Filtering surgeries are frequently used for controlling intraocular pressure in glaucoma patients. The long-term success of operation is intimately influenced by the process of wound healing at the site of surgery. Indeed, if has not been anticipated and managed accordingly, filtering surgery in high-risk patients could end up in bleb failure. Several strategies have been developed so far to overcome excessive scarring after filtering surgery. The principal step involves meticulous tissue handling and modification of surgical technique, which can minimize the severity of wound healing response at the first place. However, this is usually insufficient, especially in those with high-risk criteria. Thus, several adjuvants have been tried to stifle the exuberant scarring after filtration surgery. Conventionally, corticosteroids and anti-fibrotic agents (including 5-fluorouracil and Mitomycin-C) have been used for over three decades with semi-acceptable outcomes. Blebs and bleb associated complications are catastrophic side effects of anti-fibrotic agents, which occasionally are encountered in a subset of patients. Therefore, research continues to find a safer, yet effective adjuvant for filtering surgery. Recent efforts have primarily focused on selective inhibition of growth factors that promote scarring during wound healing process. Currently, only anti-VEGF agents have gained widespread acceptance to be translated into routine clinical practice. Robust evidence for other agents is still lacking and future confirmative studies are warranted. In this review, we explain the importance of wound healing process during filtering surgery, and describe the conventional as well as potential future adjuvants for filtration surgeries.

Purpose:To evaluate the clinical and epidemiological characteristics of children with ocular trauma.Materials and Methods:We retrospectively reviewed the medical records of 278 children (aged 15 years or less) hospitalized with ocular injuries and treated as inpatients at a tertiary referral center in Shiraz, Iran, from 2005 to 2008. Nominal variables were evaluated with a Chi-square test. A P-value less than 0.05 indicated statistical significance.Results:The cohort was comprised of 205 (74%) males, outnumbering females by a ratio of 2.81/1. The mean age was 7.6 ± 3.96 years. Rural residents comprised 125 (45%) of the cohort. Sharp objects caused ocular injury in 211 (76%) cases, and 207 (74%) cases had open-globe injuries. The lens was injured in 62 (30%) cases at initial examination and 89 (43%) patients according to ultrasound examination (P = 0.006). Twenty-eight cases (10%) developed post-traumatic endophthalmitis. Endophthalmitis was associated with needle injury [odd ratio (OR) = 19.25] and presence of intraocular foreign body (OR = 3.48). Visual acuity of patients with closed-globe injuries was 20/200 or better on both initial and final examinations. Visual acuity of patients with open-globe injuries were in the range of light perception to 20/200.Conclusions:Trauma is an important cause of childhood ocular morbidity in southern Iran. Playing with sharp objects is an important cause of ocular trauma in children, and most injuries can be prevented by careful supervision.

ABSTRACT.Purpose: To compare the anatomical results of scleral buckling with and without retinopexy and to assess the effect of retinopexy on the scleral buckling outcome. Methods: This randomized clinical trial was performed on 55 patients. Twenty-two eyes were treated with scleral buckling (segmental or encircling) with or without drainage of subretinal fluid without any type of retinopexy (group 1); 33 patients received transscleral retinal cryopexy around retinal break(s) in addition to the former procedure. The two groups were matched regarding age, sex, myopia, aphakia, stage of proliferative vitroretinopathy (PVR) and number, type and location of the break(s). Results: In the non-retinopexy group, 19 patients (86%) had complete retinal reattachment and one patient had partial reattachment after 34-48 months of follow-up. One patient did not develop attachment because of missed break out of the buckle, and one had no attachment at all because of PVR. Overall success rate was 91% (20 of 22) in this group. In the retinal cryopexy group, 26 patients (79%) had complete retinal reattachment and two had partial reattachment during 35-56 months of follow-up. In two patients, no attachment was achieved because of missed break out of the buckle; three patients developed redetachment after 1 and 3 months because of PVR. Overall success rate was 85% (28 of 33). The anatomical results in these two groups were the same statistically. Conclusion: With the permanent scleral buckling technique, retinal cryopexy adds no benefit to the success rate of anatomical retinal reattachment.

