Refractive error and vision related quality of life.

BACKGROUND: To investigate and compare the vision-related quality of life (QOL) in different types of refractive error (RE). METHODS: This cross-sectional study was performed on 200 subjects, categorized into four groups of 50 each, consisting of subjects with myopia, hyperopia, astigmatism, and emmetropia, the latter being the control group. The mean age of the participants was 23.88 ± 5.87 (range, 15 to 38: 110 females and 90 males). RE was defined as myopia, spherical equivalent (SE) < -0.25 diopters (D), hyperopia, SE > + 0.25 D, astigmatism, cylinder < -0.25 D, and emmetropia (-0.25 ≤ SE(D) ≤ + 0.25, cylinder ≥ -0.25). Groups are subdivided into very low magnitudes of RE (0.50 and 0.75) and significant RE (1.00 ≤). Vision-related QOL was assessed using the Persian version of the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25). The NEI-VFQ was scored as visual function and socioemotional scales using Rasch analysis. RESULTS: Corrected myopia, astigmatism, uncorrected myopia, and hyperopia had a lower vision-related QOL than emmetropes. (P < 0.001). Vision-related QOL in myopic subjects was lower than that in astigmatic participants. Very low myopes, who often do not use correction, had a significantly lower QOL than other groups. CONCLUSION: Individuals with refractive errors experience a lower QOL score than those without. Notably, the adverse impact on QOL score is significantly greater in myopic cases, particularly very low myopia, compared to other refractive errors. Therefore, it is strongly recommended not to neglect managing very low myopia since it may improve participants' QOL.

Prevalence and risk factors of keratoconus (including oxidative stress biomarkers) in a cohort study of Shiraz university of medical science employees in Iran.

BACKGROUND: To determine the prevalence of keratoconus in Shiraz University of Medical Sciences Employees and the related risk factors including oxidative stress biomarkers. METHODS: 2546 subjects' mean age ± SD, 40.35 ± 6.70 (46% male) were recruited. All participants underwent objective refraction using auto-refractometer and retinoscopy, followed by subjective refraction, and bio-microscopy. Pentacam imaging was performed for the detected keratoconus patients. The prevalence of keratoconus and frequency of the visual impairment among keratoconus cases were evaluated. Potential risk factors of sex, age, family history of keratoconus, body mass index ≥ 30 kg/m2, serum levels of glucose ≥ 100 mg/d, low-density-lipoprotein-cholesterol (LDL) ≥ 110 mg/dL, high-density-lipoprotein-cholesterol ≤ 40 mg/d, and triglycerides ≥ 150 mg/dL in the blood were evaluated. RESULTS: The prevalence of keratoconus at least in one eye was 0.98% (95% CI: 0.6- 1.4%). The best corrected visual acuity in the keratoconus group was 0.06 ± 0.1 and the rest of the population was 0.01 ± 0.07 logMAR (p < 0.001). The frequency of visual impairment in the keratoconus group was zero. Odds ratios of the family history of keratoconus (21.00, 95% CI: 9.00-48.00, p < 0.001) and LDL ≥ 110 mg/dL (3.00, 95% CI: 1.20-6.40, p = 0.01) were significant. CONCLUSIONS: Keratoconus is rare and is not considered a risk factor for visual impairment. A family history of keratoconus and elevated serum LDL levels are contributing risk factors, suggesting an inflammatory background for the disease. Serum levels of LDL ≥ 110 mg/dL in the blood increased the risk of keratoconus three folds.

Vision-related Quality of Life after Bilateral Implantation of Monofocal and Multifocal Intraocular Lenses.

PURPOSE: To evaluate vision-related quality of life in two sets of patients after routine cataract surgery implanting with traditional versus multifocal intraocular lens (IOLs). METHODS: In a cross-sectional prospective study, 58 and 33 candidates for cataract surgery were divided into traditional (Acrysof SN60WF, Alcon Laboratories, Inc) and multifocal IOL (AcrySof IQ PanOptix IOL TFNT00, Alcon Laboratories, Inc.) groups, respectively. The primary outcome was VFQ-25 scores. The secondary outcomes were making comparisons between the two IOL types in the near vision and the driving items. RESULTS: mean patients' age in traditional and multifocal IOL groups was 60.85 ± 7.40 (55% female) and 59.85 ± 8.95 (36% female) years, respectively. The mean VFQ-25 total scores in traditional and multifocal IOL groups before and after surgery were 63.69 ± 4.95 and 72.15 ± 9.66, and 98.08 ± 0.70 and 95.70 ± 1.30, respectively (P = 0.001 & 0.001). The mean scores of night driving in traditional and multifocal IOL groups were 38.79 ± 20.50 and 44.35 ± 21.12 (P = 0.1) before surgery which improved to 97.41 ± 7.68 and 56.45 ± 11.12 after surgery, respectively (P = 0.001). The mean scores of near vision in traditional and multifocal IOL groups were 46.83 ± 10.56 and 50.53 ± 8.58 (P = 0.2) before surgery which improved to 89.94 ± 4.87 and 100.00 ± 0.00 after surgery, respectively (P = 0.001). CONCLUSION: Vision-related quality of life after cataract surgery with either type of traditional or multifocal (PanOptix) IOLs improved to an excellent level. Traditional IOLs provided more satisfaction in nighttime driving while multifocal IOLs provided increased satisfaction in near and intermediate vision.

