Clinical efficacy of Fluorometholone versus Loteprednol eye drops after photorefractive keratectomy: A triple-blinded randomized controlled trial.

PURPOSE: This study aimed to compare the anti-inflammatory efficacy and safety of 0.1% Fluorometholone (FML) versus (vs.) 0.5% Loteprednol etabonate (LE) following photorefractive keratectomy (PRK). METHODS: A triple-blinded randomized controlled trial was conducted on both eyes of 100 patients with stable refraction who were candidates for PRK. Both eyes in each subject were randomly allocated to the FML or LE groups. The product to be tested was 0.1% FML eye drops packaged in droppers vs. the 0.5% LE sterile ophthalmic suspension (Lotemax®) packaged in identical droppers. The main clinical outcomes were changes in best-corrected distance visual acuity (BCDVA) and corneal optical density. The second clinical outcomes were a change in intraocular pressure (IOP) after the intervention. RESULTS: There was no significant difference regarding mean corneal optical density changes between the two groups, one (P = 0.55) and three months (P = 0.98) after the intervention. The mean ± SD BCDVA after one month of the intervention was 0.79 ± 0.11 and 0.84 ± 0.11 in LE and FML groups, retrospectively (P = 0.02). There was no significant difference regarding mean BCDVA between the two groups three months after intervention (P = 0.21). The IOP showed no significant difference between the two groups after one (P = 0.18) and three months (P = 0.53) of the intervention. CONCLUSIONS: The results of this clinical trial demonstrate that LE and FML treatment was effective with no clinically meaningful effect on IOP following a short course of treatment.

Recurrence Rate and Clinical Outcome of Amniotic Membrane Transplantation Combined with Mitomycin C in Pterygium Surgery: Two-Year Follow-Up.

OBJECTIVE: To evaluate the recurrence rate and outcome of pterygium surgery with amniotic membrane transplantation (AMT) and intraoperative mitomycin C (MMC). METHODS: This prospective clinical study included patients with pterygium who were candidates for pterygium excision. After the surgical excision, intraoperative local MMC were applied in the standard protocol followed by AMT. The outcome measures were recurrence and the size change of lesion. Kaplan-Meier estimation and regression analyses were performed. FINDINGS: Fifty five eyes of 55 consecutive patients including 30 male (54.5%) and 25 female (45.5%) with mean age of 47.12 ± 15.95 years were operated. The mean follow-up period was 15.21 ± 2.67 months. The overall recurrence rate was 34.5% (19/55 cases). The estimated recurrence time for larger size of pterygium before surgery was short and marginally significant (17.14 ± 0.58 month in size of ≤3.0 mm versus. 18.56 ± 0.60 month in size of <3 mm; P= 0.06). A statistically significant association was found in reduced model among the size change of the pterygium and standardized coefficient was -0.012 (P = 0.044) and -0.743 (P < 0.001) for age and size of lesion before surgery, respectively. CONCLUSION: Our findings suggest that increasing age and pterygial tissue are the risk factors for recurrence and pterygium has a substantial recurrence rate even after AMT combined with MMC.

MicroRNAs in retinoblastoma: Potential diagnostic and therapeutic biomarkers.

Retinoblastoma (Rb) is known as one of important childhood malignancies which due to inactivation of the RB gene (tumor suppressor gene in various patients). The early detection of Rb could provide better treatment for Rb patients. Imaging techniques (e.g., MRI and CT) are known as one of effective diagnosis approaches for detection of patients with Rb. It has been shown that utilization of imaging techniques is associated with some limitations. Hence, identification of new diagnosis approaches might provide a better treatment for Rb patients. Identification of new biomarkers could contribute to better understanding of pathogenesis events involved in Rb and provide new insights into design better treatment approaches for these patients. Among the various biomarkers, microRNAs (miRNAs) have emerged as attractive tools for Rb detection. miRNAs are one classes of small non-coding RNAs which could anticipate in a variety of biological process via targeting sequence of cellular and molecular pathways. Deregulations of these molecules are associated with cancerous condition. Multiple lines of evidence indicated that deregulation of various miRNAs involved in various stages of Rb. Here, we summarized a variety of tissue-specific and circulating miRNAs involved in Rb pathogenesis which could be used as diagnostic, prognostic, and therapeutic biomarkers in Rb patients.

