The short-term effects of intravitreal injection of bevacizumab on the plasma levels of vascular endothelial growth factor, insulin-like growth factor-1, and growth parameters in infants with retinopathy of prematurity

Purpose: To determine the changes in serum levels of free vascular endothelial growth factor (VEGF), insulin-like growth factor-1 (IGF-1), and growth parameters in infants with retinopathy of prematurity (ROP) who received intravitreal injection of the bevacizumab (IVB). Methods: A prospective interventional case series study, including 10 infants with Type 1 ROP was conducted. Using the enzyme-linked immunosorbent assay, serum levels of VEGF and IGF-1 were measured before, 1 month and 2 months after treatment with IVB in both eyes. Growth parameters, including weight, length, and head circumference and their Fenton's z-score, were also measured. Results: Serum VEGF levels were suppressed 1 month after IVB (P = 0.007) and then increased between 1 and 2 months (P = 0.064). Z-scores of all growth parameters except weight z-score decreased in the 1st and 2nd months. Conclusion: Serum VEGF levels showed a transient reduction after IVB which lasted at least 2 months. Growth velocity of premature infants may be affected by anti-VEGF therapy and should be followed with particular attention. © 2020 Journal of Current Ophthalmology | Published by Wolters Kluwer-Medknow

Corrigendum to �Periorbital facial rejuvenation; applied anatomy and pre-operative assessment� J. Curr. Ophthalmol. 29 (3), (September 2017) 154�168 (S245223251630213X) (10.1016/j.joco.2017.04.001))

The authors regret to inform a few displaced figures in our manuscript. While text and figure legends are correct, the following 4 figures should be re-placed. Figure 15 should be figure 12. Figure 12 should be figure 13. Figure 13 should be figure 14. Figure 14 should be figure 15. The correctly renumbered figures are also provided below. Figure presented The authors would like to apologize for any inconvenience caused. © 2017 Iranian Society of Ophthalmolog

Postoperative Blepharoptosis After Modern Phacoemulsification Procedure

Purpose: To investigate the frequency of transient (1 month) and persistent (at least 6 months) postoperative ptosis following clear corneal sutureless phacoemulsification and to analyze the factors affecting them. Design: Cohort study. Methods: Patients who underwent phacoemulsification cataract surgery from October 2016 to June 2018 in a tertiary center were enrolled. Margin reflex distance 1 (MRD1), MRD2, and levator function were measured and facial photography was taken before, 1 month, and at least 6 months after the surgery. Clinical ptosis was defined as any postoperative drop of MRD1 and clinically significant ptosis as MRD1 drop of �2 mm. Photo-based ptosis was assessed by a masked oculofacial plastic surgeon at the end of the study. Results: A total of 234 patients (313 eyelids) were included. The majority of surgeries were performed by senior residents (65.5, 205/313) and under topical anesthesia (78.0, 244/313). Persistent clinical, clinically significant, and photo-based ptosis were 25.4 (71/279), 3.2 (9/279), and 3.3 (9/276). Eyelids with persistent postoperative ptosis showed a significantly (P = .03) lower preoperative levator function (13.9 vs 15.8 mm). No other factor was significantly different between the eyelids with and without postoperative ptosis. Conclusion: Persistent clinically significant ptosis was observed in more than 3 of patients undergoing clear corneal sutureless phacoemulsification cataract surgery. It should be counseled preoperatively. Lower preoperative levator function was significantly associated with a higher frequency of postoperative ptosis. Duration of surgery, level of surgeons, and other variables did not have any significant effect on the frequency of postoperative ptosis. © 2020 Elsevier Inc

How reliable is the lacrimal scintigraphy report? An inter-observer agreement and reliability study

