Retinal and choroidal thickness in fuchs uveitis syndrome: a contralateral eye study.

BACKGROUND: To investigate the subfoveal retinal and choroidal thickness in patients with unilateral Fuchs Uveitis Syndrome (FUS). METHODS: This comparative contralateral study was performed in affected eyes with FUS versus fellow eyes. For each eye parameters such as subfoveal choroidal thickness (SCT), subfoveal choriocapillary thickness (SCCT), central macular thickness (CMT), and central macular volume (CMV) were measured; then the measured values of affected and fellow unaffected eye were compared. RESULTS: Thirty-seven patients (74 eyes) including 19 females (51.4%) with a mean age of 36.9 ± 7.6 years were enrolled. The mean SCT was lower in the affected eyes (344.51 ± 91.67) than in the fellow (375.59 ± 87.33) with adjusting for duration of disease and axial lengths (P < 0.001). The mean SCCT, CMT, and CMV were higher in eyes with FUS than in fellow eyes (P < 0.05). CONCLUSIONS: The result of our study demonstrated that affected eyes in patients with FUS tend to have thinner SCT and thicker SCCT and CMT compared to uninvolved fellow eyes.

Clinical characterizations and molecular genetic study of two co-segregating variants in PDZD7 and PDE6C genes leading simultaneously to non-syndromic hearing loss and achromatopsia.

BACKGROUND: Autosomal recessive non-syndromic hearing loss (NSHL) and cone dystrophies (CODs) are highly genetically and phenotypically heterogeneous disorders. In this study, we applied the whole exome sequencing (WES) to find the cause of HL and COD in an Iranian consanguineous family with three affected individuals. METHODS: Three members from an Iranian consanguineous family who were suffering from NSHL and visual impairment were ascertained in this study. Comprehensive clinical evaluations and genetic analysis followed by bioinformatic and co-segregation studies were performed to diagnose the cause of these phenotypes. Data were collected from 2020 to 2022. RESULTS: All cases showed congenital bilateral NSHL, decreased visual acuity, poor color discrimination, photophobia and macular atrophy. Moreover, cornea, iris and anterior vitreous were within normal limit in both eyes, decreased foveal sensitivity, central scotoma and generalized depression of visual field were seen in three cases. WES results showed two variants, a novel null variant (p.Trp548Ter) in the PDE6C gene causing COD type 4 (Achromatopsia) and a previously reported variant (p.Ile84Thr) in the PDZD7 gene causing NSHL. Both variants were found in the cis configuration on chromosome 10 with a genetic distance of about 8.3 cM, leading to their co-inheritance. However, two diseases could appear independently in subsequent generations due to crossover during meiosis. CONCLUSIONS: Here, we could successfully determine the etiology of a seemingly complex phenotype in two adjacent genes. We identified a novel variant in the PDE6C gene, related to achromatopsia. Interestingly, this variant could cooperatively cause visual disorders: cone dystrophy and cone-rod dystrophy.

Fuchs' uveitis syndrome: a 20-year experience in 466 patients.

Fuchs Uveitis Syndrome (FUS), also known as Fuchs Heterochromic Iridocyclitis, is a chronic form of uveitis characterized by mild inflammation primarily affecting one eye. This study aimed to investigate the clinical and epidemiological features of FUS in an Iranian population. A retrospective analysis was conducted on 466 patients diagnosed with FUS at an ophthalmology center affiliated with Isfahan University of Medical Sciences between 2003 and 2021. The Kimura et al. criteria were used for FUS diagnosis. Demographic data, clinical characteristics, misdiagnosed cases, concurrent diseases, and associated ocular findings were analyzed. The study included 507 eyes of 466 FUS patients, with a mean age of 34.01 ± 11.25 years. Iris atrophy, keratic precipitates, and vitritis were common clinical findings. Heterochromia was an infrequent feature. Initial misdiagnosis occurred in 13 patients, with pars planitis being the most common incorrect diagnosis. Toxoplasmosis and multiple sclerosis were common concurrent diseases. Pediatric FUS cases were noted, possibly attributed to early-onset manifestations. Differences in clinical characteristics were observed when compared to other populations. This study provides insights into the clinical and epidemiological aspects of FUS in an Iranian population. Variations in clinical features, misdiagnosis patterns, and concurrent diseases were noted. Attention to specific clinical parameters can aid in accurate FUS diagnosis. Understanding these differences contributes to a better understanding of FUS presentation and its relationship with other diseases.

