Clonal hematopoiesis of indeterminate potential as a prognostic factor: a systematic review and meta-analysis.

ABSTRACT: With advances in sequencing, individuals with clonal hematopoiesis of indeterminate potential (CHIP) are increasingly being identified, making it essential to understand its prognostic implications. We conducted a systematic review of studies comparing the risk of clinical outcomes in individuals with and without CHIP. We searched MEDLINE and EMBASE and included original research reporting an outcome risk measure in individuals with CHIP, adjusted for the effect of age. From the 3305 studies screened, we included 88 studies with 45 to 470 960 participants. Most studies had a low-to-moderate risk of bias in all domains of the Quality in Prognostic Factor Studies tool. Random-effects meta-analyses were performed for outcomes reported in at least 3 studies. CHIP conferred an increased risk of all-cause mortality (hazard ratio [HR], 1.34; 95% confidence interval, 1.19-1.50), cancer mortality (HR, 1.46; 1.13-1.88), composite cardiovascular events (HR, 1.40; 1.19-1.65), coronary heart disease (HR, 1.76; 1.27-2.44), stroke (HR, 1.16; 1.05-1.28), heart failure (HR, 1.27; 1.15-1.41), hematologic malignancy (HR, 4.28; 2.29-7.98), lung cancer (HR, 1.40; 1.27-1.54), renal impairment (HR, 1.25; 1.18-1.33) and severe COVID-19 (odds ratio [OR], 1.46; 1.18-1.80). CHIP was not associated with cardiovascular mortality (HR, 1.09; 0.97-1.22), except in the subgroup analysis restricted to larger clones (HR, 1.31; 1.12-1.54). Isolated DNMT3A mutations did not increase the risk of myeloid malignancy, all-cause mortality, or renal impairment. The reasons for heterogeneity between studies included differences in definitions and measurements of CHIP and the outcomes, and populations studied. In summary, CHIP is associated with diverse clinical outcomes, with clone size, specific gene, and inherent patient characteristics important mediators of risk.

Effects of different cryopreservation parameters on the differences between trypan blue and fluorescent SYTO 13/GelRed assays.

Post-thaw cell viability assessment is very important in cryopreservation because it is the main assessment method used to optimize cryopreservation protocols for each cell type; hence, having standardized accurate, quick, and reliable assays for post-thaw cell viability measurements is of utmost importance. The trypan blue exclusion assay and nucleic-acid-binding fluorescence-based assays are two different methods for cell viability assessment. Both assays identify cells with damaged membranes by whether they let a compound enter the cell. In this study, these two assays are compared in the context of cryopreservation and the impacts of important cryopreservation parameters on the differences in measurements are investigated. H9c2 myoblasts were cryopreserved with different freezing protocols. Cell membrane integrities were measured immediately after thaw as well as after cryoprotectant removal by a hemocytometer-based trypan blue dye exclusion assay and a dual fluorometric SYTO 13/GelRed assay; and the results were compared. This study quantifies how (i) the absence or presence of different cryoprotectants, (ii) different cell-cryoprotectant incubation conditions, and (iii) the presence or removal of cryoprotectants after thaw affect the differences between these two viability assays.

Systematic cryopreservation study of cardiac myoblasts in suspension.

H9c2 myoblasts are a cell line derived from embryonic rat heart tissue and demonstrate the ability to differentiate to cardiac myotubes upon reduction of the serum concentration (from 10% to 1%) and addition of all-trans retinoic acid in the growth medium. H9c2 cells are increasingly being used as an easy-to-culture proxy for some functions of cardiomyocytes. The cryobiology of cardiac cells including H9c2 myoblasts has not been studied as extensively as that of some cell types. Consequently, it is important to characterize the cryobiological response and systematically develop well-optimized cryopreservation protocols for H9c2 cells to have optimal and consistent viability and functionality after thaw for high quality studies with this cell type. In this work, an interrupted slow cooling protocol (graded freezing) was applied to characterize H9c2 response throughout the cooling profile. Important factors that affect the cell response were examined, and final protocols that provided the highest post-thaw viability are reported. One protocol uses the common cryoprotectant dimethyl sulfoxide combined with hydroxyethyl starch, which will be suitable for applications in which the presence of dimethyl sulfoxide is not an issue; and the other protocol uses glycerol as a substitute when there is a desire to avoid dimethyl sulfoxide. Both protocols achieved comparable post-thaw viabilities (higher than 80%) based on SYTO 13/GelRed flow cytometry results. H9c2 cells cryopreserved by either protocol showed ability to differentiate to cardiac myotubes comparable to fresh (unfrozen) H9c2 cells, and their differentiation to cardiac myotubes was confirmed with i) change in cell morphology, ii) expression of cardiac marker troponin I, and iii) increase in mitochondrial mass.

