Free-floating pyogenic granuloma of the lacrimal sac.

The authors report a 13-month-old girl with chronic dacryocystitis, and history of three times probing and once inferior turbinate infracture. She underwent dacryocystorhinostomy due to failure of previous procedures. During surgery a free floating reddish mass was extracted from the lacrimal sac. Histopathologic examination revealed the mass to be a pyogenic granuloma.

Rate of Post-traumatic Endophthalmitis with or without Injection of Balanced Salt Solution.

PURPOSE: In a study complementing a previous multicenter randomized clinical trial on prophylactic injection of intraocular antibiotics during primary repair of penetrating eye injuries (PEIs), we sought to determine whether needle entrance and injection of balanced salt solution (BSS), per se, could increase the rate of acute post-traumatic bacterial endophthalmitis (APBE). METHODS: Patients randomized to the BSS injection arm (n=167) of the Traumatic Endophthalmitis Trial, and eligible patients who had refused enrollment and received no intraocular injections during primary repair (n=111) were compared for the development of APBE. RESULTS: APBE occurred in 8 of 167 (4.8%) eyes in the BSS group and in 5 of 111 (4.5%) eyes in the non-injection group (P=0.91). Retained intraocular foreign bodies were present in 46 eyes including 25 (15%) eyes in the BSS injection group and 21 (18.9%) eyes in the non-injection group (P=0.38). Logistic regression analysis showed no significant difference between BSS injected and non-injected eyes in terms of APBE (P=0.69). However, the presence of intraocular foreign bodies was strongly associated with the risk of endophthalmitis (P<0.001, OR=14.1, 95% CI: 4.1-48.5). CONCLUSION: Needle entrance and intraocular injection of BSS during primary repair of PEIs does not increase the risk of APBE.

Causes of visual impairment among patients referred to a visual rehabilitation clinic in Iran.

PURPOSE: Epidemiologic evaluation and investigating the causes of visual impairment in any society is a matter of concern and has a direct effect on the country's health care planning. In this study we describe causes of low vision and blindness in Iranian patients referred to rehabilitation clinics for taking vision aids. METHODS: In this cross-sectional study, visual acuity was classified based on best-corrected visual acuity in the better eye according to the World Health Organization definition (blindness, visual acuity [VA] < 20 / 400; severe visual impairment, VA < 20 / 200-20 / 400; mild to moderate visual impairment, VA < 20 / 60-20 / 200). The causes of blindness and low vision were determined using the 10th version of International Classification of Diseases based on the main cause in both eyes. To describe data, we used mean ± SD and frequency. RESULTS: The study included 432 patients, 65% male, with a mean age of 43.6 ± 25.5 years (range, 3 to 92 years). Mild to moderate visual impairment, severe visual impairment and blindness were present in 122 (28.8%), 196 (46.4%) and 105 (24.8%) of the patients, respectively. The main causes of visual impairment were retinal and choroidal diseases (74.5%), optic nerve and optic tract diseases (9.8%), vitreous and globe disorders (5.3%), congenital cataract (3.1%), and glaucoma (2.6%). The distribution pattern of the causes was similar in all age subgroups. CONCLUSIONS: Diseases of the retina and choroid are the main cause of visual impairment among patients referred to an academic visual rehabilitation clinic in Iran.

Prevalence of diabetic retinopathy in Tehran province: a population-based study.

BACKGROUND: To determine the prevalence and characteristics of diabetic retinopathy (DR) among Iranian patients with diabetes. DESIGN: population-based cross-sectional study. PARTICIPANTS: patients with diabetes aged 25 to 64 years in Tehran province, Iran. This survey was conducted from April to October 2007. The study sample was derived from the first national survey of risk factors for non-communicable disease. Diabetes mellitus was defined as a fasting plasma glucose of >or= 7.0 mmol/l (126 mg/dl) or more, use of diabetic medications, or a physician's diagnosis of diabetes. All patients known to have diabetes underwent an eye examination by bio-microscope and indirect ophthalmoscope to check for any signs of DR through dilated pupils by + 78 lens. Participants were also interviewed and examined to determine their demographic characteristics, medical conditions and the regularity of their eye visits. RESULTS: Among 7989 screened patients, 759 (9.5%) had diabetes. Of them, 639 patients (84.2%) underwent eye examination. Five patients (0.7%) with media opacity were excluded. Of 634 examined patients with diabetes, 240 had some degree of diabetic retinopathy, and the overall standardized prevalence of any retinopathy was 37.0% (95% CI: 33.2-40.8), including 27.3% (95% CI: 23.7-30.8) (n = 175) with non-proliferative and 9.6% (95% CI: 7.3-11.9) (n = 65) with proliferative diabetic retinopathy. Clinically significant macular edema and vision-threatening retinopathy were detected in 5.8% (95% CI: 4.0-7.7) (n = 38) and 14.0% (95% CI: 11.3-16.7) (n = 95) of patients, respectively. Only 143 patients (22.6%) with diabetes had a history of regular eye examination. CONCLUSION: This study demonstrated a high prevalence and poor control of DR in Tehran province. This suggests the need for adequate prevention and treatment in patients with diabetes.

