​Journal of Current Ophthalmology
Year:2004 | Volume:16 | Issue:4|Papers Count:14

Purpose: To evaluate the clinical effectiveness and safety of the Nd:YAG laser for cataract surgery and to compare clinical results and complications with ultrasound phacoemulsification.Methods: In this prospective randomized clinical study, 30 eyes of 30 patients scheduled for cataract surgery were allocated based on hardness of the nucleus using the Lens Opacity Classification System III (LOCS III) system and assigned to 2 groups for lens emulsification: Nd:YAG laser or ultrasound. A complete ophthalmologic examination including slit-lamp biomicroscopy, refraction, fundoscopy, tonometry, endothelial cell count and pachymetry was performed preoperatively. A clear corneal approach for laser phaco surgery and a posterior limbal or scleral tunnel approach for ultrasound phaco were selected. All patients received a foldable posterior intraocular lens.Results: There was no significant difference between mean of preoperative UCVA and BCVA in two groups. The mean of UCVA changed from 0.28±1:0.14 to 0.75±1:0.15 in Nd:YAG laser group and from 0.30±0.15 to 0.65±0.18 in ultrasound group 2 months after cataract surgery. Complete emulsification of the lens nucleus using the Nd:YAG was not achieved in 3 eyes of grade 3 nucleus sclerosis. Mean phacoemulsification time in Nd:YAG was 2.58 minutes ±14(SD) in group 1 and 4.7±1.8 in group 2 and significantly more than was done in ultrasound phaco (1.1±0.26 in group 1 and 1.5±0.43 in group 2).Mean of total applied energy was 1.96±1.42 J and 3.5±1.71 J in 2 groups of Nd:YAG laser, and significantly less than ultrasound phaco 206.3±84.3 and 361.2±143.3 J respectively. There was no significant difference between endothelial cell counts. There were no vision-threatening complications.Conclusion: Emulsification of the lens using Nd:YAG laser was effective for performing small incision cataract surgery in eyes with soft and medium nuclei.Compared with US phaco, higher nuclear sclerosis grade take a relatively long time to emulsify and to achieve faster emulsification for higher grades, both the surgical technique and the surgical equipment must be optimized.

Background and Purpose: Keratoconus (KCN) is the most common cause of corneal transplantation in Iran. This study was undertaken to determine the outcomes of penetrating keratoplasty (PK) for KCN in patients who were operated in a private practice setting from 1994 to 2001.Patients and Methods: This longitudinal retrospective study included 181 patients who underwent PK for KCN. Medical records were reviewed and all patients were .recalled for a final examination. Variables including trephine type, preoperative keratometry and corneal condition, suturing techniques and donor-recipient disparity were evaluated and comparison were made among difference subgroups using the T-Student, ANOVA, Kruscall-Wallis and Mann-Whitney tests.Results: At the last follow up spherical equivalent was -2.3±2.7 diopters (D), corneal astigmatism was 3.4±1.80 and best spectacle corrected visual acuity (BSCVA) was 0.14±0.15 LogMAR. Trephine type, suturing techniques and severity of the disorder had no effect on final outcomes. Donor-recipient disparity had no effect on final astigmatism; however greater disparity was associated with a greater myopic shift. Overall 27.1% of the patients required keratorefractive surgery during the follow up period which resulted in 3.1 D reduction in corneal astigmatism. Graft rejection occurred in 28.7% of cases however all episodes responded favorably to medical management and none resulted in graft failure. Two instances of graft failure occurred due to trauma.Conclusion: Penetrating keratoplasty is a relatively safe and effective surgical procedure in the management of keratoplasty; its optical and visual outcomes are remarkable and can be considered for contact lens- intolerant patients or those with unacceptable visual acuity.

