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Objectives Cardiac surgeries initiate oxidative stress, increasing organ dysfunction development and mortality. The present study investigated the superoxide dismutase (SOD) activity, as an antioxidant enzyme, in patients undergoing coronary artery bypass (CABG) and heart valve replacement surgeries. Methods A prospective study was performed on patients with proven coronary artery disease (CAD) or valvular heart disease (VHD) candidates for on- or off-pump CABG and valve replacement surgery. Serum SOD activity was measured preoperatively, at 24 h postoperatively, and at the time of discharge. In addition, echocardiography was performed before surgery and at discharge. Results A total of 48, 51, and 47 patients were enrolled in the on-pump, off-pump CABG, and valve replacement groups, respectively. Baseline serum SOD activity showed no significant association with BMI, age, and blood pressure in either CAD or VHD patients. The SOD values decreased at the 24 h postoperative time and then increased at the time of discharge in all groups, except for a slight decrease in the on-pump group. The changes in serum SOD values were not significantly different for the three surgical groups. Conclusions The serum SOD activities fell significantly after CABG and valve replacement surgery. Further investigation is emphasized for the role of SOD in oxidative stress after cardiac surgery.

Purpose To evaluate the refractive outcomes of small-incision lenticule extraction (SMILE) surgery in moderate to high myopic astigmatism Study Design Prospective interventional case series Methods This study evaluated 111 eyes of 68 patients treated with femtosecond SMILE surgery for the correction of myopia and astigmatism. Inclusion criteria were myopia of − 0.5 D or more and astigmatism between − 1.0 D and −5.0 D. Refractive and visual measurements were obtained preoperatively, 1 and 12 month(s) postoperatively. Vector analysis was used to study the astigmatic outcomes at 12-month follow-up. Comparison of results in two groups of patients with astigmatism below and over 3.00 D was performed. Results The preoperative mean spherical equivalent was −5.48 ± 2.17 D (range − 1.75 to − 10.00 D) and the mean cylinder was −2.02 ± 1.09 D (range − 1.00 to − 5.00 D). The mean postoperative cylinder value was −0.60 ± 0.52 D at 12-month visit. The 12-month safety and efficacy indices were 0.98 ± 0.07 and 0.97 ± 0.12, respectively. The high astigmatism group showed significantly lower safety and efficacy indices. The postoperative residual astigmatism was 0.5 D or less in 73% of the eyes. Higher amount of residual astigmatism was observed in the high astigmatism group. The angle of error was ± 5 degrees in 49% and ± 15 degrees in 87% of the eyes. Conclusion SMILE surgery is effective and safe method for correcting myopic astigmatism. Vector analysis indicated a tendency for the under correction of astigmatism in subjects with high astigmatism.

Purpose To compare the outcomes of phacoviscocanalostomy and viscocanalostomy in patients with primary open angle glaucoma. Methods This non randomized, prospective comparative study included 168 eyes of 168 patients with primary open angle glaucoma (POAG). Phacoviscocanalostomy was performed in 94 eyes with POAG and cataract and viscocanalostomy was performed in 74 eyes with POAG. Preoperative and postoperative intraocular pressures (IOP), number of antiglaucoma medication, intraoperative and postoperative complications were recorded throughout the follow-up period. Results The mean follow-up after surgery was 20.13 ± 7.9 months. Mean IOP decreased significantly 1 month after surgery in both groups (p Conclusions Both Phacoviscocanalostomy and viscocanalostmy are effective procedures in the control of IOP in patients with POAG with and without cataract. Higher complete success rates and BCVA were achieved in phacoviscocanalostomy. Therefore, phacoviscocanalostomy and viscocanalostomy are recommended in eyes with medically uncontrolled primary open-angle glaucoma with and without coexisting cataract.

