Comparison of ARMS2/LOC387715 A69S and CFH Y402H risk effect in wet-type age-related macular degeneration: a meta-analysis.

PURPOSE: We designed this meta-analysis to pool studies which have analyzed both CFH (Y402H or I62V) and ARMS2 A69S in the same samples to compare the effect of CFH and ARMS2 in neovascular AMD. METHODS: Relevant studies identified and reviewed separately in order to select those for inclusion. Included studies had genotype data of studied groups for both ARMS2 A69S and CFH. To modify the heterogeneity in the variables, we used random effects model. Meta-analysis was performed using STATA. Funnel plot and Egger's regression test used for evaluation of the possible publication bias. RESULTS: Overall, we included 6676 neovascular AMD cases and 7668 controls. Pooled overall odds ratios (ORs) (95% CI) for neovascular AMD/control were ARMS2 A69S: OR = 2.35 (2.01-2.75) for GT versus GG; OR = 8.57 (6.91-10.64) for TT versus GG; CFH Y402H: OR = 1.94 (1.73-2.18) for CT versus TT; OR = 4.89 (3.96-6.05) for CC versus TT. ARMS2 A69S genotype OR/CFH Y402H genotype OR (homogeneous genotypes): Asia = 2.14, Europe: 1.87, America: 1.82, Middle East: 3.56, pooled: 1.75. ARMS2 A69S genotype OR/CFH Y402H genotype OR (heterogeneous genotypes): Asia = 0.93, Europe: 1.39, America: 2.06, Middle East: 1.20, pooled: 1.21. ARMS2 A69S risk genotypes have stronger predisposing effect on neovascular AMD compared to CFH Y402H risk genotypes. CONCLUSION: Our inclusion criteria to select those studies which have analyzed the effect of these two loci in the same case-control samples showed much stronger effect of ARMS2 A69S in neovascular AMD compared to the CFH Y402H.

Effects of pterygium surgery on front and back corneal astigmatism.

OBJECTIVE: To evaluate changes in front and back corneal astigmatism after pterygium surgery using the Scheimpflug imaging of Pentacam. DESIGN: Prospective interventional case series. PARTICIPANTS: We studied 96 eyes with primary pterygium that underwent surgery. METHODS: Preoperatively and at 1, 3, and 6 months after surgery, Pentacam (Oculus, Wetzlar, Germany) was used to measure astigmatism at the front and back corneal surfaces. Surgically induced astigmatism (SIA) on the front corneal surface was also calculated, using vector analysis. RESULTS: Of the eyes, 73 completed 6-month postoperative follow-up without developing pterygium recurrence. Front corneal astigmatism decreased from 3.97 ± 4.49 D preoperatively to 1.23 ± 1.88 D at 1 month (p < 0.001). Back corneal astigmatism decreased, but nonsignificantly, from 0.35 ± 0.39 D preoperatively to 0.32 ± 0.2 D at 1 month (p = 0.49). However, although back astigmatism was with-the-rule in 43.8% of patients and against-the-rule in 24.6% of patients preoperatively, these changed to 87.7% and 4.1%, respectively, at 1 month (p = 0.02). Refractive cylinder (52 eyes) reduced from 2.62 ± 2.22 D preoperatively to 1.06 ± 1.57 D at 1 month (p = 0.05). There was no significant change in any parameter after 1 month throughout the 6 months after surgery. SIA was 3.51 ± 2.66 D at 1 month postoperatively, which showed significant correlation with age, preoperative astigmatism, and pterygium length and area, but there was no correlation with gender, pterygium width, preoperative spherical power, or surgical technique. Moreover, higher grades of pterygium morphology had higher SIA postoperatively (p = 0.05). CONCLUSIONS: Pterygium surgery was associated with significant changes in front and back corneal surfaces. Eyes with more advanced pterygia achieved higher SIA.

Effects of pterygium surgery on front and back corneal surfaces and anterior segment parameters.

