Comparison of postoperative topical interferon-α2b versus intraoperative mitomycin C for pterygium recurrence prevention: a randomized clinical trial.

PURPOSE: To evaluate the effect of postoperative interferon-alpha 2b (IFN-α2b) ophthalmic drops versus intraoperative mitomycin-c (MMC) on preventing pterygium recurrence. METHODS: This prospective randomized clinical trial was conducted on patients who were candidates for pterygium surgery. A total of 75 patients were included in the study from December 2021 to December 2022, of which 64 patients (one eye each) were examined and analyzed based on the inclusion criteria. Then the patients were randomly assigned to control groups, intra-operative MMC (32 patients) and the intervention group, IFN-α2b drops after the operation (32 patients). All patients underwent pterygium surgery using the rotational conjunctival flap method. RESULTS: In terms of pterygium grading, 8 (12.5%), 25 (39.06%), and 31 (48.44%) eyes were in grades 1, 2, and 3, respectively. The average size of the pterygium was 3.6 ± 0.7 mm. The grade and size of pterygium had the same distribution in the two groups. There was no statistically significant difference between the two groups in the level of post-operative clinical inflammation. The present study showed no significant difference in complications between the two groups (p = 0.999). The recurrence rate in the control group was 9.4% (3 eyes), and 0% (no recurrence) in the intervention group (p = 0.119). CONCLUSIONS: interferon-alpha 2b group did not show a statistically significant difference in preventing pterygium recurrence compared to the mitomycin C group. The post-surgery administration of IFN-α 2b drops can effectively prevent pterygium recurrence with a comparable and even more compelling effect than MMC during surgery.

The Preventive Role of Atropine Eye Drops on Myopia Progression: A Double-Blind Randomized Clinical Trial.

Background: In the present study, we investigated the effect of two doses of atropine eye drops versus placebo on myopia progression in children and adolescents. Methods: In this double-blind, randomized clinical trial, 67 patients aged 6 to 18 years with myopia of -2 to -6 D were enrolled and randomized to receive a placebo eye drop, atropine 0.1%, or 0.01% ophthalmic solution (one drop per night for 6 months). All participants were followed-up with for one year after the beginning of the study (at zero, one, three, six, and 12 months) and their spherical equivalent (SE), axial length (AL), anterior chamber depth (ACD), and far and near visual acuity (VA) and the eye drops side effects were recorded. A comparison among the groups was performed using SPSS software, version 24.0. Results: Spherical equivalent, AL, and ACD decreased and far VA improved in atropine groups to a greater extent than the placebo group (P < .05) at the 6-month follow-up. The most common side effects of atropine 0.1% eye drop included photophobia and decreased near VA. At the end of the study (six months after the cessation of atropine), a rebound effect was observed; this effect was especially severe in the 0.1% atropine group. Conclusions: Atropine eye drops are effective for slowing down and preventing myopia progression. However, without long-term treatment, they will have a rebound effect. A lower dose (0.01%) is suggested for reducing the side effects and rebound effects.

The epidemiological aspects of fungal keratitis in a population sample from Northern Iran: A cross-sectional study.

Introduction: Fungal keratitis can be influenced by different genetic, environmental, and even iatrogenic factors that the impact of such factors can be very different in various populations. Thus, it should be attempted to provide a clear picture of the epidemiological situation of this disease in different areas. The aim of this study was to investigate the epidemiological aspects of fungal keratitis in a population sample from northern Iran. Methods: This cross-sectional study was conducted on all consecutive patients clinically suspected to fungal keratitis that were ultimately diagnosed by positive fungal culture that admitted to Amiralmomenin hospital in Rasht city, Iran, between 2011 and 2019. The sampling method was census. The required information was collected by reviewing the hospital's recorded files. Results: Forty seven patients were examined in the study that 53.2% of the patients were men. Among the population of women, housewives-farmers with the prevalence rate of 45% and among the population of men, those with farm occupation with the prevalence rate of 52% formed the most common occupational subgroups. Most patients (89.3%) had no history of any ocular surgery or manipulation. Aspergillus was the most frequent pathogen (23.4%) followed by Penicillium (19.1%) and Fusarium (17.0%). History of chronic disorders was also revealed in 44.6%. The results of smear and culture obtained from the study were as follows: in 8.5% of patients as positive smear and positive culture, and in 91.5% as negative smear and positive culture. Only 2.1% used the lens. Conclusion: Fungal keratitis affects our male population slightly higher than females with the highest overall prevalence rate in the sixth and seventh decades of life. The most frequent fungal strains responsible for fungal keratitis include Aspergillus followed by Penicillium and Fusarium.

