Occlusion therapy for amblyopia, a historical report from 9th century Persian scholar, Ali ibn Sahl ibn Rabban al-Tabari (838-870 CE).

INTRODUCTION: This study reevaluates the historical origins of occlusion therapy for amblyopia, focusing on the contributions of the 9th-century Islamic scholar, Ali ibn Sahl ibn Rabban al-Tabari (838-870 CE). METHODS: The investigation delved into al-Tabari's writings, particularly "Firdous al-Hikma," to extract insights into his approach to addressing reduced vision in one eye.Additionally, the study examined subsequent advancements in occlusion therapy by scholars such as Thabit ibn Qurrah and Rhazes, building upon al-Tabari'sfoundational work. RESULTS: Al-Tabari's reports contain significant insights into occlusion therapy for amblyopia, predating commonly attributed origins of the treatment. Within "Firdous al-Hikma," he outlines methods for addressing reduced vision, advocating for the covering of the healthier eye to promote the function of the weaker eye. These findings highlight the pioneering efforts of al-Tabari and his contemporaries in the Islamic civilization and challenge the conventional narrative surrounding the history of occlusion therapy. Subsequent advancements by scholars such as Thabit ibn Qurrah and Rhazes expanded upon al-Tabari's work, advocating for similar therapeutic approaches within the Islamic civilization. Their contributions further solidified the practice of occlusion therapy, laying the groundwork for its continued evolution and refinement in subsequent centuries. DISCUSSION: Al-Tabari's contributions to occlusion therapy underscore the rich heritage of scientific inquiry in theIslamic civilization during the medieval period. This historical perspective sheds light on the diverse contributions to medical knowledge and practice outside of Western contexts and emphasizes the importance of recognizing and honoring these contributions in the broader history of medicine.

Recent advancements in nanomaterial-laden contact lenses for diagnosis and treatment of glaucoma, review and update.

Despite the existence of numerous eye drops in the market, most of them are not sufficiently effective because of quick clearance and the barriers within the eye. To increase the delivery of the drugs to the eye, various new formulations have been explored in recent decades. These formulations aim to enhance drug retention and penetration, while enabling sustained drug release over extended periods. One such innovative approach is the utilization of contact lenses, which were originally designed for cosmetic purposes and vision correction. Contact lenses have appeared as a promising formulation for ocular drug delivery, as they can increase the bioavailability of drugs in the eye and diminish unwanted side effects. They are specifically appropriate for treating chronic eye conditions, making them an area of interest for researchers in the field of ophthalmology. This review outlines the promising potential of nanomaterial-laden contact lenses for diagnosis and treatment of glaucoma. It classifies therapeutic approaches based on nanomaterial type, summarizes diagnostic advances, discusses improvement of contact lenses properties, covers marketing perspectives, and acknowledges the challenges of these innovative contact lenses for glaucoma management.

Crocin as a vision supplement.

Crocin is a natural ingredient of saffron (Crocus sativus L.) flower that has shown potential for application as a supplement in eye health and preserving vision. Crocin has been examined for its potential to treat various eye diseases such as glaucoma, macular dystrophies, diabetic retinopathy, and age-related macular degeneration. This review briefly discusses the role of crocin in different eye diseases. The underlying pathophysiological pathways involved in the effect of crocin on ophthalmic diseases are also reviewed. Preclinical evidence shows the cytoprotective, antioxidative, anti-inflammatory, and blood-flow enhancing effects of crocin in retinal tissue. Crocin also affects the retinal pathologies by activating PI3K/Akt and inhibiting NF-κB signalling pathways. Clinical evidence suggests that crocin improves outcomes in patients with retinal degenerations, retinal dystrophies, and glaucoma. Overall, crocin can be suggested as a potential vision supplement in healthy populations and patients with eye diseases. However, more clinical studies with larger sample sizes and longer follow-up durations are needed to confirm the current evidence.

The prevalence of refractive error in schoolchildren.