Comparative analysis of optical coherence tomography angiography (OCTA) results between Behçet's disease patients and a healthy control group.

PURPOSE: This study aimed to compare optical coherence tomography angiography (OCTA) findings between patients with Behçet's disease (BD) and individuals with healthy eyes. DESIGN: A cross-sectional study. METHODS: This cross-sectional study was conducted on patients (67 eyes) with BD who were referred to Feiz Hospital and healthy eyes (43 eyes). All subjects underwent Snellen visual acuity, a slit-lamp examination, measuring intraocular pressure, conducting a dilated fundus examination, OCTA imaging, and spectral-domain (SD)-OCT imaging. OCTA retinal vascular measurements including optic nerve VD, macular-associated VD( superficial and deep), foveal avascular zone (FAZ) area, FAZ perimeter (PERIM), and vessel density within a 300-µm-wide region of the FAZ (FD) were compared between the groups. RESULTS: A significant difference was evident between the two groups (healthy one group and BD group) in terms of parafoveal and perifoveal total retinal thickness, total pRNFL VD in all quadrants except the inferior sector (P < 0.05), and macular superficial, and deep VD in all regions except temporal and superior perifoveal VD (P < 0.05) following adjustments for age, gender, and signal strength index. When comparing the two groups, ocular Behçet's disease (BD) and non-ocular BD, it was evident that peripapillary vessel density (VD) exhibited a significant decrease in ocular BD eyes in all sectors except for the superior and inferior ones, as compared to non-ocular BD eyes. In addition, the comparison of ocular BD and non-ocular BD showed superficial and deep VDs were lower in ocular BD than non-ocular BD in all regions. CONCLUSION: According to these findings, peripapillary and macular vessel density is affected in BD. Key Points • The study utilized OCTA to compare retinal features in Behçet's disease (BD) patients and healthy individuals, revealing significant differences in retinal thickness and vessel density. • Ocular BD demonstrated reduced peripapillary vessel density compared to non-ocular BD. • The demonstrated association between ADMA and cIMT in patients with early SSc may suggest a role of NO/ADMA pathway in the initiation of macrovascular injury in SSc.

Non-steroidal intravitreal injection for noninfectious uveitic cystoid macular edema: Systematic review and meta-analysis.

PURPOSE: To systematically review the published manuscripts on the non-steroidal intravitreal injection for treatment of noninfectious uveitic cystoid macular edema (CME). METHODS: The PubMed, Scopus, and Web of Science, Science Direct, ProQuest, Cochrane Library, ProQuest, Embase, Clinical Key, and Springer were searched for relevant articles published until May 2022. The random-effects models were used to estimate the mean difference (MD) and 95% confidence interval (CI) for postoperative central macular thickness (CMT) and visual acuity (VA) changes. VA was transformed into the logarithm of the minimum angle of resolution (LogMAR). Meta-regression was conducted for adjusting the effects of potential confounders. RESULTS: A total of 17 relevant studies (258 eyes) were included in this meta-analysis. A significant improvement was observed in CMT in the last follow up (350.89 ± 108.43) compared to the baseline (452.3 ± 112.67) (Log MD = 1.82, 95% CI = 1.62, 2.02; I2 = 57.7%; P = 0.002). Additionally, VA also significantly improved in the last follow up (0.56 ± 0.29) compared to the baseline (0.75 ± 0.3) (Exponential MD = 0.82, 95% CI = 0.69, 0.95; I2 = 0.0%; P = 0.98). The subgroups analyzed included ten studies on anti-vascular endothelial growth factors (VEGF), three studies on infliximab, two studies on methotrexate (MTX), and two studies on diclofenac. All subgroups showed a significant improvement in both CMT and VA at the last follow-up (P < 0.05). CONCLUSION: Non-steroidal intravitreal injection including bevacizumab, ranibizumab, infliximab, MTX and diclofenac appears to be an effective treatment option for noninfectious uveitic CME.

Ultra-Widefield Fundus Fluorescein Angiography Findings in Patients with Fuchs' Uveitis Syndrome.

