Management of retinal vein occlusion, who is responsible?

Retinal vein occlusion (RVO) is a common retinal vascular occlusive disorder and is associated with a variety of systemic risk factors. The aim of this study was to investigate whether the underlying diseases were evaluated and managed appropriately by ophthalmologists. We performed a study of 1344 patients with retinal vein occlusion (RVO). Patients were evaluated with a questionnaire including ten closed questions to determine whether ophthalmologists evaluated and informed their patients about the underlying systemic diseases. None of the patients� homocysteine levels were measured. Only a small percentage of the patients were asked about the history of thrombotic diseases or family history of thrombotic diseases. We believe that most ophthalmologists are still not entirely convinced of their responsibility of managing the underlying predisposing factors of RVO. Ophthalmologists should either manage or engage other healthcare providers in the management of RVO to guarantee the patient the best care. © 2016 Tehran University of Medical Sciences. All rights reserved

The distribution of corneal thickness in rural population

To determine the distribution of corneal thickness and its associated factors in the over 5-year-old population in the north and south rural areas in Iran. In this study, samples were selected using multi -stage cluster sampling. After vision and refraction tests and the slit lamp exam, the central corneal thickness (CCT), apical corneal thickness (ACT), and the thickness at four peripheral areas of the cornea were measured using Pentacam. Of the 3851 selected samples, after applying the exclusion criteria, the analysis was done on data from 2681 people. The mean age of the participants was 36.03±18.51 years, ranging from 6 to 90 years, and 58.1 of them were female. Mean CCT and ACT were 533.87 μm (95CI: 532.05 -535.69) and 536.72 μm (95CI: 534.9 -538.54), respectively. Mean peripheral corneal thickness was 637.46 μm (95CI: 635.09 -639.83) in the superior quadrant, and 594.34 μm (95CI: 592.2 -596.47), 620.81 μm (95CI: 618.66 -622.97), and 584.55 μm (95CI: 582.18 -586.93) in the inferior, nasal, and temporal quadrants, respectively. Linear regression analysis showed significant associations between CCT and gender (P=0.001), age (P<0.001), geographical location of residence (P<0.001), the radius of corneal curvature (P<0.001), anterior chamber depth (P<0.001), and corneal volume (P<0.001). This study is one of the few studies describing the distribution of the corneal thickness in a population of over 5-year-olds using Pentacam. Gender, anterior chamber depth, and corneal radius of curvature are some of the factors associated with CCT. © 2018 Tehran University of Medical Sciences. All rights reserved

Enantiomorphism and rule similarity in the astigmatism axes of fellow eyes: A population-based study Enantiomorfismo y similitud de la regla en los ejes del astigmatismo en ojos contralaterales: estudio poblacional

Purpose: To evaluate the relationship patterns between astigmatism axes of fellow eyes (rule similarity and symmetry) and to determine the prevalence of each pattern in the studied population. Methods: This population-based study was conducted in 2015 in Iran. All participants had tests for visual acuity, objective refraction, subjective refraction (if cooperative), and assessment of eye health at the slit-lamp. Axis symmetry was based on two different patterns: direct (equal axes) and mirror (mirror image symmetry) or enantiomorphism. Bilateral astigmatism was classified as isorule if fellow eyes had the same orientation (e.g. both eyes were with-the-rule) and as anisorule if otherwise. Results: Of the total cases of bilateral astigmatism, 80 were isorule, and in the studied population, the prevalence of isorule and anisorule astigmatism was 14.89 and 3.53, respectively. The prevalence of isorule increased with age (p 0.288). Both symmetry patterns reduced with age (p < 0.001). Among cases of bilateral astigmatism, 15.5 and 19.8 had exact direct and mirror symmetry, respectively. Conclusion: Bilateral astigmatism is mainly isorule in the population and anisorule astigmatism is rare. The enantiomorphism is the most common pattern in the population of bilateral astigmatism. © 2018 Spanish General Council of Optometr

Enantiomorphism and rule similarity in the astigmatism axes of fellow eyes: A population-based study Enantiomorfismo y similitud de la regla en los ejes del astigmatismo en ojos contralaterales: estudio poblacional

