Journal of Ophthalmic and Optometric Sciences

Purpose: To compare the results of prophylactic pars plana vitrectomy with barrier laser photocoagulation in treatment of acute retinal necrosis (ARN).
Patients and Methods: Fifteen ARN patients were retrospectively included in this study. At presentation, all patients had severe vitreous involvement without any detectable break or retinal detachment (RD), either in funduscopy or echography exams. All patients received intravenous acyclovir 2 g/daily for two weeks. Eight patients underwent prophylactic vitrectomy and seven patients underwent barrier laser photocoagulation after resolution of vitritis. Visual and structural outcomes were compared between the two groups.
Results: In eight vitrectomized patients, one patient (12.5 %) experienced RD. The mean best corrected visual acuity (BCVA) improved significantly in this group (P=  0.027). Among seven patients undergoing barrier laser photocoagulation, 3 patients (43 %) developed RD and BCVA improvement was not significant (P=  0.207). Comparison between the two groups did not show any statistically significant benefit when comparing post treatment BCVA (P=  0.59) or RD prevention (P=  0.282).
Conclusion: Early prophylactic vitrectomy, in the course of ARN has been suggested as a useful method in preventing RD and improving the visual outcome, but the results of the present study did not indicate any significant benefit for vitrectomy compared to barrier laser photocoagulation. Further studies with bigger sample size are recommended to compare these two methods of treatment.

Keywords: Retinal necrosis syndrome; Acute; Treatment outcome; Vitrectomy; Retinal detachment.

Purpose: To evaluate asymptomatic cardiac disease in patients with ocular pseudoexfoliation.

Patients and Method: Forty-two patients with ocular pseudoexfoliation (with or without glaucoma) and 40 patients without pseudoexfoliation, who had no positive signs or symptoms of cardiac ­­­­­­diseases, were enrolled in this study. For each participant a standard treadmill exercise test, as a noninvasive and reliable method for detecting ischemic heart disease, was performed under supervision of a cardiologist. The prevalence of ischemic heart disease was compared in the case and control groups.

Results: The mean age of participants was 68.38 ± 8.10 years in the case and 62.45 ± 8.40 years in the control group. There was no statistically significant difference between the two groups in terms of diabetes mellitus, hyperlipidemia, smoking, and family history of ischemic heart disease. Twenty patients (47.6 %) with pseudoexfoliation and 9 participants (22.5 %) without pseudoexfoliation had hypertension (P = 0.02). There were 10 (23.8 %) positive exercise tests in the pseudoexfoliation group and 8 (20 %) positive exercise tests in participants without pseudoexfoliation (P = 0.78).
Conclusion: Based on our findings ocular pseudoexfoliation was not associated with increased risk of asymptomatic ischemic heart disease as evaluated by a treadmill exercise test.

Keywords: Pseudoexfoliation syndrome; Exercise test; Myocardial ischemia; Iran.

Purpose: To study the possible effects of occupation vibration on human retina using electroretinogram.

Patients and Methods: Fifty workers from a segment of a textile factory with machinery creating high levels of vibration were selected. The workers had at least 6 years history of working in the factory segment where high vibrating machines were operating. The amplitude and latency of electroretinogram b-wave peak and amplitude was compared between these selected workers and 50 age and sex matched controls from other sections of the factory.

Results: The mean age was 27.5 + 1.741 years and 27.28 + 1.641 years in the case and control groups respectively. There was statistically significant lower mean amplitude of electroretinogram b-wave peak in the case group compared to the control group (P < 0.001). Also higher mean latency of the electroretinogram b-wave in the case group compared to the control group was observed (P < 0.001)

Conclusion: Occupational vibration might have adverse effects on visual system, mainly retina, causing a decrease in amplitude and increase in latency of electroretinogram b-wave peak measured using electroretinography.

Keywords: Vibration; Retina; Electroretinography; Occupational Injuries

Purpose: To investigate the association of meibomian gland dysfunction severity and glycated hemoglobin A (HbA1c) levels among type 2 diabetic patients.