REFERENCES1. Couch JR. Spontaneous intracranial hypotension: The syndrome and its complications. Curr Treat Options Neurol. 2008;10:3-11. 2. Schwedt TJ, Dodick DW. Spontaneous intracranial hypotension. Curr Pain Headache Rep. 2007;11:56-61. 3. Schievink WI. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA. 2006;295:2286-2296. 4. Zada G, Solomon TC, Giannotta SL. A review of ocular manifestations in intracranial hypotension. Neurosurg Focus. 2007;23:e8. 5. Ferrante E, Savino A, Brioschi A, et al. Transient oculomotor cranial nerves palsy in spontaneous intracranial hypotension. J Neurosurg Sci. 1998;42: 177-179. 6. Khemka S, Mearza AA. Isolated sixth nerve palsy secondary to spontaneous intracranial hypotension. Eur J Neurol. 2006;13:1264-1265. 7. Mokri B, Piepgras DG, Miller GM. Syndrome of orthostatic headaches and diffuse pachymeningeal gadolinium enhancement. Mayo Clin Proc. 1997; 72:400-413. 8. Brady-McCreery KM, Speidel S, Hussein MA, Coats DK. Spontaneous intracranial hypotension with unique strabismus due to third and fourth cranial neuropathies. Binocul Vis Strabismus Q. 2002;17:43-48. 9. Miller RS, Tami TA, Pensak M. Spontaneous intracranial hypotension mimicking Menière's disease. Otolaryngol Head Neck Surg. 2006;135:655-656. 10. Cheshire WP. Trigeminal neuralgia: For one nerve a multitude of treatments. Expert Rev Neurother. 2007;7:1565-1579. 11. Schievink WI, Maya MM, Louy C, et al. Diagnostic criteria for spontaneous spinal CSF leaks and intracranial hypotension. AJNR Am J Neuroradiol. 2008;29:853-856. 12. Cohen-Gadol AA, Mokri B, Piepgras DG, Meyer FB, Atkinson JL. Surgical anatomy of dural defects in spontaneous spinal cerebrospinal fluid leaks. Neurosurgery. 2006;58(Suppl. 2):238-245. 13. Matsushima T, Huynh-Le P, Miyazono M. Trigeminal neuralgia caused by venous compression. Neurosurgery. 2004;55:334-337. 14. Lye RH. Basilar artery ectasia: An unusual cause of trigeminal neuralgia. J Neurol Neurosurg Psychiatry. 1986;49:22-28. 15. Kirsch E, Hausmann O, Kaim A, et al. Magnetic resonance imaging of vertebrobasilar ectasia in trigeminal neuralgia.Migrainous patients may have visual field deficits at times between migraine attacks that mostly are unilateral and resolve after 7-10 days. Herein, we report a 25-year-old woman, a known case of classic migraine, with bilateral inferior altitudinal visual field defect and complete recovery after 4 months. All lab tests, including brain magnetic resolution imaging and angiography, coagulation tests and visual evoked potentials, were normal.

IntroductionThis 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.MethodsThis 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.ResultsMean 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.ConclusionThe 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.FundingThis 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.

Morning glory disc anomaly (MGDA) is a congenital malformation of the optic disc that has been reported in association with midline craniofacial defects such as basal encephalocele, hypertelorism, cleft lip and palate, and agenesis of the corpus callosum. We describe a 44 year-old woman with MGDA and Chiari type capital I, Ukrainian malformation, an association not previously reported.

Apparent measurements of ECD may not show a decrease but instead even a slight increase in some cases after uncomplicated DALK (Melles technique) for keratoconus. This finding along with a later decrease in standard deviation of mean cell area suggests that notable postoperative changes in corneal biomechanical forces may affect endothelial cell profile measurements.

ABSTRACT.Purpose: To compare the anatomical results of scleral buckling with and without retinopexy and to assess the effect of retinopexy on the scleral buckling outcome. Methods: This randomized clinical trial was performed on 55 patients. Twenty-two eyes were treated with scleral buckling (segmental or encircling) with or without drainage of subretinal fluid without any type of retinopexy (group 1); 33 patients received transscleral retinal cryopexy around retinal break(s) in addition to the former procedure. The two groups were matched regarding age, sex, myopia, aphakia, stage of proliferative vitroretinopathy (PVR) and number, type and location of the break(s). Results: In the non-retinopexy group, 19 patients (86%) had complete retinal reattachment and one patient had partial reattachment after 34-48 months of follow-up. One patient did not develop attachment because of missed break out of the buckle, and one had no attachment at all because of PVR. Overall success rate was 91% (20 of 22) in this group. In the retinal cryopexy group, 26 patients (79%) had complete retinal reattachment and two had partial reattachment during 35-56 months of follow-up. In two patients, no attachment was achieved because of missed break out of the buckle; three patients developed redetachment after 1 and 3 months because of PVR. Overall success rate was 85% (28 of 33). The anatomical results in these two groups were the same statistically. Conclusion: With the permanent scleral buckling technique, retinal cryopexy adds no benefit to the success rate of anatomical retinal reattachment.