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Visual prostheses: The enabling technology to give sight to the blind
Mohammad Hossein Maghami, Amir Masoud Sodagar, Alireza Lashay, Hamid Riazi-Esfahani, Mohammad Riazi-Esfahani
October-December 2014, 9(4):494-505
DOI:10.4103/2008-322X.150830  PMID:25709777
Millions of patients are either slowly losing their vision or are already blind due to retinal degenerative diseases such as retinitis pigmentosa (RP) and age-related macular degeneration (AMD) or because of accidents or injuries. Employment of artificial means to treat extreme vision impairment has come closer to reality during the past few decades. Currently, many research groups work towards effective solutions to restore a rudimentary sense of vision to the blind. Aside from the efforts being put on replacing damaged parts of the retina by engineered living tissues or microfabricated photoreceptor arrays, implantable electronic microsystems, referred to as visual prostheses, are also sought as promising solutions to restore vision. From a functional point of view, visual prostheses receive image information from the outside world and deliver them to the natural visual system, enabling the subject to receive a meaningful perception of the image. This paper provides an overview of technical design aspects and clinical test results of visual prostheses, highlights past and recent progress in realizing chronic high-resolution visual implants as well as some technical challenges confronted when trying to enhance the functional quality of such devices.
  2,775 239 5
Birdshot Retinochoroidopathy
Albert T Vitale
July-September 2014, 9(3):350-361
Birdshot retinochoroidopathy (BSRC) is an uncommon, but well-characterized chronic, bilateral posterior uveitis, which is uniquely associated with the human leukocyte antigen-A29 phenotype. The disease presents predominantly in middle-aged Caucasian females who complain of blurred vision, floaters, photopsias, paracentral scotomas and nyctalopia. While autoimmune mechanisms are thought to play an important role in the pathogenesis of BSRC, its etiology remains unknown. Important questions remain in our understanding of BSRC with respect to its pathogenesis, epidemiology, optimal treatment, and prognosis, including the determinants of remission and relapse, as well as the best strategy for monitoring disease activity, progression and response to therapy with electroretinographic and psychophysical testing, established and emerging imaging modalities, and peripheral cytokines profiles.
  2,144 86 -
Clinical Features and Outcomes of Strabismus Treatment in Third Cranial Nerve Palsy during a 10-Year Period
Abbas Bagheri, Morteza Borhani, Mehdi Tavakoli, Shahram Salehirad
July-September 2014, 9(3):343-349
Purpose: To evaluate the demographics and management outcomes of strabismus surgery in patients with third cranial nerve palsy. Methods: This retrospective study includes subjects with third cranial nerve palsy. We evaluated age, sex, laterality, severity of involvement, etiology, frequency of clinical findings, and types and results of treatments. Results: 52 patients including 29 male and 23 female subjects with mean age of 21.1±15.5 years were studied between January 1999 and January 2009. Etiologies of third nerve palsy included congenital in 16 (30.8%), trauma in 26 (50%) and other causes in 10 (19.2%) patients. In 24 patients (46.2%), the palsy was complete. The most common type of strabismus was exotropia associated with hypotropia (40%). Medical treatment was used in 25 (48%) and surgical treatment in 46 (88.4%) subjects. One time strabismus surgery was performed in 30 (65.2%), 2 times in 11 (24%) and 3 times in 5 (10.8%) subjects. The most common operation was large horizontal recession and resection in 78.2% of cases. Mean horizontal deviation in primary position was 66±29 prism diopters (PD) before surgery decreasing to 21±19, 13±12 and 6±8 PD after first, second and third surgery, respectively. Corresponding figures for mean vertical deviation were 13±15, 7±12, 4±6 and 1±2 PD, respectively. Abnormal head posture was 10-30° in 11 (21.1%) cases before treatment which completely resolved after surgery. Conclusion: Surgical management of strabismus in patients with third nerve palsy is difficult and challenging, however the majority of patients achieve ideal results with appropriate and stepwise surgical plans.