The Comparative Study of Refractive Index Variations between Haigis, Srk/T and Hoffer-Q Formulas Used for Preoperative Biometry Calculation in Patients with the Axial Length >25 mm.

BACKGROUND: To compare refractive index variation between Hoffer-Q, Haigis and SRK/T formulas used for preoperative biometry calculation in patients with axial length >25 mm, undergoing cataract surgery. MATERIALS AND METHODS: This is a randomized clinical trial study was performed on 54 eyes of 54 patients with ages of 40-70 years old and axial length >25 mm classified into three groups that their IOL POWER were calculated by Haigis, SRK/T and Hoffer-Q formulas before undergoing cataract surgery. Their refractive index variations were calculated from the difference between predicted refractive error formula and actual post-operative refractive error formula. The collected data was entered in SPSS software and was analyzed by ANOVA and Chi-square statistical test. RESULTS: With comparison sphere, astigmatism and spherical equivalent indexes before and after of cataract surgery between Haigis, SRK/T, and Hoffer-Q formulas, statistically significant differences were found between the mean of sphere and SE indexes in patients with use of Haigis and SRK/T formulas that have been more favorable post-operative refraction. CONCLUSIONS: Haigis formula and then, with slight difference, SRK/T formula have better and more acceptable post-operative refraction results than Hoffer-Q formula in patients with high axial myopia. Therefore, it is recommended using Haigis and SRK/T formulas for IOL power calculation in patients with high axial myopia undergoing cataract surgery.

Cornea Collagen Cross-linking for Keratoconus: A Comparison between Accelerated and Conventional Methods.

BACKGROUND: Keratoconus is a progressive degenerative disorder of the cornea in which structural changes in the cornea cause it to become thin and conical in shape. Recently, collagen cross-linking (CXL) has been introduced as an effective intervention in management of progressive keratoconus. Accelerated CXL is a new protocol of this procedure which reduces corneal ultraviolet irradiation exposure time to 5 min. This study aimed to compare visual acuity, keratometry and topographic criteria of keratoconic eyes after conventional and accelerated CXL with a six-month follow-up. MATERIALS AND METHODS: In this prospective interventional study we assessed eyes of 40 patients. Patients were divided into two groups randomly. One group underwent accelerated (5 min) CXL and the other underwent conventional (30 min) CXL. Visual acuity, topographic criteria and keratometry were assessed preoperatively and 6 months postoperatively. RESULTS: In the present study we assessed 40 patients, 50% of which were right eye (OD) and 50% were left eye (OS). Mean age of patients in the accelerated group was 22.10 and in the conventional group was 22.80 years. Our results showed no significant differences between visual acuity, keratometric and topographic criteria in the two groups before intervention. Likewise our results manifested no significant difference between visual acuity, keratometric, refractive and topographic criteria after intervention. CONCLUSION: According to our survey topographic criteria and keratometry improvement in the accelerated and conventional protocol are the same. So accelerated protocol is suggested as a safe and effective option for management of progressive keratoconus.

Comparison the post operative refractive errors in same size corneal transplantation through deep lamellar keratoplasty and penetrating keratoplasty methods after sutures removing in keratoconus patients.