CLINICAL RELEVANCE: Information on the refractive error prevalence in school-aged children will result in delivering the optimal eye health service to this group. BACKGROUND: Understanding the prevalence of refractive error in school-aged children is crucial to reduce the consequences of uncorrected refractive error. This study aims to investigate the prevalence of refractive error among school-aged children in Shiraz, Iran. METHODS: In this cross-sectional population-based study, 2001 schoolchildren aged 6-12 years participated. All participants underwent cycloplegic refraction. Spherical equivalent (SE) of -0.50 dioptre or more was considered as myopia, SE of +2.00 dioptre or more as hyperopia, and astigmatism as cylinder power of 0.75 dioptre or more. The difference of 1.00 dioptre or more between two eyes defined as anisometropia. RESULTS: The prevalence of myopia was 11.6% (95% confidence interval [CI]: 10.2-13.1%), hyperopia 6.7% (95%CI: 5.6-7.9%), and astigmatism 28.9% (95%CI: 26.9-31.0%), out of which 82.1% had with the rule astigmatism. Anisometropia was detected in 4.0% (95%CI: 3.2-5.0%) of children. Astigmatism and anisometropia were significantly higher in boys (p < 0.001, p = 0.03 respectively). The SE decreased significantly with increasing age (p < 0.001) indicating an increase in myopia with age. In addition, the rate of myopic astigmatism increased with age (p < 0.001). Among studied schoolchildren 97.0% could achieve the best-corrected visual acuity of 6/6 and 3.0% could not in the better eye. CONCLUSION: Astigmatism was the most common refractive error among primary school children. The prevalence of myopia was relatively higher than other studies conducted in Iran, and it increased with age. These results may highlight the role of lifestyle changes and increased near work activities on the myopic shift in school-aged children. The findings provide information for screening programmes in school-aged children.

The Prevalence and Causes of Low Vision and Visual Impairment in School-Aged Children: The Shiraz Pediatric Eye Study.

Purpose: To determine the prevalence and causes of visual impairment (VI) in Shiraz schoolchildren aged between 6 and 12 years. Methods: In the present population-based study, stratified random sampling was used to select 2400 schoolchildren aged 6-12 years from all four educational districts of Shiraz, Iran. Using the definitions of the World Health Organization, VI was defined as best-corrected visual acuity (BCVA) ≤0.5 logMAR (20/60) in the better eye, and blindness as BCVA worse than 1.3 logMAR (20/400) in the better eye. The low vision was defined as BCVA equal to or worse than 0.5 logMAR (20/60) in either eye. Data were recorded from a detailed interview and ocular examination of each eligible student. Results: The mean age of the students was 9.1 ± 1.6 years. The prevalence of VI was 3/2001 (0.14%). The cause of VI in all these three patients (100%) was amblyopia due to high refractive errors (high ametropia and astigmatism). Regarding the main refractive errors leading to VI among these three patients, one patient had bilateral high hyperopia (compound hyperopic astigmatism), one of them had bilateral high astigmatism, and the other one had compound myopic astigmatism. According to a visual acuity of less than or equal to 20/60 in at least one eye, 9/2001 (0.4%) of children had low vision. Conclusions: This study revealed a low prevalence of VI in a sample of 6- to 12-year-old school-aged children. Amblyopia in the setting of high ametropia and astigmatism were the most common causes of VI.

The Role of Trace Elements in Pseudoexfoliation Syndrome: A Cross-sectional Study.

PURPOSE: Pseudoexfoliation syndrome (PXF) is an age-related condition, characterized by deposition of whitish flake-shaped materials in the anterior segment of the eye. Although it occurs all over the world, a considerable racial variation exists. According to the high frequency of PXF in Iran and the importance of prevention and early treatment, we evaluated the plasma level of iron, zinc, copper, and magnesium in patients with PXF. METHODS: In this study, 83 individuals were enrolled; 40 patients with cataract and PXF as the case group and 43 age- and sex-matched individuals with cataract but without PXF as the control group. The serum levels of the mentioned microelements were compared in two groups. RESULTS: In the case group, 25 (62.5%) male and 15 (37.5%) female subjects participated. In the control group, the corresponding figures were 22 (51.2%) and 21 (48.8%), respectively. The mean age of the case group was 66.07 ± 9.46 and that for the control group was 66.88 ± 8.04 years. Regarding the case group, the serum levels of iron, zinc, copper, and magnesium were 60.58 ± 21.04, 84.7 ± 14.37, 120.23 ± 14.43, and 2.11 ± 0.23, respectively. These serum levels in the control group were 89.07 ± 26.06, 97.51 ± 17.42, 123.33 ± 19.01, and 2.14 ± 0.16. The serum levels of iron and zinc were significantly lower in the case group than the control group (P < 0.0001); however, such a difference was not observed in terms of copper and magnesium serum levels. CONCLUSION: Our study demonstrated that the serum iron and zinc levels were lower in PXF patients. Nutritional deficiency may be a cause of zonular weakness in these patients. Heme is a cofactor for the enzyme which contributes to the biosynthesis of fibrillin, the major protein in zonular fibers. Therefore, iron can play a substantial role in the biosynthesis of the fibrils and also in the zonular stability.

