[Evaluation of central corneal sensitivity in different age groups with healthy cornea in Tehran]

Corneal sensitivity is one of the indicators for corneal health which may be affected by some factors such as age and geographical area. The purpose of this study was to measure normal central corneal sensitivity in different age groups with healthy cornea in Tehran. Central corneal sensitivity of the right eye of 596 volunteers [age ranged 15-81] was measured using a Cochet-Bonnet aesthesiometer. Subjects were divided into six age groups of 1-6 based on age ranges of 15-25, 26-35, 36-45, 46-55, 56-65 and >65 years, respectively. All measurements were performed by the same optometrist in 18 degrees of centigrade temperature, 35% humidity and between 2-5 p.m. There was a significant main effect of age group [f=92.22, p=0.000]. There was statistically significant difference of central corneal sensitivity among all age groups [p

[Comparative study of three phakic intraocular lenses in correction of myopia]

To compare visual outcomes and surgical complications of three phakic intraocular lenses [pIOLs]; Artisan, Artiflex and the Implantable Collamer Lens [ICL] for correction of moderate to high myopia. In this historical cohort study, 112 myopic eyes that were operated between 2005 and 2010 and implanted with one of these three pIOLs were evaluated [Artisan 40 eyes, Artiflex 36 eyes and ICL 36 eyes]. Mean follow up period was 30 +/- 11 months. Intraoperative complications were evaluated. All patients were recalled and a complete ophthalmologic examination including refraction, best corrected visual acuity [BCVA] and intraocular pressure was performed. Pachymetry, endothelial cell count as well as postoprerative higher order aberrations were evaluated and compared with corresponding preoperative values. No significant intraoperative complications were reported. BCVA improvement, more than one line on the Snellen chart occurred in 25%, 19.4% and 38.9% of eyes in Artisan, Artiflex and ICL groups, respectively [P=0.158]. Preoperative spherical equivalent [SE] in Artisan, Artiflex and ICL groups was -11.6 +/- 3.7, -9.59 +/- 1.97 and -12.3 +/- 4.8 diopters, respectively. Reduction changes in SE was not statistically significant among the 3 groups [P=0.237]. Mean reduction of astigmatism was 0.31 +/- 0.72, 0.45 +/- 0.62 and 0.0 +/- 0.57 in Artisan, Artiflex and ICL groups, respectively [P=0.07]. Postoperatively, 60% of Artisan, 91.7% of Artiflex and 77.8% of ICL eyes were within one diopter of emmetropia, but the change was statistically significant between Artisan and Artiflex groups [P=0.017]. Percentage of endothelial cell loss was 10 +/- 9%, 9 +/- 6% and 9 +/- 10% in Artisan, Artiflex and ICL groups, respectively [P=0.694]. Pachymetry changes was minimal and the difference among groups was not statistically significant [P=0.754]. Higher order aberrations [P=0.039], vertical trefoil [P=0.032] and spherical aberration [P=0.001] were higher in Artisan than ICL. Total aberrations [P=0.028] and spherical aberration [P=0.001] was higher in Artisan than Artiflex. Visual outcomes such as BCVA improvement, reduction in SE and astigmatism were comparable among Artisan, Artiflex and ICL groups. There was no significant intra and postoperative complications in the 3 groups. Due to the increased higher order aberrations and problems in quality of vision in myopic eyes after implantation of Artisan lens, ICL and Artiflex may be better choices

Correlation of serum alkaline phosphatase with clinicopathological characteristics of patients with oesophageal cancer

Oesophageal cancer is endemic in some regions of the Islamic Republic of Iran and efforts have been made to find factors that play a role in its prognosis. We retrospectively examined the correlation of serum alkaline phosphatase [ALP] levels with several clinicopathological characteristics of 207 cases of oesophageal carcinoma. The mean ALP level in patients with lymph node involvement was significantly higher [141 [SD 77] U/L] than with node negative cancers [116 [SD 63] U/L]. Patients with ALP level > 165 U/L were 3.29 times more likely to have lymph node involvement than patients with ALP level

[Effect of mustard gas exposure on lid margin flora in chronic blepharitis: a case control study]

