of the eyes achieved a final corrected visual acuity of ≥20/200. Therefore, better treatment strategies are warranted. Immediate treatment is essential and the role of primary vitrectomy requires further investigation. In addition, RAPD, as an objective test, may complement VA for predicting the prognosis and planning the course of treatment.

Effect of Ramadan fasting in tropical summer months on ocular refractive and biometric characteristics.

BACKGROUND: Islamic Ramadan is the month of fasting, in which intake of food and drink is restricted from sunrise until sunset. The objective of the present study was to find out the effect of altered eating habits during Ramadan fasting on ocular refractive and biometric properties. METHODS: In this prospective case series, 40 eyes of 22 healthy volunteers with a mean age of 60.55 ± 12.20 years were enrolled. Patients with any systemic disorder and eyes with pathology or previous surgery were excluded. One month before Ramadan (at 8.00 am), during Ramadan fasting (at 8.00 am and 4.00 pm) and one month later during the non-fasting period (at 8.00 am), ocular refractive and biometric characteristics were measured using an autokeratorefractometer (Auto-Kerato-Refractometer KR-8900; Topcon Co, Tokyo, Japan) and contact ultrasonic biometry (Nidek Echoscan US 800; Nidek Co, Tokyo, Japan). RESULTS: Anterior chamber depth was significantly increased during fasting compared with baseline measurements and returned to baseline one month after Ramadan (3.22 ± 0.07 mm and 4.33 ± 0.17 mm for non-fasting and fasting, respectively; p < 0.001). The anterior chamber depth measurements were significantly larger at 8.00 am during fasting compared with 4.00 pm (p = 0.01). Axial length was significantly decreased during fasting and returned to baseline one month after Ramadan (23.09 ± 0.14 mm and 22.65 ± 0.18 mm, for non-fasting and fasting, respectively; p < 0.001). Intraocular lens power calculations were significantly increased during fasting and returned to baseline one month after Ramadan (SRK-T formula: 21.46 ± 0.27 D and 22.92 ± 0.46 D, for non-fasting and fasting, respectively; p < 0.001). There were no significant differences in spherical equivalent, corneal astigmatism, mean keratometry and flatter and steeper corneal radii of curvature between time intervals. CONCLUSIONS: Ramadan fasting is associated with statistically significant alterations in anterior chamber depth and axial length that result in both statistically and clinically significant changes in intraocular lens power calculations. Therefore, relying on measurements taken during this month might lead to refractive errors after cataract surgery.

Effect of povidone-iodine concentration and exposure time on bacteria isolated from endophthalmitis cases.

PURPOSE: To determine the in vitro susceptibility of post-cataract surgery endophthalmitis bacterial isolates to different concentrations of povidone-iodine at different exposure times. SETTING: Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. DESIGN: Experimental study. METHODS: Ocular-fluid samples obtained from patients diagnosed with postoperative endophthalmitis were submitted to a microbiology laboratory for culture. One milliliter of microbial isolate suspension with a McFarland standard turbidity of 0.5 was mixed with 1 mL of 1%, 2%, 5%, and 10% povidone-iodine solutions. After 1 minute, 5 minutes, and 15 minutes of exposure at 37°C, each solution was transferred to appropriate culture media and incubated at 37°C for 24 hours. RESULTS: Organisms were isolated in 30 (68%) of the 44 patients evaluated. Coagulase-negative Staphylococcus was identified in 14 cases (47%), Streptococcus species in 8 cases (27%), Staphylococcus aureus in 5 cases (17%), Bacillus cereus in 2 cases (6%), and Pseudomonas aeruginosa in 1 case (3%). Higher povidone-iodine concentrations and longer exposure times were more effective than lower povidone-iodine concentrations or shorter exposure in preventing growth of bacterial isolates. The most effective regimens were 5% povidone-iodine for 15 minutes and 10% povidone-iodine for at least 5 minutes. With a high bacterial load, 13% of bacterial isolates remain viable after exposure to 10% povidone-iodine, even with a long exposure time. CONCLUSION: Results indicate that using 5% povidone-iodine for 15 minutes or 10% povidone-iodine for 5 minutes can prevent the growth of most post-cataract surgery endophthalmitis bacterial isolates.

Clinical and epidemiologic characteristics of severe childhood ocular injuries in southern iran.

