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Purpose: The aim of this study was to analyze and compare corneal endothelial cell morphology and characteristics in bilateral keratoconus (KCN) patients with unilateral Vogt's striae. Methods: Fifty patients aged 20–38 years were recruited in this cross-sectional contralateral eye study. In this study, corneal endothelial cell parameters were evaluated in patients with bilateral KCN and unilateral Vogt's striae using the Topcon SP2000P specular microscope (Topcon, Tokyo, Japan). Results: In the current study, there were no significant differences in corneal endothelial cell parameters including endothelial cell density (ECD), hexagonal cell ratio (HEX), and coefficient of variance of cell size (CV) between the KCN groups with and without Vogt's striae, [(2968.34 ± 276.65 vs. 2980.05 ± 253.30, P = 0.618), (51.88 ± 13.57 vs. 53.24 ± 9.31, P = 0.658), and (32.50 ± 5.40 vs. 32.97 ± 4.07, P = 0.467), respectively]. Also, among study groups with and without Vogt's striae, ECD did not correlate with anterior chamber depth (ACD) [(P = 0.564, r = 0.09), (P = 0.219, r = −0.18), respectively], maximum keratometry (Kmax) [(P = 0.215, r = 0.18), (P = 0.898, r = 0.02), respectively], and central corneal thickness (CCT) [(P = 0.989, r = −0.02), (P = 0.643, r = −0.07), respectively].Our results showed significant differences in corrected and uncorrected distance visual acuity (UDVA), cycloplegic refractive error components (calculated by vectorial analysis), CCT, and Kmax between two study groups (all P

Purpose: To evaluate and compare corneal hysteresis (CH) and corneal resistance factor (CRF) in pellucid marginal degeneration (PMD), keratoconus (KCN), and normal eyes using the Ocular Response Analyzer (ORA). Methods: In this retrospective study, corneal biomechanical parameters were measured in patients with PMD (n = 102) and KCN (n = 202) and normal subjects (n = 208) using the ORA. Data, including full patient history as well as the results of refraction, slit-lamp biomicroscopy, Pentacam HR (Oculus), and ORA (Reichert; Buffalo, New York, USA), were collected from medical records. Also, the data of only one eye per individual were selected for the analysis. The inclusion criteria for PMD and KCN groups were a reliable diagnosis of these ectatic disorders based on the clinical and corneal tomographic findings. CH, CRF, CH–CRF, intraocular pressure (IOP) measurements were assessed for each subject. Data were analyzed with SPSS and MedCalc using the ANOVA, Pearson Correlation, and receiver operating characteristic (ROC) curve analysis. Results: The mean CH was 8.91 mmHg ± 1.05 [standard deviation (SD)], 8.43 ± 0.78, and 10.89 ± 1.08 in the PMD, KCN, and normal group, respectively. Also, the mean CRF was 8.21 ± 1.35, 7.19 ± 1.11, and 10.69 ± 1.41 in the PMD, KCN, and normal group, respectively. ANOVA showed differences in the mean CH, CRF, and CH–CRF between three groups (P 1.3 mmHg for CH, CRF, and CH–CRF in the PMD group, respectively. For biomechanical parameters in PMD eyes, CRF had the highest sensitivity (75.49%) while the greatest area under the ROC curve (AUC) was seen for CH (0.903). Moreover, central corneal thickness (CCT) showed no correlation with CH (P = 0.30, r = −0.104) or CRF (P = 0.75, r = 0.033) in the PMD group. Conclusions: This study presented the values of corneal biomechanics for PMD using the ORA. The results of the ORA were markedly different between PMD, KCN, and normal eyes.