BACKGROUND: Corneal transplantation is a surgery in which cornea is replaced by a donated one and can be completely penetrating keratoplasty (PK) or included a part of cornea deep lamellar keratoplasty (DLK). Although the functional results are limited by some complications, it is considered as one of the most successful surgeries. This study aimed to compare the refractive errors after same size corneal transplantation through DLK and PK methods in keratoconus patients over 20 years. MATERIALS AND METHODS: This descriptive, analytical study was conducted in Feiz Hospital, Sadra and Persian Clinics of Isfahan in 2013-2014. In this study, 35 patients underwent corneal transplantation by PK and 35 patients by DLK, after removing the sutures, the patients were compared in terms of best corrected visual acuity (BCVA) and refractive errors. Data were analyzed using Chi-square and t Student tests by SPSS software. RESULTS: The BCVA mean in DLK and PK groups was 6/10 ± 2/10 and 5/10 ± 2/10, respectively, with no significant difference (P = 0.4). The results showed 9 cases of DLK and 6 cases of PK had normal (8/10 ≤ BCVA) visual acuity (25.7% vs. 17.1%), 24 cases of DLK and 27 cases of PK had mild vision impairment (68.6% vs. 77.1%) and 2 cases of the DLK group and 2 cases of PK had moderate vision impairment, (5.7% vs. 5.7%), there was no significant difference in "BCVA" (P = 0.83). CONCLUSIONS: Both methods were acceptably effective in improving BCVA, but according to previous articles (5,9,10) the DLK method due to fewer complications and less risk of rejection was superior to another method and in the absence of any prohibition this method is recommended.

Collagen cross-linking effect on progressive keratoconus in patients younger than 18 years of age: A clinical trial.

BACKGROUND: Keratoconus is a bilateral non-inflammatory corneal disease. Collagen cross-linking (CXL) is a new treatment option for the disease that uses ultraviolet A light irradiation and riboflavin administration. The aim of this study is to evaluate the effect of CXL on corneal topographic and refractive values in patients with keratoconus younger than 18 years of age. MATERIALS AND METHODS: For the clinical trial study, 37 patients (64 eyes) younger than 18 years of age with progressive keratoconus were included. Age, sex, family history of keratoconus, and history of allergic disorders and eye rubbing were recorded. Refractive, topographic, and topometric indices were evaluated before and 12 months after the CXL with 3mW for 30 minutes. RESULTS: Mean age (±SD) of the patients was 15.83 ± 1.53 years; 26 (70.3%) of the 37 patients were male. Fourteen (37.8%) had positive family history of keratoconus, 11 (29.7%) had history of allergic disorders, and 15 (40.5%) had positive history of eye rubbing. Of the refractive values, cylinder value decreased significantly from -4.50 ± 0.29 to -4.11 ± 0.28 (P = 0.001). Also, the logarithm of minimal angle of resolution (logMAR) uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) improved significantly 12 months after CXL (P = 0.012 and 0.001, respectively). Maximum keratometry before and after the operation was 53.82 ± 0.72 and 53.33 ± 0.72, respectively (P = 0.018). Differences for simulated K values, the thinnest cornea pachymetry, keratoconus index (KI), index of highest asymmetry (IHA), and index of highest decentration (IHD) before and 12 months after the CXL were statistically significant (P = 0.015, 0.034, <0.001, 0.017, 0.019, and 0.004, respectively). CONCLUSION: CXL improves the refractory, topographic, and topometric indices in patients with keratoconus younger than 18 years of age.

Comparison of the findings of endothelial specular microscopy before and after corneal cross-linking.

