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Contradictory results of postoperative steroid application in photorefractive keratectomy (PRK) led to a meta-analysis of the existing data to achieve a definite conclusion on the optimum dosage and duration of corticosteroid therapy after PRK. The overall pooled unstandardized mean difference (PUMD) of the corneal haze score was -0.20 (95% CI, -0.29 to -0.12). In subgroup analysis, the PUMD of the corneal haze score was statistically significant in 2 subgroups, -0.57 (-0.85 to -0.30) for 3 to 6 months postoperatively and -0.13 (-0.23 to -0.04) for <= 3 months postoperatively. Analysis of the PUMD of postoperative spherical equivalent in participants with low to moderate myopia (>=-6.00 D) and high myopia (<-6.00 D) showed positive effects of steroids on prevention of myopia regression. In conclusion, long-term topical steroid application after PRK seems unnecessary in low and moderate myopia. New randomized clinical trials using current technologies are recommended for postoperative treatments. /-6.00> [ABSTRACT FROM AUTHOR]

Purpose: Clinical diagnosis of dry eye disease is based on a subjective Ocular Surface Disease Index questionnaire or various objective tests, however, these diagnostic methods have several limitations., Methods: We conducted a comprehensive review of articles discussing various applications of artificial intelligence (AI) models in the diagnosis of the dry eye disease by searching PubMed, Web of Science, Scopus, and Google Scholar databases up to December 2022. We initially extracted 2838 articles, and after removing duplicates and applying inclusion and exclusion criteria based on title and abstract, we selected 47 eligible full-text articles. We ultimately selected 17 articles for the meta-analysis after applying inclusion and exclusion criteria on the full-text articles. We used the Standards for Reporting of Diagnostic Accuracy Studies to evaluate the quality of the methodologies used in the included studies. The performance criteria for measuring the effectiveness of AI models included area under the receiver operating characteristic curve, sensitivity, specificity, and accuracy. We calculated the pooled estimate of accuracy using the random-effects model., Results: The meta-analysis showed that pooled estimate of accuracy was 91.91% (95% confidence interval: 87.46-95.49) for all studies. The mean (±SD) of area under the receiver operating characteristic curve, sensitivity, and specificity were 94.1 (±5.14), 89.58 (±6.13), and 92.62 (±6.61), respectively., Conclusions: This study revealed that AI models are more accurate in diagnosing dry eye disease based on some imaging modalities and suggested that AI models are promising in augmenting dry eye clinics to assist physicians in diagnosis of this ocular surface condition., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To determine the distribution of macular and cube thickness and their normal range in the students aged 9 years to 15 years and to investigate their associated demographic and biometric factors., Methods: This study was based on the data of the second phase of the Shahroud School Children Eye Cohort Study, conducted in 2018. After measurements of visual acuity, biometry, and subjective and cycloplegic refraction, retinal examination was performed using the Zeiss Cirrus HD 4000 optical coherence tomography., Results: The data of 5,043 right eyes were analyzed after applying the exclusion criteria. The central macular thickness was 239 ± 19.35 μ m. The mean cube volume and cube thickness were 9.94 ± 0.44 and 278 ± 12.20, respectively. According to multiple linear regression analysis, the central macular thickness was significantly lower in girls (coefficient [β]: -9.18; P < 0.001) and rural students (β: 3.86; P < 0.001) and had a direct association with axial length (β: 5.19; P < 0.001), lens thickness (β: 5.33; P = 0.003), and mean keratometry (β: 2.41; P < 0.001). The cube volume was lower in girls (β: -0.13; P < 0.001) and higher in rural students (β: 0.05; P < 0.001)., Conclusion: Macular thickness was slightly higher in Iranian children. Sex, living place, axial length, lens thickness, and mean keratometry were the main associated factors with macular thickness.

Purpose: To examine and compare corneal cellular and subbasal nerve (SBN) characteristics in post-laser-assisted in situ keratomileusis ectasia (PLE) corneas, normal post-laser-assisted in situ keratomileusis corneas (PLC), keratoconus (KC) corneas, and normal virgin corneas (NC)., Methods: In this cross-sectional comparative study, 18 PLE eyes of 11 patients, 18 PLC of 15 cases, 32 KC eyes of 32 patients, and 29 NC of 29 subjects were assessed using in vivo confocal microscopy. The density of the basal epithelial cell (BEC), anterior keratocyte, posterior keratocyte, and endothelial cell layers, as well as the characteristics of SBN fibers, was compared between the 4 groups., Results: The density of the BEC and anterior and posterior keratocyte layers was significantly lower in KC compared with NC (-650 ± 190, P = 0.013; -181 ± 39, P < 0.001; and -36 ± 11, P = 0.021, respectively). However, there was no significant difference between PLE and PLC regarding these parameters (all Ps ≥ 0.6). Mean SBN parameters, including central corneal nerve branch density, nerve fiber length, total branch density, and nerve fiber area, were significantly lower in KC compared with NC and in PLE compared with PLC (all Ps ≤ 0.021)., Conclusions: The pathophysiology of PLE seems to differ from KC. Apparent changes in the BEC and anterior and posterior keratocytes associated with KC were not observed in PLE. However, SBNs seem to be involved in both conditions.