Prevalence and Burden of Refractive Errors at National and Sub-national Levels in Iran.

PURPOSE: To estimate the prevalence, burden of refractive errors and their associated trend from 1990 to 2018 and geographic inequalities in Iran. METHODS: Data regarding the epidemiology of refractive errors was extracted from three different sources: systematic review of published literature, data from visual school screening programs, and data from Iran's national health survey (NHS). The pool of all available data on refractive errors as well as demographic, location, and socioeconomic status covariates were fitted in spatio-temporal and Gaussian process regression models to predict the prevalence of refractive errors from the years 1990 to 2018 in 31 provinces grouped by age and sex in order to calculate years lived with disability (YLDs). RESULTS: In 2018, the age-adjusted prevalence of refractive errors was 16.32% (95% uncertainty interval [UI]: 12.44-21.48%) in both sexes, 17.98% (95% UI: 13.74-23.61%) in women, and 14.66% (95% UI: 11.14-19.36%) in men. The prevalence of refractive errors reveals that it increases with age. Refractive errors contributed to 441.41 and 348.38 YLDs in men and women, respectively. The age-standardized prevalence growth was 31.30% in females and 24.32% in males from the years 1990 to 2018. Significant geographical heterogeneity was observed. The age-standardized YLDs rates of refractive errors represent an increasing trend of 28.9% increase from 1990 to 2018. CONCLUSION: Over 28 years, the prevalence of refractive errors increased significantly. Women tend to have higher rates of prevalence. The prevalence increased in older ages. Border provinces had the lowest prevalence. Age-standardized YLDs rates of refractive errors increased by about 30%.

Associated factors and distribution of posterior corneal astigmatism in a middle-aged population.

CLINICAL RELEVANCE: Posterior corneal astigmatism has an important role in diagnosis and treatment of astigmatism, but it is usually overlooked. BACKGROUND: This cross-sectional study aimed to investigate the distribution of posterior corneal astigmatism (PCA) and its associated factors in a middle-aged population that participated in the Shahroud Eye Cohort Study (ShECS) phase II. METHODS: Anterior corneal astigmatism (ACA) and PCA values were measured using rotating Scheimpflug System (Pentacam HR, Oculus). With-the-rule (WTR) astigmatism was considered when the steepest corneal meridian was aligned within 90° ± 30°, and against-the-rule (ATR) astigmatism when the steepest meridian was 0 ± 30°. All the remaining values were considered as oblique astigmatism. Logistic regression models were used for evaluating the association of PCA magnitudes with other factors. RESULTS: The current study consisted of 3871 eyes with available Pentacam data. Mean age of participants was 55.4 ± 6.1 years and 1557 (40.2%) subjects were male. Means of ACA and PCA were 0.77 ± 0.67 and -0.24 ± 0.15 D, respectively. The majority of PCA consisted of WTR astigmatism (82.43%), while ACA mostly showed ATR astigmatism (55.46%). PCA > 0.3 D was associated with male sex (OR = 1.16, P-value = 0.028) and spherical equivalent (OR = 0.93, P-value = 0.011) in the adjusted model, while PCA > 0.5 dioptre was strongly associated with myopia (OR = 4.6, P-value < 0.001). CONCLUSION: The most common forms of ACA and PCA in middle-aged Iranian adults were ATR and WTR, respectively. While the shape of posterior corneal surface remained mostly unchanged across ages of 45 to 69 years, ACA was associated with a decrease in ATR proportion. Moreover, the most significant factors associated with higher magnitudes of PCA were male sex and myopia.

