Journal of Current Ophthalmology最新文献

Purpose: To describe a case of lamellar cataract in a child with a history of neonatal hypoglycemia and illustrate the importance of meticulous history-taking in children with cataracts, especially before planning surgery.

Methods: A single case report.

Results: A 7-year-old girl with a history of neonatal hypoglycemia and ketoacidosis with high suspicion of a primary defect in ketone body utilization who presented with bilateral progressive blurred vision. Her best-corrected visual acuity (BCVA) was 20/200 in her right eye (OD) and 20/400 in her left eye (OS). Slit-lamp examination showed the presence of bilateral dense lamellar cataract. Fundus examination was unremarkable in both eyes (OU). She underwent cataract surgery with intraocular lens implantation under general anesthesia without prolonged fasting. Final BCVA was 20/82 in OD and 20/63 in OS.

Conclusion: Our aim through this case is to emphasize the importance to screen for episodes of hypoglycemic attacks in children with infantile cataracts.

Purpose: To evaluate the safety and histological findings of intravitreal injection of ketamine in rats.

Methods: Each rat received a total volume of 0.1 ml of ketamine 0.01 mol/L (5 rats as ketamine group) or a total of 0.1 ml of normal saline 0.9% (5 rats as control group) under general anesthesia in a sterile condition. A histology assessment was performed 1 month after the intravitreal injection.

Results: Lens opacity, necrosis, and atrophy of retinal layers and optic disc were not seen in five specimens in the ketamine group and five in the normal saline group. There was no inflammation in the vitreous, retinal layers, choroid, optic disc, and optic nerve in both groups.

Conclusion: Intravitreal injection of ketamine in a special dose has no obvious adverse effect on diverse intraocular tissue.

Purpose: To look for causative genetic mutations in a series of Iranian families with strabismus. In addition, we systematically reviewed all the published articles regarding the role of genetic variations in primary and nonsyndromic comitant strabismus.

Methods: Four families with a history of multiple cases of primary and nonsyndromic comitant strabismus were enrolled in this study. Polymerase chain reaction and Sanger sequencing of exons 23, 11, and 3 of the Abelson helper integration site 1 (AHI1), nebulin (NEB), and paired box 3 (PAX3) genes were performed, respectively. One offspring of a consanguineous marriage underwent whole-exome sequencing (WES) to look for possible causative variants. To conduct a systematic review, we thoroughly searched PubMed, Scopus, and ISI Web of Knowledge extracting relevant publications, released by April 2021.

Results: We examined four Iranian strabismus pedigrees with multiple affected offspring in different generations. Among these 17 participants, 10 family members had strabismus and 7 were healthy. Sanger sequencing did not reveal a causative mutation. Therefore, to further investigate, one affected offspring was chosen for WES. The WES study demonstrated two possible variants in MYO5B and DHODH genes. These genetic variants showed high allele frequency in our population and are thought to be polymorphisms in our series of Iranian families.

Conclusions: We demonstrated that mutations in AHI1, NEB, and PAX3 genes were not common in a series of Iranian patients with familial strabismus. Moreover, by performing WES, we revealed that two variants of uncertain significance as possible causative variants for strabismus are not related to this disease in our population.

Purpose: To assess the effect of oral dextrose versus acetaminophen versus placebo in pain relief in retinopathy of prematurity (ROP) examination.

Methods: In this prospective randomized, double-blind controlled clinical trial study performed in the ophthalmology clinic of Shafa Hospital (referral hospital for eye disease), Kerman, Iran, 105 premature neonates with birth weight ≤2000 g and gestational age between 28 and 34 weeks were studied. Pain score measurement with Premature Infant Pain Profile-Revised (PIPP-R) during ROP examination in three intervention groups, acetaminophen group (15 mg/kg oral acetaminophen), dextrose group (one cc of oral dextrose 50%), and placebo group (one cc of distilled water), was done.

Results: Out of 105 infants, 33 infants received acetaminophen drops, 35 infants received dextrose drops, and 37 infants received placebo. The mean pain score of the group receiving acetaminophen was 11.39, dextrose 12.17, and placebo 11.54. The acetaminophen group had a lower average PIPP-R score. This difference was not significant between the three groups (P = 0.38).

Conclusions: Acetaminophen and dextrose in comparison with distilled water did not show a significant difference in reducing neonatal pain during ROP examinations. However, the PIPP-R score in the acetaminophen group was lower compared to the other groups.

Purpose: To analyze the frequency of main keratotopographic patterns at the 1^st, 2^nd, and 3^rd stages of keratoconus and investigate corneal biomechanical properties across different patterns.

