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Abstract Background To assess transepithelial photorefractive keratectomy (tPRK) in terms of corneal epithelial healing rate, postoperative pain, postoperative discomfort, and visual and refraction outcomes compared to mechanical epithelial debridement PRK (mPRK) and alcohol-assisted PRK (aaPRK). Methods In this double-masked, randomized clinical trial, thirty-nine patients underwent tPRK in one eye and mPRK in the fellow eye (arm A), and 33 patients underwent tPRK in one eye and aaPRK in the contralateral eye (arm B). All surgical procedures were done using the Schwind Amaris excimer laser. The area of corneal epithelial defect in all eyes was captured and analyzed using ImageJ software. Results Mean epithelial healing time was respectively 3.74 ± 0.82 and 3.59 ± 0.79 days in tPRK versus mPRK (P = 0.21) in arm A, and 3.67 ± 0.92 and 3.67 ± 0.74 days in tPRK versus aaPRK (P = 1.00) in arm B. Accounting for the initial corneal epithelial defect area, the epithelial healing rate was faster in conventional PRK groups compared to tPRK (both P 0.05). Conclusions All three methods are effective in terms of visual and refractive outcomes. However, although time to complete re-epithelialization was similar with the three methods, the epithelial healing rate was faster in conventional PRK considering the initial corneal epithelial defect area, and the patients experienced less pain and discomfort in the first postoperative day. Trial registration IRCT, IRCT20200317046804N1 . Retrospectively registered 5 May 2020.

Purpose: To evaluate the repeatability of biometry and intraocular lens (IOL) power using Galilei G6 and to determine the agreement of its measurements with those of IOL Master 700 and IOL Master 500. Methods: Hundred mature cataract eyes were examined twice with Galilei G6 and the results were compared with those of other two devices. Axial length (AL), minimum (K1), maximum (K2), and mean keratometry, anterior chamber depth (ACD), white-to-white (WTW) diameter, lens thickness (LT), and the calculated IOL power were the studied parameters. The correlation coefficient, within-subject standard deviation (Sw), Bland–Altman method, and 95% limits of agreement (LoA) were used for statistical analysis. Results: The intraclass correlation coefficient (ICC) was above 0.9 for all indices, and the LoA ranged from a minimum of 0.08 mm for AL to a maximum of 0.50 D for K1. Sw also ranged between a minimum of 0.02 for AL, ACD, and WTW and a maximum of 0.13 for K1. In the Galilei G6–IOL Master 700 pair, the narrowest and widest LoA were calculated for AL (0.07 mm) and K2 (0.49 D), respectively. In the Galilei G6–IOL Master 500 pair, the narrowest and widest widths of LoA were calculated for AL (0.17 mm) and K2 (0.92 D), respectively. In the first pair, the LoA of IOL power (0.57 D) were the best for Haigis formula and in the second pair, the best agreement (LoA: 0.35 D) was observed for Holladay-1. Conclusion: Galilei G6 provided repeatable biometric measurements. The agreement between biometry and IOL power calculation was better in the Galilei G6–IOL Master 700 pair compared to the Galilei G6–IOL Master 500.

Abstract Background Vision-related quality of life is related to severity of visual impairments and show the impact of eye diseases on daily activities. This study aims to assess visual functions and disability and its association with age, gender, education, marital status, and economic status in adults aged 45–69 years. Methods Data in this population-based study were from the second phase of the Shahroud eye cohort study and collected by using a Short-Form Visual Functioning Scale. The scores of visual function and disability were calculated based on Rasch-transformed scores of the National Eye Institute visual functioning questionnaire, where a more negative score indicates a better situation. Multiple linear regression was used to investigate the factors associated with visual functions. Results Among 4737 participants the visual function data for 4715 people were analyzed. The visual function of 75.3, 17.1 and 7.5% of participants were “ideal and good”, “moderate”, and “bad and very bad”, respectively, while 0.06% were unable for vision. The running mean of the visual function was calculated to be − 3.95 ± 0.02. The visual performance was worse in females than the males (β = 0.14, p = 0.005). Visual function improved with increasing levels of education (β = − 1.06, p

Abstract In this study, corneal findings regarding keratoconus (KC) and early KC among mothers with Down syndrome children (MDS) and a group of age-at-delivery-matched mothers with normal children (MNC) were compared. KC was diagnosed based on the presence of a clinical sign and at least one abnormal tomographic or biomechanical criterion. Early KC was defined as having no clinical sign in the presence of at least one abnormal tomographic or biomechanical criterion. The normal subgroups in each group were compared in terms tomographic and biomechanical parameters. In MDS and MNC, the prevalence rates were 6.5% and 1.6% for KC (P = 0.047), and 30.9% and 14.3% for early KC (P = 0.014), respectively. Comparison between the two normal subgroups showed significant differences in mean index of height asymmetry, irregularity index, anterior asphericity, pentacam random forest index, corneal stiffness parameters at first applanation, deformation amplitude ratios, integrated radius-1 mm, highest concavity deflection amplitude, biomechanical corrected IOP, peak distance, and radius (all P

