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Purpose: Pseudophakic bullous keratopathy (PBK) is one of the unintended side effects of intraocular surgeries and traumas. This study aims to evaluate plasma as a noninvasive procedure for PBK diseases through drainage of painful and annoying bullae. Methods: Three eyes of three patients with no vision potential were included in this study. Plasma spots are applied on bullae to empty the fluid inside, and also to attach the top of the bullae to the bottom. We evaluated Pain scores, tearing, and burning sensations (scale of 0 to 10) before treatment and one week, one month, and six months after treatment. Results: The results showed that all the annoying bullae entirely eliminated in all patients. No complications and recurrence were observed during the operation and one week, one month, and six months after the procedure. After treatment, there was no tearing and burning sensation. All of the patients scored ten for pain before treatment and zero after treatment. There were no changes in the vision of the patients after treatment. Conclusions: Based on the results, the PANIS method can be used as a safe method for eliminating bullae which are not a good candidate for vision amelioration treatment. This method is safe, quick, office base and inexpensive, which can decrease pain in these patients.

Purpose: To introduce a novel technique using PANIS method (Plasma assisted noninvasive surgery) in pterygium removal surgery with conjunctival rotation flap. Methods: Two patients (1 male, 1 Female) with grade 3 and 4 of pterygium, based on SLIT2 grading system, underwent surgery with local anesthesia, removing pterygium tissue from cornea and also all related subtenon. Then surgeon used residual conjunctiva to cover bare sclera using rotational method. Fusion of the border of conjunctival flaps from nasal to superior occurred by plasma spots. UCVA, BCVA, OSDI and patient satisfaction were evaluated before, 1 month, 6 months and 1 year after the surgery, as well as 1 day and 1 week post-operation examinations included slit-lamp and external check-up that has been done by the surgeon. Results: Patients with primary pterygium, underwent surgery with PANIS method. Last follow-up session in 1 year, showed significant improvement in astigmatism and 1 line in BCVA. There were no complications and side effects during and after the surgery and also other reported complication included diplopia in lateral gaze, granuloma and scarring was not observed and no recurrence have been seen in the follow-up period and patients were satisfied. Additionally 1 day and 1 week slit-lamp examination showed plasma spots caused good attachment of conjunctival tissue with ocular surface. Conclusion: After treating 2 patients with PANIS method, it seems that plasma spots can be a good substitute for suture or glue in pterygium surgery with conjunctival rotational flap, because it's easy and fast way for fusing the conjunctival flap without any complication or side effect.

Purpose: Medical plasma application has been used in different fields recently. In this study, we assess the outcome of using plasma-assisted noninvasive surgery (PANIS) with amniotic membrane transplantation (AMT) in pterygium surgical treatment. Methods: This clinical case series was conducted in 4 patients with primary grades 1, 2, and 3 pterygium (Table 1). After exclusion and inclusion criteria considerations, patients underwent different examinations. Various measurements were obtained such as uncorrected visual acuity (UCVA), refractive error (RE), the best-corrected visual acuity (BCVA), and ocular surface disease index (OSDI). The surgical procedure was pterygium removal from the cornea and then AMT attached to the conjunctival borders with plasma spots using a white handpiece of Plexr device (Plexr, GMV s.r.l Grottaferrata, Italy) instead (Table 2). After postoperative follow-ups within the first week of the surgery and in 1 month and 6 months later the results were obtained. Results: All patients have been fully recovered after the surgery without any complications. In all 4 cases, UCVA, BCVA, and RE parameters have improved during 6 months after the surgical procedure. Every patients’ OSDI decreased after the surgery. Recurrence has not been seen in any cases during 6 months follow-up. Conclusion: Pterygium removal surgery using the PANIS technique with AMT is safe, effective, fast, and cost-benefit.

Background: Conjunctivochalasis (CCh) is a common bilateral conjunctival condition defined by loose, redundant conjunctival folds, typically in the inferior bulbar conjunctiva. In recent years, var...