To compare the safety, operating time, postoperative ocular signs, symptoms, overall patient satisfaction, complications rate and recurrence rate of autologous fibrin glue (AFG) and nylon suturing (NS) for attaching conjunctival autografts in pterygium surgery. A prospective, randomized, interventional study was performed among 120 patients (120 eyes) with primary pterygium. Superior conjunctival autograft was harvested and transferred on to bare sclera after pterygium excision. For attaching the autograft, AFG (n = 60 eyes) and NS (n = 60 eyes) were used. The patients were followed up for 12 months. The groups were compared for the safety, operative time, postoperative ocular signs, symptoms, overall patient satisfaction, recurrence and complications rate. All conjunctival autografts in both groups were successfully attached. The average operating time for the AFG group was significantly shorter (P

Introduction: Fasting during the month of Ramadan is obligatory for healthy Muslims after the age of puberty. This paper was aimed to compare the changes in hematological and biochemical parameters before and after Ramadan. Methods:This prospective study was performed one week before and one week after the month of Ramadan in 2015. Eighty-nine subjects (51males and 38 females) with a mean age of 34.52±9.05 were enrolled in this study. Patients with systemic disorder, special drug using, and/or a history of previous surgery were excluded. Blood samples were taken from all participants before and after Ramadan to evaluate the effects of fasting on hematological-biochemical factors. Hematological and biochemical measurements were performed on the blood samples using a KX-21N cell counter (Kobe, Japan) and Hitachi 717 analyzer (Roche, Japan), respectively. Results:Hematocrit, red blood cell (RBC) and Mean Red Cell Volume (MCV) decreased after Ramadan fasting (P= 0.002, P= 0.030 and P= 0.005, respectively), however mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) increased (P=0.004, P=0.002, respectively). On the other hand, no changes were seen in hemoglobin, platelets and white blood cell (WBC) after Ramadan (P=0.900, P=0.923, P=0.282, P=0.300, respectively). In this study, fasting led to decrease in uric acid, creatinine, selenium, sodium and potassium (P=0.00, P=0.015, P=0.021, 0.007 and 0.028, respectively), however, phosphor serum increased after fasting period (P=0.032). Moreover, no changes were seen in other biochemical parameters including fast blood sugar (FBS), urea, calcium, iron, zinc, and albumin (P= 0.54, P=0.300, P=0.054, P=0.372, P=0.170, and P=0.400, respectively). Conclusion:This study on healthy subjects suggests that fasting could affect some hematological-biochemical parameters but not all of them. Also, these changes in hematological-biochemical parameters were within the normal range and Ramadan fasting seems to be safe for healthy subjects.

Purpose The aim of this study was to assess and compare clinical characteristics of bilateral keratoconus patients with unilateral Vogt's striae. Methods In this contralateral eye study, refractive status were evaluated in patients with bilateral keratoconus whose corneas had definite slit-lamp biomicroscopic evidence of unilateral Vogt's striae. All cases underwent a comprehensive ophthalmic examination. Some refractive errors components provided by autorefraction were converted to vectorial notation for power vector analysis. Finally, the outcomes were compared between keratoconus eyes with and without Vogt's striae. Results Fifty patients aged 20 to 38 years (27.43 ± 5.5) were recruited in this study. The results showed a significant difference in uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), non-cycloplegic and cycloplegic autorefraction including sphere, cylinder, spherical equivalent, and J0, between keratoconus eyes with and without Vogt's striae (all P 0.05). Conclusions Comparison of the cycloplegic and non-cycloplegic autorefraction in keratoconus eyes with and without Vogt's striae showed significant differences in UDVA, CDVA, and some refractive errors components provided by autorefraction between the two groups, with a worse condition in KCN eyes with Vogt's striae.

Mohamad-Reza Sedaghat,1 Farshad Askarizadeh,2 Foroozan Narooie-Noori,3 Tahereh Rakhshandadi,3 Hadi Ostadi-moghadam,2 Sattar Rajabi2 1Cornea Research Center, Khatam-Al-Anbia Hospital, Mashhad University of Medical Sciences, Mashhad, Iran; 2Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; 3Department of Optometry, School of Rehabilitation Sciences, Zahedan University of Medical Sciences, Zahedan, Iran Purpose: The aim of this study was to evaluate and compare tomographic and biometric characteristics measured by the corneal tomography and ocular biometry in bilateral keratoconus (KCN) patients with and without corneal Vogt’s striae. Methods: Ninety-two eyes of 46 subjects with a reliable diagnosis of bilateral KCN with unilateral Vogt’s striae were enrolled in this cross-sectional contralateral eye study. In addition to refraction (calculated by vectorial analysis) and visual acuity, corneal tomographic measurements were obtained by the Pentacam (Scheimpflug-based anterior segment tomography). Also, ocular biometric characteristics were evaluated using the Ocuscan® RxP (ultrasound biometer). The KCN eyes were categorized into two groups, including eyes with Vogt’s striae and eyes without Vogt’s striae. Results: Our results showed significant differences in the sphere, cylinder, spherical equivalent, J0, corrected and uncorrected distance visual acuity, flat, steep and maximum keratometry, anterior chamber depth (ACD), and central corneal thickness (CCT) between the two groups (all P0.05). Also, there was poor agreement between the measurements of the Pentacam and ultrasound biometer for ACD in the study groups. Conclusion: Corneal tomographic and ocular biometric measurements showed significant differences between KCN eyes with and without Vogt’s striae except for AL and VL. These differences should be noticed in clinical evaluations and treatment of KCN patients. Keywords: cornea, keratoconus, corneal tomography, ocular biometry, Vogt’s striae