  1,698 115 -
Nutrient supplementation for age-related macular degeneration, cataract, and dry eye
Ronald P Hobbs, Paul S Bernstein
October-December 2014, 9(4):487-493
DOI:10.4103/2008-322X.150829  PMID:25709776
There have been enormous advances in the past decade for the treatment of age-related macular degeneration (AMD); however, these treatments are expensive and require frequent follow-up and injections which place a tremendous burden on both the healthcare system and patients. Consequently, there remains considerable interest in preventing or slowing the progression of AMD requiring treatment. Epidemiological studies have shown that diet is a modifiable AMD risk factor, and nutrient modification is a particularly appealing treatment for AMD due to the perceived universal benefit and relatively low expense. Recently, the age-related eye disease study part two (AREDS2) was concluded and demonstrated further benefit with the addition of lutein and zeaxanthin as a replacement for the β-carotene of the previous generation formulation. The addition of omega-3 essential fatty acids did not show an added benefit. This review aims to highlight some of the evidenced based body of knowledge that has been accumulated from recent studies regarding the use of nutritional supplements and their effect on AMD, cataracts, and dry eyes.
  1,466 290 2
Pars planitis: Epidemiology, clinical characteristics, management and visual prognosis
Pinar Cakar Ozdal, Nilufer Berker, Ilknur Tugal-Tutkun
October-December 2015, 10(4):469-480
DOI:10.4103/2008-322X.176897  PMID:27051493
Pars planitis is an idiopathic chronic intermediate uveitis which predominantly affects children and adolescents, and accounts for 5-26.7% of pediatric uveitis. Although an autoimmune process with a genetic predisposition has been suggested, its etiology still remains unknown. The most common presenting symptoms are floaters and blurred vision. Diffuse vitreous cells, haze, snowballs and snowbanks are typical findings of pars planitis. Peripheral retinal vasculitis, optic disc edema and anterior segment inflammation are other well-known findings. Although pars planitis is known to be a benign form of uveitis in most cases, it may become a potentially blinding disease due to complications including cataract, cystoid macular edema, vitreous opacities and optic disc edema. Cystoid macular edema is the most common cause of visual morbidity. Band keratopathy, epiretinal membrane formation, vitreous condensation, neovascularizations, vitreous hemorrhage, retinal detachment, cyclitic membranes, glaucoma and amblyopia may develop as a consequence of the chronic course of the disease. Exclusion of infectious and non-infectious causes which may present with intermediate uveitis is of utmost importance before starting treatment. Treatment of pars planitis has been a controversial issue. There is no consensus specifically for treatment of cases with minimal inflammation and relatively good visual acuity. However, current experience shows that pars planitis may cause severe inflammation and needs an aggressive treatment. A stepladder approach including corticosteroids, immunosupressive agents, anti-tumor necrosis factor-alpha and pars plana vitrectomy and/or laser photocoagulation is the most commonly used method for treatment of pars planitis. Adequate control of inflammation and prompt detection of associated complications are crucial in order to improve the overall prognosis of the disease.
  1,469 235 2
Diabetes and Retinal Vascular Dysfunction
Eui Seok Shin, Christine M Sorenson, Nader Sheibani
July-September 2014, 9(3):362-373
Diabetes predominantly affects the microvascular circulation of the retina resulting in a range of structural changes unique to this tissue. These changes ultimately lead to altered permeability, hyperproliferation of endothelial cells and edema, and abnormal vascularization of the retina with resulting loss of vision. Enhanced production of inflammatory mediators and oxidative stress are primary insults with significant contribution to the pathogenesis of diabetic retinopathy (DR). We have determined the identity of the retinal vascular cells affected by hyperglycemia, and have delineated the cell autonomous impact of high glucose on function of these cells. We discuss some of the high glucose specific changes in retinal vascular cells and their contribution to retinal vascular dysfunction. This knowledge provides novel insight into the molecular and cellular defects contributing to the development and progression of diabetic retinopathy, and will aid in the development of innovative, as well as target specific therapeutic approaches for prevention and treatment of DR.