BACKGROUND: To report the long-term findings of corneal cross-linking (CXL) with riboflavin drops on the corneal endothelial cell. MATERIALS AND METHODS: In this prospective non-randomized study, we aim to assess the long-term safety of CXL on the corneal endothelium for the treatment of progressive keratoconus, by endothelial specular microscopy. A total of 68 eyes of 42 keratoconus patients were selected. We checked the corneal thickness (with ultrasonic pachymetry), endothelial cell density, pleomorphism, and polymegathism (with specular microscopy) of the endothelial cells, before CXL and one year after this procedure. RESULTS: The mean ± SD of the preoperative and postoperative corneal thicknesses were 470 ± 40 µm and 469.8 ± 42 µm, respectively (p-value = 0.591). The mean ± SD of the preoperative and postoperative endothelial cell densities were 2753 ± 230 cells/mm[2] and 2699 ± 210 cells/mm,[2] respectively (p-value = 0.004). We found reduction in the endothelial cell density after CXL, but this reduction was less significant in a corneal thickness of less than 400 µm (which was treated with hypo-osmolar riboflavin 0.1% drops) compared to the corneal thickness of more than 450 µm. We did not find any significant differences in the cell shapes (pleomorphism) (p-value = 0.517), but the cell sizes (polymegathism) were changed after the procedure (p-value = 0.021). CONCLUSION: We found a significant decrease in endothelial corneal cell density after CXL, but this reduction was low; also the size of these cells increased after CXL. We believe that other parameters besides the corneal thickness may be the determinant factors for the changing of cell density and cell size in corneal endothelial cells.

Corneal haze and visual outcome after collagen crosslinking for keratoconus: A comparison between total epithelium off and partial epithelial removal methods.

BACKGROUND: Keratoconus is an asymmetric, bilateral, progressive noninflammatory ectasia of the cornea that affects approximately 1 in 2000 of the general population. This may cause a significant negative impact on quality of life. Corneal collagen crosslinking (CXL) is one of the recently introduced methods that have been used to decrease the progression of keratoconus, in particular, as well as other corneal-thinning processes. MATERIALS AND METHODS: A total of 44 keratoconic eyes of 22 patients were enrolled in this randomized prospective study, after obtaining informed consent. In the first group, the corneal epithelium were totally removed and in the second group, the central 3 mm of epithelium was kept intact and partial removal was performed. After collagen crosslinking in both groups, comprehensive ophthalmologic examination was performed on all patients before and 6 months after the surgery. This article is registered at www.clinicaltrial.gov with registration number NCT01809977. RESULTS: The difference between the two groups was not statistically significant regarding postoperative corneal haziness, refraction, and visual acuity (P > 0.05). However, comparison of pre- and postoperative parameters within each group revealed that total removal of the cornea has resulted in significant improvement of K-max (P value: 0.01) and Q-value (P value: 0.009); while eyes in partial removal group had better improvement of corrected vision (P value: 0.006). Both methods had significant and similar increase in optical corneal density (P < 0.0001). CONCLUSION: In our study, keeping the central corneal epithelium intact was not beneficial for decreasing corneal haziness, however, this method caused better improvement in corrected vision. Total epithelium off technique resulted in better improvement of K-max and Q-value.

The effect of pterygium surgery on wavefront analysis.

BACKGROUND: Pterygium is a common disorder of the ocular surface. It causes vision impairment -usually irregular type astigmatism- through different mechanisms. In addition, it is believed that surgical excision of the pterygium improves visual problems. The appropriate method to investigate irregular astigmatism is using wavefront analysis. This study was aimed to evaluate wavefront analysis pre and post pterygium surgery. MATERIALS AND METHODS: This study was performed on 32 patients who underwent surgical excision of pterygium in January 2012. Data were recorded and compared after pre and postoperative comprehensive ophthalmologic examinations including uncorrected and best corrected visual acuity, Orbscan, wavefront analysis and autorefraction to figure out the effects of surgery on different parameters. RESULTS: Comparison of pre and postoperative parameters showed that surgical treatment of the pterygium improves numerous parameters significantly including uncorrected and best corrected visual acuity, spherical and cylinder refractive error, higher order aberration, quadrafoil (Z440), corneal astigmatism and 3 and 5 mm central zone corneal irregularity (all P-values < 0.0001). In addition, it improves vertical coma (P:0.003) and secondary astigmatism (Z420) (P:0.004). CONCLUSION: It is concluded that surgical excision of the pterygium improves visual acuity, refractive errors and most of the corneal topographic indices and wavefront analysis parameters.

Corneal astigmatism change and wavefront aberration evaluation after cataract surgery: "Single" versus "paired opposite" clear corneal incisions.