Introduction:In this study, we aimed to evaluate the rates of preoperative risk factors and intraoperative complications in phacoemulsification, performed by ophthalmology residents. Moreover, we assessed the relationship between these risk factors and complications. Materials and Methods:In this prospective study, the rates of and the relationship between preoperative risk factors and intraoperative complications in resident-performed phacoemulsification were evaluated in the anterior segment clinic of Khatam-al-Anbia Eye Hospital, Mashhad, Iran. Results: In total, medical records of 475 patients undergoing phacoemulsification by 13 ophthalmology residents, were evaluated. The rate of intraoperative complications was estimated at 17.5%. Moreover, the rate of major complications including posterior capsule rupture, zonular dehiscence and vitreous loss, with potential effects on the final surgical results, was 7.2%. Based on the univariate analysis, preoperative risk factors, which were significantly associated with the incidence of intraoperative complications, were as follows: poor red reflex (P=0.001), pseudoexfoliation (P=0.002), poor pupil dilation (P=0.003), corneal clouding (P=0.003), dense cataract (P=0.004), shallow anterior chamber (P­=0.02) and advanced age (P

Introduction: Ramadan is a holy month for Muslims during which avoid from eating, drinking and sexual intercourse for about 13-17 hours. The aim of this study was surveying the effects of Islamic fasting in Ramadan on lipid profile and blood pressure.Materials and Methods: we designed this study in two phases, a week before and a week after Ramadan month. Eighty nine healthy subjects with 20-50 years old were participated in this study. Blood sampling for lipid profile measurement was done in the morning and blood pressure was measured in the afternoon with digital sphygmomanometer. Statistical analysis was performed with SPSS version 16.0 software.Results: In a week after Ramadan, body weight and body mass index (BMI) decreased in both sexes, comparing with the week before Ramadan measurements (p

Purpose: To investigate the effects of religious fasting during the month of Ramadan on intraocular pressure (IOP), refractive error, corneal tomography and biomechanics, ocular biometry, and tear film layer properties. Methods: This prospective study was carried out one week before and in the last week of Ramadan. Ninety-four eyes of 94 healthy adult volunteers (54 males and 40 females) with a mean ± SD age of 35.12 ± 9.07 were enrolled in this study. Patients with any systemic disorder, ocular disease, or a history of previous surgery were excluded. Corneal tomography and biomechanics, ocular biometry, IOP, refractive error, and tear break up time (TBUT) were evaluated in non-fasting and fasting periods by the Pentacam (Oculus), Corvis ST (Oculus), IOL Master (Carl Zeiss), computerized tonometer (Topcon CT-1/CT-1P), auto kerato-refractometer (Topcon KR-1), and Keratograph 5M (Oculus), respectively. Results: There was no significant difference in the central corneal thickness (CCT) between the study groups (P = 0.123) using the Pentacam while the Corvis ST showed a significant difference in all participants (P