PURPOSE: To evaluate the clinical and epidemiological characteristics of children with ocular trauma. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 278 children (aged 15 years or less) hospitalized with ocular injuries and treated as inpatients at a tertiary referral center in Shiraz, Iran, from 2005 to 2008. Nominal variables were evaluated with a Chi-square test. A P-value less than 0.05 indicated statistical significance. RESULTS: The cohort was comprised of 205 (74%) males, outnumbering females by a ratio of 2.81/1. The mean age was 7.6 ± 3.96 years. Rural residents comprised 125 (45%) of the cohort. Sharp objects caused ocular injury in 211 (76%) cases, and 207 (74%) cases had open-globe injuries. The lens was injured in 62 (30%) cases at initial examination and 89 (43%) patients according to ultrasound examination (P = 0.006). Twenty-eight cases (10%) developed post-traumatic endophthalmitis. Endophthalmitis was associated with needle injury [odd ratio (OR) = 19.25] and presence of intraocular foreign body (OR = 3.48). Visual acuity of patients with closed-globe injuries was 20/200 or better on both initial and final examinations. Visual acuity of patients with open-globe injuries were in the range of light perception to 20/200. CONCLUSIONS: Trauma is an important cause of childhood ocular morbidity in southern Iran. Playing with sharp objects is an important cause of ocular trauma in children, and most injuries can be prevented by careful supervision.

Superior oblique tendon expansion with Achilles tendon allograft for treating Brown syndrome.

PURPOSE: To report the results of treatment of Brown syndrome using Achilles tendon allograft as a superior oblique tendon expander. METHODS: Achilles tendon allografts were prepared from the tissue bank. Five eyes of 3 patients with congenital Brown syndrome (mean age, 6 years) were enrolled in the study. Surgery was performed with a superotemporal conjunctival fornix approach. The superior oblique tendon was exposed and severed; then a 2- to 3-mm-wide strip of Achilles tendon (with a thickness of 1-2 mm) was trimmed and sutured between the cut ends using double-armed 5-0 Mersilene sutures. The length of the expander ranged from 7 mm to 8 mm, depending on the severity of the disease. RESULTS: The preoperative hypotropia in primary position ranged from 15(Δ) to 30(Δ), with abnormal head position in 1 patient. Nine months after the operation, 2 eyes with moderate Brown syndrome showed an improvement in the hypotropia to <3(Δ), and 2 eyes with severe disease had residual hypotropia of 5(Δ). Another eye with severe Brown syndrome had a residual hypotropia of 20(Δ). The elevation in adduction improved by 1 grade in 1 eye and resolved in the other 4 eyes. The amount of correction in the deviation improved with time. None of the patients developed secondary superior oblique palsy, rejection, infection, extrusion, prolonged ocular inflammation, or foreign body sensation. CONCLUSIONS: Superior oblique tendon elongation with Achilles tendon allograft had acceptable short-term results in 4 of 5 eyes treated for Brown syndrome.

Ocular refractive and biometric characteristics in patients with thalassaemia major.

BACKGROUND: Thalassaemia major is associated with characteristic findings in craniofacial bony structures and thereby may render abnormal bony orbit and subsequently distinctive ocular biometry. The purpose of the present study was to evaluate the ocular refractive and biometric characteristics in patients with thalassaemia major. METHODS: This case-controlled study comprised 94 eyes of 47 patients with thalassaemia major and 88 eyes of 44 age- and sex-matched healthy control subjects. All participants had a complete ocular examination including slitlamp biomicroscopy, fundoscopy, ocular biometry, keratometry, refraction and analysis using Fourier transformation. RESULTS: There were no significant differences in spherical equivalent (p = 0.66) and total astigmatism (p = 0.83) between groups. Mean uncorrected vision and visual acuities (logMar) were similar (p = 0.32 and p = 0.71, respectively). Compared with controls, thalassaemic patients had a shorter axial length (23.01 ± 0.12 [SEM] mm versus 23.46 ± 0.12 mm, p = 0.035), thicker crystalline lens (4.01 ± 0.11 mm versus 3.87 ± 0.1 mm, p = 0.046) and steeper average keratometry (44.02 ± 0.24 D versus 43.44 ± 0.24, p = 0.03). Fifty-seven per cent of thalassaemic patients had against-the-rule astigmatism (total), while 64.6 per cent of controls showed a with-the-rule pattern (p < 0.05). These patterns were also found for corneal astigmatism. The magnitudes of total, corneal and lenticular astigmatism were similar among groups. Regression analysis showed significant correlation between corneal (J0 and J45) and total (J0 and J45) astigmatism. The correlations were less prominent between lenticular and total J0 and J45. The mean intraocular pressure was 14.68 ± 0.27 mmHg and 13.3 ± 0.26 mmHg in the thalassaemia and control groups, respectively (p < 0.001). Six eyes (12.8 per cent) of four patients in the thalassaemia group had posterior subcapsular cataract, while the condition had not been observed in controls (p = 0.049). CONCLUSIONS: Shorter axial length, thicker lens, steeper corneal curvature and more against-the-rule pattern were characteristic findings in patients with thalassaemia major.

Anti-glaucoma medication exposure in pregnancy: an observational study and literature review.