The purpose of this study was to evaluate the effects of pterygium surgery on front and back corneal surfaces and anterior segment parameters. This prospective study included 96 eyes with primary pterygium that underwent surgery. Preoperatively and at 1, 3, and 6 months postoperatively, Pentacam was used to evaluate front and back corneal surfaces, anterior chamber depth (ACD), anterior chamber angle (ACA) and anterior chamber volume (ACV). Mean simulated keratometry at the front corneal surface increased from 42.73 ± 2.21 D preoperatively to 44.45 ± 2.05 D at 1 month (P < 0.001); it then decreased to 44.32 ± 2.07 D at 3 months (P < 0.001) and 44.19 ± 2.10 D at 6 months (P = 0.01). There was no statistically significant change in mean simulated keratometry at the back corneal surface. Radius of the front corneal best-fit sphere (BFS) decreased from 7.99 ± 0.29 mm preoperatively to 7.77 ± 0.25 mm at 1 month postoperatively (P < 0.001), without further change up to 6 months. Radius of the back corneal BFS increased from 6.42 ± 0.24 mm preoperatively to 6.50 ± 0.24 mm at 1 month (P < 0.001), without further change. Postoperative changes in mean simulated keratometry and radii of BFS had statistically significant positive correlations with pterygium extension onto the cornea and grade of pterygium morphology but, not with the surgical technique. There were no significant changes in ACD, ACA, and ACV values after pterygium surgery. Furthermore, the spherical equivalent of manifest refraction changed from +0.75 ± 1.06 D preoperatively to -0.72 ± 1.33 D at 1 month postoperatively (P = 0.001), with no further significant change. In conclusion, after pterygium surgery there were significant changes in front mean keratometry and front and back corneal radii of BFS. These were correlated with preoperative pterygium size and morphology grade. No significant changes in anterior segment parameters were noted postoperatively.

Postoperative conjunctival inflammation after pterygium surgery with amniotic membrane transplantation versus conjunctival autograft.

PURPOSE: To compare the postoperative conjunctival inflammation around the surgical site after pterygium surgery using either amniotic membrane transplantation (AMT) or free conjunctival autograft. DESIGN: Prospective, randomized, interventional study. METHODS: Forty-two eyes of 42 patients with primary pterygium underwent surgical excision followed by removal of subconjunctival fibrovascular tissue and intraoperative application of 0.02% mitomycin C. Then, the patients were randomized to receive either AMT (21 eyes) or free conjunctival autograft (21 eyes), with sutures used in both groups. Main outcome measures included presence of host conjunctival inflammation around the surgical site at 1 month after surgery and also recurrence of pterygium. RESULTS: Twelve-month follow-up was completed in 39 eyes of 39 patients (19 in the AMT group and 20 in the conjunctival autograft group). At 1 month after surgery, different grades of host conjunctival inflammation were present in 16 eyes (84.2%) in the AMT group and in 3 eyes (15%) in the conjunctival autograft group (P = .02). Subconjunctival injection of triamcinolone was performed in eyes with moderate or severe inflammation, which included 12 eyes (63.1%) in the AMT group and 2 eyes (10%) in the conjunctival autograft group (P < .001). Conjunctival recurrence of pterygium was seen in 2 eyes (10.5%) in the AMT group and in 2 eyes (10%) in the conjunctival autograft group (P = .92). After surgery, pyogenic granuloma developed in 3 eyes (15.8%) in the AMT group and in 1 eye (5%) in the conjunctival autograft group (P = .31). CONCLUSIONS: After pterygium surgery, conjunctival inflammation was significantly more common with AMT than with conjunctival autograft. However, with control of such inflammation and intraoperative application of mitomycin C, similar final outcomes were achieved with both techniques.

Effects of mitomycin C on corneal endothelial cell counts in pterygium surgery: role of application location.

PURPOSE: To evaluate changes in corneal endothelial cell counts after pterygium surgery with application of mitomycin C (MMC) either on the perilimbal sclera or in the subconjunctival space. DESIGN: Prospective, randomized interventional study. METHODS: Fifty-six eyes of 56 patients with primary pterygium underwent excision followed by removal of subconjunctival fibrovascular tissue, 0.02% MMC application, and amniotic membrane transplantation. These were stratified randomly into 2 groups. In 1 group (n = 28), MMC was applied on the perilimbal bare sclera (sclera group), and in other group (n = 28), MMC was applied under conjunctiva, where subconjunctival fibrovascular tissue was removed (subconjunctiva group). Based on severity of pterygium fleshiness, MMC was used for 1, 3, or 5 minutes in 8, 13, and 7 eyes, respectively, in the sclera group and in 9, 13, and 6 eyes, respectively, in the subconjunctiva group. Central corneal endothelial cell counts were evaluated before and during 6 months of follow-up after surgery. RESULTS: Mean preoperative endothelial cell count was 2810 ± 278 cells/mm(2) in the sclera group and 2857 ± 332 cells/mm(2) in the subconjunctiva group. Mean endothelial cell losses in sclera and subconjunctiva groups were 9.7% and 9.0% at 1 week, 6.5% and 6.5% at 1 month, 4.0% and 5.0% at 3 months, and 3.4% and 4.8% at 6 months, respectively, with no statistically significant difference between the 2 groups. Longer durations of MMC application were associated with significantly greater endothelial losses in both groups. CONCLUSIONS: Regardless of application location, MMC use during pterygium surgery can cause a significant decrease in central endothelial cell count.