The aim of this study was to compare the visual field (VF) categorizations (based on the severity of VF defects) between adolescent boys with hearing impairments and those with normal hearing. This cross-sectional study involved the evaluation of the VF of 64 adolescent boys with hearing impairments and 68 age-matched boys with normal hearing at high schools in Tehran, Iran, in 2013. All subjects had an intelligence quotient (IQ) > 70. The hearing impairments were classified based on severity and time of onset. Participants underwent a complete eye examination, and the VFs were investigated using automated perimetry with a Humphrey Visual Field Analyzer. This device was used to determine their foveal threshold (FT), mean deviation (MD), and Glaucoma Hemifield Test (GHT) results. Most (50%) of the boys with hearing impairments had profound hearing impairments. There was no significant between-group difference in age (P = 0.49) or IQ (P = 0.13). There was no between-group difference in the corrected distance visual acuity (P = 0.183). According to the FT, MD, and GHT results, the percentage of boys with abnormal VFs in the hearing impairment group was significantly greater than that in the normal hearing group: 40.6% vs. 22.1%, 59.4% vs. 19.1%, and 31.2% vs. 8.8%, respectively (P < 0.0001). The mean MD in the hearing impairment group was significantly worse than that in the normal hearing group (-0.79 ± 2.04 and -4.61 ± 6.52 dB, respectively, P < 0.0001), and the mean FT was also significantly worse (38.97 ± 1.66 vs. 35.30 ± 1.43 dB, respectively, P

Purpose: The aim of this study was to determine the agreement between Pentacam HR (Scheimpflug imaging, Oculus) and Orbscan II (scanning slit topography, Bausch and Lomb) in measuring corneal parameters after photorefractive keratectomy (PRK) for hyperopia. Methods: In this prospective cross-sectional study, 38 hyperopic eyes undergoing PRK were examined before refractive surgery and 8 to 10 months postoperatively using Pentacam HR and Orbscan II. Ultrasound (US) pachymetry was also used to measure central corneal thickness (CCT). The radius of anterior (A-) and posterior (P-) best-fit sphere size (BFS), central elevation (CE), and anterior maximum tangential power in 3 mm (TG3) and 3-5 mm (TG5) zones, anterior chamber depth (ACD), and central corneal thickness (CCT) were collected and used in the analyses. To study the agreement between the measurements made by the two devices, the method described by Bland and Altman was used and the 95% limits of agreement were calculated. Results: The 95% limits of agreement show reasonable agreement between the measurements by Pentacam HR and Orbscan II for A-BFS, P-BFS, A-TG3, and CCT, but not for A-CE, P-CE, A-TG5, or ACD. CCT values obtained by both Pentacam HR and Orbscan II correlated well with the values determined by US pachymetry. Conclusion: Pentacam HR and Orbscan II after PRK for hyperopia show reasonable agreement for determining A-BFS, P-BFS, A-TG3, and CCT, but not for A-CE, P-CE, A-TG5, or ACD. CCT measurements with Pentacam HR have reasonable agreement with US pachymetry.

PURPOSE: To evaluate the clinical outcomes of Artisan phakic intraocular lens (PIOL; Ophtec BV) implantation in patients with stable keratoconus. METHODS: In a prospective, nonrandomized case series, 14 Artisan PIOLs and 2 toric Artisan PIOLs were implanted in 13 patients (16 eyes) with stable keratoconus who had contact lens intolerance. Pre- and postoperative data were collected. RESULTS: Mean follow-up was 14.2±7.8 months. Preoperative uncorrected distance visual acuity (UDVA) was counting fingers in all patients. Mean final logMAR (Snellen equivalent) UDVA and corrected distance visual acuity (CDVA) were 0.15(20/28)±0.13 and 0.11(20/26)±0.10, respectively. The improvements in UDVA and CDVA were statistically significant ( P P CONCLUSIONS: Implantation of the Artisan PIOL is effective in improving visual acuity in patients with stable keratoconus. Long-term safety remains to be established as no postoperative endothelial cell counts were performed.