Background: The aim of this study was to evaluate ultra-widefield (UWF) fundus fluorescein angiography (FFA) findings in patients with Fuchs' uveitis syndrome (FUS). Materials and Methods: This cross-sectional study was conducted in patients with FUS. All the patients underwent a complete ophthalmologic examination, and FFA was carried out with Optos UWF retinal imaging. Standard FFA and image acquisition consisted of early phase (15-45 s) images, and late-phase (5-10 min) images were also obtained for both eyes. Results: Forty eyes from twenty unilateral FUS patients, including 11 females (55%), who had a mean age of 38.50 ± 6.97 years, were enrolled. Eighty-five percent of the FUS eyes had optic disc hyperfluorescence (ODH) in the FFA. A significant relationship was observed between ODH and iris heterochromia (P = 0.004). ODH was seen in all the patients with iris heterochromia (n = 16). Peripheral vascular leakage (PVL), capillary nonperfusion, chorioretinal scar, and vascular sheathing were observed in 3, 3, 2, and 8 of the patients' eyes, respectively. Conclusion: UWF FFA imaging seemed to be mandatory for evaluating the prognosis of the FUS patients, and another investigation may require to be conducted to evaluate the effect of antivascular endothelial growth factor agents for the management of PVL in these patients.

Retinal findings of COVID-19 patients using ocular coherence tomography angiography two to three months after infection: Ocular appearance recovered COVID-19 patient.

PURPOSE: The aim of this study was to evaluate the ocular disorders in COVID-19 patients, two to three months after infection. METHODS: In this cross-sectional, historically controlled study, fifty-one COVID-19 patients were compared with thirty-seven age, and gender-matched healthy individuals. After complete ophthalmological examination, all participants underwent peripapillary and macular optical coherence tomography, and optical coherence tomography angiography (OCTA) measurements (OptoVue Inc, Freemont, CA, USA). RESULTS: The time between the initial onset of symptoms, and ophthalmologic examination was 63.31±15.21 (40-95 days). Ophthalmic examination of all the recovered COVID-19 patients was within normal range. None of the peripapillary and macular OCTA parameters were significantly different between the two groups with pairwise comparisons, but after adjusting for age, gender, axial length, and signal strength index (SSI), recovered COVID-19 eyes showed a significant increase in peripapillary retinal nerve fiber (RNFL) thickness, superficial, and deep macular vessel densities in parafoveal and perifoveal regions compared with healthy control eyes (p<= 0.05). Inner retinal thickness overall is higher in recovered COVID-19 eyes compared to healthy eyes after adjustment. CONCLUSION: Patients with moderate-intensity SARS-CoV-2 pneumonia had altered peripapillary and macular vessel density compared to healthy subjects. Further investigation is warranted to analyze the correlation of these changes with disease severity as well as evolution of these changes over time.

The effect of silicone oil tamponade on retinal layers and choroidal thickness in patients with rhegmatogenous retinal detachment: a systematic review and meta-analysis.

BACKGROUND: To evaluate the effects of intravitreal silicone oil (SO) on the retinal and choroidal thickness in eyes with rhegmatogenous retinal detachment (RRD). METHODS: A literature search was performed in Web of Science, Scopus, ProQuest, Embase, Clinical Key, Science Direct, Cochrane Library, and Springer, as well as Persian databases, including IranDoc, MagIran, SID, MOH thesis, and MOH articles until June 2020. Two reviewers independently searched and extracted the data. RESULTS: Sixteen studies (n = 391) met the inclusion criteria. The meta-analysis showed that the SO tamponade could significantly reduce the central macular thickness (CMT) in patients with RRD as compared to gas tamponade WMD = - 14.91; 95% CI: - 22.23, - 7.60; P < 0.001, I2 = 71%). No significant change was found in CMT between the eye with SO tamponade (after SO removal) and the fellow healthy eye in patients with RRD (WMD = - 3.52; 95% CI: - 17.63, 10.59; I2 = 68.6%). Compared to the preoperative stage, the SO tamponade could significantly reduce the subfoveal choroidal thickness in patients with RRD (WMD = - 18.67, 95% CI: - 30.07, - 1.28; I2 = 80.1%). However, there was no significant difference in the subfoveal choroidal thickness before and after SO removal (WMD = - 1.13, 95% CI: - 5.97, 3.71; I2 = 87.6%). CONCLUSION: The SO tamponade had a significant effect on the reduction of retinal layers and the subfoveal choroidal thickness.

Ganglion cell complex and macular thickness layers in primary open-angle glaucoma, pseudoexfoliation glaucoma and healthy eyes: A comparative study.