PurposeTo determine the reference range of corneal indices in Down syndrome patients with normal corneas (DS-N) and to compare it with the corneal indices in Down syndrome patients with keratoconic corneas (DS-KC).MethodsA study was conducted using the data of 154 eyes of 154 DS-N and 25 eyes of 25 DS-KC patients. Eighteen indices related to thickness, anterior chamber, keratometry, elevation, and aberrations routinely used for KC diagnosis were extracted from the Pentacam.ResultsThe mean age of the participants in DS-N and DS-KC groups was 16.73 ± 4.70 and 16.56 ± 4.22 years (P = 0.852). In the DS-N group, 95% CI were 511.65–520.31 for minimum corneal thickness, 2.97–3.07 for anterior chamber depth (ACD), 46.83–47.37 for maximum keratometry (Kmax), 46.13–46.62 for zonal Kmax at 3 mm, 0.35–0.58 for inferior-superior asymmetry (I-S value), 1.56–1.88 for Belin/Ambrósio display-total deviation, 8.65–10.79 for best-fit-sphere posterior elevation at the thinnest point, and 0.18–0.22 for corneal vertical coma. The age-related change in I-S value and corneal spherical aberration (SA) was significant (both P < 0.05). There were significant inter-gender differences in 11 indices; the female DS patients had shallower, steeper, more elevated, and more aberrated corneas (all P < 0.05). There were significant differences in all indices except for ACD (P = 0.372) and corneal SA (P = 0.169) between DS-N and DS-KC groups.ConclusionIn DS patients aged 10–30 years, the reference ranges of corneal indices are different from the range reported for non-DS subjects and are close to values reported for mild KC non-DS cases. The normal values are different between DS male and female; hence, sex-specific ranges should be considered for diagnosis of corneal abnormality in DS patients.

Objectives:To determine the prevalence of refractive errors and visual impairment in Down syndrome (DS) patients compared to normal controls.Materials and Methods:Cycloplegic refraction was tested in 213 DS patients and 184 normal age- and gender-matched controls using autorefraction followed by retinoscopy. Data from the worse eye of each case were used in the analyses.Results:In the DS and control groups, respectively, mean age was 17.2±4.8 and 17.2±4.4 years (p=0.993) and 53.0% and 49.5% were male (p=0.473). In the DS and control groups, respectively, mean spherical equivalent (SE) was -5.13±4.47 and -4.15±3.04 diopters (D) in myopics (p=0.050) and 2.47±1.64 and 2.36±2.04 D in hyperopics (p=0.482), mean cylinder error was -2.17±1.39 and -2.05±1.57 D (p=0.451), mean J0 was -0.03±0.89 and 0.12±0.76 D (p=0.086), and mean J45 was 0.11±1.02 and -0.13±1.03 D (p=0.024). The prevalence of oblique astigmatism was higher in the DS group (20.4% vs. 6.1%) while against-the-rule astigmatism was more prevalent in the control group (84.0% vs. 71.6%) (p

Abstract Background The refractive surgeries induce corneal higher order aberrations (C-HOAs). In this study, change of C-HOAs after small-incision lenticule extraction (SMILE) compared to femtosecond assisted laser in situ keratomileusis (femto-LASIK), and to photorefractive keratectomy with mitomycin-C (PRK) under photopic and mesopic conditions. Methods In this prospective study, age, gender, and apical corneal thickness (ACT) matched cases with moderate myopia [spherical equivalent (SE) 3.00 to 6.00D) to high myopia (SE > 6.00D)] were enrolled. In addition to visual acuity and refraction, total C-HOA, coma, spherical aberration (SA), and trefoil in the 3- and 6-mm zones were measured before and 3 and 6 months after surgery. Results Overall, 372 moderate myopia cases (124 eyes of 124 individuals in each surgical group) and 171 high myopia cases (57 eyes of 57 individuals in each surgical group) were enrolled. At baseline, the differences in age, gender, ACT, uncorrected and corrected visual acuity, and SE were not statistically significant between subgroups of surgical methods within each myopia group (all P > 0.05). At 12 months, in the moderate myopia group, there was less increase in 6-mm zone total C-HOA, coma, and SA with SMILE compared to the other groups (all P

Purpose: To show whether subcutaneous repository corticotropin injection (RCI, Acthar® Gel, a repository corticotropin injection, can be an effective potential therapeutic agent for noninfectious retinal vasculitis. Methods: Patients with active retinal vasculitis were followed with serial ultra-wide-field fluorescein angiograms and treated with 80 units of subcutaneous repository corticotropin injection twice weekly. Results: Primary outcome of ≥ 50% improvement in response level (RL) for retinal vasculitis and percent improvement in retinal vasculitis severity scoring (RVSS) by more than one quartile ( ≥ 25%) at week 12 was met in 15 and 16 of the 30 total eyes, respectively, including 1 eye with severe retinal vasculitis in each group. Complete resolution of retinal vasculitis was seen in seven eyes with a mean time of 17.1 weeks. Intraocular pressure elevation requiring therapy and cataract progression were noted in two and three eyes, respectively. One patient stopped medication due to side effects (injection site reaction). Conclusion: Repository corticotropin injection was well-tolerated overall. Repository corticotropin injection may be an effective therapeutic agent in the treatment of noninfectious retinal vasculitis.