BACKGROUND: The aim of this study was to evaluate visual and refractive outcomes and quality of vision after implantation of the AT LISA tri 839MP intraocular lens (IOL). PATIENTS AND METHODS: This interventional clinical trial comprised 46 cataractous eyes of patients who underwent phacoemulsification with IOL implantation (mean age of 58.08 ± 11.01 years; range: 36–76 years old). Spherical equivalent (SE), uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), corrected intermediate visual acuity (CIVA), uncorrected near visual acuity (UNVA), and corrected near visual acuity (CNVA) were measured 1, 3, and 6 months after surgery. Contrast sensitivity (CS) was measured at 6 months. Subjective quality of vision and presence of dysphotopsia by a short questionnaire were evaluated postoperatively. RESULTS: At 6 months, the mean visual acuity was 0.08 ± 0.11, 0.03 ± 0.08, 0.07 ± 0.09, 0.02 ± 0.08, 0.05 ± 0.09, and 0.02 ± 0.08 LogMAR for UDVA, CDVA, UIVA, CIVA, UNVA, and CNVA, respectively. The mean values of SE were − 0.4728 ± 0.32D. These variables improved over time, yet significant changes were detected in UDVA (P = 0.009) and SE (P = 0.0001). The mean CS value was 1.74 ± 0.08. The mean scores (0% = no symptoms; 100% = strong symptoms/unable to perform activities) for glare and halos were 7.07 ± 0.22% and 8.70 ± 0.23%, respectively. These items were reduced over time. Patients’ level of satisfaction mean score for performing activities was 96.66%. CONCLUSIONS: The AT LISA tri 839MP IOL provides excellent uncorrected distance, intermediate and near vision, and CS. This IOL showed a minimal level of photic phenomena and a high level of patient satisfaction.

To evaluate the safety and efficacy of dietary lentil capsules in patients suffering from dry eye symptoms.A randomized, triple-blind, interventional, placebo-controlled study was done. Sixty patients were randomized in two groups to receive either one capsule containing 500 mg of lentil powder or placebo daily for 3 months. UCVA, tear film breakup time (TBUT), Schirmer's test, tear film osmolarity, and OSDI score were recorded at baseline and 3 months after intervention. Data analysis was performed using IBM SPSS for Windows version 20 (SPSS, Chicago, IL, USA).In the lentil group, at baseline, the mean UCVA (LogMAR), OSDI, TBUT (S), tear film osmolarity (mOsm/L), and Schirmer (mm) scores were 0.104 (0.026), 22.66 (19.40), 10.31 (5.32), 301.07 (15.57), and 8.22 (6.87), respectively. These values were 0.101 (0.026), 20.85 (19.44), 13.04 (7.11), 299.81 (11.60), and 9.87 (10.11). In the placebo group, these values were 0.084 (0.027), 25.35 (20.08), 10.56 (4.95), 299.77 (15.09), and 9.35 (8.06) at baseline and 3 months later were 0.077 (0.027), 23.32 (22.90), 13.62 (6.30), 297.54 (12.08), and 8.64 (9.60), respectively. Three patients (one in the lentil group and two in the placebo group) experienced severe gastrointestinal symptoms.Although consumption of 500 mg of lentil is safe, this amount is not sufficient for reduction of dry eye syndrome in 3 months. For more validation, a clinical study with increased dosage of lentil is proposed.

Background: conjunctival nevi are benign ocular lesions with a low risk of malignant transformation to melanoma. Due to cosmetic reasons patients usually consider surgical removal options. In this case report, we are presenting a new approach using plasma-assisted noninvasive surgery (PANIS) with amniotic membrane transplantation (AMT) to sublimate the nevus border and fuse the AMT with the remaining conjunctiva.Case presentation: A 33-year-old man with a history of large conjunctival nevus in his left eye, that its benignity was proved by an expert ophthalmologist through years of examination, has visited our center in September 2020. Plasma spots were used to sublimate the nevus border and fuse AMT with the conjunctiva. The patient was discharged fully satisfied without any complications and no recurrences were seen in a year of follow-up. Visual parameters were not significantly changed while the Ocular Surface Disease Index (OSDI) was reduced dramatically. Conclusion: Conjunctival nevi removal using the PANIS method with AMT is a safe, minimally invasive, and inexpensive therapeutic option. Plasma spots are suitable for AMT adhesion to the remaining conjunctiva after the nevus removal.

