Photopigment Bleaching Phenomenon on Fluorescein Angiography in a Patient with Impending Central Retinal Vein Occlusion

Purpose: To present the second case of photopigment bleaching phenomenon in fluorescein angiography (FA) and the first case of this phenomenon due to impending central retinal vein occlusion (CRVO). Case Report: A 32-year-old healthy female noticed blurred vision in her right eye one day before presentation. Despite the 20/20 visual acuity at presentation, mild increased retinal vascular tortuosity and unilateral photopigment bleaching phenomenon in FA was observed in the right eye. Three weeks later, she developed a complete CRVO with visual acuity reduction to 20/40 that responded well to the intravitreal injection of aflibercept. Conclusion: Impending CRVO can cause unilateral photopigment bleaching phenomenon in FA that may be due to retinal ischemia

Effects of adjuvant omega-3 fatty acid supplementation on dry eye syndrome following cataract surgery: A randomized clinical trial

AbstractPurposeTo investigate the effect of omega-3 polyunsaturated fatty acid supplement on qualitative and quantitative subjective (ocular surface disease index: OSDI) and objective (Schirmer's test, tear break up time [TBUT], and tear osmolarity) dry eye indices after cataract surgery.MethodsIn this randomized clinical study, 61 eyes of 48 patients complaining of new onset dry eye symptoms after phacoemulsification were enrolled. Subjects were randomly allocated into two groups using urn randomization. Controls received conventional treatment. The treatment group received omega-3 dietary supplement in addition to conventional therapy.ResultsThere was no significant difference between the control and treatment groups in pre-treatment indices of Schirmer (3.50 ± 3.13and 2.96 ± 3.39, respectively, P = 0.582), TBUT (6.67 ± 1.36 and 4.87 ± 2.22, respectively, P = 0.687), osmolarity (316.66 ± 8.50 and 315.4 ± 17.06, respectively, P = 0.906), and OSDI (32.99 ± 19.03 and 35.32 ± 18.99, respectively, P = 0.635).Mean pre-treatment OSDI in the control group was 32.99 ± 19.03, which improved significantly after treatment to 25.43 ± 14.49 (P = 0.003). The mean pre-treatment OSDI in the treatment group was 35.32 ± 18.99 (range: 7.5–77.77), which improved significantly after treatment to 16.31 ± 13.72 (range: 2.77–47.22) (P < 0.001). OSDI improvement was significantly higher in the treatment group than the control group (P = 0.026).TBUT improved in both the control and treatment groups after treatment (P < 0.001). However, TBUT was affected significantly more in the treatment group compared with the control group (P = 0.038).Mean tear film osmolarity in the control group was 316.67 ± 8.50 (range: 308–325), which improved insignificantly after treatment to 311.33 ± 6.35 (range: 304–315) (P = 0.157). Mean pre-treatment tear film osmolarity in the treatment group was 315.40 ± 17.06 (range: 279–340), which improved significantly after treatment to 296.90 ± 14.39 (range: 260–310) (P < 0.001). Also, post-treatment Schirmer results between the two groups were not statistically significant (P = 0.155).ConclusionOmega-3 dietary supplements have an additive effect on tear film indices of patients with dry eye syndrome after phacoemulsification

Post-cataract surgery endophthalmitis: Brief literature review

AbstractPurposeTo investigate recent evidence in prophylaxis and management of post-cataract surgery endophthalmitis.MethodsWe conducted a literature search using Pubmed database for post cataract surgery endophthalmitis, and relevant articles were selected from original English papers published since 2015.ResultsForty-nine articles were published regarding post-cataract surgery endophthalmitis from January 2015 to February 2016. A low incidence of post-cataract surgery endophthalmitis has been reported. A growing number of articles are focusing on preventing endophthalmitis using intracameral antibiotics.ConclusionBased on the current evidence, intracameral antibiotics seems to be effective in preventing endophthalmitis after cataract surgery

