Geographical inequality in cataract surgery among Iranians between 2006 and 2011

Background: Cataract surgery is a highly cost-effective intervention for sight restoration but inequalities exist in its use which health care systems should aim to reduce.

Aims: This study aimed to measure the level of inequality in cataract surgery use and the changes in inequality between 2006 and 2011 in the Islamic Republic of Iran.

Methods: A number of metrics, including ranges and indexes based on Lorenz curves [Gini, concentration and dissimilarity indexes], were used to measure the inequality in cataract surgery use among Iranians in 2006 and 2011. Cataract surgical numbers and socioeconomic data were obtained from a province-based survey and the national census database.

Results: Significant inter-provincial and inter-regional differences were found in cataract surgical proportions. South Khorasan province had the lowest cataract surgical rate in 2006 and 2011, while Tehran province had the highest rate in both years. Inequality in the distribution of cataract surgery services decreased between 2006 and 2011: the Gini, concentration and dissimilarity indexes decreased by 0.028, 0.03 and 0.037, respectively. However, cataract surgery delivery remained in favour of the better-off provinces.

Conclusions: To reduce this inequality, policy-makers should improve financial and physical access to cataract surgery, especially in the relatively deprived provinces, and tackle physician-induced demand.

Detection of human papillomavirus in squamous cell carcinoma of conjunctiva by nested PCR: a case control study in Iran

Squamous-cell carcinoma [SCC] of the eye conjunctiva is a rare tumor. Its link with immune impairment suggests that infectious agents such as human papillomavirus [HPV] may be involved in the etiology of SCC. We conducted a case-control study on 50 SCC cases [mean age: 65.2] and 50 age frequency-matched control patients with lesion-free, normal conjunctival biopsies [mean age: 63.8] obtained from the cancer registry archive at Pathology Department of Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran, where SCC has become the most common conjunctival malignancy. MY/GP nested PCR was performed for HPV detection and E6/E7 consensus primers in combination of type specific primers were used in another nested PCR series for HPV typing. HPV DNA was detected in 46 of 50 samples of squamous cell carcinoma and none of the normal biopsies by nested PCR using primer sets of the HPV consensus L1 region [MY/GP]. Subsequently, specimens from the 46 positive cases were subjected to specific PCR. Although 630bp amplicon was produced in 44 of 46 samples [E6/E7 primers], none of the specific HPV PCR reactions for HPV DNA type 16, 18, 31 or 33 resulted in the detection of HPV DNA in the 44 SCC specimens of the conjunctiva. Current results confirm the role of HPV in the etiology of conjunctival SCC. The absence of HPV 16, 18, 31 and 33 in conjunctival SCC in this study raise doubts about the role of genital types of HPV in conjunctival carcinomas

Transition to phacoemulsification at the Farabi eye hospital, Iran

To provide objective evidence on the transition of cataract surgical care at Farabi Eye Hospital, Iran. Two separate years, 2003 and 2006, were selected for evaluation. One thousand nine hundred fifty-seven surgical records of age-related cataract cases were randomly selected and reviewed. Three hundred fifty-three patients [405 eyes] in 2006 and 125 patients [153 eyes] in 2003 were selected randomly for a follow-up examination. The two phases were compared in terms of surgical routines, patient characteristics and outcomes for statistical differences. P <0.05 was considered statistically significant. The phacoemulsification rate increased from 25% to greater than 90% between 2003 and 2006, rates of corneal incisions and use of foldable intraocular lenses tripled, administration of general anesthesia dropped from 80% to 12%, the outpatient admission rate rose from 5.2% to 71%, 4% vs. 66% of the operations were performed by a senior phacoemulsification surgeon and the number of advanced surgeons changed from 6% to 38% [all P-values < 0.001]. In 2006, more patients at the two extremes of age, more patients with poor systemic conditions and myopes underwent surgery [all P-values < 0.05]; the cataract surgery volume increased by 49% and post-operative visual acuity improved [P= 0.03] while patient satisfaction was unchanged. We objectively documented the transition in cataract surgery technique to phacoemulsification at the Farabi Eye Hospital in the mid-2000s. This was accompanied by significant expansion of the spectrum of cataract surgery candidates and remarkable attainment of surgical skill