Purpose: Plasma is one of the newest therapies recently used in Conjunctivochalasis, Conjunctival Cyst, and Blepharoplasty. This study aimed to evaluate a quick treatment modality of conjunctival concretions using plasma as a noninvasive procedure.Design: Six eyes of six patients with conjunctival concretions were evaluated in a clinical case series.Methods: The procedure was performed using plasma spots generated by the white handpiece of the Plexr device. The eyelid was everted and concretions sublimated by plasma spots from the upper and lower eyelids. Refractive Errors, visual acuity (BCVA and UCVA), Ocular Surface Disease Index (OSDI), and Intraocular pressure (IOP) were measured before and after six months of the procedure.Results: The results of 6 months follow-up show that this effective method had no recurrence or side effects. Treatment was effective in all of the patients. No complication and recurrence was observed. The OSDI score was improved to the normal range. This method had no effects on Refractive Errors, Visual Acuity, and IOP. Conclusions: Based on the results, it seems that the PANIS method can be used as a practical, quick, and straightforward approach for the treatment of conjunctival concretions.

Background Plasma medicine is an innovative research field focused on the application of atmospheric-pressure low-temperature plasmas (ALTP) for therapeutic purposes. Considering the potentials of plasma in ophthalmology, in this study, we evaluated the safety of plasma on the conjunctival tissue in animal models for 6 months. Methods Twelve adult male New Zealand albino rabbits were divided into four groups. The right eye of each rabbit was chosen for the test and the left eye was considered as the control. Experiments were performed using the Plexr device (GMV, Rocca Priora, RM, Italy). Four plasma spots were applied on the superior part of the conjunctiva (from 10 to 2 o’clock positions) using the continuous mode and a low power level (white handpiece) of the Plexr. For evaluation of the plasma safety, the histopathological changes were assessed 1 week (A), 1 month (B), 3 months (C), and 6 months (D) after the intervention. Results According to the histopathological findings, a mild decrease in blood vessels and severe stromal edema, as well as a superficial epithelium loss, were observed in group A. No chronic inflammation, scar tissue, deposition, and hemorrhage were found in group B. Epithelialization was confirmed by the histological examinations after 1 month. There was no evidence of atypia or dysplasia after 3 and 6 months. Conclusion In conclusion, there were no persistent histopathological changes on conjunctival tissue after plasma exposure. Then, plasma can be considered as a minimally invasive alternative method for treating some ocular surface disorders.

To identify pre-operative factors that influence post-operative performance of a full-ring intra-corneal implant (MyoRing) for the management of keratoconus.In a retrospective study, medical records of 70 keratoconus eyes of 70 consecutive surgical patients with a mean age of 28.54 ± 6.52 years, who underwent MyoRing implantation using the PocketMaker microkeratome (Dioptex GmbH), were included and analysed before implantation and for visual outcome. Variables assessed included age, gender, keratoconus shape, uncorrected distance visual acuity, corrected distance visual acuity, spherical equivalent and keratometry reading. After the last follow-up, the eyes were graded for MyoRing implantation performance into worst, moderate and best subgroups.The mean values of uncorrected distance visual acuity, corrected distance visual acuity, spherical equivalent, manifest sphere and cylinder improved significantly post-operatively (p 0.05). A statistically significant difference was found in the mean spherical equivalent (p = 0.046) and uncorrected distance visual acuity (p = 0.001) between moderate and best subgroups. No statistically significant correlation was found between age, sex, keratoconus shape, keratometric values, corrected distance visual acuity and visual outcome.According to this new grading system for MyoRing implantation performance, pre-operative uncorrected distance visual acuity and spherical equivalent are considered as the most important indicators for surgical performance in MyoRing treatment of keratoconus.