Effects of the secretome of human Wharton's jelly mesenchymal stem cells on the proliferation and apoptosis gene expression of the retinal pigmented epithelium.

Human retinal pigmented epithelium (RPE) can undergo an uncontrolled proliferation in some disorders such as retinal detachment associated with proliferative vitreoretinopathy (PVR). The present study was conducted to evaluate the effect of the conditioned medium secreted by human Wharton's jelly mesenchymal stem cells (WJMSCs-CM) on the proliferation and apoptosis gene expression of the RPE. WJMSCs-CM was collected from WJMSCs after two periods of 24-h and 9-h culture in serum-free medium. RPE cells were cultured in WJMSCs-CM versus serum-deprived media for 24 h. The effect of WJMSCs-CM on RPE cell proliferation was determined using the MTT assay. Relative expression of apoptotic genes (Bcl2, Bax, and IL-1B) was also assessed by real-time PCR. MTT assay demonstrated that RPE cell viability was reduced significantly in WJMSCs-CM treated RPE cells compared to those cultured in serum-deprived medium (64.23 ± 2.44 vs 100.10 ± 5.68; P = 0.006). Moreover, the expression of anti-apoptotic Bcl2 was significantly decreased in WJMSCs-CM compared to serum-deprived medium (0.52 ± 0.06 in WJMSCs-CM vs 1.02 ± 0.2 in serum-free treatment; P = 0.03), while the expression of pro-apoptotic biomarkers of Bax and IL-1B was not significantly different between the two treatments. The represented data showed that WJMSCs-CM can induce apoptosis in RPE cells in vitro through activating apoptosis pathways. This proof-of-the-concept study provides basic evidence for the possible effect of WJMSCs-CM on preventing PVR.

Effects of chronic methamphetamine abuse on the retinal nerve fiber layer, ganglion cell layer and Bruch's membrane opening minimum rim width.

BACKGROUND: Methamphetamine (Meth) is a highly addictive and hallucinogenic agent which is used as the second most common illicit drug globally. Meth could affect the retina and optic nerve by inducing the release of vasoconstrictive agents such as endothelin 1 and induction of severe oxidative stress with accumulation of reactive oxygen species. AIM: To evaluate the effects of chronic Meth abuse on the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL) and the Bruch's membrane opening minimum rim width (MRW). METHOD: In this case-control study, we recruited 55 Meth abusers and 49 healthy individuals with mean age of 44.63 ± 0.97 and 43.08 ± 0.91 years, respectively. RNFL thickness, GCL thickness and MRW were evaluated using optical coherence tomography. RESULTS: We found statistically significant decrease in RNFL, MRW thickness in Meth abusers (P: 0.002 and P: 0.006, respectively). We did not detect statistically significant difference regarding GCL thickness between the groups (P = 0.320). Our results showed a weak but statistically significant correlation of Meth dose increment and decrement of RNFL thickness ((P: 0.005, r = -0.193) and MRW (P: 0.013, r = -0.174). We found no correlation between duration of Meth consumption with RNFL and MRW thickness (P: 0.205, r= -0.124; P: 0.771, r= -0.029, respectively). CONCLUSION: We found a statistically significant adverse association in meth abusers with RNFL thickness and MRW. These two parameters were also statistically associated with the meth dose as measured by daily dose of Meth. Although we found a decrease in the GCL thickness, it did not reach statistical significance.

Supramaximal Recession and Resection Surgery in Large-Angle Strabismus: Outcomes of Large Interventional Case Series Exotropia and Esotropia.

