comparison of the effects of transdermal estradiol and estradiol valerate on endometrial receptivity in frozen-thawed embryo transfer cycles: a randomized clinical trial

Background: The purpose of this study was to determine the optimal endometrial preparation protocol by comparing the clinical outcome of two methods of endometrial preparation in frozen-thawed embryo transfer [FET] cycles, including that is, oral estradiol and 17 beta-estradiol transdermal patch

Methods: In this randomized controlled trial, women underwent either conventional IVF or intracytoplasmic sperm injection [ICSI] who had at least two top-quality embryos appropriate for cryopreservation and frozen embryos from previous cycles. In the study group [n=45], 17-B estradiol transdermal patches 100 microg were applied from the second day of the cycle and continued every other day. Then, each patch was removed after four days. In the control group [n=45], oral estradiol valerate 6 mg was started at the same time and continued daily

Results: There was a significant difference in estradiol level on the day of progesterone administration and the day of embryo transfer between the two groups [p=0.001 in both], but no significant difference was observed between them in biochemical and clinical pregnancy rates [32.6% vs. 33.3%, p=1.000 and 30.2% vs. 33.3%, p=0.810, respectively]

Conclusion: It is suggested that estradiol transdermal patches be used instead of oral estradiol in FET cycles. Due to the reduced costs, drug dose, and emotional stress as well as the simplicity of the protocol for patients

prevalence of astigmatism and its determinants in a rural population of Iran: the "nooravaran salamat" mobile eye clinic experience

The prevalence of astigmatism, and the astigmatic axis, and their determinants were evaluated in a rural population of Iran. In a cross-sectional study conducted from May to August 2011, 13 villages in the vicinity of the city of Khaf in northeast Iran were investigated in this study. All the examinations including visual acuity, refraction, slit-lamp biomicroscopy and fundoscopy were performed in a Mobile Eye Clinic. Written informed consent was obtained from all participants. Only phakic eye that could be reliably refracted without a previous history of ocular surgery were included. Out of 2635 participants who were screened, 2124 were analysed for this study of whom 52% were female. The prevalence of astigmatism was 32.2% [95% confidence intervals [CI]: 30.2-34.2]. Astigmatism significantly increased from 14.3% in the under 15-year-old age group to 67.2% in the age group of over 65-years old [P < 0.001]. The prevalence of With-The-Rule [WTR], Against-The-Rule [ATR], and oblique astigmatism was 11.7%, 18.1%, and 2.4%, respectively. ATR significantly increased with age [P < 0.001]. The mean corneal astigmatism was 0.73 D which linearly increased with age [P < 0.001]. Attention must be paid to astigmatism in rural areas due to the high prevalence. Further studies are suggested to discover the role of the environmental and genetic factors. It seems that environmental and occupational factors in the villages cause a significant increase in the prevalence of astigmatism with age. A high percentage of participants had ATR astigmatism, which was more common at older ages.

Corneal topography patterns in the Tehran eye study: warning about the high prevalence of patterns with a skewed radial axis

The purpose of this study is to determine the distribution of corneal topography patterns in Tehran. In this population-based study, a total of 442 individuals were randomly selected by cluster sampling for complete ophthalmologic examination. A total of 404 [788 eyes] met the inclusion criteria and were enrolled in this study. Orbscan II [Bausch and Lomb Surgical, Salt Lake City, USA] was used to determine the anterior segment indices and axial power maps for each eye. On the basis of the axial power maps, the symmetric bowtie [SB] [29.0%] and asymmetric bowtie with inferior steepening [16.7%] patterns were the most prevalent and the irregular [3.3%] and superior steepening [1.5%] patterns the least prevalent. Asymmetric bowtie pattern with a skewed radial axis [AB-SRAX] was seen in 7.6% of eyes. These cases had both thinner and steeper corneas compared with round and SB ones [P < 0.014 and P< 0.006]. Maximum anterior elevation in 5 mm zone, of AB-SRAX corneas were higher; than other patterns [P< 0.01] except for superior steepened and inferior steepened ones. The distribution of corneal topographic patterns in Iranians seems like other Asian population on the whole. The 7.6% prevalence of AB-SRAX patterns may be a warning on keratoconus prevalence in our population. This is in line with recent regional reports

