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   2013| January-March  | Volume 8 | Issue 1  
    Online since September 18, 2014

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Simultaneous Penetrating Keratoplasty and Cataract Surgery
Mohammad-Ali Javadi, Sepehr Feizi, Hamid-Reza Moein
January-March 2013, 8(1):39-46
Purpose: To determine the clinical outcomes of simultaneous penetrating keratoplasty (PK), cataract removal and intraocular lens implantation (triple procedure), and to compare the safety and efficacy of two different cataract extraction techniques during the course of PK. Methods: This retrospective comparative study was conducted on patients who had undergone a triple procedure. The technique of cataract extraction was either opensky extracapsular cataract extraction (ECCE) or phacoemulsification (PE). In the ECCE group, the posterior chamber intraocular lens (PCIOL) was implanted in the ciliary sulcus, while in the PE group PCIOLs were fixated within the capsular bag. Outcome measures included best spectacle corrected visual acuity (BSCVA), refractive results, graft clarity and complications. Results: Seventy-six eyes of 69 consecutive patients with mean age of 61.4±14.2 years were enrolled. Mean follow-up period was 61.4±37.2 months over which mean BSCVA was significantly improved from 1.40±0.68 to 0.44±0.33 LogMAR (P<0.001). Mean postoperative spherical equivalent refractive error was -2.13±3.02 D, which significantly differed from the target refraction (-0.73±0.29 D, P=0.004). At final follow-up, 89.5% of the corneal grafts remained clear. Conclusion: The triple procedure is a safe and effective approach to restore vision in patients with coexisting corneal pathologies and cataracts. However, unacceptable postoperative refractive error can be anticipated.
[ABSTRACT]   Full text not available  [PDF]
  577 209 -
Cataract Surgery in Eyes with Filtered Primary Angle Closure Glaucoma
Sasan Moghimi, Golshan Latifi, Heydar Amini, Masood Mohammadi, Ghasem Fakhraie, Yadollah Eslami, Nariman Nassiri, Joseph Caprioli
January-March 2013, 8(1):32-38
Purpose: To evaluate the effect of cataract surgery on intraocular pressure (IOP) in filtered eyes with primary angle closure glaucoma (PACG). Methods: In this prospective interventional case series, 37 previously filtered eyes from 37 PACG patients with mean age of 62.1±10.4 years were consecutively enrolled. All patients had visually significant cataracts and phacoemulsification was performed at least 12 months after trabeculectomy. Visual acuity, IOP and the number of glaucoma medications were recorded preoperatively, and 1, 3, 6 and 12 months after surgery. Anterior chamber (AC) depth was measured preoperatively and 3 months after cataract surgery with A-scan ultrasonography. The main outcome measure was IOP at 12 months. Results: IOP was decreased significantly from 18.16±5.91 mmHg at baseline to 15.37±2.90 mmHg at final follow-up (P<0.01). The mean number of glaucoma medications was significantly decreased from 1.81±0.24 to 0.86±1.00 (P=0.001) at 1 year postoperatively. At final follow up, 36 (97.2%) eyes and 32 (86.4%) eyes had IOP≤21 and IOP≤18 mmHg, respectively; 14 (37.8%) eyes and 9 (24.3%) eyes had IOP≤21 and IOP≤18 mmHg without medications, respectively. The magnitude of IOP reduction was correlated with higher preoperative IOP (r=0.85, P<0.001), shallower preoperative AC depth (r=-0.38, P=0.01) and greater changes in AC depth (r=-0.39, P=0.01). Conclusion: Cataract surgery reduces IOP and the number of glaucoma medications in previously filtered PACG eyes. This reduction seems to be greater in patients with higher preoperative IOP and shallower anterior chambers.
