en Editorial: Inherited Retinal Degenerations عمومى General سرمقاله Editorial In this issue of IrJO Movassat et al1 (P: 33-38) present a case series of leber's congenital amaurosis (LCA). LCA is the most severe form of inherited retinal dystrophy responsible for congenital blindness with an early age of onset and accounts for at least 5% of all inherited retinal diseases which affect about one in 3500 individuals in the world. Usually degenerative anomalies of the retina initially affect the rods which cause night-blindness and regression of the visual fields, but progressively the cones, retinal vessels and other cells get involved in this degenerative process. In the past decade many efforts have been focused on the genetics and pathogenesis of these blinding diseases. Although, more than 100 genes have been discovered for these degenerative diseases, we are at the beginning of a long road. Gene therapy has been used successfully to stop or slow down the degeneration of photoreceptors in species presenting degenerative diseases similar to human. Gene therapy has been used in mice, rodents, dogs and some primates. The RPE65-/- dogs present a naturally occurring and rapidly blinding disease similar to human LCA. A recombinant adeno-associated virus (AAV) carrying RPE65 injected into the vitreous has delayed the progression of the degeneration, which has been shown by successive ERG's.2 Since nucleic acids are not capable to penetrate cell membranes they are inserted into the viruses to deliver the normal genes to the photoreceptors replacing the mutated genes. Adenoviruses, AAV, and Lentiviruses have been used for this purpose. This rescuing process is possible only when at least some photoreceptors are functional and when apoptosis is extensive and most cells have been degenerated or highly affected, as it is the case in most of our retinitis pigmentosa (RP) patients, gene therapy would not be effective. In another field of research in these degenerative diseases stem cells have been used successfully to treat retinal degenerative disease, but a functional vasculature of the retina is necessary to maintain the survival of the implanted cells. In two mouse models of retinal degeneration rd1, and rd10, resembling human leber amaurosis, when a fraction of mouse or human adults bone marrow stem cells (Lineage-Negative hematopoietic stem cells [Lin- HSCs]) containing endothelial precursor cells injected into the eye of neonatal mouse, not only the sensory cells were replaced but also the retinal vessels were rescued, and active, functional photoreceptors were preserved.3 Stem cells have been isolated and cultured from many sources such as embryonic tissues, adult bone and even the retina but in human have shown little ability to differentiate into retinal phenotype.4 Transplantation of stem cells and restoration of visual function in human is possible but only when the donor cells are at a specific stage of development which is a precursor-photoreceptor stage. This very complex procedure is controlled by genetic and extrinsic regulatory factors and needs a genetic switch to activate, control and complete the procedure. This very complex pathway has not yet been completely understood and applied in molecular research. Every day, new discoveries and technology are being applied in the molecular research fields which give us hope to treat and cure these degenerative retinal diseases in a near future. References 1- Movassat M, Roohipour R, Nili-AhmadAbadi M. A Case Series Study of Leber’s Congenital Amaurosis: Clinical Description and ERG Findings. Iranian Journal of Ophthalmology 200820(3):33-38. 2- Acland GM, Aguirre GD, Ray J, et al. Gene therapy restores vision in a canine model of childhood blindness. Nat Genet. 200128(1):92-5. 3- Otani A, Dorrell MI, Kinder K, et al. Rescue of retinal degeneration by intravitreally injected adult bone marrow-derived lineage-negative hematopoietic stem cells. J Clin Invest. 2004114(6):765-74. 4- MacLaren RE, Pearson RA. Stem cell therapy and retina. Eye 200721(10):1352-9. - 1 2 http://www.irjo.org/browse.php?a_code=A-10-11-44&slc_lang=en&sid=en Hormoz Chams هرمز شمس hormozshams@yahoo.com 560031947532846001525 Yes

