Comparison of Visual, Refractive and Aberration Measurements of INTACS versus Tricyclic ICL Lens Implantation; A Four-year Follow-up

This study was performed to evaluate the visual, refractive, and aberration measurement results of 2 implants, including Intacs Intracorneal Ring Segments (ICRS) and phakic Toric Implantable Collamer Lens (TICL), in patients with moderate Keratoconus (KCN). In this retrospective cross-sectional study, 30 patients with KCN with a mean age of 29.83 years were included in 2 groups, including the Intacs Intracorneal Ring Segments (ICRS) group and the phakic Toric Implantable Collamer Lens (TICL) group. Preoperative data as well as 6-month, 1-, 2-, 3- and 4-year follow-up data after the operation were collected and analyzed with the SPSS software (ver. 23.0, SPSS, Inc., Chicago, IL), using the paired t-test, independent t-test, repeated measures Analysis of Variance (ANOVA), and one-way ANOVA. This study included 30 patients with KCN with a mean age of 29.83 years and range of 25 to 35 years, including 17 males with a mean age of 30.11 years and 13 female with a mean age of 29.25 years. Except for preoperative Uncorrected Distance Visual Acuity (UCDVA), Spherical Equivalent (SE) and astigmatism, there was a significant difference between the 2 groups regarding other variables. The TICL group had a significantly better UCDVA and Best Corrected Distance Visual Acuity (BCDVA) in all post-operative follow-ups, and SE and astigmatism values were significantly lower in all post-operative follow-ups when compared with the ICRS group. There was a significant reduction in corneal and total coma as well as internal trefoil aberrations (P<0.01, P<0.01, and P=0.014, respectively) in the ICRS group, and TICL led to a significant reduction in internal trefoil aberration with P<0.03. Comparison of the 2 groups revealed a significant difference in corneal spherical (P<0.01) and total coma (P=0.02) aberrations and no significant differences in other HOA. Both ICRS and TICL are useful in patients with moderate KCN. However, TICL appears to have more stable and predictable vision results.Â

Comparison of Visual, Refractive and Aberrometic Outcomes of Intacs® Implant and Toric Implantable Collamer Lens (TICL) in Patients with Keratoconus: 4 Years Follow Up

Background: To assess the efficacy and clinical outcomes following the use of toric implantable collamer lens (TICL) and Intacs® implant in patients with mild keratoconus. Methods: This retrospective study evaluated 30 eyes of 30 patients with keratoconic and age of 25-35. These eyes were divided into group A (15 eyes), in which Visian Toric ICL™ was implanted, and group B (15 eyes), Intacs® implantation. The outcome and complications were evaluated. We assessed the visual, refractive, and aberrometric outcome in pre-operation and 6 month, and 1, 2, 3, and 4 year post-operation. Results: There was significant difference in the mean uncorrected and best corrected distance visual acuities between the groups (P < 0.01). An uncorrected distance visual acuity of 20/30 or better was achieved in 85% of eyes in the TICL group, and 20% of eyes in the Intacs® group; visual acuity of 20/20 or better in was seen in 80% and 15%, respectively. Intacs® implant produced a significant decrease in corneal refractive spherical equivalent and coma aberration (P < 0.01). Conclusion: Intacs® implant and TICL lens, both are useful, but it seems that the TICL is better and provides good visual and refractive outcomes; indicating that it is a more predictable procedure for refractive correction of keratoconus

Barriers of Pre-Hospital Services in Road Traffic Injuries in Tehran: The Viewpoint of Service Providers

Abstract Background: Iran is one of the countries with considerable road traffic injuries. Pre-hospital interventions have an important role in preventing mortalities and disabilities caused by traffic accidents.The present study aimed to explore the barriers of pre-hospital care in traffic injuries in Tehran, Iran. Methods: A qualitative content analysis approach was conducted based on 21 semi-structured interviews with 18 participants. A purposeful sampling method was applied until reaching data saturation. Interviews were transcribed verbatim, and then data condensing, labeling, coding and defining categories were performed by qualitative content analysis. Results: Four main barriers including 4 main categories and 13 subcategories emerged; they included Barriers related to people, Barriers related to metropolitan infrastructure,Barriers related to the profession and Barriers related to managerial issues. Conclusion: Based on the findings of this study, pre-hospital service barriers in traffic accidents have many dimensions including cultural, structural and managerial domains. Policy makers in health system can use these findings to promote the quality of pre-hospital services, especially in the field of traffic injuries