To evaluate the microbiological characteristics of lid margin flora in chronic blepharitis in individuals exposed to mustard gas in comparison to nonexposed patients. In this case-control study, among 289 patients with documented ocular manifestations of mustard gas, 150 patients with clinical sings of blepharitis served as the case group. Microbiologic evaluation was conducted in these patients and compared to that of 100 unexposed patients with chronic blepharitis. In 150 patients with mustard gas exposure and chronic blepharitis, staphylococcus epidermidis [78%] and staphylococcus aureus [57%] were significantly higher than control group [P< 0.01]. Moreover, staphylococcus aureus had more resistance to common antibiotics in the case group. Fungi were isolated more frequently in cases compared with controls [30% vs. 4%, P<0.01]. Cladosporium and Candida were the most common species. Microbiological evaluation in patients with chronic blepharitis associated with mustard gas is significantly different from other patients. Staphylococcus spp, including strains resistant to Methicillin, and fungi were more frequently isolated in exposed patients. The relationship between microbial culture and the severity of ocular manifestations in mustard gas exposed cases warrants further investigation

[Deep anterior lamellar keratoplasty: review]

Lamellar keratoplasty [LK] has been a well established technique of corneal transplantation. Recent improvements in surgical instruments have revolutionized the procedure introducing a new technique employing deeper corneal dissection. This review article describes the indications, techniques, outcomes and complications of deep anterior LK

[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

[Outcomes of conjunctival-limbal autograft in unilateral total limbal stem cell deficiency]

To report the outcomes of conjunctival-limbal autograft [CLAU] in patients with unilateral total limbal stem cell deficiency [LSCD] emphasizing surgical problems, complications, and their management. In this prospective interventional case series, CLAU combined with amniotic membrane transplantation as a graft was performed on 26 patients with unilateral total LSCD due to chemical or thermal injuries. Penetrating keratoplasty [PKP] was performed on eyes with dense corneal opacification. Main outcome measures were visual acuity, corneal transparency and vascularization, and complications. Optical PKP was performed on 18 eyes. Best spectacle-corrected visual acuity [BCVA] was 2.28 +/- 0.45 LogMAR before CLAU which improved to 0.64 +/- 0.52 LogMAR and 0.35 +/- 0.13 LogMAR at final follow-up in eyes with and without PKP, respectively. Corneal transparency and vascularization, which were graded as 4+ before surgery, improved to a mean of 1.7 +/- 0.8 and 2.1 +/- 0.7 three months after surgery. Mean epithelial healing time was 8.8 +/- 4.1 [range 5 to 20] days. Longer healing occurred in 5 eyes due to small lenticules [n=2], exposure [n=2], and conjunctival encroachment [n=1]. Mean healing period for epithelial defects over PKP was 8.8 +/- 5.5 [range 4 to 14] days. Persistent epithelial defects occurred in 8 cases with cut lenticules [n=2], small-sized lenticules [n=2], and chronic exposure [n=4]. Lenticule-related complications were thick lenticules [n=4], conjunctival mantle encroachment [n=2], dislodging [n=4], progressive thinning [n=2], small size [n=3], and accidental trephination [n=2]. CLAU combined with AMT with or without PKP is effective in anatomical and visual rehabilitation of eyes with unilateral total LSCD. This procedure increases corneal transparency and decreases vascularization. The lenticules should be handled carefully in order to avoid most common lenticule-related complications

[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

[Agreement among galilei, orbscan II, and placido disk-based topography]

To evaluate agreement between Galilei, Orbscan II, and placido disk-based topography in terms of keratometry readings, and anterior and posterior elevation. In this prospective comparative study, 184 eyes of 92 keratorefractive surgery candidates were evaluated with Galilei, Orbscan II, and placido disk-based topography. Keratometry readings and anterior and posterior elevation maps were compared using ANOVA and paired t-test. Mean keratometry reading by Galilei, orbscan II and corneal topography was 44.30 +/- 1.49 D, 44.11 +/- 1.47 D, and 44.60 +/- 1.56 D, respectively. The maximum difference in SimK and astigmatism obtained three devices was less than 0.5 D with respect to the anterior and posterior best fitted sphere, the agreement between the Galilei and orbscan II was 0.96 and 0.95, respectively. Maximum elevation of the anterior central cornea was 9.17 +/- 5.1 m by orbscan II and 3.2 +/- 1.78 m by Galilei. Maximum depression of the posterior central cornea was 33.84 +/- 9.33 mm and 6.81 +/- 3.78 m, respectively. Despite a significant difference in mean keratometry readings, the three devices can be used as the difference in measurements was not clinically significant. However a large amount difference was found between Galilei and orbscan II interms of anterior and posterior maximum elevation values

Diagnostic accuracy of sixty four multi-slice ct angiography in assessment of arterial cut-off and run-off in comparison with surgical findings