en Prevalence and Risk Factors of Refractive Errors among schoolchildren in Mashhad, 2006-2007 عمومى General پژوهشی Original Purpose : To determine the prevalence of refractive condition and its risk factors among students in Mashhad . Methods : A total of 2510 students representing a cross-sectional of the population of Mashhad were sampled using random cluster sampling strategy. Primary and middle school students underwent cycloplegic refraction. The refractive errors of high school students were measured using non-cycloplegic autorefraction. Myopia was defined as spherical equivalent (SE) of -0.5 diopter (D) or more, and hyperopia was defined as SE of +0.5 diopter (D) or more, and astigmatism of 0.75 cylinder diopter or greater. Examination was carried out in the school using standardized testing protocols. Results : 2150 students (group 1: 1163 primary and middle school, group 2: 947 high school students and 13 missed data) participated. The prevalence of refractive errors in the 1st group was: myopia=2.4%, hyperopia=87.9%, astigmatism=9.8% and anisometropia=3.0% (SE difference at least 1.00 D), and in the 2nd group myopia=24.1%, hyperopia=8.4%, astigmatism=11.8% and anisometropia=5.6%. There was significant difference in refractive errors between girls and boys (P<0.001). In primary and middle school prevalence of myopia increased with age (OR=1.3 95% CI: 1.03 to 1.7 and P=0.013). Conclusion : The prevalence of refractive errors among students in Mashhad is high. Effective detection and treatment of these refractive errors is expected to reduce the incidence of amblyopia and strabismus and also can prevent substantive effects on academic performance. Iranian Journal of Ophthalmology 200820(3):3-9 Prevalence, Refractive Error, Myopia, Hyperopia, Astigmatism, Anisometropia 3 9 http://www.irjo.org/browse.php?a_code=A-10-11-45&slc_lang=en&sid=en Hadi Ostadi-Moghaddam هادی استادی مقدم ostadih@mums.ac.ir 560031947532846001526 Yes Akbar Fotouhi اکبر فتوحی 560031947532846001527 No Mehdi khabazkhoob مهدی خبازخوب 560031947532846001528 No Javad Heravian جواد هرويان 560031947532846001529 No Abbas-Ali Yekta عباسعلی يکتا 560031947532846001530 No

en Management of Duane’s Syndrome with Botulinum Toxin Injection عمومى General پژوهشی Original Purpose : Recession is the main surgical procedure in correction of eye deviation in Duane’s syndrome. We evaluate the efficacy of botulinum toxin injection in the treatment of this type of strabismus instead of surgery or before it. Methods : Three patients with Duane’s syndrome type I and one patient with Type II were selected at Poostchi eye clinic from patients who diagnosed primarily and had not any eye surgery before. Botulinum toxin (Dysport™, 10 IU) was injected into medial or lateral rectus muscles under general (2 patients) or local (2 others) anesthesia. Amount of deviation, leash phenomenon and limitation of movements were measured pre injection and 72 hours, 1, 4, 12 and 24 weeks postinjections and the results were compared. Results : The amount of deviation was decreased between 8-35 PD at 24 weeks postinjection. No significant change was observed in limitation of movement but leash phenomenon improved in 3 patients. Conclusion : I<a name="OLE_LINK1">njection of botulinum toxin in Duane’s syndrome will decrease the amount of deviation and leash phenomenon however, surgical intervention maybe necessary for residual deviation or globe retraction.</a> Iranian Journal of Ophthalmology 200820(3):10-14 Botulinum Toxin, Duane’s Syndrome, Dysport, Strabismus 10 14 http://www.irjo.org/browse.php?a_code=A-10-11-47&slc_lang=en&sid=en Mohammad-Reza Talebnejad محمدرضا طالب نژاد 560031947532846001536 No Nima Sahraian نيما صحرائيان 560031947532846001537 No Masoomeh Eghtedari معصومه صحرائيان eghtedarim@gmail.com 560031947532846001538 Yes