Comparison of Pterygium Recurrence with and without Using Postsurgical Topical Cyclosporin A 0.05%: A Randomized Clinical Trial.

Purpose: To evaluate the efficacy of 3-month administration of topical cyclosporin A (CsA) 0.05% on postoperative recurrence after pterygium surgery. Methods: In this randomized clinical trial, 78 patients undergoing pterygium surgery (using the rotational conjunctival flap technique with mitomycin C [MMC]) were enrolled and randomly allocated into the control (n = 39) and case (CsA) (n = 39) groups in a single-blind method. The patients were examined on postoperative days 1, 3, and 7 and months 1, 3, and 6, and their best-corrected visual acuity, intraocular pressure, clinical inflammation, postoperative complications, and recurrence were compared. Results: The mean age of patients was 53.22 ± 9.99 years; most (57.7%) of them were men. The two groups were not different in terms of demographics, pterygium size, or pterygium grade. The clinical inflammation at the first and third postoperative months was not different between the groups (P = 0.108 and 0.780, respectively). No serious complications were detected; complication rates were not different between the groups (P = 0.99). The recurrence rate was 5.1% in the case group and 7.7%% in the control group (P = 0.99). Conclusion: The present study showed no priority for 3-month administration of CsA 0.05% drops on postoperative outcomes, including prevention of pterygium recurrence, complications, and inflammation after the rotational conjunctival autograft technique with MMC.

Corneal Astigmatic and Refractive Changes after Rectus Muscle Surgery.

Objective:In the present study, we investigated the postoperative astigmatic and refractive changes in patients with rectus muscle strabismus surgery. Materials and methods:Ninety-three eyes of 51 patients who underwent strabismus surgery at Amir- Almomenin Hospital, Rasht, Iran, were enrolled. The ocular measurements before surgery as well as one month, three and six months postoperatively included cycloplegic refraction, the degree of near and far deviation, mean corneal power, mean keratometry, spherical equivalent (SE) and the change of astigmatism cylinder (measured using power vector analysis). All data were analyzed using SPSS software, version 21. Results:The mean age of participants was 18.31±14.58 years. A similar myopic shift was observed in all deviation groups. The mean SE values differed according to the type of surgery one month and three months postoperatively, with maximum change being seen in medial rectus (MR) recess + inferior oblique (IO) myectomy and in MR recess and lateral rectus (LR) recess six months after surgery. The change in mean J0 remained significant six months postoperatively only in MR recess surgery and in medial and lateral rectus recess groups based on topography (both P<0.001). The postoperative J0 and J45 differed according to the type of surgery (PP<0.001 and 0.007, respectively). The mean keratometry was different before-after LR recess (the minimum change), MR recess and MR recess + IO myectomy groups (the maximum change; PP<0.05). Conclusion:Refractive error toward myopic shift and with-the-rule (WTR) astigmatism are common after strabismus surgery on the rectus muscles, most of which sustain until six months postoperatively.

Macular Optical Coherence Tomography before Cataract Surgery.

PURPOSE: To determine the benefits of performing preoperative spectral domain optical coherence tomography (SD-OCT) and to identify occult macular pathologies in patients scheduled for routine cataract surgery. METHODS: In this cross-sectional study, macular SD-OCT scans were performed on all patients with clinically undetected macular abnormalities who were scheduled for cataract surgery. Patients with clinically evident macular abnormalities were excluded from the study. A retinal specialist reviewed all the scans. The severity of the cataract was determined using the Oxford Clinical Cataract Classification and Grading System. RESULTS: Of the 598 evaluated cases, 33 patients (5.52%) had an occult macular abnormality. The most common pathology found in these patients was idiopathic epiretinal membrane, which was detected in 17 eyes (51.52%), followed by vitreomacular traction in nine eyes (27.27%), and dry age-related macular degeneration in four eyes (12.12%). Full-thickness macular holes and a lamellar macular hole were found in two patients (6.06%) and one patient (3.03%), respectively. The frequency of cortical cataracts was significantly lower in patients without macular lesions (P = 0.012) than in those with macular lesions. Multivariate logistic regression analysis revealed that age >70 years (P = 0.025 and odds ratio [OR] =11.12), smoking history (P = 0.043 and OR = 3.43), and hypertension were independently associated with occult macular lesions. The surgical plan was changed for five patients (0.83%). CONCLUSIONS: Macular SD-OCT can be used to detect occult macular lesions and provide useful information about a macula before cataract surgery. Although preoperative OCT found macular abnormalities in about 5% of patients with presumed normal fundus examination, it can result in changing the surgical plan in 0.83% of all patients.