Purpose: To evaluate the relationship patterns between astigmatism axes of fellow eyes (rule similarity and symmetry) and to determine the prevalence of each pattern in the studied population. Methods: This population-based study was conducted in 2015 in Iran. All participants had tests for visual acuity, objective refraction, subjective refraction (if cooperative), and assessment of eye health at the slit-lamp. Axis symmetry was based on two different patterns: direct (equal axes) and mirror (mirror image symmetry) or enantiomorphism. Bilateral astigmatism was classified as isorule if fellow eyes had the same orientation (e.g. both eyes were with-the-rule) and as anisorule if otherwise. Results: Of the total cases of bilateral astigmatism, 80 were isorule, and in the studied population, the prevalence of isorule and anisorule astigmatism was 14.89 and 3.53, respectively. The prevalence of isorule increased with age (p 0.288). Both symmetry patterns reduced with age (p < 0.001). Among cases of bilateral astigmatism, 15.5 and 19.8 had exact direct and mirror symmetry, respectively. Conclusion: Bilateral astigmatism is mainly isorule in the population and anisorule astigmatism is rare. The enantiomorphism is the most common pattern in the population of bilateral astigmatism. © 2018 Spanish General Council of Optometr

Enantiomorphism and rule similarity in the astigmatism axes of fellow eyes: A population-based study Enantiomorfismo y similitud de la regla en los ejes del astigmatismo en ojos contralaterales: estudio poblacional

Purpose: To evaluate the relationship patterns between astigmatism axes of fellow eyes (rule similarity and symmetry) and to determine the prevalence of each pattern in the studied population. Methods: This population-based study was conducted in 2015 in Iran. All participants had tests for visual acuity, objective refraction, subjective refraction (if cooperative), and assessment of eye health at the slit-lamp. Axis symmetry was based on two different patterns: direct (equal axes) and mirror (mirror image symmetry) or enantiomorphism. Bilateral astigmatism was classified as isorule if fellow eyes had the same orientation (e.g. both eyes were with-the-rule) and as anisorule if otherwise. Results: Of the total cases of bilateral astigmatism, 80 were isorule, and in the studied population, the prevalence of isorule and anisorule astigmatism was 14.89 and 3.53, respectively. The prevalence of isorule increased with age (p 0.288). Both symmetry patterns reduced with age (p < 0.001). Among cases of bilateral astigmatism, 15.5 and 19.8 had exact direct and mirror symmetry, respectively. Conclusion: Bilateral astigmatism is mainly isorule in the population and anisorule astigmatism is rare. The enantiomorphism is the most common pattern in the population of bilateral astigmatism. © 2018 Spanish General Council of Optometr

Demographic profile, clinical, and topographic characteristics of keratoconus patients attending at a tertiary eye center

Purpose: To evaluate the demographic profile, clinical, and topographic characteristics of keratoconus (KCN) patients attending at a subspecialty eye hospital in Tehran, Iran. Methods: In this cross-sectional study, all patients who attended Noor Eye Hospital between March 2011 and March 2017 and had a diagnosis of KCN were identified, and the required number of patients was randomly selected. The following data were extracted from patient's records: age, sex, visual acuity, refraction, keratometry, pachymetry, and treatment procedures. The data of KCN laterality, severity, morphology, and cone location were also extracted by analyzing the corneal imaging maps. Results: The records of 1080 eyes of 540 patients were evaluated. The mean age of the participants was 31.04 ± 8.54 years (range, 13�63 years), and 69.3 of the patients were male. The highest and lowest frequency of KCN was seen in the age group 20�30 years and above 50 years, respectively. Bilateral KCN was detected in 93.3 95% confidence interval (CI): 91.68�94.75 of the subjects. 43.7% (95%CI: 32.88�54.48), 55.6% (95%CI: 44.73�66.38), and 0.8% (95%CI: 0.75�0.78) of the cases had nipple, oval, and globus cones, respectively. The cone was central in 52.1% (95%CI: 41.10�63.11), paracentral in 43.6% (95%CI: 36.13�51.04), and peripheral in 4.3% (95%CI: 00.76�7.86) of the cases. The frequency percentage of KCN according to severity was 15.2% (95%CI: 13.09�17.46), 56.4% (95%CI: 53.37�59.37), and 28.4% (95%CI: 25.75�31.21) for mild, moderate, and severe KCN, respectively. Among different parameters, only cone location had a significant association with age as the frequency of paracentral and peripheral cones increased with ageing (P = 0.002). Conclusions: The mean age of KCN patients in our study was higher than similar studies in other Asian countries. KCN was bilateral in most cases with an oval morphology and central cone location. Most of the patients had moderate to severe KCN. © 2019 Iranian Society of Ophthalmolog

Duration of topical steroid application after photorefractive keratectomy with mitomycin C