National and sub national prevalence of Amblyopia and its trends from 1990 to 2018 in Iran / Prevalencia nacional y provincial de la ambliopía y tendencias de 1990 a 2018 en Irán

PURPOSE: To determine the national and subnational prevalence of amblyopia and the respective provincial distribution and trend during 1990-2018 in Iran. METHODS: Amblyopia data retrieved from 26 original studies, systematic reviews, Data has been cleaned by STATA and a linear mixed effect spatio-temporal model was used to calculate Gaussian process regression mean functions. Using a Bayesian approach, by pooling empirical data based on the assumed prior, a posterior distribution obtained for age and sex specific prevalence prediction nationally during the study time and provincially. RESULTS: The overall age-adjusted prevalence of Amblyopia was 0.03 (95% CI, 0.022-0.035). The prevalence was comparable in boys and girls (p = 0.85), highest prevalence was in >30 years old (p = 0.038). Our extrapolation revealed a stable trend of prevalence of Amblyopia in Iran during 1990-2018 (national screening program has been active from 1990 onwards). While Amblyopia prevalence suggested a declining trend in three provinces of Hormozgan, Qom and Tehran and it went up in 13 other provinces. CONCLUSIÓN: Amblyopia prevalence seems unchanged despite the concurrent screening program. It is noteworthy that the coverage of the program has been improved and has reached more than 85% in 2018. Our finding mandates a formal evaluation on the program

OBJETIVO: Determinar la prevalencia nacional y provincial de la ambliopía, así como la distribución y tendencia provincial respectivas de 1990 a 2018 en Irán. MÉTODOS: Datos sobre ambliopía recabados de 26 estudios originales y revisiones sistemáticas. Dichos datos fueron depurados con STATA, utilizándose un modelo espacio-temporal de efecto mixto lineal para calcular las funciones medias de regresión del proceso de Gauss. Utilizando un enfoque Bayesiano, agrupando los datos empíricos basados en el previo asumido, se obtuvo una distribución posterior de la predicción de prevalencia específica por edad y sexo, a nivel nacional y provincial durante el periodo de estudio. RESULTADOS: La prevalencia global de la ambliopía ajustada por edad fue de 0,03 (95% IC, 0,022-0,035). Dicha prevalencia fue comparable en chicos y chicas (p = 0,85), con una mayor prevalencia en >30 años de edad (p = 0,038). Nuestra extrapolación reveló una tendencia estable de la prevalencia de ambliopía en Irán de 1990 a 2018 (el programa nacional de cribado estuvo activo de 1990 en adelante). Mientras que la prevalencia de ambliopía sugirió un descenso de la tendencia en tres provincias de Hormozgan, Qom y Teherán, y se incrementó en otras 13 provincias. CONCLUSIÓN: La prevalencia de ambliopía parece no haberse modificado, a pesar del programa de cribado concurrente. Cabe resaltar que la cobertura del programa ha sido mejorada, alcanzando a más de un 85% de la población en 2018. Nuestro hallazgo exige una evaluación formal del programa

National and sub national prevalence of Amblyopia and its trends from 1990 to 2018 in Iran.

PURPOSE: To determine the national and subnational prevalence of amblyopia and the respective provincial distribution and trend during 1990-2018 in Iran. METHODS: Amblyopia data retrieved from 26 original studies, systematic reviews, Data has been cleaned by STATA and a linear mixed effect spatio-temporal model was used to calculate Gaussian process regression mean functions. Using a Bayesian approach, by pooling empirical data based on the assumed prior, a posterior distribution obtained for age and sex specific prevalence prediction nationally during the study time and provincially. RESULTS: The overall age-adjusted prevalence of Amblyopia was 0.03 (95% CI, 0.022-0.035). The prevalence was comparable in boys and girls (p = 0.85), highest prevalence was in >30 years old (p = 0.038). Our extrapolation revealed a stable trend of prevalence of Amblyopia in Iran during 1990-2018 (national screening program has been active from 1990 onwards). While Amblyopia prevalence suggested a declining trend in three provinces of Hormozgan, Qom and Tehran and it went up in 13 other provinces. CONCLUSION: Amblyopia prevalence seems unchanged despite the concurrent screening program. It is noteworthy that the coverage of the program has been improved and has reached more than 85% in 2018. Our finding mandates a formal evaluation on the program.

Effect of slow biodegradable substrate addition on biofilm structure and reactor performance in two MBBRs filled with different support media.

