Suture-related complications after deep anterior lamellar keratoplasty for keratoconus.

PURPOSE: The purpose of this study is to determine the incidence of suture-related complications, their risk factors, and effects on the clinical outcomes after deep anterior lamellar keratoplasty (DALK) for keratoconus. METHODS: In this retrospective, comparative, interventional study, the records of consecutive patients with keratoconus who underwent DALK were reviewed for suture-related complications. Univariate analyses were used to identify risk factors for suture complications. We compared groups with and without suture-related complications to evaluate the effects of these complications on clinical outcomes after DALK. RESULTS: Of the 633 DALKs, 438 eyes (69.2%) developed suture complications including loose sutures (32.7%), spontaneous suture rupture (30%), sterile suture abscesses (22.8%), suture tract vascularization (16.4%), suture erosion (10.3%), and suture cheese wiring (6.8%). Vernal keratoconjunctivitis increased the incidence of sterile suture infiltration, premature suture loosening, and suture tract vascularization. Loose suture was observed more commonly in larger graft size, while spontaneous suture rupture was associated with late suture removal. There was no statistically significant difference in postoperative outcomes including visual acuity, refraction, graft rejection, and failure in eyes with and without suture complications. However, suture-related complications were directly associated with sight-threatening ocular morbidities, including graft rejection (39 eyes), ulcer (1 eye), and failure (2 eyes). CONCLUSION: Suture-related complications frequently occurred after DALK for keratoconus. Ocular surface inflammation, large grafts, and late suture removal increased the risk of suture-related complications. While these complications had no negative impact on clinical outcomes in the majority of cases, some of them led to sight-threatening morbidity, underlining the importance of early diagnosis and treatment.

Donor Risk Factors and Environmental Conditions Associated With Poor-Quality Corneas: An Analysis of the Central Eye Bank of Iran (2018-2021).

PURPOSE: The purpose of this study was to investigate the donor risk factors and environmental conditions associated with poor-quality corneas using the database of the Central Eye Bank of Iran over 4 years. METHODS: This cohort study was conducted on the recorded data of all donated corneas at the Central Eye Bank of Iran database from March 2018 to March 2022. Donors' characteristics and tissue variables were extracted from the database. The final corneal quality was determined based on slitlamp biomicroscopic observations and the results of specular microscopy. Environmental variables were also obtained from reliable resources. Risk factors for poor-quality corneas were calculated using logistic mixed-effect regression analysis. All analyses were performed with STATA 17.0. The significance level of 0.05 was considered for all the analyses. RESULTS: The data of 20,625 eyes of 10,601 donors were evaluated. We found that donor age had an inverse correlation with endothelial cell density (r = -0.28, P < 0.001). The trend of donated corneal poor quality decreased between 2018 and 2021. Several factors, including intoxication (odds ratio [OR] = 1.29), obesity (OR = 1.34), diabetes mellitus (OR = 1.63), hypertension (OR = 1.52), and pseudophakic eyes (OR = 1.56), were associated with the poor quality of donated corneal tissues. The outdoor temperature over 26°C was associated with higher odds of poor corneal quality (OR = 1.31), whereas high relative humidity decreased the odds of poor corneal quality (OR = 0.82). CONCLUSIONS: This study revealed that the cause of donor death, obesity, donor comorbidities, pseudophakia, and environmental factors could affect the corneal quality and make the donated corneas less suitable for transplantation.

Thickness Profile of Donated Corneas Preserved in Optisol-GS versus Sinasol: An Ex-vivo Study.