Purpose: Viscocanalostomy represents an alternative to standard penetrating glaucoma surgery. The aim of this study is to compare the outcomes of combined phacoemulsification and viscocanalostomy in eyes with primary open-angle glaucoma (POAG) versus eyes with pseudoexfoliation glaucoma (PEXG). Methods: In this prospective non-randomized comparative study, eyes with cataract and POAG or PEXG were enrolled. Pre- and postoperative data including best corrected visual acuity (BCVA), intraocular pressure (IOP), and the number of antiglaucoma medications administered were recorded at each visit. All patients underwent phacoviscocanalostomy. Complete success was defined as the IOP of 21 mmHg or less without the administration of medication while a qualified success reported the same IOP parameters either with or without the administration of medication. Results: Fifty-four eyes with POAG and fifty-four with PEXG underwent phacoviscocanalostomy. The mean follow-up time was 23.36 ± 8.8 months (range, 6–40 months). The mean postoperative IOP reduced significantly in both groups, although the mean IOP reduction was significantly greater in PEXG eyes (14.7 ± 8.9 vs 10.1 ± 7.7 mmHg) (P = 0.05). At the final follow-up visit, the mean postoperative IOP was 14.1 ± 2.1 and 16.6 ± 3.5 mmHg in the PEXG and POAG eyes, respectively (P = 0.001). A complete success rate of 88.9% and 75.9% was achieved in PEXG and POAG eyes, respectively (P = 0.07). The qualified success rate was 100% in the PEXG and 85.2% in POAG groups (P = 0.03). Conclusion: Phacoviscocanalostomy achieved significant IOP reduction and visual improvement in both POAG and PEXG patients. Our results indicated that in terms of IOP reduction, this procedure was more effective in treating PEXG.

Background: Clomiphene citrate is an estrogen receptor ligand with mixed agonistic–antagonistic properties used for the treatment of female and male infertility. Various visual disturbances and several irreversible visual outcomes have been associated with clomiphene citrate. In this report, we present a patient with presumed clomiphene-induced optic neuropathy. Case: A 33-yr-old man with acute visual loss of the right eye was referred to Amiralmomenin Hospital, Rasht, Iran in November 2018. His only medication was clomiphene citrate 100 mg daily, taken for 2 wk for fertility issues. The patient presented with a sudden decrease of visual acuity in the right eye on the 14th day of starting the treatment and subsequently developed complete loss of inferior visual field within a few days. On examination, the visual acuity was 6/20 in the right and 20/20 in the left eyes, with a right relative afferent pupillary defect and decreased red color saturation. The fundus examination revealed optic disc swelling with venous dilation in the right eye and a normal left fundus with a crowded disc (disc-at-risk). The patient was evaluated for systemic disorders, all of which were normal. Findings were suggestive of non-arteritic anterior ischemic optic neuropathy most likely due to clomiphene. Conclusion: As clomiphene may increase blood viscosity, it is hypothesized that reduced flow in a posterior ciliary artery in conjunction with the disc-at-risk contributes to the anterior ischemic optic neuropathy. It is advised that patients with disc-at-risk be aware of the possible non-arteritic anterior ischemic optic neuropathy and those experiencing visual symptoms while taking clomiphene be examined promptly for evidence of optic nerve injury. Key words: Clomiphene citrate, Optic neuropathy, Visual acuity, Ischemia.

To determine the applicability of current international and national retinopathy of prematurity (ROP) screening guidelines and to identify a suitable community-based screening criterion.A retrospective study on premature neonates (≤37 weeks gestation) referred to a tertiary eye hospital ROP clinic in the north of Iran was conducted over a 10-year period. Neonates were classified as no ROP, with ROP and type 1 ROP. Data consisting of birth weight (BW), gestational age (GA) and chief risk factors were evaluated. Various screening criteria and currently established screening guidelines were applied and compared for applicability using a receiver operating characteristic curve.A total of 716 neonates with a mean GA of 31.4 ± 2.8 weeks and BW of 1629 ± 502 grams were screened. The incidence of ROP was 22.9% and type 1 ROP requiring treatment was 0.28%. When applying the national Ministry of Health Guidelines, all neonates with type 1 ROP requiring treatment were identified; These criteria had a specificity of 7% for the diagnosis of type 1 ROP, and a large number of neonates (n=645) who are not at risk for type 1 ROP will be redundantly screened. Guidelines of the American Academy of Pediatrics and the UK would miss 4.5% of patients requiring ROP treatment. According to our data a threshold of GA≤32 weeks and/or BW ≤1600 grams demonstrated a sensitivity of 95.7% and specificity of 33.6% for the diagnosis of any ROP and a sensitivity of 100% and specificity of 26.8% for type 1 ROP requiring treatment.The ideal ROP screening guideline is one that is very sensitive and identifies patients requiring treatment without delay. To minimize redundant screening while maintaining optimum ROP requiring treatment diagnosis, we proposed a new local evidence-based screening guideline.