Abstract Introduction To compare the results of an accelerated corneal cross-linking (CXL) protocol (9 mW/cm2, 10 min) with the standard CXL protocol (3 mW/cm2, 30 min) in patients with Down syndrome (DS) who have keratoconus (KC). Methods Twenty-seven 10- to 20-year-old patients with DS who had bilateral progressive KC were enrolled in a contralateral randomized trial and completed 2 years of follow-up examinations. Fellow eyes were randomly allocated to the accelerated CXL group or the standard CXL group. The main outcome measure was change in maximum keratometry (Kmax) centered on the steepest point (zonal Kmax − 3 mm) with a non-inferiority margin of 1.0 diopter (D). Vision and refraction tests, ophthalmic examinations, and corneal tomography were performed at baseline and at 6, 12, and 24 months after CXL. Failure was defined as an increase of ≥ 1.0 D in zonal Kmax − 3 mm within a 12-month period. Results The mean age (± standard deviation) of the patients was 15.71 ± 2.40 years. The within-group change in zonal Kmax − 3 mm was not significant after 2 years in either group, and within-group zonal Kmax − 3 mm remained stable. At 2 years after CXL, the mean change in the zonal Kmax − 3 mm was – 0.02 ± 0.81 D and – 0.31 ± 0.86 D in the accelerated CXL and standard CXL groups, respectively (P = 0.088). At 1 year of follow-up, three patients in the accelerated CXL group showed treatment failure (mean change in zonal K max − 3 mm + 2.12 ± 0.11 D); no patients in the standard CXL group showed treatment failure. At 2 years of follow-up, these three patients showed a decrease of – 0.43 ± 0.18 D in zonal K max − 3 mm from a baseline value of 55.11 ± 0.32 D. The 2-year trends of the inferior–superior asymmetry and vertical coma were statistically significantly different between the two groups, with the accelerated CXL protocol showing superiority in patients with higher baseline values. Conclusion In young patients with Down syndrome, the accelerated CXL protocol was able to halt disease progression and may be an alternative for the standard CXL protocol. In advanced KC, the efficacy of the accelerated approach was delayed and appeared later in the follow-up. In asymmetric cornea, the accelerated CXL resulted in centralization of the corneal cone. Trial Registration Iranian Registry of Clinical Trials, IRCT20100706004333N3

Abstract Background To assess the diagnostic ability of Pentacam HR (Oculus Optikgeräte, GmbH, Wetzlar, Germany) tomographic indices in discriminating keratoconus (KC) and KC suspect (KCS) in 10- to 30-year-old patients with Down syndrome (DS). Methods In this study, DS patients were enrolled through special needs schools, the National Down Syndrome Society, and relevant non-profit organizations. Diagnoses were made independently by two experienced specialists. Forty Pentacam indices related to corneal thickness, volume, density, keratometry, power, shape, aberration, and elevation were extracted. For each index, the accuracy for KC and KCS diagnosis was evaluated using discriminant analysis and the area under receiver operating characteristic curve (AUROC). From each enrolled case, data from only one eye was entered in the analyses. Results Analyses were performed on data from 25 KC, 46 KCS, and 154 non-ectatic DS eyes. The best discriminants for KC were anterior higher order aberrations (HOA) (cutoff > 0.643, AUROC = 0.879), posterior vertical coma (cutoff > 0.0702 μm, AUROC = 0.875), anterior vertical coma (cutoff > 0.4124 μm, AUROC = 0.868), and total HOA (cutoff > 0.608, AUROC = 0.867). The difference between AUROCs were not statistically significant (all P > 0.05). For KCS, the best discriminants were minimum corneal thickness (cutoff ≤ 480.0 μm, AUROC = 0.775), corneal volume (cutoff ≤ 55.3 μm, AUROC = 0.727) and Belin Ambrosio display-total deviation (BAD-D) (cutoff > 2.23, AUROC = 0.718) with no significant difference between AUROCs (all P > 0.05). Conclusions In this sample of DS patients, best KC discriminators were HOA and coma which showed good diagnostic ability. For KCS, best predictors were minimum corneal thickness, corneal volume, and BAD-D with relatively good diagnostic ability. Defining a new set of KC diagnostic criteria for DS patients is suggested.