PURPOSE: To investigate the differences in the ganglion cell complex (GCC) and macular thickness measurements between primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PXG), and healthy eyes with optical coherence tomography (OCT)optovue. METHODS: In this non-randomized comparative cross-sectional study, 43 healthy eyes, 68 POAG eyes, and 57 PXG eyes were included. Patients were matched for age and disease severity. OCT angiography images were obtained for automated measurement of the GCC and macular thickness layers (inner and outer). RESULTS: All GCC parameters were significantly difference between healthy and glaucomatous eyes (mild, and moderate to severe disease).There were no significant differences in GCC parameters between POAG and PXG patients except focal loss volume (FLV) after adjustment. Moderate to severe PXG eyes exhibited significantly lower GCC, larger global loss volume (GLV) values, and FLV values when compared with mild PXG eyes (p<= 0.05). We found significant thinning patterns in inner retinal thickness (fovea, parafovea, and perifovea), and total retinal thickness (parafovea, and perifovea) in moderate to severe PXG eyes when comparing with POAG eyes. Patients with moderate to severe PXG also showed significantly thinning patterns in inner retinal layers (fovea, parafovea and perifovea) and total retinal thickness (nasal parafovea) in compared to mild PXG. CONCLUSION: It appears that GCC thickness is not significantly different between POAG and PXG except FLV. Despite similar retinal thickness in mild disease, a significant reduction in total and inner retinal thickness was demonstrated in moderate to severe PXG compared to moderate to severe POAG, in fovea, parafovea and perifovea region.

Clinical efficacy of inferior peripheral irido-capsulo-hyaloidotomy for pseudophakic malignant glaucoma.

PURPOSE: The present research aimed to investigate the effects of Inferior peripheral irido-capsulo-hyaloidotomy for the management of pseudophakic malignant glaucoma. METHOD: Ten pseudophakic eyes with aqueous misdirection were diagnosed between September 2017 and December 2018 (10 eyes of 8 patients), which were included in the prospective consecutive case series study. Seven eyes underwent Inferior laser peripheral irido-capsulo-hyaloidotomy, and three eyes underwent pars plana vitrectomy, zonulo-capsulo-hyaloidectomy, and inferior iridectomy. RESULTS: Eight eyes (80%) had angle-closure glaucoma. The mean duration of the follow-up was 12.25 ± 3.05 months (ranging from 10-18 months). The patients had a mean age of 69.25 ± 6 years. The IOP at the onset of malignant glaucoma was found to be 33.8 ± 5.5 mmHg, which was reduced to 13.9 ± 2.7 mmHg at the final visit (P value = 0.002). The reduction in the number ± SD of anti-glaucoma medications (3.3 ± 0.48 to 1.4 ± 0.51) and improvement in mean ± SD LogMAR visual acuity (1.2 ± 0.06 to 0.61 ± 0.26) between the onset and final visit were significant (p = 0.004 and P = 0.005, respectively). All the patients responded to Inferior peripheral irido-capsulo-hyaloidotomy (with YAG laser or with the surgical procedure), which led to a significant reduction in intraocular pressure (IOP) and deepening of the anterior chamber. CONCLUSION: The success rate of peripheral irido-capsulo-hyaloidotomy with laser or surgical procedure in the inferior quadrant was high regarding pseudophakic malignant glaucoma patients. The establishment of a patent inferior communication between the vitreous cavity and the anterior chamber was the main component in the treatment of pseudophakic malignant glaucoma patients.

Evaluation of optical coherence tomography angiography parameters in patients treated with Hydroxychloroquine.