[ABSTRACT]   Full text not available  [PDF]
  614 77 -
Intravitreal Diclofenac for Refractory Uveitic Cystoid Macular Edema
Alireza Ramezani, Nassim Fard Esmaeilpour, Armen Eskandari, Zahra Rabbanikhah, Roham Soheilian, Masoud Soheilian
January-March 2013, 8(1):47-52
Purpose: To evaluate the effect of a single dose of intravitreal diclofenac on bestcorrected visual acuity (BCVA) and central macular thickness (CMT) in patients with refractory uveitic cystoid macular edema (CME). Methods: In this prospective non-comparative case series, 8 eyes of 8 patients with refractory CME secondary to chronic intermediate uveitis received a single intravitreal injection of diclofenac (500 μg/0.1ml) in addition to other systemic (oral prednisolone and methotraxate) and topical (betamethasone) remission maintaining drugs. Outcome measures were changes in BCVA and CMT after treatment. Results: Mean BCVA remained relatively unchanged at 12, 24 and 36 weeks (0.69, 0.70 and 0.64 LogMAR, respectively) as compared to baseline (0.71 LogMAR). Mean CMT, however, decreased from 488 μm at baseline to 416 and 456 μm at 24 and 36 weeks, respectively. None of the changes were statistically significant. Conclusion: In eyes with refractory uveitic CME, intravitreal injection of diclofenac insignificantly reduced CMT but this was not associated with visual improvement.
[ABSTRACT]   Full text not available  [PDF]
  600 83 -
Knockdown of the Placental Growth Factor Gene Inhibits Laser Induced Choroidal Neovascularization in a Murine Model
Ramin Nourinia, Zahra-Soheila Soheili, Hamid Ahmadieh, Hassan Akrami, Mozhgan Rezaei Kanavi, Shahram Samiei
January-March 2013, 8(1):4-8
Purpose: To evaluate the effect of placental growth factor (PlGF) gene knockdown in a murine model of laser-induced choroidal neovascularization. Methods: Choroidal neovascularization was induced in the left eyes of 11 mice by infrared laser. Small interfering RNA (siRNA, 20 picomoles/10 μl) corresponding to PlGF mRNA was administered intravitreally by Hamilton syringe in all subjects. One month later, fluorescein angiography and histolologic examination were performed. Results: No leakage was apparent in the 11 eyes treated with siRNA cognate to PlGF. The results of histological evaluation were consistent with angiographic findings showing absence of choroidal neovascularization. Conclusion: Knockdown of the PlGF gene can inhibit the growth of laser-induced choroidal neovascularization in mice.
[ABSTRACT]   Full text not available  [PDF]
  601 75 -
Early Changes in Intraocular Pressure Following Phacoemulsification
Mitra Zamani, Mostafa Feghhi, Afsaneh Azarkish
January-March 2013, 8(1):25-31
Purpose: To evaluate early postoperative changes in intraocular pressure (IOP) following phacoemulsification and intraocular lens (IOL) implantation. Methods: This prospective study included 129 eyes with open angles and normal or high IOP undergoing phacoemulsification and IOL implantation for senile cataracts. The patients were divided into 3 groups (Gs) based on preoperative IOP: ≤15 mmHg (G1, n=76); from 16 to 20 mmHg (G2, n=43) and; from 21 to 30 mmHg (G3, n=10). IOP was measured by Goldmann applanation tonometry one day before surgery, and 1 and 6 weeks postoperatively. Results: IOP was decreased postoperatively in all study groups 1 and 6 weeks after surgery as follows: 2.8±1.5 and 1.8±1.7 mmHg respectively in G1 (P<0.001); 4.2±1.9 and 4.3±2.9 mmHg respectively in G2 (P<0.001), and 8.3±4.3 and 9.3±4.1 mmHg respectively in G3 (P<0.001). At the end of the sixth postoperative week, the percentage of IOP change for G1, G2 and G3 was 13.5%±12.7, 24.5%±11.7 and 38.3%±16.2, respectively. Conclusion: IOP significantly decreased after phacoemulsification and IOL implantation in normal subjects with open angles and those with ocular hypertension. IOP reduction was greater in eyes with higher preoperative IOP.