Topographic evaluation of relatives of patients with keratoconus.

PURPOSE: To evaluate topographic corneal changes in relatives of patients with keratoconus (KCN). METHODS: In a prospective study, 300 eyes of 150 relatives of 45 patients with KCN were evaluated. Complete slit-lamp examination, refraction, and corneal topography were performed for all eyes. The topographic indices for diagnosis of KCN were from Rabinowitz criteria. RESULTS: The study included 84 (56%) female and 66 (44%) male subjects. Mean age was 32.4 +/- 15 years (range, 16-83 years). KCN was diagnosed in 14% of the subjects and another 7.3% were suspicious for KCN. The overall prevalence of astigmatism was 58%, including 42.1% in the KCN group, 66.7% in the KCN suspect group, and 49.6% in the healthy group. Thirty-one eyes had high regular astigmatism (>1.5 D) including 17 (54.8%) in the KCN group and 14 (45.2%) in the healthy group. Oblique astigmatism was seen in 33 (11%) eyes, including 34.2% in the KCN group, 47.6% in the suspicious KCN group, and 4.6% in the healthy group. CONCLUSIONS: Relatives of patients with KCN have a high prevalence of undiagnosed KCN. Corneal topography is important for the diagnosis of KCN and KCN suspects in family members of patients with KCN. Therefore, keratorefractive surgery should be considered cautiously in these individuals.

Four mutations (three novel, one founder) in TACSTD2 among Iranian GDLD patients.

PURPOSE: To perform a mutation screening of TACSTD2 in 13 Iranian Gelatinous Drop-like Corneal Dystrophy (GDLD) pedigrees. To assess genotype-phenotype correlations. To determine intragenic SNP haplotypes associated with the mutations, so as to gain information on their origin. METHODS: The coding region of TACSTD2 was sequenced in the probands of 13 unrelated Iranian GDLD pedigrees. Variations were assessed in other available affected and unaffected family members and in unrelated normal control subjects by restriction fragment length polymorphism (RFLP). The variations were classified as being associated with disease if they segregated with the disease phenotype in the families, were not observed in 100 control individuals, disrupted protein expression, or affected conserved positions in the coded protein. Three intragenic single-nucleotide polymorphisms (SNPs) were used to define haplotypes associated with putative disease-causing mutations. RESULTS: The probands were each homozygous for one of four putative disease-causing variations observed in TACSTD2: C66X, F114C, L186P, and E227K. Three of these are novel. E227K was found in 10 of the Iranian patients. There were some phenotypic differences among different patients carrying this mutation-for example, with respect to age at onset. Genotyping of intragenic SNPs identified four haplotypes. C66X, F114C, and L186P were each associated with a haplotype common among control chromosomes, whereas all E227K alleles were associated with a haplotype not found among the control chromosomes. CONCLUSIONS: Although mutations in TACSTD2 among Iranian patients with GDLD were heterogeneous, E227K was found to be a common mutation. It is suggested that E227K may be a founder mutation in this population. Based on positions of known mutations in TACSTD2, significance of the thyroglobulin domain of the TACSTD2 protein in the pathogenesis of GDLD is suggested.

Prophylaxis of acute posttraumatic bacterial endophthalmitis: a multicenter, randomized clinical trial of intraocular antibiotic injection, report 2.

OBJECTIVE: To evaluate the efficacy of intraocular gentamicin sulfate and clindamycin in the prevention of acute posttraumatic bacterial endophthalmitis following penetrating eye injuries. METHOD: We conducted a multicenter, randomized, double-masked controlled trial of 346 eyes with penetrating eye injury. Following primary repair, eyes were randomized to intracameral or intravitreal injection of 40 microg of gentamicin sulfate and 45 microg of clindamycin (cases) vs balanced salt solution (controls). MAIN OUTCOME MEASURE: Occurrence of endophthalmitis within 2 weeks. RESULTS: Endophthalmitis occurred in 8 (2.3%) of 167 eyes in the control group and only in 1 (0.3%) of 179 eyes in the case group (P = .04; odds ratio, 8.93 [95% confidence interval, 1.11-71.43]). In eyes with an intraocular foreign body, endophthalmitis developed in 7 of 25 control eyes and in none of 27 eyes receiving antibiotics. However, in eyes without an intraocular foreign body, endophthalmitis developed in 1 of 142 eyes and 1 of 152 eyes in the 2 groups, respectively (P value for interaction = .04). Intravitreal injection was superior to intracameral injection in preventing endophthalmitis (P value for interaction = .01). Vitreous culture results were positive in 6 (67%) of 9 eyes with endophthalmitis. CONCLUSION: Intraocular gentamicin and clindamycin are effective in the prevention of acute posttraumatic bacterial endophthalmitis in eyes with retained intraocular foreign body. APPLICATION TO CLINICAL PRACTICE: Prophylaxis of traumatic endophthalmitis. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00398658.