Intra Corneal Cleft Secondary to Ocular Massage after Ahmed Valve Surgery

Purpose: To report a case of acute intra corneal cleft in a patient undergoing ocular massage following Ahmed valve implantation. Case Report: Acute intra corneal cleft occurred in a patient following the use of ocular massage to reduce IOP and bleb formation after Ahmed glaucoma valve insertion. Previous history of the patient was Fuchs heterochromic iridocyclitis without any report of trauma to his eye or any other ophthalmic disorders. The slit lamp examination revealed huge localized corneal bulla formation with a diameter of 3 mm in the superior mid peripheral corneal region in the right eye just after ocular massage, which persisted in the 6 months of follow up. Conclusion: Digital ocular massage might cause the occurrence of intra corneal cleft. Although this might be a very rare complication, we should consider it as an adverse effect of ocular massage.Keywords: Glaucoma; Cornea; Cleft; Massage

Cataract Risk Factors in Yazd Province, Iran

Purpose: to determine the probable cataract risk factors in Yazd province, Iran.Patients and Methods: In this cross-sectional study all patients over 40 years old undergoing cataract surgery in Shahid Sadoughi hospital, Yazd, Iran, from January to September 2016 were evaluated. A checklist was filled for all patients including information about their sex, age, weight, height, place of living (city or village), being native or non-native of Yazd, type of job, the level of household income, level of education, smoking habits, drug usage, as well as a history of related diseases such as high blood pressure, diabetes mellitus, glaucoma, rheumatism, kidney, and heart diseases. Results: Two hundred and fifty four patients (45.8%) had income of less than 6,000,000 Rials per month, 270 (48.6%) had income of between 6000000 and 10,000,000 Rials per month and the rest of patients (5.6%) had an income of over 10,000,000 Rials per month. Regarding the education level 512 patients (92.3%) had less than high school diploma, 38 (6.8%) had high school diploma and 5 patients had university education. Eighteen patients (3.2%) had a history of glaucoma. From 437 patients who their BMI was recorded 4.8% had a BMI of under 18, 49.7% had a BMI of between 18 and 25 and 45.5% had a BMI of over 25. Conclusion: Our study suggests a relationship between the income land education level as well as BMI and the prevalence of cataract among patients in Yazd province, Iran. Future case control trials, with higher number of participants, are recommended.Keywords: Cataract; risk factor; Yazd; Iran

Anterior Uveitis after Subconjunctival Injection of Mitomycin C in a Patient with Previous Trabeculectomy

Objective: To report a case of anterior uveitis after subconjunctival mitomycin C injection in a patient with a history of trabeculectomy. Case Report: A 45 year old patient, with anterior uveitis in his right eye after postoperative injection of mitomycin C one month after trabeculectomy, was treated in Basir eye clinic, Tehran, Iran. The Patient had no history of previous ocular infection. Topical prednisolone and tropicamide drops were effective in improving vision and reducing pain in our case.Conclusion: Anterior uveitis might happen after trabeculectomy surgery; however, in our case, it was more likely the result of mitomycin C administration one month after trabeculectomy. This should be considered as a differential diagnosis of postoperative bleb infections. Keywords: Uveitis; Mitomycin C; Trabeculectomy

Association of Meibomian Gland Dysfunction Severity and Glycohemoglobin Levels in Type 2 Diabetic Patients

