The Effect of Amniotic Membrane Extracted Eye Drop on Repairing The Corneal Epithelial in Patients after Trans-Epithelial Photorefractive Keratectomy: An Interventional and Historical Study.

OBJECTIVE: Recent studies imply extensive applications for the human amniotic membrane (hAM) and its extract in medicine and ophthalmology. The content of hAM meets many requirements in eye surgeries, such as refractive surgery as the most important and commonly used method for treating the dramatically increasing refractive errors. However, they are associated with complications such as corneal haziness and corneal ulcer. This study was designed to evaluate the impact of amniotic membrane extracted eye drop (AMEED) on Trans-PRK surgery complications. MATERIALS AND METHODS: This randomized controlled trial was performed during two years (July 1, 2019-September 1, 2020). Thirty-two patients (64 eyes), including 17 females and 15 males, aged 20 to 50 years (mean age of 29.59 ± 6.51) with spherical equivalent between -5 to -1.5 underwent Trans Epithelial Photorefractive Keratectomy (Trans-PRK) surgery. One eye was selected per case (case group) and the other eye was considered as control. Randomization was done using the random allocation rule. The case group was treated with AMEED, and the artificial tear drop every 4 hours. The control eyes received artificial tear drops instilled every 4 hours. The evaluation continued for three days after the Trans-PRK surgery. RESULTS: A significant decrease in CED size was found in the AMEED group on the second day after surgery (P=0.046). Also, this group had a substantial reduction in pain, hyperemia, and haziness. CONCLUSION: This study showed that AMEED drop can increase the healing rate of corneal epithelial lesions after Trans- PRK surgery and reduce the early and late complications of Trans-PRK surgery. Researchers and Ophthalmologists should consider AMEED as a selection in patients with persistent corneal epithelial defects and patients who have difficulty in corneal epithelial healing. We understood AMEED has a different effect on the cornea after surgery; therefore, the researcher must know AMEED's exact ingredients and help expand AMEED uses (registration number: TCTR20230306001).

Comparison of the effect of removing bandage contact lens on the days 3 and 5 following photorefractive keratectomy.

AIM: To compare the outcomes of removing bandage contact lens (BCL) on days 3 and 5 after photorefractive keratectomy (PRK). METHODS: One hundred patients who underwent PRK (a total of 200 eyes) were enrolled in the present study. The subjects were assigned to two groups. Group 1 consisted of the right eyes of subjects and bandage contact lenses removal were on the 3rd day; Group 2 consisted of the fellow eyes of same subjects and removed bandage contact lenses on the 5th day after PRK. Then, data obtained from both groups were compared. To evaluate complications, the subjects underwent a slit-lamp examination in all visits. RESULTS: Filamentary keratitis was observed in one eye in both groups. The frequency of haze was higher in group 1; however, it was not significant between the two groups. Using mixed model analysis, significant differences were observed in the rate of complications as well as pain and eye discomfort scores between the groups (P < 0.05). No major complication was reported. CONCLUSION: Majority of post-PRK corneal epithelial defect is healed on day 3. However, keeping BCL for 5 days postoperatively instead of the three days produces a slightly lower rate of total complication.

Long-term results of MyoRing implantation in patients with keratoconus.

Clinical relevance: This study was conducted to evaluate five-year outcomes of MyoRing implantation in patients with keratoconus. The results showed that MyoRing implantation is a minimally invasive procedure and is safe and effective for improving visual acuity and refraction in most patients with keratoconus.Background: The long-term effects of MyoRing implantation on corneal features were studied.Methods: A total of 48 keratoconic eyes of 43 consecutive patients who had undergone MyoRing implantation using the Pocket Maker microkeratome (Dioptex, gmbh, Linz, Austria) and who had completed five years of follow­ups were included in this retrospective study. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction and keratometry (K) readings were measured and assessed pre-operation, and five years post-operatively. As well, post-operation satisfaction was assessed using a validated questionnaire.Results: Five years post-operatively, there was a significant improvement in UDVA, CDVA, K readings, spherical equivalent (SE), and manifest sphere and cylinder (p < 0.001). Mean UDVA was 1.20 logMAR before the surgery and 0.42 after the surgery (p < 0.001). Mean CDVA was 0.63 logMAR before the surgery and 0.20 logMAR after the surgery (p < 0.001). SE was improved from -6.53 dioptres (D) before the surgery to -2.23 D after the surgery (p < 0.001). Moreover, the results show that the mean K was reduced by 2.82 D after the surgery (p = 0.001). Overall, 81% of patients were moderately to highly satisfied five years after surgery.Conclusion: MyoRing implantation was found to be a minimally invasive procedure, and is safe and effective for improving visual acuity and refraction in most patients with keratoconus.

