Improved Function of Orbicularis Oculi by Dynamic Transfer of Contralateral Orbicularis Oculi Muscle in Patients with Facial Palsy.

PURPOSE: The purpose of this study is to introduce the results of a new surgical technique in patients with complete facial nerve palsy using the dynamic muscle transfer of orbicularis oculi muscle (OOM) flap from the contralateral side. METHODS: This case series presents a new surgical technique in three patients with complete facial palsy and lagophthalmos who were unresponsive to other modalities. In this technique, a rectangular flap of OOM was dissected from the upper lid of fellow eye and transferred to the affected eye through a subcutaneous tunnel over the nasal bridge. The flap was divided into two halves for upper and lower lids. Each half was incised longitudinally to increase the length of the flap and cover the lateral part of the affected eyelids. RESULTS: Improvement in exposure keratitis, lagophthalmos, and other related symptoms was observed as soon as the 1st week after the surgery. Partial blinking recovered and the operation was uneventful. CONCLUSION: Muscle flap transfer technique using contralateral OOM for complete facial palsy can be considered as a helpful alternative in patients who are still symptomatic despite conventional treatment modalities.

Orbital Exenteration: A 23-year Report.

PURPOSE: Orbital exenteration is a psychologically and anatomically disfiguring procedure which indicated in some patients with malignant or progressive diseases of orbital and periorbital area. In this study, we reviewed 176 patients that underwent orbital exenteration. METHODS: This was a retrospective study of medical records from all patients who underwent orbital exenteration from March 1991 to March 2014 in oculoplastic department at an eye care center. Demographic data, diagnosis, site of primary involvement and technique of surgery were determined in patients. RESULTS: One hundred seventy-six cases of orbital exenteration were included that had documented histopathology. The age of patients ranged from 1 to 91 years (mean age ± standard deviation, 55.43 ± 27 years). Ninety-seven (55.11%) males and 79 (44.88%) females were included. Fifteen different tumors were identified. The most common indication was patients with basal cell carcinoma 49 (28%) followed by 41 (23.5%) squamous cell carcinomas, 35 (20%) retinoblastoma, and 13 (7%) adenoid cystic carcinomas. In total, adnexal malignancies were the most common tumors, secondarily involving the orbit. Eyelids 89 (50.5%) and the globe 43 (24%) were the most frequent site of involvement. Three types of exenteration were performed, based on available data of 129 operation sheets, 46 (35.7%) subtotal, 62 (48.1%) total, and 21 (16.3%) cases of extensive exenterations. In total 97 cases were evaluated pathologically for perineural involvement, of which perineural invasion was noted in 9 (7%) reports. CONCLUSIONS: Frequency of exenteration in our center has increased in past 3 years and the majority of cases were eyelid basal cell carcinoma. Patient education considering periocular lesions can help in earlier diagnosis of malignant lesions and therefore reducing the number of exenteration.

Color Doppler imaging of orbital vasculature before and after orbital decompression in thyroid eye disease.

Purpose: To measure alterations in orbital blood flow parameters using color Doppler imaging (CDI) before and after orbital decompression in patients with moderate to severe thyroid eye disease (TED). Methods: Resistance index (RI) and maximum and minimum velocity of ophthalmic artery (OA), superior ophthalmic vein (SOV), and central retinal artery (CRA) of 24 eyes (14 patients) with TED were measured before and at least 3 months after cosmetic orbital decompression procedure (single or double walls) using CDI. Complete eye examination was performed to define the severity (EUGOGO classification) and activity (clinical activity score) of TED. Results: Median OA (p = 0.003) and CRA (p = 0.001) resistance indices were significantly reduced postoperatively. Significant differences were found in maximum (p = 0.001) and minimum (p = 0.014) velocity of SOV before and after surgery. While a significant decrease in exophthalmometry was observed after the orbital decompression (p = 0.031), intraocular pressure changes were not significant (p = 0.182). Conclusion: Orbital decompression procedure led to a significant reduction of RI in both CRA and OA in patients with TED.