PURPOSE: To assess the postoperative surgical outcomes and the changes in deviation in patients treated by supramaximal recession and resection (R&R) of rectus muscles to correct the large-angle exotropia and esotropia. METHODS: This study was a prospective interventional case series, and patients with esotropia of ≥65 prism diopter (PD) or exotropia of ≥60 PD who had undergone supermaximal R&R in non-fixating eye with lower vision in unilateral strabismus or bilateral medial rectus (BMR) recession up to 8.5 mm for esotropia and bilateral lateral rectus (BLR) recession up to 12.5 mm for exotropia in bilateral strabismus were enrolled. Successful results were achieved if postoperation deviation was <10 PD for esotropia and <15 PD for exotropia during their final examinations. RESULTS: A total of 131 cases (48 patients with esotropia and 83 patients with exotropia) were included. The mean ages of the patients with esotropia and exotropia were 16.83 ± 15.06 and 23.19 ± 11.29 years, respectively. The mean preoperative esodeviations for bilateral and unilateral surgeries were 69.5 ± 6.5 and 80.7 ± 10.3, respectively, and these values for bilateral and unilateral exodeviations surgeries were 67.3 ± 7.6 and 74.2 ± 12.1, respectively. The overall successful outcomes were achieved in 50% of the esotropic patients and 79.5% of the exotropic patients. At final follow-up examination, no patient had diplopia on lateral gazes. CONCLUSION: Based on our surgical results, it is possible to consider monocular recession-resection surgery in non-fixating eye (with poor vision) or BLR and BMR recession in both eyes as a viable option for surgical treatment of large angles deviations.

Distribution of intraocular pressure in healthy Iranian children: the Shiraz Pediatric Eye Study.

PURPOSE: To describe the mean and normal range of intraocular pressure (IOP) and its associations in healthy Iranian school children using the noncontact tonometer. METHODS: In this cross-sectional study as part of the Shiraz Pediatric Eye Study, a stratified random sampling was performed among elementary school children of Shiraz, Iran. Basic demographics and socioeconomic status of households, past medical history, drug history, and eye health history were collected for each eligible student. Children underwent complete ophthalmic examination. Axial length, corneal curvature, and anterior chamber depth were measured using the IOL-Master 500. RESULTS: Of 2,001 eligible children, 1,901 (95.0%; 3,802 eyes) with a mean age of 9.1 ± 1.6 years (standard deviation; range, 6-12 years) had reliable IOP. The mean spherical equivalent refraction was 0.5 ± 1.3 D for the right eye and 0.6 ± 1.2 D for the left eye. Mean IOP in the right eye was 15.1 ± 2.5 mm Hg (median, 15.0; range, 8.0-27.0 mm Hg); in the left eye, 15.2 ± 2.5 mm Hg (median, 15.0; range, 9.0-28.0 mm Hg). In multiple regression analyses, the mean IOP was significantly lower among asthmatic children compared to normal participants (P = 0.007). The measured IOP was significantly higher in myopic participants than hyperopic patients (P = 0.003). CONCLUSIONS: This study provides a useful normative IOP database using the noncontact tonometer for healthy Iranian school children.

Oral fluoxetine in the management of amblyopic patients aged between 10 and 40 years old: a randomized clinical trial.

OBJECTIVE: The objective of this study is to assess the efficacy of oral fluoxetine therapy in improving the visual function of amblyopic patients aged between 10 and 40 years old. METHODS: In this double-blinded, randomized, controlled trial (IRCT2016052428046N1; registered retrospectively), 40 eligible participants with anisometropic or mixed amblyopia were randomly assigned to either fluoxetine or placebo groups. Participants with anisometropia and logMAR best spectacle-corrected visual acuity (BSCVA) worse than 0.2 logMAR in the amblyopic eye or at least a two-line of difference in the BSCVA between the fellow eyes were included. Participants with significant ocular or systemic diseases were excluded. In both groups, the better eye of each patient was patched for 4-6 h a day during the study period. Participants in the treatment group were treated with oral fluoxetine for 3 months. Change in the Snellen BSCVA (after 3 months) was regarded as the primary outcome measure. RESULTS: Data from 20 participants in the fluoxetine group and 15 participants from the placebo group were analyzed (aged 11-37 years). The magnitude of improvement in visual acuity (from baseline to 3 months after treatment) was significantly higher in the fluoxetine group (0.240 ± 0.068 logMAR; 2.4 line-gain) compared with the control group (0.120 ± 0.086 logMAR; 1.2 line-gain). CONCLUSIONS: This study suggests beneficial effects of fluoxetine in the management of adult and adolescent amblyopia.