Aim: There are various approaches to accomplish dacryocystorhinostomy. Our aim has been to assess the results of transcanalicular laser assisted dacryocystorhinostomy. Patients and Methods: Seventeen patients underwent 19 transcanalicular laser assisted dacryocystorhinostomy from 2001 to 2002 in Khatam Hospital. Mean age of the patients was 36.4±8.47 years (range, 25 to 53), with female to male ratio of 13 (76%) to 4 (24%). Involvement of the right, left, and bilateral lacrimal system was seen in 8, 7, and 2 patients, respectively. Operations were performed under general anesthesia. After dilation of the inferior lacrimal punctum, a 600-micron laser probe was introduced through the inferior punctum and then to the lacrimal sac. A 4mm, 30-degree nasal endoscope was introduced into the ipsilateral nostril, enabling visualization of laser beam through the lateral nasal wall. The stoma was fashioned with the diode laser and enlarged under direct vision by low energy pulses. Next a bicanalicular silicone tube was routinely introduced and secured in place with knots. This was left in place for at least 12 weeks.Results: Two of the patients had bilateral involvement. Mean followup time was 8.97 months (range, 5-12). Four recurrences were observed in 19 procedures. Overall success rate of transcanalicular diode laser assisted dacryocystorhinostomy was 78.9%. Apart from recurrences, no complications were noted in intraoperative or postoperative period.Conclusion: Transcanalicular laser assisted dacryocystorhinostomy performed with a 600-micron contact fiber is a relatively simple, effective, and scarless procedure when used in conjunction with nasal endoscopy, in treatment of lacrimal pathways distal obstruction. The technique of opening the nasolacrimal sac from inside to outside reduces the risk of thermal damage to the orbital contents with the laser. In general, this technique is well comparable to external and endonasal techniques, although the success rate is lower. With more experiences and correcting the limitations, this technique would become more popular with higher success rates.

Purpose: To report the outcome of mechanical endonasal DCR and its complications.Methods: In a prospective, noncomparative clinical trial 65 cases with NLD obstruction at Farabi hospital, with mean age of patients 33.3 (Range: 8-73 yrs.) and mean duration of disease of 3.9 (Range: 1-8 months) were enrolled. The patients underwent endonasal dacryocystorhinostomy under general anesthesia. Success rate and complications were evaluated during 1 year follow up.Results: Mean (SD) duration of operation was 25.0+2.54 minutes. The success rate of EDCR in our experience was 73.8%, 70.7% and 70.7% 6,9 and 12 months after the procedure respectively. Post operative bleeding and pain at 0-2 days and 2-7 days were 23.1%, 64.1%, 3.1% and 20% respectively.29.7% of eyes experienced periorbital swelling & echymosis.Conclusion: Although our success rate is similar to previous reports, mechanical Endonasal DCR is not as successful as External DCR and may not substitute it in all cases. Its main advantage is the absence of a cutaneous scar. External DCR remains the mainstay of surgical treatment in NLD obstruction.

Purpose: This study was performed to evaluate the ability of toric intraocular lenses (IOLs) to correct pre-existing corneal astigmatism in cataract patients.Methods: Fifteen eyes that had corneal astigmatism of 1.5 diopters (D) or more were enrolled in this retrospective study. Standard superior posterior limbal sutureless approach for phacoemulsification was done and a Staar silicone plate haptic toric IOL (AA4203TF or TL) was inserted through a 3.2 mm incision in the capsular bag.Results:' After a 6 month follow up the uncorrected visual acuity was 0.25± 0.138 LogMAR, and 100% of patients had a 20/40 or better and 69.2% a 20/30 or better unaided vision. Postoperative refractive astigmatism was 0.75 or less in 69.2%. Mean astigmatism correction was 1.560 for 2.000 and 2.220 for 3.500 toric lenses.Conclusion: Toric IOLs are safe and reliable tools to correct preexisting astigmatism.They showed promising results to reduce corneal astigmatism of 1.50 to 3.00. There was no difference in the outcome between Staar AA4203TF and TL IOL.

