[Deep anterior lamellar keratoplasty versus penetrating keratoplasty for keratoconus]

To compare the outcomes of deep anterior lamellar keratoplasty [DALK] using the big-bubble technique with that of penetrating keratoplasty [PK] in patients with keratoconus. This double-blind clinical trial included patients with moderate to advanced keratoconus and poor spectacle-corrected visual acuity or contact lens intolerance. Refractive errors, best corrected visual acuity [BCVA], contrast sensitivity function [CSF] and higher order aberrations [HOAs] were compared between the study groups. Forty-two eyes underwent DALK while 35 eyes received PK. Mean patient age was 26.91 +/- 7.9 versus 30.89 +/- 10.3 years in the DALK and PK groups, respectively [P=0.06]. Mean follow-up period was 19.0 +/- 7.9 months in the DALK and 24.6 +/- 3.5 months in the PK group [P=0.32]. Mean postoperative spherical equivalent refractive error was -3.23 +/- 3.4 D in the DALK group versus -2.22 +/- 4.6 D in the PK group [P=0.28] and mean postoperative BCVA was 0.18 +/- 0.08 logMAR and 0.15 +/- 0.10 logMAR, respectively [P=0.12]. There was no significant difference between the study groups in terms of CSF, total aberrations and HOAs. DALK may be considered as an effective alternative to PK in patients with keratoconus

[ effect of obesity on spinal anesthesia for cesarean section]

Obesity is a global health problem with an increasing prevalence which affects different medical and health care domains including anesthesia. The present study was carried out to answer the question of which anesthesia technique is proper in obese parturients. The aim of this study was to evaluate the effect of obesity on blood pressure reduction, amount and dose of ephedrine, and sensory level duration of spinal technique for cesarean section. In this cohort study the treatment group consisted of 40 expectant women with body mass index [BMI] of over 30, and the control group comprised of 40 expectant women with BMI of under 30, who were all candidate for elective cesarean section: In both groups 70 mg of Lidocaine was injected into spinal cord from L4-L5 space. Then the mean blood pressure, the amount and dose of ephedrine, sensory level of block and duration of spinal technique were measured. The collected data was compared by statistical tests. There was no statistical different in mean blood pressure reduction and sensory level of block between the two groups. Duration of spinal tap, amount and number of ephedrine injection were higher in obese cases. Relative risk of receiving two or more times of ephedrine was 1.63 times higher in obese expectant women than in normal women. Spinal anesthesia is an appropriate method for cesarean section in obese expectant women and blood pressure reduction can easily be controlled by ephedrine

Ciliochoroidal Melanoma presenting as a Subconjunctival Mass

To report a rare case of ciliochoroidal malignant melanoma presenting as a subconjunctival black-colored mass adjacent to the limbus. A 42-year-old woman presented with a subconjunctival black-colored mass adjacent to the limbus in left eye from 2 years ago. The lesion had increased in size during the previous 2 months. Funduscopic examination with scleral depression disclosed a small mass at the cilioretinal junction. Gonioscopy revealed that the superior portion of the angle was occupied by the mass. Visual acuity and intraocular pressure were normal. Other systemic examinations were unremarkable. Because of extensive extraocular extension of the tumor, the left eye was enucleated and histopathologic examination of the globe disclosed a highly pigmented medium-sized ciliochoroidal malignant melanoma of mixed cell type together with marked anterior extrascleral extension. Results of 6-month follow-up for metastasis were negative.A darkly pigmented epibulbar mass may be the first manifestation of ciliochoroidal malignant melanoma

Outcomes of surgical treatment in Cicatricial Ectropion

To evaluate the outcomes of surgery for cicatricial ectropion in Labbafinejad hospital, Tehran, Iran. This existing data study was conducted on the hospital records of 84 patients who underwent eyelid surgery because of cicatricial ectropion. Z-plasty was the most frequent method among 9 techniques. Of 92 eyelids, 60 [65%] were completely corrected. The most frequent procedure leading to correction was lateral tarsal strip + skin graft. The results of operations for cicatricial ectropion with skin graft are better than those without skin graft