Purpose: This study aimed to compare the thickness profile and the endothelial cell density (ECD) of donated corneas maintained in Optisol-GS with those preserved in Sinasol over seven days. Methods: Twenty paired donor corneas were received from the Central Eye Bank of Iran. After recording the osmolarity of each medium, one of each of the cornea pairs was preserved in either Optisol-GS or Sinasol media. Then, slit-lamp biomicroscopy and specular microscopic examinations were performed at the baseline and on day seven. Visante optical coherence tomography (V-OCT) was also performed at 1 hour (h), 24h, 72h, and one week post-preservation. The specular microscopic and V-OCT values were then compared between the two groups. Results: The mean osmolarity of the Sinasol group was significantly less than the Optisol-GS group (296 vs. 366 mOsm/L, P = 0.0008). The mean central corneal thickness at the measurement points was comparable between the two groups. However, the increase of thickness one week post-preservation in the Sinasol group was remarkably lower than those in the Optisol-GS group (P = 0.027). The mean ECD was comparable between the groups at the baseline and on day seven. However, the mean change of ECD from baseline to day seven was considerably higher in the Optisol-GS group than in the Sinasol group (P = 0.019). Conclusion: Corneal storage in Sinasol over seven days provides better and superior maintenance and preservation of corneal tissue deturgescence and a lower rate of ECD loss over Optisol-GS.

Effect of Enamel Pretreatment Using Er,Cr:YSGG Laser Irradiation on Micro-shear Bond Strength of a Self-etch Fissure Sealant.

Fissure sealant application is an efficient method for dental caries prevention. Self-etch fissure sealants (SE-FS) eliminate the separate etching step for bonding. The present study investigated the micro-shear bond strength (µSBS) of a SE-FS (Prevent seal®, Itena©, Paris, France) to enamel pretreated with different methods including Er,Cr:YSGG laser, under noncontaminated and saliva-contaminated conditions. Sixty human premolars were sectioned into halves and randomly assigned into two groups of saliva-contaminated and noncontaminated. Each group was further divided into six subgroups (N = 10) of different enamel pretreatment methods: (Laser+SE-FS), (Acid-etch+SE-FS), (Laser+Acid-etch+SE-FS), (Mechanical preparation+SE-FS), (SE-FS), and (Acid-etch+Bonding+Conventional fissure sealant) as positive control. The µSBS of the sealant material to enamel was measured in all subgroups. The two-way ANOVA and Tukey tests were applied at P < 0.05. Saliva contamination had a significant effect on µSBS (P < 0.001), while pretreatment with laser or acid etching did not significantly affect the µSBS (P = 0.251). The µSBS of SE-FS to untreated enamel surface was significantly lower than the positive control (P = 0.035). The µSBS value in the subgroup receiving laser+etching+SE-FS was significantly higher than the remaining five subgroups (P < 0.001). Other pairwise comparisons were not statistically significant (P > 0.05). Acid-etch and Er,Cr:YSGG laser exert a synergic effect on µSBS of Prevent Seal®, irrespective of saliva contamination.

The Synthesis and Application of Ionic Liquid Functionalized Mesoporous Silica SBA-15 for Organic Synthesis.

Ionic liquid functionalized mesoporous silica compounds present significant advantages in organic synthesis as catalysts. There are various preparation procedures for the synthesis of diverse ionic liquid catalysts, which have different catalytic properties with various roles in organic reactions. Therefore, due to the increment in the usage of mesoporous materials in the industry and numerous pieces of research, in this article, the information on the development of ionic liquids supported on SBA-15 between the years 2014 and 2021 was gathered.

Tehran environmental and neurodevelopmental disorders (TEND) cohort study: Phase I, feasibility assessment.