Anterior segment parameters: comparison of 1-piece and 3-piece acrylic foldable intraocular lenses.

PURPOSE: To compare anterior segment parameters between 1-piece and 3-piece acrylic foldable intraocular lenses (IOLs). SETTING: Farabi Eye Hospital, Tehran, Iran. DESIGN: Prospective randomized comparative case series. METHOD: Eyes scheduled for phacoemulsification were randomized into 2 equal groups to receive a 1-piece (AcrySof SA60AT) or 3-piece (AcrySof MA60AC) foldable acrylic IOL. Scheimpflug imaging (Pentacam) was used to measure anterior segment parameters, including anterior chamber depth (ACD), anterior chamber angle (ACA), and anterior chamber volume (ACV), preoperatively and 1 week and 3 months postoperatively. RESULTS: The study evaluated 125 eyes (123 patients). There was a statistically significant postoperative increase in ACD, ACA, and ACV at 1 week and 3 months in both IOL groups. Although the mean ACD was significantly higher in the 3-piece group at 1 week, there was no significant between-group difference in ACD, ACA, or ACV at 3 months. There was no significant change in anterior segment parameters from 1 week to 3 months in the 1-piece group; however, the 3-piece group had statistically significant decreases in ACD, ACA, and ACV. Refraction remained stable throughout the follow-up in the 1-piece group but showed a significant myopic shift from 1 week to 3 months in the 3-piece group. CONCLUSIONS: After phacoemulsification, the 1-piece acrylic foldable IOL showed little axial movement and provided stable refraction throughout the follow-up. The 3-piece IOL had significant forward movement and led to a myopic shift within 3 months postoperatively. Results indicate that spectacles can be prescribed earlier in eyes with a 1-piece IOL.

Comparison of postoperative higher-order aberrations and contrast sensitivity: tissue-saving versus conventional photorefractive keratectomy for low to moderate myopia.

PURPOSE: To assess the efficacy, predictability, safety, contrast sensitivity, higher-order aberrations (HOAs), and patient satisfaction after tissue-saving photorefractive keratectomy (PRK) and conventional PRK. SETTING: Department of Ophthalmology, Farabi Eye Hospital, Tehran Medical University, Tehran, Iran. DESIGN: Comparative case series. METHODS: This prospective study evaluated eyes with low to moderate myopia that had PRK with a Technolas 217z excimer laser. Patients were randomly assigned to have surgery using a conventional algorithm (PlanoScan) or a tissue-saving algorithm (Zyoptix). Contrast sensitivity, HOAs, and patient satisfaction were analyzed preoperatively and 1, 3, and 6 months postoperatively. RESULTS: The conventional group comprised 42 eyes (21 patients) and the tissue-saving group, 62 eyes (31 patients). At 6 months, all eyes in both groups were within ±0.50 diopter of the attempted correction and had an uncorrected distance visual acuity of 20/25 or better. However, the tissue-saving group had a statistically significantly greater increase in the mean root mean square of total HOAs and more induced spherical aberration than the conventional group (P<.05). There was no significant difference between the 2 groups in mesopic or photopic contrast sensitivity. The level of satisfaction after surgery was the same in the 2 groups. CONCLUSIONS: Although the conventional and tissue-saving algorithms for PRK were both safe and effective in treating low to moderate myopia, tissue-saving PRK induced a greater increase in HOAs than conventional PRK; this may be because of the smaller blend zone of the tissue-saving algorithm. Contrast sensitivity and patient satisfaction were comparable between the 2 methods.

The association between nuchal nevus flammeus and alopecia areata: a case-control study.

BACKGROUND: The association of alopecia areata (AA) with nuchal nevus flammeus (NNF) has been demonstrated by previous studies. OBJECTIVES: The aim of this study was to investigate whether AA is associated with NNF. METHODS: 199 AA patients and 215 controls without AA were examined for the presence of NNF. RESULTS: 35 patients (17.6%) in the AA group had NNF. In the control group, 20 patients (9.3%) had NNF (odds ratio = 2.08, 95% confidence interval 1.43-2.73; p = 0.013). A statistically significant association was found between the presence of NNF and duration of the AA (p < 0.001). The presence of NNF was associated with severity of AA (p < 0.001). CONCLUSIONS: The results of our study suggest a link between NNF and AA especially in severer and more chronic forms.