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Purpose. To compare biometric and optical coherence tomography parameters as well as refractive status in preterm children aged 4–8 years with or without retinopathy of prematurity (ROP), and evaluate their correlations with age and gender‐matched full‐term children. Methods. Retrospective comparative cohort study of four groups of children. Children with a history of preterm birth, including ROP who received intravitreal bevacizumab (IVB) treatment, children with a history of ROP that regressed without treatment and those with no history of ROP were compared to age and gender‐matched full‐term children as a control group. Best corrected visual acuity (BCVA), spherical equivalent of refraction (SE), macular and choroidal thickness, as well as biometric parameters was measured. Results. A total of 120 eyes of 120 children (30 children in each group) were included. There was no significant difference in BCVA, SE, and subjective cylinder between groups (p = 0.05, p = 0.3, p = 0.6, respectively). Axial length was significantly shorter, and the cornea was steeper in both ROP groups than in other groups (p = 0.001, p < 0.001, respectively). The central macular thickness was significantly thicker in the treated, regressed ROP and preterm groups than in full‐term children (p < 0.001). The gestational age was negatively correlated with macular thickness in both treated and regressed ROP groups (r = −0.517; p = 0.003, r = − 0.490; p = 0.006, respectively). Conclusions. Children with a history of ROP had a shorter axial length, steeper cornea, and thicker macula that correlated with lower gestational age. [ABSTRACT FROM AUTHOR]

PurposeTo evaluate the expression patterns of cytokeratin (K) 12, 13, and 19 in normal epithelium of the human ocular surface to determine whether K13 could be used as a marker for conjunctival epithelium.MethodsTotal RNA was isolated from the human conjunctiva and central cornea. Those transcripts that had threefolds or higher expression levels in the conjunctiva than the cornea were identified using microarray technique. Expression levels of three known signature genes and of two conjunctival genes, K13 and K19 were confirmed by using quantitative real-time PCR (qRT-PCR). Protein expression of K12, K13, and K19 was confirmed by immunostaining with specific antibodies on histologic sections of human sclerocornea that contained the conjunctiva, limbus, and cornea and on impression cytology (IC) specimens of the cornea and conjunctiva from normal donors. Double staining of K13/K12 and K19/K12 on histologic sections and IC specimens was performed.ResultsThere were 337 transcripts that were preferentially expressed in the conjunctiva. K13 and K19 were among the top twenty transcripts in the conjunctiva and this preferential expression pattern of K13 and K19 was confirmed by qRT-PCR. Immunohistochemical studies showed that K13 was expressed at the posterior limbal epithelium and conjunctival epithelium but was totally absent in the cornea. K12 was expressed in the corneal and anterior limbal epithelia except for the basal layer and was absent from the conjunctiva. In contrast, K19 was detected in the corneal, limbal and conjunctival epithelia. Immunostaining of the IC specimens showed K12(+) epithelial cells in the corneal region, K13(+) cells in the conjunctival area, and K19(+) cells in the corneal and conjunctival specimens. Expression of K13 and K12 on the ocular surface was mutually exclusive on both the histologic and IC samples using double immunostaining.ConclusionsK13 is more specific to the conjunctival epithelial cells than K19 and potentially could be used as a marker to identify conjunctival epithelial cells in limbal stem cell deficiency.

Purpose: To assess and compare preoperative refractive, aberrometric, topographic, and contrast sensitivity (CS) measurements with postoperative values after corneal collagen cross-linking (CXL) in patients with progressive keratoconus. Methods: Twenty-two eyes of 11 patients with keratoconus were enrolled in this prospective study. Uncorrected distance visual acuity (UDVA), best spectacle corrected visual acuity (BSCVA), CS, and higher order aberrations (HOAs) were evaluated at baseline and 1, 3, 6, and 8 months after surgery. Results: The mean total HOAs of the included patients were 2.24, 2.34, 2.28, 2.17, and 2.03 before and 1, 3, 6, and 8 months after CXL, respectively. A significant reduction in corneal HOAs including vertical coma, vertical and horizontal trefoil and spherical aberration was observed 6 and 8 months after CXL. UDVA and BSCVA improved significantly in all patients who completed the follow-up period (P = 0.001). Although mean CS declined significantly 1 month postoperatively, it improved significantly after 3, 6, and 8 months (P<0.001). Maximum keratometry was significantly lower 8 months postoperatively compared to the preoperative value. (P = 0.006). Conclusions: CXL seems to improve UCVA, BSCVA, and CS and reduce most corneal HOAs in progressive forms of keratoconus. [ABSTRACT FROM AUTHOR]