PURPOSE: To advance knowledge about childhood neurodevelopmental disorders and study their environmental determinants, we conducted a study in Tehran, Iran to assess the feasibility of prospective birth cohort study. METHODS: We evaluated participation of pregnant women, feasibility of sampling biological material, and health care services availability in Tehran in four steps: (1) first trimester of pregnancy; (2) third trimester of pregnancy; (3) at delivery; and (4) two to three months after delivery. We collected related data through questionnaires, also various biological samples were obtained from mothers (blood, urine, milk and nails-hands and feet) and newborns (umbilical cord blood, meconium, and urine samples) from February 2016 to October 2017. RESULTS: overall 838 eligible pregnant women were approached. The participation rate was 206(25%) in our study and about 185(90%) of subjects were recruited in hospitals. Out of 206 participants in the first trimester, blood, urine, hand nail, and foot nail samples were collected from 206(100%),193(93%), 205(99%), and 205(99%), respectively. These values dropped to 65(54%), 83(69%), 84(70%), and 84(70%) for the remaining participants 120(58%) in the third trimester, respectively. Also, we gathered milk samples from 125(60%) of mothers at two to three months after delivery. CONCLUSION: Our findings suggest that hospitals were better places for recruitment of subjects in a birth cohort in Tehran. We further concluded that birth cohort study recruitment can be improved by choosing appropriate gestational ages. Obtaining the newborn's urine, meconium, and umbilical cord blood were challenging procedures and require good collaboration between hospital staff and researchers.

The relationship between weight indices and injuries and mortalities caused by the motor vehicle accidents: a systematic review and meta-analysis.

BACKGROUND: The relationship between weight indices and injuries and mortality in motor vehicle accidents is unknown. Systematic review studies addressing the collection and analysis of the relationship in investigations are very limited. The purpose of this systematic review is to determine the relationship between BMI, obesity and overweight with mortality and injuries and their severity and vulnerable organs after the motor vehicle accident. METHODS: The databases (MEDLINE/PUBMED, EMBASE, Web of Science, etc) were searched for relevant abstracts using certain keywords. Of all the articles, similar ones were removed considering different filters. The collected data were entered into the STATA SE v 13.1. The heterogeneity of the data was analyzed using i2 statistics. In addition, the estimates of the study were done based on the age group (children and adults) and the impact of obesity on different regions of the body. RESULTS: A direct relationship was observed between the overall BMI and the degrees of injuries (CI=0.503-1.139), and mortality due to motor vehicle accident (CI=1.267-1.471). A positive relationship was found between obesity and AIS+2 (CI=0.653-1.426), and AIS+3 (CI=1.184-1.741), and ISS (CI=1.086-1.589). Also, a negative relationship between overweight and injuries rates, and a direct relationship between overweight and mortality (CI=0.979-1.167), and injuries with index of AIS+2 (CI=1.178-0.768) and AIS+3 (CI=0.48-2.186) were found. CONCLUSIONS: The prediction of injury, mortality and severity of injuries in the motor vehicle accident by the variable of obesity and overweight determines the need to design prevention programs for this vulnerable group at all levels.

The interaction between apolipoprotein B insertion/deletion polymorphism and macronutrient intake on lipid profile and serum leptin and ghrelin levels in type 2 diabetes mellitus patients.

PURPOSE: We aimed to study whether macronutrient intake could modify the association between ApoB Ins/Del and lipid profile, and serum leptin and ghrelin in type 2 diabetes mellitus (T2DM) patients. METHODS: In this study, 700 T2DM patients were recruited. Anthropometric, biochemical and molecular data were collected, and Diet was assessed using a food frequency questionnaire. The interactions were tested using ANCOVA. RESULTS: Del-allele carriers with high-MUFA and carbohydrate (≥ 12 and ≥ 54% of energy, respectively) had significantly higher TG (P = 0.04) and LDL-C (P = 0.02) compared to Ins/Ins homozygotes, and these were not significant in subjects with low-MUFA and -carbohydrate (< 12 and < 54%, respectively). A significant interaction was observed between ApoB Ins/Del and diet on TG in both unadjusted (P = 0.03) and adjusted models (model 2 and 3, P = 0.04 and P = 0.04, respectively), and on LDL-C only in adjusted models (model 2 and 3, P = 0.03 and P = 0.029, respectively). Besides, Del-allele carriers with protein, SFA, MUFA and n-3PUFA of ≥ 14, 9, 12 and 0.6%, respectively, had a significant increase in their serum leptin than Ins/Ins homozygotes (P < 0.05). However, these associations were not significant between the two genetic groups in subjects with low intakes of protein, SFA, MUFA and n-3PUFA. Moreover, Del-allele carriers with low carbohydrate (< 54%) had significantly higher leptin and ghrelin than Ins/Ins homozygotes (P < 0.05), however, in high-carbohydrate group, leptin and ghrelin were not significantly lower. CONCLUSIONS: These findings indicate that the interaction between ApoB Ins/Del and dietary intake of MUFA, SFA, n-3PUFA, carbohydrate and protein could modulate the serum levels of TG, LDL-C, leptin and ghrelin in T2DM patients.