BACKGROUND: One of the major side effects of Hydroxychloroquine (HCQ) is retinopathy. The aim of this study was to evaluate the Optical coherence tomography angiography (OCTA) parameters in a group of patients who have Hydroxychloroquine-induced retinopathy based on Multifocal electroretinography (mfERG) with a group who do not have retinopathy. METHOD: This is a Cross-Sectional Study. In this study, patients with Rheumatoid arthritis (RA) or Systemic lupus erythematosus (SLE) who had been taking Hydroxychloroquine for at least 7 years were included. MfERG and OCTA imaging were performed for all patients. Patients were divided into Normal mfERG and Abnormal mfERG groups based on mfERG results. OCTA parameters were studied in these two groups. RESULT: Sixty-one patients (61 eyes) were included. Forty-one patients had SLE and 20 patients had RA. Forty patients (66.7%) had Abnormal mfERG. The mean vascular density (VD) in Superficial capillary plexus (SCP) layer was not significantly different between Normal mfERG and Abnormal mfERG groups (P-Value> 0.05). Mean VD in SCP layer was not significantly different between Normal mfERG and Abnormal mfERG groups (P-Value> 0.05). In RA subgroup, mean VD in SCP layer in PeriFovea region in Abnormal mfERG group was significantly lower than normal group (P-Value < 0.05). Mean VD in deep capillary plexus (DCP) layer in Whole Image, Superior Hemi, Inferior Hemi, PeriFovea area in Abnormal mfERG group was significantly lower than normal group (P-Value < 0.05). This discrepancy was also observed in the RA subgroup but not in the SLE subgroup. The mean of none of the parameters of foveal avascular zone (FAZ) (mm2), Flow Area of Outer Retina (mm2) and Flow Area of Choriocapillaris (mm2) were not statistically significant between the groups Abnormal mfERG and Normal mfERG. (p-value> 0.05). CONCLUSION: VD in the DCP layer decreased in abnormal mfERG patients compared to patients with normal mfERG. But it seems that VD in SCP layer, FAZ Area and Flow Area are similar in both groups. OCTA may be used as a non-invasive tool in the diagnosis of early stages of HCQ-induced retinopathy, especially in RA patients, but further studies are needed.

Intravitreal vascular endothelial growth factor (VEGF) inhibitor injection in patient during pregnancy.

PURPOSE: To report the clinical course of a woman treated with intravitreal bevacizumab during pregnancy. CASE REPORT: A 27-year-old female with poorly controlled diabetes and a history of two previous miscarriage was referred to our hospital with sudden deterioration in visual acuity (VA) in her right eye. Ocular findings revealed severe Proliferative Diabetic Retinopathy (PDR) complicated with preretinal hemorrhages in her right eye, and after maximal Panretinal Photocoagulation (PRP) bilaterally, she was treated with intravitreal injection of bevacizumab (IVB) into the right eye. Twenty four hours after the bevacizumab injection, she reported vaginal bleeding, and ultrasound confirmed a 12-week pregnancy of which the patient was unaware. The patient suffered from pregnancy loss. CONCLUSION: Use of intravitreal anti-VEGF by pregnant woman may only be justified if the potential benefit outweighs the potential risk to the fetus and only if clearly needed. Intravitreal bevacizumab during pregnancy in women with a history of miscarriage should be used with caution.

Short-Term Effects of Photodynamic Therapy on Segmentation of Retinal Layers in Central Serous Chorioretinopathy.

BACKGROUND: The present study aims to evaluate the effect of photodynamic therapy (PDT) on the thickness of segmentation layers of the retina in cases with central serous chorioretinopathy (CSCR). MATERIALS AND METHODS: This was a prospective, observational study on cases with CSCR who were candidates for PDT therapy. All patients had undergone at least 1 month of conservative management without satisfactory resolution. PDT was carried out according to the safe half-dose therapy scheme. Spectral-domain optical coherence tomography was employed to evaluate the changes in morphology and segmentation of retinal layers. Patients were followed up for 3 months. RESULTS: Twenty-seven cases (18 males and 9 females) were included. Age of the patients varied from 39 to 59 years (mean: 46.61 ± 12.48 years). Cases were followed for 92.17 ± 3.28 days. Sixteen cases had functional and anatomical improvement by the treatment. Changes in overall retinal (377.39 ± 61.36 to 323.61 ± 71.36; P = 0.004) and all outer retinal segmentation layers including outer plexiform layer (34.93 ± 10.07 to 29.25 ± 6.12; P = 0.008), outer nuclear layer (63.52 ± 30.44 to 46.44 ± 20.62; P = 0.017), and retinal pigment epithelium (40.66 ± 37.73 to 23.78 ± 29.33; P = 0.016) were statistically significant. On the contrary, inner retinal segmentation layers, especially retinal ganglion cell (RGC) layer (38.29 ± 16.63 to 37.26 ± 16.18; P = 0.387), remained statistically unchanged. CONCLUSION: We postulate that PDT alleviates outer retinal edema where fluid accumulation occurs mostly, whereas it does not alter inner retinal and especially RGC layer. These findings may indicate that short-term atrophy of the inner retina did not occur following PDT and may point toward safety of this method for cases with CSCR.

Peripapillary and macular choroidal thickness in both eyes of patients with acute unilateral retrobulbar optic neuritis.

