Visual outcomes of topography-guided excimer laser surgery for treatment of patients with irregular astigmatism

The aim of this study was to evaluate the efficacy, safety, and predictability of topography-guided treatments to enhance refractive status following other corneal surgical procedures. In a prospective case series study, 28 consecutive eyes of 26 patients with irregular astigmatism after radial keratotomy, corneal transplant, small hyperopic and myopic excimer laser optical zones, and corneal scars were operated. Laser-assisted in situ keratomileusis (LASIK) (n = 8) and photorefractive keratectomy (PRK) (n = 20) were performed using the ALLEGRETTO WAVE excimer laser and topography-guided customized ablation treatment software. Preoperative and postoperative uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), manifest and cycloplegic refraction, and corneal topography with asphericity were analyzed in 12 months follow-up. Uncorrected visual acuity (UCVA) changed from 0.2 +/- 0.2 or (20/100 +/- 20/100) to 0.51 +/- 0.31 or (20/40 +/- 20/60) in the LASIK group (P = 0.01) and from 0.34 +/- 0.16 or (20/60 +/- 20/120) to 0.5 +/- 0.23 or (20/40 +/- 20/80) in the PRK group (P = 0.01). Refractive cylinder decreased from -3.2 +/- 0.84 diopters (D) to -2.06 +/- 0.42 D in the LASIK group (P = 0.07) and from -2.25 +/- 0.39 D to -1.5 +/- 0.23 D in the PRK group (P = 0.008). Best corrected visual acuity did not change significantly in either group. Topography-guided treatment is effective in correcting the irregular astigmatism after refractive surgery. Topography-guided PRK can significantly reduce irregular astigmatism and increase the UCVA and BCVA

Visual outcomes of Femto-LASIK for correction of residual refractive error after corneal graft

To evaluate the outcomes of the Femto-LASIK method in the treatment of refractive errors following penetrating keratoplasty (PK) at the Persian Eye Clinic, Isfahan, Iran In a prospective, non-comparative case series, 34 consecutive symptomatic eyes of 34 patients after corneal graft, were operated on. Tissue-saving (TS) Femto-LASIK (n = 16), and Zyoptix Personalized Treatment Advanced (PTA) Femto-LASIK (n = 18) were performed using the Bausch & Lomb Technolas 217z excimer laser and Zyoptic algorithm. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), manifest refraction, contrast sensitivity, and HOAs were evaluated preoperatively and 12 months after enhancement treatment. At 12 months, the mean preoperative myopic spherical equivalent refraction (SE) decreased from -6.50 +/- 2.8 D to -1.6 +/- 1.8 D, and mean hyperopic SE from +3.2 +/- 2.20 D to 0.37 +/- 1.2 D. The safety index was 1.42 (1.2 in the TS group and 1.5 in the PTA group). In the TS group, 100 % of eyes achieved 20/80 or better UCVA and 50 %, 20/40 or better and in the PTA group, 100 % of eyes achieved 20/80 or better UCVA and 77.7 %, 20/40 or better. The efficacy index was 1.08 (0.9 in TS group and 1.21 in the PTA group). Patients obtained statistically significant lower values of root mean square (RMS) of HOAs with spherical aberrations (p < 0.05). Femto-LASIK method with Zyoptic programs after PK was safe, effective, and predictable for correction of spherical and cylindrical components of the refractive error

Clinical manifestation and prognosis of active ocular toxoplasmosis in Iran

Toxoplasmosis is the most common cause of posterior uveitis in the world. This study described the clinical characteristics and visual outcome of 193 patients with ocular toxoplasmosis at Feiz Hospital (Isfahan, Iran) during the last six years. The setting and design used was a retrospective non-comparative observational case series. In this study, 193 patients with ocular toxoplasmosis (111 female, 82 male) were enrolled. The distribution of symptoms and fundoscopic findings were studied. The most-reported chief complaint was blurred vision in 96 (184 patients) and floaters in 13.47 (25 patients) of cases and most frequent clinical manifestations were chorioretinitis 98.48 (190 patients), macular scars 50.7 (98 patients), and atrophic optic papilla two (1.03 ) patients. Primary retinal lesions were observed in 16 (8.2 ) and combination of active lesions and old retinochoroidal scars in 177 (91.7 ) of the patients. Retinal detachment occurred in 11 (5.69 ) patients. Bilateral involvement was found in 27 of patients. Blindness was 0.05 after treatment. Recurrence rate was 14.5 . In conclusion, ocular toxoplasmosis substantially varies among patients with different age, gender, site of lesion and other factors. Suddenly blurred vision, floater, and pain could be caused by Toxoplasma gondii. Flashing, may necessitate a more precise peripheral fundus examination. © 2012 Springer Science+Business Media B.V