Purpose: To investigate the association of meibomian gland dysfunction severity and glycated hemoglobin A (HbA1c) levels among type 2 diabetic patients. Patients and Methods: In this cross-sectional, 40 type 2 diabetic patients with meibomian gland dysfunction (MGD) were studied at Basir Eye Clinic, Tehran, Iran. An expert ophthalmologist determined the MGD stage based on staging scale outlined in American academy of ophthalmology's basic and clinical science course. The HbA1c level was measured applying a standard method, certified by the National Glycohemoglobin Standardization Program (NGSP). We divided patients to two groups based on their HbA1C level; the first group included patients with HbA1c < 6.5 % and the second group included patients with HbA1c ≥ 6.5  %.Results: Our results demonstrated that 12.5 % of the participants had minimal, 52.5 % had mild and 35 % had moderate to severe MGD. We observed that different levels of HbA1c (over or under 6.5 %) were significantly associated with MGD severity (P < 0. 013). Moderate to severe MGD stage was observed in 43.7 % of individuals with HbA1c ≥ 6.5 %, while it was found in none of participants with HbA1c < 6.5 %. With increase in HbA1c level, the risk of moderate to severe MGD occurrence increased (OR = 3.57; 95 % CI: 1.05-12.13; P = 0.041). This association was not confounded by age or gender.   Conclusion: Meibomian gland dysfunction severity has an association with HbA1c levels in diabetic type 2 patients, and a rise in HbA1c noticeably aggravates the MGD stage.Keywords: Glycated hemoglobin A; Meibomian gland dysfunction; Diabetes mellitus; Dry eye syndromes; Diabetes

Laser in Situ Keratomileusis Outcomes among Myopic and Myopic Astigmatism Patients with Thin Cornea

Purpose:To evaluate refractive results after laser in situ keratomileusis among patients with thin corneas.Patients and Methods: Three hundred and two eyes from 168 patients with thin corneas undergoing laser in situ keratomileusis in Basir Eye Clinic, Tehran, Iran, were retrospectively studied. We included patients with best corrected visual acuity of better than 6/12, age of more than 18 years, and corneal thickness of less than 499 μm.Results: The mean age of patients was 30.7 ± 8.6 years and the mean preoperative spherical equivalent was - 4.61 ± 2.37 D. The results after at least one year of follow-up were as follow: 86.6 % of patients with low myopia, 71.8 % of patients with mild myopia, 50.0 % of patients with moderate myopia and 51.8 % of patients with high myopia achieved a ± 0.5 D spherical equivalent postoperatively. General linear model indicated a significant effect for the remaining stromal bed on final uncorrected visual acuity after adjustment for age, sex, and degree of myopia. No important complication occurred.Conclusion: No important complications occurred after laser in situ keratomileusis among myopic patients with corneal thickness of less than 499 μm, and most of the patients achieved satisfactory refractive results.Keywords: Laser in Situ Keratomileusis; outcome; myopia; thin cornea; Iran

Effect of mitomycin-C on corneal endothelial cell parameters after refractive surface ablation procedures

Background: The effect of mitomycin-C (MMC) on the reduction of endothelial cell count in the cornea remains controversial. We aimed to evaluate the effect of MMC on corneal endothelial cell parameters after refractive surface ablation procedures, including photorefractive keratectomy (PRK) and laser epithelial keratomileusis (LASEK). Methods: In this interventional, comparative, follow-up study, 342 eyes of 171 patients were followed up for 6 months. Patients undergoing PRK or LASEK were included and were divided into two groups: group one (188 eyes of 94 patients) with an ablation depth of ? 65 µm and who received intraoperative 0.02% MMC for 30 s, and group two (154 eyes of 77 patients) with an ablation depth of < 65 µm and who received balanced salt solution for 30 s. Changes in endothelial cell density (ECD), central corneal thickness (CCT), coefficient of variation (CV), and hexagonality values were compared between the groups at 3 and 6 months after surgery. Results: The mean ± standard deviaiton (SD) age of the patients was 28.11 ± 6.56 years. The mean ± SD ECD did not change significantly in either group between the baseline and at 3 and 6 months postoperatively. The baseline mean ECD was significantly higher in group one than that in group two (P < 0.001) and remained so at 3 (P = 0.002) and 6 months (P = 0.022) postoperatively. The baseline hexagonality value was lower in group one (P = 0.173), with a gradual decrease during the postoperative follow-up as compared with that in group two (P = 0.016 and 0.001 at 3 and 6 months postoperatively, respectively). Group one had a significantly lower CCT at 3 and 6 months postoperatively (both P < 0.001) and a higher mean CV (3 months: P = 0.028; 6 months: P = 0.328). Conclusions: A single intraoperative application of MMC for 30 s as prophylaxis for corneal haze development during refractive surface ablation procedures had no significant effect on ECD up to 6 months postoperatively. Future studies with a contralateral-eye design (to neutralize factors specific to the individual patient), a larger sample size, and longer follow-up are necessary to confirm or disprove our observations