In this study, two moving-bed biofilm reactors (MBBR1 and MBBR2) filled with different size of carrier media (Kaldnes K1 and Kaldnes K1 micro, respectively) were subjected to soluble (sugar and sodium acetate (Ac)) substrate and mixture of soluble and particulate (particulate potato starch (PS)) substrate in a very high organic loading rate (12 kgCOD/m3·d) at different temperatures (26 and 15°C, in MBBR1 and MBBR2, respectively). The effects of carrier type and substrate on biofilm structure and reactor performance have been studied. Starch was removed by adsorption at the biofilm surface and hydrolyzed which caused substrate gradient in MBBR1, however, hydrolyzed uniformly within biofilm in MBBR2. The biofilm of MBBR1 was irregular due to filamentous structure growth due to the substrate gradient, while, it was regular in MBBR2 due to uniform distribution of substrate. The performance of both MBBRs in ammonium, COD and TN removal decreased significantly when the amount of small particles in the reactor increased owing to feeding by starch, which led to biomass density decline. The type of media affected the quantity and distribution of attached biomass, which in turn influenced the activity of specific microbial functional groups in the biofilm. The biofilm in MBBR2 was thicker and consequently nitrogen removal by denitrification was much higher. The lower temperature did not affect negatively the reactor performance in MBBR2.

Safety and Bioavailability of Complete and Half-Dose Intravitreal Ziv-Aflibercept in an Experimental Model: Contralateral Eye Study.

BACKGROUND AND OBJECTIVE: To evaluate the safety and bioavailability of complete and half-dose of intravitreal ziv-aflibercept (IVZ) in an experimental model. MATERIALS AND METHODS: Thirty-two eyes of 16 male rabbits received one IVZ injection under anesthesia and the operating microscope. All right and left eyes received 1,250 µg/0.05 mL and 625 µg/0.05 mL of ziv-aflibercept, respectively. Then, rabbits were randomly allocated to four groups (four rabbits in each group). The rabbits were euthanized at predesignated intervals (at 24, 168, 336, and 720 hours), and the eyes were enucleated. Indirect ophthalmoscopy, vitreous sampling, and electrophysiological recordings were obtained before euthanization. Histological examination was performed after enucleation. Vitreous samples were evaluated by enzyme-linked immunosorbent assay to measure the concentration of aflibercept. RESULTS: No serious drug-related ocular inflammation and toxicity or systemic adverse events were identified. Electroretinogram findings showed no significant difference to the baseline measurements. Remaining vitreal concentrations of ziv-aflibercept injection for the 625 µg/mL group were 416 µg/mL, 349 µg/mL, 124 µg/mL, 41.2 µg/mL, and 18.1 µg/mL (± 10 µg/mL) and for the 1,250 µg/mL group were 833 µg/mL, 737 µg/mL, 284 µg/mL, 87.3 µg/mL, and 38.2 µg/mL (± 10 µg/mL), at zero, 24, 168, 336, and 720 hours after injection, respectively. The vitreous concentration of aflibercept was analyzed by one-compartment model. The area under curve from time 0 to the end point (AUC last) was 147,637 hours × µg/mL for the complete dose group (1,250 µg/0.05mL) and 68,498 hours × µg/mL for the half-dose group (625 µg/0.05 mL). The assessed vitreous half-life of ziv-aflibercept was 113 hours in both groups. CONCLUSIONS: IVZ proved to be safe and well tolerated, even in the complete dose group. It seems to be a cost-effective therapeutic option for the treatment of retinal vascular diseases. However, the long-term safety and efficacy of intravitreal ziv-aflibercept remain unknown. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:785-790.].

Ophthalmic Care Utilization and Out-of-Pocket Expenditure in Iran: Kurdistan Eye Health and Economics Survey-2015.