Safety and Efficacy of Oral Supplementation of Lentil (Lens culinaris Medic) in Dry Eye Patients.

OBJECTIVE: To evaluate the safety and efficacy of dietary lentil capsules in patients suffering from dry eye symptoms. METHODS: A randomized, triple-blind, interventional, placebo-controlled study was done. Sixty patients were randomized in two groups to receive either one capsule containing 500 mg of lentil powder or placebo daily for 3 months. UCVA, tear film breakup time (TBUT), Schirmer's test, tear film osmolarity, and OSDI score were recorded at baseline and 3 months after intervention. Data analysis was performed using IBM SPSS for Windows version 20 (SPSS, Chicago, IL, USA). RESULTS: In the lentil group, at baseline, the mean UCVA (LogMAR), OSDI, TBUT (S), tear film osmolarity (mOsm/L), and Schirmer (mm) scores were 0.104 (0.026), 22.66 (19.40), 10.31 (5.32), 301.07 (15.57), and 8.22 (6.87), respectively. These values were 0.101 (0.026), 20.85 (19.44), 13.04 (7.11), 299.81 (11.60), and 9.87 (10.11). In the placebo group, these values were 0.084 (0.027), 25.35 (20.08), 10.56 (4.95), 299.77 (15.09), and 9.35 (8.06) at baseline and 3 months later were 0.077 (0.027), 23.32 (22.90), 13.62 (6.30), 297.54 (12.08), and 8.64 (9.60), respectively. Three patients (one in the lentil group and two in the placebo group) experienced severe gastrointestinal symptoms. CONCLUSION: Although consumption of 500 mg of lentil is safe, this amount is not sufficient for reduction of dry eye syndrome in 3 months. For more validation, a clinical study with increased dosage of lentil is proposed.

Visual and subjective outcomes following trifocal intraocular lens implantation in Iranian cataractous patients.

BACKGROUND: The aim of this study was to evaluate visual and refractive outcomes and quality of vision after implantation of the AT LISA tri 839MP intraocular lens (IOL). PATIENTS AND METHODS: This interventional clinical trial comprised 46 cataractous eyes of patients who underwent phacoemulsification with IOL implantation (mean age of 58.08 ± 11.01 years; range: 36-76 years old). Spherical equivalent (SE), uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), corrected intermediate visual acuity (CIVA), uncorrected near visual acuity (UNVA), and corrected near visual acuity (CNVA) were measured 1, 3, and 6 months after surgery. Contrast sensitivity (CS) was measured at 6 months. Subjective quality of vision and presence of dysphotopsia by a short questionnaire were evaluated postoperatively. RESULTS: At 6 months, the mean visual acuity was 0.08 ± 0.11, 0.03 ± 0.08, 0.07 ± 0.09, 0.02 ± 0.08, 0.05 ± 0.09, and 0.02 ± 0.08 LogMAR for UDVA, CDVA, UIVA, CIVA, UNVA, and CNVA, respectively. The mean values of SE were - 0.4728 ± 0.32D. These variables improved over time, yet significant changes were detected in UDVA (P = 0.009) and SE (P = 0.0001). The mean CS value was 1.74 ± 0.08. The mean scores (0% = no symptoms; 100% = strong symptoms/unable to perform activities) for glare and halos were 7.07 ± 0.22% and 8.70 ± 0.23%, respectively. These items were reduced over time. Patients' level of satisfaction mean score for performing activities was 96.66%. CONCLUSIONS: The AT LISA tri 839MP IOL provides excellent uncorrected distance, intermediate and near vision, and CS. This IOL showed a minimal level of photic phenomena and a high level of patient satisfaction.

Estimating confined aquifer parameters using a simple derivative-based method.

