[Effect of corneal opacity in childhood on axial globe length in adulthood]

To evaluate the effect of childhood corneal opacity on the anteroposterior length of the globe in adulthood. Twenty-three patients with significant unilateral corneal opacity which had developed before the age of 6 years and the normal fellow eyes [controls] were evaluated. A comprehensive ocular examination including measurement of anterioposterior length and anterior chamber depth was performed. Mean age was 65.9 +/- 12.9 years. Mean axial length was 25.45 +/- 2.47 mm in affected eyes vs 22.85 +/- 3.34 mm in normal fellow eyes [P=0.001]. The difference in axial length was attributed to elongation of the vitreous cavity in affected eyes [18.91 +/- 2.82 vs 15.71 +/- 2.73 mm, P<0.001]. Corneal opacity in childhood can result in axial myopia in adulthood due to elongation of the posterior segment

[Comparison of cornel graft biomechanical properties following penetrating keratoplasty and deep anterior lamellar keratoplasty using the ocular response analyzer]

To compare corneal hysteresis and resistance factor after penetrating keratoplasty [PK] and deep anterior lamellar keratoplasty [DALK] using Anwar's big-bubble technique using the ocular response analyzer. Forty-five PK eyes and 23 DALK eyes with keratoconus were compared in terms of corneal hysteresis [CH], corneal resistance factor [CRF], Goldmann-correlated intraocular pressure [IOPg] and cornea-compensated IOP [IOPcc]. Mean age was 29.8 +/- 6.1 years in the PK group and 27.2 +/- 6.5 years in the DALK group [P=0.11]; patients were followed for 31.4 +/- 19.0 and 29.2 +/- 17.3 months after corneal transplantation, respectively [P=0.27]. There was no significant difference between the study groups in terms of recipient [P=0.21] and donor [P=0.57] trephine size or BSCVA [P=0.77]. Mean CH was 10.09 +/- 2.5 mmHg in the PK group and 9.64 +/- 2.1 mmHg in the DALK group [P=0.36]; mean CRF was 10.13 +/- 2.2 and 9.36 +/- 2.1 mmHg, respectively [P=0.17]. No significant difference was found between the study groups in terms of IOPg [P=0.25] and IOPcc [P=0.80]. PK and DALK techniques provide comparable graft biomechanics in keratoconic eyes

[Corneal endothelial cell density and morphology after photorefractive keratectomy with mitomycin C]

To assess the short-term effect of Mitomycin-C [MMC] 0.02% on endothelial cell density and morphology after photorefractive keratectomy [PRK] in patients with moderate myopia. Forty-two eyes of 21 participants with moderate myopia [range, -4.0 to -8.0 D] underwent PRK with MMC 0.02% for 40 seconds. Specular microscopy was performed preoperatively and repeated 6 months after surgery to determine any change in central endothelial cell density [ECD], mean cell area [MCA], and coefficient of variation in cell size [CV]. Mean patient age was 26.2 +/- 6.3. Mean preoperative spherical equivalent refractive error was -5.2 +/- 1.2 D which was reduced to -0.4 +/- 0.5 D postoperatively [P < 0.001]. Mean ECD was reduced insignificantly from 2920 +/- 363 cells/mm2 preoperatively to 2802 +/- 339 cells/mm2 postoperatively [P = 0.59]. Similarly, there was no significant change in MCA [P= 0.76] or CV [P= 0.52] at six months. Intraoperative MMC 0.02% applied for 40 seconds during PRK for moderate myopia did not significantly change central corneal endothelial cell density and morphology after 6 months

[Pseudoexfoliation syndrome in keratoconus patient following penetrating keratoplasty]

To report a case of pseudoexfoliation syndrome in young keratoconus patient following penetrating keratoplasty. A 37 year old man who underwent penetrating keratoplasty 13 years ago in his left eye due to keratoconus developed pseudoexfoliation [PEX] syndrome in the operated eye. Apart from PEX material deposition on the crystalline lens ophthalmic exam was within normal limit. The donor was 40 year old man who died because of car accident. Occurrence of PEX following ocular surgery can be accidental or related to the surgery. Occurrence of PEX syndrome following intraocular surgery can be explained by triggering effect of surgery on susceptible patient