Therapeutic options for corneal ectasia are evolving, with emphasis on the intra-stromal corneal ring for delaying or eliminating the need for penetrating keratoplasty. A 33-year-old man with grade 4 keratoconus and rising intolerance of the hard contact lens underwent a combination of a new innovative ring and graft with suture in the left eye. Excellent structural support and stability of the cornea were observed immediately post-operatively and 12 months after surgery. It appears as a feasible and safe therapy option for keratoconus eyes with reference to the instability and asymmetry of the cornea. Hence, as a safe and effective technique, it can be performed easily.

Phakic intraocular lens (pIOL) models have indicated an association between cataract formation and inadequate vaulting. In this study, the efficacy and safety of low-vault posterior chamber pIOLs in the correction of myopia were examined over 3 years. From 316 patients undergoing surgery, 14 eyes with a low vault (≤ 150 μm) were examined from 14 patients. After implanting the Visian Implantable Collamer pIOL for the correction of myopia (moderate and high), the pIOL vault, endothelial cell loss, uncorrected distance visual acuity (UDVA), corrected DVA (CDVA), and detrimental events were examined over 3 years. Based on the findings, the mean spherical equivalent reduced from − 8.15 ± 3.29 before surgery to − 1.02 ± 0.75 diopters 3 years after the surgery. In terms of visual outcomes, the mean UDVA (Log MAR) significantly increased from 0.95 ± 037 to 0.27 ± 0.28, and the mean CDVA also increased from 0.99 ± 0.11 to 0.06 ± 0.08 (P

Background: In recent years plasma medicine, played an important role in treating several ocular surface disorders. This study will introduce atmospheric low-temperature plasma (ALTP) for removing the pinguecula. Methods: In the clinical case series, five eyes of five patients (2 patients OD, 3 patients OS) with pinguecula were included. The pinguecula removed and completely healed, using the white handpiece of the plasma generator device (Plexr, GMV s.r.l Grottaferrata, Italy). Refraction parameters, uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (BDVA), intraocular pressure (IOP), corneal fluorescein staining (CFS), contrast sensitivity (CS) and dry eye tests including, tear meniscus height (TMH) and tear breakup time (TBUT) were measured before, one month and six months after treatment for all patients. Results: The median size of the pinguecula was 3.5 mm (ranged from 2.5 to 4.5 mm). In all patients, the pinguecula was completely sublimated and after six months of follow-up, no evidence of recurrence was observed. In addition, the patient follow-up did not reveal any considerable complications during or 6 months after the surgery. Conclusion: Overall, the current study showed that, plasma assisted noninvasive surgery (PANIS method) is a simple, office-based, minimally invasive, effective approach to treat pinguecula with no considerable complications but it is noteworthy that, study with higher sample size like clinical trial is needed.

Purpose: To evaluate long-term follow-up data on implantation of a full-ring intra-corneal implant (MyoRing) for management of keratoconus. Methods: A total of 40 keratoconic eyes of 37 consecutive patients who had undergone MyoRing implantation using the Pocket Maker microkeratome (Dioptex, GmbH, Linz, Austria) and completed 3 years of follow-up appointments were included in this retrospective study. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction and keratometry (K) readings were measured and evaluated preoperatively, and 3 years, postoperatively. Results: No intraoperative complications were observed in this case series. Three years postoperatively, there was a significant improvement in UDVA, CDVA, K readings, spherical equivalent (SE), and manifest sphere and cylinder (P < 0.05 for all comparisons). UDVA was significantly improved from 1.14 ± 0.27 to 0.30 ± 0.21 LogMAR (P = 0.001), CDVA was also improved from 0.52 ± 0.23 to 0.18 ± 0.12 LogMAR (P = 0.001), SE was decreased by 4.35 diopters (D) and average keratometric values were reduced by 2.34 D (P = 0.001). Overall, 81% of subjects were moderately to highly satisfied 3 years after surgery and 64.90% agreed to have the fellow eye implanted with MyoRing. Conclusion: MyoRing implantation using the Pocket Maker microkeratome was found to be a minimally invasive procedure for improving visual acuity and refraction in the majority of the patients with keratoconus.