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Purpose: To report an interesting case of concomitant bilateral Terrien's marginal degeneration-like corneal ectasia and posterior polymorphous corneal dystrophy in a young man with quiescent rheumatoid arthritis. Case Report: A 24-year-old man with history of rheumatoid arthritis presented with bilateral decreased vision since four years ago. Slit lamp examination revealed bilateral circumferential peripheral corneal thinning and bulging with vascularization and lipid deposition in addition to band-like lesions in descemet's membrane. Previous records revealed no gross corneal abnormalities up to 4 years ago. Corneal lesions were compatible with bilateral circumferential Terrien's marginal degeneration concomitant with posterior polymorphous dystrophy. Conclusion: To our knowledge, this is the first report of concomitant bilateral Terrien's marginal degeneration with peripheral corneal ectasia and posterior polymorphous dystrophy in a patient with rheumatoid arthritis. Bilateral circumferential involvement, younger age at presentation and total peripheral corneal ectasia as observed in this case are not typical for classic Terrien's marginal degeneration. [ABSTRACT FROM AUTHOR]

Herein we describe a technique for management of large inadvertent full-thickness trephination during deep anterior lamellar keratoplasty using the big-bubble technique without converting to penetrating keratoplasty. First, the anterior chamber is formed with an ophthalmic viscosurgical device (OVD). Then, the full-thickness wound is secured with one X-type 10-0 nylon suture. A 27-gauge needle is attached to a 2 mlair-filled syringe and inserted into the corneal stroma in the meridian opposite to the site of full-thickness trephination. Air is gently injected to produce a limited area of "big-bubble" detaching Descemet's membrane (DM) from the corneal stroma. The "big bubble" is slowly expanded with injection of OVD. Finally, the recipient stroma is removed, the donor lenticule is placed and the DM tear is secured with one full thickness 10-0 nylon suture. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the repeatability of a pyramidal wavefront-based refraction (WFR) measurement and its agreement with dry autorefraction (DR), cycloplegic autorefraction (CR), and subjective refraction (SR) in myopic refractive surgery candidates., Methods: One hundred eighty-nine eyes from 189 participants were evaluated. PERAMIS aberrometry (PERAMIS; SCHWIND eye-tech-solutions, Kleinostheim, Germany), DR, and CR, as well as SR, were completed for all candidates. The repeatability of PERAMIS measurements was assessed, and the Bland-Altman plots were used to test the agreement between different methods., Results: Repeatability of the PERAMIS aberrometer was very high in the measurement of all refractive elements (Sphere, cylinder, spherical equivalent [M], J0, and J45) (interclass correlation coefficient >0.980 for all). A significant myopic shift was found with WFR compared to CR (0.45 diopter [D]) and SR (0.28 D) ( P < 0.05). For the M component, there was a significant difference between WFR and CR ( P < 0.05). J0 component measured with WFR was significantly different from SR and CR ( P < 0.05). For the J45 variable, all three refraction methods were comparable (all, P > 0.05). In M > 5.00 D, a difference of 0.79 D (limit of agreement: -3.50-1.90) was found between WFR and CR., Conclusions: In lower degrees of myopia, WFR was in good agreement with the manifest autorefraction. WFR, CR, and SR techniques were comparable in measuring astigmatism, especially in oblique astigmatism., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Current Ophthalmology.)

Purpose: To investigate peripapillary retinal nerve fiber layer (pRNFL) thickness changes in preterm children with or without retinopathy of prematurity (ROP) history compared to full-term children., Methods: A retrospective comparative cohort study assessing pRNFL thickness was completed in children aged 4-8 years. Four groups of children were included ( n = 30 each group): children with a history of ROP who were treated with intravitreal bevacizumab, children with ROP who received no treatment, and preterm children without ROP compared to age- and gender-matched full-term children., Results: A total of 120 eyes from 120 children were enrolled in this study. Both treated and regressed ROP children showed a significantly thinner pRNFL in the nasal quadrant compared to full-term children ( P = 0.017 and P = 0.008, respectively). The pRNFL in the superior quadrant of treated ROP children was thinner than the preterm and control groups ( P = 0.015 and P = 0.023, respectively), whereas the inferior quadrant of treated ROP children was thinner than the preterm group alone ( P = 0.008). The pRNFL thickness in the temporal quadrant was comparable between groups ( P = 0.129). The average spatial distribution profile of pRNFL thickness in treated ROP children was significantly thinner than in the preterm group ( P = 0.041)., Conclusion: pRNFL thickness is significantly altered in children with a prior history of treated ROP with thinning of the nasal and superior quadrants compared to full-term children., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Current Ophthalmology.)