AIM: To assess the inter-observer agreement and reliability as well as intra-observer repeatability for lacrimal scintigraphy (LS) reports with and without considering the irrigation test results. � METHODS: A prospective, observational, cross sectional study. Two masked clinicians (lacrimal surgeon and nuclear medicine specialist) independently reported 100 LS images (50 patients of >6 years of age with unilateral anophthalmic socket) in a university hospital. The lacrimal surgeon performed a diagnostic irrigation test and repeated the report of the same LS images 2y after the first report (intra-observer agreement). A weighted Kappa analysis was performed to determine inter-observer agreement and reliability as well as intra-observer repeatability for the type (normal, partial and complete obstruction) and location (presac, preduct, and intraduct) of the obstruction. Subgroup analysis was also performed with consideration of irrigation test results. � RESULTS: A significantly moderate agreement was found between lacrimal surgeon and nuclear medicine specialist for both the type (Kappa=0.55) and location (Kappa=0.48) of obstruction. Agreement values were higher for the type (Kappa=0.61 vs 0.41) and location (Kappa=0.56 vs 0.31) of obstruction in cases with normal than abnormal irrigation test. Strong and significant intra-observer (lacrimal surgeon) repeatability was found for both the type (Kappa=0.66) and location (Kappa=0.69) of obstruction. LS showed no to slight reliability based on irrigation test. � CONCLUSION: A moderate agreement is found between lacrimal surgeon and nuclear medicine specialist regarding the interpretation of LS suggesting the importance of consensus groups among nuclear medicine specialists and lacrimal surgeons to create a common language for interpretation of LS. Intra-observer repeatability is strong for the lacrimal surgeon. © 2019, International Journal of Ophthalmology (c/o Editorial Office). All rights reserved

Acute primary angle closure after periorbital facial procedures report of four cases and literature review

Aims: To report four cases of acute primary angle closure (PAC) after blepharoplasty and forehead lifting procedures and review the previous reported cases in the literature. Methods: Four female subjects with age range of 50�67 years developed PAC 2�5 days after blepharoplasty and endoscopic forehead lifting procedures. All presented with pain, nausea, blurred vision, red eye, and eyelid swelling. Diagnosis was delayed in the first subject because of considering the signs and symptoms as usual postoperative ones. Presumed risk factors for the PAC were female gender (all), advanced age (all), pupillary dilation (all), and hyperopia (case 2). Results: Medical treatment controlled the pressure which was followed by bilateral YAG Laser iridotomy. They fully recovered with no optic neuropathy in their last follow-up examination 10 months to 10 years after the procedures. Conclusion: Risk of PAC should be investigated preoperatively and its presentation should be considered in the postoperative follow-up of subjects with periorbital facial procedures. © 2018 Taylor & Franci

Acute primary angle closure after periorbital facial procedures report of four cases and literature review

Aims: To report four cases of acute primary angle closure (PAC) after blepharoplasty and forehead lifting procedures and review the previous reported cases in the literature. Methods: Four female subjects with age range of 50�67 years developed PAC 2�5 days after blepharoplasty and endoscopic forehead lifting procedures. All presented with pain, nausea, blurred vision, red eye, and eyelid swelling. Diagnosis was delayed in the first subject because of considering the signs and symptoms as usual postoperative ones. Presumed risk factors for the PAC were female gender (all), advanced age (all), pupillary dilation (all), and hyperopia (case 2). Results: Medical treatment controlled the pressure which was followed by bilateral YAG Laser iridotomy. They fully recovered with no optic neuropathy in their last follow-up examination 10 months to 10 years after the procedures. Conclusion: Risk of PAC should be investigated preoperatively and its presentation should be considered in the postoperative follow-up of subjects with periorbital facial procedures. © 2018 Taylor & Franci

Diabetic versus non-diabetic rhino-orbito-cerebral mucormycosis

Objective: To compare the characteristics and outcomes of rhino-orbito-cerebral mucormycosis (ROCM) in diabetic versus non-diabetic patients. Method: It is a retrospective comparative case series on consecutive patients with biopsy-proven ROCM. Systemic and ophthalmic manifestations, imaging, management and final outcomes were compared between diabetic versus non-diabetic ROCMs referred the eye clinic of a university-based hospital (2008-2016). Results: Forty-three diabetics (55 eyes) with mean age of 54.6 (SD:12.5) years and 20 non-diabetics (24 eyes) with mean age of 57.5 (SD:13.8) years were enrolled. Patients' survival was observed in 51 of diabetics and 70 of non-diabetics (P =.1). The mortality rate was 7.4 times (CI95: 1.85-29.96) higher in diabetic ROCM treated with non-liposomal amphotericin (P =.01). Exenteration did not significantly change the mortality rate in either group. Globe survival was 40 and 50 in diabetics and non-diabetics (P = 1), respectively. Vision survival was observed in 20 of diabetics and 37 of non-diabetics (P =.2). Conclusion: Patients', globe and vision survivals were not different between diabetic and non-diabetic patients with ROCM. They were 51, 40 and 20 in diabetic and 70, 50 and 37 in non-diabetic ROCM. © 2020 Blackwell Verlag Gmb