The accurate anatomic mapping and determination of the severity of arterial disease, an important health problem of the elderly, is of great significance. We aimed to determine the diagnostic value of 64-multislice CT angiography [MSCTA] in run-off and cut-off sites of arterial disease. Throughout the study, MSCTA followed by an operative intervention was carried out on a total of 38 patients with clinical signs and symptoms suggestive of arterial disease [AD] all of whom had the indication for vascular surgery. The mean age of patients was 34 +/- 15.86 [range, 23 to 93] years. MSCTA was executed using a 64-slice CT scanner, during the arterial phase of injecting the nonionic, contrast medium with a power injector at the rate of 5 ml/sec into the antecubital vein and exploration and revascularization of peripheral arterial disease was performed intraoperatively. Atherosclerosis and arterial disease, the most common causes of vascular occlusion, were more common in the lower extremities. According to MSCTA findings, the most frequent site of stenosis was the superficial femoral artery. Spearman's correlation coefficient showed a high degree of agreement amongst the raters. The sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV] and the accuracy of MSCTA compared to surgery were 83.8%, 96%, 96.8%, 81.3% and 89%, respectively. MSCTA findings were compared with surgery as a standard of reference, which showed concordance in the majority of cases [81.6%]. Cut-off sites were correctly identified by MSCTA in 97.3% of the patients and the most common sites of discordance were the run-off sites [18.2%]. MSCTA angiography as a novel diagnostic modality may be a suitable alternative and a viable choice for routine clinical diagnosis

Utility of filter paper for preserving insects, bacteria, and host reservoir DNA for molecular testing

Appropriate methodology for storage biological materials, extraction of DNA, and proper DNA preservation is vital for studies involving genetic analysis of insects, bacteria, and reservoir hosts as well as for molecular diagnostics of pathogens carried by vectors and reservoirs. Here we tried to evaluate the utility of a simple filter paper-based for storage of insects, bacteria, rodent, and human DNAs using PCR assays. Total body or haemolymph of individual mosquitoes, sand flies or cockroaches squashed or placed on the paper respectively. Extracted DNA of five different bacteria species as well as blood specimens of human and great gerbil Rhombomys opimus was pipetted directly onto filter paper. The papers were stored in room temperature up to 12 months during 2009 until 2011. At monthly intervals, PCR was conducted using a 1-mm disk from the DNA impregnated filter paper as target DNA. PCR amplification was performed against different target genes of the organisms including the ITS2-rDNA of mosquitoes, mtDNA-COI of the sand flies and cockroaches, 16SrRNA gene of the bacteria, and the mtDNA-CytB of the vertebrates. Successful PCR amplification was observed for all of the specimens regardless of the loci, taxon, or time of storage. The PCR amplification were ranged from 462 to 1500 bp and worked well for the specified target gene/s. Time of storage did not affect the amplification up to one year. The filter paper method is a simple and economical way to store, to preserve, and to distribute DNA samples for PCR analysis

[Corneal endothelial cell loss after phacoemulsification in relation to hydrodynamic parameters: low versus high vacuum techniques]

To evaluate the effect of vacuum and flow rate on endothelial cell loss after high versus low vacuum phacoemulsification. This randomized clinical trial was performed on 60 eyes of 60 patients with moderate lens opacity [nuclear sclerosis 3+]. All surgeries were performed by one experienced surgeon using stop and chop technique with Sovereign white star machine [AMO]. Patients were randomly assigned to high and low vacuum techniques in equal numbers. The machine was set on 400 mmHg vacuum and 40 ml/min flow rate in the high vacuum group and on 200 mmHg vacuum and 20 ml/min flow rate in the low vacuum group during the chop stage. All other parameters were similar in both groups. Phacotime multiplied by average ultrasound power was defined as total ultrasound energy. Specular microscopy was performed before and 1, 6 and 12 weeks after the operation. After 12 weeks, mean endothelial cell loss was 9.0 +/- 4.0% versus 9.6 +/- 4.6% in the low and high vacuum groups, respectively [P=0.6]. Mean ultrasound power was 9.2 +/- 4.3% and 13.1 +/- 4.6% in the low and high vacuum groups, respectively [P=0.001]. Mean phacotime was 1.28 +/- 1.0 minutes in the low vacuum group versus 0.88 +/- 0.6 minutes in the high vacuum group [P=0.04]. Total ultrasound energy and total fluid volume used [turbulence] during phacoemulsification was similar between the two study groups. Total ultrasound energy was the most powerful predictor of endothelial cell loss [R2=0936, P=0.001], but turbulence was not a significant predictor [R2=0.924, P=0.1]. No significant difference in endothelial cell loss was found between low and high vacuum techniques. This study supports advice to junior surgeons to choose lower hydrodynamic phaco machine parameters; experienced surgeons can choose higher parameters to reduce phacotime

[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

[Stem cell deficiency in patients with chronic and delayed-onset mustard gas keratopathy]