Differences in the interaction between CETP Taq1B polymorphism and dietary fat intake on lipid profile of normolipedemic and dyslipidemic patients with type 2 diabetes mellitus.

BACKGROUND & AIM: Dyslipidemia is one of the major complications in patients with type 2 diabetes mellitus (T2DM). Dietary fat intake and genetic factors including CETP Taq1B polymorphism could also affect lipid profile concentrations, in particular HDL-c. We decided to study the frequency of this polymorphism and its interaction with dietary fat intake on HDL-c concentration among Iranian T2DM patients with and without dyslipidemia. METHODS: In this comparative study, serum samples were collected from 55 patients with dyslipidemia and 129 patients without dyslipidemia. Validated semi-quantitative FFQ was used for food consumption data. CETP Taq1B polymorphism was studied by polymerase chain reaction-restriction length polymorphism (PCR-RFLP). We used χ2 and two-way ANOVA tests for statistical analysis. RESULTS: The frequency of B1B1 genotype was higher in patients with dyslipidemia (p = 0.01). There was no significant relationship between CETP Taq1B polymorphism and lipid profile concentrations. In patients without dyslipidemia, the interaction between the polymorphism and total fat intake on HDL-c concentration as well as TG/HDL ratio was significant (p = 0.02 and p = 0.009 respectively). This was more evident in B1B1 genotype. Moreover, HDL-c concentration was significantly higher in B2B2 genotype with low total fat intake. CONCLUSION: Higher total fat intake may affect the relationship between CETP Taq1B polymorphism and HDL-c concentration in patients with normolipidemic T2DM.

De novo Mutation in CACNA1S Gene in a 20-Year-Old Man Diagnosed with Metabolic Myopathy.

The calcium channel, voltage-dependent, L-type, alpha 1S subunit (CACNA1S) gene encodes a skeletal Ca2+ channel which is involved in calcium-dependent processes such as muscle contraction and neurotransmitter release. Mutations in this gene have been accompanied by hypo- and normokalemic periodic paralysis, thyrotoxic periodic paralysis, and susceptibility to malignant hyperthermia. We report the clinical and genetic findings in a patient diagnosed with metabolic myopathy who had episodic attacks of muscle pain and weakness but with no family background of the disease. Next-generation sequencing (NGS) using a panel targeting metabolic myopathy and myotonia genes identified a de novo heterozygous pathogenic variant c.3724A>G, p.Arg1242Gly, in exon 30 of CACNA1S. As the second report of this variant, this case may broaden the CACNA1S-related disease spectrum to include normokalemic periodic paralysis.

Risk Factors for Pterygium in Ilam Province, Iran.

