Original Articles

Evaluation of Tear Function among Acne Vulgaris Patients Undergoing Treatment with Isotretinoin

Hamid Norouzi, Hossein Mohammad Rabei, Kourosh Sheibani, Rasoul Malekmohammadi, Shahram Salehirad

Journal of Ophthalmic and Optometric Sciences, Vol. 1 No. 1 (2016), 6 October 2016, Page 1-6

Purpose: To evaluate the effect of Isotretinoin on tear secretion among patients with Acne Vulgaris.

Patients and Methods: In this prospective study patients candidate for isotretinoin (Accutane) therapy for two months underwent complete eye examination. The best corrected visual acuity was measures and slit lamp examination of anterior segment, evaluation of tear break-up-time and Schirmer’s test were performed. The post surgical examination carried out two months post therapy consisted of complete eye examination and evaluation of dry eye level.

Findings: Thirty nine patients entered the study. There were 5 patients complaining of eye strain before treatment, which rose to 19 patients after Isotretinoin therapy (p<0.001). The tear break up time was 13±1 seconds which decreased to 9±1 (p<0.001) after therapy and the Schirmer’s test mean reading was 22±2mm, which was reduced to 18±5 (p<0.001) after treatment. There were 4 patients with blepharitis before the treatment which rose to 19 patients after the end of Isotretinoin treatment (p<0.001).

Conclusion: Isotretinoin usage (0.5-1mg/kg for two months) impairs the tear secretion and causes dry eye and blepharitis among patients. Considering the young age of patients using this drug, some of them candidates for keratorefractive surgery, a history of Isotretinoin usage should be considered before commencing the surgery. We recommend postponing the refractive surgery among these patients until the signs of dry eye are subsided. 

Effect of Mitomycin-C on Endothelial Cell Density and Polymegathism in Laser Assisted Sub-Epithelial Keratectomy

Hossein Mohammad Rabei, Hamid Norouzi, Nooshin Dadbin, Kourosh Sheibani

Journal of Ophthalmic and Optometric Sciences, Vol. 1 No. 1 (2016), 6 October 2016, Page 7-13

Purpose: To evaluate the corneal endothelial cell density and Polymegathism after laser assisted keratomileusis with mitomycin C.

Patients and Methods: One hundred and three eyes from 52 patients undergoing laser assisted sub-epithelial keratomileusis using mitomycin-C 0.02% for 30 seconds entered this study. Specular microscopy was utilized to study the corneal endothelial cells before and one year after the surgery to evaluate the endothelial cell density and polymegathism. The corneal thickness was measured before and one year after the surgery.

Results: The mean endothelial cell density before surgery was 2870±368/mm2, which changed to 2828±300/mm2 one year after the surgery (P=0.182). Endothelial cell size variation coefficient was 24±7 before the surgery, which changed to 25±7 one year after the surgery (P=0.039). The average stromal ablation dept was 65 micron (22 to 131 micron) and the remaining corneal thickness one year after the surgery was 488±42 micron (405 to 567 micron) (p<0.001).

Conclusion: Using mitomycin C (0, 02% for 30 seconds) during the laser assisted sub-epithelial keratomileusis did not significantly change the corneal endothelial cell density one year after the surgery but the change in polymegathism was significant.

Prevalence of Corneal Astigmatism before Cataract Surgery in Yazd Province, Iran

Mohsen Gohari, Farsad Noorizaheh, Samira Salimpur, Marjan Aghayi, Mohammad Reza Besharati

Journal of Ophthalmic and Optometric Sciences, Vol. 1 No. 1 (2016), 6 October 2016, Page 14-18