[Management of complications of mustard gas keratitis with corneal and limbal stem cell transplantation]

To report the clinical findings and compare the outcomes of different surgical techniques evolved over time in a large series of patients with delayed-onset mustard gas keratitis [MGK]. This interventional retrospective case series includes patients with complications of delayed MGK. Medical and surgical interventions to address dry eye, limbal ischemia and limbal stem cell deficiency [LSCD], and corneal complications were reviewed. Outcomes of limbal stem cell transplantation techniques such as living-related conjunctival-limbal allograft [lrCLAL] and keratolimbal allograft [KLAL], as well as corneal transplantation techniques including penetrating keratoplasty [PKP] and lamellar keratoplasty [LKP] were compared. A total of 175 eyes of 90 patients [all male] aged 34 to 68 years were included. Mean follow up was 101 months. The most common ocular complication was chronic blepharitis and dry eye. Conjunctival vascular abnormalities and limbal ischemia were observed in 27.4% and 29.7% of eyes, respectively. LSCD necessitating stem cell transplantation developed in 41.1% of eyes. The most common corneal signs were central and peripheral anterior stromal opacity [58.9%] followed by corneal stromal thinning [36.0%] and neovascularization [27.4%]. lrCLAL was performed in 32 eyes [18.3%] and KLAL in 40 [22.9%]. The rejection-free graft survival rate was 39.1% in the lrCLAL group and 80.7% in the KLAL group at 40 months with mean duration of 24.9 and 68.8 months, respectively [P=0.02]. 30 eyes [17.1%] underwent PKP and 51 [29.1%] received LKP. Corneal graft failure was observed in 9 [30%] PKP and 6 [11.8%] LKP eyes. The rejection-free graft survival rate was 39.0% in the PKP and 90.3% in the LKP group at 28 months with a mean duration of 29.6 and 85.0 months, respectively [P<0.001]. Chemical warfare victims may ultimately develop significant ocular involvements requiring some sorts of surgical intervention. Limbal and corneal abnormalities can best be managed by KLAL and LKP, respectively

[Lamellar keratoplasty for management of mustard gas keratitis]

To report the outcomes of manual lamellar keratoplasty [LKP] in patients with delayed-onset mustard gas keratitis [MGK] and compare visual outcomes between subgroups with simultaneous or sequential KLAL and LKP. In this retrospective, interventional study, 52 eyes of 37 male survivors of chemical warfare with MGK who underwent LKP were included. The results were evaluated with respect to best spectaclecorrected visual acuity [BSCVA], refractive error, keratometric readings and graft clarity. Eyes with sequential versus simultaneous surgery were compared in terms of BSCVA, refraction, corneal graft surface stability, and stem cell and corneal graft survival rates. Mean patient age at the time of surgery was 43.4 +/- 8.2 [36-48] years, and mean follow-up period was 41.4 +/- 19.6 [19-107] months. Mean preoperative BSCVA was 0.51 +/- 0.48 logMAR, which increased to 0.33 +/- 0.18 logMAR [P=0.03]. Mean preoperative spherical equivalent refractive error was -2.40 +/- 1.5 diopters [D], which remained unchanged postoperatively [-1.52 +/- 3.7 D, P=0.77]. No significant difference between sequential and simultaneous surgery subgroups was observed in BSCVA, refraction, keratometry readings, or corneal graft survival [90.3% and 89.9%, respectively; P=0.68]. However, the simultaneous group had statistically better stem cell survival. LKP can effectively improve BSCVA in MGK. The simultaneous approach is superior to sequential surgery when both stem cell and corneal transplantation are indicated

[Keratolimbal allograft in total limbal stem cell deficiency]

To investigate the outcomes of keratolimbal allograft [KLAL] for treatment of total limbal stem cell deficiency [LSCD]. Patients with total LSCD and adequate tear production were included. A total of 27 KLAL procedures were performed in 21 eyes of 20 patients with LSCD. Immunosuppression was achived using mycophenolate and cyclosporine. Main outcome measure was improvement in vision; in addition, KLAL survival and post operative complications were studied. Mean follow up period was 22.14 +/- 11.83 months [range 6-39]. Mean visual acuity improved from 2.53 +/- 0.21 to 1.49 +/- 0.77 LogMAR [P<0.0001]. Six KLALs never re-epithelialized and were considered as primary failures. Mean KLAL survival was 14.23 +/- 1.5 months. Graft survival rate was 61.9% at 1 year and 31% at 20 months. Complications included corneal ulcers in 6, glaucoma in 2 and scleral thining in 1 case. Keratolimbal allograft surgery is successful in the short term for visual rehabilitation of patients with total limbal stem cell deficiency