PURPOSE: To evaluate the risk factors for pterygium in the dry, high altitude province of Ilam, Iran. METHODS: The study included patients who presented to ophthalmology clinic. The patients were divided into two groups: 210 diagnosed with pterygium or pinguecula (unilateral or bilateral), and 210 healthy controls. Demographic variables, living environment, disease type, disease laterality, family history of pterygium as well as history of smoking, working outdoors, baking, welding, ocular conditions (trachoma keratopathy, glaucoma, refractive error, and dry eye), use of glasses, ultraviolet light exposure, and systemic conditions were collected from both groups and compared for risk assessment. RESULTS: Univariate analysis revealed that age (P = 0.001), sex (P = 0.001), family history of pterygium (P = 0.001), positive history of smoking (P < 0.001), history of baking (P = 0.045), welding experience (P < 0.001), severe blepharitis (P < 0.001), hyperopia (P < 0.001), dry eye (P < 0.001), hypertension (P < 0.001), ischemic heart disease (P < 0.001), obesity (P = 0.038), and primary residential area (P = 0.025) had significant associations with increased incidence of pterygium. However, in multivariate analysis, only family history of pterygium, cigarette smoking, history of baking, age, and severe blepharitis were significantly associated with the incidence of pterygium (P<0.001, P<0.001, P = 0.002, P = 0.023 and P = 0.002, respectively). CONCLUSION: This study tested more risk factors related to the prevalence of pterygium compared to previous studies. It also confirmed previously established risk factors. Family history of pterygium and blepharitis were risk factors that have not been reported in previous studies and were found to be significantly associated with the development of pterygium in this study.

The Effect of Quercetin on Inflammatory Factors and Clinical Symptoms in Women with Rheumatoid Arthritis: A Double-Blind, Randomized Controlled Trial.

OBJECTIVE: Previous studies have shown that the bioflavonoid quercetin has anti-inflammatory and anti-nociceptive effects. We investigated the effect of quercetin supplementation on inflammation, disease severity, and clinical symptoms in women with rheumatoid arthritis (RA). METHODS: The present study was a randomized, double-blind, placebo-controlled clinical trial in which 50 women with RA were allocated into a quercetin (500 mg/day) or placebo group for 8 weeks. Plasma levels of high-sensitivity tumor necrosis factor-α (hs-TNFα), erythrocyte sedimentation rate (ESR), clinical symptoms including early morning stiffness (EMS), morning and after-activity pain, and tender (TSC) and swollen joint counts (SJC) were determined. Disease activity and functional disability were assessed by Disease Activity Score 28 (DAS-28), physician global assessment (PGA), and a health assessment questionnaire (HAQ) at the beginning and end of the study. RESULTS: Quercetin supplementation for 8 weeks significantly reduced EMS, morning pain, and after-activity pain (p < 0.05). DAS-28 and HAQ scores decreased in the quercetin group compared to placebo and the number of patients with active disease significantly decreased in the quercetin group. Plasma hs-TNFα level was significantly reduced in the quercetin group compared to placebo (p < 0.05). There were no significant differences in TJC and SJC between groups but TJC significantly decreased in the quercetin group after the intervention. Supplementation had an effect on ESR but it was not significant (p > 0.05). CONCLUSIONS: Five hundred milligrams per day quercetin supplementation for 8 weeks resulted in significant improvements in clinical symptoms, disease activity, hs-TNFα, and HAQ in women with RA.

Evaluation of Er,Cr:YSGG Laser Effect on Microshear Bond Strength of a Self-Adhesive Flowable Composite in the Dentin of Permanent Molar: An In Vitro Study.

Aim and Background. Recently, new restorative materials such as self-adhesive flowable composites, because of their simple use and no need to bonding and etching, are considered important, particularly in pediatric dentistry. The aim of this study is to evaluate the effect of Er,Cr:YSGG laser on microshear bond strength of self-adhesive flowable composite on permanent teeth dentin in vitro. Material and Methods. In this experimental study, 40 dentin sections were prepared from healthy third molars and divided into two groups according to their surface preparation by Er,Cr:YSGG laser or without laser, only with silicon carbide paper. In each group, two groups of 10 teeth were treated with self-adhesive flowable composite (Dyad) and conventional flowable composite (acid etch and bonding). Samples were stored in normal saline and after 48 hours their bond strength was measured. The failure mode of samples was observed on stereomicroscope. In order to analyse the results, the one way ANOVA and Tukey's test for multiple comparisons were used. Result. The maximum bond strength was related to conventional flowable composite with laser preparation group (24/21 Mpa). The lowest one was seen in Dyad composite without laser emitting (9/89 Mpa). The statistical difference between this two groups was significant (P value = 0/0038). The microshear bond strength differences between Dyad composite groups with laser preparation (mean = 16/427 ± 1/79) and without laser preparation (mean = 12/85 ± 1/90) were statistically significant too (P value = 0/01). Conclusion. Self-adhesive flowable composite has lower microshear bond strength than conventional flowable composite. Moreover, the laser irradiation as a surface treatment can improve this bond strength.