The confined aquifer parameters, transmissivity and storage coefficient, are commonly determined using the pumping tests. Several methods have been developed to estimate confined aquifer parameters using pumping tests, but different methods suffer from different drawbacks. Those methods that use the truncated Theis well function w ( u ) , apply just early or late drawdowns, depending on the case, to estimate the aquifer parameters. Those methods, such as Theis (1935), that use non-truncated well function w ( u ) , can apply all drawdown data for aquifer parameter estimation but may still suffer from subjectivities such as personsal judgment in curve matching, time-consuming procedure and requiring values for Theis well function, w ( u ) , and its argument u ( u = r 2 S 4 T t ) . The aim of this study is to present a new method to overcome the aforementioned drawbacks and subjectivities involved in available published methods. In this paper, a simple derivative-based method is presented to estimate confined aquifer parameters applicable for entire drawdowns during the pumping period. The time derivative of drawdowns relate non-linearly with pumping time t , and therefore, aquifer parameters are estimated using developed equations based on the least squares optimization approach. The method is applied to three sets of synthetic, published and field data and results show that the estimation accuracy is acceptable. The drawdown time interval measurement has a marginal effect on parameters estimation due to the analytical basis of derivative calculations. The method does not require construction of graphs, and numerical calculations may be performed on a calculator to determine the aquifer parameters on site. It does not require curve matching, initial guess of the parameters and values of w ( u ) and u .

Tear and serum MMP-9 and serum TIMPs levels in the severe sulfur mustard eye injured exposed patients.

INTRODUCTION: Sulfur mustard (SM) intoxication produces local and systemic changes in the human body. In this study, the relationship between tear and serum matrix metalloproteinase (MMP)-9 and serum tissue inhibitors of metalloproteinases (TIMPs) are assessed in serious eye-injured SM-exposed casualties. METHODS: A group of 128 SM-exposed patients with serious ocular injuries in three subgroups (19 mild, 31 moderate, and 78 severe cases) is compared with 31 healthy controls. Tear and ocular status and serum MMPs and MMP-9/TIMPs complex levels were evaluated using enzyme-linked immunosorbent assay (ELISA). RESULTS: Serum level of MMP-9 was significantly higher in the SM-exposed group compared to the control group (P = 0.009). Mean serum MMP-9 level in the SM-exposed group with ocular abnormalities was significantly higher than that in the SM-exposed group without ocular abnormalities. SM-exposed people with corneal calcification had significantly higher serum MMP-9/TIMP-1 level compared to the SM-exposed ones without this problem (P = 0.045). The SM-exposed group with severe ocular injuries had significantly higher MMP-9/TIMP-1 than the controls (P = 0.046). The SM-exposed group had significantly lower levels of MMP-9/TIMP-4 complex than the controls (P < 0.001). The SM-exposed group with tear meniscus and fundus abnormality had significantly higher MMP-9/TIMP-4 levels than the SM-exposed group without these problems (P = 0.009 and P = 0.020). CONCLUSION: Serum MMP-9 level had increased in SM-exposed groups with ocular problems, while TIMP-1 and TIMP-2 levels had remained unchanged. Serum TIMP-4 drastically decreased in SM-exposed group, which clearly explains the severity of the systemic and ocular damages.

Evaluation of corneal biomechanical properties in mustard gas keratopathy.

BACKGROUND: Degenerative biomechanical factors and immunologic processes with effect on collagen and corneal reparative process are known as the main cause of ocular surface dysfunction in mustard gas keratopathy (MGK) and may cause changes in the corneal biomechanical values. Therefore, we evaluate corneal biomechanical properties of these patients. METHODS AND MATERIALS: This case-control study includes 61 chemical warfare victims with MGK. After omission according to our exclusion criteria, 88 eyes of patients with MGK were enrolled as the case group and also a group of 88 normal eyes, which were matched regarding their age and sex in the control group, were enrolled. Measurements of corneal biomechanical properties which reported by ORA and Corvis ST (CST) devices were compared. The SPSS software version 23.0 was used in the statistical analysis. For comparisons between groups, if the data had a normal distribution, were analyzed by Student's t-test and ANOVA, and if the data didn't have a normal distribution, Mann-Whitney U test, and Kruskal-Wallis were used. Furthermore, to identify a relationship between two groups of data Spearman's rank Correlation test was used. P value < 0.05 were considered statistically significant. RESULTS: In the MGK group, A1 length (A1L), A1 velocity (A1V), A2 velocity (A2V), deformation amplitude (DA) and peak distance (PD) were higher than the control group (P < 0.001). However, the corneal hysteresis (CH) (P = 0.003), corneal resistant factor (CRF), non-corrected IOP (IOPnct), corrected IOP based on corneal thickness (IOPpachy), and central corneal thickness (CCT) were lower than the control group (P < 0.001). The visual acuity according to the LogMAR scale and severity of MGK was positively associated with IOPpachy and negatively associated with CH, CRF, CCT and highest concavity radius (Radius). CONCLUSION: Measurement of corneal biomechanical properties may be, have a useful role in the classification, monitoring or diagnosis of MGK.