Purpose: To assess the agreement between biometric parameters measured by a spectral-domain optical coherence tomography optical biometer device (Optopol Revo NX) with a validated swept-source biometer (IOLMaster 700) and a validated optical low-coherence reflectometry biometer (Lenstar LS 900), in cataract surgery candidates., Methods: In this prospective comparative study, 100 patients (100 eyes) who were eligible for cataract surgery were involved. Bland-Altman plots were used to assess agreement between devices for biometric parameters including axial length (AL), anterior chamber depth (ACD), lens thickness (LT), and central corneal thickness (CCT)., Results: AL measurements were successful in 82 eyes (82.0%) with Revo NX, in 91 eyes (91.0%) with Lenstar LS 900, and in 97 eyes (97.0%) with IOLMaster 700. When Revo NX was compared to IOL Master 700 and Lenstar LS 900, the mean differences were as follows: -0.02 ± 0.02 mm and -0.02 ± 0.03 mm (P = 0.313, P = 0.525) for AL, 0.01 ± 0.03 mm and 0.10 ± 0.03 mm (P = 0.691, P = 0.002) for ACD, -0.15 ± 0.03 mm and 0.001 ± 0.04 mm (P < 0.001, P = 0.95) for LT, and -2.29 ± 0.92 μm, and 0.73 ± 1.43 μm (P = 0.015, P = 0.612) for CCT. Three devices were highly correlated for AL, ACD, LT, and CCT (interclass correlation coefficient > 0.75). Bland-Altman plots showed a narrower 95% limit of agreement (-0.35 to 0.31) between Revo NX and IOLMaster 700 in measuring AL., Conclusions: Despite the higher measurement failure rate in eyes with cataract, the Revo NX showed very good agreement with the IOLMaster 700 and Lenstar LS 900 optical biometers in measuring AL, ACD, LT, and CCT. However, ACD and LT measurements cannot be considered interchangeable between these devices., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Current Ophthalmology.)

Purpose: To assess the therapeutic efficacy of a combinational therapy, including conventional treatment and intense pulsed light (IPL) technique on sleep quality of patients with meibomian gland dysfunction (MGD)., Methods: Fifty participants with a clinical diagnosis of MGD were enrolled in this study. Participants underwent three sessions of IPL therapy. There was a 2-week interval between IPL sessions 1 and 2 and 1 month between sessions 2 and 3. Treatment was supplemented with conventional home-based therapy (including lid hygiene, warm compress, eyelid massage, and lid margin scrub) for MGD. Dry eye symptomatology, tear film, and ocular surface parameters were evaluated at baseline (day 0) and days 15, 45, and 75. Sleep quality was assessed before and after the study using Pittsburgh Sleep Quality Index (PSQI)., Results: PSQI components improved significantly at day 75 in comparison with the baseline (all P < 0.05). Ocular Surface Disease Index (OSDI) score, noninvasive Keratograph tear break-up time (NIKBUT), fluorescein tear break-up time (FTBUT), meibomian gland expressibility, meibum quality score, and tear osmolarity improved at follow-up visits ( P < 0.05). Younger patients showed more improvement in NIKBUT, sleep quality, and duration ( P = 0.024, P = 0.047, and P = 0.008). Sleep latency decreased with increased NIKBUT and FTBUT and decreased OSDI score ( P = 0.001, P = 0.005, and P = 0.041)., Conclusions: The treatment of MGD is effective for improving sleep quality. Younger patients may preferentially benefit from the treatment., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Current Ophthalmology.)

Purpose: To assess the possible association between keratoconus (KC) and serum levels of 25-hydroxyvitamin D (25OHD), Selenium (Se), Zinc (Zn), and Copper (Cu) and to compare it with age-matched healthy subjects., Methods: One hundred patients with KC and 100 normal subjects were included. The two groups were compared for serum 25OHD and serum levels of three trace elements: Se, Zn, and Cu. These factors were also compared between groups with different KC stages., Results: Serum levels of vitamin D, Zn, Cu, and Se were significantly different between the KC and normal groups ( P = 0.006, P = 0.015, P = 0.004, and P = 0.038, respectively). Although a lower level of 25OHD was found in severe stages of KC, it was not significantly different among different KC groups ( P = 0.441). KC stage groups were not significantly different for mean serum Zn, Cu, and Se ( P = 0.130, P = 0.98, P = 0.113, respectively). Although the Cu/Zn ratio was higher in cases than in controls, there was no significant difference between the two groups and between KC stages ( P = 0.168, P = 0.143, respectively)., Conclusion: Lower serum 25OHD, Cu, Zn, and Se were found in the KC group compared to the control group. The results of this study suggest that a lower antioxidative activity may be involved in the possible etiology of KC., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Current Ophthalmology.)