Purpose: This study aimed to assess the longitudinal changes of choroidal thickness using enhanced depth imaging optical coherence tomography (EDI-OCT) during pregnancy and post-partum.Methods: The study included 23 eyes of 23 healthy pregnant women and 23 eyes of 23 healthy non-pregnant women. Choroidal thickness (CT) was measured manually with EDI-OCT at seven locations: the fovea, 500, 1000 and 1500 μm temporal (T) from the fovea and 500, 1000 and 1500 μm nasal (N) from the fovea. Measurements were obtained at each pregnancy trimester and 6 weeks post-partum and in the follicular phase of the menstrual cycle for the control group.Results: The mean subfoveal choroidal thickness was 410.2 ± 82.4 μm, 434.8 ± 79.6 μm, 433.5 ± 80.3 μm, and 395.0 ± 71.1 μm in the first, second and third trimesters and 6 weeks post-partum, respectively. In all seven measured locations, statistically significant changes were noted during pregnancy and post-partum in the choroidal thickness (pConclusion: This study indicated significant change in choroidal thickness at seven locations measured with EDI-OCT throughout pregnancy and 6 weeks after delivery. We showed that 6 weeks after delivery, choroidal thickness remains significantly higher than non-pregnant subjects.

Purpose: A 6-month evaluation of the topographic and biomechanical changes induced by corneal collagen cross-linking (CXL) in keratoconic eyes using Pentacam and Corvis ST. Design: Longitudinal prospective case series. Methods: In this study, 67 eyes of 67 patients with progressive keratoconus (KCN) treated with “Epithelium-off” CXL were evaluated. Patients with stages 1 or 2 of KCN and a corneal thickness of at least 400 μm at the thinnest point were included. Standard ophthalmologic examinations were carried out for all patients. The topographic and biomechanical measurements of the cornea were obtained by Pentacam (Oculus Optikgeräte GmbH, Wetzlar, Germany) and Corvis ST (Oculus Optikgeräte GmbH, Wetzlar, Germany) preoperatively and 6-month postoperatively. Results: The mean age of the participants was 21.68 ± 4.23 years. There was significant difference in mean spherical equivalent (SE) before and 6 months after CXL. Uncorrected and best corrected visual acuity improved postoperatively, although not statistically significant. The mean and maximum keratometry showed a significant decrease 6 months after CXL (0.93 ± 0.38 D and 1.43 ± 0.62 D, respectively p Conclusion: Analyzing biomechanical changes after corneal cross-linking can provide basis for efficient KCN treatment. Corvis ST parameters demonstrated changes in corneal biomechanical characteristics indicative of stiffing after CXL.

Purpose To present a relatively rare case of retinal toxicity and consequent severe vision loss due to Closantel ingestion. Case report A 37-year-old female presented with sudden painless decrease vision in both eyes. She had no previous history of medical disease and denied any trauma. The patient had accidentally ingested Closantel a few days prior to presentation. Closantel is a veterinary anti-helminthic drug used mainly in livestock. Best corrected visual acuity (BCVA) at presentation was 20/200 bilaterally. There was no relative afferent pupillary defect (RAPD) and red saturation test was normal. Macular optical coherence tomography (OCT) revealed disruption in the outer retinal layer and ellipsoid zone in both eyes. A diagnosis of retinal toxicity due to Closantel was made and the patient was started on 1 mg/kg oral prednisolone acetate. On the 45th day after presentation, her BCVA had improved to 20/20 bilaterally. Conclusion Closantel is a potentially toxic drug causing destruction of the neurosensory retina and visual disturbances. We suggest eye-care personnel awareness regarding the risk of Closantel-induced retinal toxicity and prompt treatment with systemic steroids should be considered.