We aimed to systematically review the existing evidence and determine the efficacy of MyoRing as a novel method for treatment of keratoconus using meta-analysis. Online electronic search of Medline, ISI Web of Science, Embase, Scopus, and Cochrane Library databases was performed with reference lists of relevant articles for pre–post trials published through August 2017. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), sphere, cylinder, spherical equivalent (SE), maximum, minimum, and mean keratometry were considered as the visual acuity outcomes. Weighted mean difference (WMD) with 95% confidence interval was used as pooled estimation of intervention efficacy using random-effects meta-analysis. Heterogeneity was measured with the Cochran Q statistic and quantified with the I2 statistic using Stata software. Of the 47 potentially related studies, 21 eligible studies were included in the meta-analysis. The mean of uncorrected distance visual acuity (UDVA) based on LogMAR in patients with keratoconus had a significant change 3 months after implantation/embedding of the complete ring (WMD = − 0.73 (CI = − 0.88 to − 0.58), I2 = 79.9%, p

We evaluate the efficacy and safety of Keraring 355° intrastromal corneal ring segment (ICRS) implantation aided by PocketMaker microkeratome for the correction of keratoconus. Patients underwent ICRS insertion using mechanical dissection with PocketMaker microkeratome and completed 6 months of follow-up. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refraction, topographic findings, safety, efficacy index, and adverse events were reported for six months postoperatively. We evaluated 15 eyes of 15 patients (12 men) with a mean age of 28.87 ± 6.94 years (range 21–49 years). At final postoperative examination, there was a statistically significant reduction in the spherical equivalent refractive error compared to preoperative measurements (−5.46 ± 1.52 to −2.01 ± 1.63 D,P<0.001). Mean preoperative UCVA (logMAR) before implantation was 0.79 ± 0.48, and postoperative UCVA was 0.28 ± 0.15,P=0.001. Mean preoperative BSCVA (logMAR) before implantation was 0.36 ± 0.21; at final follow-up examination BSCVA was 0.18 ± 0.9,P=0.009. MeanKdecreased from 48.33 to 43.31 D,P<0.001. All patients were satisfied with ICRS implantation; 86.7% were moderately to very happy with the results. No intraoperative or postoperative complications were demonstrated. This preliminary study shows that ICRS (Keraring 355°) implantation is an efficient, cost-effective, and minimally invasive procedure for improving visual acuity in nipple type keratoconic corneas.

Objective: Human amniotic membrane (HAM) is used as a supporter for limbal stem cell (LSC) expansion and corneal surgery. The aim of study is to use HAM extracts from healthy donors to enhance proliferation of LSCs in vitro and in vivo. Materials and Methods: In this interventional experimental study, the effective and cytotoxic doses of the amniotic membrane extract eye drops (AMEED) was assessed by adding different concentrations of AMEED (0-2.0 mg/ml) to LSC cultures for 14 days. Subsequently, the expression levels of ATP-binding cassette sub-family G member 2 (ABCG2, a putative stem cell marker), cytokeratin 3 (K3, corneal maker), K12 and K19 (corneal-conjunctival cell makers) were assessed by real-time polymerase chain reaction (PCR). In the second step, the corneal epithelium of 10 rabbits was mechanically removed, and the right eye of each rabbit was treated with 1 mg/ml AMEED [every 2 hours (group 1) or every 6 hours (group 2)]. The left eyes only received an antibiotic. The corneal healing process, conjunctival infection, degree of eyelid oedema, degree of photophobia, and discharge scores were evaluated during daily assessments. Finally, corneal tissues were biopsied for pathologic evidences. Results: In comparison to the positive control [10% foetal bovine serum (FBS)], 0.1-1 mg/ml AMEED induced LSC proliferation, upregulated ABCG2, and downregulated K3. There were no remarkable differences in the expression levels of K12 and K19 (P>0.05). Interestingly, in the rabbits treated with AMEED, the epithelium healing duration decreased from 4 days in the control group to 3 days in the two AMEED groups, with lower mean degrees of eyelid oedema, chemosis, and infection compared to the control group. No pathologic abnormalities were observed in either of the AMEED groups. Conclusion: AMEED increases LSCs proliferation ex vivo and accelerates corneal epithelium healing in vivo without any adverse effects. It could be used as a supplement for LSC expansion in cell therapy.