Purpose: To determine 4-year changes of ocular biometric and dioptric components in Iranian children aged 7-11 years following the first phase., Methods: 468 children were evaluated in the first phase of the study in 2012 and again in 2016-2017. Multi-stage stratified cluster sampling was applied to select the participants. The Topcon autorefractometer and the LENSTAR/BioGraph biometer (WaveLight AG, Erlangen, Germany) were used for cycloplegic refraction and biometry, respectively. All measurements were repeated at 4 years as the baseline assessments., Results: Of 468 children, 251 (53.6%) were boys. Spherical equivalent (SE) showed a marked myopic shift ( P  = 0.000) in the second phase which was significantly higher in boys (0.24 vs. 0.18 D) ( P  < 0.001). Axial length (AL) and anterior chamber depth (ACD) increased by 0.49 ± 0.05 and 0.12 ± 0.02 mm, while lens thickness (LT) and lens power (LP) decreased by 0.08 ± 0.01 mm and 1.59 ± 0.12 D, respectively ( P  < 0.05). The mean corneal curvature and thickness did not change significantly during 4 years. All biometric component changes were greater in boys. Biometric changes in different age groups showed a decreased LP, increased AL, and increased ACD in most age groups ( P  < 0.05), while LT and SE did not change significantly in the age groups 9 and 11 years and 8 and 9 years, respectively. Changes in the corneal thickness, diameter, curvature, and refractive astigmatism were not significant in any of the age groups ( P  > 0.05)., Conclusions: Statistical and clinical changes were seen in AL, ACD, LP, and LT. The changes observed in biometric components (AL, ACD, and LT) had a sinus rhythm.

Purpose: To develop clinical practice guidelines (CPGs) for prevention, diagnosis, treatment and follow-up of ocular injuries caused by exposure to mustard gas., Methods: The clinical questions were designed by the guideline team. Websites and databases including National Guidelines Clearinghouse, National Institute for Clinical Excellence, Cochrane, and PubMed were searched to find related CPGs and explore possible answers to the clinical questions. Since there were no relevant CPGs in the literature, related articles in Persian and English languages were extracted. Each article along with its level of evidence was summarized. Additionally, hand search was performed by looking the reference list of each article. Consequently, recommendations were developed considering the clinical benefits and side effects of each therapeutic modality. The recommendations were re-evaluated in terms of customization criteria. All recommendations along with the related evidence were scored from 1 to 9 by experts from all medical universities of Iran. The level of agreement among the experts was evaluated by analyzing the given scores., Results: The agreement was achieved for all recommendations. The experts suggested a number of minor modifications which were applied to the recommendations. Finally, CPGs were developed with 98 recommendations under three major domains including prevention of injury, diagnosis and management of the acute and delayed-onset mustard gas ocular injuries., Conclusion: Considering the lack of CPGs for the prevention, diagnosis, and management of mustard gas-induced keratitis, these recommendations would be useful to prevent the serious ocular complications of mustard gas and standardize eye care services to the affected individuals., Competing Interests: There are no conflicts of interest.

Purpose: To report the indications and techniques of corneal transplantation at a tertiary referral center in Tehran over a 3-year period., Methods: Records of patients who had undergone any kind of corneal transplantation at Labbafinejad Medical Center, Tehran, Iran from March 2004 to March 2007 were reviewed to determine the indications and types of corneal transplantation., Results: During this period, 776 eyes of 756 patients (including 504 male subjects) with mean age of 41.3±21.3 years underwent corneal transplantation. The most common indication was keratoconus (n=317, 40.8%) followed by bullous keratopathy (n=90, 11.6%), non-herpetic corneal scars (n=62, 8.0%), infectious corneal ulcers (n=61, 7.9%), previously failed grafts (n=61, 7.9%), endothelial and stromal corneal dystrophies (n=28, 3.6%), and trachoma keratopathy (n=26, 3.3%). Other indications including Terrien's marginal degeneration, post-LASIK keratectasia, trauma, chemical burns, and peripheral ulcerative keratitis constituted the rest of cases. Techniques of corneal transplantation included penetrating keratoplasty (n=607, 78.2%), deep anterior lamellar keratoplasty (n=108, 13.9%), conventional lamellar keratoplasty (n=44, 5.7%), automated lamellar therapeutic keratoplasty (n=8, 1.0%), and Descemet stripping endothelial keratoplasty (n=6, 0.8%) in descending order. The remaining cases were endothelial keratoplasty and sclerokeratoplasty., Conclusion: In this study, keratoconus was the most common indication for penetrating keratoplasty which was the most prevalent technique of corneal transplantation. However, deep anterior lamellar keratoplasty is emerging as a growing alternative for corneal pathologies not involving the endothelium.