Trend in cataract surgical rate in Iran provinces

The aim of this study was to determine the trend of changes in Cataract Surgical Rate [CSR] in the provinces of Iran during 2006 to 2010 and identify high risk areas. This report is part of the national Iranian CSR Study. The percentage change in CSR in 2010 compared to 2006 was conducted in each province, retrospectively. One hundred and ten centers were chosen from all provinces, to determine CSR in each, the weight of major [>3,000 annual surgeries] and minor [3,000 annual surgeries or less] centers was calculated based on the number of selected centers, and multiplied by the number of surgeries in each province. In eight provinces, CSR was decreased by 1-60%. One province [Booshehr] showed no change. Eighteen provinces had 2-79% increase. No 2006 data was available in three provinces. North Khorasan had the most decrease while Kerman had the most increase in CSR. Six of these 8 provinces had CSR>3,000 despite a decrease in 2010, but North Khorasan had CSR<3,000 over the whole 5 year period. In 4 provinces, CSR had a gap from 3,000 despite anascending trend, and in two, the gap was quite considerable. Although CSR has an improving trend in most provinces in Iran, it is decreasing in some provinces, and despite an already low CSR, the exacerbation continues. The growing population of over 50 year olds calls for prompt measures in such provinces. Even in improving provinces, some lag behind the minimum recommended by WHO, and the growth rate of the over 50 population reveals the necessity of immediate planning

Effect of anterior chamber depth on the choice of intraocular lens calculation formula in patients with normal axial length

To compare the accuracy of Sanders-Retzlaff-Kraff II [SRK II] and 3[rd] and 4[th] generation intraocular lens [IOL] formulas and to compare the effect of different anterior chamber depths among the IOL formulas in cataract patients with normal axial length [AL; 22.0-24.5 millimeters, mm]. A retrospective chart review was performed of patients with normal AL who underwent cataract surgery. The SRK II and 3[rd] generation IOL formulas [Hoffer Q, SRK T, Holladay l] were compared to the 4[th] generation Haigis formula. For analysis, preoperative anterior chamber depth [ACD] was divided into three subgroups- =/<3, 3-3.5, and >/= 3.5 mm. The mean error [ME] and mean absolute error [MAE] of each formula was compared for each subgroup against the total. The difference between the ME and MAE of the formulas were compared for each ACD subgroup. P< 0.05 was considered statistically significant. The study sample was comprised of 309 eyes. The MAE were 0.56 D, 0.52 D, 0.51 D, 0.50 D, and 0.50 D with Haigis, Hoffer Q, SRK T, Holladay 1, and SRK II formulas, respectively The Haigis formula was a significantly weaker predictor than the SRK T [P < 0.00l] and Holladay 1[P= 0.035]formulas. The ME with Haigis formula was -0.23 D which changed to -0.06 D with ACD >/= 3.5 mm [P = 0.002]. The ME was -0.24 D with SRK II and changed to -0.09D with ACD 0.05, all comparisons]. The SRK II formula can predict refraction in patients with normal AL and ACD less than 3 mm with less error and is preferred over other formulas. The Haigis formula is the preferred choice in patients with a normal AL and ACD longer than 3.5 mm. The prediction accuracy of Hoffer Q, SRK T, and Holladay 1 is comparable in normal AL

prevalence and determinants of pterygium and pinguecula in an urban population in Shahroud, Iran

While pterygium is considered a common eye disorder, the etiology and pathogenesis is still not known. The aim of this study was to describe the prevalence of pterygium and pinguecula in the over 40 population of Shahroud and assess associated factors. The present study is part of the phase one of the Shahroud Eye Cohort Study conducted in 2009, in which the target population was people between 40 and 64 years of age. Ophthalmic examinations were performed by two ophthalmologists who made the diagnosis of pterygium and pinguecula. We used Chi-square tests, analysis of variance, and multiple logistic regression tests to examine associations. Of the 6311 invitees, 5190 people participated in the study [response rate: 82.2%]. The prevalence of pterygium in at least one eye was 9.4% [95% CI, 8.6-10.3], while 2.9% [95%CI, 2.4-3.3] had bilateral pterygium. The prevalence was significantly higher in men [11.4% vs. 8.0%], and remained relatively constant with age, while the prevalence in women significantly increased with age. The prevalence of pinguecula was 61.0% [95%CI, 59.1-62.9] in at least one eye, and 49.0% [95%CI, 47.1-50.9] in both eyes. The age difference between those with and without pinguecula was significant and the prevalence was significantly higher among men than women [70.6% vs. 53.8%]. The prevalence of pterygium in our study was lower than reported rates in the world but higher than Tehran and was significantly associated with age, gender, working outdoors, and the level of education. The prevalence of unilateral and bilateral pinguecula falls in the mid range and was significantly associated with age, male gender, smoking, working outdoors, and level of education