  1,445 205 -
Optical coherence tomography angiography in retinal diseases
KV Chalam, Kumar Sambhav
January-March 2016, 11(1):84-92
DOI:10.4103/2008-322X.180709  PMID:27195091
Optical coherence tomography angiography (OCTA) is a new, non-invasive imaging system that generates volumetric data of retinal and choroidal layers. It has the ability to show both structural and blood flow information. Split-spectrum amplitude-decorrelation angiography (SSADA) algorithm (a vital component of OCTA software) helps to decrease the signal to noise ratio of flow detection thus enhancing visualization of retinal vasculature using motion contrast. Published studies describe potential efficacy for OCTA in the evaluation of common ophthalmologic diseases such as diabetic retinopathy, age related macular degeneration (AMD), retinal vascular occlusions and sickle cell disease. OCTA provides a detailed view of the retinal vasculature, which allows accurate delineation of microvascular abnormalities in diabetic eyes and vascular occlusions. It helps quantify vascular compromise depending upon the severity of diabetic retinopathy. OCTA can also elucidate the presence of choroidal neovascularization (CNV) in wet AMD. In this paper, we review the knowledge, available in English language publications regarding OCTA, and compare it with the conventional angiographic standard, fluorescein angiography (FA). Finally, we summarize its potential applications to retinal vascular diseases. Its current limitations include a relatively small field of view, inability to show leakage, and tendency for image artifacts. Further larger studies will define OCTA's utility in clinical settings and establish if the technology may offer a non-invasive option of visualizing the retinal vasculature, enabling us to decrease morbidity through early detection and intervention in retinal diseases.
  1,172 383 9
Need for refinement of international retinopathy of prematurity guidelines and classifications
Ramak Roohipoor, John I Loewenstein
October-December 2015, 10(4):355-357
DOI:10.4103/2008-322X.176902  PMID:27051477
  486 1,042 -
Optogenetics for Retinal Disorders
Bradley S Henriksen, Robert E Marc, Paul S Bernstein
July-September 2014, 9(3):374-382
Optogenetics is the use of genetic methods combined with optical technology to achieve gain or loss of function within neuronal circuits. The field of optogenetics has been rapidly expanding in efforts to restore visual function to blinding diseases such as retinitis pigmentosa (RP). Most work in the field includes a group of light-sensitive retinaldehyde-binding proteins known as opsins. Opsins couple photon absorption to molecular signaling chains that control cellular ion currents. Targeting of opsin genes to surviving retinal cells is fundamental to the success of optogenetic therapy. Viral delivery, primarily adeno-associated virus, using intravitreal injection for inner retinal cells and subretinal injection for outer retinal cells, has proven successful in many models. Challenges in bioengineering remain for optogenetics including relative insensitivity of opsins to physiologic light levels of stimulation and difficulty with viral delivery in primate models. However, targeting optogenetic therapy may present an even greater challenge. Neural and glial remodeling seen in advanced stages of RP result in reorganization of remaining neural retina, and optogenetic therapy may not yield functional results. Remodeling also poses a challenge to the selection of cellular targets, with bipolar, amacrine and ganglion cells all playing distinct physiologic roles, and affected by remodeling differently. Although optogenetics has drawn closer to clinical utility, advances in opsin engineering, therapeutic targeting and ultimately in molecular inhibition of remodeling will play critical roles in the continued clinical advancement of optogenetic therapy.
  1,347 117 -
Combined Conjunctival Autograft and Overlay Amniotic Membrane Transplantation; a Novel Surgical Treatment for Pterygium
Siamak Zarei Ghanavati, Mohamed Abou Shousha, Carolina Betancurt, Victor L Perez
July-September 2014, 9(3):399-403
The authors report the long-term results of combined conjunctival autograft and overlay amniotic membrane transplantation (AMT) for treatment of pterygium as a new surgical technique. Nineteen patients including 12 male and 7 female subjects with pterygium (primary, 14 cases; recurrent, 5 cases) underwent combined conjunctival autograft and overlay AMT and were followed from 10 to 26 months. Mean age was 44.21±12.49 (range, 29.0-73.0) years. In one patient with grade T3 primary pterygium, the lesion recurred (5.2%, recurrence rate). No intra-and postoperative complication developed. This procedure seems a safe and effective surgical technique for pterygium treatment. Protection of the ocular surface during the early postoperative period reduces the friction-induced inflammation and might be helpful to prevent the recurrence.