en Aqueous and Vitreous Penetration of Oral Cefixime and Ciprofloxacin in Rabbit Eye عمومى General پژوهشی Original Purpose : To investigate the penetration of cefixime and ciprofloxacin to the rabbit eye on the basis of microbial inhibition of aqueous and vitreous humour after oral administration. Methods : In this experimental study, 36 rabbits (72 eyes) were randomly divided into two groups group A consisted of 20 rabbits and group B 16 rabbits. Each group was divided into four equal subgroups. The rabbits in each subgroup of group A received 4, 8, 12, and 20 mg/kg of syrup of cefixime every 12 hr respectively and the rabbits in each subgroup of group B received 20, 40, 60, and 80 mg/kg tablet of ciprofloxacin respectively every 12 hr. Immediately after the first dose of the drugs, the anterior chamber of one eye was irrigated randomly by 30-40 cc of ringer lactate solution alongside with mild traumatization of iris. Then by 4, 8, 12, 24 and 72 hr intervals after the 3rd dose, 0.1 cc of aqueous, 0.2-0.5 cc of vitreous, 3 cc of blood and one standard disk of the used antibiotic was placed on culture media of a known bacteria which was completely sensitive to the respective antibiotic. Forty eight hours later, the microbial inhibition zone of each sample and the standard disk of antibiotic were compared. Results : No microbial inhibition was seen by sample of aqueous and vitreous, although very large zone of inhibition was seen by blood sample and standard disk of antibiotic. Conclusion : It seems that oral cefixime and ciprofloxacin do not produce an effective dose for microbial inhibition in rabbit eye . Iranian Journal of Ophthalmology 200820(3):15-18 Rabbit, Cefixime, Ciprofloxacin, Aqueous, Vitreous 15 18 http://www.irjo.org/browse.php?a_code=A-10-11-48&slc_lang=en&sid=en Abbas Attarzadeh عباس عطارزاده attarza@yahoo.com 560031947532846001539 Yes Mohsen Afroozifar محسن افروزی فر 560031947532846001540 No Nader Tanideh نادر تنيده 560031947532846001541 No Jamshid Kohanteb جمشيد کهن طب 560031947532846001542 No Vahid Ghasemifar وحيد قاسمی فر 560031947532846001543 No Asadollah Katbab اسدا... کتباب 560031947532846001544 No

en Plaque Radiotherapy in Recurrent or Incomplete-Excised Conjunctival Squamous Cell Carcinoma and Melanoma عمومى General پژوهشی Original Purpose : To assess the results of brachytherapy in patients with recurrent or incomplete excised conjunctival squamous cell carcinoma (SCC) and malignant melanoma. Methods : Three patients underwent brachytherapy of one eye and one patient underwent brachytherapy of both eyes with ruthenium-106 (RU-106) plaques, all of them had a history of incomplete resection or recurrence of the tumor after surgery. All patients were male with an average age at diagnosis of 54 years (range, 34-76 years).The shape and the size of plaques were determined based on location and size of the suspected area. The plaque was inserted to deliver a target dose of 80-100 Gy in the region of conjunctival malignancy. The diagnosis was squamous cell carcinoma in three eyes and conjunctival melanoma in two eyes. All patients had surgical history of one to three previous excisions with or without cryotherapy before brachytherapy. There were microscopic residual tumors after excision in 2 eyes and recurrent lesion was evident in 3 other eyes. A mean dose of 95 Gy was delivered to the tumor bed. Results : Complete tumor regression without any evidence of recurrent lesion was obtained in all five eyes. The patients were followed for 32 months on average (range, 18-42 months). No radiation related complication was detected, with an exception of a dry eye in the last follow up. Conclusion : Brachytherapy with RU-106 plaque is an alternative method for treatment of selected patients with recurrent or residual conjunctival SCC and melanoma. Iranian Journal of Ophthalmology 200820(3):19-23 Brachytherapy, Ruthenium-106 Plaque, Conjunctival Squamous Cell Carcinoma, Conjunctival Melanoma 19 23 http://www.irjo.org/browse.php?a_code=A-10-11-50&slc_lang=en&sid=en Masood Naseripour مسعود ناصری پور masoodnp@yahoo.com 560031947532846001551 Yes Mohsen Bahmani-Kashkouli محسن بهمنی کشکولی 560031947532846001552 No Ramin Jaberi رامين جابری 560031947532846001553 No Gholam-Hossein Aghaee غلامحسين آقايی 560031947532846001554 No Ali Ahadian علی احديان 560031947532846001555 No