Purpose: To analyze the prevalence and presentation patterns of corneal astigmatism in cataract surgery candidates in Shahid Sadoughi University of Medical Sciences, Yazd, Iran.Patients and Methods: Refractive and keratometric values from 400 eyes of 365 patients were measured before surgery in patients having cataract extraction. Descriptive statistics of refractive and keratometric cylinder data were analyzed and correlated by age ranges.Results: Our data showed that 22.8% of patients had less than 1D of corneal astigmatism,12.9% had 1-1.5D, 21% had 1.5-2D and 9.3% had more than 2D of corneal astigmatism, so among all of the patients, astigmatism of 0.0 to 1.00D was the most common cylinder value (22.8%).Conclusion: Our study showed that 43.2% of preoperative cataract surgery eyes in Yazd have a corneal astigmatism of 1.0D or more, indicating that better surgical techniques or using Toric IOLs are needed to achieve better visual rehabilitation.

Comparison of Visual Evoked Potential and Electro-oculogram Tests in Early Detection of Hydroxychloroquine Retinal Toxicity

Fatemeh Allahdady, Mohammad Aghazadeh Amiri, Seyed Mohammad Masoud Shushtarian, Seyed Mehdi Tabatabaee, Farhad Sahraei, Ahmad Shojaei, Hamideh Sabbaghi, Kourosh Sheibani

Journal of Ophthalmic and Optometric Sciences, Vol. 1 No. 1 (2016), 6 October 2016, Page 19-26

Purpose: To compare the sensitivity of visual evoked potential (VEP) and electro-oculogram (EOG) tests in early detection of hydroxychloroquine (HCQ) retinal toxicity.

Patients and Methods: In this prospective cross-sectional study, 100 consecutive patients (age range: 18 to 30) with juvenile rheumatoid arteritis (JRA) and a cumulative hydroxychloroquine dosage of at least 200gr were included.  In addition 100 healthy individuals with matched age and sex were included as controls. Ocular examinations including visual acuity testing, refractive errors measurement, applanation tonometry, slit lamp biomicroscopy fundus ophthalmoscopy and electrophysiological examinations (EOG and VEP) were performed in both groups. Scores of less than 1.8 for the Arden Index in EOG (AI), as well as less than 4mv of P100 amplitude and more than 110ms of P100 latency in VEP were considered abnormal.

Results: The mean cumulative dosage of HCQ among participants was 262.4±31.9g (95% CI: 256.1 to 268.8g). The mean measurement of AI (EOG), P100 latency and amplitude of VEP were 1.8±0.4, 112.7±10.1ms and 3.7±2.1mv, respectively. There was a significant difference between case and control groups in all parameters (p<0.001 for all). There was not any significant difference between AI (EOG), P100 latency and amplitude of VEP in detecting the ocular toxicity due to HCQ.

Conclusion: We conclude that AI (EOG), P100 amplitude and latency of VEP can all be useful parameters to detect HCQ retinal toxicity, and we did not detect any difference between these two methods. 

Cataract Risk Factors in Yazd Province, Iran

Mohsen Gohari, Farsad Noorizadeh, Mohammad Taghi Moravvej, Fatemeh Zaremohazabiye, Haniye Momeniasl

Journal of Ophthalmic and Optometric Sciences, Vol. 1 No. 1 (2016), 6 October 2016, Page 42-46

Purpose: to determine the probable cataract risk factors in Yazd province, Iran.

Patients and Methods: In this cross-sectional study all patients over 40 years old undergoing cataract surgery in Shahid Sadoughi hospital, Yazd, Iran, from January to September 2016 were evaluated. A checklist was filled for all patients including information about their sex, age, weight, height, place of living (city or village), being native or non-native of Yazd, type of job, the level of household income, level of education, smoking habits, drug usage, as well as a history of related diseases such as high blood pressure, diabetes mellitus, glaucoma, rheumatism, kidney, and heart diseases.
Results: Two hundred and fifty four patients (45.8%) had income of less than 6,000,000 Rials per month, 270 (48.6%) had income of between 6000000 and 10,000,000 Rials per month and the rest of patients (5.6%) had an income of over 10,000,000 Rials per month. Regarding the education level 512 patients (92.3%) had less than high school diploma, 38 (6.8%) had high school diploma and 5 patients had university education. Eighteen patients (3.2%) had a history of glaucoma. From 437 patients who their BMI was recorded 4.8% had a BMI of under 18, 49.7% had a BMI of between 18 and 25 and 45.5% had a BMI of over 25.