BACKGROUND: Correcting the pre-existing astigmatism is an optimal goal in cataract surgery. The aim of this study is to compare the astigmatic correcting effect of a single regular 3.2 mm clear corneal incision (CCI) with paired opposite CCI in cataract patients and effect of these incisions on optical aberrations using the wavefront quantitative analysis. MATERIALS AND METHODS: This was a randomized controlled trial study undertaken in an ophthalmology referral center on 50 patients planned for cataract surgery who were randomized to either single 3.2 mm CCI or paired opposite CCI group. Post-operative evaluation was performed at 12 weeks and included refraction, keratometery, corneal topography and wavefront analysis. Corneal astigmatism and post-operative values were compared in two groups. RESULTS: The mean pre-operative corneal astigmatism was 2.58 ± 1.03 D in the single incision group and 2.70 ± 0.94 D in the paired opposite incisions group. After 12 weeks of surgery, the corneal astigmatism was reached to 2.15 ± 0.82 D in single incision group and 1.63 ± 1.21 in the paired opposite incisions group. There was a statistically significant difference in two arms of treatment regarding to surgically induced astigmatism after 3 months. The mean post-operative total and higher order aberrations and values were not significantly different in two groups. CONCLUSION: The results of our study showed that paired opposite incisions is an effective procedure for reducing pre-existing corneal astigmatism in cataract surgery. Paired incisions did not show any beneficial effect regarding wavefront aberrations compared with conventional single incision method.

A survey of outcome of adjustable suture as first operation in patients with strabismus.

BACKGROUND: Adjustable suture used for years to improve the outcome of strabismus surgery. We surveyed outcome of our patients with strabismus who underwent adjustable suture. MATERIALS AND METHODS: This retrospective study was performed at Ophthalmology Centre of Feiz Hospital in Isfahan on 95 participants that candidate for adjustable suture strabismus surgery. Patients were divided into three age groups: Under 10 years, 10-19 years, and 20 years and over. Outcome of adjustable suture surgery consequence of residual postoperative deviation was divided into four groups: Excellent, good, acceptable, and unacceptable. RESULTS: Out of 95 patients studied, 51 (53.7%) were males and 44 (46.3%) were females. The mean of deviation angles were 53.8 ± 17.9 PD (Prism dioptres) in alt XT, 44.5 ± 12 PD in alt ET and 52 ± 13.5 PD in const ET, 47.1 ± 13.1PD in cons XT, respectively. There was no significant difference between the groups (P = 0.051). Results of surgery were in 38 patients (40%) excellent, in 31 patients (32.6%) good, in 19 patients (20%) acceptable, and in 7 patients (7.4%) unacceptable. Seven (7.4%) patients required reoperation. CONCLUSIONS: In the present study, the frequency of re-operation was much lower than other similar studies (7.4% vs. 30-50%). This suggests that the adjustable technique that used in our study can be associated with lower reoperation than other adjustable techniques used in the other similar studies.

Topographic corneal changes after collagen cross-linking in patients with corneal keratoconus.