Purpose: The purpose of the study was to measure the improvement in vision and contrast sensitivity in patients with central serous chorioretinopathy after macular subthreshold laser therapy., Methods: Cases included in this clinical trial were patients diagnosed with acute central serous chorioretinopathy less than 1 month in duration. Each patient was randomized to either observation group or treatment group with subthreshold argon laser. First and sixth month of follow-up results were then recorded, and visual improvement and contrast sensitivity were compared between the two groups., Results: Of 37 patients with central serous chorioretinopathy, 25 were men and 12 were women with a mean age of 38.6 ± 5.9 years. At 6 months, mean best-corrected visual acuity improved from 0.26 to 0.03 logarithm of the minimum angle of resolution in the laser group and from 0.12 to 0.04 logarithm of the minimum angle of resolution in the observation group (P < 0.001). Except spatial frequencies of 18 cycles per degree (P = 0.207), the contrast sensitivity in spatial frequencies of 3, 6, and 12 cycles per degree was significantly more favorable in the laser group during the first and sixth month., Conclusion: Treatment of patients with acute central serous chorioretinopathy with subthreshold laser improved the best-corrected visual acuity and contrast sensitivity compared with those in the observation group. The laser group also showed a more rapid improvement. In both groups, best-corrected visual acuity improved in most patients after 6 months; however, the contrast sensitivity was significantly better in the treatment group.

Purpose: To determine the prevalence of myopia and hyperopia and the associated risk factors in the presbyopic age group of the population in Shahroud, Iran., Methods: Through a multistage random cluster sampling approach, 6311 people of the 40- to 64-year-old population residing in Shahroud were invited to this study. The prevalence of a cycloplegic spherical equivalent (SE) ≥-0.5 diopter (D) and hyperopia >+0.50 D was determined by age and gender., Results: Of the invitees, 5190 (82.2%) participated in the study and data from 4864 people was used in the analyses. On the basis of cycloplegic refraction, the prevalence of myopia and hyperopia was 30.2% [95% confidence interval (CI): 28.9 to 31.5] and 35.6 (95% CI: 34.1 to 37.1), respectively. In the multiple logistic regression model, the odds of myopia significantly increased with higher education [odds ratio (OR) = 1.02, p < 0.001] and nuclear cataract (OR = 3.23, p < 0.001). After the age of 54 years, the odds of hyperopia significantly increased compared with the 40- to 44-year age group, whereas higher education and nuclear cataract had negative association with hyperopia. The prevalence of high myopia (SE >-6.0 D) and high hyperopia (SE > 4.0 D) was 1.9% (95% CI: 1.5 to 2.3) and 1.1% (95% CI: 0.8 to 1.4), respectively. Nuclear cataract significantly correlated with high myopia (OR = 6.44) and older age significantly correlated with high hyperopia (OR = 1.12)., Conclusions: The prevalence of myopia was unexpectedly higher than that found in other parts of the Middle East. The prevalence of hyperopia was lower than that previously reported in Iran. Education correlated directly with myopia and inversely with hyperopia; however, nuclear cataract was the most important risk factor for myopia. Adjusted for other variables, the prevalence of hyperopia still increased with age.

Purpose: To study predisposing factors of endophthalmitis in patients with open-globe injury., Methods: All 2,340 patients with open-globe injury admitted to our center over 5 years were studied retrospectively, and patients with endophthalmitis were compared with other patients., Results: The number of endophthalmitis cases among patients with open-globe injury was 117 eyes, accounting for an incidence of 5.1%. The risk of endophthalmitis was significantly higher among male patients with pure corneal injuries (6.8%), intraocular foreign bodies (9.3%), traumatic lens rupture (7.1%), trauma resulting from needles (22.2%), and shorter lacerations. The existence of hyphema or iris prolapse was associated with lower rates of endophthalmitis. The mean gap between injury time and operation time was longer in the endophthalmitis group (2.1 ± 1.8 vs. 1.1 ± 1.3 days). Patients with endophthalmitis had significantly lower ocular trauma scores compared with other patients., Conclusion: Posttraumatic endophthalmitis is more likely among patients with open-globe injury that are needle related and among those who have intraocular foreign bodies, traumatic lens rupture, smaller wounds, or wounds exclusively in the cornea. Lower ocular trauma scores in this group of patients with penetrating trauma indicated a greater risk of poor visual prognosis. Therefore, it is suggested that necessary measures and immediate treatment be undertaken in high-risk patients.

Purpose: To review characteristics of open-globe injuries presented to Farabi Eye Hospital, a large referral center for serious ocular injury in the capital city of Iran., Patients and Methods: A retrospective review of 2,340 open-globe injury patients during a 5-year period was performed. Data about any patient that was diagnosed as open-globe injury were collected from medical records., Results: Of 2,340 patients, 1,904 (81.4%) were men. Mean age was 22.44 +/- 16.65 years (range, 4 months to 90 years). Seventy-five percent of cases were younger than 30 years, with a peak of 5 years. There were 561 patients who had an intraocular foreign body (24.7%). In patients younger than 16 years, a knife was the most prevalent cause (22%); in patients younger than 7 years, knives accounted for 33.6% of trauma etiology; and in patients more than 16 years, a projectile metallic foreign body was the most common cause, accounting for 27% of open-globe injuries. Endophthalmitis developed in 5.1% (117 cases). Factors that had a positive association with severity of ocular injury were visual acuity lower than 20/200 at admission, endophthalmitis, double perforation, and laceration length. According to Ocular Trauma Scoring, there was better visual prognosis in younger age groups, male sex, and intraocular foreign body groups. The rate of enucleation or evisceration was 5.3% (126 cases). We had a low sympathetic ophthalmia rate of 0.08%., Conclusion: The most prevalent trauma etiology is a projectile metallic foreign body in adults and a knife injury in children. Compared with other previous epidemiologic studies, we had younger patients, lower enucleations, and sympathetic ophthalmia.