The Shiraz Pediatric Eye Study; a Population Based Survey of School Age Children: Rationale, Design and Baseline Characteristics.

PURPOSE: To describe the rationale, study design, methodology, and baseline characteristics of the Shiraz Pediatric Eye Study, a population-based survey of schoolchildren in Shiraz, Iran. METHODS: This population-based study included schoolchildren aged 6-12 years from all four educational districts of Shiraz who were recruited in years 2015-2016. Stratified random sampling was used to select 2400 participants from all districts. Data were recorded from a detailed interview and ocular evaluation of each eligible student. The eye examination comprised uncorrected and best corrected visual acuity measurement, refraction, external eye examination (including specific strabismus and lid evaluation tests), slit lamp biomicroscopy, intraocular pressure measurement, the Ishihara color vision test, and stereoacuity. Exophthalmometry, optical biometry, and optical coherence tomography were performed for a randomly selected subset of children. General characteristics and socioeconomic variables were also recorded to assess risk factors. RESULTS: From a total of 2400 selected students, 2001 (83.3%) participated in the study. The mean age of the students was 9.1 ± 1.6 years, and 59.7% were girls. Most children had at least one parent with a diploma or less than diploma (63.5%), and 2.2% had illiterate parents. CONCLUSION: This study is expected to provide accurate estimates of the prevalence of visual impairments and their related determinants in Shiraz. In addition, it will identify children who should be targeted by blindness prevention programs.

Expression of Inflammatory-Related NFκB Genes in Iranian Patients with Pterygium: A Case-Control Study.

Pterygium is one of the most common eye conditions without any clear etiology. Some studies have suggested an association between sun exposure and pterygium, but others have proposed the role of genetic variations in its pathogenesis. To date, no study has investigated the association of inflammatory transcription factor, NFκB genes with pterygium in the Middle East. We examined the changes in expression of 3 inflammatory related NFκB1, NFκB2, and RELA genes in patients with pterygium. Thirty patients with pterygium and 30 age and sex-matched controls were enrolled in this case-control study. None of the participants showed any clinical signs of inflammation in their conjunctiva. Demographic information was obtained and the expression levels of three genes including NFκB1, NFκB2, and RELA were measured in their conjunctiva by real-time RT-PCR using gene-specific primers. Mean expression level of NFκB1, NFκB2 and RELA genes in patients were 2.4±0.3, 1.9± 0.5, and 1.8±0.4 times higher than normal subjects, respectively. Higher levels of gene expression were observed in individuals with more outdoor activity and sun exposure. Moreover, a significant correlation was observed between the expression levels of NFκB2 and RELA genes, suggesting a possible NFκB2- RELA heterodimer formation in patients with pterygium. This study has indicated a significant association between expressions of inflammatory-related NFκB1, NFκB2 and RELA genes, and pterygium. Further studies to verify the role of inflammation in the pathogenesis of pterygium, may provide new targets for managing pterygia.

The Effect of Sub-Tenon's Bupivacaine on Oculocardiac Reflex during Strabismus Surgery and Postoperative Pain: A Randomized Clinical Trial.

PURPOSE: Oculocardiac reflex (OCR), defined as bradycardia induced by manipulation of extraocular muscles, is a serious complication during strabismus surgery for which prevention and proper management is required. In the present study, we investigated the efficacy of sub-Tenon injection of bupivacaine for prevention of OCR and postoperative pain. METHODS: A prospective randomized controlled clinical trial was conducted. Fifty patients who were candidates for strabismus surgery were randomized into case (sub-Tenon's bupivacaine injection) or control (normal saline injection) groups. Standard strabismus surgery was performed for all cases. Occurrence and severity of OCR (primary outcome) and postoperative pain (using the Visual Analog Scale) were compared between the two groups. RESULTS: Both incidence (32% vs. 100%; P = 0.002) and severity of OCR (mean heart rate decrease, 10.1 vs. 38.7 beats/minute; P < 0.001) were significantly lower in the study group compared to those in the control group. Postoperative pain scores were significantly lower in the case group than in the control group (mean score, 2.8 vs. 5.9 at 60 minutes after surgery; P < 0.001). CONCLUSIONS: Sub-Tenon injection of bupivacaine as a local anesthetic can significantly prevent OCR and decrease the severity of bradycardia. This technique can also diminish postoperative pain in patients who underwent strabismus surgery.