Purpose: To study the anterior chamber (AC) dimensions, angles and pupil diameter (PD) in patients with Down syndrome compared to normal controls. Methods: Prospective study is comparing the AC parameters in patients with Down syndrome aged 10-30 years and age-matched controls. Extracted indices included average anterior chamber depth on the 2-mm ring (ACD-2 mm), 4-mm ring (ACD-4 mm), at the corneal apex from the endothelium (endo-ACD), at the corneal apex from the epithelium (epi-ACD), anterior chamber volume (ACV), mean anterior chamber angle (ACA), and PD measured by Pentacam. Results: Data from 202 patients with Down syndrome (age 17.2 ± 4.8 years) were compared with 190 normal controls (age 17.2 ± 4.5 years). In Down and normal groups, mean ± SD were 2.51 ± 0.31 and 2.83 ± 0.34 mm for ACD-2 mm, 1.65 ± 0.30 and 1.93 ± 0.31 mm for ACD-4 mm, and 3.03 ± 0.29 and 3.24 ± 0.26 mm for endo-ACD, 3.54 ± 0.29 and 3.80 ± 0.26 mm for epi-ACD, mean 169.31 ± 30.38 and 200.17 ± 33.20 mm3 for ACV, 40.69 ± 4.50 and 39.97 ± 4.12° for ACA, and 2.79 ± 0.62 and 3.59 ± 0.80 mm for PD, respectively (all P < 0.001). None of the studied indices significantly correlated with age, except for ACA (P = 0.011). All parameters, except for PD, were significantly higher in males compared to females (all P < 0.001). Temporal ACA was significantly wider in male subjects (44.61 ± 6.52 vs. 42.24 ± 6.52°; P < 0.001). Conclusion: The AC in patients with Down syndrome is smaller than normal individuals. AC in females with Down syndrome is smaller than males, and the narrower ACA is attributable to the difference in the temporal angle and not the ACA in other meridians.

Purpose: To determine the changes in the depth of the demarcation line in the central to peripheral cornea following accelerated compared to standard corneal cross-linking (CXL). Methods: In this prospective, non-randomized study, 60 eyes with progressive keratoconus underwent accelerated or standard CXL (30 in each group). Anterior segment optical coherence tomography (AS-OCT) was done one month later by two independent masked examiners to measure the depth of the demarcation line in the central cornea and on peripheral rings. Results: The inter-examiner agreement (intra-class correlation coefficient) was >0.75 for all measured points, and average measurements were used in the analysis. The depth of the visualized demarcation line in the center was 223.4 ± 67.4 μm and 354.9 ± 79.0 μm in the accelerated and standard groups, respectively (P

Purpose: To compare two-year results of femtosecond laser assisted LASIK (femto-LASIK) and photorefractive keratectomy (PRK) in terms of astigmatism correction in patients with less than 2.0 diopters (D) of spherical error and more than 2.0 D of cylinder error. Methods: In this retrospective study, data were extracted from 100 patient charts. The two study groups were matched by age, gender, and baseline uncorrected distance visual acuity (UDVA) and refractive astigmatism (RA). Preoperative astigmatism was categorized as mild: 2.00 to 0.05). However, in subgroups with ≥4.00 D cylinder, there was less astigmatic regression at 1 year in the femto-LASIK group (0.28 ± 0.43 D) than the PRK group (0.54 ± 0.68 D) (P = 0.007). Conclusions: Our results pointed to better two-year results with femto-LASIK in the treatment of different degrees of astigmatism. UDVA improvement was superior with femto-LASIK, but the two methods did not significantly differ in terms of CDVA improvement.

Purpose: To determine topographic and aberrometric changes after accelerated cross-linking (ACXL; 18 mW/cm2 for 5 min) as measured with OPD Scan III (Nidek Inc., Tokyo, Japan) and their repeatability in patients with mild and moderate keratoconus (KCN). Methods: In this prospective study, 25 eyes with mild KCN [Ksteep = 47.24 ± 3.11 diopter (D)] and 20 moderate cases (Ksteep = 52.86 ± 4.39 D) were examined under mesopic conditions (20 lux) twice, 30–45 min apart, at baseline and 6 and 12 months afterwards. Extracted indices were Ksteep, Kflat, ocular and corneal irregularity, ocular and corneal total higher order aberrations (HOAs), coma, trefoil, and spherical aberration (SA). Repeatability index (RI) and intraclass correlation coefficients (ICCs) were determined. Results: In mild cases, Ksteep and corneal irregularity had lower RI, but Kflat and ocular irregularity had higher RI (all P > 0.050) at 1 year. The RI for ocular total HOAs, coma, and SA decreased and showed no significant change for trefoil (all P > 0.050). Moderate cases showed non-significant increases in RI for Ksteep, Kflat, ocular and corneal irregularity (all P > 0.050), and all aberrometry indices, and significant increases in RI for ocular coma (P = 0.046) and corneal trefoil (P = 0.037). At 1 year, ICC was >0.75 for all indices except ocular and corneal trefoil (ICC = 0.613 and 0.390) in moderate cases. Conclusions: At one year after ACXL, OPD Scan III showed acceptable repeatability in mild cases. In moderate cases, topographic indices had acceptable repeatability but poorer compared to the mild group. Overall, ocular HOAs showed better repeatability than corneal ones. These changes should be considered in the interpretation of measurements.

