Medical Hypothesis, Discovery & Innovation (MEHDI) Journals
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Combined Lateral Rectus Myectomy and Maximal Medial Rectus Resection in Complete Third Cranial Nerve Palsy
Full text linkThis study was performed to describe lateral rectus myectomy and maximal medial rectus resection for correction of eye deviation in complete third cranial nerve palsy. A retrospective review of thirteen patients (fourteen eyes) with complete third cranial nerve palsy, who underwent lateral rectus myectomy and maximal medial rectus resection, was performed. These procedures were combined with superior oblique tendon transposition in nine patients with a large angle of exotropia (more than 60 prism diopters [∆]), or significant hypotropia (more than 5 ∆). Preoperative deviations were exotropia of 50 to 120 ∆ in thirteen cases and hypotropia of 5 to 25 ∆ in eight cases. Six months after the surgery, eleven patients were within 10 ∆ of orthotropia in primary position. Revision surgery was performed for two patients, eight and 18 months after the first operation. Eventually, five patients (38%) achieved orthotropia in the primary position, and seven patients (54%) had < 11 ∆ exotropia and < 6 ∆ vertical deviation. In conclusion, this procedure can be considered as an acceptable approach for treatment of strabismus in complete third cranial nerve palsy. This procedure is simple and can be easily performed even in very young children.
Surgical Versus Medical Treatment for Diabetic Macular Edema: A Review
Full text linkWe aimed to compare the results of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling, an alternative therapeutic strategy, with those of medical treatment for chronic macular edema. We conducted a review of the literature on the microscopic, anatomical, and functional reasons for performing PPV with ILM peeling in patients with diabetic macular edema (DME). We searched the PubMed database for articles published between 2000 and 2017. We used the medical subject heading “vitrectomy diabetic macular edema” and the keywords “diabetic macular edema”, “internal limiting membrane peeling”, “pars plana vitrectomy”, “diabetic retinopathy”, and “optical coherence tomography”. Analysis of the literature revealed that cytokines, vascular endothelial growth factor, reactive oxygen species (ROS), and advanced glycation end-products (AGEs) play a unique role in DME. The vitreous cavity serves as a physiological reservoir for all inflammatory molecules. AGE receptors are localized at the footplates of Müller cells and the external limiting membrane (ELM). The footplates of Müller cells are in contact with the ILM, which suggests that they might be responsible for the structural damage (i.e., thickening) observed in the ILM of patients with DME. Therefore, PPV could allow a reduction of cytokines and pro-inflammatory molecules from the vitreous cavity. ILM peeling could eliminate not only the physical traction of a thickened structure, but also the natural reservoir of AGEs, ROS, and inflammatory molecules. PPV with ILM peeling is a surgical option that should be considered when treating patients with chronic DME
Striped Circle Visual Acuity Chart; A Novel Visual Acuity Chart Based on the Landolt-C Chart
Full text linkMeasurement of Visual Acuity (VA) has been used for eye examinations under various clinical conditions. In addition, because of changes in VA with a range of eye diseases, its measurement is used to screen, diagnose, and evaluate response to treatment in numerous eye diseases and predict the patient's visual function. VA and the likelihood of astigmatism could be evaluated simultaneously using a newly designed Stripped Circle (SC) VA chart. This chart has been developed based on the standard VA measurement scale chart, and the Landolt-C (LC) VA chart and all the standards for a VA chart design were implemented during its development. However, to publicize the clinical application of this VA measurement chart, further studies are required to evaluate its sensitivity, specificity, and repeatability compared with a similar standard VA chart
In-Vivo Evaluation of Peripheral Refraction Changes with Single Vision and Multifocal Soft Contact Lenses
Full text linkThis study investigated in-vivo changes of peripheral refraction with commercially available single vision and multifocal soft contact lenses, utilizing different designs and various corrective power values. Starting at the fovea, wave-front aberrations were measured up to 30o nasal retinal eccentricity, in 10o increments, using a commercially available Shack-Hartmann aberrometer. Three different types of contact lenses were fitted in an adult subject’s right eye: Acuvue Oasys Single Vision (ASV), Proclear Multifocal D with 2.50 diopters (D) add power (PMD), and ArtMost SoftOK (SOK). Each lens type was fitted in corrective power values of -2.00 D, -4.00 D, and -6.00 D. Refractive errors were computed in power vector notation: The spherical equivalent (M), the Cartesian Jackson-Cross-Cylinder (J0), and the oblique Jackson Cross Cylinder (J45) from measured second order Zernike terms. Acuvue Oasys Single Vision lenses produced a slight myopic shift at 30o retinal periphery (-0.32 D ± 0.05) without significant differences between the various lens power values. Proclear Multifocal D lenses did not create clinically significant myopic shifts of at least -0.25 D. All