Effect of Intraperitoneal Injection of Saffron on the Treatment of Experimental Endotoxin Induced Uveitis in the Rabbit.

INTRODUCTION: Saffron with scientific name of "Crocus sativus" from the family "Iridaceae" is a plant without stem and root. Antioxidative and immunomodulatory effects of saffron has been demonstrated in different studies. AIM: To assess the effects of saffron in the treatment on Lipopolysaccharide (LPS) induced uveitis in the rabbit. MATERIALS AND METHODS: Thirty healthy female New Zealand white rabbits were prepared. LPS induced uveitis was confirmed via slit lamp examination 24 hours after intravitreal injection of Salmonella typhimurium LPS endotoxin in the right eye of all rabbits. Then the animals were randomly divided into two equal groups - group 1 (controls) and group 2 (saffron). After 24 hours of intravitreal injection of LPS, 60 mg/body weight of saffron was injected intraperitoneally for Group 2. On the seventh day after intraperitoneal injection, all rabbits of both groups were euthanized with an overdose intraperitoneal injection of sodium thiopental. Immediately after euthanasia, enucleation of both groups of rabbits was done. Clinical Scoring System (CSS) and pathological severity score of uveitis was assessed for each eye. RESULTS: No statistical difference in the CSS was found in days 3,5, and 7 after intraperitoneal injection of saffron. Also, Pathological Severity Score (PSS) did not show a significant difference between two groups. Additionally, the maximum PSS of both groups was very closed but the number was observed in the saffron group (20%) more than control group (10%). CONCLUSION: Intraperitoneal injection of saffron was ineffective in the management of experimental uveitis. Further studies with different dosages and follow up and using other routes of administration are needed.

Correlation Between Intraocular Pressure and Central Corneal Thickness in Persian Children.

INTRODUCTION: This study aimed to determine intraocular pressure (IOP) and central corneal thickness (CCT) measurements in healthy Persian children to find clinical reference values in this ethnicity. Additionally, we examined the possible relationship between these measurements. METHODS: This cross-sectional study included 262 eyes of 131 Persian primary school children between 6 and 13 years of age. All eyes were healthy and had no anterior or posterior segment abnormalities, corneal disease, or evidence of glaucoma. Specular microscopy was used to measure CCT and both noncontact tonometry (NCT) and Goldmann applanation tonometer (GAT) were used to measure IOP. Correlations between IOP measurements were also examined. RESULTS: Mean CCT was 513.47 ± 34.51 µm in the right eye (OD) and 513.93 ± 33.88 µm in the left eye (OS). The CCT was not significantly different between older (10-13 years) and younger (6-9 years) patients. Mean IOP measured with GAT was 13.86 ± 2.13 mmHg OD and 13.72 ± 2.04 mmHg OS and mean IOP measured with NCT was 15.26 ± 2.38 mmHg OD and 15.11 ± 2.18 mmHg OS. The IOP and CCT measured with GAT were weakly correlated (OD: r = 0.141, P = 0.114; OS: r = 0.236, P = 0.007). However, IOP and CCT measured with NCT (OD: r = 0.487, P = 0.000; OS: r = 0.456, P = 0.000) were moderately correlated. Our outcomes demonstrated that for 100 µm increase in CCT, IOP measured with GAT and NCT increased by 0.8 and 3.3 mmHg, respectively, in OD and by 1.4 and 2.9 mmHg in OS. Based on intraclass correlation coefficients, IOP measurements made with GAT and NCT were in fair agreement in OD and in good agreement in OS. CONCLUSION: The IOP and CCT in healthy Persian school children (6-13 years old) were positively correlated. Our findings revealed that corneal thickness is thinner in Persian children than in most other racial groups. FUNDING: This study has been funded by deputy dean in research of School of Medicine and deputy vice chancellor of Shiraz University of Medical Sciences, Shiraz, Iran.

Comparison of the Wave Amplitude of Visually Evoked Potential in Amblyopic Eyes between Patients with Esotropia and Anisometropia and a Normal Group.