A Study of Corneal Biomechanics in Delayed-Onset Mustard Gas Keratopathy Compared to Cases With Corneal Scarring and Normal Corneas.

PURPOSE: This study compares the corneal biomechanical properties, as measured with Corvis ST, in three groups of cases with delayed-onset mustard gas keratopathy (DMGK), chronic corneal scarring (CCS), and those with normal corneas. METHODS: Forty-five eyes were enrolled in the DMGK, CCS, and normal groups (15 eyes each). All patients were examined with the slitlamp and Corvis ST. Extracted corneal biomechanical parameters included first and second applanation time (AT1, AT2), first and second applanation length (AL1, AL2), first and second applanation velocity (AV1, AV2), deformation amplitude (DA), highest concavity time, peak distance, highest concavity radius (HCR), central corneal thickness, corrected intraocular pressure (IOP), and noncorrected IOP. RESULTS: The mean age of the participants in the DMGK, CCS, and normal groups was 49.20±5.16, 60.40±22.92, and 44.60±8.32 years, respectively. Comparison between DMGK and CCS groups showed significant differences in AT1, AT2, corrected IOP, and noncorrected IOP. There were also significant differences in AT1, AT2, HCR, DA, and noncorrected IOP between the DMGK and normal groups. None of the parameters were significantly different between the CCS and normal groups. CONCLUSION: There seems to be reduced corneal rigidity and stiffness in cases exposed to mustard gas, which causes the cornea in the DMGK group to become applanated more easily and take longer to rebound compared with the other two groups. Also, IOP was lower than normal in the DMGK group, and thus, misdiagnosis of glaucoma is likely for these patients.

An analytical enrichment-based review of structural genetic studies on keratoconus.

Keratoconus is a progressive bilateral corneal protrusion that leads to irregular astigmatism and impairment of vision. Keratoconus is an etiologically heterogeneous corneal dystrophy and both environmental and genetic factors play a role in its etiopathogenesis. In this analytical review, we have studied all the genes that are structurally associated with keratoconus and have tried to explain the function of each gene and its association with other eye disorders in a concise way. In addition, using gene set enrichment analysis, it was attempted to find the most important impaired metabolic pathways in keratoconus. Several genetic studies have been carried out on keratoconus and several genes have been identified as risk factors involved in the etiology of the disease. In the current study, 16 studies, including nine association studies, five genome-wide association studies, one linkage study, and one meta-analysis, were reviewed and based on the 19 genes found, enrichment was performed and the most important metabolic pathways involved in the disease were identified. The enrichment results indicated that the two pathways, interleukin 1 processing and assembly of collagen fibrils, are significantly associated with the disease. Obviously, the results of this study, in addition to providing information about the genes involved in the disease, can provide an integrated insight into the gene-based etiology of keratoconus and therapeutic opportunities thereof.

Pre-operative factors influencing post-operative outcomes from MyoRing implantation in keratoconus.

BACKGROUND: To identify pre-operative factors that influence post-operative performance of a full-ring intra-corneal implant (MyoRing) for the management of keratoconus. METHOD: In a retrospective study, medical records of 70 keratoconus eyes of 70 consecutive surgical patients with a mean age of 28.54 ± 6.52 years, who underwent MyoRing implantation using the PocketMaker microkeratome (Dioptex GmbH), were included and analysed before implantation and for visual outcome. Variables assessed included age, gender, keratoconus shape, uncorrected distance visual acuity, corrected distance visual acuity, spherical equivalent and keratometry reading. After the last follow-up, the eyes were graded for MyoRing implantation performance into worst, moderate and best subgroups. RESULTS: The mean values of uncorrected distance visual acuity, corrected distance visual acuity, spherical equivalent, manifest sphere and cylinder improved significantly post-operatively (p < 0.05). A statistically significant difference was found in the mean spherical equivalent (p = 0.046) and uncorrected distance visual acuity (p = 0.001) between moderate and best subgroups. No statistically significant correlation was found between age, sex, keratoconus shape, keratometric values, corrected distance visual acuity and visual outcome. CONCLUSIONS: According to this new grading system for MyoRing implantation performance, pre-operative uncorrected distance visual acuity and spherical equivalent are considered as the most important indicators for surgical performance in MyoRing treatment of keratoconus.

