Abbas Bagheri

Astigmatism induced by simultaneous recession of both horizontal rectus muscles

PURPOSEnChanges have been reported in the refractive state of the eye after various types of strabismus surgery. This study investigates the effect of large simultaneous recession of both horizontal rectus muscles on the refractive state of the eye.nnnMETHODSnTwenty-six eyes (13 patients) were refracted 1 to 2 weeks before and 6 to 8 weeks after large horizontal rectus muscle recessions for the purpose of damping nystagmus. The preoperative refraction was mathematically subtracted from the postoperative refraction, and the induced refractive changes were averaged and statistically analyzed. The relation between the amount of recession and the induced astigmatism was also investigated.nnnRESULTSnA statistically significant change in astigmatism in the with-the-rule direction was induced with this procedure (+ 0.70 diopter cylinder, axis 90.0 degrees, P <.0002). With the narrow range of amounts of recession performed, there was no demonstrable relation between the amount of recession and the amount of induced astigmatism.nnnCONCLUSIONSnRecession of both horizontal rectus muscles, the same as has been reported for recession of one horizontal rectus muscle and recession-resection surgery on both horizontal rectus muscles, tends to induce a change in astigmatism in the with-the-rule direction.

Clinicopathological Study of Lacrimal Sac Specimens Obtained During DCR

Purpose: To determine the histopathologic characteristics of lacrimal sac specimens in adult patients undergoing external dacryocystorhinostomy (DCR) for acquired nasolacrimal duct obstruction. Methods: A total of 471 lacrimal sac biopsies were obtained from 449 patients undergoing external DCR for symptoms or signs of acquired nasolacrimal duct obstruction and examined histopathologically. Results: A total of 449 subjects including 283 (63%) female and 166 (37%) male subjects with mean age of 50.02 years underwent DCR and histopathologic examination of specimens. Presenting symptoms were epiphora in 411 patients (91%), history of acute dacryocystitis in 17 patients (4%) and obstruction revealed during ophthalmic examinations in 21 patients (5%). Histopathologic findings included: chronic inflammation in 450 patients (95.5%), fibrosis in 18 patients (3.8%), lymphoma in two patients (0.4%) and reactive lymphoid hyperplasia in one patient (0.2%). Lacrimal sac appearance during surgery was grossly abnormal in two cases: one case of lymphoma and one instance of reactive lymphoid hyperplasia. Conclusions: Chronic inflammation and fibrosis are the most common histopathologic findings in lacrimal sac specimens obtained during DCR. Only two cases of lymphoma (0.4%) were encountered in the series, one of which had a suspicious lacrimal sac appearance during surgery while the other case (0.2% of all specimens) was unsuspected. The rate of malignant etiology for NLD obstruction is low enough to justify lacrimal sac biopsy only in suspicious cases.

Transcutaneous Dysport Injection for Treatment of Upper Eyelid Retraction Associated with Thyroid Eye Disease

Purpose: To evaluate the safety and efficacy of transcutaneous injections of botulinum toxin type A (Dysport) in the treatment of upper lid retraction associated with thyroid eye disease (TED). Methods: A total of 25 eyes of 16 patients including 11 female and 5 male subjects with stable TED condition were enrolled into the study. Mean age was 35.7 years (21–55). A transcutaneous injection of 20U Dysport was administered into each eyelid at the central superior tarsal border, aiming at the levator aponeurosis and Muller muscle. All patients were followed regularly for 4 to 6 months. Any complications, such as ptosis, diplopia, pain, or lid ecchymosis were recorded. Results: All patients experienced considerable reduction of palpebral fissure height. The mean lowering of the lid was 4.24u2009mm standard deviation (SD) =2.005, 2 weeks after intervention, and the effect remained for a minimum period of 4 months. There were temporary complications such as ptosis, which occurred in 4 patients for 4 weeks. Conclusions: A single transcutaneous injection of Dysport is safe and effective for treatment of lid retraction due to TED. Minor complications such as ptosis and diplopia may occur, however, this modality may offer temporary relief for patients with dysthyroid lid retraction awaiting orbital decompression or strabismus surgery or both.

Accommodative changes after photorefractive keratectomy in myopic eyes.

Purpose. To determine the changes of amplitude of accommodation (AA) and facility of accommodation (FA) in myopic patients after photorefractive keratectomy (PRK). Methods. Using Technolas 217Z excimer laser, 160 myopic eyes of 80 patients underwent PRK. The patients were categorized into two age groups: <30 and ≥30 years. Changes in AA and FA were observed before PRK and at 2 weeks, 1 month, and 3 months after PRK. The role of preoperative AA, FA, refractive spherical equivalent, age, and sex on postoperative AA and FA was evaluated. Results. In younger patients, the preoperative AA and FA values 7.77 ± 1.75 D and 7.75 ± 3.97 cpm changed to 8.36 ± 1.26 D and 11.57 ± 4.20 cpm (p < 0.001), respectively, at 3 months after PRK. In older patients, the preoperative AA and FA values 6.66 ± 1.41 D and 5.05 ± 3.26 cpm changed to 6.72 ± 1.26 D (p = 1.000) and 9.58 ± 4.29 cpm (p < 0.001), respectively. Two weeks after surgery, preoperative AA and spherical equivalent had a significant effect on postoperative AA, whereas preoperative AA and age had a significant effect on postoperative AA after 3 months (p < 0.001). Postoperative FA was positively related to preoperative FA and female sex (p < 0.05). Conclusions. This study suggests that some of the near-vision problems in younger myopes in early postoperative days after PRK might be due to decrease in AA and FA, which will eventually increase. However, in older patients, despite increase in FA, AA did not change.

Complications of hydroxyapatite pegging: comparison between polycarbonate and titanium peg system.

Purpose. Polycarbonate peg has been customarily used for pegging of hydroxyapatite for years. For better movement, tissue tolerance, and to decrease the complications of pegging, titanium peg system has been used. This study compares the two systems. Methods. Complications associated with pegging (polycarbonate: Bio-Eye® or titanium: Dr-Perry new P-K®) were retrospectively reviewed from the charts of 153 patients admitted to the Labbafinejad Medical Center, Tehran, Iran, for over 5 years from 1997 to 2003. Results. A total of 153 cases were studied. Ninety-six (62.3%) were male and 57 (37.7%) were female, and the mean age was 27.7 years (6–59 years). In 88 cases pegs were polycarbonate and sleeve system and in 65 cases pegs were titanium. Forty-one (46%) of cases with polycarbonate and 18 (27%) of cases with titanium had at least one or more complications (p=0.018). The most common complications were granulation tissue, discharge, overgrowth of conjunctiva, and peg falling out in 25%, 23%, 13%, and 8% in polycarbonate peg and 15%, 5%, 1.5%, and 0% in titanium peg group. The prevalence of the last three complications was statistically lower in titanium peg compared with polycarbonate. Twenty-five cases (35%) with polycarbonate peg and 5 cases (7.5%) with titanium peg had two or more complications (p=0.03). Peg removal was done in 11 cases of polycarbonate but only two cases of titanium peg in order to treat the complication. Conclusions. Both pegging systems had some complications, although these were less severe and prevalent in titanium peg. More studies on complications due to titanium pegs are recommended.