BACKGROUND: Due to lack of information about ophthalmic economics in Iran, health policy makers unable to distribute resources optimally in terms of efficiency and equity. Therefore, we estimated the total and eye care utilization, out-of-pocket expenditures, and its association with social determinants of health in Iran in 2015. METHODS: A multi-stage population-based, cross-sectional study in a random sample aged 50 yr or older in Kurdistan Province, Northwest Iran was used. The utilization rate of eye and general health care and related out-of-pocket expenditures was estimated during the recent last six months. To find the association between social factors and care out-of-pocket expenditures, we used a Heckman two-step regression model. RESULTS: About 81% and 37% of participants were utilized the health and ophthalmic services, respectively. Statistically significant lower ophthalmic utilization rates were observed among men, middle-aged population, illiterate participants, rural residents, daily-paid workers, and the poorest participants. The average of vision and total health-related out-of-pocket expenditures among those used these services have estimated as US$43.7 (SE: 2.6) and US$439.9 (SE: 22.8), respectively. The highest (US$ 396.6) and lowest (US$ 10.4) ophthalmic out-of-pocket costs were related to patients with Glaucoma and Central Nervous System abnormalities, respectively. Multivariate analyses confirmed an unequal probability of having the ophthalmic out-of-pocket expenditures among different subgroups especially in favor of females, older, and those with more severe visual impairment. CONCLUSION: Ophthalmic disorders reconstituted about 10% of all health services OOP expenditures on average among individuals older than 50 yr.

Rapid Assessment of Avoidable Blindness in Kurdistan, Iran.

PURPOSE: To determine the magnitude and causes of blindness and visual impairment (VI) in Kurdistan, using the Rapid Assessment of Avoidable Blindness methodology. METHODS: In this population-based cross sectional study, 99 clusters were selected through probability proportional to size sampling. Visual acuity (VA) was measured using a standard tumbling "E" chart. Ophthalmologists examined participants with VA < 6/18 in both eyes. The cause of VI in the better eye or the most treatable cause was considered as the primary cause of VI. RESULTS: A total of 3203 (response rate: 92.4%) individuals aged 50 years and older participated, of whom 1657 (51.7%) were female. The standardized prevalence of blindness, severe visual impairment (SVI), and moderate visual impairment (MVI) based on available correction (presenting VA) were 2.1% (1.5-2.6), 1.7% (1.2-2.2), and 9.6%(8.4-10.8), respectively. The proportion of avoidable causes of blindness, SVI, and MVI were 58.1%, 78.4%, and 83.4%, respectively. The most common cause of blindness and SVI was cataract (27.4% and 60.8% respectively), followed by age-related macular degeneration (25.8% and 13.7%, respectively). The leading causes of MVI were uncorrected refractive errors (RE) (37.2%) and cataract (33.6%). CONCLUSION: The prevalence of blindness in the study population seems comparable to the region. According to our results, blindness, SVI, and MVI were mostly due to avoidable causes. Cataract and refractive errors are the principal causes of blindness and VI in Kurdistan.

Effect of a Natural Eye Drop, Made of Plantago Ovata Mucilage on Improvement of Dry Eye Symptoms: A Randomized, Double-blind Clinical Trial.

Dry eye disease is a relatively common eye disorder associated with decrease in quality of life. In this study, efficacy of an eye drop of Plantago ovata mucilage on symptoms of dry eye disease was evaluated. In a randomized, double-blind, placebo-controlled clinical trial, sixty dry eye patients with ocular symptoms and total Ocular Surface Disease Index (OSDI) score of ≥12 were randomly assigned to receive either a natural ophthalmic drop, made of Plantago ovata mucilage or placebo 4 times a day for 6 weeks. The patients were evaluated at pretreatment (baseline), weeks 4 and 6 post-treatment. The evaluation of the efficacy and safety were conducted based on the OSDI questionnaire, the noninvasive tear film break-up time (NI-BUT) with keratograph, the Schirmer test without anesthesia, and the osmolarity test, as well as by monitoring possible adverse events. After 6 weeks, within group analysis showed a significant improvement in total OSDI score (p < 0.001). In addition, between group comparison revealed a significant improvement in the OSDI score of the intervention group (p < 0.001). Although, NI-BUT was significantly improved in the Plantago ovata group (p = 0.004), however no statistically significant difference was observed in between group analysis. There were no significant differences between two groups, or significant changes within the groups in the Schirmer test without anesthesia and the osmolarity test. No serious adverse events were reported. In conclusion, P. ovata mucilage is a natural, inexpensiveness, and safe lubricant polymer that could have beneficial ocular effects on subjective symptoms of the patients with dry eye disease.