Lamina Cribrosa and Choroid Features and Their Relationship to Stage of Pseudoexfoliation Glaucoma.

Purpose: To better understand the relationship of lamina cribrosa (LC) and choroid features to the severity of pseudoexfoliation glaucoma (PXG). Methods: In this cross-sectional study, 137 eyes of 122 subjects (47 eyes with moderate/advanced PXG [mean deviation (MD), -15.0 ± 7.7 dB], 34 eyes with mild PXG [MD, -2.7 ± 1.5 dB], 32 aged-matched pseudoexfoliation syndrome [PXS] eyes, and 24 aged-matched control eyes) were investigated. Optic discs, LC thickness, and anterior LC depth (ALD; midsuperior, center, and midinferior) as well as peripapillary choroidal thickness were determined. Linear mixed modeling was used to adjust for age, sex, and axial length. Results: A progressive decrease in LC thickness was found when comparing controls (271.9 ± 61.3 µm), PXS (212.6 ± 51.5 µm), mild PXG (180.8 ± 24.6 µm), and moderate/advance PXG (138.9 ± 37.5 µm) (P < 0.001). ALD was greater (P < 0.001) in moderate/advance glaucoma (306.7 ± 105.3 µm) and mild PXG (209.5 ± 79.7 µm) compared with PXS (155 ± 86.7 µm) and healthy controls (149.2 ± 103 µm). Although eyes with moderate/advance PXG had the thinnest choroid (117.2 ± 36.6 µm), choroidal thickness was comparable in mild PXG, PXS, and controls (150.0 ± 46.1, 159.7 ± 65.5, and 157.5 ± 51.1 µm, respectively; P = 0.002). Worse MD was the only factor associated with thinner LC (ß = 2.344, P < 0.001) and choroid (ß = 1.717, P = 0.009 µm) in PXG eyes. Higher IOP (ß = 4.305, P = 0.013) and worse MD (ß = -6.390, P < 0.001) were associated with deeper ALD in PXG. Conclusions: In pseudoexfoliation, LC thinning is an early sign, and there is progressive thinning with advancing glaucoma. Choroidal thinning is observable only with moderate/advanced glaucoma. In PXG eyes, LC thickness, depth, and peripapillary choroidal thickness are associated with glaucoma severity.

Surgical treatments in inferior oblique muscle overaction.

PURPOSE: To compare the outcomes of surgical procedures in the treatment of inferior oblique muscle overaction (IOOA) as a common disorder of ocular motility. METHODS: This retrospective study was performed on patients with primary and secondary IOOA who underwent three surgical treatment procedures including disinsertion, myectomy and anterior transposition, between 2001 and 2011. Type of strabismus, ocular alignment, presence of pre-and post-operative dissociated vertical deviation (DVD), pre- and post-operative degree of IOOA were obtained using specified checklist. RESULTS: A total of 122 eyes of 74 patients with mean age of 13 ± 11.7 (range, 1-51) years were included in this study. Disinsertion was performed on 12 eyes (9.8%), myectomy in 91 eyes (74.6%) and anterior transposition in 19 (15.6%). Preoperative V-pattern and DVD existed in 67 and 17 eyes; after surgery they remained in only 10 and 8 eyes, respectively. The success rate (IOOA <+1), in disinsertion, myectomy and anterior transposition groups were 91.7%, 97.8%, and 89.5%, respectively and these measures did not change after 6 months. Overall, 53.3% (n = 65) and 38.5% (n = 47) of eyes had preoperative esotropia and exotropia. Preoperative hypertropia and hypotropia were observed in 16.4% (n = 20) and 3.3% (n = 4) of eyes, respectively. After surgery there were no cases of additional strabismus. However, residual hypertropia was seen in 9 eyes, while preoperative hypotropia increased in one patient who underwent anterior transposition surgery. Esotropia and exotropia were not observed in any surgical treatment groups postoperatively. CONCLUSION: We conclude that all these three procedures are effective for treatment of primary or secondary IOOA with minimum side-effects.

Incidence of acute endophthalmitis after intravitreal bevacizumab injection in a single clinical center.