Lamellar macular hole formation following intravitreal bevacizumab injection for choroidal neovascularization by age-related macular degeneration.

This report describes a lamellar macular hole formation subsequent to intravitreal bevacizumab injection for the treatment of choroidal neovascularization (CNV) by age-related macular degeneration. A 67-year-old woman with bilateral CNV underwent 3 monthly intravitreal bevacizumab injections in her both eyes. One month after the third bilateral injection, vision loss happened. Optical coherence tomography performed for further evaluation that showed reduction of intra- and sub-retinal fluid associated with lamellar macular hole development in both eyes. Although macular hole formation, especially bilateral form, is a rare complication of intravitreal injections, surgeons should consider macular hole development in cases with vision deterioration following intravitreal bevacizumab injection.

Sulfur Mustard-related Ocular Complications: A Review of Proteomic Alterations and Pathways Involved.

Sulphur mustard (SM; (2, 2'-dichloroethylsulfide)) was used for the first time in 1917, during the World War I. SM mainly induces DNA damage, oxidative stress, and inflammation. This compound injures the respiratory system, eyes, skin and the endocrine, gastrointestinal, and hematopoietic systems. However, due to the high lipophilicity of the SM and the lipophilic nature of the tear film, and also due to the direct contact of the eyes with the environment, the eyes are the most vulnerable part of the body to SM. SM causes several proteomic alterations in the eye. It increases the production and activity of inflammatory proteins, reduces the concentration of antioxidant proteins and activates the proteins involved in the onset of apoptosis. In this study, we reviewed SM-related proteomic alterations and the association of the found proteins with other eye disorders and diseases. Furthermore, using pathway enrichment analysis, we found the most central biological processes involved in the emergence of complications caused by SM. Our results revealed that deficient cellular homeostasis, especially in terms of iron-dependent regulations, as well as pathological changes in vascular endothelial growth factor (VEGF) expression, is the most central biological process involved in eye injuries caused by SM.

Comparison among Ocular Response Analyzer, Corvis ST and Goldmann applanation tonometry in healthy children.

AIM: To explore the relationship between different parameters of Ocular Response Analyzer (ORA) and Corvis ST (CST) in a sample of healthy Iranian school-aged children and the relationship between parameters of these 2 instruments against intraocular pressure (IOP), measured by the Goldmann applanation tonometer (GAT-IOP), age and gender, and find possible correlation between ORA and CST with GAT. METHODS: This cross-sectional study included 90 healthy children. A general interview and complete eye examination were performed. Following successful GAT-IOP measurement, ORA and CST were conducted. The CST parameters were A 1/2 length (A1L, A2L), A 1/2 velocity (A1V, A2V), highest concavity deformation amplitude (HCDA), radius of curvature (RoC), peak distance (PD), central corneal thickness (CCT) and IOP. The ORA parameters were corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated IOP (IOP-G) and corneal compensated IOP (IOP-CC). Extracted data was analyzed using the Statistical Package for Social Science software. RESULTS: Totally 39 males with age of 9.08±1.60 (6-12)y and 51 females with age of 8.96±1.55 (6-13)y were included. Many CST parameters were significantly correlated with CH, CRF, IOP-G and IOP-CC. Some CST parameters had a significant correlation with GAT-IOP, including IOP-CST in both eyes and HCDA, A2L, PD, and RoC in the left eye, but none with age, except A2L in the right eye. The CRF measurement showed a significant correlation with GAT-IOP in both eyes and CH in the right eye, yet, none with age. Among all CST and ORA parameters, CCT-CST in both eyes and A1L in right eye had a significant correlation with gender, although this was a negligible negative correlation. Comparison of mean IOP values by different devices showed a significantly highest IOP overestimation by CST and lowest by IOP-CC compared with GAT. Also, IOP-G versus IOP-CST significantly had the lowest IOP overestimation among others. Overall, either low positive correlation or negligible correlation was found between IOP measurements by 3 instruments. CONCLUSION: The study finds the highest IOP overestimation by CST and lowest by IOP-CC compared with GAT. Overall, either low positive correlation or negligible correlation is found between IOP measurements by the 3 instruments.