en Results of Amblyopia Therapy in Unilateral Organic Ocular Abnormalities عمومى General پژوهشی Original Purpose : To evaluate the visual results of amblyopic therapy in pediatric patients with monocular abnormalities. Methods : The hospital records of visually immature patients with unilateral organic ocular abnormalities and decreased visual acuity, who presented to the pediatric ophthalmology clinic over a one year period, were reviewed. Those who had 8 years old of age or less and underwent amblyopic treatment included in the study. Amblyopia was defined as visual acuity difference of more than 2 lines between the two eyes, absence of central fixation or fixation with inability to maintenance. Amblyopic treatment had been performed using full time occlusion method for one month and then reevaluation of the patient. Results : Twenty patients (8 males and 12 females) with the mean age of 4±3.12 years (range: 1 to 8 years) were included in the study and were followed for a mean of 6 years (range: 2 to 8 years). No patient was excluded from the study due to loss of follow-up. Among those who were able to read the chart (16 patients), the visual acuity increased from 3 meters counting fingers (range: 1 to 5 meters counting fingers) before treatment to 4/10 (range: 2/10 to 6/10) in last visit (P<0.01). In 4 remaining eyes visual acuity increased from central to steady or steady and maintenance. Conclusion : A trial of full-time occlusion for visually immature patients with decreased visual acuity associated with unilateral organic ocular abnormalities specially traumatic or surgical injuries is recommended. Iranian Journal of Ophthalmology 2008;20(3):24-27 Amblyopia, Ocular Abnormality, Trauma 24 27 http://www.irjo.org/browse.php?a_code=A-10-11-51&slc_lang=en&sid=en Reza Asadi رضا اسدی ravamas@yahoo.com 560031947532846001556 Yes Khalil Ghasemi-Falavarjani خليل قاسمی فللاورجانی 560031947532846001557 No

en Investigation of Intraocular Pressure Changes Due to Different Serum Level Heights by Using Tonopen in Acquired Globes from the Iran Eye Bank عمومى General پژوهشی Original Purpose : To investigate intraocular pressure (IOP) changes due to different serum level heights by using Tonopen in acquired globes from the Iran Eye Bank (IEB). Methods : In this interventional prospective case series, serum were infused into 18 normal globes acquired from IEB by using 21G needle inserted in vitreal space through optic nerve head to change the IOP by different fluid level heights from the globe surface. IOP of globes were measured and recorded by Tonopen over the sclera and over the cornea at different serum level heights. Results : Twelve globes were acquired from male donors and 6 globes were from female donors. Mean age of donors were 57 year old. Mean measured pressures by Tonopen of the 18 globes at the serum level heights of 13.6, 27.2, 40.8, 54.4 and 68 cm from the globe surface were 14, 23.6, 34.8, 44 and 52.8 mmHg over the sclera and 13.1, 22.8, 34.8, 44.1 and 52.8 mmHg over the cornea respectively. Conclusion : Using a Tonopen is a proper method to measure the acquired globes IOP, except in serum level height of 13.6 cm (10 mmHg) from the globe surface. In addition, if tonometry over the cornea is not available, it can be done by using Tonopen over the sclera. Iranian Journal of Ophthalmology 2008;20(3):28-32 Tonometry, Tonopen, Globe, Intraocular Pressure, Serum Level Height 28 32 http://www.irjo.org/browse.php?a_code=A-10-11-52&slc_lang=en&sid=en Mahmood Joshaghani محمود جوشقانی joshaghani206@yahoo.com 560031947532846001558 Yes Ali Asghari علی اصغری 560031947532846001559 No Alireza Foroutan عليرضا فروتن 560031947532846001560 No Mohammad-Jafar Ghaempanah محمدجعفر قائم پناه 560031947532846001561 No Ali Ahadian علی احديان 560031947532846001562 No Masoud Janahmad مسعود جان احمد 560031947532846001563 No Maryam Almasi مريم الماسی 560031947532846001564 No