Purpose: The purpose of the study was to evaluate tissue reaction to polycaprolactone (PCL) nanofiber patches in the cornea, conjunctiva, and anterior chamber (AC) in rabbit eyes and to assess their biocompatibility for use as patch grafts. Methods: Two 100 μ PCL patches were implanted under the conjunctiva and in the corneal stroma of one albino New Zealand rabbit, and pathologic evaluation was done after 3 weeks. In the next step, two PCL patches were implanted; one in the corneal stroma and the other in the AC of two rabbits followed by pathologic evaluation after 3 months. Results: On slit-lamp examination, there was minimum inflammation in all cases. Pathologic examination showed that the contact and probably merging between the host tissue and PCL fibers were achieved with minimal tissue reaction. Conclusion: As a biocompatible material, PCL nanofibers seem to be a promising modality for the repair of different tissue defects including melting, thinning, and perforation. They may also be a suitable material for manufacturing keratoprostheses.

Purpose: To determine the 1-year changes of mesopic higher order aberrations (HOAs) and contrast sensitivity (CS) after accelerated corneal cross linking (CXL) in progressive keratoconus. Methods: In this prospective case series, 70 eyes of 62 keratoconic patients underwent accelerated CXL (18 mW/cm2, 5 min). HOAs and CS were measured using the OPD Scan III and CSV-1000 CS test charts under mesopic conditions before and 6 and 12 months after CXL. Results: At 1 year, logarithmic mesopic CS in spatial frequencies of 3, 6, 12, and 18 cycles per degree (CPD) had increased by 0.05 ± 0.29 (P = 0.029), 0.04 ± 0.88 (P = 0.012), 0.27 ± 0.46 (P = 0.172), and 0.06 ± 0.22 (P = 0.020), respectively. The decrease in ocular HOAs (0.10 ± 0.69 μm, P = 0.992) [coma (0.08 ± 1.01 μm, P = 0.613), trefoil (0.03 ± 0.37 μm, P = 0.659), and spherical aberration (SA) (0.10 ± 0.59 μm, P = 0.743)] and corneal HOAs (0.40 ± 1.69 μm, P = 0.874) [coma (0.39 ± 1.59 μm, P = 0.401), trefoil (0.33 ± 2.16 μm, P = 0.368), and SA (1.27 ± 1.14 μm, P = 0.354)] were not statistically significant. The correlations between mesopic CS and HOAs were weak before and after CXL. Conclusion: One year after accelerated CXL, CS significantly improved, but changes in HOAs were statistically insignificant. CS changes were independent of HOAs.

Purpose: To determine the short-term effect of rigid gas permeable (RGP) contact lenses on corneal aberrations in keratoconic patients. Method: Sixteen keratoconic eyes with no history of RGP lens wear were included. They all had corneal aberrometry using Pentacam, and different aberration indices of the anterior and posterior surfaces of the cornea were measured before and 3 months after fitting RGP lenses. The effect of baseline parameters on these changes was tested in univariate and multiple models. Results: Total aberrations and individual Zernike coefficients did not show statistically significant changes after using RGP lenses. Although not statistically significant, vertical coma decreased in the anterior (p = 0.073) and posterior surface (p = 0.095). Relationships that remained statistically significant in the multiple model were between baseline central corneal thickness and changes in total higher order aberrations and anterior 4th order astigmatism 0°, and between baseline 2nd order astigmatism 45° and its changes. Conclusion: In this study, corneal aberrations remained unchanged 3 months after wearing RGP contact lens. Further studies with sufficient samples in different groups of keratoconus severity or baseline aberrations are needed to obtain more accurate results.

Background: To evaluate the results of visual acuity and quality, and corneal integrity in myopic patients with a thin cornea who received photorefractive keratectomy (PRK). Materials and Methods: In this before-after interventional study, 30 myopic eyes with a myopia −3.76 ± 1.72 (−6.50 to −1.25) D and a corneal thickness of 486.03 ± 11.93 (452-499) μm at the thinnest point received PRK. In myopia was more than 4D, mitomycin C was used with PRK. The surgery was performed with an excimer laser (VISX STAR, Abbott Medical Optics, Abbott Park, US). Results: The safety and the efficacy index of the surgery was 1.01 ± 0.05 and 1.00 ± 0.05 in these patients, respectively. All the patients were within ±0.5D of emmetropia 1 year after the surgery. Mesopic contrast sensitivity (CS) had a significant increase in two spatial frequencies of six (P = 0.003) and 12 (P = 0.003). Total coma (P < 0.001), spherical aberration (P < 0.001), and total higher-order aberrations (HOA) (P < 0.001) also showed a significant increase. Corneal hysteresis (P < 0.001) and corneal resistance factor (P < 0.001) showed a significant decrease after 1 year. Conclusion: PRK is a safe, effective, and predictable procedure with desirable effects on mesopic CS in patients with corneal thickness

Purpose: To determine changes in cataract surgical rate (CSR) in Fars Province from 2006 to 2010 and identify the contributions of public and private sectors. Methods: This descriptive report is part of the Iranian Cataract Surgery Survey. To determine the provincial CSR, weights of major (>3000 annual surgeries) and minor (≤3000) centers were calculated based on the number of centers chosen for each year and multiplied by their numbers of surgeries. To determine public and private sectors' contributions, the numbers of surgeries in each sector were estimated based on the number of sampled centers. Results: Overall, CSR improved by 25%; the number of CS decreased by 16% in the public sector and increased by 157% in the private sector. In 2006, the public sector contributed to 69% of the CSR, and by 2010, this rate had decreased to 43%. Conclusion: The decreasing contribution of the public sector calls for studies to identify causes and remove potential barriers.