Efficacy of systemic diclofenac sodium on intravitreal concentration.

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs), as an alternative, are replacing corticosteroids in ocular inflammatory diseases. Diclofenac has been used mainly topically, and recent focus has been on intravitreal delivery. Both of these methods have been shown to have complications in long-term application. PURPOSE: To assess the efficacy of slow release oral diclofenac sodium on intravitreal concentration in experimental model of chemically injured eyes. METHODS: In an experimental double-masked clinical trial, right eyes of 24 albino rabbits were chemically injured by 1 N NaOH. One hour after chemical injury, 10 cc suspension gavage containing 100 mg slow release diclofenac sodium was administered in all cases. 2, 4, 6, 12, 24, 48 h after gavage, vitreous samples were obtained in all cases. Intravitreal concentration of diclofenac sodium was evaluated in all samples using high-performance liquid chromatography (HPLC) method. RESULTS: Intravitreal diclofenac levels by oral intake were enhanced by the inflammation in all the measurements. In inflamed eyes, diclofenac concentration was ten times more than control eye (2.658 ± 0.344 vs. 0.242 ± 0.0279 and 1.617 ± 0.527 vs. 0.148 ± 0.095; in 2 and 4 h, respectively). After 6 h, diclofenac concentration was statistically different, although it reduced below 1 µg/ml. CONCLUSION: Diclofenac is delivered to the inflamed eye more than healthy eye. It seems that by oral diclofenac consumption, it is possible to make a significant intravitreal concentration.

Proteomic features of delayed ocular symptoms caused by exposure to sulfur mustard: As studied by protein profiling of corneal epithelium.

Exposure to mustard gas can lead to variations in the proteome of corneal epithelium cells and after a latency period produces delayed symptoms in the eyes of chemical victims. Hence, a comparative proteome analysis was conducted between the corneal epithelial cells of chemical victims from Iran-Iraq war (1980-1988) and healthy donors. To this end, corneal epithelium samples from victims and healthy individuals were collected, and the proteome of these samples were prepared for two-dimensional electrophoresis and the analysis of spots by statistical software. Selected spots were further analyzed by matrix-assisted laser desorption/ionization time-of-flight/time-of-flight mass spectrometry. Twenty four proteins were identified of which eighteen proteins showed downregulation while six proteins were upregulated in the victims in comparison to the normal individuals. Also, six protein spots were confirmed by western-blot analysis. In conclusion, all the twenty-four identified proteins are involved in pathways which their up- or down-regulation leads to the accumulation of undesired substrates, cell death and apoptosis. Bioinformatics' tools indicated that these identified proteins were involved in various metabolic processes, DNA damage response, immune response and etc. The present study provides a suitable platform for further clinical studies.

Preliminary Results of Femtosecond Laser-assisted Cataract Surgery in a Private Clinic in Iran.

PURPOSE: To report the preliminary results of femtosecond laser-assisted cataract surgery in Iranian patients. METHODS: This prospective case series included 21 eyes of 21 patients with cataract. Mean patient age was 66.7 ± 10 years. The patients underwent femtosecond-laser assisted cataract surgery (VICTUS Femtosecond Laser Platform: Bausch + Lomb) and intraocular lens (IOL) implementation in Bina Eye Hospital, Tehran, Iran between May and October, 2014. Visual outcomes, intraocular pressure (IOP), and complications were evaluated three months after surgery. RESULTS: Mean preoperative best-spectacle corrected visual acuity (BSCVA) was 0.40 ± 0.21 logMAR which significantly improved to 0.02 ± 0.03 logMAR three months postoperatively (P < 0.001). Mean preoperative IOP was 17.88 ± 2.70 mmHg which significantly decreased to 12.5 ± 1.51 mmHg three months after operation (P < 0.001). Mean duration of operation for these patients was 29.30 ± 8 minutes and mean femtosecond laser process time was 4.20 ± 2 minutes. In terms of complications, 9 patients developed fine subconjunctival hemorrhage and eye redness and 2 patients had mild corneal edema which all subsided within less than 7 days. Serious complications such as anterior or posterior capsule tears were not encountered. CONCLUSION: Femtosecond laser-assisted cataract surgery is a relatively new method of cataract.

Clinical Practice Guidelines for Prevention, Diagnosis and Management of Early and Delayed-onset Ocular Injuries Due to Mustard Gas Exposure.