[Comparison of higher-order aberrations in conventional versus customized ablation for photo refractive keratectomy]

To compare visual outcomes and changes in high-order aberrations [HOAs] following conventional versus customized photorefractive keratectomy [PRK]. In this clinical trial, 58 eyes of 29 patients underwent myopic PRK using the Technolas 217Z excimer machine. After comprehensive evaluation for refractive surgery, one eye of each participant randomly received conventional ablation [group 1] while customized treatment was performed in the fellow eye [group 2]. Changes in postoperative visual acuity, cycloplegic refraction, and contrast sensitivity function [CSF], HOAs and subjective complaints of halos and glare were compared between the two groups. Mean subject age was 26.7 +/- 6.0 years. Mean preoperative cycloplegic spherical equivalent refractive error and refractive astigmatism were -4.92 +/- 1.6 0 and 0.91 +/- 1.0 0, respectively. There was no significant difference between the two groups in terms of preoperative HOAs and CSF. Mean follow-up period was 8.1 +/- 3.3 months. After the operation, total HOAs for 4 mm pupil was increased by 0.24 +/- 0.19 pm in group 1 and by 0.31 +/- 0.21 pm in group 2 [P<0.001]. Corresponding figures for 6 mm pupil were 0.34 +/- 0.23 [range -0.08 to 0.75] and 0.52 +/- 0.32 [-0.04 to 1.43] pm respectively [P=0.03]. The increase in postoperative HOAs was statistically significant in group 2 in the 6 mm zone [P=0.03] but not in the 4 mm zone [P=0.26]. CSF was reduced in both groups, but there was no significant difference between the study groups in terms of postoperative CSF and subjective complaints. HOAs significantly increased after PRK using conventional and customized ablation. The increase in HOAs after customized ablation was significantly greater than that after conventional ablation

[Scleral fixation of an aniridic IOL and penetrating keratoplasty: clinical outcomes in three cases]

To report the outcomes of combined aniridic intraocular lens [IOL] implantation via scleral fixation and penetrating keratoplasty [PKP] in three patients. This study included 3 patients who required PKP and had aniridia and/or aphakia requiring IOL implantation. All subjects underwent aniridic IOL scleral fixation after vitrectomy and removal of capsular remnants followed by PKP thereafter. We used a single-piece black-diaphragm aniridic IOLs [Morcher, Stuttgart, Germany] in all cases. Mean postoperative follow-up was 24 [range 18-30] months. No complications occurred during surgery. Visual acuity improved in all patients and all reported a subjective reduction in glare sensation. Two cases developed elevated intraocular pressure [IOP] after surgery. In one eye, IOP was controlled with timolol but the other required Ahmed glaucoma valve implantation. No patient developed chronic uveitis, cystoid macular edema or retinal detachment and all the patients were satisfied with the cosmetic results. Combined scleral fixation of an aniridic IOL and penetrating keratoplasty improves visual disability and aesthetic appearance. It seems to be an acceptable procedure in patients suffering from corneal opacity and cataracts or aphakia but insufficient iris and zonulae

[Intraocular lens power calculation after keratorefractive surgery]

To determine corneal power for intraocular lens [IOL] power calculation in eyes with previous keratorefractive surgery. In 13 eyes of 9 patients with previous keratorefractive surgery undergoing phacoemulcification, IOL power was calculated using the clinical history method [CHM] in one case, manual keratometry [MKR] in 2, SimK in 3, and flattest K [topographically derived] in 7 cases. SRK-T formula with applanation method was used. Final refractions [SE] are presented. Patients included 7 male and 2 female subjects aged 51.2 +/- 9.3 [range 41-70 years]. Postoperative refraction was hyperopic [+1.5 D] in eyes with the CHM, variable and unpredictable in cases with the MKR and SimK and more desirable [-0.35 +/- 0.39 D] in cases of flattest K. In this latter group the best postoperative refraction was achieved in cases which 0.5 to 1.00 D was added to the calculated IOL power. It seems using topographically derived flattest K for IOL power calculation and adding 1.00 D to the calculated IOL power in eyes with previous myopic-refractive surgery, and using the steepest K together with subtracting 1.00 D from the calculated IOL power in eyes with previous hyperopic-refractive surgery is useful when pre-refractive surgery data are not available