Photorefractive keratectomy (PRK) is a safe and effective surgical keratorefractive technique which is done with the application of mitomycin-C (MMC) in cases of high myopia to prevent the formation of corneal haze This study was conducted to evaluate 3-year visual acuity and quality outcomes of PRK-MMC in high myopia. This before-after study was conducted on 20 individuals (40 eyes) with myopia more than 6.0 diopter (D). Visual acuity and quality indices were evaluated before and three years after the procedure and their stability was examined between the 1st and 3rd years. At 3 years after surgery, mean uncorrected visual acuity was 0.03±0.06 in the logarithm of minimum angle of resolution (logMAR) unit which showed a significant improvement when compared to baseline (P

Purpose: To determine the range of contrast sensitivity (CS) and its determinants in a normal population, Mashhad, Iran. Methods: In this cross-sectional population based study, 4,453 individuals were invited of whom 3,132 persons agreed to participate (response rate, 70.4%). CS data from 2,449 eligible individuals were analyzed. CS was determined using the Cambridge low contrast square-wave grating test, and its associations with age, gender, best-corrected visual acuity (BCVA) and manifest refraction spherical equivalent (MRSE) refractive error, were analyzed. Results: Mean age of the participants was 29.1±17.3 (range, 4-89) years and 66.4% were female. Mean CS was 239.6±233.3 and 234.6±228.6 cps in right and left eyes, respectively. Mean binocular CS was 310.9±249.0 cps. Multiple linear regression showed that CS was inversely correlated with older age (β=-1.1, P

Purpose: To evaluate and modify the Randleman Ectasia Risk Score System for predicting post-laser in situ keratomileusis (LASIK) ectasia in patients with normal preoperative corneal topography. Methods: In this retrospective study we reviewed data from 136 eyes which had undergone LASIK including 34 ectatic and 102 normal eyes between 1999 and 2009. After determining the sensitivity and specificity of the Randleman system, a modified model was designed to predict the risk of post-LASIK corneal ectasia more accurately. Next, the sensitivity and specificity of this modified scoring system was determined and compared to that of the original scoring system. Results: In our sample, the sensitivity and specificity of the Randleman system was 70.1% and 50.5%, respectively. Our modified model included the following parameters: preoperative central corneal thickness, manifest refraction spherical equivalent, and maximum keratometry, as well as the number of months elapsed from surgery. Sensitivity and specificity rates of the modified system were 74.2% and 76.2%, respectively. The difference in receiver operating characteristic curves between the Randleman and modified scoring systems was statistically significant (P 4.00. Conclusion: Our modified ectasia risk scoring system for patients with normal corneal topography can predict post LASIK ectasia risk with acceptable sensitivity and specificity. However, there are still unidentified risk factors for which further studies are required.

Background: This study was conducted to identify the determinants of protective behavior in relation to HIV transmission. Since the risk of transmission is higher among those who have extramarital intercourse, the study sample constituted of such people.Methods: We started this study in 2010 and finished it in 2011. Participants were divided into low-risk and high-risk groups. High-risk people included sex workers and those who presented at drop-in centers. Interviewees were 18 men and women in the low-risk group and 12 men and women in the high-risk group. Data were collected through in-depth interviews and were analyzed using the thematic framework method.Results: In both groups, protective behavior was influenced by willingness to protect, intention or decision to protect, and personal, social, and environmental barriers and facilitators. In terms of willingness, behavior was influenced to preserve sexual pleasure by avoiding condoms. In terms of barriers and facilitators, trust in partner, misperceptions, condom inaccessibility, unplanned sex, fear of contracting the disease, partner’s wish, ethical commitments were mentioned by both groups, stigma of condom possession by the low-risk group, and partner’s force was mentioned by the high-risk group.Conclusion: Educational programs need to focus on changing the concept that “condoms reduce sexual pleasure”. In addition, interventional programs to strengthen factors such as self-efficacy, ethical commitments, faithfulness, and correct beliefs such as undue trust in partner, misconception of being safe, unplanned sex, and the stigma of possessing condoms can be very effective in changing high-risk sexual behavior.