Visual outcomes of conductive keratoplasty to treat hyperopia and astigmatism after laser in situ keratomileusis and photorefractive keratectomy

To determine the effect of conductive keratoplasty [CK] for the treatment of induced hyperopia and astigmatism after complicated myopic laser in situ keratomileusis [LASIK] or photorefractive keratectomy [PRK]. In this interventional case series, 11 eyes of seven subjects with a history of previous LASIK or PRK with inadequate stromal bed or flaps complications were enrolled. Inclusion criteria included residual spherical hyperopia of 1.00 to 3.00 diopters [D] and cylinder of-0.75 to-3.00 D. The modified Refractec nomogram and the LightTouch technique of CK were performed on all eyes. To treat cylinder, a pair of spots per-0.75 D of cylinder were delivered to the flat meridian. Uncorrected visual acuity at near and far [UCVAN and UCVAF respectively, logMAR], best corrected VA at near and far [BCVAN and BCVAF respectively, logMAR] were measured. Refractive outcome, contrast sensitivity, wave front aberrations were measured preoperatively and postoperatively. Statistical analysis was performed with the Wilcoxon signed rank test and the repeated measures analysis of variance with P<0.05 indicating statistically significant change from preoperatively to 1 year postoperatively. The mean preoperative sphere [MS] was 2.57 +/- 1.19 D and cylinder [MC] was-1.5 +/- 0.49 D. Postoperatively, there was a significant decrease in MS to 0.36 +/- 0.98 D [P=0.003] and MC to-1.25 +/- 0.76 D at 1 year [P<0.05, both cases]. Spherical equivalent [SE] significantly decreased from +2.13 +/- 1.09 D to-0.47 +/- 1.29 D [P<0.001]. The mean UCVAN significantly improved from 0.56 +/- 0.32 preoperatively to 0.17 +/- 0.16 postoperatively [P=0.003]. The mean UCVAF was 0.29 preoperatively and 0.22 postoperatively [P=0.353]. Mean BCVAN was 0.18 and 0.02 after surgery, and mean BCVAF for far was 0.07 [P>0.05, both cases]. CK is a predictable and reliable method to correct hyperopia after LASIK and PRK, however cylinder correction may induce irregular and unpredictable outcomes and a modified nomogram is required for further studies

association between refractive errors and cataract: the Tehran eye study

To determine the association between refractive errors and different types of cataract in Tehran, Iran. In a cross-sectional survey with a stratified cluster sampling approach, refractive errors were tested under cycloplegia. Myopia and hyperopia were defined as a spherical equivalent refractive error <-0.5 diopters [D] and more than +0.5 D, respectively. Cataract was graded according to the Lens Opacities Classification System III classification and the association between refractive errors and cataract was assessed. Of 1434 participants over the age of 40 years who participated in the study, data from 1313 right eyes were analyzed. The mean age of the participants was 52.7 +/- 10.0 years, and 58.3% [n = 767] were female. Overall, myopia was more prevalent among those with cataract [odds ratio [OR]: 2.00, 95% confidence interval [CI]: 1.38-2.89]. Based on the type of cataract and refractive errors, the odds of myopia was significantly higher with nuclear cataracts [OR: 1.81, 95% CI: 1.14-2.87]. The odds of myopia was higher for cases of nuclear cataract with some degrees of posterior subcapsular cataract [PSC] [OR: 3.33, 95% CL 1.42-7.80]. Of nine participants with cortical cataract, seven participants had hyperopia [OR: 3.77, 95% CI: 0.78-18.31]. Individuals with nuclear and PSC showed a significantly higher prevalence of myopia while the prevalence of hyperopia was lower in those with cataract. High myopia was seen in higher grades of nuclear cataract. The high percentage of hyperopia was also significant in patients with cortical cataract. More studies are necessary to clarify the correlation between cortical cataract and hyperopia