  1,242 95 -
Choroidal neovascularization induces retinal edema and its treatment addresses this problem
Ramin Tadayoni
October-December 2014, 9(4):405-406
DOI:10.4103/2008-322X.150799  PMID:25709762
  752 462 -
Transplantation of autologous ex vivo expanded human conjunctival epithelial cells for treatment of pterygia: A prospective open-label single arm multicentric clinical trial
Viraf Sam Vasania, Aarya Hari, Radhika Tandon, Sanjay Shah, Suhas Haldipurkar, Smitesh Shah, Shailendra Sachan, Chandra Viswanathan
October-December 2014, 9(4):407-416
DOI:10.4103/2008-322X.150800  PMID:25709763
Purpose: To establish the efficacy and safety of ex vivo cultured autologous human conjunctival epithelial cell (hCjEC) transplantation for treatment of pterygia. Methods: Twenty-five patients with pterygia were recruited at different centers across the country. Autologous hCjEC grafts were prepared from conjunctival biopsy specimens excised from the healthy eye and cultured ex vivo on human amniotic membrane mounted on inserts using a unique mounting device. The hCjEC grafts were then transported in an in-house designed transport container for transplantation. Post-surgery, the patients were followed up on days 1, 7, 14, 30, 90, and 180 as per the approved study protocol. Clinical outcomes were assessed by slit lamp examination, visual acuity, imprint cytology, fluorescein/rose bengal staining, Schirmer's test, and photographic evaluation three and 6 months post-transplantation. Results: Two patients were lost to follow-up and final analysis included 23 cases. No recurrence of pterygium was observed in 18 (78.3%) patients; all of these eyes showed a smooth conjunctival surface without epithelial defects. Recurrence was observed in 5 (21.7%) patients at 3 months post-treatment. No conjunctival inflammation, secondary infections or other complications were reported. Adequate goblet cells were present in 19 (82.6%) patients at the site of transplantation. Conclusion: We have, for the 1 st time, standardized a protocol for preparing autologous hCjEC grafts that can be safely transported to multiple centers across the country for transplantation. The clinical outcome was satisfactory for treating pterygia.
  1,028 185 1
Comparison of Topical Versus Sub-Tenon's Anesthesia in Phacoemulsification at a Tertiary Care Eye Hospital
Shambhu Rashmi, Kibballi Madhukeshwar Akshaya, Sarpangala Mahesha
July-September 2014, 9(3):329-333
Purpose: To compare the effectiveness of topical and sub-Tenon's anesthesia in providing pain relief during phacoemulsification. Methods: This randomized controlled trial was carried out at a tertiary eye care hospital, Coimbatore, Tamil Nadu, India. Patients who underwent phacoemulsification through self-sealing clear corneal incision with foldable intra-ocular lens implantation were randomized into two groups. Group 1 (n = 100) received topical anesthesia with 0.5% proparacaine (Paracaine, Sunways India Pvt. Ltd., India) drops. Group 2 (n = 100) received sub-Tenon's infiltration with 2% lignocaine (Xylocaine, AstraZeneca Pharma India Pvt. Ltd., India). As per study criteria, patients graded the pain during administration of anesthesia, during surgery and after surgery on a visual analogue pain scale. The surgeon graded overall patient co-operation. The complications were also noted. Data analysis was performed using Statistical Package for Social Sciences version 11. Student's t-test and Chi-square test were used for comparison of variables between the groups. Results: Sub-Tenon's anesthesia provided statistically significant better intra-operative pain relief and patient satisfaction than topical anesthesiat. No statistically significant difference was noted between the two groups regarding pain during administration, postoperative pain, and surgeon satisfaction. Conclusion: Sub-Tenon's anesthesia provides better pain relief than topical anesthesia during phacoemulsification.