Background and Objective: Genital herpes is increasing in Asia and the world. Based on other studies, knowledge has an important role in reducing high risk sexual behavior. In this study we evaluated knowledge among Shahid Beheshti University students as a sample of young and educated population of Iran. Materials and Methods: This cross-sectional study carried out on 409 of Shahid Beheshti University students in Tehran - Iran at Autumn 2004. Research material was questionnaire and data analyzed by SPSS-13, T-student, Chi-square, Mann-Whitney, Kruskal-Wallis Tests. Results: Mean±SD of level of knowledge, nature and transmission of genital herpes was 26.5±26%, 23.7±24.2% and 30.56±36.8%, respectively. The level of knowledge about signs, treatment and prevention of disease was 18.8%, 16.4% and 46.2%, respectively. There was a significant relation between age, marital status and education with knowledge (P

Background: Considering population aging in Iran and the importance of cataract surgery in the old age, this study was performed to show the cataract surgical rate (CSR) between 2006 and 2010 in Tehran Province. Methods: Eighteen centers were randomly selected from cataract surgery centers in Tehran. In each center, one week in every season was randomly selected and the number of cataract surgeries in the week was calculated. In total, 20 weeks were selected in each center in five years. Results: The CSR increased linearly from 8011 cases per 1,000,000 population in 2006 to 12465 cases per 1,000,000 population in 2010. As for patients below 40 years of age, the percentage of the male patients was more while after the age of 40 years, the percentage of the female patients was more in all age groups. At least 96.2% of the surgeries in each year were performed using the phacoemulsification method. From 2006 to 2010, the percentage of outpatient surgery increased from 48.7% to 72.5%. On the other hand, hospitalization for one night or more had a decreasing trend from 2006 to 2010. Conclusion: During 2006-2010, the CSR was acceptable in Tehran in comparison with other studies. However, attention should be paid to the increase in the population of the elderly people. Although more than 95% of the surgeries in the Province of Tehran are performed using the phacoemulsification method, the rate should increase to 100% in the eligible cases.

The aim of this study was to determine the trend of changes in Cataract Surgical Rate (CSR) in the provinces of Iran during 2006 to 2010 and identify high risk areas.This report is part of the national Iranian CSR Study. The percentage change in CSR in 2010 compared to 2006 was conducted in each province, retrospectively. One hundred and ten centers were chosen from all provinces, to determine CSR in each, the weight of major (>3,000 annual surgeries) and minor (3,000 annual surgeries or less) centers was calculated based on the number of selected centers, and multiplied by the number of surgeries in each province.In eight provinces, CSR was decreased by 1-60%. One province (Booshehr) showed no change. Eighteen provinces had 2-79% increase. No 2006 data was available in three provinces. North Khorasan had the most decrease while Kerman had the most increase in CSR. Six of these 8 provinces had CSR>3,000 despite a decrease in 2010, but North Khorasan had CSR

This study was conducted to identify the determinants of protective behavior in relation to HIV transmission. Since the risk of transmission is higher among those who have extramarital intercourse, the study sample constituted of such people.We started this study in 2010 and finished it in 2011. Participants were divided into low-risk and high-risk groups. High-risk people included sex workers and those who presented at drop-in centers. Interviewees were 18 men and women in the low-risk group and 12 men and women in the high-risk group. Data were collected through in-depth interviews and were analyzed using the thematic framework method.In both groups, protective behavior was influenced by willingness to protect, intention or decision to protect, and personal, social, and environmental barriers and facilitators. In terms of willingness, behavior was influenced to preserve sexual pleasure by avoiding condoms. In terms of barriers and facilitators, trust in partner, misperceptions, condom inaccessibility, unplanned sex, fear of contracting the disease, partner's wish, ethical commitments were mentioned by both groups, stigma of condom possession by the low-risk group, and partner's force was mentioned by the high-risk group.Educational programs need to focus on changing the concept that "condoms reduce sexual pleasure". In addition, interventional programs to strengthen factors such as self-efficacy, ethical commitments, faithfulness, and correct beliefs such as undue trust in partner, misconception of being safe, unplanned sex, and the stigma of possessing condoms can be very effective in changing high-risk sexual behavior.

مقدمه: کلامیدیا تراکوماتیس یكی از بیماری‌های باکتریال شایع قابل درمان است كه از راه تماس جنسی سرایت می‌كند. وضعیت اپیدمیولوژی آن در زنان جوان به ‌خوبی شناخته شده است؛ اما اطلاعات ‌راجع به شیوع عفونت در مردان بدون علامت و فعال از نظر جنسی محدود می‌باشد. هدف این مطالعه، تعیین فراوانی عفونت ادراری تناسلی کلامیدیا تراکوماتیس با روش PCR در نمونه‌ی ادرار مردان بدون علامت بود. روش‌ها: این مطالعه‌ی مقطعی از آذر ماه 1384 تا اردیبهشت ماه 1385 بر روی140 مرد 15 تا 49 ساله‌ی بدون علامت، مراجعه ‌کننده به آزمایشگاه مرجع بوعلی كه به طور اتفاقی انتخاب شدند، انجام گرفت. هر فرد دست کم از 2 ساعت قبل ادرار نکرده بود و پرسشنامه‌ای را شامل اطلاعات مربوط به سن، شغل، وضعیت تأهل و تماس جنسی نیز تكمیل نمود. نمونه به وسیله‌ی تست PCR بررسی گردید. اطلاعات پرسشنامه‌ها و نتایج آزمایشات با استفاده از نرم‌افزار SPSS ویرایش 13 تحلیل آماری شد. یافته‌ها: از 140 نمونه‌ی ادرار آزمایش شده به روش PCR فقط یک مورد (7/0%) از لحاظ کلامیدیا تراکوماتیس مثبت بود (07/2%-0%:CI 95%). نتیجه‌گیری: در حال حاضر غربالگری مردان بدون علامت ایرانی جهت عفونت کلامیدیا تراکوماتیس قابل توصیه نیست؛ با این وجود به منظور تعیین شیوع واقعی و تصمیم‌گیری قطعی برای غربالگری به مطالعات گسترده‌تر، با پراکندگی و حجم نمونه‌ی بالاتر نیاز است. پیشنهاد می شود در مطالعات اپیدمیولوژیك در جوامع با میزان آلودگی پایین از روش‌های غربالگری ساده‌تر مانند سرولوژی استفاده شود. واژگان کلیدی: کلامیدیا تراکوماتیس، فراوانی، مردان، ادرار، PCR