en A Case Series Study of Leber’s Congenital Amaurosis: Clinical Description and ERG Findings عمومى General پژوهشی Original Purpose : To evaluate the incidence of Leber’s Congenital Amaurosis (LCA) in low vision children referred to electrophysiology ward of Farabi Eye Hospital , and review the clinical features of disease and Electroretiongraphy (ERG) test values to confirm the diagnosis and severity of the disease in Iran . Design: Prospective observational case series Methods : Two-hundred and fifteen cases of low vision infants and young children were referred to electrophysiology ward of Farabi Eye Hospital during 18 months. Clinical LCA diagnosis was made and ERG tests were done and LCA diagnosis was confirmed. The symptoms, signs and the results of eye examination and ERG findings were recorded. Results : The mean age of the patients was 27.43 (range, 1-120 months). Among low vision patients fourteen percent of patients had LCA. Fifty-four percent of the patients were female. Nystagmus and low vision were the two most common clinical manifestations of these patients. Hyperopia was the main refractive error (54.80%) and mild abnormalities in fundus examinations were found in 67.70% of cases. In nearly 90% of cases consanguinity was found. ERG was flat or unrecordable in more than 90% of cases, but in less than 10% of cases with recordable curves, severe decrease in amplitude of waves was encountered. ERG confirmed LCA diagnosis in 31 out of 37 patients (positive predictive value of 83.7%). Conclusion : The incidence of LCA in low vision children is similar to other studies. ERG helped in confirmation of presence or absence of overall retinal dysfunction in the majority 31/37 (83.7%) of LCA patients. It can differentiate these cases from other cases with poor vision in infantile age but genetic testing is recommended. Iranian Journal of Ophthalmology 200820(3):33-38 Leber’s Congenital Amaurosis, Electroretinography, Congenital Retinitis Pigmentosa, Congenital Nystagmus, Congenital Stationary Night Blindness 33 38 http://www.irjo.org/browse.php?a_code=A-10-11-53&slc_lang=en&sid=en Morteza Movassat مرتضی مواسات movassat456@yahoo.com 560031947532846001565 Yes Ramak Roohipour رامک روحی پور 560031947532846001566 No Mehdi Nili-AhmadAbadi مهدی نيلی احمدآبادی 560031947532846001567 No

en Efficacy of Memantine in Acute Non-Arteritic Ischemic Optic Neuropathy عمومى General پژوهشی Original Purpose : Evaluation of efficacy of Memantine (N-Methyl-D-Aspartate Receptor Antagonist) on visual function of patients with acute non-arteritic ischemic optic neuropathy (NAION). Methods : The study was conducted as interventional case series from November 2005 through November 2006 in Farabi Eye Hospital . Twenty-two patients with acute NAION of less than 8 weeks duration entered the study. Memantine was prescribed with a dose of 5 mg per day for the first week and 10 mg per day for the following two weeks. Baseline best corrected visual acuity (BCVA); visual evoked potential (VEP) and visual field was done for all patients. BCVA recording repeated 3 weeks, 3 and 6 months later. VEP and perimetry repeated 3 months after treatment. Results : After 3 weeks, 3 and 6 months, BCVA improved -0.32±0.40 LogMAR, -0.51±0.49 and -0.51±0.49, respectively (P=0.005, P=0.001 and P=0.001, respectively). VEP recordings after 3 months, demonstrated -8.61±14.51 db mean decrease in implicit time (P=0.019). Amplitude of voltage did not show significant difference with baseline (P=0.10). Perimetry results after 3 months showed that mean deviation (MD) improved 2.77± 3.94 db (P=0.016). Conclusion : Memantine resulted in significant improvement of BCVA 3 weeks, 3 and 6 months after treatment of acute NAION. Memantine