[Outcomes of lensectomy, posterior capsulotomy, anterior vitrectomy and posterior chamber intraocular lens implantation in pediatric cataracts]

To evaluate the visual outcomes and complications of lensectomy, posterior capsulotomy, anterior vitrectomy and Acrylic hydrophobic posterior chamber intraocular lens [PCIOL] implantation for congenital or developmental cataract in children 6-9 years of age. In a prospective interventional case series, 13 eyes of 10 children with congenital or developmental cataract underwent the above-mentioned surgery. Patients were followed for at least six months postoperatively. Pre- and postoperative visual acuity as well as intra- and postoperative complications were evaluated. Mean age was 7.8 +/- 1.2 [range 6-9] years. Patients were followed for a mean period of 13.3 +/- 7 months after surgery. Mean preoperative visual acuity was 1 +/- 0.1 LogMAR which reached 0.1 +/- 0.1 LogMAR at final follow up [P<0.0001]. No intraoperative complication occurred. All cases had clear visual axis at the last visit. Lensectomy, posterior capsulotomy, anterior vitrectomy and PCIOL implantation in 6-9 years old children with congenital or developmental cataract is a safe procedure and effective in terms of visual improvement

[Deep lamellar endothelial keratoplasty [DLEK] for management of corneal endothelial disorders]

To evaluate the visual outcomes and complications of deep lamellar endothelial keratoplasty [DLEK] for management of corneal endothelial disorders. From 2003 to 2005, nine eyes of nine patients with severe bullous keratopathy due to endothelial dysfunction underwent DLEK. Uncorrected [UCVA] and best-corrected [BCVA] visual acuity were evaluated pre- and one week, 1, 3 and 6 months postoperatively. The sutures were removed 3-4 months postoperatively in all eyes. Five female and four male subjects with mean age of 66.3 +/- 10.9 years underwent DLEK. Preoperative diagnoses included aphakic bullous keratopathy [ABK, 2 cases], pseudophakic bullous keratopathy [PBK, 4 cases] and Fuchs' endothelial dystrophy [FED, 3 cases]. Mean BCVA was 1.7 +/- 0.5 LogMAR [20/1000] preoperatively which improved to 1.4 +/- 0.1 LogMAR one month [P=0.02], 1.4 +/- 0.2 LogMAR three months [P=0.04] and 1.2 +/- 0.4 LogMAR six months [P=0.01] postoperatively. Mean corneal astigmatism was 7.43 +/- 5.02 diopters one month after DLEK which decreased to 4.06 +/- 3.58 at final follow up. All eyes had clear graft and cornea after 6 months. Postoperative complications included transient leakage [two eyes], lenticule displacement, graft wrinkling, double chamber formation, mild interface hemorrhage and filamentary keratitis [each in one case]. Cystoid macular edema was present in four eyes. DLEK has acceptable results for replacement of the endothelium in patients with ABK, PBK and FED. The most important drawback of this technique is the complexity of the equipment and the procedure. DSAEK [Descemet stripping automated endothelial keratoplasty] seems to be replacing DLEK due to less dependence on instruments and being a more simple procedure