PURPOSE To evaluate the safety and efficacy of a bioengineered corneal implant using femtosecond laser-assisted anterior lamellar keratoplasty for superficial corneal opacities. METHODS Six eyes of 6 consecutive patients with superficial corneal stromal opacities involving

Comparison between surgical embolectomy and thrombolytic therapy in patients suffering from acute massive pulmonary embolism (AMPE).Prompt treatment of AMPE is necessary, although optimal management is a matter of debate.Patients with AMPE were assigned to either thrombolytic therapy or pulmonary surgical embolectomy. Early and late mortality, systolic pulmonary artery pressure (SPAP), right ventricular diameter (RVD) and bleeding complications were evaluated.Seventy eight patients were treated with thrombolytic therapy and 30 patients underwent surgery. The difference between pre-intervention and third-day post-intervention in terms of RVD and SPAP was significantly greater in patients under surgical embolectomy (P 0.001). There was a significant decline in RVD and SPAP in both groups during follow-up (P 0.001). Mortality rate in the surgical embolectomy group was lower than the thrombolytic group although not significantly.Early surgical treatment was associated with fewer complications in comparison to thrombolytic therapy.

We report a modified technique for pulmonary endarterectomy (PEA) on a 67-year-old man with chronic thromboembolic pulmonary hypertension (CTEPH) who presented with dyspnea. He was referred to our medical center for coronary artery bypass grafting. CTEPH had not been detected in his first visit to another medical center, but upon re-evaluation, the diagnosis was confirmed. PEA was performed with a modified method, which seems to be safe and suitable for the removal of clot and fibrotic materials. Iatrogenic dissection was performed with normal saline injection in the pulmonary artery, and then, the clot was removed completely. Although the technique may not be applicable for all cases, it can be used as an alternative to using an aspirating dissector and a pair of forceps.

Carcinoid tumors are rare neuroendocrine malignancies. We present two cases of metastatic carcinoid tumors, complicated by carcinoid syndrome and by cardiac valve involvement. Carcinoid syndrome is characterized by secretory diarrhea, episodic flushing, and bronchospasm. Cardiac involvement occurs in up to 50% of patients with metastatic carcinoid tumors which commonly causes abnormalities of the right sided valves. Echocardiography is the best available and non invasive technique for diagnosis. Characteristic features of carcinoid heart disease are thickened, shortened, retracted, and fixed or partially fixed valve leaflets. Three-dimensional (3D) echocardiography provided an en face view of pulmonary and tricuspid valve, not obtainable by two-dimensional echocardiography, and improved delineation of the relationship between these structures and cardiac chambers.

A 69-year-old woman presented with a 2-week history of chest pain and mitral and aortic valve replacement 15 and 5 years earlier. Transthoracic echocardiography revealed a well-seated monoleaflet mitral valve and a bileaflet aortic valve with normal function. Cardiac catheterization showed 3-vessel coronary artery disease and an abnormal cluster of new vessels derived from the left atrial circumflex and posterior ventricle branches. Two- and 3-dimensional transesophageal echocardiography identified a semi-mobile oval left atrial mass with multiple internal cystic spaces, attached to the fossa ovalis region in the interatrial septum. The mass was resected. The pathological diagnosis was atrial myxoma.

Anomalous origin of the circumflex artery of the right sinus of Valsalva is a rare finding which may be present with other cardiac malformations. A 19-year-old man presented with syncope. A transthoracic echocardiogram revealed discrete subaortic stenosis with a small defect just below the aortic valve, suggesting a ventricular septal defect. Transesophageal echocardiography showed anomalous origin of the circumflex artery from the right sinus of Valsalva. This was confirmed by coronary angiography. The patient underwent successful web resection without concomitant coronary surgery. Failure to demonstrate a coronary artery anomaly can be misleading for surgeons and perilous for patients.