BACKGROUND: there are limited data about the effects of anti-glaucoma drugs on pregnancy. The purpose of this study was to observe pregnancies exposed to anti-glaucoma medications. METHODS: six pregnant glaucomatous patients referred to the glaucoma clinic after their first trimesters were advised to continue their medications. In one patient who was on oral acetazolamide, the drug was substituted with topical medications. In the last month of pregnancy acetazolamide was started and all topical medications were stopped. The control group comprised 24 individuals with no systemic disease or exposure to medications and with comparable age and gestational age on delivery. Pregnancy and delivery complications, Apgar scores at one and five minutes, birth weight, congenital anomalies and psychophysical development of children up to two years of age were evaluated. RESULTS: the mean age of the patients was 28.17 years with mean gestational age on delivery of 38.80 weeks. Low birth weight was more common in the case group (p = 0.041). No other side-effects were observed. The one-minute Apgar scores were nine in all newborns and improved to 10 at five minutes. The psychophysical development of all children was normal up to two years after birth. CONCLUSIONS: analysis of pregnancy outcome of six mothers taking topical glaucoma medications showed no adverse effects apart from a small but statistically significant increased risk of having low birth weight.

Ocular refractive and biometric characteristics in patients with tilted disc syndrome.

BACKGROUND: Tilted disc syndrome (TDS) is associated with characteristic ocular findings. The purpose of this study was to evaluate the ocular, refractive, and biometric characteristics in patients with TDS. METHODS: This case-control study included 41 eyes of 25 patients who had established TDS and 40 eyes of 20 healthy control subjects. All participants underwent a complete ocular examination, including refraction and analysis using Fourier transformation, slit lamp biomicroscopy, pachymetry, keratometry, and ocular biometry. Corneal topography examinations were performed in the syndrome group only. RESULTS: There were no significant differences in spherical equivalent (P = 0.13) and total astigmatism (P = 0.37) between groups. However, mean best spectacle-corrected visual acuity (Log Mar) was significantly worse in TDS patients (P = 0.003). The lenticular astigmatism was greater in the syndrome group, whereas the corneal component was greater in controls (P = 0.059 and P = 0.028, respectively). The measured biometric features were the same in both groups, except for the lens thickness and lens-axial length factor, which were greater in the TDS group (P = 0.007 and P = 0.055, respectively). CONCLUSIONS: Clinically significant lenticular astigmatism, more oblique corneal astigmatism, and thicker lenses were characteristic findings in patients with TDS.

An unusual intraorbital foreign body: A brake lever.

Orbital trauma usually affects the bony parts of the orbit; however, in rare cases foreign bodies are found within the orbit. In this report, we introduce a case with unusual large intraorbital foreign bodies (two parts of a brake lever) after a motorcycle accident. Although one of the foreign bodies was located in the posterior orbit, they required only one simple operation for retrieval. We will discus the management strategy.

In vivo observations of chlorpromazine ocular deposits in a patient on long-term chlorpromazine therapy.

Chlorpromazine is known to deposit in ocular tissues when taken at high doses for prolonged periods. Chlorpromazine therapy in a 59-year-old schizophrenic man with a cumulative dosage exceeding 2500 g resulted in multiple white deposits in both corneas especially in the endothelium. Confocal microscopy revealed significant pleomorphism and polymegethism of endothelial cells. The anterior lens capsules opacities were star-shaped and concentrated in the centre. Because of cataract and chronic angle closure glaucoma our high-myopic patient underwent surgery, and light microscopic evaluation of the obtained anterior lens capsule during cataract surgery showed golden brown cytoplasmic deposits in the central epithelial cells and capsule. The peripheral epithelial cells of the removed capsule had no deposit. There were no sign of retinal deposits in the fundoscopy, optical coherence tomography and fluorescein angiography. In this patient chlorpromazine deposited mainly in the corneal endothelium, central anterior lens capsule and epithelial cells.

The role of Botulinum toxin in management of acute traumatic third-nerve palsy.

PURPOSE: To study the effect of botulinum toxin A injection in the management of paralytic exotropia resulting from acute traumatic third (oculomotor) nerve palsy. METHODS: Nine patients with acute traumatic partial third-nerve palsy of less than 2 months' duration were treated by injection of botulinum toxin A into the ipsilateral lateral rectus muscle. The horizontal deviation angles before and after the injections were recorded. A distance exotropia of less than 10(Delta) or absence of diplopia in the primary position at the last follow-up was defined as recovery. RESULTS: The mean preinjection deviation in the primary position was 48.3(Delta) of exotropia, and the mean postinjection deviation in the primary position was 14.2(Delta) at the last follow-up. Seven patients experienced recovery and regained single binocular vision in the primary position. The overall recovery rate was 77.8%. Two patients did not recover and subsequently underwent strabismus surgery. CONCLUSIONS: Patients with acute traumatic partial third-nerve palsy treated by injection of botulinum toxin A in the lateral rectus muscle showed marked recovery when injection was performed within 2 months of the onset of palsy. Botulinum toxin injection into the lateral rectus muscle may provide temporary relief of symptoms in some patients and seems to be a useful treatment option in cases of acute traumatic third nerve palsy in the short-term.