PURPOSE: To develop clinical practice guidelines (CPGs) for prevention, diagnosis, treatment and follow-up of ocular injuries caused by exposure to mustard gas. METHODS: The clinical questions were designed by the guideline team. Websites and databases including National Guidelines Clearinghouse, National Institute for Clinical Excellence, Cochrane, and PubMed were searched to find related CPGs and explore possible answers to the clinical questions. Since there were no relevant CPGs in the literature, related articles in Persian and English languages were extracted. Each article along with its level of evidence was summarized. Additionally, hand search was performed by looking the reference list of each article. Consequently, recommendations were developed considering the clinical benefits and side effects of each therapeutic modality. The recommendations were re-evaluated in terms of customization criteria. All recommendations along with the related evidence were scored from 1 to 9 by experts from all medical universities of Iran. The level of agreement among the experts was evaluated by analyzing the given scores. RESULTS: The agreement was achieved for all recommendations. The experts suggested a number of minor modifications which were applied to the recommendations. Finally, CPGs were developed with 98 recommendations under three major domains including prevention of injury, diagnosis and management of the acute and delayed-onset mustard gas ocular injuries. CONCLUSION: Considering the lack of CPGs for the prevention, diagnosis, and management of mustard gas-induced keratitis, these recommendations would be useful to prevent the serious ocular complications of mustard gas and standardize eye care services to the affected individuals.

Transepithelial Photorefractive Keratectomy for Low to Moderate Myopia in Comparison with Conventional Photorefractive Keratectomy.

PURPOSE: To compare the effectiveness, safety and stability of the results of transepithelial photorefractive keratectomy (tPRK) with conventional photorefractive keratectomy (PRK) for low to moderate myopia. METHODS: In this prospective non-randomized case-control study, patients with low to moderate myopia were assigned to the tPRK group (cases) or the PRK group (controls). In the tPRK group, eyes were treated using the Amaris excimer laser (SCHWIND eye-tech-solutions GmbH and Co. KG, Germany). Outcome measures included postoperative pain using McGill Pain Questionnaire, epithelial healing time, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), manifest refraction, and safety and efficacy indexes which were compared between the study groups. RESULTS: Three hundred forty eyes of 170 patients were enrolled in this study. Each study group comprised of 170 eyes of 85 patients. There was a significant difference between the two groups regarding the postoperative pain scores in favor of the tPRK group (P = 0.04). The tPRK group had a shorter epithelial healing time than the conventional PRK group postoperatively (P = 0.01). Mean UCVA was significantly better in the case group than in the control group at the postoperative month 2 (P = 0.01). Regarding the safety and efficacy indexes, the tPRK group had better results than the conventional PRK group (P < 0.01 for both comparisons). CONCLUSION: Transepithelial PRK seems to be superior to conventional PRK for treatment of low to moderate myopia in terms of postoperative pain, epithelial healing time, visual recovery and safety and efficacy indexes.

MyoRing Implantation in Keratoconic Patients: 3 years Follow-up Data.

PURPOSE: To evaluate long-term follow-up data on implantation of a full-ring intra-corneal implant (MyoRing) for management of keratoconus. METHODS: A total of 40 keratoconic eyes of 37 consecutive patients who had undergone MyoRing implantation using the Pocket Maker microkeratome (Dioptex, GmbH, Linz, Austria) and completed 3 years of follow-up appointments were included in this retrospective study. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction and keratometry (K) readings were measured and evaluated preoperatively, and 3 years, postoperatively. RESULTS: No intraoperative complications were observed in this case series. Three years postoperatively, there was a significant improvement in UDVA, CDVA, K readings, spherical equivalent (SE), and manifest sphere and cylinder (P < 0.05 for all comparisons). UDVA was significantly improved from 1.14 ± 0.27 to 0.30 ± 0.21 LogMAR (P = 0.001), CDVA was also improved from 0.52 ± 0.23 to 0.18 ± 0.12 LogMAR (P = 0.001), SE was decreased by 4.35 diopters (D) and average keratometric values were reduced by 2.34 D (P = 0.001). Overall, 81% of subjects were moderately to highly satisfied 3 years after surgery and 64.90% agreed to have the fellow eye implanted with MyoRing. CONCLUSION: MyoRing implantation using the Pocket Maker microkeratome was found to be a minimally invasive procedure for improving visual acuity and refraction in the majority of the patients with keratoconus.