Purpose: To report the preliminary results of femtosecond laser-assisted cataract surgery in Iranian patients. Methods: This prospective case series included 21 eyes of 21 patients with cataract. Mean patient age was 66.7 ± 10 years. The patients underwent femtosecond-laser assisted cataract surgery (VICTUS Femtosecond Laser Platform: Bausch + Lomb) and intraocular lens (IOL) implementation in Bina Eye Hospital, Tehran, Iran between May and October, 2014. Visual outcomes, intraocular pressure (IOP), and complications were evaluated three months after surgery. Results: Mean preoperative best-spectacle corrected visual acuity (BSCVA) was 0.40 ± 0.21 logMAR which significantly improved to 0.02 ± 0.03 logMAR three months postoperatively (P < 0.001). Mean preoperative IOP was 17.88 ± 2.70 mmHg which significantly decreased to 12.5 ± 1.51 mmHg three months after operation (P < 0.001). Mean duration of operation for these patients was 29.30 ± 8 minutes and mean femtosecond laser process time was 4.20 ± 2 minutes. In terms of complications, 9 patients developed fine subconjunctival hemorrhage and eye redness and 2 patients had mild corneal edema which all subsided within less than 7 days. Serious complications such as anterior or posterior capsule tears were not encountered. Conclusion: Femtosecond laser-assisted cataract surgery is a relatively new method of cataract surgery. Our preliminary results indicate an acceptable visual outcome with no serious complications. However, this technique is lengthier and more expensive than conventional phacoemulsification.

Objective: To evaluate aberrometric changes in corneas with keratoconus implanted with intrastromal corneal ring segment (Keraring 355) during a 3-months follow-up. Design: Prospective, consecutive case series Methods: In this interventional study, 22 eyes of 21 keratoconic patients with mean age of 29 ± 6 years who underwent KeraRing 355 intrastromal corneal ring insertion using a Pocket Maker Microkeratome for channel creation and completed at least three months of follow-up were included. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), refractive outcome, Orbscan finding and corneal aberrations were assessed. Results: Three months postoperately, Low order aberration (defocus and astigmatism) decreased significantly (P

Purpose To report complications after the implantation of Keraring 355° intrastromal corneal ring (ICR; Mediphacos, Belo Horizonte, Brazil) in keratoconic eyes using a Ziemer LDV femto- second laser (Ziemer AG, Switzerland) for channel creation. Materials and methods Five eyes suffering from keratoconus underwent Keraring 355° insertion using Ziemer LDV for corneal pocket creation. Intraoperative and postoperative complications were recorded. Results While intraoperatively there were no complication, postoperatively all cases showed severe side effects. Conclusion In this small case series, intracorneal ring (Keraring 355°) implantation using a femtosecond laser for channel creation was related to a number of significant postoperative problems in all cases. The most common complication was corneal melting (postoperatively). How to cite this article Jadidi K, Mosavi SA, Nejat F, Alishiri A. Complications of Intrastromal Corneal Ring Implantation (Kera- ring 355°) using a Femtosecond Laser for Channel Creation. Int J Kerat Ect Cor Dis 2014;3(2):53-56.