  1,062 83 -
Patterns of Uveitis at a Tertiary Referral Center in Southern Iran
Mansour Rahimi, Ghazaleh Mirmansouri
January-March 2014, 9(1):54-59
Purpose: To ascertain the patterns of uveitis at Motahari uveitis clinic, Shiraz University of Medical Sciences, a tertiary referral center in Shiraz, Southern Iran. Methods: All new cases of uveitis referred from June 2005 to July 2011 to our center were consecutively enrolled in the study. After taking a complete history of systemic and ocular diseases, all patients underwent a complete ophthalmologic examination including determination of Snellen visual acuity, slit lamp biomicroscopy, applanation tonometry and dilated fundus examination. Patients were classified according to International Uveitis Study Group definitions. Results: A total of 475 subjects were evaluated; mean age at the onset of uveitis was 30.5 ΁15.14 years. Uveitis was unilateral in 292 (61.4%) and bilateral in 183 (38.6%) patients. Anterior uveitis was the most common type of inflammation (190 patients, 40%), followed by posterior uveitis (133 patients, 28%), panuveitis (99 patients, 20.8%) and intermediate uveitis (53 patients, 11.1%). A specific cause was found in 295 patients (61.9%). HLA-B27 negative was the most common cause of anterior uveitis (84 patients, 44.2%), Behcet's disease was the most common etiology of panuveitis (34 cases, 34.3%) and toxoplasmosis was the most common cause of posterior uveitis (56 patients, 42.1%). The great majority of intermediate uveitis cases were idiopathic (49 patients, 92.4%). Conclusion: The most common type of uveitis in Southern Iran is anterior. The most common underlying disorders are HLA-B27 negative, toxoplasmosis and Behcet's disease.
[ABSTRACT]   Full text not available  [PDF]
  1,066 66 -
Central and Peripheral Corneal Thickness Measurement in Normal and Keratoconic Eyes Using Three Corneal Pachymeters
Sepehr Feizi, Mohammad Reza Jafarinasab, Farid Karimian, Hosein Hasanpour, Ali Masudi
July-September 2014, 9(3):296-304
Purpose: To assess the agreement among ultrasonic pachymetry, the Galilei dual Scheimpflug analyzer, and Orbscan II for central and peripheral (Galilei vs. Orbscan) corneal thickness (CCT and PCT) measurement in normal and keratoconic eyes. Methods: In this prospective study, CCT and PCT were measured in 88 eyes of 88 refractive surgery candidates and 128 eyes of 69 keratoconic patients with ultrasonic pachymetry, the Galilei, and Orbscan II. The readings by the three instruments were compared using one-way analysis of normal variance. Agreement among the three devices was assessed using Pearson and intraclass correlation coefficients, and Bland-Altman plots. The same analyses were employed to evaluate agreement between Galilei and Orbscan II for PCT measurement. Results: In the normal group, mean CCT was 551.0±39.4, 566.9±33.5, and 565.5±40.9 μm measured by ultrasonic pachymetry, the Galilei, and Orbscan II, respectively (P<0.001). The corresponding figures in the keratoconus group were 492.0±61.7, 502.0±42.1, and 470.6±56.9 μm, respectively (P<0.001). Mean PCT was 612.5±35.3 and 640.9±38.0 μm in the normal group (P<0.001) and 567.6±35.2 and 595.1±41.4 μm in the keratoconus group (P<0.001) by the Galilei and Orbscan II, respectively. CCT and PCT measurements obtained by different devices were significantly correlated in both groups. Conclusion: To measure CCT, the Galilei and Orbscan II can be used interchangeably in normal eyes, but not in keratoconic eyes. For PCT, there is a systematic error between measurements obtained by the Galilei and Orbscan II. However, it is possible to change optical pachymeter readings into those obtained by ultrasonic pachymetry using a constant.
  1,003 127 -
Surgical Treatments in Inferior Oblique Muscle Overaction
Mostafa Soltan Sanjari, Kourosh Shahraki, Shahbaz Nekoozadeh, Seyed-Morteza Tabatabaee, Kianoush Abri Shahraki, Kaveh Abri Aghdam
July-September 2014, 9(3):291-295
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.