BACKGROUND: We compared the wave amplitude of visually evoked potential (VEP) between patients with esotropic and anisometropic amblyopic eyes and a normal group. METHODS: The wave amplitude of VEP was documented in 2 groups of persons with amblyopia (15 with esotropia and 28 with anisometropia) and 1 group of individuals with normal visual acuity (n, 15). The amplitude of P100 was recorded monocularly with different spatial frequencies. RESULTS: Our statistical analysis revealed that the wave amplitude in the 2 groups with amblyopia was significantly decreased compared to that in the normal group (P<0.001). There was a significant difference regarding the amplitude in high spatial frequencies in both high- and low-contrast conditions between the groups with esotropia and anisometropia and the normal group (P<0.001). There were also significant differences in large check-size stimuli and low-contrast condition between the amblyopic groups with esotropia and anisometropia and the normal group (P=0.013 and P=0.044, respectively). In large check-size stimuli and high-contrast condition, a significant difference was indicated only in the comparison between the esotropic amblyopic eyes and the normal eyes (P=0.036). CONCLUSION: The wave amplitude parameter of VEP was influenced by both types of amblyopia, but it seems that this parameter was more sensitive to esotropic amblyopia than anisometropic amblyopia. This outcome may reflect a non-parallel pattern of cortical responses in the comparison of the 2 types of amblyopia with each other and with the control group, which may be beneficial for the diagnosis and treatment of amblyopia.

Botulinum Toxin Injection for Treatment of Acute Traumatic Superior Oblique Muscle Palsy.

PURPOSE: To evaluate the outcomes of botulinum toxin injection into the inferior oblique (IO) muscle for management of unilateral acute traumatic superior oblique (SO) palsy. METHODS: In this prospective case series, 10-20 units of botulinum toxin A (Dysport, Ipsen, Biopharm Ltd., Wrexham, UK) was injected into the ipsilateral IO muscle of 13 consecutive patients with unilateral acute traumatic SO palsy. All patients received injections within four weeks of the incident. RESULTS: Mean age was 29 ± 15 years and 12 (92%) subjects were male. Mean amount of hypertropia (in primary position) was decreased from 10.0 ± 3.9(Δ) at baseline to 4.6 ± 8.9(Δ), one month after the injection, and to 1.5 ± 2.7(Δ) at final follow-up (P = 0.001). IO overaction improved from 2.7 ± 0.6 to 1.0 ± 1.2 and 0.6 ± 0.9 (P ≤ 0.001), and subjective torsion from 5.3 ± 3.9 to 3.2 ± 3.4 and 1.6 ± 2.5 degrees (P ≤ 0.001), at the same time intervals respectively. One month after the injection as well as at final follow-up, 10 (77%) patients were diplopia-free in primary and reading positions. Subgroup analysis showed that patients who recovered had less baseline hypertropia as compared to those who failed (8.3(Δ) vs. 15.7(Δ), respectively; P = 0.01). All patients with a favorable outcome had baseline hypertropia of 10(Δ) or less. CONCLUSION: A single injection of BTA into the IO muscle can rapidly and safely resolve symptomatic diplopia in patients with acute traumatic SO palsy, while waiting for spontaneous recovery.

Monocular elevation deficiency: a case series of surgical outcome.

BACKGROUND: Inferior rectus recession, Knapp procedure, partial tendon transposition, and combined procedure are different surgical procedures in the management of monocular elevation deficiency (MED). Only a few studies have been published on the management of this problem. In this study, we report our experience with patients with MED focusing on the indications and types of surgery in the south of Iran. METHODS: In this case series, a computerized database review on 4773 patients with strabismus was performed and 18 patients diagnosed as having MED who had undergone strabismus surgery were enrolled. RESULTS: Of the 18 patients, 13 had only hypotropia and 5 had horizontal deviation as well. Preoperative vertical deviation was between 15 and 60 prism diopter (mean±SD=25.8±10.7 PD). Fourteen patients had positive forced duction test on elevation. Seventeen patients had ptosis twelve of them had true ptosis and the remaining 5 had pseudoptosis). The mean postoperative follow-up was 24.4 months. Four patients underwent Knapp procedure, 12 patients underwent inferior rectus recession, and for 2 patients a combined procedure was performed. The mean postoperative hypotropia was 6.1±7.9 PD. Twelve out of the 18 patients were corrected to within five PD of orthophoria and no one was found with overcorrection. CONCLUSION: Although MED is etiologically multifactorial, satisfactory surgical results can be achieved by judicious selection of the surgical technique based on the results of the forced duction test.