SOK lenses produced clinically significant relative myopic shifts at both 20o (-0.61 D ± 0.08) and 30o (-1.42 D ± 0.15) without significant differences between the various lens power values. For all lens types and power values, off-axis astigmatism J0 was increased peripherally and reached clinical significance beyond 20o retinal eccentricity. The increased amount of off-axis astigmatism J0 did not show a significant difference for the same type of lenses with different dioptric power. However, at 30o retinal eccentricity, SOK lenses produced significantly higher amounts of off-axis astigmatism J0, compared with ASV and PMD lenses (SOK versus ASV versus PMD: -1.67 D ± 0.09, -0.81 D ± 0.07, and -0.72 D ± 0.15). Both ASV and SOK lenses showed no clinically significant differences in the amount of introduced astigmatic retinal image blur, with various lens power values. Proclear Multifocal D lenses showed a systematic increase of astigmatic retinal image blur with an increase of add power. At 30o retinal eccentricity, -6.00 D SOK lenses introduced 0.73 D astigmatic retinal image blur, while PMD and ASV lenses introduced 0.54 D and 0.37 D, respectively. In conclusion, relative peripheral refractions, measured in-vivo, were independent of the contact lenses central corrective power. The SOK contact lenses demonstrated a stronger capability in rendering relative peripheral myopic defocus into far periphery, compared to the other lens designs used in this study. This was accompanied by higher amounts of introduced astigmatic retinal image blur
The Association of Serum Leptin Level and Anthropometric Measures With the Severity of Diabetic Retinopathy in Type 2 Diabetes Mellitus
No full textThis study was performed to determine the association amongst serum leptin level and anthropometric measures with the severity of Diabetic Retinopathy (DR) in subjects with type 2 Diabetes Mellitus (DM). This case-controlled study was conducted within a one-year period, during year 2016, at outpatient retina ophthalmology clinics of Shiraz, southern Iran. Eighty-three patients with type 2 DM, referring for ophthalmoscopy evaluation, were included. Anthropometric measures, serum leptin level, and baseline laboratory assessment was performed for all subjects. Patients were categorized as group 1, consisting of patients with severe Non-Proliferative Diabetic Retinopathy (severe NPDR) and Proliferative Diabetic Retinopathy (PDR) (n = 44), and group 2, consisting of patients without Diabetic Retinopathy (no DR) or mild/moderate NPDR (n = 39). The serum leptin level and anthropometric measures were compared between the two study groups. The correlation between these variables was also assessed. The mean age of the participants was 59.3 ± 6.9 years old. The two study groups were comparable regarding baseline characteristics. Cases of group 1 had significantly higher Erythrocyte Sedimentation Rate (ESR) (P = 0.049) and Systolic Blood Pressure (P = 0.025) when compared with those of group 2. The serum level of leptin was found to be significantly higher in cases of group 1 when compared to those of group 2 (P = 0.003). However, anthropometric measures, including Body Mass Index (BMI) (P = 0.167), Body Adiposity Index (BAI) (P = 0.061), and Waist to Hip Ratio (WHR) (P = 0.220) were comparable between the two study groups. Serum leptin level was positively correlated with BMI (r = 0.819; P < 0.001) and BAI (r = 0.630; P < 0.001) in group 1. Increased serum levels of leptin were associated with advanced stages of DR in subjects with type 2 DM. Serum leptin level might be a better indicator of the effects of obesity on DR, compared to anthropometric measures (BAI or BMI)
The Effect of Intravitreal Bevacizumab on Central Serous Chorioretinopathy
No full textThe aim of this study was to investigate the efficacy of Intravitreal Injection of Bevacizumab (IVB) in patients with Central Serous Chorioretinopathy (CSC) compared to the control group, after four months of injection. In this study, 30 eyes of 30 patients with CSC, who were in the age range of 23 to 50 years old (70% male subject) were included. Eligible patients were randomly allocated to the intervention (n = 15) and control groups (n = 15). Patients in the intervention group received a single dose injection of bevacizumab (1.25 mg in 0.05 mL), while patients in the control group were followed-up during the same time interval, without any medical interventions. Corrected Distance Visual Acuity (CDVA) and Central Macular Thickness (CMT) were evaluated as the primary outcome measures at the four-month follow-up. There was no statistically significant difference between the intervention and control groups regarding their baseline characteristics. Corrected Distance Visual Acuity was improved significantly in the intervention group (P < 0.001), while this improvement was not observed in the control group. Furthermore, greater improvement of CDVA was detected in the IVB group compared to the patients without injection (P = 0.018). The CMT findings were in line with CDVA changes in both groups, revealing a significant reduction of CMT only in the intervention group (P < 0.001). Also, thinner central retina was found in the intervention group compared to the comparison group, at the four-month follow-up (P < 0.001). Based on the findings, bevacizumab could be effective for improvement of both anatomical and functional outcomes in patients with CSC