“Inverted Snowing-Cloud” Sign in Endogenous Candida Endophthalmitis

Candida spp. is the most common cause of endogenous fungal endophthalmitis. The diagnosis of this rare disease is based on clinical findings supported by positive blood culture. Recently, it has been shown that optical coherence tomography (OCT) characteristic findings are beneficial in making a correct diagnosis of fungal infection in cases with endogenous endophthalmitis. The current photo-essay aims to highlight the role of OCT in diagnosis of Candida endogenous endophthalmitis where OCT imaging of one of the retinal lesions disclosed a pre-retinal hyper reflective lesion with overlying punctate vitreous opacities. We propose “inverted snowing-cloud” sign for this OCT pattern considering the resemblance of the vitreous opacities to snowflakes

Optical Coherence Tomography Angiography Findings in Malignant Hypertensive Retinopathy

Background: To report the findings of fluorescein angiography (FA) and optical coherence tomography angiography (OCTA) in a patient with malignant hypertensive retinopathy. Case Report: A 41year-old male was referred to our clinic with sudden visual loss in both of his eyes after an acute rise of blood pressure (200/150 mmHg). Optic disc swelling, flame shape hemorrhages especially around the optic disc, arterial narrowing, vessel tortuosity, cotton wool spots, hard exudate deposition, and multiple deep orange spots (Elschnig spots) were visible in both eyes. In the OCTA, disruption in the normal tapering patterns of the superficial and deep capillary plexuses was observed. Elschnig spots were observed as hypointense spots in the choriocapillaris slab. Leakage of the optic nerve head was seen in the FA. Conclusion: When compared with the FA, the OCTA can illustrate the ischemic areas and the Elschnig spots with greater detail

Oguchi Disease Associated with Keratoconus

This is a Photo Essay and does not have an abstract. Please download the PDF or view the article in HTML

Epidemiology and Outcomes of Candidemia in a Referral Center in Tehran

Background: Bloodstream infection with Candida, or candidemia, is the most common Candida systemic infection. In this study, we investigated the characteristics of patients with candidemia to provide appropriate perspectives on these patients and reduce the associated mortality and morbidity. Methods: In this cross-sectional study, all patients with at least one positive blood culture of Candida spp. were investigated from April 2015 to March 2016 in Imam Khomeini Hospital Complex, Tehran, Iran. Results: A total of 74 patients (44 men and 30 women), with the mean age of 53.15&#177;17.89 years, were enrolled in this study. Non-albicans Candida species was responsible for candidemia in 67.6 (50.74). The mean therapy intervals were 7 and 5.6&#177;1.5 days in patients who died and were discharged, respectively.&#160;The differences in frequencies of urinary catheter and mechanical ventilation were statistically significant among patients who died and survived (P&#60;0.001).&#160;Among the discharged patients, antifungal therapy was administered to 30.8 (12.39). The mortality rate was 54.3 (19.35) in the medical ward, 5.7 (2.35) in the surgical ward, and 40 (14.35) in the intensive care unit (P=0.041).&#160;The treatment was significantly associated with lower mortality than those with no treatment&#160;(OR=0.150 0.023-0.996, P=0.05). Conclusion: The number of candidemia cases caused by non-albicans Candida species is continuously increasing in our center. We demonstrated the epidemiologic characteristics of patients with candidemia and the significant effects of timely and appropriate treatment on their outcomes. Further studies are needed to illuminate more aspects of this healthcare proble

The Analysis of Dispersion of Cataract and Treatment in Qajar Period from the Perspectives of Foreign Tourists