Organoids and organ chips in ophthalmology

Recent advances have driven the development of stem cell-derived, self-organizing, three-dimensional miniature organs, termed organoids, which mimic different eye tissues including the retina, cornea, and lens. Organoids and engineered microfluidic organ-on-chips (organ chips) are transformative technologies that show promise in simulating the architectural and functional complexity of native organs. Accordingly, they enable exploration of facets of human disease and development not accurately recapitulated by animal models. Together, these technologies will increase our understanding of the basic physiology of different eye structures, enable

Keratorefractive Surgery Outcomes in Keratoconus Suspect Patients

Purpose. To examine the outcomes of keratorefractive surgeries in keratoconus suspect patients. Methods. This study included 192 keratoconus suspects (351 eyes), treated with photorefractive keratectomy (PRK) (211 eyes), Lasik (96 eyes), and Femto-Lasik (44 eyes) surgeries in an eye clinic. The best spectacle-corrected visual acuity (BSCVA) and subjective refraction were evaluated preoperatively and postoperatively (three months and five years after the procedure). The Orbscan II topography system was also used preoperatively and five years after the procedure. Results. The patients’ mean age was 31.6 ± 5.49 years (range: 21–47 years) in the last follow-up. There was no significant difference between the preoperative and postoperative mean values of BSCVA in any of the surgical methods (P = 0.49). The mean spherical equivalent, cylindrical power, corneal curvature, the thinnest corneal thickness, and the central corneal thickness decreased significantly in the last follow-up (P < 0.001). Four patients (3.50%) in the PRK group and one patient (1.85%) in the Lasik group needed glasses in the last follow-up. Eleven cases of corneal ectasia were detected in the last follow-up (six eyes of four patients [2.84%] and five eyes of four patients [5.20%] in the PRK and Lasik groups, respectively). Conclusion. In the present study, the high risk of postoperative ectasia was detected in keratoconus suspects following PRK and Lasik surgeries. According to the results, it can be concluded that Femto-Lasik surgery provides better outcomes than Lasik and PRK. Overall, the surgical criteria are suggested to be evaluated case by case, and the patients must be followed up over time to assess the corneal topography and refraction stability

Comparing A-Mode Biometry, B-Mode Biometry and IOL Master in Measurement of Axial Length : Phaco

Background: To perform a comparison of axial length (AL) measurements using A-mode biometry, B-mode biometry and IOL Master.Material and Methods: Axial length among patients undergoing cataract surgery in Basir Eye Clinic, Tehran, Iran from May 2017 and September 2017 was determined pre-operatively using three methods. Axial length was first measured using IOLMaster 500 (Carl Zeiss Meditec, Jena, Germany), then by A-mode biometry using immersion technique and finally using horizontal axial B-scan immersion biometry. The interval between each examination was 5 minutes.Results: Statistical analysis revealed strong correlations between AL measurement values obtained from A-mode and B-mode (r = 0.983, p &lt; 0.001), A mode and IOLMaster (r = 0.999, p &lt; 0.001) as well as B-mode and IOLMaster (r = 0.984, p &lt;0.001). All correlations were strong but the strongest correlation was observed between A mode and IOLMaster methods.Conclusion: A-mode biometry showed a stronger correlation with IOL Master AL readings compared to B-Mode, thus when there are limited resources and the optical method is not accessible, A-mode immersion echography is proffered as an alternative to IOLMaster.Keywords: Biometry; IOLMaster; Axial Length; Comparison