Treatment of Recurrent Corneal Epithelial Defect by Autologous Serum Eye Drop

Background: The aim of the present study was to evaluate the efficacy of autologous serum eye drop in treatment of recurrent corneal epithelial defect.Materials and Methods: Fourteen patients with recurrent corneal epithelial defect were studied. Autologous serum was prepared from the patients and diluted in 20% normal saline. The patients were instructed to use the autologous serum every six hours. Patients were followed for a mean period of 18 months.Results: Four males (28.6%) and 10 females (71.4%) entered the study. Four patients stopped the treatment after three months with complete satisfaction from treatment. Patients reported a reduction in frequency and severity of attacks 4.6±2 weeks after the start of treatment. The mean number of attacks before the procedure was 7.6±0.9 per year which was reduced to 2.2±0.9 per year after treatment (p<0.001). The main side effects in patients were eye pruritus and redness which were well tolerated by patients.Conclusion: Autologous serum application seems to be a safe and effective method to treat recurrent corneal epithelial defect

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

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

Study of Post Operative Regression after Photorefractive Keratectomy for Treatment of Hyperopia and Hyperopic Astigmatism

Purpose: To study post operative regression rates after photorefractive keratectomy among patients with hyperopia and hyperopic astigmatism with follow-up of at least six months.Patients and Methods: In this historical cohort study, 171 eyes from 91 patients with moderate hyperopia and hyperopic astigmatism were treated using Bausch and Lomb Technolas 217 Z Excimer Laser. Pre-operation evaluation included; best spectacle corrected visual acuity, manifest and cycloplegic refraction, diameter of optical zone, central corneal thickness and simulated keratometry. Postoperative evaluation, performed at least six months after the procedure, included measurement of corneal curvature, manifest and cycloplegic refraction, best corrected visual acuity, uncorrected visual acuity, refraction manifest, haze, and any pathologic finding.Results: The mean regression was 0.35 ± 1.04. Post surgical manifest refraction equivalent in ± 0.5 diopter range of surgeon’s desired refraction was observed in 57.1 % of eyes. Manifest refraction equivalent in ± 1.00 diopter range was observed in 85.7 % of eyes, and manifest refraction equivalent in ± 2.00 diopter range in 96.6% of eyes. Uncorrected visual acuity of 20/20 or better was reported in 37.1 % and 20/40 or better in 92 % of patients. Loss of the best spectacle corrected visual acuity of one line was observed in 13.4 % and 2 lines or more in 5.7 % of patients.Conclusion: In patients with moderate hyperopia and hyperopic astigmatism undergoing PRK the rate of regression was in ± 1 diopter range of surgeon’s intended correction in 85.7 % of patients at least six months postoperatively, which is in line with other studies findings.Keywords: Photorefractive keratectomy; Hyperopia astigmatism; Regression.

Central Toxic Keratopathy after Surface Laser Refractive Surgery: a Case Series and Brief Review

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; Revie

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

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.

Epibulbar Dermoid Cyst in a Patient with VACTERL Association

The VACTERL association is an association of multiple congenital malformationsSuch 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.

Vision Therapy/Orthoptics among Three to Seven Year Old Children

Background: Vision Therapy/Orthoptics(VT/O) is a package of treatments that enables patients to achieve the maximum level of visual performance.The aim was to determine the effect of three months vision therapy/orthoptics on best corrected visual acuity (BCVA), fusion, stereopsis and ocular alignment in 3-7 year old children.Materials and Methods: In this randomized clinical trial study, 80 children with amblyopia and/or non-paralytic horizontal deviations were randomly divided into intervention and control groups. Intervention group was treated by vision therapy/orthoptics for three months. These modalities included patch, red filter, sector patch, over minus lens, prism and synoptophore exercises. Controls were treated by only patching for the same period. Pre and post-treatment BCVA, fusion, stereopsis and alignment were compared. Visual performance was classified as excellent (BCVA≥20/30, deviation≤10pd and stereopsis≤70sec/are), acceptable (BCVA≥20/30, deviation ≤10pd and stereopsis 70 to 3000sec/are) and unsatisfactory (BCVA<20/30, deviation>10pd and no stereopsis).Results: A total of 80 cases (56 girls and 24 boys) with the mean age of 5.6±1.4 years entered the study. Although more improvement of fusion and stereopsis was seen in the intervention group (P<0.001 for both groups), there was no significant differences in BCVA and alignment between two groups. Also the difference of visual performance was not statistically significant between two groups, whereas the improvement was significant in each group (P<0.001, for both groups).Conclusion: Vision therapy/orthoptics treatment can be effective for improving sensory status in 3 to 7 year old children with amblyopia and/or strabismus. Further studies with larger sample sizes and focusing on accommodation and fusional amplitude are warranted

Concomitant Orbital Cavernous Hemangioma and Solitary Fibrous Tumor

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

Central Corneal Thickness in Highly Myopic Eyes: Inter-device Agreement of Ultrasonic Pachymetry, Pentacam and Orbscan II Before and After Photorefractive Keratectomy

Purpose To determine inter-device agreement for central corneal thickness (CCT) measurement among ultrasound pachymetry, rotating Scheimpflug imaging (Pentacam, Oculus, Wetzlar, Germany), and scanning slit corneal topography (Orbscan II, Bausch & Lomb, Rochester, NY, USA) in highly myopic eyes before and after photorefractive keratectomy (PRK). Methods: This prospective comparative study included 61 eyes of 32 patients with high myopia who underwent PRK. Six month postoperative CCT values were compared to preoperative values in 27 patients (51 eyes) who completed the follow up period. To determine the level of agreement, Pentacam and Orbscan II readings were compared to ultrasonic pachymetry measurements as the gold standard method. Results: Mean CCT measurements with ultrasound, Pentacam, and Orbscan II before PRK were 557µm, 556µm, and 564µm, respectively; and 451µm, 447µm, and 438µm 6 months after surgery in the same order. Preoperatively, the 95% limits of agreement (LoA) with ultrasound measurements were -20μm to 17μm for Pentacam and -21μm to 33μm for Orbscan II. Six months postoperatively, the 95% LoA were -30μm to 23μm for Pentacam and -69μm to 43μm for Orbscan II. Conclusion: Preoperatively, CCT measurements were higher with Orbscan II as compared to ultrasound. Postoperatively, both Pentacam and Orbscan II measurements were lower than those obtained with ultrasound, but Pentacam had better agreement. The use of ultrasound, as the gold standard method, or Pentacam both appear to be preferable over Orbscan II among patients with high myopia

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

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.