[ABSTRACT]   Full text not available  [PDF]
  577 80 -
Branch Retinal Artery Occlusion in a Patient with Patent Foramen Ovale
Nasser Shoeibi, Hoorak Poorzand, Mojtaba Abrishami
January-March 2013, 8(1):58-61
Purpose: To report branch retinal artery occlusion (BRAO) in a patient with patent foramen ovale (PFO). Case Report: A 29-year-old female patient was referred for sudden onset superior visual field defect in her left eye. Ocular examination revealed visual acuity of 20/32 in the affected eye along with a positive relative afferent pupillary defect. A calcified white embolus was noted at the first bifurcation of the inferior temporal artery in her left eye together with mild retinal edema. With a diagnosis of BRAO, the patient received oral acetazolamide, topical timolol, ocular massage and anterior chamber paracentesis. The visual field defect partially recovered and the embolus moved to the third bifurcation level as revealed by fundus examination. An extensive workup, including neurology, rheumatology, cardiology and hematology consultation, carotid ultrasonography, transthoracic/transesophageal echocardiography and laboratory testing was performed. All results were within normal limits except for a small-sized PFO detected by transesophageal echocardiography. Low-dose aspirin therapy was initiated and over the subsequent two years, no other embolic event occurred. Conclusion: The association between PFO and BRAO has not yet been reported. Intracardiac right-to-left shunting through a PFO, accentuated by Valsalva maneuver, may predispose to embolic events while the source of initial thrombosis remains unknown.
[ABSTRACT]   Full text not available  [PDF]
  567 75 -
Analysis of Schwalbe's Line (Limbal Smooth Zone) by Scanning Electron Microscopy and Optical Coherence Tomography in Human Eye Bank Eyes
Mark P Breazzano, Michael Fikhman, Jerrold L Abraham, Ann E Barker-Griffith
January-March 2013, 8(1):9-16
Purpose: Implantation of intraocular devices may become critical as they decrease in size in the future. Therefore, it is desirable to evaluate the relationship between radial location and Schwalbe's line (smooth zone) by examining its width with scanning electron microscopy (SEM) and to correlate this with observations by optical coherence tomography (OCT). Methods: Full corneoscleral rings were obtained from twenty-six formalin-fixed human phakic donor eyes. SEM of each eye yielded a complete montage of the smooth zone, from which the area was measured, and width was determined in each quadrant. In three different eyes, time domain anterior segment OCT (Visante, Carl Zeiss Meditec Inc., Dublin, CA, USA) and spectral domain OCT (Cirrus 4.0, Carl Zeiss Meditec Inc., Dublin, CA, USA) were used to further characterize Schwalbe's line. Results: The overall smooth zone width was 79±22 μm, (n=15) ranging from 43 to 115 μm. The superior quadrant (103±8 μm, n=19), demonstrated significantly wider smooth zone than both the nasal (71±5 μm, n=19, P<0.001), and inferior (64±5 μm, n=18, P<0.0001) quadrants but not the temporal quadrant (81±7 μm, n=17, P>0.05). SEM findings of the smooth zone were correlated with visualization of Schwalbe's line by Cirrus and Visante OCT imaging. Conclusion: The smooth zone appears widest superiorly and thinnest inferonasally, suggesting that as glaucoma surgical devices become smaller, their placement could be targeted clinically by using OCT with preference to the superior quadrant, to minimize damage to the corneal endothelium.
[ABSTRACT]   Full text not available  [PDF]
  562 76 -
Unusual Orange-Colored Choroidal Metastases
Hatem Krema, Hugh McGowan, Herbert Tanzer, Rand Simpson, Normand Laperriere
January-March 2013, 8(1):53-57
Purpose: To report the clinical and paraclinical features of two patients with orangecolored choroidal metastases in whom the primary cancers have not previously been associated with such lesions. Case Report: Orange-colored choroidal lesions were detected on the fundus examination of one patient with metastatic small cell neuroendocrine tumor of the larynx and oropharynx, and in another subject with metastatic alveolar soft part sarcoma of the leg. Although ultrasonographic characteristics of the choroidal masses were comparable to those of choroidal hemangiomas, fluorescein angiography revealed delayed initial fluorescence along with minimal fluorescence in subsequent phases of the angiogram which were in clear distinction from the earlier appearing and progressively intense fluorescence observed with circumscribed choroidal hemangiomas. Conclusion: Small cell neuroendocrine tumors and alveolar soft part sarcomas should be considered among the differential diagnoses for orange-colored choroidal metastases. Identifying these choroidal lesions could facilitate localizing the occult primary tumor. Fluorescein angiography may differentiate a unifocal orange choroidal metastasis from a circumscribed choroidal hemangioma.