Non-medial infectious orbital cellulitis: etiology, causative organisms, radiologic findings, management and complications.

BACKGROUND: Orbital cellulitis is an ophthalmic emergency, which is associated with vision-threatening adverse effects. The purpose of this study is investigating etiology, radiologic findings, management and complications of patients with non-medial orbital cellulitis. METHOD: A retrospective medical record and radiologic file review of patients with infectious orbital cellulitis was performed to detect all patients with non-medial orbital cellulitis who referred to Khalili hospital from 2016 to 2019. Age, sex, origin of infection, size of collection or abscess, medical or surgical management, microbiology, first and final best-corrected visual acuity, duration of admission, and complications was recorded. Patients divided into two groups; medical management and surgical management groups and all of data compared between in this groups. RESULTS: Of ninety-six patients with infectious orbital cellulitis, 23 cases (14 male, 9 female) were included. Five patients (21.7%) were managed medically and 18 patients (78.3%) were managed surgically. Patients' age range was 5-70 years old. Most common location for non-medial cellulitis was superior space (66.7% in surgical and 40% in medical group; p = 0.511). In 13 cases of surgical group (72.3%) were detected microorganisms. The mean ± SD of collection volume in medical group were 476.5 ± 290.93 mm3 and 2572.94 ± 1075.75 mm3 in surgical group (p < 0.001). Ten patients in surgical group had compressive optic neuropathy. The mean ± SD of collection volume was 3204.97 ± 879.88 mm3 in patient with compressive optic neuropathy and 1280.43 ± 880.68 mm3 in patient without compressive optic neuropathy (P < 0.001). One case complicated by subdural empyema and another case progressed to necrotizing fasciitis. CONCLUSION: Non-medial orbital cellulitis is an uncommon but sight-threatening and life-threatening condition. Timely diagnosis and accurate management reduce morbidity and mortality. Combined surgery for patients with superior or supra-temporal and large non-medial abscess is recommended.

Acute bilateral granulomatous anterior uveitis as an extra-hepatic manifestation of hepatitis A virus (HAV) infection: a case report.

Anterior uveitis (AU) is the most common form of uveitis. The differential diagnosis of AU is broad, ranging from infectious etiologies to autoimmune causes. However, approximately half remain idiopathic. Infections are the vision-threatening causes of AU which should be ruled out by history taking and detailed physical examination combined with guided work up. We report a rare case of bilateral granulomatous AU following hepatitis A virus (HAV) infection in an immunocompetent patient. A 35-year-old male presented to our center with a chief complaint of pain and redness in both eyes 3 days prior to the presentation. The patient's medical and drug history was unremarkable. He had a history of river water consumption 20 days prior to presentation. The patient was diagnosed with acute bilateral granulomatous AU. All routine work up to investigate the etiology of the disease was unremarkable, except for the serology of acute HAV infection, which was positive. The patient was managed with the topical steroid and cycloplegic for 2 weeks with no recurrence at one-year follow up. Extra-hepatic complications of HAV were reported in previous studies including arthritis, urticaria, myocarditis, nephritis, and myositis. The mechanism of extra-hepatic complication of hepatitis A is unknown; however, immune-complex deposition is most likely the etiological cause. Our report represents a rare case of sudden onset with limited duration granulomatous AU as a presenting manifestation of HAV infection. Previous studies do not provide a direct evidence of granulomatous AU associated with the HAV infection.

Corneal Collagen Cross-Linking Using Epithelium Disruptor Instrument in Progressive Keratoconus.