Deep Anterior Lamellar Keratoplasty in Keratoconic Patients with versus without Vernal Keratoconjunctivitis.

PURPOSE: To compare the clinical outcomes of deep anterior lamellar keratoplasty (DALK) for keratoconus in patients with vernal keratoconjunctivitis (VKC) versus those without VKC. METHODS: In this retrospective comparative study, records of 262 eyes with keratoconus (Group 1) and 28 keratoconic eyes with VKC (Group 2) that had undergone DALK were compiled. Reviewed parameters included length of follow-up, best-corrected visual acuity (BCVA), refractive error, complications and cumulative graft survival. RESULTS: Mean duration of follow-up was 38.6 ± 20.2 and 34.4 ± 20.9 months in groups 1 and 2, respectively (P = 0.21). Mean post-operative BCVA was 0.19 ± 0.11 and 0.20 ± 0.15 logMAR, in groups 1 and 2 (P = 0.79). BCVA≥20/40 was achieved in 91.6 and 88.5% of eyes in groups 1 and 2, respectively (P = 0.48). Epithelial problems were encountered in 31.3 and 42.9% of operated eyes, respectively (P = 0.16). Vascularization of suture tracts and stitch abscesses were encountered more frequently in the eyes with VKC (P = 0.01 and <0.001, respectively). At the 33-month follow-up examination, rejection-free graft survival rates were 56.0% in group 1 and 33.3% in group 2, with mean durations of 41.0 and 32.1 months, respectively (P = 0.15). Graft survival rates were 98.1% in group 1 and 95.0% in group 2, with mean durations of 88.6 and 88.4 months, respectively (P = 0.74). CONCLUSION: Clinical outcomes of DALK in keratoconic eyes with VKC were comparable to those in eyes with keratoconus alone. However, complications such as suture tract vascularization and stitch abscesses were more common when VKC coexisted, necessitating closer monitoring.

Effect of Donor Graft Quality on Clinical Outcomes After Penetrating Keratoplasty for Keratoconus.

PURPOSE: To evaluate the effect of donor and eye bank characteristics on graft rating and clinical outcomes after penetrating keratoplasty (PK) for keratoconus. METHODS: This retrospective interventional case series included 252 keratoconic eyes which underwent PK. Donor data included age and sex, cause of death, death-to-preservation time, preservation-to-surgery time, epithelial and stromal status, endothelial cell density (ECD) and morphology, and graft rating. Postoperative outcomes included visual acuity, refractive error, epithelial problems, suture-related complications, graft rejection, and graft transparency. Multivariate regression analysis assessed correlations between donor and eye bank characteristics and graft quality, and postoperative outcomes. RESULTS: Mean recipient and donor age was 29.7 ± 10.0 and 26.2 ± 8.8 years, respectively and mean follow-up period was 66.7 ± 38.5 months. Death-to-preservation time was significantly associated with the presence of graft epithelial sloughing (P = 0.005) and stromal cloudiness (P < 0.001). Donor age significantly influenced ECD (P = 0.02), mean cell area (P = 0.04), and hexagonality (P = 0.01). The presence of epithelial defects on postoperative day 1 correlated significantly with death-to-preservation time (P = 0.004). Graft stromal edema on postoperative day 1 was significantly associated with graft epithelial sloughing (P < 0.001). Postoperative visual and refractive outcomes, complications, and graft survival were not correlated with any donor or eye bank factors. CONCLUSION: Donor and eye bank variables affected the quality of donor corneas and early postoperative course. However, their long term effect on clinical outcomes, complications, and graft survival were insignificant.