Factors Influencing Cyclotorsion During Photorefractive Keratectomy.

PURPOSE: To determine predictive factors for intra-operative cyclotorsion in photorefractive keratectomy (PRK). METHODS: A retrospective statistical analysis of medical records pertaining to 3,996 eyes undergoing PRK was conducted. Outcome measures of this study were the likely existence of statistically significant relations between diverse and potentially influential factors and the occurrence of intraoperative cyclotorsion. RESULTS: A total of 96% of examined medical records indicated some degree of cyclotorsion with the absolute mean intraoperative value of 1.38° ± 1.67° (range: 0° to 13.6°). Absolute mean cyclotorsion showed no significant correlation with age (r = 0.14, P = .37). Female patients had significantly higher degrees of cyclotorsion versus males (P < .001). Right and left eyes showed no significant difference in absolute mean torsion (P = .05). Higher diopters of refractive errors, hyperopia, more than 2.00 diopters of cylinder, high pulse numbers (r = 0.26), and use of the advanced personalized treatment ablation algorithm were all significantly related to higher degrees of torsion (P < .0001). Ablation depth (r = 0.13) and surgeon appeared to be dependent factors. CONCLUSIONS: Incidence of intraoperative cyclotorsion is high in eyes undergoing PRK and most of them will experience some degree of torsion. Several diverse factors (sex, refractive error diopters, hyperopia, high cylinder, pulse numbers, and ablation algorithm) were significant predictors for higher degrees of the observed torsion. [J Refract Surg. 2018;34(2):106-112.].

Assessment of High Reliability Organizations Model in Farabi Eye Hospital, Tehran, Iran.

BACKGROUND: A high-reliability organization (HRO) is a separate paradigm can indicate medical error reduction and patient safety improvement. Hospitals, as vital organizations in the health care system, can transform to HROs to achieve optimal performance and maximum safety in order to manage unpredicted events efficiently. Therefore, the aim of this research was to determine the knowledge of managers and staffs of Farabi Eye Hospital, Tehran, Iran about HROs model, and the extent of HROs establishment in this hospital in 2015-2016. METHODS: In this descriptive-analytical and cross-sectional study, data were collected through HROs questionnaire and checklist. Validity of questionnaire and checklist was confirmed by expert panel, and the questionnaire reliability by Alpha-Cronbach method with 0.85. The collected data were analyzed with Spearman's correlation coefficient and Mann-Whitney test using the SPSS software version 19. RESULTS: Most of the respondents were familiar with HROs model to some extent and only 18.8% had a high level of knowledge in this regard. In addition, there was no significant correlation between the knowledge of staffs and managers with establishment of HROs model in Farabi eye hospital. CONCLUSION: Managers and staffs of Farabi Eye Hospital did not have a high knowledge level of the model of HROs and had little information about the functions and characteristics of these organizations. Therefore, we suggest HROs training courses and workshops should be established in this hospital to increase the knowledge of the managers and staffs for better establishment of HROs model.

Prevalence and Major Causes of Visual Impairment in Iranian Adults: A Systematic Review.

PURPOSE: The purpose of this study is to provide a pooled estimate of moderate-to-severe visual impairment (MSVI) and blindness in Iran for people 50 years and over and to identify the major causes through systematic review. MATERIALS AND METHODS: International (PubMed, ISI Web of Science, and Scopus) and national databases (Scientific Information Database, Barakat Knowledge Network System, Iran Databank of Ophthalmology Research, and Magiran) databases were searched. Following relevance assessment and critical appraisal, eight studies were included. A funnel plot was drawn to explore the stability for estimation. Single-variable meta-regression analysis was applied for heterogeneity assessment, and a random effect model was used (but no significant source for the observed heterogeneity was found). RESULTS: Age-standardized pooled estimate of MSVI was 4.24% (95% confidence interval [CI]: 2.92-5.56); 3.98% (95% CI: 2.37-5.59) for men, and 4.08% (95% CI: 2.95-5.21) for women. Blindness (visual acuity <3/60) prevalence was 1.31% (95% CI: 1.23-1.39); 0.96% (95% CI: 0.89-1.03) for men, and 1.13% (95% CI: 1.06-1.20) for women. Causes of visual impairment (VI) were cataract (40.23%), amblyopia (12.03%), corneal opacity (9.63%), age-related macular degeneration (9.31%), diabetic retinopathy (4.94%), and glaucoma (3.67%). CONCLUSION: VI prevalence in the 50 years and older population in Iran seems significantly better than the corresponding global estimates. A rough 60% rate of treatable VI was estimated, mostly attributable to unoperated cataract.