Patients and Methods: In this cross-sectional, 40 type 2 diabetic patients with meibomian gland dysfunction (MGD) were studied at Basir Eye Clinic, Tehran, Iran. An expert ophthalmologist determined the MGD stage based on staging scale outlined in American academy of ophthalmology's basic and clinical science course. The HbA1c level was measured applying a standard method, certified by the National Glycohemoglobin Standardization Program (NGSP). We divided patients to two groups based on their HbA1C level; the first group included patients with HbA1c < 6.5 % and the second group included patients with HbA1c ≥ 6.5  %.

Results: Our results demonstrated that 12.5 % of the participants had minimal, 52.5 % had mild and 35 % had moderate to severe MGD. We observed that different levels of HbA1c (over or under 6.5 %) were significantly associated with MGD severity (P < 0. 013). Moderate to severe MGD stage was observed in 43.7 % of individuals with HbA1c ≥ 6.5 %, while it was found in none of participants with HbA1c < 6.5 %. With increase in HbA1c level, the risk of moderate to severe MGD occurrence increased (OR = 3.57; 95 % CI: 1.05-12.13; P = 0.041). This association was not confounded by age or gender.  
Conclusion: Meibomian gland dysfunction severity has an association with HbA1c levels in diabetic type 2 patients, and a rise in HbA1c noticeably aggravates the MGD stage.

Keywords: Glycated hemoglobin A; Meibomian gland dysfunction; Diabetes mellitus; Dry eye syndromes; Diabetes.

Purpose: To describe clinical presentation, management, and outcomes of central toxic keratopathy developing after surface laser refractive surgeries.
Patients and Methods: In this retrospective case series, the records of 10 eyes of 5 patients (1 male, 4 female) were reviewed. The laser refractive surgery consisted of photorefractive surgery (PRK; 2eyes) and laser-assisted subepithelial keratectomy (LASEK; 8 eyes). Mitomycin C,
0.02 % was applied intraoperatively in all eyes.
Results: The mean patient age was 30 ± 14.5 years, (22 to 56 years). Presenting symptom was decreased vision without pain or photophobia in all cases that began 3 to 9 days postoperatively. The slit-lamp examination revealed corneal opacities and corneal thinning in the central area of the cornea corresponding to the ablated zone. There were no corneal epithelial defects or corneal stromal infiltration. Upon presentation, the mean best-corrected distance visual acuity was 20/25 (LogMAR 0.83 ± 0.34). The opacification persisted for a minimum of two months to a maximum of 6 months before clearing. The patients were followed up for 12 months. Five eyes had a decrease of 1 to 2 lines in preoperative best-corrected distance visual acuity 6 months postoperatively. All eyes had hyperopic shift and astigmatism during the follow-up period. The mean spherical equivalent at final follow up was + 0.75 ± 1.15 D.
Conclusion:  Central toxic keratopathy is a non-inflammatory central corneal opacification which is associated with significant hyperopic shift and stromal tissue loss. Visual prognosis is usually good but a decrease in best-corrected distance visual acuity may persist in some cases.

Keywords: Central Toxic Keratopathy; Refractive surgical procedures; Review

Abstract

Animal bite is a relatively frequent health problem with the main cause being domesticated dogs responsible for around 90 % of cases. Other common aggressors include cats, cows, camels, donkeys and horses. Here we report a case of total lid avulsion by a pet dog in a middle-aged man. This report represents the medical and surgical approaches used and the result of the lid injury treatment.

Keywords: Bites and stings; Eyelid; Evulsion.

Conjunctival keratoacanthoma is a rare disease which is believed to be a low-grade form of squamous cell carcinoma (SCC). Although conjunctival keratoacanthoma was primarily described almost 60 years ago, only few cases have been described in the English literature and its diagnosis and treatment guidelines are still controversial. Almost all suggested treatment options have been surgical methods and non-invasive methods have rarely been examined in treatment of this disease. Here we report an interesting case of conjunctival keratoacanthoma which was treated with topical Interferon-alpha2b.

Keywords: Interferon-alpha2b; Keratoacanthoma; Conjunctival neoplams.