Background and Objective: Ocular traumas are major cause of morbidity. There is lack of comprehensive data about epidemiology aspects of eye injuries. The objective of this study is the description of hospitalized cases of eye injuries at Farabi Hospital in the period of October 2002 to march 2003.Materials and Methods: The study was based on existing data and Records of all of the hospitalized ocular trauma cases during the specified period were reviewed and demographics and injury characteristics were extracted.Results: 400 cases were evaluated. Male to female ratio was 3.8: 1.Mean age was 23 ±15.7 years; 46% were younger than 20. Cornea was the most common site of injury (66.7%). The nature of injury was penetrating in 305 (75/7%) of the cases. Metallic foreign bodies were the most common agents in penetrating injuries (74%) and stones were the most common agents in blunt injuries (17.3%). 22% of the cases had visual acuities equal or better than 7/10 and 58.7% had acuities of hand motion or worse. 57% of the cases were undergone primary repair and 9 cases of enucleations were performed.Conclusion: The mean age of the injured is significantly lower than that of the other reports. Penetrating injuries were more common and cornea was the most common site of injury.

Purpose: Report of simultaneous 10 and SO weakening procedure in treatment of DVD with SO Overaction.Method: 2 patients with DVD and Superior Oblique Overaction (SOOA) underwent recession and posterior transposition of SO muscle and anteriorization of 10 muscles in the involved eye. They have been followed for 6 months after operation.Results: The first patient with 1/10 visual acuity in the right eye and extra foveal fixation, 35PD R HT in Primary Position (PP), +3 SOOA in involved eye after operation, deviation decreased to 5PDR HT in PP and +1 SOOA but -2 Inferior Oblique Underaction (IOUA) has been found in that eye.In the second patient with 7/10 visual acuity in right eye, 7PDR HT in PP and +2 R SOOA in the involved eye have neither HT in PP nor SOOA after operation.Conclusion: Simultaneous IO and SO weakening procedure can be suitable for DVD and SO.OA treatment but we suggest in eyes with poor vision, SO graded recession must be more than graded IO recession to prevent IOUA.

Purpose: To report of an orbital extension of maxillary sinus osteoma with resultant palpebral fissure narrowing and upward displacement of globe.Case Report: A 53 year old lady presented with upward displacement of left eye (hyperglobus), diplopia and palpebral fissure narrowing since 1 year. Her problem diagnosed as maxillary sinus osteoma and underwent subciliary incision anterior orbitotomy and a mushroom shaped osteoma excised. In last examination (7 months after surgery) all signs were improved.Conclusion: Maxillary sinus osteoma should include in differential diagnosis of inferior orbital tumors. Orbital signs can be eliminated with tumor excision.

Purpose: To describe a case of intraocular melanoma in a girl with acute lymphoblastic leukemia.Design: A case report.Method: The history and histologic findings in the enucleated eye and also blood and bone marrow of a patient with malignant melanoma and leukemia are described.Main Outcome Measures: Pathologic examination of enucleated eye. Results: The eye which was enucleated contained epithelioid cell type melanoma instead of leukemic cell infiltration.Conclusion: Intraocular malignant melanoma can occur in acute lymphoblastic leukemia.

Objectives: To assess the degree of correction in superior oblique over action in A pattern strabismus, atypical Brown's syndrome, and monocular elevation deficiency syndrome by the graduated superior oblique recession.Methods: This interventional case series comprised 10 patients (12 eyes) with an indication for superior oblique weakening. According to the grade of muscle over action, forced duction test result, A-pattern and in torsion, and via a superior temporal approach the superior oblique tendon was transposed 10-12 mm posterior to the limbos and 1-4 mm medial to the insertion of the superior rectos. The patients were followed up for at least 6 weeks post operation. Results: Ten patients aged 6-22 years (6 females and 4 males) underwent the operation. The A-pattern was corrected 94%. The over action, vertical deviation and the forced duction test were reduced by less than half in cases of atypical Brown's and monocular elevation deficiency syndromes. The improvement was significant in the 2 cases of DVD with an overacting superior oblique. Conclusion: The graduated recession of the superior oblique is an appropriate procedure for weakening the muscle and is adjustable to the grade of muscle over action, A-pattern and in torsion.