PURPOSE: The purpose of this study was to examine macular and peripapillary choroidal thickness (CT) in patients with acute unilateral retrobulbar optic neuritis. MATERIALS AND METHODS: In this cross-sectional study, 19 patients with acute unilateral retrobulbar optic neuritis were examined. A control group was matched with patients for sex and age. Enhanced depth imaging optical coherence tomography in macula and peripapillary areas in both eyes was performed for evaluation of CT. The CT was measured in subfoveal and other six points of macula and four points of peripapillary areas with a 3.4-mm scan circle centered on the optic nerve head. RESULTS: The mean subfoveal CT was 384.7 ± 101.6 µm, 380.5 ± 109 µm, and 401.2 ± 84.6 µm for affected eye, unaffected fellow eye, and healthy control, respectively. All measurements of macular CT were thinner in the patient group compared with healthy controls. Global peripapillary CT in affected eyes, unaffected fellow eyes, and healthy controls were 202 ± 43.3, 195.1 ± 42.9, and 234 ± 71.2, respectively. The difference between the three groups was statistically significant in the nasal point of peripapillary area (P = 0.023). No correlation was seen between CT and initial visual acuity or duration from symptom onset to medical survey in acute phase of retrobulbar optic neuritis. CONCLUSION: Patients with acute retrobulbar optic neuritis showed no significantly thinner macular and peripapillary CT in both eyes compared with healthy controls.

Reactivation of Varicella-Zoster Virus Anterior Uveitis after YAG Peripheral Iridotomy.

PURPOSE: To describe the reactivation of Varicella-Zoster Virus Anterior Uveitis after YAG laser peripheral iridotomy. CASE REPORT: A 69-year-old woman referred with unilateral, anterior uveitis associated with decreased corneal sensation and increased intraocular pressure 5 days after YAG laser peripheral iridotomy. The impression of herpetic anterior uveitis reactivation followed by YAG PI confirmed by polymerase chain reaction of aqueous humor by detecting varicella zoster virus. Treatment with oral acyclovir and topical corticosteroid and cycloplegic resulted control of both the intraocular inflammation and pressure. CONCLUSION: YAG PI may be a risk factor for reactivation of herpetic anterior uveitis. Prophylaxis with acyclovir may be necessary after YAG PI to prevent reactivation of herpetic anterior uveitis.

Ocular Manifestations in Hemodialysis Patients: Importance of Ophthalmic Examination in Prevention of Ocular Sequels.

BACKGROUND: Hemodialysis (HD)-associated ocular abnormalities are one of the causes of morbidity among people undergoing HD. This study evaluates the frequency of ocular abnormalities in end-stage renal disease (ESRD) patients undergoing HD and their potential link to HD and demographic parameters. METHODS: This cross-sectional study examined 242 eyes of 121 patients with ESRD undergoing regular HD after excluding the ineligible subjects. The study was designed in two parts. Medical histories of each patient including age, gender, family history, medication history, past medical history, and duration of HD collected using a structured check list. All patients underwent complete ophthalmologic examination for evaluation of the best corrected visual acuity (BCVA), intraocular pressure (IOP), and anterior and posterior segments. RESULTS: In total, 121 patients, including 68 (56.2%) males and 53 (43.8%) females, were enrolled in the study. The mean ± SD age of the patients and their mean duration of dialysis were 51.59 ± 16.01 and 3.40 ± 2.75 years, respectively. The most prevalent etiology for HD was diabetes mellitus (39.67%), followed by hypertension (38.84%), and the most common ocular findings included cataract (142 eyes; 58.7%) and ectopic calcification of the conjunctiva and cornea (78 eyes; %32.2). There was at least one abnormal ocular finding in 89.3% of the cases. The BCVA was equal to or less than finger count in 70 eyes (28.92%). There was a significant relationship between conjunctival calcification and the duration of dialysis (P = 0.02). There was significant association between etiology of HD and conjunctival calcification (adjusted odds ratio, 2.44; 95% CI, 1.05-5.67; and P value, 0.03). Such significant associations were present for corneal calcification (P = 0.009), cataract (P = 0.02), and optic atrophy (P = 0.01). CONCLUSIONS: Regular ophthalmologic examinations are recommended due to the prevalence of clinical ocular abnormalities in HD patients.

Natural Honey-Induced Acanthamoeba keratitis.