PURPOSE: To compare the effects of accelerated corneal collagen cross-linking (CXL) in progressive keratoconus (KCN) patients via epithelium removal and transepithelial techniques, using Daya Disruptor (Duckworth and Kent, Hertfordshire, UK). METHODS: This study is a double-blinded, randomized clinical trial. Patients with documented bilateral progressive KCN were randomized into two groups: one eye underwent epithelium removal (Group 1), and the fellow eye underwent epithelium disruption (Group 2). The primary outcomes were best corrected visual acuity (BCVA) and uncorrected visual acuity (UCVA), Scheimpflug-extracted keratometric indices, and anterior segment-optical coherence tomography-derived epithelial thickness profiles. These parameters were evaluated before and 12 months after CXL. RESULTS: Sixty-four eyes from 34 patients with progressive KCN (34 eyes in the epithelium-removal group and 30 eyes in the epithelium-disruption group) were included. The mean ± standard deviation (SD) of age was 23.4 ± 3.8 years in the epithelium-removal group and 23.2 ± 3.5 years in the epithelium-disruption group. The mean ± SD of the preoperative spherical equivalent (SE), front maximum keratometry (K-max), back K-max, thickness of thinnest point, and corneal apex thickness were - 2.9 ± 3.0 diopter (D) and - 3.7 ± 3.1 D (P = 0.183), 53.8 ± 5.15 D and 54.4 ± 5.53 D (P = 0.653), -6.63 ± 2.40 D and - 6.68 ± 2.48 D (P = 0.131), 459.2 ± 37.4 µm and 460.8 ± 32.7 µm (P = 0.708), 470.5 ± 37.7 µm and 469.7 ± 33.1 µm (P = 0.679), and 55.4 ± 4.97 µm and 54.6 ± 7.16 µm (P = 0.767) in the epithelium-removal and epithelium-disruption groups, respectively. The mean ± SD changes of the UCVA and BCVA 12 months after CXL were - 0.1 ± 0.11 and - 0.02 ± 0.18 and - 0.04 ± 0.12 and - 0.02 ± 0.14 in the epithelium-removal and epithelium-disruption groups, respectively. No statistically significant improvement was observed in the UCVA and BCVA between the two groups (P = 0.868 and P = 0.937, respectively). The mean ± SD changes of the SE, superior epithelial thickness, corneal apex thickness, and thickness of thinnest point 12 months after CXL were - 0.21 ± 1.1 D and + 0.32 ± 1.6 D (P = 0.0001), -0.08 ± 0.26 µm and + 0.03 ± 0.33 µm (P = 0.028), -23 ± 11 µm and - 2 ± 6 µm (P = 0.0001), and - 25 ± 8 µm and - 3 ± 7 µm (P = 0.0001) in the epithelium-removal and epithelium-disruption groups, respectively. CONCLUSIONS: This study showed that the epithelium-disruption CXL using Daya has a similar potential for halting KCN progression as the epithelium-removal CXL. However, regarding the 12-month changes, the epithelium-disruption CXL is superior to the epithelium-removal CXL in the SE and corneal pachymetry.

Fourier Analysis of Keratometric Data in Epithelium Removal versus Epithelial Disruption Corneal Cross-linking.

PURPOSE: To compare epithelium-removal and epithelium-disruption corneal crosslinking (CXL) methods in Fourier analysis of keratometric data and clinical outcomes. METHODS: In this double masked randomized clinical trial, each eye of 34 patients with bilateral keratoconus was randomly allocated to either the epithelium-removal or epithelium-disruption CXL treatment groups. Ocular examination, refraction, uncorrected and best spectacle-corrected visual acuity (UCVA and BSCVA, respectively) measurements, and Pentacam imaging (keratometry, pachymetry, and Fourier analysis) were performed at baseline and at six-month follow-up period. RESULTS: Patients' mean age was 23.3 ± 3.6 years. The preoperative thickness of the thinnest point was 459.20 ± 37.40 µm and 455.80 ± 32.70 µm in the epithelium-removal and epithelial-disruption CXL groups, respectively (P > 0.05). The corresponding figures were 433.50 ± 33.50 µm and 451.90 ± 39.70 µm, respectively, six months after the treatment (P = 0.0001). Irregularity component of the fourier analysis was 0.030 ± 0.016 µm in the epithelium-removal group and 0.028 ± 0.011 µm in the epithelium-disruption group preoperatively (P > 0.05). This measurement was 0.031 ± 0.016 µm and 0.024 ± 0.009 µm, respectively at month 6 (P = 0.04). The epithelium-disruption CXL group had better results in terms of the thickness of the thinnest point and the irregularity component as compared to the epithelium-removal group. The two study groups were comparable in spherical equivalent, mean keratometry, UCVA, BSCVA, or other Fourier analysis components (spherical R min, spherical eccentricity, central, peripheral regular astigmatism, and maximum decentration) (P > 0.05). CONCLUSION: This study shows that epithelium-disruption CXL is superior to epithelium-removal CXL regarding the short-term changes in pachymetry and corneal irregularity. Other evaluated parameters were comparable between the two techniques.