Importance of including refractive error tests in school children's vision screening

This study determined the importance of including tests for refractive errors in vision screening. In this cross-sectional study, we performed a random cluster sampling of schoolchildren in the city of Dezful, Iran. After sampling and obtaining informed written consents from their parents, children underwent examinations at the school sites. Students underwent tests of visual acuity, cover tests and cycloplegic refractions. Elementary and middle school students who had a visual acuity of 20/20 or better, in both eyes were included in the study. From 3673 elementary and middle school students, 2957 [80.5%] had 20/20 vision or better. Of these, 16.1% [95% confidence interval [Cl]: 14.8 - 17.4] were ametropic, 0.4% had myopia and 10.1% had hyperopia. Mean sphere in those with hyperopia was +2.6 +/- 0.7 [range: +2.0 to +7.28] diopter [D]. Astigmatism was detected in 6.6% and the mean cylinder was -0.9 [range: -0.75 to -3.25] D. The rate of anisometropia was 1.5% [95% Cl: 0.8 - 2.0]. Screening results of 20/20 vision for schoolchildren does not necessarily indicate normal eye status because hyperopia and astigmatism may still be sources of visual discomfort. To identify these cases and increase the sensitivity of screening tests, measurement of refractive errors by cycloplegic refraction tests might be included in vision screening

Prevalence and risk factors of refractive errors among school children in Mashhad, 2006-2007

To determine the prevalence of refractive condition and its risk factors among students in Mashhad. A total of 2510 students representing a cross-sectional of the population of Mashhad were sampled using random cluster sampling strategy. Primary and middle school students underwent cycloplegic refraction. The refractive errors of high school students were measured using non-cycloplegic autorefraction. Myopia was defined as spherical equivalent [SE] of -0.5 diopter [D] or more, and hyperopia was defined as SE of +0.5 diopter [D] or more, and astigmatism of 0.75 cylinder diopter or greater. Examination was carried out in the school using standardized testing protocols. 2150 students [group 1: 1163 primary and middle school, group 2: 947 high school students and 13 missed data] participated. The prevalence of refractive errors in the 1st group was: myopia=2.4%, hyperopia=87.9%, astigmatism=9.8% and anisometropia=3.0% [SE difference at least 1.00 D], and in the 2nd group myopia=24.1%, hyperopia=8.4%, astigmatism=11.8% and anisometropia=5.6%. There was significant difference in refractive errors between girls and boys [P<0.001]. In primary and middle school prevalence of myopia increased with age [OR=1.3 95% CI: 1.03 to 1.7 and P=0.013]. The prevalence of refractive errors among students in Mashhad is high. Effective detection and treatment of these refractive errors is expected to reduce the incidence of amblyopia and strabismus and also can prevent substantive effects on academic performance

prevalence of attention deficit hyperactivity disorder [ADHD] among school children of Nishaboor - Iran during 2006

ADHD is the most common mental disorder in children. Awareness of students' mental health has an important role in programming for decrementing their disorders and, improving their mental health and also preventing the complications of their decreased mental health. The aim of this study was to determine the prevalence of ADHD and some of the affecting factors among school children in Nishaboor localed in the North-East of Iran. This descriptive study was done on school children in Nishaboor during 2006. Subjectes selected by stratified cluster sampling. Data collection was done using the Conner's Parent and Teacher Scale questionnaire, and each student's questionnaires were completed by both the teacher and the parents. Data analysis was performed regarding to the mean scores of teachers and parents. The score 15 was chosen as the probable indicator for ADHD. 722 students [79.6%] were involved this study. Prevalence of ADHD was 12.5%, CI95%: 10-14.8%. There was no significant difference in gender distribution. The prevalence of ADHD had a significant rise with age [P < 0.05]. The highest prevalence was in spring born and the lowest was in the summer born school children [P < 0.05]. The prevalence of ADHD had a significant relationship with father's education and was lower in students whose father had higher educations [P < 0.05]. Variables such as type of delivery, pariety, mother's education had no significant relationship with the prevalence of ADHD. In this study the prevalence of ADHD is higher than similar studies. Risk groups to be followed up by the responsible organizations