Natural honey in spite of its usefulness is known to contain certain microorganisms. In the present study, we describe a case of Acanthamoeba keratitis after using topical honey administered by a traditional medicine therapist. A 32-year-old male came with red eye and blurred vision. The pain and other symptoms became more severe after the 1st week, with appearance of radial perineuritis at the cornea. A repeated interview revealed that 1 week before appearance of ocular symptoms, the patient had instilled a drop of natural honey in his left eye. Confocal microscopic cornea imaging demonstrated cyst and trophozoite of Acanthamoeba in the corneal stroma.

Simultaneous Unilateral Presentation of Three Different Ocular Manifestations of Granulomatosis with Polyangiitis.

PURPOSE: To report the simultaneous presentation of three ocular manifestations of granulomatosis with polyangiitis in one eye. CASE REPORT: A 42-year-old man with a confirmed diagnosis of granulomatosis with polyangiitis was referred to the emergency room with sudden blurred vision. Eye examination showed hyperemic conjunctiva due to necrotizing scleritis in the superior nasal quadrant of the left eye, a mass in the left superior lid, as well as central retinal artery occlusion in the same eye. CONCLUSION: This case suggests that unilateral eye involvement may be a manifestation of underlying granulomatosis with polyangiitis.

Intravitreal diclofenac for treatment of refractory uveitis-associated cystoid macular oedema: A before and after clinical study.

BACKGROUND: Cystoid macular oedema (CME) is one of the important complications of uveitis leading to irreversible blindness. Currently, there is no gold standard treatment for this condition. The aim of this study was to investigate the effects of single intravitreal diclofenac (IVD) injection on short-term outcome of refractory uveitis-associated CME. METHODS: This was a prospective clinical study on 16 consecutive patients (16 eyes) with refractory uveitis-associated CME. Intravitreal injection of 500 µg/0.1 ml of diclofenac sodium was given to the patients. The clinical outcomes considered were best-corrected visual acuity (BCVA) change and central macular thickness (CMT) changes in the pre- and postinjection periods. Follow-up examinations were performed at 1 and 4 weeks after the injection. RESULTS: Age of the patients varied from 18 to 59 years (mean ± SD: 39.5 ± 13.2 years). Ten patients (62.5%) were females. Statistically significant differences were found in the decrease of mean BCVA (logMAR) (p = 0.043) and mean CMT (p = 0.003) during the study period. There was no significant difference in the intraocular pressure (IOP) increase at the end of the study (p = 0.94). CONCLUSION: Intravitreal diclofenac (IVD) may be a promising treatment for refractory uveitis-associated CME. Further clinical trials with a larger sample size should be conducted to confirm these findings and compare them with other treatments.

Effect of iris registration on outcomes of FEMTOLASIK for myopia and myopic astigmatism.

PURPOSE: To compare the visual and refractive outcomes after FEMTOLASIK with and without iris registration. METHODS: In this randomized, prospective, comparative, contralateral eye study, 118 eyes of 59 patients with myopia and myopic astigmatism underwent LASIK using the Femto LDV femtosecond laser (160 µm) and the MEL80 with or without iris registration. For each patient, iris registration FEMTOLASIK was performed on one eye and non-iris registration FEMTOLASIK was performed on the other eye, assigned at random. Patients were evaluated before and 12 months. Uncorrected visual acuity, best-corrected visual acuity, manifest refraction, contrast sensitivity, and higher-order aberrations (HOAs) were evaluated. RESULTS: At 12 months, the mean UDVA was 0.002 ± 0.07 logMAR (20/19) in iris registration eyes and 0.00 ± 0.06 logMAR (20/24) in non-iris registration eyes (P = 0.9). 61% of iris registration eyes and 71.2% of non-iris registration eyes achieved a UDVA of 20/20 or better (P = 0.31); 98.3% of eyes with the iris registration FEMTOLASIK and 94.9% with the non-iris registration FEMTOLASIK were within ±0.50 D from emmetropia (P = 0.71). No statistically significant difference was found in postoperative contrast sensitivity between groups at 3, 6, 12, or 18 cycles/degree (P > 0.05). There was significant increase in total HOA root mean square in two groups. The mean error magnitude of surgically induced astigmatism 12 months postoperatively was -0.33 in iris registration eyes and -0.24 in the non-iris registration eyes (P = 0.36). CONCLUSIONS: FEMTOLASIK with and without iris registration provides similar results in myopic and myopic astigmatism patients.