زمینه و هدف: در دوره قاجار مناسبات گسترده‌ای میان ایران و ممالک دیگر شکل گرفت. به تناسب این تحول شرایط مناسبی برای رفت و آمد جهانگردان خارجی به این سرزمین فراهم شد. این سیاحان با ثبت مشاهدات و تجربیات خویش درباره بیماری‌های رایج عصر قاجار و شیوه‌های درمان آن‌ها، کمک شایانی به شناخت تاریخ پزشکی این عصر کرده‌اند. یکی از مهم‌ترین امراضی که در آثار این سیاحان بازتاب یافته، بیماری آب‌مروارید است. این بیماری به عدسی چشم آسیب وارد می‌کرد و معمولاً افراد مسن را درگیر می‌نمود. پژوهش حاضر تلاش دارد با بهره‌گیری از این آثار میزان شیوع بیماری آب‌مروارید و روش‌های درمان آن در عصر قاجار را بررسی کند. مواد و روش‌ها: در این پژوهش با استفاده از رویکرد توصیفی – تحلیلی، مهم‌ترین سفرنامه‌های خارجی عصر قاجار در جهت دستیابی به اهداف تحقیق مورد بررسی و تجزیه و تحلیل قرار گرفته‌اند. یافته‌ها: سیاحانی که در دوره قاجار به ایران سفر کردند، نیات و انگیزه‌های متفاوتی داشتند. این سیاحان با توجه به کنجکاوی و روحیه جزئی‌نگر خویش گزارش‌های بسیار سودمندی درباره اکثر جنبه‌های زندگی اجتماعی مردم ارائه داده‌اند. میزان ابتلای افراد به بیماری آب‌مروارید و شیوه‌های درمان آن از جمله مواردی است که مورد توجه این جهانگردان قرار گرفته است. سیاحان خارجی گذشته از روشنگری‌هایی که درباره میزان گسترش این بیماری در سطح جامعه ارائه داده‌اند، یافته‌های مدرن در زمینه بیماری آب‌مروارید را نیز به پزشکان ایرانی منتقل کرده‌اند. نتیجه‌گیری: شایع‌ترین بیماری چشمی دوره قاجار از منظر سیاحان خارجی، بیماری آب‌مروارید بود. این بیماری در مناطق مختلف ایران همچون اصفهان، مازندران، ارومیه و تهران و در میان اکثر طبقات جامعه گزارش شده است. درمان آب‌مروارید به وسیله کحالان ایرانی و پزشکان خارجی صورت می‌گرفت.علیرغم مهارت برخی از کحالان ایرانی در درمان این بیماری، شیوه‌های درمانی آنان چندان رضایت‌بخش نبود. در مقابل پزشکان اروپایی با اتکا به دانش جراحی نوین و بهره‌گیری از تجهیزات مراکز درمانی میسیون‌های مذهبی، نقش بسیار مهمی در مداوای قربانیان آب‌مروارید ایفا نمودند.Background and Aim: Qajar period coincided with widespread relationships between Iran and foreign countries. Thus, this change made suitable conditions for commuting of foreign tourists. The tourists recorded their observations and experiences about common illness and their treatment, which helped to acknowledge that period's medical history. Those records suggested cataracts as one of the common illnesses in the old population and harmed their eye lens. This research studies the prevalence of such an illness and its treatment regarding those records. Materials and Methods: The Qajar period's important foreign travelogues were analyzed by descriptive-analytic method for this research. Findings: Different purposes and motivations did the tourists' journeys during the Qajar period. These tourists offered helpful and detailed reports about every aspect of their social life with their curiosity and particular spirit. The degrees of infection and the treatments were reflected in the tourists' works. These tourists shed light on the spread of this illness in society and gave the modern findings to the Iranian doctors. Results: Cataract was a common illness in the Qajar period. This illness was common in the regions such as Isfahan, Tehran, Mazandaran, and Urmia. Persian ophthalmologists and foreign doctors treated this illness. The Persian ophthalmologists were somehow skillful in treating cataracts, but the methods were not satisfactory. In return, the European doctors had an undeniable role in treating the individuals who were victims of cataracts by adopting new surgery techniques using facilities of medical centers of religious missions

Paradoxical head tilt in unilateral traumatic superior oblique palsy

Purpose: We report a patient with abnormal head posture following ocular blunt trauma. Methods: This is report of a case that despite findings compatible with diagnosis of left superior oblique (SO) palsy, the patient acquired an ipsilateral (left) head tilt. The interesting observation in our patient was reduction of left hypertropia and consequent less diplopia with ipsilateral head tilt. Results: After blunt trauma, our patient adopted paradoxical left head tilt and consequently less diplopia despite acquired left SO palsy. Left inferior oblique myectomy resulted in significant improvement of patient's strabismus and abnormal head position. Conclusion: Traumatic SO palsy may present with paradoxical head tilt. Keywords: SO palsy, Head tilt, Traumatic strabismu