Methods: The study comprised two stages. The first stage was computational-experimental, where we utilized COMSOL Multiphysics® software (COMSOL AB, Stockholm, Sweden) to mathematically model corneal mechanical behavior under intraocular pressure and pulsed air jet action in both normal and keratoconic conditions. The second stage was the clinical phase, during which we retrospectively analyzed the examination results of both healthy subjects and patients with keratoconus. In total, the study included 256 eyes (256 subjects). Among them, 174 eyes (174 healthy individuals) had normal corneas with different refractions, and 82 eyes (82 individuals) had stages 1, 2, and 3 of keratoconus based on Amsler-Krumeich classification. The keratotopographic characteristics of the participants were assessed using Sirius (Schwind, Germany) and Pentacam AXL (OCULUS Optikgeräte GmbH, Germany) keratotomographs, while the corneal biomechanical properties were studied using noncontact tonometry with the Corvis ST device (OCULUS Optikgeräte GmbH, Germany). The study focused on evaluating corneal stiffness index values in the central optical zone under various keratotopographic patterns. In addition, it compared the elastic coefficient values c₁, c₂, and c₃ for the model of hyperelastic behavior of corneal material outside the keratoconus zone. Furthermore, the study examined the values of reduced stiffness zone characteristics, including the stiffness reduction factor ψ_max, effective radius R_k, and the ratio of maximum and minimum strain intensity in keratoconus of different stages.

Results: The mean age of the patients in the study was 30.16 ± 8.31 years, with 166 men and 90 women participating. The study revealed typical keratotopographic patterns in the examined keratoconus stages, as well as their occurrence frequency. In the 1^st stage of keratoconus, the pattern of asymmetric astigmatism was noted more frequently (in 75% of cases). In the 2^nd stage, the pattern with an ectasia zone in the lower cornea was observed in 80% of cases, and in the 3^rd stage, a centrally located keratotopographic ectasia pattern was found in 42% of cases. Comparative analysis showed that the greatest decrease in stiffness parameter (SpA1) and stress-strain index occurred in the central pattern (by 64% and 46%, respectively), while the least decrease was observed in local corneal radius reduction in the lower cornea (by 42% and 33%, respectively).

Conclusions: The decrease in strength properties in keratoconus occurs in a local area, the size and degree of which a

Purpose: To evaluate the effect of early posttrabeculectomy bleb leakage on trabeculectomy surgery outcomes and success rate.

Methods: The present prospective cohort study was conducted on 203 eyes of 203 patients who underwent trabeculectomy at Torfeh and Imam Hossein Medical Centers, Tehran, Iran, between 2016 and 2021. Patients were divided into two groups: those with early bleb leakage (within the 1^st month of surgery) and those without bleb leakage. The success rate of surgery was compared 12, 18, and 24 months after surgery in the two groups. The average intraocular pressure (IOP) and the need for medications in patients 1, 3, 6, 9, 12, 18, and 24 months after the trabeculectomy were also compared.

Results: Bleb leakage was detected in 33 eyes during the 1^st month after a trabeculectomy (16.3%). The mean decrease in IOP in the group with leakage was significantly lower than in patients without leakage at 1, 6, 9, 12, 18, and 24 months after surgery (P < 0.05). The need for antiglaucoma medication was significantly higher among patients with bleb leakage at 3 months (P = 0.04) and 9 months (P = 0.047) after surgery (P < 0.05). The success rate at 12, 18, and 24 months after surgery was significantly lower in the group with leakage than the group without.

Conclusions: The results of our study suggest that early posttrabeculectomy bleb leakage negatively impacts surgery success. Furthermore, IOP reduction was lower in patients with early leakage.

Purpose: To present updated information on the role of anti-vascular endothelial growth factor (anti-VEGF) therapy for treating retinopathy of prematurity (ROP).

Methods: We searched through PubMed and Scopus databases using the keywords of this article and gathered relevant published articles from the year 2005 to December 2022. The selected articles were classified and summarized, and reasonable conclusions were made accordingly.

Results: Considering the current evidence, anti-VEGF agents are superior to laser therapy for the initial treatment of type 1 ROP in zone 1 or posterior zone 2. However, there is a substantial risk of reactivation or persistent avascular retina after solo treatment with anti-VEGFs, and many cases may require laser therapy within the following weeks or months. Thus, vigilant follow-up examinations are mandatory.

Conclusions: The role of anti-VEGF agents in the treatment of ROP is indispensable. However, future studies are required to improve indications and dosage and determine long-term ocular and systemic safety.