  1,004 119 -
Cataract Surgery in Eyes with Low Corneal Astigmatism: Implantation of the Acrysof IQ Toric SN6AT2 Intraocular Lens
Jaskirat S Aujla, Stephen J Vincent, Shane White, Jai Panchapakesan
July-September 2014, 9(3):324-328
Purpose: To assess the refractive and visual outcomes following cataract surgery and implantation of the AcrySof IQ Toric SN6AT2 intraolcular lens (IOL) (Alcon Laboratories, Inc., Fort Worth, TX, USA) in patients with low corneal astigmatism. Methods: This study is a retrospective, consecutive, single surgeon series of 98 eyes of 88 patients (with low preoperative corneal astigmatism) undergoing cataract surgery and implantation of the AcrySof IQ Toric SN6AT2 IOL. Postoperative measurements were obtained 1-month postsurgery. Main outcome measures were monocular distance visual acuity and residual refractive astigmatism. Results: Mean preoperative corneal astigmatic power vector (APV) was 0.38±0.09 D. Following surgery and implantation of the toric IOL, mean postoperative refractive APV was 0.13±0.10 D. Mean postoperative distance uncorrected visual acuity was 0.08±0.09 logMAR. Postoperative spherical equivalent refraction (SER) resulted in a mean of –0.23±0.22 D, with 96% of eyes falling within 0.50 D of the target SER. Conclusion: The AcrySof IQ Toric SN6AT2 IOL is a safe and effective option for eyes undergoing cataract surgery with low levels of preoperative corneal astigmatism.
  967 96 -
Commentary on the Outcomes of Inferior Oblique Muscle Weakening in Inferior Oblique Muscle Overaction
David Silbert, Noelle Matta
July-September 2014, 9(3):289-290
  953 99 -
Rho-Associated Kinase Inhibitors: Potential Future Treatments for Glaucoma
Ramin Daneshvar, Nima Amini
July-September 2014, 9(3):395-398
  908 140 -
Amniotic Membrane Extract Preparation: What is the Best Method?
Mirgholamreza Mahbod, Saied Shahhoseini, Mehdi Khabazkhoob, Amir-Houshang Beheshtnejad, Haleh Bakhshandeh, Fatemeh Atyabi, Hassan Hashemi
July-September 2014, 9(3):314-319
Purpose: To compare different preparation methods for a suitable amniotic membrane (AM) extract containing a given amount of growth factors. Methods: In this interventional case series, we dissected the AM from eight placentas within 24 hours after delivery, under clean conditions. After washing and mixing, AM extracts (AMEs) were prepared using pulverization and homogenization methods, and different processing and storing conditions. Main outcome measures were the amount of added protease inhibitor (PI), the relative centrifugal force (g), in-process temperature, repeated extraction times, drying percentage, repeated pulverization times, and the effect of filtering with 0.2 μm filters. Extract samples were preserved at different temperature and time parameters, and analyzed for hepatic growth factor (HGF) and total protein using ELISA and calorimetric methods, respectively. Results: The extracted HGF was 20% higher with pulverization as compared to homogenization, and increased by increasing the PI to 5.0 μl/g of dried AM. Repeating centrifugation up to 3 times almost doubled the extracted HGF and protein. Storing the AME at −170° for 6 months caused a 50% drop in the level of HGF and protein. Other studied parameters showed no significant effect on the extracted amount of HGF or total protein. Conclusion: Appropriate extraction methods with an adequate amount of PI increases the level of extractable components from harvested AMs. To achieve the maximal therapeutic effects of AMEs, it is necessary to consider the half-life of its bioactive components.
  913 113 -
Measurement of central corneal thickness using ultrasound pachymetry and Orbscan II in normal eyes
Mohammad Mehdi Sadoughi, Bahram Einollahi, Neda Einollahi, Javad Rezaei, Danial Roshandel, Sepehr Feizi
January-March 2015, 10(1):4-9
DOI:10.4103/2008-322X.156084  PMID:26005545
Purpose: To compare ultrasound pachymetry and Orbscan II for measurement of central corneal thickness (CCT) in normal eyes. Methods: The current study was performed at Labbafinejad Medical Center (LMC), Tehran, Iran. Three hundred eyes from 150 healthy individuals referred for keratorefractive surgery were assessed first by Orbscan II and then by ultrasound pachymetry, and CCT values were recorded and compared. Results: Overall, Orbscan II overestimated CCT as compared to ultrasound pachymetry by about 2.4% (mean values 547.6 ± 34.7 versus 534.8 ± 34.7, respectively, P < 0.001). The difference was more significant when CCT was less than 500 microns (mean values 493.2 ± 16.9 versus 479.9 ± 15.6, mean overestimation: 2.6%, P < 0.001). There was good linear correlation between the two methods (Pearson's correlation r = 0.968, P < 0.0001). Conclusion: Orbscan II has good correlation with ultrasound pachymetry for measurement of CCT in normal eyes; however Orbscan II should not be used to evaluate corneal thickness before keratorefractive surgeries, as it tends to overestimate corneal thickness and may result in undesirable, low residual stromal thickness.