Comparing quantitative and qualitative indices of the donated corneas maintained in Optisol-GS with those kept in Eusol-C.

This study was conducted to compare the quantitative and qualitative indices of the donated corneas maintained in either Optisol-GS or Eusol-C storage media. In an ante-grade single blind study, two corneas from each donor with a death to preservation time of less than 30 h and with a minimum of "an apparent good cornea rating" were maintained in corneal storage media; randomly one in Optisol-GS and the other in Eusol-C. Slit-lamp biomicroscopic and specular microscopic examinations were performed on days 1 and 7. The results of the qualitative and quantitative indices and the final cornea rating were recorded. Statistical analyses were performed to evaluate any differences between the two media. 180 corneas from 90 donors with an age range of 29.3 ± 22.4 years were allocated in two groups: 90 corneas in Optisol-GS and the other 90 in Eusol-C. Five corneas in Optisol-GS and four corneas in Eusol-C were excluded from the study due to lack of specular images. There was no significant change of endothelial rating from day 1 to day 7 between two media (P = 0.175). As the maintenance time of the donated corneas increased, no significant difference was noted between the two groups in terms of endothelial indices, stromal edema, and Descemet's folding. This study shows no superiority between Eusol-C and Optisol-GS in short term preservation of donated corneas.

Graft epithelial defects after deep anterior lamellar keratoplasty.

PURPOSE: The aim of this study was to report the incidence of epithelial defects and identify donor factors that might correlate with the presence of epithelial defects and graft reepithelialization time after a deep anterior lamellar keratoplasty (DALK). METHODS: In this retrospective study, 283 consecutive keratoconic eyes underwent DALK using donor corneas of different qualities, ranging from fair to excellent. The donor data included age and sex, cause of death, death-to-preservation time, preservation-to-surgery time, epithelial and stromal status, endothelial cell density and morphology, and graft rating. On the first postoperative day, the corneal surface was carefully examined before and after the application of fluorescein stain, and the patients were followed up daily until complete reepithelialization occurred. A multivariate regression analysis was used to assess the correlation between donor characteristics and graft epithelial defects on postoperative day 1. RESULTS: The mean donor and recipient ages were 33.5 ± 13.2 and 27.6 ± 7.9 years, respectively. Two hundred sixty-four (93.3%) grafts had epithelial defects on day 1. The epithelial defects completely healed after 3.5 ± 2.7 (range, 1-37) days. In the univariate analysis, the presence of epithelial defects on postoperative day 1 had a significant correlation with donor preservation-to-surgery time (P = 0.01), epithelial sloughing (P < 0.001), and graft rating (P = 0.004). In the multivariate analysis, only donor epithelial sloughing significantly influenced the presence of epithelial defects on postoperative day 1 (odds ratio = 9.26, P < 0.001). CONCLUSIONS: Graft epithelial defects were very common after DALK. The epithelial status of donors was the only independent factor predictive of the surface integrity on the first postoperative day.

Effect of donor graft quality on clinical outcomes after deep anterior lamellar keratoplasty.

