In this issue of IRJO Akbari and coworkers have introduced and indicated the advantages of “4-horizontal rectus muscle tenotomy on visual function and eye movement records with familial nystagmus syndrome without abnormal head posture and strabismus”. In this prospective study they have shown that tenotomy improves both visual function and eye movements in patients without strabismus and eccentric null point. In the ophthalmic literature various extraocular muscle surgeries on infantile nystagmus syndrome associated with abnormal head posture and eccentric fixation are published and they have been more or less successful.1-3 however, recently some interventional case-series have been published on 4-muscle tenotomy efficacy improving both the vision and the nystagmus which is easier to perform and having less complications highlighting this simple and successful intervention.
Beheshtnejad et al reported their experience on “Mid-Term Outcome of Phacoemulsification in Congenital Iris Coloboma”. In this prospective study 19 patients with cataract and congenital iris coloboma have been operated on and followed. The best corrected visual acuity has been improved significantly after the investigation (p<0.0001). Meanwhile, the endothelial cell density has been decreased from 2313/cell/mm2 before surgery to 1361 cells which was also significant. They have used Morcher capsular tension using type 14 MR-1400 in 14 of the 19 patients and used horizontal chop technique with vacuum 250 mmHg, air pressure 80 mmHg and power 30% by phaco machine.
Naseripour and colleagues have studied on 60 eyes of 48 patients who had choroidal metastases during 10 years. They reported that the primary site of the tumor was breast in 37.5% (N=18), lung 22.9 (N=11), lymphoproliferative, thyroid and gastrointestinal tract 6.7% (N=3) in each, prostate 4.2% (N=2), brain 2.1% (N=1) and unknown etiology in 14.5% (N=7). In 75% (N=36) the eye was involved unilaterally. The main symptom has been blurred vision in 42 patients. Their study showed that in Iranian patients with choroidal metastasis the symptoms and original sites of the tumor were similar to that of the other reports.4,5
Concerning strabismus Guita Ghiasi et al have investigated “The Psychosocial Improvement after Strabismus Surgery in Iranian Patients”. 124 strabismic patients have been selected. They have been older than 15 years who were asked to complete a questionnaire before and after surgery concerning their psychological experience which included the effect of surgery on self-esteem, self-confidence, self-assessment of intelligence, employment and interpersonal relationships concerning the outcome of the investigation. The above mentioned complexes were all significantly improved after the surgery.6 Nelson et al have proposed a questionnaire to assess strabismic patients’ psychological problems. They showed that many qualitative and quantitative improvements are obtained by surgery.
Such evaluations are essential to be performed in different ethnics and cultures. Ghiasi and coworkers have performed this essential investigation for the first time in our society.
“Detection of Herpes Simplex Virus in Corneal Buttons with Clinical Diagnosis of Corneal Scarring” is presented by Asadi-Amoli and colleagues. Although it has been shown previously that Herpes Simplex Virus (HSV) can persist in corneal scar as well as cervical ganglion.7,8 This present communication on 83 corneal samples investigated by real-time polymerase chain reaction indicating that 9.6% (8/83) of patients presented HSV and more important 7.3% of these patients have had no suspicion of HSV keratitis. The authors propose that “HSV keratitis to be considered as one of the underlying etiologies in any patient with corneal scar”. Therefore, investigation is necessary to eliminate HSV infection.
Finally, thanks to Jafarzadehpur and coworkers who finally proposed and fabricated a near-vision Persian chart which is based on scientific investigations.
Hormoz Chams, MD
1. Hertle RW, Dell’Osso LF, FitzGibbon EJ, Thompson D, Yang D, Mellow SD. Horizontal rectus tenotomy in patients with congenital nystagmus: results in 10 adults. Ophthalmology 2003110(11):2097-105.
2. Hertle RW, Dell’Osso LF, FitzGibbon EJ, Yang D , Mellow SD . Horizontal rectus muscle tenotomy in children with infantile nystagmus syndrome: a pilot study. J AAPOS 20048(6):539-48 .
3. Wang Z, Dell’Osso LF, Jacobs JB, Burnstine RA, Tomsak RL. Effects of tenotomy on patients with infantile nystagmus syndrome: foveation improvement over a broadened visual field. J AAPOS 200610(6):552-60 .
4. Singh AD, Damato BE, Pe’er J, Murphree AL, Perry J. Clinical ophthalmic oncology: SciELO Spain 2009.
5. Wharam J, Schachat AP. Choroidal metastasis. In: Ryan SJ (ed). Retina. St. Louis, Mosby2006812-8.
6. Nelson BA, Gunton KB, Lasker JN, Nelson LB, Drohan LA. The psychosocial aspects of strabismus in teenagers and adults and the impact of surgical correction. J AAPOS 200812(1):72-6 e1.
7. Nesburn AB, Cook ML, Stevens JG. Latent herpes simplex virus. Isolation from rabbit trigeminal ganglia between episodes of recurrent ocular infection. Arch Ophthalmol 197288(4):412-7.
8. Cantin EM, Lange W, Openshaw H. Application of polymerase chain reaction assays to studies of herpes simplex virus latency. Intervirology 199132(2):93-100.