Endogenous Candida Endophthalmitis as a Rare Complication of Trans-Urethral Lithotripsy in a Healthy Woman: A Case Report

Endogenous endophthalmitis is a serious sight-threatening ocular emergency that usually occurs in patients with serious underlying risk factors. In this report, we describe a case of endogenous Candida endophthalmitis following trans-urethral lithotripsy in an immunocompetent woman. In our case, the retinal lesion regressed completely and vision was restored. We discuss diagnostic procedures and management strategies in this article.

Unilateral endogenous Candida endophthalmitis after extracorporeal shock wave lithotripsy for a renal stone in an immunocompetent woman: a case report.

PURPOSE: To report a case of endogenous Candida endophthalmitis that may cause catastrophic sight-threatening outcomes, after extracorporeal shock wave lithotripsy (ESWL) in a healthy woman. CASE PRESENTATION: A 32-year-old woman presented to the ophthalmology clinic with the symptom of blurred vision and floater in her right eye. She underwent ESWL for renal stone 1 week prior to her presentation. Fundus examination showed an elevated white lesion in para-fovea with fluffy border. Smear of diagnostic vitreous sampling showed pseudo-hypha and budding yeast. Systemic and immunologic and infectious workups were unremarkable. In our case, response to intravitreal and intravenous injection of amphotericin-B and oral fluconazole was dramatic. Six weeks after starting the treatment, infiltrative lesion completely disappeared. The authors review previous MEDLINE literature about this topic. CONCLUSION: Endogenous Candida endophthalmitis following renal stone lithotripsy is a serious and rare intraocular infection that may happen in healthy individuals without any risk factors.

Vision-Related Quality of Life in Iranian Patients With Keratoconus: National Eye Institute Vision Function Questionnaire-25.

BACKGROUND: Use of patient-reported outcomes to evaluate the impact of ocular conditions on quality of life (QoL) is rising. Hence, the aims of this study were to determine the impact of keratoconus on QoL, and assess the National Eye Institute of the United States Vision Function Questionnaire (NEI-VFQ) performance in an Iranian population. METHODS: From November 2016 to June 2017, patients with keratoconus definitive diagnosis for more than one year who were being routinely followed at a cornea clinic were recruited. The NEI-VFQ-25 was administered during a face-to-face interview. Ocular examinations comprised best-corrected visual acuity (BCVA) was logged monocularly and binocularly, anterior segment biomicroscopy, refraction, and corneal topography. Keratoconus severity was graded based on steep keratometric (K) reading values. A group of 30 age- and sex-matched subjects with other ocular diseases (except keratoconus) were selected randomly from the cornea clinic. P<0.05 was considered as significant. RESULTS: The mean age of participants was 28.7±7.6 years. The lowest NEI-VFQ subscale scores were related to ocular pain, general vision, mental health, and role difficulty. Almost all NEI-VFQ scores in patients were statistically significant less than mean score of the control group. Composite and all subscales NEI-VFQ scores were lower significantly among patients with higher disease duration (≥5 years). Among clinical data, patients with BCVA ≥0.5 in the better eye had significantly lower NEI-VFQ composite score. Severe keratoconus patients (steep K reading ≥52) had lower NEI-VFQ scores in mental health and dependency subscales (P<0.05). The overall and subscales Cronbach α was above 0.7. CONCLUSION: Iranian patients with keratoconus had physical, emotional, and social impairment in QoL. The NEI-VFQ-25 might be applicable in further studies.

Lens Densitometry after Corneal Cross-linking in Patients with Keratoconus Using a Scheimpflug Camera.

PURPOSE: To evaluate changes in crystalline lens densitometry following corneal cross-linking (CXL) in keratoconic patients. METHODS: In a quasi-experimental study, three-dimensional lens densitometry was performed using the Pentacam Scheimpflug camera (Oculus Optikgerate GmbH, Wetzlar, Germany) at baseline and six months after CXL. Densitometry was performed in a fixed area of 2 inch × 1 inch of the anterior capsule and anterior lens cortex. The subject group included patients with progressive keratoconus who underwent CXL (n = 40) and the control group was comprised of aged-matched patients with non-progressive keratoconus (n = 36). RESULTS: Mean age of the case and control groups was 25.8 ± 4.0 and 25.0 ± 4.1 years, respectively (P = 0.392). Mean lens density in the CXL group was 6.68% ± 0.58% at baseline and 6.77% ± 0.53% at the last visit (P = 0.352). Corresponding figures in the control group were 6.53% ± 0.27% and 6.39% ± 0.31%, respectively (P = 0.213). There was no significant difference between the study groups at baseline or six months later (P = 0.96). CONCLUSION: In this short term study with six months' follow-up, we observed no significant impact on lens density following exposure of the crystalline lens to ultraviolet A and riboflavin free radicals in the CXL procedure.