Open Access Case study

Role of Magnetic Resonance Imaging in Herpes Zoster Ophthalmicus Ophthalmoplegia

Sandy Zhou Wenting, Srinivasan Sanjay

Ophthalmology Research: An International Journal, Page 189-195
DOI: 10.9734/OR/2014/8098

Aims: To hypothesize the mechanisms of herpes zoster ophthalmicus (HZO) related ophthalmoplegia by magnetic resonance imaging (MRI).

Case Presentation: A 61-year-old Chinese man diagnosed with right sided HZO and a positive Hutchinson’s sign, subsequently developed right eye complete ptosis, mydriasis and limitation of elevation 1 month after the onset of HZO. MRI showed thickening and enhancement of right oculomotor nerve and enhancement of right extraocular muscles. CSF revealed leukocytosis and positive varicella zoster virus (VZV) DNA without any clinical signs of meningitis. The diagnosis HZO-related ophthalmoplegia and asymptomatic VZV meningitis was made based on the clinical and laboratory findings. The external ocular muscle palsies of this patient were due to both oculomotor nerve palsy and orbital myositis demonstrated by MRI.

Conclusion: The pathogenesis of HZO associated ophthalmoplegia is attributed to multiple factors such as neuritis of the cranial nerve and orbital myositis which can be diagnosed with MRI.


Open Access Original Research Article

Risk Factors for the Development of Ophthalmopathy in Patients with Hashimoto’s Thyroiditis

Ilhem El Kochairi, Bernard Champion, Jack R. Wall

Ophthalmology Research: An International Journal, Page 177-188
DOI: 10.9734/OR/2014/4562

Background: Ophthalmopathy, or thyroid eye disease (TED), is more often associated with Graves’ hyperthyroidism than Hashimoto’s thyroiditis. In the latter disorder, the pathogenesis of the eye signs may be different and the influence of well-known risk factors for the development of eye signs in patients with Graves’ hyperthyroidism, such as smoking, age and gender, have not been studied in patients with Hashimoto’s thyroiditis. The aim of our study was to identify the risk factors which might influence the development of ophthalmopathy in patients with Hashimoto’s thyroiditis.

Methods: A retrospective cross sectional study included 105 patients with Hashimoto’s thyroiditis with and without ophthalmopathy and investigated 6 potential risk factors namely; age, gender, smoking, vitamin D deficiency, serum TSH and serum levels of antibodies to thyroid peroxidase (TPO) and thyroglobulin (Tg). A binary logistic regression test was used to determine whether one or more of the factors were predictive for i) ophthalmopathy ii) upper eyelid retraction (UER), often the only sign in patients with Hashimoto’s thyroiditis iii) the type of ophthalmopathy (congestive ophthalmopathy, ocular myopathy or both) or iv) the activity of the eye disease assessed as Clinical Activity Score (CAS), in patients with Hashimoto’s thyroiditis.

Results: Our analyses showed a protective effect of ageing on the development of ophthalmopathy in patients with Hashimoto’s thyroiditis, the risk decreasing by 5.4% for each additional year and a detrimental effect of smoking, with a risk of ophthalmopathy 5.5 times greater in smokers. Increased serum TSH was not shown to be a risk factor for ophthalmopathy or its severity.  High serum levels of TPO antibodies were found to be protective against the development of UER but not ophthalmopathy. None of the tested factors seemed to influence the risk of any ophthalmopathy subtype namely, congestive ophthalmopathy, ocular myopathy or mixed disease. However, gender has an effect on the activity of ophthalmopathy, men with Hashimoto’s thyroiditis related eye disease being 18 times more likely to develop active ophthalmopathy than women.

Conclusions: Because the risk of ophthalmopathy in patients with Hashimoto’s thyroiditis decreases with age, but is linked to smoking at all ages, patients with Hashimoto’s thyroiditis should be advised not to smoke as a preventive measure against development of ophthalmopathy, regardless of their age. Hashimoto’s thyroiditis-related ophthalmopathy is more active in male patients who should therefore be monitored more closely. The mechanism for the observed risk reduction of UER development in the presence of high levels of TPO antibodies could be studied to help with our understanding of the pathophysiology of ophthalmopathy and the development of new therapies.