Conclusion: Our study suggests a relationship between the income land education level as well as BMI and the prevalence of cataract among patients in Yazd province, Iran. Future case control trials, with higher number of participants, are recommended.

Keywords: Cataract; risk factor; Yazd; Iran.

Case Reports

Epibulbar Dermoid Cyst in a Patient with VACTERL Association

Nader Nassiri, Mohammad Hasan Seifi, Mahsan Assadi, Hossein Mohammad Rebei, Kourosh Sheibani

Journal of Ophthalmic and Optometric Sciences, Vol. 1 No. 1 (2016), 6 October 2016, Page 27-31

The VACTERL association is an association of multiple congenital malformations

Such as vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula, renal anomalies, and limb abnormalities in which the rate and number of the characteristic anomalies varies according to the population.

We present a case of VACTERL association who was referred with a nodular dermoid cyst in her left eye since birth. Dermoid cysts as a part of Goldenhar’s syndrome and the VACTERL association have been reported very rarely; however there have been a few reports of children having the VACTERL association and orbital dermoid.  This shows the possibility of finding orbital dermoid cysts in the context of VACTERL association and demonstrates that such cysts could be a surrogate for feasible diagnosis of VACTERL association. Nonetheless, additional findings of an ipsilateral orbital dermoid cyst should stimulate serious discussion concerning the pathophysiology and etiology of this complex disorder. 

Concomitant Orbital Cavernous Hemangioma and Solitary Fibrous Tumor

Ahmad Ali Ferdousi, Kourosh Sheibani, Ahmad Shojaei, Ahmad Reza Karami, Mozhgan Rezaei-Kanvi, Katayoun Goharimoghaddam

Journal of Ophthalmic and Optometric Sciences, Vol. 1 No. 1 (2016), 6 October 2016, Page 32-36

Cavernous hemangiomas are the most frequent tumors in orbital region. Hemeangiopricytomas and solitary fibrous tumors are uncommon neoplasms found in different location, including the orbit. We present a 50-years-old man with coincide unilateral orbital cavernous hemangioma and solitary fibrous tumor. The initial diagnosis was orbital tumor. Computed tomography (CT) was performed. On CT two intraconal solid mass in right orbit positioned relatively near each other Antro-postriorly were observed. Tumors were excised totally with lateral orbitotomy method and sent for histopathologic examination. To our knowledge, only one case report of splenic hemangiopricytoma adjacent to cavernous hemangioma of colon has been reported in the literature. Our case shows the coincidence of hemangiopricytoma adjacent to cavernous hemangioma is possible and should be considered.

A Rare Case of Concurrent Granular Corneal Dystrophy and Keratoconus

Mohsen Gohari, Ahmad Shojaei, Sanaz Rahmatkha, Heidar Salehi

Journal of Ophthalmic and Optometric Sciences, Vol. 1 No. 1 (2016), 6 October 2016, Page 37-41

A 23-year-old female presented with progressive bilateral visual loss for the past 5 years. The patient had no history of systemic disease, surgery or medications. Complete ophthalmologic examination and topography were performed. On ophthalmic examination, uncorrected visual acuity was 20/30 in the right eye and 20/50 in the left eye. Both corneas appeared hazy on gross examination. On slit-lamp biomicroscopy, few well circumscribed gray white discrete granular deposits in the central corneal stroma of both eyes were observed. Both corneas were thin and bulging. Corneal topography showed a pattern consistent with keratoconus. The patient was clinically diagnosed as a case of concurrent granular dystrophy and keratoconus, which is a very rare presentation.