Unexplained infertility as primary presentation of celiac disease, a case report and literature review

Celiac sprue [gluten sensitive enteropathy] is an autoimmune disease which is hereditary and its pathology mainly bases on immunologic intolerance to gluten. It has a vast variety of signs and symptoms and its clinical features range from a silent disease to a typical gastrointestinal disorder. In this study we reviewed and summarized some other related issues about this disease and its relation with infertility. Case: The case is a 26 years old lady who had referred to a gynecologist because of infertility for 2 years and later it revealed that she has celiac sprue. Screening for its silent or subtle types especially among suspicious cases such as unexplained infertility seems to be a cost effective action. Meanwhile, in time administration of a gluten-free diet can lead to an almost complete cure

Astigmatic outcomes of temporal versus nasal clear corneal phacoemulsification

To compare the astigmatic outcomes of phacoemulsification cataract surgery using temporal versus nasal clear corneal incisions. In a clinical trial, consecutive patients with senile cataracts underwent phacoemulsification and implantation of a hydrophobic acrylic foldable intraocular lens through a horizontal clear corneal incision [temporal in right and nasal in left eyes]. Outcome measures included keratometric astigmatism and surgically induced astigmatism [SIA] calculated by the vector analysis method using the Holladay-Cravy-Koch formula. The nasal and temporal groups consisted of 20 eyes each. Mean preoperative keratometric astigmatism was 0.63 +/- 0.48 D and 0.38 +/- 0.39 D in the temporal and nasal incision groups respectively [P=0.09]. Data on 10 eyes in each study group was available for the six-month analysis. Mean keratometric astigmatism was as follows in the temporal and nasal groups respectively: 0.85 +/- 0.47 D versus 1.95 +/- 0.45 D at 1 week [P < 0.001], 0.73 +/- 0.46 D versus 1.79 +/- 0.55 D at 4 weeks [P < 0.001], and 0.63_0.30 D versus 1.05 +/- 0.56 D at 6 months [P = 0.053] after surgery. SIA at the same follow-up intervals was 0.71 +/- 0.20 D versus 1.80 +/- 0.22 D [P < 0.001], 0.63 +/- 0.20 D versus 1.65 +/- 0.31 D [P < 0.001] and 0.26 +/- 0.46 D versus 0.92 +/- 0.36 D [P=0.002] in the temporal versus nasal incision groups respectively. Temporal clear corneal phacoemulsification induces significantly less astigmatism as compared to similar surgery using the nasal approach

Peripapillary retinal nerve fiber layer thickness measurement by three-dimensional optical coherence tomography in a normal population

To determine peripapillary retinal nerve fiber layer [RNFL] thickness values by three-dimensional optical coherence tomography [3D-OCT] in a normal Iranian population and to evaluate the concordance of these measurements with those obtained by the second generation of optical coherence tomography [OCTII]. In a cross-sectional observational study, 96 normal Iranian subjects 20-53 years old were enrolled. Peripapillary RNFL thickness in one randomly selected eye of each subject was measured by 3D-OCT and also by OCT II. Standard achromatic perimetry, corneal pachymetry and A-scan ultrasonographic biometry were also performed. Other study variables included age, gender, laterality [right versus left eye], refractive error, corneal diameter and disc area. Mean peripapillary RNFL thickness measured by 3D-OCT [75.50 +/- 8.38] micro m was significantly less than that measured by OCT II [144.10 +/- 33.32 pn] [P<0.001]. Using 3D-OCT, no significant difference in peripapillary RNFL thickness was observed by gender [P=0.90] or laterality [P=0.17]; RNFL thickness had no correlation with age [P=0.95], axial length [P=0.32], spherical equivalent refractive error [P=0.21], central corneal thickness [P=0.66] and disc area [P=0.31]. However, a positive correlation was found between peripapillary RNFL thickness and corneal diameter [P=0.03]. 3D-OCT seems to yield lower RNFL thickness values as compared to OCT II. It seems advisable to obtain separate baseline measurements when using different generations of OCT machines