PURPOSE: The aim of this study was to determine the effect of donor features, including age, death-to-preservation time, preservation-to-surgery time, graft rating, and endothelial cell features, on visual and refractive outcomes and complications occurring after deep anterior lamellar keratoplasty (DALK) in patients with keratoconus. METHODS: In this retrospective study, 290 consecutive keratoconic eyes underwent DALK using donor corneas of different qualities, ranging from fair to excellent. Donor corneas were stored in intermediate-term storage medium. Donor data included age and sex, death-to-preservation time, preservation-to-surgery time, epithelial and stromal status, endothelial cell density and morphology, and graft rating. Postoperative outcomes included visual acuity, refractive error, epithelial problems, suture-related complications, graft rejection, and graft transparency. A multivariate regression analysis was used to assess the correlation between donor characteristics and postoperative outcomes. RESULTS: Mean donor and recipient ages were 33.4 ± 13.1 and 27.7 ± 8.0 years, respectively. The mean follow-up period was 38.2 ± 20.2 months. The presence of epithelial defects on postoperative day 1 had a significant correlation with donor epithelial sloughing (R = 0.26, P < 0.001), preservation-to-surgery time (R = 0.21, P = 0.001), and graft rating (R = -0.17, P = 0.004). Graft stromal edema on postoperative day 1 was significantly correlated with donor epithelial sloughing (R = 0.31, P < 0.001), preservation-to-surgery time (R = 0.24, P < 0.001), and graft rating (R = -0.28, P < 0.001). Suture-related complications, graft rejection episodes, graft clarity, visual acuity, and refractive outcomes at the final follow-up examination were found to have no correlations with any donor factors. CONCLUSIONS: The use of low-quality donors for DALK increased the rate of epithelial defects and stromal edema immediately postoperatively. However, the donor features had no influence on visual and refractive outcomes and complications.

The effect of quercetin on plasma oxidative status, C-reactive protein and blood pressure in women with rheumatoid arthritis.

BACKGROUND: Considering the increased production of free radicals and inflammatory factors in rheumatoid arthritis (RA) and the effects of bioflavonoid quercetin on reducing oxidative stress, inflammation and blood pressure, the present study examined the effects of bioflavonoid quercetin on total antioxidant capacity (TAC) of plasma, lipid peroxidation and blood pressure in women with RA. METHODS: The current study was a randomized double-blind clinical trial in which 51 women with RA aged 19-70 years, were participated. Patients were assigned into quercetin (500 mg/day) or placebo groups for 8 weeks. Dietary intake was recorded using 24-h dietary recall questionnaire and the physical activity was assessed through an international short questionnaire of physical activity at the beginning and end of the study. Plasma TAC and malondialdehyde (MDA) using colorimetric method, oxidized low density lipoprotein (ox-LDL) and high sensitivity C-reactive protein (hs-CRP) using enzyme-linked immunosorbent assay method and also blood pressure were measured at the beginning and end of intervention. RESULTS: After 8 weeks there were no significant differences in TAC of plasma, ox-LDL, MDA, hs-CRP, systolic and diastolic blood pressure between quercetin and placebo groups and in each group comparing before and after. CONCLUSIONS: In this study, quercetin had no effect on oxidative and inflammatory status of plasma and blood pressure in patients with RA. Further studies are needed to ensure the effect of quercetin on oxidative stress and inflammation in human.

Preparation of pre-cut corneas from fresh donated whole globes for Descemet's stripping automated keratoplasty: 3-year results at the Central Eye Bank of Iran.

To describe the technique and the results of the preparation of pre-cut corneas for Descemet's stripping automated endothelial keratoplasty (DSAEK) during a 3-year period at the Central Eye Bank of Iran (CEBI). The method of preparation of pre-cut corneas from donated whole globes at the CEBI is described and the frequency and percentage of pre-cut corneas prepared for DSAEK, between April 2009 and March 2012, are specified. Moreover, post-operative reports are reviewed for any complaints about using pre-cut tissues for DSAEK. Out of the 1,518 donated whole globes appropriate for DSAEK, 1,478 (97.4 %) pre-cut corneas were successfully prepared. The method of preparation failed in 40 (2.6 %) cases. Based on the eye bank post-operative reports, thickness of pre-cut tissues for DSAEK was deemed unacceptable in only 6 (0.4 %) cases prior to surgery; five of these were too thick and one was too thin. Preparation of pre-cut corneas, for DSAEK from donated whole globes, in the CEBI is a safe and easy method, with very good preservation of endothelial cells after the preparation of the pre-cut corneas and reduced risks from corneal manipulation.