  841 179 1
Glaucoma in Iran and contributions of studies in Iran to the understanding of the etiology of glaucoma
Fatemeh Suri, Shahin Yazdani, Elahe Elahi
January-March 2015, 10(1):68-76
DOI:10.4103/2008-322X.156120  PMID:26005556
Epidemiologic and genetic/molecular research on glaucoma in Iran started within the past decade. A population-based study on the epidemiology of glaucoma in Yazd, a city in central Iran, revealed that 4.4% of studied individuals were affected with glaucoma: 1.6% with high tension primary open angle glaucoma (POAG), 1.6% with normal tension POAG, and 0.4% each with primary angle closure glaucoma (PACG) and pseudoexfoliation glaucoma (PEXG), and other types of secondary glaucoma. Two notable observations were the relatively high frequency of normal tension glaucoma cases (1.6%) and the large fraction of glaucoma affected individuals (nearly 90%) who were unaware of their condition. The first and most subsequent genetic studies on glaucoma in Iran were focused on primary congenital glaucoma (PCG) showing that cytochrome P450 1B1 (CYP1B1) is the cause of PCG in the majority of Iranian patients, many different CYP1B1 mutations are present among Iranian patients but only four mutations constitute the vast majority, and the origins of most mutations in the Iranians are identical by descent (IBD) with the same mutations in other populations. Furthermore, most of the PCG patients are from the northern and northwestern provinces of Iran. A statistically significant male predominance of PCG was observed only among patients without CYP1B1 mutations. Clinical investigations on family members of PCG patients revealed that CYP1B1 mutations exhibit variable expressivity, but almost complete penetrance. A great number of individuals harboring CYP1B1 mutations become affected with juvenile onset POAG. Screening of JOAG patients showed that an approximately equal fraction of the patients harbor CYP1B1 and (myocilin) MYOC mutations; MYOC is a well-known adult onset glaucoma causing gene. Presence of CYP1B1 mutations in JOAG patients suggests that in some cases, the two conditions may share a common etiology. Further genetic analysis of Iranian PCG patients led to identification of Latent-transforming growth factor beta-binding protein 2 (LTBP2) as a causative gene for both PCG and several diseases which are often accompanied by glaucomatous presentations, such as Weill-Marchesani syndrome 3 (WMS3). The findings on LTBP2 have contributed to recognize the importance of the extracellular matrix in pathways leading to glaucoma.
  848 149 2
Topical cyclosporine a for treatment of dry eye due to chronic mustard gas injury
Khosrow Jadidi, Yunes Panahi, Ali Ebrahimi, Mostafa Mafi, Farhad Nejat, Amirhossein Sahebkar
October-December 2014, 9(4):417-422
DOI:10.4103/2008-322X.150803  PMID:25709764
Purpose: To evaluate the efficacy of topical cyclosporine A (tCsA) for treatment of dry eye disease in patients suffering from chronic ocular complications of mustard gas (MG) injury. Methods: This interventional case series included patients with MG injury suffering from severe dry eye despite receiving artificial tears and punctal plugs. Patients were administered tCsA 0.05% twice daily for 3 months. Severity of the condition was evaluated by measuring tear osmolarity, ocular surface disease index (OSDI), tear break-up time (TBUT), and Schirmer's test at baseline and at the end of study. Results: A total of 34 patients with chronic MG injury and mean age of 47.1 ± 6.5 years were studied. Compared to baseline values, tear osmolarity (301.7 ± 11.5 vs. 286.3 ± 7.9 mOsmol/L, P < 0.001) and OSDI (47.5 ± 7.2 vs. 42.7 ± 7.1, P < 0.001) were significantly improved. Likewise, Schirmer's test (4.6 ± 1.3 vs. 5 ± 1.3 mm, P < 0.001) and TBUT (1.9 ± 1.4 vs. 2.7 ± 1.5 s, P < 0.001) also significantly recovered at the end of the study. Conclusion: TCsA 0.05% reduces tear osmolarity and improves dry eye symptoms and can serve as an efficacious treatment for ocular complications in patients with chronic MG injury.