also resulted in significant decrease of implicit time and significant improvement of mean deviation in VEP and perimetry after 3 months. Iranian Journal of Ophthalmology 2008;20(3):39-44 Non-arteritic Ischemic Optic Neuropathy, Memantine, Neuroprotection, Visual Evoked Potential, Perimetry 39 44 http://www.irjo.org/browse.php?a_code=A-10-11-54&slc_lang=en&sid=en Zahra Aalami-Harandi زهرا اعلمی هرندی 560031947532846001568 No Afsaneh Gholami افسانه غلامی 560031947532846001569 No Mohammad Riazi-Esfahani محمد رياضی اصفهانی riazifahimi@yahoo.com 560031947532846001570 Yes Abdolreza Tabasi عبدالرضا طبسی 560031947532846001571 No Niloofar Piri نيلوفر پيری 560031947532846001572 No Ahmad Mirshahi احمد ميرشاهی 560031947532846001573 No Mehdi Nili-AhmadAbadi مهدی نيلی احمدآبادی 560031947532846001574 No Morteza Movassat مرتضی مواسات 560031947532846001575 No Ghasem Fakhraee قاسم فخرايی 560031947532846001576 No

en A Novel Technique of Small Incision Fascia Lata Harvesting without a Faciatome for Frontalis Suspension Procedure عمومى General پژوهشی Original Purpose : To introduce a small incision technique of fascia lata (FL) harvesting for frontalis suspension blepharoptosis procedure. Methods : A skin incision was made in a line between the lateral condyle of the tibia and the anterior superior iliac crest, starting 4- 5 cm above the knee and extending upward 2- 2.5 cm . Approximately 8 cm superior to the first incision, a second skin incision was made with the same length. The FL was dissected from subcutaneous tissue from 1 cm superior to superior border of upper incision to 1 cm inferior to inferior border of lower incision. A 15 mm x 5- 10 mm strip of FL was excised. The fascial defect was left open. Subcutaneous and deep layers were closed with three 4-0 plain catgut sutures and the skin with subcuticular 5-0 prolene sutures. Results : The technique was used in 22 patients from 4 to 47 years of age (Mean: 18.29±14.20) for 34 frontalis sling procedures. Mean follow-up time was 6.17±3.21 (3-16) months. Wound hematoma (1/22, 4.5%), wound discharge (2/22, 9%), pain at rest (100%, up to 4 days), pain on walking (20/22, 90% up to 3 weeks), limping (13/22, 59.1% up to 7 days) were the main postoperative complications. No significant skin scar was observed and none of the patients needed scar revision. Conclusion : Small incision FL harvesting procedure is a good alternative method when the FL stripper is not available. Iranian Journal of Ophthalmology 200820(3):45-48 Fascia Lata, Frontalis Suspension, Ptosis 45 48 http://www.irjo.org/browse.php?a_code=A-10-11-55&slc_lang=en&sid=en Mohsen Bahmani-Kashkouli محسن بهمنی کشکولی bahmanik@yahoo.com 560031947532846001577 Yes

en Topiramate Induced Bilateral Angle-closure Glaucoma عمومى General گزارش موردی Case report Purpose : To describe a case of acute angle-closure glaucoma associated with oral topiramate (Topamax, Aria Daroo) therapy Case report: Two weeks after initiation of oral topiramate therapy for epilepsy, a 35-year-old woman presented with blurred vision and headache. Intraocular pressure in both eyes was significantly elevated and her visual acuity was 20/30 Ocular Uterque (OU). Bilateral conjunctival chemosis, shallow anterior chamber and mild corneal edema were observed. Topiramate therapy was discontinued. Topical therapy was initiated in both eyes with betamethasone, atropine and timolol Results : Symptoms and signs including vision accuracy, refraction and intraocular pressure resolved over the next 2 weeks. Conclusion : Topiramate therapy may be associated with ciliochoroidal effusion resulting in angle-closure glaucoma; therefore, patients on such therapy should be carefully monitored. Iranian Journal of Ophthalmology 2008; 20(3):49-52 Topiramate, Angle-closure Glaucoma, Ciliochoroidal Effusion 49 52 http://www.irjo.org/browse.php?a_code=A-10-11-56&slc_lang=en&sid=en Rana Sorkhabi رعنا سرخابی sorkhabi-r@yahoo.com 560031947532846001578 Yes Nazli Taheri نازلی طاهری 560031947532846001579 No