Correlation of corneal elevations measured by Scheimpflug corneal imaging with severity of keratoconus.

PURPOSE: To evaluate the correlation of corneal elevation and difference elevation with severity of keratoconus. METHODS: Anterior and posterior corneal elevations with both conventional and enhanced best-fit spheres (using rotating Scheimpflug camera) were measured. Front and back difference elevation were extrapolated from difference map of Belin/Ambrosio Enhanced Ectasia Display of the Scheimpflug system. Data from corneal elevations and difference elevations were correlated with maximum keratometry, minimal corneal thickness, and severity of keratoconus as assessed by Amsler-Krumiech classification of keratoconus. RESULTS: Ninety eyes of 55 keratoconus patients of different clinical stages were evaluated. There was a significant positive correlation between keratoconus severity and corneal elevations (anterior and posterior elevation as measured with both conventional and enhanced best-fit spheres) and also between keratoconus severity and corneal elevation differences (P < 0.001 and r > 0.625 for all). Maximum keratometry (Kmax), mean keratometry (Kmean), and all corneal elevations and difference elevations were highly correlated (P < 0.001 and r > 0.840 for all). A significant negative correlation was found between minimum corneal thickness and all corneal elevations and difference elevations (P < 0.001 and r < 0.711 for all). Receiver operating characteristic (ROC) curve analyses showed that anterior and posterior difference elevations have the best predictive accuracy for grading keratoconus severity. CONCLUSION: Evaluation of corneal elevation and difference elevation data obtained from Scheimpflug corneal imaging is useful for grading severity of keratoconus.

The Outcome of Corneal Collagen Cross-Linking in Patients with Advanced Progressive Keratoconus: A 2-Year Follow-up Study.

PURPOSE: The aim of this study was to evaluate the safety and efficacy of collagen cross-linking (CXL) in advanced progressive keratoconus with a maximum keratometry (Kmax) value of more than 58 diopters (D). METHODS: This prospective interventional case series involved patients with advanced progressive keratoconus with a Kmax of more than 58 D. The best-corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), Kmax, mean keratometry (Kmean) value, corneal astigmatism, and thinnest corneal thickness before surgery and 24 months after CXL were determined for 30 eyes of 27 patients. A Pentacam was used to measure the paraclinical parameters. RESULTS: The mean age of the patients was 24.47 ± 3.33 years. The mean logarithm of the minimum angle of resolution (logMAR) of the uncorrected visual acuity UCVA decreased from 0.73 ± 0.36 D at baseline to 0.48 ± 0.30 D (P = 0.01), while the mean thinnest point thickness of the cornea decreased from 438.65 ± 40.11 µm to 431.43 ± 61.92 µm (P = 0.005) after 24 months. The decreases in the mean logMAR of the BCVA, Kmax and Kmean values, and corneal astigmatism were not statistically significant (P > 0.05) at the 24-month follow-up. Progression was halted in 29 eyes (96.6%); only 1 eye (3.3%) showed an increase in the Kmax value of more than 2.0 D, which was indicative of treatment failure. In contrast, most other eyes showed a decrease in the Kmax value although it was not statistically significant. There were no major complications in any of the patients during the study period. CONCLUSION: Standard CXL treatment was safe and stabilized both the visual acuity and tomographic parameters at the 2-year follow-up in eyes with advanced progressive keratoconus.

The epidemiological characteristics of patients with thyroid eye disease in a referral center in northern Iran.

PURPOSE: This study was conducted to determine the demographics, clinical features, severity, and activity of thyroid eye disease (TED) in patients of a referral center in the north of Iran. METHODS: Patients with TED who were referred to Amir-Almomenin Hospital, Rasht, Iran from March 2012 to March 2014 were enrolled in this cross-sectional study. The measurements of proptosis, lid width, lagophthalmos, extraocular muscle function, and visual acuity were recorded. The activity of ophthalmopathy was scored according to the clinical activity score (CAS). RESULTS: TED was diagnosed in 103 patients with a mean age of 42.1 ± 13.91 years. Of those patients, 52.4% were women, and 80% had hyperthyroidism. The mean duration of TED was 36.5 ± 53.12 months. Extraocular muscle involvement (98%) and eyelid retraction (88.3%) were the most common manifestations. Per the CAS results, 86 (83.5%) patients were at stage 0, and there was a significant difference in CAS scores between male and female patients, P = 0.02. CONCLUSIONS: The characteristics of TED in patients of the studied referral center during a two-year period, including common signs and symptoms, disease duration, treatment, an activity of disease were determined. Notably, many patients in this study had orbital squeal of TED meaning that they had inactive TED. Proper management of this serious complication requires close cooperation between endocrinologists and ophthalmologists to ensure timely referrals for appropriate care.