Effect of iris registration on outcomes of FEMTOLASIK for myopia and myopic astigmatism.

PURPOSE To compare the visual and refractive outcomes after FEMTOLASIK with and without iris registration. METHODS In this randomized, prospective, comparative, contralateral eye study, 118 eyes of 59 patients with myopia and myopic astigmatism underwent LASIK using the Femto LDV femtosecond laser (160 µm) and the MEL80 with or without iris registration. For each patient, iris registration FEMTOLASIK was performed on one eye and non-iris registration FEMTOLASIK was performed on the other eye, assigned at random. Patients were evaluated before and 12 months. Uncorrected visual acuity, best-corrected visual acuity, manifest refraction, contrast sensitivity, and higher-order aberrations (HOAs) were evaluated. RESULTS At 12 months, the mean UDVA was 0.002 ± 0.07 logMAR (20/19) in iris registration eyes and 0.00 ± 0.06 logMAR (20/24) in non-iris registration eyes (P = 0.9). 61% of iris registration eyes and 71.2% of non-iris registration eyes achieved a UDVA of 20/20 or better (P = 0.31); 98.3% of eyes with the iris registration FEMTOLASIK and 94.9% with the non-iris registration FEMTOLASIK were within ±0.50 D from emmetropia (P = 0.71). No statistically significant difference was found in postoperative contrast sensitivity between groups at 3, 6, 12, or 18 cycles/degree (P > 0.05). There was significant increase in total HOA root mean square in two groups. The mean error magnitude of surgically induced astigmatism 12 months postoperatively was -0.33 in iris registration eyes and -0.24 in the non-iris registration eyes (P = 0.36). CONCLUSIONS FEMTOLASIK with and without iris registration provides similar results in myopic and myopic astigmatism patients

Intravitreal vascular endothelial growth factor (VEGF) inhibitor injection in unrecognised early pregnancy

The use of intravitreal vascular endothelial growth factor (VEGF) inhibitor medications has widened considerably to include indications affecting females of reproductive age. Our patient was inadvertently exposed to bevacizumab within the first trimester when placental growth and fetal organogenesis take place and patient suffered pregnancy loss. There is insufficient information to suggest that such use is safe, nor is there definitive evidence to suggest that it causes harm. We advise that ophthalmologists discuss pregnancy with women of childbearing age undergoing intraocular anti-VEGF injections and in pregnant woman counselling is needed to explain the potential risks and benefits

Postlaminectomy lumbar pseudomeningocele with nerve root entrapment: a case report with review of literature

Pseudomeningocele is a rare but well-recognized complication of lumbar surgery. Most of the patients tolerate the presence of the cyst well, however, some present with back pain and spinal claudication, presumably due to neural compression. We report a case who presented with radicular symptoms and signs after disk surgery. The cause of his pain was nerve root herniation into large pseudomeningocele. The diagnosis was made by magnetic resonance imaging. The patient underwent surgery for the pseudomeningocele with reduction in the nerve root into the dural canal and primary closure of the dural defect. Postoperative results were gratifying

Anti-vascular Endothelial Growth Factor for Choroidal Neovascularization Associated with Toxoplasmosis: A Case Series

The purpose of the study was to evaluate the efficacy and safety of intravitreal anti-vascular endothelial growth factor (anti-VEGF) in treatment of choroidal neovascularization (CNV) secondary to toxoplasmic retinochoroiditis in five patients. After six months the CNV resolved as confirmed by fluorescein angiography and optical coherence tomography (OCT) in all patients. The visual acuity improved from mean 20/400 to 20/80 and Central Macular Thickness (CMT) decreased from 390 μm to 253 μm, which was maintained till the last follow-up visit

Association of invasive breast carcinoma and multicentric high grade astrocytoma: a case report with a review.