Objective(s)Rapid tests for detection of Streptococcus agalactiae or Group B Streptococci (GBS) at the onset of labor are needed to permit early intrapartum antibiotic prophylaxis. This study aimed to evaluate the PCR assays targeting the 16S ribosomal RNA gene (16S rDNA) for detection of the GBS in comparison with a specific culture method. Materials and MethodsTwo swabs were used to obtain vaginal specimens from the 330 pregnant women attended delivery room at Hedayat hospital, Tehran, Iran. One swab was analyzed by direct plating onto selective GBS agar medium (ISLAM) and the other swab was used for a PCR assay, which amplified the 16S rDNA of S. agalactiae. Comparative study between the selective culture and the PCR assay was done among the 330 tested women.ResultsThe GBS colonization rate based on the culture results was 20.6% (68/330). Both culture and PCR methods were positive for 56 and negative for 253 women. The culture method was positive and PCR was negative in 12 women. The culture was negative and the PCR positive for 9 women. Sensitivity of the PCR assay was 82.3% and specificity was 96.5%. The positive predictive value was 86.15% and negative predictive value was 95.4%. ConclusionISLAM diagnostic procedure and PCR are rapid and reliable analyzing methods, which might be useful for accurate diagnosis of GBS colonization in pregnant women at the time of delivery.

Group B streptococci (GBS) or Streptococcus agalactiae are members of the normal flora of the female genital tract. GBS normally colonizes the vagina in many women asymptomatically. During labor this organism may infect the newborn, leading to neonatal sepsis and meningitis. This study aimed to investigate the prevalence of group B streptococcus in pregnant women by a rapid and easy culture method. It seems that in cases in which GBS carriage is not suspected until the time of labor, using such a quick and specific culture method would be valuable. A total of 330 vaginal swabs were collected from women attending delivery room at Hedayat hospital, Tehran, Iran, from April through July 2008. Cotton swabs contaminated with vaginal fluid were placed into Amies transport medium and transported to the Avicenna laboratory daily. Vaginal specimens were cultured on selective GBS Agar Base medium (ISLAM) for isolation and detection of group B streptococcus. The plates were incubated at 35-37°C under anaerobic condition for 24 hours. Incubated S.agalactiae developed orange/red pigmented colonies in GBS agar plates. Among the 330 women, the results of the culture were positive for GBS in 68 women (20.6%). Statistical analyses showed no significant relationship between demographics, reproductive histories and obstetric characteristics of subjects with the test results. Solely the antibiotic therapy was associated with GBS colonization. The results are indicating that the relatively high maternal GBS colonization rate in pregnant women warrants a routine screening and prophylactic treatment of the infected women. Colonization with group B streptococcus can be identified directly by GBS agar medium and decrease the time to detection of GBS.

Background: The use of ionizing radiation has led to advances in medical diagnosis and treatment. Objectives: The purpose of this study was to determine the risk of radiation cataractogenesis in the interventionists and staff performing various procedures in different interventional laboratories. Patients and Methods: This cohort study included 81 interventional cardiology staff. According to the working site, they were classified into 5 groups. The control group comprised 14 professional nurses who did not work in the interventional sites. Participants were assigned for lens assessment by two independent trained ophthalmologists blinded to the study. Results: The electrophysiology laboratory staff received higher doses of ionizing radiation (17.2 ± 11.9 mSv; P < 0.001). There was a significant positive correlation between the years of working experience and effective dose in the lens (P < 0.001). In general, our findings showed that the incidence of lens opacity was 79% (95% CI, 69.9-88.1) in participants with exposure (the case group) and our findings showed that the incidence of lenses opacity was 7.1% (95% CI:23-22.6) with the relative risk (RR) of 11.06 (P < 0.001). Conclusions: We believe that the risk of radiation-induced cataract in cardiology interventionists and staff depends on their work site. As the radiation dose increases, the prevalence of posterior eye changes increases.