Ocular biometric changes after Ahmed glaucoma valve implantation

Purpose: To investigate the ocular biometric changes after uneventful Ahmed glaucoma valve implantation. Methods: Patients with refractory glaucoma who were candidate for Ahmed valve surgery were prospectively included in this study. Patients with a history of any kinds of corneal surgery were excluded. Refractive status, intraocular pressure, axial length, anterior chamber parameters including anterior and posterior mean keratometry, central corneal thicknesses, and anterior chamber depth, anterior chamber volume, and anterior chamber angle were evaluated at baseline and 1 and 3 months after surgery. Results: A total of 20 eyes from 20 patients were included. Mean intraocular pressure at baseline was 33.4 ± 12.3 mm Hg that significantly decreased to 14.6 ± 6.2 mm Hg at 1 month and 13.5 ± 4.3 mm Hg at 3 months after Ahmed glaucoma valve implantation (p 0.05 in all). Conclusion: Ahmed glaucoma valve implantation had a significant effect on axial length at 3 months after surgery but its effect on keratometry and other anterior chamber parameters was not significant. © The Author(s) 2019

Revisiting Anchor Epicanthoplasty in Mild to Moderate Asian Epicanthal Folds: A Clinicopathological Study

Background: To assess the epicanthal fold (EF), eyelid, eyebrow, scar, and patients� satisfaction after anchor epicanthoplasty and upper blepharoplasty and histopathologically compare Asian epicanthal fold skin with non-Asian counterpart. Methods: Asian Iranians with grade 2 and 3 EF were included. Photographs were taken before and at least 12 months after the surgery. Photoanalysis included EF grade, inter-canthal distance (ICD), margin reflex distance 1 (MRD1), tarsal plate show (TPS), brow fat span (BFS), and eyebrow height. Manchester scar scale score (5�28) and patients' satisfaction score (0�100) were documented. The most medial skin of 5 Asian and 5 non-Asian subjects was histologically compared for the thickness and elastic fiber density and morphology. Results: Included were 89 patients (178 eyelids) with a mean age of 31.6 years and follow-up of 13.1 months. Mean ICD significantly decreased by 3.5 mm (shortening ratio of 9.7). All grade 2 and almost half of the grade 3 EF disappeared. Significant postoperative increase in mean MRD1 (0.3 mm) and TPS (1.1�1.4 mm) and decrease in BFS (3.3�3.6 mm) and eyebrow height (1.7�3.4 mm) were observed. Revision rate of epicanthoplasty was 7.3. Mean satisfaction and scar scores were 97.1 and 5.4, respectively. Histopathologically, Asian and non-Asian medial upper eyelid skin was not significantly different. Conclusion: Anchor epicanthoplasty eliminated grade 2 and improved grade 3 EF with a high satisfaction and negligible scar. Simultaneous upper blepharoplasty significantly increased MRD1 and TPS and decreased eyebrow height. EF skin was not histologically different from non-Asians. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. © 2020, Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery

Smoking and worsening disability in multiple sclerosis: A meta-analysis

Objectives: Multiple sclerosis (MS) is a chronic demyelinating disorder affecting young adults. Environmental factors and lifestyle behaviors are pivotal in MS pathophysiology. Smoking has been considered as an important risk factor in MS. Various recent studies have been conducted to measure the role of smoking on worsening disability in patients with MS, thus we intended to systematically assess effect of smoking on evolution of disability in this study. Materials & methods: We queried MEDLINE, EMBASE and Cochrane Library with following keywords �Multiple Sclerosis, Smoking, Tobacco Use, Disability� on December 1st 2016. Original articles were included when smoking history was mentioned, disability was measured via expanded disability status scale (EDSS) or multiple sclerosis severity score (MSSS). Studies with insufficient outcome data, non-human, or in other languages than English were excluded. Results: Through literature review after duplicate removals, 268 articles were retrieved. A total of 56 articles were screened and 15 articles were assessed for eligibility, finally, eleven articles were included in this systematic review and meta-analysis. Ever smoking was significantly associated with increased EDSS (standardized mean difference (SMD) = 0.15, 95 CI = 0.01-0.28), but had no significant association with risk of reaching EDSS 4 (HR = 1.24, 95 CI = 0.89-1.72) or EDSS 6 (HR = 1.17, 95 CI = 0.88-1.57). Smoking had no effect on MSSS (SMD = 0.14, 95 CI = �0.04-0.32) or T2 lesion volume (SMD = 0.07, 95 CI = �0.08-0.22). Conclusions: This meta-analysis showed smoking increased EDSS, insignificant findings were possibly due to the small number of studies, significant differences in methodologies, and variations in reporting of disability outcomes. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Lt