PURPOSE: To assess the rate of infectious endophthalmitis in a single clinical center in Iran and to compare the rate of endophthalmitis in patients receiving postinjection antibiotics with those who did not. METHODS: A retrospective chart review of patients who received intravitreal injections of bevacizumab was undertaken. Cases of clinical diagnoses of endophthalmitis were reviewed. Bevacizumab was obtained at the time of injection from a commercially available vial after aseptic cleansing of the rubber cover. RESULTS: Five patients (six eyes) developed clinical endophthalmitis after the intravitreal bevacizumab injection. The risk per injection was 0.10% (6/5,901). One culture-positive case was found overall. Postinjection antibiotic drops were prescribed for 68% of eyes. All endophthalmitis cases were among those who received postoperative antibiotic eye drops. The difference in the rates of endophthalmitis between those receiving postinjection antibiotics and those who did not was not statistically significant (P = 0.18). CONCLUSION: A low risk of endophthalmitis consistent with the range of previous studies was observed notwithstanding the usage of multiple use of a single vial. Postinjection antibiotic drops may not be necessary.

Isolates and antibiotic resistance of culture-proven endophthalmitis cases presented to a referral center in Tehran.

PURPOSE: To evaluate the spectrum of organisms causing endophthalmitis and their resistance pattern to standard antimicrobial agents. MATERIALS AND METHODS: Medical records of culture positive eyes treated at Rassoul Akram Hospital for endophthalmitis during the past 5 years were reviewed. Specimens were obtained during pars plana vitrectomy or vitreous tap. RESULTS: Sixty-five isolates including 36 (55.4%) gram-positive organisms, 28 gram-negative organisms (43.1%), and 1 (1.5%) fungus were studied. The most common organism identified was Coagulase-negative staphylococcus in 16 eyes (24.6%). Among the antibiotics available for intravitreal injection, the least antibiotic resistance was for vancomycin in gram-positive organisms and amikacin and ceftazidime in gram-negative isolates. CONCLUSIONS: Gram-positive isolates were the most prevalent organisms; however, a high isolation rate for gram-negative organisms was obtained. Considering that no single antibiotic provides coverage for all of the organisms, a combination therapy using vancomycin/amikacin or vancomycin/ceftazidime seems to be useful as the initial empiric treatment of suspected bacterial endophthalmitis.

Central retinal artery occlusion in Crohn disease.

Crohn disease is an inflammatory bowel disease frequently associated with extraintestinal manifestations. Ocular manifestations are uncommon but may cause significant morbidity, including blindness. We report the first case of a 9-year-old boy with biopsy-proven Crohn disease who developed a cilioretinal artery-sparing central retinal artery occlusion. After 2 months of follow-up, the patient developed optic atrophy with no change in visual acuity.

Intrafamilial seropositivity of hepatitis in patients with hepatitis B and C virus in hepatitis clinic in Hamadan, Iran.

OBJECTIVE: To determine intrafamilial seropositivity of HBV and HCV and to compare them in families of infected persons with HBV and HCV in Hamadan clinic of hepatitis. MATERIAL AND METHODS: In this analytic cross-sectional study, 651 family members of 200 HBV and HCV infection index cases were entered into the study and after signing an informed consent, they were referred to Blood Transfusion Center. With completion of laboratory tests, interviewers filled the questionnaires. RESULTS: One hundred and eighteen (20.5%) and 107 (18.6%) family members were HBsAg and HBcAb positive respectively. 21 (3.6%) were isolated HBcAb positive. Only one person (1.3%) was HCVAb positive. The general rate of infection in family members of HBV infected people (atleast one case) (49.4%) was significantly higher than that of HCV infected people (3.3%), p < 0.001. Interspouses transmission was evaluated and prevalence of interspouses HBV and HCV infection were 32.3 and 8%, respectively. CONCLUSION: Intrafamilial and interspousal seropositivity of HBV is obviously more than those of HCV. More attention should be paid to screening and risk lowering activities particularly about HBV infected people and their families.