Intraocular lens power calculation in keratoconus; a review of literature

Purpose: To review the published literature regarding cataract surgery in keratoconus (KCN) patients with emphasis on challenges encountered during intraocular lens (IOL) power calculation and their solutions. Methods: A literature review was performed to investigate all the relevant articles on the advancements of IOL calculations in KCN patients. Results: Cataract surgery in keratoconic eyes can improve patients' refraction, and proper patient selection and IOL calculation methods are necessary to get the best results. The main problem in KCN patients is unreliable biometric measurements. It is more difficult to make conclusions in more advanced keratoconic corneas, as the steep keratometric values in these eyes will result in the selection of a low-power IOL. Presence of a low-power IOL will yield in extreme postoperative hyperopia, and IOL exchange might be mandatory. In cases in which keratoplasty may be needed in the future, contact lens fitting can help surgeons make a better decision preoperatively. Axial length (AL) measurements may have better repeatability and reproducibility than keratometry (K) readings in keratoconic eyes. SRK II formula may provide the most accurate IOL power in mild KCN. There is still not a comprehensive consensus of which formula is the best one in moderate and severe KCN, as the literature is limited in this subject. Conclusions: Various methods of IOL power calculation optimization and recommendations may hold the key to improve surgical outcomes in keratoconic eyes. There are multiple sources of biometric error in KCN patients, hence IOL calculation methods may not be as efficient as expected in these eyes. © 2019 Iranian Society of Ophthalmolog

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

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

Evaluation of right ventricular function and various models of delayed enhancement with cardiac magnetic resonance imaging in patients with repaired tetralogy of fallot

Background: Tetralogy of Fallot (TOF) is considered as the most frequent cyanotic congenital heart disorder. Right ventricular (RV) dysfunction is possible to be observed in patients with repaired TOF. Delayed enhancement (DE) is one of the recommended findings for RV dysfunction. Objectives: This study aimed at investigating the DE and its probable relationship with RV function through cardiac magnetic resonance (CMR). Patients and Methods: In this cross-sectional study, the values of cardiovascular magnetic resonance of 110 symptomatic patients, who had repaired TOF for 35 years, were gathered. We compared cardiac function indices (CFI) in patients with and without DE. Results: The patients had an average age of 21.93 ± 6.94 years (59.12 were male and 40.94 were female). 93.66 of the subjects showed DE and 6.44 of them did not have DE. 78.61 of the samples had DE of the right ventricular outflow tract (RVOT); whereas, 21.39 showed DE of the other sites. The differences between mean regurgitation fraction, average RV end-diastolic volume (RVEDV), average RV end systolic volume (ESV), and average RV ejection fraction in DE positive and negative patients were statistically significant (P values = 0.01, 0.04, 0.04, and 0.01, respectively.) Conclusion: DE commonly occurs as a complication of surgery to repair TOF and could be used as a factor for impaired RV function and other complications. Using CMR imaging for follow up of these patients could lead to diagnosis of these complications. © 2020, Iranian Journal of Radiology. T

Effects of fasting on peripapillary capillary density, peripapillary nerve fiber layer, intraocular pressure and central corneal thickness

Purpose: To investigate the effects of fasting on intraocular pressure (IOP), central corneal thickness (CCT), radial peripapillary capillary (RPC) density and retinal nerve fiber layer (RNFL) thickness during Islamic fasting month of Ramadan. Methods: Twenty-seven healthy fasting volunteers were enrolled. All subjects underwent full ophthalmic examination and optical coherence tomography angiography (OCTA) of both eyes. All measurements were recorded first in the morning (8:00�10:00 a.m.) and then in the evening (4:00�6:00 p.m.). The first visit was performed during the second and third week of Ramadan and then two months later in a nonfasting routine day. Results: Mean age of participants was 40.07 ± 9.29 years. A significant decrease was found for evening IOP (11.17 ± 2.29 mmHg) in comparison with morning IOP (12.00 ± 2.28) (p = 0.00) only on fasting days. A decrease was observed for CCT both on fasting (6 μm) and nonfasting days (3 μm) (p = 0.00 and p = 0.02, respectively) in the evening. There was a significant increase in whole and peripapillary RPC density () on fasting days (48.79 ± 3.08 morning, 49.72 ± 2.85 evening for whole and 50.57 ± 4.06 morning, 51.64 ± 3.71 evening for peripapillary) (p = 0.00). Average RNFL thickness was decreased from morning to evening both on fasting days (0.80 μm) and nonfasting days (1.25 μm) (p = 0.00). Optic nerve head (ONH) vertical cup/disc (C/D) ratio was greater on fasting days (0.30 ± 0.25 morning, 0.31 ± 0.24 evening) in comparison with nonfasting days (0.27 ± 0.25 morning, 0.28 ± 0.25 evening) (p = 0.02). Conclusion: Fasting decreases the IOP and CCT in healthy subjects. OCTA revealed significant difference in RPC vessel density, RNFL thickness and ONH vertical C/D ratio during fasting hours in comparison with nonfasting days. © 2020, Springer Nature B.V

Ru-106 plaque radiotherapy for vasoproliferative tumors of retina: a 15-year single-center experience

Purpose: This study evaluates the outcomes of ruthenium-106 (Ru-106) plaque brachytherapy for vasoproliferative tumors (VPTs) of the ocular fundus in a single referral ocular oncology center. Methods: The clinical charts of all patients diagnosed with VPT who underwent plaque radiotherapy from 2002 to 2017 were reviewed. Clinical features, types of treatment, outcomes and complications were evaluated. Results: Of 46 patients with VPT diagnosis in our ocular oncology clinic, 25 (54.34) cases were treated with Ru-106 plaque brachytherapy. Eleven patients (44) were male, and the mean age at the time of diagnosis was 40.92 ± 13.11 years. The mean follow-up time was 47.56 ± 36.87 months. Inferotemporal quadrant was the most common site of the tumor (64.00). The mean delivered apex and scleral dose was 101.56 ± 6.51 and 412.26 ± 113.66 Gray (Gy), respectively. Initial tumor length, width and thickness were 10.26 ± 3.42, 8.05 ± 2.83 and 4.27 ± 1.10 mm, respectively. The mean tumor thickness decreased to 2.60 ± 0.63 mm, postoperatively. Complete resolution of subretinal fluid around the tumor was achieved in 81.80 of cases. Visual acuity was more than 20/400 in 64 of patients before treatment and 60 of patients at last follow-up. Conclusion: Our study showed that Ru-106 plaque radiotherapy is an effective and safe method of treatment in VPTs. © 2020, Springer Nature B.V