Outcomes of Phacoemulsification in Eyes with and without Pseudoexfoliation

To evaluate the incidence of pseudoexfoliation syndrome [XFS] in patients with senile cataract who were scheduled for phacoemulsification and intraocular lens implantation [PE + IOL] and to compare the outcomes of PE+IOL between eyes with and without XFS. We retrospectively reviewed 2200 eyes with cataract undergoing PE + IOL. All procedures were performed by a single surgeon [M.A.J] at a private clinic. Patients with XFS were considered as the case group and age and sex matched patients without XFS were selected as controls. The incidence of XFS was 4.1% [90 eyes]. Mean age was 71.8 +/- 7.1 and 70.7 +/- 6.7 years in the case and control groups, respectively. XFS was unilateral in 60% of the cases. The prevalence of hypertension, diabetes mellitus [DM] and diabetic retinopathy [DR] was 31.1%, 6.7% and 0% in the XFS group vs 42.9%, 26.6% and 5.2% in the control group, respectively [P< 0.05]. Glaucoma was present in 25.6% of the XFS group and 6.5% of the control group [P<0.0001]. Vitreous loss occurred in one eye in each group; only one eye had zonular dehiscence in the XFS group. Iris stretching was performed during surgery in 11.1% in the XFS group and 1.9% in the control group [P<0.0001]. Anterior capsule contraction occurred in 9.1% of the XFS group vs 0% in the control group [P=0.007]. PE + IOL in patients with XFS is as safe and effective as pure senile cataract. The incidence of DM and DR is significantly lower in XFS

[Outcomes of keratoprosthesis at Labbafinejad medical center]

To evaluate the results of keratoprosthesis [KPS] at Labbafinejad Medical Center. In this case-series 29 eyes of 27 patients who underwent KPS between 1995-2002 were evaluated for results and complications. Patients included 22 male and five female subjects. Diagnoses included chemical burn [17 cases], Stevens-Johnson syndrome [three cases], ocular cicatricial pemphigoid [seven cases], corneal retransplantation [one case] and old corneal scar [one case]. Preoperative visual acuity was hand motion or light perception [no light perception, hand motion, or light perception in the fellow eyes],. Prostheses were Girard in 20 cases, tibiakeratoprosthesis in 3 cases, and Dohlman type 1, Dohlman type 2 and Pintucci, each in two cases. Postoperative visual acuity improved in 21 patients [72.4%] of which 66.7% experienced major complications including bacterial endophthalmitis [42.9%], retinal detachment [28.6%], uncontrolled glaucoma [21.4%], and spontaneous extrusion [7.1%]. Although KPS is hopeful in the short term with acceptable initial results, the long-term complication rate is high and the prognosis is poor. So it is better that KPS be preceded with safer procedures such as keratolimbal graft especially in young patients

[Visual outcomes and complications of phacoemulsification and intraocular lens implantation]

To evaluate the prevalence of concomitant systemic and ocular diseases in patients scheduled for phacoemulsification and intraocular lens implantation [PE+PC IOL] and post surgical visual outcomes and complications in 1253 cases. Medical records of all patients of a private clinic who underwent PE+PC IOL from 1999 to 2003 were reviewed. All operations were performed by as single surgeon [MAJ]. Among 1253 operated eyes, 95.9% had senile cataracts. Mean age was 61 years and mean follow up was 10 +/- 12.5 months. Incidence of systemic hypertension, diabetes mellitus [DM], ischemic heart disease, pseudoexfoliation syndrome [PXF], and glaucoma were 16%, 11.5%, 7.7%, 3.1%, and 2.7%, respectively. After the operation 71.9% and 90.4% of the eyes gained UCVA and BCVA of 20/40 or better, respectively. The most important intraoperative and postoperative complications were sterile uveitis [4.8%], vitreous loss [0.23%], endophthalmitis, CME, RD and, corneal decompensation each in one eye [0.08%]. Significant posterior capsule opacity requiring Nd: YAG capsulotomy occurred in 5.8% of the eyes. PE+PC IOL is a safe and effective procedure in patients with cataract. Systemic hypertension and DM are important concomitant systemic disorders in this group of patients

[Posterior segment complications following laser assisted in situ keratomileusis [LASIK]: a report of 5 cases]

To report complications involving the posterior segment after laser assisted in situ keratomileusis [LASIK] in 5 myopic patients ranging in age from 26 to 38 years. Case on developed bilateral cilioretinal artery obstruction in association with ischemic optic neuropathy. Case two presented with nonsimultaneous bilateral delayed-onset optic neuropathy. In case three, aggravation of the symptoms and signs of Stargardt's maculopathy was noticed. Case four showed rapid progression and worsening of diabetic retinopathy in both her eyes. In case five, early onset unilateral macular hemorrhage was observed. The increased intraocular pressure LASIK surgery may disturb blood flow in posterior ciliary arteries and choroid. The deleterious effect of LASIK on ocular circulation may result in sight threatening complications in predisposed patients