Incidence and Risk Factors for Retinopathy of Prematurity in North of Iran.

PURPOSE: To report the incidence and risk factors for retinopathy of prematurity (ROP) among preterm infants referred to Amiralmomenin Eye Hospital, Rasht, Iran. METHODS: This cross-sectional retrospective study included all preterm infants with birth weight ≤2500 g and/or gestational age ≤36 weeks who had been referred to our facility for ROP screening over a five year period from September 2005 to September 2010. Possible risk factors and findings related to eye examinations were extracted and analyzed. RESULTS: Among 310 infants, ROP was diagnosed in 64 (20.6%) of referred preterm infants (95% CI: 17.7%-23.5%); these included stage I in 48%, stage 2 in 29%, and stage 3 or higher disease in 23% of subjects. Mean gestational age (GA) and birth weight (BW) in the ROP-affected infants was 30.18 ± 2.28 weeks and 1,422.8 ± 420.8 g, respectively. Low BW, low GA, oxygen therapy, phototherapy, blood transfusion and apnea were risk factors for ROP. After logistic regression analysis, only low GA and low BW were independently associated with the condition. CONCLUSION: ROP is a relatively common finding in preterm infants of Guilan Province in the North of Iran. Low BW and low GA were significant risk factors for the disease.

Silicone oil pupillary block after laser retinopexy in aphakic eyes with presumed closed peripheral iridectomy: report of three cases.

Closure of the peripheral iridectomy (PI) may lead to forward displacement of silicone oil (SO) in some but not all SO-filled aphakic eyes. In this study, we report three patients with a history of a combined three-port pars plana vitrectomy and cataract surgery, SO injection and inferior PI who underwent laser retinopexy a few months postoperatively. The postoperative courses of these patients were unremarkable except for the closure of the PI without anterior displacement of SO; however, a few hours after laser therapy the SO was displaced to the anterior chamber, leading to acute glaucoma in one of the cases. Yttrium aluminium garnet (YAG) laser was successfully used to reopen the PI in all three patients. The induction of a pupillary block following laser retinopexy in SO-filled aphakic eyes with a closed PI and no forward displacement of SO underscores the necessity of a follow-up examination after laser therapy in such patients and the importance of the prophylactic use of a YAG laser to reopen the PI before laser therapy.

Preoperative anterior segment optical coherence tomography as a predictor of postoperative phakic intraocular lens position.

PURPOSE: To evaluate anterior segment optical coherence tomography (AS-OCT) in the preoperative simulation of postoperative iris-fixated phakic intraocular lens (pIOL) position in the anterior chamber. SETTING: Farabi Eye Research Center, Department of Ophthalmology, Tehran University of Medical Sciences, Tehran, Iran. DESIGN: Case series. METHODS: Using AS-OCT, the pIOL position was simulated preoperatively in 2 ways and compared with the actual postoperative pIOL position. For preoperative evaluations, the simulator was placed on the posterior pigmented epithelium of the iris. Then, the simulation was performed with the simulator placed in the middle of the iris tissue. The following distances were measured: from the center of the pIOL to the endothelium, from the edge of the pIOL to the endothelium, and from the posterior surface of the pIOL to the crystalline lens. RESULTS: The study examined 26 eyes (16 patients). Although all distances in both simulation methods (except the lens vault in the first method of simulation) were highly correlated (all P<.009), only the results with the simulator placed in the middle of the iris tissue were not statistically different from the corresponding postoperative measurements (P=.209 and P=.564 for distance from endothelium to the center and the pIOL edge, respectively). CONCLUSIONS: Using the pIOL template of the AS-OCT system for preoperative simulation of iris-fixated pIOLs improved the criteria for patient selection for implantation of these pIOLs. The simulator should be placed in the middle of the iris tissue for preoperative simulation. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.