To evaluate stem cell deficiency using impression cytology [IC] in patients with chronic and delayed-onset mustard gas keratopathy [MGK]. A consecutive series of patients with MGK underwent IC Thirty-five eyes of 18 patients [all male] with mustard gas keratopathy were included in this observational case series. Presence of goblet cells on the corneal side of specimens was considered to indicate stem cell deficiency. Corneal involvement was graded as mild, moderate and severe. Relation between IC findings and clinical grading was evaluated. There was limbal stem cell deficiency in at least one quadrant of the cornea in all 35 eyes [100% of cases]. No differences was found between impression cytology findings [positive versus negative for corneal goblet cells] among different quadrants [p= 0.378]. Clinical grading was the same between nasal and temporal quadrants [P=0.266] and between superior and inferior quadrants [P= 0.263]. Combining the superior and inferior quadrants [vertical zone] and also the nasal and temporal quadrants [horizontal zone] together, clinical grading was more severe in horizontal versus vertical zones [p< 0.001]. There was no correlation between stem cell deficiency and clinical corneal severity [p=0.893]. Varying degrees of stem cell deficiency was demonstrated in all patients with chronic or delayed-onset MGK using IC Clinical corneal manifestations are more severe in nasal and temporal quadrants. We found no correlation between stem cell deficiency and clinical manifestations. Other factors such as perilimbal conjunctival ischemia might play a role

[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

[Results of descemet`s stripping with endothelial keratoplasty [dsek] in patients with bullous keratopathy after cataract surgery]

To evaluate the anatomical and visual outcomes of Descemet`s stripping with endothelial keratoplasty [DSEK] in patients with bullous keratopathy after cataract surgery. The study was performed on 20 eyes of 20 patients [13 male, 7 female] with bullous keratopathy [pseudophakic=15, aphakic=5]. Donor lenticule was prepared using a micro keratome [n=12] or manual dissection [n=8]. Patients were excluded in case of extensive corneal scarring and/or vascularization. DSEK surgery was performed by removal of recipient endothelium and Descemet`s membrane, and replacement by the donor lenticule. Patients were followed at least for 6 months. Mean age at surgery was 64.6 +/- 6.7 years and mean follow up was 7.3 +/- 2.1 months. At final follow up 15 grafts were clear. Failure was seen in 5 cases. Visual acuity LogMAR was 1.96 +/- 0.38 before and 0.52 +/- 0.09 after the procedure [P<0.0001]. Mean topographic keratometry was 46.0 +/- 2.9 D before surgery which reached 44.4 +/- 1.7 D postoperatively [P=0.219]. Preoperative astigmatism was 2.5 +/- 1.7 D which decreased to 1.1 +/- 2.3 D at final follow up [P=0.229]. Mean pre- and postoperative surface regularity index [SRI] were 1.47 +/- 0.60 and 0.43 +/- 0.17, respectively [P=0.006]. No case of endothelial rejection was observed. DSEK surgery is an effective treatment modality in cases of bullous keratopathy after cataract surgery with acceptable anatomical and visual outcomes

[Acute comitant esotropia following penetrating keratoplasty]

To report a case of bilateral kertatoconus who presented with acute comitant esotropia after penetrating keratoplasty in the fellow eye. A 17-year-old male with keratoconus underwent penetrating keratoplasty in his right eye. He experienced diplopia after removal of the patch from the operated eye 12 hour postoperatively due to esotropia in his left [unoperated] eye. Diplopia was controlled using prism glasses and botulinum toxin A until penetrating keratoplasty was performed in his left eye which resulted in return of fusion which remained stable after 3 years of follow up. Acute comitant esotropia may occur after loss of fusion due to patching of one eye in a vulnerable patient. In this patient fusion was preserved with non-surgical methods until it was permanently returned surgically

[Delayed-onset actinomyses keratitis after LASIK]

To present a case of delayed-onset unilateral keratitis due to Actinomyses israelii after laser in situ keratomileusis. A 28-year-old lady was referred to our clinic with foreign body sensation and mild blurring of vision in her left eye. She had undergone bilateral LASIK about five months ago. On examination, there was an area of infiltration at the interface with an overlying area which stained with fluorescein in the center of the cornea. The LASIK flap was elevated and scraping of the interface and the bed was performed. Results of culture and smear showed Actinomyses israelii as the causative agent. Antibiotic treatment was initiated according to the sensitivity results and the infection was controlled. Actinomyses must be considered in differential diagnosis of delayed-onset infectious keratitis after LASIK in addition to fungal and atypical Mycobacteria. Elevation of the flap and scraping the involved area can be helpful in obtaining specimens for culture and smear as well as reducing the infectious bulk. Adherence to aseptic techniques is mandatory for prevention of infections

[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