[ABSTRACT]   Full text not available  [PDF]
  557 71 -
Ocular Biometry in Angle Closure
Mohammad Reza Razeghinejad, Mohammad Banifatemi
January-March 2013, 8(1):17-24
Purpose: To compare ocular biometric parameters in primary angle closure suspects (PACS), primary angle closure glaucoma (PACG) and acute primary angle closure (APAC). Methods: This cross-sectional study was performed on 113 patients including 33 cases of PACS, 45 patients with PACG and 35 subjects with APAC. Central corneal thickness (CCT), axial length (AL), anterior chamber depth (ACD) and lens thickness (LT) were measured with an ultrasonic biometer. Lens-axial length factor (LAF), relative lens position, corrected ACD (CACD) and corrected lens position were calculated. The parameters were measured bilaterally but only data from the right eyes were compared. In the APAC group, biometric parameters were also compared between affected and unaffected fellow eyes. Logistic regression analysis was performed to identify risk factors. Results: No statistically significant difference was observed in biometric parameters between PACS and PACG eyes, or between affected and fellow eyes in the APAC group (P>0.05 for all comparisons). However, eyes with APAC had thicker cornea (P=0.001), thicker lens (P<0.0001), shallower ACD (P=0.009), shallower CACD (P=0.003) and larger LAF (P<0.0001). Based on ROC curve analysis, lower ACD, and larger LT, LAF and CCT values were associated with APAC. In the APAC group, LAF (P<0.0001) and CCT (P=0.001) were significant risk factors. Conclusion: This study revealed no significant difference in biometric characteristics in eyes with PACS and PACG. However, larger LAF and CCT were predictive of APAC.
[ABSTRACT]   Full text not available  [PDF]
  519 77 -
Transorbital Penetrating Brain Injury with a Large Foreign Body
Arti Singh, Shashi Kumar Bhasker, Balvant Kumar Singh
January-March 2013, 8(1):62-65
Full text not available  [PDF]
  414 81 -
Unilateral Decreased Vision in a Middle-Aged Man
Alireza Ramezani
January-March 2013, 8(1):66-71
Full text not available  [PDF]
  403 77 -
Placental Growth Factor Inhibition for Choroidal Neovascularization
Nader Sheibani
January-March 2013, 8(1):1-3
Full text not available  [PDF]
  395 73 -
Can Fly Photoreceptors Lead to Treatments for RhoP23H-Linked Retinitis Pigmentosa?
Lauren Aerni-Flessner, Mohammad Haeri, Barry E Knox, Francesca Pignoni
January-March 2013, 8(1):86-91
Full text not available  [PDF]
  392 63 -
Proliferative Vitreoretinopathy and Genetic Profile
Khalil Ghasemi Falavarjani
January-March 2013, 8(1):92-93
Full text not available  [PDF]
  374 62 -
Increased Latency of Visual Evoked Potentials in Healthy Women during Menstruation
Fatih Cakir Gundogan, Kadir Colakoglu, Omer Faruk Sahin
January-March 2013, 8(1):94-96
Full text not available  [PDF]
  372 57 -
Proceedings of the Fourth Annual Meeting of the SUNY Eye Institute
Steven J Fliesler
January-March 2013, 8(1):72-73
Full text not available  [PDF]
  367 62 -
Optimizing Contrast Sensitivity Perimetry for Clinical Use
Mitchell W Dul
January-March 2013, 8(1):74-76
Full text not available  [PDF]
  368 60 -
The Bull's Eye: Are We Off-Target for Corneal Endothelial Cell Physiology?
Sangita P Patel
January-March 2013, 8(1):83-85
Full text not available  [PDF]
  363 65 -
New Insights into the Function of the Matricellular CCN1: an Emerging Target in Proliferative Retinopathies
Brahim Chaqour
January-March 2013, 8(1):77-82
Full text not available  [PDF]
  359 59 -