Optical aberrations, accommodation, and visual acuity with a bioanalogic continuous focus intraocular lens after cataract surgery.

PURPOSE: To evaluate the visual outcomes, pseudoaccommodation, and wavefront aberrometry after implantation of Wichterle IOL-Continuous Focus (WIOL-CF®, Gelmed International, Kamenne Zehrovice, Czech Republic) by i-Trace aberrometry. METHODS: In this retrospective interventional case series study, after cataract surgery with implantation of accommodative WIOL-CF®, the patients were evaluated with i-Trace aberrometer for measurement of modulation transfer function (MTF), point spread function (PSF), total aberrations, higher order aberrations (HOAs) at far and near and pseudoaccommodation. The pre and postoperative visual acuity at near and distance were also measured. RESULTS: Forty eyes of 20 patients (aged 40-77 years) were enrolled in this study with mean follow-up time of up 13.10 ± 5.52 months. The mean logMAR corrected distance visual acuity (CDVA) improved from 0.20 ± 0.14 preoperatively to 0.10 ± 0.09 at the last follow-up after surgery (P = 0.002). The results were 60% J1, 70% J2, 85% J3, 90% J4, 95% J5 and 100% for J6. The mean pseudoaccommodation, range of accommodation volume, and average of peak accommodation were -2.52 ± 1.56 diopters (D), 1.50 to 5.25 D and -3.25 ± 1.25 D, respectively. The mean MTF at 5 cycles per degree at far was 0.200 ± 0.10 and for near was 0.207 ± 0.10. PSF at far and near was 0.0002 and 0.001, respectively. The mean root mean square (RMS) value of HOAs; total, coma spherical aberration, trefoil, and secondary astigmatism were 1.08 ± 0.48 µm, 0.89 ± 0.45 µm, -0.33 ± 0.23 µm, 0.25 ± 0.17 µm, and 0.15 ± 0.13 µm for far and 0.88 ± 0.49 µm, 0.73 ± 0.46 µm, -0.25 ± 0.22 µm, 0.19 ± 0.16 µm and 0.11 ± 0.10 µm for near, respectively. There was a decrease in HOAs at near relative to far (P < 0.05). CONCLUSION: WIOL-CF® seems to be an acceptable accommodative intraocular lens (IOL) in terms of uncorrected near and distant visual outcomes, MTF and HOA.

Association of ocular findings and outcome in cerebral venous thrombosis.

BACKGROUND: Cerebral venous thrombosis (CVT) is a potentially life-threatening underdiagnosed disease. Headache is a common but nonspecific finding in CVT. Other features such as ocular finding can assist to correct diagnosis, but their frequency in CVT has not been previously evaluated. The aim of this study is to evaluate the ocular symptoms and signs in CVT and their association with outcome. METHODS: The demographic, clinical, laboratory, radiological, and outcome data were collected and analyzed from patients referred to a tertiary hospital during 6 years. Based on delay from symptom onset to hospital admission, mode of onset was categorized as acute (<2 days), subacute (2-14 days), or chronic (>14 days). RESULTS: Fifty-three patients were identified with a mean age of 33.7 years (17-60 years). Ocular symptoms and signs were the most frequent clinical presentations (77.4%) following headache (83%). Papilledema and diplopia were the main findings in chronic CVTs (P = 0.003 and 0.002, respectively). Proptosis was significantly associated with thrombosis in cavernous sinus (P = 0.00). Otherwise, there was no relationship between any specific ocular findings and the type or number of thrombosed sinus or hemorrhagic infarction. Mortality rate and recurrence in our patients were 3.8% and 5.7%. Absence of proptosis and vision loss was associated with favorable outcome (P = 0.001 and 0.003, respectively). CONCLUSION: Ocular features were among the most common presentation of CVT in every three phases of CVT and could be the sole finding of CVT. Patients who do not have vision loss and proptosis might have a better outcome in CVT.