BACKGROUND: Corneal collagen cross-linking with riboflavin, also known as collagen cross-linking (CXL), involves the application of riboflavin solution to the eye that is activated by illumination with ultraviolet A (UVA) light. We survey here the topographic corneal changes one year after CXL in patients with corneal keratoconus. MATERIALS AND METHODS: This prospective randomized clinical trial study comprised 66 patients with progression of keratoconus during one year who were enrolled at Feiz University Referral Eye Center in Isfahan. Before and after the operation, patients were examined with slit lamp and funduscopic examinations and measurement of uncorrected visual acuity (UCVA), and best spectacle-corrected visual acuity (BSCVA) was done with a logarithm of minimal angle of resolution (logMAR) scale. Corneal topographic and pachymetry values were derived from Orbscan II. The paired t-test test was used for statistical analyses with SPSS software version 20 (SPSS Inc., Chicago, IL, USA). RESULTS: All 66 patients completed postoperative follow-up at 12 months. The mean age of the patients was 22.4 ± 5.4 years (range: 18-29 years). Thirty-six (54.55%) subjects were men and 30 (45.45%) were women. The mean preoperative sphere was -2.66 ± 2.14 diopter (D), the mean cylinder was -3.97 ± 2.29, and the mean spherical equivalent (SE) was -4.64 ± 2.56. Postoperatively, the mean sphere was -2.22 ± 2.57 D, the mean cylinder was -3.60 ± 2.40 D, and SE was -4.02 ± 2.93 D (P = 0.037). SE also demonstrated a mean difference of 0.62 ± 0.37 D significantly (P = 0.006). The mean diameter of preoperative posterior best-fit sphere (BFS) was 6.33 ± 0.35mm (range: 5.51-7.73 mm) before operation, and it improved to 6.28 ± 0.34mm (range: 4.36-6.13 mm) after operation; the difference was significant (P = 0.039). CONCLUSION: Our study showed a significant improvement in topographic corneal changes and refractive results in patients with corneal ectasia after CXL.

Comparative Study of Two Silicone Hydrogel Contact Lenses used as Bandage Contact Lenses after Photorefractive Keratectomy.

BACKGROUND: Silicon hydrogel bandage contact lenses are used to enhance epithelial healing, control surface-generated pain, and prevent epithelial erosions after refractive surgery. Considering the importance of faster reepithelialization in preventing complications of photorefractive keratectomy (PRK) and the fact that the features and specifications of these commercially-available lenses are different and their performance as a postoperative bandage lenses would be different also, the aim of this study was comparison the efficacy of senofilcon A and lotrafilcon A after PRK. METHODS: In this prospective study, 44 patients with PRK in both eyes randomly received a silicon hydrogel contact lens of senofilcon A in one eye and lotrafilcon A in other eye. Then the epithelial defect size, visual acuity and subjective level of pain and discomfort were measured for both eyes and compared on day 1, 3 and 5 postoperatively. RESULTS: There was no statistical difference in rate of reepithelialization between senofilcon A and lotrafilcon A (P > 0.05). The mean pain and discomfort index was significantly lower in eyes with senofilcon A (P < 0.05). The mean subjective visual scores were similar with both bandage contact lenses (BCLs) (P > 0.05). CONCLUSION: Silicon hydrogel BCLs are safe and effective for corneal reepithelialization and have great therapeutic outcome on visual outcomes after PRK. But, senofilcon A had better effect on postoperative pain and discomfort which made it superior than lotrafilcon A. However for more conclusive results, it is recommended to study larger sample size with evaluation the possible factors responsible for the obtained findings regarding postoperative pain and discomfort.

Bilateral angle-closure glaucoma in a young female receiving cabergoline: a case report.

PURPOSE: To report a case of bilateral acute angle-closure glaucoma after oral administration of cabergoline for the treatment of galactorrhea. METHODS: A diagnosis of secondary drug-induced angle-closure glaucoma was made in a patient with elevated intraocular pressure (IOP) and myopic refractive shift, which was confirmed by ultrasound biomicroscopy (UBM) of the ciliary body and anterior segment, sonography, and optical coherence tomography. The treatment included the discontinuation of the culprit drug and the administration of topical anti-glaucoma drops. The treatment course was followed with serial measurements of the IOP and refraction, and with performing UBM. RESULTS: Five hours after he received a single 0.5-mg oral cabergoline tablet, the patient suffered from acute secondary angle-closure glaucoma and myopic refractive error. UBM demonstrated both effusion of the ciliary body and an anterior rotation of the iris-ciliary body. IOP was reduced 8 h after cessation of the causative agent and administration of anti-glaucoma drops. Refractive errors returned to normal levels after 8 days. CONCLUSION: Secondary acute angle-closure glaucoma has been reported to occur after the administration of some drugs. In this report, an attempt has been made to describe this adverse reaction after oral cabergoline intake.