Purpose: Needling bleb revision with MMC is an accepted method of management of failed trabeculectomy with encapsulated bleb. The authors present the outcome of the needling bleb revision with MMC in poorly functioning filtering blebs over Molteno drainage device.Patients and Methods: Sixteen eyes of 16 patients with encapsulated bleb around the Molteno plate and elevated lOP that had not been controlled by medical management, underwent bleb revision with MMC. Results: There were 16 eyes of 16 patients with 5-65 years old (mean, 28.8±22.7). Six patients were female (37.5%) and 10 patients were male (62.5%). In this study aphakia and congenital glaucoma were the most common causes of glaucoma. The mean period of follow up was 24 months and the duration between surgery and needling was 18.25±12.1 months. The mean lOP reduction was from 28.25+3.70 mmHg to 16.69+3.14 mmHg at third month and to 21.13+4.11 mmHg at 6 months and the success rate was 87.5% at 3rd month, 37.5% at 6th month, and 12.5% after 2 years follow up. Conclusion: Needling bleb revision with MMC is a relatively safe and effective method in the management of failed encapsulated Molteno tube implant. Although its effectiveness may be limited, it is a repeatable procedure.

Introduction: Different physical and chemical mechanisms that protect the central Nervous system (CNS) from injuries are the most important reasons that have made physicians look after indirect indexes in order to evaluate CNS function. One of the most important specifications of cranium, as the container of the brain, is its pressure, which its pathologic alterations will lead to major CNS dysfunctions. Nowadays, the most common method used for measuring intracranial pressure (ICP), is lumbar puncture (LP), which is a painful and invasive but sensitive procedure with some complications and contraindications. In this study we wanted to know if there is any relationship between ICP and intraocular pressure (IOP) which its measuring is very easy, noninvasive, cheap and safe. Materials and Methods: According to the results of one previous study the number of cases was estimated 50 that were chosen from the patients of neurology wards of two big hospitals of Tehran University of Medical Sciences by simple randomization. All the patients have undergone LP because of other clinical work-ups and a neurologist measured their ICPs with the same instrument and in the same position. Patients' lOPs were estimated by a Schiotz tonometer and by measuring the pressure of each eye with two different scales and obtaining the mean pressure from these 4 measurements by an ophthalmologist who had not any information of the patient's ICPs. Our exclusion criteria were: 1-Glaucoma histories, 2-History of using IOP altering drugs since last month, 3- Abnormal fundoscopic exam (except papillary edema in RICP group), 4-Age under 15. Results: From total 50 patients, 29 were female and the range of their age was between 15 to 73 years old. According to the disease type the patients were categorized in 8 different groups. Twenty-five of patients had raised ICP. Among the raised ICP cases 92% had raised IOP too; and all of the normal ICP patients had normal IOP. The statistical analysis by SPSS 10 software, showed an adjusted R-square of 0.912 between the two main variables (p<0.001) and on the basis of the regression model, this formula was obtained: ICP=1.16 IOP- 4.86. (ICP and IOP are in mmHg) Conclusion: Although LP is the best clinical method for (CP measurement, but according to the significant correlation between IOP and ICP and because of the noninvasive, safe, easy and cheap nature of measuring IOP in comparison to LP, it could be advisable in some special cases.

A 30-year-old man developed a lamellar keratitis around the flap, both inside and outside the flap margin after LASIK. With an impression of peripheral diffuse lamellar keratitis (DLK), topical and systemic steroid were started which led to a dramatic improvement in signs and symptoms. Although, diffuse lamellar keratitis is most often seen in the flap interface, it may be seen outside the flap margin, within the untouched cornea.