Contradictory results of postoperative steroid application in photorefractive keratectomy (PRK) led to a meta-analysis of the existing data to achieve a definite conclusion on the optimum dosage and duration of corticosteroid therapy after PRK. The overall pooled unstandardized mean difference (PUMD) of the corneal haze score was -0.20 (95 CI, -0.29 to -0.12). In subgroup analysis, the PUMD of the corneal haze score was statistically significant in 2 subgroups, -0.57 (-0.85 to -0.30) for 3 to 6 months postoperatively and -0.13 (-0.23 to -0.04) for � 3 months postoperatively. Analysis of the PUMD of postoperative spherical equivalent in participants with low to moderate myopia (�-6.00 D) and high myopia (<-6.00 D) showed positive effects of steroids on prevention of myopia regression. In conclusion, long-term topical steroid application after PRK seems unnecessary in low and moderate myopia. New randomized clinical trials using current technologies are recommended for postoperative treatments. © 2020 Elsevier Inc.. All rights reserved

The distribution of near point of convergence in an Iranian rural population: A population-based cross-sectional study

Objective: To determine the distribution of near point of convergence (NPC) according to age, sex, and refractive error in a rural population above 1 year of age in 2015. Methods: In this population-based cross-sectional study, multistage cluster sampling was applied to randomly select two underserved areas from the north and southwest of Iran and all individuals above 1 year living in these areas were invited to participate in the study. All participants underwent ocular examinations including visual acuity measurement, refraction, binocular vision testing including cover test and measurement of NPC, and slit lamp biomicroscopy. Results: Of 3851 who were invited, 3314 participated in the study (response rate: 86.5). The NPC was 8.42 ± 2.94 cm in the whole population, 8.59 ± 3.07 cm in men, and 8.30 ± 2.84 cm in women. Subjects above 70 years of age had the most remote NPC (mean: 10.44 ± 3.07 cm). The mean NPC was 7.79 ± 2.93, 8.83 ± 2.72, and 9.63 ± 2.70 cm in emmetropic, myopic, and hyperopic participants, respectively. According to the results of a multiple linear regression model, NPC had a positive correlation with age (b: 0.058, p < 0.001), male sex (b: 0.336, p: 0.005), and hyperopia (b: 0.044, p: 0.011). Among the evaluated variables, age had the greatest effect on NPC (Standardized coefficient: 0.402). Conclusion: The distribution of NPC in the Iranian population is different from other populations. Since NPC is influenced by age more than any other variable and presented normal values according to age in this study, the results can be used to interpret clinical measurements for diagnosis and treatment purposes. © 2019 The Author

The prevalence of ptosis and nystagmus in rural population

Purpose: To determine the prevalence of ptosis and nystagmus in the general rural population in Iran. Methods: Two villages were selected from the north and southwest of Iran using a multi-stage cluster sampling approach. After selection of the participants and inviting them to a complete eye exam, they all had vision tests and an ophthalmic examination. Vision tests included measurement of visual acuity, refraction, and the cover test. Then the slit-lamp exam was performed, and the diagnosis of ptosis and nystagmus was determined by an ophthalmologist. Results: Of the 3851 invitees, 3314 people participated in the study. The prevalence of ptosis in this study was 2.23 95% confidence interval (CI): 1.73-2.74, and 45.3% of the cases were bilateral ptosis. The prevalence of ptosis was lowest in the 21-30 year (0.2%) and the under 5 year (0.8%) age groups, and the highest prevalence was observed in people over 70 years of age (6.7%) (P < 0.001). The prevalence of ptosis was higher in illiterate people than those with an academic education level (P = 0.012). The prevalence of astigmatism was 62.8% in those with ptosis and 34.2% in those without ptosis (P < 0.001). The prevalence of nystagmus was 0.39% (13 cases). Conclusions: This study found that the prevalence of ptosis is relatively high in the general rural population in Iran, and the prevalence increases with age. Astigmatism is significantly high among cases with ptosis, and its prevalence has an inverse relation with the level of education. Nystagmus also had a high prevalence in this population. © 2020 Journal of Current Ophthalmology | Published by Wolters Kluwer-Medknow

Endophthalmitis caused by Acinetobacter spp. as the presenting manifestation of diabetes mellitus

Purpose We describe a patient with endogenous endophthalmitis caused by Acinetobacter spp. as the first clinical presentation of diabetes mellitus. Method A 48-year-old otherwise healthy woman was referred with signs and symptoms of acute endophthalmitis in the left eye. Systemic work-up, vitreous tap, and intravitreal antibiotic injection were performed followed by pars plana vitrectomy. Results The laboratory tests confirmed the diagnosis of diabetes mellitus. Vitreous culture was positive for Acinetobacter spp., and the organism was sensitive to colistin. One month after surgery, vision was no light perception, and the eye was phthisical. Conclusion Diagnostic work-up should be performed even in otherwise healthy patients with endogenous endophthalmitis. © 2016 Iranian Society of Ophthalmolog