  836 130 1
Outcomes of Single Segment Implantation of Conventional Intacs versus Intacs SK for Keratoconus
Mohammad Nasser Hashemian, Mohammad Ali Zare, Mehrdad Mohammadpour, Firouzeh Rahimi, Mohammad Reza Fallah, Fereydoun Keramat Panah
July-September 2014, 9(3):305-309
Purpose: To compare the visual, refractive, and keratometric outcomes of single-segment conventional and severe keratoconus (SK) types of Intacs for correction of inferior keratoconus (KCN). Methods: A total number of 41 consecutive eyes of 23 patients with a diagnosis of inferior KCN underwent Intacs implantation. Eight eyes were excluded due to postoperative complications (4 eyes) and loss to follow-up (4 eyes) and finally 33 eyes underwent statistical analysis. Two groups were created according to Intacs type insertion; conventional group (17 eyes) and SK groups (16 eyes). Intracorneal ring segments (ICRS) implantation was indicated in keratoconic patients with contact-lens intolerance or reduced best spectacle-corrected visual acuity (BSCVA). Results: In the conventional group, mean uncorrected distance visual acuity (UCDVA) improved from 0.45 ± 0.41 preoperatively to 0.69 ± 0.39 six months after surgery representing a gain of 2 Snellen lines, and in the SK group mean UCDVA changed from 0.40 ± 0.35 preoperatively to 0.58 ± 0.48 equivalent to two Snellen lines improvement 6 months after operation (P = 0.48). Mean preoperative BSCVA in the conventional group improved from 0.72 ± 0.41 to 0.86 ± 0.39 (2 lines improvement) postoperatively and in the SK group improved from 0.71 ± 0.69 to 0.75 ± 0.45 (0.50 line improvement) ( P = 0.29). Mean preoperative spherical equivalent (SE) decreased from −4.86 ± 2.26 D to −3.57 ± 2.21 D (conventional group) and from −4.20 ± 1.82 D to −3.60 ± 1.89 D (P = 0.34), mean astigmatism (AST) decreased from −5.20 ± 2.07 D and −4.50 ± 2.26 D to −4.02 ± 2.57 D and − 3.18 ± 2.14 D in the conventional and SK groups, respectively (P = 0.68). Finally, mean K min decreased from 47.11 ± 2.51 D to 45.40 ± 3.30 D in the conventional group and from 45.05 ± 2.59 D to 44 ± 3.88 D in the SK group (P = 0.63) and mean K max was decreased from 52.82 ± 3.23 D to 50.52 ± 3.57 D and from 49.72 ± 3.17 D to 48.55 ± 4.50 D, respectively (P = 0.48). Conclusion: Single-segment implantation of conventional and SK Intacs improved UCDVA and BSCVA, decreased corneal AST and keratometry in both groups with comparable outcomes.
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Cytochrome P450 1B1 and primary congenital glaucoma
Yun Zhao, Christine M Sorenson, Nader Sheibani
January-March 2015, 10(1):60-67
DOI:10.4103/2008-322X.156116  PMID:26005555
Cytochrome P450 1B1 (Cyp1b1) belongs to the CYP450 superfamily of heme-binding mono-oxygenases which catalyze oxidation of various endogenous and exogenous substrates. The expression of Cyp1b1 plays an important role in the modulation of development and functions of the trabecular meshwork (TM). Mutations in Cyp1b1 have been reported in patients with primary congenital glaucoma (PCG). Mice lacking Cyp1b1 also exhibit developmental defects in the TM similar to those reported in congenital glaucoma patients. However, how Cyp1b1 deficiency contributes to TM dysgenesis remains unknown. In the present review, we will address the significance of Cyp1b1 expression and/or its function in anterior segment development. Cyp1b1-deficient ( Cyp1b1−/−) mice are discussed as a promising model for an oxidative stress-induced model of PCG, in which Cyp1b1 activity is revealed as an important modulator of oxidative homeostasis contributing to the development and structural function of the TM. This conclusion suggests a possible clinical intervention for individuals who are genetically at high risk of developing PCG.
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