Breast cancer is the most common cancer in women. Multicentric gliomas are uncommon lesions of the central nervous system (CNS) with an unprecise rate of occurrence that diffusely infiltrate large portions of the brain. High grade astrocytoma is the most agressive form of gliomas and often has a distinct neuroimaging pattern with a poor prognosis. We report a case of a 29-year-old woman patient with primary breast carcinoma and high grade astrocytoma subsequently developed. The woman was treated by mastectomy and 20 months post-diagnosis of the cancer she exhibited a transient facial paralysis. Magnetic resonance imaging (MRI) revealed two cranial masses suspicious of metastasis. A complete tumor removal from the brain was performed. On histological examination, this tumor was a high grade astrocytoma

Intravitreal vascular endothelial growth factor (VEGF) inhibitor injection in patient during pregnancy

Purpose: To report the clinical course of a woman treated with intravitreal bevacizumab during pregnancy. Case report: A 27-year-old female with poorly controlled diabetes and a history of two previous miscarriage was referred to our hospital with sudden deterioration in visual acuity (VA) in her right eye. Ocular findings revealed severe Proliferative Diabetic Retinopathy (PDR) complicated with preretinal hemorrhages in her right eye, and after maximal Panretinal Photocoagulation (PRP) bilaterally, she was treated with intravitreal injection of bevacizumab (IVB) into the right eye. Twenty four hours after the bevacizumab injection, she reported vaginal bleeding, and ultrasound confirmed a 12-week pregnancy of which the patient was unaware. The patient suffered from pregnancy loss. Conclusion: Use of intravitreal anti-VEGF by pregnant woman may only be justified if the potential benefit outweighs the potential risk to the fetus and only if clearly needed. Intravitreal bevacizumab during pregnancy in women with a history of miscarriage should be used with caution

Multivariable analysis of clinical and laboratory data manifestations predicting severity and mortality risk in patients with Coronavirus disease 2019 in the mountainous west of Iran: a retrospective single-center study

Background Few reports have addressed the clinical and laboratory features of patients with coronavirus disease-2019 (COVID-19) in mountainous areas, especially in Iran. Objectives To report the clinical and laboratory data and manifestations predicting mortality of patients with COVID-19 in the west of Iran. Methods We conducted a retrospective cohort study of 286 patients hospitalized with COVID-19 between 25 February 2020 and 12 May 2020 to describe their clinical symptoms and laboratory test findings when they were admitted at the Hajar Hospital affiliated with the Shahrekord University of Medical Sciences, and a multivariable analysis of factors that predict their disease severity and mortality. Results After hospital admission, 18 patients died and 268 were discharged. Older age [odds ratio (OR) = 1.02, 95% confidence interval (CI) = 1.01-1.04, P = 0.001], presence of underlying diseases (OR = 1.86, 95% CI = 1.01-3.45, P = 0.04), elevated hematocrit (OR = 1.08, 95% CI = 1.03-1.13, P = 0.002), and increase in red blood cell distribution width (RDW) coefficient of variation (OR = 1.18, 95% CI = 1.02-1.36, P = 0.02) were significantly associated with disease severity. Older age (OR = 1.00, 95% CI = 1.00-1.07, P = 0.03), hypocalcemia (OR = 0.20, 95% CI = 0.09-0.58, P = 0.002), hypophosphatemia (OR = 0.50, 95% CI = 0.26-1.02, P = 0.04), and increase in platelet-larger cell ratio (P-LCR; OR = 1.10, 95% CI = 1.00-1.15, P = 0.04) were significantly associated with mortality. The areas under the receiver operating characteristic curves were as follows: calcium 0.759; lactate dehydrogenase (LDH) 0.731; phosphorus 0.725; bilirubin 0.689; C-reactive protein 0.679; and RDW - standard deviation (RDW-SD) 0.624. Conclusions Those who did not survive tended to be elderly and had a greater incidence of comorbidities. Elevated LDH, decreased levels of calcium and phosphorus, and anemia at diagnosis were associated with greater risk of death for these Iranian patients hospitalized with COVID-19. Regular assessment of these markers would help to manage patients with COVID-19