Purpose To determine the effect on postoperative outcomes of different sites for intrastromal corneal ring segment (ICRS) implantation in keratoconic eyes. Setting Eye Research Center of Mashhad University of Medical Sciences, Khatam-al-Anbia Eye Hospital, Mashhad, Iran. Design Case series study. Methods After a detailed ophthalmologic examination, pairs of 160-degree Ferrara ICRS were implanted in eyes with keratoconus. Patients were categorized into 2 groups depending on the axis of ICRS implantation as follows: vertical implantation, in which the axis of the radial incision was between 70 degrees and 110 degrees, and oblique implantation, in which the axis was outside the vertical range. An independent-samples t test was used to compare the postoperative refractive and visual outcomes in the 2 groups. Results This series included 48 eyes of 48 patients (28 men, 20 women) with a mean age of 26.65 years ± 6.8 (SD). The vertical implantation group comprised 23 patients and the oblique implantation group, 25 patients. There was no statistically significant difference in any preoperative parameter between the groups. The mean postoperative corrected distance visual acuity and astigmatism reduction were significantly better in the vertical group than in the oblique group (P Conclusion Although the improvements in refractive outcomes and visual acuity were significant in eyes with vertical or oblique astigmatism, simulated keratometry showed that patients with a vertical steep axis had more favorable results than those with an oblique steep axis. Financial Disclosure Neither author has a financial or proprietary interest in any material or method mentioned.

Purpose To compare 2 corneal biomechanical parameters—corneal hysteresis (CH) and corneal resistance factor (CRF)—before and after collagen crosslinking (CXL) for keratoconus. Setting Eye Research Center of Mashhad University of Medical Sciences, Khatam-al-Anbia Eye Hospital, Mashhad, and Department of Ophthalmology, Baqiyatallah University of Medical Science, Tehran, Iran. Design Case series study. Methods Topical riboflavin was applied to the deepithelialized cornea every 3 minutes for 30 minutes and every 5 minutes during ultraviolet-A irradiation of the cornea. Corneal hysteresis and CRF were measured by biomechanical waveform analysis (Ocular Response Analyzer) before and 6 months after CXL. The values were compared using the paired Student t test. Results The study comprised 51 patients (56 eyes). The mean age of the patients was 23.27 years ± 6.3 (SD). Before CXL, the mean CH was 7.9 ± 1.5 mm Hg and the mean CRF was 7.3 ± 1.4 mm Hg. Six months after CXL, the mean values were 8.20 ± 1.5 mm Hg and 7.59 ± 1.5 mm Hg, respectively. The changes in CH and CRF were not statistically significant ( P >.05). The changes in central corneal thickness and Goldmann-correlated intraocular pressure (IOP) between preoperatively and postoperatively were not statistically significant, although the change in corneal-compensated IOP was ( P Conclusion Although previous in vitro studies found a change in corneal rigidity, this study found no significant change in CH or CHF measured by biomechanical waveform analysis. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Purpose: To evaluate the clinical features, and visual outcomes of sterile uveitis after iris-fixated phakic intraocular lens implantation (pIOLs) (Artisan-Artiflex® and Verisyse-Veriflex® ). Material and Methods: In this retrospective non-comparative case series, the medical records of 117 eyes implanted with Artisan-Artiflex® (Ophtec BV, Groningen, Netherlands) and Verisyse-Veriflex® (AMO, Santa Ana, CA) iris claw phakic IOLs were analyzed for postimplantation sterile uveitis. The mean age of the 87 patients included in the study was 27.2±7.4 years. Of these patients, 56 (64.3%) were men and 31 (35.6%) were women. Patient age, gender, IOL brand type, refractive error, optic diameter, unilateral vs bilateral implantation, and anterior chamber depth were analyzed. Features of uveitis, uncorrected and best corrected visual acuity (VA) at presentation and at follow-up visits were examined. The mean follow-up time was 14.6 months (range: 6-37 months). Results: Clinically significant uveitis was observed in 12 of 117 eyes (10.3%) in a total of ten patients. Of these ten patients, four (40%) were women and six (60%) were men, and the mean age was 25.1±5.3 years (range: 18-36 years). Among those with bilateral implantation, 6.9% of patients developed bilateral uveitis, while 13.8% (4 of the 29 implanted bilaterally) developed unilateral uveitis. Foldable pIOL implantation was the only variable associated with the development of uveitis (P=.03). Conclusion: Although the prognosis is usually benign, sterile uveitis occurred in 10.3% of patients after iris-fixated pIOL implantation. The implantation of a foldable pIOL was the only variable associated with sterile uveitis. Appropriate medical management can be effective treatment, without the need for pIOL replacement.