Prevalence of Helicobacter pylori Infection in Patients with Central Serous Chorioretinopathy: A Review
Full text linkHelicobacter pylori is a prevalent cause of gastrointestinal infections. Recently, several studies have shown a relationship between H. pylori infection and a variety of extradigestive manifestations. The aim of this study was to review the literature regarding the prevalence of this infection in cases of central serous chorioretinopathy (CSR). We reviewed the EMBASE, Cochrane Library, and Google Scholar search engines; hand-searched many journals; and searched the cited references in published articles for relevant studies. We assessed 81 studies for eligibility. Finally, nine articles that met the inclusion criteria were included. The relationship between H. pylori infection (as the etiologic factor) and chorioretinal involvement was assessed by the effect size with 95% confidence interval (CI). Both fixed- and random-effects models showed that the prevalence of H. pylori infection in patients with CSR was significantly higher than in the control group (2.5-fold and 2.7-fold higher, respectively; P < 0.01). The results were not significantly different between the two models. Treatment of H. pylori infection should be considered in patients with CSR. However, additional randomized controlled clinical trials are required to determine the possible role of H. pylori eradication in the prognosis and treatment of patients with CSR
Combined Argon Laser and Low Dose Acetylsalicylic acid in Treatment of Acute Central Serous Chorioretinopathy
Full text linkThis study was designed to evaluate the efficacy of low-dose of oral acetylsalicylic acid (aspirin) with focal argon laser for the treatment of acute central serous chorioretinopathy (CSCR). In this prospective case-control study, 40 Patients with acute CSCR were classified randomly to two groups; group A with no treatment as the control group and group B with argon Laser in focal treatment once, followed by aspirin, 100 mg per day orally, with follow up period of 12 months by evaluation of visual acuity, and by Optical Coherence Tomography (OCT) every three months for one year. Patients in second group treated with argon Laser and aspirin showed more clinically significant improvement in both visual acuity and OCT macular thickness by the end of follow up period when compared with the observational group. It was concluded that argon Laser with low-dose oral aspirin results in improvement of visual acuity and OCT macular thickness
Use of Rho kinase Inhibitors in Ophthalmology: A Review of the Literature
Full text linkThe use of Rho Kinase (ROCK) inhibitors as therapeutic agents in ophthalmology has been a topic of discussion for several years, particularly in the realm of glaucoma, Fuchs’ endothelial dystrophy, and diabetic retinopathy. In this review, the authors provide a detailed and comprehensive overview of the published literature on the use of Rho kinase inhibitors for the aforementioned purposes. A thorough search of several databases was conducted to find sufficient literature on ROCK inhibitors. This research found strong evidence demonstrating that inhibition of Rho kinase significantly decreases IOP, increases healing of the corneal endothelium, and decreases progression of diabetic retinopathy. The main side effect of ROCK inhibitors is conjunctival hyperemia that is often present in more than half of the patients in certain formulations. Additional clinical trials investigating the reviewed treatment options of Rho kinase inhibitors are necessary to further validate previous findings on the topic. Nonetheless, it is clear that Rho kinase inhibitors have the potential to be another potent therapeutic option for several chronic diseases in ophthalmology
Teleophthalmology Support for Primary Care Diagnosis and Management
Full text linkThis study was performed to evaluate a healthcare strategy based on teleophthalmology for diagnosis and management of primary healthcare users. A descriptive cross-sectional study was conducted to review the medical records of patients from January 2013 to December 2014 from primary care units in the city of São Paulo. The units referred patients, who had diabetes or high blood pressure, and were users of chloroquine compounds, for a fundus examination. The images were sent to a reading center for review, diagnosis, and patient referrals. From 9173 analyzed patients, 570 (6.2%) were excluded because of poor image quality. Of the remaining patients, 4933 (57.3%) had diabetes, 7242 (84,2%) systemic hypertension, and 113 (1.3%) used chloroquine. Of these, 989 (11.5%) patients needed ophthalmologic treatment. The most frequently prescribed treatments were cataract extraction in 692 (70%) of 989 and photocoagulation in 245 (24.8%) of 989 cases. Overall, cataract extraction was indicated in 692 (8%) of 8603 cases and photocoagulation in 245 (2.8%) of 8603 cases. When only patients with diabetes were considered, the indication for photocoagulation increased to 4.5%.The results showed that non-medical professionals could produce good-quality ocular images for screening of ocular diseases in most cases; only 6.2% of ocular images did not meet quality requirements. Most patients referred for fundus examination did not need a specific treatment, indicating that this system could be an inexpensive and reliable tool for use in developing countries.