Purpose: To evaluate the efficacy of topical cyclosporine A (tCsA) for treatment of dry eye disease in patients suffering from chronic ocular complications of mustard gas (MG) injury. Methods: This interventional case series included patients with MG injury suffering from severe dry eye despite receiving artificial tears and punctal plugs. Patients were administered tCsA 0.05% twice daily for 3 months. Severity of the condition was evaluated by measuring tear osmolarity, ocular surface disease index (OSDI), tear break-up time (TBUT), and Schirmer′s test at baseline and at the end of study. Results: A total of 34 patients with chronic MG injury and mean age of 47.1 ± 6.5 years were studied. Compared to baseline values, tear osmolarity (301.7 ± 11.5 vs. 286.3 ± 7.9 mOsmol/L, P < 0.001) and OSDI (47.5 ± 7.2 vs. 42.7 ± 7.1, P < 0.001) were significantly improved. Likewise, Schirmer′s test (4.6 ± 1.3 vs. 5 ± 1.3 mm, P < 0.001) and TBUT (1.9 ± 1.4 vs. 2.7 ± 1.5 s, P < 0.001) also significantly recovered at the end of the study. Conclusion: TCsA 0.05% reduces tear osmolarity and improves dry eye symptoms and can serve as an efficacious treatment for ocular complications in patients with chronic MG injury.

Purpose The plasma soft surgery is as an alternative to invasive surgical cosmetic procedures that can reduce the recovery time and possible complications after surgery. Due to the sensitivity of ocular surface tissue and the potential of the plasma, it can be evaluated to treat some ocular surface disorders. Accordingly, we evaluated the safety of the cold plasma on the ocular surface tissue in three areas located in the cornea, limbus, and conjunctiva. Methods Nine adult male New Zealand albino rabbits which divided into three groups were used for experiments. The left eye of each rabbit was chosen for test and the right eye was as the control. Experiments were performed on three ocular surface areas under the influence of the plasma. For this purpose, the plasma was created by Plexr device in continues mode and low power level (white handpiece; 0.7 W) was utilized at 0.7 s intervals using a 22-gauge needle. For evaluation of plasma safety, ocular surface integrity and histopathological changes were assessed after 24 h (A), one week (B), and one month (C) exposure to plasma. Results According to the external and slit-lamp examinations, after 24 h (A) only epithelial defect was visible while ocular surface in other groups (B & C) was healthy had completely recovered. OCT imaging and histologic examination also confirmed these results. After 24 h conjunctival and corneal sections showed a localized area of epithelial loss together with infiltration of inflammatory cells in the subepithelial stroma, but during the one-month period, recovery was evident. Generally, after the first week, the loss of integrity of corneal epithelium has not been completely improved yet, while it was recovered nearly to be normal in group C. It was noteworthy that in all groups the loss of endothelium cells was not apparent which confirming the lack of damage to the deep layers of the eye. Conclusion According to the plasma safety results, it seems that plasma soft surgery has the potential to be used as an alternative method for treatment of some of the ocular surface disorders without needing to conventional surgical procedures.

Purpose: To customize clinical practice guidelines (CPGs) for cataract management in the Iranian population. Methods: First, four CPGs (American Academy of Ophthalmology 2006 and 2011, Royal College of Ophthalmologists 2010, and Canadian Ophthalmological Society 2008) were selected from a number of available CPGs in the literature for cataract management. All recommendations of these guidelines, together with their references, were studied. Each recommendation was summarized in 4 tables. The first table showed the recommendation itself in clinical question components format along with its level of evidence. The second table contained structured abstracts of supporting articles related to the clinical question with their levels of evidence. The third table included the customized recommendation of the internal group respecting its clinical advantage, cost, and complications. In the fourth table, the internal group their recommendations from 1 to 9 based on the customizing capability of the recommendation (applicability, acceptability, external validity). Finally, customized recommendations were sent one month prior to a consensus session to faculty members of all universities across the country asking for their comments on recommendations. Results: The agreed recommendations were accepted as conclusive while those with no agreement were discussed at the consensus session. Finally, all customized recommendations were codified as 80 recommendations along with their sources and levels of evidence for the Iranian population. Conclusion: Customization of CPGs for management of adult cataract for the Iranian population seems to be useful for standardization of referral, diagnosis and treatment of patients.