Open Access Original Research Article

Intraoperative Complications of Laser in Situ Keratomileusis in Yazd

Mohammad Reza Shoja, Sara Keshavarzi, Mohammad Reza Besharaty, Nasim Oveisi, Elahe Abbasi Shavazi

Ophthalmology Research: An International Journal, Page 196-203
DOI: 10.9734/OR/2014/5965

Purpose: Laser in situ keratomileusis (LASIK) is a popular method for correcting refractive errors. We survived the incidence and types of LASIK intraoperative flap complications in Yazd refractive surgery center.

Methods: Medical records of all patients who underwent Laser in situ keratomileusis were reviewed retrospectively. Flap related complications including buttonhole, incomplete, irregular, free and thin flaps were studied. Finally data was analyzed by SPSS-16 based on aims.

Results: In 1000 eyes (from 395 males and 605 females), 16 cases (1.6%) were affected by flap related complications. the most frequent complications were incomplete flap (56.3%), irregular flap (31.3%) and buttonhole (12.5%), respectively. The age group of 40-45 years old and patients with 580-590µ corneal thickness affected from the complications frequently. Also, statistically significant difference was seen between anterior and posterior corneal radius of curvature and incidence of complications (P. Value=0.0001).

Conclusions: Incomplete flap is the most frequent flap related complication in Yazd; we conclude that with higher corneal radius of curvature incidence of this complication is higher.


Open Access Original Research Article

Prevalence of Visual Impairment among Deaf and Mute Schools Children

Asmaa Mohamed Refat Abd El-Aziz, Amin Faisal Ellakwa, Abd El-Rahman El-Sebaey Sarhan, Hassan Gamal El-Din Farahat

Ophthalmology Research: An International Journal, Page 204-211
DOI: 10.9734/OR/2014/9256

Background: Particular attention must be paid to ocular abnormalities in deaf children, as their early detection and proper treatment will greatly affect their social and professional performance.

Aims: To determine the prevalence and causes of visual impairment in deaf and mute children.

Place and Duration of Study: The study was done from December 2011 to April 2012 in Shebin El-Kom and Menoufcities, Menoufia governorate, Egypt.

Methods: This is a cross section study done including two schools for deaf and mute children (435 students from 6 to 18 years old) in order to evaluate the prevalence of visual impairment among them. A screening test using Landolt broken ring chart was done to measure the visual acuity of each child. Children with visual acuity 6/12 or less in one or both eyes were referred to Menoufia University Hospital for detailed ophthalmic examination.

Results: The study revealed 39 students (9%) had visual acuity ≤6/12 in one or both eyes. 19 children had astigmatism (4.4%), 4 were myopic (0.9%) and 9 were hypermetropic (2.1%). Strabismus found in 2 children (0.5%) while other 2 were amblyopic (0.5%). 3 children suffer from retinitis pigmentosa and associated disorders.

Conclusions: The prevalence of visual impairment recorded in two schools for deaf and mute children (aged from 6 to 18 years) was 9%.


Open Access Original Research Article

Combined Trabeculectomy with Beta Irradiation with and without Intravitreal Bevacizumab for Neovascular Glaucoma

Sawsan Abdel Sabour, Mohamed Yasser S. Saif, Ahmed Tamer S. Saif, Passant S. Saif

Ophthalmology Research: An International Journal, Page 212-218
DOI: 10.9734/OR/2014/8366

Purpose: To evaluate the efficacy and safety of intravitreal bevacizumab (IVB) and adjunctive Strontium-90 (Sr90) beta radiotherapy with trabeculectomy  in the management of  neovascular glaucoma (NVG).   

Methods: Thirty seven eyes with NVG were randomly selected and divided into two groups according to the treatment given

Group 1: Trabeculectomy with Beta-irradiation (n=18 eyes). 

Group 2: Preoperative (IVB) followed after two weeks by trabeculectomy and Beta-irradiation (n=19 eyes). 

Intraocular pressure (IOP), and regression of rubiosis iridis (NVI) are the used outcome measures.   

Results:  By 6 months postoperatively, the mean IOP levels decreased from 38.6mmHg pre-operatively to 11.3mmHg on the first postoperative week and 16.2 at the end of follow up for all cases. No significant difference between both groups as regard of success, while group 2 (IVB) showed more regression of NVI and less incidence of complications.

Conclusion: Preoperative IVB combined with filtration surgery and adjuvant Strontium-90 (Sr90) beta radiotherapy is a safe and effective method of controlling intraocular pressure in NVG.